U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office,

http://bookstore.gpo.gov. For more information, contact the GPO Customer Contact Center,

U.S. Government Printing Office. Phone 202–512–1800, or 866–512–1800 (toll-free). E-mail, gpo@custhelp.com.

i 

65–586 2011

[H.A.S.C. No. 112–19] 

HEARING 

ON

NATIONAL DEFENSE AUTHORIZATION ACT 

FOR FISCAL YEAR 2012 

AND

OVERSIGHT OF PREVIOUSLY AUTHORIZED 

PROGRAMS 

BEFORE THE

COMMITTEE ON ARMED SERVICES 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED TWELFTH CONGRESS 

FIRST SESSION 

SUBCOMMITTEE ON MILITARY PERSONNEL HEARING 

ON

MILITARY HEALTH SYSTEM OVERVIEW 

AND DEFENSE HEALTH PROGRAM COST 

EFFICIENCIES 

HEARING HELD 

MARCH 15, 2011 
(II) 

SUBCOMMITTEE ON MILITARY PERSONNEL 

JOE WILSON, South Carolina, Chairman 

WALTER B. JONES, North Carolina 

MIKE COFFMAN, Colorado 

TOM ROONEY, Florida 

JOE HECK, Nevada 

ALLEN B. WEST, Florida 

AUSTIN SCOTT, Georgia 

VICKY HARTZLER, Missouri 

SUSAN A. DAVIS, California 

ROBERT A. BRADY, Pennsylvania 

MADELEINE Z. BORDALLO, Guam 

DAVE LOEBSACK, Iowa 

NIKI TSONGAS, Massachusetts 

CHELLIE PINGREE, Maine 

JEANETTE JAMES, Professional Staff Member 

DEBRA WADA, Professional Staff Member 

JAMES WEISS, Staff Assistant 
(III) 

C O N T E N T S 

CHRONOLOGICAL LIST OF HEARINGS 

2011 

Page 

HEARING: 

Tuesday, March 15, 2011, Military Health System Overview and Defense 

Health Program Cost Efficiencies ....................................................................... 1 

APPENDIX: 

Tuesday, March 15, 2011 ........................................................................................ 35 

TUESDAY, MARCH 15, 2011 

MILITARY HEALTH SYSTEM OVERVIEW AND DEFENSE HEALTH 

PROGRAM COST EFFICIENCIES 

STATEMENTS PRESENTED BY MEMBERS OF CONGRESS 

Davis, Hon. Susan A., a Representative from California, Ranking Member, 

Subcommittee on Military Personnel ................................................................. 3 

Wilson, Hon. Joe, a Representative from South Carolina, Chairman, Subcommittee on Military Personnel ........................................................................ 1 

WITNESSES 

Green, Lt. Gen. Charles Bruce, USAF, Surgeon General, U.S. Air Force .......... 12 

Robinson, VADM Adam M., USN, Surgeon General, U.S. Navy ......................... 9 

Schoomaker, LTG Eric B., USA, Surgeon General, U.S. Army ........................... 6 

Stanley, Hon. Clifford L., Ph.D., Under Secretary of Defense for Personnel 

and Readiness ....................................................................................................... 4 

Woodson, Hon. Jonathan, M.D., Assistant Secretary of Defense for Health 

Affairs .................................................................................................................... 5 

APPENDIX 

PREPARED STATEMENTS: 

Davis, Hon. Susan A. ....................................................................................... 42 

Green, Lt. Gen. Charles Bruce ........................................................................ 109 

Robinson, VADM Adam M. .............................................................................. 82 

Schoomaker, LTG Eric B. ................................................................................ 59 

Stanley, Hon. Clifford L., Ph.D., joint with Hon. Jonathan Woodson, 

M.D. ................................................................................................................ 44 

Wilson, Hon. Joe ............................................................................................... 39 

DOCUMENTS SUBMITTED FOR THE RECORD: 

[There were no Documents submitted.] 

WITNESS RESPONSES TO QUESTIONS ASKED DURING THE HEARING: 

Dr. Heck ............................................................................................................ 131 

QUESTIONS SUBMITTED BY MEMBERS POST HEARING: 

Mrs. Davis ......................................................................................................... 135 

Dr. Heck ............................................................................................................ 144 

(1) 

MILITARY HEALTH SYSTEM OVERVIEW AND DEFENSE 

HEALTH PROGRAM COST EFFICIENCIES 

HOUSE OF REPRESENTATIVES, COMMITTEE ON ARMED SERVICES, SUBCOMMITTEE ON MILITARY PERSONNEL, Washington, DC, Tuesday, March 15, 2011. 

The subcommittee met, pursuant to call, at 10:03 a.m., in room 

2212, Rayburn House Office Building, Hon. Joe Wilson (chairman 

of the subcommittee) presiding. 

OPENING STATEMENT OF HON. JOE WILSON, A REPRESENTATIVE FROM SOUTH CAROLINA, CHAIRMAN, SUBCOMMITTEE 

ON MILITARY PERSONNEL 

Mr. WILSON. Ladies and gentlemen, I would like to welcome everyone to the Military Personnel Subcommittee hearing today on 

the Military Health System [MHS] overview and Defense Health 

Program cost efficiencies. 

And today, the subcommittee meets to hear testimony on the 

Military Health System and the Defense Health Cost Program for 

the fiscal year 2012. I would like to begin by acknowledging the remarkable military and civilian medical professionals who provide 

extraordinary care to our service members and their families along 

with veterans, here at home and around the world, often in some 

of the toughest and most austere environments. 

I have recently returned from Balad and Bagram where I am always appreciative of the professionals who have saved so many 

American, Iraqi, and Afghani lives. I have firsthand knowledge of 

their dedication and sacrifice from my second son, who has served 

in Iraq and is now an orthopedic resident in the Navy, but we are 

joint service. As a grateful dad, as a military family, I was reassured to the medical care available for my Army son and my Air 

Force nephew who also both served in Iraq. 

The subcommittee remains committed to ensuring that the men 

and women who are entrusted with the lives of our troops have the 

resources to continue their work for future generations of our most 

deserving military beneficiaries. Even in this tight fiscal environment, the Military Health Care System must continue to provide 

world-class health care to our beneficiaries and remain strong and 

viable in order to maintain that commitment to future beneficiaries. 

The Department of Defense [DOD] has proposed several measures aimed at reducing the cost of providing health care to our 

service members and their families and military veterans. While I 

appreciate that your plan is a more comprehensive approach than 

previous cost cutting efforts, the challenge here is to find a balance 
2 

between fiscal responsibility while maintaining a viable and robust 

military health care system. 

We must be sure to remember these proposals have complex implications that ‘‘go beyond beneficiaries.’’ They also affect the people who support the defense health system, such as local pharmacists, as health care employees at hospitals and contractors. The 

subcommittee has a number of concerns about the Department’s 

initiatives. To that end, we would expect the Department’s witnesses to address our concerns, including first, the proposed 

TRICARE Prime fee increase for the fiscal year 2012, while appearing to be modest, is a 13 percent increase over the current rate. 

DOD proposes increasing the fee in the out years based on an inflation index. You suggest 6.2 percent but it is not clear which 

index you are using now and in the future. Second, you plan to reduce the rate that TRICARE pays the sole community hospitals for 

inpatient care provided to our Active Duty, family members, and 

veterans. 

Several of these hospitals are located very close to military bases; 

in fact some are right outside the front gates, especially important 

for 24-hour emergency care. What analysis have you done to determine whether reducing these rates will affect access to care for our 

beneficiaries and in particular the readiness of our Armed Forces? 

I would also like our witnesses to discuss the range of efficiency options that were considered but not included in the President’s 

budget. 

I would appreciate hearing your views on the recent GAO [Government Accountability Office] recommendations included in their 

report on Federal duplication, overlap and fragmentation. GAO 

made recommendations regarding establishing a unified medical 

command and for the DOD to finally jointly modernize their electronic health record system with the Veterans Administration. 

In addition, I would like to hear from the military surgeons 

about efforts they are taking within the military departments to increase the efficiency of the health care systems and reduce cost. I 

would also like the military surgeons’ views on areas where additional efficiencies can be gained across the DOD health system. 

The Department of Defense, just last week, recently announced 

they have hired Governor John Baldacci, the former Governor of 

Maine, to undertake a full-scale review of the military health care 

and the impacts of military health care on the forces. I would appreciate hearing from Dr. Stanley the considerations for this review 

and what the Department hopes to gain from Governor Baldacci’s 

efforts. I am concerned. 

First of all, I have faith in Dr. Stanley. He is a graduate of South 

Carolina State University. So I know of his capabilities. Why is 

having a military health care czar not a duplication of the duties 

already assumed by Under Secretary Stanley and Assistant Secretary Woodson? 

Finally, I would like to make it clear that in the effort to reduce 

the cost of military health care and find efficiencies in the military 

health care system, we must never lose sight of the population that 

the military medical system serves. The members of the Armed 

Forces and their families who currently serve and those who served 

as veterans for a full career in the past warrant the best health 
3 

care system available. Reducing cost must never result in reduced 

quality of the availability, or the availability of health care they 

earned and they deserve. 

I hope that our witnesses will address these important issues as 

directly as possible in their oral statements and in the response to 

Members’ questions. Before I introduce our panel, let me offer 

Ranking Member, who is a distinguished former chairman of this 

subcommittee, Congresswoman Susan Davis an opportunity to 

make her opening remarks. 

[The prepared statement of Mr. Wilson can be found in the Appendix on page 39.] 

STATEMENT OF HON. SUSAN A. DAVIS, A REPRESENTATIVE 

FROM CALIFORNIA, RANKING MEMBER, SUBCOMMITTEE ON 

MILITARY PERSONNEL 

Mrs. DAVIS. Thank you. Thank you, Mr. Chairman. And thank 

you for summarizing many of the issues that are before us today, 

I look forward to hearing from Under Secretary Stanley and Assistant Secretary Woodson on their views on the status of the military 

health care system, particularly the TRICARE program and their 

efforts to improve the care that we are providing to our service men 

and women, retirees, survivors, and their families. 

Assistant Secretary Woodson, we welcome you. We are delighted 

that you are here. And I understand that it is your first testimony 

before this subcommittee. I am pleased that the Senate finally confirmed you as the Assistant Secretary for Health Affairs. The Department is confronting many issues and having you there is important if we are to be successful in facing those challenges. 

I also look forward to hearing from our Surgeon Generals, General Schoomaker and Admiral Robinson, thank you very much for 

your service. And I know that both of you, I believe, are retiring 

this year. So we will miss you. It has been a pleasure working with 

both of you over the past several years. 

The last 10 years of conflict have taken a toll on our forces, and 

in particular those who serve in our military health care system. 

The constant demand on the system and the successes that we 

have seen both on the battleground and back home here in the 

States have been remarkable and a testament to your leadership. 

General Green, welcome back to you, sir. With the departure of 

General Schoomaker and Admiral Robinson, of course, you would 

be the most senior Surgeon General and I look forward to continuing to work with you. 

While I suspect that the majority of this hearing will focus on the 

Department of Defense’s health care proposals that were included 

in the budget, this hearing will probably be one of the only hearings on health care that we will have prior to the subcommittee 

and committee markup. 

So as such, it is important that members of the subcommittee 

have an understanding of all the challenges that the military 

health care system is facing, not just the budgetary constraints. 

Our military personnel and their families are under constant pressure and challenges. And access to quality health care should not 

be on that list of concerns. 
4 

I look forward to your testimony on how we are caring for our 

injured, ill, and wounded and what can be done to continue to improve the military health care systems. 

Thank you, Mr. Chairman. 

[The prepared statement of Mrs. Davis can be found in the Appendix on page 42.] 

Mr. WILSON. Thank you, Mrs. Davis. 

We have five witnesses today. We would like to give each witness 

the opportunity to present his testimony and each Member an opportunity to question the witnesses. I would respectfully remind 

the witnesses that we desire that you summarize to the greatest 

extent possible the high points of your written testimony in 3 minutes. I assure you that your written comments and statements will 

be made part of the record. 

And, of course, first we want to welcome the Honorable Dr. 

Clifford L. Stanley, the Under Secretary of Defense for Personnel 

and Readiness [P&R], Dr. John Woodson, Assistant Secretary for 

Defense for Health Affairs and this—Doctor, I know it is your first 

appearance so we are delighted to have you here. And Lieutenant 

General Eric Schoomaker, the Surgeon General of the Department 

of the Army and General, thank you for your distinguished career. 

And this is your last appearance and we just wish you well in your 

future career. 

And Vice Admiral Adam Robinson, the Surgeon General of the 

Department of the Navy and indeed General Robinson, thank you. 

This, too, I can see the big smile on your face which means this 

is your last appearance here. And we appreciate your service and 

thank you for in every way, for your service. And then soon to be 

the senior Surgeon General amazingly enough, Lieutenant General 

Charles Bruce Green, the Surgeon General of the Department of 

the Air Force. 

And at this time, Dr. Stanley, you may begin. 

STATEMENT OF HON. CLIFFORD L. STANLEY, PH.D., UNDER 

SECRETARY OF DEFENSE FOR PERSONNEL AND READINESS 

Secretary STANLEY. Good morning and thank you, Mr. Chairman 

and members of the committee, I really do appreciate this opportunity to appear before you today to discuss the future of the Military Health System, particularly our priorities for the coming year. 

Dr. Woodson, the Surgeon Generals and I look forward to discussing our health care plans for 2011 and 2012. At the outset, I 

just want to acknowledge the performance and courage of our military medical professionals serving in combat theaters. For service 

members wounded in combat, their likelihood of survival after a 

medic arrives remains at historic and unmatched levels. 

For those seriously wounded service members who require 

months, years and sometimes a lifetime of medical rehabilitation 

and treatment, we are committed to ensuring that they and their 

families receive the finest evidence-based medical services available 

in this country. And we are working ever more closely with our colleagues in the Department of Veterans Affairs [VA] to ensure our 

activities are better coordinated to include the disability evaluation 

process, the sharing of personnel and health information and collaboration on our future electronic health record. 
5 

In addition to the efficiencies that we will discuss today, I have 

asked the former Governor and former Representative John 

Balucci—Baldacci, excuse me, from Maine to help us work in a 

deep dive review of health care and wellness. Dr. Woodson and our 

Assistant Secretary of Defense for Health Affairs ensures that the 

military health care system runs smoothly every day. 

But I have asked the Governor to pursue a four azimuth deep 

dive approach which is focusing on readiness, improve health population, patient experience and care and lastly, cost. And with that, 

I would turn to Dr. Woodson. Before I do that, I would like to also 

thank the subcommittee for the tremendous support you provide 

the Department for our service members and their families, particularly the Military Health System. Thank you. 

[The joint prepared statement of Secretary Stanley and Dr. 

Woodson can be found in the Appendix on page 44.] 

Mr. WILSON. Next, we have Dr. Woodson. 

STATEMENT OF HON. JONATHAN WOODSON, M.D., ASSISTANT 

SECRETARY OF DEFENSE FOR HEALTH AFFAIRS 

Dr. WOODSON. Mr. Chairman, Ranking Davis and members of 

the committee, thank you so much for this opportunity to appear 

before you today. I will briefly elaborate on Dr. Stanley’s opening 

statement. I have had the privilege of serving the Military Health 

System both in uniform as an officer and physician and in my current role as senior medical advisor to the Secretary of Defense. 

This system has shown time and again that it is a vibrant, learning organization capable of self-improvement and rapid incorporation of lessons learned into both our combat and peacetime endeavors. 

In our combat theaters, Dr. Stanley has already noted the historic rates of survival among those who are injured. I would also 

point out the reductions in disease and injuries through improved 

public health and preventative medicine strategies. Thanks to the 

ongoing support of Congress, we are continuing to invest deeply in 

medical research and development on the most challenging medical 

issues we are confronted with from the war. 

We are accelerating the delivery of our scientific findings from 

the laboratory to the bench—to the battlefield to include prevention, diagnosis, and treatment for both visible and invisible wounds 

of war. We are also making important investments in how we deliver care to all of our beneficiaries. The Patient-Centered Medical 

Home is a transformative effort within our system. 

