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deleted162650
We have carriers covering it for psychiatric indications. Again, not all - but a not insignificant number either.
Hiring anesthesiologist
- Thread starter Piebaldi
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(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....)
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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.
I agree - obviously if you hire a doctor, it's more $$. If you hire a nurse or CRNA obviously can make it cheaper. And the cheaper rate obviously implies that it's cash based so the expense of insurance personnel is not incurred. I'm planning on charging prob between $500-800 which is still cheaper than the competition. Some of these centers charge as much as $1200-2000.
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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.
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Even for depression you will have people coming in primarily for the high. I know someone who was profoundly depressed, failed ect, and had a good result with IV ketamine. However, he continues to go every 3 weeks primarily because he enjoys the high and can afford it. Also happens to be addicted to benzos and opioids.
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.
I agree with you. Your response was totally appropriate..
First of all who are you? Are you an Anesthesiologist? Are you a business man?
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.
Nope - I posted originally asking how much would be a fair to pay an anesthesiologist to work in an infusion clinic. I'm in PM&R/soon to be pain doc too. Soon to be IV ketamine clinic owner.
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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.
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.
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.
$100 is TOO cheap. But probably $300 for basic infusions to $800 for others is realistic since most clinics charge far more.
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..
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Hey if you had to split appetizers, you'd sound that way too!
Re-quoted for emphasis.
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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.
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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".
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The plastic surgeon isn't treating the subdural bleed headache with the breast augmentation. If he was treating a 10 cm hard immobile mass in the left breast by putting an implant in the right one to make her feel better about being lopsided, yeah, he's on the hook.
The hangover bus doctor or noctor IS treating the subdural bleed headache with an IV banana bag. Absolutely on the hook for providing symptomatic treatment for a condition that wasn't evaluated or worked up properly.
The ketamine clinic doctor or noctor IS treating the MM osteolytic lesion back pain with an IV ketamine infusion. Absolutely on the hook for providing symptomatic treatment for a condition that wasn't evaluated or worked up properly.
As mentioned for a cash business there really aren't regulations and the overhead is probably dirt cheap.
As mentioned, I think you need accreditation hoops to jump through irregardless of the payor.
DEA regulations, HIPAA regulations, state specific health regulations, medical board license regulations and ethics reviews, malpractice insurance requirements, office worker benefits, workman's comp, retirement benefits, health insurance, accounting, payroll.
You can probably take care of all those things if you wanted, just a lot more headache than it is worth.
I knew a few docs and a CRNA that tried to run one, but they all failed. Before they set it up they said it was a sure thing Benjamin printing press.
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This has become Anesthesia Shark Tank.
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.
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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.
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.
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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?
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.
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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.
I respectfully disagree with you - and this is how it works in this type of setting.
Patient with depression with diagnosis of depression comes to me, gets ketamine injection. I do ketamine injection, they do fine. Patient 2 months later commits suicide bc of depressive symptoms. Nothing that i did would make me responsible. Patient has a psychiatrist treating them for this. That's how it works. Where on earth do you think that physicians are on the hook for things that are outside the scope of their practice?
In the medispa case above you are simply incorrect. They have no duty to treat me. They are simply doing a procedure, that's it. They have no responsibility to treat me. The PA is "supervised" by a physician - the clinic is owned by a FM and a surgeon I believe. There is no work up no diagnosis.
To pretend that they would somehow diagnose, work up is absurd. I don't think you have enough expeirnece with this stuff, no offense.
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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.
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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.
there are as mentioned numerous infusion clinics - for chemo stuff, for biologics for RA/autoimmune/Rheum type disease processes, antibiotics, etc etc that are done at infusion centers in my neck of the woods. I'm sure some oncologists do infusions at their offices, i'm simply spekaing about what i'm seeing.
Yes I would agree with uon ur second statement.
chemo infusions are all going to be insurance claims or CMS, though, not cash based which eliminates huge swaths of regulation
I think the only difference for a controlled substance is the licensing of who is ordering it and the record keeping/documentation and wasting of it.
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More Wild West mentality. No thanks.
www.statnews.com
www.medscape.com
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
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
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More Wild West mentality. No thanks.
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.
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.
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.
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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.
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.
You are correct that I am PM&R trained. To suggest that "there isn't much diagnosing in the daily practices" is rather unfair. Particularly on an outpatient/msk/pain basis there is plenty of diagnosing.
I disagree that anesthesiologists do much diagnosing - they have a valuable and very important role in the surgical setting absolutely, but I disagree that they do much diagnosing. I don't say this in any negative way.
It;s not just an "adventure" - I believe very much in allowing patients to have alternatives to treatment that might be beneficial - and charging a price that's reasonable.
I have had a perfectly comfortable position with a good salary and could easily move up and make evne more $ within the same group - but I am opening up to new alternatives that from what I have seen have been very beneficial to patients.
I know there is a lot of skepticism on the forum - and i respect that.
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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.
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.
I hardly think that "everyone is opening one."
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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.
Anyway, good looking out. Me personally, practicing in Chicago sounds scary AF. Those malpractice awards are monstrous. A Ketamine clinic where patients are referred to you by a psychiatrist though sounds low risk.
