Empowering Physicians to Treat Sleep Apnea

1. The MD Home Sleep Program Empowering Physicians to Treat Sleep Apnea Presented by Dr. Avi Ishaaya, MD Medical Director

2. Overview • Background: OSA • Prevalence of Sleep Apnea • Consequences & Comorbidities • Program Goals • How MDHSP Works • A Brief Overview • Billing & Financials • Closing • Physician’s Responsibilities • MDHSP Achievements • Free Tools & Resources • Where To Go From Here • Q&A

3. Obstructive Sleep Apnea & the MD Home Sleep Program

4. The Prevalence of Sleep Apnea • At least 1 in 5 Americans has mild OSA and 1 in 15 has moderate-to-severe OSA (Young et al. 2007). • It is the second most common sleep disorder (Lettieri 2009). • About 9% of middle-aged women and 24% of middle-aged men are affected (Young et al. 1993). • OSA remains undiagnosed in approximately 92% of affected women and 80% of affected men (Young et al. 1997).

5. The Severity of Untreated Sleep Apnea • Recurrent arousals disrupt sleep, resulting in chronic sleepiness, poor concentration, mood disturbance, loss of motivation • Low levels of oxygen place stress on the heart, leading to heart failure, hypertension, and stroke • Metabolic changes can influence insulin and trigger obesity • Loud snoring creates marital discord • Apneas can be fatal in and of themselves • Diminished alertness raises risk of repeated vehicular accidents by a factor of 6

6. Comorbidities Associated with OSA The US Department of Health and Human Services, in cooperation with other federal agencies launched the HealthyPeope.gov initiative whose #1 sleep objective is to “Increase the proportion of persons with symptoms of obstructive sleep apnea who seek medical evaluation.”

7. The MD Home Sleep Program’s Goals • Empower physicians from all specialties to feel confident in diagnosing and treating sleep apnea. • Streamline the process as much as possible by • Avoiding expense, discomfort, and inconvenience of lab testing by using home sleep tests; • Using technology to simplify diagnosis and treatment; • Absorbing logistical responsibilities so physicians can focus on medicine while earning revenue.

8. How MDHSP Works

9. How MDHSP Works    HST • Physician screens patients using screening tools • Physician prescribes a home sleep test (HST) online • Aviisha coordinates shipping with Patient, administers and scores the test     AutoCPAP • Physician receives quarterly treatment compliance reports prepared by Aviisha • Physician prescribes AutoCPAP online • Physician receives HST Scoring Report with test results

10. How MDHSP Works •  Physician Screens Patient How are you sleeping? • Patient completes Medical Information form when entering clinic • Patient completes HST Lease Agreement before leaving clinic • Physician reviews form (screening tool) and inquires about sleep

11. How MDHSP Works • Physician Screens Patient (continued) Screening tools provided: • Patient Medical Information form • Given to patients to complete at clinic • Incorporates Epworth Sleepiness Scale • Score ≥10 indicates excessive daytime sleepiness and requires testing • Even scores below 10 can require testing if other symptoms are present • Universally recognized by medical professionals and insurance companies • Incorporates Berlin Questionnaire (comes with quick scoring key) • OSA Symptoms Guide • Simple checklist of symptoms

12. How MDHSP Works  Physician Orders a Home Sleep Test HST • Physician prescribes Home Sleep Test online • Clinic completes order information online • Clinic submits Medical Information form and signed Lease Agreement

13. How MDHSP Works Aviisha Administers Home Sleep Test Philips Alice PDx Portable Monitoring Device • Aviisha ships the patient the HST, administers, and scores it • Aviisha follows up with a phone call to patient when device is received • Device comes with Step-by-Step Instructional Guide • 21 channels measuring airflow, breathing effort, heart rate, SpO2, body position • Meets standards of Type II, III and IV diagnostics • “Good Study Indicator” help track success of study • Aviisha available for customer support 8:30- midnight PST

14. How MDHSP Works Physician Receives HST Scoring Report The Home Sleep Test Scoring Report • Aviisha scores and interprets the test and emails the physician a report • Report has diagnosis and recommendations from sleep-boarded physician • Narrative portion • Demographics, Procedure, Definitions • Indications (symptoms, BMI) • Conclusions (key study conclusions) • Recommendations (confirmed by board-certified sleep physician) • Technical portion • Respiratory Events, Snoring, Heart Rate, Oximetry • Body-Position Summary (may indicate positional apnea) • Hypnogram

15. How MDHSP Works  Physician Prescribes APAP System One REMstar AutoCPAP Machine with A-Flex • Sent directly to patient with instructional setup video and modem • Aviisha follows up with telephone call when device received • Modem hooks up to Aviisha compliance system • APAP can record data on SD card for patients without internet access • PAP therapy is the “Gold Standard” in treating OSA • APAP reduces unnecessary air pressure by up to 40% compared to CPAP • No titration needed

16. How MDHSP Works Treatment Compliance Reports Aviisha’s Compliance Management System • APAP connects to Aviisha compliance system via modem • APAP records data on SD card in case modem unavailable • Aviisha manages treatment compliance and generates progress reports • Progress reports shared with MD • MD bills for compliance calls

17. Physician’s Duties • Screen patients using screening tools • Prescribe HST • Send Aviisha Patient Medical Information form and signed HST Lease Agreement (Clinic duty) • Review report and prescribe APAP if needed

18. Billing & FinancialsPatients Accepted, Reimbursement

19. Patients Accepted • Out-of-network (preferred) • Cash patients • In-network • Medicare (HST only) MDHSP is available for all patients Billing options: Physicians can bill on their own or have Aviisha bill for them.

20. Reimbursement Amount depends on whether physicians bill on their own or elect Aviisha to bill for them (for out-of-network only)

21. Closing

22. Free Tools & Resources • Contact Information Webinars Screening Tools • Epworth Sleepiness Scale (Key) • Berlin Questionnaire (Key) • OSA Symptoms Guide • OSA Risk Factors • OSA Education webinars every month • Presented by Dr. Avi Ishaaya, MD • http://www.aviisha.com/mdhsp/webinars.php • 877-634-7748 • mdhsp@aviisha.com • Learn more: www.aviisha.com/mdhsp

23. MDHSP Achievements MDHSP has already signed up over 600 physicians and has about 3,500 in progress. MDHSP physicians have reached an 85% conversion ratio from home sleep test to positive diagnosis using our screening tools. Our current treatment compliance rate is over 74%, almost twice the industry average.

24. Where To Go From Here Contact Aviisha or Merritt Hawkins to sign up. There is no fee to join or participate, and there are no obligations at any point in time. • Taylor Bonham • 469-524-1462 • taylor.bonham@merritthawkins.com • 877-634-7748 • mdhsp@aviisha.com • Learn more: www.aviisha.com/mdhsp