Day in the Life: A Healthcare Surveyor

Go behind the scenes with a LARA healthcare surveyor and discover how their work helps protect patients and ensure quality care across Michigan's healthcare facilities.

Transcript

Anastasha Osborn 0:19

Welcome back to another episode of the LARA Living Room Podcast. I'm your host, Anastasha Osborn, and today's episode is going to be a little bit different than our usual conversations. Now, typically, we focus on one of Lara's bureaus, our type one agencies, and the important work that they do to serve Michiganders. But today we're going to be taking you behind the scenes for a day in the life. And this is going to be one of our very own employees to give you a firsthand look at careers that many people may not even realize exist. So when you think about healthcare facilities like home health agencies, hospice providers, outpatients, rehabilitation clinics, you probably don't spend much time thinking about the professionals who help ensure those facilities are meeting important standards for quality and patient care. But that's exactly what today's episode and our guest is going to do for us. So joining me today is Yolanda Crosby, a healthcare surveyor with LARA's Bureau of Survey and Certification, or we love our acronyms, BSC. And Yolanda works with a variety of healthcare providers across Michigan. So I'm excited to bring her on. But before we bring our guest on, go ahead and fill up your coffee or your drink of choice, grab a seat, and get comfortable because you are now in the LARA Living Room. Yolanda, welcome to the LARA Living Room Podcast. Hi there.

Yolanda Crosby 1:28

Thank you. Thank you for having me.

Anastasha Osborn 1:30

Of course. We're so excited to have you on. This is actually one of the first times we're doing like a day in the life behind the scenes episode. So you're a first-timer for that. I'm excited. So let's um start just by getting to know you. Um I want you to tell us a little bit about yourself, what led you into a career in healthcare?

Yolanda Crosby 1:46

Okay, well, uh, I am Yolanda Crosby. I am a registered nurse by way of discipline. I've been a nurse for a little over 32 years, uh, a vast degree of experience prior to becoming a healthcare surveyor. But what drew me to this particular position is I had an opportunity to work, I want to say as a CNA and maybe as an LPN in the long-term care facility where I could possibly see some things that I wasn't too pleased about. And I figured I would never work in that area because I knew I couldn't make a difference. I now can make a difference as a regulator, hence uh healthcare surveyor, and so I'm very excited to be doing what I'm doing.

Anastasha Osborn 2:29

Yeah. Um, and before we jumped in, my next question, because you made me think of something, and I know um I bring this up all the time on our podcast that we love our acronyms. We love using acronyms for everything. You mentioned um CNA and you mentioned another acronym.

Yolanda Crosby 2:44

CNA is a Certified Nursing Assistant and LPN licensed profession Licensed Professional Nurse. Okay. So before becoming a Registered Nurse.

Anastasha Osborn 2:53

Okay. Beautiful. And so that ultimately then brought you into the Healthcare Surveyor position. Okay. And before we jump into what the healthcare surveyor actually does, I kind of want you to tell me a little bit about the work that you do within that bureau. So, or what the bureau actually does, I guess I should say. So, for our listeners who maybe aren't familiar with that bureau, um, what does the Bureau essentially do versus our other teams?

Yolanda Crosby 3:18

If I could put it in a nutshell, uh we're of the specialized healthcare services division, and so we survey uh not each surveyor surveys all of the provider types under that umbrella, but uh our umbrella services or surveys uh home health agencies, hospice agencies, outpatient physical therapy, rural health clinics. But in a nutshell, what we are doing is going into that particular provider to make sure that they are in compliance with the conditions of participation as set forth by CMS, uh, Centers for Medicare and Medicaid.

Anastasha Osborn 3:56

Perfect. Okay, so then let's talk about what does that quote unquote day in the life of a healthcare surveyor look like?

