Oncology Hospital Planning Checklist: What Investors & Planners Must Know
Building a successful oncology hospital requires careful planning, substantial investment, and a clear understanding of both clinical and business requirements. If you're an investor or planner considering a cancer care facility, you're entering a field that's both financially demanding and incredibly rewarding. The global oncology spending reached 193 billion U.S. dollars in 2022, showing the significant market opportunity and the critical need for quality cancer care facilities.
This guide will walk you through everything you need to know before breaking ground on your oncology hospital project. We'll cover the essential planning phases, regulatory requirements, and investment considerations that can make or break your facility's success.
Understanding the Four Main Planning Phases
Cancer care facility development follows a structured process. According to healthcare planning experts, there are four critical phases that you need to master for a successful project.
Strategic Planning Comes First
Before you think about construction costs or equipment budgets, you need a solid strategic plan. This phase involves assessing your market position, understanding competitor offerings, and determining which cancer services you'll provide. Working with experienced hospital project consultants during this phase can help you avoid costly mistakes down the road.
You'll need to examine several key areas:
- Which tumor sites will your facility focus on (breast cancer, lung cancer, etc.)
- What treatment modalities you'll offer (surgery, radiation, medical oncology)
- Whether you'll pursue growth in place or regional expansion
- How you'll integrate clinical trials and research programs
The strategic plan should address both current program capabilities and future aspirations. Many successful facilities start by determining which cancer sites to prioritize first, then expand their services over time.
Business Planning and Financial Modeling
Once your strategic direction is clear, it's time to crunch the numbers. A comprehensive hospital feasibility study objectively quantifies the need for your facility and its financial viability.
Your business plan needs three essential elements:
First, you must model clinical volumes at both service and modality levels. These projections should be based on your strategic goals combined with realistic assumptions about market capture, growth percentages, and service utilization rates (such as treatments per patient).
Second, you'll develop financial projections that account for revenue streams, operating costs, and return on investment timelines. Keep in mind that oncology facilities require sustained funding due to both program growth and inflation. The National Cancer Institute's budget, for example, totaled $7.2 billion in fiscal year 2024, reflecting a 1.7% increase from the previous year.
Third, your plan should include scenario analysis for different growth patterns and market conditions. This helps you understand potential risks and opportunities before committing major capital. Take time to avoid common hospital budget mistakes that can derail even well-planned projects.
Facility Planning and Design Considerations
This is where your vision starts taking physical shape. Facility planning and design determines the scope of renovation or construction required to support your strategic goals.
Modern oncology facility design has shifted toward what's called a "platform-based" model. Understanding common hospital design mistakes can save you from costly errors during this critical phase. This approach includes:
- Universal clinic modules that can be used by various disciplines
- Diagnostic and treatment components (infusion areas, labs, imaging, radiation oncology, pharmacy)
- Possibly oncology urgent care services
- Centralized workspaces that support team-based care
Room sizes should meet minimum requirements, but variations are acceptable based on your unit's specific needs. For example, a typical oncology unit might include 12, 18, 24, or 30 treatment spaces depending on projected patient volume. Treatment bays must accommodate both hospital beds and recliners, with the percentage of each determined by facility management preferences.
Regulatory Requirements You Can't Ignore
Accreditation isn't just a nice-to-have. It's essential for credibility, reimbursement, and patient trust.
Commission on Cancer Accreditation
The Commission on Cancer (CoC) accreditation is the gold standard for cancer programs. CoC-accredited facilities undergo on-site visits every three years, where trained reviewers assess compliance with standards outlined in "Optimal Resources for Cancer Care."
Programs must demonstrate compliance with revised standards that took effect January 1, 2024. The accreditation process includes data reporting to the National Cancer Database (NCDB), which allows hospitals to compare their quality of care and identify areas for improvement.
There are different CoC facility categories based on your structure, services, and annual caseload:
- Academic Comprehensive Cancer Programs (requires postgraduate medical education in at least four areas)
- Comprehensive Community Cancer Programs (500+ newly diagnosed cases annually)
- Community Cancer Programs (100-500 cases annually)
- Hospital Associate Cancer Programs (nonhospital-based with at least one treatment modality)
Joint Commission Standards
Joint Commission accreditation provides objective evaluation of healthcare organizations. The 2024 hospital accreditation standards underwent major revisions to reduce regulatory burden while maintaining high safety and quality standards.
