Private practices face a number of challenges—especially those offering innovative treatments like TMS or ketamine.

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Many people forget that mental health clinicians are running their own businesses! We covered the exorbitant costs of innovative treatment for patients, but what about costs for clinicians?

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Starting and growing a private practice requires both time AND money, as most clinicians bootstrap their businesses and create their own systems.

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Practices must deal with administrative matters like insurance, billing, finding new patients, scheduling, documenting, accounting, taxes, etc. For all the autonomy that comes with owning your practice, clinicians can feel overwhelmed from wearing so many hats (including business, legal, and tech skills they don’t teach in school).

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In this article, we’ll cover costs innovative clinicians incur, with a focus on time costs. We’ll then propose solutions to give clinicians their time and autonomy back.

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Clinical costs:

A typical 40-minute ketamine infusion for mental health may cost clinicians hundreds of dollars. This includes multiple clinicians’ oversight time, monitoring equipment, the use of physical space, and more.

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Non-Clinical Costs:

Clinicians in private practice incur many non-clinical costs. They have to set a budget for bookkeeping, business and legal startup costs, marketing, and associated software costs.

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Beyond finances, clinicians are short on time. Our survey asked private practitioners who offer ketamine treatments,

“What are the most time-consuming non-clinical activities?”

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Here are the top 3 responses:

1. Marketing
2. Scheduling
3. Billing

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When asked which tasks clinicians need the most help with to run their practice successfully, their responses were largely aligned with the time-consuming tasks above: Billing, patients, scheduling, and marketing.

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Marketing

Without insurance reimbursement, cash-pay practices are forced to spend valuable time finding new patients, often shelling out thousands of dollars for marketing agencies and advertising.

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Or, they invest time into learning the most important aspects of marketing themselves, whether through books, courses, or guides. The landscape for mental health marketing is a wild west right now, and clinicians may wonder about the best way to acquire more patients without being pushy. We recommend clinicians start with our free marketing articles—written in-house by Dr. Carlene MacMillan, a psychiatrist, and entrepreneur who has her finger on the pulse of how to ethically market and grow your practice.

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Scheduling and Billing

Ask any clinician why they got into mental health, and none will say, “because I love double-checking schedules, documenting notes, and filling out forms!”

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Yet, a 2022 study found that full-time physicians spend 3.5 to 6 hours per day inside electronic health records (EHRs). Most of this time is spent on clerical and administrative tasks, such as repetitive logins and inbox management, creating a significant time burden while consuming valuable time that could be spent on patient care (or rest and recharging for that matter).

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Technology can automate repeated admin and give clinicians their time back. For example, using two-way calendar sync and automated reminders so patients and clinicians don’t need to double-check multiple calendars. This helps reduce no-shows and save time.

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But, when built poorly, tech can contribute to surmounting feelings of burnout.

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These issues are exacerbated when clinicians offer innovative treatments that may not be the standard of care. Clinicians faced increased hurdles around documentation, compliance, billing, and more.

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For example, with Spravato, clinicians are required to fill out multiple forms as part of the FDA’s Risk Evaluation Mitigation Strategy (REMS). Clinicians must fill out patient enrollment and patient monitoring forms, amounting to multiple hours of additional documentation weekly. At Osmind, we automate REMS for Spravato, saving clinicians time and reducing the barriers to providing innovative treatments.

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Clinicians need to stay up to date with technology to make use of it. 83% of the clinicians surveyed said that “current training needs to be changed to keep up with advances in the field.” In particular, clinicians said “health care training and education should stay up to date with new scientific knowledge and technologies.”

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If we want to make clinicians’ lives easier, we need to empower them with intuitive tech to run their practice, and arm them with knowledge.

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Before we dive deeper into solutions, let’s first examine why most of the current tech falls short.

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Why are legacy EHRs so cumbersome and time-consuming? How did we get here?

The government enacted laws to enforce the use of technology in the clinical setting (e.g., the Meaningful Use program of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act).

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Legacy software re-emerged when these laws were enacted to take advantage of new government regulation, and hasn’t substantially improved or updated since then. Most providers use this archaic software to run their entire practice. They use it to:

• Document on patients

• Make prescription orders

• Schedule

• Bill

• And more

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Much of the existing software only adds time, particularly if they’re not tailored to a given specialty or workflow.

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How to help Innovative Practices thrive with technology

Given the feedback we received from providers, there are a number of ways we can help innovative mental health practices expand and improve care.

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Osmind is focused on three core tenets:

1. Give back time and energy to clinicians to focus on patient care.
2. Empower clinicians with powerful technology that supports evidence-based medicine.
3. Push forward new research with innovative mental health treatments that can fundamentally improve patient outcomes via better clinical practice and patient access.

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1) Give clinicians their time back

As mentioned previously, clinicians are extremely busy. They’re spending precious working time on administrative tasks instead of patient care.

