29222 Rancho Viejo Rd., Suite 127
San Juan Capistrano, CA 92675

August 2019

CMS Issues SNF PPS Final Rule for FY 2020
The Centers for Medicare & Medicaid Services (CMS) issued the final rule for SNF PPS fiscal year 2020 update on Tuesday, July 30, 2019. This rule becomes effective October 1, 2019. Most of the elements for which we have been preparing with the shift to the new Patient Driven Payment Model will continue as expected. Most pertinent to therapy services, specifically, is that CMS finalized the proposed change in the definition of group therapy so that starting October 1, a group can consist of 2-6 people. This will allow more freedom and flexibility for our therapists with regard to clinical decision-making surrounding group treatment. For more information regarding the content of the Final Rule, contact Deb Bielek at dbielek@ensignservices.net  

CMS Releases the Proposed Rule for CY 2020 Part B Physician Fee Schedule
Just prior issuing the SNF PPS FINAL RULE FOR FY 2020, CMS released on Monday, July 29, 2019, the Proposed Rule for the CY 2020 Part B Physician Fee Schedule which targets our Medicare Part B programs. While we are just beginning to dig into the specifics with this rule, there is one area that has caught our attention regarding how CMS proposes to allocate the therapy assistant modifiers in situations where the therapy/therapist assistant is providing a second set of hands for the treating therapist. While the payment impact won’t go into effect until CY 2022, there are important reasons for us to begin addressing this language now, and we are participating with the Therapy Policy Advisory Group through the AHCA. They have already begun mobilizing efforts with the APTA and AOTA to respond with one voice. Our therapy leadership team will also be providing support to our affiliated therapists throughout the organization on how to comment and respond to the proposed rule prior to the September 27, 2019 deadline. More to come… For more information regarding the content of this proposed rule, please contact Deb Bielek at dbielek@ensignservices.net  
Exciting Changes to Reduce Administrative Burden
of our Therapy Teams!    
By Tamala Sammons, Senior Therapy Resource
In an effort to ensure our clinical practice and policies match regulatory requirements, we frequently review therapy policies and POSTettes. Recently, we identified a number of areas where we could make changes to help reduce the administrative burden of our therapists. Effective Aug. 1, 2019, the following changes were put into practice. Read On...
Congratulations to the following Physical Therapists from our organization who recently completed the training portion to obtain their Certified Exercise Experts for Aging Adults (CEEAA) Certificates!!
From Left to Right: JB Chua, Flagstone; Amy and Kelly Alvord, Sunstone; Dominic DeLaquil, Pennant; Kai Williams, Keystone; Casey Murphy, Keystone; Gary McGiven, Milestone; Lisa Brook, Milestone; Lito Ortiz, Flagstone; Scott Hollander, Sunstone; Carlos Pena, Flagstone
This certification is designed to enhance physical therapists' expertise in clinical decision-making skills in: 
  • Designing and applying an effective examination and exercise prescription; and 
  • Measuring the effectiveness and reflecting the current evidence of exercise for all aging adults.
The process to attain the CEEAA® credentials included completing formal didactic education and participation in supervised and mentored skills development, home-based reflection and critical thinking. This was accomplished by attending three courses of two days each that addressed evidence-based examination and different and increasingly complex aspects of exercise design and delivery.

Pilot Programs Provide New Ideas for Enhancing Patient Care
By Deb Bielek, Therapy Education Resource
Currently, several of our facility therapy teams have been supporting efforts toward identifying best practice approaches as well as new tools and resources available to help us continue on our path toward effective and efficient delivery of therapy to our residents and patients.  Not only do we see more and more specialty programs popping up where our patients and residents are receiving state of the art care and getting better because of it, but we are also finding effective ways to engage them in care throughout their recovery process. Currently, we have facilities who have been participating in Pilot Programs with focus on innovative care delivery systems partnering with technological resources, enhancements to our therapy software system, interdisciplinary assessment processes for measuring functional outcomes through Section GG, leadership of Restorative Nursing programs.