Yolanda Crosby 4:02

A typical day for me varies. Uh, it depends on what I'm assigned to do. For example, if I'm assigned to conduct a complaint investigation, then that actually that process would start the day prior because my responsibility is to notify the complainant, uh, to make sure that they know I am in receipt of their complaint and to see if they have any additional concerns or just to make sure I have the facts correct before I go into the facility. Uh that being said, uh the next day, all of our complaints, all of our surveys regardless, are unannounced. We go in, I do a little pre-survey prep, so I have all of my paperwork. I've done Google searches and gone in our system to see historically the last time they were surveyed, if they were cited on anything to kind of get a feel of what I may be walking into. Um I also try to look at their hours of operation if they're listed uh on the web so that I know not to be there at 7 when they open up at 10. And so um, and then if they open up at 10, respectfully, I may go in 10:15, 10.30, give them an opportunity to open up the systems, and you know you want to be respectful. Absolutely. Uh, and then uh we will conduct an entrance. Now, this is all for the complaint, but it doesn't change for the other types of surveys. There's an entrance, uh, you establish how things will be, uh, the time that I plan to be on site, uh, requested items, uh, you interview various staff, uh, agency, or provider leadership, and uh then you go from there. And at the end of that, uh, well, throughout that process, you're reviewing clinical records, uh, you've made your observations. If that patient is still an active patient, then you may have an opportunity to go and visit that patient. If not, then it would be a closed record review. Uh, and after you've reviewed all of your findings uh and interviewed, then you make your determination, preliminarily speaking, of course, and then you conduct your exit conference, which is to let the agency providers know. And not specifics, because things are always subject to change. You'd never let them know if you were able to substantiate or not. Um, you may, as a courtesy, let them know that you didn't find uh any deficient findings. However, everything is subject to managerial oversight in the QA process. And uh we exit the facility, and that is for a complaint. If it is for uh, let's say a standard um home health survey, then the process is the same. The management manager will uh designate who will be the team leader. The team leader will make an assignment how many records you're going to review, uh, how many home visits you'll have based on a particular unduplicated census. That means for the census for that last previous year, that will dictate how many records and how many home visits. I'll make the assignment accordingly, and it's always subject to change depending on the actual numbers once we get there. I'll set a time of arrival if I'm the lead. Uh we go in as a team, we give them our business cards, they give us a conference room, uh, and the same will happen then. We'll establish uh what will take place, how long we anticipate being on site, uh, what we'll be looking at, and of course we're open and entertain any questions. We want it to be an open dialogue. Um and each surveyor will essentially do their own thing. They act independently in in that they're reviewing their own records, but we'll come together and meet as a whole to determine where we are in the survey process. Uh and again, that will conclude by uh by way of a survey exit uh where we we owe them that to let them know where where we stand. Uh, we'll let them know how many days we have to write and uh that they should expect their what we call 2567. That's also known as a statement of deficiencies in X amount of time. Uh we give them specific instructions on how to document that and we welcome them to call us. I know I do. Welcome them to give me a call if they have any questions on how to formulate that plan of correction. Okay, and uh that then that's in manager's hand. We don't send them the actual report that comes from management.

Anastasha Osborn 8:28

Okay. Two questions that I thought of.

Yolanda Crosby 8:30

Yes, ma'am.

Anastasha Osborn 8:31

One is um complaints, when those are coming in, is it from anybody, just from the general public, or could it be also from somebody from that facility?

Yolanda Crosby 8:39

All of the above.

Anastasha Osborn 8:40

All of the above, okay.

Yolanda Crosby 8:41

All of the above.

Anastasha Osborn 8:41

And then you guys, as you receive those complaints, then you are responding to them and going out there. Yes. Okay. Um, and then my second question was you mentioned uh a home health facility. Can you explain what that is?

Yolanda Crosby 8:53

Uh the home health facility is essentially, I want to say an agency.

Anastasha Osborn 8:58

Okay.

Yolanda Crosby 8:59

Uh we'll go into the office. That is where the administrators are located, maybe the directors of nursing, uh, the route staff where they would meet to document or what have you. That's where their policies and procedures are. I want to say like their headquarters. Okay. And then from there, we will establish everything. They will help us set up home visits and we'll go out to the home visits, even in hospice, and oftentimes even for complaints, um, as needed and as necessary. And then we'll come back to the aid their agency, uh, their headquarters to chart, to review the records and things of that nature.

Anastasha Osborn 9:34

Okay. And so it sounds like there's a lot of traveling involved.

Yolanda Crosby 9:38

A lot.

Anastasha Osborn 9:39

So how often or how much time are you spending um, let's say in a week traveling?

Yolanda Crosby 9:44

Um, well, again, that varies uh because it if I'm in a particular area where an agency is located, I may be assigned there. And so that could be a half hour away from me, traveling back and forth four days a week. However, we survey the entire state of Michigan and the UP, Upper Peninsula. And so we do have a couple of surveys going on up there. That's an eight to ten hour drive where we will stay, there we'll be housed there, we'll have our hotels and everything there throughout that time. So it really does vary uh depending on where you're assigned.

