Case Medical Opportunities Let your customers know to visit us at the IAHCSMM Conference in Albuquerque on April 29-May 2 Case Medical is at Booth 329. Loaner Opportunities STERRAD and V-Pro Opportunities Feedback on wipes Two new CEU programs now available online www.casemed.com/caseacademy Territory Activity Reports due April 15th Feedback from AORN leads

Using SteriTite® Containers & MediTray® Inserts Cost Benefit Analysis Using SteriTite® Containers & MediTray® Inserts Copyright 2003, Revised 2012

Why has the Cost-Benefit Analysis been updated? To demonstrate cost savings over the competition To quantify savings when the acquisition cost is higher To address the needs of the global market To address opportunities with loaners

Value We have a universal container system cleared by the FDA for all current sterilization modalities, for multi-level trays, and for all surgical devices. Orthopedic trays are the greatest challenge to process. Our SteriTite container was originally designed to package orthopedic sets. Updated info: AAMI is in the process of approving Annex A providing a template for integrating “loaners” into sealed containers.

Sterilization Trends Higher value instrumentation More complex devices, including endoscopes, power equipment and robotics Inventory control & materials planning Reduction in labor Reduction of costs in Central Processing Rapid turns and volume

Industry Trends Muslin Wrap to Disposable Wrap to Sealed Containers EO Gas to STERRAD Sterilization V-Pro and V-Pro maXX Single Use Devices to Re-usable Devices Plastic Custom Trays to Aluminum Trays and Sealed Containers Temperature and moisture sensitive devices, new sterilization modalities and packaging compatibility. Low temperature sterilization

Benefits Case Medical Universal Containers Using one case for all saves inventory costs Can protect valuable instrumentation Contributes to surgeon satisfaction Compatible with all devices and sterilization modalities Container organizer systems will reduce instrument loss and damage and be seen as a value by the customer. Reusable components are cost effective. Instrument protection reduces costs for repair and replacement.

SteriTite®, the Universal Container Compatible with every major sterilization method including STERRAD® , V-Pro, and recently validated for Optreoz Filter-less option for “Immediate Use” High durability with corrosion resistant seal Flexible design reduces affiliate costs and protects devices Ideal for containerizing loaners 4/21/2017

Utilization Instrument Safety Personalized Organized Inventory Savings Reduced Costs per Use Productivity Increase Reduced Labor Reduced Disposables Quicker Turns Reduced Reprocessing Operating Room Immediate use: pre-vac & gravity Central Processing Steam: pre-vac & gravity, EO, STERRAD 4/21/2017

Customer Gains Value In steam sterilization Instrument protection Event related storage Cost savings in labor and processing In EO/STERRAD® and V-Pro® Sterilization Reduced instrument loss, damage Reduced handling costs Universal container that can go to third-party processors and/or STERRAD® Processing Ability to sterilize flexible endoscopes

Savings Over the Other Brand With 1/3 more interior volume, the number of containers needed is reduced. Lower profile container reduces weight and addresses ergonomic issues. Ability to stack inner trays within container keeps the set together for surgery and reduces inventory/shelf space. Ability to stack containers in the autoclave. Saves energy and processing costs.

Savings Over the Other Brand Sealed immediate use (flash) container reduces infection rates from cross contamination and staff injuries due to burns. Durable construction increases useful life of product and avoids added expense of repair or replacement. Corrosion-resistant, anodized seal provides 10x more useful life and reduces surgical site infections from galvanic reaction. Unconditional warranty for manufacturer’s defects avoids service charges.

Savings Over the Other Brand SteriTite for multiple methods of sterilization avoids unnecessary inventory duplication. Avoid multiple wrapped trays or different containers for each process or set. SteriTite cleared for 35 lbs. total weight. 22 lbs. of instruments and all types of devices reduces stock. Dry loads avoid reprocessing costs.

Savings Over the Other Brand Utilizing a lower profile container addresses ergonomic issues and reduces total weight. Interchangeable components reduces stock. Off-set filter retention plate: Reduces time needed to inspect filter integrity in the OR. Eliminates need for a secondary lid, which adds cost and weight to container.