The following Pilot Programs have been used over the recent weeks to help us grow in our understanding of how these tools and approaches can help us succeed in our current operations.  We are excited to share some detailed results of the following pilot programs during our Leadership WebEx meeting scheduled for Friday, August 9 from 12:15 – 12:45 pm Pacific. Read On...
Highlights on Nursing and Therapy Partnership
Travis Jacobsen (DON) (L) and Brooke Burt (ADON)(R) with DOR Angela Anderson, Gateway Transitional Care, Pocatello, ID
At Gateway in Pocatello, Idaho, we are blessed to have a very cohesive team that believes in making a difference for our patients. We have been able to create a task force with Nursing, CNA staff, RNS and activities, as well as PT/OT/SLP, to identify the greatest risks and needs for our patients and implement a true IDT approach. This collaboration has empowered the different departments to develop new ways to address a common goal. It started years ago when our nursing leadership, Travis Jacobsen (DON) and Brooke Burt (ADON) started coming to the weekly rehab meeting. It was in this setting that the Therapy and Nursing teams started building trust and working on patient impairments as a team.  Read On...
Nursing Profile: Kiran Sahota
Kiran Sahota is Director of Nursing Services at Park View Post-Acute Care Center in Santa Rosa, California. Kiran exudes a warmth and friendliness that makes a person want to know her. She joined Parkview in 2006 as a certified nursing assistant, working full time while earning her RN and MSN. She quickly assumed the DON role where she has been successfully leading and inspiring those around her ever since.

As a clinical leader, Kiran loves the many opportunities she has to work as a team and collaborate with her colleagues on a multitude of levels. As a clinician, she finds great joy in taking care of her staff and her patients. She conducts regular meetings with her staff not only to address issues that come up , but also to celebrate with them in their successes. She is on the floor in the facility daily, doing rounds and stepping in to help her team with anything at any time. Kiran’s office door is always open , and it is a welcome place for everyone in the facility.
Building Your Next One Up: Filling the “Shoes” of a DOR 
By Maryann Bowles, Therapy Resource
Quite often leadership will have to take time off, and sometimes it’s lengthy as in a maternity leave. You need an interim DOR! 

The questions arise : W ho will take charge while you’re gone? Will they know how to do the tasks that are required? Will the systems stay intact? Will the staff they lead follow the direction of interim well? Will the IDT team work well with the interim? Will it feel like there are holes or missing components? Will we still be able to grow our programs?? Well , at the Villas at Sunny Acres (VASA), we can’t believe three months have come and gone! Our DOR at VASA was out on maternity leave. VASA is a busy rehab program that services SNF, ALF, memory care unit, ILF and outpatient. 

