Episode 17

Proton Therapy Access That Puts Patients First with Jennifer Maggiore

Episode 17 Jennifer Maggiore Executive Director, National Association for Proton Therapy (NAPT) ~120 minutes

Episode Summary

In this episode of The Cancer Project podcast, David Raubach sits down with Jennifer Maggiore, Executive Director of the National Association for Proton Therapy (NAPT), to trace her unlikely path from oncology social work to leading the nation’s most prominent proton therapy advocacy organization. Jennifer began her career embedded in radiation oncology departments, where she developed a firsthand understanding of the daily burdens cancer patients face, financial, emotional, and physical, during weeks-long treatment regimens. That clinical intimacy, she explains, became the philosophical foundation for everything NAPT does today: keeping the patient at the center of every policy push, every insurance appeal, and every new center opening.

Jennifer recounts her pivotal role at Acriman Cancer Center in Jacksonville, Florida, one of the first physician-owned, freestanding proton therapy centers in the United States and only the second Mevian (then Still River) single-room center to come online. Working closely with Dr. Scott Arian for over 15 years, she helped build the social work infrastructure, individual counseling, patient navigation, insurance advocacy, that became a model for community-based proton centers. The challenges were substantial: limited reimbursement, a skeptical insurance environment, and no established blueprint for a private-practice proton center. Yet the experience proved that a multimodality, community-focused model could work, a lesson the broader industry is still absorbing.

A significant portion of the conversation focuses on the access gap in proton therapy. Jennifer presents a stark statistical picture: roughly 2 million Americans received cancer diagnoses in 2024, approximately 1 million of those require radiation, and a conservative 20 percent estimate places 200,000 patients as candidates for proton therapy. Yet only about 18,000 patients received proton treatment last year, fewer than 2 percent of all radiation episodes, and only 9 percent of eligible patients currently have geographic access to a proton center. With one proton room available per 3 million Americans, Jennifer argues forcefully that the industry’s problem is not oversaturation but profound undersupply, a fact she uses to push back on critics who cite high-profile center closures as evidence against further development.

Jennifer outlines NAPT’s multi-front advocacy strategy in Washington, D.C., where the organization engages CMS, HHS, the White House, congressional offices, and Medicare Advantage plan administrators to counter the narrative of proton therapy as a high-cost, low-value modality. She highlights the organization’s health economics research initiatives, including a grant to Dr. Frank whose work demonstrates reduced hospitalizations, fewer ER visits, and lower total cost of care when toxicity to healthy tissue is minimized, as the evidentiary backbone for that advocacy. She also notes a landmark study soon to be published in The Lancet showing improved overall survival in head and neck cancer patients treated with proton therapy, a development she sees as a turning point in how payers and policymakers perceive the modality.

The episode closes with an optimistic look at the near-term future: the University of Wisconsin and Southwest Florida Proton, a community center modeled on the Acriman approach, are set to open, NAPT’s annual conference in San Francisco drew nearly 400 attendees (up from roughly 50 a decade ago), and approximately 70 percent of NCI-designated cancer centers either have proton therapy or are actively developing it. Jennifer and David agree that the industry has moved decisively from defending the technology’s existence to scaling its reach, supported by stronger reimbursement arguments, smarter single-room center economics, and a proton therapy community that, as both guests note, has shifted from competitive to genuinely collaborative.

What You’ll Learn in This Episode

Oncology Social Work as a Foundation: Jennifer’s career began as a licensed oncology social worker inside radiation oncology departments, giving her direct insight into the emotional, financial, and logistical barriers patients face during 4-to-8-week daily treatment courses, insight that still drives NAPT’s patient-first philosophy.
Proton Therapy Access Gap: Of an estimated 200,000 U.S. patients annually who qualify for proton therapy under conservative Group 1 Astro indications, only about 18,000 received it in 2024, less than 2 percent of all radiation episodes, because only 9 percent of eligible patients live near a proton center.
One Room per 3 Million People: Current U.S. proton capacity sits at roughly one treatment room per 3 million Americans, meaning the industry faces a capacity shortage rather than the oversaturation often cited by critics; Jennifer uses this metric to argue that even multi-center markets like Jacksonville are not over-served.
Single-Room Centers as the Growth Engine: The emergence of single-room proton systems, originally Still River, now Mevian, dramatically lowered the capital barrier to entry and made community-based, physician-owned centers like Acriman in Jacksonville viable, a model Jennifer sees as the primary vehicle for expanding geographic access.
Insurance Denials and Denial by Delay: Jennifer distinguishes between outright denials and “denial by delay,” where prior authorization processes cause patients to wait weeks before starting treatment; she notes that most Medicare Advantage cases that go through appeal, roughly 80-85 percent of commercial and MA cases, are ultimately approved in the patient’s favor.
Health Economics Research Initiatives: NAPT has funded research, including work by Dr. Frank drawing on CMS data, demonstrating that fewer hospitalizations, reduced ER visits, and avoided adverse side effects make proton therapy cost-effective for the health system overall, even though the per-fraction cost exceeds conventional radiation.
Total Cost of Care vs. Upfront Cost: An MD Anderson / University of Texas study Jennifer cites found that even though proton therapy cost more upfront for head and neck cancer patients, total cost of care was actually higher for conventionally irradiated patients because of downstream management of severe side effects, a framing NAPT now uses in D.C. briefings.
Overall Survival in Head and Neck Cancer: A study led by Dr. Frank, soon to be published in The Lancet, shows a statistically meaningful improvement in overall survival for head and neck cancer patients treated with proton therapy versus conventional radiation, a landmark data point for the reimbursement and policy debate.
Theranostics Cost Comparison: A single injection of Lutetium-177 PSMA (used in metastatic prostate cancer) costs approximately $50,000; a full six-injection course runs $300,000, two to five times the cost of a full course of proton therapy, illustrating that proton therapy is comparatively economical within the broader oncology treatment landscape.
NAPT’s Four Strategic Pillars: The organization’s roadmap is organized around research (including health economics data and a biannual research forum), advocacy (engagement at CMS, HHS, congressional, and White House levels), education (annual conference, webinars, peer-to-peer learning), and mission sustainability (supporting existing members and new center development).
Bipartisan Political Support: Cancer crosses party lines, and Jennifer reports that congressional representatives from both sides of the aisle actively champion local proton centers; she encourages member centers to invite elected officials to patient events and facility tours as a grassroots complement to NAPT’s federal advocacy.
Community Collaboration Over Competition: The proton therapy community has shifted from a competitive posture, common in the early years when fewer than 50 people attended NAPT conferences, to a collaborative one in which centers openly share best practices, appeal strategies, and operational learnings, a dynamic both David and Jennifer credit for the industry’s resilience.

