Medical commanders from the Europe Regional Medical Command, including Brig. Gen. Keith W. Gallagher, ERMC commander; U.S. Medical Activity Bavaria; the Vilseck and Grafenwoehr Health Clinics; Brig. Gen. David R. Hogg, commander, Joint Mulitnational Training Command; Brig. Gen. Stephen R. Lanza, deputy chief of staff, G-3, U.S. Army Europe and Seventh Army, Germany; and other senior leaders within the community listened and responded to questions from family members during a medical town hall held June 6 at the Vilseck Theater on Rose Barracks.
Issues included:
TRICARE Process
Family members expressed frustration with the TRICARE process.
The referral process itself can be time-consuming, with patients making an appointment to see TRICARE approximately nine days after the initial request for referral from the Vilseck Health Clinic. During that appointment, TRICARE schedules an appointment for the patient to see a German physician.
Col. Theresa M. Schneider, BMEDDAC commander, commented on the current appointment method.
"The process just doesn't make sense right now. Col. (Alfonso) Alarcon and I are looking to fix the problem so that it aligns with common sense. You shouldn't have to make an appointment to make an appointment," Schneider said.
Alarcon, U.S. Army Health Clinic Vilseck commander, added that the TRICARE referral process was evaluated by a managed care consultant to see if the "hassle factor" for the patient could be decreased.
As a result, walk-in appointments for referrals will begin this month.
Vilseck Health Clinic Appointments
In the past, calling to get an appointment had been difficult, with long wait times and busy signals.
Alarcon said that the phone system's technical problem was recently fixed but that current wait times may be long during high volume calling periods.
An answer is on the horizon: Alarcon said that two more receptionists will be hired to make appointments in addition to the two already on staff, which should provide more people to answer the phones and alleviate the wait time.
Staffing of Health Clinics
The Vilseck Health Clinic currently has four and a half full-time equivalent primary care providers for the current population of 4,500 and plans to receive three more by the end of the summer when the community population will return to around 8,000.
The Army staffing model is one provider for about 1,178 patients.
"In combination with the host nation network, the health clinic can cover down on surges. When the clinic runs low on appointments, family members can be seen downtown quickly," Alarcon said.
Currently, the Grafenwoehr Health Clinic has four full-time primary care providers and three more arriving in the near future. A pediatrician will be one of the new hires for the current population of 6,800.
Lt. Col. Telita Crosland, Grafenwoehr Health Clinic commander, said that the clinic often utilizes Eschenbach for overflow of acute care during busy periods.
The clinics are capable of providing acute care for minor illness, routine care for chronic illness, and wellness examinations such as physicals. In addition to the primary care providers, both clinics also have physical therapy, optometry, audiology, and behavioral health services.
Reimbursement for Travel
TRICARE Prime Patients will be reimbursed for certain travel expenses if they are referred for care outside their health clinic. BMEDDAC appreciates that there is confusion on the reimbursement process for mileage to German hospitals or medical temporary duty for U.S. hospitals.
There are specific procedures to receive your reimbursement for your costs when you travel to and from appointments that are off post. Medical reimbursement regulations for active duty and family members have different requirements and processes.
BMEDDAC is working with ERMC to design an information brochure that will be available at health clinics and online for each community.
There was a request for some sort of public transportation to and from local hospitals - the Vilseck Health Clinic and U.S. Army Garrison Grafenwoehr will review the idea and report on the viability of the request.
For patients who do not have access to transportation, Schneider said that family members should try to work as a team and reach out to help each other with appointments.
Pediatrics and Well-Baby Exams
There is currently one pediatrician, Dr. Renata Lukezic, on staff at the Vilseck Health Clinic. According to Crosland, the clinic does not currently have a pediatrician on staff, but is working on having one in the near future.
Crosland said that the distribution of pediatricians is based on the number of babies delivered at the military treatment facility, and with no deliveries taking place at the health clinics it is difficult to request one of 30 pediatricians in the worldwide Army medical system.
However, according to Alarcon and Crosland, there are 10 pediatrician providers in the Vilseck footprint and seven in Grafenwoehr. Crosland said that the German pediatricians speak English and are excellent caregivers. Your TRICARE specialists can assist in selecting the pediatrician who is right for your family, and don't be afraid to ask for credentials, said Alarcon.
