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 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."
"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."
The health system is rolling out an enterprise communication strategy that gives every nurse and doctor access to a smartphone, and expecting to see ROI in everything from reduced steps per shift to better patient care.
It’s still not unusual to see a doctor or nurse walking around in a hospital with several different communication devices. Sentara Health is investing millions of dollars in a program to reduce that cluster to one smartphone.
The health system, with 11 hospitals in Virginia and one in northeastern North Carolina, is equipping nurses and doctors across the enterprise with a specialized smartphone from Mobile Heartbeat, giving them one device to communicate, access patient records, scan labels and devices, take images of patient wounds, check medications and submit orders.
Tim Skeen, Sentara’s Executive Vice President and Chief Information Officer, says the health system needs to erase pain points caused by slow or ineffective communications and problems with data access. Those problems not only endanger clinical outcomes, but also contribute to staff stress and burnout.
“This was really important for us, especially for our nurses,” he says. To accommodate clinicians who “don’t want another device,” Sentara made the platform available through an app that they could download on their own smartphones.
The devices aren’t typical smartphones. They don’t allow access to cell service, social media, games or app stores, but they are HIPAA-compliant and integrated with Sentara’s Epic EHR.
Tim Skeen, EVP and Chief Information Officer, Sentara Health. Photo courtesy Sentara Health.
Skeen says Sentara’s leadership had planned on a two-year rollout but shortened that timeline after seeing how successful the devices have been. Scanning compliance has jumped from roughly 85% to almost 100%, he says, while access to so-called “flowsheet information” has gone from hours to minutes.
Clinicians—especially nurses--are also communicating much more frequently with the devices. Skeen says one hospital logged roughly 35 messages between clinicians in the two months prior to rolling out the smartphones, and saw more than 1,310 messages in the month after the devices were introduced.
“This phone improves workflow and patient safety,” Christy Grabus, Chief Nursing Officer of Sentara Northern Virginia Medical Center, said in a story posted by the health system in September. “All of this helps us prioritize and spend more time at the bedside with our patients.”
“We can be more in the moment with the patient,” added Adrienne Cruz, a registered nurse unit coordinator at Sentara Princess Anne Hospital. “I can answer more questions than I could’ve before. We have more time to give the patient that little extra tender loving care that we'd like to.”
Additionally, Skeen and Sentara executives are expecting to see a reduction in the time physicians spend waiting for an imaging or diagnostic test, and the time spent by nurses and physicians trying to find someone, either by paging them or just walking through the hospital. Medications will be administered and treatments started faster, potentially reducing a patient’s length of stay. They’ll also see a change in nurse workflows, such as less steps taken during a shift, a precursor to reduced stress and anxiety and a better nurse satisfaction rate.
“Giving a patient medication through an IV pump has gone from 80 steps to just 10 steps,” Madison Carrara, a nurse and senior IT specialty analyst at the health system, said in the Sentara release. “Nurses used to have to walk around the room four or five times to scan everything. Now with the phone, they can walk up to the bedside, scan the patient, medication, and pump all from the same spot.”
Skeen says that data will be important in proving the value of an enterprise device strategy.
“It’s not easy to get a hard ROI around this significant investment--it’s millions and millions of dollars,” he says, noting it will take a good 12-18 months of full operation to get the metrics they need to prove ROI. “There are some hard cost benefits, and there are benefits that are very hard to document and measure.”
The strategy isn’t new. Health systems and hospitals have been choosing between in-house communications and bring-your-own-device (BYOD) strategies for close to two decades. But the technology and the connectivity have greatly improved over that time, giving executives more of a reason to embrace devices that can efficiently address a larger number of pain points.
Still, Skeen said Sentara Health took almost a year to plan the rollout. They had to make sure every campus was fully accessible by Wi-Fi, so that no urgent messages would be dropped or lost, and that the health system’s IT infrastructure could support the additional devices. The devices themselves had to be rugged and durable, surviving drops and other potential catastrophes, and equipped with a remote-wipe capability should they be lost or stolen. And charging stations had to be mapped out, so that clinicians could easily and conveniently check in, get a fully charged device, and return them at the end of the shift to a charger.
Leadership also had to create separate protocols for doctors, with different levels of access for employed physicians and for those with access privileges. And all doctors who access the platform on their own devices have to agree to certain conditions regarding privacy and security.
