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Welcome everyone to the Becker's Healthcare podcast series.

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I'm Mariah Muhammad, writer and moderator with Becker's

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Healthcare. And I'm thrilled to have with me

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today Caleb Ashmore, orthopedic rehabilitation

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services supervisor at Harris Health. Caleb, welcome to

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the podcast. We're very excited to have you

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join us today. To get us started, would

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you mind please introducing yourself and telling us

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a bit about your background?

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Sure. Thank you very much for having me

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back. I really appreciate it.

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Yeah. My name is Caleb Ashmore. I'm a

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physical therapist

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by training,

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ortho specialist, and a, manual therapy fellow, and

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I was both residency and fellowship trained here

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in Houston.

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Currently working toward an EMBA

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with an emphasis on health care leadership

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through UT Dallas.

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I'll be done with that next year, so

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I've been learning a ton. And it's a

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really cool, program. It's a cohort style,

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with leaders from Harris Health and then our

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two local med schools, Baylor College of Medicine

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and UT Health as well. And I've been

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a supervisor

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in the, orthopedic rehab department for four years,

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And this is the largest outpatient center that

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we have at Harris Health that's here in,

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Bel Air, Texas.

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Not Bel Air, California. Bel Air, Texas. It

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is a it is a small pocket, community

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within Houston.

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And just a little bit about Harris Health

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is that we are a a teaching hospital.

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About half of the physicians in Harris County

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were trained at Harris Health.

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And there was a recent study that showed

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for every dollar of tax support that we

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get for the community, we return,

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six.

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And so for every $1, we return six

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in economic benefit.

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And last year,

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we had 5,000,000,000

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returned to Harris County and almost 6,000,000,000 in

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in economic impact to the state of Texas,

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which is was pretty cool and something to

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be proud of.

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And, currently, one in 70 jobs within Harris

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County are at Harris Health. So we're,

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a very big employer. We have

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about 11 almost 11,000 employees at this time.

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And the reason, that that we are

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so important and why I love working here

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is that

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the mission and that we have, 1,200,000

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uninsured people in Houston currently,

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which is the most uninsured individuals in our

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country.

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And so

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that stands to probably increase after the the

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recent legislation,

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over the next couple of years with the

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Medicaid cuts.

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And but currently, our payer mix is about,

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50%

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uninsured, 20% Medicaid, 20% Medicare, and then about

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12% private insurance.

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And then, finally, we have about 300

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almost 300,000

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individual patients that we're currently treating at Harris

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Health.

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Wonderful. Wonderful. Well, thank you so much for

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that background information.

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To jump into the questions, what are some

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of the most exciting or impactful

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changes

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you've seen recently in the orthopedic

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rehabilitation,

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area, whether it's new research, tools, or treatment

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approaches.

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Yeah. Over my, twelve plus years of being

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a physical therapist, a lot of things have

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changed.

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Lately, over the past couple of years, there's

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been sort of a a move away from

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manual therapy approach and other other, types of

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passive treatments,

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like modalities,

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dry needling, and things like that. Things that

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really haven't,

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shown as much support in the literature as

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they've been studied year after year.

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And then,

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basically, increasing evidence based practice by leaning into

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more,

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treatments that are that are more active, like

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exercise,

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different tissue loading tactics,

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things with more of a solid,

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support in the in the in the, research

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that's out there. Also, patient education is a

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huge one for for our profession.

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Also,

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as as all other areas of health care,

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telehealth has been huge after after the pandemic.

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And so,

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you know, whereas before the pandemic, hardly any

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PTs were utilizing

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telehealth.

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We're using it a ton. I know not

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every

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organization

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is just due

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to constraints with reimbursement and things like that.