Jennifer Maggiore’s journey from oncology social worker to national advocate encapsulates everything The Cancer Project stands for: meeting patients where they are, understanding the systemic barriers between them and the best available care, and doing the unglamorous policy and community work required to dismantle those barriers. Whether she is sitting with a head and neck cancer patient who cannot swallow, navigating a Medicare Advantage appeal, or briefing a congressional office on proton therapy’s total cost of care advantage, she brings the same conviction, that a treatment this effective at preserving healthy tissue deserves to be available to far more than the 9 percent of patients who can currently access it. If you found value in this conversation, please share it with someone who is weighing radiation treatment options or working in cancer care, and subscribe wherever you listen to podcasts so you never miss an episode of The Cancer Project.

Full Transcript

Read Full Transcript

Transcript generated from the episode’s audio. Speaker names are identified from the context of the conversation rather than from recorded speaker data, and automatic transcription may misspell names and terminology. Please refer to the video for the authoritative version.

David Raubach: Jennifer, thank you for joining us today on the Cancer Project podcast. I’m really excited to have you here and just learn a little bit about you and your story and then talk about the proton therapy industry and some of the exciting things that we see happening. So first of all, I’d love to get to know a little bit about how you ended up in proton therapy.

Jennifer Maggiore: Well, first, thanks for having me. It’s very exciting. Congratulations on doing this podcast and I appreciate your initiative to make sure we get the word out on the value of proton therapy. My story is I actually started as an oncology social worker many years ago working in a cancer center and specifically with radiation oncology patients and then moved into leadership roles and had the opportunity to work at the first physician-owned freestanding center in Jacksonville, Florida. With that I became very involved in implementing bringing that proton therapy project to light with the team at Ackerman Cancer Center. I was very honored to be part of that team and then we didn’t have a lot of support, right? There weren’t as many proton centers and there was only one other single room centers. So most of these were, you know, large room centers like Oklahoma Proton and such. So it was a little bit different.

Jennifer Maggiore: It was multimodality, a lot of different things to think through as you implement that into the center. And so I joined the board of NAPT hoping to strengthen the support that NAPT would provide to some of these smaller centers as well and then moved into this role about six years ago.

David Raubach: So oncology social work talk a little bit about what that means on a day-to-day basis.

Jennifer Maggiore: Oh, going back to my roots, oncology social work is very close to my heart because it’s really focused on supporting the patient through their experience, right? So, from diagnosis through survival. And with that, I had the opportunity to work with patients that really understand what their experience was, some of the barriers they face. And that included very much in the world of photon and proton therapy, right? So, with radiation therapy, it’s very unique, right? Because these patients come every day for anywhere from 4 to 7 to 8 weeks of treatment. So you get to know these patients in a little bit of a deeper level.

Jennifer Maggiore: You know this because you see you get very involved in these patients and offering groups to them at the night in the night where or in the evening where you can really hear from them some things that go beyond that daily treatment and there are a lot of barriers that these patients face and so I became very committed in this role as a leadership role at NAPT to always keep in mind if that patient is at the heart of what we do and understanding those access barriers and it’s not just always easy for people to just travel to get proton therapy or any advanced treatment. And so recognizing what that means emotionally, physically, financially to leave your home and why it’s so important now and why we advocate together to make sure that we do have the opportunity for patients to have this in their own region. Right.

Jennifer Maggiore: So really the vision of NAPT, so we have a mission like everyone, but the vision is to ensure that every patient has informed access to proton therapy empowered by advocacy, education, and research.

David Raubach: Okay. So, just going back to the oncology, social work component of your life, very component. We’re digging deep. We’re digging deep here. So did [clears throat] you was did you have a personal experience with cancer or a family experience with cancer? Like what led you to the field of oncology or was it just there was a job and you were a social worker?

Jennifer Maggiore: No, no, that’s [clears throat] a Wow, you’re really going back into the I feel like I’m in the Freudian seat maybe or in the therapy seat. So no, I was a business major actually went to college. I was very much going to be an entrepreneur or a business which probably helps me a little bit in the field that I’m in now or the leadership that I’m in now. And I started taking classes. I have to take required sociology classes and I really was touched by some of the curriculum and the mission around social work to really empower people. So it was really not enabling people but empowering them through whatever they’re going through. And healthcare was always an interest of mine and so started to really look into what that would mean and so transferred. My dad was not very happy that I transferred into social work.

Jennifer Maggiore: You know, most parents have a different idea of what they want your degree to be, but I was able to make this career into something where I can still advocate for patients on that level and do that in a macro way in DC and advocate patient for patients to have equal access to treatments like this. And so cancer is very devastating for many patients. It’s really a lifelong diagnosis. I think so often we think of patients like once they’re survived, right? They’re cured, their survival, everything’s fine. But it really is a long-term process when you have cancer. And so what I really am drawn to in the proton therapy community is I really believe like you asking these questions, there’s a commitment from all of our proton centers to support patients in variety levels whether it be emotionally, like I said, emotionally, clinically, and economically so that they can get this treatment.

Jennifer Maggiore: And there’s a true commitment from all of our members. To make sure that we make that happen.

David Raubach: Yeah. And I think I that really started with some of the early centers like the Loma Linda, MGH, MD Anderson, UFPI where they really established what it meant to exist as a proton center and what it meant to treat patients. You know, you had this different unique technology and I thought those centers did a really good job of also creating a different unique experience for patients. Everything was very it just felt kind of just above and beyond a normal healthcare experience. And I know in Oklahoma we’ve tried to maintain that and actually our first social worker we she was our patient services lead her husband got treated at UFPI and she went down to UFPI and learned about their patient services program and then we took that and established it and grew it in Oklahoma when we opened in 2009.

David Raubach: And part [snorts] of what we tell our staff is we want every patient that leaves this facility to say this was the best healthcare experience that they’d ever had. Which is really hard to do when you think about like what you’re talking about how difficult it is to go through cancer. To say this was a great healthcare experience, but yet there’s all of this trauma, stress, angst that goes along with it, physical, mental. That’s hard to do. But I think again some of those I give credit to some of those early centers for kind of establishing this playbook for what it just being different in the way that we care for patients and you guys did that at Ackerman for sure.

Jennifer Maggiore: Yes. So we had a very strong program of licensed clinical social workers that provided anything from individual counseling to the patient navigation to connecting to resources. It’s really what I love about the field of social work and the reason I chose that was really this multifaceted approach to helping people right not just in one sense of that but making sure you’re really looking at that whole picture and I think our proton centers and really these are most of the centers now as you know are multimodality centers but many of these patients that are seeking proton therapy are self-referred so they are looking for this experience they want to make sure that they have the care they need and that they’re wrapped in those services. And so our centers do a phenomenal job with that, whether it be from the beginning of navigating that patient through the system.

