MedStar Georgetown University Hospital's business case for proton beam

A patient who has been treated at the Medstar Georgetown University Hospital Proton Therapy Center poses on the proton beam machine to show its operations. (MedStar Georgetown)

It wasn't long ago that stories about the race to offer the latest proton beam therapy to patients seemed as likely to end with lessons about the serious financial pressures they placed on hospitals as their capabilities to fight cancer.

Even as MedStar Georgetown University Hospital joined that race with its own proton beam center last year, Kaiser Health News pointed out just how big a financial risk they were taking: Nearly a third of the existing centers lose money, defaulted on debt or have had to overhaul their finances. Less than 45 miles away, the $200 million Maryland Proton Beam Therapy Center with five different therapy vaults in Baltimore struggled to make money in its first years of operations.

But recently marking a year of operations at MedStar's Proton Therapy center, officials say they've shown—with careful calculations and a "single-room strategy"—the $40 million investment to install the 28th proton beam center was a risk worth taking. 

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"I think the concept of a single-room strategy for hospitals is probably the way it's going to go in the future," Anatoly Dritschilo, M.D., MedStar Georgetown University Hospital's chief of the hospital’s radiation medicine department, told FierceHealthcare.

He was speaking over the hum of the proton beam therapy machine located inside a 40-by-60-foot room at the Washington, D.C., hospital. The MEVION S250i with HYPERSCAN machine resembles a traditional X-ray in appearance but actually requires a massive proton accelerator that spans three floors in order to deliver a more precise type of radiation treatment, he said.

"About 15 years ago, there was a group of investors that tried to sell us the idea on a five-room operation. I actually turned it down," Dritschilo said. "The reason I turned it down is because proton is just like any other highly advanced treatment modality in our field and it should be suitable and the right size. In other words, it should not be the tail wagging the dog."

Since then, he said, proton beam therapy machines have gotten smaller and they've gotten more precise in their ability to effectively attack tumors without damaging surrounding healthy cells. The version MedStar invested in uses what's called pencil beam scanning (PBS).

Even with their capabilities, Dritschilo said, hospitals have found careful calculations are needed to ensure the proton technology doesn't become a costly burden.

For instance, MedStar Georgetown has about 1,400 cancer patients it treats a year and already has two linear accelerators and two cyberknives, he said. Officials estimated they expected about 15% of their patients might benefit from proton beam therapy for roughly 200 patients a year worth of demand, he said.

"We're a teaching hospital, we're a cancer center. We have to have all the capabilities. So this makes sense," he said. "A five-room operation would be too costly for us to maintain. "While at Georgetown, we think about what works best for the patient, there is a business end that you have to think about. That business end is, 'If I have to put 200 patients in one room and that means I have to find 1,000 patients for five rooms, where are those patients going to come from? They have to come from other hospital systems. Why would we want to do that as a business strategy?"

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As it turns out, he said, MedStar Georgetown's proton beam center has been at capacity since it opened, and the D.C.-area health system is putting another facility in one of its sister hospitals, Dritschilo said. Dozens more are in the works across the country 

Only time will tell how the investments in the technology will play out over the long term. 

MedStar faces a future uptick in potential competition among other local hospitals in the greater D.C. area, with a proton therapy center due to open just a three miles away at the Johns Hopkins'-owned Sibley Memorial Hospital this fall and another center set to open at Inova Health System's new cancer center, located just 14 miles away in Northern Virginia, next year.