All Branch Topic (ABT) Is someone trying to kill the MTF?

[TheTruckGuy]

Serious question here. It seems as though our local MTF is doing less and less work and is getting less and less staff. Referrals sit unprocessed for over a week sometimes, and when they are processed they're frequently deferred to network providers out in town. Some of the referrals are obviously legitimate, if they don't have a certain specialty. But frequently they have the specialty, that specialty just isn't doing a certain procedure, or doesn't have the staff to support taking on more patients.

It has to be frustrating for the specialists I would imagine. But it's definitely frustrating for us PCMs. Like I referred someone on 2/16, and in the system it looked like the referral was sent to the network. The patient called the call center to set up an appointment, and the call center forwarded the call to the front desk of the department. The department told them to call back and make the appointment with the call center. No one bothered to tell him his referral was sent to the network. Then I tried going through the process with him, and ended up calling Tricare with him. Long story short, I spent over an hour with him trying to figure it out, and eventually just sent him to the MTF to figure it out in person - turns out he was referred to a nearby MTF since our MTF was at capacity.

Is this the DHA transition? If they want to cut active duty billets in non-critical wartime specialties, shouldn't they replace them with civilian contractors? Or is it just COVID and people being unable to see patients? It's getting to the point where patients are expecting to be sent to the network, and are upset when they have to get seen at the MTF, because obviously military docs aren't real doctors.

Rant over. What are y'all's experiences?

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[DrMetal]

Serious question here. It seems as though our local MTF is doing less and less work and is getting less and less staff. Referrals sit unprocessed for over a week sometimes, and when they are processed they're frequently deferred to network providers out in town. Some of the referrals are obviously legitimate, if they don't have a certain specialty. But frequently they have the specialty, that specialty just isn't doing a certain procedure, or doesn't have the staff to support taking on more patients.

It has to be frustrating for the specialists I would imagine. But it's definitely frustrating for us PCMs. Like I referred someone on 2/16, and in the system it looked like the referral was sent to the network. The patient called the call center to set up an appointment, and the call center forwarded the call to the front desk of the department. The department told them to call back and make the appointment with the call center. No one bothered to tell him his referral was sent to the network. Then I tried going through the process with him, and ended up calling Tricare with him. Long story short, I spent over an hour with him trying to figure it out, and eventually just sent him to the MTF to figure it out in person - turns out he was referred to a nearby MTF since our MTF was at capacity.

Is this the DHA transition? If they want to cut active duty billets in non-critical wartime specialties, shouldn't they replace them with civilian contractors? Or is it just COVID and people being unable to see patients? It's getting to the point where patients are expecting to be sent to the network, and are upset when they have to get seen at the MTF, because obviously military docs aren't real doctors.

Rant over. What are y'all's experiences?

All of the above is true at the Navy MTFs. We're frickin ghost towns. I love it when the sub-specialty clinics go 'Active Duty only'. B/c there's a lot of AD folks with complex rheum disorders.

I don't know if it's DHA to blame . . .this has been an ongoing issue for at least 10 years, in my estimation. Lot of laziness in the .mil, and not enough accountability.

The DOD is trying to get out of the business of complex health care. Can't say that I blame it. It is after all the Department of 'Defense', not the Department of Complex Healthcare , nor the Dept of GME.

What's stupid is that we, in the medical corps, continue to perpetuate the facade of a system that does do (or is interested in) complex healthcare/GME. Nothing could be further from the truth, and we should admit it.

 

[backrow]

Serious question here. It seems as though our local MTF is doing less and less work and is getting less and less staff. Referrals sit unprocessed for over a week sometimes, and when they are processed they're frequently deferred to network providers out in town. Some of the referrals are obviously legitimate, if they don't have a certain specialty. But frequently they have the specialty, that specialty just isn't doing a certain procedure, or doesn't have the staff to support taking on more patients.

It has to be frustrating for the specialists I would imagine. But it's definitely frustrating for us PCMs. Like I referred someone on 2/16, and in the system it looked like the referral was sent to the network. The patient called the call center to set up an appointment, and the call center forwarded the call to the front desk of the department. The department told them to call back and make the appointment with the call center. No one bothered to tell him his referral was sent to the network. Then I tried going through the process with him, and ended up calling Tricare with him. Long story short, I spent over an hour with him trying to figure it out, and eventually just sent him to the MTF to figure it out in person - turns out he was referred to a nearby MTF since our MTF was at capacity.

