accelerated care plus, inc

CONFIDENTIAL AND PROPRIETARY, COPYRIGHT © 2002-2009, ACCELERATED CARE PLUS CORP., ALL RIGHTS RESERVED, #PPT 0208 Rev3 1

Revolutionizing RehabilitationRevolutionizing RehabilitationPPT 0208 Rev3PPT 0208 Rev3

2CONFIDENTIAL AND PROPRIETARY, COPYRIGHT © 2002-2009, ACCELERATED CARE PLUS CORP., ALL RIGHTS RESERVED, #PPT 0208 Rev 3 2

Who is Accelerated Care Plus?

• The leading provider of integrated clinical programs, therapeutic modalities, products and services for geriatric rehabilitation

• Currently serving over 3,000 skilled nursing and outpatient facilities nationwide, including the most recognized providers in the industry

• Founded by long-term care professionals in 1994 – Located in Reno, NV.

• Over 100 licensed clinical professionals throughout the U.S.

• 30 years of medical device research and development

• Equipment of choice for over 100 professional and collegiate sports teams, including NFL, NBA, MLB, NHL, NCAA and NASCAR


ACPACP’’s s ““Total SolutionTotal Solution”” ApproachApproach


The ACP Value EquationThe ACP Value Equation

Superior Outcomes for a broader patient population =

better quality of life and a stronger clinical practice

A stronger clinical practice & expanded services drives Referrals, Census, Quality

Mix & Facility ROI

Proactive mgmt.. of regulatory, compliance, survey, liability and costs associated with prevalent

geriatric conditions

The ACP Advantage


• Physical Agent Modality Basics• Pain Management• Contracture Management• Fall Prevention• Wound Healing • Continence Improvement• Osteoarthritis of the Knee

ACPACP’’s CEU Approved Clinical Programss CEU Approved Clinical Programs• Stroke Recovery• Stroke Hand Edema• Chronic Obstructive Pulmonary Disease• Rheumatoid Arthritis of Wrist and Hand• Herpes Zoster• Electrode Application & Safety• Orthotic Therapy• Physical Agent Modality Documentation

Supporting efficacy and safety, ACP’s equipment, protocols and clinical programs are founded in evidence-based practice using sources such as The Cochrane

Collaboration, The Ottawa Panel, The Philadelphia Panel, The AHRQ, ECRI Evidence-based Practice Center and other refereed sources.


What is a Clinical Solution?What is a Clinical Solution?

• Safe, non-invasive, drug free, reimbursable treatment interventions• Proven physical agent modalities including Ultrasound, Electrotherapy, Shortwave

Diathermy and Infrared therapy• Multidisciplinary approach in collaboration with facility’s therapy, nursing and operations

personnel • Comprehensive, integrated and effective clinical protocols founded in evidence based

practice and developed to address the complex needs of the geriatric patient population• On-site implementation, education and training - ongoing mentoring and support• On-going development of new Clinical Solutions to engage therapists and

broaden therapy services

Documentation, Compliance & Reimbursement

Patient EvalDisease PathologyAnatomy/PhysiologyMechanism of Action

Proprietary ClinicalPathways

State-of-the-ArtPhysical Agent

Modalities

On-Site Education & On-Going Support


Physical Agent Modalities for Superior OutcomesPhysical Agent Modalities for Superior Outcomes

Modalities provide the tools and skill sets therapists need to treat a more diverse range of patients and conditions

• Treat pain - not just manage it• Reduce inflammation and edema • Accelerate introduction of traditional therapies• Enable more intensive therapy, earlier in the stay• Accelerate wound healing • Decrease incontinent episodes• Reduce contractures• Lower risk of falls• Muscle re-education• Provide therapists with more options to extend patients’ functional

gains


State-of-the-Art Modalities and Therapeutic Equipment• Electrotherapy - Omnistim® 500, Omnistim® FX2

• Therapeutic Ultrasound - Omnisound® 3000• Shortwave Diathermy - Megapulse®

• Infrared Therapy – Neuroprobe® 500 (Add-on Equipment)• Active-assist Therapy Cycle - Omnicycle® (Add-on Equipment)• Specialty infection control supplies and electrode systems

Biomedical Services:• Includes all maintenance/repair and “on-site” annual calibration • 72-hour equipment replacement

