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Buck52
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Opportunities Missed to Contain Spending on Sleep Apnea Devices and Improve Veterans’ Outcomes

Veterans Affairs Office of Inspector General (OIG) sent this bulletin at 01/14/2020 12:34 PM EST

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

01/13/2020 07:00 PM EST

 

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.

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Loaners, eh? That worries me because of all the gear the military loaned me while in the service which had issues and problems. Imagine getting your loaner CPAP machine and it craps out after a couple of days because it's previous user did a shoddy job taking care of it.

These thing are not built sturdy, like portable oxygen generators.

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I'm not sure I like the idea of a loaner either. I can see a unit being returned, not inspected and cleaned up, and just put on the shelf to be shipped out to some other veteran. And speaking about clean, that doesn't sound too great either. Gotta be germs just sitting  there waiting to get into you. And, unless you live close enough to hand carry it to the VAHC for an immediate replacement, it's gotta take several days to ship it back and get another one in the return mail. That's several days of unhealthy sleeping.Na, I don't think I like the idea.

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They need better adjustable fitting mask and offer veteran option of a longer hose instead of him finding out about this after the fact from other vets.  Last visit they said there was no need for me to even bring the machine with me as they can tell from there read outs if it is being used.  I have had trouble with two of their mask and may buy one for a better fit if I can find it.  As in many cases the VA never volunteers any additional info that might help the vet.  He has to learn a lot from other vets.

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Dustoff 11 Last September I got 2 replacement masks after getting a hard time from them; seems usage is supposed to be minimum of 2 months per mask. I told the tech that the rubber wouldn't hold up and would tare after only 3 or 4  weeks. I used to use masking tape to patch them up so they wouldn't leak.This last 2 replacement masks are GREAT! They must have changed suppliers or something. As it so happens, I ordered and just receive some new equipment; new mask, harness and hose. And you are right about them collecting the data; they get it every morning digitally. We don't have to bring it in unless it is a repair situation. I just hope the material used for the mask is the same as my last ones.

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1 hour ago, Dustoff 11 said:

They need better adjustable fitting mask and offer veteran option of a longer hose instead of him finding out about this after the fact from other vets.  Last visit they said there was no need for me to even bring the machine with me as they can tell from there read outs if it is being used.  I have had trouble with two of their mask and may buy one for a better fit if I can find it.  As in many cases the VA never volunteers any additional info that might help the vet.  He has to learn a lot from other vets.

You are so correct. There were some nights when I awaken to find out that I rolled over and pulled the machine off the table beside my bed.

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1 hour ago, GBArmy said:

Dustoff 11 Last September I got 2 replacement masks after getting a hard time from them; seems usage is supposed to be minimum of 2 months per mask. I told the tech that the rubber wouldn't hold up and would tare after only 3 or 4  weeks. I used to use masking tape to patch them up so they wouldn't leak.This last 2 replacement masks are GREAT! They must have changed suppliers or something. As it so happens, I ordered and just receive some new equipment; new mask, harness and hose. And you are right about them collecting the data; they get it every morning digitally. We don't have to bring it in unless it is a repair situation. I just hope the material used for the mask is the same as my last ones.

They give me some cheap ResMed supplies. The stuff is utter crap. It works fine for about a month (aside from not fitting perfectly), but then the seals start going. Nothing like wearing a nasal pillow and having the seal joint leak and blow air all over you. Rotating the hose joint can sort of help, but after another month forget it. I just started sending them secure messages to let them know that the garbage they send me has began leaking again. And then the VA boasts online about having top quality medical care, but they don't let people know they use substandard medical supplies. 

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1 hour ago, GBArmy said:

Dustoff 11 Last September I got 2 replacement masks after getting a hard time from them; seems usage is supposed to be minimum of 2 months per mask

They tell me that I am supposed to get replacement masks only every six months. Oof...

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I asked for a longer hose pretty early and got it no problem. I do think the worse thing is getting the mask to fit properly and be comfortable. I was told that the type that just fits over your nose is the most comfortable, but I have to have the full face mask. I can't breath thru my nose very well. I must admit my tech has always been willing to help. Just like anything else at the VA: you either get a good one or a bozo. I think the majority are in the middle. Just don't be stupid and give them a hard time; what goes round comes around.

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I asked for a longer hose pretty early and got it no problem. I do think the worse thing is getting the mask to fit properly and be comfortable. I was told that the type that just fits over your nose is the most comfortable, but I have to have the full face mask. I can't breath thru my nose very well. I must admit my tech has always been willing to help. Just like anything else at the VA: you either get a good one or a bozo. I think the majority are in the middle. Just don't be stupid and give them a hard time; what goes round comes around.

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Vync I don't know now. I just checked what I got today and it is the same brand, ResMed. That was the same as before. I really hope they changed the manufacturing process on the seals. I won't know until I give them a try.

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I wish the VA would come up with something other than the C-PAP to use and get updated on modern medicine and its technologies.

I keep my c-pap clean and cleaning it a lot will cause things to start leaking  I guess it dries out and becomes brittle or something?  so I get out the old masking tape  eh! 

My supplier at my center is getting more and more hard for us to get new hoses mask ect,,ect,, a year or so ago it was fairly easy to go get replacement parts  but now they make it hard and ask well have you been cleaning it   if you don't keep it clean it will start leaking and causing problems  I said yeah whatever  normally they tell me they will have to order it and I wait a week or so before they let me know its in.

They make things now for OSA that is a lot better and safer /cleaner to use other than the Cpap  just things I read about and seen on TV ec,,,ect,,,I am going to check in on that.