Jennifer Maggiore: Even being an advocate through the insurance and appeal. I was just visiting one of our centers in Ohio and their intake person really it was phenomenal because as I was talking walking through this center and taking a tour, one of the therapists went up to the intake corner and said, “Oh, this patient really wants to meet you because you were so helpful in connecting her to resources and getting and just validating and supporting her when her insurance denied that case and she had to wait about two weeks to start treatment. So our centers are very well positioned to support them and so patients often come out of that experience just feeling very supported and so some of the work you’re doing when I visited your center the proton pals the groups in the evening those all are very important to the individual patient and their family.

Jennifer Maggiore: The hope in the heartland luncheon which you came out to which is a survivorship celebration with Shannon Miller. Yeah they feel very celebrated they feel very cared for and I think that’s very important.

David Raubach: So, were you at Ackerman before the Proton Center opened?

Jennifer Maggiore: I was.

David Raubach: Okay. So, take us back to those conversations. What was it like thinking about or discussing doing Protons, especially as a small private practice?

Jennifer Maggiore: Sure. So, I’ve known Scott Ackerman for about 30 years. We met at the hospital. We did some work together and he’s always been a champion for patients, always wanted to bring the best care to them and [clears throat] just a champion for the community. We both worked we worked at a Catholic hospital, St. Vincent’s Sister D Sales, you know, our mission was to treat all patients and bring in all patients through that door whether they had the ability to pay or not. And so that commitment was continued when he opened his own private practice as well. So that not many probably no private practices had social workers really. You saw social workers in hospital settings and such. But he knew that was important to get those patients the lodging the transportation and really insurance coverage. This was before the days of the Affordable Care Act.

Jennifer Maggiore: So, we had a significant number of uninsured patients in Jacksonville, just like many cities did and some still do, but it was worse back then because we didn’t have any safety nets and such. And so he really did want he had a vision to bring proton therapy to Jacksonville. UF was the sixth center in the United States. It’s been open 20 years. But he very much knew that was going to be the future. He’s very much a visionary. So I think a lot of people doubted whether a small private practice could do that. So there was a lot of conversations around how we could implement that. He’s a very intelligent man and but he’s very committed as well.

Jennifer Maggiore: And so I think what’s really important for new centers is you have to have a champion, someone that really believes in this because it is not easy to plan and develop and bring a proton therapy center to even a freestanding area or even a hospital-based center. So it does take a lot of grit. It takes a lot of dedication, perseverance, and you have to have a staff that believes in it as well. And we did as a team. We knew that this was the future. And so once proton therapy being a single room center being much more affordable, as you’re probably I think talking to others today, we know that those single room centers are really the future, right? That’s how we get this technology to other areas of the United States.

David Raubach: So that would have been So UFPI opens in 2006, correct? When were you guys having those conversations?

Jennifer Maggiore: When did those conversations right after it was always in his mind because it was really when Mevion announced that they had a single room solution Dr. Ackerman knew some of the physicians at WashU.

David Raubach: Yep.

Jennifer Maggiore: And so there was definitely a commitment to how can we bring more single room centers. I mean it really is the perfect opportunity. UF being the legacy center bringing that to the academic center in Jacksonville. The city was very supportive of having proton therapy as well. I think that’s important for cities that are interested is to really support their health systems in that. [snorts] but we also need we also know and you know this very well. We need to see make sure that this treatment is accessible from outpatient centers as well, right? Not all you know people have often said how does a city justify two centers? Very clearly and very easily it does because not every patient has the ability to access each healthcare system in their community, right? There’s different insurances, there’s different barriers and so it really does benefit a community to have a variety of providers that can offer this solution.

David Raubach: What was interesting I think about that story at that time is that we were actually going through something very similar in Oklahoma. Because you had ProCure announce the construction and start the construction of their proton center which was an IBA facility. So similar to UFPI and their IBA facility and then the University of Oklahoma pretty quickly after that project got announced said well we’re going to do protons and they decided and at the time I guess Mevion was called Still River. It was so U picked a single room Still River system about the same time that Scott picked or selected it to do a Still River single room system. And so we were kind of like those two markets. Which was interesting.

David Raubach: We were running parallel to a certain extent, although the roles were a little bit reversed cuz we were the freestanding facility with the IBA system, you know, use the academic facility trying to get a Still River system. And so when did and not everybody probably people new to the proton industry maybe don’t know this whole history, but Still River announced that they were going to make this single room system. But it took a few years, of course, before they received their FDA approval and then they went through a name change. And this is now Mevion. And we’re going to get to talk to Tina, the CEO of Mevion on this podcast later today. But, when did So, when did you guys open? So, you start in ‘ 07 having those conversations. When did you go live with Proton Therapy at Ackerman?

Jennifer Maggiore: Not too long after UF was established, but still one of the first, I think, a second Mevion Center and one of the first single rooms in the United States and unique in the sense that it is a community based center, right? So, it’s not associated with a hospital center. It’s not an academic center. It’s truly there to serve the patients in the community.

David Raubach: So talk a little bit about that because I think Scott and you and the team there, you guys really pioneered a model that I think a lot of people didn’t think would be successful. The equipment’s expensive. There’s challenges with reimbursement. How can you have a community practice with a single room make something like that profitable? When we and when we talk about profit I always think it’s important we talk about this with our staff you know we’re a not for-profit facility in Oklahoma but without a margin there’s no mission meaning you do have to actually cover your operating expenses so profit can kind of have a bad connotation sometimes within healthcare but you have to make enough money to justify the service that you’re providing so from a profitability standpoint were there questions early on like is this going to work or Scott

Jennifer Maggiore: It’s just Yeah. So, Scott Ackerman is truly, you know, he definitely is a visionary. You don’t when you meet him, you know, you know that when he believes in something the negative chatter or the questions don’t matter because if he truly believes in this technology and he knows it’s right for the patients and that was very important. I don’t think anyone goes into this thinking this is going to be something that is extremely profitable. It’s how can we serve our community in a multimodality center. And so you have to really diversify your offerings in a any physician office, right? You can’t put all your eggs in one basket. And so it is a good model to have that multimodality. So yes, there were a lot of questions and a lot of doubts. And I think so there yeah a lot of doubts.

Jennifer Maggiore: I truly believe that if you know that reducing toxicity to healthy tissues is the right thing for a patient then everybody would want to make sure they bring this technology and the cost is prohibitive but it is much better than it used to be and we are working this organization number one advocacy right so we are working to make sure that there is sustainable reimbursement right so that outpatient facilities and hospitals can bring this technology so that it’s not just an imbalance in any community. So, it’s very important that we work on that end. And then, of course, the insurance and denial end, which you and I talk about often. I’m sure you’ll have someone on your podcast very soon to address those.

David Raubach: And we had Dr. Frank on.

Jennifer Maggiore: Yes. He’s a great spokesman in that Yeah. Understands that very well. And you remember, we didn’t have Apollo and a lot of these, you know, Matt Palmer with Legion and a lot of these options even six or seven years ago, right? So this community has come together to say what are those barriers and let’s reduce that. So the barriers are the cost to invest right. So this community has worked hard to make that more affordable. What are the barriers around insurance denials and even not even getting some authorizations or backend denials. And so our community works very hard together. And so we have many organizations that have popped up that say let’s really focus just on those prior offices such as Apollo and Legion. And I think that’s very important because we all come together. We’re not competitive. We come together and work together and share best practices.

