The Pipeline

Three lessons from proton therapy providers you need to learn


Catherine Castillo, Service Line Strategy Advisor

If the experience of operating proton centers is any indication, you may need to adjust your expectations for your center’s capacity and throughput before making a decision to enter the market.

Based on reports from various institutions at this year’s National Proton Conference, young proton centers are experiencing unanticipated challenges in their first years of operation, including slow ramp-up periods, high rates of referrals for complex cases, and workflow inefficiencies. When combined, these challenges have reduced centers’ total potential capacity and consequently dampened their financial outlook. 

Institutions considering protons must learn from the combined experience of existing centers and change their strategy, first by modeling realistic assumptions for throughput, capacity, and referrals. For those that ultimately decide to make the center a reality, it will also be crucial to seek opportunities to improve operational efficiency once the center is open for business. 

Here are our top recommendations for adjusting your proton therapy strategy:


Build ramp-up period delays into the business model

  • It takes time before a new center can operate at its planned capacity. When planning for your center, anticipate this ramp-up period and build it into the model to avoid an overestimation of revenue in the first years of business.

  • The actual duration of the period is affected by different factors, including the staff’s familiarity with protons. Early training or hiring staff with prior experience at other proton facilities can shorten the learning curve.

  • Base your opening strategy on minimizing downtime. By gradually adding patients to treatment plans, you can provide staff with the time they need to adjust and improve workflow. At multi-room facilities, give staff the opportunity to tweak patient scheduling around beam switches by opening one treatment room at a time.

Plan for a complex case mix and engage referral network

  • Centers are reporting significantly more referrals for patients with complex tumors and fewer of the high-volume disease sites, like prostate, than originally hoped for. Expect similar referral patterns for your center and focus on building the business by capturing “classic” proton cases with established clinical evidence of superiority, e.g. pediatric and neurological tumors, as well as emerging sites of research interest, including head and neck, GI, and lung cancers.

  • Given the actual case mix your center is likely to see, you will need to plan for longer treatment times (and thus, reduced capacity) to accommodate for the immobilization needs of pediatric patients and positioning challenges associated with complex cases.

  • Engage your targeted provider base early on to align referring physicians to your vision for the utilization of the proton center and secure more of the referrals you hope to treat.

Improve efficiency at every step of the treatment

  • To minimize downtime, continuously look for opportunities to increase throughput at different steps of the treatment appointment, including imaging, patient prep and positioning, QA procedures, intermediate checks, set up of in-room devices, etc.

  • Optimize scheduling by assigning patients to appointments based on their case complexity.

  • Keep abreast of research demonstrating efficacy of hypofractionated treatments, which could be implemented to open up capacity for additional patients.

More from Service Line Strategy Advisor

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