Military Update: BRAC would cut inpatient access
Military health officials concede that some retirees will see higher costs if the Base Realignment and Closure Commission accepts a plan to downsize nine stateside hospitals to outpatient clinics and to refer patients needing hospitalization to civilian facilities.
Most of these patients, however, still will be treated by military physicians under facility-sharing arrangements with local communities, said Lt. Gen. George Peach Taylor Jr., the Air Force surgeon general.
Taylor chaired the Medical Joint Cross-Service Group that shaped the draft BRAC recommendations on health care. The hospital downsizing plan, if accepted by the commission, will affect 148 inpatients a day, 6 percent of all inpatients treated in military stateside hospitals.
Even if patients are treated off base by military physicians, their out-of-pocket costs will rise because Tricare fees and co-payments for off-base care will apply. Some lawmakers and military associations have criticized the move as an attempt by the Bush administration to deny on-base medical care to more service beneficiaries, particularly retirees and their families.
Taylor, however, said the actual goals are to create a more cost-efficient medical system, improve patient care and enhance medical staff skills and combat readiness.
Hospitals slated to downsize to clinics or outpatient surgery centers are at the Air Force Academy, Colo.; MacDill Air Force Base, Fla.; Great Lakes Naval Training Center, Ill.; Scott Air Force Base, Ill., Andrews Air Force Base, Md.; Keesler Air Force Base, Miss.; Marine Corps Air Station Cherry Point, N.C.; Fort Knox, Ky.; and Fort Eustis, Va. The estimated cost savings is $62 million a year.
Two medical centers also will lose their inpatient mission but to nearby military facilities. Wilford Hall Medical Center at Lackland Air Force Base, Texas, will send inpatients to Brooke Army Medical Center, 16 miles away. Brooke will be renamed the San Antonio Regional Medical Center. Walter Reed Army Medical Center in Washington will close. Its patients will be treated at Bethesda Naval Medical Center, six miles away, which will be renamed the Walter Reed National Military Medical Center at Bethesda.
Richard M. Dean, executive director of the Air Force Sergeants Association, wrote to commission chairman Anthony Principi last month, urging careful scrutiny of the rationale behind hospital downsizing. Several hospitals are “heavily used,” he said, casting doubt on claims of excess capacity. Retirees and their families, Dean said, “feel they are specifically being targeted” and that BRAC 2005 is “a veiled way to push retirees, family members and survivors out of the military health care system in order to avoid funding for their health care and medicines.”
Rep. Gene Taylor, D-Miss., whose district includes Keesler, said he is worried about higher out-of-pocket costs for young military families.
Whether treated in military or civilian hospitals, active-duty family members enrolled in Tricare Prime, the managed care network, pay no hospital charges. If not enrolled, they pay $13.90 a day at a civilian hospital.
Enrolled retirees and their dependents under age 65 pay $11 a day. But under-65 retirees who rely on Tricare Standard, the military’s fee-for-service plan, pay $250 a day in civilian hospitals, or 25 percent of negotiated charges plus 20 percent of negotiated professional fees, whichever is less.
Older retirees sent to civilian hospitals typically have Medicare and Tricare for Life coverage, which covers almost all their costs.
Tricare and mail-order pharmacy benefits, said Gen. Gen. Taylor said, provide a cushion for beneficiaries that didn’t exist in earlier BRAC rounds. Still, in recommending downsizing, Taylor said, the group he led weighed the impact on beneficiaries. Top priorities, however, were quality of care and cost efficiency. The group found opportunities to improve both by cutting excess capacity.
Doctors are better able to maintain their skills at larger, busier hospitals than at small hospitals like at Eustis, Cherry Point and Great Lakes that have fewer than 10 inpatients a day. Still, Taylor said, the number of patients treated by military physicians should not change because the services intend to lease space at civilian hospitals and continue the care.
“Same care, different place,” Taylor said.
But that is not guaranteed, he added. In the end, each community will determine the level of support provided in this way to military beneficiaries.
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