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Kerstiens J, Johnstone GP, Johnstone PAS. Proton Facility Economics: Single-Room Centers. J Am Coll Radiol 2018; 15:1704-1708. [PMID: 30158085 DOI: 10.1016/j.jacr.2018.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/09/2018] [Accepted: 07/20/2018] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
| | - Gregory P Johnstone
- Oncology Clinic Foundation, Ochsner Cancer Institution, New Orleans, Louisiana
| | - Peter A S Johnstone
- Departments of Radiation Oncology and Health Outcomes & Behavior, Moffitt Cancer Center & Research Institute, Tampa, Florida.
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Galle JO, Long DE, Lautenschlaeger T, Zellars RC, Watson GA, Ellsworth SG. Effects of Proton Center Closure on Pediatric Case Volume and Resident Education at an Academic Cancer Center. Int J Radiat Oncol Biol Phys 2018; 100:710-718. [DOI: 10.1016/j.ijrobp.2017.10.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/18/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
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Mejia EJ, O'Connor MJ, Lin KY, Song L, Griffis H, Mascio CE, Shamszad P, Donoghue A, Ravishankar C, Shaddy RE, Rossano JW. Characteristics and Outcomes of Pediatric Heart Failure-Related Emergency Department Visits in the United States: A Population-Based Study. J Pediatr 2018; 193:114-118.e3. [PMID: 29221691 DOI: 10.1016/j.jpeds.2017.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/01/2017] [Accepted: 10/11/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe the frequency, characteristics, and outcomes of heart failure-related emergency department (ED) visits in pediatric patients. We aimed to test the hypothesis that these visits are associated with higher admission rates, mortality, and resource utilization. STUDY DESIGN A retrospective analysis of the Nationwide Emergency Department Sample for 2010 of patients ≤18 years of age was performed to describe ED visits with and without heart failure. Cases were identified using International Classification of Disease, Ninth Revision, Clinical Modification codes and assessed for factors associated with admission, mortality, and resource utilization. RESULTS Among 28.6 million pediatric visits to the ED, there were 5971 (0.02%) heart failure-related cases. Heart failure-related ED patients were significantly more likely to be admitted (59.8% vs 4.01%; OR 35.3, 95% CI 31.5-39.7). Among heart failure-related visits, admission was more common in patients with congenital heart disease (OR 5.0, 95% CI 3.3-7.4) and in those with comorbidities including respiratory failure (OR 78.3, 95% CI 10.4-591) and renal failure (OR 7.9, 95% CI 1.7-36.3). Heart failure-related cases admitted to the hospital had a higher likelihood of death than nonheart failure-related cases (5.9% vs 0.32%, P < .001). Factors associated with mortality included respiratory failure (OR 4.5, 95% CI 2.2-9.2) and renal failure (OR 7.8, 95% CI 2.9-20.7). Heart failure-related ED visits were more expensive than nonheart failure-related ED visits ($1460 [IQR $861-2038] vs $778 [IQR $442-1375] [P < .01].) CONCLUSIONS: Heart failure-related visits represent a minority of pediatric ED visits but are associated with increased hospital admission and resource utilization.
