Large number of vets not receiving follow-up care for their sleep apnea, OIG says

WASHINGTON - The Veterans Health Administration 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, according to the Office of Inspector General.

Nearly half of the almost 114,000 veterans who were not consistently using their devices did not receive the necessary follow-up care, the OIG found.

“Sleep medicine clinicians at VA medical facilities told the audit team they were unable to use available usage data to proactively monitor veterans' use on a large scale because they do not have enough staff resources,” the report states. “The OIG found that VHA did not have a staffing model for sleep medicine, though it is developing one.”

The number of veterans being treated for sleep apnea has skyrocketed from about 342,000 in FY2014 to about 669,000 in FY2018, a 96% increase, according to the OIG. The VHA spent about $147.6 million on devices and supplies in FY2014, an amount that grew to about $233.9 million by FY2018, a 59% increase, it found.

The VHA could save up to about $39.9 million per year by implementing alternative processes used by other insurers, such as loaning devices to veterans during a trial period, according to the OIG. It could also reduce the risk of needlessly purchasing supplies for veterans who will not or cannot use their devices, potentially saving up to $12.4 million per year, it found.

“With an average annual cost of about $540 per veteran for sleep apnea devices and an additional average annual cost of about $190 per veteran for device supplies, VHA is exposed to significant financial risk when veterans do not regularly use their devices as recommended by VHA's source book to derive benefit from the expenditures,” the OIG states.

The OIG recommends the under secretary for health determine if sleep medicine staffing levels are sufficient for monitoring sleep apnea device use and conducting follow-up appointments. It also recommends that the under secretary ensure VHA is leveraging existing technologies to routinely monitor veterans' use of sleep apnea devices to more promptly identify individuals at risk of noncompliance.

The OIG further recommends the under secretary coordinate with appropriate offices to assess whether purchasing sleep apnea devices is in VHA's best interest.

The under secretary concurred with the OIG.