Clinician Interview with Kyle Freeman, Physical Therapist
After a short break we are back with another interview detailing the life of a clinician working the frontlines in delivering care for patients. We speak with a Doctor of Physical Therapy based in San Diego (by way of Arizona). Here in this interview we get a glimpse of how a clinician manages their time and logistics as well as some tips and tricks for patients to keep their schedules, make them happy and other insights to improve the day to day of a mobile clinician.
SHELLEY ACKERMAN: Tell me a bit about yourself.
KYLE FREEMAN: I am a 27 year old Doctor of Physical Therapy. I graduated December of 2016 and started out my first year working in a permanent position at an inpatient rehab center and outpatient orthopedics clinic in Arizona. I then moved to San Diego where I started per diem work at a Home Health agency for the first time. I also started my mobile cash based practice. I realized I did not want to be settled into a business and wanted to travel the country. So I decided to travel for some time and once I returned I got into travel contracts. I have been in the home health setting for over 2 years.
SHELLEY ACKERMAN: Can you walk me through a typical work day?
KYLE FREEMAN: Currently, I go to the office in the mornings to sync my tablet since currently I can’t sync at home. Normally, you can sync at home and you don’t have to go to the office that often. When I’m at the office, I sync and update my schedule after seeing who’s been added or taken off. I then call my patients, schedule a time with them if they haven’t already been scheduled, chart review and then start my day seeing patients. After I see all my patients, I head back to the office to finish documentation. Sometimes I get my entire documentation done in the car although most of it is already done during point of care.
SHELLEY ACKERMAN: When do you typically schedule your patients and how do you plan your day for it to be the most efficient with your time?
KYLE FREEMAN: It depends, because schedules change. For evaluations, it is best to schedule the night before, in some cases I need to call in the morning. During the evaluation visit, I try to schedule out my patients at least a week or two in advance, that way my schedule is set and I don’t have to consistently ask to figure out times. If the patient has to change the visit day or time, I will change it.
To be the most efficient with my time, I make sure to get to the office at a reasonable hour so it gives me time to sync and plan my day. I make sure all my notes are completed the day before. I also make sure that I have enough time in between patients so I’m not rushing or late to the visit. So when I’m scheduling my day, I try to schedule the patients appropriately based on location and how long of a visit I think it might be.
SHELLEY ACKERMAN: How do you plan drive times between patients and do you plan for the first/last visit to be closest to your home?
KYLE FREEMAN: I honestly don’t plan my drive because I start at the office and I go back to the office to end my work day. I am able to get reimbursed for those miles so I don’t worry about my route as much.
SHELLEY ACKERMAN: Do you ever find yourself driving back and forth, if you aren’t mapping out your day?
KYLE FREEMAN: I do, a bit. Fortunately, the agency I work for allows us the time. I have the time to see my patients appropriately and not rush through my visits or rush to get to the patient’s appointment on time. Patients are homebound, as long as I call and let them know I’m going to be 20 minutes late, they usually understand. I also give the patient a 30 minute window when I’m scheduling, So I don’t have to explain myself.
SHELLEY ACKERMAN: We all use EMRs to plot patients, but those EMRs typically don’t have a place to schedule the actual appointment time? How do you keep your schedule? Do you use a tool or an app? Do you use paper and pen?
KYLE FREEMAN: I usually use my phone to manage my schedule. Also in our EMR there is an option to plot your patients schedule. They want clinicians to use the schedule within the system to have an idea of where we are. Also, if a patient called the office wondering what time their appointment is, they can take a look at our schedule on the EMR.
SHELLEY ACKERMAN: When you have a cancellation, are you responsible for calling the scheduler or do you document it on the EMR?
KYLE FREEMAN: It depends what type of visit it is. If it’s a start of care, we have to contact the scheduler to let them know that the patient refused to be seen or the visit was rescheduled. If it’s a revisit, we just have to notify the office and provide a reason why the patient cancelled. For scheduling, let’s say I did an evaluation and the Occupational Therapist (OT) was ordered, as well. If the patient refuses OT, I have to let the scheduler know the patient refused OT so the scheduler can remove the OT Eval visit. I also have to let the scheduler know if I need to add an OT Eval.
SHELLEY ACKERMAN: If you have a cancellation for a follow up, to keep your productivity high..do you call or do they not expect you to call.
KYLE FREEMAN: That’s the thing, with the agency I work for, I have never had my productivity questioned. It was questioned once, but that was when my supervisor was out and it was a stressful time.
SHELLEY ACKERMAN: Do you ever have any issues with patients keeping appointments? Does it happen often, what percentage of the time would you say it happens? And do you have any tricks or tips to help patients keep their appointments?
KYLE FREEMAN: I’d say right now, I do not. 50% of my caseload are orthopedic patients – post op. So the patient knows how important Physical Therapy is. When I worked at another agency where it was a more mixed case load, I had to explain and educate the patient and family the importance of why they would benefit from me being there.
SHELLEY ACKERMAN:Any tips/tricks?
KYLE FREEMAN: The most important thing is for the patient to understand why you’re there and how they benefit from your visits. The patient is more likely to cancel or not want your therapy when they do not understand. It’s important to ask them what their goals are and explain how you’ll help them achieve them.
SHELLEY ACKERMAN: Communication between field clinicians and office staff, do you feel like it could improve? How do you communicate with schedulers and care team today?
KYLE FREEMAN: My agency is pretty on top of things. The only communication that could improve is between disciplines, because we never see each other. At the other agency I worked for, I experienced a lack of communication from the scheduling staff also from the discipline who opened the case, and other disciplines. I try to encourage the care team and schedulers by communicating a lot which might promote them to do so too.
We have a specific type of compliant messaging app where we can talk about patients specifically. But if I’m just contacting a clinician without patient info, I’ll just text them.
SHELLEY ACKERMAN: Let’s move onto some housekeeping questions. When do you calculate mileage? What methods have you seen? Which ones do you like the most. Have there been any agencies that do not reimburse mileage?
KYLE FREEMAN: I put my daily mileage in, every day. Since I’m a contractor, I submit it through my staffing companies portal. I always forget to start the odometer although it is the easiest way to do it. But if you stop for lunch, those mileages don’t count. I’m only supposed to calculate from the first patient to my last patient. But since I go to the office, I calculate from the office first. I use Google maps to calculate my mileage. Since I have the schedule in my phone, at the end of the week, I plot patient to patient and add all the mileage up for the week. It doesn’t take me too long.
SHELLEY ACKERMAN: If I had a magic wand, and I could do something to make your life easier as a mobile clinician, what would you want me to do when I waved it?
KYLE FREEMAN: Give me a scribe to do all my documentation.