Name that tune! Music therapy now entering home care market

Therapist supply, payment issues hinder sound idea

Are your staff members struggling to find relief for patients suffering with intractable pain? Does your patient mix include seniors with dementia or other mental and emotional impairments? Would you like to see improved mobility and speech among stroke rehab clients?

Then consider making music therapy part of your operations. Those involved in the field say it dramatically improves the quality of patients’ lives, producing positive, lasting physiological and emotional changes.

"This is such an extremely important intervention; because it has both a medical and psychological impact, it is a very powerful change agent to improve patients’ quality of life," says Sally Hough, MMT, MT-BC. Hough is president and founder of The Institute for Music and Human Potential, in Columbus, OH, a community health center that provides music therapy, home care, transportation, and behavioral specialty services.

Music therapy is now moving from the periphery into mainstream medicine, and it’s also gaining support in home care, albeit slowly. In the past, patients and health care professionals alike may have looked at it askance. However, new technologies and research documenting its clinical effects and a heightened interest in holistic healing have given it more acceptance in the medical community.

Moving around the clock

As stationary as some people appear, the human body is actually a perpetual motion machine. We vibrate all the time, and through the process of entrainment, our bodies constantly try to synchronize their internal beats with external rhythms. Music therapy takes advantage of this process by using musical frequencies and vibrations to slow the frequency of body rhythms. This creates a host of physiologic responses, from reducing the expression of certain hormones to lowering blood pressure, all of which promote healing. Thanks to PET scans and MRIs, these responses can now be isolated and analyzed.

"There’s now a whole body of neurological research; we can analyze where music is processed and also see the changes it makes biochemically. We can now say, I changed that part of the brain with music,’" Hough explains.

The brain processes music holistically, using its left and right hemispheres. This causes it to create impulses that it otherwise wouldn’t, enabling it to build neuro-pathways over damaged areas.

Eliminating pain

Other interventions only impact a specific area of the brain. Speech therapy, for example, just affects the speech center. That explains why some post-stroke patients already receiving speech therapy only speak after they begin music therapy, according to Hough.

By helping the body focus on other rich and interesting sensory information, music therapy can also block pain. Janalea Hoffman, RMT, MA, president of Rhythmic Medicine in Leawood, KS, uses specially created music and biofeedback exercises to perform what she calls musical acupuncture. Patients visualize musical tones smashing into the area of their body experiencing pain. The technique can eliminate otherwise intractable pain, she reports.

Music therapy also has strong emotional effects. "It can revitalize family relationships, especially among the elderly. They grew up with music, singing with the piano and radio, and they still love and appreciate it. You can ask the healthy spouse of someone in the late stages of Alzheimer’s to name a favorite song, perhaps one they danced to when they were dating. The [sick] person can recognize and sing along with the song even though she doesn’t speak anymore, and they can have moments of their love again. It’s so special to be part of that," says Hough.

With so many documented benefits and broader acceptance, music therapy is primed to take off, especially in home care. Well, sort of. There are a couple of issues holding it back.

The supply of therapists is one. There are only about 5,000 nationally, and most of them are employed in hospitals, schools, and psychiatric day treatment facilities, according to Al Bumanis, MT-BC, director of communications for the American Music Therapy Association (AMTA), in Silver Spring, MD. Very few are in private practice, and even fewer of those work in home care settings. Only 51 out of 1,600 AMTA members who responded to a recent survey indicated that they were in private practice, Bumanis reports. That is changing, however.

Some areas of the country currently have an ample supply of music therapists. They are clustered in cities where music therapy schools are located, such as Denver, Dallas, and Cleveland, according to Hough.

Musical acupuncture

If there are music therapists in your area, work with those who have the capabilities to address the particular patient population you are interested in serving, Roger Conant recommends. Conant is CEO of Austin, TX-based CCC Music Therapy. The company also operates in San Antonio, Houston, and Dallas. Although the music therapy profession has a board certification, it doesn’t yet recognize separate specialties or certifications such as rehabilitation or behavior modification.

