You wake up feeling lousy. You have the chills, your sinuses are stuffed, and your throat is scratchy and sore – all the classic symptoms of the flu.
In this day and age, you can call your primary care provider, and chances are good you can get an appointment that same day. If your doctor’s schedule is booked, you can go to an Urgent Care or similar facility and be seen by a care provider that day.
It has become a staple of modern medicine that the delivery of medical care has become as immediate as delivering a pizza.
Except in the military.
Many serving in the military have a different experience when looking for medical help and that different experience is not good.
For instance, take an active-duty military man or woman at Joint Base McGuire-Dix-Lakehurst feeling those same flu-like symptoms.
The active-duty member calls to request an appointment at the base’s medical facility. Usually there are no same day appointments available – in fact, the wait could be as long as a week or even up to six weeks.
So, the active-duty member defaults to a second option and calls the Nurse Advice Line (a 24/7 service providing access to registered nurses who can answer health care related questions).
The active-duty member waits and gets a call back from a nurse who uses a protocol to do an over-the-phone triage. Likely, the active-duty member will get a referral to go to an Urgent Care to be seen within the next eight hours.
With this kind of service profile as a backdrop, leadership of the 87th Medical Group at McGuire-Dix-Lakehurst decided it was time for a radical change. It was time to upgrade health care services to the expectations of the modern-day patient.
“We got together, and we said we are not meeting the needs of our patients,” said Colonel Ann McManis, commander of the 87th Medical Group. “We were at the point where it took about six weeks to get an appointment, and it was very unusual to get a same-day appointment.”
The 87th Medical Group is responsible for the health care of the 42,000 military members, retirees, veterans and civilians – and their families – who work at the Joint Base.
“We had to modernize. Health care is evolving and if we do not evolve with it, we are going to be left behind,” emphasized Lt. Colonel Steven Poe, chief administrator and medical support squadron commander at the 87th Medical Group.
“There is a reason why you see an Urgent Care on every corner,” Poe continued. “Because it works. We are living in a “now” generation. They want their pizzas delivered now. They want their oil changed now. They want everything right now, including their healthcare. We needed to create a service that recognizes that reality.”
The 87th Medical Group plunged into weeks of research, visiting emergency rooms and Urgent Care facilities.
“I got into the mindset that if you can’t beat them, join them,” Poe explained. “We spent time with their clinic directors and clinic teams, and we asked them about their best practices, how they did business and what metrics they tracked. We took what we learned and developed an on-demand urgent care model.”
The model they created became the Joint Base’s first-ever Same Day Acute Care (SDAC) clinic. It opened on April 8. The clinic offers walk-in, on-demand service for its patients. It is designed to treat non-life-threatening acute conditions such as sore throats, colds, cases of flu and minor injuries.
“We had eight subject matter experts including administrative and nursing staffs and provider staff and people from our sectors give us different ideas,” said Major David Kornack, director of the new SDAC. “Eventually we knew what we wanted to do. Then we had to figure out how to implement it.”
First and foremost, the new clinic was created to improve care and substantially reduce the time patients had to wait to see a doctor.
“Our biggest challenge is getting our patients in to see our doctors when they want to be seen,” said McManis. “But we have providers who get deployed and so they come and go – that is a challenge unique to us that you don’t see in the civilian world.”
“In the civilian world, when a new clinic is opened, they hire new providers,” said Kornack. “We were in a resource neutral environment. We could not hire new providers. We could only use our current resources, and we still needed to do the mission of primary care.”
The solution, according to Kornack, was a rotating model whereby primary care physicians- and their assigned staff members would rotate to the clinic one day of the week.
“We revamped what people were doing to free them up to work in the clinic,” said McManis. “It worked out well. We could meet the needs of our patients and get them back to the fight.”
“We made it flexible and convenient – you show up and we will see you,” said Poe.
“You walk into the clinic, check in at the kiosk and you will be seen that day,” said Kornack.
The second major consideration in creating the SDAC was financial.
“The clinic addressed the need for immediate care while also allowing us to be fiscally responsible,” said Poe, who explained that the Medical Group gets its funding from the Defense Health Agency (DHA) which is the national health entity for the military.
“We are in a financially constrained environment,” continued Poe. “DHA is very clear that we get a certain amount of dollars each year and if we do not take care of a patient – say a patient goes to an outside provider or an urgent care facility instead of coming to our clinic – then the dollars go with that patient. That has a negative implication on our next year’s budget. We had to develop a model that would keep our patients here.”
“We were seeing the costs of off-base care go up,” said McManis. “We were in the position where we were spending more money to send people away. We were sending so many people with unique interesting and unique cases off base, it took away opportunities for our providers to get experience with these cases.”
Poe and Kornack emphasized that the financial considerations did not trump their focus on quality-of-care. Regarding acute care treatment, Poe said his team learned that the average outside provider spends three to five minutes with a patient.
“For the most part, this is not trying to manage multiple medications or comorbidities (multiple medical conditions in the same patient) that need constant care,” Poe said. “Speed and efficiency matter. You can be quick and efficient and still provide excellent care.”
“We are still focused on doing the mission of primary care,” said Kornack. “One of the big benefits I have seen in our rotating system is that we can provide continuity of care to our patients. It is a managed care concept.”
The new Same Day Acute Clinic is seeing, on average, 50 to 70 patients a day according to Kornack with as many as 85 seen on very busy days.
In total, the clinic has seen 3,655 patients since it opened on April 8, which translates to about $740,000 in terms of dollars for the clinic that would have gone to outside care facilities had those patients gone for care off the base.
“This new clinic recognizes the fact that a majority of our business – 60 percent or more – is acute care,” Poe pointed out.
The new SDAC clinic has expanded the immediacy of its service model to other aspects of its services, such as the 87th Medical Group’s laboratory.
“The lab plays a critical role in this,” said Poe. “We had to change the way we do business there too. When a provider from the SDAC puts in a request, the old way would take three to five days for a result. Now, every request that comes from SDAC is determined to be an ASAP request. In a lot of cases, the turnaround now is two hours.”
The SDAC also an ambulance service at the ready at all times. The ambulance sits on a driveway behind the clinic.
“If someone had an issue and we believe he or she has to go to a full-line emergency room, we put them in the ambulance and send them to an off-base ER,” said Poe.
In addition, the clinic is supported by supplemental providers and has an ER doctor from Virtua Health at the clinic on Mondays – their busiest day of the week.
Word of this revolutionary approach quickly made its way through the medical hallways of military institutions across the country.
“Recently,” said Poe, “we had the opportunity to present this to all of the clinical leaders across Air Mobily Command [the major Air Force command which spans numerous air force installations around the globe]. We also discussed it with the Defense Health Agency and the word they used was ‘phenomenal.’”
Kornack also pointed out that surveys completed by patients who have come to the SDAC for treatment have been overwhelmingly positive.
The clinic is open five days a week and is available to active-duty military members, retirees, veterans, and their families, plus civilians who work on the Joint Base, provided they are enrolled.
“What puts a big smile on my face,” said Kornack, “is when a retiree or dependent comes to us and when they hear us say ‘we can see you today’ they react with amazement. They are ecstatic and their response is they have never seen anything like this before.”
“One of the big things we needed to get after was how to get our active-duty members with a medical need back to duty and into the fight as quickly as possible?” said McManis. “It is about readiness – you come here, and we can get you back to duty quickly or we can get you to a higher level of care quicker.”
“This is the wave of the future,” said Poe.
