First Quarter 2013

FlagPOST Archives
Fanatic Discipline

In a previous edition of The FlagPOST, we discussed a concept from Jim Collins' Great By Choice called "Productive Paranoia" - always preparing for when, not if, the next big change and disruption to our industry will occur. Another key core behavior that Collins observed is "Fanatic Discipline": Companies that thrive in times of chaos tend to continue at the same pace regardless of the difficult conditions that they face.


We will continue to face many changes this year that will impact our therapy programs. The new Medicare G Codes and Functional Limitation Reporting that will be required for our Part B patients starting July 1, 2013, is yet another requirement by CMS that we are anticipating. Thankfully, our partners at Rehab Optima and our therapy resources are already prepared for these changes to make this as easy as possible for our therapists. We will continue to stay ahead of any new requirements so that you can continue to focus on amazing patient care. We cannot let the conditions of our industry stop us from our ongoing quest to become the provider of choice in our communities. We are marching forward with expanding our student programs, exploring new outpatient markets, looking at our opportunities to get better with our managed care population, improving our dementia care programs, and developing internal falls prevention and seating/positioning programs. This is just the tip of the iceberg, and we continue to learn and grow from you. We will arm you with both the regulatory guidance and the best evidence-based clinical programming ideas to inspire transformative care in these challenging times.

AOTA Fieldwork Educator's Seminar
AOTA Course 3
Many of our occupational therapists enjoyed a two-day Fieldwork Educator's Certificate Seminar on Feb. 2 at Southland Care Center in Norwalk, CA. Our student programs are blossoming all across the organization, and it is so wonderful to be able to provide our therapists with additional training and resources to make our student programs extraordinary. Thank you, Gina Tucker-Roghi, for organizing the seminar and making it a success! We will be holding more clinical instructor trainings in 2013, so make sure you check with your therapy resource for dates and locations.  

 Ultimus Software is an awesome tool for our ADR and denials management process. Once the record is scanned in the Ultimus system by the medical records clerk, our role in this process is to review all documentation related to therapy so that we make sure the record is complete. The DOR will receive an email from the Ultimus system to alert them that there is a record ready for review. The DOR will log on to, enter their username and password, and review the scanned record. The record is then forwarded on in the system to the business office manager to submit to our Medicare Administrative Contractor (MAC). If the record is paid in full, there is nothing more we have to do. If the record is denied or partially denied, we begin to assemble our appeal letter. There are appeal letter templates available on the portal, and your therapy resources are ready to help.

Brookfield Healthcare Develops Customized App for Patient Care Brookfield App
The I-Motion Analyzer Mobile Application was developed by Brookfield's very own talented therapists as a way to compare, analyze and share videos and snapshots to help patients and their caregivers in understanding the recovery process during rehabilitation. The application was developed when a lot of caregivers asked for the progress of their family members during care plan meetings, or even just on a regular basis. We came up with the idea of videotaping the patient after getting consent and used that video to report progress to the family. The application allows+ us to play one to two videos simultaneously and compare the videos to determine the progress of the patient. We also added an editing option to make it more functional for the therapists. We continue to receive great feedback about our application from the families, patients, staff and even contracted HMOs, who see the potential of even better care in a long-term care setting by having this kind of technology in the facility.
Pet Therapy
By Jon Anderson, PT, Keystone Therapy ResourcePet Therapy
Can a pet improve the quality of life for a human? Those of us who own pets know they make us happy. But growing scientific research is showing that our pets can also make us healthy, or healthier. That helps explain the increasing use of animals - dogs and cats mostly, but also birds, fish and even horses - in settings ranging from hospitals to nursing homes.


Nursing homes were one of the first settings to graciously open their doors to the concept of pet therapy, which was developed by Therapy Dogs International (TDI) more than 30 years ago. Today, therapy dogs and cats are registered from all types of breeds, and many are rescue animals. In 2012, there were roughly 25,000 therapy dogs registered. All therapy dogs and handlers are volunteers and are located in all 50 states. The typical therapy dog is at least 1 year of age, and each dog must pass a temperament evaluation and demonstrate appropriate behavior around people with the use of some type of service equipment (e.g., wheelchairs or crutches) in order to become a therapy dog. Read On...