Jennifer Maggiore: So, as you know, you’re on this call once a month. We get on the call with all of our members and we say, “What are some of the barriers? How can we break through some of the issues we’re having with Aetna, United, EviCore, and we’ve addressed those individually with EviCore as well.” and so it’s really a multifaceted approach to make sure that we are supporting these patients that need access to this treatment.

David Raubach: So in Jacksonville, you have these two centers now that are operating and I think this is a question that I hear from time to time. I’m sure you get it more than I do is can you have two proton centers in a market?

Jennifer Maggiore: Absolutely. Yes.

David Raubach: And so why do you say that?

Jennifer Maggiore: Because well there’s two reasons I say that. I’ve seen it work for one reason. I can tell you that. The second reason is right now currently if you look at the stats of how many people get cancer, let’s talk about the stats real quick. 2 million Americans were diagnosed with cancer in 2024. 1 million of those need radiation per ASTRO and Advimed and other studies that have been done. All right? So 1 million need radiation therapy. Right? If you look at just group one ASTRO indications, which really don’t cover all the patients that really do need proton therapy, but let’s just do a conservative analysis. Y so let’s just say 20% of those need proton therapy. That’s 200,000. Right? Right now, only about 18,000 patients received proton therapy last year. So less than 2% of all radiation episodes are proton therapy. And only 9% of patients who need proton therapy have access to proton therapy.

Jennifer Maggiore: 9%. That’s a very small number. So I know that even in Jacksonville when people say, “Oh, Florida has too many proton centers.” We actually don’t have enough. I push back on that concept because if you really take that number of the 200,000 right now, we only have one room per 3 million people. So we do need more capacity. We do have more studies that are showing the benefit. Now we have a study from Dr. Frank, who I know you’re talking to soon, soon to be published in the Lancet showing an overall survival that’s higher with head and neck cancers with proton therapy. So, we need more capacity for these patients. So, I would I push back very strongly on those. I also think patients need their choice, right? They need to know and choose between centers. Maybe they have a certain physician, maybe they’ve been getting cancer treatments and they want treatment at that center.

Jennifer Maggiore: So there is room. And I think planning these one room centers in these regions is a great way to do that. And our academic centers and our hospitals are doing a really good job pushing out this research. We have a prolific research community. I mean if you look at the research we have over a thousand studies just on proton therapy specifically in this community and more many more to come. And so our academics are doing a great job showing the evidence supporting where this technology best fits for certain patients and our community centers are going to do a really good job delivering that care.

David Raubach: So let you made a comment that I want to touch on because I think this is important when you think about who needs protons, where do you need to put proton centers, what’s the potential utilization of a proton center. So in Oklahoma City, we have two centers. So the University of Oklahoma has a single room. We have four rooms at the Oklahoma Proton Center. There’s about 6,000 probably closer to 7,000 now patients that’ll get diagnosed with cancer in Oklahoma City metro this year. So you using that same math about 3,500 radiation patients, you know, and this is the question that I want to get to. You said you mentioned a 20% of those. That’s a very conservative that’s very conservative, right?

Jennifer Maggiore: So we would say and I think a lot of radiation oncologists who work within the field of proton therapy and also a lot of patients would say why would I even ever want to get extra radiation to healthy tissue. Dr. Herman Suit, a pioneer in proton therapy. Worked at the Harvard Cyclotron Laboratory. He had a famous statement and his statement was complications don’t occur in cells that are not exposed to radiation. And I butchered the exact quote, but the gist is why would you ever want to deliver excess radiation?

David Raubach: Yeah.

Jennifer Maggiore: Yeah, if you deliver excess radiation to healthy tissues, that’s where you’re going to cause potential problems. So, I think that percentage might be 50% or 60% or 80%.

David Raubach: And so talk a little bit about when you say group one, group two, what patients should be getting protons, you know, how are we kind of thinking about that and why do we think about it?

Jennifer Maggiore: So the reason I mentioned group one and group two because many insurance companies follow NCCN or ASTRO model policy for proton therapy and so you will hear that but if you really look I think you’re exactly right there’s many patients many more patients that would benefit and there’s many patients in what we would consider group two that are under clinical trials or registry that are treated with proton and we’re starting to see that evidence you know evidence development is very important and so group two is really about evidence development so any of those patients still are treated because we know that the dosimetric volume of or those plans show a true benefit with proton therapy. And so back to Dr. Suit’s quote that around this healthy tissue is we’re really looking at those patients that this benefits the most for around those critical structures.

Jennifer Maggiore: But don’t forget there’s many patients as we see more cancer survivors than ever before. Our cancer mortality rate is lowest than it’s ever been and our cancer survivorship is higher than it’s ever been. It continues to grow. And as we’re seeing that number grow, remember there’s patients that unfortunately are diagnosed with a di, you know, second occurrence, a recurrence, right? And so many of those patients would benefit if they didn’t get proton in the first stage first diagnosis or first treatment, they would many times likely benefit in the second round as well, what we call reirradiation depending on that. And so those numbers again, you know, numbers are great, right? But numbers are not people. And so when you have a patient in front of you, that really shows those advantages. And that’s what we fight for.

Jennifer Maggiore: And so I think that there’s a wider variety of patients that could benefit based on close to clinical critical structures, but it is a limited resource. So what we hear is many of our centers, especially these single room centers, part of a hospital system, are having to triage who is the patient that benefits the most. And so I want to not hear that we have to triage those. I want those patients that really do need this treatment to be able to access that.

David Raubach: So you joined the board of NAPT.

Jennifer Maggiore: I did.

David Raubach: You’re now the executive director of NAPT.

Jennifer Maggiore: I am.

David Raubach: What happened there? You went So you left the clinic. What was that? So what happened with that transition?

Jennifer Maggiore: So in 2019, our previous executive director, Scott Warwick, moved into a different position. And being on the board of directors, you have a very keen insight to the strategic priorities and the importance of an organization like this. And so this was an opportunity that I really felt I could advocate for patients in that macro level and advocate for our members in a way that would be very unique. And so had the opportunity to join NAPT in 2019. It was very hard to leave. I had been at Ackerman Cancer Center for over 15 years. You know, I still very much enjoy visiting them and seeing their growth and their success. But this is an opportunity for me to help Ackerman Cancer Center and really all of our members in a larger way. Go to DC. We have a presence in DC that we have never had before.

