Congressional Modifications The Congress and this Subcommittee in particular have assisted us by enacting several modifications to current programs and creating additional options and incentives for critically needed health care personnel to join both the active and reserve components. The stipend program has been expanded and restructured with additional options for payback of the service commitment in the Individual Ready Reserve (IRR). The loan repayment program has been extended to cover individuals who received loans for their nursing education under Title VIII of the Public Health Service Act. Constructive service credit may now be granted to greatly needed skilled nurses if the professional experience of the individual will be used directly by the Service. The ceiling on the amount of incentive special pay that may be paid to medical officers has been removed, and the purpose of this pay in attracting critically needed wartime skills has been reemphasized. The age at which reserve medical officers must retire has been extended, along with the age for initial appointment, if the medical officer is trained in a critically needed skill. Finally, the Congress followed up on an issue discussed at this hearing last year by authorizing the Selective Service System to develop and implement a system for the rapid post-mobilization registration of health care professionals. DOD Efforts to Market and Implement Programs to Attract Critically Needed Skills Mr. Chairman, your Committee's dedication to solving the shortfall problem that jeopardizes our medical readiness is evident. We thank you for your assistance and we are moving out to see that all these new legislative incentives are implemented and marketed efficiently. Direct Mail Marketing To this end, we have decided to employ a tactic that has been used successfully in other recruiting efforts marketing campaign. - the direct mail I have just begun to mail out nearly 200,000 letters to surgeons, orthopedic surgeons, anesthesiologists, nurse anesthetists, operating room nurses, emergency nurses, and critical care nurses informing them of the benefits of joining the Reserves and of reaping the financial rewards of the loan repayment and stipend programs. We have Reserve and Guard physicians and nurses manning telephones, ready to receive and follow up on all inquiries from this mailing. Other types of direct mail campaigns generally yield a one- to two-percent response rate, and we hope to achieve at least this rate. We are also publicizing the opportunities for and benefits of Reserve participation through the media of a number of the professional associations. Organizations such as the American Medical Association and the American Nurses Association, to name only two of several, have been most cooperative and helpful. Physician Skills Enhancement A new Physician Skills Enhancement Program has been established to direct the training of our peacetime physician specialties in the tasks and procedures that would be most frequently required in wartime. This special effort will address the existing imbalance between the distribution of active component physician specialists and DOD's wartime specialty requirements shortfalls. With appropriate skills enhancement training in specific tasks, some non-surgical specialists will be able to perform many of the tasks of, or in the case of certain specialties, substitute for, the critically short specialties in wartime. We have completed the first phase of this effort identifying specific physician specialties that can be cross-utilized to augment critical wartime shortage specialties. Under the Army's leadership, panels of specialists have been formed to identify the tasks to be trained; they have already developed implementation plans for training physicians in selected cross utilization specialties. Earlier this month, for instance, the panels' work on the three critically short specialties of anesthesiology, orthopedic surgery, and general surgery was completed. During the remainder of this year, the various panels will continue to meet until all of the specialties have been considered and their implementation plans finalized. Incentive Special Pay With the Congress having just lifted the cap on Incentive Special Pay and given us renewed direction to target these resources to critically short specialties, we have successfully argued within the Department to augment the resources devoted to this program in FY 1989. During the rest of FY 1988, we will continue with our plans to retarget this special pay to ensure that all the Services are using these resources to provide an additional incentive to physicians with critically needed skills. Experienced physicians in the specialties of general surgery, orthopedic surgery, and anesthesiology will receive $8,000 each in FY 1988. As a result of both the lifting of the cap and a DOD-approved funding increase in FY 1989, experienced physicians in the critically short specialties will receive incentive special pay totalling $16,000 each and, in subsequent years, $20,000. The Department will continue in future years to target those specialties in shortest supply for wartime to receive the highest amount of incentive special pay. COMPOSITE HEALTH CARE SYSTEM The recent contract award for Stage II (operational test and evaluation phase) of the Composite Health Care System (CHCS) procurement is a giant step forward for the Department of Defense in its long-awaited acquisition of a comprehensive, integrated medical information system. The ability to integrate our medical information and provide standard automated support worldwide through CHCS will change the way we provide health care in DOD well into the 21st century. This system is critically important to us in these times of austere budgets, and we intend to complete operational testing and begin deployment as soon as we possibly can. CHCS will enable us to make the best possible use of our most precious resource our health care providers, but those who will certainly benefit from this system most-will be our patients. - We owe thanks to this Committee for all of your support, but in particular for the critical role you have played in all of the initiatives I have mentioned today. I will be glad to answer your questions. Senator GLENN. Thank you. We will go on to General Chesney in just a second. I have been very much involved in the officer cuts in the medical area, right in the middle of it, as you are probably aware. We exempted medical cuts. So what are you referring to when you say officer cuts affected you? If you had to take any officer cuts, then we have some bones to pick with the people over your head at the Pentagon, I will tell you, because doctors, medical personnel, were specifically exempted from that by last year's legislation. Dr. MAYER. So far to my knowledge we have not. I posed that as a real danger. Senator GLENN. All right, fine. It may be danger out in the future, but it is not an existent danger right now, fine. General Chesney, go ahead. STATEMENT OF LT. GEN. MURPHY A. CHESNEY, SURGEON General CHESNEY. Let me answer that. The language is unclear. We could not tell whether it exempted just doctors or nurses or everyone, and we could not tell whether the number of doctors and nurses and medics came out of the entire Air Force, for instance. So we have taken some cuts, yes. Senator GLENN. Well, we specifically addressed that and that was certainly not the intent, and there has been a misinterpretation of that. The staff will sure look into that one. OK, go ahead with the rest of your statement, Dr. Chesney, and then we will get on that, because if there has been a misinterpretation of that it is just exactly that, a misinterpretation, because we did not mean to-that language was supposed to be very clear, because we have recognized for the past 3 years the situation, our medical situation in our military, and we have been trying to work to correct it, not make it worse. Go ahead with your statement. General CHESNEY. Mr. Chairman, it is a great pleasure to be here today to present our Air Force program to you. I will put my entire statement in for the record and I have only two or three brief things to mention. Senator GLENN. It will be included in full. General CHESNEY. We are very pleased with the progress we have made in our war readiness program in the Air Force. The programs we have, the buys that we have, put us to a point where we think we could at least care for most of our patients in wartime right now, give some care to all, not optimal care to all. But we are ready right now for wartime in Air Force medicine. Our most pressing concern today is the very constrained medical O&M budget this year. We faced a tremendous shortfall in fiscal year 1988. We are somewhere around $55 million short of finishing the year right now, and each of our major commands has a dropdead date at which time they will run out of O&M money. I am confident that the Air Force line will help us with some additional funding in this, but this comes at a time when we are trying to reduce the CHAMPUS cost by doing most of the medical care in-house, and if we have to stop this and send the patients out to CHAMPUS it will of course increase CHAMPUS at a time when we think we can save money by caring for patients both in-house and in our Air Force clinics. We have pursued a number of things to improve our medical care and our cost savings, including sharing programs with the Veterans Administration and with the other services, a program we call health care finder, where we obtain care for our patients wherever we cannot do it. We are getting ready to implement a catchment area management test at two bases to see if we cannot save money and also give better care for our patients. And we have looked at our staffing. Overall our number of people, our number of staff, is close to what we can handle in the facilities that we have. |