The Journey to Wellness at Plymouth Tower
The Journey to Wellness Wall of Fame at Plymouth Tower in  Riverside, CA, began with an inspirational patient story. Cynthia arrived at Plymouth Towers following a flap surgery for a stage IV sacral ulcer. She was bed-bound for nearly two years following a spinal stroke causing paralysis, and she required 24-hour care. Despite the odds stacked against her, she announced to the evaluating therapists that she was determined to walk out of the facility and limit her caregivers to a couple of hours a day. The theraPlymouth Journeypy team supported her, but at the time thought that it was a near-impossible goal, especially given the fact that she was restricted from sitting up for the early part of her rehabilitation program.


Cynthia poured her heart into her therapy program, and incredibly enough, she walked out of the facility with a FWW and a huge smile of victory on her face! The entire staff was so moved by her inspirational story that they wanted to capture and highlight it in the facility to motivate others during those often difficult hours of therapy. Bobbi Ridge, DOR at Plymouth Tower, and her therapy team put their heads together, and the Journey to Wellness Wall was born. The team hopes to one day cover the entire wall with photos and stories of patients with the drive and determination to overcome limitations and accomplish the unexpected.

Stepping Stones Fall Prevention Course SteppingStones
Mike Johanson, MSPT for Horizon Home Health in Idaho, wrote and has trained Cornerstone and other therapists with his Stepping Stones program of fall prevention. The one-and-a-half-day course helps therapists to further their understanding of differential diagnosis regarding symptoms of dizziness, disequilibrium motion sensitivity, imbalance, gait instability resulting from BPPV, central dizziness, visual weakness, somatosensory loss, musculoskeletal imbalance and movement disorder. Read On...
Brookfield 5K

Healthy Brookfield 

We are advocates of health - that's why we promoted the Big5K run to all our teammates. More than 30 people signed up for the event, including our two Medical directors!

 A Thriving Student Program at Lemon Grove Care and Rehabilitation Center 
Nerida Gerona is the Director of Rehabilitation in Lemon Grove, CA, and her partnership with local universities for ongoing student internships is legendary in Southern California. In the past 12 months, the Lemon Grove center has taken 15 students from six different schools, with two new schools being added in the early summer. What makes her student programs stand apart is how the Lemon Grove team embraces our Core Values and incorporates them into their students' experience. The students truly become part of the team and have the experience of being part of a dynamic interdisciplinary rehab program. The team celebrates their successes and ensures that each student gets the opportunity to work with a variety of different diagnoses and disciplines. Because of the extraordinary feedback that the students have about their experience at Lemon Grove, Nerida was one of the clinical educators who were asked to be a part of the certification process for a new Physical Therapy Program at San Diego State University. In addition, four of the therapists at Lemon Grove are now certified instructors.
Way to go, Team Lemon Grove!

Lemon Group

Rehab All-StarsArroyo Vista at Arroyo Vista

Sometimes the simple but meaningful ideas to motivate patients, family, and staff are the most effective. At Arroyo Vista Nursing Center in San Diego, CA, the therapy staff has dedicated a wall in their therapy gym to their Rehab All-Stars.  Patients receiving therapy are nominated by therapists, facility staff members, or even other patients and residents when they are making remarkable progress in therapy. The patient is then highlighted on the wall with a story about their rehab success, including a personal account of their experience in therapy. The stories are always changing, and each one is equally inspiring. Currently on the wall is a patient who was told by her surgeon that she would never walk again, and she recently took her first steps!  Family members love to read the stories during therapy, and patients are motivated to continue to improve and work hard to achieve their goals - and possibly earn an opportunity for an all-star picture! Keep in mind that a photo consent is necessary when we are posting information about our patients.

Legendary Angels Baseball Hero Visits Plymouth Tower!

By Bobbi Ridge, DOR, Plymouth Tower, Riverside, CAPlymouth Baseball

John Stewart is one of Plymouth's most loved residents. Anyone that knows him can tell you his favorite sport is baseball, and his favorite team is the Angels. He wears his Angels 2002 World Series cap every day and loves all things baseball, including hotdogs! Last Tuesday, we were honored to have two-time World Series champ Scott Spiezio here to visit John. Scott was instrumental in the first-ever World Series win for the Angels organization in 2002 and went on to play for the St. Louis Cardinals, where he won another championship in 2006. Scott personally autographed John's hat and gave him a picture of the winning home run he hit in game six of the 2002 Angels World Series. Scott sat with John and helped him play bingo with other residents while they talked about their love of baseball. Nearly a week later, John is still talking about his visit and showing people his hat. Scott is a friend of mine and was touched to have a chance to meet one of baseball's biggest fans!

