by Alofagia Oney
Landstuhl Regional Medical Center
The Enhanced Access Clinic at Landstuhl Regional Medical Center will permanently close, Nov. 1, in an effort to maximize medical and budgetary resources for Active Duty Service Members and their families.
The healthcare providers from the EAC will be transferred to the Emergency Department and primary care clinics in order to increase access to care for TRICARE beneficiaries.
Starting Nov. 1, LRMC will only offer same-day space-available appointments from noon to 4 p.m. Monday through Friday, a major change to the seven-day advanced booking currently offered in the EAC.
“The primary mission at Landstuhl Regional Medical Center is to support the needs of combatant commanders by ensuring that the joint warfighter is medically ready to fight and win,” said Col. Richard Kynion, chief medical officer at LRMC. “Doing so also means caring for the families of our Active Duty military personnel and ensuring that they too enjoy outstanding access to care at the hospital. To accomplish this primary mission, we need to redistribute our limited personnel resources to other areas of LRMC and close the EAC.”
The EAC opened in May 2016 when an abundance of staff and resources were available to Medical Military Treatment Facilities across the Department of Defense, allowing LRMC to offer more same-day appointments for TRICARE beneficiaries who were unable to schedule a visit with their normal primary care provider. The additional appointments in the EAC also increased the number of space-available visits open to those who were not TRICARE beneficiaries, such as DOD civilians, Department of Defense Education Activity staff, and U.S. contract employees.
Historically, the EAC was staffed by three doctors, two nurse practitioners and six licensed practical nurses, making access to space-available appointments for non-TRICARE beneficiaries almost guaranteed. During the three years since the EAC opened, that number of providers has steadily decreased in order to boost the number of staff in the Pediatrics, Internal Medicine and Family Medicine clinics. EAC providers were also considered “floaters,” meaning they could be assigned for duty in a different clinic that had a staff shortage that day. Space-available care — an available appointment not already booked — declined as a result; however, even now, nearly 70 percent of all EAC patients are non-TRICARE beneficiaries who are only able to receive care on a space-available basis.
“The Military Health System’s Priorities of Care categorizes Active Duty military and their families as our top two patient groups, meaning available appointments for them must align with the TRICARE Access to Care Standards,” said Kynion.
With the closure of the EAC, many of its current patients, namely non-TRICARE beneficiaries and military retirees who do not already have an assigned primary care provider at LRMC, will have to seek medical treatment in a host nation facility.
Kynion noted that some of the main adjustments those patients will have to make involve billing processes with their health insurance carrier, as well as the variety of differences in healthcare delivery between German and American providers.
“LRMC is an outstanding hospital and we appreciate the trust our community has placed in us to provide for their medical needs” said Kynion. “I am not surprised that DOD civilians, DODEA employees, and contractors prefer to be seen at LRMC, but I want to assure them that we have built so many amazing partnerships with host nation providers in our area and I am confident that they will get the same level of safe, quality care at a German healthcare facility that they would at LRMC.”
Impact of the closure on emergency medicine
According to Maj. Mark Jones, chief of the healthcare support division at LRMC, there is a correlation between low access to care levels and the increase in patient volume at the LRMC Emergency Room.
“When patients have difficulties booking an appointment with their primary care provider, usually their next stop is to the emergency room,” said Jones. “Patients with non-emergent issues end up in the ER waiting room for hours and get bypassed for care by those who come in with true emergencies.”
Jones, who oversees a variety of patient support areas such as access to care, patient satisfaction, and clinic capacity and availability data, said that by transferring the providers in the EAC to primary care clinics at LRMC, more appointments will be available for routine and acute care issues and the ER should see a decrease in the number of non-emergent cases.
“Waiting in the ER can be painful, both physically and mentally,” said Jones. “And by permanently relocating the EAC providers to both the Emergency Department and our primary care clinics, we can reduce the patient backlog that we’ve been experiencing.”
One concern for Maj. Mark Black, chief of the emergency department at LRMC, is that non-TRICARE patients who can no longer obtain primary care at the EAC may begin to use the ER for routine care.
“Sometimes patients will come to the ER knowing their situation isn’t an emergency,” Black said. “All this does is increase everyone’s ER wait time and truly stresses the emergency and trauma response systems. A lot of the cases that come through the ER are more suitable for visits with primary care doctors, so it’s very important to establish that patient-provider relationship early.”
Through collaboration between Jones and Black, LRMC will begin a new program that identifies TRICARE patients in the ER whose situations are better situated for a primary care visit. If a space-available appointment in one of the LRMC primary care clinics is open within the hour after being triaged in the emergency room, the ER staff will be able to book the appointments and reroute those patients to the clinics for faster routine or acute care treatment. This option for care will only apply to TRICARE patients currently empaneled with a primary care provider at LRMC.
Obtaining host nation care for non-tricare beneficiaries
Non-TRICARE beneficiaries should work through their private insurance company to establish a primary care provider in the local community. They should also check with their insurance companies to ensure that visits to host nation providers are reimbursable and to discuss the claims processes.
LRMC continues to offer specialty care for retirees and non-TRICARE beneficiaries on a space-available basis. To find out what Specialty Care is available, visit the LRMC Website (https://rhce.amedd.army.mil/landstuhl/index.cfm). On the main page click on the green “Specialty Care Services” button. This frequently updated roster provides information on specialty services available to ADSM, ADFM, Retirees and their families, and non-TRICARE beneficiaries. Specialty care at other RHCE medical treatment facilities varies widely across the region based on staffing and support to operational units. Beneficiaries in these categories should not rely on space-available care as their primary source for health care.
For more information on the EAC closure at Landstuhl Regional Medical Center, follow the LRMC Facebook page at www.fb.com/LRMCOfficialPage.