Sleep Market Panel Results for June 2015
Notes: o This is a monthly trending report of panel member data along with additional analysis by: Sleep labs affiliated with Hospitals vs. Independent Labs o Hospital - Labs affiliated with hospitals o Independent - Labs that are stand alone entities Sleep labs conducting HSTs vs. Non-HST labs o HST - Labs reported conducting at least ONE home sleep test a month o Non-HST - Labs reported conducting NO home sleep tests 2
Panel Member Profile, June 2015 o In June, a total of 179 labs from 39 states submitted their data (6 are new panel members) June 2015 Data Collected from 39 States 10 9 Sleep Lab Business Model Trend 8 7 6 5 42% 38% 4 39% 45% 47% 48% 48% 51% 48% 4 45% 4 3 2 54% 52% 55% 56% 43% 49% 47% 47% 44% 49% 55% 51% State Represented in June Not Represented Note: No representation from Alaska or Hawaii 1 1 12% 4% 5% 5% 4% 5% 5% 3% 2% 2% 3% 1% July Aug Sep Oct Nov Dec Jan Feb Mar April May Jun Independent/Stand Alone Affiliated with Hospital/Medical Group - Hospital Based Affiliated with Hospital/Medical Group - Managed by outside entity Affiliated with Hospital/Medical Group - Physcian Free-Standing 3 Note: Tracking of Physician Free-Standing as a type of business model began Mar 2015.
Number Beds per Sleep Lab Panel Member Profile, June 2015 o Lab sizes ranged from 1 18 beds, with an overall average of 5 beds and a median of 4 beds o In June, 15% of labs dispense therapeutic sleep apnea equipment to patients o The percentage of labs dispensing sleep equipment averaged 19% in the last 12 months Jul'14 - Jun'15 20 18 16 14 12 10 8 6 4 2 0 4 35% 3 25% 2 15% 1 5% Distribution of Beds per Sleep Lab 83% of sleep labs have 6 beds Percent of Sleep Labs Dispensing Sleep Apnea Equipment 27% 27% 25% 22% 23% 19% 16% 15% 13% 13% 14% 15% 4
Sleep Labs Planning to Add Beds Next Month o 3% of total labs plan to add more beds to their facility in June 12% Sleep Labs Adding Beds Next Month By Business Model o The percentage of total labs planning to add beds in the next month averaged 3% in the last 12 months Jul'14 - Jun'15 1 8% 6% 4% 2% 9% 6% 4% 3% 1% 1% 2% 1% 6% 3% 2% 2% 2% 5% 4% 3% 3% 3% 2% 3% 2% 2% 1% 1% 1% 2% 6% 4% 3% 5% 3% 2% -2% Hospital Labs Inpedendent Labs All Labs 5
Split-Night Studies and Auto-scoring o In June, 22% of overnight tests were conducted as split-night studies o The percent of split-night studies conducted over the last 12 months Jul'14 - Jun'15 averaged 25% 4 35% 3 25% 2 15% 1 5% Overnight Tests Conducted as Split-Night Studies 28% 25% 26% 26% 27% 27% 24% 22% 23% 22% 21% 22% o In June, 18% of labs reported using Auto-scoring or Computer Assisted Scoring o The percent of labs using Autoscoring over the last 12 months Jul'14 - Jun'15 averaged 14% 4 35% 3 25% 2 15% 1 5% Percent of Sleep Labs Utilizing Auto-scoring Software 18% 18% 15% 13% 13% 13% 14% 13% 15% 13% 11% 1 6
# Studies per Bed # Studies per Bed Volume of In-lab Overnight Sleep Testing Per Bed 40 Distribution of # Overnight Studies per Bed o In June, labs conducted an average of 14.2 in-lab overnight tests per bed, with a range of 1-29 35 30 25 20 15 Average tests per bed = 14.2 10 5 0 o The number of tests conducted per bed in the last 12 months Jul'14 - Jun'15 averaged 14 20 15 10 5 Average Monthly In-Lab Tests Per Bed 16 14 14 15 15 14 14 14 14 13 13 14 0 7
Home Sleep Testing (HST) o In June, 77% of labs conducted portable, at-home sleep studies Among those conducting home testing, an average of 99% at-home studies were billed to insurance per month o The percentage of sleep labs conducting home sleep tests has been increasing, averaging 73% in the last 12 months o In June, Home Sleep Testing was 14.5% of the total testing volume 9 85% 8 75% 7 65% 6 55% 5 45% 4 2 18% 16% 14% 12% 1 8% 6% 4% 2% Sleep Labs Conducting Home Sleep Testing 83% 8 76% 77% 72% 74% 73% 73% 7 69% 69% 65% HST as a Percentage of Total Test Volume 15% 13% 12% 12% 12% 1 1 9% 1 1 1 9% 8
