Although proton therapy is considered effective, its uptake in clinical practice has been hindered by the high cost of establishing a facility and the lack of consistent insurance reimbursement, wrote a team led by John Kerstiens of Cancer Care Centers of Brevard in Melbourne, FL. Along with colleagues Gregory Johnstone of the Ochsner Cancer Institute in New Orleans and Dr. Peter Johnstone of the Moffitt Cancer Center in Tampa, FL, Kerstiens sought to identify what factors best contribute to a proton therapy center's financial health in the current healthcare environment.
Multiple-room proton therapy centers can cost upward of $160 million, according to the authors. Over the past few years, a number of these centers have closed, due in part to the effects of the Affordable Care Act, which reduced reimbursement for the treatment. In response, interest in single-room centers has grown, the team wrote.
For the current study, Kerstiens and colleagues assumed a standard construction cost and debt for a single-gantry system room of $40 million, with 75% of the construction funded through 20-year financing. They then calculated the optimal case mix required to cover construction and debt costs.
Their analysis was based on a single proton beam therapy room running 15 hours daily, with all treatment slots filled. Room time was modeled at 30 minutes for complex cases and 15 minutes for simple cases. The group assumed routine use of pencil-beam scanning, a technique that reduces throughput time.
The researchers found that a center's ability to pay its daily debt principal and interest was affected not only by case complexity but also by payor mix: As both complexity and Medicare-based payor mix increased, the percentage of daily patients needed to pay principal and interest also increased.
The group outlined the following factors that would ensure the financial health of a new $40 million single-room center:
- Establish a tax-exempt, hospital-based facility.
- Finance completely with donations, or donations that pay up to 75% of construction and installation.
- Have a case mix that fills all available proton treatment slots, minimizing complex cases and those with Medicaid reimbursement.
"In this scenario, as few as five patients (10% to 15% of patients treated per day) would be allocated to covering principal and interest," Kerstiens and colleagues wrote.
Although it may seem obvious, decreasing debt and increasing private insurance coverage is key to a proton therapy center's success, the group concluded.
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