The Coast Guard does not have a process for reliably measuring access to care, including appointment wait times, at its clinics and sickbays, according to a recent Government Accountability Office (GAO) report, and therefore it cannot determine whether it is meeting access to care standards for the servicemembers who rely on these facilities for medical care.

MOAA has taken this issue to Capitol Hill to ensure the Coast Guard and the military health system (MHS) develop plans to effectively use data from MHS Genesis, the new electronic health record, to measure access to care for both servicemembers and beneficiaries.

The FY 2021 National Defense Authorization Act (NDAA) required GAO to conduct the report to address concerns regarding Coast Guard members’ access to care given the recent surge in deployments of personnel who staff Coast Guard treatment facilities.

The Coast Guard, a military service within the Department of Homeland Security (DHS), provides limited primary care and dental services to its personnel through 43 outpatient clinics and 122 sickbays. Those who need specialty care may be referred to civilian providers.

Coast Guard personnel and their dependents are eligible for TRICARE and can receive care through DoD military treatment facilities (MTFs) and the TRICARE network of civilian providers.

Approximately 60% of active duty Coast Guard personnel obtain their primary care at Coast Guard clinics. Retirees, dependents, and Coast Guard active duty personnel enrolled in TRICARE Prime Remote receive their primary care through civilian providers in the TRICARE network or at MTFs.

[RELATED: MOAA’s 2021-22 TRICARE Guide]

Most staff at Coast Guard outpatient clinics and sickbays are Coast Guard enlisted personnel and officers who serve as health service technicians and physician assistants. For dentists and physicians, Coast Guard clinics rely heavily on U.S. Public Health Service officers who fill more than 75% of those billets – the remainder are contracted positions.

Deployments of Coast Guard personnel and USPHS officers for missions away from their clinics and sickbays nearly doubled from 4,111 days in 2018 to 7,975 days in 2020, then doubled again to approximately 16,000 days in 2021 to support the response to COVID-19, wildfires, and other national priorities.

“Coast Guard officials expressed concern with difficulties in maintaining already burdened clinic operations when health care staff are deployed, which can result in clinics deferring services,” according to the GAO report.

The Coast Guard uses a manual paper-based process for collecting access to care data at its clinics and sickbays. That process does not produce reliable measures of appointment wait times and does not provide an accurate assessment of performance against access-to-care standards, the report found.

[RELATED FROM 2021: ‘Stepping Into Chaos’: USPHS Officers on the COVID-19 Fight]

The Coast Guard is in the process of implementing MHS Genesis, DoD’s electronic health record system. Officials said they are working with the Defense Health Agency (DHA) to determine what data will be available through MHS Genesis but they don’t know whether the new electronic health record will enable the Coast Guard to monitor access to care at its clinics and sickbays.

MOAA is drafting report language for the FY 2023 NDAA to ensure the MHS Genesis rollout includes plans for access-to-care metrics and reporting at the facility level so DHA and the Coast Guard can monitor access to care performance at MTFs, clinics, and sickbays.

It is imperative the Coast Guard and DHA have systems to monitor access to care, particularly given uniformed provider deployments across both the MHS and Coast Guard medical facilities and MHS reform initiatives that have the potential to impact beneficiary access to care.