Expanded Clinical Service Options for Physician Practices Allergy and Dermatology Services
Confidential Table of Contents
• Introduction to Skin and Allergy Centers of America (SACA) • Executive Team • Mission • Business Model Overview • Allergy Service Description and Business Model • Dermatology Service Description and Business Model • Summary and Next Steps • Discussion
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
2 Introduction to Skin and Allergy Centers of America (SACA)
• Richard C. Wright, Scott Sumrall, Abdul Ibrahim, Benjamin Hayes, PhD MD, Ryan Sullivan MD, TeamTeam Richard Becker MD, Phyllis Arnold • Seasoned healthcare professionals with complimentary skills in healthcare management
• Provides allergy and dermatology services in primary care practice settings • Delivers high quality, safe and effective allergy testing and immunotherapy Key Pillars • Delivers high quality, safe and effective primary dermatologic services
• Provide custom allergy services to physicians under the direction of a board certified allergist and clinical staff Allergy Services • Environmental, Food and Penicillin Testing, Scratch/Prick and Intradermal Testing • Immunotherapy: Subcutaneous and Sublingual • Spirometry
• Diagnosis and treatment of a broad range of dermatologic conditions under the direction of a board certified dermatologist and clinical staff Dermatology • Biopsy, excision and treatment of benign and premalignant and malignant skin lesions Services • Diagnosis and Treatment of chronic skin conditions • Cosmetic Skin treatments including chemical peels and Botox R
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
3 SACA Executive Team
RichardTeam C. Wright Scott Sumrall Abdul Ibrahim President Executive Vice President Executive Vice President
• 35+ years healthcare • Extensive experience in facilities • 35+ years of professional management and transaction development and outpatient experience in the diagnosis and experience services treatment of allergies and asthma • Highly recognized and • Co-founded Texscan MRI, which experienced acute and provided outpatient imaging • More than 10 years of clinical outpatientAllergy acquisitions services throughout Texas trials and study research in the specialistServices areas of allergy, asthma and • Regional Director of Imaging immune related diseases • Lead on UHS acute care Services for Image America transactions, development, • Director of Clinical Trials acquisitions, divestures and • Regional Sales Director for Department ENT & Allergy strategic planning Dermatology Dominion Diagnostics Specialists • AmericanServices Medicorp leadership • Internationally published and development for 8 years prior to UHS
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
4 SACA Executive Team
Ryan Sullivan, MD Richard Becker, MD Ben Hayes, MD PhD Medical Director Senior Advisor Senior Medical Advisor
• Fellowship in Allergy, Asthma • 25+ years of medical leadership • 20+ years of experience in and Immunology at the and clinical experience dermatology and University of Kansas dermatopathology • Former CEO of The George • Board certified by the American Washington University Hospital • Co-Founder of the Skin & Allergy Board of Internal Medicine as and The Brooklyn Hospital Center, a team based clinical well as the American Board of Center provider of dermatologic and Allergy and Immunology allergy care in Tennessee • Senior healthcare investment • Member of the American advisor to multiple private • Board certified in Dermatology Academy of Allergy, Asthma, equity firms and Dermatopathology and Immunology and of the American College of Allergy, • Board certified in • PhD in Pharmacology Asthma, and Immunology Anesthesiology and Critical Care & Immunotoxicology Medicine • Adjunct Clinical Instructor with Vanderbilt Dermatology Residency Program
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
5 Our Mission Create easy access to high quality allergy and dermatology services
Expand Access • Family Practice, Internal Medicine, Pediatrics, General ENT, Pulmonary Medicine to Allergy and • Multi-provider (5+ including NP’s and PA’s) independent practices Dermatology • Acute care hospitals and health care systems Services • Rural and Critical Access hospitals
• ASA provides complete, high quality allergy diagnostics and treatment services • Over 10,000 patients tested, 45,000 treatments administered and 1,200 active immunotherapy Allergy patients in 2016 Services • Excellent patient, physician and staff satisfaction with no reported adverse or symptomatic Impact reactions Allergy • Provides growth and additional revenue to physician practices, with added patient Services convenience