If you operate in an area with either few music therapists or few in private practice, your company can still offer some beneficial music therapy interventions. With appropriate training, clinical staff can perform certain music therapy techniques.

Hoffman sells cassettes of her specially composed music along with accompanying instructions. She also gives day-long seminars on musical acupuncture techniques.

CCC Music Therapy also presents seminars on the therapeutic use of music, according to Conant.

If there are no music therapists in your area, contact the AMTA to find the one nearest you, with expertise in the type of interventions you’re interested in, Hough suggests. Ask that person to consult with your agency, even if it’s by phone. Ideally, the music therapist could initially develop treatment plans and establish goals and objectives, and subsequently support the caregiver delivering the ongoing interventions, she says.

While it is possible for those without formal music therapy backgrounds to provide certain interventions, it’s important to have professional guidance, Hough warns. Despite its many positive benefits, music therapy can have detrimental affects as well. Inappropriate music can create negative emotions that block treatment or speed, rather than slow body rhythms.

"Music therapy is not just relaxing music. The music is no good without a person who understands not just the body and physiology, but also why the music is working," Conant explains.

Costs aren’t standard

Rates for those who practice in home care vary significantly. "I’ve seen it everywhere from $30 to $150 an hour, and I don’t think there’s an average," says Conant. Hoffman usually charges $50 per hour.

Reimbursement is another issue holding music therapy back. The service is not a universally recognized benefit, and reimbursement is still more on a case-by-case basis with individual clients, according to Angela Heim Jeter, AMTA government and public relations associate.

Medicare only has formal payment guidelines for its use with patients in partial hospitalization situations such as mental health day treatment facilities, Jeter reports. Some state Medicaid programs recognize it; the Pennsylvania Department of Aging waiver is one that does.

Only about 20% to 25% of the music therapy provided to patients with commercial insurance coverage is reimbursed, Jeter estimates.

Reimbursement often requires persistence and insistence on the part of the beneficiary. The mother of one of Hough’s autistic pediatric patients demanded that her insurer cover his music therapy. The child was already receiving several other therapies covered by the insurer, but the mother did not believe the other therapies were effective. She was convinced, however, that the music therapy was. The insurer agreed and paid for the service, according to Hough.

If you see a role for music therapy with your patients, start paving the road now with payers, Hough advises. Join forces with a music therapist and make presentations to local case managers and their supervisors if possible. Concentrate on areas where you want or expect to perform therapy, for example, to improve mobility of stroke rehab patients. "Emphasize that music therapy has assessments, a definite course of therapy, and outline the expected outcomes," she says.

"The key [to getting reimbursed] is to say, This is the problem, this what we’ll accomplish in this number of visits, and we guarantee that we’ll do it.’ We’re extremely careful to get the results that we say we’ll get because [music therapy] is so unknown and so scarce," Conant agrees.

Hough is using such an approach to increase her company’s managed care business. It’s now only about 5% of total volume. She is now collaborating with an Ohio State University-affiliated hospital to educate payers in the Columbus area. They plan to meet with the local case managers and propose a pilot study involving pain management in oncology patients. "We hope to show a decrease in pain medications and a reduction in nausea, also leading to less drug use," she says.

The music therapy profession’s education efforts are beginning to pay off, Hoffman reports. A health care company in the Northeast just purchased 300 of her tapes and plans to have music therapists in the area use them with hypertensive members.

(Editor’s note: Cassettes and compact discs of Hoffman’s musical acupuncture recordings, along with accompanying guides, start at $12.95 and $19.95, respectively. Hoffman charges $100 per person for her daylong seminars on musical acupuncture.

CCC Music Therapy’s rates for its seminars on the therapeutic use of music vary depending on the number of participants and the scope of the training, but generally run between $125 to $150 per hour, plus expenses.)