Patented & Proven Therapeutic ModalitiesPatented & Proven Therapeutic Modalities

OMNISOUND® 3000ULTRASOUND

MEGAPULSE ®SHORTWAVE DIATHERMY

OMNISTIM® 500 / FX2

ELECTRICAL STIMULATIONNEUROPROBE®

INFRARED THERAPYOMNICYCLE®

ACTIVE ASSIST THERAPYCYCLE

Standard Equipment Package Add-on Equipment


• ACP provides complete education and training on clinical protocols and therapeutic modalities

• Training currently covers 10 Clinical Solutions and 10 Accelerated Clinical Practices

• Small group mentoring and on-site training by ACP’s professional Clinicians elevates clinical expertise

• Educational materials include lecture and lab handouts, desk references, bibliographies and assessment tools

• Address Compliance needs through correct documentation, current reimbursement coding, indications and contraindications

• ACP’s clinical education programs provide CEUs at no additional cost to its clients ($500 Value per Therapist)

ACPACP’’s Education Builds Therapist Skillss Education Builds Therapist Skills


ACP Marketing ToolsACP Marketing ToolsWith ACP, facilities and rehab providers are able to enhance their image in the community, create differentiation versus competitors and generate new referrals. ACP offers a range of tools to help capitalize on these opportunities:

• Patient brochures (1 acrylic rack and 6 brochure packs of 25 included in install kit)• Physician/Discharge Planner letter templates• Press releases• Facility implementation and marketing guides• Caseload development training for administrators, MDS coordinators, Nursing and

Rehabilitation


• ACP is an extension of your Team, using a multi-disciplinary approach to build caseload and optimize treatment outcomes!

• Clinical Program Managers (CPM’s) visit facilities at least quarterly to provide training, mentoring and support

– Clinical expertise in modalities and geriatric programs– Program implementation knowledge– Medicare regulation, reimbursement and billing expertise– Patient identification/caseload development

• Clinical Training, Education & Communication– Follow-up phone calls between visits– Consultation/questions via phone, email, fax– Facility Visit Summaries are produced after each ACP

visit to identify program opportunities/challenges– Maintains dialogue with Customer’s Management Team on

status, troubleshooting, etc

Implementation & OnImplementation & On--Going SupportGoing Support


Resident # 1 RHC 310.64$ 30 RVC 358.81$ 30 9,319.20$ 10,764.30$ 1,445.10$ PART A IMPACT DUE TO ACP INTERVENTION 1,445.10$ Monthly Lease Cost = $1,000 ($950 plus applicable sales & property taxes) ($1,000.00)

NET PART A POSITIVE REVENUE IMPACT DUE TO ACP 445.10$

One resident receiving ACP program treatment will more than absorb the monthly leasecost.

Total Revenue w/o ACPResident RUG w/o

ACP Per Diem # Days

Sample Part A ImpactPatient RUGS Increase from High to Very High

Total Revenue w/ACP ACP BENEFITRUG with

ACP Per Diem # Days

ACP Part A Return on Investment ACP Part A Return on Investment –– InIn--House TherapyHouse Therapy


Resident # 1 RHC 46.43$ 30 RVC 71.43$ 30 1,392.90$ 2,142.90$ 750.00$ Resident # 2 RHC 46.43$ 15 RVC 71.43$ 15 696.45$ 1,071.45$ 375.00$ PART A IMPACT DUE TO ACP INTERVENTION 1,125.00$ Monthly Lease Cost = $1,000 ($950 plus applicable sales & property taxes) ($1,000.00)

NET PART A POSITIVE REVENUE IMPACT DUE TO ACP 125.00$

A minimum of 1-2 patients receiving ACP program treatment will absorb the monthly leasecost.

Total Revenue w/o ACP

Resident RUG w/o ACP

Contract Therapy Rate Based on a Charge of $1.00 Per Minute

Per Diem # Days

Sample Part A ImpactPatient RUGS Increase from High to Very High

Total Revenue w/ACP

ACP BENEFITRUG with ACP

Per Diem # Days

Part A Return on Investment Part A Return on Investment –– Contract TherapyContract Therapy


$26.00 $1,000.00 38.5 9.6 1.9

*An average of 2 ACP Part B CPT treatment codes per day will absorb the monthly leasecost.

