Etc $

[NeuroKlitch]

Do psychiatrist really get reimbursed 100-200$ per treatment ?? Last I heard cardiologist are getting reimbursed only 300$ per cath/stent .

Wouldn't this be quite a supplemental cash cow ? From the estimates of previous posts seems like u can fit 4-5 pts per hour . Couldn't you easily make around an extra 6k per week by doing this , just by doing say 3x per week in the AM. What am I missing ? I must be missing something . That would add 300k if u worked 52 weeks. I'm guessing patient referral is pretty low ?


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[Bartelby]

I'm not sure of the reimbursement per procedure, but it can be lucrative. You can line up four patients in an hour, and usually you can stick with that schedule. There are barriers though:

-You need an anesthesiologist and several nurses to sustain that rate
-You need appropriate facilities and equipment
-You need to build a referral stream, and you typically need to do evaluations (not just pressing the button) to determine appropriateness for treatments

Overall, though, I think you could make real money doing this if you find an appropriate setup.

 

[NeuroKlitch]

Sounds pretty sweet . Thanks for the reply


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[splik]

Since most ECT is done on those over 65, the majority of ECT patients are medicare patients. A psychiatrist will get about $89 for each ECT on a medicare pt. Each ECT is 2.5 wRVUs - it's the anesthesiologists that are cleaning up. It's unusual for psychiatrists to make a lot of money doing ECT (and rightly so), they usually do it because they believe this should be available to patients. It's pretty unethical to be making lots of money doing ECT because then you're basically going to be invested in offering ECT to everyone. It always makes me cringe when I see all these borderlines and others who aren't going to get better with ECT get it from zealots who stand to profit off it (and not particularly well either). Private insurances might pay more.

In order to see 4+ patients/hr you would have to have the appropriate space (i.e. a PACU). You're not gonig to be be able to turn over that many patients in an OR space. That is the main rate limiting factor. You wouldn't be able to do more than 3 pts per hour if you only have a single room. Hospitals can make more money using that space for other things and thus it can be hard to get that space, and if you do get it, for much time.

Outpatient ECT is not very lucrative for hospitals. Inpatient ECT can be as insurance companies don't fight as much to discharge pts if you're doing ECT, which leads perverse incentives for them to do ECT on everyone regardless of whether they need it or not. I have seen this happen (and psychiatrists aren't even involved in the decision).

The flip side is that many people who would benefit from ECT don't get access to it because it is not widely offered. When I did my ECT rotation as a resident we had patients flying from out of state for ECT because there wasnt single ECT provider where those patients were. In some states there is only a single ECT provider/service and they have limited capacity to see patients. Which makes it all the more annoying that other people are more than happy to electrocute any borderline/alcoholic/autistic patient that wants some juice.

 

[SeniorWrangler]

I've looked into this before and it doesn't really pencil out unless you have a LOT of ECT patients, like half a day at least, every time you do ECT. If you're employed and the hospital is paying for the anesthesia stuff, you can do it in the mornings and have a nice RVU-generating sideline.

 

[TexasPhysician]

Do psychiatrist really get reimbursed 100-200$ per treatment ?? Last I heard cardiologist are getting reimbursed only 300$ per cath/stent .

Wouldn't this be quite a supplemental cash cow ? From the estimates of previous posts seems like u can fit 4-5 pts per hour . Couldn't you easily make around an extra 6k per week by doing this , just by doing say 3x per week in the AM. What am I missing ? I must be missing something . That would add 300k if u worked 52 weeks. I'm guessing patient referral is pretty low ?


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In my experience, it works nothing like this. Each patient takes about 20+ minutes including set-up, induction, procedure, documentation, and brief recovery. Reimbursement that I've seen is <$100 per patient. Unless you already work in the hospital, commute time makes ECT a sunk cost.

Many psychiatrists want no part of ECT because it often earns less per hour than a busy practice.

 

[F0nzie]

Not to give you the wrong ideas but if you are looking for spammable procedures, TMS and Ketamine are the current trend.


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[Shikima]

Not to give you the wrong ideas but if you are looking for spammable procedures, TMS and Ketamine are the current trend.


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I think I read recently that Ketamine wasn't all that?

 

[justabanana]

I think I read recently that Ketamine wasn't all that?

This is something I'm interested in. I can't find any studies that compare ketamine and ECT in treatment resistant depression. All I can find are things suggesting that ketamine+ECT may be better than ECT alone and studies suggesting that ketamine+ECT might not be better than ECT alone.

Have their been studies actually comparing the two on their own that shows ketamine isn't better than ECT that anyone knows of?

edit: just found one saying ketamine is better than ect. http://www.psy-journal.com/article/S0165-1781(13)00771-3/fulltext?cc=y=

 

[F0nzie]

I think I read recently that Ketamine wasn't all that?

I have a pt with chronic depression who wanted to try ketamine after she came across it in ads and the news. She asked me a few questions and I informed her that ketamine was still an investigational drug for depression. Unfazed, she found a ketamine clinic and proceeded with the treatment. Unfortunately it made her feel worse. :/ Back to SSRIs and convincing her to do therapy.


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[F0nzie]

This is something I'm interested in. I can't find any studies that compare ketamine and ECT in treatment resistant depression. All I can find are things suggesting that ketamine+ECT may be better than ECT alone and studies suggesting that ketamine+ECT might not be better than ECT alone.

