Military Personnel
Military Departments Need to Ensure That Full Costs of Converting Military Health Care Positions to Civilian Positions Are Reported to Congress Gao ID: GAO-06-642 May 1, 2006Based on studies showing that many military members are performing tasks that are not considered military essential, the Air Force, Army, and Navy have plans to convert certain numbers of military health care positions to civilian positions. Questions have surfaced regarding the potential effects of these conversions on the Defense Health Program. The National Defense Authorization Act for Fiscal Year 2006 prohibits the military departments from performing any further conversions until the secretary of each department certifies to Congress that the conversions will not increase costs or decrease quality or access to care. The act also requires GAO to study the military departments' conversions and their potential effects. Specifically, GAO examined (1) the military departments' plans for and actions to date in converting military health care positions to civilian positions and the departments' experiences in filling the converted positions with civilians and (2) the potential effects of converting military health care positions to civilian positions on the Defense Health Program.
The Air Force, Army, and Navy have converted or have plans to convert several thousand military health care positions to civilian positions and have made progress in hiring civilian replacement personnel. From fiscal years 2005 through 2007, the Air Force, Army, and Navy collectively have converted or plan to convert a total of 5,507 military health care positions to civilian positions. Of the 5,507 military health care positions, the departments plan to convert 152 physician positions, 349 nurse positions, and 208 dental positions to civilian positions. In fiscal year 2006, there were a total of 10,352 military physicians, 9,138 nurses, and 3,020 dentists in the Air Force, Army, and Navy. The Navy is the most significantly affected of the three military departments, having converted or planning to convert a total of 2,676 military health care positions, representing 49 percent of the total 5,507 positions converted or planned for conversion. While the departments have been recruiting for about 4 to 7 months to hire civilian replacements for converted positions, to date, they have not experienced significant difficulties filling the civilian positions. The military departments do not expect the conversions to affect medical readiness, quality of care, recruitment and retention of military health care personnel, or decrease beneficiaries' access to care. However, it is unknown whether the conversions will increase or decrease costs to DOD. At present, the military departments may not prepare their congressional certifications using cost data prepared by DOD's Office of Program Analysis and Evaluation, which is identifying the full costs for military health care positions. Instead, the military departments may use cost data that do not contain all the costs, like training, necessary to support a military medical position. Without accounting for the full costs in their methodologies, the military departments will not be able to make a true comparison of the total costs required to support military positions versus civilian positions. Moreover, Congress will be unable to judge the extent to which the departments' certifications are based on actual and anticipated compensation costs for civilian hires unless they include such delineations in their certifications.
RecommendationsOur recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.
Director: Team: Phone:GAO-06-642, Military Personnel: Military Departments Need to Ensure That Full Costs of Converting Military Health Care Positions to Civilian Positions Are Reported to Congress
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United States Government Accountability Office:
GAO:
Report to Congressional Committees:
May 2006:
Military Personnel:
Military Departments Need to Ensure That Full Costs of Converting
Military Health Care Positions to Civilian Positions Are Reported to
Congress:
GAO-06-642:
GAO Highlights:
Highlights of GAO-06-642, a report to congressional committees.
Why GAO Did This Study:
Based on studies showing that many military members are performing
tasks that are not considered military essential, the Air Force, Army,
and Navy have plans to convert certain numbers of military health care
positions to civilian positions. Questions have surfaced regarding the
potential effects of these conversions on the Defense Health Program.
The National Defense Authorization Act for Fiscal Year 2006 prohibits
the military departments from performing any further conversions until
the secretary of each department certifies to Congress that the
conversions will not increase costs or decrease quality or access to
care. The act also requires GAO to study the military departments‘
conversions and their potential effects. Specifically, GAO examined (1)
the military departments‘ plans for and actions to date in converting
military health care positions to civilian positions and the
departments‘ experiences in filling the converted positions with
civilians and (2) the potential effects of converting military health
care positions to civilian positions on the Defense Health Program.
What GAO Found:
The Air Force, Army, and Navy have converted or have plans to convert
several thousand military health care positions to civilian positions
and have made progress in hiring civilian replacement personnel. From
fiscal years 2005 through 2007, the Air Force, Army, and Navy
collectively have converted or plan to convert a total of 5,507
military health care positions to civilian positions. Of the 5,507
military health care positions, the departments plan to convert 152
physician positions, 349 nurse positions, and 208 dental positions to
civilian positions. In fiscal year 2006, there were a total of 10,352
military physicians, 9,138 nurses, and 3,020 dentists in the Air Force,
Army, and Navy. The Navy is the most significantly affected of the
three military departments, having converted or planning to convert a
total of 2,676 military health care positions, representing 49 percent
of the total 5,507 positions converted or planned for conversion. While
the departments have been recruiting for about 4 to 7 months to hire
civilian replacements for converted positions, to date, they have not
experienced significant difficulties filling the civilian positions.
The military departments do not expect the conversions to affect
medical readiness, quality of care, recruitment and retention of
military health care personnel, or decrease beneficiaries‘ access to
care. However, it is unknown whether the conversions will increase or
decrease costs to DOD. At present, the military departments may not
prepare their congressional certifications using cost data prepared by
DOD‘s Office of Program Analysis and Evaluation, which is identifying
the full costs for military health care positions. Instead, the
military departments may use cost data that do not contain all the
costs, like training, necessary to support a military medical position.
Without accounting for the full costs in their methodologies, the
military departments will not be able to make a true comparison of the
total costs required to support military positions versus civilian
positions. Moreover, Congress will be unable to judge the extent to
which the departments‘ certifications are based on actual and
anticipated compensation costs for civilian hires unless they include
such delineations in their certifications.
Table: Military to Civilian Health Care Position Conversions, Fiscal
Years 2005–07:
Military department: Air Force;
Actual conversions: FY 2005; 0;
Actual conversions: FY 2006; 401;
Planned conversions: FY 2007; 813 ;
All conversions: FY 2005-07; Total: 1,214;
Percent: 22%.
Military department: Army;
Actual conversions: FY 2005; 0;
Actual conversions: FY 2006; 1,029;
Planned conversions: FY 2007; 588;
All conversions: FY 2005-07; Total: 1,617;
Percent: 29%.
Military department: Navy;
Actual conversions: FY 2005; 1,772;
Actual conversions: FY 2006; 215;
Planned conversions: FY 2007; 689;
All conversions: FY 2005-07; Total: 2,676;
Percent: 49%
Total: Actual conversions: FY 2005; 1,772;
Actual conversions: FY 2006; 1,645;
Planned conversions: FY 2007; 2,090;
All conversions: FY 2005-07; Total: 5,507.
Percent of total conversions:
Actual conversions: FY 2005; 32%
Actual conversions: FY 2006; 30%
Planned conversions: FY 2007; 38%
All conversions: FY 2005-07; 100%
Source: GAO analysis of Air Force, Army, and Navy data.
[End of table]
What GAO Recommends:
GAO is making recommendations for the Department of Defense (DOD) to
account for the full costs of military health care positions converted
or planned for conversion. In reviewing a draft of this report, DOD
agreed with GAO‘s recommendations.
[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-06-642].
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Derek Stewart at (202)
512-5559 or [Hyperlink, stewartd@gao.gov].
[End of section]
Contents:
Letter:
Results in Brief:
Background:
Military Departments Converting Military Health Care Positions to
Civilian Positions and Making Progress Filling Civilian Positions:
Conversions Not Expected to Alter Medical Readiness, Quality of Care,
Recruitment and Retention, or Access to Care, but Effects on Cost to
DOD Unknown:
Conclusions:
Recommendations for Executive Action:
Agency Comments and Our Evaluation:
Appendix I: Scope and Methodology:
Appendix II: Conversion of Navy Military Physician Positions by
Specialty:
Appendix III: Conversion of Military Health Care Positions to Civilian
Positions by Geographic Region:
Appendix IV: Navy's Experience in Recruiting Civilians for Converted
Military Health Care Positions, Fiscal Year 2005:
Appendix V: Comments from the Department of Defense:
Appendix VI: GAO Contact and Staff Acknowledgments:
Tables:
Table 1: Defense Health Program Appropriation, Fiscal Years 2005-07:
Table 2: Number of Military Health Care Positions Converted or Planned
for Conversion to Civilian Positions, Fiscal Years 2005-07:
Table 3: Military Health Care Positions Converted or Planned for
Conversion to Civilian Positions by Type of Position and Grade, Fiscal
Years 2005-07:
Table 4: Military Health Care Positions Converted or Planned for
Conversion to Civilian Positions by Type of Position and Grade, Fiscal
Years 2005-07 (Detailed):
Table 5: Combined Air Force, Army, and Navy Military Medical Readiness
Requirements Compared to Combined Military Departments' Medical and
Dental Personnel End-strength, Fiscal Year 2004:
Table 6: Navy Military Physician Positions Converted by Specialty,
Fiscal Years 2005 and 2006:
Table 7: Military Installations, by Military Department, with the
Largest Cumulative Numbers of Military Health Care Positions Converted
or Planned for Conversion to Civilian Positions, Fiscal Years 2005-07:
Table 8: Navy Experience in Recruiting Federal Civilian Health Care
Personnel to Fill Converted Military Positions in Fiscal Year 2005 by
Type of Position, as of January 31, 2006:
Abbreviations:
DHP: Defense Health Program:
DOD: Department of Defense:
GS: General Schedule:
MHS: Military Health System:
MQA: Medical Quality Assurance:
PA&E: Office of Program Analysis and Evaluation:
United States Government Accountability Office:
Washington, DC 20548:
May 1, 2006:
The Honorable John Warner:
Chairman:
The Honorable Carl Levin:
Ranking Minority Member:
Committee on Armed Services:
United States Senate:
The Honorable Duncan L. Hunter:
Chairman:
The Honorable Ike Skelton:
Ranking Minority Member:
Committee on Armed Services:
House of Representatives:
Since September 11, 2001, the high pace of operations has created
significant stress on the military's operating forces. In late 2003,
the Department of Defense (DOD) reported that recent studies had found
thousands of military personnel were being used to accomplish work
tasks that were not military essential. DOD found that civilian or
private sector contract employees could perform these tasks in a more
efficient and cost-effective manner than military personnel. As a
result, DOD directed the military departments to identify and convert
certain targeted numbers of military positions to federal civilian or
contract positions.[Footnote 1] Along with other functional areas, the
military departments identified military health care[Footnote 2]
positions that could be converted. Questions have surfaced, however,
regarding the potential effects of these actual and planned conversions
on the Defense Health Program (DHP), especially given that military
health care personnel provide care to the families of servicemembers
and to retirees in addition to active duty members.