Jenny Kuehn, PT, DOR, (pictured right) has always been a proponent of “building your next one up.” She did a poster on it for our Annual Leadership Meeting. She has cross-trained many of her staff that have goals of having a leadership role later in their careers. She has sent two therapists through the DORITO program. Jenny takes pride in building future leaders in our company. She prepped and trained Kinga Gianna , PT , to cover while she was gone. Read On...
Shadow Boxes are a Hit at Legend Oaks New Braunfels
By Keystone Therapy
Over the last year, Legend Oaks in New Braunfels, Texas, has implemented shadow boxes for all long-term care residents in an effort to decrease wandering, increase the patient’s ability to engage in meaningful interactions with other residents/staff/caregivers, and provide personalized, meaningful care in accordance with the patient’s Allen Cognitive Level. Residents were evaluated by a licensed therapist and determined if skilled therapy services were appropriate for the design and implementation of an FMP (Functional Maintenance Program).  Read On...
TWO MONTHS UNTIL PDPM – How are we trending with our Modes of Treatment?
By Chad Long, Therapy Resource
Just a quick update as to how each of our Independent Affiliated companies is doing regarding utilization of Concurrent and Group modes of treatment. Near the end of July, all combined companies averaged 5.8% for ALL Payers and 17.8% for Non-PPS Payers (July is tracking to be the highest use of these modes yet!!!). Emerald and Bandera continue to provide strong programming for Non-PPS, while Endura and Sunstone are demonstrating growing programs for their PPS patients. Great job preparing and becoming efficient providers of therapy services!
PDPM Ready – Speech Therapy
By Lori O'Hara , MA, CCC-SLP, Therapy Resource - ADR/Appeals/Clinical Review
CMS thinks that speech therapy is so special that it gave speech five different considerations for the payment category. Thanks, CMS! So here are a few tips for being an SLP CMI Ninja Warrior:
  • If you have a patient with concomitant ortho and CVA diagnoses driving their stay, you will generally select the ortho condition for the principle medical condition. But then you should always get an SLP co-morbidity because Active Dx: CVA/TIA (item I4500) would be checked on the MDS. There might be additional co-morbidity diagnoses coded from the SLP treatment conditions, but you only need one to count! Read On....
Updates By Mahta Mirhosseini, Therapy Resource
Have you wondered what it would be like to go paperless with Therapy documentation? You can stop wondering, because our Optima software has features and modules that can help us go paperless today!

Clinisign is Optima’s answer for getting timely and efficient physician signatures for our therapy documents. Facilities that utilize Clinisign do not have to print out any of their therapy documents, because each eval and/or recert is electronically sent to the physician for signature. Once the physician e-signs the document, it is automatically returned to Optima and PCC, thereby getting rid of the need to scan our therapy documents into the Misc tab of PCC!  A nd that’s not all. Did you hear the great news about the revision to our therapy clarification orders policy?    Read On...
Financial Health
Positive Patient Outcomes and Increased Productivity
By Ciara Cox, Therapy Financial Resource
Therapy professionals skilled in providing group and concurrent treatment to their clients create shared experiences and increase social interaction between clients while providing excellent care. Apart from the benefits to our clients, there is also a correlation between group/concurrent treatment and increased productivity providing more space in a therapist/assistant’s day.  
This graph illustrates the correlation between the increase in group/concurrent minutes in Ensign affiliated SNFs and increased productivity over the last year, (r(10) = .89, p < .01)
Group Therapy
F.A.S.T Pace Rehab Program at
St. Elizabeth
By Dennis Baloy, DOR, St. Elizabeth Healthcare & Rehabilitation, Fullerton, CA
Our facility is heavy on short-term patients (HMO and Medicare). Most patients come from St. Jude Hospital. Our payer sources and MDs are as aggressive and enthusiastic as the staff and team that we have. We wanted to capitalize on this and incorporate our group and concurrent treatment along the way. We came up with St. Elizabeth’s F.A.S.T. Pace Rehabilitation Program. 

F.A.S.T. stands for F unction and A bility based interventions for S afe and successful T ransition to Home. St. Elizabeth Healthcare & Rehabilitation prides itself on improving patient outcomes and providing excellent customer service. Our therapy programs are evidenced-based and patient-centered, implemented within a fun, encouraging and supportive atmosphere. Our goal for each resident is to go back home or to a safe discharge environment.  Read On...
LTC Think Tanks--A Vision to Reality By Kai Williams, Therapy Resource
Abigail O’Keefe shared the details of how the implementation of a seating and positioning program helped to drive the success of her outpatient service delivery. We had a very engaging discussion about the use of vendors, funding parameters and the need to focus on seating and positioning. Stay tuned; Abigail will be working on a POSTette for each of you to use for guidance. Thank you so much, Abi!

