Major upgrades coming in health

Extraordinary steps in the evolution of military medicine are occurring in the Washington, D.C., area where new medical facilities are being built to consolidate services, and a joint command is being readied to adopt cutting-edge concepts to improve quality and efficiency of service health care.

Two famed medical facilities — Walter Reed Army Medical Center and Bethesda Naval Medical Center — are being combined into one “world class” medical center, the biggest in the military, said the project’s top officer.

Two nearby community hospitals also are being merged into one large new hospital at Fort Belvoir, Va., a facility that will cover as much ground as a local shopping mall with its length equal to that of two aircraft carriers.

At both facilities military staff will be Army, Navy and Air Force health care providers and serve in joint billets. The proportional mix of service staff has not been set but will be influenced by medical deployment needs.

Overseeing the $2.4 billion project, the largest capital infrastructure investment ever made in the military health system, and struggling to mesh three service cultures under a single command is Navy Vice Adm. John Mateczun, commander of Joint Task Force National Capital Region Medical.

In an interview, Mateczun said National Capital Region Medical will be a test bed not only of joint staffing but for “transformative business practices” and new approaches to military health care delivery.

In the NCR, for example, officials will strive to improve integration of health care service provided through military facilities and through purchased care from the Tricare network of civilian physicians or health insurance.

NCR Medical has decided to run a single civilian work force structure for all of its medical facilities, including 37 clinics. It will be organized to eliminate other cross-service redundancies and to centralize specialty care services.

It is here too that differences in service practices and approaches are being revealed, with the weakest to be discarded and the best embraced as standard procedures. The National Capital Region also will continue to serve as the primary casualty reception site for wounded returning from war, Mateczun said, and care of the wounded will remain its top priority.

Orders to recapitalize and consolidate military medical facilities in the D.C. area came down in the 2005, the most recent round of base closures and realignments ordered by Congress. This was the first round of closures to include a comprehensive review of medical infrastructure.

The medical region’s realignment is to be completed by Sept. 15, 2011. By then service at Walter Reed will be transferred to an expanded medical center at Bethesda and to the new hospital at Fort Belvoir. The medical center at Andrews Air Force Base will become a clinic and its inpatient capability added to Belvoir or Bethesda depending on care required.

The consolidated facilities are to have the same total patient capacity as area facilities had before realignment. Mateczun said reorganization and construction plans are progressing on schedule.

He has led the task force since it was established in September 2007. Mate­czun calls it a privilege and challenge to reorganize a region with the “largest collection of military medical forces we have any place in the world.”

Considering the medical school on the Bethesda compound, called the Uniformed Services University of the Health Sciences, and the experience of clinicians in the region, “we have the opportunity to bring together some of the best capabilities … to come up with some of the solutions I think everyone is looking for” to improve quality and efficiency in the system.

The region has a combined military and civilian medical staff of 12,000. Eligible beneficiaries total 545,000, but only about 282,000 of them are enrolled in managed care through one of the military facilities. The rest rely on civilian providers for care, mostly with Tricare.

Visit militaryupdate.com.