3 Minute TMS

[Sushirolls]

FDA just approved a protocol for the 3 minute treatments that can yield remission/response in 1 week for depression with TMS.

This is a game changer. Even if it doesn't approximate the remission rates of ECT or is on par with pharmacotherapy, its speed will propel its use. I believe this will mark a new paradigm in Psychiatry. I remember seeing the presentation on this a few years back at a conference and knew that it would be a game changer then. I believe this is the start of a TMS machine in every office.

I predict by 2025 more than half of all MD/DO/ARNP offices will have one.

Neurostimulation chapter of Psychiatry here we come. We haven't had this level change since the schism of 'Biologic/Psychodyanmic.'

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[PikminOC]

Remind me SDN in 5 years.

 

[Sushirolls]

I will.

 

[randomdoc1]

where to I find info on this? I wonder if I can get my brainsway to do that protocol? If so, it'll really help social distancing too. You know, less time in the office and all and maybe better tolerance of the treatment.

 

[wolfvgang22]

Hopefully it's more effective than the rTMS available here. One out of three patients seem to benefit.

 

[finalpsychyear]

your all a bit late to the ballgame. The payments now for rtms are pretty crappy not surprising this is now magically getting approved.. wink.

Last I checked with the few colleagues who didn't go broke doing this it was 150-170 for 1 treatment session gross but a few years ago this was 3-4x this amount. Then you pay the tech 30 bucks out of that and neurostar charged 60-70 each treatment session (the greed). Don't forget the 70-100k cost of the machine plus 10k annual "maintenance" you pay plus any additional liability insurance.

Edit: the brainways machine doesn't do the each treatment 60-70 cost instead their machine alone is 200k or slightly more
Also, rumors are that insurance will be updating their payments for the 3 min protocol instead of the current 19-38 min ones which means even less $

This is great for patients who can get this service and results in 1 week but stick you money in the market when it retraces under 20k very soon.

 

[randomdoc1]

your all a bit late to the ballgame. The payments now for rtms are pretty crappy not surprising this is now magically getting approved.. wink.

Last I checked with the few colleagues who didn't go broke doing this it was 150-170 for 1 treatment session gross but a few years ago this was 3-4x this amount. Then you pay the tech 30 bucks out of that and neurostar charged 60-70 each treatment session (the greed). Don't forget the 70-100k cost of the machine plus 10k annual "maintenance" you pay plus any additional liability insurance.

Edit: the brainways machine doesn't do the each treatment 60-70 cost instead their machine alone is 200k or slightly more
Also, rumors are that insurance will be updating their payments for the 3 min protocol instead of the current 19-38 min ones which means even less $

This is great for patients who can get this service and results in 1 week but stick you money in the market when it retraces under 20k very soon.

I don’t think it’s that grim. I negotiated some spanking good rates and set up a good payment system for my techs so I’m not hemorrhaging money. I got the H coil about 18 months ago and it’s paid off. Pure profit and it’s not pay per use. Brainsway is actually pretty customizable but I need to look into what exactly that 3 minute protocol is. I’ve already made a good earning off TMS. So don’t lose hope guys! I’m just looking for ways to optimize more. That and I hope to kick everyone else’s ass at SEO so I can keep this going. Got a few other tricks up my sleeve. What can I say? It’s a business, as long as you do better than competitors, you are alright.

 

[liquidshadow22]

your all a bit late to the ballgame. The payments now for rtms are pretty crappy not surprising this is now magically getting approved.. wink.

Last I checked with the few colleagues who didn't go broke doing this it was 150-170 for 1 treatment session gross but a few years ago this was 3-4x this amount. Then you pay the tech 30 bucks out of that and neurostar charged 60-70 each treatment session (the greed). Don't forget the 70-100k cost of the machine plus 10k annual "maintenance" you pay plus any additional liability insurance.

Edit: the brainways machine doesn't do the each treatment 60-70 cost instead their machine alone is 200k or slightly more
Also, rumors are that insurance will be updating their payments for the 3 min protocol instead of the current 19-38 min ones which means even less $

This is great for patients who can get this service and results in 1 week but stick you money in the market when it retraces under 20k very soon.

Market under 2000??? No way dude.

 

[PikminOC]

where to I find info on this? I wonder if I can get my brainsway to do that protocol? If so, it'll really help social distancing too. You know, less time in the office and all and maybe better tolerance of the treatment.

You don't have to be present somewhere in the office?

 

[PikminOC]

I don’t think it’s that grim. I negotiated some spanking good rates and set up a good payment system for my techs so I’m not hemorrhaging money. I got the H coil about 18 months ago and it’s paid off. Pure profit and it’s not pay per use. Brainsway is actually pretty customizable but I need to look into what exactly that 3 minute protocol is. I’ve already made a good earning off TMS. So don’t lose hope guys! I’m just looking for ways to optimize more. That and I hope to kick everyone else’s ass at SEO so I can keep this going. Got a few other tricks up my sleeve. What can I say? It’s a business, as long as you do better than competitors, you are alright.

H coil is for ocd?
The local tms people are advertising on fbook

 

[splik]

Also, rumors are that insurance will be updating their payments for the 3 min protocol instead of the current 19-38 min ones which means even less $

insurance does not set RVUs for CPT codes. the AMA does. I would not be surprised if there were a CPT code developed for this but it would not be insurance companies doing that.

