NTAP Means SAINT Treatment for Depression can be Paid By Medicare in the Hospital
A victory lap update.
The Frontier Psychiatrists is a daily health-themed publication. It does some advocacy!
A couple of months back, my readers will remember I was advocating for open comments, regulations.gov, supporting “the new technology add-on payment program” or NTAP application for Stanford Accelerated Intelligent Neuromodulation Treatment.
The short version is that Medicare would pay more for people with Medicare to have fMRI-guided accelerated brain stimulation in the hospital. Treatment similar to this has existed in the outpatient setting, but historically, people must pay out-of-pocket.
Hospitals couldn't give the best treatment because there was no way to have it reimbursed. Now, they get paid more to do it. This resulted from my readers—and others— leaving comments on regulations.gov. Those comments changed what is possible in inpatient psychiatry.
79% remission of treatment-resistant depression with only five days of treatment. This is a change. Subsequently, category III CPT codes were approved by the American Medical Association to describe the treatment in the outpatient setting as well. This is the beginning of a remarkable change in the treatment of psychiatric disorders. If you can describe a treatment using the current systems that allow for payment, now you can talk about getting treatment for people— and not ONLY out of their pocket.
I want to thank my readers for actively participating in the regulatory process by leaving those open comments. It opens the door for every breakthrough treatment to get additional payment models in the future. To be very clear, this is how psychedelic medicine will be paid for.
Many other stakeholders must get on board; I'm looking at you, major payers. I'm looking at plan sponsors. I'm looking at 50 state MOCs that decide Medicare. I'm looking at Medicaid, reducing health care costs, and providing the best treatment when they are the same. Great choice! Especially given there are now class action firms trolling for cases to sue you if you don’t.
But I'm thanking my readers— your advocacy has changed as much as possible. The SAINT system got about ten times as many comments supporting its application as any other applicant under the program in the same year.
We did it. We can do it again. We can keep doing it. We can advocate. And it can change what's possible.
If you can’t wait to get SAINT— or would prefer the outpatient setting—the Open-Label Dose Optimization study—which still requires out-of-pocket payment!—is available at clinics like mine in Brooklyn NYC, called Fermata and other sites, like Acacia Clinics in Sunnyvale, California.
Thanks for reading, and let’s keep advocating for coverage in EVERY setting, not just hospitals. It’s a huge leap forward. More are coming….
I’m having a conference on the topic the night before JPM starts. Get your tickets now. Jan 7th! Rapid Acting Mental Health Treatment 2024 will be the hot party, with all the innovators from the front lines speaking!