We have enrolled more than 655,000 beneficiaries to date, with 

promising results in the use of preventive services, reducing emergency room [ER] use, and provision of more timely care. In addition 

to our investments in readiness, improved population and improved 

service to our patients, we also have proposed some changes that 

will allow us to more responsibly manage our cost. 

Our efficiency initiatives share the responsibility for cost controls 

among all of the participants including us internally at Health Affairs and TMA [TRICARE Management Activity], among provider 

communities and with our beneficiaries for whom we propose a 

very modest change to select out-of-pocket costs. 
6 

Throughout our proposals, we have taken steps to protect those 

who are enrolled in existing programs or who have special circumstances that must be considered and protected. Our proposed 

budget helps keep fidelity with our core principles. We will never 

lose our focus on our commitment to all the men and women who 

serve our Armed Forces, their families, those who have served in 

the past and present, and those will serve in the future. 

We are proud to represent the men and women who comprise the 

Military Health System and we look forward to your questions this 

morning. 

[The joint prepared statement of Dr. Woodson and Secretary 

Stanley can be found in the Appendix on page 44.] 

Mr. WILSON. Thank you very much. 

And General Schoomaker. 

STATEMENT OF LTG ERIC B. SCHOOMAKER, USA, SURGEON 

GENERAL, U.S. ARMY 

General SCHOOMAKER. Chairman Wilson, Ranking Member 

Davis, distinguished members of the committee, thanks for permitting me to talk with you today about the dedicated men and women 

of the Army Medical Department who bring value and inspire trust 

in Army Medicine. 

Despite over 9 years of continuous armed conflict, for which 

Army Medicine bears a heavy load, every day our soldiers and their 

families are kept from injuries, illnesses, and combat wounds 

through our health promotion and prevention efforts; and are treated in a state-of-the-art fashion when prevention fails; and are supported by an extraordinarily talented medical force including those 

who serve at the side of the warrior on the battlefield. 

We are a member of this Military Health System team committed to partnering with soldiers and families, and veterans to 

achieve the highest level of fitness and health for all. And we have 

been leaders in innovation for trauma care and preventive medicine that have saved lives and improved the well-being of our warriors and improvements that have really changed even clinical 

practices in the civilian sector. We are focused on delivering the 

best care at the right time and place. 

I would like to talk about our work through the lens of the five 

E’s: Enduring, Early, Effective, Efficient, and an Enterprise fashion. We have an enduring commitment to care through initiatives 

such as the Warrior Care and Transition Plan and the Soldier 

Medical Readiness Campaign Plan. 

We have an enduring responsibility alongside our sister services 

in the Department of Veteran Affairs to provide care and rehabilitation for wounded, ill and injured for many, many years to come. 

We have a warrior transition command in the Army Medical Department under the leadership of Brigadier General Darryl Williams, many of you have met him. He is a key in our provision of 

care and provides a centralized oversight for the Army’s Warrior 

Care and Transition Program. 

Our focus is on investing soldiers and families with dignity, respect, and self determination to successfully reintegrate them either back into the force or into the community. Since we stood up 

the first warrior transition units in June of 2007, more than 40,000 
7 

wounded, ill, and injured soldiers and their families have either 

progressed through or are currently in care, and we have returned 

over 16,000 soldiers to the force. 

We have also created a Soldier Medical Readiness Campaign that 

has been brought about because of the rising cost of health problems in our force, especially within the Reserve Components. 

Among its many goals under the leadership of Major General Rich 

Stone, a mobilized Reserve Component physician from Michigan 

there to identify the medically non-ready soldier population and 

implement medical management programs to reduce this medically 

non-ready population with an ultimate end state of a deployment 

of healthy, resilient, and fit soldiers, and increase Army medical 

readiness. 

Those soldiers that can no longer meet retention standards have 

to navigate our physical disability evaluation system. Assigning 

disability has long been a contentious issue. DOD and VA have 

jointly designed a new disability evaluation system that integrates 

the DOD and VA processes with a goal of expediting the delivery 

of VA benefits to service members. This pilot, called the Integrated 

Disability Evaluation System or IDES, began in late 2007 at Walter Reed. It is now in 16 of our Army Medical Treatment facilities. 

And it will be the DOD and VA replacement for the legacy Disability Evaluation System. But even with this improvement, disability evaluation remains complex and adversarial. Our soldiers 

still undergo dual adjudication where the military rates only on fitting condition and the VA rates all service-connected conditions. 

Dual adjudication is confusing to soldiers and leads to serious 

misperceptions about the Army’s appreciation of the wounded, ill, 

and injured soldiers’ complete medical and emotional situation. 

And IDES has not changed the fundamental nature of the dual adjudication process. Under the leadership of the Army Chief of Staff 

and the Army G–1, we continue to forge the consensus necessary 

for a comprehensive reform of the Physical Disability Evaluation 

System in which the Army and the DOD only determines fitness 

for duty, and the VA determines disability compensation. 

Our second strategic aim is to reduce suffering, illness, and injury through early prevention. Army public health protects and improves the health of the Army community through education and 

promotion of healthy lifestyles, and disease and injury prevention. 

The health of the total Army is essential for readiness and prevention is the key to health. 

The examples of this are the promotion of healthy lifestyles, of 

achieving the highest measures of population health measured by 

[inaudible], the implementation of Patient-Centered Medical Home 

that you have heard about already, and I hope you will hear more 

about, and the focus on, for example, body mass index, and childhood obesity. 

The Army is leading the way also in the recognition and treatment of mild traumatic brain injury [TBI] or concussion through an 

‘‘Educate, Train, Treat, Track’’ strategy. Vice Chief of Staff of the 

Army Pete Chiarelli has led personally in this and we have refined 

this through General Richard Thomas, my Assistant Surgeon General for Force Projection. We fielded this program, which some have 

called the ‘‘CPR for the brain,’’ increasing the awareness and 
8 

screening of concussive injury and leading to a decrease of the stigma associated with seeking care. 

The use of evidence-based practices are aimed at the most effective care for us, is our third strategic aim. For example, we have 

harvested the lessons of almost a decade of war and now strengthen our soldiers’ and families’ behavioral health and emotional resiliency through a campaign that aligns all of the behavioral health 

programs within this human dimension of the Army’s Force Generation cycle. We call this the Comprehensive Behavioral Health 

System of Care. We have got now outcome studies that demonstrate the profound value of using multiple touchpoints in assessing and coordinating health and behavioral health for soldiers 

and families across this cycle. 

Coupled with the major advances in battlefield care under the 

Joint Theater Trauma System which was birthed in the Army’s 

Medical Research and Materiel Command and the Army’s Institute 

of Surgical Research, we have made great strides in preventing and 

managing physical and emotional wounds of war. 

Additionally, we have launched a comprehensive pain management strategy to address chronic pain that our soldiers are focused, 

it is holistic, multidisciplinary, multimodal. Utilizes art—the stateof-the-art care, and it is focusing on non-pharmacologic practices 

such as incorporating complementary and alternative therapies, 

like acupuncture, and massage therapy, movement therapy, yoga, 

and other mind-body medical practices. 

Our fourth strategic aim is optimizing efficiencies that you have 

alluded to. We do that through leading business processes and 

partnerships with the other services and veterans organizations. 

Ultimately, I would like to say that the principal efficiency and cost 

saving step in health care is the maintenance of health, promotion 

of good health, and the focus on good clinical outcomes and evidence-based practices. 

But we are also working with the DOD and the VA to create a 

single electronic health record, seamlessly transferring patient data 

between and among the partners to improve efficiencies and continuity of care. We share a significant amount of health information today. No two health organizations in the Nation share more 

non-billable health information than the DOD and the VA. 

The Departments continue to standardize this sharing activity 

and are delivering information technology solutions that will significantly improve the sharing of appropriate electronic health information. 

Our fifth aim is an enterprise approach. We have reengineered 

Army Medicine. We have created a Public Health Command. And 

we have reengineered our regional medical commands to align with 

the TRICARE regions so that we can more efficiently provide 

health care in a seamless way through our TRICARE partners. 

We also have at each regional medical command, a deputy commander who is responsible for readiness and can reach out even to 

our Reserve Component elements within their area of responsibility 

to ensure that all medical and dental services are being provided 

and our Reserve units are optimally ready. 

This is my last congressional hearing cycle as the Army Surgeon 

General and the Commanding General, The Army Medical Com-
9 

mand. I would like to thank the committee for the opportunities 

that I have been given to highlight the accomplishments we have 

made, the challenges that we face, to hear your collective perspectives regarding the health of our extended military family and the 

health care we provide. 

I have appreciated your tough questions, your valuable insights, 

the sage advice you have offered and the deep commitment you 

have all demonstrated to our soldiers and their families. On behalf 

of over 140,000 dedicated soldiers, civilians, contractors that make 

up my command in Army Medicine, I would like to thank also the 

Congress for your continued support in providing the resources we 

need for delivering leading edge health services, and build healthy 

and resilient communities. 

Thank you. 

[The prepared statement of General Schoomaker can be found in 

the Appendix on page 59.] 

Mr. WILSON. General Schoomaker, thank you very much. And 

thank you for being so candid. 

And Admiral Robinson, again, I am so grateful for the briefing 

you provided at your very historic office. And so, thank you for 

coming by today. 

STATEMENT OF VADM ADAM M. ROBINSON, USN, SURGEON 

GENERAL, U.S. NAVY 

Admiral ROBINSON. Thank you very much, Mr. Chairman. 

Chairman Wilson. 

Congresswoman Davis. 

Distinguished members of the subcommittee, I am pleased to be 

with you today. And I want to thank the committee for the tremendous confidence and unwavering support of Navy Medicine, particularly, as we continue to care for those who go in harm’s way, 

their families, and all beneficiaries. 

Force Health Protection is the bedrock of Navy Medicine. It is 

what we do and why we exist. It is our duty, our obligation, and 

our privilege to promote, protect and restore the health of our sailors and marines. This mission spans the full spectrum of health 

care, from optimizing the health and fitness of the force, to maintaining robust disease surveillance and prevention programs, to 

saving lives on the battlefield. 

I along with my fellow Surgeons General traveled to Afghanistan 

last month and again witnessed the stellar performance of our men 

and women delivering expeditionary combat casualty care. At the 

NATO [North Atlantic Treaty Organization] Role 3 Multinational 

Medical Unit, Navy Medicine is currently leading the joint and 

combined staff to provide the largest medical support in Kandahar 

with full trauma care. 

This state-of-the-art facility is staffed with dedicated and compassionate Active and Reserve personnel who are truly delivering 

outstanding care. Receiving 70 percent of their patents directly 

from the point of injury on the battlefield, our doctors, nurses, and 

corpsmen apply the medical lessons learned from 10 years of war 

to achieve a remarkable 97 percent survival rate for coalition casualties. 
10 

The Navy Medicine team is working side by side with Army and 

Air Force medical personnel and coalition forces to support U.S. 

military coalition forces, contractors, Afghan nationals, police, army 

and civilians as well as detainees. The team is rapidly implementing best practices and employing unique skill sets such as an 

interventional radiologist, pediatric intensivist, hospitalist and others in support of their demanding mission. 

I am proud of the manner in which our men and women are responding—leaving no doubt that the historically unprecedented 

survival rate from battlefield injuries is the direct result of better 

trained and equipped personnel, in conjunction with improved systems of treatment and casualty evacuation. 

We spend a lot of time discussing what constitutes world class 

health care. I would like to be clear that there is no doubt in my 

mind that the trauma care being provided in theater today to our 

casualties is truly world class as are the men and women delivering it. Their morale is high and professionalism unmatched. 

We also had the opportunity to visit our Concussion Restoration 

Care Center [CRCC] at Camp Leatherneck in Helmand Province. 

The center which opened in last—which opened last August, assesses and treats service members with concussion or mild TBI, 

mild traumatic brain injury, and musculoskeletal injuries, with the 

goal of safely returning to duty many service members as possible 

to full duty following recovery of cognitive and physical function. 

The CRCC is supported by an interdisciplinary team including 

sports medicine, family medicine, mental health, physical therapy, 

and occupational therapy. The CRCC, along with other programs 

like OSCAR, our Operational Stress Control and Readiness program, in which we embed full-time mental health personnel with 

deploying marines, continues to reflect our priority of positioning 

our personnel and resources where they are most needed. 

We have no greater responsibility than caring for our service 

members, wherever and whenever they go. We must understand 

that preserving the psychological health of service members and 

their families is one of the greatest challenges we face today. We 

recognize that service members and their families are resilient at 

baseline but the long conflict and repeated deployments challenge 

this resilience. 

We also know that nearly a decade of continuous combat operations has resulted in a growing population of service members suffering with traumatic brain injury. We are forging ahead with improved screening, surveillance, treatment, education, and research. 

However, there is still much we do not yet know about these injuries and their long-term impact on the lives of our service members. 

I would specifically point out that the issuance of the directive 

type memorandum in June 2010 has increased line leadership 

awareness of potential traumatic brain injury exposure and mandates post-blast evaluations and removal of blast-exposed warfighters from high risk situations to promote recovery. 

We also recognize the important of collaboration and partnerships, and our efforts include those coordinated jointly with the 

other services, the Department of Veterans Affairs, the Centers of 

Excellence, as well as leading academic and research institutions. 
11 

Let me now turn to patient- and family-centered care. Medical 

Home Port is Navy Medicine’s Patient-Centered Medical Home 

model, an important initiative that will significantly impact how 

we provide care to our beneficiaries. Medical Home Port emphasizes team-based comprehensive care and focuses on the relationship between the patient, their provider and the health care team. 

Critical to its success is leveraging all of our providers and supporting information technology systems into a cohesive team that 

will not only provide primary care but integrate specialty care as 

well. We continue to move forward with the phased implementation 

of Medical Home Port and our medical centers and family-practice 

teaching hospitals, and the initial response from our patients is 

very encouraging. 

Both force health protection and patient and family-centered care 

are supported by robust research and development capability and 

outstanding medical education programs. These are truly force 

multipliers. The work that our researchers and educators do is having a direct impact on the treatment we are able to provide our 

wounded warriors and helping to shape the future of military medicine. 

Finally, I would like to address the proposed Defense Health Program cost efficiencies. Rising health care costs within the MHS 

continue to present challenges. The Secretary of Defense has articulated that the rate at which health care costs are increasing 

and relative proportion of the Department’s resources devoted to 

health care cannot be sustained. He has been resolute in his commitment to implement systemic efficiencies and specific initiatives 

which will improve quality and satisfaction while more responsibly 

managing cost. 

The Department of the Navy fully supports the Secretary’s plan 

to better manage costs moving forward and ensure our beneficiaries have access to the quality care that is the hallmark of 

military medicine. 

In summary, I am proud of the progress we are making, but not 

satisfied. We continue to see ground-breaking innovations in combat casualty care and remarkable heroics in saving lives, but all of 

us remain concerned about the cumulative effects of worry, of 

stress and anxiety on our service members and their families 

brought about by a decade of conflict. Each day resonates with the 

sacrifices that our sailors, marines, and their families make quietly 

and without bravado. 

It is this commitment, this selfless service that helps inspire us 

in Navy Medicine. Regardless of the challenges ahead I am confident that we are well-positioned for the future. Since this is my 

last cycle of hearings, I too would like to extend my sincere appreciation to the committee, to the Members and the professional 

staffers for all of the support, the insights and the advice being 

given; it has been a true honor being before you and actually working with you. 

I appreciate the opportunity to be here today and look forward 

to your questions. Thank you very much. 

[The prepared statement of Admiral Robinson can be found in 

the Appendix on page 82.] 

Mr. WILSON. Admiral, thank you very much. 
12 

And General Green. 

STATEMENT OF LT. GEN. CHARLES BRUCE GREEN, USAF, 

SURGEON GENERAL, U.S. AIR FORCE 

General GREEN. Good morning, Mr. Chairman, Representative 

Davis, and distinguished members of the committee, I appreciate 

the opportunity to meet with you today representing the men and 

women of the Air Force Medical Service. 

We cannot achieve our goals of better readiness, better health, 

better care and best value for our heroes and their families without 

your support, and we thank you. 

Military Health System achievements have changed the face of 

the war. We deploy and set up hospitals within 12 hours of arrival 

anywhere in the world. We move wounded warriors from the battlefield to an operating room within minutes and have achieved 

and sustained less than 10 percent died-of-wounds rate. 

