MEDFAC

MEDFAC  Telecon Thursday, May 20, 2017

MEDFAC Telecon:
1. Telecon Thursday July 20, 2017:
a. Phone number:1-888-328-6502 Access code: 3500#
b. Time: 2100 EDT, 2000 CDT, 1900 MDT, 1800 PDT. In response to the concerns of several members, the meeting time was moved back one hour to 9:00 pm EDT. (the line will actually open 30 minutes earlier in case anyone wishes to chat; I will be on then. Thanks to Donna Meador for setting this up.)
c. Duration: 60 minutes; any items generating prolonged discussion will be continued at the end of the meeting or another date
2. Roll Call of Members. (MEDFAC spreadsheet attached to email, but not posted here due to personal information)
a. Dr. Perino & Black have communicated military commitments, but will try to participate depending upon connectivity.
3. Minutes from last meeting (attached) Thanks Capt Hinman MED FAC Meeting Minutes (14 Mar 17)
4. Topics:
a. Nurse practitioner manning (LtCol McChesney information appended below)
b. GMU full time provider-update
c. DDRP-update
d. Flight surgeon recruiting and SERE.
e. Credentials (Col Perino to report since he now has the most experience)
f. Solicit suggestions for AE representative replacement
g. Welcome Chief Thomas Katt. (EFAC minutes attached)
h. Air War College as prerequisite to medics promoted to O6.
i. SG Score Card (copy attached along with recommendations and coments) SG Scorecard DRAFT      SG Scorecard Recommendations and Comments SGP corrections
j. Reiterate concerns from the line and ADFAC:
i. Reduce processing time for MEBs
ii. Re-evaluate ALC codes
iii. Improve MEPs process
iv. Some items, though touched by medical, are not within the purview of the ANG medical to fix, but we can identify the problems and propose some solutions; this is where the ADFAC can help by getting line support to fix some items that are beyond the control of the ANGMS.
5. We will need to prioritize the top 3 issues needing new or continued support from the line and ADFAC. I have attached the ADFAC MEDFAC Quad Chart August 2017 Single Slide (002) in progress (each council is limited to one, but there is a lot of explanatory information in the notes section).
6. Election of officers: select date and announce solicitation of nominations
7. Any comments or questions, please feel free to call me.
Thanks
Col William W. Pond, MD, CFS, MC, INANG
Indiana State Air Surgeon
wwpond@gmail.com
(260) 602-5167 (cell)
(877) 917-5507 (secure fax)
11011 West Sycamore Hills Drive
Fort Wayne, IN 46814

