From 20 years on the vendor side of LINAC capital and service negotiations, the data point most radiation oncology programs do not see with the same precision the vendor sees it: their own unbooked machine hours. Every unbooked hour is a fixed cost paid for and not recovered. The 15-minute utilization audit is the cheapest margin discipline in the 2026 reimbursement environment.

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Capital decisions hold up when the year-five reality is considered before the signature. They break when only year-one numbers are. From 20 years on the vendor side and now on the program side, the year-five question that protects margin through a multi-year operating commitment in radiation oncology.

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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.

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Benign disease radiation uses LINAC capacity that is already paid for in most programs. The growth question is referral pathway, not capital. From 20 years of watching programs add and grow service lines.
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From 20 years on the vendor side and now on the program side, the capital form decision that gets skipped on most theranostics service-line additions. Build or partner sets the next decade. With reference to Kenneth Brooks and Christine Stone’s published build case study at Wellstar Health System. medsolvedynamics.com | [email protected]

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.

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A moment from the AMAC Spring Symposium 2026 talk on the day I told a room of oncology administrators that I have watched programs lose margin on contracts I helped sell them. Plus the 17-year ROI case study. medsolvedynamics.com | [email protected]

A short clip from the AMAC Spring Symposium 2026 talk on the discipline programs need to apply to every capital decision in the current environment. Forward-looking, not policy-blame.

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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.

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Jeff Siupik, 35 years in oncology operations, on where volume responsibility actually belongs in a healthy program. The C-suite looks at P&L. The clinical team looks at compassionate care. Where leaders most often misallocate the volume expectation, and where it should sit instead.

Full episode: https://youtu.be/9bPM8rjsv6Y

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