We move our sickest patients in less than 24 hours of injury and 

get them home to loved ones within 3 days to hasten recovery. We 

have safely evacuated more than 85,000 patients since October, 

2001, 11,300 in 2010 alone, many of them critically injured. 

The Air Force Medical Service has a simple mantra: Trusted 

Care Anywhere. This fits what we do today and will continue to do 

in years ahead. It means creating a system that can be taken anywhere in the world and be equally as effective whether in war or 

for humanitarian assistance. 

Medics at Air Combat Command have now developed an EMEDS 

[expeditionary medical support] deployable hospital that is capable 

of seeing the first patient within 1 hour of arrival and performing 

the first surgery within 3 to 5 hours. These systems are linked 

back to American quality care and refuse to compromise on patient 

safety. 

Providing trusted care anywhere requires the Air Force Medical 

Service to focus on patients and populations. Patient-centered care 

builds new possibilities in prevention by linking the patients to 

provider teams that both the patient and the provider can be 

linked to an informatics network dedicated to improving care. 

Efficient and effective health teams allow recapture of care at 

our medical treatment facilities to sustain currency and continually 

improving our readiness insures patients and warfighters always 

benefit from the latest medical technologies and advancements. 

The Air Force supports the DOD strategy to control health care 

costs, and believes it is the right approach to manage the benefit 

while improving quality and satisfaction. By the end of 2012, Air 

Force Patient-Centered Medical Home will provide 1 million of our 

beneficiaries new continuity of care via single provider led teams 

at all of our Air Force facilities. 

We will do all in our power to improve the health of our population while working to control the rising costs of health care. 

The Air Force Medical Service treasures our partnerships with 

OSD [Office of the Secretary of the Defense], the Army, Navy, Veterans Administration, civilian, and academic partners. We leverage 

all the tools you have given us to improve retention and generate 

new medical knowledge. We will continue to deliver nothing less 
13 

than world-class care to military members and their families, wherever they serve around the globe. 

Thank you and I look forward to answering your questions this 

morning. 

[The prepared statement of General Green can be found in the 

Appendix on page 109.] 

Mr. WILSON. Thank you very much, General. 

And as we begin questions I want to make it clear, we are going 

to have a 5-minute rule and first of all it applies to me. And we 

have someone very impartial who is going to be observing this and 

monitoring it, Jeanette James. 

And so, Ms. James, on the mark, get set, go. 

With this in mind and to you, Dr. Stanley, knowing your background, your military background and medical, and Dr. Woodson, 

I have faith in both of you and I have faith in both of you as to 

the oversight of military health care. And so, it was a real surprise 

to me that out of the blue, last week, there would be a military 

health care czar appointed, Governor Baldacci, a former governor 

of Maine. And I understand he is to conduct a 1-year review. 

I truly believe that is a duplication and the General Accountability Office just 2 weeks ago said that our government suffers 

from duplication, overlap, fragmentation; and then in light of that, 

a new position is created at a time where we are all concerned 

about efficiencies and now we are adding a new job, I believe, a 

$163,000 a year. That just doesn’t seem right to me. 

And then I am also concerned and in light of this study, why 

should Congress enact what you are proposing which are the defense health cost efficiencies, if this work could be overturned by 

another major reform by another party. 

Secretary STANLEY. First of all, Congressman and Chairman, I 

thank you first of all for your confidence because the efficiencies 

that we are talking about today and specifically are de-coupled and 

are not directly related to what Governor Baldacci is going to be 

doing. 

His charge, by me, because I asked him—first of all, I wanted to 

have an objective, outside look. I have looked at GAO reports; my 

charge from Secretary Gates when I first joined the Department 

last year was to look at P&R a little differently. 

We have not really been as open as I think we should have been 

with VSOs [veteran service organizations], I don’t think we have 

been as open as we should have been in terms of following some 

of the things that have been laid out before in terms of recommendations and I needed an outside look and I had a Member 

of Congress as well a former governor now who served two terms 

to help with not only the Guard, Reserve issues but also looking 

at the holistic viewpoint of readiness, of wellness, of looking at how 

we are going to do, you know, patient satisfaction and then cost 

was the last piece. 

So the duplication is not what I actually see right now, actually 

I am asking Dr. Woodson to work very closely with him as we look 

at the objectives assessment of this. 

Mr. WILSON. And Dr. Woodson. 

Dr. WOODSON. Thank you for that question. I think in part with 

the delay in my confirmation and sort of the inconsistent leader-
14 

ship within health affairs there was a need to in fact look at how 

business was conducted within health affairs. 

I do not see the governor’s mandate as interfering with my statutory authorities and the efficiencies that we need to roll out. To the 

extent that Governor Baldacci conducts his studies and produces 

products that informs me in terms of what additional reforms need 

to made, I look forward to his work. 

Mr. WILSON. I am concerned too and I am glad you brought up 

about confirmation. I don’t believe this position goes through confirmation; that concerns me. 

General Schoomaker, real quickly with the—it is so important 

about the Walter Reed Bethesda what I consider to be merger, but 

I am very concerned about the level of support provided for the 

wounded warriors. Will it be equal to what we know is world class 

currently at Walter Reed? 

General SCHOOMAKER. Sir, we have worked—I think all the services have worked very, very hard to ensure that that is going to 

occur. We have had some very, very tight schedules and some unexpected hurdles that we are going to have to overcome. 

I feel that I should say, honestly, that there are going to be some 

patients and some clinical situations in a new system that is going 

to be, who are going to be facing unfamiliar terrain. We are going 

to have a new physical plant, a new organizational arrangement 

and a new virtual space, that is the Electronic Health Record to deliver that care. But I can say that we are working as hard as we 

can to meet those, both the deadlines as well as the standards of 

high-quality care. 

Mr. WILSON. Thank you, and with the 5-minute rule, Mrs. Davis. 

Mrs. DAVIS. Thank you. 

Dr. Stanley, I understand that the Department analyzed a number of options before it considered what proposals to put forward 

to try and address the growing health care budget. So I wondered 

if you could share with the subcommittee what other proposals 

were considered and subsequently rejected by the Department? 

Secretary STANLEY. Yes, Congresswoman Davis. The Department 

did, in fact, look at other options, everywhere from curtailing certain studies, doing curtailment on research, dealing with not only 

cancer research but looking at a whole range of options that I know 

that I am going to ask Dr. Woodson to help with some of this but 

the bottom line is, is that over the years, before I came, there were 

actually higher costs looked at which were rejected not only by this 

body but also internally looking at ways to be more efficient but 

also having minimal impact or effect on our troops and affecting 

our Active Duty Component. 

So we looked at things that will have minimal impact on Active 

Duty and at the same time not really affecting even our retirement 

community or Reserve and Guard significantly, just looking at 

ways to manage costs but still deliver quality care. And that is the 

side, that is where we came down with these minimal efficiencies 

that we are looking at. 

Mrs. DAVIS. Dr. Woodson. 

Dr. WOODSON. Thank you very much for that question. Producing 

efficiencies and reduction in costs in health care is an ongoing ef-
15 

fort, both within the Military Health System and within civilian 

sector as well. 

Since 2007 $1.65 billion have been saved in the Military Health 

System by introducing mail-order pharmacy products, going after 

Federal price ceilings, using outpatient perspective payment systems, enhanced fraud detection, and standardizing medical supplies and equipment. 

And of course I would remind the committee that the factors that 

are influencing the rise in health care include the fact that we have 

an increased number of users, new products and we have growing 

pharmacy use and growing utilization of health care resources. 

Now we have endeavored to streamline our practices and produce 

efficiencies. We mentioned Patient-Centered Home as a method for 

particularly managing chronic disease which reduces cost but also 

improves quality of care. We have undergone consolidation and initial outfitting and transition of equipment efficiencies. We have 

centralized procurement of medical equipment and devices. We 

have also reduced service contracts and we continue to look at this 

as a source of efficiencies and as you know we are undergoing an 

efficiency evaluation to reduce 780 FTEs [full time equivalents] 

from Health Affairs and TRICARE Management Activity. 

We streamlined TMA, TRICARE Management Activity operations and expanded the use of urgent care and nurse advice lines 

to produce better quality of care and more efficient care. 

So there have been a number of initiatives that have been implemented and continue to be implemented, and again I would remind 

the committee that between 2001 and 2008, the rise in cost of 

health care was about 11.8 percent per year. We are really desperately trying to bend that curve and produce all sorts of efficiencies, and that is why we have considered for fiscal year 2012 

a really balanced approach to bending that cost curve. Thank you. 

Mrs. DAVIS. I appreciate, you know, your response. And one of 

the things I was wondering about this, Surgeons General, could 

you just talk a little bit about the engagement of you all and 

whether you felt that there was adequate opportunity for people to 

weigh in on these issues? 

Admiral, did you want to—— 

Admiral ROBINSON. Yes, Congresswoman Davis. I think that the 

Surgeon Generals, all of us have been brought into the whole efficiency movement. I think that coming from Health Affairs, we have 

all been tasked to look not only at what we are doing externally 

with the five efficiencies that have been named, but also the internal approach. 

And it has been through, in my opinion, the Medical Home where 

all three services leverage some of the efficiencies that are occurring in terms of access to care for primary care, integration of specialty care, having a real provider-patient relationship 24 hours, 7 

days a week, decreasing urgent and emergency room visits, and 

having the ability to emphasize prevention rather than disease 

care. 

So, in the Medical Home Port model, what the Navy calls, the 

same model that, the Medical Home is what Air Force and Army 

uses also—I think that it is going to be one of those major efficiency moves in terms of quality of care. 
16 

Yes, ma’am. 

Mrs. DAVIS. I think my time is up. General, perhaps later we will 

have a chance for your response. 

Mr. WILSON. And thank you very much. 

Congressman Jones of North Carolina. 

Mr. JONES. Mr. Chairman, thank you very much. And my question will be directed to Admiral Robinson and General Schoomaker. 

I want to thank you first for your service, and the many times you 

have testified, and the fine work you have done for our military. 

I, like most Members of Congress, I have visited Walter Reed 

and Bethesda on a regular basis. And I make reference to this article of March 9th report reveals steep increase in war amputations 

the last fall. 

And it seems like the last year that I have had the privilege to 

visit the heroes at Walter Reed and Bethesda, that the severity of 

the wounds are deeper or more severe than ever. 

One being a kid that lost most of his lower body parts, the other 

being a sergeant first class who on a fourth tour in Afghanistan as 

he told me that day that he has always told the young marines to 

walk in the boot print in front. He did and it blew his leg off and 

other parts of his lower body were injured. 

My concern for those who are still in the military who are severely wounded as well as when they leave the military, but this 

panel today, and that is why I have to single out the admiral and 

the general for this answer, are you satisfied that we are where we 

need to be as it relates to psychiatrists in the Army and the Navy? 

Do we have an issue there that the government needs to really 

reach out and try to encourage those who are graduating from the 

schools, who are getting degrees in psychiatry, to look more at trying to come into the military? Or do you feel like the numbers are 

where they need to be? 

My concern is—I am going to let you answer in one sec—my concern is not only the young injured, but if they have a mom and dad 

or if they have a wife and children. My concern is that I want to 

make sure that they get the mental health care as well as the 

physical health care. 

General, I would go to you first and then the admiral second. 

General SCHOOMAKER. Well, mindful of the time, sir, I am going 

to say two things real quickly. First of all, not to minimize or in 

any way to marginalize the interest that you have in this complex 

injury pattern that you have seen, we have recognized the same 

thing. 

In fact, I have started up a task force a month or so ago to look 

in greater detail under the leadership of Brigadier General Joe 

Caravallo from the Southern Regional Medical Command and 

Brooke Army Medical Center. 

He has pulled a team together to look at the data and look at 

the magnitude of the injuries that we are now seeing. We are seeing a larger number as you have seen of complex injuries from dismounted operations in Afghanistan with more multiple limbs lost, 

and higher limbs with abdominal and genital injuries as well. 

We think this is the dark side of a good story. Soldiers and marines are surviving even more than they have in the past. The battlefield medicine is improving in all facets. 
17 

But what we get is a soldier, marine, sailor, airman who is very, 

very severely injured. And we are focusing now on what we need 

to do for them. 

As far as psychological care, this is a moving target. We have 

seen as Dr. Woodson talked about it, increasing utilization especially in behavioral health across all of our units and families. 

We have increased the number of behavioral health specialists, 

not just psychiatrists, but social workers, psychologists, our nurse 

psychiatric workers as well as our enlisted. 

The Army has allowed us to put more of them down into battalions and brigades. We continue to chase that; we are not satisfied 

as you pointed out. The need is still there. 

Mr. JONES. Admiral. 

Admiral ROBINSON. The entire nation has a real challenge with 

behavioral health needs. The military certainly has an even increased challenge. I would say that what General Schoomaker said 

is correct. I would ditto everything that he has said. 

We don’t have enough psychiatrists, psychologists, social workers, or nurse practitioners in the sense that I can always use more. 

If we look at the retention rates particularly with psychiatry, we 

are probably in the Navy at 72 percent. 

With that said, we have spent about $240 million in contracts. 

We have now about 144 more behavioral health contractors at 14 

of our MTFs [military treatment facilities]. 

We have billeted for an increase in social workers from 35 to 

about 86, which is a substantial increase. We are looking at each 

facet of behavioral health, who we have, where they are located, 

and how we use them. We also put them and we embed our mental 

health professionals with our operational stress control, our 

OSCAR teams, we put them with the deploying units so that we 

can get care to people that they need immediately. 

On the home front, we have FOCUS—or Families OverComing 

Under Stress. It is a focus, the program is called, in which we look 

at families and their behavioral health needs and the needs of the 

children and spouses, et cetera. 

So we are putting together, I think, across the Military Health 

System a comprehensive look. Is it enough? It is all that we have 

now. We can always do better. And this is the major challenge as 

I said in my opening statement, a continuing major challenge. It 

really is a moving target. 

We are trying to stay with it. And we will never leave those men 

and women behind. 

Mr. JONES. Thank you, sir. Thank you, Mr. Chairman. 

Mr. WILSON. Thank you. 

And it is a good story. In January, I visited a young injured marine, Corporal Kyle Carpenter. And Kyle has had dozens of operations. He was gruesomely injured. 

And he—last week it was on the front page, the newspapers 

across South Carolina appearing at the South Carolina Senate 

where he was on the floor. And all the members of the Senate welcomed him and shook his hand. And he was given a hero’s deserved 

welcome. 

Congresswoman Niki Tsongas of Massachusetts. 
18 

Ms. TSONGAS. Thank you all for being here. And I have to say 

I share Congressman Jones’ concern. But I too have a good story. 

Last week, I visited a young first lieutenant in the Army who 

had been injured by an IED [improvised explosive device] in Afghanistan. He had sadly lost the lower portion of his leg. But he 

was on a good recovery, yet another example of a very determined 

young man who wants to make the best of his service to our country and to the life that lies before him. 

So, I thank you all for the great work that you are putting in, 

in challenging times. But I will also wanted to start out by commenting on the Uniformed Services Family Health Plan [USFHP]. 

The USFHP had its genesis 30 years ago when the direct care system needed help to meet the health care needs of our military personnel, retirees, and dependents. 

And since then, as you all know, they have become the highest 

rated health care program in the Military Health System based on 

beneficiary satisfaction with a 90.4 percent satisfaction rate in 

2009. 

Their approach to patient care management with the focus on 

prevention and a continuum of care has improved clinical outcomes, decreased emergency room visits and hospital admissions. 

This health plan is a model for what we have been aiming to do 

as we all struggle with the rising cost of health care. So, I would 

urge that as a body, we give careful analysis to the impact of your 

proposals to shift its cost to Medicare for retirees. Simply a statement of concern. 

But I have a question, Secretary Stanley and Dr. Woodson. Secretary Gates has stated that, ‘‘Healthcare costs are eating the Defense Department alive.’’ And according to the US News & World 

Report, ‘‘Healthcare cost as part of the Defense budget have gone 

from $19 billion in 2001 to about $55 billion now, about a 10th of 

the total.’’ 

Currently the over 2 million military retiree families enrolled in 

the lifetime health insurance system, TRICARE, pay $460 per family per year for health insurance. And an individual pays $230 per 

year. As we all know, these fees have not been raised in 15 years. 

