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

2. Aviisha Medical Institute, LLC | www.aviisha.com 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. Aviisha Medical Institute, LLC | www.aviisha.com Obstructive Sleep Apnea & the MD Home Sleep Program

4. Aviisha Medical Institute, LLC | www.aviisha.com 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. Aviisha Medical Institute, LLC | www.aviisha.com 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. Aviisha Medical Institute, LLC | www.aviisha.com 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. Aviisha Medical Institute, LLC | www.aviisha.com The MD Home Sleep Program’s Goals 1. Empower physicians from all specialties to feel confident in diagnosing and treating sleep apnea. 2. 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. Aviisha Medical Institute, LLC | www.aviisha.com How MDHSP Works

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

10. Aviisha Medical Institute, LLC | www.aviisha.com How MDHSP Works  Physician Screens Patient Patient completes Medical Information form when entering clinic Physician reviews form (screening tool) and inquires about sleep How are you sleeping? Patient completes HST Lease Agreement before leaving clinic

11. Aviisha Medical Institute, LLC | www.aviisha.com How MDHSP Works Screening tools provided: 1. 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) 2. OSA Symptoms Guide Simple checklist of symptoms  Physician Screens Patient (continued)

12. Aviisha Medical Institute, LLC | www.aviisha.com  Physician Orders a Home Sleep Test How MDHSP Works Clinic completes order information online Clinic submits Medical Information form and signed Lease Agreement Physician prescribes Home Sleep Test online HST

13. Aviisha Medical Institute, LLC | www.aviisha.com  Aviisha Administers Home Sleep Test How MDHSP Works 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, SpO 2, 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. Aviisha Medical Institute, LLC | www.aviisha.com  Physician Receives HST Scoring Report How MDHSP Works 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. Aviisha Medical Institute, LLC | www.aviisha.com  Physician Prescribes APAP How MDHSP Works 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 System One REMstar AutoCPAP Machine with A-Flex

16. Aviisha Medical Institute, LLC | www.aviisha.com  Treatment Compliance Reports How MDHSP Works 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 Aviisha’s Compliance Management System

17. Aviisha Medical Institute, LLC | www.aviisha.com Physician’s Duties 1. Screen patients using screening tools 2. Prescribe HST 3. Send Aviisha Patient Medical Information form and signed HST Lease Agreement (Clinic duty) 4. Review report and prescribe APAP if needed

18. Aviisha Medical Institute, LLC | www.aviisha.com Billing & Financials Patients Accepted, Reimbursement

19. Aviisha Medical Institute, LLC | www.aviisha.com 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. Billing options: Physicians can bill on their own or have Aviisha bill for them.

20. Aviisha Medical Institute, LLC | www.aviisha.com Reimbursement Amount depends on whether physicians bill on their own or elect Aviisha to bill for them (for out-of-network only) Aviisha-BillSelf-Bill For Home Sleep TestMD paid $200 MD pays Aviisha’s fee and keeps remainder of reimbursement For AutoCPAPMD paid $500 MD pays Aviisha’s fee and keeps remainder of reimbursement Medicare (HST only)N/A About $135 directly from Medicare

21. Aviisha Medical Institute, LLC | www.aviisha.com Closing

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

23. Aviisha Medical Institute, LLC | www.aviisha.com 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. Aviisha Medical Institute, LLC | www.aviisha.com 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. 877-634-7748 mdhsp@aviisha.com Learn more: www.aviisha.com/mdhsp Taylor Bonham 469-524-1462 taylor.bonham@merritthawkins.com