TESTIMONY OF
ALFRED S. BUCK, MD, FACS
CHAIRMAN
DOD HEALTHCARE QUALITY INITIATIVES REVIEW PANEL

BEFORE THE
SUBCOMMITTEE ON TOTAL FORCE
HOUSE ARMED SERVICES COMMITTEE
UNITED STATES HOUSE OF REPRESENTATIVES

REGARDING
DEFENSE HEALTH PROGRAMS

 March 18, 2004
 

Mr. Chairman and members of the Subcommittee, it is an honor for me to appear before you today. 

The DoD Healthcare Quality Initiatives Review Panel (HQIRP) was convened during the period September 1999 through January 2001 as a Federal Advisory Committee chartered by the Congress in Public Law 105-174.  Its report, released by DoD in July 2001, was a unanimous statement and is available in its entirety for review.  Of $4.7 millions appropriated for the work, $4.4 millions were allocated to specific quality initiatives.  The remainder was expended for support of Panel activities and tasks. 

Among the conclusions and 48 recommendations conveyed by the Panel in its report was an understanding that the military health care system is overall, a successful one - one that is an essential and valuable national resource.  Report content was favorably received by various individuals, who included members and staff of the Congress, staff of the DoD Health Affairs office, and various constituency groups and patient advocates. 

The recommendations in the Report were considered essential to ensure continued improvement within the DoD Health System.  Have they been addressed?  Are there residual priorities? 

While it is not possible for former Panel members, at a distance, to offer conclusive responses to the questions above, we certainly are hopeful about progress.  The nine problem areas addressed by the Initiatives and by the Panel will very likely prove to be "works in progress."  They will remain central to the delivery of health care by, or through, the auspices of the military services and DoD - especially when considering the challenging operational environment currently facing the direct care component of the military health system.  These problem areas correspond to Report chapters.  In sequence they are:   

·    training and oversight of healthcare providers -  especially general medical officers  

·    consolidation of high-risk, resource intense clinical activities at specified facilities

·    reporting adverse actions affecting healthcare providers to the National Practitioner Data Bank (NPDB) as established in Public Law 99-660

·    licenses for and credentialing of healthcare providers

·    utilization of an annual DoD-level quality management report

·    communication with beneficiaries about the quality of their care

·    strengthening the DoD Quality Management Program

·    refinement of laboratory standards

·    patient data accuracy and information management 

While it is reasonable to anticipate progress is being achieved, specific needs may persist that are essential for improvement.  This concern bears emphasis because the egregious outcomes that prompted the Initiatives and the Panel's charter were most essentially related to staffing (quantity, competency, and continuity) and medical records (accuracy, completeness and continuity).  In the mind of the Panel, these factors in turn were related to system deficiencies such as workload reporting, cost and outcome analyses, and resource process.    

Accepting a high probability of omitting some items of current interest, I have attempted to craft ten questions, as examples, that can serve to bridge the statements of the Report with today's dynamic environment. Hopefully, these relate potential ongoing issues or concerns to specific recommendations in the Report.  The latter are referenced in parenthetical citations by page number in the Report, chapter number or title, and recommendation number. 

1)  Has a "level playing field" been achieved in providing comparable oversight and accountability for the purchased care as well as the direct care components of TRICARE? (p.12, General Recommendation 2.) 

2)  Have data systems been implemented that can be audited for accuracy and that can measure and monitor quality outcomes, resource utilization and healthcare costs? (p.14, General Recommendation 4.) 

3)  Have demonstration projects been designed and implemented that will provide policy guidance to enable consolidation and safer performance of high risk procedures (e.g., organ transplantation, joint replacement, cardiac surgery, etc.) as recommended in Chapter II? 

4)  Has a streamlined tri-Service risk management process been implemented that achieves review of specified adverse outcomes and all closed malpractice cases, manages pertinent summary data, produces analyses of experience, and assures uniform identification and reporting of practitioners not meeting the standard(s) of care to the NPDB? (p.41, Chapter III., 1,5.) 

5)  Does the Centralized Credentials Quality Assurance System (CCQAS) periodically provide updated reports at the military treatment facility and command levels listing unlicensed physicians on staff and license expiration dates for those licensed? (p.51, Chapter IV., 3.) 

6)  Can any portion of the annual Quality Management Report (QMR) now be prepared with supportive data automatically?  (p.57, Chapter V., 2.) 

7)  Are reports being developed or tested for the promulgation to beneficiaries of data-based, objective system and clinical progress? (p.67, Chapter VI., 5.) 

8)  Has a standard resource methodology been achieved through TRICARE that is flexible and responsive to clinical needs and quality management? (p.79, Chapter VII., 2.) 

9)  Is CCQAS now used to manage the credentials of all laboratory professionals? (p.85, Chapter VIII., 3.) 

10) Is a "longitudinal" electronic patient record now available for all active duty patients and other beneficiaries? (p.91, Chapter IX., 4.)     

To the best of my understanding, the examples cited would prove useful in facilitating assessment of progress in resolving conclusions and recommendations of the DoD HQIRP.  Other examples could be developed.  We hope that such an assessment can be undertaken. 

In closing, on behalf of each of our Panel members, I would like to express my respect to the Subcommittee and my appreciation for its interest and consideration.  I welcome comments and questions.