RE: Letter to the Editor RE "Outcomes for Arthroplasties in Military Health: A Retrospective Analysis of Direct Versus Purchased Care".

The article discusses the potential consequences of centralizing surgical care in higher-volume military training facilities (MTFs) for "low-volume, high-risk" procedures such as total knee and hip arthroplasties. The authors argue that consolidating care in higher-volume facilities may compromise the training of future surgeon subspecialists, increase surgeon dissatisfaction, and strip lower-volume MTFs of resources, potentially compromising patient outcomes and access to surgical care. They suggest that further analysis, including the use of the Time-Driven Activity-Based Costing (TDABC) methodology, should be conducted to understand the true costs and resource utilization associated with different care settings. The authors emphasize the importance of conducting additional studies before fully implementing the Military Healthcare System overhaul to ensure the dual mission of improving combat readiness and providing quality care to beneficiaries is upheld. [Extracted from the article]