Welcome everyone to the Becker's Healthcare podcast series.
I'm Mariah Muhammad, writer and moderator with Becker's
Healthcare. And I'm thrilled to have with me
today Caleb Ashmore, orthopedic rehabilitation
services supervisor at Harris Health. Caleb, welcome to
the podcast. We're very excited to have you
join us today. To get us started, would
you mind please introducing yourself and telling us
a bit about your background?
Sure. Thank you very much for having me
back. I really appreciate it.
Yeah. My name is Caleb Ashmore. I'm a
physical therapist
by training,
ortho specialist, and a, manual therapy fellow, and
I was both residency and fellowship trained here
in Houston.
Currently working toward an EMBA
with an emphasis on health care leadership
through UT Dallas.
I'll be done with that next year, so
I've been learning a ton. And it's a
really cool, program. It's a cohort style,
with leaders from Harris Health and then our
two local med schools, Baylor College of Medicine
and UT Health as well. And I've been
a supervisor
in the, orthopedic rehab department for four years,
And this is the largest outpatient center that
we have at Harris Health that's here in,
Bel Air, Texas.
Not Bel Air, California. Bel Air, Texas. It
is a it is a small pocket, community
within Houston.
And just a little bit about Harris Health
is that we are a a teaching hospital.
About half of the physicians in Harris County
were trained at Harris Health.
And there was a recent study that showed
for every dollar of tax support that we
get for the community, we return,
six.
And so for every $1, we return six
in economic benefit.
And last year,
we had 5,000,000,000
returned to Harris County and almost 6,000,000,000 in
in economic impact to the state of Texas,
which is was pretty cool and something to
be proud of.
And, currently, one in 70 jobs within Harris
County are at Harris Health. So we're,
a very big employer. We have
about 11 almost 11,000 employees at this time.
And the reason, that that we are
so important and why I love working here
is that
the mission and that we have, 1,200,000
uninsured people in Houston currently,
which is the most uninsured individuals in our
country.
And so
that stands to probably increase after the the
recent legislation,
over the next couple of years with the
Medicaid cuts.
And but currently, our payer mix is about,
50%
uninsured, 20% Medicaid, 20% Medicare, and then about
12% private insurance.
And then, finally, we have about 300
almost 300,000
individual patients that we're currently treating at Harris
Health.
Wonderful. Wonderful. Well, thank you so much for
that background information.
To jump into the questions, what are some
of the most exciting or impactful
changes
you've seen recently in the orthopedic
rehabilitation,
area, whether it's new research, tools, or treatment
approaches.
Yeah. Over my, twelve plus years of being
a physical therapist, a lot of things have
changed.
Lately, over the past couple of years, there's
been sort of a a move away from
manual therapy approach and other other, types of
passive treatments,
like modalities,
dry needling, and things like that. Things that
really haven't,
shown as much support in the literature as
they've been studied year after year.
And then,
basically, increasing evidence based practice by leaning into
more,
treatments that are that are more active, like
exercise,
different tissue loading tactics,
things with more of a solid,
support in the in the in the, research
that's out there. Also, patient education is a
huge one for for our profession.
Also,
as as all other areas of health care,
telehealth has been huge after after the pandemic.
And so,
you know, whereas before the pandemic, hardly any
PTs were utilizing
telehealth.
We're using it a ton. I know not
every
organization
is just due
to constraints with reimbursement and things like that.
But
since our health care system doesn't really have
to worry about that as much,
We,
you know, there's a pretty big push in
our system
to to utilize this because we have you
know, Houston is so spread out. It's it
covers so much territory,
so many miles that
we're able to reach,
many more patients who have difficulty,
utilizing our services
for a variety of factors, like
their work schedules,
mobility limitations, their financial constraints, and also,
issues that they have with with transportation.
And so
through the, this expansion of telehealth services, it's
been it's been really,
really really amazing. We've been able to enroll
more people and and have better,
patient accessibility
or, for people who
might not otherwise be able to finish out
a a plan of care, for example.
And helps not only with our our Ortho
rehab team, but also
with,
a class that we have called FAST,
which stands for, fit and strong together.
And
it's a twelve week course that we have
that's led by physical therapists and dietitians,
and it's twice a week.
Before COVID, they were all in person. And
so, you know, patients had to commit to
coming into our clinic twice a week, which
is pretty tough for a lot of folks.