Sample Part B ImpactPart B CPT Codes Required to cover ACP Cost

ACP Required Codes/Day

Avg Part B Billing Rate/Code ACP Cost/Month

Part B Billing Rate Based on 100% of CPT Values

ACP Required Codes/Month

ACP Required Codes/Week

Part B Return on Investment Part B Return on Investment –– InIn--House TherapyHouse Therapy


$19.67 $1,000.00 50.8 12.7 2.5

*An average of 2-3 ACP Part B CPT treatment codes per day will absorb the monthly leasecost.

Sample Part B ImpactPart B CPT Codes Required to cover ACP Cost

ACP Required Codes/Day

Avg Part B Billing Rate/Code ACP Cost/Month

Contract Therapy Part B Rate Based on 75% of CPT Values

ACP Required Codes/Month

ACP Required Codes/Week

Part B Return on Investment Part B Return on Investment –– Contract TherapyContract Therapy


The ACP AdvantageThe ACP Advantage

How Does ACP Pay for Itself and More each Month?

• JUST ONE MORE PATIENT….. with specialized care needs that you might not otherwise be able to treat

• JUST ONE REFERRAL……as a result of clinical expertise and improved clinical outcomes

• JUST ONE RUGS CATEGORY INCREASE….

• JUST ONE THERAPIST SATISFIED AND RETAINED……

• JUST ONE PATIENT RETURNED TO NORMAL FUNCTION!


The ACP AdvantageThe ACP Advantage• Build a stronger clinical practice by treating a broader patient population and a wider range

of conditions • Compliment traditional therapy services with more aggressive treatment interventions for

superior outcomes and better quality of life• Initiate therapy earlier, increase intensity, and extend recovery of pre-morbid status• Medicare A - Enhance patient tolerance & response to traditional therapies to provide

medically appropriate LOS and care levels (RUGs)• Medicare Part B - Provide treatment for “patients in need” who are entitled to Part B

benefits for medically appropriate treatment• Proactively manage quality indicators, documentation, liability, etc.• Manage routine costs for prevalent conditions such as U.I. and wounds• Strengthen therapist satisfaction, recruitment and retention• Generate more referrals and admit more patients requiring skilled services and specialized

therapy• Improve community image and create facility differentiation through specialized treatment

services and “Clinical Superiority”


ACP Lease/Service AgreementACP Lease/Service Agreement

Basic Monthly Lease: 1-10 facilities $ 1,150

11-30 facilities $ 1,050

> 30 facilities $ 950

Initial Supply Charge: $ 350

Initial Shipping Charge: $ 250

Cancellation Agreement - 30 days

Plus Sales/Property Tax, if applicable.

CONFIDENTIAL AND PROPRIETARY, COPYRIGHT © 2002-2009, ACCELERATED CARE PLUS CORP., ALL RIGHTS RESERVED, #PPT 0208 Rev3 19

AppendixAppendix


AddAdd--On PricingOn Pricing

• Omnistim® FX2 or 500: $150/month

• Omnisound®: $150/month

• Megapulse®: $300/month

• Neuroprobe®: $225/month

• OmnicycleTM: $300/month

* Cancellation agreement- 30 days


• Increases neuromuscular recruitment by decreasing nerve and muscle disuse atrophy

• Increases strength using only mild muscle twitch contractions (comfort)

• Decreases spasticity and hypertonicity

• Accelerates neuromuscular return for stroke victims

• Recent research with COPD patients using Omnistim® FX2 demonstrated a 39% increase in Quad strength and a 36% improvement in walking distance

General Benefits of Electrical Stimulation:

Weakness and Disuse AtrophyWeakness and Disuse Atrophy


Chronic and Acute PainChronic and Acute Pain

MEGAPULSE IISHORTWAVE DIATHERMY

Ultrasound, Shortwave Diathermy and Electrical Stimulation are used to:

• Decrease acute, subacute and chronic pain in a wide variety of conditions

• Relieve muscle spasm


Shortwave Diathermy, Ultrasound and/or Electrical Stimulation are used to:

• Increase local circulation to reduce acute and chronic inflammation and edema

• Decrease pain and joint stiffness associated with edema

• Provide muscle pump (Electrical Stimulation) to reduce edema

EdemaEdema


ContracturesContractures

Ultrasound, Shortwave Diathermy and/or Electrical Stimulation are used to:• Decrease pain

• Reduce tone in spastic muscles

• Increases soft tissue extensibility through heating the soft tissue, which allows for stretching of collagen fibers in the joint capsule, ligaments and tendons without tissue damage

POST NERVE BLOCK 1 TXPRE NERVE BLOCK


Falls and Loss of BalanceFalls and Loss of Balance

The ACP Fall Prevention Program:• Thoroughly assesses risk factors – strength, coordination, ROM, balance, vision, pain,

cognition, continence, hx of falls, meds, co-morbidities, etc.