Is this the DHA transition? If they want to cut active duty billets in non-critical wartime specialties, shouldn't they replace them with civilian contractors? Or is it just COVID and people being unable to see patients? It's getting to the point where patients are expecting to be sent to the network, and are upset when they have to get seen at the MTF, because obviously military docs aren't real doctors.

Rant over. What are y'all's experiences?

If your MTF falls under DHA then the DHA mandates that all referrals be adjudicated in essentially 24 hours. They have also removed consult review from within department and centralized it to be adjudicated based on referral criteria and capability reports.

DHA has also instituted requirements to use the appointment centers instead of booking at the clinic and track the percentage of appointments booked via the appointment center vs the clinic. Therefore clinics direct patients to call the appointment center.

The easiest way for a patient to figure out their referral status is to check the Tricare online website where they can see their entire medical record and status of referrals. They can also call Tricare.

In regards to another comment about “active duty only” this is a direct correlation to downward trends of specialists and a mandate that active duty be seen within 14 days. Clinics have to keep more SPECs held back for active duty to meet this requirement.

So overall yes, these are issues directly related to mandates set forth by DHA and the current Manning trends.

 

[DrMetal]

In regards to another comment about “active duty only” this is a direct correlation to downward trends of specialists and a mandate that active duty be seen within 14 days. Clinics have to keep more SPECs held back for active duty to meet this requirement.

I don't think anyone would disagree with AD getting preference or head-of-the-line privileges . . .but when your favorite neighborhood endo/rheum is only seeing 3-4 patients/day (if that) and when the support staff is closing up shop at 1100 and going home, you would think they could see a few dependents/retirees so that these patients don't have to wait 3 months to see the civilian equivalent.

 

[militaryPHYS]

I don't think anyone would disagree with AD getting preference or head-of-the-line privileges . . .but when your favorite neighborhood endo/rheum is only seeing 3-4 patients/day (if that) and when the support staff is closing up shop at 1100 and going home, you would think they could see a few dependents/retirees so that these patients don't have to wait 3 months to see the civilian equivalent.

In my experience dealing with DHA requirements everything was negotiable so long as DHA requirements were being met. i.e. if you wanted to stray away from default template you could pitch it to Dir. Healthcare Business and get approval. This is command dependent of course and also dependent on staff who are willing to go above and beyond the basics.

 

[HighPriest]

This was basically my experience at a small Army MTF as well and that was in 2014. So I don’t think it’s DHA. I always chalked it up to, you know, milmed has no desire or perhaps just no ability to be a high quality, efficient medical organization - especially at the MTF level.

 

[Volatile]

It seems the military’s end goal is to employ only deployable specialties and have everyone work in civilian hospitals. Rid itself completely of MTF’s. Active duty would still have tricare and have all healthcare done at civilian institutions. This has been discussed for over a decade now and I suspect in another few decades that’s where we will end up. I’ll count my blessings that we have stayed busy at our MTF and I feel I have been able to mostly maintain my skill set.

 

[backrow]

It seems the military’s end goal is to employ only deployable specialties and have everyone work in civilian hospitals. Rid itself completely of MTF’s. Active duty would still have tricare and have all healthcare done at civilian institutions. This has been discussed for over a decade now and I suspect in another few decades that’s where we will end up. I’ll count my blessings that we have stayed busy at our MTF and I feel I have been able to mostly maintain my skill set.

You have to define “military” here as really it’s two different institutions with two different goals fighting over the same turf right now.

Military = DHA: they don’t necessarily want to shutter MTFs, they just want to treat them as if they are civilian hospitals.

Military = individual military service: yeah, they’re mission is now “readiness” and want to trim whatever doesn’t fit in that definition.

The biggest issue in my opinion is who gets to define what “readiness” is: the Services? Or is it DHA? Because right now they seem to be operating from different dictionaries.

A hang-up for both of them is a need for a physician/corpsman/medic/nurse training pipeline. If you don’t have MTFs you don’t control your own pipeline.