But now
with telehealth, we're able to expand the class
and and reach a lot more people
and impact a lot more lives.
So, you know, that's been pretty pretty exciting.
A few other things too. Like, we have
some some novel research that we have going
on right now with,
a couple of our orthopedic.
So
another thing I I failed to mention is
that,
Benta, we currently have, is one of our
hospitals. We currently have one level one trauma
center,
and we're currently in the process of building
a,
second level one trauma capable hospital,
at LBJ.
And so we get a lot of trauma
cases, which is kinda different than a lot
of other
PT settings. And so
we have a surgeon who specializes
in,
treating
these patients with an external fixator when they've
had
really,
traumatic comminuted fractures.
And,
so and then we he loves PT, and
we have a really good relationship with him.
So
with our our,
current
and future,
PT residents, we have research going on with
him and then also
with another, one of the surgeons who is
working on a new procedure. He's been he's
been, testing it out. And this this is
a procedure for fixing
calcaneal fractures, which we actually see a lot
in our system.
And it's a novel approach and something that
hasn't been, tried before. And so in both
of these areas, there's very little research,
little to no research. And so,
yeah, we're really looking forward to to being
able to,
put our our footprint, so to speak, and
and to to just put some stuff out
there for people who for other people who
do treat these patients as well.
Yeah. Yeah. Absolutely. No. That definitely sounds so
amazing. And how do you approach rehab for
patients with complex orthopedic conditions?
We'll also have social economic barriers to care,
which I know you spoke a little bit
about,
and I'm assuming that Harris Health likely sees
this pretty often.
Yes. We do. It
it impacts you on a regular basis,
and and really,
it's something that you have to think about
with each patient,
you know, getting into social determinants of health,
which are, you know, non
health care related factors that affect a person's
health and well-being. And so,
you know, there was, there's been several studies
that have come out, that I learned about
in my EMBA program
where but, essentially, they look at at people
and how much health care can actually affect
a person's life. And, actually,
what, multiple studies have found is that even
at even at our best as health care
workers, we can only affect about 20% of
a person's life. The rest of the 80%
of that person's life
are affected by, social determinants of health. And
so
it's something that not a lot of folks
think about unless you work in a system
like this. And, you know, I mean, you
probably do think about it in other in
other systems, but not on a regular basis
like we do, you know, almost every day
and all day.
We have a population health team, which works,
you know, directly with patients out in the
community. We're the currently, the only
hospital system in Houston that has a, a
hospital at home program
where
they have, patients that are would normally be
in a hospital. But in order to
keep them out of our hospitals
and actually treat them
more effectively and reduce risk of
getting a a nosocomial
infection,
they'll be treated within the,
the confines of their own home, which is
really nice. And so people,
nurses, and other health care providers go out
to the person's home.
And,
and that's been really successful so far. And
what they're looking to
expand that program and actually include, rehab. So
that's pretty exciting. And I was actually, talking
with them today about potentially
in including us in that in that process.
So it's pretty pretty exciting.
Lots of changes coming.
We have
currently, I believe, 37 clinics throughout Houston,
outside of our our large hospitals. And so
we really try to to put these clinics
out in areas where
the patients need them,
and so that it's more
convenient for them.
You know, a lot of our a lot
of our folks take buses and have different
transportation issues if they get rides
and, you know, don't have their own vehicles
and things like that. And so,
or or maybe their vehicle is not as
reliable. And so we we really just try
to to meet these patients where they are
and where they need us to be.
As I mentioned, telehealth has really helped with
that.
We have we have a lot of patients
without stable housing and and, you know, they
might be living in shelters, and so that
presents
difficulties.
And there's lots of, pain management that goes
on at these clinics.
We have a, several, actually, food pharmacies
for patients,
with diabetes.
And it's really cool. They can get referred
directly to these pharmacies, and they have
high quality,
healthy food for, patients who would otherwise not
be able to afford it. And this is
food,
donated from Houston Food Bank. And so there's
there's a lot of really cool partnerships we
have with organizations throughout Houston to help
care for these these patients.
And so
sometimes patients come in, and you don't end
up doing a lot of traditional therapy.
