Your Next TMS and Spravato Patients are Already in Your Panel

This is a summary of "What Breaks When Interventional Psychiatry Practices Scale," an Osmind webinar with guest speakers, Justin Gammill and Jake Buchanan co-founders of Rise4, and Will Sauvé, MD, Osmind's Chief Medical Officer. Performance figures attributed to Rise4 are internal and self-reported, and are described as such inline.

TL;DR

• Capacity and patient volume are separate levers. Growth multiplies whatever system you already have, working or broken.
• Start inside your own panel. By Sauvé's conservative arithmetic, 300 to 400 medication management and therapy patients may already include 50 to 60 who'd clear prior authorization for TMS or esketamine today.
• Your 5-part referral engine + website guidance
• Paid demand comes last, once you can respond, educate, schedule, and measure.

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Fix Treatment Capacity before adding new demand

You add a second TMS device or Spravato bay, then a third. Potential treatment capacity triples, yet patient flow barely moves. What's going on?

Scale multiplies whatever's broken or working in your practice operations.

If you're feeling like your patient panel growth is hitting a wall, your first instinct may be to chase referrals or deploy paid ads to find more. But before you spend money to pour water into a leaky bucket, you should audit your operational bottlenecks like intake.

Three growth pillars feed your interventional program

1. Internal patient identification is closest to care and cheapest to influence.
2. External referral relationships come next.
3. Paid acquisition comes last, once your practice can absorb what it generates.

Step 1: Start with the patients already in your panel

"Out of maybe a 300 to 400 patient panel, at least 50 or 60 would likely get prior authorization for something like TMS or esketamine right now," Sauvé said. "That's why it's just so important to keep looking internally. I'd say before you do anything else."

If you do the arithmetic on your own panel, 300 to 400 medication management and therapy patients, more than half usually carry a depression diagnosis, often with something co-occurring. A third of that group has failed two or more adequate trials, which is the clinical definition of treatment-resistant and, for most payers, the bar for TMS or esketamine.

That's roughly 50 people who are still sick. They're taking the medication, keeping their appointments, and not getting better, and most of them would get prior authorization today. They are sitting in a chair across from a clinician every eight to twelve weeks or so.

Gammill tells clinic owners that 30 to 40% or more of an interventional caseload should come from inside the practice. If yours is well under that, it isn't a marketing problem.

Someone has to own the second look

A prescriber running back-to-back follow-ups is managing side effects, refills, sleep, and whatever the patient walked in with that morning. Reading back through two years of chart to re-examine the entire treatment plan is a different task, and the typical short follow up visit has no room in it. That's the job you assign to someone.

One or two trained staff review the next day's charts, apply criteria your practice has approved, and tell the treating clinician one to two hours before the visit. Not a note in the record. A person telling another person, early enough to change what happens in the room.

Caption: The one-to-two-hour window is the part that matters. A flag sitting in a chart is a flag nobody reads.

Gammill says the handoff can be as straightforward as, "Hey, John, Nurse Practitioner, today at four o'clock you have a patient that's tried four medications. They have MDD diagnosis. They look, from the surface level, like they could be a very good candidate for interventional."

Two things that break the second look as you scale

The first is hiring. "Just because you hire four new providers doesn't mean it's going to be an automatic switch to start getting more internal patients cleared for treatment," Gammill said.

New clinicians need months, sometimes years, to learn which device the practice uses, which protocols it allows, whether theta burst is on the menu, and what the self-pay options look like. Until they know, a new clinician can look straight at a treatment-resistant patient and have nowhere to send them. Payer medical policy churns constantly too, which is what turns clinician education from an onboarding task into a standing meeting.

The second is that nobody tracks it. Track how many patients get flagged each week and how many end up having a real conversation about changing treatment. If 30 were flagged and one conversation happened, look upstream of the clinician first: criteria too loose, flags arriving too late, or no clear answer available about what your practice can actually offer that week. Some of those 29 will be sound clinical judgment. You can't tell which without the number.

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Step 2: Build a psychiatry referral engine with five parts

Sauvé had a psychiatrist in Richmond who sent him roughly 100 to 150 patients over a few years.

The relationship worked because the referring psychiatrist could text him, and sometimes called with the patient still in the office. Acutely depressed patients disappear into the gap between a referral and an appointment, so the faster that referral happens the better.

Eventually that psychiatrist tried to place a patient with a TMS practice several states away, outside Sauvé's reach, and ran into the admin hoops and layers of process. He sent Sauvé a four-or-five-paragraph text apologizing for ever taking him for granted. "In us, he had a one-phone-call shop," Sauvé said.

We wrote an in-depth guide on building your referral network. But the gist is that a repeatable referral engine has five parts:

1. Priority relationships. The colleagues and therapists already sending you patients.
2. A simple referral path. One clear, defined way for a referrer to send you a patient, whether that's a text thread, a phone line, or a form on your site.
3. Closed communication. Confirmation back at receipt, at scheduling, and after the evaluation.
4. Named ownership. One person accountable for each relationship, with a backup.
5. Downstream conversion tracking. Which relationships produce evaluations and treatment starts, not how many touches your BD hire logged.

Prioritize your colleagues and therapists already sending patients through the door. It's easier to get repeat referrals than to do new business development.

Once they're sending you patients, make sure you follow up with the person sending you referrals, even after treatment is done.

"A lot of people will send referrals out, and they kind of get sent off to the void," Gammill said. Someone on your team has to own the referral relationship: confirm you received the referral, confirm the patient is scheduled, and confirm when the evaluation happened. Let the referrer know with text or email, whichever's easiest.

