D.C. area becoming test bed of military medical reforms

By Tom Philpott: CNJ columnist

Extraordinary steps in the evolution of military medicine are occurring in the Washington, D.C., area where new medical facilities are being built to consolidate services, and a joint command is being readied to adopt cutting-edge concepts to improve quality and efficiency of service health care.

Two famed medical facilities — Walter Reed Army Medical Center and Bethesda Naval Medical Center — are being combined into one “world class” medical center, the biggest in the military, said the project’s top officer.

Two nearby community hospitals also are being merged into one large new hospital at Fort Belvoir, Va., a facility will cover as much ground as a local shopping mall with its length equal to that of two aircraft carriers.

At both facilities military staff will be Army, Navy and Air Force health care providers and serve in joint billets.

Overseeing the $2.4 billion project, the largest capital infrastructure investment ever made in the military health system, and struggling to mesh three service cultures under a single command is Navy Vice Adm. John M. Mateczun, commander of Joint Task Force National Capital Region Medical.

Mateczun said National Capital Region Medical will be a test bed not only of joint staffing but for “transformative business practices” and new approaches to military health care delivery.

In the NCR, for example, officials will strive to improve integration of health care service provided through military facilities and through purchased care from the TRICARE network of civilian physicians or health insurance.

The National Capital Region also will continue to serve as the primary casualty reception site for wounded returning from war, Mateczun said, and care of the wounded will remain its top priority.

Orders to “recapitalize” and consolidate military medical facilities in the D.C., area came down in BRAC 2005, the most recent round of base closures and realignments ordered by Congress. This was the first BRAC to include a comprehensive review of medical infrastructure.

The medical region’s realignment is to be completed by Sept. 15, 2011. By then service at Walter Reed will be transferred to an expanded medical center at Bethesda and to the new hospital at Fort Belvoir. The medical center at Andrews Air Force Base will become a clinic and its inpatient capability added to Belvoir or Bethesda depending on care required.

The consolidated facilities are to have the same total patient capacity as area facilities had before BRAC. Mateczun said reorganization and construction plans are progressing on schedule.

Mateczun said the task force’s biggest challenge has been cultural differences between services. Some are merely style and easy to address. Others are mission-related and must be accommodated. For example, medical support in the Army and Marine Corps are maneuver-capable units. But “deployable” Air Force support is still intended to be next to a runway.

To combine the medical centers alone, more than 160 working groups are deciding what assets and services will be at Bethesda or at Belvoir or at both.

Mateczun said judgments the task force makes in taking control of all medical assets in the region, and how that command operates, will inform a long-running debate over whether to establish a joint or unified medical command to oversee all military medical personnel and resources.

Tom Philpott can be contacted at Military Update, P.O. Box 231111, Centreville, Va. 20120-1111, or by e-mail at: