Learn how to launch TMS or Spravato services—costs, billing, REMS logistics, training, and what’s next in interventional psychiatry.
For clinicians considering adding interventional psychiatry services to their practice, Ryan Wakim, MD, shared insights on how to practically incorporate these treatments into clinical models. Treatments like transcranial magnetic stimulation (TMS) and esketamine (Spravato) had comparable efficacy and safety endpoints but required different implementation pathways, Wakim said. On types of equipment useful for offering these treatments, Wakim added that "as of right now, there doesn't seem to be any clear frontline winner in terms of this TMS system is notably better than this other one.” Neither service could simply be added to an existing practice, Wakim highlighted; each addition required its own business approach. "It does take real operational commitment and excellence. It does take real clinical education and commitment, and there's financial commitments there too," Wakim emphasized.
TMS carried the greater upfront financial commitment, Wakim noted. Multiple devices are available, and some vendors offered rent-to-own models for typically expensive machines. Wakim advised clinicians to consult providers using different devices before determining whether the financial model worked. Billing for TMS in this fashion is often more straightforward than for Spravato, and training can include hands-on instruction with certification through the device manufacturer, as well as resources from the Clinical TMS Society, its Pulses course, and programs at Neurostar University.
Spravato, on the other hand, requires less financial commitment because many insurers cover it and treatment does not require expensive machinery. Operational demands may be greater, however. Billing varied by payer: some payers required clinics to purchase the drug and bill insurers to recoup costs, whereas others allowed billing as a standard outpatient visit. Spravato is also administered only under a Risk Evaluation and Mitigation Strategy (REMS) protocol, and facilities had to apply for REMS certification and pass an audit.1
In terms of interventional optioins, psilocybin analogues in advanced stages of study also showed promising results. Focused ultrasound, not yet commercially available, could deliver pinpoint stimulation, whereas electromagnetic energy from TMS spread with increasing depth; focused ultrasound therefore might reach deep structures that TMS could not reach comfortably. Wakim added that focused ultrasound is also being studied for Alzheimer disease and addiction.2
Dr Wakim is chief medical officer at Transformations Care Network.
References
1. McIntyre RS, Rosenblat JD, Nemeroff CB, et al.
2. Rezai AR, D'Haese PF, Finomore V, et al.