Skeen advises healthcare executives looking into an enterprise device strategy to carefully map out all the uses and endpoints on the platform, making sure no program or use is overlooked. And spend plenty of time on HIPAA compliance, endpoint security and connectivity.
He says the devices play into Sentara Health’s virtual and connected care strategies, including telesitting, virtual ICU and virtual nursing. He expects the devices will someday be made available to clinicians in more than 400 care sites in the Sentara Health network and even incorporated into home health and acute care at home programs.
“There are a lot of things that we’re trying to virtualize now,” he says.
Nurses should be involved in innovation so that it happens with them, not to them, says this CNE.
It’s an exciting time for innovation in the healthcare space, as new technologies pop up across the industry that can improve care delivery.
Health systems everywhere are experimenting with several new innovations, all with the goal of streamlining processes and removing unnecessary burdens from nurses and physicians alike.
At Houston Methodist, the innovation team built what the Houston Methodist Center for Innovation Technology Hub, nicknamed the Tech Hub, which according to Murat Uralkan, director of innovation at Houston Methodist, serves as a hands-on living laboratory.
“When we need to push a new configuration, or a new network setup, we can do this all in isolation, without disrupting any patients,” Uralkan said. “We can try things before [they hit] the floor, because no matter how small a pilot is, it is still going to be very disruptive.”
A peek inside the Tech Hub
Within the Tech Hub, there are several rooms that simulate the patient’s experience, both at home and at the hospital. There, the health system tests new technologies before implementing them, Uralkan explained.
“We bring it here first, the technology is not fully ready for operations, but we’ll host it here,” Uralkan said, “and then we’ll start building awareness first, then we’ll start building proof of concept, and when it’s ready we’ll start taking it to operations.”
Inside the Tech Hub, along with the health system’s virtual nursing platform, are digital whiteboards, which show the care team members, the patient’s isolation status or risks, and when the patient has made a request from another handheld screen. Another piece is the BioButton, which can monitor a patient’s vitals and streamline data into the electronic health record more frequently and regularly.
“Today, the standard of practice is someone comes into the room every four hours, or every six hours, to take your vitals,” Uralkan said. “We’re taking your vitals, or at least important critical vitals, every minute now, and we can trend that data and help nurses relieve the burden, and also increase safety.”
Getting nurses involved
Last week, Gail Vozzella, senior vice president and chief nurse executive at Houston Methodist, spoke live from the Houston Methodist Tech Hub at the Ion, to talk about why and how nurses should get involved with innovation, and how leaders can use their seat at the table to advocate for nursing technology.
According to Vozzella, nurses should lead innovation for four reasons: nurses are vocal and will give direct feedback; they understand the “why” and are directly impacted by new technologies; the most successful innovations happen with nurses, and not to nurses; and lastly, nurses are able to help spread the technology across health systems quickly.
“You have to have nursing involved at the unit level in trialing [new technology],” Vozzella said. “We have to be open to the feedback that they give us.”
Vozzella also sat down with HealthLeaders live at the Ion to further this discussion, so tune in below to hear her insights.
Chief clinical executives such as CMOs are focused on a range of issues, including quality, patient capacity, care variation, and high reliability.
This year, HealthLeaders interviewed more than a dozen new CMOs, chief physician executives, and chief clinical officers. Here are seven executives that are poised to make an impact in 2025:
Frost was named senior vice president, CMO, and chief quality officer of Lifepoint in July. He has served in two other leadership roles at the Brentwood, Tennessee-based health system: chief medical officer of Lifepoint Communities and national medical director of hospital-based services. Frost is a member of the HealthLeaders CMO Exchange.
Frost says the core elements of promoting quality care include a leadership component, a process improvement component, and a culture of safety.
The leadership component includes the recognition of the importance of leadership in every aspect of the organization, according to Frost. It also includes engagement of all the quality stakeholders and an accountability process.
Frost says Lifepoint has a checklist of 10 critical components for performance improvement, including huddles that clinical care teams use to focus on clinical workflows, whiteboards at every clinical care unit to identify opportunities for improvement, and tracking data that demonstrate progress or regression.
The culture of safety at Lifepoint includes the engagement of patients and their families as well as fostering an environment where all team members experience psychological safety and have a voice in the safety process, according to Frost.
Galante was named CMO of the Sacramento, California-based academic medical center in July. He had served as interim CMO for a year and was the hospital’s trauma medical director for many years.
Addressing patient capacity is one of his top challenges.