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All partners and vendors that work with clinicians should be focused on saving clinicians time. At Osmind, our EHR was built with this intention at its core. We bring a modern, clean design approach, with psychiatry-specific workflows and automation. We even automate compliance requirements, such as the REMS form for Spravato, saving providers hours weekly.

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2) Empower clinicians with technology that supports evidence-based medicine.

Relatedly, partners and vendors to clinicians should be focused on enabling clinicians to more effectively treat patients, and ultimately improve patient outcomes.

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One way is to remove barriers to practicing Measurement-based Care (MBC). MBC involves systematically evaluating patient progress throughout treatment, including administering symptom rating scales. MBC operates from a simple concept: if you can’t measure it, you can’t treat it.

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Why Measurement-based care (MBC)

MBC has many benefits.

• MBC improves clinical outcomes and reduces burnout.

• Collecting data through MBC makes the case for expanded access to life-saving treatments.

• Studies also show that patients like MBC since it gives them more control over their treatment journey, with tools to monitor their own progress.

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Despite MBC’s strengths, only 18% of Psychiatrists and 11% of therapists implement MBC in their practice, citing obstacles such as extra time for no extra reimbursement. MBC is gaining traction, albeit slower than it could be if those barriers were removed.

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The Osmind platform is the leading EHR to offer integrated measurement-based care, including seamless automation and an intuitive interface for patients to track their progress for clinicians to see. As a clinician, you can feel empowered to operate at the apex of science with tools that streamline MBC, regardless of your clinical or research background.

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3) Empower clinicians with technology that generates real-world evidence for innovative mental health treatments

We’re still in the early innings of innovative mental healthcare. The FDA approved many treatments including Spravato, TMS, and generic ketamine. But, these treatments haven’t reached the number of patients who could benefit from them.

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Ketamine reimbursement specifically is held back by a lack of randomized control trials (RCTs) specifically for depression*.* While RCTs for Ketamine exist in academia, more are needed to ease insurance companies’ hesitancy. In the absence of RCTs, real-world evidence must fill the gap. Real-world studies, which start with MBC, can provide data on the efficacy and safety of these treatments outside of clinical trials.

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Payers and research institutions can turn to real-world evidence by systematically collecting data on what providers are already doing in their clinics. As mentioned earlier, part of the puzzle involves enabling measurement-based care (MBC).

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How to generate more Real-world Evidence (RWE) for innovative treatments:

Real-world data may be messier than RCTs, but with a large enough sample size, researchers can analyze correlations between treatment protocols for ketamine that show promise for patients of varying backgrounds. RWE can bridge the gap, with clinicians at the forefront.

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At Osmind, we conduct research and facilitate clinical trials to help set new standards for mental health interventions. Our goal is to illuminate how innovative mental health treatments are being used in the community and their effectiveness on patients on a large scale, via aggregate, anonymized data collected through our EHR.

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For example, we are currently conducting the Osmind Real-world Ketamine Analysis (ORKA) series in collaboration with academics at the Stanford University School of Medicine that assesses long-term patient outcomes in large samples of real-world patients undergoing ketamine infusion therapy (KIT) for depression. We published ORKA-1 in January 2022, which was the largest analysis of KIT outcomes in community care settings to date.

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The RWE provided by this study represents a significant improvement over existing case series and anecdotal evidence regarding KIT for depression, with a response rate after 2–3 weeks of KIT that outpaced standard antidepressant medications, which can take 6–8 weeks and often result in no treatment response, and with comparable efficacy to transcranial magnetic stimulation (TMS), which is covered by insurance.

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The study establishes KIT as a rapid, robust, and durable treatment for depression. We hope that this type of research is used to advocate for better insurance coverage of, and therefore patient access to, breakthrough treatments like KIT, in addition to guiding the development of additional future therapies. Real-world evidence helps make the case for insurance coverage for proven, evidence-based therapies. This coverage would unlock access to life-saving care for millions.

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These findings wouldn’t be possible without collecting real-world evidence through clinics on the frontline. Clinicians should feel empowered to contribute to innovative research, and they need intuitive tech to make it easier.

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Conclusion:

Clinicians face numerous administrative barriers that drain their time—time better spent elsewhere. For all the tech progress we see in other fields, Electronic health records (EHRs) have evolved at a glacial pace.

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We can empower clinicians by creating a better operating system for them to:

1. Streamline administrative tasks
2. Implement measurement-based care (MBC)
3. Generate real-world evidence (RWE)

Better technology can improve all three, creating a positive ripple effect: Clinicians will have more time, create better outcomes, and make the case for life-saving treatments.

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In pt. 3 of The State of Innovative Mental Health Care, we'll address clinicians' interests and concerns when embarking on this frontier of psychedelic-assisted treatments.