{"id":18325,"date":"2019-11-15T21:03:45","date_gmt":"2019-11-15T21:03:45","guid":{"rendered":"https:\/\/one.sightlinemg.com\/navytimes\/uncategorized\/2019\/11\/15\/prognosis-good-for-navy-medicine-but-budget-concerns-loom\/"},"modified":"2026-08-08T18:59:40","modified_gmt":"2026-08-08T18:59:40","slug":"prognosis-good-for-navy-medicine-but-budget-concerns-loom","status":"publish","type":"post","link":"https:\/\/one.sightlinemg.com\/navytimes\/news\/your-navy\/2019\/11\/15\/prognosis-good-for-navy-medicine-but-budget-concerns-loom\/","title":{"rendered":"Prognosis good for Navy Medicine, but budget concerns loom"},"content":{"rendered":"\n

FALLS CHURCH, Vir. \u2014 It was Oct. 11 when the 38th surgeon general of the Navy rose from his chair to greet Navy Times.<\/p>\n\n\n\n

An aide announced that their visas had gone through, so Vice Adm. C. Forrest Faison III<\/a> would jet to Brazil hours later to deliver a keynote speech on the Navy\u2019s experience with what\u2019s called \u201cvalue-based care.\u201d<\/p>\n\n\n\n

In S\u00e3o Paulo, physicians from across the hemisphere lauded Faison\u2019s Navy Bureau of Medicine and Surgery for ongoing efforts to improve the treatment of sailors and Marines, military retirees and their families in an era of skyrocketing healthcare costs.<\/p>\n\n\n\n

\u201cWe\u2019re going through the most substantive and transformative changes in healthcare in 50 years,\u201d Faison told Navy Times.<\/p>\n\n\n\n

He retired two weeks later. He\u2019s been replaced by Rear Adm. Bruce Gillingham<\/a>, an orthopedic surgeon, who was confirmed on Halloween by the Senate.<\/p>\n\n\n\n

Faison touched on the medical innovations that made his address in Brazil possible, plus the partial installation of the Defense Department\u2019s $4.3 billion electronic health record system \u2013 MHS GENESIS<\/a> \u2013 at Naval Hospital Bremerton and Naval Health Clinic Oak Harbor in Washington and how he almost became a preacher instead of a neurodevelopmental pediatrician.<\/p>\n\n\n\n

But much of the hour was spent remembering the war in Iraq.<\/p>\n\n\n\n

\"\"
U.S. Navy Surgeon General Vice Adm. C. Forrest Faison, III gives a presentation on the U.S. Navy experience in moving toward value-based care during the 5th Latin American Forum on Quality and Safety in Healthcare in S\u00e3o Paulo, Brazil, on Oct. 14. (Cmdr. Denver Applehans\/Navy)<\/figcaption><\/figure>\n\n\n\n

He spoke of the large number of patients who arrived at his field hospital with limbs lopped off by improvised explosive devices. He paused, then recalled the morning after a green medical crew arrived, the three helicopters rising over the horizon, nine IED casualties inside, several of them amputated by blast and steel, one patient dead on arrival.<\/p>\n\n\n\n

They began triage on the tarmac.<\/p>\n\n\n\n

\u201cBlood everywhere. And there, right in the middle of all this carnage, was a young hospitalman apprentice, about 19 years old, from the clinic in Gulfport, Mississippi, where the only thing he\u2019d ever seen was a runny nose, standing there in shock. About the color of the white in that paper,\u201d Faison said, pointing to a nearby notepad.<\/p>\n\n\n\n

\u201cI went over to him and I put my arm around this young man and I said, \u2018How\u2019s it going, son?\u2019<\/p>\n\n\n\n

\u201c\u2018Uhhh. OK.\u2019\u201d<\/p>\n\n\n\n

\u201cI said, \u2018Tell me about your home.\u2019 Over the next 10 minutes or so, I talked him out of shock, so he could go back and be part of the resuscitation effort. But we can\u2019t do that for every corpsman. People will die. So corpsmen have got to see blood. They must become comfortable around trauma.\u201d<\/p>\n\n\n\n