Average Monthly Testing Volume Conducted Per Lab (In-Lab + HST): By Business Model # of Total Sleep Tests o In June, the average number of total sleep tests were: Hospital Labs: 82 Independent Labs: 92 All Labs: 87 o The number of tests conducted per lab in the last 12 months Jul'14 - Jun'15 averaged: Hospital Labs: 80 Independent Labs: 83 All Labs: 81 120 110 100 90 80 70 60 50 40 30 89 85 79 82 79 Total Volume of Sleep Tests Conducted Hospital Labs vs. Independent Labs 83 80 82 78 93 92 90 70 74 78 81 83 79 85 80 81 87 74 80 75 75 76 85 84 83 79 72 67 92 87 82 20 Hospital Lab Independent Lab All Sleep Labs 9
# of Total Sleep Tests Average Monthly Testing Volume Conducted Per Lab (In-Lab + HST): HST vs. Non-HST Labs o In June, the average number of total sleep tests were: HST Labs: 99 Non-HST Labs: 48 All Labs: 87 o The number of tests conducted per lab in the last 12 months Jul'14 - Jun'15 averaged: HST Labs: 96 Non-HST Labs: 45 All Labs: 81 110 100 90 80 70 60 50 40 30 102 85 52 98 80 46 Total Volume of Sleep Tests Conducted Labs Conducting HST vs. Non- HST Labs 95 82 48 104 92 56 91 74 35 96 83 50 94 80 43 84 75 38 97 96 80 35 84 47 90 72 36 99 87 48 20 HST Labs Non-HST Labs All Sleep Labs 10
# of Sleep Tests by Test Method Average Monthly Volume of In-Lab Tests vs. HSTs Conducted Per Lab o In June, the average number of sleep tests per lab by test method: In-Lab: 74 HST: 13 100 90 80 9 Total Volume of Sleep Tests Conducted 9 7 9 8 10 8 10 83 7 10 10 13 o The number of tests conducted per lab in the last 12 months Jul'14 - Jun'15averaged: 70 60 50 40 76 73 73 66 76 72 65 71 74 62 74 HST In-Lab In-Lab: 72 30 HST: 9 20 10 0 11
# of Overnight Sleep Tests Plus HST Volume of In-lab Sleep Tests Conducted Per Lab o In June, the number of sleep In-lab tests per lab: 100 Volume of In-Lab Testing Per Lab Mean: 74 Median: 58 Range: 2-345 o The average number of tests conducted per lab in the last 12 months Jul'14 - Jun'15 was 72 (with a median of 73) 90 80 70 60 50 40 76 73 73 60 58 57 83 67 66 61 76 70 72 62 71 74 65 57 58 58 63 47 74 58 Mean Median 30 20 10 12
Avg. # of Home Sleep Tests Conducted Volume of Home Sleep Testing o Among those conducting home testing in June, the number of sleep tests conducted per lab: Mean: 17 Median: 10 Range: 1-100 o The average monthly number of home tests conducted per lab in the last 12 months, Jul'14 - Jun'15 was 12 Jul 18 16 14 12 10 8 6 4 2 Volume of Home Sleep Testing Per Lab 17 13 13 13 14 11 12 12 10 11 11 12 10 Mean 9 8 8 8 Median 6 6 6 6 6 6 6 Base: Labs conducting HST Range of Home Sleep Studies Conducted Per Lab Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 1-60 1-54 1-82 1-58 1-50 1-48 1-70 1-84 1-63 1-84 1-93 1-100 13
Cancellations as % of Total Tests Conducted Volume of Patient Cancellations o In June, cancellations per lab averaged 10, with a range of 0-68 per lab Distribution of Cancellations as % of Total Tests Conducted 12 o Cancellations per bed averaged 1.9 with a range of 0-13 per bed o Cancellations as a percentage of studies conducted averaged 14%, with a range of -10 10 8 6 4 Average cancellations as a percentage of studies = 14% 2 Cancellation is defined as an appointment that is dropped and not rescheduled. 14