A Good Therapy Team Makes Nursing Home Stay Less Daunting 


Palomar Vista
L to R: Jimmy Manalang, OTR/L; Rino Aquino, PT/DOR; Patricia Kaiser, rehab aide; Ria Olaes, COTA; Bernard Villaseca, PTA;
Dennis Pulangas, PTA
Palomar Vista in Escondido, CA, was recently praised in an article published in U-T San Diego, written by a former patient and freelance columnist, Agnes Herman. Agnes shares her experience and feelings about the exceptional care and team support she received at Palomar: "Each therapist is dedicated to helping us avoid pitfalls in the environment, to strengthen muscles, increase range of motion and learn to walk safely and be comfortable in our own skin. These young folks who are professionals enjoy working together to create an atmosphere of 'can do.' They do not finish each other's sentences, but they could. ... When we fall, there is fear and apprehension along with pain. A caring environment and dedicated teamwork can cushion the impact of any fall."  Read the full story here... 

Implementing the Claims-Based Data Collection Requirement for Part B Therapy Services (aka, Functional G-codes)

The Middle Class Tax Relief and Jobs Creation Act of 2012 (MCTRJCA; for more information, see ) states: "The Secretary of Health and Human Services shall implement, beginning on January 1, 2013, a claims-based data collection strategy that is designed to assist in reforming the Medicare payment system for outpatient therapy services subject to the limitations of section 1833(g) of the Social Security Act (42 U.S.C. 1395l(g)). Such strategy shall be designed to provide for the collection of data on patient function during the course of therapy services in order to better understand patient condition and outcomes."


This claims-based data collection system is being implemented to include both 1) the reporting of data by the SNF and the therapists furnishing the therapy services, and 2) the collection of data by the Medicare Administrative Contractors (MACs). This reporting and collection system requires claims for therapy services to include non-payable G-Codes and related modifiers. The non-payable G-Codes and severity/complexity modifiers will provide information about the patient's functional status at:

  • The outset of the therapy episode of care,
  • Specified points during treatment (i.e., at least once every 10 treatment days), and
  • The time of discharge.

These G-codes and related modifiers are required on all Part B claims provided to residents in our SNF and/or to patients visiting our outpatient treatment centers, regardless of their Part B cap or threshold status.

Read On...

Managed Care Control

 By Dawn Webster, Managed Care Resource


One of the golden opportunities for becoming the rehab facility of choice in your community is to be an extraordinary partner and a preferred provider with managed care organizations.   Superior communication is the remarkably simple key to success, yet so many facilities do not implement systems and organizational strategies to keep the external case manager informed and integrated into the overall management of the patient. The external case manager can become our biggest ally, and as trust is built and outcomes are achieved, the result is nothing but extraordinary for our patients.  


Some of the key factors that have proved to aid in achieving that goal include providing documentation and updates to the managed care organization's case manager, either directly or indirectly through a case manager at the facility.  The top five ways the therapy team can help may be summarized through the following tips and ideas:Read On...

The Alta Project:

Moving Beyond Standard Care


Congratulations, Alta Vista Rehabilitation and Healthcare Center, on recently being published in the Winter 2012-13 * Vol. 36 .No. 4 issue of Journal of the American Society on Aging!


The article highlights the Alta Project at Alta Vista's facility in Brownsville, Texas. Led by Medical Director Dr. Lorenzo Pelly, the project focuses on patient accountability and delivering the highest-quality care before, during and after a patient's admission. Dr. Pelly continually works with and trains staff to enable them to exceed standard care practices, using the following program goals as a guide toward delivering exceptional care: Read On...

Understanding Seating Systems:
Skilled Nursing and Long-Term Care


Curtis Merring, OTR/L, MOT developed a seating and positioning course for our therapy programs, and piloted the training at Panorama Gardens on March 21, 2013. Staff from Panorama, Glenwood, and Mission Care learned about the most recent research and seating and positioning solutions specifically for our population. This is an excellent opportunity to develop positioning strategies for both our short-term rehab patients and our long-term residents.  We will be offering this course across the organization, so check with your therapy resource for when the training will be in your area

Keystone North Hosts Advanced

Kinesio TapingŪ Course


Kinesiotaping continues to take the Rehabilitation and Sports Medicine world by storm, and our therapists are taking this evidenced-based practice to our geriatric populations as a technique to reduce pain, re-educate the neuromuscular system, and promote lymphatic  flow and healing .


