First-time Attendees: Logistics

First-time Attendees: Logistics Thomas Cornwell, MD President, AAHCM AAHCM

Downstream Revenue: 2003-2013 HomeCare Physicians Referrals to CNS Home Health and Hospice Home Health Hospice Private Duty HCP Referrals 3,235 1,077 195 CNS Total 41,793 8,238 2051 Percent 7.80% 13% 9.50% CNS Home Health and Hospice is owned and operated by Cadence Health which also owns and operates HomeCare Physicians 2002-2013 47% of 4,633 Dr. Cornwell s certifications and recertifications for home health were with CNS. 53% were with 60 other home health agencies. In many of these cases the outside home health agency referred the patient to HCP.

Marketing: HomeCare Physician 2013 Referral Sources Source Referrals Percent Doctors 61 19% HHA 58 18% Hospital/Rehab 57 17% ALF 44 13% Group Homes 40 12% Word of Mouth 32 10% Other 34 10% Total 326 100% Note: These numbers are representative of a very mature program. New program referrals largely come from home health agencies (80%).

HomeCare Physicians Payer Mix 2013 Payer Source Number % Medicare Only 114 11% Medicare + Supplemental 669 65% Medicare + Medicaid 98 9% Medicare Advantage 29 3% Medicaid Only 24 2% Medicaid Manage Care 31 3% Insurance 57 5% Uninsured 9 1% HMO Only 6 1% Total 1037 100%

Medicare House Call Codes/Payments 1997 New 1997 1998 New (Min) 1998 2014 AHCCS 3 IDPA 2 99341 $62.51 99341 (20) $57.53 $58.99 $43.91 $27.95 99342 $77.71 99342 (30) $77.58 $85.34 $63.29 $37.40 99343 $101.62 99343 (45) $110.19 $139.16 $103.94 $54.90 99344 1 (60) $140.50 $193.94 $144.46 $70.55 99345 1 (75) $166.24 $233.70 $174.02 $85.55 1997 Estab. 1997 1998 Est. (Min) 1998 2014 AHCCS 3 IDPA 2 99351 $46.66 99347 (15) $45.43 $59.39 $44.18 $24.25 99352 $59.37 99348 (25) $65.54 $89.64 $66.84 $31.30 99353 $74.80 99349 (40) $94.92 $135.18 101.33 $47.50 99350 1 (60) $136.00 $189.15 $140.87 $68.85 1 Additional 1998 higher level Medicare house call codes 2 IDPA: Illinois Department of Public Aide 3 Arizona Health Care Cost Containment System (Arizona Medicaid) Shaded payments are most frequently used house call codes Note: Medicare Payments vary by locality. These are for Locality 15. Place of Service Code for Home = 12

Domiciliary (Assisted Living) CPT Codes/ Payments 2005 New 2005 2006 New (Min) 2006 2014 AHCCS 3 IDPA 2 99321 $43.19 99324 (20) $62.80 $59.37 $44.18 $18.60 99322 $60.92 99325 (30) $91.76 $86.27 $63.83 $26.70 99323 $75.00 99326 (45) $132.71 $148.09 $110.51 $34.85 99327 1 (60) $174.47 $198.01 $147.50 $42.95 99328 1 (75) $215.85 $229.07 $171.29 $51.05 2005 Estab. 2005 2006 Estab. (Min) 2006 2014 AHCCS 3 IDPA 2 99331 $38.14 99334 (20) $48.73 $64.61 $48.03 $16.00 99332 $48.30 99335 (30) $76.88 $100.82 $75.09 $21.00 99333 $59.10 99336 (40) $118.22 $141.84 $106.58 $26.05 99337 1 (60) $173.63 $205.28 $152.75 $31.05 1 Additional 2006 higher level Medicare house call codes 2 IDPA: Illinois Department of Public Aide 3 Arizona Health Care Cost Containment System (Arizona Medicaid) Shaded payments are most frequently used house call codes Note: Medicare Payments vary by locality. These are for Locality 15. Place of service code = 13

Care Plan Oversight (CPO) and Home Health Certification / Re-certification Payments Medicare Reimbursement IDPA 3 Total # Total # Total # Total # 1997 2001 2014 2010 2011 2012 2013 CPO HH G0181 1 $78.73 $127.30 $114.16 $0 89 82 63 20 CPO Hospice G0182 1 $78.73 $140.79 $114.92 $0 48 59 54 42 HH Cert G0180 2 $77.50 $56.61 $0 323 371 383 345 HH Re-cert G0179 2 $65.35 $43.78 $0 379 405 371 408 1 In 2001 CPT codes 99375 and 99378 changed to G0181 and G0182 respectively 2 Medicare began paying for certification and re-certification of home health in 2001 3 IDPA: Illinois Department of Public Aide Note: Medicare payments vary by locality. These payments are for locality 15.

House Call Program Logistics: Billing other commonly billed procedures CPT Procedure Medicare $ 1 11042 Debride: Subcutaneous $67.93 11043 Debride: Muscle $256.69 11721 Toenail Debridement $48.14 17250 Dest. granulation tissue (AgNO3) $88.97 29580 Unna Boot $58.62 43760 Change G-tube $571.65 69210 Cerumen Removal $57.43 93000 EKG $19.85 93040 Rhythm Strip $14.42 1 Medicare Payments vary by locality. These are for Locality 15 for 2014.