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But

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since our health care system doesn't really have

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to worry about that as much,

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We,

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you know, there's a pretty big push in

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our system

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to to utilize this because we have you

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know, Houston is so spread out. It's it

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covers so much territory,

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so many miles that

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we're able to reach,

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many more patients who have difficulty,

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utilizing our services

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for a variety of factors, like

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their work schedules,

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mobility limitations, their financial constraints, and also,

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issues that they have with with transportation.

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And so

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through the, this expansion of telehealth services, it's

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been it's been really,

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really really amazing. We've been able to enroll

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more people and and have better,

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patient accessibility

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or, for people who

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might not otherwise be able to finish out

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a a plan of care, for example.

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And helps not only with our our Ortho

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rehab team, but also

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with,

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a class that we have called FAST,

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which stands for, fit and strong together.

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And

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it's a twelve week course that we have

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that's led by physical therapists and dietitians,

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and it's twice a week.

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Before COVID, they were all in person. And

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so, you know, patients had to commit to

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coming into our clinic twice a week, which

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is pretty tough for a lot of folks.

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But now

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with telehealth, we're able to expand the class

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and and reach a lot more people

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and impact a lot more lives.

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So, you know, that's been pretty pretty exciting.

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A few other things too. Like, we have

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some some novel research that we have going

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on right now with,

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a couple of our orthopedic.

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So

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another thing I I failed to mention is

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that,

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Benta, we currently have, is one of our

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hospitals. We currently have one level one trauma

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center,

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and we're currently in the process of building

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a,

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second level one trauma capable hospital,

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at LBJ.

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And so we get a lot of trauma

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cases, which is kinda different than a lot

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of other

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PT settings. And so

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we have a surgeon who specializes

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in,

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treating

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these patients with an external fixator when they've

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had

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really,

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traumatic comminuted fractures.

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And,

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so and then we he loves PT, and

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we have a really good relationship with him.

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So

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with our our,

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current

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and future,

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PT residents, we have research going on with

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him and then also

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with another, one of the surgeons who is

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working on a new procedure. He's been he's

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been, testing it out. And this this is

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a procedure for fixing

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calcaneal fractures, which we actually see a lot

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in our system.

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And it's a novel approach and something that

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hasn't been, tried before. And so in both

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of these areas, there's very little research,

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little to no research. And so,

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yeah, we're really looking forward to to being

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able to,

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put our our footprint, so to speak, and

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and to to just put some stuff out

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there for people who for other people who

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do treat these patients as well.

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Yeah. Yeah. Absolutely. No. That definitely sounds so

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amazing. And how do you approach rehab for

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patients with complex orthopedic conditions?

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We'll also have social economic barriers to care,

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which I know you spoke a little bit

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about,

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and I'm assuming that Harris Health likely sees

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this pretty often.

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Yes. We do. It

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it impacts you on a regular basis,

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and and really,

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it's something that you have to think about

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with each patient,

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you know, getting into social determinants of health,

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which are, you know, non

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health care related factors that affect a person's

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health and well-being. And so,

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you know, there was, there's been several studies

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that have come out, that I learned about

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in my EMBA program

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where but, essentially, they look at at people

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and how much health care can actually affect

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a person's life. And, actually,

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what, multiple studies have found is that even

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at even at our best as health care

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workers, we can only affect about 20% of

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a person's life. The rest of the 80%

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of that person's life

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are affected by, social determinants of health. And

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so

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it's something that not a lot of folks

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think about unless you work in a system

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like this. And, you know, I mean, you

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probably do think about it in other in

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other systems, but not on a regular basis

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like we do, you know, almost every day

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and all day.

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We have a population health team, which works,

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you know, directly with patients out in the

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community. We're the currently, the only

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hospital system in Houston that has a, a

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hospital at home program

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where

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they have, patients that are would normally be

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in a hospital. But in order to

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keep them out of our hospitals

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and actually treat them

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more effectively and reduce risk of

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getting a a nosocomial

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infection,

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they'll be treated within the,

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the confines of their own home, which is

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really nice. And so people,

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nurses, and other health care providers go out

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to the person's home.