With this in mind, I do believe that Congress needs to take on 

the difficult task of reviewing this fee structure. It is an issue that 

will have to be dealt with because of the massive strain which has 

been placed on the defense budget by rising health care cost. 

However, I believe it must be done in such a way as to minimize 

its impact. It would be inexcusable to deprive our retired heroes of 

the health benefits they have earned. 

For Active Duty personnel, the Department has different annual 

deductible rates for TRICARE Extra and TRICARE Standard on 

the basis of pay grade. For example, under TRICARE Standard, 

the deductible is $150 per individual or $300 per family for beneficiaries at E5 and above and $50 per individual or $100 per family 

if the beneficiary is under E5. 

Retirement benefits vary greatly depending on how long a person 

served and at what rank they retired. 

One of the most significant changes made by the National Defense Authorization Act for Fiscal Year 2000 was a lifting of the 
19 

75 percent cap used in the calculation of retired pay for members 

eligible for service retirement. 

Under this calculation, a retired O10 with 45 years of service could earn over $210,000 per year before taxes in retirement. But 

an E5 with 20 years of service would earn only around $17,000 in 

annual retirement pay before taxes. 

Keeping this great gap in benefits in mind, I would like to ask, 

has the Department seriously reviewed any proposals for a stepped 

increase of TRICARE Prime fees determined on the basis of rank 

at the time of retirement and retiree benefits earned. 

Secretary STANLEY. Congresswoman Tsongas, thank you very 

much for the question. 

I am not aware of stepped increase look. The amount that was 

chosen was considered really a minimalist approach to addressing 

probably a longstanding issue of prices just not changing, or cost 

or charges being, you know, put onto the beneficiaries. 

If Dr. Woodson, I am not sure if you have heard anything on 

that. I haven’t. 

Dr. WOODSON. Thank you, Dr. Stanley. 

Thank you for the question. I agree that we haven’t looked at the 

step-wise increases because we have introduced very modest 

changes. And as an administrative process, it becomes more difficult to assess income and who should have the step-wise increase 

because of that. 

Even an enlisted person who retires after 20 years may actually 

enter a very good-paying job. And so what they actually make may 

not always relate just to their retirement pay. 

And I would just remind the committee members to reflect on the 

fact that our proposals suggest modest increases for working-age 

retirees. And so, we would probably have to means-test against the 

issue of what their total salaries are; it is conceivable that following retirement, as talented as our men and women are who 

serve, they contribute greatly, get advanced degrees, and may be 

doing quite well. 

So, administratively, it would be very tough to means-test. If we 

were proposing large fee increases, I would agree with you strongly. 

Ms. TSONGAS. Thank you. 

Mr. WILSON. Thank you, Ms. Tsongas. 

And we are very grateful to have distinguished freshmen on the 

committee. The first is Dr. Joe Heck of Nevada. He is actually a 

staff alumnus of the Uniformed Services University of Health 

Sciences. 

Dr. HECK. Thank you, Mr. Chairman. 

And Dr. Stanley, Dr. Woodson, Surgeons General, thank you for 

being here today and thank you for your commitment to our service 

men and women’s health and the health of their families. 

I am going to refer to the joint written statement of Dr. Stanley 

and Dr. Woodson specifically, Reserve health readiness. You have 

referenced the individual medical readiness metric that has been 

developed. And in your statement you quote—‘‘Within the Reserve 

Component, medical readiness is below our benchmarks.’’ 

And of course this is an area of great concern for me. And it 

raises several issues that I would like to bring up revolving pri-
20 

marily around the LHI [Logistics Health Incorporated] contract 

and how that service has currently performed for the Army Reserve. 

You know, as you well know, we have units in the Army Medical 

Reserve, MSUs, Mobilization Support Units, whose job it is to accomplish the medical aspect of soldier readiness processing when 

they get mobilized to their support base. 

However, they are prohibited from performing that very same 

service for their own Reserve counterparts on a BTA [battle training assembly] weekend. 

In your notes, you mentioned issues with minor dental procedures and immunizations being an issue that can be readily fixed 

in pre-mobilization or pre-deployment mobilization. Yet, in my unit, 

I have dentists that on a BTA weekend can go out and provide 

services to homeless people as a community service, but can’t examine the reservists that are in their own unit because it is prohibited because of the LHI contract. 

In immunizations, every fall, our immunization readiness plummets because a new flu vaccine comes out and everybody’s compliance falls off until everybody gets their flu vaccine. You would 

think that in a medical unit full of doctors, nurses, and medics, we 

could immunize each other. But we can’t even get the vaccine because we have to put in a voucher for LHI to come and do the immunizations. 

The issues here are multiple. One, as you well recognize, it impacts our medical readiness. Two, it impacts our ability to perform 

real world training. Certainly, our doctors and nurses are doing 

that in their day job. But my 68 Whiskeys, my combat medics, they 

could be a janitor, they could be garbage man, they could be a 

schoolteacher, and we are taking away an opportunity for them to 

actually do their medical training on a drill weekend. 

We send people to a PHA [periodic health assessment]. We send 

soldiers that are well and they come back to us broken. They go 

in well and they come back with a P3 profile. They are now medically non-deployable. And it takes us 6 months or more to backtrack and get that profile lifted because the folks doing these 

physicals don’t understand what the profile process is. 

I am encouraged by Major General Kasulke at AR–MEDCOM 

[Army Reserve Medical Command] who is starting a pilot project 

to review all these things and trying to find a way to take care of 

these mis-profiles. But the answer is not to have the person come 

back broken to begin with. 

So my questions are: I understand that the LHI contract is up 

for renewal. I would like to know who has the formal approval authority for that contract? Is the Army considering any other options 

or modifications to the contract? What is the overall cost? And how 

can we document whether or not the LHI contract has provided 

any value-added service to our medical readiness? 

Dr. WOODSON. Thank you, Congressman, for that very good question. And I would like to take that one for the record and get back 

to you with the substantive facts and answer you specifically. I 

think that probably it is time for review as we look at individual 

medical readiness and seeing how we can get added value out of 

all of the contracts that we employ. 
21 

[The information referred to can be found in the Appendix on 

page 131.] 

Dr. HECK. I appreciate that. And I think it is critical that we also 

look at the opportunities to allow—I mean, back in the old days— 

and I guess, for the record, I should probably disclose that the Honorable Woodson used to be my rater when he was Brigadier General Woodson at AR–MEDCOM. And I thank you for all those good 

ratings, sir. 

But, you know, we need to get back to the point where our Army 

Reserve medical personnel can do medical stuff on BTA weekend 

and maintain their skills. In the old days, we used to do all the 

physicals. And then all of a sudden there was an LHI contract and 

we were prohibited from doing those same things that we did for 

decades. 

So, I look forward to the answers for the record, sir. Thank you. 

General SCHOOMAKER. And, Congressman, if I could just make 

one comment. I think what you described also is why we stood up 

the Soldier Medical Readiness Campaign under mobilized reservist 

Rich Stone. And I would welcome the opportunity to have him 

come out and talk to you about that and what we are trying to do 

in partnership with both the Guard and Reserve. 

Dr. HECK. Okay, thank you, General. I appreciate that. 

Mr. WILSON. Thank you very much. And the issues that we are 

dealing with are so important for our service members, families, 

and veterans. In consultation with the ranking member, we will do 

a second round of one question each. But at this time, we immediately, of course, go to Ms. Pingree of Maine. 

Ms. PINGREE. Thank you very much, Mr. Chair, Secretary Stanley, Dr. Woodson and all of the Surgeons General. I really appreciate your service to our country, your testimony this morning and 

so much of what you have been talking about are things that I appreciate hearing about, whether it is how you treat traumatic brain 

injury or using alternative methods of care to find more ways to 

heal our soldiers, talking about the medical home concept. 

There are so many good things that you are doing. And I appreciate it, and I appreciate all the work that you have done. And I 

understand Chair Wilson’s concern about the recent appointment of 

the governor from my state, Governor Baldacci, and his interest in 

making sure we are doing everything that is as cost effective as 

possible. 

But I do want to say that Governor Baldacci has a great work 

ethic. He is very devoted to our military. He has worked very closely with the National Guard in our state to improve many of the 

practices in our state. So I look forward to him looking for some 

of the efficiencies that could be found. 

But I want to reiterate some of what my colleague from Massachusetts talked about earlier. It is a deep concern for me. I represent the state of Maine, and I am proud to represent many Active 

Duty members and their families as well as military retirees and 

their families. I have over 34,000 military families and retirees 

that are fortunate to have access to outstanding health care provided by U.S. Family Health Plan at Martin’s Point Healthcare in 

Maine. 
22 

I visited their facility. I have seen their use of the Medical Home 

model of care. The beneficiaries tell me how much they like this 

health care option. I mean, it has been said many times. This is 

exactly where we want to go with health care with our military retirees. And they are very happy, very satisfied about it. 

In March, I sent a letter to you stating my unequivocal support 

of how this program currently works and suggesting that I would 

oppose any changes that would negatively impact the ability of 

them to provide care to beneficiaries, including those aged 65 and 

over who have earned their health benefits through their service to 

our Nation. 

I am sorry to say, General Stanley, and with all due respect, I 

wasn’t completely pleased with your response. And now the fiscal 

year 2012 President’s budget request includes a proposed legislative provision that future enrollees would not remain on the plan 

upon reaching age 65. I am concerned about this proposal, that it 

would eliminate access for those in greatest need of care and their 

ability to receive what is the highest rated health care plan in the 

military. 

Let me just shorten up some of my conversation here because I 

know you know exactly what my concerns are and what I am talking about. But I want to reiterate that I am sure you know by law, 

the government cannot pay more for the care of a U.S. Family 

Healthcare Plan enrollee than it would if that beneficiary were receiving care from another government program. 

So I have a hard time seeing this as anything but a cost shift 

over to Medicare while destabilizing what is already a very successful program. So I guess I would like to hear you address that and 

also address my concerns that the destabilization of this program, 

in my opinion, isn’t consistent with DOD’s stated priorities of improved health management and the continuity of care. 

I am just not pleased about what we are doing here in the budget. I understand the importance of cost efficiencies, but, to me—and 

I guess it is a little smoke and mirrors and maybe not going to be 

good for the long-term health care of the people of my state. 

Secretary STANLEY. Thank you for the question, Congresswoman 

Pingree. I think, as we look at what we are proposing, that each 

hospital that we are working with particularly with the Family 

Health Plan that we are going to be working very closely with 

them because the changes first of all may be minimal in some cases 

or almost barely perceptible initially as we work, as we look at how 

the Medicare, you know, the funding is worked out because you 

really don’t want to just unplug and move right into something 

that becomes a cost shift. 

At the same time, we are trying to address something that had 

not been addressed for a number of years in terms of how we, you 

know, work with the cost and everything. So the bottom line is we 

are going to work with them. 

And I hear your concern and I recognize your concern. And we 

are going to do our very best to work with them. I am going to ask 

Dr. Woodson to address this also. 

Dr. WOODSON. Thank you very much for that very important 

question. I think the issues that we need to remind ourselves of is 

that this is not about taking a beneficiary away from their doctor. 
23 

They can continue to see their doctor. They can continue to go to 

the same hospitals. But we pay about $16,000 per member per year 

in capitated fees to the Uniformed Services Family Health Plans. 

And it is important to note that their plan is not just about hospital fees, but it is about the money that is also paid to their primary care physicians, whereas, the cost to the government for, let’s 

say, TRICARE Prime is about $4,500 and for TRICARE Standard 

is about $3,500. Just good business practice in this day and age 

would suggest that we have to get better value for the dollar. 

Now, I want to say up front that we consider all of these facilities 

and providers that are in the Uniform Services Family Health Plan 

as great partners. We don’t want to lose them. I just think that in 

these tough times of budget constraints and rising health care cost, 

we look at contracts everywhere and say how can we get the best 

of value. 

The proposal actually will save the entire Federal Government 

about $300 million over about 10 years because right now, of 

course, we pay about 42 percent higher in cost than we would pay 

under Medicare fees. I remind you also that most of the individuals 

that are Medicare eligible actually have taken already on part B. 

Ninety percent or so all ready have part B because if they were 

to move or circumstances in their life cause them to shift to other 

doctors, if they don’t take it on at age 65, they pay severe penalties. 

So the impact to any individual patient is likely to be not that dramatic as well. 

So it is about being good stewards of public money. It is about 

preserving money for the future and making sure that the Military 

Health System and the provisions under TRICARE remain strong 

in the future for those who might serve in the future and bringing 

equity, if you will, to the benefits for all Medicare eligible beneficiaries as well as equity in terms of how we pay all of our providers and hospitals that may serve our men and women who have 

served. 

So there are multiple reasons to really consider this. And I think 

again, it is one of those modest changes that on the balance says 

that we have looked at a number of initiatives to produce efficiencies. 

Ms. PINGREE. My time is up, but thank you. I am sure—— 

Mr. WILSON. And, Ms. Pingree, we will get back to another question, too. So thank you so much, very good question. 

And as we conclude this first round, it is very fitting that we 

have another distinguished freshman, Colonel Allen West of Florida, who himself has had an extraordinary record of military service. 

Colonel West. 

Mr. WEST. Thank you, Mr. Chairman, also Madam Ranking 

Member, the Honorable Stanley, Honorable Woodson, General 

Schoomaker, General Green, and Admiral Robinson. Thank you so 

much for appearing here today. 

We talked about the visible injuries that we see coming out of 

the combat theaters of operation in Iraq and Afghanistan, but one 

of my concerns is the unseen injury and, of course, that is traumatic brain injury, TBI. 
24 

I have had the opportunity to visit with a gentleman by the 

name of Dr. Ray Kraul down at South Florida who has been offering hyperbaric oxygen treatments to several returning veterans. I 

have had the chance to sit down with three of them and we have 

seen some noticeable improvements. 

About 3 weeks or so ago, I had the opportunity to sit down and 

have lunch with Vice Chief of Staff General Chiarelli, and we 

talked about the opportunities and the options of the hyperbaric oxygen treatment. One of the things he said is that there are some 

obstacles out there to the implementation of this as a viable treatment for returning veterans. 

And so I would like to know what are those obstacles that are 

out there and how can this committee help to, I guess, eradicate 

some of those obstacles so we can facilitate taking care of our veterans? 

General SCHOOMAKER. Well, I don’t think there is anything that 

the committee can necessarily do for this, Congressman. Thanks for 

that question. Hyperbaric oxygen is currently an FDA [Food and 

Drug Administration] regulated treatment. It is not currently approved by the FDA for treatment of either concussive brain injury 

or for post-traumatic stress disorder. 

We have offered through your generous funding any and all investigators out there who are administering hyperbaric oxygen to 

design and administer protocols that would test and demonstrate 

the utility of this. We finally undertook those investigations ourselves. We have currently three projects. One has been completed 

at the LDS Hospital in Salt Lake City by an international expert 

in hyperbaric medicine, Dr. Lin Weaver. 

Its results on a non-randomized and uncontrolled study show 

that hyperbaric oxygen appears safe at this point for patients with 

moderate and stable brain injury. We currently are awaiting the 

results of an Air Force School of Aerospace Medicine study that has 

just been concluded that is controlled and sham controlled so that 

we can see what the effect of the hyperbaric oxygen is against a 

semblance of that administration of oxygen, but without it. We 

have yet to see what the results of that. And we are awaiting a 

more definitive study that will be overseen by the Army’s Medical 

Research and Materiel Command that will include four or five sites 

across the country, military and non-military. 

So the summary of all of this is that despite a series of published 

and unpublished anecdotes, there really remains no medical evidence that hyperbaric oxygen has a therapeutic role in the relief 

of symptoms of—or brain dysfunction for warriors with post concussive syndrome, or mild traumatic brain injury, or posttraumatic 

stress disorder. 

And until we have that, we just can’t in good conscience provide 

care which is quite expensive without knowing its ultimate safety 

and its utility. 

Mr. WEST. Well, I guess the thing is when you sit down and you 

do speak to some of these young men as I have that say that it has 

made a difference, I think that is some pretty good anecdotal evidence for myself. 

