May 8, 2023
Carlene MacMillan, M.D.
This year’s Clinical TMS Society Annual Meeting, held in Colorado Springs from May 4-6, attracted a record 605 attendees from 18 countries.
A hotly anticipated session entitled “TMS Targeting and Accelerated Schedules: What’s Essential for Optimal Treatment Outcomes?” included a survey of the current practice patterns and attitudes towards offering TMS that approximates, to varying degrees, the accelerated, neuronavigated SAINT protocol.
Rather than providing any definitive answers about what the “secret sauce” is that leads to the best outcomes, it highlighted the need for ongoing work to tease apart the essential elements of the recipe.
The survey of 161 attendees revealed that while 65.8% had not delivered accelerated iTBS (defined as 10 sessions per day for at least 3 business days) without any MRI-based targeting, 34.2% had delivered this service in their practice. Dr.Linda Carpenter, who moderated the panel, emphasized that we must now think about several variables when offering TMS: the schedule (daily or multiple per day), the type and number of pulses on a specific device and whether or not neuronavigation played a role. Stay tuned for a consensus perspective article on accelerated TMS coming out in the Harvard Review of Psychiatry later this month!
There were a number of other interesting sessions that stood out including “Neural Substrates of Courage and Resilience” by Dr. Jonathan Downar.
He emphasized that in addition to tracking traditional depression rating scales, like the PHQ-9, other scales that measure other aspects of functioning that matter to patients, like the Work and Social Adjustment Scale (WSAS).
With Osmind's Psychiatry EHR, clinicians can easily send out over 40 different scales, including the WSAS.
There was even a session by Dr.Bashar Badran on “Administering TMS in Zero Gravity and Considerations for Interplanetary Travel,” a topic I don’t think most of us had on our CTMSS meeting bingo card. As usual, there were also many fascinating posters, many of which utilized real-world evidence to look at clinically relevant subjects such as tapering treatment and retreatment.
One of the top four winning posters examined whether "Chronic Caffeine Consumption Reduces rTMS-induced Plasticity." This study highlights how tracking things beyond PHQ-9 scores could be helpful in understanding variability in TMS outcomes.
The CTMSS meeting is always a mix of more research-oriented presentations and practical presentations on running a TMS practice.
One breakout session entitled “The Business of TMS” featured practical tips such as:
I also co-led a breakout session on “Lessons Learned from U.S. Insurance” where we reviewed notable improvements in coverage TMS policies in the past year. These include highlights such as Cigna and Highmark BCBS covering TMS for OCD and Optum decreasing the number of prior antidepressant trials from 4 to 2 along with removing the requirement for a prior trial of psychotherapy.
There is, however, still much advocacy work to be done in order to increase access to TMS. Members learned of an opportunity to make comments during an open comment period regarding a special type of “New Technology Add-on payment” that would allow for the accelerated SAINT protocol to be reimbursed on certain types of acute psychiatric inpatient units.
Psychiatric inpatients stand out in contrast to other medical inpatient units in that due to some unfortunate regulations around insurance reimbursement and misaligned financial incentives, innovative treatments for severe depression and suicidality such as TMS, ketamine and esketamine are not often available to the patients in these units. Imagine being admitted to an acute cardiac unit only to be told that the very interventions you need are only available on an outpatient basis!
Individuals interested in making comments regarding the proposed coding change, can go to the government's website before June 9, 2023 to let their voice be heard!
This year’s meeting also welcomed the launch of a new charitable foundation, the Foundation for the Advancement of Clinical TMS (FACTMS), to support educational endeavors, raise public awareness of the benefits of TMS and expand access to it worldwide. We got to hear from FACTMS Board Member, Cindy Elkins, about how transformative SAINT TMS had been for her daughter, who also shared her story.
Cindy shared how it took awhile to find out about TMS and lamented that “it should be the first thing every psychiatrist talks about. It should be simple to get!” We agree and are encouraged that through the efforts of FACTMS, CTMSS and everyone around the world offering TMS, we will move closer and closer to this being the reality for the field of psychiatry.
If you attended the meeting let us know what stood out for you! Next year’s meeting will be in London, marking the first time it is being held outside North America. Register in advance for discounted pricing. Hope to see you across the pond!
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