The SteriTite® Container System on a Per Cycle Basis Customer pays a similar price on a per use basis as cost for wrap Customer saves on wrap, tape, absorbent liners, and other accessories. Avoids damage and reprocessing costs. Lease or pay as you go option. Expense avoids a capital purchase. Utilize and reduce budget for wrap.

Disposable Wrap System Costs Per Use: Item Cost Quantity Total Disposable Wrap 1.50 2 3.00 Autoclave Tape 0.10 1 Labor (per minute) 0.24 3 0.72 Disposal Cost 0.09 0.18 Reprocessing 0.50 Instrument damage reserve 0.30 Total wrap per use 4.80 Additional Costs to Consider: Cost of tray liners and tray belts Cost of peel pouches Cost of corner protectors and tip protectors Cost of dust covers Re-sterilization due to tears

New Wrapped Tray Accessories and Added Costs

Linen Wrap Cost Per Use Additional Costs Include: Labor for inspecting wrap Re-sterilization due to tears Poor barrier for sterility maintenance Contributes to surgical site infections

SteriTite® Sealed Container Costs Per Use: Item Cost Quantity Total Disposable Filters* 0.10 3 0.30 Disposable Seals 0.16 2 0.32 Labor (Per Minute) 0.24 1.0 Container cost per use ** 1.30 1 Total Container per use 2.16 * Average number of filters used in perforated bottom universal container. ** The cost per use for the container amortized over a 3 year term. Savings Include: Eliminates Rips and Tears 80% Disposable Cost Savings 28% Lower Labor Costs (1/3 of time to wrap) Greatly Reduced Reprocessing

Pricing and Value Strategy Value per cycle to customer = cost of inventory for duplicate containers + cost of inventory for multiple wrapped trays + cost of wrap or cost of washing linen + cost of inspection/repair/or multiple wrap in linen due to damage of linen + cost of disposal of single use wraps + reprocessing costs due to short shelf life + hidden cost of instrument damage + hidden cost of instrument loss + personal pride in instrument

Demonstration See excel sheet and questionnaire

Additional Savings Save a minimum of 20% over competitive brands by eliminating the cost of additional containers for low temperature sterilization modalities or sealed immediate- use sterilization. Reduce container inventory by 1/3 with SteriTite® containers which provide added internal space and stacking capability. Save 25% on energy and reprocessing costs with stackable, low profile containers in the autoclave.

Additional Savings Save an additional 25% in repair and sharpening costs using MediTray® inserts. Save $3,600 a year adapting an event-related sterility policy using SteriTite® containers. Save up to $200.00 per container in refurbishing costs.

Reduce the Cost of Instrument Repair with MediTray® Protective Inserts Instrument Repair & Sharpening Expense Note: Above data based on information provided by hospitals in PA, TX and FL Reduce other hidden costs: Labor costs searching for replacement instruments Excess inventory and duplication Cost of delay and lost billings Cost of OR suite and staff time and labor Re-sterilization and reprocessing

Reduce The Cost Of Instrument Repair With MediTray® Endo Trays and Inserts Scope Repair and Sharpening Expense *(25% savings by reducing repair and sharpening costs based on using MediTray product in FL, PA) Reduce other hidden costs: Increase in laparoscopic procedures along with rising expense for repair as well as replacement costs of scopes and endoscopic instruments.

The Value of SteriTite® Containers and MediTray® Inserts SteriTite® sealed containers and MediTray® protective inserts provide a simple, cost-effective system for the sterilization, transport and storage of operating room instruments. Based on labor and repair cost savings, SteriTite® containers can fully justify initial investment within one to two years.

