Skip the Clinic? Not So Fast: The Case for Spravato
Spravato for Ketamine Clinics: One Provider's Honest Take
Introduction
If you're reading this as a ketamine provider, I'm sure you've felt how quickly this field has evolved over the past few years -- some changes for the better, others… not so much. If you want to stay relevant and build something sustainable, you have to adapt. And early on, that usually means being willing to grind to make change happen.
I know this firsthand. I've been running an IV ketamine clinic in California for the past four years, and like many of you, I came into this space looking for a new path forward. I was burnt out -- years of trauma surgery, long stretches of overnight call, constant pressure from hospital systems and admin bigwigs, and not nearly enough time for the people who matter most. Opening a ketamine clinic felt like a way to still practice medicine, but on my own terms. Lower acuity than the OR, but still deeply impactful. And in the middle of a growing mental health crisis, it feels like work that really matters.
I'll save the full backstory for another time. What I really want to share here is my experience transitioning from a purely cash-pay IV ketamine model to a practice that is now nearly 90% insurance-based after adding Spravato. I was skeptical at first. But making that shift has been one of the most important decisions for both my patients and my business.
So, if you're wondering whether you should add Spravato to your practice, I'll give you the short answer upfront: yes -- 100 times yes. Let's talk about why, what to expect, and what I've learned along the way.
Supervised, in-clinic ketamine therapy offers something at-home treatment models can't -- medical oversight, a controlled environment, and a provider who's present for the entire experience.
Why Spravato -- and Why Now?
I'll be the first to admit, it wasn't that long ago that I was a bit of a Spravato skeptic. In my mind, it was IV ketamine or nothing at all. IV has always been considered the gold standard, with decades of data supporting its use in treatment-resistant depression. Why settle for anything considered less effective?
I was wrong.
The ketamine industry is changing fast. The at-home ketamine market is exploding, and competing with direct-to-consumer companies marketing convenience and polished messaging is an uphill battle. When patients are seeing ads that say things like "Skip the clinic. Heal from home." alongside images that make clinics look cold and clinical compared to a cozy living room, it's not hard to understand why the phone started ringing less and less.
However, there's still a large group of patients and referring providers who want something different. Psychiatrists want FDA-approved options. Patients who have failed multiple medications are looking for something that feels legitimate, structured, and medically supervised. They don't want to experiment with drugs at home; they want to be cared for in a safe environment. And for many of them, Spravato represents a bridge: something evidence-based, insurance-covered, and accessible in a way IV ketamine just isn't.
But Does It Even Work?
One of the biggest surprises for me has been just how well patients respond to Spravato. Most of them do not have the kind of psychedelic or dissociative experience we often see with IV ketamine. But as time goes on, the more I've realized that the psychedelic experience may not matter nearly as much as we once thought. When PHQ-9 scores consistently drop, and patients say things like "I feel like myself again" or "This has worked better than anything I've tried," it forces you to rethink what's actually driving the therapeutic benefit.
Set the Right Expectations on Timeline
That said, the response pattern is different -- and this is important. The biggest lesson for me has been patience. With IV ketamine, you often know pretty quickly who's going to respond -- usually after the first few infusions. Spravato doesn't work that way. Many patients don't show meaningful improvement until after several weeks, sometimes not until after that first full month of treatment. If you're expecting the same rapid feedback you get with infusions, you and your patients will be disappointed. Setting clear expectations with patients about how long it may take to feel better is key.
Think of It as a Long-Acting Antidepressant
The other major shift is how to think about the treatment itself. Spravato isn't a one-and-done series in the way IV ketamine is often structured. It functions much more like a long-acting antidepressant than a discrete psychedelic intervention. Patients come in consistently -- twice weekly at first, then once weekly, then every other week -- and in many cases, this becomes an ongoing part of their care.
And that's not a bad thing. From a business standpoint, recurring visits create stability in both your schedule and cash flow. But more importantly, from a patient standpoint, it smooths out the roller coaster. Instead of cycling through relief and relapse while waiting -- and often saving up -- for their next IV booster, patients have consistent care. Something accessible. Something they can rely on.
Adding Spravato isn't a small step -- it's a leap. The credentialing process is slow, the learning curve is real, and the patience required is significant. But for providers willing to make the jump, the landing is worth it.
The Sooner You Jump In, the Better -- and In the Meantime, Be Creative
Adding Spravato to our practice has not been easy. Or fast. If anything, it's been a bit of a nightmare. If you take one piece of advice from this, let it be this: find a credentialing and billing team that actually knows what they're doing, and has been vetted by someone you trust.
I don't love throwing people under the bus. But I'll say this plainly: not all credentialing partners are created equal. We had a costly experience -- financially and in lost time -- with a vendor who was unable to deliver on their promises and eventually became unresponsive. Do your homework before hiring anyone. Ask for referrals from colleagues you trust, not just forum recommendations. The wrong partner can cost you thousands of dollars and, more painfully, an entire year of momentum.
I wish I had a great recommendation for you here, but we're currently on our second credentialing team, and it's still too early to tell if this is going to be a win or just round two of the same story.
Don't Sit Still While You Wait
So what do you do while you're stuck in limbo -- waiting on applications, approvals, contracts, and all the rest? My advice: don't sit still. If you've already made the leap out of the hospital and don't have another side hustle to support you during the ebbs and flows at the clinic, think hard about a Plan B. Build something else alongside your clinic. Stay productive. Be creative.
For us, that meant launching a supplement company focused on mental health, specifically for patients undergoing ketamine therapy. It's called Newy. It's been one of the best things we could have done during this process. It's been fun to build, our patients are reporting positive responses to it, and Newy gave us something meaningful to focus on while we waited -- and waited, and waited -- for insurance contracts to come through. Because if there's one thing you can count on in this process, it's that it's going to take longer than you think.
Dr. Ray Rivas is a board-certified acute care and trauma surgeon and founder of Innerbloom Ketamine Therapy. After more than a decade in trauma medicine, he now specializes in ketamine therapy for depression, anxiety, PTSD, and chronic pain.
Takeaways
Hang in there. It takes time to build roots in the community and develop a steady client base, but there are many upsides to being a ketamine provider.
The risk is worth the reward. Seeing patients—some labeled with treatment-resistant depression for decades—finally improve, having a more livable work-life balance, and being part of a dynamic field that truly changes lives make it all worth it.
KSU alumnus Dr. Ray Rivas shares his firsthand experience adding Spravato to his IV ketamine practice -- clinical outcomes, credentialing pitfalls, and why it's worth it.
KSU alumnus Dr. Ray Rivas went from cash-pay IV ketamine only to nearly 90% insurance-based -- after adding Spravato. Here's his honest account of what worked, what didn't, and what he wishes he'd known sooner.