Family members at the medical town hall requested the return of Well-Baby Wednesdays to ensure immunizations are done at the proper time for children. Alarcon said that families should stop into Vilseck Health Clinic for Well-Baby Wednesdays, which start back up today.
Schneider and the clinic commanders will be reviewing a pediatric physical therapy clinic in the local German community, per the recommendation of a family member at the town hall, and BMEDDAC will move to add those pediatric therapists to the Preferred Provider Network.
EDIS
The goal of Educational and Developmental Intervention Services is to make sure that all children are ready to learn when they reach school age by providing services and support to eligible families who have concerns about their child's development.
Developmental screenings are provided for all children under the age of three. Evaluation and treatment is provided for all children who qualify.
School age children are referred for physical therapy, occupational therapy, psychological evaluations, and social work through the Department of Defense Dependents Schools' special education process.
Recognizing the growing concerns of the community, BMEDDAC worked with Medical Command on a recently completed staff-assisted visit of the EDIS program in Europe, including the Vilseck and Grafenwoehr communities, to identify needs and potential resources.
As a result of the evaluation, an additional Early Childhood Special Educator will arrive in July, and a speech language pathologist has been approved and is in the hiring process.
Allergy/Dermatology Appointments
Currently, the allergist from Landstuhl makes an annual visit to the Vilseck and Grafenwoehr communities. Lt. Col. Henry Spring, deputy chief of clinical services for BMEDDAC, explained that German physicians have different brands and types of allergy medications than American physicians.
Referring current allergy patients to the local community may mean that the patient needs to start from an assessment phase with a new physician. BMEDDAC has one dermatologist to support Bavaria who visits all the clinics in the footprint, but will soon be headed for a deployment.
Alarcon said that he will request American specialists for allergies and dermatology visit the communities on a more frequent basis so that current patients can continue with their treatment and will contact patients on dates when the specialist will be in town.
Translation of Records, Lab Results
Several family members were concerned that their German medical records were taking longer than the standard of four weeks to translate. The physician's office sends a report to the health clinic, which the health clinic then sends for medical translation.
The translated clinical note is then scanned into your electronic medical record. Alarcon said the clinic is looking into average turnaround time; and if the process can be improved.
Another family member asked if lab tests could be conducted in the local community and results sent back to the health clinic in order to eliminate the waiting time when sent to Heidelberg, Landstuhl, or Walter Reed for analysis. The chief of laboratory services for BMEDDAC has been working with the ERMC laboratory consultant and host nation partners to investigate options with medical laboratory facilities in the local communities of Germany.
Patient Liaisons
Look for the clinics' patient liaisons to play an even bigger role in your relationship with German hospitals, as PL staff has recently doubled. If you are in the hospital, the patient liaisons make daily rounds and are available by phone.
Both Alarcon and Crosland are looking into having patient liaisons assist you during your discharge from the hospital so that you understand instructions from the doctor and have proper medication for your time at home.
Hospital tours conducted by the patient liaisons are also in the works.
Adverse Medical Events
Schneider said that if you are concerned about treatment that you received in the local German community, or at a U.S. Army Health Clinic, contact your health clinic commander or the patient advocate. The command team is responsible for facilitating care between patients and German partners.
"We need to hear your concerns in order to address them. We will make an inquiry and respond to you," Alarcon said.
Schneider reminded attendees at the town hall that BMEDDAC headquarters is in the process of moving to Vilseck and will be located in Bldg. 700 by early August.
"That means that you have a host of experts and resources at your fingertips. Don't be afraid to contact us," she said.
Communications
BMEDDAC is committed to providing you with all the information you need to make good medical decisions. The clinics' Web sites have been recently updated at https://t-ermc.detrick.army.mil/MTFs/Bavaria/Bavaria_MEDDAC.html and some medical information is now available on the USAG Grafenwoehr Web site at http://www.grafenwoehr.army.mil/. Also look for regular updates on the issues discussed in this article in upcoming editions of Bavarian News.
Clinic commanders often speak about current issues live on AFN radio; dates and times will be announced.
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