After he took the helm of BUMED four years ago, Faison\u2019s urgent mission became convincing a sprawling bureaucracy to prepare for what could be a much uglier war waged against a rising rival, like China.<\/p>\n\n\n\n

In the halls of the Pentagon, White House and Capitol Hill, however, a very different war has occupied much of his time, an ongoing battle to contain healthcare costs and a series of spending bills over the past three years designed to reorganize military medicine to dig for deeper savings.<\/p>\n\n\n\n

That was punctuated in President Donald J. Trump\u2019s Fiscal Year 2020 budget request to Congress and its plan to trim about 18,000 medical billets from the Air Force, Army and Navy, which also provides healthcare for Marines and their families.<\/p>\n\n\n\n

Pentagon officials estimate a quarter of the slots are empty already and some uniformed positions can morph into civilian jobs increasingly overseen by the Defense Health Agency, which was launched in 2012 to better integrate the services\u2019 military treatment facilities dotting the globe.<\/p>\n\n\n\n

That\u2019s why Faison met Navy Times inside DHA\u2019s Falls Church headquarters. His office was there, too.<\/p>\n\n\n\n

\"\"
Lt. Cmdr. Julie Suguitan, a dentist assigned to the hospital ship Comfort, examines a Saint Lucian woman\u2019s teeth at a temporary medical treatment site in Castries, Saint Lucia, on Sept. 26. (Mass Communication Specialist 3rd Class Brendan Fitzgerald\/Navy)<\/figcaption><\/figure>\n\n\n\n

What the proposed budget cuts and ongoing mergers mean for the Navy\u2019s clinics, hospital ships and research units around the world is unclear, but the figure that glows like neon in Faison\u2019s brain is \u201c5,386.\u201d<\/p>\n\n\n\n

That\u2019s the number of medical personnel he might need to boot to satisfy budget cuts. At the same time, the Pentagon is trying to build a 355-ship Navy and expand the sea service\u2019s air squadrons, commands that will need more medical personnel to staff them.<\/p>\n\n\n\n

If enacted, the sailors most likely to be affected are the 30,000 active duty corpsmen. They\u2019re divided into 40 technical specialties, everything from the dental lab to urology, and corpsmen serve at 128 different facilities across the globe and on board ships at sea. They\u2019re taking care of 2.7 million people.<\/p>\n\n\n\n

\u201cThis is personal to me because I ran a combat hospital in OIF,\u201d said Faison. \u201cAnd I looked in the eyes of those casualties as they were offloaded from the helicopters. They\u2019re missing an arm. They\u2019re missing a leg. I look in their eyes and I see the fear. And I see that we made a commitment to you.<\/p>\n\n\n\n

\u201cI talk to Navy Medicine and I tell them, \u2018Look, we\u2019re honored to take care of the less than 1 percent of our nation that will sacrifice to serve and defend our freedom. And every single one of them is depending on us to provide them the best care our nation can offer and to do everything in our power to return them home to their families, safe and alive. I consider that to be a trust and that trust is put into our hands every day.\u2019<\/p>\n\n\n\n

\u201cWhen I look in their eyes, I see them asking, \u2018You\u2019re going to make good on that trust for me, aren\u2019t you, Doc?\u2019 That\u2019s why I look at the system and all these changes and say, \u2018We have to make sure that no matter what we do in the future, we have to make good on that trust.\u2019\u201d<\/p>\n\n\n\n

Officials at the Pentagon and DHA declined to talk to Navy Times about the proposed cuts or Faison\u2019s fears, except to note that House lawmakers inserted language into a rival spending bill that would postpone many of the changes until the Pentagon produces detailed plans that account for risks to beneficiaries, especially service members prepping for future combat.<\/p>\n\n\n\n