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And,

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and that's been really successful so far. And

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what they're looking to

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expand that program and actually include, rehab. So

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that's pretty exciting. And I was actually, talking

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with them today about potentially

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in including us in that in that process.

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So it's pretty pretty exciting.

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Lots of changes coming.

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We have

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currently, I believe, 37 clinics throughout Houston,

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outside of our our large hospitals. And so

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we really try to to put these clinics

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out in areas where

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the patients need them,

282
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and so that it's more

283
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convenient for them.

284
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You know, a lot of our a lot

285
00:10:02,274 --> 00:10:04,514
of our folks take buses and have different

286
00:10:04,514 --> 00:10:06,294
transportation issues if they get rides

287
00:10:06,995 --> 00:10:09,154
and, you know, don't have their own vehicles

288
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and things like that. And so,

289
00:10:11,075 --> 00:10:13,075
or or maybe their vehicle is not as

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00:10:13,075 --> 00:10:14,754
reliable. And so we we really just try

291
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to to meet these patients where they are

292
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and where they need us to be.

293
00:10:19,290 --> 00:10:20,889
As I mentioned, telehealth has really helped with

294
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that.

295
00:10:21,929 --> 00:10:23,529
We have we have a lot of patients

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00:10:23,529 --> 00:10:25,610
without stable housing and and, you know, they

297
00:10:25,610 --> 00:10:27,529
might be living in shelters, and so that

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00:10:27,529 --> 00:10:28,029
presents

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00:10:28,955 --> 00:10:29,455
difficulties.

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00:10:30,154 --> 00:10:32,955
And there's lots of, pain management that goes

301
00:10:32,955 --> 00:10:34,095
on at these clinics.

302
00:10:34,634 --> 00:10:37,855
We have a, several, actually, food pharmacies

303
00:10:38,154 --> 00:10:38,815
for patients,

304
00:10:39,195 --> 00:10:40,415
with diabetes.

305
00:10:41,179 --> 00:10:42,940
And it's really cool. They can get referred

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00:10:42,940 --> 00:10:45,199
directly to these pharmacies, and they have

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00:10:45,659 --> 00:10:46,319
high quality,

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00:10:46,620 --> 00:10:49,980
healthy food for, patients who would otherwise not

309
00:10:49,980 --> 00:10:51,659
be able to afford it. And this is

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00:10:51,659 --> 00:10:52,159
food,

311
00:10:52,699 --> 00:10:54,699
donated from Houston Food Bank. And so there's

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00:10:54,699 --> 00:10:56,595
there's a lot of really cool partnerships we

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00:10:56,595 --> 00:10:59,095
have with organizations throughout Houston to help

314
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care for these these patients.

315
00:11:02,034 --> 00:11:02,695
And so

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sometimes patients come in, and you don't end

317
00:11:06,274 --> 00:11:08,215
up doing a lot of traditional therapy.

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00:11:08,674 --> 00:11:10,274
Yesterday, I was having a patient. I was

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00:11:10,274 --> 00:11:11,014
helping him,

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00:11:12,019 --> 00:11:14,500
fill out paperwork to get a handicap placard

321
00:11:14,500 --> 00:11:16,019
because he really does need it. His hip

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00:11:16,100 --> 00:11:18,820
he has, like, really bad, hip arthritis. And

323
00:11:18,820 --> 00:11:20,420
so I was like, you know what? Actually,

324
00:11:20,420 --> 00:11:22,580
I do think you need this. And so

325
00:11:22,580 --> 00:11:23,779
I was helping him with that. And so

326
00:11:23,779 --> 00:11:26,200
you just never know on a given day

327
00:11:26,764 --> 00:11:28,365
what your job's gonna look like, but it's

328
00:11:28,365 --> 00:11:30,384
never boring. It is never boring.

