Is the current referral trend a threat to the Military Health System? Perioperative outcomes and costs after colorectal surgery in the Military Health System versus civilian facilities

Integrated military and civilian partnerships are necessary for effective trauma-related training and skills sustainment during the inter-war period

“…This is just one indicator of the operative volume that continues to leak out of the MTF direct care network to civilian hospital purchased care. For example, between 2006 and 2015 only 25% of the over 20,000 MHS beneficiaries requiring colorectal surgery had their operation within the direct care network at an MTF 85 . Furthermore, between 2005 and 2019, only 10% of 292,411 patients requiring pancreatectomies, hepatectomies, esophagectomies, coronary artery bypass grafts, abdominal aortic aneurysm repairs and carotid endarterectomies eligible for MTF care, actually received their care within the MTF 86 .…”

“…For example, between 2006 and 2015 only 25% of the over 20,000 MHS beneficiaries requiring colorectal surgery had their operation within the direct care network at an MTF. 85 Furthermore, between 2005 and 2019, only 10% of 292,411 patients requiring pancreatectomies, hepatectomies, esophagectomies, coronary artery bypass grafts, abdominal aortic aneurysm repairs and carotid endarterectomies eligible for MTF care, actually received their care within the MTF. 86 Many of these subspecialists, particularly cardiothoracic surgery, are working at civilian institutions through partnerships or off-duty employment because few MTFs have the appropriate case volume to maintain their skillset.…”

Data resources for evaluating the economic and financial consequences of surgical care in the United States

“…Notable limitations include difficulty comparing the payments between direct care and purchased care systems, high rates of missing information on race/ethnicity, and regulatory barriers to accessing the data 12,13 . Researchers have used Tricare claims to evaluate for racial disparities in access to surgical care and outcomes in this near universally insured population, 14–16 as well as costs after colorectal surgery, variation in costs of common surgical procedures, and bundled payments for spine surgery 17–19 …”

“…12,13 Researchers have used Tricare claims to evaluate for racial disparities in access to surgical care and outcomes in this near universally insured population, [14][15][16] as well as costs after colorectal surgery, variation in costs of common surgical procedures, and bundled payments for spine surgery. [17][18][19]…”

Declining Military Surgical Cases and the Impact on Military Surgical Graduate Medical Education

“…The reliance on civilian organizations is a response to meet defined category minimums and provide educational exposure to the acuity, complexity, and surgical cases types that are not found within military hospitals. 7 Some military surgical programs have fully shifted to a civilian center serving as the primary institution with the military treatment facility as a small rotation. 8 If a reversal of the decline in GME contribution by MHS facilities is desired, a significant re-expansion of military hospitals through increased funding and beneficiary enrollment would be necessary.…”