Yesterday, I was having a patient. I was
helping him,
fill out paperwork to get a handicap placard
because he really does need it. His hip
he has, like, really bad, hip arthritis. And
so I was like, you know what? Actually,
I do think you need this. And so
I was helping him with that. And so
you just never know on a given day
what your job's gonna look like, but it's
never boring. It is never boring.
And on that note, we actually have a
Harris Health is now the official medical provider
for, the corrections facilities at Harris County. So
we're also seeing,
you know, a fair amount of incarcerated patients
as well. And so just trying to provide
the best care possible
for every single person on your schedule.
Some days, you gotta get creative. If you're
doing a telehealth call with somebody and they
don't have weights, I'll say, okay. Can you
grab some water jugs, or what do you
have handy?
One thing that was really cool is that,
many years ago, a patient a student of
ours,
as his his internship project, he came up
with a list of all of the local
discounted and free gyms throughout Houston.
And then,
last year, somebody digitized it. The the Gen
z, students are really pretty incredible when it
comes to technology.
They digitized it, attached it to Google Maps,
and so all the person has to do
is scan this QR code,
and it will find all of the local
free and discounted gems that are close to
the person's house. And so that really helps
us to
have a better long term carryover effect for
maybe, for folks that don't have access to
a gym and and might not be able
to afford it. And,
the the fast class that I mentioned before
really
really works on, our CEO, doctor Porras, his
overarching goal
of disease prevention and health promotion.
Because
if we're able to,
affect change
on on on these levels and maybe dip
into that 80% a little bit,
then we can, you know, keep people out
of the emergency department and and save our
system and,
taxpayers a lot of money.
Yeah. Yeah. Absolutely. That definitely makes a lot
of sense, and I definitely see a lot
of, opportunities
for growth and a lot of things that
you said.
For you, what's one leadership lesson you've learned
while working within a safety
net like Harris Health that's kinda shaped you,
to how to show up for your team
and your patients?
There are so many. I had to I
wrote a bunch down, and I had to
delete a bunch because I wouldn't have time
to get to it all, but
I'll just I'll hit the highlights. I think
for me,
grace
for not just for your patients, but also
those that you work with and also for
yourself.
Basically,
the the saying that I like from the
office is called that they say is that
po buddies are perfect, which is a funny
way of saying nobody's perfect. But, you know,
don't stress out. Don't don't feel like you
have to be
living up to, you know, insane expectations. Make
sure you have realistic expectations.
You know, just assume positive intent. If somebody
is rubbing you the wrong way or you
think you feel like maybe a person has
it out for you or or is trying
to make your life miserable, just consider that
they they're most likely doing the best they
can that day, and you don't really know
what's going on in their lives. As I
mentioned previously,
when it comes to our patients, but also
the people you work with, you really don't
know
what all is going on in their lives.
So give people grace. People are complex. We're
all going through our our own trials and
tribulations.
And so,
you know, afford other people the grace that
you would
hope that they would afford you. And
just remember that everybody that you work with,
no matter what level,
be
it EBS or frontline all the way up
to c suite, everybody is important.
And we can only succeed if we all
succeed. So just try to take care of
each other. Just try to be good to
other people in general.
That's something that we that we say in
my family a lot is
when one of us succeeds with with our
kids, we've been hammering this. When one of
us succeeds, we all succeed. That way,
I have two little girls. I have a
a three year old and a five year
old, and they can get kinda competitive with
each other. And so we'll say to each
other, hey. Just because
for example, the other day, we were playing
a board game
randomly.
My three year old daughter ended up winning
the board game. And so my five year
old's getting upset because she's, you know, losing.
And so we just have to say, like,
when one of us is winning, we're all
winning. Be happy for each other.
Applaud other people's successes.
Comparison is the thief of joy. That's another
thing that I like to say a lot
is just try not to compare yourself to
others. I know our society
is very into that with social media, but
just just kind of
stay in your own lane and and keep
plugging along. Try to get
1% better and grow every day as a
person, as a as a professional, as a
health care worker.
And, yeah, you'll be on the right track.
Yeah. Yeah. Absolutely. Great words of, wisdom there.
Thank you so much for those final thoughts.
It's definitely been a very informative discussion. So
I wanna thank you so much for coming
back on Becker's Healthcare. We really do appreciate
it, and I look forward to connecting with
you again soon. Thank you very much. I
really appreciate it. Have a good one.