System's 2nd in command maps 2008 plans

Negative press dogged the Department of Defense's health affairs in 2007. Reports of neglect came out of Walter Reed Army Medical Center in Washington. Stories followed of bureaucratic nightmares, and concerns for troops returning with mental disorders made headlines.

Stephen L. Jones, second in command of the Military Health System, recently sat down with The Post and Courier to discuss work done to address the problems. The Isle of Palms resident headed federal relations and economic development at Medical University of South Carolina for about 20 years before moving to the Pentagon.

After the last year of critical press, Jones wants to share what the Defense Department has done to right the scandal. "We haven't told that story very well as to how we responded to the wounded warrior criticisms," he said.

The Defense Department's Military Health System comprises the health and medical services of the Army, Navy and Air Force, and includes TRICARE insurance. The system is responsible for more than 9 million beneficiaries and accounted for 8 percent of the Defense Department's $532 billion budget for fiscal 2007, or about $42 billion. If the high-cost health care trend continues, Jones said that by 2015, Military Health System will reach 12 percent.

Year 2008, Jones said, will see advances in the following three areas:

--Research in post-traumatic stress disorder and traumatic brain injury, and reducing stigmatization of mental disorders.

--Streamlining case work to prevent troops from falling through the cracks when they transition from military to VA hospitals.

--Sharing information with the Department of Veterans Affairs.

On the legislative front, however, President Bush vetoed Dec. 28 the defense authorization bill, which included the Wounded Warrior Act. The act was designed to improve the management of medical care, personnel actions and quality-of-life issues for outpatient troops.

Bush vetoed the legislation because of a provision that would permit plaintiffs' lawyers to freeze Iraqi funds, exposing Iraq to massive liability in lawsuits concerning the misdeeds of the Saddam Hussein regime, according to White House deputy press secretary Scott Stanzel.

Meanwhile, the Wounded, Ill and Injured Senior Oversight Committee continues its work. The committee was formed to handle the influx of recommendations coming out of numerous task forces designed to look critically at the system and can make changes immediately whenever possible within the law, Jones said.

The Defense Department's funding is in place, passing separately in an appropriations bill. "We're spending and planning those programs under way," Jones said.

Among the changes already in place is the December creation of the Center of Excellence for Psychological Health and Traumatic Brain Injury. The concept is to network expertise and build a blueprint for treatment and research, Jones said.

Another emphasis of the committee's work is a close partnership between the Defense Department and VA, both of which are represented on the committee.

The departments are piloting a program that would eliminate duplicate processes in the departments' disability evaluation systems. Troops would only need to undergo a single physical exam from the VA, not one from both departments.

The VA/Defense partnership has local reach, as the departments are pooling their resources for a super clinic in Goose Creek, set to open in spring or summer of 2009. Services available at the Naval Weapons Station and at the Navy's former North Charleston hospital, now called Naval Health Clinic Charleston, will be handled at the new facility. The new clinic will also have an outpatient center run by the VA.

In another program designed to ease transition from the Defense Department to the VA, especially for the severely wounded, nine federal recovery coordinators have been hired to oversee care before, during and after the handover.

"It hit us head-on because all of a sudden we have the severely wounded who don't need to be in the hospital but need all the treatments," Jones said.

In making that transition easier, information sharing between the Defense Department and VA becomes critical. The Defense Department already shares data reaching back to 1989 for separated service members, shared patients and new veterans receiving care from VA.

While those medical records are viewable by the VA, they are not truly joint records because the departments use different systems and cannot modify each other's files.

A study on creating a joint Defense/VA inpatient electronic health record is expected to be complete this year.

"The goal is not to waste a lot of money on having one record," he said. "The goal is to have the information there so the provider can diagnose you and give you the best treatment."

Another fiscal responsibility measure may mean an increase in TRICARE fees, which have remained frozen since 1996. Last month, a task force reported the need for increasing fees for retirees. Congress may consider the recommendation this year.

"There's no doubt those who've served should get the best health care available, but we need to ensure some reasonable balance," Jones said.