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Top doc urges Marines to get Navy care

Nov. 4, 2012 - 12:17PM   |   Last Updated: Nov. 4, 2012 - 12:17PM  |  
A newborn reconnoiters Naval Hospital Camp Lejeune, N.C. The Navy surgeon general wants Marine families who gravitated to civilian care during the war years to return to military facilities.
A newborn reconnoiters Naval Hospital Camp Lejeune, N.C. The Navy surgeon general wants Marine families who gravitated to civilian care during the war years to return to military facilities. (CPL. JONATHAN WRIGHT / MARINE CORPS)
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SAN DIEGO — The Navy's top medical officer is urging Marines and their families to come back to military hospitals and clinics and also to take advantage of the Navy's new "virtual care" services.

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SAN DIEGO — The Navy's top medical officer is urging Marines and their families to come back to military hospitals and clinics and also to take advantage of the Navy's new "virtual care" services.

Vice Adm. Matthew L. Nathan, chief of the Bureau of Medicine and Surgery, said that during the past 11 years of war, many military beneficiaries began bypassing military medical facilities in favor of off-base providers because of longer wait times and inconsistent medical care as Navy doctors and nurses were needed downrange.

But with fewer medical personnel deploying to Afghanistan, this is not an issue, Nathan said.

"I really need you to have your baby at my hospital instead of going out … because I can do it that much cheaper," he said, adding that it's a huge value when compared to civilian care.

With medical costs rising and defense budgets taking a hit, Navy officials are also looking at ways to save on medical care expenses without hindering services.

One plan is to expand the Navy's "virtual care" services, said Nathan, the Navy surgeon general, in an Oct. 17 interview. The idea is to enable patients to make appointments, obtain lab results, consult with a specialist or get a second opinion, all via smartphone or computer. This saves time and trips to a hospital or clinic, while also fostering preventive care, Nathan said.

"The only time you'll have to go see a doctor is when you are really sick," said Nathan,.

Nathan touted this new approach to health care during a three-day visit to San Diego. The Navy is expanding the Patient-Centered Medical Home or "Medical Home Port" beyond the 107 clinics where it's currently offered, he said. Visiting multiple California bases, he also encouraged sailors and Marines to take more advantage of Navy hospitals, clinics and medical centers.

The savings could be critical to the Navy as health care costs continue to rise.

Military medical costs have jumped from $19 billion in 2001 to $52 billion in 2011, a trend that "is not sustainable," Nathan said. The high costs make health care a target for budget cutters at the Pentagon and on Capitol Hill.

"There's a desperation in D.C. right now … to try to figure out how to change … the trajectory of health care costs," Nathan told the San Diego Military Affairs Council on Oct. 17.

The per capita annual cost for health care in the Navy and Marine Corps is $340, compared to $360 in the Army and $302 in the Air Force, according to BUMED.

Nathan said these budget constraints have a plus side: They force innovation.

What is virtual care?

An internal medicine physician by training, Nathan tested the "virtual care" concept a few years ago when he commanded Walter Reed National Military Medical Center in Bethesda, Md.

The pilot program put half the enrolled patients into a Patient-Centered Medical Home clinic where they got care not just from their primary care provider, but from a "pod," or team, of doctors, nurses and specialists who coordinated their care. Nathan provided funding so patients could submit and receive medical information via a secured site, instead of visiting the office.

Nine months into the pilot, Nathan said, he found a quiet and serene clinic — the virtual clinic did have physical space at the medical center — and learned fewer patients came in for appointments compared to the regular clinic. When he reviewed patients' lab and test results, data on emergency room visits and hospital admissions, he found "a healthier population being taken care of better."

Keeping patients healthier well into their 70s means "a huge paradigm change in my costs," Nathan added.

The Navy began to implement the program last year. Fifty more medical practices will take part by the end of 2012, according to BUMED, and more will come online in 2013.

While older patients have been more resistant to it, younger patients take to it eagerly, he said.

"We have a culture that is emerging that wants to be more electronically dialed in." Doctors in the virtual clinic have more enrolled patients, he said, but their overall workload hasn't increased because "those patients are getting what they need and they are healthy."

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