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deleted162650
We have carriers covering it for psychiatric indications. Again, not all - but a not insignificant number either.
Sure, but keep in mind you aren’t doing this for the Prozac poppin’ I’m kinda sad housewife crowd. You are doing this for the severe refractory suicidal ideation ECT didn’t work for me crowd, and there are far fewer of those running around.
(I don't do pain)
(I don't have a ketamine clinic nor will I open one)
But if I was running a ketamine clinic for cash payments, I'd run it cheap (way undercut the competition) and make it big and inclusive for lots of people. Chronic pain, fibro, depression, whatever. Could probably profitably do it for $100-$200 per patient. Make it look like a day spa. Have an RN to start their IV infusion, some comfy chairs and soothing music (or just put headphones on and listen to whatever you want).
(but I'm not doing that, but if we ever get medical marijuana in my neck of the woods look out....)
(I don't do pain)
(I don't have a ketamine clinic nor will I open one)
But if I was running a ketamine clinic for cash payments, I'd run it cheap (way undercut the competition) and make it big and inclusive for lots of people. Chronic pain, fibro, depression, whatever. Could probably profitably do it for $100-$200 per patient. Make it look like a day spa. Have an RN to start their IV infusion, some comfy chairs and soothing music (or just put headphones on and listen to whatever you want).
(but I'm not doing that, but if we ever get medical marijuana in my neck of the woods look out....)
Nope. You need $300-$400 per patient to cover costs, overhead and make a profit. IMHO, $400 would still be very cheap vs the competition. Medical Marijuana is legal in my area so I could throw that in for the $400.
Medical marijuana is going to lose steam pretty soon - here in IL it's alreayd legal. First day sales - over 3 million. My parents live close by a dispensary - on january 1, there was a line wayyyyy out the door and i think probably a couple of blocks for legal marijuana.
Ive seen several Ketamine clinics in my area close their doors recently (not sure of the exact details). I think your best bet is to partner up with a Psychiatrist who can diagnose appropriate patients with refractory depression and recommend Ketamine that you can then infuse. That way insurance companies may cover it...
Not to derail the threat but IV Ketamine for chronic pain is garbage. There are no studies, no actual protocol or dose. In theory it sounds great but in practice it doesnt. Your patients will be coming back for the high and maybe a few weeks of subjective pain relief. Perioperatively its a great adjunct but thats about it.
Yep medical marijuana was a big business in California until recreational use was legalized. Now any college kid can get marijuana delivered to their dorm via an app. It’s as easy as ordering a pizza. There are no medical marijuana clinics left.
I agree with you. Your response was totally appropriate..Wait a minute . Dude omens on here with that kind of question, then says he was looking to pay some schmuck 2 bills an hour and I’m the “douche”?!!! Lol. Fwiw really didn’t think this was serious post...
First of all who are you? Are you an Anesthesiologist? Are you a business man?Right. So all those doctors who gave up their practices to do medical marijuana are going to be in big trouble - reasno why i'm a proponent of never forgetting that doing one's main gig to some extent is always important.
its just in case **** goes awry and you need intubation ventilation pressors etc etc etc.. Sounds like an easy job for someone who is semi retired but as with anything in anesthesia your day can go south at ANY moment.it sounds like you want someone to put in IVs and monitor vitals, doesn’t really scream needs a medical degree to me. Unless you want MDAs to diagnose depression and write scripts?
First of all who are you? Are you an Anesthesiologist? Are you a business man?
Why are you doing so few patients? These are not high dose ketamine infusions we are talking about, unless you are doing something different than the usual. One MD can supervise a number of infusions simultaniously.
Also, it would take ~500 an hour to get me to do that, however, I also find that type of work very unfulfilling so there is a premium added.
Nope. You need $300-$400 per patient to cover costs, overhead and make a profit. IMHO, $400 would still be very cheap vs the competition. Medical Marijuana is legal in my area so I could throw that in for the $400.
you think if I could do 30 patients in a day that I would need to collect $9-12K a day just to make a buck? I mean you'd be talking about less than $50 of consumables per patient. One nurse can start IVs all day. Rent, some scented candles, some comfy chairs, etc.
I mean you could staff the whole thing with like 1 medical assistant, 1 RN, and 1 doc and add someone to sit at the front desk if you want to be flashy.
I don't think 30 patinets a day is realistic - most people don't have even 300-400 bucks available for frequent infusions - even pain patients want everything covered by insurance. the average patient number is around 8 based on my understanding - like 30-40 patients weekly, which depending how much you charge is still a good chunk of change. But the set up you describe is kind of how most clinics work - typically an owner physician, a nurse or two, and a front desk person, with a front desk, and i've seen a couple of set ups - either a communal area where people sit down in fancy couches and chat during their infusions, or small private rooms where people relax.
i agree it's not a huge financial investment -
that's why I think you could do it for something like $100 a treatment and still make a profit. Undercut everybody else because the consumables are so cheap.
There has to be a ****-ton of regulations to get through. Overhead has to be substantial. And you probably have to be a certified ASC and accredited. Plus you have to pay an RN (PACU) monitors, oxygen. all equipmen.. You cant do this in the back room of some nail salon..you think if I could do 30 patients in a day that I would need to collect $9-12K a day just to make a buck? I mean you'd be talking about less than $50 of consumables per patient. One nurse can start IVs all day. Rent, some scented candles, some comfy chairs, etc.
I mean you could staff the whole thing with like 1 medical assistant, 1 RN, and 1 doc and add someone to sit at the front desk if you want to be flashy.
Hey if you had to split appetizers, you'd sound that way too!By the way you write, it sounds like it.
Sure, obviously you can hang your shingle and run infusions for whatever “indication” you want for whatever rate the local cash pay market will bear. It all just depends on how (un)ethical you want to be.
I’m only poo pooing you because you seem utterly clueless as to what goes into making this work.
Our clinic has been up and running for about 3 years, and insurance has been paying for most of that time. Of course it’s carrier/plan dependent.
Re-quoted for emphasis.There has to be a ****-ton of regulations to get through. Overhead has to be substantial. And you probably have to be a certified ASC and accredited. Plus you have to pay an RN (PACU) monitors, oxygen. all equipmen.. You cant do this in the back room of some nail salon..
Why not? (I'm not suggesting the nail salon is a good idea.)There has to be a ****-ton of regulations to get through. Overhead has to be substantial. And you probably have to be a certified ASC and accredited. Plus you have to pay an RN (PACU) monitors, oxygen. all equipmen.. You cant do this in the back room of some nail salon..
This sounds irrelevant.... catching multiple myeloma is not a requirement for you to treat a symptom. This should be what her PCP should be doing. You think a plastic surgeon doing a breast augmentation is going to get sued if a patient complains of a headache and then the patient drops dead a day or two later? You can always give the standard boilerplate disclaimer of "go to the ED if your symptoms dont get better".Why not? (I'm not suggesting the nail salon is a good idea.)
If it's a cash-only business, what do you really need besides a medical license and DEA #? It's your facility, so there's no credentialing committee to worry about. Joint Commission won't ever visit. You can order equipment, supplies, even scheduled drugs over the internet and get them delivered to your place of business. You can practice all kinds of dodgy bad medicine off on your own, until the day comes that someone gets hurt.
As for insurance ... someone will underwrite it.
The big risk to all these brilliant go-it-alone cash-only entrepreneurial schemes is the missed diagnosis. Vegas party fiend shows up to your "hangover therapy bus" on Sunday morning with a headache, gets a $400 infusion, drops dead in the airport lounge from his subdural an hour later. Anxious housewife with fibromyalgia shows up to your "ketamine spa" for her weekly back pain treatment and drops dead six months later from multiple myeloma.
People certainly are doing this stuff with low overhead and high profit margins. The key seems to be finding a liability sponge, er, I mean a doc willing to supervise it all for a nice hourly wage.
I wouldn't work for the OP for any wage, unless all the patients were referred for treatment by another specialist physician. Cash from anyone who walks in the door with a symptom and fills out a screening questionnaire? Hell no. Bad medicine, stupid risk to take.
This sounds irrelevant.... catching multiple myeloma is not a requirement for you to treat a symptom. This should be what her PCP should be doing. You think a plastic surgeon doing a breast augmentation is going to get sued if a patient complains of a headache and then the patient drops dead a day or two later? You can always give the standard boilerplate disclaimer of "go to the ED if your symptoms dont get better".
There has to be a ****-ton of regulations to get through. Overhead has to be substantial. And you probably have to be a certified ASC and accredited. Plus you have to pay an RN (PACU) monitors, oxygen. all equipmen.. You cant do this in the back room of some nail salon..
As mentioned, I think you need accreditation hoops to jump through irregardless of the payor.As mentioned for a cash business there really aren't regulations and the overhead is probably dirt cheap.
I think there are accreditation issues to deal with. FOr example, im not sure you can open a cash only surgery center and not be accreditated by the state dept of health. Credentialing is not an issue but Im sure there are rules such as, stocking certain items etc etcWhy not? (I'm not suggesting the nail salon is a good idea.)
