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Remote care for wounded warriors raises concern

Apr. 24, 2014 - 11:55AM   |  
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The potential for thousands of wounded soldiers to have to rely on remote medical care has some Defense Department healthcare officials challenging Army logic.

Members of the Recovering Warrior Task Force, an organization which oversees the services’ wounded warrior programs, at a recent business meeting in Arlington, Va., questioned the wisdom of providing remote care to soldiers with complicated healthcare needs.

“When I take your website and your [presentation], how do we not assume that your intent is to indirectly manage this very complex population?” Dr. Richard Stone, a member of the task force, asked Tom Webb, deputy to the commander of Army Warrior Transition Command, on April 16.

Driven by a shrinking wounded warrior population, the Army announced in January it would restructure community-based care for wounded warriors. It will launch 13 new Community Care Units across 11 installations by Sept. 30, and mothball its nine Community-Based Warrior Transition Units, which primarily provide care for Reserve and National Guard troops. These units support more than 1,300 soldiers.

Community-Based Warrior Transition Units provide remote management to soldiers whose medical needs were not deemed complex and are able to live with their families. These units are to be replaced by Community Care Units nested within Warrior Transition Battalions on active-duty Army installations, cutting administrative overhead.

At the same time, the Army has rolled out a website to provide information information about programs and benefits for wounded warriors.

Stone also questioned how the command could project dropping to 5,500 wounded warriors by the end of 2015 when the service has 27,000 troops in the Integrated Disability Evaluation System.

Stone said the Army would have roughly two thirds of its wounded population under distributed management, referencing “significant problems” in the Marine Corps two years ago, before it began to actively manage its wounded population.

“Of 27,000, you’re going to manage at least 20,000 in a remote manner, so how can we be assured you won’t have the same problem other services have had, or return to 10 years ago,” Stone said. “What’s the safety net?”

Col. Jean Jones, the deputy chief of staff for Warrior Transition Command, said nurse case managers at Army patient-centered medical homes do track personnel in the IDES process. However, she could not immediately answer Stone about how many of the 20,000 were assigned a nurse case manager.

Stone noted many of the 20,000 might not be assigned to a patient-centered medical home.

Officials with the Army National Guard and Army Reserve noted that their soldiers, while in the IDES process, are supervised by a case management team. In both the Guard and Reserve, soldiers have to be assigned a nurse case manager to enter the process.

In January, Warrior Transition Command announced it is “inactivating” the five Warrior Transition Units where the populations of wounded, ill or injured soldiers were considered extremely low. None had more than 36 soldiers, and most had fewer than 10.

Army officials noted that soldiers would not move, and care plans would not be changed. Soldiers would not necessarily have to go to the installations where the Community Care Units are based to get care, according to Webb.

“If they’re not close, we’ll actually take that [CCU] team on the road to identify major populations in order not to incur that burden of travel,” Webb said.

As part of the move, the ratio of nurse case managers to soldiers will double from 1-to-20 to 1-to-10 at Warrior Transition Battalion headquarters units, easing the workload of cadre members. The ratio of squad leaders, who assess incoming troops, the ratio will rise from 1-to-10 to 1-to-8.

A CBWTU, as an independent unit, requires a headquarters element and its own providers, but in the shift to CCUs, those resources would be garnered from the installation’s WTU. Nurse case managers, platoon leaders and other staff would replace Reserve staff.

Webb said there will be two “footprints,” with soldiers assigned to and living at the WTU, and cadre assigned exclusively to the CCU in an “extended footprint.”

“In terms of establishing those Community Care Units, we don’t see anything we’re going to lose,” Webb said. “In fact, when the transition is complete, we see nothing but benefits, as far as having it be on an installation ... in terms of the resources available to the cadre.”

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