Joyce was holding her first grandchild when she asked her physician daughter to plan a trip to Switzerland for assisted suicide. After seven years of treatment-resistant depression and failing "pretty much any SSRI you can think of" plus ECT, she had reached a breaking point.

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That grandmother is now living her best life eight years later, medication-free, after a single course of TMS treatment. Her new lease on life inspired her son-in-law, Dr. Don Vaughn, to leave his Silicon Valley startup and ask a simple question: why isn't this technology accessible to everyone?

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Dr. Vaughn went on to develop a solution that addresses TMS's biggest barriers: complexity, cost, and space requirements. Recently, he joined Dr. Will Sauvé, Chief Medical Officer at Osmind, for a webinar exploring how new approaches to TMS delivery could change how you think about adding this treatment to your practice.

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What You'll Learn:
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• Why traditional TMS creates operational headaches that keep many practices from offering it
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• How Ampa’s new mobile system eliminates the need for dedicated rooms
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• Early observational clinical data on a One Day treatment protocol showing 70% remission rates
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• The subscription model that lets you test TMS without major capital risk
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• Integration strategies that handle billing and quality control automatically

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Why Most Practices Skip TMS (And Why That's Changing)

You know TMS works.^1-5 The research is clear. But you probably also know why you haven't added it yet.

"It's really difficult to deliver TMS as wonderful as these results are. It's not as simple as a prescription," explains Dr. Vaughn, CEO of Ampa and neuroscientist.

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Here's what stops most practices:

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Training Takes Forever: Standard TMS training typically lasts around four weeks at a reputable clinic. Your techs need to manually calculate coordinates using trigonometry, create treatment caps by hand, and perform motor threshold testing through trial and error. "Often techs are passionate, but it takes a long time to learn how to do this accurately," Dr. Vaughn notes. Then you have turnover and need to start over.

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You Need a Dedicated Room: Traditional devices often take up an entire room. You're dedicating valuable real estate, needing to fill enough appointments to justify it. Miss on patient volume, and you're stuck with expensive equipment taking up space.

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The Upfront Investment Hurts: Current systems cost about $100k+, or long-term lease commitments. You're locked in whether patients show up or not.

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These barriers create what Dr. Vaughn calls an "anti-virtuous cycle" where staff fall out of practice, feel uncomfortable delivering treatments, and end up not offering TMS at all.

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How to Set Up TMS in Your Existing Space with Ampa

Ampa rebuilt TMS around a simple premise: make it as easy as possible to deliver.

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Start With Equipment You Can Hold

Instead of room-sized machines, you get a 2-pound handheld coil. Your staff won't need to build muscle just to operate the device—you can hold it with your hand. The coil has a built-in camera system that visualizes the target you intend to be on.

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No more guessing if you're targeting the right spot.

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Skip the Manual Mapping

Traditional TMS requires your staff to hand-draw treatment locations after taking multiple head measurements. Ampa uses pre-printed caps with all common TMS sites already marked with unique codes. "Rather than having someone come in and needing to take all these head measurements and then draw all this with markers, you have a preprinted cap," Dr. Vaughn explains.

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Pop on the cap, match the code, start treatment.

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Lock In Your Protocols

The Ampa system uses "digital prescriptions" that lock in your treatment parameters. You create templates for your standard treatments, which download to the device. Your technicians cannot change them, ensuring every patient gets exactly what you prescribed.

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The AI-powered system can disable treatment if the coil moves off target. If it moves during treatment, the pulses will stop.

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Monitor Multiple Locations Remotely

If you run multiple sites, every pulse and placement gets logged to the cloud. The system flags issues automatically: "We're working on an insight dashboard that will be sent to you and say, 'Hey, with this technician on these days, we saw a little more movement than normal. You might want to go ahead and do a little further training."

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"You get quality control without being physically present, though your ability to bill for remote supervision depends on individual insurer requirements for direct versus general supervision.” You get quality control without needing to be physically present.

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What One-Day TMS Treatment Protocol Data Shows

Beyond making standard TMS easier, Independent clinical sites tested something that sounds impossible: compressing 36 days of treatment into one day.

The protocol combines 20 sessions of three-minute theta burst stimulation with neuroplasticity agents (d-cycloserine and lisdexamfetamine) given at the start to "fertilize the soil" of the brain before delivering TMS.⁵

The study was conducted under NSR IRB oversight by independent clinical sites. Ampa supported the study by analyzing data collected from participating clinics.

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Remission, Response, and Durability of One Day TMS

In a early observational data from over 100 patients across multiple clinic chains:

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• 70% remission rate (measured by Hamilton Depression Rating Scale)
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• 90% response rate
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• 6-month durability in follow-up data

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Compare that to traditional 36-day protocols, which typically achieve about 50% remission rates in real-world settings.⁶ "We were surprised," Dr. Vaughn admits. "We discovered it back in September or October. And then we didn't publish it; we replicated it in a different clinic."

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What This Means for Your Practice

A one-day protocol addresses a major patient compliance issue. You're asking severely depressed patients—people who "often can't unload the dishwasher"—to drive in every day for 36 days. Many don't finish the full course.