Jennifer Maggiore: So now if you go to see many of the Congress people, if you talk to your Congress person, they will they most likely know about proton therapy because we’re talking about it at a federal level and our centers are now talking about it regionally as well. And I think that’s very important. Dr. Makary, our FDA commissioner just said in a recent meeting a couple m gosh I think it was in March in front of HHS I’m sorry cut that out in front of HHS secretary in front of the CMS administrator in front of our president basically said that US leads the world in proton therapy yeah and so you know these are conversations that DC is quite aware of this unique value of proton therapy so we’ve changed this narrative just in the last five or six years from being looked at as a wasteful technology being high cost, low value to being the best in the world in proton therapy.

Jennifer Maggiore: And that’s a real key shift and that’s a real key transition and that is really due to the work all of our members do with NAPT but also our researchers and clinicians that are putting out this research as well. So I’m very excited about what the next five years can bring us in that awareness.

David Raubach: Yeah, it’s been amazing to see the growth. I remember going to NAPT in 2010 and I think there were maybe 50 of us in the room.

Jennifer Maggiore: There were not I was there with you, I think.

David Raubach: Yeah, there were not very many. We were in DC at the in Pentagon City, right?

Jennifer Maggiore: That’s right. Yeah. And that’s 50 total people attending the conference. Now we have almost that many centers that are open in the US. So, I think it’s been there really has been a paradigm shift where it’s just kind of this unique treatment and there’s not going to be that many centers to now you’re really seeing all top academic programs say we have to have this modality if we’re going to continue to be a top academic cancer center, but you’re also seeing physician-owned groups or community hospitals put in proton therapy. And so it’s just been really neat to see that expansion. Yeah, about 70% of NCCN NCI designated centers either have the technology now or are in development. And so I think two good examples is Duke just recently announced their system and then you also have Southwest Florida Proton. Dr.

Jennifer Maggiore: Shannon MacDonald’s here speaking this afternoon at ASTRO and that’s a community center similar to what Ackerman did in Jacksonville in the Southwest Florida corridor. So, two good examples of how we’re starting to see this development. And I would say, yes, we’ve seen this growth, but this year we’ve only had well, we only have one opening this year. Next year, I think we’ll have a few more that’ll come online and maybe COVID slowed down some of these projects as well, but I wouldn’t say that this is a prolific growth, right? This is a steady strategic growth. Takes time to develop these centers. They’re developed in a very thoughtful strategic way. Now, we’ve learned from some of our past centers and we’ve learned about you know, how the tumor sites treated are really evolving and it’s a different type of mix of payers as well.

Jennifer Maggiore: And now we’re starting to see more AYA patients and I think that’s really important to talk about as well because we’re starting to see more younger people diagnosed with cancer. We’ve never seen that before. The American Cancer Society is really digging into this. They have some research pending and so until we know you know the reasons why we definitely have to be positioned to make sure that these young people have the treatment that is kind to their bodies so that they can have their fertility have their life ahead of them. And so I think that’s really important message as well.

David Raubach: So when you talk about advocacy in DC I think it’s important especially for people that are thinking about doing protons to understand the support that they’re going to have with the NAPT. What does that advocacy look like? What specifically are you advocating for in DC?

Jennifer Maggiore: That’s a great question. So, we’re advocating for a few different things, but our main support is the sustainability of our proton centers in our hospitals that are providing this treatment. And we do that to make sure there’s adequate reimbursement. And the only way to ensure adequate reimbursement is make sure you’re showing your value. And so, we definitely make sure that we’re highlighting the value that proton therapy has for patients individually, but also for the health system. So, we have funded two research studies, the health economics research initiatives. Dr. Frank, you should ask him about that when you talk to him a bit more. He’s a recipient of one of our grants and really looking at how we can actually these shaving co saving toxicity saves adver or prevents sorry about that. Okay. We can prevent these adverse side effects that can cause debilitating hold on I lost my train of thought. Okay.

David Raubach: Well, I think I mean I remember the paper that MD Anderson did with the University of Texas. I guess it was the health system and the university. So you had those covered lives and they looked at I believe it was for head and neck cancer patients specifically.

Jennifer Maggiore: Yes, they looked at the total cost of care during and for a short period after treatment. And even though proton therapy was more expensive upfront, at MD Anderson, the total cost of care was actually higher for patients that got traditional radiation because of all of the side effects.

David Raubach: Exactly. So adverse side effects cost the health system money and they cost patients money, too.

Jennifer Maggiore: So if we’re talking about financial toxicity for patients and also for our health system. So, we have data that we have pulled from CMS data showing less hospitalizations, less ER visits, all of that saves the system money. [snorts] And so, we’re constantly telling that story of the value for the patient, but also the value for the healthcare system, too, because when you do have a higher cost treatment, you want to make sure that you show all the aspects of how it is valuable. So, pharmaceutical companies you know, those treatments cost a lot more money than radiation. I don’t think we have done a good job as an organization to tell the story in DC of the cost effectiveness of radiation oncology as a whole right even compared to surgery on some things Dr.

Jennifer Maggiore: Slater from Loma Linda did a great study that was published in the American Cancer Society journal Cancer or that really talked about in liver cancer comparing chemo ablation surgeries and to proton therapy and showing that patients did just as well but it was a much more cost-effective treatment. So when we’re in DC we tell those stories right but we’re also telling stories of this prior off so you know that this is a national issue. It’s not specific to the proton therapy world, but it’s very acute in our world. And so when you have a treatment that’s been questioned or that’s been labeled as low co low value, high cost in the past and we’re switching that narrative, it is much harder to finally educate these insurers on this value. There’s been some high-profile litigation. There’s been some high-profile legislation in state in certain states. Louisiana just passed their own legislation on this as well.

Jennifer Maggiore: Regarding patients rights around prior off and as more and more Medicare beneficiaries are now under Medicare advantage plans this is a really key issue that we all need to work together all stakeholders ASTRO AMA ACRO all of the stakeholders need and with NAPT need to really be telling this story because we have Medicare beneficiaries being denied for treatment if they have a Medicare advantage plan when a Medicare beneficiary that’s next door can get that treatment and so there’s a real inequity of access around the barriers of insurance authorization and that is a very strong focus of NAPT when we’re in DC and also with other stakeholders just to work with the industry to move the needle on that

David Raubach: And I think one of the things that you guys do a good job with your advocacy is taking it back again to the patient we can talk at this macro level but ultimately it’s a person who is impacted by this

Jennifer Maggiore: Absolutely.

David Raubach: We had a patient just recently at the Oklahoma Proton Center. So, we have three linear accelerators along with our four proton treatment rooms and we do run into issues with getting coverage for some proton cases. And so, we had a patient that didn’t get approved for protons. And so unfortunately was going to need to get treatment on a linear accelerator traditional radiation treatment and they were in the lobby and we had a brochure in the lobby that showed a comparative treatment plan. So it showed the radiation exposure to healthy tissue with traditional radiation for their particular disease site and then with protons and there the moment that the patient saw that of course you know we’re saying hey photons is a great treatment. We’re going to do a good job with this.

