January 27, 2022

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Defense Health Care: Actions Needed to Define and Sustain Wartime Medical Skills for Enlisted Personnel

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<div>What GAO Found The military departments have not fully defined, tracked, and assessed wartime medical skills for enlisted medical personnel. The departments have defined these skills for 73 of 77 occupations. However, among other issues, the Army and the Air Force have not defined skills for numerous highly-skilled subspecialties that require additional training and expertise, such as Army Critical Care Flight Paramedics. Subspecialty personnel are key to supporting lifesaving medical care during deployed operations. The Army does not consistently track wartime medical skills training for enlisted medical personnel in its official system. The military departments are not able to fully assess the preparedness of enlisted medical personnel because, according to officials, they have not developed performance goals and targets for skills training completion. As a result, the military departments lack reasonable assurance that all enlisted medical personnel are ready to perform during deployed operations. The Department of Defense (DOD) has not fully developed plans and processes to sustain the wartime medical skills of enlisted medical personnel. While the Defense Health Agency (DHA) has initiated planning efforts to assess how the military departments' three primary training approaches sustain readiness (see figure), these efforts will not fully capture needed information. For example, DHA's planned metrics to assess the role of military hospitals and civilian partnerships in sustaining readiness would apply to a limited number of enlisted occupations. As a result, DHA is unable to fully assess how each training approach sustains readiness and determine current and future training investments. Approaches to Train Enlisted Medical Personnel's Wartime Medical Skills DOD officials have identified challenges associated with implementing its training approaches. For example, DOD relies on civilian partnerships to sustain enlisted medical personnel's skills, but DOD officials stated that licensing requirements and other issues present challenges to establishing and operationalizing civilian partnerships. DOD has not analyzed or responded to such risks, and may therefore be limited in its ability to sustain wartime medical skills. Why GAO Did This Study DOD has over 73,000 active-duty enlisted medical personnel who must be ready to provide life-saving care to injured and ill servicemembers during deployed operations, using their wartime medical skills. Senate Report 116-48 accompanying a bill for the National Defense Authorization Act for Fiscal Year 2020 included a provision for GAO to review DOD's efforts to maintain enlisted personnel's wartime medical skills. This report examines, among other objectives, the extent to which (1) the military departments have defined, tracked, and assessed enlisted personnel's wartime medical skills, and (2) DOD has developed plans and processes to sustain these skills and assessed risks associated with their implementation. GAO analyzed wartime medical skills checklists and guidance; reviewed plans for skills sustainment; and interviewed officials from DOD and military department medical commands and agencies, and nine inpatient military medical treatment facilities.</div>
Department of the Army 1. The Secretary of the Army should ensure that the Commanding General, U.S. Army Medical Center of Excellence, takes corrective action to define wartime medical skills for enlisted medical subspecialties with an expeditionary role. (Recommendation 1)

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When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Air Force 2. The Secretary of the Air Force should ensure that the Surgeon General of the Air Force, in coordination with the Commander, Air Force Medical Readiness Agency, takes corrective action to define and implement wartime medical skills for enlisted medical subspecialties with an expeditionary role. (Recommendation 2)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Air Force 3. The Secretary of the Air Force should ensure that the Surgeon General of the Air Force, in coordination with the Commander, Air Force Medical Readiness Agency, establishes guidance that requires the development of wartime medical skills for current and future enlisted medical subspecialties with an expeditionary role. (Recommendation 3)