• Reduce skin disease burden and improve outcomes with more active diagnosis and treatment Dermatology of skin conditions • Improve dermatological access for current patient population with fewer outside referrals Services • Allow primary care providers to see more patients and increase current patient population Impact • Produce excellent patient, physician and staff satisfaction • Provide additional revenue to primary care practices
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
6 SAC A Business Model Overview Our turnkey process provides swift and seamless development of allergy and dermatology services within primary care settings
• Physicians complete a practice analysis form located on SACA website (www.asallc.net) • SACA develops provider proforma • Provider enters into Provider Services Agreement (PSA) with SACA Provider allocates space, certain equipment and supplies Initial Process • Allergy • Provider ensures internet and phone access and connectivity Services • ICD 10 analysis for allergy and dermatology related codes in existing practice • Provide SACA with EHR access
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
7 SACA Business Model Overview Consolidated Allergy and Dermatology Services Proforma*
A FEB ARCH APRI AY U E U Y AUGUST SEPT CT V DEC YEAR T TA REVE UE
Dermatology Revenue $53,546 $49,486 $55,576 $53,546 $55,576 $53,546 $53,546 $57,606 $49,486 $55,576 $51,516 $51,516 $640,522
Pathology Revenue $26,922 $24,358 $28,204 $26,922 $28,204 $26,922 $26,922 $29,486 $24,358 $28,204 $25,640 $15,110 $311,252
Allergy Revenue $20,423 $24,188 $35,068 $41,505 $49,134 $55,571 $62,593 $70,719 $73,320 $84,178 $90,030 $97,074 $704,327 Allergy Services T ta Reve ue $100,891 $98,032 $118,848 $121,973 $132,914 $136,039 $143,061 $157,811 $147,164 $167,958 $167,186 $163,700 $1,656,101
EXPE SE
SACA Expe ses & Fees $82,805 $82,805 $82,805 $82,805 $82,805 $82,805 $82,805 $82,805 $82,805 $82,805 $82,805 $82,805 $993,660
H SPITA ARGI $18,086 $15,227 $36,043 $39,168 $50,109 $53,234 $60,256 $75,006 $64,359 $85,153 $84,381 $80,895 $662,441
*Revenues and Expenses based upon projected targets based upon current knowledge of existing practice and is subject to revision during due diligence phase **SACA Expenses and Fees include Allergy & Dermatology Medical Directors, Nurse Practioner/Physician Assistants, Medical Technicians, Medical Supply, Travel, Training, Education, Furniture, Equipment, IT, Miscellaneous Operating Expenses and Corporate Overhead
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
8 SACA Allergy Services Business Model Overview Comprehensive lab commissioning process initiates safe and efficient delivery of allergy services
• Lab is commissioned under physician license, and SACA performs services under the physician’s license • Provider allocates space, certain equipment and supplies • SACA recruits and provides training to allergy technician and providers Commissioning the • SACA purchases antigens, medical supplies and minor equipment AllergyAllergy Lab Services • SACA provides policies, procedures and protocols to ensure safety, sanitation, sterilization and compliance • SACA delivers all process materials (blue sheets / symptom identification forms) for circulation to patients in advance of patient/provider encounter
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
9 SACA Allergy Services Business Model Overview We operate high quality allergy labs that precisely follow established, accepted national protocols
• Physician refers patient for allergy consultation • SACA trained allergy technician evaluates patient and performs appropriate testing • Clinical director reviews test results and develops specific treatment recommendations • Provider reviews and approves treatment recommendations • SACA’s allergy lab prepares customized immunotherapy treatment • After full patient consent obtained, allergy tech administers treatment as prescribed by Operating the physician AllergyAllergy Lab Services • Allergy tech performs all documentation and posts to SACA and physician practice EHR • SACA completes ”superbill” and transmits to physician practice business office for processing • Provider bills and collects for services rendered; SACA bills fee per procedure • Provider retains operating profit from delivery of allergy diagnostic and treatment services
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
10 SACA Allergy Services Clinical Approach Initial patient evaluation ensures proper identification of candidates for immunotherapy