PAP Device Scripting o In June, 46% of sleep studies resulted in a script for a PAP device PAP Device Scripting Split CPAP APAP Bilevel 10.9% 24.5% 64.6% 15
Billing o In June, 5 of sleep studies were billed to private health insurance and 33% were billed to Medicare (traditional and/or managed) 10 9 8 Billing Split Private insurance Medicare Medicaid Out of pocket 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 2% 12% 11% 12% 15% 16% 15% 15% 15% 15% 14% 13% 15% o 39% of labs reported tracking insurance pre-authorizations 7 6 31% 3 31% 28% 28% 28% 29% 28% 33% 34% 35% 33% Among those labs, an 5 average of 62%of studies required pre-authorization, 4 with a range of 1-10 3 56% 58% 56% 56% 55% 56% 55% 57% 51% 51% 51% 5 2 1
Month-to-Month Trending o Monthly comparisons (month-to-month percent change) can only be made using data from the exact same sleep labs. o In the slides that follow, we refer to sleep labs who provided their data for 2 months in a row as repeat panel members Number of Repeat Panel Members Jun- Jul Jul- Aug Aug- Sep Sep- Oct Oct- Nov Nov- Dec Dec- Jan Jan- Feb Feb- Mar Mar- Apr Apr- May May - June 126 140 130 117 131 147 146 144 137 126 137 135 17
% Month-to-Month Change Month-to-Month Changes in Volume of In-lab Overnight Sleep Testing o For repeat panel members, the volume of in-lab sleep tests decreased 1% from May'15-Jun'15 5 4 3 Volume of In-Lab Sleep Testing Month-to-Month % Change o There was an no change in monthly testing volume over the last 12 months Jul'14 - Jun'15 2 1-1 -2 7% 6% -1 6% -4% -7% 9% -1% -6% 3% -1% -3-4 -5 Jun- Jul- Aug Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- 18
% Month-to-Month Change Month-to-Month Changes in Volume of Home Sleep Testing o For repeat panel members, there was a 1% increase in Home Sleep Testing from May'15-Jun'15 5 4 3 Volume of Home Sleep Testing Month-to-Month % Change o On average, there was a 1% increase in monthly testing volume over the last 12 months Jul'14 - Jun'15 2 1-1 -3% 6% 4% 7% 9% -3% 3% 12% -1% 1% -2-16% -3-4 -5 Jun- Jul- Aug Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- 19
% Month-to-Month Change Month-to-Month Changes in Volume of Patient Cancellations o o For repeat panel members, there was a 1 decrease in the number of cancellations from May'15-Jun'15 There was no change in cancellations on average in the last 12 months, Jul'14 - Jun'15 5 4 3 2 1-1 -2 5% 6% Volume of Patient Cancellations Month-to-Month % Change -5% 8% -2% 7% 11% -15% -2% -1-3 -4-5 Jun- Jul- Aug Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- 20
% Month-to-Month Change Month to Month Change in % of Sleep Studies Resulting in Scripts o o For repeat panel members, there was a 3% increase in the percent of sleep studies resulting in scripts from May'15- Jun'15 On average, there was a 2% increase in number of studies resulting in scripts in the last 12 months, Jul'14 - Jun'15 5 4 3 2 1-1 -2-3 -4 Month to Month Change in % of Sleep Studies Resulting in Scripts 1% 2% -4% 6% -8% 9% 1% 9% -1% 2% 3% -5 Jun- Jul- Aug Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- 21
Month-to-Month Change Month-to-Month Change in PAP Device Scripting Split o For repeat panel members, the PAP scripting changed as follows from May'15-Jun'15: CPAP increased 2% APAP decreased 1% Bi-level decreased 1% 12% 11% 1 9% 8% 7% 6% 5% 4% 3% 2% 1% -1% -2% -3% -4% -5% -6% -7% -8% -9% -1-11% -12% Month-to-Month Change in PAP Scripting Split CPAP APAP Bilevel Jun- Jul- Aug Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- 22