But, you know, perhaps, Mr. Chairman, we ought to look at seeing if we do need to send a letter over to the FDA and ask what 
25 

impediments that they are making. But we cannot, you know, take 

too much time because every day some soldier, sailor, airman, marine is going through an IED blast. And these IEDs continue to 

cost much injury as far as TBI. So, hopefully, we can put a little 

bit more emphasis and a little bit more speed to this. 

Thank you very much and I yield back. 

Mr. WILSON. Thank you, Congressman. I look forward to working 

with you in a joint letter or whatever. And I appreciate your promotion of this issue. 

We will now have a second round with everyone, a single question. And, for me, so often we hear the bad, but there is so much 

good. And military medicine really has been the best in the world 

providing for care of people with brain injuries and trauma injuries. And this applies to the civilian world of auto accidents and 

these who are people who are injured in sports injuries, additionally, prosthetics, truly the best in the world now, our American 

military medicine and available to the civilian population. 

With this, I would like to know from each of the Surgeons General what you have done in regard to cost efficiencies. Can you give 

us an example of a cost efficiency on behalf of the taxpayers of our 

country. And we will begin with General Schoomaker, the senior 

person and then we will end up with the junior general. 

General SCHOOMAKER. Sir, what we have focused on a lot within 

Army Medicine is standardization of practices, both administrative 

and clinical practices. It has been widely discussed both in the private sector as well as in government medicine that elimination of 

unwarranted variation in practices—clinical practices and administrative practices—will squeeze out a lot of waste in the system. 

We have focused very hard on that. We have also used a business case model for all of our hospitals and clinics in which commanders are encouraged to target health promotion and health improvement as a way of preventing preventable hospitalizations, ER 

visits and the like. 

And, finally, I would say that all of us here—and we commend 

the Air Force for their lead on this—have embraced the PatientCentered Medical Home, which we think is going to be transformative in bringing into the primary care sector both ready access continuity, because many of our patients seek continuity 

where we think they are looking for access alone, and a fusion site 

for behavioral health, for pain management and many of the other 

things that we are doing that will ultimately result I think in better and healthier people, better and healthier communities and reduction and cost over all. 

Mr. WILSON. Thank you. 

Admiral. 

Admiral ROBINSON. Thank you very much for the question. In 

addition to what General Schoomaker said—I am not going to repeat that—many of the Navy initiatives are along the same line. 

We have also taken some internal looks. And partnering with the 

Applied Physics Lab at Johns Hopkins and also the Center for 

Naval Analyses, we have come through and looked at business 

practices and also clinical practices in our medical treatment facilities across the enterprise. 
26 

We are taking an enterprise approach, having industrial engineers come through, look at the orthopedic departments and how 

we have patient flows at Balboa or Camp Pendleton, how we have 

access to care for the patient, how we then work them through our 

system, how we could do that more efficiently, not only from a patient perspective, but also from a provider perspective. 

I am talking about from the corpsman, from the nurses, from the 

physicians, from everyone on that team. So we are trying to take 

an enterprise look at how we can implement that across the board 

and doing what Eric said in terms of the standardization of practice so that we can reduce the variation. 

Additionally, in the financial world and I, not being a financial 

expert, am blessed to have a really excellent Navy Medicine controller who has instituted a great deal of effort at standardization 

of how we in fact do our financial accounting, how we do our audits 

and how we look at the financial program’s execution. He has been 

sensational and there is so much more that I can’t describe, but he 

has been sensational and has become a real best practice for not 

only the Department of the Navy but also the Department of Defense. So he is being utilized and a lot of his programs are being 

utilized there. 

Those two business practices, that industrial engineering and the 

way we do our financials across the gamut within Navy Medicine 

have produced efficiencies and savings that have really made a 

much better enterprise approach to the way we do Navy Medicine. 

Mr. WILSON. Thank you, and General. 

General GREEN. We have looked at several different things. We 

actually decreased our headquarters manning to increase the manning back to the hospitals trying to recapture care. We have looked 

at standardizing our practice. Part of the Medical Home was to basically look at support staffing ratios and put some of the nursing 

staff back into hospitals again, based on business case analysis to 

bring the care back in. 

We have had systems looking at our ORs [operating rooms] and 

at our emergency rooms basically trying to maximize the efficiency 

to increase access. We have seen at some of our bases as much as 

a 40 percent increase in the surgical cases that can go through our 

ORs by recapturing care. Under the Patient-Centered Medical 

Home, the satisfaction is up, the continuity jumps from about 40 

percent to 70 percent, and we end up encouraging the providers to 

work at the top of their license based on changes to their practice. 

I would tell you that the partnerships that we are doing are 

based on bringing care back into the direct care facilities, both for 

currency and to decrease cost in terms of what is going to the private sector. And finally, the efforts in disease management and 

case management across all three services are reducing care cost. 

In fact, in one case out at Hill Air Force Base we have saved probably $400,000 in reduced utilization by diabetics based on the output and the efforts to try to case manage. 

Mr. WILSON. Thank you all very, very much, and Mrs. Davis. 

Mrs. DAVIS. Thank you, Mr. Chairman. One thing that I would 

like to mention is I hope that we will have an opportunity to look 

at mental health issues overall, whether or not we are providing 

the support to encourage people to go into those fields and also a 
27 

look at some of the research and development that has been done, 

and whether or not we are utilizing those dollars well and coordinating those efforts in a way that we really do know what has happened over the last number of years, because we have certainly put 

a lot of effort into that and I would like to take a look at that and 

see how it is really affecting our service members and their families. 

But I wanted to go back to Ms. Pingree’s question, I think generally because the new proposal really could have an impact on our 

Active Duty members and because there is in the proposal we are 

reducing possible payments to Sole Community Hospitals, and 

those hospitals may of course decide to limit TRICARE participation due to the reduced rates. And so I am wondering, and this 

goes really I think to General Green, whether or not the Air Force 

has particularly engaged with Sole Community Hospitals outside of 

Air Force bases to assess the impact of this proposal on the beneficiaries in those communities, and if you are confident that the 

proposal will not severely impact them. 

In addition to the concerns that I think a lot of our Members are 

going to have because there are certain Members, communities 

that are more affected by this than others, we also know that those 

hospitals that have many cases of disproportionate share hospitals 

also even in urban communities might be affected by this. So I am 

wondering if you could address it, General Green and perhaps others quickly. What do we know about that and what can we anticipate could be the impact on our beneficiaries? 

General GREEN. Eight of the 20 hospitals that have over 5 percent of their income based on admissions are from Air Force areas 

and so, when you look at those, about 4 of those facilities actually 

are in the 10 percent to 15 percent range for us. We are not the 

highest, but it is a concern. 

The reality of the implementation is that we have had longstanding partnerships with these organizations. We believe that 

the care will still continue to go to these organizations. As you 

change the payment and bring it in line with payment elsewhere 

in the country in terms of how we receive care, we believe that the 

implementation is conservative enough in terms of the basically 

bringing online over a 4-year period that we can look at it, work 

with the local facilities and if necessary, work with Health Affairs 

in terms of any type of transitional changes in payments to make 

certain that this is sustainable. 

Our belief is that this is a reasonable approach to try and bring 

this back in line with what is going on elsewhere in the Nation and 

obviously remains to be seen, particularly with these hospitals 

where it is a large portion or a larger portion of their income. 

There should be no effect on our beneficiaries because their care 

would still go to the same areas. They just would be at the rate 

of payment that is provided at every other site where they might 

go and seek care if they were out of that area. And so the question 

is going to be does it end up affecting the facilities to the point 

where despite the long-term partnerships, they feel they have to 

change the mix of patients, and so we will be watching that very 

closely. 
28 

General SCHOOMAKER. Yes, I would echo those comments. Two of 

the 20 are Army-centric including a hospital in the community that 

our Secretary of the Army represented at one point, and I think everything that General Green said applies to the Army as well and 

we have been reassured by Dr. Woodson that the financials of this 

will be looked at very carefully and that we won’t erode the relationship that we have with these hospital systems. 

Dr. WOODSON. Thank you for that question. I think I want to emphasize that we are willing to reach out proactively to these hospitals to look at their revenue streams and how they will be impacted. We do have the ability as the law is allowed to pay Medicare rates when practicable and if it turns out in a situation that 

there is hospital that is providing needed services and there are no 

other hospitals, adjustments can be made. So I want to emphasize 

that in fact we are going to be proactive about this. We want to 

be fair about this. But again, we need to in this day and age, make 

sure that all of our contracts are really looked at carefully and add 

value and—as well as quality in terms of the care that is provided. 

Mr. WILSON. Thank you very much. We now go the Mr. Jones. 

Mr. JONES. Thank you, Mr. Chairman. And my question in just 

a moment would be for you Admiral Robinson. I appreciate the 

question by Congressman West. I remember 10 years ago I think 

I was briefed by Dr. Harch from LSU about hyperbaric oxygen as 

a treatment for head wounds. And I know I had a conversation a 

couple of years ago, I cannot remember the Air Force officer, about 

where the research is going and I appreciate your statement, General Schoomaker, that my concern or interest is this—Admiral Robinson, I know that—and I want to thank Admiral Mullen. 

Quite frankly, I brought this up at a full hearing about a year 

ago about hyperbaric chamber down at Camp Lejeune. We do have 

one at Camp Lejeune. And I believe that they are in the process 

now preparing to be part of a pilot program to treat marines down 

at Camp Lejeune which I am grateful for. 

Help me understand when—I understand the need for studies, 

please understand I do realize they are very, very important. But 

when would the military get to a point after the study by the Air 

Force, maybe the Army, I don’t know that. Maybe the Navy as 

well. When did you get to a point that the studies say and I will 

tell you why, then I am going to let you answer, I have called numerous moms and dads whose sons and a couple of daughters had 

been in the hyperbaric chamber for treatment. What really sticks 

with me and I want to use this before and then you answer please, 

sir. 

I called Colonel Bud Day who won the medal of honor in Vietnam, and he told me that his grandson had a severe brain injury 

from Iraq I believe at that time, and he was just not satisfied with 

the treatment, and at his own expense, he sent his grandson to 

LSU to Dr. Harch and I know I will never forget what Colonel Day 

said to me. He said that, ‘‘I will go anywhere I need to go to testify 

that this treatment has given my grandson a quality of life that he 

would never have had if he had not had the hyperbaric treatment.’’ 

So now this—was the question—I just remember. When do we 

get to the point that we say, meaning Department of Defense, that 

this protocol does help, it does work? 
29 

Admiral ROBINSON. Congressman Jones, thanks for the question. 

This has been for me as a Surgeon General of the Navy a 4-year 

question. We have looked at hyperbaric oxygen and Dr. Harch who 

has been at several meetings and I have met him many times and 

looked at his results. 

We have invited him to come through and participate firsthand 

in our double-blinded studies so that we can get away from the anecdotal results of individual patients, families, and other anecdotal 

lessons, and we can get down to what we have to have from an objective and a definitive way so that we can base clinical practice 

guidelines both for the Military Health System and also for the private sector. We need to base those therapies on objective clinical 

data that cannot be influenced by opinions of people who have benefited, but we can’t prove that benefit in a scientific way. So we 

need to employ a scientific method. 

What we have done, and I can say that after in my fourth year 

as Surgeon General, we now have studies—we are now beginning 

to produce data from competent studies that look at, number one, 

hyperbaric oxygen seems to be safe, so I think that that is a clear 

improvement in terms of our knowledge. And now we need to go 

and look more deeply at the Air Force study and that study has 

been completed, but the analysis has not been done. So I think we 

are very, very close to getting more data. 

I think when we can get some studies on the record that actually 

look at the efficacy of hyperbaric oxygen therapy, I think at that 

point we can simply say, that is an effective treatment, it is not an 

effective treatment, but it is a treatment that can be utilized in 

complementary medical ways so that people who may benefit from 

it can use it, it certainly not going to harm them. We will have an 

array of answers. 

I think we are literally months away from getting there, but it 

normally takes—and this is one of the issues with medicine—it 

normally takes time to get to where we need to be and we have 

to base it on a scientific method unless, in order to keep from having everything become a clinical practice guideline, things that are 

not proven. So the scientific method is being utilized in this way. 

Mr. JONES. Thank you, Admiral. Thank you, Mr. Chairman. 

Mr. WILSON. Thank you and next we go to Ms. Pingree of the 

great state of Maine. 

Ms. PINGREE. Thank you, Mr. Chair. Thanks for the opportunity 

to discuss these issues with you again in a second round. And I just 

want to say again, I understand how well you are all doing your 

job and the importance of all of you looking for cost efficiencies in 

what you do as we face a difficult time with the budget deficit. And 

also where there is a lot of examination of the military budget and 

looking for places where we can cut. 

And maybe my first comment really is more to my fellow committee members than to all of you, but I might see more places to 

cut the fat in the military budget than others of my colleagues, but 

I am deeply concerned that we are going after medical care for both 

our Active Duty personnel and our retirees when I think there are 

other places to make more effective cuts. So I know you have to do 

your job and look for those cuts, but almost everything that is before us today, either myself or one of my colleagues has mentioned 
30 

a concern about, whether it is the changes to TRICARE, how we 

are going to deal with some of our Sole Community Hospitals. I 

have two in my district, there are four in our state of only 1.2 million people in a state where we have almost a fifth of our citizens 

are either Active Duty or retired military. 

So there is a very big dependence on this system in our state and 

I am worried about that particular program. So for me, many of the 

efficiencies that you are talking about are going to reduce the level 

of medical care to the people who have served us, to whom we have 

made a huge promise. And there is going to be, I think, a reduction 

in the services that they receive, so I just—I know you have to do 

your job, but I don’t like it and I don’t think it is all necessarily 

good. 

And the only other program that hasn’t been brought up today 

but I might ask you to comment on is the pharmacy co-pay. I have 

seen a little bit about that and know that some of the co-pays will 

be reduced through using mail order pharmacies. I have concerns 

about that as well because I do believe that people get better care 

when they go directly to a pharmacist in their community, that is 

where we catch a lot of redundancies or problems with the medications that people are taking, particularly with retirees. 

So, in my opinion, having to go to mail order to get your pharmaceutical products is not necessarily always good treatment or good 

service. And one of the things I might ask is how much the Department is doing to negotiate for better prices with the pharmaceutical 

companies and bringing costs down in that way as opposed to this 

other option? That was my question, if you have got any comments 

about that. 

Dr. WOODSON. We continue to have efforts to negotiate with 

pharmaceutical companies. I think in fact that the mail order advances care because there is a large percentage of retail prescriptions that are never picked up and there are breaks in terms of the 

supply of medications. 

Our proposal not only reduces the cost, but it ensures timely supply of medicines and, of course, linked with our concept of the Patient-Centered Home, they have a team of health care providers 

that can counsel, coach, monitor their medicines. We have new 

electronic databases that highlight medication to medication interactions and notify practitioners of medications that may be unsafe. 

So, I think there are a number of things that we are doing that 

are going to enhance the quality of care while reduce the costs and 

provide a better service for the beneficiaries. 

Ms. PINGREE. I appreciate your perspective on that. That is useful information in thinking about the program. Back to the question of negotiating, is that an active activity that goes on today, to 

negotiate for cost-cutting? We still continue to pay some of the 

highest prices in the world in this country for prescription drugs 

and I know the military has done a better job of bringing down the 

costs, but I just—I wonder how engaged we are in the process and 

how much resistance there is to it? 

General SCHOOMAKER. Ma’am, I am told that is a commodity 

that is managed through the Defense Logistics Agency and the center in Philadelphia. And I am told that the Department of Defense 
31 

has some of the most favorable cost profiles of any organization in 

the United States because of our—because of leveraging volume. 

Ms. PINGREE. Great. I will take up that issue with them. Thank 

you again for your answers today. 

Mr. WILSON. Thank you and I share your appreciation of local 

pharmacists too. We will conclude with Dr. Joe Heck. 

Dr. HECK. Thank you, Mr. Chairman. And not to belabor the 

issue, but I am going to go back to TBI. First, I appreciate the Surgeons General and the academic rigor with which their reviewing 

the HBOT [hyperbolic oxygen therapy] issue and please, I encourage you and implore you to keep that academic rigorous approach 

before we make a determination on its application. 

No matter how that turns out and no matter what treatment 

process we have in place for TBI, my biggest concern is identifying 

the soldier, sailor, airman, marine who has TBI. Based on my deployment to Iraq, when young guys were getting their bells run so 

many times that they had the MACE [Military Acute Concussion 

Evaluation] card memorized, it no longer became a valid screening 

tool because they knew the answers before I asked them. 

