Better prep. Fewer no-shows. Less phone work.

Assumptions, made visible

• Late cancellation reduction: 20% / 35% / 50% (conservative / expected / potential).
• No-show reduction: 15% / 25% / 40%.
• Prep-aware backfill rate on late cancellations: 55% / 65% / 75%, against a current rate you set (default 25%). The model credits only the lift over your current rate, on late cancellations only. Pilot-to-prove against your own baseline.
• Prevention is netted by your current backfill: a late cancellation you would have refilled anyway is not counted as a recovered slot, so prevention and backfill do not double-count.
• A recovered slot is valued at the recovered revenue (gross facility fee) you set, not contribution margin. The endoscopist professional fee, anesthesia and pathology are shown as separate full-episode lines and stay out of the facility figure and the ROI multiple, since anesthesia accrues to the anesthesia group and pathology to the lab.
• Endoscopist professional fee: the per-scope figure you set drives the separate endoscopist loss line, on the same recoverable slots. Default $400 is a reasonable commercial professional fee for a colonoscopy — Medicare pays ~$220–300 (CPT 45378/45385 at the 2026 conversion factor) and commercial ~$300–500. Against the commercial facility fee that is about a 2.5:1 facility-to-professional split, the normal commercial range. Set both to your own rates.
• Staff time is included in the figures above: 60% of your nurse prep-call minutes (default 20 min/patient) at $45/hr loaded. Treat it as the soft part of the range: it is real cash only if you redeploy the freed hours into more cases or a deferred hire.
• Aescia price: $8/scope, US institutional rate, which is the spend the ROI multiple is measured against. Volume tiers and design-partner discounts not reflected here.
• Aescia commits to the conservative band in writing during design-partner pilots; the backfill lift is confirmed against your own baseline in the pilot.
• Backfill applies to late cancellations only (about a day's notice). Same-day prep failures and no-shows are not backfillable, so they count toward prevention, never backfill. No-show default 8% (typical 5–15%).
• Beran 2024 (Am J Gastroenterol, n=358,257, 154 studies) anchors that inadequate prep is a common, upstream problem with addressable risk factors. Cancellation/no-show effect sizes are from the prep-coaching and SMS-reminder literature.
• Facility fee: Allen 2023, CMS ASC CPT 45378–45385 (USD $989–$1,034).
• Anesthesia: about $240/scope, the expected MAC-weighted figure (commercial roughly $410 per monitored-anesthesia case at about 58% utilization; Predmore 2019, USC Schaeffer 2021). Accrues to the anesthesia group, shown for the full-episode picture, not in the ROI multiple.
• Pathology: about $60/scope expected, biopsy-weighted (CPT 88305 commercial about $82 per specimen, roughly 1.7 specimens on about 45% of scopes; PayerPrice 2026, GIQuIC). The softest figure here, and it accrues to the lab, not the ROI multiple.
• Inadequate prep: default 15% of scopes (US real-world 10–25%; 2025 USMSTF benchmark 10% or less). Coaching, navigation and reminders cut it by 25% / 40% / 50% (Guo 2016, Tian 2021, Faveri 2025). About 30% of inadequate preps consume a repeat or aborted slot (GIQuIC 32% recommended within a year, VA 59% completed). This repeat recovery is folded into the recovered slots and the ROI above.
• Surveillance recapture: roughly half of post-polypectomy patients are overdue or never return (US Medicare 5-year non-return about 48%; Schoen 2014, cross-checked against high-risk-adenoma and large-polyp cohorts). Reminders roughly double completion (Sci Reports 2021). Capacity-conditional and outside the ROI multiple.