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One-day treatment removes that barrier entirely.

IImportant caveat: This represents early research, with a peer-reviewed case study already published.⁷, and another just accepted. The protocol remains in early stages of clinical evaluation. Dr. Vaughn is transparent about disclaimers and notes, "your mileage may vary.

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Flexible Business Model: Insurance Foundation Plus Cash-Pay

Ampa's strength lies in its versatility. You can start with traditional insurance-reimbursed 36-day TMS protocols and offer one-day treatment for patients seeking convenience.
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Some clinics offer premium cash-pay service lines at varying price points. While most clinics charge around $5,000 per patient for one-day treatment, high-throughput practices can offer competitive pricing. With the ability to treat multiple patients per day, this creates significant revenue potential from a device that costs $3,000 monthly.

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How to Test TMS Without Breaking Your Budget Using Ampa

Here's where the business model matters for your decision-making.
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Instead of $100K+ upfront, you pay $3,000 monthly for everything: • Treatment device with both lateral and medial coils • Training and ongoing support • Cloud software access • Repairs and replacements • Only additional cost: $30 per disposable cap
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"If you don't like it, you're welcome to send it back. We haven't had anyone send the system back yet," Dr. Vaughn notes.
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Cross-Train Your Existing Staff

You don't need to hire TMS specialists. "We've had several facilities, and they don't bring anyone new in. They just cross-train their existing staff." Training takes one day instead of four weeks.
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If you already offer ketamine or Spravato, your staff can handle TMS with the same setup.

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Use It When You Need It

The system packs into two Pelican cases. Some practices store it during the week and bring in multiple patients on Fridays for single-day treatments. Others use it in their multi-purpose procedure room.
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You're not tied to a dedicated TMS room anymore.
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Scale Your Throughput

Ampa’s nimble setup enables high patient volume. Practices report "around six total sessions an hour" or "12 total treatments in an hour" when combining different stimulation sites.
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That throughput impacts your ROI and the number of patients you can help.
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TMS Billing and Prior Authorizations

The biggest operational headaches with TMS aren't the treatment itself—they're everything around it.
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Interventional psychiatry-tailored EHR and billing services make everything easier. Osmind is your all-in-one practice partner. Informed by experts who’ve delivered over 100k TMS treatments, we offload menial tasks so you can spend your time on what matters.

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Treatment data from Ampa integrates seamlessly with Osmind's specialized EHR, which automates billing workflows.

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Osmind’s software and staff handle prior auths and claims management, so you don’t have to.

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Your Next Steps: Should you add Ampa to your practice?

You no longer have to worry about TMS barriers like space, costs, and billing headaches. By combining Ampa’s portable TMS and Osmind’s psychiatric billing services + EHR, you’re ready to see more TMS patients without drowning in operational complexity.

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For your decision-making process:

Start with your patient population. If you're already treating treatment-resistant depression in adults with other modalities, you have TMS candidates.
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Consider your space constraints. Ampa is portable and can be used in multi-purpose rooms or stored between uses.
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Run the numbers on subscription versus purchase. Monthly costs let you scale with patient volume instead of betting on a large upfront investment.
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Factor in staff training time. One-day training versus month-long programs gets your staff up and running.
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With Osmind and Ampa, you have a playbook to deliver life-saving treatments with ease. The barriers are gone. The technology works. Visit Ampahealth.com and Osmind to get started.

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References

1. Papakostas, G. I., et al. (2024). Comparative effectiveness research trial for antidepressant incomplete and non-responders with treatment-resistant depression (ASCERTAIN-TRD): a randomized clinical trial. Molecular Psychiatry.
   
   
2. Cole, E. J., et al. (2022). Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial. American Journal of Psychiatry, 179(2), 132-141.
   
   
3. Rossi, S., et al. (2021). Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines. Clinical Neurophysiology, 132(1), 269-306.
   
   
4. Perera, T., et al. (2016). The Clinical TMS Society Consensus Review and Treatment Recommendations for TMS Therapy for Major Depressive Disorder. Brain Stimulation, 9(3), 336-346.
   
   
5. Vaughn, D. A., Marino, B., Engelbertson, A., Dojnov, A., Weiss, N., Vila-Rodriguez, F., ... & Downar, J. (2024). Real-world effectiveness of a single-day regimen for transcranial magnetic stimulation using Optimized, Neuroplastogen-Enhanced techniques in Depression (ONE-D). Research Square. https://www.researchsquare.com/article/rs-5679327/v1
   
   
6. Blumberger, D. M., Vila-Rodriguez, F., Thorpe, K. E., et al. (2018). Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial. The Lancet, 391(10131), 1683-1692. https://www.thelancet.com/article/PIIS0140-6736(18)30295-2
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7. Vaughn, D., Marino, B., Engelbertson, A., Dojnov, A., Weiss, N., Vila-Rodriguez, F., et al. (2025). An optimized, neuroplastogen-enhanced regimen for transcranial magnetic stimulation in depression (ONE-D) allowing completion of treatment in a single day. Biological Psychiatry, 97, S173. https://doi.org/10.1016/j.biopsych.2025.02.427