Does TMS generate large profit?

[annoyedpsychiatrist]

Just curious because of how popular it is these days, every private office seems to have one. Not familiar with billing/reimbursement for it.

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[littlefred]

Just curious because of how popular it is these days, every private office seems to have one. Not familiar with billing/reimbursement for it.

General principle but... procedures = more reimbursement.

One of the few that psychiatrists actually do, the issue is that tou might need multiple machines. 1 session can take 30 to 45 minutes so it is limited by that.

 

[TexasPhysician]

Think of TMS more like an esthetics machine from a financial perspective. If you have enough patients to fill the day with TMS patients, the machine can be quite financially rewarding. The problem is that the majority of clinics can’t fill the machine with patients. Then it becomes expensive office decor.

 

[Merovinge]

Keep in mind that courses of the current TMS are very time/cycle intensive. You go 5 days/week for several weeks so it results in absurd number of visits compared to any other type of mental health treatment. I haven't reviewed the literature, but I wouldn't be surprised if behavioral activation made up the bulk of the benefit. Supposedly going for a walk prior to treatment enhances the effect, huge shocker there.

 

[comp1]

I definitely agree that the primary benefit is getting the person out of the house five days a week even if there is some marginal benefit over sham treatments. In terms of profit, sure, of course. It has high reimbursement rates.

 

[smalltownpsych]

It is important to make sure that you have enough patients that would be willing or able to do the five days a week thing. A number of family practice NPs around here bought the machines and then found out that their depressed patients really weren’t that depressed and hence not that motivated to do something that intensive. Heck, most of the people who present with depressive symptoms in primary care aren’t even motivated enough to show up to see me for psychotherapy once a week.

 

[Sushirolls]

The other issue is some pubs supporting, theta burst protocol? which can be done in 3 minutes sessions and complete in 5 days.

So if the course of remission is faster, this means less ongoing treatments, and the machine needs a higher volume to justify it. But I suspect current clinics aren't chomping at the bit to do a faster protocol.

I've thought about it a few times, but I just don't have the volume to justify a machine.

 

[Merovinge]

I mean if theta burst goes on to replicate at anything resembling the initial Stanford work, a lot of modern mental health treatment is going to be rendered irrelevant. Definitely need a healthy dose of skepticism for something like what they are purporting, especially as it seems to have fallen off the news cycle which would be odd for something with great convenience and profound benefit to risk ratio.

 

[Sushirolls]

These days, just because something falls off the news cycle doesn't mean it isn't news worthy.
I'm not on top of TMS articles enough to know where things stand if theta really is the direction treatments should go and its being neglected with intent or if not yet proven itself or was a flop. As I hope that professionalism still has a core, a beating heart that lives, deep in medicine, I hope that it isn't being neglected for business reasons.

 

[psycho-matic]

The other issue is some pubs supporting, theta burst protocol? which can be done in 3 minutes sessions and complete in 5 days.

So if the course of remission is faster, this means less ongoing treatments, and the machine needs a higher volume to justify it. But I suspect current clinics aren't chomping at the bit to do a faster protocol.

I've thought about it a few times, but I just don't have the volume to justify a machine.

Is that what this is? They claim they are first in the nation to offer the SAINT protocol.

UAMS First in Nation to Offer Groundbreaking Therapy for Treatment-Resistant Depression - UAMS News

LITTLE ROCK — The University of Arkansas for Medical Sciences (UAMS) is the first medical facility in the United States to provide an innovative therapeutic treatment for major depressive disorder (MDD).

news.uams.edu

 

[DOswag]

Love tms and seeing the results with patients. We currently have 2 chairs and are moving to a new office soon where the plan is to expand chairs, think the goal is to eventually get 4-5.

 

[brazilianpsych]

Love tms and seeing the results with patients. We currently have 2 chairs and are moving to a new office soon where the plan is to expand chairs, think the goal is to eventually get 4-5.

That is fantastic. Any advice or insight on how you guys did that? Seems that some people have trouble filling one, but you are planning on getting 5. On a similar note, has anyone ever run the numbers on how many patients weekly on TMS you need to pay off the machine?

 

[DOswag]

That is fantastic. Any advice or insight on how you guys did that? Seems that some people have trouble filling one, but you are planning on getting 5. On a similar note, has anyone ever run the numbers on how many patients weekly on TMS you need to pay off the machine?

I don't have much insight into how the group I work with actually did this by the numbers but our exec team does keep up with this in detail for each clinic. Work for a company/clinic/group (whatever you want to call it) that has clinics in multiple states, started officially in 2017 in AZ and has expanded since then. The clinics that have been established for longer have several TMS chairs, most offices that they open in new locations start with just one. They do have team members that they hire to go out to primary care offices, OB clinics etc to establish a referral base and promote that we do offer TMS and ketamine treatments on top of medication management for patients and educate outside providers about TMS as well which really helps an upstarting clinic gain patients. We often have patients that come to us saying they've tried x number of meds and are interested in TMS as they have been provided some amount of information on it. If someone calls to make an appointment, our schedulers also educate people briefly over the phone about TMS, how it works etc.

 

[mistafab]

TMS is a huge money maker if you keep it up with volume. Your biggest limiter is pipeline - I.e. finding people it can help. The RVU you get after a map session and turning it over to techs and nurses is insane. You can churn through and treat huge amounts of TRD which is needed in almost any metro

 

[MedMan80]

TMS Therapy, Psychiatry & Primary Care - Depression Treatment | Salience Health. see this practice in TX

I think they rack it up with TMS.

 

[TexasPhysician]

TMS Therapy, Psychiatry & Primary Care - Depression Treatment | Salience Health. see this practice in TX

I think they rack it up with TMS.

