MILITARY UPDATE
Maternity care to get overhaul
By Tom Philpott
Maternity care has been a weak spot in military medicine. Surveys show too many patients dissatisfied with continuity of care, scheduling of appointments, availability of ultrasound, limited pain management options, and even a lack of childcare services or close-in parking for doctor visits.
Improvements in all of these areas are on the way.
The Department of Defense unveiled on Aug. 27 a care initiative for expectant mothers. Dr. William Winkenwerder, assistant secretary of defense for health affairs, said it will deliver a world-class obstetrics benefits across the military.
A few factors drive the initiative. One is the loss of authority, effective Dec. 28, for military hospitals to force maternity patients who use TRICARE Standard to seek care first from service hospitals if they live within 40 miles.
Some active-duty dependents could even decide to disenroll from TRICARE Prime if dissatisfied with maternity care. That's because, under an exception to law that Congress has declined to change, active duty family members are exempt from the usual TRICARE Standard cost shares when seeking maternity care.
That is forcing military obstetric care to be more competitive, said Dr. David N. Tornberg, deputy assistant secretary for clinic and program policy.
Another factor behind the initiative, Tornberg said, is the need to move military medicine toward a family-centered approach.
"If you look at the military health system, our number-one activity is maternal/infant care. Thirty percent of our admissions are maternity-related visits," Tornberg said.
Private sector health networks long have viewed quality maternity care as the way to win a family's loyalty. If a hospital makes new mothers happy, it wins their families for years to come.
A year ago, the military began to develop a strategy to upgrade and standardize maternity care.
Clinics will help women sort out type of delivery, anesthesia desired, if any, and how involved other family members will be in the birth.
"What we wanted to establish was a uniformed service (and) uniformed expectations across our health system," Tornberg said.
The commitment to improved maternity care will require more spending by the services to upgrade obstetric facilities and staff. Precisely how much, Tornberg couldn't say.
Patients will see appointment scheduling improve. Ultrasound will become more available, Tornberg said.
OB clinics also will pay more attention to creature comforts, he said including more parking, particularly reserved spaces for women in the final trimester.
Continuity of care will improve through a team concept of providers, common in the private sector. Women will be assigned an obstetrician but will meet other physicians in the group so that on the day of delivery, if their own doctor isn't available, a doctor familiar to them will be.
Defense and service health leaders will monitor closely how patient satisfaction improves and track number of deliveries in the military system versus deliveries under the Standard benefit, said Tornberg, who also serves as chief medical officer for the TRICARE Management Activity.
Questions, comments and suggestions are welcomed. Write to Military Update, P.O. Box 231111, Centreville, VA 20120-1111, or send e-mail to: milupdate@aol.com. Or visit Tom Philpott's Web site.