Anastasha Osborn 10:20

Yeah. So I was gonna say it sounds like you guys, because of your type of work, you're more of that field staff where you're out there or community staff.

Yolanda Crosby 10:27

That's exactly what we're termed field staff.

Anastasha Osborn 10:29

Field staff. Okay. All right. So now when you're conducting these surveys, um, I mean you kind of walked through like the complaint process, and I think you did a phenomenal job explaining what that looks like. Um, but what you're looking for aside from like the complaint side of things, what are you actually looking for when you're going in for those surveys?

Yolanda Crosby 10:48

Again, the overall is to make sure that they are in compliance with the conditions of participation. And so for your understanding, we have what's called a state operations my uh state operations manual. We call it the Psalm. That is the surveyor's Bible, but it's public knowledge. Uh, if you're the administrator, once we do our entrance, we always ask if you have the most updated copy because it's no secret. If you're reviewing that and you stay in compliance with that, then you're in compliance with the conditions of participation. And so that's what we're holding the uh agency leaders accountable to. Uh there are different tags, their numbers. Uh, for example, G536 is the drug review, and so on uh on admission, um the agency is responsible for getting all of the patients' medications, herbal, over-the-counter, anything, and running them through a system to see if there are any untoward findings. If there are duplicate medications, serious drug findings or what have you, they're responsible to document that, to document those findings, and to um notify the physician accordingly. Now the physician is aware of what he or she prescribes. However, he or she may not be aware of the interactions that each medication would cause. And so the agency has a responsibility to notify that physician. From a surveyor standpoint, when I'm reviewing the record, I see that there are severe findings. Now I want to know if you notified the physician accordingly. If you didn't, then that's a potential um citation.

Anastasha Osborn 12:22

Okay. So what would you say is something about your job that most people would find surprising?

Yolanda Crosby 12:29

They wouldn't expect uh that we're essentially all on the same page. That we all want what's best for the patient. Uh we're all surveyors. When you think about it, we all go through and we look at records, uh, we monitor patients' health, and we we we're looking for the same things. And the the goal, the outcome is to make sure that that patient receives ultimate quality care.

Anastasha Osborn 12:54

Absolutely.

Yolanda Crosby 12:54

Um the other misconception, uh, if you will, is that we're there to close them down. The minute we walk in the building, there is uh a fear that I can't explain. And so I'm a people person, I'm a lover of people. I'm going to come in with a smile. They understand I have a job to do, but there is nothing in the regulatory language that says that I can't compliment you on the beautiful blouse that you have on. Or how are you today? or something like that. Break the ice and then you go on professionally with the survey process. So we're not there to close you down. We don't want that because ultimately that would affect the people we advocate for, which is the patients.

Anastasha Osborn 13:34

Yeah.

Yolanda Crosby 13:35

So we're there to support you. Our training is that we we're not supposed to coach, educate, teach, consult, but if I'm knowledgeable about something, I will tell you for all listening, I don't mind sharing something about what I know to help you grow to help the patients.

Anastasha Osborn 13:53

Absolutely. And that's the number one goal. Yes. So after doing this work for so long, um, do you feel like it's changed the way that you view healthcare in terms of how you approach it for yourself or for your family?

Yolanda Crosby 14:06

Um, I I still get I'm human. And so I still get very, very emotional about some of the things that I see. Uh I have to take a step back every now and again. I maybe walk out to my car uh to make sure that I'm uh maintaining objectivity uh so that I can approach it fairly. Um it makes me wonder um how everyone will be when no one is around, because a lot of the patients we service uh or we we advocate for don't have families. Uh they have guardians or DPOAs, durable power of attorney, and so there's no one up close and personal to sit by them to make sure they're receiving the services they should uh receive. So that's kind of um scary for me overall, and probably will always be because you wonder and you're concerned and you care about those who don't have. And so uh that will be a continuum. And so I'm grateful that there is a service such as ours because we will be that family that is not there to visit you. We show up randomly, uh, we go around, and I can't speak for what have what happens once we leave or what have you. Um, but for this entire time that we're here, uh you will know of our presence and uh you will be treated like the royalty that you are.

