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Patient Resources

Policies & Procedures

Interactive Customer Evaluation (ICE) vs Formal Complaint

ICE Complaint Process

  1. ICE complaint is filed electronically via BAMC Website at https://ice.disa.mil/
    Click on the following links:
    > ARMY > CONUS > Brooke Army Medical Center > HEALTH > Select the specific Service Provider
  2. ICE Complaints are viewed by:
    • ICE Service Provider Manager
    • Clinic Supervisors
    • Administrative Officer
    • ICE Site Manager
    • Hospital Commander
  3. ICE Complaints are responded to within 5 to 7 business days as long as the individual provides contact information. Generally most complaints are resolved within 24 to 72 hours.
  4. Clinic / Department will contact the individual that filed the complaint to discuss a healthy resolution / explanation reference the complaint.

Formal Complaint Process

  1. A written complaint filed with the Patient Experience Branch as described in the Overview above.
  2. Complaints are processed through Clinic / Department Chief who will investigate to help resolve the issue.
  3. Formal Complaints have 30 business days for resolution.
  4. Clinic / Department will contact the individual that filed the complaint to discuss the resolution of the complaint to the Patient Experience Branch.

Our facility is accredited by the Joint Commission. If your care or safety concerns are not resolved to your satisfaction, we invite you to contact the Joint Commission Office of Quality Monitoring at (800) 994-6610 or via e–mail at complaint@jointcommission.org

TRICARE Inpatient Satisfaction Survey (TRISS)

What is TRISS?

TRISS is the TRICARE Inpatient Satisfaction Survey. TRICARE conducts this bi-monthly survey of inpatient discharges in response to a congressional mandate to assess the healthcare provided to TRICARE. This survey aims to provide performance feedback that is actionable and will aid in improving overall quality of health care for adult beneficiaries. The main goals of the TRISS are to:

  • Provide feedback from beneficiary users to DoD leadership so they may implement process improvement initiatives
  • Establish a uniform measure of beneficiary satisfaction with the health care services they have received
  • Provide high quality survey data to be used for evaluating the satisfaction and access of Military Health System (MHS) beneficiaries to health care services utilizing Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) protocol. Satisfy Congressional requirements to measure perceptions of beneficiary satisfaction and access

Who is responsible for TRISS?

The DHA is a Combat Support Agency supporting the Military Services. The DHA supports the delivery of integrated, affordable, and high quality health services to beneficiaries of the MHS, and executes responsibility for shared services, functions, and activities of the MHS and other common clinical and business processes in support of the Military Services. The DHA serves as the program manager for the TRICARE health plan, medical resources, and the market manager for the National Capital Region (NCR) enhanced Multi-Service Market. The DHA manages the execution of policy as issued by the Assistant Secretary of Defense for Health Affairs and exercises authority, direction, and control over the inpatient facilities and their subordinate clinics assigned to the DHA in the NCR Directorate.

The Decision Support Division supports the DHA by using a multidisciplinary approach to investigate complex issues in measuring, evaluating and analyzing the performance of healthcare delivery systems and develop innovative methods for financing high-quality health care. The staff develop and promote science based tools and methods for analyzing/benchmarking MHS health care, examine results to ensure accurate presentation and completeness and provide the ability to see the "big picture" by rapidly acquiring the background and knowledge needed to assist DHA and the Services in decision making.

For more information, please visit Health Care Program Evaluation/Decision Support Division.

Who is surveyed?

A representative sample of TRICARE beneficiaries is selected to be contacted and asked to participate in TRISS. The sample consists of respondents who have recently received inpatient care from a military treatment facility (MTF) or a TRICARE civilian network hospital. Treatment from MTFs is labeled as “direct care,” while civilian hospital care is labeled as “purchased care.” TRISS is conducted world-wide for an annual sample of 187,000. The basic sampling protocol is a random sample of eligible discharges for purchased care, and a census for the direct care system. The patient’s principal diagnosis at discharge determines whether he or she falls into one of the three product line categories (i.e. Maternity Care, Medical, or Surgical) eligible for HCAHPS.