A unique element of the medical center's patient capacity crunch has been California's seismic compliance requirements, which prompted the closing of many beds, according to Galante.
"We have had to close 70 beds over the past year," he says. "By closing those beds, we had to find 70 new beds to open in different locations throughout the hospital."
UC Davis Medical Center has had to do more than open beds to address the facility's capacity challenge, Galante explains.
"You must apply the operations and workflows to be able to move patients more seamlessly and get them discharged," he says.
3. Cameron Mantor, MD, MHA, chief physician executive at OU Health and president of OU Health Partners
In September, Mantor was named chief physician executive at the Oklahoma City, Oklahoma-based academic health system and president of OU Health Partners, the health system's physician practice. He had been serving in the roles on an interim basis since January.
OU Health Partners is positioned for growth, and one of Mantor's primary responsibilities is to help manage the recruitment of new physicians. Oklahoma ranks low for the number of physicians per capita in the country for almost every primary care area as well as specialties.
One recruiting advantage for OU Health and OU Health Partners is the tripartite mission of the organization: education, research, and clinical care, according to Mantor.
"Our goal is to show physician recruits what we are looking to create, so they see what our vision is and hopefully that aligns with them," he says. "That tends to attract recruits. We have a great academic health center, with seven colleges on our campus, so we can attract physician recruits both from an education standpoint and a research standpoint."
McGinn was appointed senior executive vice president and chief physician executive officer of the Chicago-based health system in September. He joined the health system in 2021 as executive vice president for physician enterprise.
McGinn says he is passionate about reducing clinical care variation to boost patient safety and quality.
"My background is in evidence-based medicine and looking at clinical standards," he says. "We have a national program that sets clinical standards."
According to McGinn, the key to success in setting clinical standards is to have clinicians drive the process.
"It is not a top-down approach," he says. "We put the standards in front of the clinicians, we give them some options, we have multiple group meetings, then the clinicians come to a consensus about the clinical standards."
Pancioli assumed the role of senior vice president and chief clinical officer at the Cincinnati-based academic health system in August. Prior to taking on his new position, he was chief transformation officer of the health system.
This year, UC Health launched an initiative to become a high reliability organization.
"Many healthcare organizations across the country have taken on the concept of high reliability," Pancioli says. "It is a well-studied science that is a methodology of improvement of an entire organization. We have just entered an engagement with a consultancy, and we are starting our journey to high reliability."
The first step in this process, he says, is assessment.
"The first thing you do is determine your current state and opportunities for improvement in high reliability, which is the pursuit of zero harm in a highly complex organization," Pancioli says.
Puri was appointed CMO of the Chicago-based academic medical center in September. He joined UChicago Medicine as an internal medicine resident in 1999 and has held several physician leadership roles, most recently associate CMO.
To address health equity concerns, a health system or hospital must be inquisitive, according to Puri.
"It starts with asking questions about health equity," he says.
The next step is harnessing data, Puri explains.
"You need to have data that you can act on," he says. "Our data and analytics team has done a good job of creating an equity lens that we can use when we look at any of our data and break data down along multiple patient demographics, including race, gender, and Zip codes."
Schissel became CMO of the 665-bed academic medical center, which is operated by RWJBarnabas Health, in August. He had been CMO and vice president of medical affairs at Brigham and Women's Faulkner Hospital in Boston, where he also served as associate CMO and chief of medicine.
Like Pancioli, Schissel is focusing on high reliability, which he also pursued in Boston.
"We had a system of just culture, where patient care was examined from the perspective of systems improvement and accountability that goes beyond individual human error," he says.
Staff from all disciplines at the Boston-based hospital shared a vision of high reliability and worked collaboratively on care and quality goals, Schissel says.
"In addition, every decision we made in healthcare leadership placed the patient's best interest and safety at the center," he says. "Creating and maintaining this kind of culture is hard work, and it is a continuous process."
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Often called neighborhood hospitals, these small-footprint facilities give health systems a branded presence in competitive and underserved markets.
That shiny new hospital complex or fancy tower might not be the best way to extend the health system footprint into new communities.
With capital expenses on a very short leash and consumers looking for a more connected approach to care, healthcare leaders are partnering to build micro-, mini- or neighborhood hospitals. They’re fully accredited and smaller in size, covering about 15,000 to 60,000 square feet, with 8-30 inpatient beds for short stays, and 24/7 ED capabilities.