The National Defense Authorization Act for Fiscal Year 2006[Footnote 3]
prohibits the military departments from performing any further
conversions of military medical or dental positions to civilian
positions until the secretary of each department submits, not before
June 1, 2006, to the Committees on Armed Services of the Senate and the
House of Representatives a certification that the conversions will not
increase costs or decrease quality of care or access to care. The act
also requires us to study the military departments' plans and progress,
and the potential effects on the DHP of converting military health care
positions to civilian positions. For this report, we examined (1) the
military departments' plans for and actions to date in converting
military health care positions to civilian positions and the
departments' experiences in filling these converted positions with
civilians and (2) the potential effects of converting military health
care positions to civilian positions on the DHP.
To examine the military departments' completed and planned conversions
of military health care positions, we obtained the number, type, and
location of positions converted or planned for conversion from military
health care positions to civilian positions during fiscal years 2005
through 2007 from the offices of the surgeon general of the Air Force,
Army, and Navy. To examine the military departments' experience in
filling the converted positions with federal civilian or contract
employees, we requested that the offices of the surgeons general for
the Air Force, Army, and Navy provide information on the extent to
which the converted positions were filled, the time required to fill
converted positions, and reasons for delays in filling the positions.
To identify the potential effects of converting military health care
positions on the DHP, we obtained and examined the offices of the
surgeons general's assessments regarding how the conversions would
affect medical readiness,[Footnote 4] cost of the DHP, quality of care,
beneficiaries' access to care, and recruitment and retention of
military medical and dental personnel. In addition, we conducted
focused analyses at the Naval Medical Center, Portsmouth. We chose this
facility because it had the largest number of health care conversions
of any Navy facility for fiscal year 2005 and represented the location
with the largest number of conversions planned during fiscal year 2005
through fiscal year 2007. At the Naval Medical Center, Portsmouth, we
examined data on waiting times for appointments in selected departments
before and after conversion of military physician positions. We
determined that the data used in this report were sufficiently reliable
for our purposes. We also discussed the potential effects on the DHP of
converting military health care positions to civilian positions with
officials from the TRICARE Management Activity in the Office of the
Assistant Secretary of Defense for Health Affairs; from the offices of
the surgeon general for the Air Force, Army, and Navy; from the Office
of Program Analysis and Evaluation (PA&E); and from the Naval Medical
Center, Portsmouth. For more detailed information on our scope and
methodology, see appendix I. We performed our work from November 2005
through April 2006 in accordance with generally accepted government
auditing standards.
Results in Brief:
The Air Force, Army, and Navy have converted or have plans to convert
military health care positions to civilian positions and have made
progress in hiring civilian replacement personnel. From fiscal years
2005 through 2007, the Air Force, Army, and Navy collectively have
converted or plan to convert a total of 5,507 military health care
positions to civilian positions, representing 6.1 percent of the
military departments' DHP military personnel. Specifically, the
military departments converted 1,772 positions (32 percent of the total
planned conversions) in fiscal year 2005[Footnote 5] and 1,645
positions (30 percent of the total) in fiscal year 2006, and plan to
convert 2,090 positions (38 percent of the total) in fiscal year 2007.
The Navy is the most significantly affected of the three military
departments. The Navy has converted or plans to convert 2,676 military
health care positions, representing 49 percent of the total positions
converted or planned for conversion. In contrast, the Air Force has
converted or plans to convert 1,214 positions, or 22 percent of the
total conversions and the Army has converted or plans to convert 1,617,
or 29 percent of the total conversions. Of the total military health
care positions converted or planned for conversion, the majority are
enlisted positions, while about 20 percent are military officer
positions. By the end of fiscal year 2007, the departments plan to have
converted 152 physician positions, 349 nurse positions, and 208 dental
positions to civilian positions. By comparison, in fiscal year 2006,
there were a total of 10,352 military physicians, 9,138 nurses, and
3,020 dentists in the Air Force, Army, and Navy. The Navy, however, is
the only department that plans to convert any physician positions.
Regarding the hiring of replacements, the Navy has the most experience
hiring civilians for the converted positions, but that experience is
limited to 7 months. While the departments have been recruiting for a
short time to hire civilian replacements for converted positions, they
have each made varying degrees of progress and to date, have not
experienced significant difficulties filling the civilian positions. In
7 months time, the Navy filled two-thirds of the positions it converted
in fiscal year 2005, and the Air Force and Army have filled 37 percent
and 30 percent of their fiscal year 2006 positions, respectively,
within 4 months' time.
While the military departments do not expect the conversions to affect
medical readiness, quality of care, recruitment and retention of
military health care personnel, or to decrease beneficiaries' access to
care, it is unknown whether the conversions will increase or decrease
costs to DOD. Based on our examination of the military departments'
application of the DOD medical readiness sizing model for determining
which military health care positions are required for medical
readiness, and our understanding of how the military departments
determined which health care positions should be considered for
conversion, it is unlikely that the conversions will affect medical
readiness. Only military positions in excess of those required to meet
the demands of the operational scenarios included in the national
military strategy were considered candidates for conversion. Similarly,
because each military department has maintained the same credentialing
and privileging processes for civilian medical and dental care
providers, quality of care is not expected to be affected by the
conversions. In addition, given that many factors could affect a health
care professional's decision to join or leave military service, it is
difficult to isolate what potential effect the military-to-civilian
conversions will have on recruitment and retention of military medical
and dental personnel. However, it is unknown whether the military to
civilian conversions will increase or decrease costs to DOD because (1)
it is uncertain what actual compensation levels will be required to
successfully hire replacement civilian personnel and (2) the
methodologies each department is considering using in its
certifications to Congress may not include the full costs for military
personnel. Currently, the military departments may not prepare their
certifications using cost data prepared by DOD's PA&E, which is
currently identifying total costs for military health care positions.
Without accounting for the full costs in their analyses, the military
departments will not be able to make a true comparison of military
positions to the costs to support civilian positions. Also, Congress
will be unable to judge the extent to which the military departments'
certifications are based on actual and anticipated compensation costs
for completed and future civilian hires unless the military departments
include such delineations in their certifications to Congress.
We are making recommendations to ensure that the military departments
account for the full costs of military health care positions converted
or planned for conversion when they report to Congress. In written
comments on a draft of this report, DOD generally concurred with our
recommendations. DOD's comments are reprinted in appendix V.
Background:
The Military Health System (MHS) provides health support for the full
range of military operations and for military servicemembers and their
families, military retirees, retiree family members, and survivors. The
Defense Health Program (DHP) appropriation supports worldwide medical
and dental services to eligible beneficiaries, veterinary services,
medical command headquarters, graduate medical education and other
training of medical personnel, and occupational and industrial health
care. The DHP appropriation supports operations of 70 inpatient
facilities, 409 medical clinics, 417 dental clinics and 259 veterinary
clinics, and funds multiple TRICARE[Footnote 6] contracts that augment
health care delivery. Table 1 shows total DHP appropriations and budget
estimates for fiscal years 2005 through 2007.
Table 1: Defense Health Program Appropriation, Fiscal Years 2005-07:
Dollars in millions.
Operation and maintenance[A];
FY 2005: $17,497.1;
FY 2006: $19,386.9;
FY 2007: $20,249.2.
Procurement;
FY 2005: $368.3;
FY 2006: $403.9;
FY 2007: $396.4.
Research, development, test and evaluation;
FY 2005: $523.1;
FY 2006: $536.9;
FY 2007: $130.6.
Total;
FY 2005: $18,388.5;
FY 2006: $20,327.7;
FY 2007: $20,776.2.
Source: Department of Defense and President's Budget Position for
Fiscal Year 2007.
[A] The military departments programmed $ 35.8 million in fiscal year
2005, $ 215.7 million in fiscal year 2006, and $135.4 million in fiscal
year 2007 for the conversion of military health care positions to
civilian positions.
[End of table]
In fiscal year 2005, the MHS employed approximately 42,400 federal
civilian employee full-time equivalents whose costs were funded by the
DHP. The MHS also employed about 90,000 military medical, dental, and
support personnel. The cost of these military personnel who support
DHP-funded activities is funded by each military department's military
personnel appropriation.
In December 2003, DOD directed the military departments to convert
certain targeted numbers of military positions, including some health
care positions, to federal civilian or contract positions based on
evaluations that showed many military personnel were being used to
accomplish work tasks that were not military essential and could be
performed more cost efficiently by civilians.[Footnote 7] According to
DOD officials, the conversion process began in late 2003/early 2004
with the creation of a task force, chaired by the Director of PA&E
including members from offices of the Assistant Secretary of Defense
for Health Affairs and the surgeons general for the Air Force, Army,
and Navy, to identify military medical and dental positions that could
be converted to federal civilian or contract positions. The task force
examined 121 occupational medical and dental specialties for potential
conversion. It applied a DOD medical readiness personnel sizing model
to identify the baseline medical readiness personnel requirements for
each military department, taking into consideration only those
positions that members believed would not be required for medical
readiness, would not degrade clinical capabilities, would not reduce
access to medical or dental care to beneficiaries, or would not
increase costs to DOD.
