The Coast Guard provides health care to its personnel through outpatient clinics. It had 1,022 health care staff in 2021. Is that enough?
A Government Accountability Office (GAO) review has found that the Coast Guard can’t be sure because it doesn’t have standards to outline the number and types of health care staff it needs.
The Coast Guard is tasked with providing health care to its approximately 47,000 active duty and reserve personnel. The Coast Guard staffs its 43 outpatient clinics and 122 sickbays with enlisted personnel and officers, who primarily serve as health service technicians and physician assistants, as well as with U.S. Public Health Service officers, including physicians and dentists. In addition, the Coast Guard uses a contract to fill some of its vacancies and augment other health care staff roles. As of July 2021, Coast Guard data show the service had 1,022 Coast Guard, Public Health Service, and contracted health care staff serving its health services program of clinics and sickbays.
GAO found that the Coast Guard generally fills positions for its clinics and sickbays based on historical staffing levels. However, the watchdog says the current staffing approach does not address surge deployments of health care staff for missions away from clinics, such as hurricane response. Deployments have nearly quadrupled from 4,111 days in 2018 to more than 16,000 days in 2021, according to Coast Guard’s own data.
Coast Guard officials told GAO that there were difficulties in maintaining already burdened clinic operations when health care staff are deployed, which can result in clinics deferring services.
To monitor access to care, the Coast Guard relies on each of its clinics to manually estimate access by counting the number of days to the next available appointment. However, Coast Guard officials told GAO that this approach does not produce reliable information on whether the Coast Guard is meeting its access-to-care standards. Coast Guard officials said they hope to collect system-wide data on access to care using a new electronic health record system by September 2022. The Coast Guard began implementing an electronic health record system in 2020 by procuring Military Health System (MHS) Genesis. The Department of Defense (DOD) administers the MHS Genesis contract and the Coast Guard is reliant on DOD for configuring the system. GAO’s review found that Coast Guard officials have not yet determined how to use the system to monitor access.
According to GAO, the Coast Guard’s process for collecting access-to-care data at its clinics and sickbays does not produce reliable measures of appointment wait times, which impedes the service’s ability to accurately determine the extent to which it is meeting its access-to-care standards. The MHS Genesis system could eliminate the need to collect appointment timeliness data manually and provide ready access to more robust utilization and wait time data for clinics and sickbays systemwide if configured accordingly.
GAO said that while the Coast Guard has taken steps to help ensure adequate staffing at its clinics and sickbays, including the use of contract staff, its efforts are hampered by the lack of health care staffing standards that account for surge deployments. As a result, the government watchdog believes the Coast Guard cannot ensure it has the right number and type of medical and dental staff to keep its personnel ready to meet its mission, particularly when health care staff are deployed away from their clinics.
Consequently, GAO recommends that the Commandant of the Coast Guard should ensure the Assistant Commandant for Human Resources implements health care staffing standards for its health services program that account for health care staff deployments, including surge deployments. The Department of Homeland Security (DHS) concurred and said that the Coast Guard has already initiated a manpower requirements assessment for its clinics, which will include medical staff deployments in support of external workload.
DHS also concurred with GAO’s second recommendation that the Coast Guard improves its process to collect more reliable data on access-to-care at clinics and sickbays to monitor whether access-to-care standards are being met while the service works with the Defense Health Agency to better understand the capabilities of the new electronic health record system for monitoring access-to-care.