• Provider performs an initial ENT evaluation, including review of systems • Provider refers appropriate patients for allergy consultations Thorough and • Allergy Technician performs Spirometry, Scratch/Prick Test and Intradermal Test Efficient Clinical Process • Clinical Director determines if patient is a candidate for immunotherapy and then prepares a prescription for physician approval Allergy • Compliant with AAAAI & ACAAI protocols Services
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
11 SACA Allergy Services Clinical Approach Symptom/Syndrome identification process is consistent with the highest practice standards
Patient History and Physical Examination ICD-10 search Review of Systems Form
Symptoms Conjunctivitis Common Asthma Symptoms
• Sneezing • Redness of the eye • Cough • Runny nose • Redness of the inner eyelid • Shortness of breath • Itchy nose • Increased amount of • Chest tightness tearing • Wheezing • Post nasal drip • Itchy eyes • Stuffy nose • Swelling of the eyelid
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
12 SACA Allergy Services Business Model Development Complete Medical Practice and Payor Analysis Ensures Success from the Beginning
Patie t Hist ry a d Physica Exa i ati •ReviewSACA utilizes f Syste s existing practice F r data to develop annualized projections for allergy services • SACA proforma analysis will include revenue, expense and profit projections based upon existing practice data
95004 95024 95165 94010 (Allergy Prick Test) (Intradermal (Immunotherapy 1 year) (Spirometry) Injection) BCBS AllergyUHC ServicesHumana Aetna Cigna Medicaid Medicare Other:
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
13 SACA Allergy Services Business Model Development Sample fee schedule illustrates typical procedure and treatment reimbursements
Common CPT Codes and SamplePhysica Reimbursements Exa i ati CPT Procedure Total Unit Total Payor Code Description Units Reimbursement Reimbursement
95004 Allergy Prick Test 40 $6.26 $250.40 95024 Intradermal 35 $7.25 $253.75 95165 Immunotherapy 1 year 300 $12.00 $3600.00 94010 Spirometry 1 $39.50 $39.50 95115 Injection single 1 $8.17 $8.17 95117 Injection (Multi) 1 $9.48 $9.48
• Sublingual Immunotherapy (SLIT) is typically $900/yr and is not typically reimbursed by payors. • SACA offers annual, semiannual and quarterly payment plans SLIT patient convenience
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
14 SACA Allergy Services Business Model Development Sample billing analysis—SACA provides constant oversite of billing and payor complexities*
CPT Code 95165 Billing Frequency Physica Exa i ati Insurance Max Billable Max Billable Number of Frequency of Units per Additional Instructions Provider Units Yr 1 Units Yrs 2-5 Claims per Yr Claims Claim Claim
AETNA 120 120 1 1 120 0 Bill 120 units x1 each year BCBS 300 300 10 1/Month 30 0 Up to 60 units every 2 months
CIGNA 120 120 1 1 120 0 2-5 yrs, 84 units 1 st month and 36 units next month HUMANA 300 300 1 1 300 0 100 units/month x 3 consecutive months MEDICARE 20 & 30 20-30 Clinics typically bill 30 units each month Monthly Allergy TRICARE Services300 300 3 1/Quarter 100/claim 0 100 units per quarter UHC 300 300 4 1/Month 75/claim 75 Bill 75 units/month x 4 months until 300 units reached MEDICAID 160 160 1 1 160/claim 0 Bill 160 units in 1 claim per year ALL OTHER 300 300 1 1 300 0 Bill 300 units in one claim ALL OTHER 300 300 1 1 300 0 Bill 300 units in one claim ALL OTHER 300 300 1 1 300 0 Bill 300 units in one claim ALL OTHER 300 300 1 1 300 0 Bill 300 units in one claim ALL OTHER 300 300 1 1 300 0 Bill 300 units in one claim
*Insurance schedules have changed to periodic billing each month as illustrated above
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
15 SACA Allergy Services Business Model Development Sample Practice Proforma demonstrates significant long term practice revenue enhancement*
REVE UE A FEB ARCH APRI AY U E U Y AUGUST SEPT CT V DEC T TA
CPT Code Days/Month Patie t21 Hist ry 19 a d 22 21 22 21 21 23 19 22 20 20 Physica Exa i ati 95004 Prick Test Review $4,956 f Syste s$4,484 $5,192 F r $4,956 $5,192 $4,956 $4,956 $5,428 $4,484 $5,192 $4,720 $4,720 $59,236 95024 Intradermal $6,048 $3,325 $6,336 $6,048 $6,336 $6,048 $6,048 $6,624 $3,325 $6,336 $5,760 $5,760 $67,994
95165 SCITS** $8,160 $14,720 $21,280 $27,840 $34,400 $40,960 $47,520 $54,080.00 $60,640 $67,200 $73,760 $80,320 $530,880
94010 Spirometry $735 $665 $770 $735 $735 $735 $735 $805 $665 $770 $700 $700 $8,785
95117 Muti Injection $260 $540 $826 $1,086 $1,385 $1,645 $1,918 $2,178 $2,438 $2,698 $2,958 $3,218 $21,150
95115 Single Injection $180 $378 $576 $756 $963 $1,143 $1,332 $1,512 $1,692 $1,872 $2,052 $2,232 $14,688
TOTAL REVENUE $20,339 $24,112 $34,980 $41,421 $49,046 $55,487 $62,509 $70,627 $73,244 $84,068 $89,950 $96,950 $702,733