As the military departments began to implement the conversions, each
military department reassessed the availability and affordability of
civilian replacement personnel in the geographical areas where
conversions were planned. Adjustments were then made to the military
departments' plans to reflect local medical commanders' assessments.
According to officials with the offices of the surgeons general for the
Air Force and Army, conversions of military health care positions in
their military departments are planned to be replaced on a one-for-one
basis with civilian or personnel. However, according to a Navy
official, the Navy decided to link a reassessment of appropriate
medical and dental staffing levels in its medical centers to the
conversion process. This reassessment, among other things, reviewed the
number and type of staffing required to meet clinical productivity
goals and quality standards. Applying the results of the staffing
reassessments resulted in the Navy concluding that there was no need to
hire civilian personnel replacements for 345 of the 1,772 positions
converted for fiscal year 2005.
Military Departments Converting Military Health Care Positions to
Civilian Positions and Making Progress Filling Civilian Positions:
The Air Force, Army, and Navy have each begun implementing plans to
convert non-military essential health care positions to civilian
positions and have made progress in hiring civilians to fill the
converted positions. During fiscal years 2005 through 2007, the
military departments have converted or plan to convert about 5,500
military health care positions to civilian positions, including certain
numbers of physician, nurse, and dental positions. While the
departments have been recruiting for a short time to hire civilian
replacements for converted positions, they have each made varying
degrees of progress and to date, have not experienced significant
difficulties filling the civilian positions.
Air Force, Army, and Navy Have Converted or Plan to Convert Military
Health Care Positions to Civilian Positions:
The Air Force, Army, and Navy have each made plans and begun converting
military health care positions to civilian positions. During fiscal
years 2005 through 2007, the departments have converted or plan to
convert a total of 5,507 military health care positions to civilian
positions, representing 6.1 percent of the total DHP military
personnel. Specifically, the departments converted 1,772 positions (32
percent of the total planned conversions) in fiscal year 2005, 1,645
positions (30 percent) in fiscal year 2006, and plan to convert 2,090
positions (38 percent) in fiscal year 2007. Table 2 summarizes the
number of planned/converted positions by military department.
Table 2: Number of Military Health Care Positions Converted or Planned
for Conversion to Civilian Positions, Fiscal Years 2005-07:
Military department: Air Force;
Actual conversions: FY 2005; 0;
Actual conversions: FY 2006; 401;
Planned conversions: FY 2007; 813 ;
All conversions: FY 2005-07; Total: 1,214;
Percent: 22%.
Military department: Army;
Actual conversions: FY 2005; 0;
Actual conversions: FY 2006; 1,029;
Planned conversions: FY 2007; 588;
All conversions: FY 2005-07; Total: 1,617;
Percent: 29%.
Military department: Navy;
Actual conversions: FY 2005; 1,772;
Actual conversions: FY 2006; 215;
Planned conversions: FY 2007; 689;
All conversions: FY 2005-07; Total: 2,676;
Percent: 49%
Total: Actual conversions: FY 2005; 1,772;
Actual conversions: FY 2006; 1,645;
Planned conversions: FY 2007; 2,090;
All conversions: FY 2005-07; Total: 5,507.
Percent of total conversions:
Actual conversions: FY 2005; 32%
Actual conversions: FY 2006; 30%
Planned conversions: FY 2007; 38%
All conversions: FY 2005-07; 100%
Source: GAO analysis of Air Force, Army, and Navy data.
[End of table]
Conversion by military department: The Navy is the most significantly
affected of the three military departments by the military to civilian
conversions. The Navy has converted or plans to convert 2,676 military
health care positions, representing 49 percent of the total positions
converted or planned for conversion in DOD. In addition, as table 2
shows, the Navy was the only department that converted positions in
fiscal year 2005, converting a total of 1,772 positions--32 percent of
the total number of planned/converted positions. By contrast, the Air
Force has converted or plans to convert 1,214 positions, or 22 percent
of the total conversions and the Army has converted or plans to convert
1,617, or 29 percent of the total conversions.
Conversion by type of position and grade: While each of the departments
plans to convert both enlisted and officer health care positions to
civilian positions, the majority of positions planned for conversion
are enlisted positions (80 percent), while military officer positions
account for about 20 percent of the conversions. Military health care
positions consist of (1) medical--including not only health care
providers who directly interact with patients, but also a variety of
support positions whose functions directly relate to medical care, such
as laboratory, radiology and dietary technicians; (2) dental--including
dentists and dental technicians and assistants; and (3) other--
including a variety of positions that are part the DHP but which do not
directly affect the provision of medical or dental care to patients,
such as administrators and public affairs officers. Table 3 shows the
breakdown of types of health care positions converted or planned for
conversion by each military department.
Table 3: Military Health Care Positions Converted or Planned for
Conversion to Civilian Positions by Type of Position and Grade, Fiscal
Years 2005-07:
Type of position: Medical: Officers;
Air Force: 228;
Army: 128;
Navy: 412;
Total: 768.
Type of position: Medical: Enlisted;
Air Force: 589;
Army: 794;
Navy: 1,622;
Total: 3,005.
Medical: Subtotal:
Air Force: 817;
Army: 922;
Navy: 2,034;
Total: 3,773;
Percent: 69%.
Type of position: Dental: Officers;
Air Force: 0;
Army: 32;
Navy: 176;
Total: 208.
Type of position: Dental: Enlisted;
Air Force: 132;
Army: 59;
Navy: 388;
Total: 579.
Dental: Subtotal;
Air Force: 132;
Army: 91;
Navy: 564;
Total: 787;
Percent: 14%.
Type of position: Other DHP: Officers;
Air Force: 15;
Army: 44;
Navy: 67;
Total: 126.
Type of position: Other DHP: Enlisted;
Air Force: 250;
Army: 560;
Navy: 11;
Total: 821.
Other DHP: Subtotal;
Air Force: 265;
Army: 604;
Navy: 78;
Total: 947;
Percent: 17%.
Total:
Air Force: 1,214;
Army: 1,617;
Navy: 2,676;
Total: 5,507;
Percent: 100%.
Source: GAO analysis of Air Force, Army, and Navy data.
[End of table]
As table 3 shows, the majority of the health care positions that have
been or are scheduled for conversion fall into the medical category (69
percent). Dental positions account for 14 percent of the total
conversions, while other positions represent 17 percent of the total
conversions.
Of all health care positions, the type of position most affected by the
conversions for fiscal years 2005 through 2007 is the position
categorized by the Navy as enlisted corpsman, by the Army as an
enlisted medic, and by the Air Force as enlisted aerospace medical
services personnel.[Footnote 8] Within the medical category, the three
positions with high rates of conversion are physician, nurse, and
dentist. By the end of fiscal year 2007, the departments plan to have
converted 152 physician positions, 349 nurse positions, and 208 dental
positions to civilian positions. In fiscal year 2006, there were a
total of 10,352 military physicians, 9,138 nurses, and 3,020 dentists
in the Air Force, Army, and Navy. The Navy, however, is the only
department that plans to convert any physician positions--neither the
Army nor the Air Force plans to convert any military physician
positions to civilian positions. Appendix II shows the military
physician positions by specialty converted by the Navy in fiscal year
2005 and fiscal year 2006.
Table 4 provides a detailed breakdown of military health care positions
converted or planned for conversion to civilian positions by type of
position and grade.
Table 4: Military Health Care Positions Converted or Planned for
Conversion to Civilian Positions by Type of Position and Grade, Fiscal
Years 2005-07 (Detailed):
Type of position/grade: Officers: Air Force: [Empty]; Army: [Empty];
Navy: [Empty]; Total: [Empty]; Percent: [Empty].
Type of position/grade: Officers: Physicians;
Air Force: 0;
Army: 0;
Navy: 152;
Total: 152;
Percent: 3%.
Type of position/grade: Officers: Physician assistants;
Air Force: 3;
Army: 0;
Navy: 39;
Total: 42;
Percent: 0.8%.
Type of position/grade: Officers: Nurses[A];
Air Force: 177;
Army: 75;
Navy: 97;
Total: 349;
Percent: 6%.
Type of position/grade: Officers: Dentists;
Air Force: 0;
Army: 32;
Navy: 176;
Total: 208;
Percent: 4%.
Type of position/grade: Officers: Pharmacists;
Air Force: 6;
Army: 13;
Navy: 29;
Total: 48;
Percent: 0.9%.
Type of position/grade: Officers: Optometrists;
Air Force: 5;
Army: 11;
Navy: 3;
Total: 19;
Percent: 0.3%.
Type of position/grade: Officers: Psychologists;
Air Force: 2;
Army: 8;
Navy: 1;
Total: 11;
Percent: 0.2%.
Type of position/grade: Officers: Social workers;
Air Force: 11;
Army: 6;
Navy: 0;
Total: 17;
Percent: 0.3%.
Type of position/grade: Officers: Other medical positions[B];
Air Force: 24;
Army: 21;
Navy: 91;
Total: 136;
Percent: 2%.
Type of position/grade: Officers: Other DHP positions[C];
Air Force: 15;
Army: 38;
Navy: 67;
Total: 120;
Percent: 2%.
Officers: Total officers[D];
Air Force: 243;
Army: 204;
Navy: 655;
Total: 1102;
Percent: 20%.
Type of position/grade: Enlisted: Corpsmen, medics, aerospace medical
services;
Air Force: 47;
Army: 482;
Navy: 1620;
Total: 2149;
Percent: 39%.