David Raubach: It didn’t really hit home until the patient saw that image and saw all of the extra radiation and understood the amounts of radiation that were going to be hitting healthy tissue and they were very upset about that.

Jennifer Maggiore: And this was and I just it comes to my mind as you’re talking because that was a person who was denied care that almost certainly would have been better for them. And so now they have the trauma of going through cancer and they also have the trauma of their insurance company saying you’re not going to get the care that your doctor is recommending. So it is a real issue and it impacts people I think is the point with that.

David Raubach: Absolutely. It definitely impacts people.

Jennifer Maggiore: But it’s interesting if you I get calls from patients about twice a month on this issue and I work with them I tell them that their proton centers are very well equipped to help support them and so we have an insurance and appeal toolkit also to support patients so they can understand this process. It’s a very complicated process when you’re going through a denial, right? You know this because you’ve done this on the business side and then the patient side supporting the patients as well. And so, we make sure that those patients have the support of understanding what a second appeal is, what a, peer-to-peer review is, understanding their benefits. Do they have a self-funded plan? Can they work with their employer as well? How to advocate for themselves. But what’s interesting is most of these cases, especially MA plans, are overturned and in the favor of the patient.

Jennifer Maggiore: So, it’s really a delay of care. It’s really denial by delay.

David Raubach: Thank you.

Jennifer Maggiore: And so we really try to tell that story as well. We don’t want people to not seek proton therapy because they’re worried I don’t want to go through this insurance and appeal process. Go through that process. It can work and it does work and you’ll get that support as well. And we are seeing these delays are lasting a you know a little bit longer but we’re definitely seeing more success in those appeals as well. And so when we tell the story in DC the Congress people CMS we interact and engage with all levels of policy makers in DC whether it be CMS, HHS, the White House, the vice president’s office. We’ve done all kinds of visits in the past 5 years to tell this story and of course to the Congress people as well. What I want to mention to you is they are very proud of the Proton centers in their community.

Jennifer Maggiore: They really are. And so I work with our members to say anytime you have an event, invite them to your event because they actually do talk about it and are very proud that this is offered in their community and they want to safeguard that and make sure that they support. And so they are very much true champions for this. And cancer is bipartisan. Let’s be real. We can be very much on both sides of the aisle on here and it’s very refreshing because when I do go I’m working with all sides on this issue.

David Raubach: Well, it’s also something that impacts everybody. I mean, it’s very rare that you talk to somebody that hasn’t been impacted by cancer either directly or family member, friend. And I do think that’s a good point that we think about advocacy and awareness being patients and doctors in the local community, [clears throat] but there also is this political advocacy at the local level that should occur. And each center should think about that. And we, you know, we get about 80% of our commercial pay and Medicare Advantage cases approved. It might even be a little bit higher, 85%. And that’s honestly, that’s up from 15 years ago. I mean, 15 years ago, we may have been 50 or 60%. So, things are getting better.

Jennifer Maggiore: And I do think you’re right that first no doesn’t have to be the final no. There is an appeals process and most of the proton centers have great teams that advocate for patients on that behalf.

David Raubach: So, you said that you’re excited for the next 5 years of proton therapy. What do you mean by that or what are some of the things that you’re excited about?

Jennifer Maggiore: So short term, I’m really excited to welcome some new members. And so as we have some new centers coming online, University of Wisconsin will be opening next year. Southwest Florida will open later this year. It’s very exciting to see a new energy come into the organization and of course serve their communities as well. I’m also excited about in renewed engagement. We had a reception here on Saturday night. We expected about 50. We had a hundred. So it’s and you like you said at our conferences we have close to 400 rather than 50 now. And so I’m very excited as we’re providing education that we have so many that want to speak they want to come to the conferences and they’re networking and engaging at that level. And then we have really clear strategic focus. So our board of directors is a very dynamic engaged board of directors.

Jennifer Maggiore: You know Tom’s on our board of directors as well so you probably get updates but we have pillars of priorities is what we call them. And so those priorities is how we guide. It’s our roadmap for the next few years. And that’s around research, advocacy, education, and mission sustainability. And so supporting those members as our mission sustainability, growing this organization, which we’ve seen great growth in this organization, but that’s also growing our leaderships teams. So volunteer leadership and such as well. And then collaboration with the research. I mentioned our health economics research initiatives. So continuing to fund those. And then our annual member survey. So, we put out a press release today. We are the only organization that monitors the trends and outcomes in proton therapy. And so, we have those results are out. And so, we put out a press release with some of the teaser stats on that.

Jennifer Maggiore: And it really helped you understand the really the state of proton therapy. And then last is education. We don’t just do that annual conference. We do webinars. We do a lot of peer-to-peer education as well. And so we’re excited to expand some of those educational opportunities in the next few years.

David Raubach: So what when you talk about research, what are you hoping that the proton community focuses on or what do we need to focus on from a research standpoint?

Jennifer Maggiore: Yeah. Clinically or data in the sense of operational?

David Raubach: I mean I think you talked about research being a mission or an objective of NAPT. Maybe talk a little bit about what that means.

Jennifer Maggiore: Yeah, that’s a actually a good question because our board often says, you know, well, Jennifer, we’re not doing the clinical research. Why is that? What? Tell us about that priority pillar for you. So, remember our research is data, right? So, our data of our annual member survey, our data that I talked to you about are pulling data around reduction in hospitalizations. We pushed a publication around the trends in treatment for proton center for proton therapy with Dr. Bill Hartsell and some of our physician leaders. We have a physician advisory committee that works together to publish some of these data points that I think are very important around the narrative of proton therapy and then supporting the research community that we have. So we collaborate with PTCOG, PCG. We host an annual actually it’s a biennial research forum. We did it last year in DC. We’ll do it again in 2026.

Jennifer Maggiore: And that’s where our leading pre proton therapy researchers come together and to find what are the research studies that we really what are the questions that we need to answer. And so this is a very thought-provoking day as we look through comparing proton therapy with immunotherapy against surgery looking at some a little bit beyond what some of our randomized trials have already done and what the f future of immunotherapy can be. What are the indications that show that the proton therapy could show an even a synergy with im immunotherapy to really benefit the patient. And so we really want to support those stakeholders and make sure that we support the research that’s coming out.

David Raubach: And so when you talk about clinical research, I guess part of the question that I have is why do we even need to do that? I mean, you talked about maybe the payers are asking for this research, but what specifically are they wanting [snorts] to see or what’s the data that we’re trying to produce? Cuz, and I say that, you know, if I’m a patient, I’m thinking, well, it’s pretty obvious proton therapy. Look at the plan. Look at the plan. There’s less radiation to healthy tissue. Why wouldn’t I just get that treatment and not the other treatment?

