We will work with you to develop a business plan and proforma that is specific to your clinical program, business assumptions and unique program needs. This plan will be used to support the financing for the center and will include income statements; cash flows; payer mix; clinical review; sources and uses of funds; and all required revenue, cost and related assumptions and plans.

Proton centers are complex undertakings, but adopting a building designed by Proton International will save you both time and money. Savings and risk reduction are embedded in innumerable design and engineering cost efficiencies derived from learned lessons. The equipment vendor will move into the building more quickly, which allows centers to open sooner. Even where a design not created by Proton International is favored, there are still substantial savings derived through the knowledge we bring to the process of design, construction and equipment set up. Our team has extensive expertise and experience in the areas of facility design, construction and maintenance management.

Facility Design
• Provide oversight and coordination of architects, engineers and all other design consultants to ensure adherence to schedules, budgets and timeframes.
• Offer drawing analysis and proactive coordination with the architect, engineers and other consultants to study methods and materials.
• For projects not using a Proton International design, we review and provide oversight of the design process to incorporate efficiencies that are realized in a Proton International projects.

Facility Construction
• Provide development and oversight of bidding, purchasing and contracting strategies.
• Offer on-site management of the construction process, from pre-construction through the post-construction and move-in phases.
• Oversee budget and schedule development and oversight, including detailed reporting and payment management.
• Ensure coordination of interfaces between building infrastructure, proton equipment and medical equipment installation.

Facility Maintenance Management
• Ensure that procedures and policies are established and implemented to take advantage of economies-of-scale and lessons learned from one facility to another.

It takes the experience of a full building cycle to understand how to efficiently commission a proton center. Having commissioned multiple centers, our team brings significant efficiencies in this area. Expertise in equipment selection, purchase, maintenance and support is essential for efficiently and successfully opening a proton center. We also host weekly vendor meetings and provide status updates to develop a comprehensive timeline and ensure all tasks are on or ahead of schedule. We utilize the most innovative technology and equipment in our proton centers to deliver cutting-edge treatments that produce the best possible results.

We are vendor neutral when selecting the equipment for our proton centers, and we evaluate each opportunity across all feasible providers to ensure the best combination of technology, price and terms.

Commissioning
Mechanical: Complete evaluation of all mechanical components of treatment room including
X-ray system, treatment couch, gantry, snout and laser system

CT: Proton specific calibration, transmission measurements and calculation of number-to-stopping-power rations (required by TPS)

Treatment Planning System: Collection of all data required for TPS beam modeling, comprehensive data collection for validation of TPS beam mode and source characterization for percentage depth dose, lateral profiles and output factors.

X-ray Patient Alignment System: Complete end-to-end test of data transfer and integrity, performance testing of all modes of patient alignment with high-precision anthropomorphic phantom (Manual, Fiducial and Automatic Registration), Patient Positioning System (treatment couch) motion accuracy testing with analysis of PPS precision for translational, rotational and small corrections.

OIS: Imaging system and treatment machine integration for network configuration, network traffic testing and application configuration.

End-to-end data transfer test: OIS to Imaging System to Treatment Machine to OIS.

TRS-398 output calibration, concurrent daily QA configuration and calibration of patient-specific devices: Configuration and testing for in-house milling as well as third-party suppliers.

Installation
• Oversee the equipment installation, ensuring the vendor meets and exceeds all contractual commitments and standards.
• Management of key milestones based on past experience from other centers.

We have developed an effective, low-cost solution that simultaneously limits healthcare entity balance sheet impact. By leveraging a debt service reserve fund guarantee provided by the healthcare entity, we are able to access tax-exempt/ taxable bond market rates that are historically low.

The debt service reserve fund guarantee would only be tapped if project revenues are not sufficient to cover principal and interest. At current market levels, the breakeven to cover debt service is approximately 20 patients per day. With an average patient load, the probability that the debt service reserve fund would be tapped is low.

This finance structure enables the project to be funded at levels close to where the healthcare entity would borrow on its own, without incurring the same balance sheet impact. The impact to the healthcare entity’s financials would be limited to the amount of the debt service reserve fund, not the total amount of debt issued.

We work with your team to identify and define the organizational structure needed to fulfill the goals and objectives of your center.

An ownership structure that will support the finance strategy, development services and the ongoing operational strategy helps ensure the clinical partner can maintain control and meet its financial obligations. Our team will help establish or define the role of ownership and the Board, create development and operational agreements, and provide training services.

Proton International provides all required training for physicians, physics, dosimetry and therapy. Our training program includes comprehensive curriculum on all aspects of proton treatment, clinic workflow, and the technology and equipment in the center. There are individualized curriculums for physicians, physicists, dosimetrists, nurses and radiation therapists.

Our training allows us and our affiliates to open and ramp up operations faster, as personnel are already proficient and experienced in all procedures and systems.

Purchasing, coordination and implementation of the multiple information technology (IT) systems must be integrated as one synchronized design and connected to a patient’s passage throughout their continuum of care. At Proton International, we achieve this objective through a series of tasks including IT project management and infrastructure build-out, clinical systems acquisition and implementation, ancillary systems acquisition and implementation, external interfaces and connectivity, and start-up support.

IT Project Management
• Develop a project plan for all the IT-related tasks for the center.
• Coordinate the tasks and timeline with other disciplines (physics, facilities, clinical operations, etc.).
• Manage the project plan and oversee IT implementation tasks throughout the project.

IT Infrastructure Build-Out
• Identify IT infrastructure requirements (voice, data, wireless, servers, storage, PCs).
• Create configuration documents for bidding
• Manages vendor selection, infrastructure implementation and the audit/validation of infrastructure installation.

Clinical Systems Acquisition and Implementation
• Identify clinical system requirements
• Obtain, review and validate proposals for clinical systems.
• Work with appropriate clinical and other staff to implement and configure clinical systems.
• Coordinate training as needed.

Ancillary Systems Acquisition and Implementation
• Identify ancillary system requirements (billing, administrative, etc.).
• Obtain, review and validate proposal) for ancillary systems.
• Work with staff to implement and configure ancillary systems.
• Coordinate training as needed.

External Interfaces and connectivity
• Identify requirements for external system connectivity.
• Determine interface system requirements.
• Manage the acquisition and implementation of interface engine if needed.
• Coordinate the configuration and implementation of external interfaces with internal and external parties.

Start-up support
• Develop, manage, lead and document end-to-end testing of center systems workflow.
• Provide technical support for initial center start-up and patient treatment.

An effective proton center must be able to treat patients with the highest quality standards, a competent and well-recruited physician staff, a comprehensive medical program, treatment protocols and guidelines for prospective disease sites, and a research platform for clinical trial participation. Proton International provides all of these.