In the past year, the Defense Department has seen significant advances in its medical response to the COVID-19 pandemic within the DOD and in its support of the civilian-sector pandemic, the official performing the duties of assistant secretary of defense for health affairs said before the Senate Appropriations Committee, March 29, 2022. 

Dr. David J. Smith said the National Defense Authorization Act for fiscal year 2017 "enacted sweeping reforms" to the organization and the management of military medicine. 

"We've made significant progress in implementing these reforms," he said, adding "Today, the Defense Health Agency exercises authority, direction and control over all in [military treatment facilities] worldwide. The same law directed the DOD to restructure or realign MTFs as necessary and appropriate to support the department's readiness requirements." 

However, those restructuring efforts will pause April 2 as a result of resources needed to respond to the COVID-19 pandemic, he noted. "But we clearly plan to restart implementation beginning in the first quarter of fiscal year '23 with the targeted completion in September 2026. The department's mission requirements in supporting our national COVID response, however, have adversely affected the defense health program budget in FY 2022," Smith said. 

Despite short-term budgetary challenges, the military health care system continues its sustained, decade-long track record of responsibly managing health care costs, which remain below the national health expenditures per capita rate, he said. "And the department continues to pursue opportunities for greater effectiveness and efficiency by fully integrating the operation of our medical services and streamlining internal operations." 

To sustain momentum and prepare for future pandemics, the DOD's future medical budget will support pandemic readiness and response in the MHS by enhancing its capabilities to conduct rapid research and medical countermeasure development — such as diagnostics, treatments and vaccines — while strengthening the capability of the department to quickly identify and characterize new variants and other emerging biologic threats, Smith noted. 

"Our FY 2023 budget will present a balanced, comprehensive strategy that aligns with the [Secretary of Defense's] priorities, to include ongoing response to the COVID-19 pandemic. We look forward to working with you over the coming months to further refine and articulate our requirements," he told the committee. 

Army Lt. Gen. (Dr.) Ronald J. Place, Defense Health Agency director, focused on some critical responsibilities the DHA has in support of the military departments and combatant commands. 

"The response to the COVID-19 pandemic was one of our top priorities, vital to the medical readiness of our forces in the health and well-being of all Americans," he told the committee. "The department expanded its COVID-19 testing capability and capacity. We have 140 operational laboratories for COVID-19 testing, and we conducted over 6.2 million tests worldwide," he noted. 

The DHA regularly updates its COVID-19 practice management guidelines — which is on version No. 8 — to provide military clinicians and military medical treatment facilities worldwide with a single document on best practices, and the latest evidence and guidance across all clinical care specialties, Place said. 

The DHA also led a comprehensive campaign to administer COVID-19 vaccines. As of March 23, the MHS had administered nearly 8 million doses of COVID-19 vaccines and more than 1.6 million military personnel have been fully vaccinated, he added. 

"Throughout the pandemic, the DOD provided extensive support to [the Federal Emergency Management Agency] for COVID-19 response that included both mass vaccination and health care delivery, augmentation and [aided] communities needing additional personnel resources," he said. 

"We also delivered medical support to the Departments of State and Homeland Security for assisting evacuees from Afghanistan. Our medical teams are proud to contribute to this whole-of-government response to both events and non-COVID activities," Place said. 

The DOD continues to proceed with a multi-year implementation of its new electronic health record, which is dubbed MHS Genesis. It has been deployed at 66 MTFs and more than 1,300 individual locations with more than 93,000 active DOD users of that system, he said, adding, "We will complete the deployment by the end of calendar year 2023 on schedule." 

COVID-19 has only exacerbated these known challenges, Place said. "Nonetheless, we remain vigilant about our medical expenditures. And we appreciate that Congress continues to grant the department carryover authority. Allowing the DOD to maintain better funding flows to minimize disruption of health care services to our beneficiaries."