“Micro-hospitals, if designed appropriately, accrue four strategic advantages to hospital sponsors: broaden market expansion, lessen capital risks, decrease operating costs and increase consumer appeal,” the Erdman report states. “They are designed and built to optimize patient experiences, maximize staff productivity and serve as a flexible footprint for additional services as demand warrants. While the regulatory climate for micro-hospitals is volatile, the sector is expected to grow as health systems deploy capital to micro-hospital projects. Therefore, micro-hospitals serve as a critical element of a hospital’s strategic plan for growth and scale.”
Fulfilling a health system’s expansion strategy
Allegheny Health partnered with Texas-based Emerus in 2014 to build four neighborhood hospitals in and around Pittsburgh, a competitive market it shares with, among others, UPMC. CFO Brian Devine says the micro-hospitals give them a means of extending the brand into neighborhoods where access to care might be limited.
“We wanted to create a way to control ED costs, to control our own destiny with access points,” he says.
While the new sites proved especially valuable during the pandemic, taking pressure off of Allegheny Health’s main hospitals and especially their EDs, the strategy for sustainability goes far beyond pandemics. Allegheny Health’s four neighborhood hospitals give patients a quick and convenient access point for emergency care, and patients are either discharged home or transferred to other care sites in the Allegheny network for continued treatment.
“We saw a significant ramp-up in growth of the brand and ED visits to those facilities, and [we have] significantly benefited from transfers into our tertiary hospitals,” Devine says. “I know the market has changed. I know the competition has changed. But at the end of the day we are seeing benefits from them providing access to our system at four key points around the city of Pittsburgh.”
One key factor in the success of the partnership is medical office space. Allegheny Health has medical offices and imaging services alongside two of the four sites, enabling the health system to keep the patient’s care journey in-house. Devine says that capability will factor into future expansion plans.
As for partnering with Emerus in the first place, Devine says many health systems today don’t have the resources to “go big” and build new hospitals. They’re either building up their main campus and hospitals or looking at a strategy that expands care opportunities into communities.
The partnership with Emerus is “significantly helpful from a capital perspective,” he says, and it also allows them to outsource those responsibilities and focus on other areas of growth.
“It comes down to bandwidth and where we’re prioritizing, and what we’re prioritizing is different areas of growth with our institutes and different levels of efficiency in our core hospitals,” he says.
“We are used to running a traditional hospital, a much larger hospital facility,” Devine says. “But they have a national model that’s been proven, and we have to have some reliance on and trust in that.”
An integrated, and branded, part of the network
“We are completely licensed hospitals with a small footprint,” says Rachel George, MD, CMO for Emerus, a Texas-based developer of micro-hospitals that launched in 2000 and has built 42 hospitals to date for health systems like Allegheny Health, Ascension, Baptist Health, Baylor Scott & White Health, Dignity Health, Providence, INTEGRIS WellSpan Health and ChristianaCare. “And we are able to take care of anything and everything that walks through our door.”
George and David Hall, Emerus’ chief growth officer, say neighborhood hospitals—George dislikes the ‘micro-hospital’ moniker—are fully integrated with the partner health system, right down to the branding. They integrate with the health system’s EHR, adhere to their standards of care, and transfer all patients who need transferring to care sites within that health network.
George says these sites are not designated trauma centers, with no surgery services, but they do take care of, stabilize and manage trauma care patients, then make sure those patients are transferred to the right location for continued care. The average length of stay for observational patients is around 28 hours, and most patients are discharged in less than three days, at least one day less than the average.
Emerus staffs its hospitals with its own nurses and emergency care clinicians, pointing to a much lower nurse-to-patient ratio than most hospitals, and has an on-demand telehealth platform that connects its hospitals to physicians and specialists, such as cardiologists, intensivists, and infectious disease specialists.
“We’re able to discharge a very large percentage of our patients back to their homes, which is great for the community, great for the patient and great for the health system,” George notes.
“A big part of what we're doing right now is becoming a part of that brand, understanding exactly how they want to position themselves and what they represent to the communities that they serve,” adds Hall, noting that while it takes, on average, 35 minutes to get to the nearest hospital, neighborhood hospitals are designed to be 5-10 minutes away.
Looking to the future
Devine says Allegheny Health will plan carefully for any future neighborhood hospitals, taking into account not only location and access to medical offices but the population around such a site.
“We would be looking at communities that may not have the right access today [or are in] jeopardy of losing access,” he notes, adding this plays into Allegheny Health’s strategy of developing community healthcare hubs.
