Charles Miller, CRNA, Founder and Chief Medical Officer of Scenic City Neurotherapy in Chattanooga, Tennessee, shares his inspiring journey of starting and scaling a successful breakthrough treatment clinic.

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From humble beginnings with picnic chairs in the waiting room to becoming a thriving practice offering ketamine infusion therapy and transcranial magnetic stimulation (TMS), Charles offers a master class in entrepreneurship, patient care, and the power of perseverance in bringing innovative treatments to those who need them most.
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Key Takeaways:

• The unexpected challenges of running a medical business and how to overcome them

• Balancing clinical excellence with business acumen

• Strategies for patient education, retention, and community outreach

• Navigating the complex world of insurance reimbursement for novel treatments

• Leveraging technology to streamline operations and improve patient care

• Building a strong team and managing the financial aspects of a growing practice

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Join us as we unpack Charles' journey from cashing out his 401k to pioneering a successful interventional clinic. His story demonstrates what it really takes to build a thriving practice from scratch while bringing innovative treatments to those who need them most.

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The Journey from Anesthesiology to Ketamine Therapy

Charles' interest in ketamine infusion therapy initially stemmed from his background in anesthesiology and pain management. As he delved deeper into the literature, he discovered ketamine's potential for treating mental health conditions. This sparked a passion to make these innovative treatments more accessible to patients in need.

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"It [the literature] started to slide into the use of ketamine infusion for mental health. And that lit a spark in me that was like, this needs to be something that is accessible and available," Charles explains.

Starting Small and Scaling Smartly

Rather than taking out loans, Charles and his wife cashed out their 401k to fund the initial startup costs. They began with a small, 1,000-square-foot facility and minimal equipment. This conservative approach allowed them to test the market without overextending themselves financially.

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"We didn't want to take out loans because at the end of the day, we had no idea what this was going to be, if our community would even accept this therapy," Charles says.

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As demand grew, they reinvested profits into expanding their services and facility. Within a year, Charles worked full-time at the clinic, providing 8-12 infusions daily, five days a week. This rapid growth demonstrates the high demand for innovative mental health treatments.

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Navigating Business Challenges

The path to establishing a new medical practice is fraught with unique challenges. Charles shares his hard-earned lessons about financial management:

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"We opened up a business account before we opened and said, this is where we're going to keep the business money separate and the personal money separate, and we'll have QuickBooks. I took for granted that QuickBooks was going to divvy everything up for me," Charles recalls. Recognizing the complexity of financial management, he adds, "We ended up hiring a bookkeeper after that."

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Read also: Planning for Your Revenue and Costs (Downloadable Template)

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Licensing requirements pose another hurdle for new clinics. Charles notes, "We have to have a County license. We have to have a state license. We have to have a city license. And then we have to make sure that our certifications are appropriate for what we're administering."

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The Importance of Patient Education

Charles emphasizes the critical role of thorough patient education in achieving better outcomes and higher success rates. He dedicates significant time to ensuring patients understand what ketamine infusion therapy can and cannot do for them.

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"Every single person that we treat, we spend hours with beforehand, kind of talking about making sure they understand, making sure they can repeat back. This is what ketamine infusion can do for you. This is what it can't do for you," Charles explains.

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Navigating Insurance and VA Contracts

Securing insurance contracts and developing partnerships with the VA have been key factors in providing access to treatment for more patients. Charles and his team worked to establish a Veterans Care Agreement, allowing for better reimbursement rates than standard community care contracts.

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"We're able to get reimbursement for pieces of the process that Optum's Community Care won't pay for," Charles notes, highlighting the importance of persistence and creativity in navigating the world of insurance reimbursement.

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Leveraging Technology for Practice Management

Charles credits the Osmind platform with streamlining many aspects of his practice operations. From mood measurement and documentation to insurance billing and payment processing, Osmind has become an integral part of Scenic City Neurotherapy's workflow.

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"I'm able to run my whole practice out of Osmind. There's not a piece that I have to use something else for, which is kind of awesome," Charles enthuses.

Hear from Charles’ wife and co-founder, Ami Miller on how they use Osmind to automate measurement-informed care, documentation, and business admin so they can focus on operating at the top of their licenses.

Building a Strong Team and Community Reputation

As the practice grew, Charles focused on hiring compassionate, knowledgeable staff members who shared his passion for innovative treatments. He emphasizes the importance of a rigorous interview process and seeking out individuals eager to learn and contribute to the practice's mission.

