Pentagon officials on Wednesday released a list of military treatment facilities and clinics that will no longer provide care to military retirees and active-duty families as part of a shift in focus to supporting active-duty readiness.

"The military health system is in the midst of implementing several significant reforms aimed at building a more integrated and effective system of readiness and health," said Tom McCaffery, assistant secretary of defense for health affairs. "We reviewed all facilities through the lens of their contributions to military readiness -- that includes MTFs [being] operated to ensure service members are medically ready to train and deploy. It also means MTFs are effectively utilized as platforms that enable our military medical personnel to acquire and maintain the clinical skills and experience that prepares them for deployment in support of combat operations around the world."

The list is included in a 61-page report to Congress delivered Wednesday. The report lays out the process through which officials selected the locations slated for changes.

Those changes, first announced in a Feb. 3 memo obtained by Military.com, are slated to impact 200,000 retirees and active-duty family members. Of those, officials said Wednesday, about 80,000 are active-duty family members, while the remaining 120,000 are retirees and their families.

Related: Some Retirees Have Already Been Pushed to Off-Base Providers in Tricare Shift

Of the 38 facilities that will no longer see retirees or family members, 24 are slated to shift to active-duty only over the next several years, officials said. Eleven clinics have already started the process of moving to active-duty only, and three are slated to close to all users.

An additional four facilities are slated for downgrades. For example, the hospital at Marine Corps Air Station Beaufort, South Carolina, will downgrade to an ambulatory care center under the plan. Two facilities will shift to mostly active-duty care, but will take families as needed. And two hospitals could be given upgrades, including the hospital at Camp Lejeune, North Carolina.

While officials said military readiness, not cost savings, is the primary driver for the changes, pushing retirees and active-duty families into the community for care should save the system money.

For 2021, that savings is expected to reach about $36 million, officials said.

"We have generally found that, through our contracts, that our care often is cheaper in the network from a government purchase point of view than the cost of actually doing it within our direct-care system in some locations," Dr. Dave Smith, deputy assistant secretary of defense for force health, told reporters. "And clearly, as part of our methodology, that was one of the questions we asked, but our principal question was, 'Are we getting readiness value out of this location that is worth the cost, if you will, compared to putting that somewhere else in the system.'"

But the changes will bring higher costs to many users forced to see doctors within the civilian community. For retirees on Tricare Prime, receiving care off base costs $20 per visit for primary care and $31 for specialty care. That’s for in-network doctors outside the MTF, and comes on top of a $600 per family annual registration fee.

For active-duty families on Tricare Prime, the change will carry no out-of-pocket costs.

The Feb. 3 memo noted that "in many cases" all users will still be able to receive pharmacy services at the impacted facilities.

All the clinics listed as shifting to active duty-only were noted as keeping pharmacy service for all users. However, pharmacy services provided by the facilities slated for complete closure will cease. That means users who previously received drugs from those facilities will need to shift to a different military pharmacy or pay out of pocket for drugs from a local retail pharmacy or mail order.

Officials told reporters Wednesday that no clinics identified for transition will do so until care is secured within the civilian community for each patient, a process that they said could take as long as five years. The Defense Health Agency, which manages the Tricare program and its private contractor, will oversee that process, McCaffery said.

"It will be the Defense Health Agency working with the local MTF leader, the installation commander and our Tricare network partners in making those determinations in terms of assessing the ability of that civilian health care market to take on additional patients," he said. "We recognize that this is an MTF by MTF, market by market implementation."

Officials said they examined more than 300 military health facilities as part of their review. Of those, they looked at 77 for a "detailed assessment" and determined that 50 warrant changes. Thirty-eight were then identified as having the necessary nearby civilian medical support to absorb an influx of new patients, they said.

That civilian capacity was assessed by surveying the local provider network and working with base commanders and MTF officials, the report says.

For example, researchers looked at primary, specialty and in-patient care within specific drive-time standards. For primary care, officials looked at providers within 15 miles of the current MTF for urban areas, and 30 miles for rural areas. For specialty care, the standard was 40 miles for urban areas and 55 miles for rural areas. And for in-patient hospital care, the standard was a 60-minute drive time.

For in-patient care, special attention was paid to labor and delivery services, the report states. In many cases, it notes, decisions were made specifically based on that issue. For example, at Fort Campbell, Kentucky, closing Blanchfield Army Medical Center to non-active duty patients is not an option because the local hospitals, in nearby Hopkinsville, Kentucky, and Clarksville, Tennessee, would not be able to handle a resulting 267% increase in annual deliveries, the report states.

Below is a list of facilities slated for changes or closures. The list can also be downloaded here. The complete report to Congress is available here.

Facilities closing to non-active duty patients include:

Facilities that have either already transitioned to active duty-only, or are in process:

Facilities that will close completely to all users:

MacDill Air Force Base's Sabal Park community clinic in Brandon, Florida

Fort Benning, Georgia, North Columbus-Benning clinic

Fort Irwin, California, Department of Behavioral Health

Facilities that could see upgrades:

Camp Lejeune, North Carolina, upgrade to Level II Trauma Center

Tripler Army Medical Center, Hawaii, could be closed to non-active duty patients if officials determine that the local community can handle providing the necessary medical care.

Facilities slated for downgrade:

Fort Meade, Maryland, Kimbrough, Ambulatory Care Center to downgrade to a clinic

Marine Corps Air Station Beaufort, South Carolina, Naval Hospital Beaufort downgrade to ambulatory surgery center

Joint Base Langley-Eustis, Virginia, downgrade to an ambulatory surgery center and outpatient clinic; McDonald clinic downgrade from ambulatory surgery to an outpatient clinic

Fort Leavenworth, Kansas, downgrade from ambulatory surgery to an outpatient clinic

Facilities that may continue to see active-duty families

Naval Technical Training Center Meridian, Mississippi, outpatient clinic

Southern Command (SOUTHCOM), Miami, Florida, Gordon outpatient clinic

-- Amy Bushatz can be reached at amy.bushatz@military.com.

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