113 The Effect of Civilian Purchased Care on Military Neurosurgery Wartime Readiness

Abstract

INTRODUCTION: The current landscape of military neurosurgery reflects the relative peacetime for the US-World relationship - a problem of intrinsically low case volume compounded by patients being deferred away from Military Treatment Facilities (MTFs). TRICARE is the healthcare program of the US Department of Defense Military Health Care System, in which ‘Purchased Care’ or civilian based health care, is used to supplement healthcare needs when services are not readily available to TRICARE beneficiaries. Within military neurosurgery, case volume and complexity continue to be diverted via purchased case pathways, greatly affecting wartime readiness. Neurosurgery wartime readiness can be measured through the Knowledge, Skills and Abilities (KSA) metric based on case complexity and volume. METHODS: We analyzed case counts and KSA values of active-duty military neurosurgery capable MTFs and purchased care counterparts using the CarePoint Access portal. Residents, civilian contractors, and retirees were excluded. RESULTS: In 2022, the KSA total for 16 MTFs was 139005, a result of 2286 cases and 47 surgeons. The average KSA/surgeon/month was 393.8, extrapolating to 4725.5/surgeon/year - 59% of the KSA goal of 8000/surgeon/year. The purchased care KSA of 10 MTFs totaled 301535 in 2022 from 7324 cases. Purchased care out-performed MTF case volume by over 300%. Recovering full purchased care volume would increase the individual MTF neurosurgeon KSA by 135%. CONCLUSIONS: The military neurosurgical community cannot maintain wartime readiness as defined by the KSA metric with current trends in military neurosurgery case volume and high incidence of purchased care. The solution lies in either recovering purchased care patients or expanding military-civilian partnerships to base military neurosurgeons at local academic hospitals and trauma centers.