Jennifer Maggiore: Yeah. Well, from a payer standpoint, if you’re a payer and you know you have two different modalities or you know quite a few modalities let’s not it’s not just photon right we have brachytherapy there’s a lot of different radiation oncology modalities but one is bit more expensive than another you want proof right that what is that benefit and which patients does it benefit the most we know that IMRT has advanced as well which is really good just like proton therapy is evolving and we got pencil beam therapy pencil beam scanning now we’re looking at flash you know IMRT evolves as So there are certain cases, right? I mean, I think we can say this that there are certain cases. We’re both advocates for proton therapy, but there are certain cases where maybe it’s not that much beneficial that patient maybe doesn’t need it. And I often tell those patients, too, right?

Jennifer Maggiore: Because you talked about this patient that said, well, I couldn’t get, you know, here I am getting Photon, but I’ve heard about Proton, but there’s still very good treatments with that aren’t proton that are very specific and targeted as well. And so I think what we really need to do is define that patient that subset of patients that benefits the most because this is still a limited resource. So although we’re seeing expanded cover access we’re seeing more centers come online, it’s still a limited resource. It’s still going to take time to get this in every community.

David Raubach: So yeah. So really it what it boils down to is a cost effectiveness element to proton therapy. Can you justify the incremental cost for this particular modality or this particular treatment as opposed to an alternative?

Jennifer Maggiore: And I think you bring up a good point that we do a really good job treating patients with photons as well. And there’s been advances in treatment planning. There’s been advances in room imaging. We just have a much better ability to control radiation, whatever the source is, and understand what’s happening and where it’s going, than we did 10 or 15 or 20 years ago.

David Raubach: So, somebody is considering doing protons, let’s say it’s a community hospital, limited funds, they come to you and they say, “Jennifer, how should we think about this process or how should we approach this process? We don’t even know where to start in thinking about doing protons. We think we want to do it, but we just don’t even know how to take the first step. What do you tell them?

Jennifer Maggiore: Yeah. So, I’m not This is not a like a plug for our conference, but I really truly believe that our conference is a great way to kind of enter, dip your foot into the water of like what the Proton community is and learn about that. We often bring in speakers about that. But I tell them to visit a Proton Center that’s currently providing care similar to theirs. So, if you’re a hospital center in the community, you’re looking at a single room center, then visit one of those. Visit the Huntsman, visit WashU, visit OSF and get an idea and talk to our experts that are already delivering this. This is a very big decision, but it’s a very good decision because making sure that your patients have access to this type of treatment is really important because if not, they’re going to go out of your system.

Jennifer Maggiore: So keeping them in the system actually makes sure that you are providing the leading cutting edge technology in your area and you’re also bringing in patients to your system because patients do want to be treated where there is the most advanced technology. They want to go just like you and I like to go to dinner at maybe the newest hottest restaurant, right? They definitely want to be at when they have cancer be treated at the center that’s going to offer them a variety of different types of treatments. And so I think it’s very important to get the education to do the pro formas and to do your due diligence and our community supports new development and is very giving of their time in helping others do that.

David Raubach: So let’s say that same hospital system that’s interested they say well you know we’ve heard that a lot of proton centers have failed. Very few have failed. Shouldn’t we be concerned about that?

Jennifer Maggiore: I love this question because I’m like when you say a lot define that to me because very few have failed and yes we have learned from some of those centers and there is and that’s the reason to do it now is because now the road map is there right so we know what not to do and what to do so now is the time we have that education we’ve learned some of those lessons and reimbursement is let’s be very clear we should be paid a higher amount. That’s the reason we fought the RO model when CMS came out with that in 2019. We should not be paid the same as other modalities. This is a very unique modality. I am unapologetic about that and we should not be concerned about that at all. That’s reason we advocate for that.

Jennifer Maggiore: And so if we do that then there is a roadmap to make sure that centers can in implement this and be able to afford this and have their patients have access to all their modalities that are necessary.

David Raubach: Well and I think you bring up a good point earlier about the cost of proton therapy versus for example some expensive immunotherapy drugs or we were talking before we came on about the emerging field of theranostics.

Jennifer Maggiore: A single course or a single injection of this radioactive drug agent that’s used in the treatment of metastatic prostate cancer cost $50,000. That’s one injection and a patient typically gets six injections. So you’re talking about $300,000 for this particular new drug, which that amount, $300,000 is anywhere from double to four or 5x what a course of proton therapy talks about or costs a payer. And so yes, proton therapy might be more expensive than traditional radiation treatment, but in the grand scheme of what the cost to care for cancer, it’s actually relatively small. And again, I think it’s radiation oncology as a whole is a very cost effective treatment.

Jennifer Maggiore: And if when you look at comparing ourselves to pharmaceuticals and like I said, we should want to make sure that patients have less exposure to radiation and so I think when you really think through you know I think when you talk to people outside of our realm, right, when you talk to your family or friends about what we do, well, why wouldn’t we pay more for this type of treatment? So I mean we have in the last few years, David, you and I have been doing this for a long time. And we’ve had to really defend the cost of this treatment, right? It’s been criticized and skeptics have come but it’s not valid some of their arguments.

Jennifer Maggiore: And when you really look and so that’s the reason you asked me going back to that question why it’s important to have that research is so that we can back up our argument that this is really truly a beneficial treatment for many patients with cancer.

David Raubach: Well, and you mentioned this overall survival element. I mean, think about that, right? You’re literally talking about a specific disease site where protons versus photons could actually lead to a patient living longer and what’s the value of that? What is the price that you put on extending life for patients?

Jennifer Maggiore: And we because we talk about side effects but then that’s a reality as well. Extending life but getting back to work, avoiding tube feedings avoiding dependence on certain medications and such. You know patients many patients and I worked directly with many head and neck patients if you want me to go back to my days in oncology social work but I worked with these patients and I worked so closely with them I’ll tell you why I worked so closely with them because they struggled through treatment they needed more help than most of these other patients because they came every day they couldn’t swallow they lost a significant amount of weight and I saw the differences once some of these patients were treated with proton therapy a huge difference now that’s anecdotal right so I’m not a researcher right but I know that those patients got back to work quicker And I knew that those patients were doing better.

Jennifer Maggiore: And so when you see that firsthand in someone’s personal life, these are patients in their 50s and 60s. They have children that they’re supporting. They have children in college. They want to get back to work and they want to have a life, right? When you lose the ability and you have side effects that cause you to not be able to swallow, to not be able to go out in public because you don’t feel good, you lost so much weight, you want to get back to doing holiday gatherings with your family and friends. Those that’s the real advantage of reducing the side effects of treatment.

David Raubach: Yeah. And there’s a benefit to that person. There’s a benefit to their family. There’s a benefit to their employer if you’re talking about a self-funded insurance plan, that person getting back to work or missing fewer days of work.

Jennifer Maggiore: And Dr. Frank will tell you more of the stats. I don’t want to steal it, you know, steal his show. And I know we’re probably short on time, too, but he’ll ask him some specific questions because he will talk to you about even getting people back to paying their taxes, right? So, when you’re working, you’re paying taxes. You’re not on disability and such. And so, he’s really dug into that with our health economics research initiative that we funded. And it’s going to be very valuable research that’s not going to be published in the Lancet. That will be a separate publication. So, yeah.