At any rate, even if there were a new CPT code, the greater volume of patients that could be treated would still be a net + for those who are able to fill their chairs.

 

[wolfvgang22]

insurance does not set RVUs for CPT codes. the AMA does. I would not be surprised if there were a CPT code developed for this but it would not be insurance companies doing that.

At any rate, even if there were a new CPT code, the greater volume of patients that could be treated would still be a net + for those who are able to fill their chairs.

You mean...it's the AMA who have been screwing us with low RVUs all this time?

 

[splik]

You mean...it's the AMA who have been screwing us with low RVUs all this time?

If you historically look at the make up of the RUC (the committee that does all this) they have been overly represented by specialities such as GI, derm, ortho -- specialties that have not coincidentally commanded much higher income. psychiatry has had more representation in recent years and one of the reasons why psychiatrists income has increased substantially in recent years is as a result of those changes (particularly the move to E&M codes and psychotherapy add-on codes). The trend is to increasing reimbursement for cognitive specialties and decreasing payment for procedural specialties.

Relevant to the example above for TMS - one reason GI gets paid so much is the RVUs for scopes were based on how long it took to do a scope in 1992 (AMA estimate 75mins then) and now its much quicker to do a colonoscopy so they can do a lot more of them and there was no reduction in RVUs. Cataract extraction RVUs was based on estimate of 84 mins, but today it takes a fraction of that. That has led to the impetus to revise procedural codes but again it is the AMA that does this and the standard had been NOT to change them (until very recently)

The conversion factor (i.e. $ per RVU) is set by medicare and individual insurance contracts

The AMA has to toe a careful line as they are constantly at risk of losing the RUC (it is a historical quirk and mistake the AMA even does this in the first place!) so they can't be too greedy about this.

ETA: interestingly the CPT code for psychologist prescribing is worth 0 RVUs...

 

[oldiebutgoodie1211]

If you historically look at the make up of the RUC (the committee that does all this) they have been overly represented by specialities such as GI, derm, ortho -- specialties that have not coincidentally commanded much higher income. psychiatry has had more representation in recent years and one of the reasons why psychiatrists income has increased substantially in recent years is as a result of those changes (particularly the move to E&M codes and psychotherapy add-on codes). The trend is to increasing reimbursement for cognitive specialties and decreasing payment for procedural specialties.

Relevant to the example above for TMS - one reason GI gets paid so much is the RVUs for scopes were based on how long it took to do a scope in 1992 (AMA estimate 75mins then) and now its much quicker to do a colonoscopy so they can do a lot more of them and there was no reduction in RVUs. Cataract extraction RVUs was based on estimate of 84 mins, but today it takes a fraction of that. That has led to the impetus to revise procedural codes but again it is the AMA that does this and the standard had been NOT to change them (until very recently)

The conversion factor (i.e. $ per RVU) is set by medicare and individual insurance contracts

The AMA has to toe a careful line as they are constantly at risk of losing the RUC (it is a historical quirk and mistake the AMA even does this in the first place!) so they can't be too greedy about this.

ETA: interestingly the CPT code for psychologist prescribing is worth 0 RVUs...

it should be 0 they should stay in their lane

 

[Sushirolls]

Not all insurance companies pay on straight RVU conersation factor formular. Some simply pay X for CPT code 98###, which means they can and do adjust when they please.

 

[NickNaylor]

We have a device in our clinic that can do theta burst protocols which allows for 3-minute treatments. The results thus far have not been so amazing. It doesn't seem to be any more or less effective than standard TMS, though it is more patient-friendly in that the treatment sessions are far shorter. I wonder if some patients might actually be less likely to respond to the 3-minute protocol since it is less "intense" and intrusive.

It certainly hasn't been equivalent to ECT.

 

[Sushirolls]

How have you decided which protocol a patient is prescribed? What is preventing the complete adoption of the 3 minute protocol at your clinic?

 

[oldiebutgoodie1211]

We have a device in our clinic that can do theta burst protocols which allows for 3-minute treatments. The results thus far have not been so amazing. It doesn't seem to be any more or less effective than standard TMS, though it is more patient-friendly in that the treatment sessions are far shorter. I wonder if some patients might actually be less likely to respond to the 3-minute protocol since it is less "intense" and intrusive.

It certainly hasn't been equivalent to ECT.

TMS has never been equivalent to ECT though so I doubt shortening the length will make it more efficacious

 

[NickNaylor]

How have you decided which protocol a patient is prescribed? What is preventing the complete adoption of the 3 minute protocol at your clinic?

We use the 3-minute protocol by default.

 

[randomdoc1]

There's definitely some placebo, as can be the case for any treatment. I have seen patients in a separate practice perceive the shorter sessions as less efficacious. Back when TMS sessions were 40 minutes, some were not fans of the new 18 minute protocol. rofl. I also wonder if the longer sessions allow the patients to perceive more opportunity to develop a relationship with the staff. Which in and of itself can be a corrective experience given the high comorbid axis ii and in itself can be therapeutic.

 

[randomdoc1]

Just an update folks! I haven't looked into 3 minute TMS yet. But wanted to tell y'all that it's NOT too late in the game. TMS is bouncing back and I've got 9 cases running and 4 more in the pipeline. Plus the cases I had earlier in the year. It's just about running your business smartly ;D. In other words, you just have to somehow stand out from your competitors. But it's doable!

 

[Sushirolls]

Price is coming down on devices! 50K

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Love to see what others think about this device.