\u201cI\u2019d be very, very clear, and define in very fine detail, this question for reform: \u2018What is success? And what does success look like?\u2019\u201d he said. \u201cAs you start to make changes to this health system, you ought to have a pretty clear definition and understanding about what success is.<\/p>\n\n\n\n

\u201cThere are those who would say that \u2018success is an integrated system of readiness and health.\u2019 But what does that mean? Every service member and their mom and dad back home is depending on that system to deliver the same combat survival rate in any future conflict.\u201d<\/p>\n\n\n\n

\"\"
Hospital Corpsman 2nd Class Brock Hite and Naval Aircrewman (Helicopter) 3rd Class Quentin Chandler participate in a vertical replenishment of the amphibious assault ship Bataan on Oct. 23. (Mass Communication Specialist 2nd Class Zachary A. Anderson\/Navy)<\/figcaption><\/figure>\n\n\n\n

Faison warns that the Navy isn\u2019t \u201cKaiser in uniform,\u201d a nod to the massive California-based managed care consortium Kaiser Permanente, a health network that generated nearly $80 billion in revenues last year and treated more than 12 million patients.<\/p>\n\n\n\n

About 28 percent of Faison\u2019s staff exited the service this year \u2013 14 times higher than the typical turnover rate at a civilian hospital. And they\u2019re young. Nearly 40 percent of BUMED\u2019s workforce graduated from high school less than five years ago.<\/p>\n\n\n\n

The Navy relies on that all-volunteer force, and too many cuts could ripple through a civilian population he needs for talent, sending the message that the military isn\u2019t hiring.<\/p>\n\n\n\n

Faison also cautioned that his medical system is \u201cmatrixed.\u201d For example, a baby delivery room needs a galley, or moms don\u2019t eat. His entire healthcare system functions in the same way, with key parts supporting others in ways outsiders often don\u2019t notice.<\/p>\n\n\n\n

\u201cIt\u2019s all connected,\u201d Faison said. \u201cBecause of that, as you start to make cuts and changes there isn\u2019t a linear relationship between cuts and impacts. Because it\u2019s so matrixed, you actually reach a tipping point, beyond which the system starts to collapse. You ought to know what that tipping point is.\u201d<\/p>\n\n\n\n

During the wars in Afghanistan and Iraq, Navy Medicine guaranteed a 97 percent battlefield survival rate for wounded troops, an unprecedented accomplishment in American military history.<\/p>\n\n\n\n

Several key factors helped make that possible, including American air superiority and an abundance of aircraft to ferry casualties quickly to trauma centers strategically placed around the countryside because U.S. forces seized and held the terrain. A seamless communications network connected casualties and their caregivers from the point of injury to a hospital back home.<\/p>\n\n\n\n

A rival power such as China or Russia could take those advantages away, and how the Navy organizes for combat at sea doesn\u2019t help.<\/p>\n\n\n\n

The focus for generations was the Navy\u2019s large hospital ships. But as the fleet began to embrace concepts such as \u201cdistributed lethality,\u201d spreading vessels across vast distances to survive enemy detection and ship-killing weapons, the floating trauma wards lost relevance.<\/p>\n\n\n\n

War games convinced Faison that the Navy must staff destroyers with surgical teams able to supplement the vessels\u2019 medical departments. And those teams need seasoned corpsmen who won\u2019t flinch at the first sight of blood.<\/p>\n\n\n\n

They also needed to learn how to stretch the \u201cGolden Hour\u201d of lifesaving into what likely will be hours, even days, of constant care as patients are transported across long distances to a hospital ship or clinics ashore.<\/p>\n\n\n\n

\"\"
Hospital Corpsmen recite the Corpsman Pledge on board the amphibious assault ship Boxer in the Bay of Bengal during a June 19 ceremony celebrating the 121st birthday of the rating. (Mass Communication Specialist 3rd Class Alexander C. Kubitza\/Navy)<\/figcaption><\/figure>\n\n\n\n