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When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Army 4. The Secretary of the Army should ensure that the Commanding General, U.S. Army Medical Center of Excellence, takes corrective action to fully incorporate joint wartime medical skills into Army wartime medical skills checklists. (Recommendation 4)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Air Force 5. The Secretary of the Air Force should ensure that the Surgeon General of the Air Force, in coordination with the Commander, Air Force Medical Readiness Agency, takes corrective action to fully incorporate joint wartime medical skills into Air Force wartime medical skills checklists. (Recommendation 5)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Air Force 6. The Secretary of the Air Force should ensure that the Surgeon General of the Air Force, in coordination with the Commander, Air Force Medical Readiness Agency, issues guidance requiring the incorporation of joint wartime medical skills into Air Force checklists. (Recommendation 6)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Air Force 7. The Secretary of the Air Force should ensure that the Surgeon General of the Air Force, in coordination with the Commander, Air Force Medical Readiness Agency, takes corrective action to review and update outdated wartime medical skills checklists for enlisted medical occupations. (Recommendation 7)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Army 8. The Secretary of the Army should ensure that the Commanding General, U.S. Army Training and Doctrine Command, updates its guidance to require the specification of acceptable methods of sustainment training for wartime medical skills for enlisted medical personnel. (Recommendation 8)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Army 9. The Secretary of the Army should ensure that the Commanding General, U.S. Army Medical Center of Excellence, incorporates findings on skills degradation from DOD’s project on highly perishable and mission-essential medical skills into its processes to identify appropriate training frequencies of wartime medical skills. (Recommendation 9)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Navy 10. The Secretary of the Navy should ensure that the Surgeon General of the Navy incorporates findings on skills degradation from DOD’s project on highly perishable and mission-essential medical skills into its processes to identify appropriate training frequencies of wartime medical skills. (Recommendation 10)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Air Force 11. The Secretary of the Air Force should ensure that the Surgeon General of the Air Force, in coordination with the Commander, Air Force Medical Readiness Agency, incorporates findings on skills degradation from DOD’s project on highly perishable and mission-essential medical skills into its processes to identify appropriate training frequencies of wartime medical skills. (Recommendation 11)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Army 12. The Secretary of the Army should ensure that the Surgeon General of the Army requires the consistent tracking of training on wartime medical skills for enlisted medical personnel. (Recommendation 12)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Army 13. The Secretary of the Army should ensure that the Surgeon General of the Army establishes performance goals and targets for the completion of training on wartime medical skills for enlisted medical occupations and tracks performance toward achieving the goals and targets. (Recommendation 13)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Navy 14. The Secretary of the Navy should ensure that the Surgeon General of the Navy establishes performance goals and targets for the completion of training on wartime medical skills for enlisted medical occupations and tracks performance toward achieving the goals and targets. (Recommendation 14)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Air Force 15. The Secretary of the Air Force should ensure that the Surgeon General of the Air Force, in coordination with the Commander, Air Force Medical Readiness Agency, establishes performance goals and targets for the completion of training on wartime medical skills for enlisted medical occupations and tracks performance toward achieving the goals and targets. (Recommendation 15)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of Defense 16. The Secretary of Defense should ensure the Director, DHA, develops metrics to assess the contributions of MTF workload to sustaining wartime medical skills that include the medical care provided by enlisted medical personnel. (Recommendation 16)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of Defense 17. The Secretary of Defense should ensure the Director, DHA, develops the required inventory of civilian partnerships to include all partnerships in which enlisted medical personnel may participate. (Recommendation 17)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of Defense 18. The Secretary of Defense should ensure the Director, DHA, develops a process to identify opportunities to streamline or add military-civilian training partnerships. (Recommendation 18)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of Defense 19. The Secretary of Defense should ensure the Director, DHA, develops metrics to assess the contributions of civilian partnerships to sustaining wartime medical skills that include the medical care provided by enlisted medical personnel. (Recommendation 19)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of Defense 20. The Secretary of Defense should ensure the Director, DHA, performs the proposed assessment of available simulation programs, demand for them, and gaps in clinical training and simulation requirements. (Recommendation 20)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Army 21. The Secretary of the Army should ensure the