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Community education and advertising play a crucial role in building a strong reputation. Charles explains, "Educating your community is everything. Removing stigma requires adding education. People fear what they don't fully understand or they have a poor idea about what we do."

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For those just starting out, Charles offers this practical advice: "You start small with online advertising, and move to being on TV. There's all those wonderful early morning shows that my grandmother watches, and she loves, and you become that “ketamine” guy that people see."

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Expanding Services: Adding TMS to the Mix

As Scenic City Neurotherapy grew, Charles looked for ways to expand services and provide more options for patients. The addition of Transcranial Magnetic Stimulation (TMS) was a natural progression.

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"TMS was just a natural segue," Charles explains. "Looking at transcranial magnetic stimulation and the targeted effects we're able to stimulate improvements in plasticity and function, it made a lot of sense right off the bat."

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Measurement-Informed Care and Vitals Monitoring

Scenic City Neurotherapy uses a combination of standardized assessments and personalized goal-setting to measure patient outcomes. Charles reports a success rate of over 92% of patients reaching their self-defined treatment goals.

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The practice also continually seeks ways to improve, incorporating new assessment tools and refining their treatment protocols based on patient feedback and emerging research. One key aspect of their approach is the emphasis on continuous patient monitoring throughout the entire ketamine infusion process.

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"We use Caretaker's VitalStream monitors for real-time, trackable monitoring," Charles explains. "This technology not only enhances patient safety but also provides detailed reports for each session, which we incorporate into the patient's record."

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Watch: How to monitor vitals without distracting patients with the CareTaker x Osmind integration

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Managing Supply Chain Challenges

To avoid potential shortages of essential materials like ketamine and lidocaine, Charles emphasizes the importance of diversifying suppliers.

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"We have four or five different ketamine suppliers," Charles notes. "Our practice management team makes sure we don't run out. Diversification of your resources is key - nobody should get all of your business."

Proactive Regulatory Compliance

Taking a proactive stance on regulatory compliance can save headaches down the road. Charles shares his approach:

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"We called up OSHA and said come inspect our facility and he came and told me everything I needed to make sure I was up to code... It's the same thing with the DEA. We invited them to come to our facility. Tell me what I'm doing wrong. Tell me what I can do better."

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Advice for Aspiring Clinic Owners

For those considering starting their own breakthrough treatment clinic, Charles offers these key pieces of advice:

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1. Start small and scale gradually

2. Invest heavily in patient education

3. Diversify your supply chain to avoid shortages

4. Build a strong, passionate team

5. Focus on community education and outreach

6. Leverage technology to streamline operations

7. Be persistent in navigating insurance and regulatory challenges

8. Commit to ongoing learning and research


Scenic City Neurotherapy’s website is a rich resource hub, featuring articles, videos, and comprehensive guides. Their resource page and/or FAQ page are great resources for those seeking to open a clinic. Take advantage of years of hard-earned wisdom at your fingertips.

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One piece of advice stands out above the rest: "Starting small was the best thing we ever did. There were plenty of periods where things could have quickly fallen apart if we had just jumped to the big facility."

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Finally, Charles concludes with an inspirational message for those considering entering the field: 

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"This will be the greatest and most rewarding thing that you've ever done in your practice. It doesn't mean it's going to be easy. It doesn't mean it's going to feel good all the time, but it is the most rewarding thing I have ever done."

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About Scenic City Neurotherapy

Founded in 2019, Scenic City Neurotherapy is at the forefront of advanced and comprehensive treatments for those facing treatment-resistant conditions. Our mission is to optimize brain function and elevate well-being through cutting-edge therapies. We specialize in two pioneering approaches: Minimally Stimulated Ketamine Infusion Therapy (MSKIT®) and Transcranial Magnetic Stimulation (TMS).

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If you are exploring innovative solutions for mental health, chronic pain, and other neuro-degenerative conditions, Scenic City Neurotherapy offers transformative treatment options. Join us in leading the charge towards groundbreaking brain optimization treatments and empowering individuals to reclaim their lives.

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Contact Founder and Chief Medical Officer, Charles Miller today to learn more about our proven protocols for Minimally Stimulated Ketamine Infusion Therapy (MSKIT®). Call 423-228-0579 or visit www.ScenicCityNeuro.com.