What We Did:
The objective of this audit was to assess the effectiveness of the Defense Health Agency’s (DHA) management of military medical treatment facilities (MTFs) outside the continental United States (OCONUS) in meeting access to primary care standards for DoD beneficiaries.
What We Found:
The DHA updated its organizational structure and developed tools to assist OCONUS MTFs in meeting access to care standards; however, the DHA could manage access to care more effectively at OCONUS MTFs. We selected a nonstatistical sample of 15 out of 79 MTFs located OCONUS, including Hawaii and Alaska. Specifically, personnel at the 15 OCONUS MTFs we sampled operated inconsistently using different access to care guidance; spent significant time researching and resolving or developing workarounds for inaccurate or unreliable data within the DHA access to care dashboards; and did not have sufficient staff to meet the access to primary care standards. This occurred because the DHA did not:
• issue finalized guidance to the MTF personnel establishing roles, responsibilities, and access to care requirements that reflected the DHA's updated structure, operations, and performance goals;
• analyze data discrepancies within the DHA access to care dashboards or consistently update MTF personnel on data corrections; or
• manage staffing to meet the DHA’s mission of delivering timely health care to DoD beneficiaries in the MTF or to support a ready medical force for the DoD.
As a result, according to the DHA Near Real Time dashboard data, Service members and their families faced delays in access to care during the timeframe of our audit, ranging on average from 1.2 days to 21.1 days for urgent appointments and from 7.2 days to 36.8 days for future appointments, which increased the risk for negative outcomes and preventable complications, and decreased patient satisfaction. Lastly, MTF personnel were at risk of decreased readiness, had decreased morale, and experienced burnout.
What We Recommend:
We made 11 recommendations to the DHA Director to improve access to care management, including to finalize and implement guidance and to analyze and remediate data quality issues. Regarding staffing, we recommend that the DHA Director track data on why personnel are leaving MTFs, perform a comprehensive review of the authorized staffing at OCONUS MTFs, and track support staff availability. Further, we recommend that the DHA Director, in coordination with the Military Departments, determine the time spent on tasks for the DHA healthcare and DoD readiness missions and make adjustments to balance the workforce.