The Clinical Case for Sunlight Therapy to Reduce Hospital Stays with Dr. Roger Seheult
January 8, 2026
55
min read
00:0000:00
Could a simple, free resource dramatically reduce hospital stays and save the healthcare system billions? In this episode, we explore the powerful clinical case for sunlight therapy with one of the most respected medical educators online, Dr. Roger Seheult. He begins with the astonishing story of a 15-year-old boy given two days to live due to a flesh-eating fungal pneumonia, who made a miraculous recovery after one simple request: to go outside. This episode confronts the "magical thinking" skepticism head-on, presenting a data-driven argument that hospitals and policymakers can't afford to ignore.
We're joined by Dr. Roger Seheult - a quadruple board-certified physician in pulmonary, critical care, and sleep medicine, and the founder of Medcram - to dissect the science behind sunlight and infrared light. Dr. Seheult breaks down the groundbreaking randomized controlled trials, including recent studies in Nature, that demonstrate the profound link between infrared light and mitochondrial function. Learn how specific wavelengths of light can pass through the human body, making our cellular batteries (mitochondria) more efficient, boosting ATP production, and impacting the root cause of many chronic diseases. This robust photobiomodulation evidence suggests we've overlooked a fundamental element of human health.
The discussion pivots from cellular mechanics to systemic impact, focusing on the staggering potential for reducing hospital length of stay. Dr. Seheult cites multiple studies showing that patients exposed to more sunlight or targeted infrared light are discharged 3-4 days earlier - a reduction of over 30%. We analyze the immense financial implications, calculating potential savings of $5,000-$7,500 per admission for hospitals operating on bundled DRG payments. The episode tackles the practical and bureaucratic hurdles, from the inertia of hospital administration to the need for a new light therapy reimbursement policy. We explore actionable pathways for change, including updates to CPT codes, integration into CMMI value-based care models, and the power of the HCAHPS patient satisfaction survey to drive adoption. This conversation makes a compelling case that adopting light therapy isn't just good medicine; it's a financial and ethical imperative.
About Our Guest:
Dr. Roger Seheult is a quadruple board-certified physician (Internal Medicine, Pulmonary Diseases, Critical Care Medicine, and Sleep Medicine) and an Associate Clinical Professor at the UC Riverside School of Medicine and on faculty at Loma Linda University. As a critical care doctor, he sees the sickest patients in the hospital, which pushed him to explore foundational health principles that could pull patients back from the brink. He is the co-founder of MedCram, a leading online medical education platform with millions of viewers, where he excels at explaining complex medical topics in a clear and accessible way.
Episode Resources:
Explore MedCram's Health Optimization Courses (CME available)
Explore the Swedish study on sun exposure and all-cause mortality
Introduction
Dr. Roger Seheult: A 15-year-old boy diagnosed with a flesh-eating fungus. The fungus had actually gone over to the right side, so now his right lung was involved. His left lung was gone. He was getting worse. In fact, we think he's only got about two days to live. He simply says, I just want to go outside. And the first day, he's out there for about five hours. Five days later, the right lung seemed to be almost completely resolved. Completely resolved. This is a boy that was made DNR and given two days to live, completely resolved.
Dr. Amar Rewari: Anthony, we're back, and our listeners heard a little clinical case teaser that we'll get into later in this episode, which I'm very excited about because we're going to be talking about a novel medical therapy, which is not even necessarily medical in nature. It's the use of natural light and visible light to help treat patients.
Dr. Anthony Paravati: This episode is all about the big idea. It's all about the clinical case for sunlight and infrared light as a stand-in when sunlight's not possible. We're going to go through the evidence, the economics for this. We're going to go through, as we usually do on this channel, which is all about healthcare finance and health policy, the pathway to reimbursement on a national scale and why we think it's worth doing that.
Dr. Anthony Paravati: And we're so excited to have somebody who's a physician, well-known all over the internet through all the work that he does. His name is Dr. Roger Seheult. He is on faculty at Loma Linda University and UC Riverside. He is quadruple board certified, including in pulmonary and critical care, as well as sleep medicine. He is also the founder of medcram.com and the Medcram YouTube page, which does tremendous numbers of views, millions of views on all their content because he is such an excellent educator on even the most complicated medical topics.
Dr. Anthony Paravati: But the fact that he is a pulmonary and critical care medicine physician is really interesting for our topic today, because this means that in his specialty, he takes care of the sickest patients in the hospital, patients who could die at any time. And the fact that he's taking care of these critical patients is what pushed him to go down the pathway to study these things like sunlight, like other interventions that can really make the difference and pull patients back from these critically ill conditions that he finds them in. Together, we are going to get into a deep dive into the mechanisms, clinical impact, and reimbursement impact of sunlight therapy.
Dr. Amar Rewari: And as our listeners know, this is not a wellness podcast. What's important to recognize with this episode is our guests will talk about the science behind it, quoting randomized control studies published in major journals such as Nature. And then we will move into the finances about how this can impact your hospital systems or your practices, how it can impact patients, how it can shorten hospital length of stays, and improve outcomes. And some of it sounds almost miraculous and too good to be true, but there is science behind it.
Dr. Anthony Paravati: Before recording this episode with Roger, I was floored by the quality of the evidence. I think he does a great job summarizing that. If you want a deeper dive into it, he's been on other big-name podcasts where he's spoken for two and three hours on these data. We're really excited. Why don't we get right into it? Roger, thank you so much for being here. Let's start with a great case.
Dr. Roger Seheult: Thanks so much, Anthony, for inviting me. Great case, something that really puts it into perspective. A 15-year-old boy—by the way, this is a case that was told to me by his mom. I actually got the medical records and reviewed it because when I heard the story, I really needed to see it for myself. So I got the records. This is a 15-year-old boy in Minnesota, diagnosed with acute lymphoblastic lymphoma, who went on chemotherapy a couple of years ago now. And he did well for a number of months. But as the case happens sometimes, the chemo kicks in, immunocompromised state, he developed pneumonia and was admitted in June of 2024.
