John Kerstiens1, Gregory P Johnstone2, Peter A S Johnstone3. 1. Cancer Care Centers of Brevard, Melbourne, Florida. 2. Oncology Clinic Foundation, Ochsner Cancer Institution, New Orleans, Louisiana. 3. Departments of Radiation Oncology and Health Outcomes & Behavior, Moffitt Cancer Center & Research Institute, Tampa, Florida. Electronic address: peter.johnstone@moffitt.org.
Abstract
OBJECTIVE: We have previously described the central nature of simple cases for financial feasibility of proton beam therapy centers-especially four- to five-room centers. In the 5 years since that publication, such construction has slowed drastically, and smaller, single-room projects are in vogue. We now seek to show under what circumstances a single-room system is optimally financially viable. MATERIALS AND METHODS: A "standard" construction cost and debt for a single gantry system of $40 million was presumed, with 75% of the construction funded through standard 20-year financing. We then modeled a statistical analysis, deriving the optimal case mix required daily to cover construction and debt service costs. RESULTS: We previously published that a single gantry treating only complex patients would need to apply 85% of its treatment slots simply to service debt, though it would cover its debt treating 4 hours of simple patients. As the business model has changed, debt maintenance, profit and operational costs have somewhat reduced the business case for adding a large number of simple patients. Debt maintenance is possible with as little as 13% of daily patients for a 40% Medicare case mix, but these numbers are critically sensitive to continued patient throughput. CONCLUSIONS: Even in a single-room system, reducing overall debt, using tax-exempt financing, and having a case load emphasizing simple, private payer patients is paramount to fiscal health of the facility. Unused capacity is a huge risk if insufficient patients are available.
OBJECTIVE: We have previously described the central nature of simple cases for financial feasibility of proton beam therapy centers-especially four- to five-room centers. In the 5 years since that publication, such construction has slowed drastically, and smaller, single-room projects are in vogue. We now seek to show under what circumstances a single-room system is optimally financially viable. MATERIALS AND METHODS: A "standard" construction cost and debt for a single gantry system of $40 million was presumed, with 75% of the construction funded through standard 20-year financing. We then modeled a statistical analysis, deriving the optimal case mix required daily to cover construction and debt service costs. RESULTS: We previously published that a single gantry treating only complex patients would need to apply 85% of its treatment slots simply to service debt, though it would cover its debt treating 4 hours of simple patients. As the business model has changed, debt maintenance, profit and operational costs have somewhat reduced the business case for adding a large number of simple patients. Debt maintenance is possible with as little as 13% of daily patients for a 40% Medicare case mix, but these numbers are critically sensitive to continued patient throughput. CONCLUSIONS: Even in a single-room system, reducing overall debt, using tax-exempt financing, and having a case load emphasizing simple, private payer patients is paramount to fiscal health of the facility. Unused capacity is a huge risk if insufficientpatients are available.
Authors: Matthew K Forsthoefel; Elizabeth Ballew; Keith R Unger; Peter H Ahn; Sonali Rudra; Dalong Pang; Sean P Collins; Anatoly Dritschilo; William Harter; Nitika Paudel; Brian T Collins; Jonathan W Lischalk Journal: Front Oncol Date: 2020-05-29 Impact factor: 6.244
Authors: Alexander Lin; John H C Chang; Ryan S Grover; Frank J P Hoebers; Upendra Parvathaneni; Samir H Patel; Juliette Thariat; David J Thomson; Johannes A Langendijk; Steven J Frank Journal: Int J Part Ther Date: 2021-06-25