One and Two Room Proton Therapy Solutions

Addition to Current

Radiation Facility Program

Some features areunder development andwill be subject to reviewby competent authorities(FDA, Notified bodies,et al...)

Proton Therapy Myths and Realities – What You Need To Know

• 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

Risk Factors - Learning From Experience

• 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?

The Solutions For A Viable Proton Facility

• 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

Proton International, USA Solutions – Cost• 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

Proton International, USA Solutions – Ownership and Control

• 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

Proton International, USA Solutions – Reimbursement

• 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!!

Proton International, USA Solutions – Clinical Applications

• 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

The Proton International, USA Turnkey Solution

• 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

The Proton International, USA Turnkey Solution

• 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

Proton International, USA Operations Services

• 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

What Do We Do Next?

• 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