Type of position/grade: Enlisted: Dental assistants/technicians;
Air Force: 132;
Army: 59;
Navy: 388;
Total: 579;
Percent: 11%.
Type of position/grade: Enlisted: Other Medical Positions;
Air Force: 542;
Army: 312;
Navy: 2;
Total: 856;
Percent: 16%.
Type of position/grade: Enlisted: Other DHP positions;
Air Force: 250;
Army: 560;
Navy: 11;
Total: 821;
Percent: 15%.
Enlisted: Total enlisted;
Air Force: 971;
Army: 1413;
Navy: 2021;
Total: 4405;
Percent: 80%.
Total: Air Force: 1214;
Army: 1617;
Navy: 2676;
Total: 5507;
Percent: 100%.
Source: GAO analysis of Air Force, Army, and Navy data.
[A] Nurses includes eight nurse practitioners scheduled for conversion
by the Air Force, five in fiscal year 2006 and three in fiscal year
2007.
[B]Other military medical officer positions include dieticians,
physical therapists, speech pathologists, radiation health/radiation
specialists, microbiologists, and biochemists.
[C] Other DHP military officer positions include administrative
positions. dIncludes Army warrant officers.
[End of table]
Appendix III provides information regarding the military departments'
military to civilian conversions by geographical region.
Military Departments Making Progress Hiring Civilian Replacements:
Each of the military departments has made varying degrees of progress
in hiring civilian personnel to fill military health care positions
that have been converted to civilian positions. According to military
department officials, the Air Force ceased hiring actions to fill its
fiscal year 2006 converted positions in January 2006 and the Army in
February 2006 after enactment of the National Defense Authorization Act
for Fiscal Year 2006. However, their experiences to date suggest they
have not encountered significant difficulties hiring civilian personnel
to fill converted positions.
Of the three departments, the Navy has the most experience hiring
civilian replacements, filling two-thirds of the positions it converted
in fiscal year 2005. As table 2 shows, the Navy converted a total of
1,772 military health care positions to civilian positions in fiscal
year 2005. According to a Navy official, while these conversions took
place on October 1, 2004, the first day of fiscal year 2005, the Navy
did not begin recruiting civilians to fill the converted positions
until July 2005 to allow for (1) Navy military treatment facilities to
assess their staffing needs, (2) military personnel to vacate the
converted positions, and (3) consultations with human resource offices
to develop federal civilian job announcements. Also, the Navy decided
not to fill all of the military health care positions it converted.
After reassessments of medical and dental staffing levels at its
facilities, the Navy decided to fill only 1,361, or 77 percent, of the
1,772 converted military positions. Over a 7-month period for these
1,361 positions, the Navy had successfully recruited 907, or 67
percent, of the civilians needed, as of January 31, 2006. Appendix IV
provides more detailed information about the Navy's experience in
hiring civilian personnel by type of position. Before enactment of the
National Defense Authorization Act for Fiscal Year 2006, Navy officials
indicated that they had planned to begin hiring civilian personnel in
April 2006 to fill the 215 military health care positions converted at
the beginning of fiscal year 2006.[Footnote 9]
A Navy official told us that there have been no significant
difficulties in filling such a large number of federal civilian
positions within a short period of time. However, public and private
employers report a limited supply of certain types of medical and
dental personnel both on a national level and in certain geographical
areas. In 2005, the Bureau of Labor Statistics reported that nurses
were considered difficult to hire and retain by non-military employers
and forecast that employers will continue to compete for nursing
services. In addition, in December 2005, the Health Resources and
Services Administration, an agency of the Department of Health and
Human Services, reported that about 20 percent of the U.S. population
lives in a primary medical care health professional shortage
area.[Footnote 10] According to a Navy official, based on this
information, the Navy is recruiting on a national level to hire four
types of personnel--physicians, dentists, pharmacists, and laboratory
officers--at its various facilities. For its other types of medical and
dental positions, the Navy is seeking to hire civilian personnel by
targeting local markets. Also, the Navy is using various special pay
provisions to allow it to compete with other employers, such as
Department of Veterans Affairs' medical centers in selected
geographical areas.
Because the Air Force and Army only began converting military health
care positions to civilian positions in fiscal year 2006, their
experiences hiring civilians to fill converted positions are more
limited than the Navy's experience. However, as of January 2006, the
Air Force had successfully recruited 149, or 37 percent, of the 401
positions converted within 4 months. The Army recruited 305, or 30
percent, of the 1,029 military health care positions converted within 4
months. Air Force and Army officials told us that they have not
experienced significant difficulties in hiring civilian replacement
personnel.
Conversions Not Expected to Alter Medical Readiness, Quality of Care,
Recruitment and Retention, or Access to Care, but Effects on Cost to
DOD Unknown:
The military departments do not expect conversion of military health
care positions to civilian positions to have any effect on medical
readiness, the quality of care, recruitment and retention of military
health care personnel, and beneficiaries' access to care. However, it
is unknown what effect the conversions will have on the cost to DOD.
Medical Readiness:
Based on our examination of the military departments' application of
the DOD medical readiness sizing model for determining which military
health care positions are required for medical readiness, and our
understanding of how the military departments determined which health
care positions should be considered for conversion, it is unlikely that
the conversions will affect medical readiness. Incorporating scenarios
that reflected operational plans, each military department applied
DOD's medical readiness sizing model to identify the number of military
health care personnel required for medical readiness. In determining
which specific military health care positions would be converted, each
department, in consultation with military health care facilities, then
assessed the impact of conversions on medical readiness. Senior medical
officials told us that the military departments' plans for converting
military health care positions to civilian positions are not expected
to have any effect on medical readiness because only military positions
in excess of those needed for medical readiness were candidates for
conversion. In defining medical readiness personnel requirements, the
military departments included those military health care personnel
required to meet the demands of the operational scenarios included in
the National Military Strategy. Moreover, while not generalizable to
all facilities and all military departments, our examination of
military health care positions converted at Naval Medical Center,
Portsmouth showed that the conversions did not affect medical
readiness.
According to DOD officials, in 2004, the Air Force, Army, and Navy, in
identifying which military health care positions were candidates for
conversion, initially determined the military positions that would be
required for medical readiness, incorporating scenarios that reflected
operational plans. The operational plans incorporated joint medical
requirements, and the military departments then used these requirements
to define medical requirements to respond to anticipated casualties,
including those wounded in action and those with disease and nonbattle
injuries. In defining medical readiness requirements for the military-
to-civilian conversion process, each military department used the
national military strategy that was current at that time. Using a DOD-
approved medical readiness personnel sizing model,[Footnote 11] the
military departments identified the number of military medical and
dental personnel that was required for medical readiness. Table 5 shows
the number of positions the departments determined to be required for
medical readiness compared to the military medical and dental
endstrength for the Air Force, Army, and Navy for fiscal year 2004.
Table 5: Combined Air Force, Army, and Navy Military Medical Readiness
Requirements Compared to Combined Military Departments' Medical and
Dental Personnel End-strength, Fiscal Year 2004:
Medical corps: Number of positions required for medical readiness:
10,557;
Military medical/dental endstrength, FY 2004: 12,067;
Non-medical readiness end-strength, FY 2004: 1,510.
Nursing corps: Number of positions required for medical readiness:
9,652;
Military medical/dental endstrength, FY 2004: 10,412;
Non-medical readiness end-strength, FY 2004: 760.
Dental corps: Number of positions required for medical readiness:
2,735;
Military medical/dental endstrength, FY 2004: 3,532;
Non-medical readiness end-strength, FY 2004: 797.
Other medical service: Number of positions required for medical
readiness: 10,587;
Military medical/dental endstrength, FY 2004: 11,709;
Non-medical readiness end-strength, FY 2004: 1,122.
Total officers: Number of positions required for medical readiness:
33,531;
Military medical/dental endstrength, FY 2004: 37,720;
Non-medical readiness end-strength, FY 2004: 4,189.
Enlisted medical: Number of positions required for medical readiness:
65,162;
Military medical/dental endstrength, FY 2004: 74,388;
Non-medical readiness end-strength, FY 2004: 9,226.
Enlisted dental: Number of positions required for medical readiness:
4,706;
Military medical/dental endstrength, FY 2004: 6,816;
Non-medical readiness end-strength, FY 2004: 2,110.
Total enlisted: Number of positions required for medical readiness:
69,868;
Military medical/dental endstrength, FY 2004: 81,204;
Non-medical readiness end-strength, FY 2004: 11,336.
Total: Number of positions required for medical readiness: 103,399;
Military medical/dental endstrength, FY 2004: 118,924;
Non-medical readiness end-strength, FY 2004: 15,525.
Source: Office of Assistant Secretary of Defense for Health Affairs.
[End of table]
Only those military positions in excess of those positions required for
medical readiness were considered for possible conversion to federal
civilian or contract positions.
According to a DOD official, in 2005, the military departments again
used the DOD-approved medical readiness personnel sizing model to
identify their medical readiness requirements for the purpose of
setting end-strength requirements for the fiscal years 2006-2011 time
frame. Medical officials for the Air Force, Army, and Navy told us that
they again used the national military strategy, which was current at
that time, in applying the medical readiness sizing model. Officials
from the Air Force, Army, and Navy told us the model produced results
showing that the services' medical/dental personnel endstrength
exceeded medical readiness personnel requirements.
Our review of military positions converted at Naval Medical Center,
Portsmouth showed no apparent effect on medical readiness requirements.