Dr. Roger Seheult: And actually specifically June 1st, as I recall, and was diagnosed with a pretty severe form of pneumonia, in this case, was mucor. And for those who don't know what mucor is, it's a flesh-eating fungus that requires, in most cases, surgery and at the very least, very high-powered antifungal medication. So he was on this for a couple of weeks and kept getting worse so that by the end of the month, by July 1st, he was transferred over to the adult side. Cardiothoracic surgery reviewed the case, and they actually recommended complete pneumonectomy on the left because of that pneumonia. And it was devastating. But they did the surgery, came back to the floor, and instead of getting better, he lingered along for some period of time until he was about six weeks in and things started to get worse pretty rapidly. They did a CT scan and it showed that the fungus had actually gone over to the right side. So now his right lung was involved. His left lung was gone and he was getting worse. Doctors had a meeting with the family and they came to the conclusion that...
Dr. Roger Seheult: Because his oxygen requirement was getting worse and because he was not doing well—he's on BiPAP at this point—they said, we really should not intubate him. We don't think that doing a bronchoscopy is going to be of much benefit and we don't think that doing a thoracentesis or putting a needle in was going to be of much benefit either.
Dr. Roger Seheult: Really, if he gets worse, and we think he is going to get worse—in fact, we think he's only got about two days to live—that we should go ahead and just make him DNR, comfort care, and not do anything further. Of course, as the mom is telling me this, she's breaking down. She is remembering the words in her mind and what she was thinking at that time.
Dr. Roger Seheult: This guy, he's 15, he's completely awake, completely alert. He's on a breathing machine but understands exactly what's going on. He asks what is going on and they come and they tell him that he's basically got two days to live.
Dr. Roger Seheult: So it's a difficult time. And they ask him, what is it that you want to do?
Dr. Roger Seheult: And without knowing anything about what we're going to talk about today or anything involved with that, he simply says, "I just want to go outside." Now, if you are like me, if anybody in healthcare knows this, that if you're a physician or nurse and you've got somebody that's not doing well, maybe not going to make it, and they have a last request, you're going to do anything that you can possibly do to fulfill that request. And that's exactly what this staff did. They got him into a mobile chair. They had all of these drips and everything with a portable ventilator that they could take him outside with. And they did that.
Dr. Roger Seheult: At this point, of course, the mom is calling her friends, calling colleagues. One of them is actually involved with doing a light therapy. And so they have a little device called a Firefly, and they start to do this stuff on him outside. It takes about 15 or 20 minutes to do. But here's the key point: whereas before he was inside for six weeks, all of his medication was continued, for the first time now he's outside. And the first day he's out there for about five hours. And before this, they did a CT scan and this is what led them to believe that he had about two days to live because his entire right lung was involved except for a small portion at the bottom.
Dr. Roger Seheult: And the first day he went outside, he had a fever. His white count was in the twenties. Neutrophils were elevated, all consistent with exactly what was wrong with him, which is a severe right pneumonia. And what happened at this time is he just kept going outside and getting this sunlight. Fortunately, this was in June of 2024, so there was plenty of sun. And the next day, his fever was gone. His white count started to come down. The next day, the fever was gone, the white count started to come down even more. Oxygen requirements started to come down more to the point where five days later, he was much, much better. And when they talked to the physicians, they were scratching their heads about what was going on.
Dr. Roger Seheult: They said, "Well, maybe we ought to get a CAT scan." And the mom told me that they all gathered in the room to see what the results were. And when they brought up the film, they were just completely aghast. There was a gasp that went out in the room because what they saw was that while the left lung was completely gone, and it was still gone, obviously, the right lung seemed to be almost completely resolved of its fungal infection. This is an infection that had been on two very powerful drugs, Amphotericin B and Posaconazole, and despite that, was getting worse. Now, he was almost completely resolved.
Dr. Roger Seheult: He went on to obviously not die two days later, was discharged from the hospital, came back in October of that year, no sign of any kind of disease in the right lung. He is still alive to this day and still getting treatment for his ALL. He had just had his Make-A-Wish. Completely resolved. This is a boy that was made DNR and given two days to live. Completely resolved. Wow.
Dr. Amar Rewari: I'm not a critical care doc. This story is so powerful. But the question is, from your perspective, is there anything else that could have accounted for this, besides obviously the light therapy? Was there any other drug started during that time? Anything else given that was different?
Dr. Roger Seheult: No. And I actually have the medical records and the documentation. They decided that they were going to let him go outside, but they were going to continue everything. So nothing was stopped, everything was continued.
The Clinical Case for Light Therapy: Examining the Evidence
Dr. Anthony Paravati: As Amar was saying, this is such a poignant story. This is the kind of thing that is truly unforgettable, and it gives us an entry point into what I would consider is the big idea of this episode, and that is the clinical case for light therapy. The evidence, the economics, and how the U.S. healthcare system may be in a position to lead to substantial clinical improvement and substantial cost savings. At first glance, it's an idea that's so simple, it seems like it must be too good to be true. But we're going to walk through together with you, Dr. Roger Seheult, the evidence that you've recounted in many other settings so well. And we're going to channel that discussion to how we can understand how this could be done and implemented system-wide here in the United States.
Dr. Roger Seheult: It almost sounds like magical thinking. It's not. And I would just draw the attention to the skeptic that if we were 300 years ago on a British ship and I came to someone there on the ship who had scurvy and people around them were dying and their teeth were falling out and they had bleeding gums, and I held up a cup of lime juice and I said, "This cup will solve all of your problems," that would sound like magical thinking, except it's actually true. And it's because, as we'll talk about, we have basically led ourselves into a condition of deficiency, a deficiency of infrared light.
Dr. Roger Seheult: And what I like to do is instead of just talking about these fanciful stories of cases, which are very dramatic, what we really need to talk about is the evidence for this. Because if there isn't evidence for this and good quality evidence-based medicine, if there isn't that, then what we're talking about is useless. We need to have evidence for what we're talking about. And I'm talking about the highest level of evidence. We're talking about randomized controlled trials published in very good journals that are international with high-level professors at top universities.