Here is a quick synopsis and some thoughts regarding

• Nurse practitioner manning–LtCol McChesney and LtCol Hackworth will address the issue. Would like to get a consensus as to the breath of the issue across the ANGMS and its effect on units.
• GMU full time provider-update . Funding the positions will either be done via the POM at NGB level (in the works…currently 60 of 89 positions are funded) or “taken out of hide” at the Wing level. SG office can work directly with the non-have units on how to potentially move funding around at GMU level. Need an explanation as to the workload needed to justify a position. Is there a possibility of a part time position, e.g. days to fund a position 2 days per week?
• DDRP-update DDRP–we already have an approval for a contract to do the sample collection (~$8M across the enterprise) to begin FY 18. The sample collection would be contracted while the Medical Review Officer/Legal/Command functions would remain with the military for those few samples which test positive.
• Flight surgeon recruiting and SERE.
a. Physicians are difficult to recruit and guide through the long credentials/privileging process which often takes more than a year, losing some in the process because they just get tired of waiting. The process is further compounded by removing SERE from the final training increment of the Aerospace Medicine course and requiring yet another training school. Would it be reasonable to swear in the physician, just like any other member, and then work on the credentials? If the physician failed to gain credentials, then the physician’s service would be terminated just as an intel officer who was unable to get top secret clearance. Of course the physician could not see patients until credentialed, but the physician could drill, attend officer training, bond with the unit or attend the aerospace medicine course and be mentored by senior physicians.
b. SERE training was previously appended to the end of the aerospace medicine training and was quite sufficient to the level of risk encountered by flight surgeons in the last 50 years. When the AMP course moved from Brooks to Wright Pat, the SERE was removed from the AMP course leaving only the long aviator course at Fairchild. This then required additional time and travel expense for no demonstrated value.
• Credentials (Col Perino to report since he now has the most experience) The use of national contractors and Level 1 Reviewers has substantially improved the process, in efficiency, timeliness and quality. (Kudos to LtCol Hackworth)
• Solicit suggestions for AE representative replacement—with the current change in position for the current the AE representative, we are soliciting your suggestions for a replacement.
• Welcome Chief Thomas Katt. (EFAC minutes attached) So good to have the Chief providing input. EFAC will have met earlier in the day, so the Chief can give us the latest.
• Air War College as prerequisite to medics promoted to O6. There should be equity between the Guard and Active Duty and Reserves on this issue. I do not anticipate support from the line in simply removing the requirement; I do see support or at least acquiescence if this requirement were replaced with an equally robust process of educating and demonstrating excellence in military medicine.
• SG score card—this is an excellent way to provide transparency and equity in evaluating units. It is straightforward and easily presented to the JFHQ leadership by the State Air Surgeons as an indicator of quality metrics. It is also imperative that the appropriate data be collected, that the effort not be overly burdensome and that the data is accurate. The card has already had modifications and with the help of the MEDFAC and the field, a truly valuable product will be created.
• TOP CONCERN FOR THE LINE AND ADFAC: Expediting processes which are touched by the medics, including waivers, accessions, transfers, Line of Duty (LOD) s, Medical Evaluation Boards, (MEB) s, etc. The ADFAC will support our efforts if we identify the problems and solutions. We have an outstanding staff, at unit level and at NGB, who are working diligently; nonetheless, military medical processes take far longer than their similar civilian counterparts. There have been many proposed solutions, to name a few:
a. Acquire a full-time medical provider to be accountable for the programs, (along with other responsibilities).
b. Acquire a computerized tracking system so that the status of a package will be known at any point in time.
c. Design screening checklists to assist in submission of complete packages without need for return.
d. Disseminate military transfer checklist to recruiters and State Air Surgeons to expedite transfer process.
e. Regularly inform leadership of the status of packages and number of packages that have been returned.
f. Develop and enforce standards for return of requested information and performance of evaluations.
g. Make business case/return on investment of hours spent expediting package versus savings to system
• It is also important to realize that
a. Most of the time taken by the packages is not taken by actual work, but rather waiting in the queue or for other items to be accomplished.
b. Expediting processes may cost time and or resources, but there will a net savings to the enterprise by expeditiously resolving issues.
c. System improvement may occur by many small modifications.”

Note from LtCol Black
Col Pond,
Just wanted to let you know that I may not be in attendance. I’ll be joining my unit on Thursday. They’re doing AT at Camp Grafton in Devils Lake North Dakota. We’re out in the boonies doing some army style medical readiness training. I don’t know what the evening schedule looks like yet.
If I have decent cell reception and can slip away, I will. I think SWAT and I were going to try add to the discussion regarding full time providers. I think the benefits of having a full time provider are pretty obvious in the
current very busy environment. I agree with Col Desko, the funding and
classification of these positions is were the focus needs to be placed. If this positions are Title 5 (GS 12 or midlevels and GS 14 for physicians) without any incentive pays, the compensation may not attract applicants despite having funded positions. I wrote a recommendation letter this summer for new NP graduate. He is starting at $95,000/year. Granted Fargo is not top on people’s list of places to live. I don’t know what salaries
look like nationally. A GS 12 salary without incentive pays would be about
$72,000 per year. Additionally, this would be horrible position for new graduate who needs to see a lot of sick patients to develop their skills.
Well those are my thoughts on that particular issue.

Hopefully we will be talking soon.

V/R

Fred

Note from LtCol McChesney:
Thanks Col Pond, MEDFAC members –

As a reminder we will be discussing potential ways of utilizing Adult Nurse Practitioners in the ANG. We have asked Lt. Col Hackworth to join the call to add her insight into the matter.

Please see below for a summary of the issue as well as potential COA’s.

Thanks

 

Joshua McChesney Lt. Col, IN ANG
122 Medical Group
Fort Wayne, IN
———————————————————————————————————————————–
Col Pond/ Lt Col Hackworth

Please see the attached e-mail that addresses the issue of credentialing adult nurse practitioners in the guard. I would like to see the topic addressed at the upcoming MEDFAC meeting.
Hopefully after the MEDFAC’s review we can push this issue up to the SG office for discussion/implementation.
Col Pond – can you please push this out to the other MEDFAC members after reviewing it if you see fit, prior to our meeting. I am happy to discuss the issue further on our call.

BLUF – The Air National Guard (ANG) is not currently utilizing board certified Adult-Gerontology Nurse Practitioners (AGNP) as providers within the units. The ANG should strongly consider working with our active duty and ARC counterparts to expeditiously find a way to allow these highly-trained professionals to practice to the full extent of their licensure/certification.

