LOS for ECT

[ObsequiousAplomb]

I've been contemplating whether or not I would like to add ECT to the list of services I will provide when I move across the country to Ohio in the next few months. I know I will already be working with TMS, Spravato, Ketamine, and psychedelic therapy. At this point, the ECT is just a hypothetical. I know that the area I'm moving to has a huge need for all of these services, since I grew up in the area and have many close ties. I think it would round out my ability to market myself as a neuro-stim and treatment-refractory specialist. After all, isn't it a little annoying to refer a patient to a psychiatrist for one of those treatments, then have to refer them to a second or third psychiatrist to conduct the others?

My problem then arises in not wanting to go through the rigamarole of working in a hospital system - most of the local hospitals don't credential physicians who aren't employed by them, and they also have non-competes for employees that would interfere with my other services. The few that I know of that aren't like that don't have inpatient psychiatric units.

That has me thinking - is it possible to conduct ECT at an ambulatory surgical center? There are a host of ASCs within 5 minutes of my planned office location, and that would make the whole operation much smoother for me than getting set up with a hospital (at least, I think). I know that it's often a good idea to have the ability to admit someone, especially early in the course of ECT, if needed. Still, the idea of an ASC sounds to me a better route than a hospital.

When I have tried to look this up, I haven't found a clear answer. Most likely because I don't know where to look for the best answer.

I know that the answer will vary widely based on location, as different states have different rules regarding what can be done where. For discussion and posterity, I'd love to also hear about areas other than Ohio where this is either allowed or forbidden as well.

What are your thoughts? Am I way off base in this thought experiment or am I onto something? Are there additional hurdles I haven't thought of? Ways to negotiate with somewhere like the Cleveland Clinic to let me do ECT there but also have carte blanche for my private practice?

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[splik]

The answer is that the procedure has to be on the CMS ACS covered procedure list or else medicare won't cover it (and most ECT patients are medicare beneficiaries). Private payers tend to follow CMS lead as well. ECT is not on the list, despite APA trying year after year to get it on the list.

 

[ObsequiousAplomb]

The answer is that the procedure has to be on the CMS ACS covered procedure list or else medicare won't cover it (and most ECT patients are medicare beneficiaries). Private payers tend to follow CMS lead as well. ECT is not on the list, despite APA trying year after year to get it on the list.

Thanks Splik!

 

[Sushirolls]

Concur with Splik. A few years ago I heard a rumor that it was getting phased out (or in?) in a few years. So it might possibly be covered. But you will need to know this with 100% certainty first.

Some private commercial insurance will cover, but I only got as far as one emailing confirmation yes. Another verbally said yes. Others, who knows. Even if you get paid, the next issue is if aneshesiology will? And can the ASC get the facility fee?

Demographics of ECT population skew medicare age. Very hard to have enough volume to be worth it.

So the real answer is politics and hospital priviliges. See a thread I have 'practice in progress' which details my start of this... and then giving up.

I did build a whole service up from zero at a hospital fresh out of residency. That's a long story.

 

[Sushirolls]

My observations of CCF years ago, they are not wanting to play ball with independents. They want to behave like an HMO. You are in, drinking the koolaid, or you are out.

ECT absolutely belongs in ASC... but bureaucracy.

Join the ISEN-ECT, and get on their email list serv.

 

[ObsequiousAplomb]

Concur with Splik. A few years ago I heard a rumor that it was getting phased out (or in?) in a few years. So it might possibly be covered. But you will need to know this with 100% certainty first.

Some private commercial insurance will cover, but I only got as far as one emailing confirmation yes. Another verbally said yes. Others, who knows. Even if you get paid, the next issue is if aneshesiology will? And can the ASC get the facility fee?

Demographics of ECT population skew medicare age. Very hard to have enough volume to be worth it.

So the real answer is politics and hospital priviliges. See a thread I have 'practice in progress' which details my start of this... and then giving up.

I did build a whole service up from zero at a hospital fresh out of residency. That's a long story.

I remember in your thread one of the dream killers was the frustration with hospitals dragging their feet regarding ECT. You had leased a big beautiful space with the same intentions I am discussing, but the slow process of getting the neuro-stim component up and running made that big beautiful lease way too expensive for the solo med management practice you had in the meantime.

My plan to work around this issue is to have my office on-site (adjacent suite) to a TMS satellite office of a larger network of TMS locations (a national chain that you can probably guess). I'd be the on-site provider for their TMS and Spravato, making it so that the current doctors don't have to drive an hour each way to cover that location. I'd also avoid all the overhead for the TMS and Spravato, but of course I'd make less money than owning it myself.

Then, with all the free time between checking in on those patients, I'd be seeing my own private patients (already cleared with that big box that the non-compete is specific to TMS and Spravato). Since I'm already being the on-site provider for those treatments, as I slowly (and I do mean slowly, selectively, and judiciously) build up the psychedelic practice and I'd also be able to be the REMS-required on-site provider when psilocybin - assisted psychotherapy reaches the market.

Budget-wise, THE BOSS is also a psychiatrist with a "real job" so the plan is that worst-case scenario we live off of her income even if 100% of my TMS & Spravato money goes down the drain propping up my rather lean private practice.

My biggest reluctance is to be signing away my freedom committing to being an on-site provider for the Big Box Shop, since prior to this opportunity opening up I was planning on working 20 or fewer hours a week to get extra time at home while my baby girl is still young.

 

[Merovinge]

I remember in your thread one of the dream killers was the frustration with hospitals dragging their feet regarding ECT. You had leased a big beautiful space with the same intentions I am discussing, but the slow process of getting the neuro-stim component up and running made that big beautiful lease way too expensive for the solo med management practice you had in the meantime.

My plan to work around this issue is to have my office on-site (adjacent suite) to a TMS satellite office of a larger network of TMS locations (a national chain that you can probably guess). I'd be the on-site provider for their TMS and Spravato, making it so that the current doctors don't have to drive an hour each way to cover that location. I'd also avoid all the overhead for the TMS and Spravato, but of course I'd make less money than owning it myself.

Then, with all the free time between checking in on those patients, I'd be seeing my own private patients (already cleared with that big box that the non-compete is specific to TMS and Spravato). Since I'm already being the on-site provider for those treatments, as I slowly (and I do mean slowly, selectively, and judiciously) build up the psychedelic practice and I'd also be able to be the REMS-required on-site provider when psilocybin - assisted psychotherapy reaches the market.

Budget-wise, THE BOSS is also a psychiatrist with a "real job" so the plan is that worst-case scenario we live off of her income even if 100% of my TMS & Spravato money goes down the drain propping up my rather lean private practice.

My biggest reluctance is to be signing away my freedom committing to being an on-site provider for the Big Box Shop, since prior to this opportunity opening up I was planning on working 20 or fewer hours a week to get extra time at home while my baby girl is still young.

I know very little about the type of work you are doing but did want to say kudos to you for trying to work less hours to spend with your kiddo, particularly as the male in the relationship. Navigating childcare and time at home with 2 MD households is no joke, I hope you can set something up that still gives you the time with your family that you were searching for and professional fulfillment.