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Affiliation(s)
- Erika J Mejia
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Matthew J O'Connor
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Perlman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Kimberly Y Lin
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Perlman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Lihai Song
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Heather Griffis
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Christopher E Mascio
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Perlman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Pirouz Shamszad
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Perlman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Aaron Donoghue
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Chitra Ravishankar
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Perlman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Robert E Shaddy
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Joseph W Rossano
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Perlman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
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Odei B, Frandsen JE, Boothe D, Ermoian RP, Poppe MM. Patterns of Care in Proton Radiation Therapy for Pediatric Central Nervous System Malignancies. Int J Radiat Oncol Biol Phys 2017; 97:60-63. [DOI: 10.1016/j.ijrobp.2016.09.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/29/2016] [Accepted: 09/10/2016] [Indexed: 10/21/2022]
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Chapman TR, Ermoian RP. Proton therapy for pediatric cancer: are we ready for prime time? Future Oncol 2017; 13:5-8. [DOI: 10.2217/fon-2016-0373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
| | - Ralph P Ermoian
- Radiation Oncology, University of Washington, Seattle, WA, USA
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Indelicato DJ, Merchant T, Laperriere N, Lassen Y, Vennarini S, Wolden S, Hartsell W, Pankuch M, Brandal P, Law CCK, Taylor R, Laskar S, Okcu MF, Bouffet E, Mandeville H, Björk-Eriksson T, Nilsson K, Nyström H, Constine LS, Story M, Timmermann B, Roberts K, Kortmann RD. Consensus Report From the Stockholm Pediatric Proton Therapy Conference. Int J Radiat Oncol Biol Phys 2016; 96:387-392. [DOI: 10.1016/j.ijrobp.2016.06.2446] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/26/2016] [Accepted: 06/14/2016] [Indexed: 11/15/2022]
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Johnstone PA, Kerstiens J. Reconciling Reimbursement for Proton Therapy. Int J Radiat Oncol Biol Phys 2016; 95:9-10. [DOI: 10.1016/j.ijrobp.2015.09.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 10/21/2022]
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Proton Therapy in Children: A Systematic Review of Clinical Effectiveness in 15 Pediatric Cancers. Int J Radiat Oncol Biol Phys 2016; 95:267-278. [DOI: 10.1016/j.ijrobp.2015.10.025] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 10/05/2015] [Accepted: 10/13/2015] [Indexed: 12/31/2022]
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Pfister DG, Spencer S, Brizel DM, Burtness B, Busse PM, Caudell JJ, Cmelak AJ, Colevas AD, Dunphy F, Eisele DW, Foote RL, Gilbert J, Gillison ML, Haddad RI, Haughey BH, Hicks WL, Hitchcock YJ, Jimeno A, Kies MS, Lydiatt WM, Maghami E, McCaffrey T, Mell LK, Mittal BB, Pinto HA, Ridge JA, Rodriguez CP, Samant S, Shah JP, Weber RS, Wolf GT, Worden F, Yom SS, McMillian N, Hughes M. Head and Neck Cancers, Version 1.2015. J Natl Compr Canc Netw 2015; 13:847-55; quiz 856. [PMID: 26150579 PMCID: PMC4976490 DOI: 10.6004/jnccn.2015.0102] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
These NCCN Guidelines Insights focus on recent updates to the 2015 NCCN Guidelines for Head and Neck (H&N) Cancers. These Insights describe the different types of particle therapy that may be used to treat H&N cancers, in contrast to traditional radiation therapy (RT) with photons (x-ray). Research is ongoing regarding the different types of particle therapy, including protons and carbon ions, with the goals of reducing the long-term side effects from RT and improving the therapeutic index. For the 2015 update, the NCCN H&N Cancers Panel agreed to delete recommendations for neutron therapy for salivary gland cancers, because of its limited availability, which has decreased over the past 2 decades; the small number of patients in the United States who currently receive this treatment; and concerns that the toxicity of neutron therapy may offset potential disease control advantages.
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McMullen KP, Hanson T, Bratton J, Johnstone PAS. Parameters of anesthesia/sedation in children receiving radiotherapy. Radiat Oncol 2015; 10:65. [PMID: 25889312 PMCID: PMC4362639 DOI: 10.1186/s13014-015-0363-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 02/18/2015] [Indexed: 11/25/2022] Open
Abstract
Background Previous reports establish low risk of complications in pediatric treatments under anesthesia/sedation (A/S) in the outpatient setting. Here, we present our institutional experience with A/S by age and gender in children receiving daily proton RT. Methods After Institutional Review Board approval, we reviewed our center’s records between 9/9/2004 and 6/30/2013 with respect to age and gender of A/S requirement in our pediatric patients (defined as patients ≤18 years of age). Results Of 390 patients treated in this era, 182 were girls. Children aged ≤3 invariably required A/S; and by age 7–8, approximately half of patients do not. For pediatric patients ≥ 12 years of age, approximately 10% may require A/S for different reasons. There was no difference by gender. Conclusions Beyond age 3, the requirement for A/S decreases in an age-dependent fashion, with a small cadre of older children having difficulty enough with sustained immobilization that A/S is necessary. In our experience, there is no difference in A/S requirement by gender.
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Affiliation(s)
- Kevin P McMullen
- IU Health Proton Therapy Center, Bloomington, Indiana. .,Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
| | - Tara Hanson
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
| | | | - Peter A S Johnstone
- IU Health Proton Therapy Center, Bloomington, Indiana. .,Department of Radiation Oncology, Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.
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