Case Study — Interventional Psychiatry Operations
Running a 70-Patient Spravato Program Without Losing Track of a Single Authorization
How a growing integrative psychiatry clinic in Oregon replaced email-and-spreadsheet authorization tracking with an automated data feed, a custom scheduling app, and a daily program view.
Client identity anonymized. Results described are specific to this engagement and are not a guarantee of outcomes for any other practice.
The Situation
A growing integrative psychiatry clinic in Oregon runs one of the more operationally demanding services in behavioral health: a Spravato (esketamine) and ketamine treatment program with roughly 70 active patients. The treatment protocol itself creates the scheduling load — new patients induct at twice a week, then taper toward maintenance frequency — which translates to 12–15 in-clinic sessions per day across treatment slots running 7am to 7pm.
Layer the payer landscape on top: Anthem, Providence, Moda, PacificSource OHP, and UnitedHealthcare, among others, each with its own prior-authorization rules, renewal windows, and documentation requirements. Every one of those ~70 patients has an authorization with an expiration date, a session count, and a payer-specific renewal process. A Spravato program does not fail loudly; it fails one lapsed authorization at a time.
The Challenges
Authorization Tracking Spread Across Email, Spreadsheets, and the EHR
Auth expirations lived in three places at once and nowhere authoritatively. Whether a renewal got started on time depended on someone remembering — and the people doing the remembering were also running a 12–15-session treatment day.
Every Patient Fact Retyped Into 4–6 Systems
Demographics, insurance, treatment phase, session schedule — each fact was manually re-entered across the EHR, spreadsheets, tracking documents, and communication tools. That is hours of duplicated staff work per week, and every retype is a chance for the versions to disagree.
No Daily Program Visibility
There was no single view answering the operational questions a program of this size generates every morning: who is in today, in which slots, in which treatment phase, under which payer, and whose authorization is closest to running out.
An EHR With No API
The obvious fix — integrate the systems — had an obvious blocker: the clinic’s EHR offers no API. Any solution had to get clean data out of a system that was never designed to share it.
What We Built
- An automated EHR-to-SharePoint data feed. With no API available, we engineered around it: a scheduled export pipeline that pulls appointment and patient data on a 90-day horizon using a two-pull, deduplicate-and-merge design (working within the EHR’s own export range limits), and lands it in the clinic’s SharePoint environment automatically. No staff member types that data anywhere, ever again — the systems stay in sync because a machine does the syncing.
- A custom scheduling and tracking web app. Purpose-built for the program’s actual clinical rhythm: induction-versus-maintenance phases, 7am–7pm slot structure, and per-patient payer context. It tracks every authorization with expiration alerts that surface renewals before the window closes, not after a claim bounces.
- A daily census view. One screen for the morning huddle: today’s sessions, treatment phases, payer mix, and the authorizations that need attention this week.
- Billing/RCM and workflow support around the tooling. Software alone does not run a program. We support the billing and revenue cycle side and the staff workflows that connect the front desk, the treatment team, and the authorization work.
How It Works Now
The program’s operating facts flow in one direction: from the EHR, through the automated feed, into the tracking app and the daily view. Staff enter patient information once, in the system of record. Authorization renewals are a managed queue with lead-time alerts instead of a memory exercise. The daily census turns “who is coming in and what do we need to worry about” from an investigation into a glance.
The results we hold ourselves to here are operational, and they are the ones that matter for a program like this: full visibility across ~70 active patients, manual retyping eliminated from the data path, and authorization expirations caught on lead time — before a lapse costs a patient their treatment continuity and the clinic its billable sessions. We do not publish revenue claims for this engagement, and no case study should be read as a guarantee.
What This Means for Your Program
If you run — or are building — a Spravato or interventional psychiatry program, the pattern in this case study almost certainly rhymes with yours: a demanding session cadence, a payer-by-payer authorization burden, staff retyping the same facts into disconnected systems, and an EHR that will not integrate on its own. None of that requires heroics to fix. It requires someone who understands both the interventional-psychiatry workflow and how to build the connective tooling your systems refuse to provide — including when the EHR has no API at all. That combination — custom software and automation plus billing and revenue cycle support — is the core of how we work with interventional programs.
Running an Interventional Program on Spreadsheets and Memory?
Tell us your patient volume, payer mix, and where authorizations are tracked today. We will map what a managed version of your program would look like.