WHAT IS THE ANSAR AND WHY HAS DON BEEN RECOMMENDING IT FOR MORE by xarrnet

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									WHAT IS THE ANSAR AND WHY HAS DON BEEN
  RECOMMENDING IT FOR MORE THAN 6
                YEARS?
 (other than the $55,000 to $93,000 avg increase
           to primary care physicians?)

                           IT SAVES LIVES.
                         IT IMPROVES LIVES.
The Ansar is a device that uses a blood pressure cuff, 3 lead EKG, computer and a
software developed by Harvard and MIT to perform heart rate variability in association
with respiration variability to detect Autonomic Nervous System dysfunctions and
imbalances. This test is able to tell whether a patient with CHF has too many beta-
blockers or not enough. Keeping in mind that the American College of Cardiology says
that 30% of patients with CHF have TOO-MANY beta blockers on board, this test
becomes invaluable. The test is effective with diabetes, hypertension, syncope, CHF,
Orthostatic Hypotension, Sleep Apnea, Pediatrics and Geriatrics.




          A. Why ANS monitoring in Diabetes?
             Autonomic Nervous System Monitoring is recommended as a Standard of
             Care by the AAN, ADA, AHA, AAFP, Juvenile Diabetes Association,
             National Heart, Lung and Blood Institute, and the National Diabetes,
             Digestive and Kidney Diseases.
             Diabetic patients Parasympathetic and Sympathetic systems are both out
             of balance. Each patient is metabolically different; therefore, there is no
             one example that best explains a “common situation” for Diabetes. The
             one thing that is a constant is an imbalance. The more out of balance the
             Parasympathetic and Sympathetic is, the faster the disease will progress.
             The physician, after identifying the severity of the autonomic imbalance
     with the ANX 3.0, would then customize a treatment plan to bring both
     branches into balance.

B.      Why ANS monitoring in Hypertension?
     Autonomic Nervous System Monitoring is recommended as a Standard of
     Care by the AAN, ADA, AHA, AAFP, Juvenile Diabetes Association,
     National Heart, Lung and Blood Institute, and the National Diabetes,
     Digestive and Kidney Diseases.
     Parasympathetic tone is low and Sympathetic tone is high in Hypertensive
     patients. Once the physician reduces sympathetic-blockers they can lower
     Sympathetic tone and bring the two branches closer to balance. Another
     situation that arises is Autonomic Hypertension. In this case,
     Parasympathetic tone is high and the Sympathetic tone is abnormally or
     exceptionally high, which indicates PPS. The physician would need to
     treat the Parasympathetic tone and then they would be able to correctly
     treat the Sympathetic tone and restore balance.


C.      Why ANS monitoring in Orthostatic Hypotension?
     Autonomic Nervous System Monitoring is recommended as a Standard of
     Care by the AAN, ADA, AHA, AAFP, Juvenile Diabetes Association,
     National Heart, Lung and Blood Institute, and the National Diabetes,
     Digestive and Kidney Diseases.
     During the postural change the Parasympathetic tone abnormally increases
     and/or the Sympathetic tone abnormally decreases in patients with
     Orthostatic Hypotension. Physician must correct abnormality to resolve
     Orthostatic Hypotension.


D.    Why ANS monitoring in Cardiovascular Autonomic
     Neuropathy?
     Autonomic Nervous System Monitoring is recommended as a Standard of
     Care by the AAN, ADA, AHA, AAFP, Juvenile Diabetes Association,
     National Heart, Lung and Blood Institute, and the National Diabetes,
     Digestive and Kidney Diseases.
     Both the Parasympathetic and Sympathetic tone are low in patients with
     Cardiovascular Autonomic Neuropathy. The physician would manage
     drugs to increase relative Parasympathetic tone to preserve longevity and
     quality of life. If the relative Sympathetic tone is low but still much higher
     than Parasympathetic tone, the patient is in risk of sudden death.

E.      Why ANS monitoring in Syncope?
     Autonomic Nervous System Monitoring is recommended as a Standard of
     Care by the AAN, ADA, AHA, AAFP, Juvenile Diabetes Association,
                National Heart, Lung and Blood Institute, and the National Diabetes,
                Digestive and Kidney Diseases.
                Peak Sympathetic response to postural change approximately the same or
                higher than peak response to valsava is associated with syncope in young
                people. Too much response Parasympathetic response through out the test
                is associated with syncope with older people. Physician would then
                customize therapy.

           F.      Why ANS monitoring in Sleep Apnea?
                Autonomic Nervous System Monitoring is recommended as a Standard of
                Care by the AAN, ADA, AHA, AAFP, Juvenile Diabetes Association,
                National Heart, Lung and Blood Institute, and the National Diabetes,
                Digestive and Kidney Diseases.
                It is known that with sleep apnea the Sympathetics are exceedingly high
                and the Parasympathetics are low normal to low. So much so that the
                natural inversion that should take place in the evening fails. The high
                Sympathetics (due to the stresses of sleep apnea), prevent the inversion
                and thereby prevent proper sleep. CPAP helps to remove some of the
                stressors that are associated with sleep apnea and over time the
                Sympathetics decrease and the Parasympathetics normalize. ANS
                monitoring can document this and, thus, document CPAP compliance.