Last fall over 50 therapists from throughout Texas attended our Kinesio Taping 1 and 2 classes. On Saturday March 16, thirty of these therapists went on to learn advanced fundamentals of Kinesiotaping and are now eligible to sit for the exam and become a certified  practitioner.


The University of North Texas Science Center (UNT HSC) provided a state-of-the-art venue for the course. Deb Ellis and Jon Anderson organized the event. They were able to offer registration to several professors and allowed 4 students to monitor the course. The course was offered to therapists from Keystone North and South Facilities as well as therapists from the surrounding communities, and with the proceeds, we were able to award UNT HSC Student Organization a check for $2000.

US News & World Report
Best Nursing Homes - 2013

Issue: 1

In This Issue
AOTA Fieldwork Educator's Seminar
Ultimas Software
Brookfield Healthcare Develops Customized App for Patient Care
Pet Therapy
The Journey to Wellness at Plymouth Tower
Stepping Stones Fall Prevention Course
Healthy Brookfield
A Thriving Student Program at Lemon Grove
Rehab All-Stars
Legendary Angels Baseball Hero Visits Plymouth Tower
A Good Therapy Team Makes Nursing Home Stay Less Daunting
Implementing the Claims-Based Data Collection Requirement for Part B Therapy Services
Managed Care Control
The Alta Project
Understanding Seating Systems
Keystone North Hosts Advanced Kinesio Taping® Course
U.S. News & World Report - Best Nursing Homes

The Compliance Corner 


We are thrilled to introduce to you our new Chief Compliance and Privacy Officer, Debbie Miller. Debbie is an RN, JD, and former CNA with a wealth of experience in making the partnership between compliance and operations extraordinary. In the short three and a half months since she has been with Ensign, she has hired 22 compliance team members to strengthen and support our culture of integrity and ethical behavior.


Compliance team members other than the CCO are referred to as "compliance partners." This name was chosen as a symbolic sign that compliance is not optional but is a collaborative effort with operations.


Compliance partners walk with operational leadership and assist in guiding the day-to-day implementation of a compliant and ethical workplace environment. Several of these partners have been designated as "lead compliance partners." These individuals serve as the compliance officer for their designated Ensign companies and the facilities within that company. Their duties include but are not limited to the following:


> Serve as the compliance officer for the designated company

> Meet with company leadership at least monthly to discuss current risks within the company and assist in developing and coordinating remediation activities

> Coordinate and participate in all audits for all facilities within the company

> Coordinate and/or perform the investigations for all facilities within the company subsequent to reports to compliance

> Collaborate with human resources when employee action is determined to be necessary;

> Track corrective action plans related to any adverse findings

> Facilitate and track required compliance education

> Facilitate other required compliance activities


Partners by Company 


Administrative Support Covina Dominguez (analyst); Lucie Baker (administrative) 

Bandera and North Flagstone Merrisue Corris, M.S., OTR/L

Bridgestone and Keystone North Peggy Kleffner, MHA, NHA, OTR/L 

Colorado Super Cluster Cathy Rayes, RN, RAC-CT, WCC 

Cornerstone Marilyn Tatro, RN, HCS-D 

Flagstone South  Brian Del Poso, OTR/L 

Gateway Shelley Johnson, M.S., CCC-SLP, CHC

Keystone South  Priscilla Diazdeleon, MA, CCC-SLP 

Milestone Jack Rolfe, PT 

Pennant and Northern Pioneers Lorraine Finnegan, OTL, RAC-CT

Touchstone - Kelly Welsh, OTR/L 

Radiology Deb Miller, RN, JD

Urgent Care Deb Miller, RN, JD


Additional Staff for Auditing, Education and Investigations


Lead Clinical  Hannah Suhr, RN

HIPAA and Privacy Rebecca Lea, RAC-CT  

Clinical and MDS -Jennifer Culley, RN, RAC-CT 

Erin Peterson, BSN, RN 

Beth Ringwald, RN, MDS 


Deb Piluri, RN, MSN

Resurrecion del Castillo, RN, MSN

Coder -

Casey Bastemeyer, RHIT  



Visit our Therapy Website at:

Mary Spaeder, Editor 

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