NuMotion has been a hands-on vendor with The Health Care Resort in Kansas City. They have supported the facility by providing marketing services as well as having an active ATP to be available during clinical evaluations performed by the therapists. Feel free to reach out to Abi’s contact for further information on how your facility can partner with NuMotion in your local area: Brian Johnson, Specialty Account Manager, Brian.Johnson@numotion.com , Phone: 816-206-8286, Fax: 877-328-7896
Flagstone Barbecues Raise Funds for EEF
By Sacchin Bhatia, Therapy Resource
The Employee Emergency Fund provides a means to help your co-workers in times of emergency financial need following a tragedy or crisis. Camarillo Healthcare, Glenwood Care Center and Panorama Gardens recently held Employee Emergency Fund (EEF) barbecues to raise awareness and increase donations to the fund. They had quite a few new employees enroll with contributions and several employees who enlisted to increase their contributions. 27 NEW employees signed up for the EEF at Panorama Gardens. This is the highest number we signed up at any facility! The barbecue was also an opportunity to thank the employees for all that they do. It all comes down to awareness, education and embracing our core values. Thank you, Camarillo, Glenwood and Panorama Gardens!

If you haven’t already, please consider setting up an automatic donation to the Ensign Employee Emergency Fund. You can donate as little as $1 a paycheck, and you will impact the lives of those with whom you work. Go to http://theemergencyfund.net/ and click on Donate/Apply to get started.
Parklane West Featured in Video Commercial for NURO Bladder Control
Congratulations, Parklane West in San Antonio, Texas! They were featured in the video commercial for NURO, Medtronic’s Bladder Control device. Parklane was one of the first five senior living facilities in the United States to offer this program. At the recent Keystone DOR/DNS meeting, many indicated that they would like to get this program implemented at their facility. If you haven’t done so yet, please reach out to your local Therapy resource for support and training. 
What's Your WELL Commitment?
Dragon boat racing is an amateur watersport which has its roots in an ancient folk ritual held over the past 2000 years throughout southern China. While 'competition' has taken place annually for more than 20 centuries as part of religious ceremonies and folk customs, dragon boat racing has emerged in modern times as an international sport.

Therapy Leader, Lito Ortiz, is not one to sit around!! This innovative Physical Therapist, Director of Rehab and Therapy Resource, is inspiring others to make a WELL Commitment, while HAVING FUN doing it! For the second year in a row, Lito and an entire team of “Therapy Ensignistas” (aka, Therapists employed by Ensign-Affiliated Facilities) came together to compete in the Long Beach Dragon Boat Festival. They ended up making it to the Gold Division and placing sixth, but the real “win” was the camaraderie, fun, creativity and spirited fitness motivated by competing in this event. 

The team has enjoyed so many benefits that touch the very core of creating a WELL Mind, Body, Spirit and Heart (social emotional connectedness), that therapy leader and dragon boat team member Peter Cruz suggested they continue through a membership that will allow the influence of this invigorating event to continue to spread throughout the organization.
Miriam Janove!
Miriam Janove, an August 2019 PT graduate from The University of Puget Sound, Washington, is our 3rd quarter SPARC winner! 
... We spend much of our Doctor of Physical Therapy (DPT) program learning about the structures and functions of the body in order to use evidence-based practice to treat our patients. Recently, we have shifted focus towards examining the impact of illness by discussing the patients’ participation goals using the International Classification of Functioning, Disability and Health (ICF) model. No longer is it appropriate to treat impairments in patients without accounting for the fact that we are working with human beings who have rich and demanding lives.
Congratulations to our Newest CTOs!
Julia Schmutz, PT, DOR, Camarillo Care Center, Camarillo, CA
Lito Ortiz, PT, Therapy Resource, DOR, Brookfield Healthcare, Downey, CA
Aimee Bhatia, OT, DOR, Glenwood Care Center, Oxnard, CA
Therapist Profile: Scott Langdale
Scott Landale (Top Right) with the team at Beacon Hill: Kelli Shoemaker, Morgan Vaughn, Jeanne Hochstein, Lorena Libby and Katrina Brett
Did you know….
Scott Langdale is a stand-out leader in our Washington operations. He is one of those dedicated clinicians who quietly goes about doing whatever needs to be done — in his own facility as well as his partner facilities — no matter what it takes and without any expectation of recognition. “We are so lucky to have him on our team,” says Mira Waszak, his therapy resource.