• Rehab focuses treatment to overcome barriers to function in order to improve outcome.

• Targets strength, ROM, balance, and coordination to decrease risk of falls and maintenance of functional independence.

• Uses physical agent modalities as appropriate in the clinical pathways for fall prevention treatment


• Electrical Stimulation for retraining and strengthening the pelvic floor muscles uses surface electrodes placed on the accessory muscles

• Electrical stimulation is used in conjunction with pelvic muscle exercises, prompted voiding, urge inhibition training, voiding diary and medication management

Urinary IncontinenceUrinary Incontinence

0

1

2

3

4

5

6

7

Prio r to Tre atm e n tIn te rve n tio n

Afte r Tre atm e n tIn te rve n tio n

Clinical Analysis of 48 Continence Improvement Case Studies

Average Decrease in U.I. episodes – 4.89

Average number of treatment sessions was 26.6 to achieve an average decrease of 4.89 incontinent episodes per day


Wound HealingWound Healing

Ultrasound, Shortwave Diathermy, and/or Electrical Stimulation:

• Accelerates healing of vascular, arterial, and pressure ulcers by increasing circulation

• Assist in the management of symptoms associated with wounds such as pain and edema

12/2/97 4.5 x 4.5 x .5 cm 12/19/97 3.5 x 4.5 x.3 cm

1/14/98 2.8 x 3.5 cm1/27/98 2.0 x 2.8 cm

2/18/98 1.4 x 1.0 cm 3/12/98 .5 x .5 cm


Resident # 1 RVC 344.33$ 14 RUC 450.09$ 14 4,820.62$ 6,301.26$ 1,480.64$ Resident # 2 RHC 309.70$ 30 RVC 344.33$ 30 9,291.00$ 10,329.90$ 1,038.90$ PART A IMPACT DUE TO ACP INTERVENTION 2,519.54$ Lease Cost for 1 month= $950 ($950.00)

NET PART A POSITIVE REVENUE IMPACT DUE TO ACP for 30 days 1,569.54$

Part A Case Mix Improvement due to ACP ModalitiesGastonia, NC - a sample of residents from 6/16/04 to 7/15/04

Total Revenue w/ACP ACP BENEFITRUG with

ACP Per Diem # Days Total Revenue w/o ACPResident RUG w/o

ACP Per Diem # Days

Sample Part A ImpactSample Part A Impact


Resident # 1 RVB 406.00$ 23 RUB 490.34$ 23 9,338.00$ 11,277.82$ 1,939.82$ Resident # 2 RVC 419.99$ 29 RUC 547.75$ 29 12,179.71$ 15,884.75$ 3,705.04$ Resident # 3 RVB 406.00$ 38 RUB 490.34$ 38 15,428.00$ 18,632.92$ 3,204.92$ Resident #4 RVB 406.00$ 24 RUB 490.34$ 24 9,744.00$ 11,768.16$ 2,024.16$ Resident # 5 RVB 406.00$ 14 RUB 490.34$ 14 5,684.00$ 6,864.76$ 1,180.76$ Resident # 6 RVC 419.99$ 11 RUC 547.75$ 11 4,619.89$ 6,025.25$ 1,405.36$ Resident # 7 RVB 406.00$ 11 RUB 490.34$ 11 4,466.00$ 5,393.74$ 927.74$ PART A IMPACT DUE TO ACP INTERVENTION (without considering cost of therapy ) 14,387.80$ Lease Cost for 2 months = $1900.00 ($1,900.00)


Part A Case Mix Improvement due to ACP ModalitiesNiantic, CT - a sample of residents from install 6/1/04 to 7/23/04