Their Accreditation 360 approach uses technology and data analytics to help healthcare systems focus on what matters most: patient care. Over 24,000 organizations globally trust Joint Commission standards to improve patient outcomes.
Radiation Oncology Specific Requirements
If your facility includes radiation therapy services, you'll need additional accreditation from the American College of Radiology (ACR). Each radiation oncology program must have a medical director who is a board-certified radiation oncologist responsible for departmental oversight.
Radiation therapy programs require certification in specific areas and continuous quality improvement measures, including peer review, chart rounds, and patient satisfaction surveys.
Critical Infrastructure and Design Elements
Radiation Bunker Planning
One of the most technically complex aspects of oncology hospital planning involves radiation therapy bunkers. These specialized rooms house linear accelerators (the primary treatment units for radiotherapy).
Key considerations include:
- Bunker size depends on equipment selection and radiation shielding requirements from safety specialists
- The weight of radiation shielding equals approximately two levels of basement car parking
- Access is typically via a twisted corridor called "the maze" to contain radiation
- Good external access is required for equipment delivery by large vehicles
Some modern facilities use prefabricated, demountable, and stackable concrete and lead blocks for shielding rather than structural concrete. This allows for future reassignment of space if treatment methods change. Removable facade panels enable 10-tonne machines to be lifted in or out of buildings during installation or upgrades.
Infection Control and Patient Safety
Oncology patients often have compromised immune systems, making infection control critical. Your facility design must include:
- At least one handwashing bay conveniently accessible to staff stations
- Antiseptic hand rubs at points of care throughout the facility
- Standard single patient rooms classified as Class S isolation
- Minimum number of Class N negative pressure isolation rooms as outlined in planning guidelines
Handbasins must comply with infection control standards, and antiseptic hand rub placement should be consistent and reliable throughout your facility.
Patient-Centered Design Features
Research shows that the physical environment significantly impacts patient wellbeing and treatment outcomes. Your facility design should address both clinical requirements and patient comfort. Learn more about patient-centered hospital design principles to create healing environments.
Consider these elements:
- Natural lighting in treatment and waiting areas
- Private consultation rooms for sensitive discussions
- Comfortable infusion areas where patients may spend several hours
- Accessible parking close to the entrance (patients may have mobility challenges)
- Clear wayfinding and navigation throughout the facility
The hours and days of operation will depend on your service level. Most units operate five to seven days per week with 8 to 12-hour working days. Chemotherapy infusions can take anywhere from 15 minutes to 12 hours depending on the treatment protocol.
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Staffing and Personnel Requirements
Your facility is only as good as the team running it. Staffing requirements vary based on your facility category and services offered.
Core Clinical Staff
At minimum, you'll need:
- Board-certified medical oncologists
- Radiation oncologists (if offering radiation therapy)
- Oncology-certified nurses and nurse managers
- Medical physicists for radiation therapy programs
- Pharmacy staff specialized in chemotherapy preparation
- Social workers and patient navigators
Office areas should be provided according to role delineation and the number of approved full-time positions in your unit. Staff and support rooms may be shared between functional planning units depending on location and accessibility.
Supportive Care Teams
Modern comprehensive cancer care requires more than just oncologists. You'll need:
- Genetic counselors for risk assessment
- Palliative care specialists
- Rehabilitation therapists
- Nutritionists familiar with cancer patient needs
- Behavioral health professionals
- Financial counselors to help patients manage costs
Equipment and Technology Investment
Medical equipment represents a major capital investment. Biomedical equipment procurement requires careful planning and vendor selection. Linear accelerators (Linacs) are the primary treatment units for radiation therapy and can cost several million dollars each. Modern facilities like Guy's Cancer Centre use systems such as the Varian TrueBeam precision radiotherapy system.
Your imaging suite may be shared with collocated radiation oncology units and should include control stations sized according to manufacturer specifications. CT or MRI simulation rooms are used for treatment planning, though smaller facilities might omit simulation rooms where other positioning methods are available.