Using Cost Benefit Analysis Tools Selling Case Solutions and SuperNova Using Cost Benefit Analysis Tools

Customer Gains Value In utilizing super concentrated product Pennies on the dollar at cost per use dilution Cost savings in labor and processing Frees up storage space Standardized cleaners and process No unnecessary components Environmentally preferred products Saves instrument inventory

Customer Gains Value Non-hazardous cleaners Protect staff, patients and the environment Protect valuable instrument from corrosion Contribute to a long useful life Save on instrument replacement Save on hazardous waste disposal Prevent accidents and their associated costs for medical care and punitive damages

Green Cleaning: Hazards By the Numbers 17,000: the number of petrochemicals available for home use, only 30 percent of which have been tested for exposure to human health and the environment.   63: the number of synthetic chemical products found in the average American home, equals ~10 gallons of harmful chemicals.   100: the number of times higher that indoor air pollution levels can be above outdoor air pollution levels, according to US EPA estimates. 275: the number of active ingredients in antimicrobials that the EPA classifies as pesticides because they are designed to kill microbes. 5 billion: the number of pounds of chemicals that the institutional cleaning industry uses each year. 23: the average gallons of chemicals (that's 87 liters) that a janitor uses each year, 25 percent of which are hazardous.

SuperNova: The Products SuperNova Multi-Enzymatic Cleaner SuperNova .1 multi-enzymatic SuperNova .25 multi-enzymatic SuperNova NPHD Detergent SuperNova .1 NPHD SuperNova .25 NPHD SuperNova InstruCreme Lubricant CaseDry Drying Agent

Case Solutions: The Products PentaPrep PentaZyme SchmutzOff Ink and Tape Remover InstruCreme Ready-To-Use New Product Release EndoWipes Alcohol Wipes

Benefits of Case Solutions and SuperNova Super concentrated cleaners save space, address ergonomic issues and provide more product for the $$. May be disposed in standard recycling. Small packaging frees up inventory space. Multi-enzymatic cleaners facilitate the cleaning process 1 million times faster than non-enzymatic cleaners May be used for both manual and automated cleaning Effective even at lower temperatures to further cut energy costs.

Additional Value Hypoallergenic with sealed dispensing to avoid allergic reactions Automatic dosing with flow control to avoid over or under use of product Color coded to avoid confusion MSDS readily available: online and on the bottle to avoid injuries and fully comply with guidelines Most effective at lowest cost Proprietary hardware provided at no additional cost

The meat and potatoes The real cost savings lies in the cost per use. While the acquisition cost may be equal or slightly greater than other concentrated cleaners, the real savings is at the actual use dilution. Users will get anywhere from 4-10x more product for their money. Utilizing the correct amount of product reduces costs. Warning: Purchasing only looks at acquisition cost. Education is critical. Use the cost benefit analysis tool, which demonstrates the real cost savings at use dilution.

Use the SuperNova Cost Benefit Analysis Questionnaire Find out what products the customer is currently using. Determine the number shipping units per month for each product. Ask the user for actual dilution rate set at the machines. Record information about pH and whether an acid neutralizer is used.

Cost Benefit Analysis Spreadsheet Demonstration

Understanding the Cost Reduction The acquisition cost is higher. The fee per use cost is significantly lower. Over 1,000 uses per case.

SuperNova – Cost Per Use Calculation SUPERNOVA Part # Description Concentr. [oz/galr] Retail Price [$] 33% off Price [$] 40% off Price [$] Tier1 Price [$/gal.] Tier 2 Price [$/gal.] Dilution Rate Lowest Dilution Price per Gal. [$/gal.] Highest Dilution Price per Gal. [$/gal.] CSNB25G SUPERNOVA .25 Detergent (4Gal./Case) 1/4 $ 206.80 $ 136.49 $ 124.08 $ 34.12 $ 31.02 1:512 $ 0.067 $ 0.061 CSNB25 SUPERNOVA .25 Detergent (5Gal./Case) $ 235.00 $ 155.10 $ 141.00 $ 28.20 $ 0.055 CSNC01G SUPERNOVA .1 MultiEnzymatic (4Gal./Case) 1/10 $ 514.80 $ 339.77 $ 308.88 $ 84.94 $ 77.22 1:1280 $ 0.066 $ 0.060 CSNC01 SUPERNOVA .1 MultiEnzymatic (5Gal./Case) $ 585.00 $ 386.10 $ 351.00 $ 70.20 CSNC25G SUPERNOVA .25 MultiEnzymatic (4Gal./Case) $ 305.36 $ 201.54 $ 183.22 $ 50.38 $ 45.80 $ 0.098 $ 0.089 CSNC25 SUPERNOVA .25 MultiEnzymatic (5Gal./Case) $ 347.00 $ 229.02 $ 208.20 $ 41.64 $ 0.081 CSNL01 SUPERNOVA .1 InstruCreme Lubricant (5Gal./Case) $ 220.00 $ 145.20 $ 132.00 $ 29.04 $ 26.40 $ 0.023 $ 0.021 CSNL01G SUPERNOVA .1 InstruCreme Lubricant (4Gal./Case) $ 176.00 $ 116.16 $ 105.60 $ 29.04 CSNCD1 SUPERNOVA .1 Case Dry Concentrate (5Gal./Case) 2/100 $ 346.00 $ 228.36 $ 207.60 $ 45.67 $ 41.52 1:6400 $ 0.007 $ 0.006

