Building a Defensible Cancer Center Proforma

 

Volume assumptions, payer mix, sensitivity, and the math most proformas skip.

 

Medsolve Dynamics builds and stress-checks cancer program proformas, including the sensitivity work a capital committee will ask for.

 

Short field notes, recorded as they came up. Newest first.

 

 

The Hospital Math Says Build. The Physician Math Says Do Not. That Gap Is The wRVU Trap.

May 27, 2026 · Listen

Most rad onc programs sitting on soft Q2 numbers are looking outside the building for offsetting revenue. The infrastructure for radioligand therapy is already inside the building, and a Jefferson-authored paper accepted by Practical Radiation Oncology in May 2026 puts the 340B-eligible hospital gross margin at roughly $101,000 per Pluvicto patient over a full course. The same paper names why programs stall. The rad onc on a dollars-per-wRVU comp model takes a 26-wRVU haircut against EBRT for picking up RPT. The credential map is already in the department. The comp model discussion is in the way. The operator move is to renegotiate the comp model with the 340B margin as the leverage before the service line gets approved.

 

The Proforma Altitude Problem In 2026 Oncology Capital Decisions

May 13, 2026 · Listen

From 20 years on the vendor side and now on the program side, the math that wins capital approval is not the math the program runs in year two. The reimbursement environment moved more than the headline rate change.

 

Capital Is A 7-10 Year Commitment: The Math Most Proformas Skip

May 8, 2026 · Listen

Capital decisions in radiation oncology are not point-in-time decisions. The proforma that wins approval at signature is not the proforma that runs the program in year five. From 20 years on the vendor side and now on the program side, the math that protects margin through a full capital cycle.

 

Why Vendor Proformas Don't Survive Year Two: A Capital Decision Reality Check

May 5, 2026 · Listen

The capital case in a vendor proforma is usually solid. The operating case is rarely modeled. From 20 years on the vendor side selling these programs, here is the operational reality that shows up in year two and never lives in the original proforma. Applies to LINAC purchases, theranostics expansions, and benign disease program builds.

 

Running a Cancer Program in 2026: Capital, Operations, and the Job Behind the P&L

May 4, 2026 · Listen

Yoel Bakas sits down with Jeff Siupik, a healthcare executive with 35 years in oncology operations and 25 years in oncology leadership. Jeff has put in eight to ten linear accelerators across his career, led oncology programs through every reimbursement shift since the early 1990s, and currently oversees operations across a multi-program system. The conversation walks through the actual job of an oncology administrator in 2026. The balance between growth and expense control. Why P&L looks worse before it looks better when a program is in growth mode, and what most administrators are explaining to finance committees right now. How to read your operation when the metrics look green. The stoplight framework Jeff uses for evaluating efficiency, and why a green department can still have staff running in the red line of mental capacity. The disconnect between the C-suite and the clinical team. Where volume responsibility actually belongs in a healthy program, and where leaders most often misallocate it. Capital decisions in radiation oncology. What separates the programs that get capital right from the ones that do not. Service contracts, software licensing, the ongoing-cost trap, and creative offsets like block leases. AI in oncology operations. A pragmatic take on what AI is actually doing in cancer programs right now versus what is being pitched. Where AI creates time, where it slows things down, and how to think about the patient-side implications. A worked example of how a leadership team handles competing capital requests across service lines, and why "every specialty feels their request is the highest priority" is the room every administrator is in. Yoel and Jeff have known each other for over a decade across the vendor and operator sides of radiation oncology. This is operator-thinking from someone who has lived the job. 22 minutes. Worth the time for any administrator, medical director, or system executive running an oncology program in 2026. Medsolve Dynamics: Reach the team:.

 

Can you afford it at 80% of the current reimbursement?

April 10, 2026 · Listen

The conversation explores the critical question of whether decisions hold up at 80% of the current reimbursement, emphasizing the importance of considering this in every capital decision and service renewal.

• Financial decisions must consider sustainability at 80% reimbursement.

• Every purchase decision should be evaluated based on sustainability at 80% reimbursement.

 

Reevaluate assumptions and review budget numbers in response to budget cuts.

March 17, 2026 · Listen

The conversation highlights the significant impact of budget cuts on oncology programs, particularly on capital decisions, pre-approved purchases, and service line expansion. It emphasizes the need for reevaluating assumptions and conducting a rigorous review of budget numbers in response to budget cuts.

• Budget cuts impact capital decisions.

• Reevaluation of assumptions is crucial.

 

Physicians need to translate clinical intent into financial implications.

March 17, 2026 · Listen

Physicians are increasingly involved in capital decisions, impacting clinic autonomy and program success. Clinical decisions now affect workflows, coverage models, and daily possibilities. Physicians need to translate clinical intent into operational and financial implications to ensure program sustainability.

• Physicians' involvement in capital decisions impacts clinic autonomy and program success.

• Physicians need to translate clinical intent into operational and financial implications for program sustainability.

 

Capital plans, AI investments, and margin pressure.

March 17, 2026 · Listen

Yoel Bakas discusses his focus on the conversations at ACRO and the challenges in healthcare administration, including capital plans, AI investments, and margin pressure.

• ACRO conversations.

• Challenges in healthcare administration.

 

Impact of the reimbursement change on capital plans.

March 17, 2026 · Listen

The conversation delves into the impact of the reimbursement change on capital plans and the hidden strategy gap in growth plans. It also explores the need for a sanity check in response to the changing landscape of healthcare delivery.

• Reimbursement change impact.

• Hidden strategy gap.

 

More field notes: AI validation · Theranostics & service line growth · all seven topics