Addition to Current Radiation Facility Program Some features are under development and will be subject to review by competent authorities (FDA, Notified bodies, et al...) • Existing facilities are too large • Controversy reins within the radiation community on the best use of the particle • Once you announce you are interested everyone will come out of the woodwork to “pitch” protons • Often the information is wrong and self serving • Costs, proformas, business plans, and financing strategies are offered that are unrealistic • Often there is little to no experience involved with the group, even though they may say they have it. • There is no free lunch: • There is a better way • Protons are feasible • You need to lead with the clinical desire and focus • Match the financial and business terms as a result of the clinical needs and approach • Cost – Large expensive facilities require cash flows to repay the loans that are difficult achieve due to the large number of daily patients required to reach breakeven • Ownership and Control – Existing facilities often position the hospital and MDs as minority participants creating a program on campus that someone else controls • Reimbursement – Strong pressure on reimbursement for proton therapy and the use of the technology has implications for what you may treat and the resulting business plans. • Clinical Applications – Given the controversies how is the particle best used? • Build one or two room solutions under a cost structure and operational structure that can withstand reimbursement pressure • Match size to clinical demand and desires of the MD community and patient needs • Leverage experience and purchasing power • Be Smart, Understand and Include all costs, not just equipment and building as many will quote • Structure a financing solution that is low cost, long term, and does not demand unrealistic throughput assumptions • Above all own and control the project • Assure your clinical demands match your technology solution • Understand the various technology solutions to assure you are choosing wisely for your project • All In Project Costs Must Support Realistic Breakeven and Patient Throughput • Equipment • Building and Design • Financing Costs • Interest During Construction Period • Length of Time to First Patient (Most Important Driver of Cost) • Working Capital • Legal and Other Fees • PI, USA Can Provide Cost Effective Solutions That Can Tolerate Reimbursement Pressure: • Favorable Equipment Rates • Development Experience Multiple Centers • Less Expensive Financing Solutions • Reducing Time to First Patient • Full Turnkey Solutions For All Project Phases • Maintain 100% ownership • Minimize capital invested (4M for One Room) • Structure in a financially efficient manner • Long Term Single Digit Debt • There is no need for an external partner • Building One and Two Room Centers That Can Withstand Reimbursement Pressure • Minimize Cost • Establish Financing Strategies That Allow Reasonable Patient Numbers To Service the Debt • Stop The Madness – Focus On Reasonable Financial Returns For The Service. Why Are You Developing Protons? To Make Money Or To Have The Technology For Your Patients While Assuring Financial Viability? • Open A Center That Can Operate At Reduced PT Reimbursement • One Room Facilities That Can Work At Photon Rates!! • The Use Of Proton Therapy Should Be Driven Clinically Not Financially • Our Solutions Are Based On Effective Cost, Financing, and Equipment Strategies That Allow The Program To Focus On Clinical Applications Not “Filling” Rooms • Treat What You Want To Treat • Don’t Rely On One Diagnosis • Understand The Interplay Between Diagnosis, Fields, Throughput, Reimbursement and Project Viability. • There Are Viable Solutions That You Can Employ To Effectively Treat Your Patients In One and Two Room Facilities That Deliver Clinical Relevance With Financial Success • Project Business Plan and Feasibility • Equipment Selection and Purchase • Financing Package • Long Term Debt • Single Digit Rates • Low Equity Requirements 4M For One Room • Building Design • Project Management of Key Elements • Experienced Team Assures On Time On Budget Project Based On Experience From 4 Projects All Completed Ahead of Schedule and Under Budget • • • Management of Construction Management of Installation Management of Commissioning and Physics Oversight • Complete Clinical Envelope • Clinical Treatment Protocols • Clinical Research and Registry Set Up • All Required Training • • • • MDs Physicists Dosimetrists Others As Needed • Operations Oversight • Guaranteed Equipment Uptime • On Site Trained Engineers and Operators • All Periodic Maintenance • Emergency Response • All Spare Parts • Emergency Response • Software and Hardware Upgrades • Throughput Management • Insurance and Reimbursement Support • Initial Contracting • Ongoing Support • Initial Meeting To Present Program And Financial Proforma and Sensitivity Analysis • Collection Of Data To Review Project Specific Plans • Financial evaluation and clinical review • Enhance model with hospital payer mix • Enhance model with clinical expectations of treatment mix • Enhance model with hospital expected staffing model • Enhance model with unique hospital assumptions • Follow Up Meeting • Presentation Of Proforma And Plans • Provide Term Sheet