Surgeon General develops and implements a consistent clinical readiness assessment process for wartime medical skills maintenance to identify and address gaps in training. (Recommendation 21)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Navy 22. The Secretary of the Navy should ensure the Surgeon General develops and implements a consistent clinical readiness assessment process for wartime medical skills maintenance to identify and address gaps in training. (Recommendation 22)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of Defense 23. The Secretary of Defense should ensure the Director, DHA, in conjunction with the Surgeons General of the Army, the Navy, and the Air Force analyzes and responds, as appropriate, to risks to sustaining enlisted personnel wartime medical skills associated with: (1) staffing challenges at MTFs; (2) managing rotations of non-MTF personnel to MTFs; (3) barriers to civilian partnerships; and (4) challenges in providing enlisted medical personnel opportunities to train on expeditionary medical equipment. (Recommendation 23)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Army 24. The Secretary of the Army should develop annual retention goals, by skill level, for enlisted medical personnel. (Recommendation 24)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Navy 25. The Secretary of the Navy should develop annual retention goals, by skill level, for enlisted medical personnel. (Recommendation 25)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Air Force 26. The Secretary of the Air Force should develop annual retention goals, by skill level, for enlisted medical personnel. (Recommendation 26)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Army 27. The Secretary of the Army should consider incorporating data on civilian pay for comparable occupations in the Army’s decision-making processes for awarding retention bonuses. (Recommendation 27)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Navy 28. The Secretary of the Navy should consider incorporating data on civilian pay for comparable occupations in the Navy’s decision-making processes for awarding retention bonuses. (Recommendation 28)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Air Force 29. The Secretary of the Air Force should consider incorporating data on civilian pay for comparable occupations in the Air Force’s decision-making processes for awarding retention bonuses. (Recommendation 29)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Department of the Navy 30. The Secretary of the Navy should include information on the cost of training in its decision-making process for awarding retention bonuses. (Recommendation 30)

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

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  • Capitol Police: Applying Effective Practices to Address Recommendations Will Improve Oversight and Management
    In U.S GAO News
    What GAO Found The U.S. Capitol Police (Capitol Police) may benefit from applying practices to help implement recommendations from auditing entities, such as those from GAO and the Capitol Police Office of the Inspector General (OIG). These effective practices include the following: Provide management oversight over the prompt remediation of deficiencies and delegate authority. Federal internal control standards state that management should oversee the prompt remediation of deficiencies. This should be done by communicating the corrective actions to the appropriate personnel and delegating authority for completing these actions. Communicate regularly with auditing entities on the status of recommendations. Engagement between Capitol Police and auditing agency leaders could provide important leadership attention to help ensure actions are taken to implement recommendations. Work with Congress to address recommendations. Congress plays a key role in providing oversight and maintaining focus on recommendations from audit entities. For example, federal agencies, including the Capitol Police, are required to report on the implementation status of public recommendations. Further, agencies can also assess the need for legislation to address recommendations and report their findings to Congress. Follow key organizational transformation practices . As the Capitol Police takes steps to implement recommendations from auditing entities, the agency may benefit from following key organizational transformation practices, such as (1) setting implementation goals and a timeline, (2) dedicating an implementation team to manage the transformation process, and (3) involving employees to obtain their ideas and gain their ownership for the transformation. Coordination between the Capitol Police and its Board is critical to addressing its recommendations. The Capitol Police Board (the Board) is charged with oversight of the Capitol Police. Given the oversight role of the Board, the Capitol Police may need approval from the Board in order to take actions to address recommendations from auditing entities. GAO's 2017 work on the Board assessed whether the Board, in fulfilling its role in overseeing the Capitol Police, had developed and implemented policies that incorporate leading practices to facilitate accountability, transparency, and