Don't forget about software and data systems. You'll need robust electronic medical records, treatment planning systems, and potentially AI-powered software applications for automated contouring and treatment planning that received FDA clearance in 2024.
Opening Day Planning and Transition
Planning for your opening day is critical to ensure a smooth transition that maintains quality patient care throughout the move. A comprehensive hospital commissioning checklist helps ensure nothing gets overlooked during this critical phase.
Scenario planning should cover:
- Time and day of the week for the transition
- Equipment move scheduling
- Opening sequence of departments
- Notification to the community about the old space closing
- Real-time issue escalation through a command center if necessary
Because most cancer centers are ambulatory in nature, planning is less intense than for inpatient hospital transitions. However, you still need careful coordination to avoid disrupting patient care schedules.
Market Trends and Investment Climate
Understanding current market trends helps inform your investment strategy. In 2024, there's growing interest in value-based care models for oncology. The Centers for Medicare and Medicaid Services (CMS) expanded the Enhancing Oncology Model (EOM) to recruit a second cohort of participants, with applications accepted through September 16, 2024.
The EOM includes increased monthly payments for enhanced oncology services and higher thresholds for recoupment (rising from 98% to 100% of benchmark amounts). The model has been extended through June 30, 2030, reflecting CMS's commitment to improving oncology care while managing healthcare costs.
Private equity investment in oncology has also increased, with platforms like OneOncology pursuing affiliation models that help practices reduce administrative burden while maintaining clinical autonomy.
Conclusion
Building an oncology hospital is a complex undertaking that requires careful attention to strategic planning, regulatory compliance, facility design, and financial modeling. Success depends on understanding both the clinical requirements for excellent cancer care and the business realities of healthcare investment.
Start with a clear strategic vision, ensure you understand all accreditation requirements, design your facility with both clinical excellence and patient comfort in mind, and plan carefully for your opening day. The market opportunity is significant, with global oncology spending continuing to grow, but so are the responsibilities to patients who will depend on your facility during one of the most challenging times of their lives.
By following this checklist and working with experienced hospital project management consultants, you can build a facility that delivers excellent patient outcomes, meets all regulatory requirements, and achieves your financial goals.
Frequently Asked Questions
How long does it typically take to plan and build an oncology hospital?
The complete process from initial strategic planning through opening day typically takes 3-5 years. This includes 6-12 months for strategic and business planning, 12-18 months for design and permitting, 18-24 months for construction, and several months for equipment installation and staff training. The timeline can vary significantly based on facility size, complexity, and regulatory approval processes in your location.
What is the minimum investment required to start an oncology facility?
Initial investment varies widely based on facility size and services offered. A small community cancer program might require $10-20 million, while a comprehensive cancer center with radiation therapy can exceed $100 million. Major cost drivers include radiation bunker construction ($2-5 million per bunker), linear accelerators ($2-4 million each), imaging equipment, and build-out costs. Your business plan should include detailed capital requirements for your specific project scope.
What are the most important accreditations for an oncology hospital?
The Commission on Cancer (CoC) accreditation is considered essential for credibility and often required for certain insurance reimbursements. Joint Commission hospital accreditation is also critical. If offering radiation therapy, ACR Radiation Oncology Practice Accreditation is necessary. For comprehensive cancer centers, NCI designation as a Comprehensive Cancer Center represents the highest level of recognition but requires securing an NCI peer-reviewed Cancer Center Support Grant.
Can I start with a smaller oncology facility and expand later?
Yes, many successful cancer programs start small and expand over time. You might begin as a Community Cancer Program (100-500 cases annually) and grow into a Comprehensive Community Cancer Program (500+ cases). Start with core services like medical oncology and infusion, then add radiation therapy, surgical oncology, and research programs as your patient volume and revenue grow. Make sure your initial facility design allows for future expansion.
What are the ongoing operational costs for an oncology hospital?
Ongoing costs include staff salaries (typically the largest expense), pharmaceutical costs for chemotherapy drugs, equipment maintenance and upgrades, facility operations, insurance, and quality improvement programs. Chemotherapy drugs alone can represent 30-40% of operating costs. You'll also need to budget for continuous staff training, accreditation fees (paid annually), data reporting requirements, and technology updates. Most facilities plan for 5-10% annual cost increases due to inflation and rising drug prices.
