Your vendor's service team reviews your account every quarter. Somewhere in their building there is a slide with your program's name on it and five numbers underneath. Most programs see the service contract twice: the day it is signed and the day it renews.

The five numbers are not a secret. Uptime delivered against contracted uptime. Dispatch response against the SLA. Preventive maintenance hours scheduled against PM hours delivered. Parts replaced under coverage against parts billed outside it. First-call resolution rate. Every one of them rolls up to the bonus structure of the account team that will sit across from you at the renewal. I spent twenty years on the side of the table that builds that deck. The vendor knows your numbers cold.

Most programs measure none of the five. They pay the invoice, call when the machine goes down, and renew when the term ends. So the renewal arrives with one side holding a quarter-by-quarter record and the other side holding a feeling about how service has been. That conversation has already been lost.

Here is the scorecard, metric by metric, with where the data already sits.

Uptime. The contract guarantees a number, usually with credits attached if the vendor misses it. The catch is whose clock measures it. Scheduled maintenance is excluded. Downtime the vendor classifies as customer-caused is excluded. The measurement window may not match your treatment day. Pull the vendor's uptime report from the service portal, then run your own definition against your treatment calendar. If the machine was down during clinical hours, your patients do not care that the contract calls it excluded time. The gap between the two definitions is a renewal conversation.

Response time. The SLA promises a response inside a set number of hours. The portal logs when the ticket opened and when the vendor says it responded. Your own log, if you keep one, records when an engineer actually walked through the door. Responded and on site are different events, and the difference is measured in treatment days. Start the log. A shared sheet with four columns: ticket opened, vendor acknowledged, engineer on site, machine released. That sheet is the cheapest leverage the program will build this year.

PM hours. The premium for full coverage is mostly a bet on preventive maintenance, so count it. PMs scheduled, PMs delivered, PMs compressed or pushed into clinical hours because the calendar was tight. Undelivered PM is prepaid service that was never rendered, and it shows up later as unscheduled downtime that the uptime exclusions then absorb. The portal has the PM history. Most programs have never opened that tab.

Parts. Coverage has an exclusions schedule, and the invoices for not-covered parts land in accounts payable where nobody reconciles them against the contract. Add them up for the year. The real cost of the service contract is the contract price plus that pile. That total, not the contract line, is the number to put against a time-and-materials model or a third-party bid at renewal.

First-call resolution. How often the same fault takes two or three visits to fix. The vendor tracks it because it tells them which engineers to keep on your account. The program tracks it because it is the argument for dedicated-engineer language in the next term, which costs the vendor little and almost nobody asks for.

The fix is mechanical, not heroic. Pull the portal quarterly. Reconcile delivered against contracted. Keep the dispatch log. Put the result into a one-page quarterly service review that the program runs, on the program's calendar, with the vendor in the room. By the time the renewal lands, you walk in with your own record instead of reacting to theirs.

One more page to read while the contract is open: the renewal terms. The auto-renew clause with the 90-day notice window and the escalator attached is where programs lose money without a meeting ever happening. A 4% escalator on a $380,000 contract that rolled because nobody flagged the notice date is $15,000 spent without a decision being made. Multiply that by every contract in the program running on autopilot.

The portal login takes five minutes to dig up. The first quarterly pull takes an hour. The renewal is coming either way. The only question is which side of the table arrives with the record.

The comprehensive service contract, run against the exclusions schedule.

The Pitch: "Full coverage. One annual number. Guaranteed uptime, with credits if we miss it. Parts, labor, PMs, software updates, all in. You will never see a surprise bill."

The Reality: The uptime guarantee is measured on the vendor's definitions, and the exclusions absorb most of the hours that hurt. The one annual number carries an escalator that compounds every term. All-in has an exclusions schedule, and the parts on it arrive as separate invoices that never get reconciled against the promise. The single number is the point. It ends the conversation at signature, because one price is easy to approve and seven prices invite questions. The scorecard is how the conversation gets reopened, with the program's own record on the table instead of the vendor's summary.

The scorecard reopens what the vendor delivers. The rate reopens what you pay for it.

A comprehensive service rate is almost always a flat percent of the original list price. It does not move as the machine ages, even though what it costs to service the machine does. Published analysis puts the real cost to service a LINAC near half the contract price. The gap between the two, across the remaining term, is the most negotiable line in the contract, and it is the one almost nobody reopens.

We built a small tool that runs it on your own numbers: list price, your rate, the machine's age. It shows where the gap sits and what it is worth over the term.

It runs entirely in your browser, and nothing you enter is sent anywhere or saved.

Run your contract through it

With Heather Turner, RT(T), PMP

The 2026 Code Overhaul Needs a Quarterback. If your clinical team and your back-office billers are not speaking the same language right now, your facility is probably leaking cash.

The shift to complexity-based delivery coding (77402, 77407, 77412) retired the old IMRT and 3D codes. CMS pitched it as streamlined modernization. In practice, private payers are treating the transition as an invitation to downcode Level 3 treatments to lower-paying tiers, or to trap authorizations in loops of requests for clinical justification. Every delayed authorization lands on a physician, who then spends clinical hours in peer-to-peer reviews defending a treatment decision to an insurance reviewer. The way out is to prove the code's necessity before the payer can flag it.

As an administrator, it is easy to assume defending these codes is the therapists' job at the console. It is not. Surviving this system is a team effort, and the administrator is the quarterback who aligns the workflow starting the second the patient walks into simulation. Downstream fixes do not hold. You rebuild the documentation templates from the top.

Hardwire the provider's intent. A clean claim starts with the physician's pen. When a payer audits a Level 3 delivery charge, they do not just read the daily treatment log. They trace it back to the consultation, the prescription, and the simulation orders. Work with your providers to build smart-text templates in your OIS so the orders explicitly document the clinical triggers, active motion management, multiple isocenters, that justify the high-complexity tier before the patient ever touches the table.

Bridge the simulation gap. The simulation note has to mirror the physician's intent. If the prescription calls for respiratory gating, the sim documentation details the specific immobilization and motion management used. When the setup at simulation matches the daily tracking the therapists run, the audit trail holds.

Reinforce the console. Once the process is in place, the therapists lock it down. Daily OIS treatment sessions verify that the high-complexity parameters in the orders were executed. A templated drop-down or a one-line note confirming active motion management, instead of clicking through the automated prompts, is what makes the record stand up to an audit.

Downcoding is an institutional problem, and no single clinical role can solve it. The administrator who standardizes documentation from the prescription through daily treatment protects the technical revenue and takes the guesswork off the frontline staff. Open your OIS this week and read one Level 3 order the way an auditor would. If the trigger is not on the page, that is where the rebuild starts.

If a service renewal is inside the next twelve months and the only record in the room is the vendor's, the Medsolve 30-minute program review is the conversation.