329
00:11:31,085 --> 00:11:33,785
And on that note, we actually have a

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00:11:34,125 --> 00:11:36,225
Harris Health is now the official medical provider

331
00:11:36,365 --> 00:11:40,304
for, the corrections facilities at Harris County. So

332
00:11:40,365 --> 00:11:41,504
we're also seeing,

333
00:11:42,019 --> 00:11:44,100
you know, a fair amount of incarcerated patients

334
00:11:44,100 --> 00:11:46,179
as well. And so just trying to provide

335
00:11:46,179 --> 00:11:47,240
the best care possible

336
00:11:47,860 --> 00:11:49,960
for every single person on your schedule.

337
00:11:50,419 --> 00:11:52,019
Some days, you gotta get creative. If you're

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00:11:52,019 --> 00:11:54,100
doing a telehealth call with somebody and they

339
00:11:54,100 --> 00:11:56,424
don't have weights, I'll say, okay. Can you

340
00:11:56,424 --> 00:11:57,945
grab some water jugs, or what do you

341
00:11:57,945 --> 00:11:58,605
have handy?

342
00:11:59,304 --> 00:12:01,245
One thing that was really cool is that,

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00:12:01,784 --> 00:12:03,705
many years ago, a patient a student of

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00:12:03,705 --> 00:12:04,205
ours,

345
00:12:04,904 --> 00:12:07,865
as his his internship project, he came up

346
00:12:07,865 --> 00:12:09,589
with a list of all of the local

347
00:12:09,809 --> 00:12:11,750
discounted and free gyms throughout Houston.

348
00:12:13,009 --> 00:12:13,730
And then,

349
00:12:14,209 --> 00:12:17,250
last year, somebody digitized it. The the Gen

350
00:12:17,250 --> 00:12:19,490
z, students are really pretty incredible when it

351
00:12:19,490 --> 00:12:20,470
comes to technology.

352
00:12:21,125 --> 00:12:24,024
They digitized it, attached it to Google Maps,

353
00:12:24,164 --> 00:12:25,605
and so all the person has to do

354
00:12:25,605 --> 00:12:27,065
is scan this QR code,

355
00:12:27,524 --> 00:12:30,024
and it will find all of the local

356
00:12:30,084 --> 00:12:31,764
free and discounted gems that are close to

357
00:12:31,764 --> 00:12:33,605
the person's house. And so that really helps

358
00:12:33,605 --> 00:12:34,345
us to

359
00:12:34,769 --> 00:12:37,649
have a better long term carryover effect for

360
00:12:37,649 --> 00:12:39,970
maybe, for folks that don't have access to

361
00:12:39,970 --> 00:12:41,410
a gym and and might not be able

362
00:12:41,410 --> 00:12:42,769
to afford it. And,

363
00:12:43,649 --> 00:12:45,670
the the fast class that I mentioned before

364
00:12:46,529 --> 00:12:47,029
really

365
00:12:47,684 --> 00:12:50,644
really works on, our CEO, doctor Porras, his

366
00:12:50,644 --> 00:12:51,785
overarching goal

367
00:12:52,245 --> 00:12:54,184
of disease prevention and health promotion.

368
00:12:54,884 --> 00:12:55,384
Because

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00:12:56,164 --> 00:12:57,384
if we're able to,

370
00:12:58,245 --> 00:12:59,225
affect change

371
00:13:00,019 --> 00:13:02,500
on on on these levels and maybe dip

372
00:13:02,500 --> 00:13:04,360
into that 80% a little bit,

373
00:13:04,660 --> 00:13:06,580
then we can, you know, keep people out

374
00:13:06,580 --> 00:13:08,660
of the emergency department and and save our

375
00:13:08,660 --> 00:13:09,559
system and,

376
00:13:09,940 --> 00:13:11,320
taxpayers a lot of money.