Anastasha Osborn 15:30

Yeah, that's so beautiful. And I think it's it's incredible too because you guys are there to protect them. And I think they see you come in, they may not have that same fear, you know, that the providers might have. Um, but I think it's wonderful to know that there are people like you who work in this field that want to take care of these people, that want to make sure that they are being taken care of, um, they're getting the highest quality of care that they can.

Yolanda Crosby 15:53

Absolutely.

Anastasha Osborn 15:54

Yeah. So let's say, for example, let's say you were to bring one of our listeners along with you just for a day in the life. Um, what part of your job do you think would surprise them then the most? What would be a surprise to them? Whether it's your drive-in, is it once you're at the facility, is it interacting with those individuals, the paperwork?

Yolanda Crosby 16:14

Uh the the good and bad. The the bad, if you will, for lack of a better word, uh, would be day one. Oftentimes thinking that it's smooth sailing. A lot of times day one is a complete and total wash trying to wait for the agency to give us uh EMR, electronic medical record access, uh, access to the physical charts, uh, establish home visits for us. Uh it's often viewed as a wasted day because a lot of times we're sitting there. There's nothing to really learn from day one. And so you pack your patients and you just uh start doing things that you can do. Uh, there are other tasks that we have to do. We have to review uh the admissions packet. So while I'm waiting, give me your admissions packet. While I'm waiting, let me see your emergency preparedness binder. That's something that all provider types have to be in compliance with so that in the event of an emergency, all staff will be hands up, boots on the ground, hands on deck, and you will know how to respond. So some things that we can look at while we wait. That's day one. The good part is when you go in and uh you meet these awesome patients. Uh that's the highlight for me. No matter what the scenario, no matter what the surroundings, all I see is is the patient. Uh we're shadowing the discipline, so the discipline is there. And oftentimes the discipline is nervous, and so I have a very silly, bubbly personality. I may be um looking at the photos on the wall, or I may see the little puppy that you've created uh because you knew I was coming. And I'm making side conversations only to make sure the discipline is calm, because if I'm just sitting there staring at him or her, they're gonna they're sure to make a mistake. And after that, uh I've not met a discipline who didn't say, Well, you know, Miss Crosby, that was thank you. That was nothing like what I would uh have expected and what have you. I think anyone shadowing me as I'm doing my job uh would find that most pleasing.

Anastasha Osborn 18:23

Yeah. Um, well, before we kind of close out, I just wanted to say, you know, for our listeners, if they are maybe listening in and they feel inspired to get into this field of work, um, what would you tell them about getting into this career and becoming a healthcare sur a healthcare surveyor themselves?

Yolanda Crosby 18:42

Make sure your heart is in taking care of people. If you're in it for uh the money, don't don't get in it.

Anastasha Osborn 18:51

Yeah.

Yolanda Crosby 18:51

Just just don't. There's too many other things that would would speak to your area of interest. Um but be in it because you want to make a difference. The other half of my paycheck, if I may, is the smile I see on that patient's face. Uh it is when I go back for a revisit after I've cited an agency heavily, and I go back for a revisit and I see all of the corrections. If I make a home visit and they tell me things are changed, uh that's that's the other half. Those are the extra benefits. So just get into it for the right reason.

Anastasha Osborn 19:25

Yeah, that's so beautiful. Well, thank you so much for being here. It's honestly was such a delight chatting with you, and you are a delight. You are such a little I mean, I wish everyone could see you because you are you're just this petite little thing, but you just radiate so much happiness and love and kindness. So I really appreciate you being here.

Yolanda Crosby 19:42

I appreciate you and I appreciate your time.

Anastasha Osborn 19:45

Yes, thank you. Well, that is all we have today. So, again, I just want to say to our listeners, um, hopefully you've learned something that this is a career maybe that you never knew about. You didn't know it existed. Um, but it definitely plays a really big vital role in protecting the health and safety of all Michiganders. So it's easy to take for granted. The systems that help ensure healthcare providers are delivering safe quality care. But again, as we learned today, there is a slew of dedicated teams of professionals who are working behind the scenes to make sure that that happens. So, to our listeners, we hope you enjoyed the special day in the life episode of the LARA Living Room podcast. If you like this format, please stay tuned. We may have more opportunities to introduce you to the incredible people and careers that make up LARA. As always, thank you for listening from our living room to yours. We'll see you next time.