Dr. Roger Seheult: So I want to start, in terms of the evidence, start backwards a little bit with the most recent paper that was just published that I think is groundbreaking. Glen Jeffery, a professor at University College London, published this in Nature Scientific Reports, basically showing that the infrared portion of the sun, which makes up the majority of the photons from the sun, is able to pass completely through the body and be absorbed in huge amounts and cause changes in mitochondria both in the path and outside of the path of that light.
Dr. Roger Seheult: He demonstrated this in a number of patients in his randomized controlled trial that was published in July of this year and showed substantial, statistically significant improvement in visual discrimination of color, which is highly dependent on mitochondria in the tissue of the body that has the highest concentration of mitochondria. But he's not only shown it there, he's also shown it in another randomized controlled trial where people were given a glucose tolerance test. And it showed that the administration of long-wavelength light through the skin was able to statistically, significantly, and dramatically by 26% drop the spike of postprandial glucose after someone was given 75 grams of glucose. And at the same time increase the end-tidal CO2 levels, which are indicative of the fact that this is a metabolism mitochondrial function.
Dr. Roger Seheult: So a number of these kinds of studies, which are randomized placebo-controlled trial data that show causation and is backed up by decades of data showing that infrared light is very, very beneficial and has receptors and shows changes in the mitochondria, which is in every single cell of our body except for red blood cells, and is highly tied to two very important things. Number one, longevity. And number two, chronic diseases that we see a lot of here in the United States.
How Infrared Light Boosts Mitochondrial Function
Dr. Amar Rewari: With infrared light, is it unique and separate from the sunlight that we were talking about, or is it all part of the same thing? Can you maybe talk to our viewers a little bit about how infrared light is related to the visible light we see or other forms of light that cause cancer that we're always talking about, like UV light? And maybe that could be a good way to start.
Dr. Roger Seheult: Yes. So if you look at a light coming from the sun, it's really divided into three parts arbitrarily. It's the light that we can see with our eyes, which is visible light. And then you've got light on the other side of that red, which is infrared. And you have light on the other side of that violet, which is ultraviolet. It's the ultraviolet light that is responsible for making vitamin D. It is also responsible for nitric oxide, a couple of other beneficial things. It also damages your skin at high levels and for a long period of time. Visible light is very important in terms of circadian rhythm and mood.
Dr. Roger Seheult: Actually, recent evidence is showing that green light and blue light are very important in terms of reducing pain thresholds, so improving your pain if you have pain. But then infrared light, which is that light that we really don't talk much about, and it's that light that is beyond red that you cannot see. It's the type of light that you can feel when you're standing in the sun because it penetrates through your clothes. You can feel that warmth that's deep in your skin. It can penetrate through your clothes; it can penetrate through the atmosphere very easily. The sun doesn't need to be very high in the sky to have those photons coming through. And as I said, this paper shows that it actually clearly goes right through the whole body, but only a fraction of it gets through the other side because the majority of it is being absorbed.
Dr. Roger Seheult: And we believe, based on evidence, is that this light is affecting the electron transport chain in the mitochondria. For those of you who are not up-to-date or study biochemistry, the mitochondria is the battery of the cell. And the final common pathway of all of the metabolites from sugar and protein and fats goes into something called the matrix of the mitochondria where the Krebs cycle occurs, making all of these electrons, these reducing electrons, which then go to the electron transport chain. It's there that electrons fall down their concentration gradient, so to speak, in a redox reaction with oxygen being the final acceptor, pushing those protons into the inner membrane space, which are then used as a gradient to make ATP, which is the final product.
Dr. Roger Seheult: What does infrared light do here? Very good evidence, and there are papers coming out on this that show that the infrared light facilitates the transfers of electrons from one protein to another and speeds up that reaction. And this is really important. It makes the mitochondria more efficient. Why is that important? Because as we get older, we can lose 30, 40, 50—in the retina, up to 70%—of the ATP output from the mitochondria. In terms of diseases, heart disease, lung disease, kidney disease, Alzheimer's, diabetes, obesity, long COVID, cancer, at the epicenter of all of these chronic diseases that plague industrialized countries, the mitochondria is right there, right in the center. So you can see the far-reaching aspects of what we're talking about here and how much of a game-changer this actually can be.
Sun Exposure, All-Cause Mortality, and Global Health Patterns
Dr. Anthony Paravati: And Roger, you know this from our past conversations as well as the materials I prepared for our conversation tonight. But I'm glad you started with this Nature data and these randomized trials because they're the most recent. It's the highest quality evidence. But if we go back in time, like you were saying, there are all these papers showing differences in T-cell motility and immune function, data on blood pressure, data from, I think it was Sweden, looking at the trade-off between mortality risk compared to smoking and mortality risk from sun exposure, basically being a net positive, if you get the sun exposure being much more impactful positively than the risk of even smoking. So if you could talk about a little bit of this data, and then after that, we're going to talk about something that's really practical, and that is length of stay related to sun exposure, sunlight exposure.
Dr. Roger Seheult: Sure. And so this is high-quality data that we're talking about here with the randomized controlled trials that are done in a lab under controlled settings. If those are true, and there's no reason to believe that they're not true because they're very high-quality studies, we should also expect to see similar data epidemiologically, and that's exactly what we've seen over the last decade. A 2016 Swedish study, a survey of women and how long they spent in the sun. Those women that spent more time in the sun had lower all-cause mortality, lower cardiovascular, and lower cancer mortality compared to those that did not spend much time in the sun. And the magnitude of that difference was on the order of smoking, such that those women that went out into the sun and smoked had the same mortality as those women that did not go out in the sun and did not smoke.
Dr. Roger Seheult: That study was essentially repeated again just last year and published by Richard Weller, a dermatologist of all people at the University of Edinburgh. And this time it was 10 times bigger, with both men and women, and found exactly the same results. And by the way, on that study, obviously being a dermatologist, he was interested in the melanoma data: no increased risk of melanoma deaths at all in those people that were having higher sunlight and UV exposure, either from solariums, which are extensions off of their house in the UK. By the way, this is a UK Biobank study, and/or just getting outside into the sunlight.