EXPE SES A FEB ARCH APRI AY U E U Y AUGUST SEPT CT V DEC T TA Allergy 95004 Pric Test Services $3 990 $3 610 $4 180 $3 990 $4 180 $3 990 $3 990 $4 370 $3 610 $4 180 $3 800 $3 800 $47 690 95024 I trader a $3 675 $3 325 $3 850 $3 675 $3 850 $3 675 $3 675 $4 025 $3 325 $3 850 $3 500 $3 500 $43 925
95165 SCITS $3,672 $6,624 $9,576 $12,528 $15,480 $18,432 $21,384 $24,336 $27,288 $30,240 $33,192 $36,144 $238,896
94010 Spir etry $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0
95117 uti I ecti $120 $252 $384 $504 $642 $762 $888 $1,008 $1,128 $1,248 $1,368 $1,488 $9,792
95115 Si g e I ecti $80 $168 $256 $336 $428 $508 $592 $672 $752 $832 $912 $992 $6,528
T TA EXPE SE $11,537 $13,979 $18,246 $21,033 $24,580 $27,367 $30,529 $34,411 $36,103 $40,350 $42,772 $45,924 $346,831
PRACTICE ET ARGI $8,802 $10,133 $16,734 $19,729 $24,466 $28,120 $31,980 $36,216 $37,141 $43,718 $47,178 $51,026 $355,902
* Actual revenue and net margin dependent on case volume, payor reimbursement rates and actual expenses **95165 (SCITS) revenues continue to compound each month as compliant patients are added
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
16 SACA Allergy Services Summary Provides access to modern, high quality allergy diagnostic and treatment services, improves patient satisfaction and enhances physician practice revenue
• Respond to the growing shortage of allergists, SACA provides real time diagnosis and allergy treatment services for primary care practices ASA Physicia • Convenience and control of treatment with program administered under the direction of a part erships Board Certified Allergist with testing performed by qualified Allergy Technicians a ig edAllergy f r • SACA’s turnkey approach expands primary care services while often improving practice utua Services be efit efficiency • SACA business model provides practice with significantly increased ancillary revenue
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
17 SACA Dermatology Services Significant concern around high incidence of dermatologic conditions, including skin cancers, across populations
• Skin cancer is the most common cancer in the United States and is the primary driver for demand of Team dermatology services • In the U.S., approximately one in five people will develop skin cancer in their lifetime with nearly 9,500 newly General diagnosed skin cancers every day • Melanoma rates in the United States doubled from 1982 to 2011 with estimates that 161,790 new cases of 1 Prevalence melanoma, 74,680 noninvasive (in situ) and 87,110 invasive, will be diagnosed in the U.S. in 2017 • 5.4 million cases of nonmelanoma skin cancer (NMSC), including basal cell carcinoma and squamous cell carcinoma, were treated in 3.3 million people in the United States in 2012 • The overall incidence of BCC increased by 145 percent between 1976-1984 and 2000-2010, and the overall incidence of SCC increased 263 percent over that same period with significant rises in people younger than 40
• Invasive melanoma is projected to be 5th most common male cancer and 6th most common female cancer in 2017 Allergy • Melanoma is the second most common form of cancer in females age 15-29 and is increasing faster in females IncidenceServices and age 15-29 than in same aged males. 1 • Before age 50, melanoma incidence rates are higher in women than in men, but by age 65, rates are twice as high Gender in men • Women had the greatest increase in incidence for both types of NMSC, but the incidence in men ages 80 and older is 3x higher than same aged women
Dermatology • Caucasians and men older than 50 have a higher risk of developing melanoma than the general population IncidenceServices and • The annual incidence rate of melanoma in non-Hispanic Caucasians is 26 per 100,000, compared to 5 per 100,000 in Hispanics and 1 per 100,000 in African-Americans 1 Ethnicity • In people of color, melanoma is often diagnosed at later stages, when the disease is more advanced • Melanoma in Caucasian women younger than 44 has increased 6.1 percent annually, which may reflect recent trends in indoor tanning
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
18 High Demand for Dermatology Services Access Issues and Increasing Costs
Team • There are fewer than 10,000 licensed dermatologists in the U.S., or 3.4 per 100,000 population, significantly below the recommended minimum of 4.0 per 100,000 General Access • The distribution of dermatologists is skewed towards more densely populated, affluent to Dermatology urban areas and away from economically challenged urban or rural geographies Services 1 • There is a current shortage of dermatologists that is expected to persist for the foreseeable future • Increasing demand for dermatology services driven primarily by rising occurrence of skin cancer and the aging of the population.
