Military Hospitals Get Quality Check

Hospital accreditation and peer review go hand-in-hand with DoD's policy of providing the highest quality medical care available, according to John Mazzuchi, deputy assistant secretary of defense for clinical services. The quality checks also are a product of the 1980s when DoD didn't seek or accept outside watchers. For that and other reasons, Mazzuchi said, military medicine suffered.

"In the 1980s, I was worried about the quality of military medicine," Mazzuchi said. "There were so many allegations [of substandard health care], and we didn't have the answers, because we didn't have anybody looking at us from the outside to tell us what we were doing wrong. Our attitude was that we were under siege, so we'd better protect ourselves."

A recent series of widely published newspaper articles by the Cox News Service sought to lay siege once again to military health care. Mazzuchi said he thinks the writers, however, looked too far back in time. What was true in the late 1970s and early 1980s -- when quality did suffer -- isn't true today, he said. For example, DoD no longer recruits most of its new physicians from the street but instead draws them from DoD-owned scholarship and education programs. Also today, all military doctors must be licensed by a state to practice medicine unsupervised in military hospitals. This wasn't true before 1988.

The Cox reports focused on many older cases and glossed over quality improvements DoD has made to its health care system, Mazzuchi said. "You cannot measure a system by anecdote," he said. "You can go to any health system in the country and find somebody who didn't get good care, some mistake was made, and indict the hospital. Or you can use a set of objective measures. They will not guarantee that there's not a single physician who won't make a mistake, but they will measure whether you have a systemwide problem -- and whether the system has taken measures to ensure quality."

DoD decided the latter way made more sense and invited the Joint Commission on Accreditation of Healthcare Organizations to inspect military hospitals. The national accrediting body has to date accredited 96 of 115 military hospitals and eventually will inspect the others. All those inspected passed, and 12 were commended for exceptional quality, Mazzuchi said.

One accrediting agency concern is quality assurance programs, and it gives DoD facilities high marks. "DoD scores about 92, markedly higher than the national average, which is in the 60s," Mazzuchi said.

Besides accreditation, DoD let a $7 million contract with Forensic Medical Advisory Service to conduct external peer review of the largest groups of procedures performed in military hospitals. The service, which specializes in abstracting medical records, looks at birthing, orthopedics, mental health and a number of other most commonly performed procedures.

"We have Forensic look at all our hospitals and show us which one has the best outcomes, then get that information out to everyone in the system," Mazzuchi said. "Most physicians don't want to not practice good medicine. If you present them with a study of all our hospitals and point out the best one, they're going to want to bring their practice up to that level."

Other civilian review organizations that inspect DoD facilities include the American College of Pathology, American Association of Blood Banks, Nuclear Regulatory Commission, Accreditation Council for Graduate Medical Education and residency review committees.

DoD also holds its physicians to the highest standards of medical care and reports malpractice cases to a national databank, Mazzuchi said.

"When Dr. Ed Martin came here in the early 1990s, he said we could never afford again not to do what our civilian medicine counterparts do," he said of the acting DoD health chief. "Our view is, we've got to have an open system, because closed systems don't work. Today, our system is open, and it works. I am very confident that the military has one of the finest quality health care systems going."