Dr. Amar Rewari: I've always been interested in some of this evolutionary biology thing. And I lived in Denmark for a little bit. Is there any correlation with where you live in the world with this in terms of with melanin production and stuff like that? For example, in Northern Europe, there's a lower incidence of lactose intolerance, and a lot of it has been attributed to the fact that there's less sun exposure there. And so the only way to obtain a lot of vitamin D was not through the sun, but by obtaining milk. And so they've not developed lactose intolerance like a lot of the Asian countries did. But I'm curious, from an evolutionary biology perspective, is there any correlation with this no matter where you live in the world, or is it irrelevant?
Dr. Roger Seheult: It's really interesting. So let's just assume that the origin of human races was at the equator. Whether you believe it's out of Africa or whether you believe it's out of Mesopotamia or the mountains of Ararat, it's all from the center of the earth. So what does this mean? This means that as the human population spread out away from the equator, you have to realize that, at least in terms of adaptation, the races of Northern Europe, who are obviously much whiter than their ancestors would have been at the equator, that the skin or the body realized that sunlight was so important as they started to move further north that their skin had to become lighter for them to still have that same benefit. That's actually astounding if you think about that. That having light skin is actually an adaptation to having less sunlight.
Dr. Roger Seheult: And so you can imagine what happens when people, because of modern-day travel, relocate from the equator who have dark skin and then we place them in locations like Northern England or in Sweden. They're not going to do well. And that's exactly what we see on a clinical standpoint. Those people have significantly lower vitamin D levels and are not getting as much light and infrared light. Interestingly, though, if you look at what's going on, for instance, in Australia, it's an interesting thing because the ultraviolet there from a latitude basis is much higher than we would expect or that we see in the Northern Hemisphere.
Dr. Roger Seheult: What's interesting there is that the people that are naturally indigenous to Australia are the Aborigines. And they are not light-skinned whatsoever. They maintained their dark skin. And I have to imagine it might have to do with the fact that there's just more ultraviolet light there. I think there are a lot of questions about exactly why the different races have different color skin. But if you think about it in terms of that main example, here you have dark-skinned people at the equator. And as they start to move into Europe, there is definitely a clear direction where skin color becomes more pale because of the fact that sunlight, I believe, is so important.
Dr. Roger Seheult: The other thing I was going to mention real quickly, and this is a point that Richard Weller actually brings out and actually probably halfway discovered, is that before 1980, before we had very good quality blood pressure medications, we were able to actually show that as you move further away from the equator, blood pressures go up. And if you look at the whole splay, it's about a difference of about five millimeters of mercury. So it's not huge, but it's very clear. The other thing that's latitude-affected is also multiple sclerosis and a number of other autoimmune conditions. Sunlight is a big player.
Dr. Anthony Paravati: The other thing that I found so compelling in some of your other presentations were two particular pieces of data. And maybe you could explain those to us. They were, one, the predictable pathway of COVID surges throughout Northern Europe down to Greece and how that occurred relative to the calendar in the year and how much sun exposure those countries were receiving in those periods. And then the other one is you presented data on the relative constancy of flu incidence in Singapore. And so I find both of those really interesting. If you could just talk our listeners through those two points.
Dr. Roger Seheult: Yes, so you all remember in 2020, there was a huge surge in Italy in March, April, and May. And then as it started to cool down in July and August, there was that second rise in Europe that happened in the autumn of 2020. When they tried to correlate those nations with temperature and humidity, they were not able to find a correlation whatsoever. But when they lined them up by latitude, there was a very, very high correlation. In fact, it started with Finland and ended with Greece. So in fact, if you correlated those countries with when the amount of ultraviolet radiation dropped below 32% of what they got at the equator, the correlation was 0.993. That's the R-squared, 0.993. That's an incredible correlation.
The Clinical Impact: Reducing Hospital Length of Stay
Dr. Roger Seheult: The other one that you wanted me to talk about is the flu in Singapore. So if you look at the number of deaths from natural causes in the United States, whether it's infectious or non-infectious, they all go up at the same time and they all come down together as well. They all go up and peak about one to three weeks after the shortest day of the year, and they all go down and are at a nadir one to three weeks after the longest day of the year. The flip of that is true—well, actually, the same thing is true in Australia, except those times are flipped because the sun is either down there or up here.
Dr. Roger Seheult: But the point about Singapore is interesting because it's only about 80 miles away from the equator. And because of its position, the sun doesn't travel very far from the equator. And so there is no flu season in Singapore. It's just a random thing that just goes along. And it has absolutely nothing to do with the month of the year. The cherry on the top, of course, for us in medicine, we look at randomized controlled trials. So out of Brazil, a randomized controlled trial that showed that when COVID patients admitted to the hospital—sick enough to be admitted—got infrared light, which is the type of light we're talking about, 940 nanometers for 15 minutes a day, once a day, all of the endpoints were statistically significant. It was crazy. It was only 30 patients. So imagine only 30 subjects in a trial, and yet every single one of those endpoints was statistically significant.
Dr. Roger Seheult: What does that mean? It means that the power of the intervention is so high that the power of the test is incredible that you can get statistical significance. So better oxygenation, deeper breaths, blowing out volumes faster, improved heart rhythm, reduced respiratory rate, improved immune system—all of those statistically significant. Better for the infrared. And then finally, of course, the one that's just amazing to me and probably for the rest of our discussion is the fact that instead of 12 days on average being admitted to the hospital in the non-intervention group, the control group, it was eight days. So a full four days or a reduction of about 33% in that situation is incredible.
Dr. Anthony Paravati: I really want to highlight that. And that's one study. There's at least two others that we know about where the absolute difference in hospital length of stay, and this dates back to a 1996 paper, a paper from 2005, obviously long before COVID. Both of those different studies showed a delta of about three days shorter admission for the patients in sunnier hospital rooms. So they basically mapped out the hospital and the bed positions and looked at everybody's length of stay and controlled for a bunch of factors and showed that difference. Very, very interesting stuff.
