TMS is a safe, non-invasive treatment cleared by the FDA to help treat depression. In this Behavioral Health Business article, Mindpath Health’s Chief Medical Officer, Priyanka, helps explain TMS’ necessity and potential trade-offs.
Outpatient mental health providers look for new options to improve patient outcomes and add a new service line to their business.
Transcranial magnetic stimulation (TMS) has come to the fore among a handful of alternative options that may help providers deliver additional value to patients and health plan partners. TMS is growing in popularity as a service line among providers as some national platform companies have added the services to their offerings.
“TMS is effective at getting people into remission,” says Dr. Owen Muir, founder of Fermata.
“If what you want is for your depression to be over, not 50% less miserable, then TMS is a really great choice because it does that reliably with extremely limited adverse effects.”
Muir said most antidepressants and other medications have limited benefits for most patients but come with serious side effects. While often not considered a first treatment, TMS has more benefits for more people.
One study found that high-dose TMS led to an 87% reduction in depression assessment scores, and 90% of study participants were considered to be in remission with their depression. Another study from 2015 finds that TMS demonstrates “both a statistical and clinically meaningful durability of acute benefit over 12 months.”
TMS in practice
While TMS is an FDA-cleared intervention for depression and other mental illnesses, health plans often treat it skeptically. This requires behavioral health providers to be ready to engage more staff to handle prior authorizations and other reimbursement issues while working with health plans.
“It’s a lot better now. But even up until a year ago, there was a significant level of things you had to do to get patients qualified for TMS,” says Dr. Priyanka, chief medical officer for the Sacramento-based outpatient mental health provider Mindpath Health. Priyanka does not use a last name.
Several years ago, the company’s top leader wanted to bring in new treatment options. The company saw TMS as an opportunity to engage with providers by offering new training and development options and an alternative for treating patients. It also allowed the company to add to its service line.
However, Priyanka said TMS is not a panacea from either the clinical or business aspects. It may not be appropriate for all patients in the first place. Additionally, many health plans require patients to try other treatments before giving clearance for TMS.
Mindpath Health had an advantage in rolling out TMS. The company has had offices in California for over 20 years, its original state market. So, it had an existing patient base to whom it could introduce the new line of treatment. The company looks for offices in its footprint where clinicians are interested in establishing TMS and have a patient base that may need the treatment.
“It comes with significant investment in making sure that infrastructure is in place,” Priyanka said.
Adding TMS is not a “casual decision” and shifts the experience from running a therapy practice to running a business, Muir said. Other medical specialties made similar decisions about using medical devices and other major technologies a long time ago. However, outpatient mental health has historically lagged behind other specialties in technology adoption.
TMS requires an intensity in both treatment and study that some may find surprising.
A course of treatment described by the U.S. Department of Veterans Affairs requires patients to come in for 3 to 40 minutes a day for anywhere from a week to eight weeks.
More intensive courses of treatment, or accelerated pattern of treatment, do 10 treatments a day across five days. More common treatment courses are 36 once-daily treatments for a few minutes or until the patient is in remission. Treatment can last between 4 and 6 weeks, Muir said.
Offering more value
The wider behavioral health industry is seeing a slow but continuous movement toward value-based care. While widely varied in conception, most arrangements between payers and providers account for some accountability in care outcomes or processes. Adding TMS may help providers engage in value-based care practices better.
Mindful Health Solutions steps patients through different levels of treatment rather than taking them straight to intensive treatments, the company’s CEO John Minahan previously told BHB.
Mindful Health Solutions and Mindpath Health focus on operating on an in-network basis, making partnerships with health plans vital to their businesses. However, access to TMS, even for patients using in-network coverage, is still challenging.
“Outcomes in TMS are very important to push on the clinical and patient sides, but also the payer side of it all,” Priyanka said. “If patients are seeing the benefit, then why not make access easier.”
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