Cost Per Use Calculation Gallons of water Automated Washer has approximately 9 gal. Sonic has approximately 4 gal. Sink has approximately 4 gal. Basin for Soaking has approximately 1 gal. Question What is the approximate cost per use of Case Medical product in the Automated Washer? Cost per use in the Sonic? Cost per use in the Sink? And cost per use in the Basin?

SuperNova – Cost Per Use Analysis How can we use our Cost Analysis to compete against the Competition? Prolystica is offered as a similar product, but at a higher cost. Compare by price. All others use cost per use template. Cost/Gal. SuperNova .25 Cost/Gal. Steris Prolystica Enzymatic $154 to 63.36 [$/gal] 41.64 [$/gal] Prolystica Lubricant 105.60 [$/gal] 33.00 [$/gal]

SuperNova – Cost Per Use Analysis - Scenario Customers says Brand X “EZenzyme” costs only $75/bottle. Case Medical equivalent solution costs $400/case.

SuperNova – Cost Per Use Analysis - Scenario Questions to ask: Bottle units (gallons, liters)? Concentrated product? Diluted gallons out of 1 gallon of concentrate (1:1280, 1:512 or maybe 1:100)? Compare price per concentrated gallon. Compare price per diluted gallon. Compare price per use.

Dilution Rate Calculation SuperNova.25 concentration = ¼ [oz./gal.] ¼ oz. of Case Medical product per gal. of water 1 gal = 128 oz. ¼ : 128 [oz./oz.] = 1:512 SuperNova.1 concentration = 1/10 ounce per gallon 1/10:128[oz./oz.] = 1:1280

Remember SuperNova was validated at the dilution rate identified by the product name on the label, but it can go lower depending on water quality and degree of soil and in automated washers.

Super Concentrated Products Contribute to major cost savings. The SuperNova .1 can be further diluted to 1/40 oz/gal depending on water quality. Validated, safe, cost effective products results in better patient outcome and frees staff for needed patient care. SuperNova results in significant cost and labor savings, reduced storage/inventory expense, freeing funds for needed patient care. 48

Copyright 2009 © Case Medical Inc. Cost Savings Case Medical’s instrument cleaners are super concentrated which provides the user with a significant cost savings over the competition. Each bottle of SuperNova provides up to 1,000 uses and costs pennies on the dollar. Multiple enzymes in higher concentrations provide rapid soil breakdown at use dilutions. Up to a million times quicker than soap and water. Copyright 2009 © Case Medical Inc.

Savings Over the Other Brand Avoid numerous unnecessary cleaners and steps Totally pH neutral means no corrosion Water-soluble liquid detergents means no residue Lowest cost when compared at use dilution means more bang for the buck Highest level of synergistic enzymes to speed up the cleaning process Super concentrated saves on shipping costs, inventory space and large drum disposal. Sealed system prevents cross contamination and spoilage.

Final Notes and Q&A If any questions regarding this come up later on feel free to call or email us. Also, please let your customers know to visit us at the IAHCSMM Conference in Albuquerque on April 29-May 2 Case Medical is at Booth 329.