Devine says there needs to be the right mix of Medicaid, Medicare and commercial payer coverage to support a neighborhood hospital. Without commercial coverage, he says, the smaller hospital wouldn’t be sustainable, particularly as Medicare and Medicaid reduce reimbursements.
“You’d have to be very judicious around the patient mix that you expect to get, which would be payer mix,” he says. “And you also want to make sure that you can get those inpatient stays. Clearly an inpatient stay is very helpful to the economics, and you want to make sure that it's in an area that would garner enough visits to yield a few inpatient stays. That's the fine balance of balancing access with the economics of healthcare today.”
“Clearly, the rationale for developing micro-hospitals varies depending on the strategic aims of the sponsor,” the Erdman report notes. “Return on capital goals is different if a micro-hospital is part of a health system’s long-term master site plan for growth and a private investor’s goal is profitability. Both must remain flexible in the scale and scope of services offered as market opportunities evolve, regulations emerge, licensing and accreditation standards are codified, consumer expectations change and competition heats up. Thus, for a community hospital or health system sponsor, the investment in a micro-hospital is both an offensive and defensive strategy: to strengthen competitive positioning and protect against competitive encroachment.”
Gen Z is looking for purpose at work, says this CNE.
HealthLeaders spoke to Jean Putnam, chief nurse executive at Baptist Health South Florida and HealthLeaders Exchange member, about workforce challenges in nursing and innovative ways to recruit and retain Gen Z nurses. Tune in to hear her insights.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
The agency is eliminating copayments for all telehealth encounters and putting more money into a controversial program that creates telehealth stations for veterans in remote and rural areas.
The largest telehealth provider in the country is proposing to eliminate copayments and expand a controversial program that provides access to care in rural and remote regions through telehealth stations.
The U.S. Department of Veterans Affairs announced on Veterans Day that it aims to amend the Commander John Scott Hannon Veterans Mental Healthcare Improvement Act of 2019 to end all copayment obligations for veterans, greatly expanding a decision earlier this year to waive copayments for a veteran’s first three outpatient mental healthcare visits per year through 2027.
In addition, the VA plans to establish a grant program to support new telehealth access points in non-VA facilities. The funding would bolster The Accessing Telehealth through Local Area Stations (ATLAS) program, which launched in 2019, by supporting organizations, such as non-profits and businesses, to create and maintain telehealth stations where veterans could access VA care services.
The idea behind the program is to create a network of locations that would enable veterans to access care outside of VA hospitals and care sites, giving veterans more convenient options for care. Current sites are located in Walmart stores, American legion posts and Veterans of Foreign Wars posts.
Interestingly, the ATLAS program so far hasn’t performed up to expectations. Just a month ago, the Government Accountability Office (GAO) issued a report that found that 14 of the 24 sites supported by the program weren’t used at all in FY 2022 or 2023.
"I think it's a noble idea,” GAO Healthcare Director Alyssa Hundrup told a Virginia TV station in an October interview. “They've put in an effort but, unfortunately, it has yet to be used. VA really needs to be looking at the effectiveness of these sites, where they are, how they're using them, are they getting the word out to communicate with the veterans the availability of these? Otherwise, these sites are sitting there being unused and it's a real missed opportunity.”
VA officials said the two new announcements aim to build on a successful platform for veterans, and an understanding that many veterans either can’t or won’t visit VA centers or other VA-affiliated care sites.
“Waiving copays for telehealth services and launching this grant program are both major steps forward in ensuring Veterans can access healthcare where and when they need it,” VA Secretary Denis McDonough said in a press release. “VA is the best and most affordable care in America for veterans. With these steps, we can make it easier for veterans to access their earned VA healthcare.”
The announcement continues a growth trend for the nation’s largest health system, which serves more than 16.2 million veterans. In fiscal year 2023, more than 2.4 million veterans, or 12% of that total, were treated through more than 11.6 million virtual care encounters, including some 9.4 million on the VA Video Connect platform.
Also last month, the VA expanded its tele-emergency care (tele-EC) platform to veterans across the country, after the success of pilot programs in selected regions. Veterans can now use a smartphone and associated app to access emergency care at any time and from any location.
Chief among the system's drivers of ROI is a coding automation platform grown close to home.
Let's face it: We're not getting any younger.
"Our population [is] getting older, more complex, more challenging, so there's always going to be more volume than we can keep up with," says Michael Mercurio, vice president of revenue cycle operations at Mass General Brigham, a 12-hospital system headquartered in Boston.