To test the assertion that none of the positions converted at the Naval
Medical Center, Portsmouth, had a mobilization/readiness mission, we
examined the 352 military health care positions that were converted to
federal civilian positions on October 1, 2004, for fiscal year 2005. Of
the 352 military positions examined, we found 349 positions did not
have mobilization/readiness missions. Although three of the 352
military positions had mobilization/readiness missions, a Navy medical
official explained that they transferred the mobilization requirement
for the converted military positions to other positions that were not
scheduled for conversion to avoid any effect on medical readiness. We
verified that the mobilization missions for the converted military
positions were transferred to other military positions not scheduled
for conversion.
Quality of Care:
Because the military services have maintained the same processes and
requirements for delivery of health care by civilian employees and
considering the results of our limited testing of the credentialing and
privileging process at Naval Medical Center, Portsmouth, the military
departments' plans for military-to-civilian conversions are not
expected to adversely affect the quality of care. Officials in the
offices of the surgeon general for the Air Force, Army, and Navy told
us that converting military health care positions to civilian positions
will not result in decreased quality of care because each department
has maintained the same credentialing and privileging
requirements[Footnote 12] for civilian personnel. Also, in developing
civilian position descriptions for converted military health care
positions, officials told us that they give close attention to
appropriately identifying the required education, training, and
professional qualifications of applicants. Officials also stated that
before civilian applicants are hired, their compliance with the
educational and other minimum qualification requirements for the
civilian positions will be verified. Our examination of the
credentialing and privileging documentation for selected civilian
personnel hired to fill converted military health care positions at the
Naval Medical Center, Portsmouth, found that required queries of
national health care databases were performed for each civilian
employee and the results of the queries revealed no adverse information
about the civilian employees hired.
In May 2002, the Assistant Secretary of Defense for Health Affairs
defined quality in health care in responding to the Healthcare Quality
Initiative Review Panel's recommendation to promulgate a definition of
quality concerning healthcare and related services within the Military
Health System to orient current and future measurement initiatives.
Quality in health care was defined as "the degree to which health care
services for individuals and population increase the likelihood of
desired health outcomes and are consistent with current professional
knowledge."[Footnote 13] In conjunction with the promulgation of this
definition, the Assistant Secretary of Defense for Health Affairs
required that the quality of health care be assessed by performance
measures addressing three specific questions: (1) Is the foundation for
the provision of high-quality care in place and is this foundation
robust? (2) How well does our health care system perform with respect
to measurable processes and outcomes of care and other comparable data?
and (3) How is our health care delivery system and quality of health
care provided viewed by our beneficiaries, military leadership, and
Congress?
Officials in the offices of the surgeon general for the Air Force,
Army, and Navy told us that they have many processes and performance
measures within the MHS to ensure the delivery of quality health care.
Each military department already employs many civilian employees who
work in military treatment facilities. Officials told us that these
civilian employees are subject to the same quality of care assessments
and processes as military medical and dental personnel. The civilian
personnel who will be hired to replace converted military positions
will also be subject to the same quality of care processes and
performance assessments.
To test the credentialing and privileging processes for the civilian
replacement personnel hired at the Naval Medical Center, Portsmouth, we
examined the credentialing and privileging files for 27 civilian
employees: 5 physicians, 8 dentists, 3 pharmacists, and 11 other types
of personnel hired to replace converted military positions in fiscal
year 2005. All five civilian physicians hired were board certified in
their respective specialty. As part of our examination, we also
reviewed the files for documentation that officials had queried health
care practitioner databases, as required by DOD.[Footnote 14] We found
documentation in the credentialing and privileging files from the
National Practitioner Data Bank[Footnote 15] and the Healthcare
Integrity and Protection Data Bank[Footnote 16] showing that both data
banks were queried, as required, for all of these civilian employees.
The query results revealed no adverse information about the civilian
employees hired.
Recruitment and Retention of Military Health Care Personnel:
Given the multitude of factors that may influence an individual health
care professional's decision to join or leave military service, it is
difficult to isolate the potential effect of converting military health
care positions to civilian positions on the recruitment and retention
of military health care personnel. Officials in the offices of the
surgeons general for the Air Force, Army, and Navy told us that the
military-to-civilian conversions will not have any impact on recruiting
and retention of military health care personnel. For example, Navy
officials commented that while the Navy is experiencing difficulties in
recruiting and retaining certain types of health care personnel,
factors other than planned military-to-civilian conversions, such as
military pay levels and the Global War on Terrorism, are responsible.
Army officials commented that they recognize the importance of viable
medical career fields and will perform career progression analyses to
ensure that the medical career fields are viable. Air Force officials
commented that conversions will be accomplished through normal
attrition, and no individuals will be forced to retire or separate from
the military as a result of the conversions.
Access to Care:
Officials in the offices of the surgeon general for the Air Force and
Army stated that converting military health care positions to civilian
positions will not result in any degradation in the availability of
medical or dental care to servicemembers, their families, or retirees
because converted military medical and dental positions are being
replaced on a one-to-one basis. So for every converted military health
care position, there will be a civilian personnel replacement.
Moreover, neither the Air Force nor the Army plans to convert any
physician positions during fiscal years 2006 and 2007. While the Air
Force and Army's decision not to convert any military physician
positions will probably decrease the likelihood for significant
reductions in the availability of medical care, it is important to note
that delays in filling the civilian positions after the military
positions have been removed may result in decreased military medical
capacity. Air Force and Army medical officials pointed out that they
have the option of purchasing medical or dental care from the managed
care network of health care providers, if necessary, to avoid any
decreases in servicemembers' or beneficiaries' access to care.
Officials in the office of the surgeon general of the Navy told us that
they do not expect any decreases in servicemembers' or beneficiaries'
access to care attributable to the conversions even though, in many
instances, military health care positions were not replaced on a one-
for-one basis. With the new staffing levels, Naval Medical Center,
Portsmouth, officials believe that the mix of current staffing for
departments is more efficient and will not result in longer waiting
times for appointments. Also, Naval Medical Center, Portsmouth,
officials pointed out that the purchased care system (managed care
network of health care providers) is available if capacity within the
medical center becomes temporarily limited.
At the Naval Medical Center, Portsmouth, we examined data on waiting
times for appointments before and after the conversion in two
departments and a family practice clinic that had military physician
positions converted for fiscal year 2005 and found that for the most
part, waiting times did not increase after the conversions. On October
1, 2004, military physician positions were converted in the departments
of internal medicine and physical therapy and in the family practice
clinic at the Naval Medical Center, Portsmouth. Naval Medical Center,
Portsmouth, officials told us that it is difficult to attribute changes
in appointment waiting times to the military-to-civilian conversions
because several factors, such as the deployment of military physicians
or the arrival or departure of ships, may affect the departments'
capacity or demand for appointments. Data that we obtained from the two
departments and a family practice clinic at the Naval Medical Center,
Portsmouth, showed for the most part that waiting times were within
standards for appointment waiting times for varying types of
appointments.
Cost of Conversions to DOD:
It is unknown whether the conversion of military health care positions
to civilian positions will ultimately increase or decrease costs for
DOD because:
* it is uncertain what actual compensation levels will be required to
successfully hire most civilian replacement personnel and:
* the programming rates the departments are considering using in their
certifications to Congress about the cost of the conversions to DOD do
not include the full compensation costs for military personnel.
While officials in the offices of the surgeons general for the Air
Force, Army, and Navy believe that the military-to-civilian conversions
will not increase costs, we believe it is uncertain how much it will
cost to hire civilian replacement personnel for recent and planned
conversions of military health care positions and whether this cost
will exceed the cost for the military positions. While the military
departments have made progress in hiring civilian personnel within a
short time, many civilian personnel remain to be hired. As of January
31, 2006, the Navy had recruited 67 percent of the personnel it plans
to hire for the conversions made in fiscal year 2005, and the Air Force
and Army had recruited 37 percent and 30 percent, respectively, of the
positions they converted in fiscal year 2006. However, according to DOD
officials, as of March 6, 2006, the Air Force, Army, and Navy had not
compared the actual costs to hire these federal civilian employees with
what it had cost them to employ military personnel in these positions.
The methodologies the military departments may use to certify
conversion costs in their reports to Congress may understate savings
associated with the elimination of military medical and dental
positions, according to PA&E officials. While the Air Force, Army, and
Navy had not finalized the methodologies they plan to use in the
certification process, at the time of our review, representatives from
the offices of the surgeons general for the Air Force, Army, and Navy
discussed the possibility of using military department-specific
programming rates. These rates are calculated by dividing the military
personnel budgets by the number of military personnel currently
employed by the Air Force, Army, and Navy. However, according PA&E
officials, this calculation omits several significant costs (such as
training, recruitment, educational assistance, and health benefit
costs) incurred by military medical personnel which may lead to
understated cost projections for the converted military positions.
PA&E officials told us that at this time they lack complete information
on all of the costs that are associated with compensating military
medical and dental personnel. Officials told us that PA&E is completing
a project designed to determine true military medical and dental
personnel costs, but the project is not expected to be completed until
summer 2006, which is after the June 1, 2006 date when the military
departments may submit certifications to the House and Senate
Committees on Armed Services that their planned conversions of military
medical or dental positions will not increase costs. In the meantime,
PA&E has completed preliminary estimates, which officials believe are
far more complete in estimating the cost of military medical and dental
positions than the programming rates that may be used by the Air Force,
Army, and Navy. These preliminary estimates show that the programming
rates considerably understate military medical and dental personnel
costs when compared to the PA&E estimates. Currently, the military
departments are not required to coordinate the development of their
cost comparisons for the congressional certifications with PA&E. By not
coordinating their cost analyses efforts with PA&E to ensure that they
are considering the full costs of the military medical and dental
positions they have converted or plan to convert to civilian positions,
the Air Force, Army, and Navy will be unable to determine the true cost
implications for defense health care.