Scott joined our organization when his facility, Beacon Hill, was acquired in 2014. He was a staff therapist at the time but quickly became a Director of Rehabilitation when the position opened up in 2016. He is passionate about developing others and believes that developing others is what great leaders do — they give the people they lead the tools and culture to grow and then get out of their way!    

This therapy veteran has been part of many different teams over the years. What sets his current team apart from all the others is their closeness and genuine love for each other. Beacon Hill therapy is extremely supportive of all of the facility departments and has developed outstanding relationships with each one. Because of this close partnership, patient outcomes and satisfaction are excellent. Read On...
Meet TheraTrooper Laura D’Antona, COTA!
Laura D’Antona has been making her way through our organization offering support to a number of facilities from the Pacific Northwest to the Southwest, from the Midwest and into the Rocky Mountain states of Utah and Nevada. Laura enjoys travel, but her passions don’t stop there!! She is very close with her family which includes an older brother and two younger sisters who she considers her best friends. Laura describes herself as an outdoor enthusiast and finds time to volunteer to do trail maintenance because, as she says, “I want others to love and respect the environment as much as I do.”  

Laura has been working with post-acute patients, outpatients and LTC residents in Skilled Nursing Facilities for over 6 years and with Ensign-Affiliated SNF & HHA for the past two years. She has a special place in her heart for geriatric patients and she particularly enjoys treating neuro patients.  She is very passionate about OT, and loves that her job combines science, compassion, and now travel. She is actually exploring options for continuing her schooling toward a masters or doctorate in Occupational Therapy!

When Laura’s not busy working with one of our facilities, you can find her “hanging around.” Laura is a Rock Climber and has located spots to climb, whether in a gym or in the great outdoors, while on location as a TheraTrooper. THANK YOU FOR SHARING YOUR PASSIONS WITH US LAURA!! And, thank you for your living example of a WELL Commitment to Mind, Body, Spirit and Heart!  
NOTE: TheraTroopers™ is a small, Ensign-Affiliated staffing company helping to serve the needs of our affiliated facilities and HH Agencies. For more information, contact your Therapy Resource.  
Moment of Truth
Submitted by Kelly Schwarz, Therapy Resource
Gordon Murray, Rehab Tech, has worked at North Mountain Medical and Rehab Center for over 14 years. Gordon has built many friendships with residents over the years due to his calm, gentle approach with residents.

Gordon has a gift for motivating therapy patients, builds special bonds with them and has been referred to as “The Patient Whisperer” by his peers! He discovered that one of the therapy patients, Leigh Gholston, was very apprehensive about getting his hair cut in the facility. Upon hearing this, Gordon spoke with his own barber to see if he would come in with Gordon to cut Leigh’s hair. Gordon’s barber was anxious about going to a “nursing home;” his barber pictured a dark, impersonal building and did not want to come in to do the haircut. Gordon was able to convince him that our facility is not at all what he was imagining, and finally he agreed to come cut Leigh’s hair. Read On...
Patient Highlight
Submitted by Jennifer Wintle, Therapy Resource
It's easy to get caught up in the day-to-day routine in this line of work. You have new programs you want to start, financial markers you strive to hit, and all of this trickles down to your team. However, every so often, you are reminded of why you chose this profession. It's the people, their stories, their lives, and all they share. 

One of my PTAs at Sloan’s Lake, Meghan Ricketson, just shared this with me. We had a patient recently who wanted to get better so badly, but his body (his heart) just wasn't having it. He was sent back to the hospital twice while he was a skilled resident with us. He even asked another PTA, Brent Cook, to just try to ride the bike even though his O2 sats were in the high 70% just sitting in his w/c. He asked Brent in an unsure voice, "Am I dying?"   Read On...