By Mr. Jerry Harben (Army Medicine)February 27, 2009
The Army Surgeon General recognizes that access to care is not where it should be at all military treatment facilities (MTFs) and is taking aggressive steps to improve access and ensure that beneficiaries' have access to quality care. Access is when our beneficiaries have the "The right provider, at the right time, in the right venue."
Several factors have contributed to what military healthcare providers across the services acknowledge are barriers to efficient and effective Access To Care. Most notable is the high number of war wounded and injured since hostilities began more than six years ago. This situation is amplified by a military healthcare system that was already understaffed and ill-equipped for the volume of war related injuries. Furthermore, our already stretched system was further stressed by a growing beneficiary population of active duty and reserve component military family members and retirees and their family members. To date, beneficiaries enrolled to Army military treatment facilities total more than 1.6 million. The most immediate shortfall for primary care providers is at 12 Army installations and The Army Surgeon General has provided the funding for those MTFs to hire the provider and support staff.
Ensuring Army military treatment facilities' capabilities are aligned with the number of beneficiaries they are charged to provide care for is the critical factor to improving access. The number of beneficiaries enrolled to an MTF must not exceed the MTF's capacity. Over-enrollment at an MTF results in frustration for both the beneficiaries and the healthcare team. Of course, the second component is ensuring Primary Care Managers (PCM) are available for clinic to meet the demand of the enrolled population. We make a commitment to provide healthcare within DoD established access standards when beneficiaries chose to enroll to the MTF.
There are key areas in our system that we have identified as friction points and they must be addressed and they are: phone service, online appointments, and follow-up appointments. The MEDCOM policy is to have 90 percent of appointment calls in the appointment call center's queue answered within 90 seconds, have 80% of all primary care appointments on TRICARE on-line for internet booking, and to provide follow-up appointments during the healthcare visit or place beneficiaries on an automated appointment scheduling list.
Army MTFs will optimize usage of the TRICARE contract. The Assistant Secretary of Defense for Health Affairs has published a policy that requires military treatment facilities to "offer the beneficiary a timely referral to obtain treatment in the TRICARE private sector network" if the MTF is unable to provide access to care within established standards.
The Army Medical Command also recognizes how important it is for our patients to understand the various ways to obtain care and the processes involved, including how to obtain appointments by phone, via the internet (TRICARE On-Line), and more. MEDCOM will standardize Access To Care information on all MTF websites and in beneficiary information handouts provided during enrollment.
Finally, MEDCOM is establishing a methodology for accounting for all beneficiary requests for access to primary care. Knowing who is requesting care, but not given an appointment at the MTF immediately, is just as important as knowing who did receive care. This detailed accounting will enable the MTF to make appropriate adjustments in enrollment and clinic schedules.
While there are many areas under current review that will enhance access to care, The Army Surgeon General and his MTF commanders are working very hard to identify all Access To Care barriers and fix them; fully realizing that some will have relatively simple solutions, while others are more complex and will require more time.
These efforts will result in markedly improved access and provide MTF commanders with the tools for maintaining situational awareness so that they may make the appropriate adjustments to provide care at the MTF or give the beneficiary the choice of receiving care in TRICARE civilian network.