Operations guide

How to start a survivorship clinic inside the practice you already have

No new entity, no franchise structure, no parallel record. A recurring session, a small team, a defined cohort, and a visit that is worth the slot. Here is the eight-week build.

Download the eight-week build checklist

Every phase below as printable checkboxes, plus the capacity and cost planning ranges on the last page. Free tier, same one-time email unlock as the rest of the library.

Phase 1Weeks 1-2

Define the population and the promise

Pick the starting cohort: adult survivors of childhood cancer, breast-cancer survivors post-anthracycline or HER2 therapy, or HSCT recipients. One cohort first.
Write the one-sentence promise for that cohort, in the survivor's words.
Agree the exclusion line: what stays with treating oncology and never moves to survivorship.

Phase 2Weeks 2-4

Staff the smallest viable team

Clinical lead: an oncologist, cardio-oncologist, or advanced-practice clinician with survivorship interest. 0.2 FTE covers a half-day clinic.
APP or nurse navigator: the operational center of gravity. 0.5 FTE runs intake, exposure summaries, and follow-up.
Scheduler and coder support: shared with the parent practice at first, not dedicated.
Optional at launch, valuable by month six: pharmacy for deprescribing, psychology or social work for distress and financial navigation.

Phase 3Weeks 4-6

Build the visit

Pre-visit: survivor completes the exposure worksheet; navigator assembles the transition-of-care plan draft.
Visit: 40 minutes for a new survivorship consult, 20 for an annual review. Structure it around the surveillance calendar, not a general review of systems.
Post-visit: hand-off letter to primary care naming who owns which late effect and the re-referral triggers.

Phase 4Weeks 6-8

Get paid for it

Time-based or MDM-based office visit codes for the consult and annual review.
Chronic care management and principal care management where the survivor has qualifying chronic conditions and consent is documented.
Advance care planning, behavioral health integration, and remote monitoring codes where the service is genuinely delivered.
Confirm every code with your own compliance and revenue-cycle teams before billing. Coverage and coding rules vary by payer and by year.

Phase 5Ongoing

Measure and defend the slot

Track: new consults per month, annual-review completion rate, surveillance studies completed on schedule, and re-referrals generated back into the parent practice.
Report downstream volume. A survivorship clinic that generates imaging, cardiology, endocrine, and screening referrals defends its own schedule.
Review the exclusion line quarterly. Scope creep is the most common failure mode.

Capacity and cost, in plain numbers

Planning ranges drawn from how these sessions typically run. Model against your own payer mix and referral base before committing schedule time.

Half-day clinic capacity: 6-8 visits (2 new consults, 4-6 annual reviews)
Steady-state ramp: 3-6 months to fill a recurring half-day slot from internal referrals alone
Primary staffing cost: 0.5 FTE APP or navigator plus 0.2 FTE clinical lead
Largest hidden cost: Exposure-summary assembly when treatment records live in another system
Largest hidden value: Downstream imaging, cardiology, and screening referrals retained in-network
Most common failure: No exclusion line, so the clinic absorbs active-treatment complexity it was never staffed for

Questions before you put it on the schedule

Do I need a separate legal entity or a franchise to run a survivorship clinic?

No. Most programs run inside an existing oncology or primary-care practice as a dedicated session. Licensing the toolkit is a software and content arrangement, not a franchise structure, so there is no franchise disclosure process to work through.

What is the minimum staffing to start?

A clinical lead at roughly 0.2 FTE and an advanced-practice clinician or nurse navigator at roughly 0.5 FTE. The navigator carries intake and exposure summaries, which is where most of the work sits.

How long until a survivorship session fills?

Internal referral flow typically fills a recurring half-day session within three to six months, faster where a pediatric long-term follow-up program is already transitioning patients out.

How do we justify the clinic financially?

Visit-level billing rarely tells the whole story. Track the downstream imaging, cardiology, endocrine, and screening volume the program generates and retains, alongside the completion rate for guideline-indicated surveillance.

Build it with the toolkit already made

Licensing gives you the surveillance library, care-plan builder, and hand-off templates as a software arrangement inside your own practice.

See licensing Schedule a 30-minute call Template library Surveillance schedules

See something wrong on this page?

Guidelines move. If an interval, threshold, or source link is out of date, flag it and a clinical reviewer will look at it. Please do not include any patient information.