If it's a cash-only business, what do you really need besides a medical license and DEA #? It's your facility, so there's no credentialing committee to worry about. Joint Commission won't ever visit. You can order equipment, supplies, even scheduled drugs over the internet and get them delivered to your place of business. You can practice all kinds of dodgy bad medicine off on your own, until the day comes that someone gets hurt.
As for insurance ... someone will underwrite it.
The big risk to all these brilliant go-it-alone cash-only entrepreneurial schemes is the missed diagnosis. Vegas party fiend shows up to your "hangover therapy bus" on Sunday morning with a headache, gets a $400 infusion, drops dead in the airport lounge from his subdural an hour later. Anxious housewife with fibromyalgia shows up to your "ketamine spa" for her weekly back pain treatment and drops dead six months later from multiple myeloma.
People certainly are doing this stuff with low overhead and high profit margins. The key seems to be finding a liability sponge, er, I mean a doc willing to supervise it all for a nice hourly wage.
I wouldn't work for the OP for any wage, unless all the patients were referred for treatment by another specialist physician. Cash from anyone who walks in the door with a symptom and fills out a screening questionnaire? Hell no. Bad medicine, stupid risk to take.
I think there are accreditation issues to deal with. FOr example, im not sure you can open a cash only surgery center and not be accreditated by the state dept of health. Credentialing is not an issue but Im sure there are rules such as, stocking certain items etc etc
This sounds irrelevant.... catching multiple myeloma is not a requirement for you to treat a symptom. This should be what her PCP should be doing. You think a plastic surgeon doing a breast augmentation is going to get sued if a patient complains of a headache and then the patient drops dead a day or two later? You can always give the standard boilerplate disclaimer of "go to the ED if your symptoms dont get better".
But if they come to you for back pain, you inject a facet joint without doing any type of work up and it turns out their back pain is from bony mets then you could be on the hook for that one.Exactly - if a patient comes to me for piriformis pain, i give them a steroid injection, then a month later they die from a heart attack - that's irrelevant to anything i've done. Their cardiologist should have been on the ball. Or if they come to me for fibro and then a month later they die from asthma or copd exacerbation - irrelevant to anything i've done. just like with anything else. i'm not an oncologist and not treating them for that nor woudl i be expected.
just like if they came to my asc and i did a SIJ injection and they died of rectal cancer the following month.
But if they come to you for back pain, you inject a facet joint without doing any type of work up and it turns out their back pain is from bony mets then you could be on the hook for that one.
You are not a procedure monkey, you're a physician.
So if you're relying on referrals from other physicians, and not your ads on TV or billboards, where are your customers going to come from? Presumably these other physicians are referring their patients to other clinics they have an existing relationship with. Will they start referring to you? Why?Same with a ketamine clinic - they have to have diagnosis of x, y and z- I am not treating them for depression for example. They come from psychiatirst with diagnosis of depression. I treat them with ketamine. Psych is the treating physician. I'm not working them up for depression.
Same thing with Fibro - I am treating them symptomatically. I am not going to give them psychotherapy, or whatever the casemight be.
So if you're relying on referrals from other physicians, and not your ads on TV or billboards, where are your customers going to come from? Presumably these other physicians are referring their patients to other clinics they have an existing relationship with. Will they start referring to you? Why?
I guess I'm just surprised that you're going to hang out a shingle and get patients referred to you.
If a cash paying customer walks in off the street because they saw your sign, would you do the ketamine infusion?
If you're the one who finds the mets and the only action you take is to inject them, you are likely on the hook for poor outcomes. Referring to oncology is definitely the best option and if you do that you're covered.If they come to me with back pain, I do x-rays/MRI and there are bony mets, I can still inject them - the pain may or not get better. At that point the person would be likely under the care of oncology. I'm not treating them for the mets. If they are not under the care of the oncologist I would be like hey you have bony mets, you have to see oncology for management.
I can still treat you for the pain. If they die from cancer the next month, it's not on me. I treat the pain - not the bony mets. It's outside of the scope of my specialty. Heck if I treated them for bony mets I'd be sued as I'm acting outside the scope of my training.
Same with a ketamine clinic - they have to have diagnosis of x, y and z- I am not treating them for depression for example. They come from psychiatirst with diagnosis of depression. I treat them with ketamine. Psych is the treating physician. I'm not working them up for depression.
Same thing with Fibro - I am treating them symptomatically. I am not going to give them psychotherapy, or whatever the casemight be.
If it turns out your hair loss was because of a serious medical condition that a delay in diagnosis from that medispa resulted in significant morbidity, they absolutely would be on the hook for that.Regardless, IV infusion for ketamine are a symptomatic treatment not a diagnostic.
