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Medical Joint Cross-Service Group Section 8: Recommendations Medical Joint Cross-Service Group
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Medical Joint Cross-Service Group


Summary of Selection Process


Introduction

The Medical Joint Cross-Service Group (JCSG) was chartered to review Department of Defense
healthcare functions and to provide base closure and realignment (BRAC) recommendations
based on that review. Assigned functions included Department of Defense (DoD) Healthcare
Education and Training; Healthcare Services; and Medical and Dental Research, Development
and Acquisition (RD&A). The Air Force Surgeon General chaired the Medical JCSG, and other
principal members included senior medical members from the Military Departments, the Joint
Staff, and the Office of the Secretary of Defense (OSD). The summary that follows details the
groups strategies, processes, and recommendations for consideration for of 2005 BRAC
Commission.

Responsibilities and Strategy

The Medical JCSG was responsible for a comprehensive review of its assigned functional areas,
an evaluation of alternatives, and the subsequent development and documentation of realignment
and closure recommendations for the Secretary of Defense. In developing its analytical process,
the Medical JCSG established internal policies and procedures consistent with DoD policy
memoranda, the force structure plan prepared by the Chairman of the Joint Chiefs of Staff, an
installation inventory, BRAC final selection criteria, and the requirements of the Defense Base
Closure and Realignment Act of 1990, as amended.

The Military Healthcare System (MHS) must ensure that DoD has trained, proficient, and
deployable medics to support the warfighter. In addition, DoD must foster and deliver research,
development and acquisition of unique military medical and dental technology and techniques.
In its current form, the DoD healthcare delivery system accomplishes this mission through two
complementary organizations: the Direct Care System which includes military treatment
facilities, and the TRICARE health benefit program which provides access for beneficiaries to
the civilian healthcare system.

The Medical JCSG developed key strategies to guide deliberations based on the key objectives
above. These strategies came from an analysis of the BRAC final selection criteria criteria. The
Medical JCSG focused its efforts on:

Supporting the warfighter and their families in-garrison and deployed;
Maximizing military value while reducing infrastructure footprint, while maintaining an
adequate surge capability; Section 8: Recommendations Medical Joint Cross-Service Group
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Maintaining or improving access to care for all beneficiaries, including retirees, using
combinations of the Direct Care and TRICARE systems;
Enhancing jointness, taking full advantage of the commonality in the Services healthcare
delivery, healthcare education and training, and medical/dental research, development
and acquisition functions;
Identifying and maximizing synergies gained from collocation or consolidation
opportunities; and
Examining out-sourcing opportunities that allow DoD to better leverage the large U.S.
health care system investments.

The groups final recommendations were based on a review of the entire Military Healthcare
System, including the TRICARE program, with a view towards advancing these strategies. To
facilitate efforts, the group developed categories of functions for evaluation and organized into
subgroups corresponding to these functions. Each subgroup, in turn, developed strategies for
evaluating its functions. These strategies were based on the Medical JCSG key focus areas and
guided by BRAC selection criteria 1-8.

Analytical Process

The Medical JCSG approach to the BRAC process involved iterative and concurrent actions in
close collaboration with the Military Departments and the other Joint Cross Service Groups. The
Medical JCSG Principals formed the deliberative body; subgroups generated ideas, proposed
overall scope for analyses and brought forth recommendations for consideration. All data
collection was conducted and certified in accordance with BRAC process guidance.

The Medical JCSG developed attributes and metrics proposed by subgroups to determine the
capacity of all installations for its assigned functions. The metrics were used to develop
questions designed to solicit necessary data, which were subsequently issued to all DoD
installations in the form of a controlled data call.

The Medical JCSG used the responses from the installations (submitted in the form of certified
data) to perform a capacity analysis and review surge requirements. At each step in the process,
adequacy and quality of the data was independently validated by the DoD Inspector General.

Once the group acquired capacity information, it conducted a military value assessment of each
function at each installation. The group developed military value data call questions from BRAC
selection criteria 1-4 to generate data for the quantitative portion of military value which includes
both quantitative data, as well as military judgment. Using each installations responses, the
Medical JCSG subgroups identified realignment or closure scenarios that corroborated their
strategies and were supported by data. The Medical JCSG believed these scenarios would
advance jointness, achieve synergy, capitalize on technology, exploit best practices, and
minimize redundancy, while maintaining the fundamental healthcare mission of the DoD. Once
scenarios were developed, the remaining selection criteria (criteria 5-8) were assessed, using
standard DoDs procedures and/or models.
Section 8: Recommendations Medical Joint Cross-Service Group
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The Medical JCSG approved 22 candidate recommendations for presentation to the
Infrastructure Steering Group (ISG) and Infrastructure Executive Council (IEC). All Medical
JCSG decisions were made by vote, and dissenting opinions were entered into the meeting
minutes and presented to the ISG/IEC. Review and adjudication by the ISG and IEC resulted in
the recommendations.

The recommendations approved by the Secretary of Defense follow:
Section 8: Recommendations Medical Joint Cross-Service Group
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Recommendations and Justifications


Walter Reed National Military Medical Center, Bethesda, MD

Recommendation: Realign Walter Reed Army Medical Center, Washington, DC, as follows:
relocate all tertiary (sub-specialty and complex care) medical services to National Naval Medical
Center, Bethesda, MD, establishing it as the Walter Reed National Military Medical Center
Bethesda, MD; relocate Legal Medicine to the new Walter Reed National Military Medical
Center Bethesda, MD; relocate sufficient personnel to the new Walter Reed National Military
Medical Center Bethesda, MD, to establish a Program Management Office that will coordinate
pathology results, contract administration, and quality assurance and control of DoD second
opinion consults worldwide; relocate all non-tertiary (primary and specialty) patient care
functions to a new community hospital at Ft Belvoir, VA; relocate the Office of the Secretary of
Defense supporting unit to Fort Belvoir, VA; disestablish all elements of the Armed Forces
Institute of Pathology except the National Medical Museum and the Tissue Repository; relocate
the Armed Forces Medical Examiner, DNA Registry, and Accident Investigation to Dover Air
Force Base, DE; relocate enlisted histology technician training to Fort Sam Houston, TX;
relocate the Combat Casualty Care Research sub-function (with the exception of those
organizational elements performing neuroprotection research) of the Walter Reed Army Institute
of Research (Forest Glen Annex) and the Combat Casualty Care Research sub-function of the
Naval Medical Research Center (Forest Glen Annex) to the Army Institute of Surgical Research,
Fort Sam Houston, TX; relocate Medical Biological Defense Research of the Walter Reed Army
Institute of Research (Forest Glen Annex) and Naval Medical Research Center (Forest Glen
Annex) to Fort Detrick, MD, and consolidate it with US Army Medical Research Institute of
Infectious Diseases; relocate Medical Chemical Defense Research of the Walter Reed Army
Institute of Research (Forest Glen Annex) to Aberdeen Proving Ground, MD, and consolidate it
with the US Army Medical Research Institute of Chemical Defense; and close the main post.

Justification: This recommendation will transform legacy medical infrastructure into a premier,
modernized joint operational medicine platform. This recommendation reduces excess capacity
within the National Capital Region (NCR) Multi-Service Market (MSM: two or more facilities co-
located geographically with shared beneficiary population) while maintaining the same level of
care for the beneficiaries. Walter Reed Army Medical Center (AMC) has a militar