           G.     Why ANS monitoring in Pediatric and Geriatric
                Diseases?
                Autonomic Nervous System Monitoring is recommended as a Standard of
                Care by the AAN, ADA, AHA, AAFP, Juvenile Diabetes Association,
                National Heart, Lung and Blood Institute, and the National Diabetes,
                Digestive and Kidney Diseases.
                In Geriatric Diseases both the Parasympathetic and Sympathetic tone are
                depleted due to age in addition to the disease. Low normal balance
                (Slightly elevated parasympathetic tone) preserves quality of life and
                longevity.
                In Pediatrics diseases Parasympathetic tone is excessive. Physician would
                use a low dose, short term, anti-cholinergic. (String of disorders include:
                ADD, Depression, Anxiety, Bipolar Disorder, and Sleep Problems)

It is the standard of care by many associations, hospitals and groups. Patients with any
of the above diseases should be tested twice a year, with the exception of Medicare
patients in New York. If a patient is tested and determined that a modification to the
treatment or therapy (such as an increase in the Coreg, reduction in the Toprol, starting
the patient on Midodrine or ProAmitine, etc…) is called for, then the patient should be
tested in 8 weeks as it takes about 6-7 weeks to make a noticeable change in the ANS.
Medicare patients in New York have the only LCD in the country, at
http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=3134&lcd_version=10&show=all
which limits the coverage to the following diagnosis:

255.2    ADRENOGENITAL DISORDERS
333.0    OTHER DEGENERATIVE DISEASES OF THE BASAL GANGLIA
337.0    IDIOPATHIC PERIPHERAL AUTONOMIC NEUROPATHY
337.1    PERIPHERAL AUTONOMIC NEUROPATHY IN DISORDERS CLASSIFIED
         ELSEWHERE
337.20 REFLEX SYMPATHETIC DYSTROPHY UNSPECIFIED
337.21 REFLEX SYMPATHETIC DYSTROPHY OF THE UPPER LIMB
337.22 REFLEX SYMPATHETIC DYSTROPHY OF THE LOWER LIMB
337.29 REFLEX SYMPATHETIC DYSTROPHY OF OTHER SPECIFIED SITE
337.3    AUTONOMIC DYSREFLEXIA
337.9    UNSPECIFIED DISORDER OF AUTONOMIC NERVOUS SYSTEM
358.1    MYASTHENIC SYNDROMES IN DISEASES CLASSIFIED ELSEWHERE
458.0    ORTHOSTATIC HYPOTENSION
458.1    CHRONIC HYPOTENSION
742.8    OTHER SPECIFIED CONGENITAL ANOMALIES OF NERVOUS SYSTEM
780.2    SYNCOPE AND COLLAPSE
785.0    TACHYCARDIA UNSPECIFIED



The CMS website does not have a Medicare Limited Coverage Decision on any other
state than New York.

Office managers and CFOs love it for it’s profitability in a practice, The 5 year license of
the software, $1.00 buyout of the hardware and a 5 year complete warranty is leased to a
practice or physician for $895 a month, plus local taxes. If a practice wishes to pay cash
or arrange their own financing, the cost is $42,000.

The average Medicare allowed is $130.00. Your locality may be a little higher or lower,
depending on the Medicare allowed. Private and commercial insurances usually pay the
doctor between $155 and $265, with the exception of those in the 5 states where the
doctors have signed contracts for below Medicare rates (PA, OH, NY, NJ, MD and the
Orlando area of Florida)

Almost every single primary care practice we have sold an ANSAR to over the past 6
years tests between 3 and 4 patients a day – PER PROVIDER. Some of our practices
with mid levels and multiple physicians are testing between 10 and 12 patients a day.
What does this do to your income?

                    RETURN ON INVESTMENT (ROI)*
Cost per Patient                                      $40.47
Average Reimbursement per Patient             $130.00
Average Profit per Patient                     $89.53
1 Patient per Day
                             Monthly                      Annual
Cost                         $895                         $10,200
Income                       $2,730                       $32,760
Profit             $1,835                                 $22,020
2 Patients per Day
Cost per Patient                                      $21.31
Average Reimbursement per Patient             $130.00
Average Profit per Patient                     $108.69
                             Monthly                      Annual
Cost                         $895                         $10,200
Income                       $5,460                       $65,520
Profit                       $4,565                       $54,780

5 Patients per Day
Cost per Patient                                      $8.52
Average Reimbursement per Patient             $130.00
Average Profit per Patient                     $121.48
                             Monthly                      Annual
Cost                         $895                         $10,200
Income                       $13,650                      $163,800
Profit                       $12,755                      $153,065

   •   These calculations are based on a 21 working day per month schedule, and
       Medicare’s allowable payment per patient. This does not count the office visit
       paid by all carriers or rhythm strip charge, payable by most carriers other than
       Medicare. It does not count the $155 to $265 payment by most carriers. It is only
       calculated using the $130 payment for the combined 95921 plus the 95922.

