As such, the military population on Guam is expected to grow by  over 160 percent, from 15,000 to over 39,000 by 2020. The Navy Plans to Replace the Current Hospital and Construct Two New Branch Health Clinics to Meet Increased Health Care Demand on Guam

To accommodate the additional inpatient and outpatient requirements  resulting from the expected increase in the military population on Guam,  the Navy plans to expand inpatient and outpatient care in the replacement  hospital and move primary outpatient and dental care to the two new  branch health clinics. According to Navy officials, the development of the  requirements for the clinics allowed the Navy to retain the size and  footprint of the initially planned version of the replacement hospital,  which was already programmed and approved by TRICARE Management  Activity in 2004, prior to the announcement of the Defense Policy Review  Initiative. The hospital will be funded through DOD military construction  appropriations, while the two outpatient primary care clinics are to be  funded through a special Department of the Treasury account established  to hold funds contributed by the government of Japan as part of the  agreement to realign military units from Japan to Guam. The replacement hospital will be located on the site of the current  hospital, while a new branch health clinic will replace the medical and  dental clinics currently in operation on Naval Base Guam, and a new  branch health clinic will be located in North Finegayan. The Navy’s proposed military treatment facility solution on Guam expands  on the health care services currently offered on Guam, but in instances  when patients require care not offered on Guam, the Navy determined that  it will continue to medically evacuate them to other military treatment  facilities, such as Naval Hospital Okinawa, Tripler Army Medical Center in  Hawaii, or Naval Medical Center San Diego. However, although the  Navy’s health care requirements analysis accounts for the expected  increase in health care workload by multiplying the health care utilization  rates observed in a base year for different types of beneficiaries and health  care services by the anticipated beneficiary population, it does not show  how this workload translates into the size and configuration of the Navy’s  proposed facilities because it omits documentation on the methods and  criteria for how the Navy reached staffing decisions for its proposed  facilities and does not show the workload expected to be performed at  each facility. The health care  analysis also estimates the overall health care workload for the services  the Navy intends to offer on Guam following the realignment. Therefore it is unclear how  this number is supported. Since the Navy’s health care requirements analysis is not sufficiently  documented, specifically with regard to health care and staffing  requirements, both the Navy and TRICARE Management Activity may not  be sufficiently assured that (1) Navy’s military treatment facility solution  of the replacement hospital and two branch health clinics will be adequate  to meet the demand of the military population on Guam and (2) result in  the most cost-effective facility solution that will meet the expected  increase in military population on Guam. However, the Navy’s health care requirements analysis  report does not clearly document the analyses and assumptions used by  the Navy to determine its military treatment facility requirements,  including forecasting health care demand and determining health care  workload and staffing requirements nor could Navy officials adequately  explain their analyses or assumptions. Without such  documentation, the Navy cannot fully demonstrate to TRICARE  Management Activity and other stakeholders that its conclusions about the  size and configuration of its military treatment facility solution result in  the most cost-effective solution in meeting the health care needs of the  expected increase in military population on Guam. As stated in our report, we believe that the  Navy’s documentation used to support its recommended military  treatment facility solution for Guam does not clearly demonstrate how the  Navy determined the size and configuration of the proposed branch health  clinics. Appendix I: Scope and Methodology

Our objectives were to (1) describe the Navy’s plans for developing a  military treatment facility solution to meet the expected increases in the  military population on Guam, and (2) examine the extent to which the  Navy is assured that its proposed military treatment facility solution on  Guam will adequately meet the requirements for the expected increase in  military population.
Why GAO Did This Study

The Navy determined that its current hospital on Guam does not meet modern facility standards. Moreover, the military population on Guam is expected to grow from 15,000 to over 39,000 due to DOD plans to move Marine Corps units from Okinawa, Japan to Guam and expand other on- island capabilities. The Navy plans to construct a new hospital and two outpatient clinics as part of its facility solution to replace the current hospital and accommodate additional health care requirements. This report (1) describes the Navy's plans for developing its military treatment facility solution to meet the expected increases in the military population on Guam, and (2) examines the extent to which the Navy is assured that its proposed military treatment facility solution on Guam will sufficiently meet the requirements for the expected increase in military population. To address these objectives, GAO reviewed documentation including the Navy's plans for its military treatment facility solution and interviewed key officials within the Military Health System

What GAO Found

To accommodate the additional inpatient and outpatient requirements resulting from the expected increase in military population to Guam, the Navy plans to expand inpatient and outpatient care in the replacement hospital and move primary outpatient and dental care to two new branch health clinics. Primary outpatient care generally includes caring for acute and chronic illnesses, disease prevention, screening, patient education and follow-up care from hospitalization. The replacement hospital will be located on the site of the current hospital, while one of the new branch health clinics will replace medical and dental clinics currently in operation on Naval Base Guam, and the other clinic will be located in North Finegayan on the site of a proposed Marine Corps base. According to Navy officials, the development of the requirements for the clinics allowed the Navy to retain the size and footprint of an initially planned version of the replacement hospital, which was already programmed and approved prior to the announcement of the proposed military buildup on Guam. The two outpatient primary care clinics are to be funded by the government of Japan as part of the agreement to realign Marine Corps units from Okinawa, Japan to Guam, and DOD will fund the new hospital. The Navy's proposed military treatment facility solution on Guam expands on the health care services currently offered on Guam, but in instances when patients require care not offered on Guam, the Navy determined that it will continue to medically evacuate them to other military treatment facilities, such as Naval Hospital Okinawa, Tripler Army Medical Center in Hawaii, or Naval Medical Center San Diego. GAO found that the Navy's documentation used to support its recommended military treatment facility solution for Guam does not clearly demonstrate how the Navy determined the size and configuration of the proposed branch health clinics, nor could Navy officials adequately explain their analyses or assumptions. Navy officials indicated that the Navy's health care requirements analysis report was the basis for decisions regarding the size and configuration of the proposed military treatment facilities. The Navy's health care requirements analysis report estimates the overall health care workload for the services the Navy intends to offer on Guam following the realignment, but does not show how this workload translates into the size and configuration of the Navy's proposed facilities. Therefore, it is difficult for stakeholders to be fully assured that the facility solution will be the most cost- effective solution to meet beneficiary health care needs following the realignment. Without clear documentation of key analyses and identification of risks, the Navy cannot fully demonstrate that it is making the most cost-effective decisions with its proposed military treatment facility solution on Guam.

What GAO Recommends

GAO recommends that Navy clearly document the basis for health care workload and staffing on Guam. In commenting, DOD generally concurred and said that more information on the branch health clinics' planning has been developed by the Navy and is under review.