Trends in Surgical Volume and Outcomes and Workforce Availability in a Health System in Transition, 2016-2023

Area of Science:

• Healthcare administration
• Surgical outcomes research
• Military healthcare systems

Background:

• 2016 Military Health System (MHS) reforms aimed to restructure military healthcare.
• Concerns existed regarding reduced access to military treatment facilities (MTFs) and potential impacts on care quality and patient safety.
• This study evaluated changes in surgical procedure volume and staffing within an integrated healthcare region.

Purpose of the Study:

• To assess changes in surgical procedure volume in military and civilian healthcare sectors post-MHS reform.
• To examine the influence of staffing levels on surgical volume and patient outcomes.
• To evaluate healthcare quality through 90-day all-cause hospital readmissions.

Main Methods:

• Retrospective cohort study using MHS Data Repository administrative and claims data (Oct 2015–Sep 2023).
• Analysis included MHS beneficiaries aged 18–64 in the National Capital Region.
• Surgical volumes, staffing data, and 90-day hospital readmissions were primary and secondary outcomes.

Main Results:

• A total of 39,724 surgical procedures were identified; 20,593 in MTFs and 19,131 in the civilian sector.
• Surgical volume declined overall at Department of Defense (DoD) facilities, with observed staffing reductions across provider types.
• Ninety-day readmissions showed varied trends, declining initially then increasing in MTFs, with different patterns in the civilian sector.

Conclusions:

• Declining surgical procedures and staffing at MTFs indicate a shift in care to the civilian sector, influenced by MHS restructuring and pandemic-related capacity limits.
• The MHS needs to define optimal direct care services, align staffing accordingly, and implement strategies to retain beneficiaries.
• Maintaining a ready provider workforce is crucial for the MHS's long-term operational effectiveness.