Medical Melodies: Music Therapy Strikes a Chord with Providers

From stroke recovery to behavioral health treatments, music is finding its niche in health systems and hospitals

Looking for a non-addictive, painless and less expensive alternative to drugs or invasive medical procedures? Music just might be the answer.

Healthcare organizations are finding value in music to address a variety of health concerns, from Alzheimer's to behavioral health concerns to stroke recovery. It's a treatment as old as time, yet often overlooked by clinicians.

"The idea of music being healing is not one that is new," says Danielle Porter, MM, MT-BC, music therapy coordinator at Brooks Rehabilitation in Jacksonville, Florida, and a neurologic music therapist fellow. "You've got theologians such as Aristotle and Plato and the Greeks. They all believed that music had the ability to heal."

Over the past 10-15 years, Porter says, healthcare has taken an interest in music, as part of a much larger strategy to embrace the arts as an alternative treatment. Music has the potential to replace costly and dangerous medications and to improve clinical outcomes. It has even been used to help nurses deal with stress.

"Everybody can relate to music," Porter points out. "A lot of people take comfort in music or are motivated by music. Music is salient. For us, it holds a lot of memories … and it makes us feel good."

According to the American Music Therapy Association, music therapists are working in more than 36,000 healthcare facilities across the country as of 2021. In 2023, Cleveland-based University Hospitals published a study detailing how music therapy is an integral part of care management.

"Music therapy services are embedded across the UH healthcare system and integrated into frontline interdisciplinary teams caring for critically ill patients," Seneca Block, PhD(c), MT-BC, The Lauren Rich Fine Endowed Director of Expressive Therapies at UH Connor Whole Health and co-author of the study, said in a press release. "We are committed to providing non-pharmacologic support to patients from diverse backgrounds for both physical and psychological vulnerabilities."

Staying Alive: Tuning in to the clinical value of music

Patients react to music much differently than, say, their doctor or nurse. It heightens engagement, even creates energy. Think of a runner using music to go that extra mile, a weightlifter powering through a tough routine, or a baseball player striding up to the plate to face a tough pitcher.

Now apply that to healthcare. Think of a person recovering from a stroke who's working to regain mobility, someone living with Alzheimer's engaging in memory exercises, a patient who's recently had major surgery, a transplant, or an amputation and needs to get back on the treadmill, the bike, the pool.

"It helps normalize what would otherwise be a difficult experience for somebody who's in a hospital setting," Porter says.

MedRhythms is among the leaders applying music to clinical treatment. The Portland, Maine-based company uses music and digital health to create a clinical playlist for walking and mobility. The process, called neurotherapeutics, was initially trialed at Spaulding Rehabilitation in Boston, as a means of helping stroke victims recover their mobility.

"We're now doing multiple clinical trials," says Brian Harris, the company's co-founder and CEO. "There's so much more research now than there was 10 years ago … and providers are much more aware that this is a potential option now."

And while one of the primary barriers to clinical adoption is reimbursement, that may be changing.

The company, which has received FDA clearance to market its InTandem Rehabilitation System for Chronic Stroke Gait Impairment, recently learned that the Centers for Medicare & Medicaid Services (CMS) has assigned a unique HCPCS (Health Care Common Procedure Coding System) code to InTandem under Medicare's Durable Medical Equipment (DME) benefit category. The code, E3200, is set to take effect this October.

"The technology has gotten us to a point where we can do much more than just teletherapy," Harris says. "It's advancing us to a place where we can really be helpful."

Colour My World: Part of a much larger playlist

Music is just one facet of a collection of innovative treatments that health systems are considering to offset the surge in stress, burnout, and the accompanying substance abuse epidemic, says Kelly Palmiero, COO of Sierra Tucson, a well-known Arizona treatment center.

"We're treating the whole person," says Palmiero, whose center offers such treatments as adventure therapy, nature hikes, art therapy, equine therapy, acupuncture, massage, shiatsu, even ukelele classes.

Palmiero works with the center's chief clinical officer to decide what therapies they can offer based on research into clinical outcomes and availability (because someone on the staff knew how to play the ukelele, the center could offer that treatment). And they're always looking for new treatment options.

"The buzzword right now is integration," Palmiero says. Sierra Tucson operates under the Acadia Healthcare umbrella, which includes more than 200 hospitals. The 150-acre, 40-year-old center, with some 20+ doctors on staff, gets referrals from across the country, and many of those patients have been through traditional treatments, including medication, and are looking for something more effective.

The treatments have to show clinical outcomes, and the center collects and shares data with other providers to figure out what works and what doesn't. And it's important, Palmiero adds, to think beyond the conservative healthcare mindset that focuses on medication and medical interventions.

"I think you always have to be thinking forward," Palmiero says. "It's part of life that you constantly have to be willing to change and evolve."

Even dancing may have a place in treatment. According to a study published earlier this year in Neuroscience News, structured dance programs could prove better that traditional rehabilitation for a variety of health concerns, including depression.

"Preliminary evidence suggests that dance may be better than other physical activities to improve psychological well-being and cognitive capacity," Alicia Fong Yan, MD, of the University of Sydney's Faculty of Medicine and Health and Sydney Musculoskeletal Health and lead author of the study, said. "Adherence to physical activity is an ongoing challenge in clinical trials and even more so in community. Dance can provide an enjoyable physical activity that is easier to maintain."

Don't Dream It's Over: The path to sustainability

According to Porter, the reimbursement puzzle for music therapy is complex. Some state Medicaid programs support some services, especially for pediatric care, and some private insurers are starting to take notice. Many programs still rely heavily on gifts and grants.

"We are pretty underpaid compared to our other therapeutic counterparts," Porter says.

However, the National Institutes of Health (NIH) is supporting studies on music and therapy, and there are two national publications, Perspectives and the Journal of Music Therapy, that have posted studies on the clinical relevance of these treatments.

"When we're starting to see support from the government, it's hard for these healthcare facilities to ignore the fact that it's working," Porter says, noting that Brooks Rehabilitation works with Baptist Health Jacksonville and gets referrals from Wolfson's Children Hospital, which has a music therapist on staff.

One health plan taking notice of music therapy is Avesis, based in Phoenix. Sean Slovenski, the company's former CEO (he's since moved on to lead PatientPoint), says the service is often included in specialty health benefits, which "has [kind of] been in the Land of Misfit Toys for a long time."

"I think [payers] are starting to realize that these services can make a difference in people's lives that isn't just a pill or a treatment," Slovenski says.

According to Slovenski, one factor that may propel music therapy is the healthcare industry's interest in social determinants of health. As more healthcare organizations embrace ideas, like food as medicine, and see how alternative treatment can impact clinical outcomes, they'll take a look at music, dance, art, even innovative ideas like prescribing a trip to the park, the museum, or a concert.

"They'll want to see how it can make a difference before they start talking about whether it can be reimbursed," Slovenski says.

Porter says health systems and hospitals are starting to come around to the idea of using music and other innovative treatments, but with less than 9,000 music therapists in the U.S., access is an issue.

"You have to pave your way," Porter says. "All of us are out here pioneering."