The 87th Medical Group has teamed up with Keller Army Community Hospital located at West Point, New York to bring advanced orthopedic care to service members assigned to Joint Base McGuire-Dix-Lakehurst, New Jersey.

Starting February 2022, U.S. Army Col. Chad Haley, MD, KACH chief of surgery, will be traveling to Joint Base MDL once a month to evaluate patients in need of potential surgical and postoperative orthopedic care. 

"Being a military surgeon, I know how to do the profiles, I know what my patients need to do in their job for the most part, and I know about the medical board system,” Haley said. “We keep our records on the same platform as the providers here. Immediately, they can see what I write on a patient and know what the plan is versus going to a civilian physician where patients have to either hand-carry their records or electronically send them to the military medical facility. That doesn’t always happen or [the records] get lost.”

Joint Base MDL is an outpatient medical facility – patients are referred to civilian doctors off the installation for their surgical needs. This usually requires double appointments for military members to see their primary care physician and the referred doctor, transferring medical records by hand between facilities, medical decisions made by professionals who may not understand military standards and requirements, and additional payments to the medical office from the Department of Defense. As a mitigation, the medical leadership at Joint Base MDL and KACH  are experimenting with the "traveling provider," starting with Haley.

"Medical-wise, all branches of service are falling under the Defense Health Agency,” said U.S. Air Force 1st Lt. Giuseppe Francioni, 87th MDG group practice manager. “They are trying to align local medical treatment facilities to reduce purchase care [off base]. We knew there was an orthopedic doctor within [reach] so we reached out to [KACH] to do this initiative.”

DHA is a joint, integrated Combat Support Agency that enables the U.S. Army, Navy, and Air Force medical services to provide a medically ready force and ready medical force to Combatant Commands. The DHA uses the principles of Ready, Reliable Care to advance high-reliability practices across the Military Health System by improving system operations, driving innovative solutions, and cultivating a culture of safety. 

"We are sending patients out to the civilian sector to get care when we have the capability in-house,” said Francioni. “ We lose close to $2 million a year by sending patients to civilian doctors. If we are able to provide that care in-house, then we could save a significant amount of money for the Department of Defense.”

According to Francioni, orthopedic surgeries can range between $15,000 to $25,000 per person. This initiative recaptures money back to the force that can be focused on adding to or improving existing departments, processes, or even medical staff.

"Orthopedics is the biggest demand we have here amongst our active-duty population, and probably the biggest impact to our readiness,” said Travis Pearson, 87th MDG group practice manager. “Hopefully, we can improve readiness by utilizing this ‘traveling provider’ that understands military requirements as well as save the DoD a lot of money. The DoD is already paying for Dr. Haley and any other military surgeon, we are already paying for the operating room and staff so by sending these patients to [KACH] instead of civilian hospitals, we save all of that money.” because we're accruing no real additional cost since the doctors, staff, and equipment is already paid for. The amount of money it would cost for travel is negligible compared to what we would save.”

The U.S. Military Academy’s sports program has given them extensive experience with general to complex procedures from all over the world. Haley says the Cadets are one of the highest risk categories of patients in the military as they are required to quickly return to all their classes and sports teams, otherwise, they risk being removed from the program. This gives the surgeons access, equipment, and the capabilities needed to improve the health of service members as well as to uphold their readiness and maintain their active military status.

Military surgeons have the educational tools to make a medical decision while keeping military standards in mind which could keep a patient's career intact. Details such as understanding the impact of a surgery that makes a member non-deployable for 12 months versus a non-invasive procedure that brings a member back to deployable status in 30-60 days, can make a difference.

"Hopefully, aligning functionality under DHA can set a standard moving forward and can be mimicked across the entire DoD,” said Francioni. “Instead of sending patients [off base], we can look at our local military surgeons. We want to preach DHA’s mission of being interchangeable and this is the first step toward aligning under one organization.”