Because the wars in Iraq and Afghanistan waned, Navy hospitals don\u2019t get a large number of combat casualties today. They\u2019re more likely to have mothers giving birth to babies, and Faison didn\u2019t want his corpsmen changing diapers.<\/p>\n\n\n\n

If trauma wouldn\u2019t come to his medical facilities, he\u2019d send corpsmen to emergency rooms in major American cities.<\/p>\n\n\n\n

For nearly two decades, the Navy has been sending medical teams to Los Angeles<\/a>, but Faison\u2019s aides hammered out another deal with a Cleveland hospital. They\u2019ve continued to work on similar initiatives in New York, Seattle and Austin, Texas, too.<\/p>\n\n\n\n

Every other month, the Navy sends 30 \u201cA\u201d School grads to Chicago to witness blood and complex patient care so when a sailor or Marine yells \u201cCorpsman up!\u201d they\u2019ll run to the sound of the gunfire and know what to do when they get there.<\/p>\n\n\n\n

\u201cThey\u2019re so good, when a casualty rolls in the doctors ask for them, not the nurses,\u201d Faison said. \u201cIt\u2019s created some drama. We\u2019re working through that.\u201d<\/p>\n\n\n\n

Faison sees another payoff with the programs, too \u2014 making it easier for patients to connect with Navy medicine.<\/p>\n\n\n\n

One of his initiatives \u2014 Connected Corpsmen in the Community \u2014 kicked off in Florida\u2019s Naval Hospital Pensacola in late 2017.<\/p>\n\n\n\n

The Navy\u2019s medical system at home has been centered on large medical hospitals for generations. To get care, a patient was directed to primary care clinics, usually inside or near the hospital, even if they weren\u2019t on the same base as the service member.<\/p>\n\n\n\n

In Pensacola, sailors spent long hours commuting to the hospital and then moving through its wards to see physicians, retrieve prescriptions and obtain records.<\/p>\n\n\n\n

Although researchers knew that 70 percent of the patients who go to Navy hospitals don\u2019t need to see a physician, sailors, most of them students, were still being sent to the primary care clinics on Pensacola\u2019s medical campus.<\/p>\n\n\n\n

So Faison\u2019s teams began moving clinics into the basements of the military schools there and staffing them with newly minted corpsmen. They\u2019re overseen by independent duty corpsmen, with physicians connected by a telemedicine screen if they\u2019re needed.<\/p>\n\n\n\n

\u201cWe cut absenteeism in schools by 93 percent,\u201d Faison said, a real savings to the Navy.<\/p>\n\n\n\n

\"\"
Vice Adm. Forrest Faison, then-Navy surgeon general and chief of the U.S. Navy Bureau of Medicine and Surgery, visited Naval Air Station Sigonella on July 22. (Gunner\u2019s Mate Seaman Rashond Grant\/Navy)<\/figcaption><\/figure>\n\n\n\n

Part of Faison\u2019s push to get corpsmen into the community also stemmed from the Navy\u2019s need to compete with \u201cminute clinics,\u201d online healthcare services, unregulated cellphone medical apps of dubious accuracy and other 21st century innovations designed to woo patients with convenience.<\/p>\n\n\n\n

While they proliferated and Congress offered more choices for military families to find care in town, Faison faced the dilemma of military hospitals becoming irrelevant to a younger generation of sailors.<\/p>\n\n\n\n

Fewer patients meant less chances for corpsmen to learn about taking care of the sick and injured. And the inability for government electronic records systems to connect with private sector providers spelled trouble for a service that needs to take the pulse of its personnel.<\/p>\n\n\n\n

\u201cThe last thing I ever want is a CO to call me and say, \u2018Doc, what\u2019s going on with my sailor?\u2019 and I\u2019ve got to say, \u2018I don\u2019t know. He\u2019s getting his care somewhere else,\u2019\u201d Faison told Navy Times.<\/p>\n\n\n\n