History – Several years ago, the Nurse Practitioner Air Force Specialty Code (AFSC) was converted from a 46N (shred out) to 46Y. Under the 46N AFSC four different classifications of Nurse Practitioners were recognized to include: 46N3A – Women’s Health, 46N3B – Pediatric, 46N3C – Adult, and 46N3H – Family Practice. After the conversion to the 46Y AFSC all the previous Nurse Practitioner specialties were carried over apart from the Adult specialty.

Adult-Gerontology Nurse Practitioners (AGNP) are highly trained professionals that assess, diagnosis and treat individuals age 18 and above. All the AGNP’s are nationally certified by the American Academy of Nurse Practitioners (AANP), or American Nurses Credentialing Center (ANCC). They are ever so capable of assisting medical units in addressing individual medical readiness, pre-/post deployment, and waivers/case management.

Recommendations/Solutions – When considering the integration of the AGNP’s into the ANG/ARC, one of the main challenges that we face is that there is currently no AFSC for this specialty that is recognized by active duty. There are however, two potential solutions that should be considered.

• Potential Solution #1 – AFI 46-101 (Chapter 4, paragraph 4.5) allows for authorizations for extended scope of practices for nurses/medical technicians under the following conditions:
– The expanded scope of the task or procedure must be mission essential.
– The member must be trained for the expanded scope by a competent trainer and that training must be documented.
– The expanded role is restricted solely to military mission performance.

Once it is deemed that each of the above criteria have been accomplished the member may then submit for the waiver to the Air National Guard Readiness Center/Command Surgeons Office (ANGRC/SG).

All AGNP’s meet the criteria for the waiver as the board certification validates their training/competency and the tasks that they will be performing are undoubtedly mission essential. With the SG’s approval, we could utilize this process to identify specific tasks/functions that AGNP’s could be authorized to do within their unit. This would not cause problems with our active-duty counterparts as the member would remain as a 46N as their primary AFSC, however be allowed to assist the ANG/ARC in completing provider essential tasks. There will of course be specific credentialing requirements that will need to be hashed out with this recommendation however, this option is feasible for the ANG/ARC

• Potential Solution #2 – The ANG/ARC may consider propositioning the active-duty to bring back the adult/geriatric NP AFSC for ANG/ARC components. Once this formal AFSC is back the member can then be credentialed in that area. If there is an issue with active-duty not wanting to bring this back because of alignment issues with active duty/reserve specialties, we could mitigate this by adding the AGNP as a secondary AFSC and keeping the individuals primary AFSC as a 46N. This would allow us to credentialed the member within that AFSC without adjusting their assigned positons.

It is my hope that the MEDFAC can see value in this proposition and work with the SG office to move it forward and offer units’ additional options in caring for our Airmen.

Respectfully submitted

 

On Jul 17, 2017, at 01:05, William Pond <wwpond@gmail.com> wrote:
MEDFAC Colleagues,

1. Please send additional topics for consideration along with supporting or explanatory information. I will send you a finalized agenda and supporting information the day before as well as post it to http://www.aangfs.com/medfac/
2. The hot topic for ADFAC is streamlining and speeding medical processes; it is multifaceted; we need all points of view.
3. Put on your thinking caps for these additional topics
a. Nurse practitioner manning (LtCol McChesney information appended below)
b. GMU full time provider-update
c. DDRP-update
d. Flight surgeon SERE.
e. Credentials (Col Perino to report since he now has the most experience)
f. Select AE representative replacement and welcome Chief Thomas Katt.
4. We will need to select and prioritize the top 3 issues for presentation to the ADFAC-these are due the day following our telecon.
5. Due to his breath of experience as a clinician, flight surgeon, credentials reviewer and leader, along with his demonstrated attention to detail and ability to work on projects on a national level such as rewriting/updating the State Air Surgeon regulation, I have selected Col Louis Perino to serve as vice-chair of the MEDFAC.
6. I will be stepping down from MEDFAC chair at the end of the summer, so anyone wishing to consider a leadership role, please give me a call and we can have a chat about the history, position and responsibilities. We will tentatively have elections in September.
7. Attached please find the current roster, including those who have replied as having received email notification of the telecon. If I do not receive positive confirmation, I will be calling you or contacting your unit because it is imperative that I know that you have received notification. I don’t want to miss anyone because they did not get the message. If you cannot attend, please designate an alternate.
Of course, feel free to call me anytime with any issues or concerns.