When I came back, it spurred me to write my joint forces staff 

college paper on TBI entitled ‘‘Re-thinking the Treatment Paradigm’’ and that was 3 years ago last month. I don’t think we have 

come that far in 3 years, as far as we should have, in being able 

to recognize folks suffering from MTBI [mild traumatic brain injury]. 

I know there was an initiative underway that everyone pre-deployment was supposed to get cognitive assessment, the ANAM 

[Automated Neuropsychological Assessment Metric] or equivalent. 

Where are we in that process in making sure that everybody before 

they deploy has a baseline cognitive assessment done so that we 

can find the small changes when they come back. 

And then specifically going back to my heart of hearts in the Reserve side of the house, it seems it is the reservists that are getting 

lost to the follow-up. They get home, get irritable. The spouse or 

family member saying, ‘‘Well, he is just reintegrating. We got to, 

you know, this is his re-acclimation process.’’ Three months later, 

he is still irritable and then somebody starts to think, ‘‘Well, maybe 

it is something more than just he has been gone for a year.’’ But 

by that time, we have lost 3 months of intervention. 

So again, the status of the cognitive assessment pre-deployment 

and what are we doing to make sure we don’t lose reservists to follow-up or it just gets brushed aside as they are just getting reintegrated or re-acclimated. 

General SCHOOMAKER. Let me take a stab at this if I might, Congressman. First of all, I think we have come a long way in the last 

few years especially with the publication as was referred to earlier 

of the decision type memorandum. 

Early in the war as you may recall, we had clinical practice 

guidelines in the battlefield, but they were not mandatory in their 

application and we failed to recognize that the soldier, the marine, 

the sailor, the airman who was actively engaged in battle and was 

part of the team was very reluctant to leave formation, and would 

celebrate their survival of an IED but then would go right back in 

the fight. 
32 

We now have a mandatory screening tool down range. In our recent trip to Afghanistan, we looked at its application and how well 

we are complying with it. We are seeing very good acceptance by 

combatants, by their small unit leaders, all the way up to General 

Petraeus himself. And with resiliency centers such as the one that 

Admiral Robinson mentioned, and we have seven in eastern Afghanistan and southern Afghanistan, we are seeing rapid turnaround. 

So, we have mandatory screening of a clinical diagnosis only, as 

you know, at this point and then we apply tools like the ANAM, 

the Automated Neurocognitive Assessment Module, to do longitudinal tracking of whether they are recovering. We have done studies now with the ANAM down range with fresh casualties to be 

able to know that as a screening tool, it is insensitive and nonspecific. It misses about a quarter to a third of those who are concussed and it includes about 50 percent of people who aren’t concussed. 

We are doing a head to head evaluation between the ANAM and 

the impact tool that the National Football League uses and so 

many high schools use right now. But you are absolutely right. 

Right now, we have no single definitive test for the diagnosis other 

than the clinical diagnosis of concussion. But we are being very 

much more aggressive. And right over the horizon we see biomarkers and other tools that we think will be useful. 

Dr. HECK. Thank you very much. Admiral, did you want to answer that? 

Admiral ROBINSON. I think that General Schoomaker was very 

comprehensive. I will add one piece. We also have the NICOE [National Intrepid Center of Excellence] and the Defense Center of Excellence that is devoting a great deal of research efforts both in the 

basic science areas and in the areas of trying to understand how 

we can diagnose and then how we can assess and treat traumatic 

brain injury. 

Now, I am not going to mix the two, but PTS is also there and 

it is on the continuum. But I am going to stay with the TBI. So 

I think that we are not only doing the in-theater assessments, we 

are reporting the data, we are actually compiling data, reporting it. 

I think that General Schoomaker has emphasized the concussion 

part because concussion as a clinical diagnosis is at least something we can diagnose and follow as opposed to just TBI which becomes a little bit more difficult to define and understand. 

But with the ANAM and with the MACE, with our professionals 

trained, with the Uniformed Services University deployment psychology group training our professionals, just in time training as 

they go over into theater, and with adequate data, having the concussion restoration centers, multicomprehensive teams, I think we 

are going to get at least a look at who has been involved, how we 

can do a longitudinal look at them and make sure that we can at 

least follow them even if we can’t do a lot in terms of understanding how it works now. We don’t understand this completely, 

but we are not going to let it go. 

Mr. WILSON. Thank you and I would like to again point out how 

much we appreciate all of you being here today, particularly General Schoomaker, Admiral Robinson. We want to wish you God-
33 

speed in your future endeavors and again, I think it has been so 

illuminating and we want the best for our military, military families and veterans. 

At this time, we are adjourned. 

[Whereupon, at 11:48 a.m., the subcommittee was adjourned.] 

A P P E N D I X 

MARCH 15, 2011 

PREPARED STATEMENTS SUBMITTED FOR THE RECORD 

MARCH 15, 2011 

(39) 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 
51 
52 
53 
54 
55 
56 
57 
58 
59 
60 
61 
62 
63 
64 
65 
66 
67 
68 
69 
70 
71 
72 
73 
74 
75 
76 
77 
78 
79 
80 
81 
82 
83 
84 
85 
86 
87 
88 
89 
90 
91 
92 
93 
94 
95 
96 
97 
98 
99 
100 
101 
102 
103 
104 
105 
106 
107 
108 
109 
110 
111 
112 
113 
114 
115 
116 
117 
118 
119 
120 
121 
122 
123 
124 
125 
126 
127 
128 
WITNESS RESPONSES TO QUESTIONS ASKED DURING 

THE HEARING 

MARCH 15, 2011 

(131) 

RESPONSES TO QUESTIONS SUBMITTED BY DR. HECK 

Dr. WOODSON. The contracting authority for the contract is the U.S. Army Medical Research Acquisition Activity; the office of the Deputy Assistant Secretary of 

Defense for Force Health Protection and Readiness administers the contract. (The 

Reserve Health Readiness Program (RHRP) is a Department of Defense (Health Affairs) program developed by Force Health Protection and Readiness, and executed 

by its contractor, Logistics Health Inc. (LHI).) 

Unless the Service Components request new services (for example, mental health 

assessments) to augment their readiness, we do not plan to modify or re-compete 

this contract at this time. The Reserve Health Readiness Program (RHRP) contract 

for medical and dental readiness services was awarded to Logistics Health Inc. in 

September 2007, after a full and open competition, for a base year and four option 

years. The contract is currently in its third option year. The fourth option year, if 

exercised, will conclude at the end of September 2012. 

The contract for the five-year period is capped at $790,295,941(the total value of 

the orders against the contract cannot exceed that amount). 

We can and have documented such value added. 

According to the most recent data from the Office of the Surgeon, U.S. Army Reserve Command, readiness rates have never been higher. From October 2008 to 

March 2011, the percentage of Army Reserve soldiers with a current Periodic Health 

Assessment (PHA) has risen from 45 percent to 88 percent; achieving dental readiness rose from 53 percent to 75 percent; and current immunizations increased from 

34 percent to 79 percent. The percent that are medically ready to deploy immediately or within 72 hours has similarly risen from 24 percent to 64 percent. 

Overall, the RHRP contract provides a broad array of services in response to requests by the Service Components to assist them in achieving medical readiness. 

The contract provides the PHA, Post-Deployment Health Reassessment, Mental 

Health Assessment, dental exam, dental treatment, and other Individual Medical 

Readiness services that satisfy key deployment requirements and supplement the 

Services’ own efforts. Services are provided at the request of the Reserve Components and implemented per their guidance. The annual dental examinations, annual 

PHAs, and current immunizations for each Service member are required Department of Defense elements for medical readiness. 

For Fiscal Year 2010, RHRP providers addressed approximately 650,000 reservists and guardsmen across all Military Services—conducting 218,000 dental examinations, 255,000 PHAs and 372,000 immunizations. Each of these adds value to 

medical readiness. [See page 21.] 

QUESTIONS SUBMITTED BY MEMBERS POST HEARING 

MARCH 15, 2011 

(135) 

QUESTIONS SUBMITTED BY MRS. DAVIS 

Mrs. DAVIS. Several of the reserve components continue to see issues with medical 

readiness of its force. To ensure the readiness of its force, the Air Force National 

Guard and Reserve requires its personnel to be medically ready or they are not allowed to participate in drill or training exercises. Should this requirement be extended to the Army, Navy and Marine Corps? If not, what efforts should be undertaken to ensure the medical readiness of the reserve component? 

Secretary STANLEY. No, not at this time and we do not recommend any change 

to the current policy. Preventing service members from attending drill or AT may 

compound the problem. Many commanders use these active duty periods for readiness activities that include medical and dental appointments. There are also certain 

aspects, such as annual preventive health assessments (PHA), which require members to meet face-to-face with military health providers. 

Mrs. DAVIS. If not, what efforts should be undertaken to ensure the medical readiness of the reserve component? 

Secretary STANLEY. The instructions may be drafted to ensure members can drill 

or be placed on orders to complete their medical/dental requirements, but will not 

drill for training until the issues are resolved. 

Reservists may be placed on military orders for the purpose of receiving military 

medical/dental evaluation, or examination. Reservists receiving medical/dental care 

during a tour of duty will be voluntarily retained on Active Duty orders to continue 

treatment. Reservists not on military orders may be placed on invitational travel orders when directed by appropriate military medical authority to receive an examination or evaluation by military medical/dental facilities to meet military requirements. Invitational travel orders may also be issued to those reservists receiving 

military medical/dental care at military medical treatment facilities for the purpose 

of medical/dental appointments. 

Reserve or Active Duty medical units do not extend, authorize the extension of, 

or issue military orders, or invitational travel orders. Order issuance or an extension 

is the responsibility of the commander. 

Mrs. DAVIS. Can you explain what impact the current continuing resolutions are 

having on the Military Health System and on your particular Service? 

Dr. WOODSON. While the Department worked vigorously to ensure that such stopgap funding measures would not directly impact patient care, the resolutions create 

inefficiencies hinder effective planning efforts and exacerbate the operational challenges associated with supporting mission requirements. For example, to limit the 

level of expenditures during the continuing resolution periods, the MHS undertook 

several actions including delayed hiring actions, restricted acquisitions, deferred life 

cycle replacements of medical equipment, and limited supply replacements. 

Mrs. DAVIS. Health care costs of the Department continue to grow, and is a concern both to the Department and the Congress. Can you break down for the subcommittee, the cost growth figures over the past ten years? For example, could you 

determine how much of the health care cost growth is due to the increase in end 

strength for the Army and Marine Corps over the past several years, vice an increase in health care utilization among the population vice an increase in eligible 

beneficiaries returning to the system? If so, would you please provide that information to the subcommittee? 

Dr. WOODSON. Excluding Overseas Contingency Operation (OCO) funding, health 

care costs for the Department grew approximately $30 billion from Fiscal Year (FY) 

2000 to FY 2010. 

Generally speaking, 35 percent of that increase was due to medical inflation; 36 

percent was due to congressionally mandated benefits (with TRICARE For Life 

being the major contributor); 10 percent was due to the higher percentage of retirees 

and their families who are now using the Military Health System (MHS) as their 

primary coverage; and 20 percent was due to higher utilization and greater intensity 

of care among beneficiaries using the MHS. 

Over that ten-year period, the number of beneficiaries unrelated to OCO funding 

has remained relatively stable or slightly declining, so the effect of total population 

was a small (less than 1 percent) reduction. However, the reduction would have 
136 

been greater if the Army and Marine Corps end strength had not increased. Those 

increases have returned 1 to 2 percent of the population to the overall growth. 

Mrs. DAVIS. What are the strategic issues that the subcommittee should be looking at to ensure the success of the military health system? 

Dr. WOODSON. The leadership of the Military Health System (MHS) has developed 

a strategic framework around which we assess our performance across four critical 

priorities: Readiness, Population Health, Patient Experience and Cost. 

For each of these priorities, we have developed a series of specific goals, metrics 

and measures. At the center of our framework is readiness—our primary mission 

and obligation. There are two core questions pertaining to this priority: (1) Are the 

members of the Armed Forces medically ready to engage in combat (or non-combat) 

operations? (2) Are the medical forces ready to provide the full-spectrum of medical 

operations worldwide? 

Based on our experience this past decade, we believe the answer is ‘‘yes’’ to each 

of these questions. We recognize that sustaining top performance requires continuous investment in medical research, technology, education and information, modernization and human capital management. 

Our other strategic issues—population health, patient experience, and responsibly 

managing the cost of care—are interdependent priorities. We measure performance 

against ourselves over time and against leading civilian standards in each of these 

areas. Fundamentally, we must improve the health of our population in order to better manage costs. Cost control is nearly impossible with a population engaging in 

unhealthy behaviors, and we are seeking to change behaviors for all 9.6 million of 

our beneficiaries. 

Mrs. DAVIS. Nearly two years after the original protest was filed, the Department 

recently announced the T3 award in the South, which has been protested again. 

What efforts is the Department taking to ensure that lessons learned from T3 are 

not repeated in T4, and can we expect that all of the T3 contracts to be successful 

resolved before the Department engages in T4? 

Dr. WOODSON. Lessons learned are collected and documented in the final phases 

of the acquisition process. The documented lessons learned from previous acquisitions become key inputs to the planning phase for subsequent acquisitions. In other 

words, lessons learned from the original T–1 TRICARE contracts influenced the 

TNEX acquisition strategy which, in turn, influenced the T–3 strategy. Lessons 

learned from the TNEX acquisition were collected by a consultant contractor 

through a process that included surveying, interviewing participants and publishing 

a final report. TMA has hired a consultant contractor to perform an after-action review of the T–3 source selection evaluation process, and may seek a final report 

comparable to the TNEX product. All of this information and the Government Accountability Office (GAO) decisions will be provided to the T–4 acquisition strategy 

team. That team will develop an acquisition plan for T–4 that incorporates all the 

lessons learned and GAO findings. In addition, one of the objectives of the Peer Review process required by OUSD(AT&L)/DPAP policy is to facilitate the sharing of 

lessons learned and best practices across the Department of Defense. All the T–3 

and T–4 acquisitions are subject to the Peer Review process. 

The first T–3 contract award for the North region included health care delivery 

options through March 31, 2015 and the ability to add another calendar year of performance. The South and West regions will include option periods that run through 

at least March 31, 2017. The re-evaluation of the West will take a minimum of six 

and half months, but will be accomplished well before the T–3 NORTH contract expires. There should also be ample time to accommodate any directions from the ongoing GAO review of the South region award. 

Mrs. DAVIS. Several of the reserve components continue to see issues with medical 

readiness of its force. To ensure the readiness of its force, the Air Force National 

Guard and Reserve requires its personnel to be medically ready or they are not allowed to participate in drill or training exercises. Should this requirement be extended to the Army, Navy and Marine Corps? 

Dr. WOODSON. No, not at this time and we do not recommend any change to the 

current policy. Preventing service members from attending drill or AT may compound the problem. Many commanders use these active duty periods for readiness 

activities that include medical and dental appointments. There are also certain aspects, such as annual preventive health assessments (PHA), which require members 

to meet face-to-face with military health providers. 

Mrs. DAVIS. If not, what efforts should be undertaken to ensure the medical readiness of the reserve component? 

Dr. WOODSON. The instructions may be drafted to ensure members can drill or 

be placed on orders to complete their medical/dental requirements, but will not drill 

for training until the issues are resolved. 
137 

Reservists may be placed on military orders for the purpose of receiving military 

medical/dental evaluation, or examination. Reservists receiving medical/dental care 

during a tour of duty will be voluntarily retained on Active Duty orders to continue 

treatment. Reservists not on military orders may be placed on invitational travel orders when directed by appropriate military medical authority to receive an examination or evaluation by military medical/dental facilities to meet military requirements. Invitational travel orders may also be issued to those reservists receiving 

military medical/dental care at military medical treatment facilities for the purpose 

of medical/dental appointments. 

Reserve or Active Duty medical units do not extend, authorize the extension of, 

or issue military orders, or invitational travel orders. Order issuance or an extension 

is the responsibility of the commander. 

Mrs. DAVIS. Can you explain what impact the current continuing resolutions are 

having on the Military Health System and on your particular Service? 