Resident RUG w/o ACP Per Diem # Days RUG with

ACP Per Diem # Days Total Revenue w/o ACP

Total Revenue w/ ACP ACP BENEFIT



Resident # 1 (Bd) RHB 286.39$ 30 RUB 412.32$ 30 8,591.70$ 12,369.60$ 3,777.90$ Resident # 2 (By) RMC 302.18$ 46 RUC 450.09$ 46 13,900.28$ 20,704.14$ 6,803.86$ Resident # 3 (Ck) RHB 286.39$ 30 RVB 333.84$ 30 8,591.70$ 10,015.20$ 1,423.50$ Resident #4 (Cr) RHB 286.39$ 30 RVB 333.84$ 30 8,591.70$ 10,015.20$ 1,423.50$ Resident # 5 (Er) RHB 286.39$ 30 RVB 333.84$ 30 8,591.70$ 10,015.20$ 1,423.50$ Resident # 6 (Fn) RHB 286.39$ 30 RUB 412.32$ 30 8,591.70$ 12,369.60$ 3,777.90$ Resident # 7 (He) RHC 309.70$ 46 RVB 333.84$ 46 14,246.20$ 15,356.64$ 1,110.44$ Resident # 8 (Hr) RMB 271.90$ 16 RVB 333.84$ 16 4,350.40$ 5,341.44$ 991.04$ Residnet # 9 (Jn) RHB 286.39$ 30 RVB 333.84$ 30 8,591.70$ 10,015.20$ 1,423.50$ Resident # 10 (WJN) RVC 344.33$ 40 RUC 450.09$ 40 13,773.20$ 18,003.60$ 4,230.40$ Resident # 11 (St) RHB 286.39$ 30 RVB 333.84$ 30 8,591.70$ 10,015.20$ 1,423.50$ Resident # 12 ( Hy) SE2 267.90$ 30 RHC 309.70$ 30 8,037.00$ 9,291.00$ 1,254.00$ Resident # 13 (Lr) SE2 267.90$ 30 RHC 309.70$ 30 8,037.00$ 9,291.00$ 1,254.00$ Resident # 14 Rk) RVC 344.33$ 30 RUC 450.09$ 30 10,329.90$ 13,502.70$ 3,172.80$ PART A IMPACT DUE TO ACP INTERVENTION 33,489.84$ Lease Cost for 2 months = $1900 ($1,900.00)


Total Revenue w/ ACP

ACP BENEFIT

Part A Case Mix Improvement due to ACP ModalitiesMOORESVILLE, NC - a sample of residents from install 6/16/04 to 7/31/04

Resident RUG w/o ACP

Per Diem # Days RUG with ACP

Per Diem # Days Total Revenue w/o ACP



New OmnicycleNew OmnicycleTMTM Rehabilitation Cycling SystemRehabilitation Cycling System

• The OmnicycleTM accommodates post-acute patients who may not typically be able to participate in therapeutic exercises due to lack-of-strength, coordination, paralysis and other conditions

• The System provides UE & LE training in three “motor-assist” modes:

- “Assisted” exercise- “Active-assisted” exercise- “Active” exercise

• Expanded therapy services for Neuro, ortho and cardio rehabilitation

• Biofeedback training and spasticity control• Direct wheelchair access eliminates transfers• Integrated (chest) heart monitor and voice activated

“stop”• Large Color Display• Variable pedal length/radius


Therex Through the Continuum of Care Therex Through the Continuum of Care

• Supports post-acute exercise, even with partial motor control and significant muscle inhibition - all the way through to active resistance training

• PENS and Biofeedback options improve neuro, muscular and functional re-education

• Supports the following ACP “Clinical Solutions” for Stroke Recovery, Joint Replacement, Arthritis, COPD, Neuromuscular Re-education

The OmnicycleTM addresses a broader spectrum of patients and conditions than traditional “resistance” cycling systems

FULL FUNCTION PATIENTS

Facilitate Appropriate Length of Stay

Reach Appropriate RUGS levels

Part B Revenue from previously

untreated patients

Address MDS - Compliance - Regulatory

ACPSuperior Outcomes

and a Stronger Clinical Practice

Doctor & Discharge Planner Referrals

Improve Quality Mix

Develop Post Acute Outpatient Opportunities

Build Census

When YouWhen You’’re Passionate About Patient Carere Passionate About Patient Care……GREAT THINGS HAPPEN!GREAT THINGS HAPPEN!

Create Marketing Differentiation

Enhance Community image with Clinical Superiority

Improve discharge destination

Proactively manage liability risks

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