Downstream tracking is where a practice can deceive itself. Counting outreach attempts tells you how busy your business development hire is. Tracking which relationships produce evaluations, treatment starts, and reliable referral loops tells you which ones deserve more of your time.

Why you should leave your patients with an exit folder

Gammill's most portable idea is a three-page document every interventional patient takes home at the end of a completed course, whether that's 36 TMS sessions or a Spravato induction series.

It records the protocol: which device, how many sessions, theta burst or standard, accelerated or not. Patients routinely can't answer those questions two years later, and that becomes a problem when they need care again. The folder also charts their PHQ-9 and GAD-7 scores as a line graph, so change over the course is visible rather than described.

That one document serves three purposes.

• The patient leaves with clarity.
• The prescribing clinician gets a summary instead of 36 progress notes.
• The referring clinician stays in the loop without anyone having to remember to call, assuming the release of information was signed back at the first visit.

Symptoms return for a meaningful share of patients inside a year, and a payer may authorize another round when they do. The patient who can say what they had, on what device, at what protocol, starts that conversation somewhere better than one who remembers only that they did TMS a couple of years ago.

Practically, the folder lives wherever your documentation does. In Osmind, the completed folder gets uploaded to the patient's chart so your team can pull it up later, and documentation can be exported as a PDF to share with the patient and their referring clinician.

Of course, make sure to prioritize clinical, payer, and privacy review before any retreatment or coverage language goes into a document a patient carries out of the building. Here are 5 patient policy form templates to get you started.

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Step 3: Fix your digital front door before you buy an ad

Can patients find you, and can you find patients?

Buchanan recently spoke with a practice that had no Google Business Profile at all, invisible on Maps, in a market where patients search "TMS near me." He regularly sees practices that bought a device eight or nine months ago and still don't mention they offer TMS on their website.

Your six-point audit:

• Google Business Profile exists and is claimed
• Service listings match what you actually offer
• Website states each treatment clearly
• Reviews and photos are recent
• Phone and referral paths are obvious
• All of the above matches how your practice actually operates

Patients and referring clinicians both check your listing before they contact you, though your digital footprint moves patient decisions more than it moves referrer decisions.

For more on shoring up your website and digital footprint, read also:

1. Psychiatry reputation and listings guide
2. What to put on your website
3. Psychiatry practice marketing basics

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Step 4: Add paid demand once your practice can absorb it

For every patient who knows to google "TMS near me," there are hundreds who don't know these treatments could help them.

Dr. W. Scott West had a patient, a woman around 40 who came to see him last year after three medications and a course of therapy failed her. She had grown up less than two miles from his Nashville clinic. Her mother had lived with depression her whole life, her uncle died by suicide, and her father was a surgeon. And yet, she had never heard of TMS until the week before she walked through Dr. West's door.

"If she'd been any closer, she could have heard the machine," West said. "Still didn't know it was there."

Meta creates awareness, and awareness is scarce here. Buchanan's informal test is asking your Uber driver whether they've heard of TMS. Nine times out of ten they haven't. Google captures people who already know what they want, which makes it fast and gives it a ceiling. "If your SEO's not good, don't worry. Just spend money on Google Ads and boom, you're right there at the top," Buchanan said, before noting that it turns into a bidding war with little room for creative differentiation.

Meta, on the other hand, is good for getting in front of people who may not know they could benefit from an interventional treatment.

What kind of Meta ads should you run?

We won't go into the nuances of Meta here, since that could be a whole other guide. But the practices performing well on Meta, across Rise4's client base, tend to run custom video featuring their actual clinicians and technicians, so the relationship starts before the phone call.

What you can't say in a Spravato or ketamine ad (spoiler: the names of the drugs themselves)

What you can't say in a Spravato or ketamine ad (spoiler: the names of the drugs themselves)

As of August 2026, Meta ad policy blocks the words ketamine, esketamine, and Spravato in ad copy, on-screen text, and audio.

Rise4 works around it rather than skipping the channel. Bleep the word in video, write "K-E-T" in on-screen text, and build the creative so the gap doesn't have to carry the message. You can describe what the treatment does without naming it. "It's a little odd," Buchanan said, "but we haven't seen it impact performance in any sort of meaningful way."

Should you get LegitScript certified?

Applying for LegitScript certification doesn't seem to make a difference for approval. That's Rise4's observation across a client base that includes accounts both with and without it, rather than a statement of platform policy. We've seen it at Osmind with our own ads too: no matter what, mentioning psychedelics or Spravato gets blocked.

Before you increase spend

Confirm your practice can respond, educate, schedule, and measure. More leads into a weak intake process just buys a bigger leak.

That's the harder half of this work, and it's the subject of the companion piece: [What breaks when interventional psychiatry practices scale]. It covers the nine numbers worth tracking, the seven places patients actually leave, and how to tell which one is costing you the most.

Can patient identification be automated?

So glad you asked. Coming soon in Osmind: automated patient identification

Step 1 of this guide asks someone on your staff to review upcoming charts by hand, every day, against criteria your practice approved. That works. It's also the kind of work software should be doing.

Osmind is building to automate patient identification, and looking for design partners to shape it: automatically flagging the patients in your panel who may qualify for Spravato or TMS, along with the ones who finished a course and may be eligible for another, then routing them to the treating clinician. So you can stop scouring 400 charts to find 50 eligible patients.

Conclusion

Before you buy another Spravato chair, make sure you can fill it. Start with a named owner for chart review, a referral loop that closes, and a website that mentions the device you just bought.

Ready to scale impact and revenue?  See how Osmind is breaking growth barriers for 1000+ practices like yours.