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Results for June 2016

Sleep Market Panel

©ResMed 2016 I 2

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

Notes:

©ResMed 2016 I

Panel Member Profile, June 2016

o In June, a total of 153 labs from 37 states submitted their data (6 are new panel

members)

2% 2% 1% 2% 2% 1% 1% 2% 1% 2% 1% 1%

53% 45% 55% 53% 53%

52% 56% 53%

47% 50% 49% 55%

44% 50%

42% 43% 43% 47% 43% 44%

52% 47% 43% 42%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

July Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

Sleep Lab Business Model Trend

Independent/Stand AloneAffiliated with Hospital/Medical Group - Hospital BasedAffiliated with Hospital/Medical Group - Managed by outside entityAffiliated with Hospital/Medical Group - Physcian Free-Standing

Note: No representation from Alaska or Hawaii

June 2016 Data Collected from 37 States

State Represented in June

Not Represented

3

©ResMed 2016 I

Panel Member Profile, June 2016

o Lab sizes ranged from 1–15

beds, with an overall average

of 4.4 beds and a median of

4 beds

o In June, 13% of labs

dispense therapeutic sleep

apnea equipment to patients

o The percentage of labs

dispensing sleep equipment

averaged 17% in the last 12

months Jul'15 - Jun'16

0

2

4

6

8

10

12

14

16

88% of sleep labs have ≤ 6 beds

Nu

mb

er B

ed

s p

er

Sle

ep

Lab

Distribution of Beds per Sleep Lab

14% 16%

13% 15% 16%

21%

15%

22% 19%

21%

15% 13%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

Percent of Sleep Labs Dispensing Sleep Apnea Equipment

4

©ResMed 2016 I

Sleep Labs Planning to Add Beds Next Month

o 3.9% of total labs planned to add

more beds to their facility in June

o The percentage of total labs

planning to add beds in the next

month averaged 2% in the last

12 months Jul'15 - Jun'16

3%

2% 2%

0%

3%

2%

1%

2%

0% 0%

1% 1% 1%

4%

7%

5%

4%

2%

0% 0%

2%

0%

3%

9%

2% 3%

3%

2%

3%

2%

1% 1%

1% 0%

2%

4%

-2%

0%

2%

4%

6%

8%

10%

12%

Sleep Labs Adding Beds Next Month By Business Model

Hospital Labs Inpedendent Labs All Labs

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May June

5

©ResMed 2016 I

Split-Night Studies and Auto-scoring

o In June, 20% of overnight tests

were conducted as split-night

studies

o The percent of split-night

studies conducted over the last


averaged 22%

o In June, 18% of labs reported

using Auto-scoring or

Computer Assisted Scoring

o The percent of labs using Auto-

scoring over the last 12 months

Jul'15 - Jun'16 averaged 14%

14% 11%

14% 15% 11%

13% 15% 15%

12% 16% 16%

18%

0%

5%

10%

15%

20%

25%

30%

35%

40%


Percent of Sleep Labs Utilizing Auto-scoring Software

23% 24% 24% 21% 20% 20%

23% 23% 21% 22% 23%

20%

0%

5%

10%

15%

20%

25%

30%

35%

40%


Overnight Tests Conducted as Split-Night Studies

6

©ResMed 2016 I

Volume of In-lab Overnight Sleep Testing Per Bed

o In June, labs conducted an

average of 14.5 in-lab

overnight tests per bed, with a

range of 1-34

o The number of tests

conducted per bed in the last


averaged 15

0

5

10

15

20

25

30

35Distribution of # Overnight Studies per Bed

Average tests per bed = 14.5

# St

ud

ies

pe

r B

ed

15 14 14

15 14

15 13 13

14 14 15 15

0

5

10

15

20


Average Monthly In-Lab Tests Per Bed #

Stu

die

s p

er

Bed

7

©ResMed 2016 I

Home Sleep Testing (HST)