Conclusions:
While the Air Force, Army, and Navy are already well under way in
converting about 5,500 military health care positions to civilian
positions, they are not currently in the position to know how the
conversions will affect the cost to DOD. Because none of the military
departments has plans to use cost data prepared by the DOD's PA&E, they
risk using methodologies to certify program costs that omit several
significant factors, such as training, recruitment, and educational
assistance. Without ensuring that they are accounting for the full
costs--both direct and indirect--of converting the military health care
positions to civilian positions, the military departments will be
unable to provide Congress with accurate comparative costs for their
conversions. Further, Congress will be unable to judge the extent to
which the military departments' certifications are based on anticipated
compensation costs for completed and future civilian hires unless the
military departments include such delineations in their congressional
certifications.
Recommendations for Executive Action:
To ensure that the military departments account for the full costs of
military health care positions converted or planned for conversion when
they report to Congress, we recommend that the Secretary of Defense
direct the Secretaries of the Air Force, Army, and Navy to take the
following two actions:
* Coordinate the development of their congressional certifications for
military health care conversions with the Office of Program Analysis
and Evaluation in order to consider the full cost for military
personnel and for federal civilian or contract replacement personnel in
assessing whether anticipated costs to hire civilian replacement
personnel will increase costs to DOD for defense health care.
* Address in their congressional certifications for military health
care conversions the extent to which total projected costs for hiring
federal civilian or contract personnel include actual compensation
costs for completed hires and anticipated compensation costs for future
hires.
Agency Comments and Our Evaluation:
DOD provided written comments on a draft of this report and generally
concurred with our recommendations.
In commenting on our recommendation that the secretaries of the
military departments coordinate with DOD's PA&E in developing their
congressional cost certifications, DOD noted that PA&E's effort to
identify the total cost for military health care positions is not yet
complete and that it is unlikely that these data will be available in a
final format for use by June 1, 2006, the date DOD stated the military
departments are required to provide their cost certifications to
Congress. We note, however, that the National Defense Authorization Act
for Fiscal Year 2006 does not require the secretary of each military
department to submit such certifications by June 1, 2006. Instead, the
act requires the department secretaries to submit their certifications
not before June 1, 2006. DOD also commented that the PA&E data add
several personnel cost items that are not included in the military
departments' programming rates, and that these additional costs will
generate a higher average cost per military member than that reflected
by the programming rates. While it is indeed possible that using PA&E
data--which include costs such as training, recruitment, educational
assistance, and health benefits--will provide higher average costs for
military members than the military departments' programming rates that
do not include these additional costs, we believe it is important that
the military departments provide Congress with the most accurate
comparative costs of converting the military health care positions to
civilian positions.
In commenting on our recommendation that the military departments
certifications address the extent to which total projected costs for
hiring civilian personnel include actual compensation costs for
completed hires and anticipated compensation costs for future hires,
DOD stated that our recommendation appears to be unnecessary because in
order to make a certification that the conversions will not increase
costs, each secretary will review actual civilian employee and contract
employee costs for conversions already completed, as well as estimated
costs for pending conversions. It is important to note that while the
military departments have made progress in hiring civilian replacement
personnel, 74 percent of the civilian replacement personnel for
military health care positions converted and planned for conversions
during fiscal years 2005 through 2007 had not been hired as of January
31, 2006. So, the military departments' certifications on the total
projected costs of the conversions are likely to be based more on
anticipated rather than actual compensation costs. Consequently, we
believe that it is important for Congress to understand the extent to
which the military departments' certifications are based on actual
compensation costs for completed hires versus projected compensation
costs for future hires.
DOD's comments are reprinted in appendix V. DOD also provided technical
comments, which we have incorporated in the final report where
appropriate.
We are sending copies of this report to the Secretary of Defense and
other interested parties. We will provide copies of this report to
others upon request. In addition, the report is available at no charge
on the GAO Web site at [Hyperlink, http://www.gao.gov].
If you or your staffs have any questions about this report, please
contact me at (202) 512-5559 or stewartd@gao.gov. Contact
points for our Offices of Congressional Relations and Public Affairs
may be found on the last page of this report. GAO staff who made key
contributions to this report are listed in appendix VI.
Signed By:
Derek B. Stewart:
Director:
Defense Capabilities and Management:
[End of section]
Appendix I: Scope and Methodology:
To meet our objectives, we reviewed pertinent documents, reports, and
other information, as available, that related to the conversion of
military health care positions to federal civilian or contract
positions. We also interviewed cognizant officials in the TRICARE
Management Activity within the Office of the Assistant Secretary of
Defense for Health Affairs, the offices of the surgeons general of the
Air Force, Army, and Navy, the Office of Program Analysis and
Evaluation, and the office of the Undersecretary of Defense for
Personnel and Readiness. We also performed additional work at the Naval
Medical Center in Portsmouth, Virginia.
To examine the extent to which the military departments have developed
and implemented plans to convert military health care positions to
civilian positions, we obtained data on Defense Health Program
positions that have been converted since October 1, 2004, and those
planned for conversion through fiscal year 2007 from the offices of the
surgeon general for the Air Force, Army, and Navy. For each position
converted or planned for conversion, we requested that the offices of
the surgeons general to provide the geographic location, type of
position, and the grade (either officer or enlisted position). We
analyzed the data obtained from each military department to identify
the characteristics of the positions converted for fiscal year 2005 and
fiscal year 2006 and planned for conversion in fiscal year 2007. We
also obtained information regarding the process used by the military
departments in selecting the number and types of positions converted
and planned for conversion from discussions with officials within the
offices of the surgeons general and reviews of documentation.
To identify the experiences of the military departments in filling the
converted military positions with civilian personnel, we requested that
the military departments identify for each converted position the
following information as of January 31, 2006:
* Location:
* Former military position title:
* Date converted:
* Billet occupied on date of conversion:
* Current civilian position title:
* Programmed as General Schedule (GS) or contract position:
* Date recruitment initiated:
* Date civilian or contract employee reported for duty:
* Whether civilian position was filled as of January 31, 2006:
* Whether the civilian position was filled by a GS or contract
employee:
* If civilian position was not filled, status of recruitment efforts:
* If civilian position was not being recruited, reasons why:
We analyzed the data obtained from the military departments to identify
the characteristics of their experiences in filling the federal
civilian or contract positions by type of position and by geographical
area and to identify reasons for difficulties in filling positions, if
any. We also reviewed information from the Bureau of Labor Statistics
and the Health Resources and Services Administration to identify the
types of health professional positions that are considered to be
difficult to fill.
We took steps to ensure the reliability of the data we used in our
review. We provided an Excel spreadsheet and specification of data
elements to the Army, Air Force, and Navy. The spreadsheet had 16
defined variables in which we requested data for military health care
positions converted to a civilian position since October 1, 2004.
Several of the data elements were restricted to drop-down menu choices
to minimize error and clearly convey the type of response we were
seeking. The military departments returned the Excel spreadsheet to us
in electronic format. To assess the reliability of these data, we
reviewed the data for obvious inconsistency errors and completeness and
compared the total number of positions converted with official numbers
we were given in interviews with officials. In addition, we reviewed
any related accompanying documentation and worked closely with agency
officials to identify any data problems. When we found discrepancies
(such as nonpopulated fields or data inconsistencies), we brought them
to our points of contact's attention and worked with them to correct
the discrepancies before conducting our analyses. In addition, we sent
an electronic questionnaire with questions regarding the data to our
points of contact and followed up on any issues we felt pertinent
regarding the reliability of the data. Based on these efforts, we
determined that the data were sufficiently reliable for the purposes of
our report.
In regard to the potential effects of conversions, we focused on
potential impacts on medical readiness, cost, quality of care, access
to care, and recruitment and retention of military medical and dental
personnel. For each of these potential effects, we requested that the
military departments provide their assessments and the basis for their
views. To obtain detailed information regarding the effects of
conversions, we selected the Naval Medical Center, Portsmouth, for
focused analyses because it had the largest number of health care
conversions of any Navy facility for fiscal year 2005 and represented
the location with the largest number of conversions planned from fiscal
year 2005 through fiscal year 2007.
Regarding potential effects of the conversions on medical readiness, we
obtained and examined information regarding the process used by the
military departments in determining the medical readiness personnel
requirements. We did not assess the validity of the DOD medical
readiness personnel sizing model or the reasonableness of the
assumptions and data used in applying the model. Also, we examined
whether each of the 352 positions converted for fiscal year 2005 at the
Naval Medical Center, Portsmouth, had a mobilization/readiness mission
and, if so, whether the mission was transferred to another position
that was not converted.
Regarding the potential effects of the conversions on the quality of
care, we obtained information on the processes that the military
departments will use to ensure quality of care delivery by civilian
replacement personnel. We examined the credentialing and privileging
documentation and assessed whether queries were made, as required, to
the National Practitioner Data Bank and the Healthcare Integrity and
Protection Data Bank as part of the credentialing and privileging
process in hiring the civilian replacement employees at Naval Medical
Center, Portsmouth.
Regarding access to care, we obtained and examined military department
representatives' assessments of the potential effect of conversions on
servicemember and beneficiary access to care. We also requested and
analyzed data from the Naval Medical Center, Portsmouth, on the extent
to which TRICARE access to care standards were being met in those
departments where military physician positions were converted.
Regarding the potential effect of the conversions on the cost of
defense health care to DOD, we discussed with officials in the offices
of the surgeons general, the methodology that they planned to use in
certifying to Congress that planned conversions would not increase
costs. We also discussed the extent to which military department-
specific programming rates include the full costs for military
personnel with representatives from the Office of Program Analysis and
Evaluation and from the Office of the Undersecretary of Defense for
Personnel and Readiness.
We performed our work from November 2005 through April 2006 in
accordance with generally accepted government auditing standards.
