Compression Solutions 2014 Compression Holdings, LLC Compression Solutions Management, LLC

Mission Statement To provide medical products and services that increase patient safety, reduce liability and health care costs through convenient solutions.

Why Compression Solutions CS has been in the DME and DVT business for 22 years. CS pioneered the DVT take home market We understand the billing and reimbursement issues. We understand the challenges with broken, field failures and lost rental equipment.

Drug-free DVT Prevention CS focuses on providing a convenient, cost effective program that increases patient safety by decreasing DVT and related PE. Triple Play VT is a “drug free” alternative in DVT prevention, and the first portable product to address DVT, cold and compression in a single compact unit. Comparison picture of triple play alongside the competitor product. Picture of Wang Zhongmin with the unit on, and a quote from him! Mark’s reputation is as a visionary, finding the new avenues.

What is the problem? DVT Deep vein thrombosis (DVT) – a blood clot that forms in a vein deep in the body. Most DVTs occur in the lower leg or thigh. Pulmonary Embolism (PE) – a blood clot in a deep vein that breaks off and travels to an artery in the lungs, blocking blood flow. PE is a serious condition. that can damage the lungs and other organs in the body and cause death. Source: National Heart Lung and Blood Institute (http://www.nhlbi.nih.gov/health/health-topics/topics/dvt/)

The DVT Challenge DVT is the leading cause of death in the U.S. Each year, more than 2 million people develop DVT leading to 300,000+ deaths In the US, more people die each year from PE than motor vehicle accidents, breast cancer and AIDS combined. DEEP-VEIN THROMBOSIS: ADVANCING AWARENESS TO PROTECT PATIENT LIVES Public Health Leadership Conference on Deep-Vein Thrombosis Some Causes of Death in the US Annual Deaths Pulmonary embolism 300,000+ AIDS 14,499 Breast cancer 40,200 Highway fatalities 42,116

How is DVT prevented? Prophylaxis is an action taken to prevent disease. Two types of DVT prophylaxis – mechanical & anticoagulants (blood thinners). Compression Solutions’ products are a mechanical DVT prophylaxis method. Source: University of Massachusetts

Why Mechanical Prophylaxis? Studies show that mechanical prophylaxis is just as effective as anticoagulants. When mechanical and anticoagulants are combined they have a synergistic effect. Patients with bleeding risks cannot tolerate anticoagulants. Doctors hesitate to prescribe drugs for moderate to high risk patients. Mechanical prophylaxis has zero side effects.

Increased Patient Care “Pharma + Mechanical = 75% DVT Reduction” Eleven studies, six of them randomized controlled trials, were identified. The trials included 7431 patients, in total. Compared with pharmacological prophylaxis alone, the use of combined modalities significantly reduced the incidence of DVT (from 4.21% to 0.65%; OR 0.16, 95% CI 0.07 to 0.34) Source: The Cochrane Library 2008, Issue 4. “Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism in high-risk patients (Review)”. Kakkos SK, Caprini JA, Geroulakos G, Nicolaides AN, Stansby GP, Reddy DJ

The Home Market Cost pressures continue to drive the healthcare industry toward more “in-home” medical solutions. Post-surgical patients are at the highest risk for DVT while recovering at home

DVT Risk Continues at Home “…50% of DVT begin intraoperative, with the highest incidence occurring during surgery and on the first postoperative day, and that 75% of DVT develop within the first 48 hours after surgery.” (Spencer. F.A. 2007 Venous Thromboembolism in the Outpatient Setting.” Archive of Internal Medicine. July 23)

Who Says? 75% of all DVTs occur in the first 48 hours following a THA/TKA. Caprini guidelines recommend 10 days of DVT prophylaxis following major orthopedic surgery. Studies demonstrate that the peak incidence of a DVT occurs on the fifth postoperative day. Women are 70 times more likely to be admitted with VTE in the first six weeks after an inpatient operation and 10 times more likely after an outpatient surgery.

Preventing DVT After Discharge According to JACO all facilities should be doing a risk assessment on all patients It’s not the procedure being performed, it’s the patient’s risk factors By a simple risk assessment your patients can be protected from life threatening DVT, which reduces the physician’s liability and results in better patient outcomes

CHEST Consensus Guidelines 2012 Risk Caprini Score *VTE incidence Prophylaxis Very low 0.5% Early ambulation Low 1-2 1.5% IPC Moderate 3-4 3.0% LMWH, UFH,IPC High 5+ 6.0% LMWH, UFH + IPC or GS *Estimated baseline risk in the absence of pharmacologic or mechanical prophylaxis Gould, MK et al; CHEST 2012; 141(2)(Suppl):e227S–e277S

More Cost Effective To Prevent Than to Treat Mechanical prophylaxis is as effective as pharmacological prophylaxis and has no side effects or risk of bleeding. And when combined with pharmacological prophylaxis can more greatly reduce the risk of postoperative DVT.  

Mechanical Prophylaxis is as Effective as Pharmacological with No Bleeding   Mechanical methods of prophylaxis act on the same principle as early mobilization Intermittent pneumatic leg compression enhances blood flow in deep veins. Method is virtually free of side effects and particularly useful in patients at risk of bleeding Compression is as effective as low-dose heparin in patients undergoing abdominal surgery. Mechanical and pharmacological methods of VTE prophylaxis are both effective and when used in combination have synergistic effects. In moderate-risk patients when pharma is contraindicated, IPC can be used as an alternative.

Mechanical Prophylaxis is as Effective as Pharmacological with No Bleeding Analysis of studies on the use of mechanical methods has shown that general surgery patients on average have about a 9% chance DVT if compression is used compared with a 20 to 24% chance if no prophylaxis is employed. University of Massachusetts Medical, DVT Best Practices 2008

Mechanical Prophylaxis is More Cost-Effective than Pharmacological Pharmacological therapy can cost as much as $1800 per month per patient. Mechanical prophylaxis has fee schedules of less than $400. Anticoagulant Typical Dose Typical Cost/Day Typical Cost/Monthly Enoxaparin/Lovenox 40-90 mg $30 - $70 $900 - $2100 Warfarin/Coumadin 3-6 mg $3-$6 $90 - $190 + INR testing Fondaparinux/Arixtra 2.5 mg $50 - $100 $1500 - $3000

Triple Play VT and the Home Market Compression Solutions’ Triple Play VT was created specifically for the home market Drug-free alternative in DVT prevention First portable product to address DVT, Cold and compression in a single compact unit. Mobile Patient-friendly, easy to use

Triple Play VT ® & EZ-Fit

Triple Play VT Continuum of Care Triple Play VT—1st portable DVT, cold and compression device specifically designed to move from the facility to home throughout recovery Prevents DVT for any at-risk patient

Cold and Compression Therapy The use of combined cryotherapy and compression in the postoperative period after ACL reconstruction results in improved, short-term pain relief and independence from narcotic use compared with cyrotherapy alone. Brian R. Waterman, CPT, MC et al., J Knee Surg 1538-8506, 2012. A recent study showed cold/compression groups reported significantly less swelling and pain than the cold-alone groups. Schroder D, Passler HH. Knee Surg Sports Traumatol Arthrosc 2(3):158-65, 1994.

Patient Benefits Just one product reduces all three. Prevents DVT Reduces pain and swelling No messy ice and water Re-freezable and malleable joint cold therapy 12 hours of battery life Mobile device can be used anywhere anytime means better compliance

Patient Benefits Easy to use Small, lightweight, quiet Simple to set up and maintain Improves compliance

Program Details LifeCycle Program No capital outlay No repair costs No chasing lost equipment 24 hr. Patient Service 24 hr. Quick Swap Program