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 betablockers 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:
255.2 333.0 337.0 337.1 ADRENOGENITAL DISORDERS OTHER DEGENERATIVE DISEASES OF THE BASAL GANGLIA IDIOPATHIC PERIPHERAL AUTONOMIC NEUROPATHY 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 337.3 337.9 358.1 458.0 458.1 742.8 780.2 785.0 AUTONOMIC DYSREFLEXIA UNSPECIFIED DISORDER OF AUTONOMIC NERVOUS SYSTEM MYASTHENIC SYNDROMES IN DISEASES CLASSIFIED ELSEWHERE ORTHOSTATIC HYPOTENSION CHRONIC HYPOTENSION OTHER SPECIFIED CONGENITAL ANOMALIES OF NERVOUS SYSTEM SYNCOPE AND COLLAPSE 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 Average Reimbursement per Patient Average Profit per Patient $40.47 $130.00 $89.53
1 Patient per Day Monthly
Cost Income $895 $2,730
Annual
$10,200 $32,760
Profit $1,835 2 Patients per Day
Cost per Patient Average Reimbursement per Patient Average Profit per Patient $130.00 $108.69
$22,020
$21.31
Monthly
Cost Income $895 $5,460
Annual
$10,200 $65,520
Profit 5 Patients per Day
$4,565
$54,780
Cost per Patient Average Reimbursement per Patient Average Profit per Patient
$8.52 $130.00 $121.48
Monthly
Cost Income $895 $13,650
Annual
$10,200 $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, Primary Effect Agent Nervous System Primary Affected Site of Action Heart ↓ Heart Rate Beta-1 Adrenergic Sympathetics Antagonists Beta-2 Adrenergic Agonists Alpha Adrenergic Agonists Cholinergic Antagonists Sympathetics Sympathetics Lungs ↑ Air Flow
Vasculature Constrict Vasculature
Parasympathetics Entire Body ↓ Parasympathetic activity Kidneys Heart ↓ Blood Pressure ↓ Blood Pressure
Angiotensin Blockers Sympathetics Calcium-Channel Blockers Sympathetics
and there are basically only four
abnormal autonomic states:
a. Sympathetics are too high – consider sympathetic blockers (e.g., Betablockers, 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 anticholinergics (tricyclic antidepressants, 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