[End of section]
Appendix II: Conversion of Navy Military Physician Positions by
Specialty:
The Navy is the only military department that has converted any
military physician positions since October 1, 2004--converting 148
physicians during fiscal year 2005 and 4 physicians during fiscal year
2006. Of the 152 military physician positions converted by the Navy,
41, or 27 percent, were family practice physicians; 37, or 24 percent,
were pediatric physicians; 21, or 14 percent, were general medical
officers; and 17, or 11 percent, were internal medicine physicians, as
shown in table 6. There are no military physicians scheduled for
conversions in fiscal year 2007.
Table 6: Navy Military Physician Positions Converted by Specialty,
Fiscal Years 2005 and 2006:
Type of Specialty: Family practice;
Fiscal Year 2005: 41;
Fiscal Year 2006: 0;
Total: 41.
Type of Specialty: General surgeon;
Fiscal Year 2005: 1;
Fiscal Year 2006: 0;
Total: 1.
Type of Specialty: General medical officer[A];
Fiscal Year 2005: 21;
Fiscal Year 2006: 0;
Total: 21.
Type of Specialty: Internal medicine[B];
Fiscal Year 2005: 17;
Fiscal Year 2006: 0;
Total: 17.
Type of Specialty: Neurology;
Fiscal Year 2005: 2;
Fiscal Year 2006: 0;
Total: 2.
Type of Specialty: Nuclear medicine;
Fiscal Year 2005: 2;
Fiscal Year 2006: 0;
Total: 2.
Type of Specialty: Obstetrics/gynecology;
Fiscal Year 2005: 6;
Fiscal Year 2006: 0;
Total: 6.
Type of Specialty: Ophthalmology;
Fiscal Year 2005: 2;
Fiscal Year 2006: 0;
Total: 2.
Type of Specialty: Pathology;
Fiscal Year 2005: 9;
Fiscal Year 2006: 0;
Total: 9.
Type of Specialty: Pediatrics[C];
Fiscal Year 2005: 34;
Fiscal Year 2006: 3;
Total: 37.
Type of Specialty: Physical medicine;
Fiscal Year 2005: 3;
Fiscal Year 2006: 0;
Total: 3.
Type of Specialty: Psychiatry;
Fiscal Year 2005: 8;
Fiscal Year 2006: 1;
Total: 9.
Type of Specialty: Radiology;
Fiscal Year 2005: 1;
Fiscal Year 2006: 0;
Total: 1.
Type of Specialty: Urology;
Fiscal Year 2005: 1;
Fiscal Year 2006: 0;
Total: 1.
Type of Specialty: Total;
Fiscal Year 2005: 148;
Fiscal Year 2006: 4;
Total: 152.
Source: GAO analysis of Navy data.
[A] A general medical officer has completed medical school, including a
1-year internship but has not completed specialty residency training.
[B] Internal medicine conversions include internal medicine physicians
with specialties in cardiology, gastroenterology, and pulmonary disease
as well as general internal medicine physicians.
[C] Pediatrics conversions include pediatric physicians with
specialties in adolescence, cardiology, genetics and sexual abuse in
addition to general pediatric physicians.
[End of table]
[End of section]
Appendix III: Conversion of Military Health Care Positions to Civilian
Positions by Geographic Region:
The military departments' plans for converting military health care
positions to civilian positions are widely dispersed among many
locations within each military department. The Navy's actual and
planned conversions of military health care positions to federal
civilian positions are occurring at 39 different locations, both in the
United States and overseas. Of these locations, the majority--34, or 87
percent--have fewer than 200 positions scheduled for conversion. Table
7 shows the locations of the largest numbers of military health care
positions to civilian positions.
Table 7: Military Installations, by Military Department, with the
Largest Cumulative Numbers of Military Health Care Positions Converted
or Planned for Conversion to Civilian Positions, Fiscal Years 2005-07:
Location: Army: William Beaumont Army Medical Center, Fort Sam Houston,
San Antonio, Texas;
FY 2005: 0;
FY 2006: 170;
FY 2007: 51;
Total: 221.
Location: Army: Walter Reed Army Medical Center, Washington, D.C;
FY 2005: 0;
FY 2006: 125;
FY 2007: 56;
Total: 181.
Location: Army: Madigan Army Medical Center, Fort Lewis, Washington;
FY 2005: 0;
FY 2006: 13;
FY 2007: 98;
Total: 111.
Location: Army: Tripler Army Medical Center, Hawaii;
FY 2005: 0;
FY 2006: 54;
FY 2007: 27;
Total: 81.
Location: Army: Brooke Army Medical Center, Fort Bliss, Texas;
FY 2005: 0;
FY 2006: 48;
FY 2007: 26;
Total: 74.
Location: Navy: Naval Medical Center, Portsmouth, Virginia;
FY 2005: 347;
FY 2006: 34;
FY 2007: 111;
Total: 492.
Location: Navy: Naval Medical Center, San Diego, California;
FY 2005: 208;
FY 2006: 52;
FY 2007: 78;
Total: 338.
Location: Navy: Naval Hospital, Great Lakes, Illinois;
FY 2005: 224;
FY 2006: 40;
FY 2007: 65;
Total: 329.
Location: Navy: National Naval Medical Center, Bethesda, Maryland;
FY 2005: 158;
FY 2006: 33;
FY 2007: 72;
Total: 263.
Location: Navy: Naval Health Care-New England, Newport, Rhode Island;
FY 2005: 120;
FY 2006: 7;
FY 2007: 83;
Total: 210.
Location: Air Force: Lackland Air Force Base, San Antonio, Texas;
FY 2005: 0;
FY 2006: 46;
FY 2007: 61;
Total: 107.
Location: Air Force: Keesler Air Force Base, Biloxi, Mississippi;
FY 2005: 0;
FY 2006: 33;
FY 2007: 68;
Total: 101.
Location: Air Force: Travis Air Force Base, Fairfield, California;
FY 2005: 0;
FY 2006: 27;
FY 2007: 38;
Total: 65.
Location: Air Force: Wright Patterson Air Force Base, Dayton, Ohio;
FY 2005: 0;
FY 2006: 17;
FY 2007: 39;
Total: 56.
Location: Air Force: Langley Air Force Base, Hampton, Virginia;
FY 2005: 0;
FY 2006: 19;
FY 2007: 34;
Total: 53.
Source: GAO analysis Air Force, Army, and Navy data.
[End of table]
The military-to-civilian conversions of Air Force health care positions
are occurring at 62 locations in the United States. The majority of
these locations, 57, or 92 percent, are scheduled for fewer than 50
conversions for fiscal years 2006 and 2007. At 5 Air Force locations
the number of conversions planned exceeds 50, including Lackland Air
Force Base, Keesler Air Force Base, Travis Air Force Base, Wright-
Patterson Air Force Base and Langley Air Force Base. Lackland and
Keesler are the most significantly affected with 107 and 101
conversions, respectively.
The military-to-civilian conversions of Army military health care
positions are occurring at 124 locations in the United States and
overseas. Of these 124 locations, 59 are Army installations, 20 are for
Army personnel at other service installations, and 45 are at military
entrance processing commands. The majority of these locations, 116, or
94 percent, are scheduled for fewer than 50 conversions for fiscal
years 2006 and 2007. At 8 locations, the number of Army conversions
planned exceeds 50 including Fort Sam Houston, Walter Reed Army Medical
Center, Fort Lewis, Tripler Army Medical Center, Fort Bliss, Fort
Bragg, Fort Rucker, and Fort Gordon. Fort Sam Houston and Walter Reed
Army Medical Center are the most significantly affected with 221 and
181 conversions, respectively.
[End of section]
Appendix IV: Navy's Experience in Recruiting Civilians for Converted
Military Health Care Positions, Fiscal Year 2005:
As of March 16, 2006, the Navy had hired exclusively federal civilians
as replacement personnel under the General Schedule but had also
approved the hiring of 14 physicians as contract employees because of
concerns that higher compensation levels than are available under the
General Schedule system would be necessary to hire these physicians.
The Navy's experience in successfully recruiting federal civilian
health care personnel to replace military health care positions
converted in fiscal year 2005 varied by type of position, as shown in
table 8.
Table 8: Navy Experience in Recruiting Federal Civilian Health Care
Personnel to Fill Converted Military Positions in Fiscal Year 2005 by
Type of Position, as of January 31, 2006:
Type of Position: Physicians;
Number who are on board/accepted job offers: 49;
Number being recruited: 77;
Percentage of converted positions: 64.
Type of Position: Physician assistants;
Number who are on board/accepted job offers: 13;
Number being recruited: 25;
Percentage of converted positions: 52.
Type of Position: Nurses;
Number who are on board/accepted job offers: 92;
Number being recruited: 122;
Percentage of converted positions: 75.
Type of Position: Dentists;
Number who are on board/accepted job offers: 60;
Number being recruited: 89;
Percentage of converted positions: 67.
Type of Position: Pharmacists;
Number who are on board/accepted job offers: 27;
Number being recruited: 31;
Percentage of converted positions: 87.
Type of Position: Optometrists;
Number who are on board/accepted job offers: 1;
Number being recruited: 1;
Percentage of converted positions: 100.
Type of Position: Psychologists;
Number who are on board/accepted job offers: 0;
Number being recruited: 1;
Percentage of converted positions: 0.
Type of Position: Social workers;
Number who are on board/accepted job offers: 5;
Number being recruited: 6;
Percentage of converted positions: 83.
Type of Position: Dental assistants/hygienists;
Number who are on board/accepted job offers: 126;
Number being recruited: 199;
Percentage of converted positions: 63.
Type of Position: Other medical or DHP positions;
Number who are on board/accepted job offers: 534;
Number being recruited: 810;
Percentage of converted positions: 66.