Dr. Amar Rewari: Is there any data to show any difference between if they just have, as you said, more sunlight with better rooms with windows or spending more time outside versus actual supplementation with specific infrared light and those type of lights in rooms?
Dr. Roger Seheult: Yes. So recently we've gotten data from LED lights that are very tuned to specific wavelengths. And I think most of the data that we're now seeing coming out are looking at that type of stuff because it's in this new fancy world of photobiomodulation, they call it, so that they can give a specific light and test it.
Dr. Roger Seheult: Basically, the same kind of studies that we're seeing now doing that have been done decades ago, looking at the same type of situation, except as you mentioned, you've got a two-bed room and you're looking at which patient gets discharged from the hospital faster. You're looking at rooms that have bigger windows versus smaller windows. You're looking at those people that get outside. And all of those studies have been done and they've all shown benefits in various different ways in various different populations.
Dr. Roger Seheult: So there was a recent study that was just published where they did photobiomodulation, and it was in, I think, 850 nanometers in a population of ICU patients. So these are really sick patients. They were all-comers. So these are people who had surgical reasons to be in the ICU and medical reasons to be in the ICU. So a very diverse causation here. And all of them got 15 minutes of 850 nanometers, which is in the infrared spectrum, using these lights on their body. Again, discharged from the hospital 30% faster and actually got out of the intensive care unit stronger so that they didn't need as much of the acute rehab that their counterparts in the control group needed to have.
Practical Implementation: Prescribing Light Therapy in a Hospital Setting
Dr. Anthony Paravati: We've gone through a lot of the highlights of the mechanistic or pathways behind why light therapy and specifically red light as that subtype of the light that comes from the sun produces these benefits. I want us to start to think a little bit practically about how these benefits could be delivered to patients. And one of the questions I had written down to ask you, but in reality, you do this in your practice, is the question is, let's imagine I'm a hospitalist, which I'm not. Amar and I are oncologists. Let's imagine I'm a hospitalist. Help us understand what prescribing infrared light would actually look like practically in the hospital setting. Devices, you were just talking a little bit about room design. And I know, Roger, that you've done this for your patients in various situations. So talk to us about that.
Dr. Roger Seheult: So basically it boils down to two ways of doing it: getting them outside into the sunlight, which I do believe actually is probably better because it's got multiple wavelengths. One of the problems that we have by giving these devices, which are infrared light, is we're giving out a particular wavelength. We're not sure if that's the right wavelength. We just know that there are studies that seem to indicate that it's beneficial in that area from other studies, but there could be better wavelengths. And the thing about going out into the sun is that you're getting all of the wavelengths.
Dr. Roger Seheult: And so there are two ways of doing it, getting them outside into the sun or using photobiomodulation with these devices, which can either be shone on the body or actually like a pad that is wrapped on the body and given directly there. A couple of issues there if we're talking about this. If we're talking about the sun, the sun is obviously not the same every day, and it's not standardized. So that is one problem in terms of doing studies. Also, the sun is not always out. And then also, it may be difficult in an inpatient setting to have a patient stable enough to get outside to get into that sun. And it could also be that it's just extremely cold or windy, and the weather is just not conducive to that type of therapy.
Dr. Roger Seheult: So because of those disadvantages, especially when we're looking at patients in the hospital who may be too unstable to move, looking at some of these devices that can be wrapped onto people and actually give a standard dose for a specific amount of time at a very specific wavelength lends itself to study and also to be able to see whether or not this is actually working. The added problem there, though, is that you've got to have a device that can be easily cleaned and disinfected so it doesn't spread infection from patient to patient, especially as you will very well know in neutropenic patients and things of that nature.
Overcoming Barriers: The Financial and Logistical Case for Change
Dr. Anthony Paravati: So you're starting to get into some of the structural barriers to widespread adoption. And I wanted to, as I say, talk about some of the basics, talk about the implications for admitted patients, and now think about policy. A helpful way to start is thinking through those barriers—barriers practically, clinically, barriers to reimbursement, evidence standards, and we've been talking about evidence. There's a number of things. Let's start to unpack this.
Dr. Roger Seheult: I think the biggest barrier is the inertia of people's minds. People have not really grasped the importance of people getting outside and getting fresh air and sunlight, even in a sick setting. And a lot of times, hospital administrators, people who are there are very conservative, they're very defensive, and they're very risk-averse. And the first question is going to be, "Well, what's the risk of taking somebody outside?" That sounds really scary, taking somebody outside of a hospital because in the hospital, you have all of the protocols that you can do. You have crash carts, you have nurses, you have the ability to observe a patient.
Dr. Roger Seheult: But we do this already. There are hundreds of community hospitals that have their MRI machines outside or their CT scans outside because it's provided by a tractor-trailer that's brought in as a portable. And you've got to take those patients outside of the hospital to get that done. So we do it very easily. And those can go much longer than 15 minutes. And what we're talking about here pretty much on all of these scales is about a 15-minute treatment to get that amount of energy that's required to have that kind of a change.
Dr. Roger Seheult: So the biggest barrier, as I said, is just changing people's minds. The other aspect of it is, and this is a really big barrier, is finding resources within the hospital to get this done. If I tell a nurse who is ratioed at two to one, three to one, four to one, that she's got to go take a patient outside, you can see very quickly that if they don't understand the importance of what they're doing there, that that's going to be prioritized way down at the bottom, only if the nurse has time. And of course, when do nurses have time? They don't have time for anything. And it's not their fault. It's just that there are so many demands being made on the nursing staff that this is another thing that we're asking them to do.
Dr. Roger Seheult: So I do really think that there has to be a fundamental change that happens from the top down where people in policy positions need to understand the benefits of this and really allow the, if I could say it, the activation energy of these transactions to occur and to be a catalyst to have these happen, either through CPT reimbursement codes or giving incentives to hospitals who come up with programs to get funding, to get people to get these people outside, to do research on this stuff. Because if any of this stuff is even halfway true, what we've talked about, and there's no reason to believe why it's not, the incredible amount of cost savings that can happen at the end-user here at the hospital in terms of Medicare, Medicare Advantage. As you know this better than I do, if you can cut the amount of cost of treatment at the hospital, not only do you cut costs, but you also open up more rooms and have the ability to treat more patients.