Col William W. Pond, MD, CFS, MC, INANG
Indiana State Air Surgeon
wwpond@gmail.com
(260) 602-5167 (cell)
(877) 917-5507 (secure fax)
11011 West Sycamore Hills Drive
Fort Wayne, IN 46814

 

 

MEDFAC documents of Interest:

***MEDFAC Credentials Board Schedule 2017

***ADFAC MEDFAC Key Issues Oct 2016
***ADFAC MEDFAC Key Issues April 2016
***ADFAC MEDFAC Key Issues Nov 2015
***ADFAC MEDFAC Key Issues Apr 15
***DPH ADFAC Brief Apr 15
***MEDFAC Charter 2008 (for comparison: F-16_WSC_Charter_2010)
***2014 Pond Analysis of 2008 MEDFAC Charter
***MEDFAC 2014 Update Col Pond
***MEDFAC Structure (prior to 2017 restructure)
***2012 08 04 MEDFAC Minutes (prior to sequestration)

***MEDFAC Charter 2017
***MEDFAC Charter BBP

The following discussion highlights an issue caused by current budgeting constraints along with efforts creatively to address it.  Any thoughts or volunteers?  Shoot them my way: wwpond@aol.com or call me (260) 602-5167   William W. Pond, MEDFAC Chair

=======================

McPherson and Pond replies in Bold Blac

==================================

MEDFAC Organizational Update:

BLUF: MEDFAC continues to evolve to meet mission requirements and fiscal constraints.

Historical Background:  When the Medical Field Advisory Council (MEDFAC) was formed in 2008, it was composed of a chair and 3 representatives from 3 sub-councils: the State Air Surgeons, MDG Commanders and Senior Enlisted.  These each met in conjunction with national meetings such as Readiness Frontiers and then conducted additional discussions by teleconference.  The 3 sub-council representatives, along with the MEDFAC chair, also met at the same national meeting and by additional teleconferences.  With input from the MEDFAC, the ANG SG staff, and ANG Medical Service Assistants, the Air National Guard Medical Service issues of national important could be identified and raised to the Air Director’s Field Advisory Council  (ADFAC) by the MEDFAC chair for information and support.

Sequestration, restrictions on national meetings, and movement of key personnel severely impacted participation by the MDG Commander and Enlisted representatives while MEDFAC Chair, State Air Surgeon, ANG SG and Assistant input and participation remained strong.  Budgetary constraints and meeting limitations will continue for the foreseeable future; consequently, means of meeting the purpose of the charter should be met while working within these constraints.   While teleconferences can be valuable for disseminating information, in person discussions are essential for frank, collegial, sensitive discussions.  If in person meetings are to be held, but there is no monetary support for them in spite of their value, then in person gathering the members at another training or working venue might be a solution.

The MEDFAC Charter clearly outlines purpose and goals, but is flexible in the way that these may be accomplished. Here are some ideas for purposes initiating a discussion on the future:

1)      MEDFAC will continue to be composed of representatives from State Air Surgeon, Commander, and Enlisted members. – AGREED

2)      Strong input and support will continue from the offices of the Air National Guard Surgeon General and involvement will continue from ANGMS assistants.  AGREED

3)      Homeland Response has grown since the charter was formulated and as such should be recognized.

This is an interesting point.  How do you propose we recognize or work on this?  It has become one of the things I have found rewarding as it touches on our civilian lives as well as military.  As the PHEO liaison the SAS is in a unique position to have impact here, but I’m not sure we are as engaged a we could be.  I have found that I have to ask to be included in exercises, to have medical injects and even to get the AARs from them.

                Homeland response could be represented by both the SAS because of the SAS roll as the PHEO liaison as you point out, but also by the CERF/HRP Commander

4)      In person discussions and gatherings of the component sub councils should occur in conjunction with required training or other functions, e.g. State Air Surgeons at SAS refresher course, Commanders at Commanders course, national credentialing functions etc. with follow up by teleconferences

I agree here, but they are still few and far between.  I get pumped up after the meeting then I still don’t see anyone for another year.  By then I’ll probably be retired.  For the foreseeable future, getting together more than once a year may not be possible.  At least that would be a good start with follow-up telecons quarterly.

5)      At such gatherings, sub council members would be in official status as training students or instructors with discussions to be held during non-training times, so no additional costs would be incurred.

We need to be able to have additional time set aside for OUR meeting together, not just the training.  If we could even get one extra day, we would be better able to interact.  The last two times I have been to these training sessions they were so packed with training that we had no other time to get together except the one social function.  You are correct; the training venues have been fully utilized.  Setting aside an evening or the morning or afternoon of a travel day might work.