377
00:13:12,035 --> 00:13:14,675
Yeah. Yeah. Absolutely. That definitely makes a lot

378
00:13:14,675 --> 00:13:17,075
of sense, and I definitely see a lot

379
00:13:17,075 --> 00:13:18,215
of, opportunities

380
00:13:19,394 --> 00:13:21,075
for growth and a lot of things that

381
00:13:21,075 --> 00:13:21,735
you said.

382
00:13:22,355 --> 00:13:24,915
For you, what's one leadership lesson you've learned

383
00:13:24,915 --> 00:13:26,399
while working within a safety

384
00:13:27,600 --> 00:13:29,800
net like Harris Health that's kinda shaped you,

385
00:13:30,000 --> 00:13:31,519
to how to show up for your team

386
00:13:31,519 --> 00:13:32,340
and your patients?

387
00:13:33,600 --> 00:13:36,000
There are so many. I had to I

388
00:13:36,000 --> 00:13:37,360
wrote a bunch down, and I had to

389
00:13:37,360 --> 00:13:38,720
delete a bunch because I wouldn't have time

390
00:13:38,720 --> 00:13:39,940
to get to it all, but

391
00:13:40,394 --> 00:13:42,735
I'll just I'll hit the highlights. I think

392
00:13:43,355 --> 00:13:44,014
for me,

393
00:13:45,195 --> 00:13:45,695
grace

394
00:13:46,075 --> 00:13:48,815
for not just for your patients, but also

395
00:13:48,955 --> 00:13:51,115
those that you work with and also for

396
00:13:51,115 --> 00:13:51,615
yourself.

397
00:13:52,659 --> 00:13:53,159
Basically,

398
00:13:54,659 --> 00:13:56,259
the the saying that I like from the

399
00:13:56,259 --> 00:13:58,100
office is called that they say is that

400
00:13:58,100 --> 00:14:00,019
po buddies are perfect, which is a funny

401
00:14:00,019 --> 00:14:02,419
way of saying nobody's perfect. But, you know,

402
00:14:02,419 --> 00:14:04,980
don't stress out. Don't don't feel like you

403
00:14:04,980 --> 00:14:05,799
have to be

404
00:14:06,794 --> 00:14:09,274
living up to, you know, insane expectations. Make

405
00:14:09,274 --> 00:14:11,615
sure you have realistic expectations.

406
00:14:12,875 --> 00:14:15,534
You know, just assume positive intent. If somebody

407
00:14:15,674 --> 00:14:17,195
is rubbing you the wrong way or you

408
00:14:17,195 --> 00:14:18,715
think you feel like maybe a person has

409
00:14:18,715 --> 00:14:20,259
it out for you or or is trying

410
00:14:20,259 --> 00:14:23,059
to make your life miserable, just consider that

411
00:14:23,059 --> 00:14:25,379
they they're most likely doing the best they

412
00:14:25,379 --> 00:14:27,779
can that day, and you don't really know

413
00:14:27,779 --> 00:14:29,539
what's going on in their lives. As I

414
00:14:29,539 --> 00:14:30,519
mentioned previously,

415
00:14:31,379 --> 00:14:32,820
when it comes to our patients, but also

416
00:14:32,820 --> 00:14:34,419
the people you work with, you really don't

417
00:14:34,419 --> 00:14:34,919
know

418
00:14:35,375 --> 00:14:36,815
what all is going on in their lives.

419
00:14:36,815 --> 00:14:40,014
So give people grace. People are complex. We're

420
00:14:40,014 --> 00:14:42,174
all going through our our own trials and

421
00:14:42,174 --> 00:14:42,674
tribulations.

422
00:14:43,294 --> 00:14:44,115
And so,

423
00:14:44,975 --> 00:14:46,975
you know, afford other people the grace that

424
00:14:46,975 --> 00:14:47,634
you would

425
00:14:48,009 --> 00:14:50,909
hope that they would afford you. And

426
00:14:51,449 --> 00:14:53,929
just remember that everybody that you work with,

427
00:14:53,929 --> 00:14:55,230
no matter what level,

428
00:14:55,610 --> 00:14:56,110
be

429
00:14:56,809 --> 00:14:58,970
it EBS or frontline all the way up

430
00:14:58,970 --> 00:15:01,470
to c suite, everybody is important.