Allergy Services
• About 4.9 million U.S. adults were treated for skin cancer each year from 2007 to 2011, for Cost Impact of an average annual treatment cost of $8.1 billion • This represents an increase over the period from 2002 to 2006, when about 3.4 million Dermatologic adults were treated for skin cancer each year, for an annual average treatment cost of $3.6 DermatologyConditions 1 billion Services • The annual cost of treating nonmelanoma skin cancer (NMSC) in the U.S. is estimated at $4.8 billion, while the average annual cost of treating melanoma is estimated at $3.3 billion
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
19 SACA Dermatology Services Clinical Approach Symptom / Syndrome identification is a complete process consistent with the highest physician practice standards
Patient HistoryTeam and Review of Symptoms Physical Examination ICD-10 search
Signs Symptoms Common Codes
• AllergyRash • Itchy Skin • Psoriasis • ServicesSkin growth • New Skin growth • Acne • Psoriasis • Mole changing color or • Eczema shape • Eczema • Pruritis • Skin Dryness •DermatologyMole checks • Basal Cell Carcinoma • ServicesAcne
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
20 SACA Dermatology Services Business Model Development Complete Medical Practice and Payor Analysis Ensures Success from the Beginning
Patient History and Review Physical Examination • SACATeamof utilizesSymptoms existing Form practice data to develop annualized projections for dermatology services • SACA proforma analysis will include revenue, expense and profit projections based upon existing practice data
Data Sheet: Annual Case Volume for Common Dermatology CPT codes by Payor 99212 99213 99214 17111 BCBSAllergy ServicesUHC Humana Aetna Cigna Medicaid Dermatology Medicare Services Other:
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
21 SACA Dermatology Services Business Model Overview Turnkey process brings an increased scope of dermatologic care to physician practices
Team
• Physicians complete a practice analysis form located on SACA website (www.asallc.net) • SACA develops provider proforma • Provider enters into Provider Services Agreement (PSA) with SACA Initial Process • Provider allocates space, certain equipment and supplies Allergy • Provider ensures internet and phone access and connectivity Services • ICD 10 analysis for dermatology related codes in existing practice • Provide SACA with EHR access
Dermatology Services
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
22 SACA Dermatology Services Business Model Overview We manage all aspects to initiate safe and efficient delivery of dermatology services
Team • SACA performs services under the physician’s license • Provider allocates space, certain equipment and supplies • SACA recruits and provides training to physicians, and dermatology nurse practitioner Developing the or physician’s assistant Dermatology • SACA purchases medical supplies and minor equipment Service Allergy • SACA provides policies, procedures and protocols to ensure safety, sanitation, sterilization and compliance Services • SACA delivers all process materials (blue sheets / symptom identification forms) for circulation to patients in advance of patient/provider encounter
Dermatology Services
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
23 SACA Dermatology Services Business Model Overview Provides high quality dermatology services that precisely follow established and accepted national protocols
