Research for Medical Treatment Facilities

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Provision and Use of Navy Medicine Primary Care: Empirical Background for Optimization
August 1, 2001
The purpose of this research memorandum is to report and comment on the findings of an analysis of Navy Medicine Primary Care (NMPC) to members of the Primary Care Product Line (PCPL) Advisory Board (the Board) and to the Bureau of Medicine and Surgery (BUMED). This report is part of the support that CNA is providing to the product line. It analyzes Ambulatory Data System (ADS) records of visits made to Navy Medical Treatment Facilities (MTFs) during FY 2000, as well as data from two Department of Defense (DOD) surveys that provide information on the satisfaction of users of NMPC. Its intent is to provide empirical information as background to the Board's and BUMED's optimization activities. In this report, we describe what NMPC is, based on what primary care providers (PCPs) do in Navy MTF primary care (PC) settings, and identify how and to what extent the content and nature of NMPC varies by provider and setting. This approaches NMPC from the supply side - what care is provided by whom, and where. Its focus is not on how much care is provided (e.g., number of visits) but rather on the nature and distribution of that care (e.g., percentage of visits by clinical content and provider type).
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Are the DHP Savings From Utilization Management Achievable ?
March 1, 1999
This annotated briefing examines if Defense Health Program (DHP) savings from Utilization Management (UM) are achievable. We examined the effects of reductitions in the DHP budget associated with efficiencies arising from practicing UM at military medical facilities and clinics. We looked at key measures of efficiency and cost between DHP and the civilian health care market. We also determined how the system would respond to cuts in the budget due to UM efficiencies. Finally, we created a mathematical model that captured the way that money could be saved by practicing UM within DHP. We found that the mandated UM savings are achievable; however, the DHP faces several potentially difficult problems that will make it hard to achieve the intended savings.
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Medical Play in Kernel Blitz '97: Findings and Recommendations
January 1, 1998
This CNA annotated briefing (CAB) summarizes findings and recommendations for medical play in KERNEL BLITZ '97, an amphibious exercise held in June-July 1997. The project was sponsored by the CINCPACFLT Surgeon.
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Information Requirements in Future Medical Operations
October 1, 1996
In the future, medical support for Naval Expeditionary Forces will face different and perhaps more difficult challenges. Under traditional doctrine, medical support relies heavily on placing its assets on the beach, after an initial buildup of forces clears the area of enemy threats. In future operations, however, under the Operational Maneuver From the Sea Concept, there will often be no buildup of forces at a beach landing site. The warfighters will operate with great force and at a pace that allows them to dictate the terms of the conflict. They will act decisively, at multiple locations if called for, over large distances, keeping the enemy reactive and ineffective by applying strengths to enemy weaknesses. Small units will move independently, exploiting weaknesses that could not have been predicted before battle. This research memorandum addresses two questions: What are Navy medicine's alternatives for handling the greater need for information and communication in the new battle environment? And What are Navy medicine's minimum information and communication requirements for doing its job in such taxing conditions?
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Tidewater TriCare: An Analysis of Beneficiary Access and Satisfaction
March 1, 1996
As medical care in the civilian sector is moving toward managed care, so it is in the military. The Office of the Secretary of Defense (Health Affairs) has sponsored a series of demonstration projects - limited implementations of health care management programs. One such program is TriCare, in the Tidewater area of Virginia. The project, which began in late 1992, was to have two major changes in the financing and delivery of health care. The program included three options for beneficiaries: Prime (an HMO), Extra (a preferred provider organization) and Standard (the standard CHAMPUS) option. The purpose of this research memorandum is to present the findings from our analysis of changes in the levels of access and satisfaction with military-sponsored medical care. The analysis is based on data we collected for an evaluation of the TriCare demonstrations project in Tidewater, Virginia.
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Determining Navy Primary Care Requirements
January 1, 1996
There are basically two different approaches to determining requirements of staffing a primary-care-based system. Both approaches have their strengths and weaknesses, but we found that the optimization model, although technically feasible from a modeling point of view, wasn't an approach we could follow and complete. The primary disadvantages concern the need for certain kinds of data. To determine who should staff a primary care system and how generalists and specialists substitute for each other, you need to carefully define who can do what. We used HMO staffing ratios for a large number of medical subspecialities. After applying these ratios to Navy beneficiary populations at 22 U.S. naval hospitals and nine overseas naval hospitals, we derived the kinds of staffing that would be observed had the HMO provided care for these beneficiaries.
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A Comparison of Civilian and Military Utilization Rates
October 1, 1995
The military and civilian health care systems, while distinctly different, share some concerns. These common concerns include the overutilization of inpatient care and the rising cost of medical care. Overutilization is of concern in the private sector for a number of reasons. First, insurance reduces the sensitivity of individuals to health care costs. As a result, people may use too much medical care. Cost sharing and cost containment programs tend to reduce this problem. Second, doctors may increase the use of medical services to increase their own profits and to shelter themselves from malpractice suits (i.e., defensive medicine). Cost containment programs - like concurrent review - help to reduce this incentive. Overutilization is also a concern in the military sector. Like the civilian sector, beneficiaries may use too much health care because insurance reduces the cost of care. In addition, the Department of Defense historically allocated resources to hospitals on the basis of past need. As a result, hospital commander had no financial incentive to curtain hospitalizations. This paper, which is part of a CNA self-initiated study, compares the inpatient use of nine military catchment areas to the civilian sector. The variables we study include: gender- and age-adjusted inpatient admission rate, and case-mix-adjusted length of inpatient hospital stay. Length of stay measures the intensity of treatment once a patient enters the hospital. The inpatient admission rate measures the likelihood of entering the h
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Desert Storm Reconstruction Report, Volume XI: Medical
October 1, 1991
This volume of the Desert Storm Reconstruction Report describes the medical support provided by the Navy during Desert Shield/Desert Storm and discusses the lessons learned during the operation.
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Use of MEPRS Data for Comparing CHAMPUS and MTF Costs
August 1, 1990
The Medical Expense and Performance Reporting System (MEPRS) contains detailed cost and workload data for Navy Medical Treatment Facilities (MTFs). This memorandum describes some of the limitations of MEPRS data for calculating cost per admission by medical specialty. Some of these limitations stem from the organization of MEPRS data by functional work centers; others reflect problems in the collection of MEPRS data.
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