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Stakeholders Widely See Resource-Sharing Agreements as Beneficial

• MTFs and local counterparts that use such agreements universally find them mutually beneficial, although the MTFs find the guidance documents outdated, insufficient, and in need of updating.
• Military stakeholders reported benefits to the Army that include better access, quality, and continuity of care for beneficiaries; proficiency maintenance and exposure to industry best practices for military professionals; and perceived cost savings to TRICARE.
• Benefits that local civilian counterparts cited included revenue generation (TRICARE payment for beneficiary care) and more-productive utilization of their infrastructure by military personnel.
• The strong consensus among military and civilian users and leaders regarding the benefits of external medical practice suggests that such practice is warranted when both the MTF and local partner can justify it in their respective business plans.

Army medical professionals must maintain the high level of proficiency required to fulfill the Army's medical missions of supporting military operations and providing beneficiary care. Because beneficiary care demands in a U.S. medical treatment facility (MTF) do not mirror those in a combat setting and sometimes can exceed the MTF's capacity, some MTFs enter into agreements with local civilian facilities to meet shortfalls in beneficiary care or training. The study's objective was to assess Army medical practice in U.S. Department of Veterans Affairs and non–Veterans Affairs civilian facilities and suggest opportunities for improving military–civilian synergies.

• Chapter One

  Introduction

• Chapter Two

  History and Authorities for External Medical Care and Training

• Chapter Three

  Information from the Medical Training Facility Data Call

• Chapter Four

  Types of Agreement and Review of Selected Agreements

• Chapter Five

  Findings from Stakeholder Discussions, Including Site Visits

• Chapter Six

  Conclusions and Recommendations

• Appendix A

  Organizations Consulted

• Appendix B

  Office of the Surgeon General and Army Medical Command Policy Guidance on Department of Veterans Affairs — Department of Defense Sharing Agreements

• Appendix C

  Office of the Surgeon General Policy Guidance on Gratuitous Training Agreements

• Appendix D

  Details of Findings Related to Medical Treatment Facilities