For revenue cycle teams, it means the pressure is on "to not only perform well and bring in as much cash as we can as effectively, compliantly, and quickly as we can, but [to] do it at a cost that isn't burdensome to the organization," he explains. "Because every dollar that they spend on me is one dollar [that] they don't spend on a clinician or on research or on community assistance or on direct patient care."
To help those dollars more readily reach their intended targets, Mercurio has half a dozen "bot builders" implementing robotic process automation (RPA). "We're looking to continue to expand that as quickly as we can," he explains.
Ahead, more ways Mercurio taps tech to keep pace with RCM's ever-upping ante.
Cracking the CAC code
Today, Mass General Brigham's rev cycle team is automating more than 80% of their radiology-related coding activity with CodaMetrix's platform, which Mercurio helped launch in 2019 to commercialize the computer-assisted coding (CAC) solution developed by the system's physician organization billing office.
This focus has paid off big, Mercurio says. "The quality is excellent, and we've seen a reduction in denials and therefore a reduction in cost on the backend, which we've been able to pass on to our practices or reinvest in ourselves by redeploying staff to areas [that] need it as opposed to working things that would have been denied."
When considering automation, Mercurio recommends starting with higher-volume service lines where notes typically follow a standard template or format, such as radiology or pathology. "There's significant volumes of those, so the machines can learn very well on past history and do a really good job predicting the future," he explains.
Making humans happier
Apart from creating economies of scale in house through CAC and RPA, Mercurio sees an opportunity for tech advances to make work more joyful for the humans in the loop.
"Our providers are severely overburdened and that's causing a lot of challenges clinically from an access perspective and doctors losing the joy of medicine. So AI is going to help there," Mercurio says. "From our [RCM] perspective, it's really making us think, ‘do we really want to do X if technology is going to maybe potentially give us a boost or a lift or resolve this problem for us?'"
He points to new AI tools on the horizon, along with companies offering tech that tees up appeals to denials likeliest to get overturned based on a payer's policies and historical activity.
Laying the groundwork
Though such possibilities are ripe for ROI, they risk being waylaid by waning budgets and bandwidths. "There are so many companies and technologies and opportunities out there," Mercurio says. Though there's no silver bullet for these "killer bees," the following strategies are some worthy repellants.
Talk shop
"I rely heavily on my network," Mercurio says. "If someone's already using a vendor or a process, that's a good head start to narrow it down." He recommends asking peers which partners and solutions they've chosen and/or shortlisted, and based on what criteria, "so we don't have to do that market scan ourselves."
Avoid vaporware
Tapping your network also means you can learn from their mistakes. Mercurio recalls a peer who ran into early misunderstandings about an AI product they were purchasing that, one full year after implementation, left them where they thought they'd be on day one.
"It's so new, and there's a lot of hype, and people are quick to jump on to that," Mercurio explains. "If you're not asking the right questions or doing the right reference checks, and really digging in to understand the full breadth and depth and scope of your potential partner—which you should do for anything, not just AI—then you could end up getting bitten."
To sniff out potential snake oil, he recommends connecting with a peer organization already using a prospective solution to discuss how implementation went. "There's a very big difference between selling and installing," he notes.
Empower teams
System leadership is generally supportive of tech-enabled experimentation to "drive more value at a lower cost and a higher quality," Mercurio says.
As for staff whose roles might be directly impacted, such as coders, buy-in "comes down to the communication and the trust that your team has in you as a leader and your leadership team," he explains. The objective, he tells his staff, is to elevate team performance so members can build capabilities and take on more valuable work—not lose their jobs.
"We're not looking to eliminate any of the coders on our teams because of technology. We have more volume than we can keep up with," he says. "We want to make sure that we have the right coders who are trained in various subspecialties and are experts in their field and can really provide the value to our overall organization."
Put value over cost
Though price is "obviously important," Mercurio is "more interested in the quality of the outcome of the service we're buying, the relationship that we're going to have with that vendor," he explains. "We want them to be sticky. It's not a great idea to save 60% and then have seven times as many problems and constant turnover with account managers or teams where you're then managing more than you were to begin with and you're spending more than you were to begin with."
See the vision
"I like to try to find the companies that are really trying to do something different and special," Mercurio says. "That's who we would want to partner with to see if we can elevate our game and provide more value to our patients and our providers and our practices."
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