The University of Pennsylvania's center, under construction, was paid for by the institution. The University of Florida used tax-exempt bonds. Financing options vary widely and are tailored to the project from outright purchase to debt equity financing, leasing, fee-per-use rental, special purpose tax-exempt bonds, and other arrangements.

"Every transaction is different with the magnitude of the expense varying widely," said Jon W. Slater (also James' son), President and CEO, Optivus Proton Therapy Inc., San Bernardino, CA. "The preferred financing for most of the academic centers and a lot of smaller non-profits is to work with large financial firms to put together a bond financing device to limit the liability exposure of the hospital yet have them maintain full control of clinical operations." Optivus, the engineering firm that maintains and upgrades Loma Linda's center, is working on more than a half-dozen prospects for new proton therapy centers at U.S. sites.


The reality for health care organizations that want to offer proton therapy is that many years of planning and approvals, along with institutional, state and federal aid, plus private investment, may all be needed to bring a center to fruition.

But some new ideas are springing up in the private sector. A few innovators offer turnkey solutions so that physician groups or hospitals can get into the segment. One such business model comes from ProCure Treatment Centers, Inc.

"A proton project is a very capital intensive, very complex process. It is going to be beyond the wherewithal -- the staffing and financial capabilities--of larger doctor groups or community hospitals," says ProCure's CEO Hadley Ford. The company, staffed by technical experts in this esoteric field and backed by venture capital, builds the centers for its partners including radiation oncology groups and hospitals. ProCure has two centers in the works. Partners in their first site in Oklahoma City include two radiation oncology physician groups, and INTEGRIS Health, the state's largest non-profit health system. IBA, the leading proton therapy particle accelerator manufacturer, is providing its cyclotron for the project. Another ProCure site is planned in the western Chicago suburbs at Central DuPage Hospital.

ProCure handles the business end of gaining investment and running the entire project and facility, while partner physicians handle the clinical end. "It's a typical outsource model," Ford says. "It's not dissimilar from EDS or IBM installing a large computer system into your company. They own it and run it and man the help desks so that you can focus on what your business does best. We figure hospitals and doctors treat patients best. We build proton centers best so it's a good match."

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