A new IG report on VHA sleep apnea health care spending called on the agency to implement spending reforms that cut up to $200 million over 5 years.
The report focused on the spending and distribution of positive airway pressure devices. The population of veterans receiving the devices increased by 96 percent from 342,000 in FY 2014 to an estimated 669,000 in FY 2018. The amount spent during that period increased from $147.6 million to 233.9 million on devices and supplies.
IG concluded half the veterans receiving the devices were using the devices less than half the time resulting in a misallocation of resources. The report put out three recommendations VHA agreed to that could result in decreasing spending up to $200 million over 5 years.
Sleep Apnea Device Mismanagement
“The mismanagement occurred in part because VHA did not identify veterans who were not using their devices as recommended and follow up with them in a timely manner. Furthermore, VHA lacks guidance on alternatives to purchasing sleep apnea devices for all veterans or to take back devices not being used.“
The alternative IG paints for readers seems compelling:
“Therefore, if VHA does not act to change its current sleep apnea device issuance practices and leverage opportunities to reduce spending, the OIG estimated VHA is at risk of potentially spending $261.3 million over the next five years on sleep apnea devices and supplies that veterans will not use.“
The report seems to place a lot of the blame on mismanagement on VHA for not properly staffing its sleep medicine programs to adequately monitor usage and follow-up.
One agreed to recommendation was to develop alternatives to purchasing the items in the event the veteran does not tolerate or use the device.
Another recommendation was to “to more promptly identify individuals at risk of noncompliance with recommended therapies.”
Impact On Veterans
So, what does this all mean for us? The focus on the report is certainly on withdrawing services rather than increasing them on the services.
On the one hand, it seems reasonable to use distribution model where the machines are lent out to see if the treatment can be tolerated rather than simply buying the device and giving it to a veteran without knowing if it will help.
On the other hand, VA always dishes up a nice bowl of backlash against veterans when it gets spanking. Usually, whenever IG or GAO issue a report blasting VA for mismanagement, the agency usually clamps down harshly on veterans.
A few years ago, GAO hammered Vocational Rehabilitation and Employment for not more carefully buying resources for veterans seeking self-employment or Independent Living benefits. The end result was counselors were afraid to approve the benefits without making very disabled veterans jump through impossible hoops first or simply denying the benefits outright.
You may also recall the exposure of the agency’s negligent prescriptive practices using opioids. Once the scandal was exposed, VA dramatically cut the use of opioids after many veterans became addicted without an appropriate treatment plan to ween the veteran off the opioids. Many veterans were adversely impacted when VA doctors cut them off the cold turkey in response to the backlash.
For sleep apnea spending, if there is a backlash, veterans seeking new benefits for sleep apnea should anticipate significant roadblocks when seeking treatment and possibly Compensation benefits.
Meaning, veterans seeking Compensation for sleep apnea may be more heavily scrutinized for their usage of a CPAP breathing machine. This would not be dissimilar to how some veterans with PTSD are penalized for avoiding using VA mental health services.
Likewise, veterans seeking a diagnosis for sleep apnea may also be more scrutinized when seeking a sleep study or when seeking a CPAP for the treatment of a diagnosed condition.