David Raubach: So I do want to go just in the last few minutes, I do want to make sure we kind of close the loop on the narrative about well, there’s been these proton center failures.

Jennifer Maggiore: Okay. Really going to drive that home, huh?

David Raubach: Well, I just Yeah. I just want to make sure that we address that because I mean I

Jennifer Maggiore: Well, yeah.

David Raubach: I mean, run a center that there was a narrative that this center couldn’t be successful or

Jennifer Maggiore: Yeah.

David Raubach: It I mean, it did actually shut down.

Jennifer Maggiore: And so I think when you zoom back out and you say, “Okay, yes, there’s been maybe a couple here or there, high-profile, large facilities, four or five rooms that maybe from a cost standpoint were there was a bigger capital investment made at the time the center was built and was sustainable. Most [clears throat] of those have been restructured.

David Raubach: I think about Oklahoma the center in Oklahoma was doing about 350 patients a year in 2016 17 18 shut down. We bought it. We [clears throat] reopened it. Recruited new doctors that were really dedicated and focused to proton therapy and figuring out how to treat different disease sites and educating the community. And we’ll treat 750 patients this year. And that’s at a community center that’s not part of a hospital system. We don’t have a built-in organic referral base. And so I think that’s if you have a good business model and you go out and you do things the right way and you operate efficiently, you can make a center successful. The Ackerman is center is another great example. That’s a that is a privately owned individual physician group that has made a proton center successful. And of course you see these big academic centers MD Anderson’s expanding.

David Raubach: But yeah, I mean maybe just address a little bit more for somebody who’s not in the weeds with protons and you see a headline, you know, high-profile bankruptcy or proton center failure, whatever the narrative is. Maybe just touch on that a little bit more.

Jennifer Maggiore: Well, think through this, right? It’s a high cost investment. So, you’re putting you’re investing a significant amount of resources in developing the center, but it also takes significant resources to maintain the center. Right? Most [clears throat] people don’t realize that Proton centers have on-site engineers. They live in that city. They’re at that they’re working there. This is not an inexpensive proposition to invest in and then to maintain but having that champion going back to that message is extremely important. I think you all are a great example of that at Oklahoma. Right. So you took this center that you saw that was important for the community and how can we make sure that this is financially viable and so you have to do that with the right cost structure.

David Raubach: Yep. The right champions and an investment in the community as well.

Jennifer Maggiore: And so you also have to fight those insurance. So remember these centers invested a lot of money and then insurers weren’t were pulling back, not paying back as much. And so there were and then we also had COVID was a real issue for many centers as well. And so if you were really on a thin line, a thin line of walking that thin line, I should say, it could be very hard to keep your doors open. And so that’s why we’re seeing this now with rural hospitals, right? So we’re seeing this now because we’re not seeing that federal support and reimbursement for some of these rural hospitals. So it’s not unique in healthcare to see hospitals or centers experience financial strain or even bankruptcy.

Jennifer Maggiore: So I think we have to look at this from a broader lens is how do we make sure we support this from a federal policy level for adequate reimbursement staffing levels champions and support our community centers because they are very important for every region in the United States.

David Raubach: So there I you bring up a good point with rural hospitals because you know proton centers they tend to be high-profile projects correct and so if [clears throat] a couple [snorts] out of 50 Mhm. Don’t do as well which is to be expected in any industry they tend to be high-profile failures. There’s been lots of cancer centers that have shut down. There’s been lots of hospitals that have shut down or gone through bankruptcy or restructuring. We’re sitting here in San Francisco today. You think about tech companies and AI. There’s going to be a lot of AI companies that start up and raise lots of money and then end up failing.

David Raubach: But you don’t say, “Well, we’re just not going to do AI because we’ve had a few companies that didn’t make it because of [clears throat] whatever structure or product or whatever they were doing.” And [snorts] so I don’t I want the takeaway to be that yes, just like in every other industry, there’s always going to be a few projects that for whatever reason don’t work the way that they’re supposed to work. That’s not a reason not to invest in proton therapy because and especially now with costs coming down, we understand a lot more about how to make centers successful from an operation standpoint, from a cost structure day-to-day standpoint.

Jennifer Maggiore: We have a better understanding of what patients to treat, when to treat them, how to treat them. Things are more efficient from a treatment planning standpoint with advances in treatment planning software. And so I think that I’m very optimistic on the future of the industry. And you see big academic centers like Mayo and MD Anderson investing more in protons. Anybody who asks me what should I be thinking about in terms of the future of a particular modality or the future of medicine, I say look at what the top cancer centers are doing. What are they investing in? How are they treating patients? They’re typically going to be at the forefront. MD Anderson just opened a second center. Mayo is building a third facility in Jacksonville with carbon ion and expanding up in Rochester. And so I think the clinical evidence is there. Again, we we’ve better understand how to run centers and make them successful.

Jennifer Maggiore: And so, yeah, I’m very optimistic, which I know you are too. I think we share that passion.

David Raubach: Yeah. Yeah. So, last question. What have you enjoyed most about San Francisco being here?

Jennifer Maggiore: Just reconnecting with all of our friends in the Proton community and being here with our team and I think our reception on Saturday night, just seeing the excitement, like you said, the optimism around Proton Therapy. It’s always great to be around the leaders in the United States and around the world that are doing this good work.

David Raubach: I told the people that I was with here at the conference, I said I don’t recognize a lot of people at the reception, which is a really neat thing. It means that there’s a lot of new people.

Jennifer Maggiore: Yeah.

David Raubach: Joining the industry. So, what’s your best thing about being in San Francisco?

Jennifer Maggiore: You know, I same. I mean just meeting with people and hearing stories and learning what other centers are doing to deal with things like for example staffing issues like and that’s healthcare in general. There’s staffing issues.

David Raubach: You said something earlier that struck me and I think it’s so true. Our community really does support each other.

Jennifer Maggiore: And I think that’s rare to a certain extent and it didn’t always be that way.

David Raubach: Yeah. When I went to the conference 10 years ago, it was definitely more of a competitive it was what are you guys doing here?

Jennifer Maggiore: I remember Stuart Klein and you know Stuart was always you know a little bit you know because it was competition in Jacksonville and stuff. So and now Stuart and I have dinner together you know once a month you know it’s just the community is very much supporting each other because we want each other to succeed because we know how valuable it is for those patients.

David Raubach: So well thank you so much for joining us today Jennifer. I really appreciate your time.

Jennifer Maggiore: Oh, thank you so much for having me. It’s just a delight to be able to talk to you in this casual forum.

David Raubach: So, I’ll see you soon in Nashville.

Jennifer Maggiore: Yep. Sounds good. Sounds good.