Patient selection and patient referral are pivotal.

In the past centers with 4 or even 5 treatment rooms projected to treat over 2000 patients annually. To achieve half of that counts as a major success — a success that very few centers will achieve.

The overall cost of a proton therapy center has come down considerable since the early days of proton therapy. Revenues are also coming down, however. More and more healthcare insurers want to see more evidence of the clinical benefit proton therapy has over other radiotherapeutic modalities. In several countries they are bringing down their reimbursement rates as well.

Depending on the definition of what constitutes significant clinical benefit, between 5 and 15% of all patients receiving radiotherapeutic treatment for a malignancy qualify for proton therapy. To know how high a percentage is realistic for a given initiative — and then how to identify these patients — is a challenge.

Too many centers are treating patients who will have only a marginal benefit, if any. The so called “model-based approach” as introduced in the Netherlands — using Normal Tissue Complication Probability (NTCP) models to predict the likelihood of reduction of serious side-effects using proton therapy — is a big step forward in this respect. But no matter how you want to do it, getting patient selection right takes an effort.

An effort potential referrers are unlikely and or or unable to make. If a doctor can’t tell for sure whether a patient will benefit from proton therapy, the patient is unlikely to be referred. If external referral is essential to make a success of your proton therapy center (and it usually is) work on reaching out and building a network has to start early.

How many patients are likely to benefit from proton therapy? What are realistic internal referral numbers?  How many external referrals are needed? Where might they come from? What are referrers in need of?

Trees with Character can help you to get these questions answered.

 

***

If you found this to be of interest perhaps you may want to read the following original contributions: Solutions in proton therapy — for initiatives (a report), Procuring proton therapy equipment (a case) and A Business Case for a proton therapy initiative (a case).

 

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This is how we make proton therapy a success

Independent consultancy made the difference for us.

Proton therapy vendors have a lot of expertise and a need to sell equipment. They may not protest when unrealistic assumptions are made. Some consultants combine great expertise with ties to a vendor. Independent consultancy can make a difference.

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You can start to minimise risk in proton therapy today.

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Proton Therapy’s biggest problem is lack of transparency.

Proton Therapy's biggest problem is lack of transparency. Initiatives don't share their overall aims, vendors focus on technology. Everybody is blind to the other side's needs and capabilities. But there is another way.

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Proton therapy technology is the least of your worries.

There is too much risk in the field of proton therapy, but the problem is not the technology. Focussing on technology often results in underestimating the real challenges. Challenges a vendor may help you with.

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Patient selection and patient referral are pivotal.

Many proton therapy centers struggle because of an unrealistic projection of the number of patients that will be treated. In the past, and even in the present, the number of patients projected to be treated was simply the number that was required to make the business case look good. Today we know that the most successful centers treat, on average, no more than 300 patients per treatment room. But to achieve even this number takes great effort. There is the challenge of identifying the patients who will benefit from proton therapy, and there is the challenge of getting these people referred to the center.

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Don’t buy equipment, identify the right vendor.

Initiatives who want to provide proton therapy treatments — often hospital organisations — are confronted with very complex and very capital intensive equipment they have never procured before. A proton therapy project is perceived as a major risk, and rightly so. Too many centers have failed or are failing. The risk lies not with the equipment, however. All vendors build reliable machinery delivering identical protons. Not all vendors, however, provide the same expertise and solutions. Initiatives should not focus on technology, but on identifying the vendor who is best able to meet their particular challenges.

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You can start to minimise risk in proton therapy today.

A decision is a conclusion reached after careful consideration. If you have to think about something it means this something is not transparent. If you take a decision when something is not transparent risk increases. This risk is minimised by unambiguous aims and access to expertise. What is it that you need to achieve? Who is the expert that will help you achieve it? Trees with Character helps with both.

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Proton therapy technology is the least of your worries.

Cyclotrons and synchrotrons alike are built to last for decades — as is shown by the early proton therapy centers who became operational in the previous millennium. To this day, however, the complexity of the equipment often is an initiative’s biggest concern and many resources are spent on trying to understand it. Meanwhile none of the proton therapy centers who failed failed because of the technology. There are other, much more relevant issues and challenges to be considered.

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Independent consultancy made the difference for us.

Proton therapy vendors have a lot of expertise. They also need to sell their equipment and associated services and may not point out which of an initiative’s assumptions are unrealistic. Some consultants possess great expertise — as well as an agreement with a vendor. Independent consultancy can make a difference. Independent consultancy means that the only interest to consider is your interest. Trees with Character will help you to make the right choices.

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Proton Therapy’s biggest problem is lack of transparency.

Initiatives don’t share their overall aims, vendors focus on technology. Everybody is blind to the other side’s needs and capabilities. Without transparency everything is a risk. Everybody is looking for safety and control. Many resources are spent on inspections, on meetings, on the contract. But there is another way.

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