General SCHOOMAKER. The numerous continuing resolution (CR) extensions 

caused a general disruption of operations across the command this year. Despite 

ASD (HA) and OSD (Comptroller) efforts to respond to OMB’s numerous data calls 

to validate Service Medical Department requests for exception apportionment, the 

temporary, short-term budgets caused activities to defer spending to preserve resources for must-fund bills like payroll. Although clinical service delivery was not 

compromised at any time, it appears that this behavior did contribute to a slowdown in the growth rate of program improvement required to meet the demands of 

a larger Army with increased benefits, utilization, and Wounded, Ill, and Injured 

workload. 

CR limitations and associated administrative processes have had the following impact: 

• Slowed down program improvements in access initiatives designed to match capacity to escalating demand resulting from increased end strength, rising utilization, benefit enhancement, and increasing level of effort to manage and process Wounded, Ill, and Injured. 

• Strained internal compliance with BRAC-directed project milestones and/or validation of BRAC-related ‘‘incidental’’ costs at several locations due to artificial 

budget execution masking actual conditions. 

• Delays in the augmentation of Occupational Health/Industrial Hygiene capability to address previously neglected remote area services for the Army’s atrisk civilian workforce. 

• Delays in Initial Outfitting and Facility transition of medical treatment facilities generated by extensive investment in MILCON and renewal projects in previous years. 

• Delays in implementation of the enhanced, integrated Disability Evaluation 

System designed to streamline disability processing of separating service men 

and women. 

• Delayed full-scale implementation of the Comprehensive Pain Management 

Plan. 

Mrs. DAVIS. Given the reductions in the Services recruiting and retention budgets, 

how are you ensuring that we continue to recruit and retain the qualified medical 

providers that are necessary to support the military health care system? 

General SCHOOMAKER. The mission to recruit our military health care providers 

rests with United States Army Accession Command. To date, we have received no 

indication of any significant funding constraints placed upon them that would affect 

recruitment of health care professionals. We have no indication that there will be 

any reduction in the number of health care recruiters in the field or that the funding to support them will be significantly decreased. 

The Office of The Surgeon General is working diligently to maintain the level of 

funding support for the health professions officer special pays that are critical to the 

recruiting and retention efforts of the past years. As the Assistant Secretary of Defense for Health Affairs converts the Services programs from the legacy Special Pays 

to the Consolidated Special Pays, we do not anticipate any support for growth within these pays; however, we believe that in the near term we will be able to maintain 

the status quo. This includes support for the Health Professions Officer Accession 

and Retention Bonuses for Clinical Psychologists, Clinical Social Workers, Physician 

Assistants, and Veterinarians, as well as the Critical Wartime Skills Accession 

Bonus for Physicians and Dentists. 

Mrs. DAVIS. As your Services move toward the Patient-Centered Medical Home 

(PCMH) concept, how will deployments of providers impact this process? Will PCMH 

providers need to be civilian or contract providers in order to maintain continuity 

of care? 
138 

General SCHOOMAKER. By limiting the size of our PCMH teams to 3–5 Primary 

Care Providers and ensuring a variable mix of military, civilian and contract providers, the Army decreases the impact of a military provider’s deployment and relies 

upon the PCMH team to provide the patients with continuity of care. One of the 

core principles of the PCMH model is to ensure that there is a standardized, consistent and continuous relationship between the patient and the PCMH team which 

includes the assigned provider as well as the designated support staff. Under this 

model, providers deploy with the units to which they are assigned, providing Soldiers continuity of care before, during, and after the deployment. The Army does 

have a number of providers who will deploy with other units and in these situations 

other providers in the PCMH provide coverage during the deployment. 

Mrs. DAVIS. Where are [we] on the transition and closure of Walter Reed, and is 

the Army, Navy, and the Joint Task Force on National Capitol Region Medical (JTF 

CAPMED) prepared to ensure an orderly transition by September of this year? 

General SCHOOMAKER. The majority of the medical Base Closure and Realignment 

(BRAC) construction at both the Bethesda and Fort Belvoir sites is complete. Current progress indicates that they will be finished in time to transition patients and 

clinical functions from Walter Reed Army Medical Center (WRAMC) by September 

15, 2011. The Army, JTF CapMed, and the other Services are working together to 

ensure an orderly transition. Patient care and patient safety remain the top priorities related to the move and all stakeholders continue to pay close attention to the 

timeliness and milestones necessary to achieve the final moves. 

Mrs. DAVIS. The U.S. Olympic Committee’s Paralympic Military Program provides 

our wounded warriors the ability to compete in several adaptive sports. However, 

I understand that funding challenges may affect the future of this program. What 

efforts, if any, are the Services taking to ensure that such opportunities continue 

for our wounded warriors? 

General SCHOOMAKER. The Army leverages the U.S. Olympic Committee’s (USOC) 

Paralympics’ Military Program as a critical complement in our efforts to improve 

the quality of life of our injured Soldiers while they are on active duty and during 

their transition to civilian life. The Army is addressing the future funding challenge 

by pursuing funding through the Defense Health Program for Adaptive Non-Clinical 

Reconditioning Activities (ANCRA). ANCRA includes Warrior Games participation 

and associated costs, pre-Warrior Games clinics and training camps, adaptive adventure training, the Army Center for Enhanced Performance (ACEP) trainers, and 

adaptive equipment. The goal is to instill ANCRA into the warrior care rehabilitation process. 

Mrs. DAVIS. The Integrated Disability Evaluation System (IDES) started as a pilot 

program, and has recently been expanded across the country. While the program 

goals are to reduce the time wounded warriors spend going through the disability 

process, I understand that timelines have actually increased. What are the challenges each of your medical systems have been seeing as the IDES program has 

been implemented? What improvements have been made under the program? What 

challenges still remain under the program? 

General SCHOOMAKER. The Army population that requires entrance to the physical disability evaluation system continues to grow and challenge our capacity to 

process them in a timely manner. The Army continues to take the necessary steps 

to address the challenges of the IDES program and has implemented numerous 

practices and process improvements to improve physical disability evaluation processing times. These improvements include: the development and implementation of 

a new IDES Narrative Summary format; implementation of the Medical Evaluation 

Board (MEB) processing guidance to standardize the MEB processes; assignment of 

dedicated MEB Physicians; improving staffing shortages; the implementation of the 

electronic Medical Board (eMEB) in July 2010; and the development of the IDES 

Implementation Plan that requires Senior Commanders play a central role in certifying that a IDES site is fully resourced, staffed, trained and ready to meet processing standards prior to Initial Operating Capability date. The major challenge is 

that the disability evaluation system remains complex. 

Mrs. DAVIS. Can you explain what impact the current continuing resolutions are 

having on the Military Health System and on your particular Service? 

Admiral ROBINSON. We continue to face challenges associated with operating 

under a potential continuing resolution for the remainder of the year, particularly 

in the areas of provider contracts and funding for facility special projects. The Defense Health Program (DHP) has taken specific actions as a result of the continuing 

resolution including: reducing the number of hours for patient care provider contracts; limiting medical facilities sustainment/maintenance contracts to only ‘‘life 

safety’’ implications; deferring life cycle replacement of medical equipment; maximizing utilization of existing inventory of supplies and medicines; and limiting 
139 

quantity of replacement pharmaceuticals. We continue to work with ASD (HA) to 

mitigate adverse effect on the quality and timeliness of healthcare provided to military members, retirees, and their families. 

Mrs. DAVIS. Given the reductions in the Services recruiting and retention budgets, 

how are you ensuring that we continue to recruit and retain the qualified medical 

providers that are necessary to support the military health care system? 

Admiral ROBINSON. Navy active duty (AC) medical recruiting has been successful 

in attaining overall accession goal in FY09 and FY10, and retention has been relatively stable across all health professions. Recruiting is projected to meet most 

FY11 goals for active component Medical Corps officers; however, direct accession 

physicians and dentists present challenges. Recruiting medical and dental students 

for the Health Professions Scholarship Program (HPSP) is the most vital contributor 

to Navy physician and dentist inventory, accounting for more than 80 percent of active duty accessions into the Medical and Dental Corps. Medical and dental HPSP 

accessions have been successful over the past two years due, in large part, to a 

$20,000 signing bonus. 

Targeted special and incentive pays and bonuses are offered at critical career 

points to incentivize retention behavior. Medical Special and Incentive pays are critical to maintaining Navy Medicine professional inventory—doctors, dentists, nurses, 

psychiatrists, clinical social workers, and other providers. 

Direct appointment recruiting of physicians and dentists for both active and reserve forces remains a challenge, primarily because these healthcare professionals 

have well-established medical practices and are very well compensated in the civilian market. Interrupting their civilian medical careers is often personally and financially unattractive to many private medical providers. In the case of both AC and 

RC Physician and Dentist recruiting, a credible recruiting bonus is critical to attracting these professionals. 

We continue to evaluate the financial incentives within budgetary constraints to 

target specific communities that are, and will remain, critical to our mission. 

Mrs. DAVIS. As your Services move toward the Patient-Centered Medical Home 

(PCMH) concept, how will deployments of providers impact this process? Will PCMH 

providers need to be civilian or contract providers in order to maintain continuity 

of care? 

Admiral ROBINSON. As Navy continues to implement the Patient-Centered Medical Home (PCMH) model, we are seeking to structure the teams in a way that sustains deployment of military providers in support of operational commitments, while 

ensuring continuity of care for Navy beneficiaries assigned to the PCMH team. 

Navy’s approach has been to build PCMH teams that have both military and civilian (civil service and contract) assets integrated. Ideally, 50 percent of staffing on 

a Navy PCMH team is civilian, ensuring stability within the team that can withstand deployments, supports continuity while providing patient and family-centered 

care. When an active duty PCMH provider deploys, Navy Medical Treatment Facilities 

(MTFs) are encouraged to use a strategy successfully applied at other sites. A contract provider is hired to cover the deployed provider’s panel of patients (in a locum 

tenens type arrangement) and works within the PCMH team during the provider’s 

absence. This allows the patient to keep the same primary care manager (PCM) during the deployment, but have identified coverage during their PCM’s absence; patients can be notified of their PCM’s pending deployment, length of absence and the 

provider providing temporary coverage using blast secure patient messaging. 

When the deployed provider returns to the MTF, patient’s can once again be notified regarding their pending return using secure messaging; the contract provider 

can then be utilized elsewhere in the MTF to cover another provider’s practice while 

they deploy. 

Mrs. DAVIS. Where are [we] on the transition and closure of Walter Reed, and is 

the Army, Navy, and the Joint Task Force on National Capitol Region Medical (JTF 

CAPMED) prepared to ensure an orderly transition by September of this year? 

Admiral ROBINSON. Navy is committed to the successful transition of the new 

Walter Reed National Military Medical Center (WRNMMC) onboard the campus of 

the National Naval Medical Center, Bethesda. This realignment is significant and 

we are working diligently with DoD’s lead activity, Joint Task Force Medical—National Capital Region, NSA Bethesda and WRAMC staff to ensure we are on track 

to meet the Base Realignment and Closure (BRAC) deadline of 15 September 2011. 

Mrs. DAVIS. The U.S. Olympic Committee’s Paralympic Military Program provides 

our wounded warriors the ability to compete in several adaptive sports. However, 

I understand that funding challenges may affect the future of this program. What 

efforts, if any, are the Services taking to ensure that such opportunities continue 

for our wounded warriors? 
140 

Admiral ROBINSON. All Service components collaborate with organizations outside 

the United States Olympic Committee (USOC), including Paralyzed Veterans of 

America, Challenged Athletes Foundation, Team Semper Fi (which supports Sailors, 

as well as Marines), Disabled Sports USA and the Lakeshore Foundation. These, 

along with numerous other adaptive sports organizations, offer competition opportunities and training in adaptive athletics for wounded warriors. Additionally, Navy 

Safe Harbor has appointed an Adaptive Athletic Program Manager and Headquarters Transition Coordinator, to include adaptive athletics opportunities in the 

rehabilitation plans of Sailors. In FY11, Safe Harbor has executed two adaptive athletic training camps at Naval Base Port Hueneme, CA. 

Mrs. DAVIS. The Integrated Disability Evaluation System (IDES) started as a pilot 

program, and has recently been expanded across the country. While the program 

goals are to reduce the time wounded warriors spend going through the disability 

process, I understand that timelines have actually increased. What are the challenges each of your medical systems have been seeing as the IDES program has 

been implemented? What improvements have been made under the program? What 

challenges still remain under the program? 

Admiral ROBINSON. The IDES process is achieving the primary goals that were 

intended when this process was designed in 2007. Most notable of these goals is 

that our Sailors and Marines receive both their post–service military and Veterans 

Administration benefits on the first day authorized by law. This eliminates the ‘‘benefits gap’’ experienced under the previous DES system. To achieve this significant 

benefit, the IDES process has the secondary impact of keeping our service members 

in uniform for a longer period of time. This is a concern because the length of time 

needed to process cases has direct proportional adverse impact on the services’ readiness for their military mission. Those in the IDES spend longer in uniform which, 

for any given end-strength, reduces the number of active duty available for unrestricted assignment. Therefore, in the near term a principle focus must be on reducing the amount of time consumed by the process itself without debasing what we 

do for our Wounded, Ill and Injured (WII) service members. 

The simplest and most direct means of monitoring the IDES process is through 

the observation of case flow—the time service members’ cases spend transiting the 

IDES’ waypoints. Tracking and evaluating process time brings clarity for resourcing 

decisions and process improvements. To this end, based on a review of data from 

IDES operations over the past six months (period ending March 31, 2011), we would 

like to reduce the average time taken by the Medical Evaluation Board (MEB) 

Phase of the IDES by approximately 100 days. However, since some of the processing events occurring within this phase are controlled by the Military Treatment 

Facilities (MTFs) and some are controlled by the Veterans Administration, reducing 

the average MEB Phase time requires both Departments to ensure resources and 

internal processes are aligned to support timeliness goal. 

To significantly reduce the overall processing time, Navy Medicine has implemented four main improvement initiatives. Navy Medicine has highlighted MTF 

MEB timeliness as a Strategic Goal, providing increased awareness by reviewing 

monthly metrics. Development of a SharePoint tool will allow for enhanced program 

management of data between the MTF and Veterans Tracking Application data. 

Thorough evaluation of MTF business practices and throughput has allowed for 

identification for appropriate resourcing to address areas of need. Additionally, innovations to leverage existing programs, technologies, and resources are ongoing, such 

as the use of Armed Forces Health Longitudinal Technology Application (AHLTA) 

electronic medical record vice narrative summaries. Finally, the Department of the 

Navy has recommended specific changes to ‘‘remodel’’ the IDES. This IDES Remodel 

allows us to keep what is good about the current IDES process while making needed 

improvements and renovations. The recommended IDES Remodel can be implemented under current laws, avoids any post-service benefit gap, maintains the service member’s due process rights and can be completed in significantly less time required by the current IDES process. This remodel is currently under review by both 

DoD and the VA for possible near-term implementation. By seizing process design 

change opportunities, properly resourcing the processes we decide to deploy and better leveraging existing capabilities, both the WII service member and readiness for 

our military mission will benefit. 

Mrs. DAVIS. Can you explain what impact the current continuing resolutions are 

having on the Military Health System and on your particular Service? 

General GREEN. Contracting: The Air Force Medical Service (AFMS) is holding 

$62M in contracting actions until we have an approved budget. The more we delay 

passing an appropriations act, the more pressure and undue burden is placed on the 

Air Force Base Contracting Office to get the contracting documents processed once 

a full budget is received. 
141 

Restoration and Modernization (R&M): The AFMS programmed $61.4M for R&M 

projects. Under the numerous FY11 Continuing Resolutions (CRs), the AFMS has 

only released $34M for emergency military treatment facility repairs or time sensitive facility renovation. Additionally, the AFMS has approximately $120M in estimated R&M projects that still need to be completed. If full year funding is not received in FY11, the AFMS will be forced to put R&M projects at risk to fund higher 

priority issues. Withheld R&M funds will be used to offset lack of funding for patient care and other urgent bills. If CRs continue, the AFMS may not be able to 

fund R&M in FY11. The lack of FY11 funding will simply push the requirement into 

FY12 at a potentially higher cost. 