 I agree with GB Army ,I am not one to reuse a C-PAP either  I think its just to many germs will spread and make things more complicated ...maybe that's their Ideal of killing us all off sooner than later  eh!

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8 minutes ago, Buck52 said:

I wish the VA would come up with something other than the C-PAP to use and get updated on modern medicine and its technologies.

 

 

 

 

Buck52 OSA is serious; it means you are stopping to breath. Not a good situation; I learned very early in life that breathing is a good thing. Unfortunately, many veterans and people in general can't stand wearing the mask and just quit wearing it. Several of my friend have done so. It is a hasel and it is uncomfortable. But having a heart attack or stroke is uncomfortable too because you stopped breathing. I'll bet you had a hard time getting used to it; I sure did. Still don't like it, but as the saying goes: it beats the alternative.IMO

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GB

I Totally agree OSA Is serious  for sure, for everyone that needs the c-pap

I am glad I got one  if not I'd more than likely be dead by now, it did take some time getting use to and make all the necessary adjustments  but its worth it.

.This new technologies they have out now VA is way behind   because they are making things that replace the Cpap machines and is 90% easier to use  now not sure the cost? but its supposed to be better to use wise and more cost effective over the long run,  but is supposed to be better for our OSA

I am just not sure what all they got out there now-days

I also think that every Veteran &their spouse should learn how to do CPR they can take a free class at their respected VAMC.

I hear you about the Strokes and Heart Attacks...my spouse had triple by pass in 2005, LUCKLY for us this was when the VA used the Citie program  not sure what its called?  but she had ChampVA and she could use the VAMC just like us veterans but they took her last  in the clinics,  they are the ones that did her heart surgery,  we lived about 89 miles from the VA  So after she spent about 3 weeks in the VA HOSPITAL   They discharge her and wanted us to come in every day for her reahab...it was just to far to drive that everyday  so the heart surgeon showed me how to clean her wound and redress it  so i did this for another 3 months until the wound closed on its own....

 Anyway  even if we use a c-pap or know of someone that does  its good to know CPR

I believe that above about some Veterans do not use there C-pap because their OSA is not as bad as they claim  and more than likely just got the c-pap to up their compensation , its unfortunate  but they are Veterans out there that  do this (jmo)  I don't know of any that do  but that is a pretty high figure don't you think>?

 VA diagnose me for sleep apnea as mild ,because I take so many medication that cause me to stop breathing while sleeping , so I use mine every night but I am not service connected  for it  I may can get it service connected secondary to my PTSD  but I am ok with what I get on my compensation.

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My C-pap is also a Res Med  but it seems ok to me. 

its the parts that go bad like the hose  the mask the tubes  ect,,ect,,

A Little trick I figured out   clean your hose with mouthwash/rinse and hang to dry  and when you refill the water tank make sure you use distilled water only   there's a difference in using drinking water or purified water .

  Distilled water is the best to use   anyway getting back to my trick  I put about two/three ice cubs in my tank   these ICE cubes I make from the distilled water from pop cycles forms my grand kids use when they come over,  I just fill them up with the distilled water and freeze them and break them up into cubes and put them in my cpap water tank  it seems to make the air cooler and makes me sleepy.  this may or may not work for you  but ya might give it a try.

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2 hours ago, Buck52 said:

I keep my c-pap clean and cleaning it a lot will cause things to start leaking  I guess it dries out and becomes brittle or something?  so I get out the old masking tape  eh! 

Been there, done that. But I used teflon tape. It did a better job at getting into crevices and holding a seal.

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Buck52 and Vync Couple good tips for CPAP users from you. On cleaning, I use 3 steps: 1) really hot soapy  water and white vinegar. 2) rinse  ot to get the vinegar out but with hot soapy water again, then 3) rinse with tap water. Do that to the mask parts and hose and reservoir. Only use distilled water lick Buck said. You don't want those germs to get together and multiply because you didn't clean it well.

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3 hours ago, GBArmy said:

Buck52 and Vync Couple good tips for CPAP users from you. On cleaning, I use 3 steps: 1) really hot soapy  water and white vinegar. 2) rinse  ot to get the vinegar out but with hot soapy water again, then 3) rinse with tap water. Do that to the mask parts and hose and reservoir. Only use distilled water lick Buck said. You don't want those germs to get together and multiply because you didn't clean it well.

When I got the new Philips Dreamstation CPAP machine, they told me that the plastic water reservoir is rated for top shelf use in a dishwasher. I never cleaned it that way though. I just use dishwashing liquid and a soft sponge to clean everything.

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I would never accept a used C-PAP machine, I would raise hell with anyone who would listen. Besides not knowing if the previous user maintained it correctly, was it properly sanitized prior to giving out to someone else.

I hate my C-PAP machine but I also like breathing at night, I wake up a lot at night for the mask slipping or because of the way I am laying. My wife has told me several times to close my mouth at night (because of air blowing out) so I use a chin strap to help keep my mouth closed. It is uncomfortable but need to use it.

Hopefully the VA does not go to re-using C-PAP machines.

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@paulstrgn Have you tried other types of face/nasal masks? I remember my full face mask would leak and make fart noises that woke up my wife.

I use a saline nasal rinse before bed. I figured out how to keep my mouth closed without using the chin strap. You know how you use your tongue when you are eating candy? Do the same thing. Just create a mild suction to keep your tongue to the roof of your mouth. That coupled with a night guard really helped me.

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@paulstrgn, see if you can get a new mask.  I had leaking problems before and got issued a new mask and headset that eliminated leaks where previously the CPAP was not working due to leaking.

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