Total: Number who are on board/accepted job offers: 907;
Number being recruited: 1,361;
Percentage of converted positions: 67.
Source: GAO analysis of office of the surgeon general of the Navy data.
[End of table]
[End of section]
Appendix V: Comments from the Department of Defense:
The Assistant Secretary Of Defense:
1200 Defense Pentagon:
Washington, DC 20301-1200:
Health Affairs:
Derek B. Stewart:
Director:
Defense Capabilities and Management:
U.S. Government Accountability Office:
441 G. Street, N.W.:
Washington, DC 20548:
Dear Mr. Stewart,
This is the Department of Defense (DoD) response to the Government
Accountability Office (GAO) Draft Report entitled "MILITARY PERSONNEL:
Military Departments Need to Assure that Full Costs of Converting
Military Health Care Positions to Civilian Positions Are Reported to
Congress," dated April 7, 2006 (GAO Code 350754/GAO-06-642).
Thank you for the opportunity to review and comment on the draft
report. First, let me say that I appreciate the collaborative,
insightful and thorough approach that your team has taken with this
important issue. Successful implementation of these conversions is
critical to the accomplishment of the missions assigned
to the Military Health System.
I agree with your assessment that the planned conversions of military
health care positions to civilian health care positions will not have a
detrimental impact on medical readiness, the quality of health care
delivered in military health care facilities, military recruitment and
retention, or access to health care. However, I do have some concerns
with the draft report's "Recommendations for Executive Action." These
concerns, as well as several suggested technical corrections, are
included in the attached formal response.
Again, thank you for the opportunity to provide these comments. My
points of contact for additional information are Mr. Jack Thornburg and
Mr. Mark Yow (Functional) at (703) 681-3518 and Mr. Gunther Zimmerman
(Audit Liaison) at (703) 681-3492.
Sincerely,
Signed By:
William Winkenwerder, Jr., MD:
Enclosure: As stated:
GAO DRAFT REPORT DATED APRIL 7, 2006 GAO-06-642 (GAO CODE 350754):
"Military Personnel: Military Departments Need To Assure That Full
Costs Of Converting Military Health Care Positions To Civilian
Positions Are Reported To Congress"
Department Of Defense Comments To The Recommendation:
To assure that the military departments account for the full costs of
military health care positions converted or planned for conversion are
reported to Congress, we recommend that the Secretary of Defense direct
the Secretaries of the Air Force, Army, and Navy to take the following
two actions:
Recommendation 1: Coordinate the development of their Congressional
certifications for military health care conversions with the Office of
Program Analysis, and Evaluation in order to consider the full cost for
military personnel and for federal civilian or contract replacement
personnel in assessing whether anticipated costs to hire federal
civilian or contract replacement personnel will increase costs to DoD
for defense health care.
DOD RESPONSE:
Concur with comment. The Office of Program Analysis and Evaluation
(PA&E) leads the working group, consisting of both Offices of the
Secretary of Defense and Military Department representatives, that
determined the cost of conversion of the positions identified by the
Military Departments as excess to their readiness requirements and
selected for conversion. This working group also estimated the cost of
the government civilian or contract personnel that will replace the
military personnel being converted, and PA&E concurred with that
estimated cost. A principal factor in the determination of the
positions selected for conversion was that the resulting civilian and
contractor cost, in total, would not exceed the military programming
rate cost.
As stated on page 4 of the draft report, PA&E "is currently identifying
total costs for military health care positions." This effort is not yet
complete, nor has it been reviewed by the Department's senior
leadership. It is unlikely that this data will be available in a final
format for use by the Secretaries of the Military Departments in time
for them to provide their required certifications by June l, 2006, in
accordance with the FY 2006 National Defense Authorization Act (P.L.
109-163).
Furthermore, the PA&E data adds several items of personnel cost that
are not included in the programming rates. It is apparent that the end
result of this analysis will generate a higher average cost per
military member than that reflected by the programming rates. It would
be highly unlikely if additional civilian cost factors would
result in a "total cost" which would exceed the higher and more
accurate rendering of military costs that the Department's analysis is
revealing. Therefore, if the Secretaries of the Military Departments
are able to certify by comparing the projected civilian and contractor
costs to the programming rates, certification based upon comparison to
the PA&E data would seem to be assured.
Finally, although the PA&E approach may result in more accurate
portrayal of the full cost of military personnel, that does not
guarantee that additional funds would be made available to the Defense
Health Program (DHP) Operation and Maintenance budget to pay for
civilian and contractor personnel. The Military Personnel Appropriation
programming rates represent the amount of budgetary authority allocated
to the Assistant Secretary of Defense (Health Affairs) to fund military
personnel, and these conversions must remain within the upper bound of
that budgetary authority to be deemed cost effective to the DHP.
Recommendation 2: Address in their Congressional certifications for
military health care conversions the extent to which total projected
costs for hiring Federal civilian or contract personnel include actual
compensation costs for completed hires and anticipated compensation
costs for future hires.
DOD RESPONSE:
Concur with comment. This recommendation appears to be unnecessary.
Section 744 of the 2006 National Defense Authorization Act (P.L. 109-
163) requires the Secretaries of the Military Departments to certify
that the conversions within their department will not increase costs.
In order to make such a certification, each Military Department
Secretary must review actual civilian employee and contract employee
costs for conversions already completed, as well as estimated costs for
pending conversion actions.
Additionally, requiring the Secretary of Defense to provide direction
to the Secretaries of the Military Departments provides an additional
administrative step that may jeopardize the ability of the Military
Department Secretaries to provide certification by June 1, 2006.
Further, Section 744(a)(2)(A) requires the certification to include
"the methodology used by the Secretary in making the determinations
necessary for the certification, including the extent to which the
Secretary took into consideration the findings of the Comptroller
General in the report under subsection (b)(3)." Therefore, this
requirement appears to be unnecessary.
[End of section]
Appendix VI: GAO Contact and Staff Acknowledgments:
GAO Contact:
Derek B. Stewart (202) 512-5559 or stewartd@gao.gov:
Acknowledgments:
In addition to the individual named above, Sandra Bell, Assistant
Director; Steve Fox; Benjamin Bolitzer; Alissa Czyz; Dawn Godfrey;
Jennifer Jebo; Lynn Johnson; William Mathers; Julia Matta; and Terry
Richardson made key contributions to this report.
(350754):
[End of section]
FOOTNOTES
[1] The military departments consist of the Air Force, Army, and Navy.
The Navy is responsible for providing medical and dental support to the
Marine Corps. Also, hereafter, we will refer to federal civilian or
contract positions as "civilian positions."
[2] For the purpose of this report, military health care personnel
includes medical, dental, and other personnel associated with the
delivery of health care in the Defense Health Program.
[3] Pub. L. No. 109-163, § 744 (2006).
[4] For the purposes of this report, medical readiness personnel
requirements include those military health care personnel required to
meet the demands of the operational scenarios in the national military
strategy.
[5] The Navy was the only military department to convert any military
health care positions to civilian positions in fiscal year 2005. Also,
the Navy made a staffing decision not to convert military health care
positions to civilian positions on a one-for-one basis.
[6] DOD provides health care through TRICARE, a regionally structured
program that uses civilian contractors to maintain health care provider
networks that complement health care provided at military treatment
facilities.
[7] Program Budget Decision 712, December 24, 2003.
[8] Navy corpsmen serve in various hospital departments such as
radiology, laboratory, and clinics and also perform administrative
duties such as patient records management and appointment scheduling.
Army medics provide emergency and routine outpatient and inpatient
medical care and also perform administrative duties. Aerospace medical
services personnel serve in various capacities such as licensed
practical nurses, occupational health specialists, and emergency
medical technicians and perform other administrative functions.
[9] According to DOD officials, the military departments remove
military positions from authorized military endstrength for conversion
to civilian positions on October 1, the first day of the fiscal year.
Hiring of civilian or contract personnel to fill converted positions is
a separate action which may occur later. In the case of the Navy,
funding for hiring civilian replacement personnel becomes available at
the midpoint of the fiscal year in the first year of conversion.
[10] This designation is based on the number of physicians in a
geographic area, per unit of population. A separate designation is
based on the number of dentists.
[11] We did not assess the validity of the DOD medical readiness
personnel sizing model or the reasonableness of the assumptions and
data used in applying the model.
[12] Credentialing of health care personnel refers to the process of
inspecting and verifying the credentials of health care practitioners.
The credentials process is conducted before the granting of clinical
privileges and is repeated at the time of reappointment and renewal of
privileges. Clinical privileging refers to the granting of permission
and responsibility of a health care provider to provide specified
health care within the scope of a provider's license, certification, or
registration. Clinical privileges define the scope and limits of
practice for individual providers and are based on the capability of
the health care facility, licensure, training, experience, health
status, judgment, and peer and department head recommendations.
[13] Department of Defense, Office of the Assistant Secretary of
Defense for Health Affairs, Military Health System Definition of
Quality in Health Care, HA-Policy: 02-016, May 9, 2002.
[14] Department of Defense Directive 6025.13, Medical Quality Assurance
(MQA) in the Military Health System (MHS), signed by the Deputy
Secretary of Defense, May 4, 2004.
[15] The National Practitioner Data Bank was established under the
Health Care Quality Improvement Act of 1986, Pub. L. No. 99-660 (1986),
as an information clearinghouse to improve the quality of health care
by collecting and releasing information related to the professional
competence and conduct of physicians, dentists, and other health care
practitioners.
[16] The Healthcare Integrity and Protection Data Bank was established
by the Health Insurance Portability and Accountability Act of 1996,
Pub. L. No. 104-191 (1996), as a means to prevent fraud and abuse in
health insurance and health care delivery and to improve the quality of
care.
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