VHA May Cut Sleep Apnea Spending Up To $200 Million After ‘Mismanagement’

Sleep Apnea

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

About 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.

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  1. Maybe you are right.

    Maybe just do away with the VA?

    Maybe just don’t take the VA’s money?
    Ya think?

  2. In my opinion, we veterans need to focus on providing more negative articles about the incompetent VA. And these articles need to be addressed DAILY!

  3. Personally, I have SA and can not see how anyone, truly with SA, can function at less than 100% compliance. I wake up gasping for breath off the machine and this is how I found the SA. When a vet fakes SA the machine functions as a lie detector. We who truly need help for SA would appreciate if the fakes would hike.

  4. Probably related to the fraud: “https://www.justice.gov/opa/pr/resmed-corp-pay-united-states-375-million-allegedly-causing-false-claims-related-sale”

  5. Before I came to VAHC, I was issued a CPAP. They mailed my insurance company over$4000. I could not use it. It was horrible. 20 months ago, the VA talked me into an auto-pap “Dream Machine”. Amazing difference.

    I don’t know how often the VA polls my CPAP data. I’ve called a couple of times for info on adjusting ramp times etc and waking “events” to determine if it was my dreams or apnea’s that Jack me up. The techs don’t have a live data file to look it up, and had to dial it up to poll the data. Perhaps the OEM or other data miner harvests usage info outside of our regular respiratory care folks.

  6. Although I’m 100% DAV, I use Medicare for my CPAP and routine monitoring/medical and to just reduce the hassle with the local VA (I realize that not all vets are currently Medicare eligible). My CPAP has the built in modem so my medical provider can download all of my data between semi-annual office visits. Every week or so I manually upload my data so my doctor can get reports. My office visits are usually 15-20 minutes, with short wait times. I get very good assessments and feedback during my visits.

    Medicare rents the CPAP and purchases replacement items, i.e., filters, tubing, face/nose masks, etc., on a routine schedule. My doctor reports my compliance to Medicare based on my CPAP data and office visits.

    I initially tried cleaning my equipment, but that process got old real quick. Medicare would not pay for a cleaning machine, so I bought a “SoClean” which seems to work quite well. You do get that “ozone” smell in the mask right at first, but I hardly notice it after a few minutes of use.

    I’m sure that managing a huge CPAP program can be a daunting task, but I believe it is doable. All CPAP should have built in modems and VA needs to have a frequent, uniform monitoring protocol and veteran counseling for non-compliant patients. If a vet is not using the CPAP as required, then the frequency and need for supplies goes way down. The cost savings in supplies may outweigh the additional staffing required to provide proper surveillance of the local programs. If a vet is non-compliant and has had multiple counseling sessions, or a doctor medically determines the vet is not benefiting from the treatment, then a decision can be made regarding the future use of CPAP therapy.

  7. Using a CPAP ain’t that simple.
    The monitor card is not the answer.

    The VA will provide re-education on the device. But they are short-staffed.

    I would suggest regular classes and training on the device.

  8. So if we are Dx “sleep apnea, mixed” w/ a cpap ….should we file straight away or wait for the outcome of this?

  9. The New ones, which I have used for three years , a Resmec uploads your nightly settings to a web server which the VA can monitor and the company monitors and sends you reports or you can logon and look at as well.
    If the VA doesn’t bother doing it or the agency that generated this report and made this report then again it’s all nothing but Politics to the detriment of Veterans

  10. CPAP machines are Bluetooth and monitored remotely by the VA, specifically to identify any veteran with usage below a certain percentage (I believe it was 85 or 90% usage??). It has not been a big secret that the VA can drop a sleep apnea claim if the veteran does not use their CPAP so the VA’s backlash on this quickly illuminates how quick they are to make the veteran suffer and pay rather than manage their organization better (or even at all).

    Notice how the VA did offer up a reduction/elimination of their annual performance bonuses right?

  11. I get dry bleeding nose and sore throat every time I use mine. And I feel like I am being suffocated during use.

  12. I wonder how many people on Medicare and/or Medicaid aren’t using their “CPAP Machine”! Also, how many can’t use it? Because, like me – don’t like something on their face when trying to get some sleep!
    Oh, before anyone jumps on me. I don’t have sleep apnea. Therefore, I’ve never been issued one.

    1. Being on Medicare I can tell you that if you are not compliant, Medicare does not/will not pay for these services/medical expenses. Sorry I can’t recall what he % number is, but my CPAP has a modem and the Dr.’s office can download it when I visit – I don’t even need to take in the SD card any longer.

  13. They need more money for bonuses and art! The only other agency worse than VA is the social security disability system that leaves citizens loosing their homes and committing suicide over deliberate denials. The government so worried about other countries killing its citizens while ours does it with pills and years of denials. System a sham.

  14. I have used the CPAP more recently, but it tends to create problem with the my sinuses, even with the cleaning process recommended by the VA. I also inquired about a new product on the market where in that you just put the hose or tube in the machine and it cleans the CPAP machine clean for you. Although it is unfortunate that some of us need this badly but aren’t able to tolerate the use of the machine without an infection or other medical issues, therefore we look for other alternatives, for example some of us are allergic to the materials use to construct the device.

    1. while I do not use a C machine, I also have problems with my sinuses. All I got from the VA is a nasal spray and a gismo that supposedly cleaned the sinuses but does nothing for me.

  15. I have used VA CPAP for the past 10 years. I cannot sleep well without it.
    Ref VA monitoring usage, thats easy. Every machine that I have had has a SD card that records time of usage as well as other perimeters. All the VA has to do is require the vet to bring or mail the card periodically

    1. The NEW Cpaps have built in cell phones to monitor and make adjustments on settings. Putting everyone on the new machine should take care of the non users

  16. See, again, it ALL comes down to the monies. Then, quote; *”On the other hand, VA always dishes up a nice bowl of backlash against veterans when it gets a spanking. Usually, whenever IG or GAO issue a report blasting VA for mismanagement, the agency usually clamps down harshly on veterans.”*

    When will our “powers that be” understand the VA is completely broken AND is the second most corrupt government agency? All they do is steal taxpayers monies for self indulgence and gratification!

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