78%

66% 69%

75%

67%

76% 76% 78%

71%

78% 75%

78%

40%

45%

50%

55%

60%

65%

70%

75%

80%

85%

90%


Sleep Labs Conducting Home Sleep Testing o In June, 78% 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

averaged 74% in the last 12

months

o In June, Home Sleep Testing

was 14.3% of the total testing

volume

13% 13% 14% 14% 14% 15% 15% 16% 15% 15% 15% 14%

0%2%4%6%8%

10%12%14%16%18%20%22%24%26%


HST as a Percentage of Total Test Volume

8

©ResMed 2016 I

Average Monthly Testing Volume Conducted Per Lab

(In-Lab + HST): By Business Model

88

69

79

89

68

74 72 73 68

71

83

72

97 93 93

97 100

95

87 88

97 92 90 88 93

78

84

93

78 81

78 78 78 80 86

78

20

30

40

50

60

70

80

90

100

110

120


# o

f To

tal S

leep

Tes

ts

Total Volume of Sleep Tests Conducted Hospital Labs vs. Independent Labs

Hospital Lab Independent Lab All Sleep Labs

o In June, the average number of

total sleep tests were: – Hospital Labs: 72

– Independent Labs: 88

– All Labs: 78

o The number of tests conducted

per lab in the last 12 months

Jul'15 - Jun'16 averaged: – Hospital Labs: 76

– Independent Labs: 93

– All Labs: 82

9

©ResMed 2016 I

Average Monthly Testing Volume Conducted Per Lab

(In-Lab + HST): HST vs. Non-HST Labs

105 101

104 107

94 92 90 89

94 91

101

88

54

33

40

50

42

47 41 42 41

45 44 48

93

78

84

93

78 81

78 78 78 80 86

78

20

30

40

50

60

70

80

90

100

110

120


# o

f To

tal S

leep

Tes

ts

Total Volume of Sleep Tests Conducted Labs Conducting HST vs. Non- HST Labs

HST Labs Non-HST Labs All Sleep Labs


total sleep tests were: – HST Labs: 88

– Non-HST Labs: 48

– All Labs: 78



Jul'15 - Jun'16 averaged: – HST Labs: 96

– Non-HST Labs: 44

– All Labs: 82

10

©ResMed 2016 I

Average Monthly Volume of In-Lab Tests vs. HSTs Conducted Per

Lab

80

68 72

79

67 69 66 66 67 68

73

67

13

10

12

13

11 12

12 12 11 12

13

11

0

10

20

30

40

50

60

70

80

90

100


# o

f Sl

eep

Tes

ts b

y Te

st M

eth

od

Total Volume of Sleep Tests Conducted

HST

In-Lab


sleep tests per lab by test

method: – In-Lab: 67

– HST: 11



Jul'15 - Jun'16 averaged: – In-Lab: 70

– HST: 12

11

©ResMed 2016 I

Volume of In-lab Sleep Tests Conducted Per Lab

80

68

72

79

67 69

66 66 67 68

73 67

66

49

60 64

50

56

49 48 50 51 55 53

10

20

30

40

50

60

70

80

90

100


# o

f O

vern

igh

t Sl

eep

Tes

ts P

lus

HST

Volume of In-Lab Testing Per Lab

Mean

Median

o In June, the number of sleep

In-lab tests per lab: • Mean: 67

• Median: 53

• Range: 2-250

o The average number of tests

conducted per lab in the last 12

months Jul'15 - Jun'16 was 70

12

©ResMed 2016 I

Volume of Home Sleep Testing

17 16

17 18

16 16 16 16 16

16

17

15

9 9 9

11

8 8 9 9 9

8

11 11

2

4

6

8

10

12

14

16

18

20


Avg

. # o

f H

om

e Sl

eep

Tes

ts C

on

du

cted

Volume of Home Sleep Testing Per Lab

Mean

Median

o Among those conducting

home testing in June, the

number of sleep tests

conducted per lab: • Mean: 15

• Median: 11

• Range: 1-93

o The average monthly number

of home tests conducted per

lab in the last 12 months,

Jul'15 - Jun'16 was 16

Range of Home Sleep Studies Conducted Per Lab


1-80 1-101 1-110 1-155 1-110 1-149 1-157 1-153 1-106 1-129 1-186 1-93

Base: Labs conducting HST

13

©ResMed 2016 I 14

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

o In June, cancellations per lab

averaged 9, with a range of 0-97 per

lab

o Cancellations per bed averaged 1.9

with a range of 0-16 per bed

o Cancellations as a percentage of

studies conducted averaged 14%,

with a range of 0%-89%

Volume of Patient Cancellations

Distribution of Cancellations as % of Total Tests Conducted

Can

cella

tio

ns

as %

of

Tota

l Te

sts

Co

nd

uct

ed

“Cancellation” is defined as an appointment

that is dropped and not rescheduled.

