Proton Facility Economics: Single-Room Centers
Proton Facility Economics: Single-Room Centers
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DOI：
10.1016/j.jacr.2018.07.020
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发表时间：
2018-12-01
影响因子：
4.5
通讯作者：
Johnstone, Peter A. S.
中科院分区：
文献类型：
--
作者：
Kerstiens, John;Johnstone, Gregory P.;Johnstone, Peter A. S.
目的：我们先前已经描述了质子束治疗中心，特别是四到五个房间的中心的财务可行性的简单情况下的核心性质。在该出版物发布后的5年里，这种建筑已经急剧放缓，较小的单间项目正在流行。我们现在试图展示在什么情况下一个单室系统是最佳的财务可行性。材料和方法：一个“标准”的建设成本和债务为4000万美元的一个单一的龙门系统被假定，与75%的建设资金通过标准的20年融资。然后，我们建立了一个统计分析模型，得出最佳的情况下，每天所需的组合，以支付建设和还本付息costs.Results：我们以前发表的是，一个单一的机架只治疗复杂的病人将需要应用85%的治疗插槽简单的服务债务，虽然它会支付其债务治疗4个小时的简单病人。随着商业模式的改变，债务维持、利润和运营成本在一定程度上降低了增加大量简单患者的商业案例。债务维持是可能的，只有13%的日常病人的40%的医疗保险的情况下组合，但这些数字是非常敏感的持续患者throughput.Conclusions：即使在一个单间系统，减少整体债务，使用免税融资，并有一个案件负荷强调简单，私人付款人的病人是最重要的财政健康的设施。如果没有足够的病人，未使用的能力是一个巨大的风险。
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.