What is HCAHPS?

The TRICARE Inpatient Satisfaction survey is modeled after the HCAHPS program (Hospital Consumer Assessment of Healthcare Providers and Systems). HCAHPS was developed by the Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) and was the first national, standardized, publicly reported survey of patients' perspectives of hospital care. HCAHPS created a common metric and national standard for collecting and publicly reporting information about patient experiences of care. HCAHPS scores are based on four consecutive quarters of patient surveys and are publicly reported on the Hospital Compare web site, www.medicare.gov/hospitalcompare. These scores are also reported in this website as “Civilian Benchmarks.”

For an overview of the HCHAPS program, please see the HCAHPS Fact Sheet. For information about HCAHPS policy updates, administration procedures, patient-mix and survey mode adjustments, training opportunities, and how to participate in the survey, please visit HCAHPS On-Line at www.hcahpsonline.org.

Where do the benchmarks come from?

The benchmark is a national average of civilian hospitals that participate in HCAHPS and are included in the CMS database. DHA relies on benchmark data to compare the performance of its MTF and civilian network providers both internally and externally to the MHS. As a result, TRISS methodology and questionnaires are modeled on the HCAHPS protocols sponsored by the Department of Health and Human Services.

What are respondents asked?

The total length of the questionnaire is four (4) pages strongly based on the HCAHPS survey. The survey asks recently discharged patients two global questions: to rank their overall satisfaction with the hospital and whether they would recommend the hospital to their family and friends. It asks about their communication with medical providers and the responsiveness of hospital staff. It probes into specific aspects of their care, such as pain management and the discharge experience. The survey also delves into the patients' perception of their expertise, including quietness of their hospital room. The core of the survey contains items that ask “how often” or whether patients experienced a critical aspect of hospital care, rather than whether they were “satisfied” with their care. In addition to HCAHPS questions, additional DoD questions have been added to assess and address specific areas of the military population's patient experience. Questions 26-35 of the survey are added by DoD.

TRISS IRIS Targets

BAMC: Baseline $15.8M for TRISS

Table 6 IRIS FY 18 TRISS tiers and targets

TRISS Table

Tier 1 0.% - 71.99%: 0%
Tier 2 72% - 75.99%: 2%
Tier 4 82% & Above: 6%

TRISS performance is tiered based on the TRISS satisfaction percentage and is shown in the table above. In order to receive payment for a TRISS factor, the initial target minimum of 72% or greater must be achieved.

Joint Out-patient Experience Survey (JOES)

  • The Joint Out-patient Experience Survey (JOES) combines and standardizes the long-standing Services outpatient surveys:
    • Army (AMEDD Provider Level Satisfaction Survey-APLSS)
    • BUMED (Patient Satisfaction Survey- PSS)
  • This single, out-patient-visit based instrument is being standardized across the MHS and will assist in avoiding duplicate surveys to those who have multiple appointments at clinics within 90 days thus reducing the burden on beneficiaries
  • JOES will continue to focus on the beneficiary health care experience with care received in MTF with the goal of improving the experience
  • It will also include a separate monthly survey based on the DHA TRICARE Outpatient Satisfaction Survey (TROSS), called JOES-C where “C” stands for Consumer Assessment of Health Providers and System (CAHPS)-clinician and group survey
    • JOES-C will continue to focus on beneficiary experience in both direct and purchase care provider offices, and will allow MHS to compare our beneficiary results to the civilian benchmark results
  • JOES will be managed by a Tri-Service working group using a single central contract

What is JOES?