Average cancellations as a

percentage of studies = 14%

©ResMed 2016 I

PAP Device Scripting

o In June, 45% of sleep studies resulted in

a script for a PAP device

58.1%

29.9%

12.0%

PAP Device Scripting Split

CPAP APAP Bilevel

15

©ResMed 2016 I

Billing

o In June, 54% of sleep studies

were billed to private health

insurance and 31% were billed to

Medicare (traditional and/or

managed)

o 39% of labs reported tracking

insurance pre-authorizations

• Among those labs, an

average of 61% of studies

required pre-authorization,

with a range of 1-100%

50% 51% 51% 53% 53% 56%

47% 51% 54% 50% 53% 54%

33% 32% 33% 32% 28%

28%

35% 33% 30% 33%

33% 31%

16% 15% 14% 14% 18% 15% 16% 15% 15% 15% 13% 15%

1% 2% 2% 1% 1% 1% 1% 1% 1% 1% 2% 0%

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Billing Split Private insurance Medicare Medicaid Out of pocket

©ResMed 2016 I 17

oMonthly 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”

Month-to-Month Trending

Jun- Jul

Jul- Aug

Aug- Sep

Sep- Oct

Oct- Nov

Nov- Dec

Dec- Jan

Jan- Feb

Feb- Mar

Mar- Apr

Apr- May

May- Jun

Number of Repeat Panel Members

142 111 126 133 117 128 130 129 144 140 125 124

©ResMed 2016 I

Month-to-Month Changes in Volume of In-lab Overnight Sleep Testing

4% 0%

-2%

5%

-5%

7%

-13%

8% 7%

0% 3%

1%

-50%

-40%

-30%

-20%

-10%

0%

10%

20%

30%

40%

50%

Volume of In-Lab Sleep Testing Month-to-Month % Change

% M

on

th-t

o-M

on

th C

han

ge

o For repeat panel members,

the volume of in-lab sleep

tests increased 1% from

May'16 - Jun'16

o There was a 1% increase

in monthly testing volume

over the last 12 months,

Jul'15 - Jun'16

18

Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

©ResMed 2016 I

Month-to-Month Changes in Volume of Home Sleep Testing

-1% -1%

6% 4% 0%

16%

-10%

6% 4%

-5%

5% 5%

-50%

-40%

-30%

-20%

-10%

0%

10%

20%

30%

40%

50%

Volume of Home Sleep Testing Month-to-Month % Change

% M

on

th-t

o-M

on

th C

han

ge

o For repeat panel members,

there was an increase of

5% in Home Sleep Testing

volumes from

May'16 - Jun'16

o On average, there was a

2% increase in monthly

testing volume over the last

12 months, Jul'15 - Jun'16

19


©ResMed 2016 I

Month-to-Month Changes in Volume of Patient Cancellations

-2% -1% -4%

-16%

10%

3%

-7%

0%

-10% -5%

1% 4%

-50%

-40%

-30%

-20%

-10%

0%

10%

20%

30%

40%

50%

Volume of Patient Cancellations Month-to-Month % Change

% M

on

th-t

o-M

on

th C

han

ge

o For repeat panel

members, there was a 4%

increase in the number of

cancellations from

May'16 - Jun'16

o There was a 2% decrease

in cancellations on

average in the last 12

months, Jul'15 - Jun'16

20


©ResMed 2016 I

Month to Month Change in % of Sleep Studies Resulting in Scripts

-5% -3% -1%

0%

-1%

0% 0% 0% 2% 0% 1%

-2%

-50%

-40%

-30%

-20%

-10%

0%

10%

20%

30%

40%

50%

Month to Month Change in % of Sleep Studies Resulting in Scripts

% M

on

th-t

o-M

on

th C

han

ge

o For repeat panel

members, there was a

2% decrease in the

percent of sleep studies

resulting in scripts from

May'16 - Jun'16

o On average, there was a

1% decrease in number

of studies resulting in

scripts in the last 12

months, Jul'15 - Jun'16

21


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