Dr. Amar Rewari: You brought up a lot of interesting points along the finances as a barrier also, both on the revenue side, because there's no reimbursement mechanism, and also the expense side, to design, redesign these rooms and the investment that goes into that or purchasing these devices, maybe having to shift staffing models around. But if you had to, and you do this, when you justify this to your CFOs of these hospitals, can you walk us through a little of the math that you may do to show what a two to three-day reduction in length of stay actually means and would save the hospitals?
Dr. Roger Seheult: Yes. And I think it's even compounded. So if you just look at a very simple question and you look at those two studies, the one about the ICU stay that was 30% reduced and the one going from 12 days to eight days, which was a 33% reduction, you're talking about a 30% reduction in length of stay in some of these big players that come in and have a lot of things that need to be done. Conservatively, what is the cost of stay in intensive care or on the floor? It's thousands of dollars a day just in the room charges. So if you're getting paid as a DRG, you can see the wheels clicking when I'm talking to CEOs, when I'm talking to finance people, and they see this, they see the potential here, but they're not equipped to be risk-takers in this sense.
Dr. Roger Seheult: They're educated and they're equipped to negotiate with insurance companies and to figure out what their cap is and all this stuff. They don't want to stick their nose out and do something that's going to actually cause risk. The other aspect of this, though, is that we are increasingly living in a world where patients can choose which hospitals to go to. And if we look around in the United States, a lot of people are now waking up and they're agitating for better healthcare. They're agitating for doctors to become more sophisticated and understand exactly what the patients' wants are.
Dr. Roger Seheult: Can you imagine being a hospital where you're competing with other hospitals and you say, "By the way, we believe in patients getting whole care. We believe in patients getting sunlight. We care about you, not just about the things, reimbursements and things of that nature. We don't just want to have good hip replacements and good knee replacements and have a good ortho and good cardiac and have a cath lab. We understand that you getting out and getting the best healthcare in terms of sunlight and oxygen and those sorts of things...?" That can really have a dramatic effect in marketing, saying that this is a hospital that's really forward-thinking and able to actually implement those kinds of changes. So I really don't see a downside to this at all. And all that really needs to be worked out are protocols in terms of safety that are really happening already, honestly. People get transported out of hospitals all the time. People go to CT scans and MRIs outside the hospital all the time. We're not talking about a huge stay. We're talking about 15, 20 minutes. And that's what we're talking about.
Dr. Anthony Paravati: The American public is clamoring, in fact, for what you were just talking about, Roger. They are clamoring for their medical providers, their hospitals, to demonstrate to them that they care, that they care about their whole health, their well-being, and they don't look at them as a piggy bank from which to extract as much as possible.
Dr. Anthony Paravati: But I think the math on this, you already led us a little bit along the pathway. I think the math on this is really not too difficult. We have very good data about what it costs to house a patient in an acute care setting every day. And I just want to, before we talk about that very briefly, to just quantify the opportunity on savings, is just to remind the listener, we have a lot of very sophisticated listeners, but to remind them, inpatient care, especially let's just take it Medicare, it's a bundled payment. You guys both referred to DRGs. And so basically how sick the patient is, what their admitting diagnosis is, results in essentially one payment for the entire stay. And so if you can reduce—if the hospital is at risk, basically, in that model, they're not getting more for doing more stuff.
Dr. Anthony Paravati: If you can reduce the length of stay by a few days at an average savings of, let's say, $2,000 to $3,000 per day, you're talking about something like $5,000 to $7,500 in savings per admission. And so you scale that number up based on these large hospital systems, and we work for some of them. You're talking about a savings—let's see if you imagine a savings of just $3,000 per admission times 1,000 Medicare admissions. That's easy math, that's $3 million.
Dr. Anthony Paravati: It could be, if you take a high end, the $7,500 per admission, that's obviously for 1,000 admissions, $7.5 million. And then it goes up from there. So for 5,000 discharges, you're in the range of $15 million to $37.5 million per year. A lot of these changes, reconfiguring rooms, the installation of these light platforms that you talked about, they're going to come in well under that. And so what, time to break even? A year, two years maximum?
Dr. Roger Seheult: Yes. And then it compounds from there because now you're the hospital that's known for light therapy. People want to get their knees done there. People want to get their hips done there because part of the recovery in post-op, and hopefully they're not there for more than half a day or a day at most, usually they get them out there pretty fast. But you're going to that hospital that has that reputation.
Dr. Anthony Paravati: If you think about it, I just covered the inpatient setting. I just want to briefly talk about the outpatient setting. And this is an area where we have expertise. Amar has tremendous expertise is that we really would have to look at, you mentioned it very well, Roger, what are the cost inputs it would take to do this routinely for patients? Because those cost inputs are going to be necessary to come up with an updated billing code for delivery of phototherapy in the outpatient world. Because right now we have one, it's 96900, and that pays a minuscule $30 a day. That's the CPT code. It could be built in the outpatient setting and it's not worth very much. So it has to be revalued.
Pathways to Reimbursement: Policy and Payment Models for Light Therapy
Dr. Amar Rewari: Exactly, Anthony. And I was going to mention that beyond just CPT codes, which may not necessarily be the best way to reimburse this, though it could be an idea, but as you said, the expenses and the time are just minuscule. So another way could be looking at it either as a quality metric through a value-based purchasing type model or including it in a post-surgical bundle or a bundle with some other procedural admission.
