In an effort to build confidence in the quality of care that patients receive at military hospitals, the Defense Department will order the Army, Navy and Air Force to have independent health organizations review some of their inpatient records, an unprecedented measure that is expected to cost at least $6 million.
Health care officials familiar with the decision, which they said has been discussed for months and is expected to be announced Friday, said the assistant secretary of defense for health affairs, Dr. William Mayer, decided last week to order the reviews and that he has described them as "a way to measure just how good treatment is."
According to those officials, about 15 percent -- what one called "a good, substantial chunk" -- of all hospital admissions will be checked through the external review. In addition, incidents in which questions of care could be raised, including all surgical deaths and all deaths of patients admitted through emergency rooms, will be reviewed.
The new review, which is expected to cost at least $40 for each of the 150,000 admissions checked, should be in place by January, health officials said.
Military medical care has come under harsh scrutiny since internal Defense Department audits released earlier this year revealed deficiencies in the record keeping, training and review of health care professionals who work in the 168 military hospitals, which serve 10.2 million active service personnel, retirees and dependents.
In recent months, the announced court martial of Navy Cmdr. Donal M. Billig, a heart surgeon at Bethesda Naval Hospital who has been charged in the deaths of four patients there, again focused concern on the question of how military doctors are approved and reviewed for practice.
Mayer, who has been told on several occasions by Defense Secretary Caspar W. Weinberger to take steps to improve military medicine, has already ordered a number of reforms designed to strengthen controls over military health professionals, such as the licensing of all doctors.
Mayer could not be reached for comment yesterday about the newest measure, but health officials familiar with the decision said that he planned to present the reform during a regular monthly meeting of the Defense Health Council, a group that includes the surgeons general from each branch of the armed forces, the U.S. surgeon general and the medical director of the Veterans Administration.
" Mayer felt it would bring credibility and build confidence in the system," said a federal health care official involved in the decision.
The Associated Press reported yesterday that a letter written by Mayer to the administrator of the Health Care Financing Administration, a unit of the U.S. Department of Health and Human Services, indicated he wanted "military hospitals worldwide to be subjected to systematic external peer review similar to that done for Medicare patients."
The Health Care Financing Administration manages the Medicaid and Medicare programs and has contracts with peer review organizations, groups mandated since 1984 by Congress to monitor hospital usage under Medicare. Health officials said yesterday that Mayer has discussed using the same 50 organizations to assess quality of military health care and it is "highly likely they will be used."
David Newhall III, principal deputy assistant secretary of defense for health affairs, confirmed yesterday that Mayer had sent a letter to HCFA and that the subject of the letter was peer review. Newhall would not discuss specifics.
According to the Associated Press, Mayer sent the letter to HCFA administrator Carolyne K. Davis, and in it he called the move for stricter review an "unprecedented decision, which will dramatically complement the quality-assurance programs we have put in place in Defense medical facilities during the past two years.
"Statewide civilian peer review organizations will review the appropriateness, quality of utilization of in-patient care in our military hospitals and monitor the effectivness of our internal quality assurance efforts," he wrote.
"Particular emphasis will be put on reviewing records in certain categories where quality may be questioned. For example, we plan to review records of all deaths of patients admitted through the emergency room, all surgical deaths, all re-admissions within seven days of previous discharge, and all anesthesia-related events resulting in nervous system injury, including coma."
The external reviews are not expected to conflict with internal review teams now at each military medical facility, according to persons who have discussed the feasibility of the measure during the last few months.
The internal teams review the patient-treatment records of doctors and other health care professional on a yearly basis. The external teams will be asked to submit monthly reports on each military hospital, officials said.