Medical Equipment: The AFMS has minimized medical equipment purchases to emergency items only during the numerous CRs. AFMS programmed $75M and 

have currently only funded $2M for emergency equipment buys to prevent mission 

stoppage and prevent patient safety issues. 

Administrative: The numerous CRs place an exorbitant amount of extra work to 

process documents. It is comparable to having six fiscal year closeouts in one year. 

Mrs. DAVIS. Given the reductions in the Services recruiting and retention budgets, 

how are you ensuring that we continue to recruit and retain the qualified medical 

providers that are necessary to support the military health care system? 

General GREEN. Reductions in the recruiting and retention budgets for the Services add to a challenging environment for accessing and retaining health care professionals. Air Force (AF) recruiting is limited by many of the same shortages the 

Nation faces in health care professions such as: nursing, general surgery, family 

practice, psychology, and oral maxillofacial surgery. Our recruiting difficulties lie in 

accessing fully qualified professionals, not our training pipelines. We face keen competition for fully qualified specialists from the private sector and other Federal 

agencies where multiple deployments are not an issue, such as the Department of 

Veterans Affairs hospitals and the Public Health Service. Also, there are significant 

pay disparities between military and private sector employers, especially those surgical specialties crucial for wartime support. These disparities hinder our ability to 

retain experienced providers. The changing demographics of health professions with 

increased numbers of women entering the profession, who may be less inclined to 

choose military service, provide a challenging environment in which to recruit. Additionally, current data suggests less than 7 percent of eligible graduates consider entering military service. 

Using feedback from exit interviews and informal counseling as well as our experiences with various incentives, the Air Force Medical Service (AFMS) confronts the 

recruiting and retention challenges in a three-pronged approach addressing: (1) education, (2) compensation, and (3) quality of life. 

(1) Education: Due to historical difficulties recruiting fully qualified specialists, 

the AFMS deliberately places increased emphasis and funding into educational scholarship opportunities rather than continually focusing on a manpower intensive program that has shown only moderate success. With this 

change, we have found great success in ‘‘growing our own,’’ either through the 

scholarship programs or through training in the Uniformed Services University of Health Sciences (USUHS). Historically the highest retention occurs 

when we control the educational environment and service obligations associated with these advanced training programs. The Health Professions Scholarship Program (HPSP) is a resounding success with over 1,400 students currently enrolled, projected to be 1,568 by the end of this fiscal year. As reflected 

in the DOD budget for FY13, AF has a programmed budget to support an ultimate increase to 1,666 students. We have also optimized our enlisted commissioning programs, such as the InterService Physician Assistant Program (37 

graduates per year) and the Nurse Enlisted Commissioning Program (50 graduates per year). Additionally, the AF receives small numbers of new health 

professionals through other training venues, such as the Airman Education 

Commissioning Program, Reserve Officer Training Corps, and United States 

Air Force Academy. The Nurse Transition Program is a robust recruiting tool. 

It provides an incentive for new graduates to consider AF nursing as a career 

option upon graduation. However, there are various limitations with our training programs. As a result of fiscal guidance from AF and Congress, under Section 2124 of Title 10, HPSP enrollment DoD-wide is capped at 6000 students. 

USUHS programs have physical constraints of the facility and academic accreditation constraints of oversight committees. Third, enlisted commissioning 

programs are constrained by the number of training-years programmed and 

funding against all enlisted training. Even with these limitations, education 

has proven the most successful avenue of accession and retention of health 

professionals. 
142 

(2) We also seek to entice fully qualified specialists into the AF and retain them 

through competitive compensation using accession bonuses and other financial 

incentives. Under the auspices of Health Affairs, the AF has funded accession 

bonuses and incentive pays to target fully qualified specialists in selected 

areas. For FY11, the AF has sufficiently budgeted $13M towards accession bonuses for personnel in fully qualified critical specialties based on historical 

rates of accession. Historically, as outlined in the first paragraph and under 

section (1), above, our physician and dental specialist accession bonuses have 

been of limited success due in part to statutory bonus restrictions, as section 

301d and 301e of Title 37 are mutually exclusive of section 302k and 302l of 

Title 37. Because these accession bonuses cannot be taken with a multiyear 

special pay, only 2 of 22 fully qualified physicians entering in FY10 took the 

accession bonus. Our dental officer recruiting had limited success with 10 of 

14 fully qualified dentists accessed in FY10; however, none of them took the 

accession bonus due to the statutory restrictions. In contrast, with new accession bonuses and incentive pays, our nursing program had great success with 

296 selected out of 290 requirements. Overall, we have found compensation 

helps, but does not entirely ease the burden of multiple deployments. As we 

migrate our compensation portfolio under the new pay authority of section 335 

of Title 37, we will be able to initiate specialty pays for the mental health care 

providers and other critical wartime or shortage specialties that previously 

were excluded from accession and incentive pays. We feel this move will be 

of great benefit to the Air Force and military health care in general, allowing 

targeted accession bonuses, incentive pays, and retention bonuses to address 

the manning shortages in the health professions. Due to the complexity of 

medical specialty and incentive pays and entitlements, the scheduled migration of these contractual agreements under the Assistant Secretary of Defense, 

Health Affairs, will take time to fully implement. In general, recruiting success of many fully qualified specialists without accessions bonuses is extremely limited. 

(3) Finally, no recruit enters, and few medical providers stay in the military, 

without discussing quality of life issues, whether this is family services, medical practice, educational or leadership opportunities, or frequency of moves 

and deployments. We address many of these issues amongst the AF agencies. 

Ongoing AFMS projects include the Family Health Initiative, which is a medical model that better leverages our personnel. In addition, we are building 

force sustainment models in collaboration with AF Manpower and Personnel, 

evaluating promotion opportunities, and developing a more proactive approach 

to provide additional opportunities for advancement. In specialties with increasing wartime deployments, we are better able to distribute the deployment requirements more evenly among our members. Restructuring of our 

medical groups and the deliberate force development of our personnel allow 

increased opportunities for all health professions to become leaders in the AF. 

We remain committed to providing the best in health care for our Nation’ s military and their family members through enhanced recruiting and retention efforts 

maximizing the tools provided for education, compensation and creative quality of 

life efforts of new health professionals. 

Mrs. DAVIS. As your Services move toward the Patient-Centered Medical Home 

(PCMH) concept, how will deployments of providers impact this process? Will PCMH 

providers need to be civilian or contract providers in order to maintain continuity 

of care? 

General GREEN. PCMH providers do not need to be civilian. In the Air Force Medical Service most of the PCMH providers are active duty and roughly 10% of these 

providers are deployed at any given time. In the past year, we have averaged 32 

family physicians deployed, with overlap of rotations transiently raising this level 

as high as 40–45 for periods of 1–2 months. With a current workforce of 299 family 

physicians in clinical billets, this is over a 10 percent loss of family physicians. This 

loss is compounded by the fact that our current fill rate for active duty family physician billets is 78.6 percent. 

Hiring of replacements for these deployed providers with overseas contingency operations (OCO) funding has met with varied success depending on location. At locations where hiring has occurred, the impact on PCMH has been lessened. The presence of these civilian providers who fill in for the deployed provider decreases the 

impact, but there is still an impact on continuity. At locations where hiring has not 

occurred, these deployments cause not only loss of continuity, but also some diminution in access to care. 

While the use of civilian and contract providers in Air Force military treatment 

facilities (MTFs) is and will continue to occur, we have a large number of Air Force 
143 

MTFs in locations where hiring of quality civilian providers has consistently been 

difficult. As such, we will continue to balance the use of active duty providers in 

addition to civilian and contract providers. 

Mrs. DAVIS. The U.S. Olympic Committee’s Paralympic Military Program provides 

our wounded warriors the ability to compete in several adaptive sports. However, 

I understand that funding challenges may affect the future of this program. What 

efforts, if any, are the Services taking to ensure that such opportunities continue 

for our wounded warriors? 

General GREEN. We budgeted approximately $85K to support the 2011 Warrior 

Games to cover coaching support and travel expenses for our athletes attending the 

two Air Force training camps. 

With the help of OSD, we have funded adaptive equipment for archery, track and 

field, aquatic lifts for swimming pools, basketball, volleyball, and a variety of cardio 

equipment for our wounded warriors and customers with disabilities. In addition, 

we send 20 Air Force personnel each year to Penn State University to received 

training on inclusive recreation. Penn State University provides them with fundamental skills sets which allow them to offer programs and services to meet the 

needs of Air Force community members with disabilities. We will continue to support programs serving our wounded warriors. 

Mrs. DAVIS. The Integrated Disability Evaluation System (IDES) started as a pilot 

program, and has recently been expanded across the country. While the program 

goals are to reduce the time wounded warriors spend going through the disability 

process, I understand that timelines have actually increased. 

General GREEN. The legacy Disability Evaluation System (DES) which includes a 

separate Department of Defense (DoD) and Veterans Affairs (VA) process, takes 

∼500 days to completely process a service member’s case through the DES. The estimated timeline for processing cases within the IDES is ∼295 days however, the Air 

Force is currently processing cases within 340 days; a 160 day improvement from 

the legacy DES. While the IDES timeline has drastically decreased to less than a 

year, the AF is committed to continue and improve the IDES process. We expect 

the timeline for the IDES process to continue to decrease as we implement ‘‘lessons 

learned’’ from the other sites during the rollout process. 

Mrs. DAVIS. What are the challenges each of your medical systems have been seeing as the IDES program has been implemented? 

General GREEN. Within the Air Force Medical Service (AFMS), the greatest challenge is completing the Medical Evaluation Board (MEB) package that is ultimately 

submitted to the Informal Physical Evaluation Board (IPEB). There are several variables affecting the completion of the MEB package. They are: 

• Completion of the Compensation and Pension (C&P) examination from the VA: 

Predominantly, these exams are complete, but there are instances when a 

health condition has not been thoroughly evaluated and/or another condition is 

identified requiring further examination before the MEB Narrative Summary 

(NARSUM) can be written. 

• Military Treatment Facility (MTF): Continuity of care is sometimes a challenge. 

For example, if a physician deploys or changes duty stations before completing 

a NARSUM, a new physician must be assigned the case and allowed time to 

become familiar with the medical history before writing the NARSUM. 

• Unit Commander: The MEB package must include input from the Airman’s unit 

commander. The Commander’s letter provides the IPEB with insight on the Airman’s health condition such as, how it affects his or her ability to perform duties, and the impact on the distribution of workload within the unit. If the Commander’s input is not received in a timely manner, the Physical Evaluation 

Board Liaison Officer (PEBLO) must track it down before forwarding the MEB 

package. 

• Line of Duty (LOD) determinations: For Reserve Component members, the 

health conditions that caused the MEB referral must be accompanied by a LOD 

determination to determine if the injury or illness was incurred in the LOD and 

was not as a result of negligence or misconduct. Delays in completing the LOD 

determination will inadvertently delay the MEB package. 

Mrs. DAVIS. What improvements have been made under the program? 

General GREEN. Within the AFMS, PEBLOs are being encouraged to be more 

proactive in securing the NARSUM from military physicians and to engage the Medical Director’s for assistance before the MEB becomes late. For MTFs with increasing MEB workload, additional PEBLOs are being hired or other assigned personnel 

from within the MTF are being directed to assist with case management and/or administrative requirements. Additionally a comprehensive training website is already 

available for the PEBLOs. The website includes MEB guidance, training slides, and 
144 

other tools. Lastly, training for physicians involved in the MEB process has also 

been developed. Physicians may access pertinent information under the AFMOA 

SGH Link on the Knowledge Exchange, which is a separate location from the 

PEBLOs. 

Mrs. DAVIS. What challenges still remain under the program? 

General GREEN. The main challenge is the time it takes to process Airmen 

through the IDES. Although the IDES has drastically improved its timeline, the 

overall IDES process remains cumbersome and lengthy. To improve the overall 

IDES process, OSD (P&R) directed a working group comprised of all the Services, 

in collaboration with the VA, to focus on reducing the IDES timelines. Other improvement objectives are to properly resource activities and better leverage existing 

capabilities to ensure Airmen with service-incurred or service-aggravated disabilities 

are expeditiously processed through the IDES. 

Mrs. DAVIS. Your testimony indicates that the Air Force will begin to add 36 fulltime Special Needs Coordinators at 35 medical treatment facilities to assist families 

with a special needs child. Since these coordinators are not expected to be brought 

on-board until October of this year, what is currently in place to assist families with 

special needs? 

General GREEN. There are currently Special Needs Coordinators appointed by the 

Medical Treatment Facility (MTF) Commanders at each MTF available to assist 

sponsors and special needs family members. These have traditionally been Mental 

Health officers who performed this role as an additional duty. Given the increased 

demands now seen for Mental Health, Air Force (AF) determined additional manning is needed to provide dedicated support to uniformed personnel who have a special needs child or spouse. Additionally, AF is incorporating the use of existing 

Health Care Integrators, Case Managers or Utilization Managers to provide specific 

support to families with special needs until the new coordinator being brought on 

board is in place and to provide support at those installations that will not receive 

a full-time Special Needs Coordinator. 

QUESTIONS SUBMITTED BY DR. HECK 

Dr. HECK. Who is the formal approving authority for the LHI Contract? 

Dr. WOODSON. The contracting authority for the contract is the U.S. Army Medical Research Acquisition Activity; the office of the Deputy Assistant Secretary of 

Defense for Force Health Protection and Readiness administers the contract. The 

Reserve Health Readiness Program (RHRP) is a Department of Defense (Health Affairs) program developed by Force Health Protection and Readiness, and executed 

by its contractor, Logistics Health Inc. (LHI). 

Dr. HECK. Is the Army considering any other options or modifications to the contract? 

Dr. WOODSON. No. Unless the Service Components request new services (for example, mental health assessments) to augment their readiness, we do not plan to 

modify or re-compete this contract at this time. The Reserve Health Readiness Program (RHRP) contract for medical and dental readiness services was awarded to Logistics Health Inc. in September 2007, after a full and open competition, for a base 

year and four option years. The contract is currently in its third option year. The 

fourth option year, if exercised, will conclude at the end of September 2012. 

Dr. HECK. What is the overall cost of the contract? 

Dr. WOODSON. The contract for the five-year period is capped at $790,295,941 (the 

total value of the orders against the contract cannot exceed that amount). 

Dr. HECK. How can we document whether or not the LHI contract has provided 

any value added service to our medical readiness? 

Dr. WOODSON. According to the most recent data from the Office of the Surgeon, 

U.S. Army Reserve Command, readiness rates have never been higher. From October 2008 to March 2011, the percentage of Army Reserve soldiers with a current 

Periodic Health Assessment (PHA) has risen from 45 percent to 88 percent; achieving dental readiness rose from 53 percent to 75 percent; and current immunizations 

increased from 34 percent to 79 percent. The percent that are medically ready to 

deploy immediately or within 72 hours has similarly risen from 24 percent to 64 

percent. 

The Reserve Health Readiness Program (RHRP) contract provides a broad array 

of services in response to requests by the Service Components to assist them in 

achieving medical readiness. The contract provides the Periodic Health Assessment 

(PHA), Post-Deployment Health Reassessment, Mental Health Assessment, dental 

exam, dental treatment, and other Individual Medical Readiness services that satisfy key deployment requirements and supplement the Services’ own efforts. Serv-
145 

ices are provided at the request of the Reserve Components and implemented per 

their guidance. The annual dental examinations, annual PHAs, and current immunizations for each Service member are required Department of Defense elements for 

medical readiness. For Fiscal Year 2010, RHRP providers addressed approximately 

650,000 reservists and guardsmen across all Military Services, conducting 218,000 

dental examinations, 255,000 PHAs, and 372,000 immunizations. Each of these adds 

value to medical readiness. 

The Army Reserve leadership uses the RHRP almost exclusively for its medical 

readiness services. According to the most recent data from the Office of the Surgeon, 

U.S. Army Reserve Command, its readiness numbers have never been higher. From 

October 2008 to March 2011, the percentage of Army Reserve soldiers with a current PHA has risen from 45 percent to 88 percent, achieving dental readiness rose 

from 53 percent to 75 percent, and current immunizations increased from 34 percent 

to 79 percent. The percent that are medically ready to deploy immediately or within 

72 hours has similarly risen from 24 percent to 64 percent. 

Æ