Dr. Amar Rewari: And so adding it in there, there are some other alternative payment models that CMMI, the Center for Medicare and Medicaid Innovation, looks at, whether it could be attached to other things through an accountable care organization. So there are a lot of other interesting ways to potentially get this reimbursed. And it reminds me of something else, and this I think is interesting in how healthcare is going, and I'd like to hear your thoughts, Roger. I've spoken recently a bit about prehabilitation before surgeries, and there's actually a decent amount of data in colorectal cancer and now expanding to lung cancer and stuff where patients get rehab programs. Instead of just light in this setting, they also get structured exercise programs, nutrition programs, and stuff. And it's also been shown to reduce hospital length of stays, improve outcomes, and sometimes even improve survival rates. And so it's interesting how I think healthcare is shifting toward looking at this thing from a larger perspective. But there are these barriers around implementation and financial remuneration for them. But I think eventually we might get there.
Dr. Roger Seheult: I agree with you. There's so much stuff to do. Sunlight is just one aspect. There's also nutrition, exercise, so many other aspects that we could actually get involved with. There's another, even other compounding benefit to this. And as you know, hospitals are paid and reimbursed based on their survey data. Are patients satisfied? And there's ample data that shows that patients that are in well-lit rooms by big windows, getting plenty of sunlight, always rank the hospitals higher in terms of their satisfaction.
Dr. Anthony Paravati: Amar rattled off some great points. You just hit on a great one. So that's part of the HCAHPS survey you're talking about there. So for our listeners who aren't deeply involved in Medicare and running hospitals, this is a very important survey that links to reimbursement. It's two-sided. It's called HCAHPS, which stands for Hospital Consumer Assessment of Healthcare Providers and Systems. And that's the HCAHPS there, the HCAHPS. I would do that, if I'm in charge of CMS and I want to make this happen, if I'm convinced, Roger, if your arguments have moved me, and the arguments of many, it's not just you, of course, but if these arguments have moved me, I put it in HCAHPS, I have it as a quality metric, and tie it to conditions of participation in the Medicare program, like many other standards, a whole host of things that hospitals have to have to participate in the Medicare program. If that were done, the game is over. Checkmate. It would happen in no time.
Rediscovering Old Wisdom: The History and Future of Heliotherapy
Dr. Roger Seheult: And it would bring costs down. We're looking for something that can bring costs down. This is probably the lowest-hanging fruit that I can identify, simply getting it out. It was so obvious. For some, people would think, "Oh, this is new." This is not even new. In fact, this is actually going back to our DNA. If we go back 100 years ago, even more than that, 150 years ago, people like Florence Nightingale talked about the need for absolute sunlight and fresh air. And she didn't have an echocardiogram. She didn't have all of these scientific accouterments that we have today to measure that. She could just see it just walking past the patients and attending to them. She was known as the lady with the lamp. So it was pretty obvious to people back in the 1800s that sunshine and fresh air made a huge impact. And I'll tell you, we were getting much more natural light back then than we are today.
Dr. Amar Rewari: And if you think even to germ theory and just the idea of washing your hands, Louis Pasteur and all this type of stuff, it's all similar analogies. These little things like you were mentioning with scurvy with vitamin C or giving people tonic water to prevent malaria, they all seemed revolutionary at the time, but they all have science behind it. It's not just wellness.
Dr. Roger Seheult: No, there's plenty of science behind heliotherapy, going back to Rollier up in the hills or the mountains in Europe, treating tuberculosis, to John Harvey Kellogg and his light machines that he repackaged and Europeans bought them. Hospitals back in the 1920s were built with the specific idea that patients needed to get fresh air and sunlight. It was around the 1920s, 1930s, when we had the discovery of penicillin and randomized controlled trials for pharmaceutical medications. Not knocking it, it had some definite pluses there. I'm glad that we have those tools, but there was a definite shift. And instead of taking those discoveries as an "and," they made it as an "or." And what happened was, is that for the first time, and it was scandalous when it happened, they started to build hospitals where there wasn't a window in every single patient's room. And there's a huge article on this in Life Magazine back then about the scandal of the architecture of modern hospitals and what they were doing and how they were changing those. And from there, we just never looked back.
Dr. Amar Rewari: Have you seen anything that hospitals have done wrong when they're trying to implement some of this, that you're like, "Oh my God, what are they doing?" Is there anything you would recommend people don't do?
Dr. Roger Seheult: I think one of the pitfalls could very easily be simply getting them to a room with windows. And I think that's great. I think there's bright light. There are definitely benefits in that category where there's increased visible light. The problem is that most hospitals today use glazed windows that specifically block infrared light. Now, I'll say that any infrared light is better than nothing. But if you think that you're going to get the same benefits behind glazed low-E glass that you would going outside, it's not going to happen. You can tell very easily simply by just standing there at the glass. And if the sun is coming through, if it's hitting you and you're not feeling the warmth from that sun, it's blocking the infrared light and you're not going to get the same benefit.
Dr. Roger Seheult: So really what you're looking for here is, if you want efficacy, is you just get outside if you can. And there are some places in the United States that get 300-plus days of sunlight a year, where it makes sense that that would be something. I happen to live here in Southern California where we get that. But I understand that that's not everywhere, like Boston, Minnesota. So in those kinds of situations, you've got to do the best that you can do. And in that kind of a situation, you're talking about photobiomodulation, infrared light, things of that nature.
Dr. Roger Seheult: But I will say this. I actually had a friend who was a neurosurgeon and she trained up in Seattle at the old county hospital in Seattle. And she distinctly remembers a huge solarium that they had up there as part of the hospital construction, where in the wintertime, they would have the glass up so that you could be in there kind of like a greenhouse, but they would take that down during the summertime so the air and the sunlight could come in. This is a hospital that went way back and was part of that construction era.
Dr. Anthony Paravati: Hey, Roger, I'm interested to know, you've been studying this for years now, talking about it, writing about it, appearing on podcasts like this one, podcasts way bigger than this one. Are people coming to you and asking you for advice? How do we do this practically in our clinic, in our doctor's offices, in our hospitals? And I'm curious what questions they're asking you.