effective external communication. In that effort, GAO examined the Board's main governing document, its Manual of Procedures, and determined that it fully incorporated one leading practice and partially incorporated five others. Specifically, the Board's manual did develop processes for the internal functions of the Board but did not address any Board responsibilities in ensuring that any audit findings and recommendations to the Capitol Police were promptly resolved. By incorporating leading practices into its manual, the Board can ensure it is facilitating accountability, transparency, and effective external communication as it fulfills its oversight role of the Capitol Police. Why GAO Did This Study The attack on the U.S. Capitol on January 6, 2021, highlighted the critical need to identify and address deficiencies in the management and security functions of the Capitol Police. Various auditing entities have work ongoing related to the attack on the U.S. Capitol, including GAO and the Capitol Police OIG. It is important that the Capitol Police is well positioned to respond to existing and future recommendations from auditing entities. To do so, Capitol Police will also need to work closely with the Capitol Police Board, which has varied and wide-ranging oversight roles and responsibilities per statute. This statement discusses (1) effective practices for addressing recommendations from auditing agencies and (2) GAO's open recommendation to the Capitol Police Board from February 2017. To identify effective practices for addressing recommendations, GAO reviewed reports and testimonies issued from July 2003 through March 2021 that discussed the implementation of GAO recommendations, federal internal control standards, and organizational transformation. GAO also reviewed its February 2017 report on the Capitol Police Board, and used information gathered from its recommendation follow up efforts with the Capitol Police Board in 2020 and 2021.
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  • Houston-Area Physician and Anesthesiologist Sentenced to 84 Months in Prison for Role in Health Care Benefit Scheme
    In Crime News
    A Houston-area physician and anesthesiologist at two registered pain clinics, Texas Pain Solutions and Integra Medical Clinic, was sentenced today to seven years in prison for his role in fraudulently billing health care programs for at least $5 million dollars in medical tests and procedures, and for the role his fraud played in multiple patient deaths.
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  • USDA Market Facilitation Program: Information on Payments for 2019
    In U.S GAO News
    The U.S. Department of Agriculture's (USDA) Farm Service Agency (FSA) distributed about $14.4 billion in 2019 Market Facilitation Program (MFP) payments to farming operations in all 50 states and Puerto Rico. According to USDA, these payments were intended to offset the effects of trade disruptions and tariffs targeting a variety of U.S. agricultural products. FSA distributed these payments to 643,965 farming operations. The average MFP payment per farming operation for 2019 was $22,312 but varied by county, ranging from $44 to $295,299. MFP payments for 2019 also varied by type of commodity. Three types of commodities were eligible for 2019 MFP payments: (1) nonspecialty crops (including grains and oilseeds, such as corn and soybeans); (2) specialty crops (including nuts and fruits, such as pecans and cranberries); and (3) dairy and hogs. Most of the 2019 MFP payments went to farming operations that produced nonspecialty crops. Less than 10 percent went to farming operations that produced specialty crops or dairy and hogs. USDA made approximately $519 million in additional MFP payments for 2019 compared with 2018 because of increases in payment limits—the cap on payments that members of farming operations can receive. FSA distributed these additional MFP payments to about 10,000 farming operations across 39 states. The amount of additional MFP payments that FSA distributed for 2019 varied by location. Farming operations in five states—Texas, Illinois, Iowa, Missouri, and Minnesota—received almost half of all additional payments. In May 2019, USDA announced it would distribute up to $14.5 billion in direct payments to farming operations that were affected by trade disruptions, following the approximately $8.6 billion USDA announced it had distributed for 2018. USDA referred to these 2018 and 2019 payments as the MFP. In comparison with 2018, USDA changed the 2019 payment structure for the three types of commodities that were eligible for payments. For example, USDA increased the payment limit for each of these three types. GAO was asked to review the distribution of MFP payments for 2019. This report examines, among other things, MFP payments for 2019 and how they varied by location, farming operation, and type of commodity, as well as additional MFP payments for 2019 compared with 2018 that resulted from increased payment limits. To accomplish these objectives, GAO analyzed data from USDA and interviewed agency officials knowledgeable about the data. For more information, contact Steve Morris at (202) 512-3841 or morriss@gao.gov.
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