  • The primary functions of Survey Operations and Information Control include:
    • Provide timely and accurate information and date for program evaluation, performance management, case management, and decision support for the MHS (MCSC 3.0, Population Health, etc.)
    • Establish premiere, cost effective and integrated assessment programs
    • Assist in benchmarking the MHS to its civilian counterparts
    • Develop strategy for identifying, articulating, and achieving information needs, and requirements
    • Oversee survey duplication, burden, cost, and quality in and (when feasible) outside the MHS
  • Similar to APLSS, there will be continued focus on the beneficiary experience with care received in MTFs

Exclusion Rules

  • Sample exclusion rules
    • Ages 11-17 will be excluded
    • Minors excluded from OB-GYN visits
    • Respondents selected will be excluded if no contact information(no mailing address for non-AD; no mailing address AND no email address for AD)
    • For JOES-C, only one family member will be sampled per month
    • Same patient in past 90 days
    • Same patient and provider in past 6 months
    • Do Not Contact/Deceased/DOA
    • Completeness rules (email. Mail address addresses)
    • Invalid facility

JOES & IRIS

  • Patient satisfaction data comes from question 22 of the Joint Outpatient Experience Survey (JOES)
    • The percentage achieved and adjustments are calculated at the Parent DMIS level with the number of survey displayed
    • ents tier adjustment factor will be established for each MTF, for each question, based on satisfaction survey return categories
  • Adjusted Target
    • Question22 – Overall, I am satisfied with the healthcare I received on this visit
  Tier 1 Tier 2 Tier 3 Tier 4 Tier 5
Q22 - Overall, I am satisfied with the healthcare I received on this visit 0 - 94.99% 95 - 95.99% 96 - 96.99% 97 - 98.99% >99%
  0 $100 $300 $500 $1,000

JOES Website Access

  • The site will be available for all CAC users; non-CAC users will need to be approved for access
    • If a non-CAC user is associated with a military service, their request for access will be forwarded to that service’s representative; it will be forwarded to DHA
  • There are 28 questions on the JOES survey
    • Two open ended questions # 23 & 27
    • Air Force- Question # 7/8
    • Army- Question #9
    • Navy- Question # 25/26
  • For JOES data will be reported at the following intervals, monthly, quarterly, and at a rolling 12 months
  • There is a 1-800 number along with email account for respondent inquires, questions, and comments
  • All providers will be in JOES
  • All scores (including comments) will be available for all users, including provider scores. Provider comments, however, will be locked down
  • Two website URLs are registered:

DoD Interactive Customer Evaluation (ICE)

  • ICE is a web-based tool that collects feedback on services provided by various organizations throughout the Department of Defense (DoD).
  • This tool allows customers to submit online comment cards to rate the service providers they have encountered at military installations and related facilities around the world.
  • It is designed to improve customer service by allowing managers to monitor the satisfaction levels of services provided through reports and customers comments.
  • DoD ICE web site available 24/7/365.

How do I access the BAMC ICE Site?

There are three (3) ways to access BAMC ICE site:

Smart Phone:
If you have a Smart Phone, please scan the Quick Response Code below into your smart phone to access the BAMC ICE site and the provider listing.

Quick Response (QR) Code

Via Internet:
Log on to: https://ice.disa.mil
Click on the following links:
> ARMY > CONUS > Brooke Army Medical Center > HEALTH > Select the specific Service Provider

ICE Kiosks:
During your visit to BAMC/SAMMC, and the outlying clinics please locate one of the ICE Kiosks and click on ICE ICON to access ICE. The HEALTH link will take you to 121 Service Providers list, which enables you to provide customer feedback.

We value your input and Please Put It On ICE!

Thank you for taking the time to rate us and provide us with your comments and suggestions. We remain committed to constant improvement of our services, facilities and it is our goal to provide excellent customer service and quality care for all our patients, in both a timely and efficient manner. Your feedback will help us in this endeavor. Please remember to check “Response Requested” and provide your contact information if you would like a manager to follow-up with you regarding your comments. If you are unable to locate the specific Service Provider you wish to comment on, please submit your comments using the Site Suggestions, Questions, and Comments cards.

Please select the appropriate Service Provider for the area you wish to rate and tell us…. How Are We Doing? How Is Our Customer Service? How Can We Make A Difference?

Don't forget to keep your family's information up-to-date in DEERS.