• Physician refers patient for in-house dermatology consultation Team • SACA trained dermatology mid-level provider (NP or PA) evaluates patient • Dermatology NP, with oversight from board certified dermatologist, develops specific treatment recommendations • After full patient consent obtained, dermatology mid-level provider performs treatment (prescription, cryosurgery, biopsy, surgery) • Biopsy material sent to SACA dermatopathologist for microscopic analysis and Operating the definitive findings Dermatology Allergy • Dermatology mid-level provider and physician receive pathology result, communicate ServicesService with patient and schedule follow up visit as needed. • Dermatology mid-level provider performs all documentation and posts to SACA and physician practice EHR • SACA completes ”superbill” and transmits to physician practice business office for processing Dermatology Services • Provider bills and collects for services rendered; SACA bills fee per procedure • Provider retains operating profit from delivery of dermatology diagnostic and treatment services
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
24 SACA Dermatology Services Clinical Approach Initial patient evaluation ensures proper identification of candidates for additional dermatology consultation
Team • Primary Care Physician (PCP) performs an initial dermatologic evaluation • Patient referred to dermatology mid-level provider for further evaluation and treatment
• Dermatology mid-level provider performs detailed evaluation and confers as needed with SACA’s Board Certified Dermatologists via telehealth connection Thorough and • Appropriate treatments include prescription medication, incisional or excisional Efficient Clinical biopsy are performed with proper consents and disclosures Allergy Process • All biopsy specimens submitted for review and analysis by Board Certified Services Dermatopathologist
• Results returned to PCP and discussed, as appropriate, between PCP, patient and dermatology providers
• Patient and PCP determine next steps, including additional consultation as needed Dermatology • Compliant with best of practice dermatology protocols Services
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
25 SACA Dermatology Services Business Model Development Sample fee schedule illustrates typical procedure and treatment reimbursements
Team Common CPT Codes and SamplePhysical Reimbursements Examination CPT Procedure Total Net Code Description Units Reimbursement
11100 Skin biopsy 1 $46.97 11101 Additional biopsy 1 $22.72 17000 Cryosurgery, precancer x 1 1 $50.21 17004 Cryosurgery, precancer > 14 1 $94.74 17110 Cryosurgery, benign x 1 1 $65.90 17114 Cryosurgery benign > 15 1 $81.19
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
26 SACA Dermatology Services Business Model Development Sample Practice Proforma demonstrates significant long term practice revenue enhancement*
th a uary February arch Apri ay u e u y August Sept ct ber v Dec YTD T ta s CPT C de Reve ue 21 days 19 days 22 days 21 days 22 days 21 days 21 days 23 days 19 days 22 days 20 days 20 days Der 99213 $95 $15 960 $14 440 $16 720 Physical $15 960 $16 720 Examination $15 960 $15 960 $17 480 $14 440 $16 720 $15 200 ICD-10 $15 200 search $190 760 99212 $95 $7 980 $7 220 $8 360 $7 980 $8 360 $7 980 $7 980 $8 740 $7 220 $8 360 $7 600 $7 600 $95 380 99214 $95 $5 985 $5 415 $6 270 $5 985 $6 270 $5 985 $5 985 $6 555 $5 415 $6 270 $5 700 $5 700 $71 535 17000 $85 $8 925 $8 075 $9 350 $8 925 $9 350 $8 925 $8 925 $9 775 $8 075 $9 350 $8 500 $8 500 $106 675 17003 $12 $96 $96 $96 $96 $96 $96 $96 $96 $96 $96 $96 $96 $1 152 17004 $180 $1 440 $1 440 $1 440 $1 440 $1 440 $1 440 $1 440 $1 440 $1 440 $1 440 $1 440 $1 440 $17 280 17110 $181 $1 448 $1 448 $1 448 $1 448 $1 448 $1 448 $1 448 $1 448 $1 448 $1 448 $1 448 $1 448 $17 376 17111 $80 $1 680 $1 520 $1 760 $1 680 $1 760 $1 680 $1 680 $1 840 $1 520 $1 760 $1 600 $1 600 $20 080 17261 $185 $1 480 $1 480 $1 480 $1 480 $1 480 $1 480 $1 480 $1 480 $1 480 $1 480 $1 480 $1 480 $17 760 11100 $171 $1 368 $1 368 $1 368 $1 368 $1 368 $1 368 $1 368 $1 368 $1 368 $1 368 $1 368 $1 368 $16 416 11101 $56 $840 $840 $840 $840 $840 $840 $840 $840 $840 $840 $840 $840 $10 080 11300 $112 $672 $672 $672 $672 $672 $672 $672 $672 $672 $672 $672 $672 $8 064 11301 $155 Business$930 $930Model $930 Development $930 $930 (DEVELOP $930 $930 DERM $930 PROFORMA) $930 $930 $930 $930 $11 160 11401 $100 $800 $800 $800 $800 $800 $800 $800 $800 $800 $800 $800 $800 $9 600 11602 $150 $1 200 Sample $1 200 $1 200 Practice $1 200 Proforma $1 200 $1 200 demonstrates $1 200 $1 200 $1 200significant $1 200 $1 200 $1 200 $14 400 96910 $107 $642 $642 $642 $642 $642 $642 $642 $642 $642 $642 $642 $642 $7 704 C s etic che ica pee $100 long$2 100 term $1 900 practice $2 200 revenue $2 100 $2 200 enhancement* $2 100 $2 100 $2 300 $1 900 $2 200 $2 000 $2 000 $25 100
Subt ta $51,446 $47,586 $53,376 $51,446 $53,376 $51,446 $51,446 $55,306 $47,586 $53,376 $49,516 $49,516 $640,522
Path 88304 $38 $798 $722 $836 $798 $836 $798 $798 $874 $722 $836 $760 $760 $9 538 88305 $65 $12 285 $11 115 $12 870 $12 285 $12 870 $12 285 $12 285 $13 455 $11 115 $12 870 $11 700 $1 170 $136 305 88341 $88 $3 696 $3 344 $3 872 $3 696 $3 872 $3 696 $3 696 $4 048 $3 344 $3 872 $3 520 $3 520 $44 176 88342 $100 $6 300 $5 700 $6 600 $6 300 $6 600 $6 300 $6 300 $6 900 $5 700 $6 600 $6 000 $6 000 $75 300 88313 $61 $3 843 $3 477 $4 026 $3 843 $4 026 $3 843 $3 843 $4 209 $3 477 $4 026 $3 660 $3 660 $45 933 Subt ta $26,922 $24,358 $28,204 $26,922 $28,204 $26,922 $26,922 $29,486 $24,358 $28,204 $25,640 $15,110 $311,252 T TA REVE UE $78,368 $71,944 $81,580 $78,368 $81,580 $78,368 $78,368 $84,792 $71,944 $81,580 $75,156 $64,626 $951,774 SACA Expense & Fees $47,021 $43,166 $48,948 $47,021 $48,948 $47,021 $47,021 $50,875 $43,166 $48,948 $45,094 $38,776 $571,064 HOSPITAL MARGIN $31,347 $28,778 $32,632 $31,347 $32,632 $31,347 $31,347 $33,917 $28,778 $32,632 $30,062 $25,850 $380,710
* Actual revenue and net margin dependent on case volume, payor reimbursement rates and actual expenses
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
27 SACA Dermatology Services Summary Skin and Allergy Centers of America provides access to modern, high quality dermatology services, improves patient satisfaction and enhances physician practice revenue
Team
• Respond to the growing shortage of dermatologists, SACA provides real time dermatology services for primary care practices • Convenience and control of treatment with program administered under the SACA / Physician direction of a Board Certified Dermatologist with testing performed by partnerships aligned qualified Dermatology trained mid-level provider for mutual benefit • SACA’s turnkey approach expands primary care services while often improving Allergy practice efficiency Services • SACA business model provides practice with significantly increased ancillary revenue
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
28 Contact Information
Richard C. Wright Scott Sumrall Abdul Ibrahim
President Executive Vice President Executive Vice President (919) 240-7556 (214) 384-9013 (484)995-5019 [email protected] [email protected] [email protected]
Ryan Sullivan, MD Richard Becker, MD Phylly Arnold
Medical Director Senior Advisor Director, Business Development (615) 585-5549 (347) 852-3664 (817) 917-7896 [email protected] [email protected] [email protected]
Confidential S i a d A ergy Ce ters f A erica C Pr vidi g c passi ate a d patie t ce tered care
29