By Mr. Jerry Harben (Army Medicine)September 30, 2009
The medical care provided in Army hospitals and clinics is regarded as among the best in the world. All entitled beneficiaries want to receive the care they have earned, and sometimes that means demand exceeds supply, especially when Army medics also must support an Army at war.
To try to keep customers satisfied and meet the needs of the Army and all beneficiaries, the Army's top medical officer has begun an Access to Care Campaign.
"I have directed all of our medical treatment facility commanders to make access to care one of their top priorities," said Lt. Gen. Eric B. Schoomaker, Army Surgeon General and commander of Medical Command. "Our goal is to have the right provider providing care at the right time, using the right venue."
Access to care is incorporated in major objectives of Medical Command's Balanced Scorecard, the management tool used to establish goals and measure accomplishments in MEDCOM. It also has been included in MEDCOM's command organizational inspection program, and military treatment facilities (MTF) have been given specific recommendations for process improvements.
Factors that complicate access to care at Army MTFs include requirements to deploy military medical personnel in support of Operation Iraqi Freedom and Operation Enduring Freedom, pre- and post-deployment care needed by deploying Soldiers, and in some locations enrollment in TRICARE Prime beyond the facility's ability to provide timely care.
MEDCOM is hiring more healthcare providers, examining TRICARE Prime enrollments to ensure MTFs do not enroll more beneficiaries than they can care for within access standards, and educating medical personnel and beneficiaries about access policies and standards.
Since 2004, the Army has added about 500 primary-care providers (including military personnel, civilian employees and contractors). MEDCOM has identified locations where additional primary-care teams are needed, based on growth in beneficiary population and local TRICARE network limitations.
More than 270 behavioral health providers have been added, helping meet needs in that field due to stress associated with combat deployments.
Networks of civilian healthcare providers are available to augment the military healthcare system when it cannot meet patient needs in-house in a timely manner. About 85 percent of Army beneficiaries' primary care is done in house, about 15 percent is referred off post.
"Where do Army Families live' Everywhere. That's why the Army will open Community Based Primary Care Clinics in the off-post areas," Schoomaker said. "By late 2010 we plan to open at least 17 clinics around 12 installations and the number is growing. Your doctor near your home. Continuity and convenience with the Army seal of quality that our Families trust."
"These clinics are part of a broader push to increase access to care for our patients at all Army medical clinics and hospitals," he continued. "I have also directed that where the Army facility can't meet the patients' requirements for access that we maximize the use of the TRICARE network. We are aggressively pushing to add civilian care networks and urgent care clinics and to create an Urgent-care Hotline for our patients to access the care they need at any time, even when they are out of their local area. Our goal is to have our patients see the right doctor, at the right time, in the right place for them."
The Department of Defense has established standards for the time a patient may wait to see a provider, ranging from 24 hours for acute care to 28 days for a specialty or wellness appointment. Policy states that a patient will be offered an appointment through the TRICARE network if the MTF cannot meet these standards.
A Patient Bill of Rights is posted in every MTF. The DoD instruction that establishes patient rights and responsibilities can be viewed on line at www.dtic.mil/whs/directives/corres/pdf/600014p.pdf.
MTFs also are standardizing their Internet homepages to explain appointment and access procedures, and outline the options beneficiaries may pursue.
Beneficiaries may find it convenient to book appointments through TRICARE On-Line rather than calling the MTF. They only have to register at www.tricareonline.com and they can schedule routine primary-care visits at the MTFs where they are enrolled. MEDCOM has established a goal of having 5 percent of appointments booked through TRICARE On-Line.
Schoomaker understands that beneficiaries want greater access to the health care they have earned. He has directed steps to make improvements, determined to see that patients get the right care at the right time, and in the right place.