Navy medicine had to reinvent itself, driving costs down and patient outcomes up. Faison\u2019s mantra became \u201cvalue-based care,\u201d the subject of his speech in Brazil. His Navy got so good at it, Faison found himself moonlighting as an instructor every few months at Harvard Business School, where he taught healthcare executives the lessons his physicians were learning nationwide.<\/p>\n\n\n\n

\u201cThe first question we ask you is, \u2018Hey, what would success be in your treatment?\u2019 And we gear your treatment around what you consider to be a success,\u201d Faison told Navy Times. \u201cWhat does that mean? You now have skin in the game. What we\u2019ve found is that when you do that, compliance goes up.\u201d<\/p>\n\n\n\n

For example, a retired sailor wants to walk his daughter down the aisle at her wedding, without suffering diabetic foot pain. That\u2019s the goal. It\u2019s the Navy\u2019s job to figure out how to help get the patient there.<\/p>\n\n\n\n

\"\"
Hospitalman Kevin German checks a patient\u2019s ear at Naval Branch Health Clinic Jacksonville\u2019s treatment room on Oct. 17. (Jacob Sippel\/Navy)<\/figcaption><\/figure>\n\n\n\n

Sometimes, math and computer science help light a path. About one out of every five residents in San Diego County county qualifies for military healthcare. That\u2019s roughly 250,000 people, but not every patient is the same.<\/p>\n\n\n\n

The Navy discovered that 640 beneficiaries \u2014 about a quarter of 1 percent of the patient population \u2014accounted for 15 percent of the Navy healthcare system\u2019s costs there.<\/p>\n\n\n\n

Because they use so many medical services, they\u2019re nicknamed \u201chot spotters.\u201d One patient averaged an ER visit daily.<\/p>\n\n\n\n

And researchers began to realize that they also used municipal and county services, everything from 911 dispatch, firefighters and paramedics to police officers to connect with healthcare providers.<\/p>\n\n\n\n

So Faison\u2019s team targeted 200 of the patients in a program that partnered the Navy with local agencies to share services, such as home healthcare and monitoring equipment and transporting them to scheduled appointments instead of emergency room visits.<\/p>\n\n\n\n

That saved the Navy $4 million in the first year, just for 200 people. The second year? $12 million.<\/p>\n\n\n\n

\u201cSo then we looked at how we could predict who these people were going to be before they became hot spotters, because once they become hot spotters you\u2019re already behind the power curve. They\u2019re using our services.\u201d said Faison.<\/p>\n\n\n\n

Researchers developed algorithms to target those patients most likely to suffer complex, serious and expensive ailments, formulas that now are used increasingly across Navy Medicine.<\/p>\n\n\n\n

\"\"
Navy Lt. Nick Trottier, battalion surgeon with 2nd Tank Battalion, 2nd Marine Division, performs a live whole-blood transfusion drill at Marine Corps Air Ground Combat Center Twentynine Palms, California, on Oct. 26. (Gunnery Sgt. Leon Branchaud\/Marine Corps)<\/figcaption><\/figure>\n\n\n\n

Faison told Navy Times he wished he could\u2019ve stayed a little longer to finish some of the reforms, especially those that leaned on telemedicine.<\/p>\n\n\n\n

But after 39 years in uniform, retirement loomed and he had to close what he called \u201cchapter 1\u201d of his life.<\/p>\n\n\n\n

He\u2019s going to stay a physician, but he\u2019s eyeing a \u201cleadership in medical education\u201d post somewhere, probably at a university medical school that concentrates on reaching out to underserved minorities.<\/p>\n\n\n\n

\u201cYou know, you go into medicine to help people,\u201d Faison said. \u201cChapter 2? I feel like I help people in this job and in my career in the military. Chapter 2 is an extension of that, just in a different way.\u201d<\/p>\n\n\n\t