There are some companies in Texas that really push TMS and likely make good $$. They have FT marketers on staff. They heavily advertise TMS. It is a niche business, not an outpatient psych practice. Think $10K+ advertising per month.

I’m not saying you couldn’t replicate this, but most generic psych practices are not a good fit. You need to plan to market and advertise heavily or have a team of psychiatrists/midlevels in the practice doing internal referrals.

 

[MedMan80]

absolutely, i just wanted to share an example of how some places bank from it.

 

[manly_man246]

I don't have much insight into how the group I work with actually did this by the numbers but our exec team does keep up with this in detail for each clinic. Work for a company/clinic/group (whatever you want to call it) that has clinics in multiple states, started officially in 2017 in AZ and has expanded since then. The clinics that have been established for longer have several TMS chairs, most offices that they open in new locations start with just one. They do have team members that they hire to go out to primary care offices, OB clinics etc to establish a referral base and promote that we do offer TMS and ketamine treatments on top of medication management for patients and educate outside providers about TMS as well which really helps an upstarting clinic gain patients. We often have patients that come to us saying they've tried x number of meds and are interested in TMS as they have been provided some amount of information on it. If someone calls to make an appointment, our schedulers also educate people briefly over the phone about TMS, how it works etc.

I think I interviewed w/ this company or at least one like it (AZ/UT/TX, expanding rapidly, has a name that sounds like peace and tranquility). High vol, they wanted to max out TMS referrals but also packed in the outpatient schedule 20-30 a day, the spreadsheet they sent along for how the MD could earn $500k+ included billing 90833 on about half of the f/u cases. They were also "branching out" into ADHD. Felt sketch AF.

 

[DOswag]

I believe that is the one you interviewed at lol. My honest opinion is I have had nothing but a positive experience working for them. Granted my only previous experience to compare it to is 4 years as a psychiatrist in the Air Force and residency prior to that so, it's exponentially better than working in milmed. I work 4 days per week 10 hr days, typically see anywhere from 15-20ish patients which keeps me busy. I think the most I've ever seen in a day is 23-24 which is on a day when I just happen to have mostly follow ups scheduled in the day without any intakes but I do typically have a no show or 2 on most days. Never seen 30 patients in a day and I've been here a year now. There is somewhat of a push or should I say, incentive to get patients in to TMS but it does works very well for patients and side effects are less than meds. But there are plenty of psychiatrists that work for them that don't use it as much as others so it's not problematic if someone doesn't necessarily refer patients that often for it. Great support, again exponentially better than anything I experienced in the Air Force. I get a 3 day weekend every weekend, no nights, weekends, or call. I'm not sure what "branching out into ADHD" means though. We see patients that have ADHD but that's not like a main focus of the practice. I've seen people post on here that they had a similar sentiment of it being sketchy for some reason, but I've really enjoyed my time here so far. It is possible to make 500K and there are some that exceed that but most are around 350-400. I'm on pace for about 400K in my first year here so I'm not complaining. Way more than I ever made active duty.

 

[calvnandhobbs68]

I think I interviewed w/ this company or at least one like it (AZ/UT/TX, expanding rapidly, has a name that sounds like peace and tranquility). High vol, they wanted to max out TMS referrals but also packed in the outpatient schedule 20-30 a day, the spreadsheet they sent along for how the MD could earn $500k+ included billing 90833 on about half of the f/u cases. They were also "branching out" into ADHD. Felt sketch AF.

If you're doing 10 hour days like this guy, 20 patients a day is every 30 minutes. About 50% 90833s for 30 minute followups is probably typical if not low if you're actually spending 25-30min on appts.

 

[DOswag]

I'm happy where I'm at currently but was ready for pretty much anything after the military as I assumed it couldn't get worse than that. But I've had a great experience where I work so far and not planning to leave at this time.

 

[brazilianpsych]

I believe that is the one you interviewed at lol. My honest opinion is I have had nothing but a positive experience working for them. Granted my only previous experience to compare it to is 4 years as a psychiatrist in the Air Force and residency prior to that so, it's exponentially better than working in milmed. I work 4 days per week 10 hr days, typically see anywhere from 15-20ish patients which keeps me busy. I think the most I've ever seen in a day is 23-24 which is on a day when I just happen to have mostly follow ups scheduled in the day without any intakes but I do typically have a no show or 2 on most days. Never seen 30 patients in a day and I've been here a year now. There is somewhat of a push or should I say, incentive to get patients in to TMS but it does works very well for patients and side effects are less than meds. But there are plenty of psychiatrists that work for them that don't use it as much as others so it's not problematic if someone doesn't necessarily refer patients that often for it. Great support, again exponentially better than anything I experienced in the Air Force. I get a 3 day weekend every weekend, no nights, weekends, or call. I'm not sure what "branching out into ADHD" means though. We see patients that have ADHD but that's not like a main focus of the practice. I've seen people post on here that they had a similar sentiment of it being sketchy for some reason, but I've really enjoyed my time here so far. It is possible to make 500K and there are some that exceed that but most are around 350-400. I'm on pace for about 400K in my first year here so I'm not complaining. Way more than I ever made active duty.

Are they hiring remote psychiatrists? You got me interested lol. I tried finding the name of the company but not sure if I am looking at the right one.

 

[DOswag]

Are they hiring remote psychiatrists? You got me interested lol. I tried finding the name of the company but not sure if I am looking at the right one.

sent you a pm

 

[MedMan80]

sent you a pm

Can you CC me as well?

 

[DOswag]

Can you CC me as well?

Sent you an invite

 

[Justice1071]

I was able to observe TMS for the first time last week. While in there I saw a sheet detailing how much it would be for Self-Pay for the initial treatment (I think 5 days per week, 20 minutes per treatment, for a month). The total was 20-21k for this place.
Of course, that's most likely not what insurance pays. But still pretty pricey.