Obviously I plan on doing advertising, meeting with local docs, etc.
There arent' a ton of these places around.
It's no different than many other things - for example, I got PRP for hair last year. I went to a medispa type place, the NP/PA or whatever did the procedure. There wasn't any history, anything other than blood draw, centrifugation, etc. and bam! injections. I am not going to this place for a diagnosis/work up.
If you ever go get any type of procedure that's cash based - say you go get botox, fillers, PRP, lasers or whatever - they do a minimal history and that's it. There's no diagnosis, work up of anything. You pay for a procedure and you get it. There are all sorts of caveats/consents to explicitly specify this.
I guess that's what you/others are not understanding. It's just a symptomatic treatment and not diagnostic treatment.
I think there are accreditation issues to deal with. FOr example, im not sure you can open a cash only surgery center and not be accreditated by the state dept of health. Credentialing is not an issue but Im sure there are rules such as, stocking certain items etc etc
If you're the one who finds the mets and the only action you take is to inject them, you are likely on the hook for poor outcomes. Referring to oncology is definitely the best option and if you do that you're covered.
If it turns out your hair loss was because of a serious medical condition that a delay in diagnosis from that medispa resulted in significant morbidity, they absolutely would be on the hook for that.
You fail to understand that as a physician, it is very rare for you to be able to say "I'm just providing a treatment, you can't hold me responsible for poor outcomes not directly related to that treatment" and have that actually protect you.
Neither the medical boards nor malpractice cases work like that. "Just symptomatic treatment" isn't really a thing.
I suspect there are drastically different levels of accreditation between states. Setting up an IV infusion likely requires way less hassle than performing surgery.
It’s probably analogous to in office chemo infusions that oncologists do. I don’t know what hoops they need to jump through.
There are all sorts of "infusion centers" - not ketamine - that are just that - infusion centers for all sorts of things - antibiotics, chemo drugs, etc. They dont require tremendous hooks - they are done in order to have patients not stay in the hospital for prolonged periods of time - they are typically not even owned/managed by doctors. They are based on protocols, and treating physicians send patients here. The local ones I think are called infusion express.
I know iv vitamins/iv hydration clinics exist but everyone I know who has had cancer have had their outpatient chemo at an oncologist’s office. Since ketamine is a controlled substance, it probably has more regulatory issues than infusing vitamins.
It’s probably analogous to in office chemo infusions that oncologists do. I don’t know what hoops they need to jump through.
I know iv vitamins/iv hydration clinics exist but everyone I know who has had cancer have had their outpatient chemo at an oncologist’s office. Since ketamine is a controlled substance, it probably has more regulatory issues than infusing vitamins.
More Wild West mentality. No thanks.
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Ketamine gives hope to patients with severe depression. But some clinics stray from the science and hype its benefits
The booming ketamine treatment business offers hope to patients with severe depression. But a STAT investigation found wide-ranging inconsistencies in screening and dosing in the dozens of free-standing clinics across the U.S.www.statnews.com
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US Ketamine Clinics Continue to Mushroom With No Regulation
Patients could end up the losers if some questionable practices aren't kept in check, say clinicians and medical organizations.www.medscape.com
You'll see a lot of those clinics are run by NPs/PAs. I specifically want physicians - and one of the posters asked why I would have a physician on staff. Sigh. The irony.
I am going out on a limb here. Since OP is trained in PM&R, all her patients are from referrals. There isn’t really much diagnosing in the daily practices.
Even as anesthesiologists, at least in OR/PACU settings, we still have to act or behave like the “primaries.” For those who had other speciality trainings, IM, peds, CCM the concept of we are not just “procedure monkeys” are even more ingrained in our daily practices.
Not passing any judgments, OP. Maybe just how you’re trained and how I interpret your approach of the discussion.
Just my penny for the day.
OP please do keep us updated, it seems like a fun adventure, and certainly generated lots of interests here.
Not that it matters to the OP because I think they've already made up their mind, but for anyone else reading this, we've had a couple residents in the last 5 years set up or work at a ketamine clinic and have already moved on to other things.
I think it's one of those things that sounds better in theory than in practice. I think you probably have to make a killing financially in order to make it worth the trade-off in lack of intellectual stimulation/career development, and now that the secret's out and everybody is opening one, it's hard to make a killing financially any more.
Yeah, I agree with you. We are the ones who are part of the problem. But if you want to maximize profits that's what you do.You'll see a lot of those clinics are run by NPs/PAs. I specifically want physicians - and one of the posters asked why I would have a physician on staff. Sigh. The irony.