Dr. Roger Seheult: We are so far, we are not yet at the consultation phase. We are at the awareness phase. In fact, I was just asked to give the end-of-the-year faculty address to Kaiser in LA. It was a large group and we talked exactly about what we're talking about here. And it was well-received and they are looking at things to try to implement this. As you know, Kaiser is a vertically integrated health system. And they're very interested in finding out ways how to reduce costs internally so they can provide good care for low cost. So this is something that's perfect for them. It's perfect for single-payer systems. It's perfect for hospitals who have medical risk that want to be able to stretch their dollar, try to get patients better faster, and discharge from the hospital faster. So I think the time has come.
Dr. Anthony Paravati: And so you mentioned Kaiser. You mentioned the VA, a single-payer system here in the U.S., akin to the NHS, certainly the NHS itself. Huge purchasers with huge applicability to this way of thinking. And frankly, every Medicare participant in the United States is a price taker for these admissions in the form of DRGs. And so it matters really to all of us. And so, one of the things I wanted to ask you, thinking way ahead, like 10 years, if we get this right, what does the American healthcare system look like? But I think that's the wrong question. I think 10 years is too slow. We definitely have the ability to move faster on this. And so, help me understand. What's that look like for you in terms of what's changed? Let's say in three to five years.
Dr. Roger Seheult: It's good to be on the program with you guys because you guys have a finger on the pulse of that end of the spectrum, which is the policy implementation, what's going on in Washington. I think also what we need to do is not only work there, of course, as we are, but also at the hospital setting, which we've done. But the other aspect of this, which I think is my responsibility as well, and we tried to fulfill that on our channel, is to just educate the lay public. If they ask for this stuff, that's also a demand that's going to be heard. If they're going to the hospital and they're asking their loved ones to be taken outside, if you are the patient yourself, God forbid, and you're in the hospital, to be asked to get outside into the sunlight, then it's going to start to be more commonplace. People are going to accept it. And people are going to have to accommodate that sort of thing. So I really do think that pressure at every single point along the conveyor belt of healthcare is going to be the key to getting this done.
Dr. Amar Rewari: I agree with you that getting it out through the channels you're doing and especially all the amazing podcasts you've been on, but also on mainstream media is huge because if patients ask for it, that's the only way we'll really get change. It's the only way change oftentimes happens in this country from a policy perspective is mass groups of people clamoring for change.
Dr. Roger Seheult: The needle is moving. The needle is definitely moving. Even early on in the pandemic, I heard of a story that got back to me where a lot of nursing homes were given vitamin D supplementations, and that's great. I have nothing against vitamin D supplementation. I just think that sunlight is way more than just vitamin D. And I heard of a nursing home where, and again, this is purely anecdotal, but it's a story. And the nursing home director was very adamant about getting all of his tenants, all the people there in his nursing home, outside at least once a day during the pandemic. And the report was that hardly anybody came down with COVID and the ones that did were not sick enough to have to go to the hospital, which for a nursing home is remarkable.
Actionable Resources and How to Get Involved
Dr. Anthony Paravati: I remember you discussing that in another setting as well. And yes, that is impressive. So we talked a good deal about the evidence, the mechanisms that underlie the physiologic benefits of sun exposure or infrared light therapy in the absence, of course, of sun exposure. We've gone through perhaps policy opportunity. We've quantified the opportunity at the individual hospital level. And I'd like to follow up and really put in motion what you just said, Roger, about the lay public. And so I want to make sure that in closing together, that we direct listeners to some really practical resources that may be out there that they can read more about and cite as they, as you say, engage policymakers to try to have their voice heard in this direction. Where would you point listeners to in terms of some resources that are at the lay public level?
Dr. Roger Seheult: And we try to direct our education at that level and more education is coming out all the time. So one of the first places I would naturally refer them to is our YouTube channel, MedCram. If you just go to YouTube and type in MedCram, you'll see the video listing on our channel. And we've actually spent a lot of attention on this topic in the last year or two.
Dr. Roger Seheult: There's also, for those who are a little bit more scientifically inclined, I would highly recommend a YouTube channel called the Guy Foundation. This is Jeffrey Guy, who is a PhD in London, and he's put together a beautiful autumn series where we had a number of these professors that I just mentioned to you, like Robert Fosbury, Glen Jeffery, and Richard Weller. I was actually also a part of that symposium and a number of talks talking about the effects of light on the human body, both from the quantum mechanics side, but also the astrophysics side and the biochemical side. There's a wonderful series where a number of scientific silos, if you will, were broken open and we mixed and had a discussion. The most tantalizing was the last video series of that channel, which was just published about a week ago, where we actually had on architects, like major corporate architects that are responsible for building the buildings for Apple and for Microsoft. And asking them about exactly what it is that they needed and what we could provide in terms of information to make healthier buildings and make healthier hospitals.
Dr. Roger Seheult: I would also direct people to our website, which is medcram.com. We actually have a health optimization series for those who are healthcare providers. We have continuing medical education offerings too on our website, medcram.com.
Dr. Anthony Paravati: I highly recommend that. I told you, Roger, that I did sign up and I have been checking out your lessons on those topics. Really good stuff.
Dr. Amar Rewari: And we'll definitely link to some of those resources in our show notes. And I would also love to hear from some of our listeners in either the comments or feedback to us if you have had any success with implementing this in your hospital systems or where you're at and sharing some of your stories.
Dr. Anthony Paravati: The takeaway is that the evidence is strong and high quality. You led with that, Roger, in this episode. We talked about the economics in terms of cost savings. The question is, are we going to be able to build the advocates for light therapy and several of these interventions that really take us back to basics? Are we going to develop the political will and policy approach to get them over the finish line? I think that's the next question. And that's why we here at Value Health Voices, which is all about health policy and healthcare finance, why we're so interested to talk to you, Roger. And we thank you so much for joining us. Like Amar said, we'll link up all the MedCram resources you mentioned, the others you mentioned, and the studies that we went through during our conversation together so that our readers, if they do, and listeners, if they do want to take a deep dive into the science, they can do it directly by reading the studies.
Dr. Amar Rewari: Thank you.
Dr. Anthony Paravati: It's been a great pleasure, Roger. Hope to see you again soon.
Dr. Roger Seheult: Thank you.