The CPT codes are 95921 and 95922 and we have a letter from CMS that says these
codes CANNOT be bundled into the CCI edits. They are paid separately as one denotes
testing of the sympathetic nerves and the other is for the parasympathetic nerves.
You should also bill code 93040 as the 3 lead EKG rhythm strip is a necessary and
separately payable diagnostic test with the ANSAR.

WHICH CARRIERS PAY? The ONLY carrier that I have seen any problems with
payment in this country is the Alabama Blue Cross. I have never seen any denials from
any other carrier and I started selling this over 6 years ago.

RECOMMENDATIONS: I have physicians around the country that recommend this to
their colleagues. Some have been using it for more than 5 years and some have only been
using it a month or less. It would be my pleasure to provide anyone with some phone
numbers and names of physicians, if your physician is truly interested in talking to others.

We also have hundreds of EOBs from all kinds of carriers, from most parts of the country
and we’ll be glad to send those to you – including Medicare EOBs. Of course, the
patient’s name and HIC number is removed from the EOB, but the rest of the information
is there and in most cases, the name of the doctor as well. Our clients are happy to tell
others about what it has done to save the lives of their patients as well as what it has done
to the financial health of their practice.

MORE INFORMATION FOR YOUR DOCTOR

ANSAR: “Clinical Questions That Doctors Need Answered”
The 5 Questions all doctors need to have answered:
   1. What are the signs?
   2. How are they measured?
   3. What do the numbers mean?
   4. How can they be corrected with treatment?
   5. What is expected on follow-up?
Answers:
   1. Autonomic Symptoms (e.g., Vertigo, either upon standing or unexplained) and
      Chronic diseases.
   2. Respiratory activity analysis and heart rate activity analysis is combined to
      independently and simultaneously measure BOTH autonomic branches;
      qualitatively and non-invasively.
   3. Sympathetic (low frequency area, LFa) and Parasympathetic (respiratory
      frequency area, RFa) terms:
      a. At rest they show relative health (absolute levels), parasympathetic
                                                                       protection of
                                                                       the heart,
                                                                       and balance
                                                                       which can
         aid in titration of therapy
      b. During breathing challenges (deep breathing and Valsalva) they typically
         identify existence and level of autonomic dysfunction
      c. During Stand they indicate possible reasons for Vertigo and advanced
         autonomic dysfunction (including paradoxic parasympathetic syndrome,
         PPS).
4. Autonomic imbalance can be corrected using common medications,
          Agent         Nervous System Primary         Primary Effect
                           Affected          Site of
                                             Action
  Beta-1 Adrenergic   Sympathetics        Heart      ↓ Heart Rate
  Antagonists
  Beta-2 Adrenergic     Sympathetics        Lungs        ↑ Air Flow
  Agonists
  Alpha Adrenergic      Sympathetics        Vasculature Constrict
  Agonists                                              Vasculature
  Cholinergic           Parasympathetics Entire Body ↓ Parasympathetic
  Antagonists                                        activity
  Angiotensin Blockers Sympathetics         Kidneys      ↓ Blood Pressure
  Calcium-Channel       Sympathetics        Heart        ↓ Blood Pressure
  Blockers


                                         and there are basically only four
                                         abnormal autonomic states:
           a. Sympathetics are too high – consider sympathetic blockers (e.g., Beta-
              blockers, Calcium channel blockers, or Angiotensin blockers – ACE-Is or
              ARBs)
           b. Parasympathetics are too low - consider reducing anti-cholinergics or
              adding sympathetic blockade
                                                                   c. Parasympathetics
                                                                      are too high –
                                                                      consider anti-
                                                                      cholinergics (tri-
                                                                      cyclic anti-
              depressants, or SSRIs), or consider stimulating the sympathetics directly
              (e.g., adrenergic agonists if stand or pulmonary concerns), or consider
              reducing anti-cholinergics.
           d. Sympathetics are too low - consider reducing sympathetic blockade, or
              consider stimulating the sympathetics directly (e.g., adrenergic agonists if
              stand or pulmonary concerns).
                                                         5. A return to balance or
                                                             normalization of challenge
                                                             (e.g., stand) response is
                                                             expected. Establishing and
                                                             maintaining balance
       improves outcomes [Low, 2001], improves quality of life (eating and sleeping
       well, going to the bathroom by yourself, and having sex) and optimizes longevity
       [Singer, 2006]. It can also reduce the number of secondary disorders and
       symptoms. Testing two or more times per year to ensure balance is maintained
       detects adverse changes early and reduces the cost and time of intervention.



If you want additional info – call me at 903 839-7045 or email me at
donself@donself.com or fax us at 903 839-7069. We’re here to help you help your
patients and help yourselves. That’s why we’ve been in business for 19 years and we’re
published to more than 100,000 offices each and every month.

Don Self

								
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