Opportunities Missed to Contain Spending on Sleep Apnea Devices and Improve Veterans’ Outcomes

The VA Office of Inspector General (OIG) conducted this audit to determine if the Veterans Health Administration (VHA) is efficiently managing positive airway pressure devices (sleep apnea devices) and supplies for veterans diagnosed with sleep apnea. The number of veterans diagnosed with sleep apnea who receive devices and supplies increased dramatically between fiscal years 2014 and 2018. This has significantly increased the financial risk to VA. If VHA does not change its practices and leverage opportunities to save money, the OIG estimates it risks spending about $261.3 million over the next five years on devices and supplies veterans will not use. VHA did not efficiently manage sleep apnea devices and associated supplies. The OIG found that almost half of the 250,000 veterans issued a device from October 2016 through May 2018 used it less than half the time. This can reduce therapy effectiveness. The mismanagement occurred in part because VHA did not identify and follow up with veterans who were not using their devices as recommended. The OIG also found that VHA did not have a sleep medicine staffing model to help ensure it conducted patient follow up. A model will determine staffing to help ensure follow up is conducted. VHA could save up to $39.9 million per year by loaning devices to veterans rather than issuing them for permanent use. A loan program would allow unused devices to be returned and reused. VHA could save up to an additional $12.4 million per year by not purchasing device supplies for veterans who do not use their devices. The OIG made three recommendations to the under secretary for health regarding sleep apnea device management. The recommendations include studying staffing levels, looking at using existing technologies to better monitor device use, and looking at alternatives to purchasing devices.