6)      Dissemination of information would continue by the ANG SG “Heads Up,” AANGFS Newsletter, and internet searchable web site. Good

7)      SAS Weapons System Council would continue to represent dominant weapons system and State Air Surgeon issues.  The SAS would represent the dominant weapons system of the state. Total members would be limited to the number of weapons systems

I have fallen down here, Bill.  I need to work harder at identifying specific people (though we have been hampered by a piecemeal address list)  I invite input from every SAS.  I should put out an appeal to gain members again.  I believe our address list should be close to cleaned up.  I’ll check with Frank.  Current commercial emails and cell phones are imperative.  It is a lot of work initially, but after the database is established, it really does not take too much effort to maintain.  The SAS Society did give me permission to post the roster in the SAS page of the aangfs web site with password protection.  This would allow easy, commercial access without bots being able to access the data.  I’ve already tested the issue, just waiting for an updated list.

8)      Commanders sub council would be limited to 10 with distribution throughout the FEMA regions. How active has this been?  The ban on meetings and sequestration severely impacted the formal representation by the Commanders and the Enlisted sub councils, while the SAS representation, ANG SG office and Assistants remained strong. 

9)      Enlisted representation would continue by Senior Health Technicians, First Sergeants or other key enlisted personnel.  Same question, how active and informative have these been?

10)   Each sub council will continue to elect its own chair; members are selected by the sub council chair from volunteers, or absent a council chair by the MEDFAC chair.

11)   CERFP/HRF will have a MEDFAC sub council and a representative to the MEDFAC with the mechanics left to the sub council  Great idea.  Now that we are splitting up it makes perfect sense to do this.  Cutter has some good ideas and has offered to place them in writing and we will do the same. 

The telecon on October the 28th might be a good time to solicit volunteers.  The MEDFAC is fundamentally different from say the F-16 WSC whose members are determined by their positions as Commander of an F-16 Wing.  Some of the councils are relatively small, since there just are not that many wings.  From the MEDFAC standpoint, we are trying to get broad field input.  Perhaps each sub council would do well with 4-5 participating members, rather than a large number of which only a few participate.

One idea: MEDFAC composed of representatives from SAS, MDG Commanders, Enlisted & Homeland Response.  Each group would have 5 members of which one would be the chair. MEDFAC would meet yearly in conjunction with flight surgeon/SAS meeting which would guarantee funded spots of for 2 of the 4 in addition to the chair.  Cutter suggested that if there were national credentialing body, the sub chairs could serve on this body and then meet at the same time as part of MEDFAC.  This idea has a lot of merit, because those doing the credentialing should be senior experienced, involved leaders, and these are the same ones who should be on the MEDFAC.

 

The charter did not have a mechanism to create or recreate the sub councils.   In order to reanimate the process, I would like to suggest.  So here are some possible suggestions.

  • The charter be updated.
  • Membership in the MEDFAC will consist of one representative from State Air Surgeons, Commanders, Enlisted & Homeland Response.
  • We solicit 3- 5 volunteers for each sub council and select those with proven track records for performance.
  • Sub councils will immediately select a chair.

 

  1.  ANG SG office and MEDFAC chair and will be invited non voting guests at the sub council meetings.

======================================================

Cutter,

Thank you for your thoughts and support.    The purpose of the MEDFAC is to have a body for the identification and elevation of issues that are important to the field.  The MEDFAC chair is tasked with informing and  advocating those medical issues that are Guard wide among other Weapons System Council Chairs at the Air Director’s Field Advisory Council (ADFAC).  To have credibility, the representative to the ADFAC must have qualities and experience commensurate to the other members of the ADFAC.

The structure that was envisioned when the MEFAC was created may not be sustainable
in the current resource-constrained environment; consequently, we might need to re-formulate a mechanism that meets the objectives while being consistent with our
current allocation of resources.

There is merit in combining the credentials function with the MEDFAC since MDG/CCs & SASs would be senior, operational Guard members who could execute both functions.

I have a version of the charter and am checking records to see if there has been an
updated/changed version.

Do you have a name of a contact in the with the Army National Guard equivalent of the Air Guard MEDFAC?   I would like to give him/her a call for information .

Thanks,

Bill

==========================================
Bill,

I’m not sure how the travel money issue will be in FY16–we may be back to
Sequestration, but the ARNG was able to continue their equivalent to the
MEDFAC by tying it to their centralized credentials process.
My goal would be to have SASs and MDG/CCs on the credentials/privileged board
as well as reps for dentists, PAs, NPs and Optometrists.  Many of these
members can also be on the MEDFAC (we can make sure there is a member from
each corps) as well as fulltime reps (both enlisted and officer).  Those folks
that are tied only to the MEDFAC may be limited on travel, but the
credentials/privileges should be able to continue–that would make having a
quorum a little easier and the full-timers could call-in if necessary.
Do you have the charter in electrons?  And if so can you send it to me so I
can at least be familiar with it.

Thanks!
Cutter

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