The economics and future financial outlook for the medical device industry. Presented by Martin Gold at Credit Suisse MedTech Day on March 24, 2009. Focus is on orthopedics and cardiovascular.

1. Economic Sales Strategies

2. Note: A margin is calculated as payments minus costs, divided by payments; margins are based on Medicare-allowable costs. Analysis excludes critical access hospitals. Medicare inpatient margins include services covered by the acute inpatient prospective payment system. Overall Medicare margin covers acute inpatient, outpatient, hospital-based home health and skilled nursing facility (including swing bed), and inpatient psychiatric and rehabilitation services, plus graduate medical education. Source: Report to the Congress: Medicare Payment Policy . March 2009 Overall Medicare and Medicare Inpatient Margins

3. Note: Data are for all hospitals covered by Medicare acute inpatient prospective payment system in 2007. A margin is calculated as payments minus costs, divided by payments; margins are based on Medicare-allowable costs. Overall Medicare margin covers acute inpatient, outpatient, hospital-based skilled nursing facility (including swing bed) and home health, and inpatient psychiatric and rehabilitation services, plus graduate medical education. Source: Report to the Congress: Medicare Payment Policy . March 2009 Hospital Medicare margins

4. Effects of Economic Crisis on Hospitals

5. Effects of Economic Crisis on Hospitals

7. Win the Hearts & Minds of Physicians

8. Hospitals Engage Physicians

9. Source: ECRI Institute Navigate the Process for New Technology

10. Requests for Proposals (RFPs) The request for proposal (RFP) process is a widely accepted purchasing tool that, when done correctly, allows hospitals to save time and money. - “Find the True Value in RFPs.” Supply Chain Solutions . November 2007.

11. Medical Devices and DRGs Included in the DRG weight is the cost of all technology items utilized during the course of a patient’s stay in the hospital. As new technologies and treatments are developed, they are assigned to a DRG based upon the patient condition being treated and the nature of the treatment. Medicare provided for additional payment for new technology used in the inpatient setting through the New Technology Inpatient Add-On Payment The New Technology Add-On Payment is additional to the DRG payment

12. APC Categories Device Dependent APCs Clinical APCs APCs that are associated with existing medical and surgical procedures New Technology APCs APCs that address new medical procedures and technologies APCs containing procedures that cannot be provided without the use of one or more devices

13. Evaluating a New Technology