Have their been studies actually comparing the two on their own that shows ketamine isn't better than ECT that anyone knows of?

edit: just found one saying ketamine is better than ect. http://www.psy-journal.com/article/S0165-1781(13)00771-3/fulltext?cc=y=

One of my ECT attendings in residency occasionally sprinkled in ketamine to give the pt a boost, but he didn't really think it helped that much.


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[Merovinge]

One of my ECT attendings in residency occasionally sprinkled in ketamine to give the pt a boost, but he didn't really think it helped that much.

Yup we tested that out as well, was not terribly promising.

 

[carlosc1dbz]

I have a pt with chronic depression who wanted to try ketamine after she came across it in ads and the news. She asked me a few questions and I informed her that ketamine was still an investigational drug for depression. Unfazed, she found a ketamine clinic and proceeded with the treatment. Unfortunately it made her feel worse. :/ Back to SSRIs and convincing her to do therapy.


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In what way did it make your patient feel worse?

 

[F0nzie]

In what way did it make your patient feel worse?

More depressed and headaches.


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[carlosc1dbz]

More depressed and headaches.


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Maintenance ECT....I mean Ketamine. ;P

 

[Sushirolls]

A bigger impact on ECT turn over is the EMR and fidelity anesthesia must have towards their case start/stop times. PACU models of throwing the curtain and moving from bed to bed are unlikely anymore. You'll more typically find designated room, or designated bay in a PACU. Assume 30 minutes per case, and only if everything is flowing appropriate may you get to 20 minutes per case. You will have issues of patients showing up late. Unable to get IV, now have to track down the super star nurse who can. Patient is having reservations that day, or more family/spouse questions, and those delay the start. Patient has post ictal agitation in stepdown, and needs further management. Or your geriatric patient comes in and as Anesthesia is reviewing the rhythm strip, notes A-Fib. Typically you need to do weekly Cognitive scale and depression scale. Are those being done before a procedure? or separately in the office on a different day? I suggest after the first procedure at least, for the psychiatrist to talk with family/patient before discharge, and that means time. Weather delays in winter. You also have to have your procedure note documented, that is typically quick if you have good smart phrases. But one of the biggest time delays is when the H&P is due. CMS requires a fresh H&P every 30 days. This has no relevance to ECT, but its still lumped in that category, and you have to repeat an H&P. Even if it is an abbreviated version, it will stake time, and that pushes turnover. This is more of an issue for a twice weekly service or a patient on a twice weekly regimen compared to those on thrice, but also in an issue for the continuation & maintenance patients.

Assume 30min per procedure.

 

[ridethecliche]

Isn't TMS not the wonder treatment everyone was hoping for? IIRC some recent studies weren't all that strong.

 

[clausewitz2]

Isn't TMS not the wonder treatment everyone was hoping for? IIRC some recent studies weren't all that strong.

More of a w$nd$r trestmenr

 

[Mad Jack]

A bigger impact on ECT turn over is the EMR and fidelity anesthesia must have towards their case start/stop times. PACU models of throwing the curtain and moving from bed to bed are unlikely anymore. You'll more typically find designated room, or designated bay in a PACU. Assume 30 minutes per case, and only if everything is flowing appropriate may you get to 20 minutes per case. You will have issues of patients showing up late. Unable to get IV, now have to track down the super star nurse who can. Patient is having reservations that day, or more family/spouse questions, and those delay the start. Patient has post ictal agitation in stepdown, and needs further management. Or your geriatric patient comes in and as Anesthesia is reviewing the rhythm strip, notes A-Fib. Typically you need to do weekly Cognitive scale and depression scale. Are those being done before a procedure? or separately in the office on a different day? I suggest after the first procedure at least, for the psychiatrist to talk with family/patient before discharge, and that means time. Weather delays in winter. You also have to have your procedure note documented, that is typically quick if you have good smart phrases. But one of the biggest time delays is when the H&P is due. CMS requires a fresh H&P every 30 days. This has no relevance to ECT, but its still lumped in that category, and you have to repeat an H&P. Even if it is an abbreviated version, it will stake time, and that pushes turnover. This is more of an issue for a twice weekly service or a patient on a twice weekly regimen compared to those on thrice, but also in an issue for the continuation & maintenance patients.

Assume 30min per procedure.

We've got one hell of an efficient ECT setup. Basically they just open the PACU early, we have s CRNA and an anesthesiologist as well as two nurses. Resident preps patients beforehand, attending shows up to do a brief evaluation and run the machine. Residents chart afterward. Can go through 4 patients an hour easy

 

[nexus73]

The efficient setup I saw was an ECT space setup just outside the inpatient psych unit. The psychiatrist would get paged for ECT and excuse themselves from whatever they were doing, go to the ECT room, have a brief conversation with the patient, then anesthesia puts the patient under, then ECT-->seizure-->seizure stops, record duration, then back to seeing inpatients while the ECT RN and CRNA wake the patient up, move them to the recovery space and prep for the next patient. Repeat x 4-8 patients every morning from 8-10am every Monday/Wed/Friday.

 

[NickNaylor]

We have a pretty busy ECT service at one of our hospitals. On that service, 4 attendings work on the unit but they rotate in 4-week blocks (matching the resident schedule) such that 1 attending is on the ECT service full-time for a block. This includes doing all of the ECT documentation, doing the actual procedure, following up with patients (if needed), and seeing ECT evaluations outside of the hospital. All of the attendings are fans as it shakes things up a bit from the relative monotony of constant inpatient work. By the time they're nearing the end of their ECT block, they're looking forward to coming back to the unit for 3 months.