431
00:15:02,705 --> 00:15:04,945
And we can only succeed if we all

432
00:15:04,945 --> 00:15:06,384
succeed. So just try to take care of

433
00:15:06,384 --> 00:15:07,904
each other. Just try to be good to

434
00:15:07,904 --> 00:15:09,285
other people in general.

435
00:15:10,144 --> 00:15:12,304
That's something that we that we say in

436
00:15:12,304 --> 00:15:13,684
my family a lot is

437
00:15:14,065 --> 00:15:15,839
when one of us succeeds with with our

438
00:15:15,839 --> 00:15:17,440
kids, we've been hammering this. When one of

439
00:15:17,440 --> 00:15:19,860
us succeeds, we all succeed. That way,

440
00:15:20,480 --> 00:15:22,159
I have two little girls. I have a

441
00:15:22,159 --> 00:15:23,360
a three year old and a five year

442
00:15:23,360 --> 00:15:25,120
old, and they can get kinda competitive with

443
00:15:25,120 --> 00:15:27,360
each other. And so we'll say to each

444
00:15:27,360 --> 00:15:28,720
other, hey. Just because

445
00:15:29,784 --> 00:15:31,065
for example, the other day, we were playing

446
00:15:31,065 --> 00:15:31,884
a board game

447
00:15:32,264 --> 00:15:32,764
randomly.

448
00:15:33,144 --> 00:15:34,664
My three year old daughter ended up winning

449
00:15:34,664 --> 00:15:36,585
the board game. And so my five year

450
00:15:36,585 --> 00:15:38,845
old's getting upset because she's, you know, losing.

451
00:15:39,384 --> 00:15:41,325
And so we just have to say, like,

452
00:15:41,720 --> 00:15:43,320
when one of us is winning, we're all

453
00:15:43,320 --> 00:15:45,420
winning. Be happy for each other.

454
00:15:46,120 --> 00:15:47,660
Applaud other people's successes.

455
00:15:49,080 --> 00:15:51,399
Comparison is the thief of joy. That's another

456
00:15:51,399 --> 00:15:53,100
thing that I like to say a lot

457
00:15:53,160 --> 00:15:55,399
is just try not to compare yourself to

458
00:15:55,399 --> 00:15:56,620
others. I know our society

459
00:15:57,394 --> 00:15:59,634
is very into that with social media, but

460
00:15:59,634 --> 00:16:01,414
just just kind of

461
00:16:02,115 --> 00:16:03,955
stay in your own lane and and keep

462
00:16:03,955 --> 00:16:05,654
plugging along. Try to get

463
00:16:06,195 --> 00:16:08,754
1% better and grow every day as a

464
00:16:08,754 --> 00:16:10,595
person, as a as a professional, as a

465
00:16:10,595 --> 00:16:11,495
health care worker.

466
00:16:12,240 --> 00:16:14,340
And, yeah, you'll be on the right track.

467
00:16:15,360 --> 00:16:19,120
Yeah. Yeah. Absolutely. Great words of, wisdom there.

468
00:16:19,120 --> 00:16:20,720
Thank you so much for those final thoughts.

469
00:16:20,720 --> 00:16:23,360
It's definitely been a very informative discussion. So

470
00:16:23,360 --> 00:16:24,879
I wanna thank you so much for coming

471
00:16:24,879 --> 00:16:27,120
back on Becker's Healthcare. We really do appreciate

472
00:16:27,120 --> 00:16:29,032
it, and I look forward to connecting with

473
00:16:29,032 --> 00:16:31,112
you again soon. Thank you very much. I

474
00:16:31,112 --> 00:16:32,732
really appreciate it. Have a good one.