HCP Patient Satisfaction FY13 N=200 % Excellents Level of support provided your family and/or caregiver 82% Provider spending adequate time and not seeming rushed 84% Provider s level of courtesy and friendliness 91% Provider s explanation of medical condition and treatment 83% Provider s level of compassion 85% Ability to obtain a timely house call for an urgent problem 82% Staffs level of courtesy and caring with the office is called 89% Overall quality of care provided by HomeCare Physicians 88%* Likert Scale: Poor, Fair, Good, Very Good, Excellent * Other responses: Very good 9%; Good 3%; Fair 0%; Poor 0%

HCP Patient Satisfaction FY12 N=152, FY12 N=152 Respondents were asked in the past 12 months: Yes No Uncertain FY13 FY12 FY13 FY12 FY13 FY12 1. HCP s services have reduced my trips to the Emergency Room: 82% 85% 13% 9% 5% 6% 2. HCP s services have helped me avoid hospitalizations: 80% 87% 15% 10% 5% 3% 3. HCP s services have helped me avoid being placed into a nursing home: 80% 84% 10% 11% 10% 5%

5/14/09 2/18/11 (1 year, 9 months (645 days)) 44 Emergency Department Visits (avg 16 days between visits) 27 Hospitalizations over half required ICU days (avg 25 days between stays) HCP First Visit 3/2/11 (365 Days) 1 ED visit + 1 Hospitalization (May 2011) Expected: 25 ED visits, 15 Hospitalizations Following Year: 0 ED, 0 Hospitalizations

1/1/12-12/5/12 17 Emergency Department (ED) Visits 13 Hospitalizations (69 Days) Multiple rehab stays HCP First Visit 12/5/12 1 ED Visit/1 Hospitalization 12/18/12 (4 days) 0 ED Visits/0 Hospitalizations in 2013 Passed away at home 7/22/13 on hospice

Cost of End of Life Care 25.1% of the $556 billion Medicare dollars goes to care in last year of life Riley, Lubitz; Health Services Research 4/2010 From 2000 to 2009 deaths increased at home 30.7% to 33.5% and decreased at hospitals from 32.6% to 24.6%, use of hospice increased from 21.6% to 42.2% ICU stays in last month increased from 24.3% to 29.2% Hospitalizations in last 3 months of life increased from 62.8% in 2005 to 69.3% in 2009 Short hospice stays (<3 days) increased 22.2% to 28.4% (40.3% were preceded by hospitalization with ICU stay) Teno; Change in End of Life Care for Medcare Beneficiaries JAMA 2/2013

End-of-Life Care HomeCare Physicians Patient Deaths 2003-2013 Number Percentage Total 2049 100% Home 1,521 74% Hospital 389 19% Nursing Home 102 5% Unknown 37 2%

HomeCare Physicians and End-of-Life Care 9/1/12-8/31/13 215 deaths 79% died at home 71% where on hospice Average length of stay 2.1 years Median length of stay 0.56 years 25 died in first 30 days 23 (92%) died at home 2003-2012: 898 referrals to health system owned CNS hospice 36% died in the first two weeks of service vs. >50% nationally HCP works with an additional six hospices Decreased hospital mortality: of 2,049 deaths over past 13 years 74% at home vs 33.5% nationally. This is additional 835 deaths at home over 13 years = 64 deaths per year = 5.4 deaths per month.

High-Cost Medicare Beneficiary Spending Top Quartile Second Quartile Bottom Half Medicare Spending % of Total Mean 85% $24,800 11% $3,290 4% $550 Total 100% $7,310 Medicare Spending % of Total Mean Top 5% 43.1% $63,030 Top 6-10% 18.4% $26,900 Top 11-25% 23.5% $11,430 Source: Congressional Budget Office based on data from the Centers for Medicare and Medicaid Services. Note: Spending reported in 2005 dollars

Average Traditional Medicare per capita Spending, 2009 $60,000 $55,763 $50,000 $40,000 $30,000 $20,000 $10,000 $4,584 $9,702 $- Bottom 90% Top 10% Average Source: The Kaiser Foundation

Costs of Care Before vs During HBPC for 2002 (per patient per year) *includes HBPC cost N=11,334 $103,048,728 Total Cost of VA Care Before HBPC During HBPC Change $38,228 $29,136* -$9,092 (- 24%) P < 0.0001 Hospital $18,868 $7026 $11,842 (- 63%) Nursing home $10,382 $1382 $9000 (- 87%) Outpatient $6490 $7140 $650 (+ 10%) All home care $2488 $13,588* $11,100 (+ 460%)

Patient Assistance 1997-1999: Central DuPage Auxiliary donates $30,000 to patient assistance 4/00: HCP receives a $15,000 grant from DuPage County for the Patient Assistance Fund 2001 HCP receives a $300,000 estate gift to permanently endow the patient assistance fund

HomeCare Physicians Public Relations Sun Times Front Page Tribune (6) Daily Herald (11) Local Newspapers (35) Medical Publications (21) TIME Magazine, UIC Magazine (cover) Television: PBS Healthweek, WGN News, local CBS, NBC, ABC News; 1998/1999 contacted by NBC Dateline; 2002 & 2009 contacted by Oprah Winfrey s producer