TAMPA — As Col. Dennis Beatty walks through MacDill Air Force Base's new $104 million, state-of-the-art medical facility, he sometimes catches himself using a word that is forbidden.
It's a clinic, not a hospital.
"My staff has to pay me a dollar every time they use the word 'hospital,' " said Beatty, commander of MacDill's 6th Medical Group.
MacDill will celebrate the opening of its 254,000-square-foot medical clinic at a ribbon cutting Friday — the clinic actually opened in late September — in a ceremony that underscores the military's efforts to streamline health care and move away from expensive inpatient services at bases around the nation.
The new clinic provides an array of services, including dental care, an imaging department with an MRI and CAT scan, physical therapy, cardiology and internal medicine.
MacDill converted its hospital to a clinic in 2005, closing its emergency room and sending urgent-care patients to private hospitals as the need arises.
The move away from hospital service was necessary, base leaders say, because patient traffic was too low. And with large hospitals such as Tampa General close by, patients still have access to excellent care, MacDill says.
The military's insurance program, TriCare, covers those seeking care in the private sector, including active-duty, military retirees and their families.
During a media tour of the clinic last week, Beatty said doctors need to see a higher number of patients than is available at MacDill to stay proficient in their specialties. On average, the new clinic is expected to see 300 to 350 patients a day.
"You want a cardiologist who does lots of open-heart surgeries to be the guy who cracks your chest," Beatty said. "We don't have the population to (justify) keeping a hospital open."
Hospital closures don't affect those wounded in Iraq and Afghanistan, the Pentagon says, because facilities such as MacDill's are not typically utilized to treat those patients.
Often, these kind of cuts hit retirees more than active-duty personnel, some critics contend.
A 2003 study by the Congressional Budget Office said the Pentagon had decreased the number of inpatient beds available in its medical system by 74 percent from 1990 to 2001. More current figures were not available.
"On the one hand, the changes made (the Defense Department's) system of in-house treatment facilities more cost-effective, allowing the department to avoid the cost of maintaining facilities that it no longer required for its wartime mission," the report said.
"On the other hand, they amounted to a de facto decline in the level of benefits provided to Medicare-eligible retirees," it said.
Bob Sawallesh, 72, of Tampa, a retired Army officer active in the area's veterans community, is one of the harsher critics of MacDill's decision not to offer hospital services. Private facilities, he said, won't give military personnel priority treatment. And an emergency room is critical for a base with as much activity as MacDill, he said.
"I guess the generals think if they have to spend money on hospitals they won't have money to spend on the tanks and planes," Sawallesh said.
But MacDill officials have said an emergency room requires extensive support from inpatient services at a hospital. And even when MacDill had an emergency room, the base hospital did not have the same level of care as larger hospitals elsewhere.
So when a seriously ill person was brought in, he would often be transferred elsewhere after doctors at MacDill stabilized him, the base said.
"A true emergency department cannot be provided at the MacDill clinic," the base said in a statement. "And maintenance of a quasi-emergency service there would likely cause dangerous delays in the delivery of definitive emergency care."
The base maintains basic life support ambulance service, though Tampa Fire Rescue responds to more serious cases requiring advanced life support.
MacDill remains one of the military's most important bases and is home to U.S. Central Command and Special Operations Command, which are leading the wars in Iraq and Afghanistan.
MacDill's eligible beneficiary population runs from 106,000 to 250,000, depending on the season. That's the highest number for any medical facility in the Department of Defense, Beatty said.
But since a large portion of that number includes retirees with Medicare, many never seek care at MacDill.
MacDill's old, eight-building medical complex, which dates to the 1950s, is going to be torn down. During a short transition in September, both the new and old clinic were open at the same time.
"During one week, we were occupying the oldest facility in Air Force medical services and the newest," Beatty said.
William R. Levesque can be reached at firstname.lastname@example.org or (813) 226-3432.