Military Personnel: Guidance Needed for Any Future Conversions of Military Medical Positions to Civilian Positions Page: 6 of 42
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analyses of potential effects of conversions including the key assumptions. In
addition, officials within the USD, P&R and the TRICARE Management Activity stated
that such guidance was not issued because the law required the secretaries of the
military departments-not the Secretary of Defense-to submit the certifications.
These OSD officials acknowledged, however, that leadership was needed in this area
at the OSD level. As stated previously, under DOD's manpower management
directive, OSD (P&R) is responsible for issuing guidance on manpower management,
which would include guidance related to determining the least costly mix of military,
civilian, and contract personnel. Specifically, regarding the military to civilian
conversion certifications, we found that each of the military departments provided
documentation to support its assessment of the impact of conversions on medical
readiness,14 along with documentation to demonstrate how their cost comparisons
were performed. On the other hand, we found that even though each of the
departments stated that planned and completed conversions would not have a
negative impact on access to care, only the Navy provided an analysis of patient
waiting times for medical appointments to support this conclusion. Air Force and
Army officials told us that they based their assertion that conversions would not
decrease access to care on the assumption that converted military positions would be
filled on a one-to-one basis by qualified civilian employees, and thus qualified
providers would be available to prevent problems with access to care. Regarding the
quality of care received by beneficiaries, all of the military departments stated that
quality of care would not be affected by conversions because the civilians being hired
would be required to have the same qualifications, credentials, and licenses as the
military personnel who had held the positions being converted. However, none of the
departments provided documentation-for example, an assessment that quality of
care performance measures15 had not been negatively impacted by conversions-to
demonstrate this. Similarly, all of the military departments stated that they did not
expect conversions to negatively impact recruitment or retention of military
personnel, but none provided any data supporting this view. Officials from each of
the military departments stated that the impact of conversions on access to care,
quality of care, and recruitment/retention of military personnel would be difficult to
isolate and document because many factors would influence any performance metric
used to assess any impacts. These factors include the cost growth discussed earlier,
increased number of beneficiaries covered by the defense health program, as well as
deployments and temporary duty travel. However, federal internal control guidance
states that appropriate documentation should be maintained for significant events,
and internal controls are designed to provide reasonable assurance concerning
compliance with applicable laws and regulations." Without guidance from OSD to
'4Each of the military departments stated that medical readiness was based on DOD's most recent
Medical Readiness Review (MRR) and that planned conversions are in excess of those positions
required for the readiness mission. However, we have not reviewed the assumptions and data used in
the conduct of the MRR.
'"In addition to credentialing and licensing, these performance measures would include how well the
health care system performed with respect to measurable processes and outcomes of care for clinical
performance measures and in response to surveys to measure how well the health care system is
viewed by the beneficiaries, military leadership, and Congress.
'"See GAO, Standards for Internal Control in the Federal Government, GAO/AIMD-00-21.3.1
(Washington, D.C.: November 1999).GAO-08-370R DOD Medical Conversions
Page 6
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United States. Government Accountability Office. Military Personnel: Guidance Needed for Any Future Conversions of Military Medical Positions to Civilian Positions, text, February 8, 2008; Washington D.C.. (https://digital.library.unt.edu/ark:/67531/metadc297532/m1/6/: accessed July 16, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.