Hospital revenue cycle VP on AR aging, staffing and other challenges

Jan 18, 2023 8:30:00 AM / by Aspirion

Excerpts from RCM Fireside Chat with Kimberly Scaccia, VP of Revenue Management at Mercyhealth Systems, and Ben Gleason, VP of Sales at Aspirion


What was the onset of COVID like as a hospital revenue cycle executive?


We had some major financial challenges. We were set to lose millions of dollars in one of our markets, and it would have been the first time and the 40-year history of mercy that had ever happened. I had to mobilize and figure out how to keep business going, very quickly. I had to decide how to keep the follow-up teams and the billing team rolling and not miss a beat. Oh, and by the way, deal with a pandemic, and either socially distance them or send them home–whatever the case may be. So, it was a huge challenge.

I look back every day and think, wow, we've done a lot. So, we had to top everything off, we had major technology challenges that we had to go through. We had to figure out how to get people access, and how to make sure they were doing the right things at the right time. And in all the years that I've been in revenue cycle, I have never walked into an organization and said, “You're understaffed,” ever—like it's never happened. When I came to Mercy, even before I accepted the role and did the analysis, I was like, it's like you have about a third of the staff that you need. We're six hospitals. We have 800 employees and physicians; it was a minimal staff. Basically, through the years of growth and mergers and acquisitions, and hiring new physicians, they just never added staff. They were just struggling tremendously and so we had some major challenges to get through for sure.


What were some of the things you did to create ways to deal with the staffing challenges?


The two biggest things that we made sure to do. The first was to add technology. We implemented an application that included exception-based workflows so that we could make sure that the right person was working the right account at the right time.

The second was to recruit right. But as you know, and as most people in the industry know, when you recruit somebody, there’s a lot of training and upskilling time that you have to go through. Additional support is super important and that was through a partner, or multiple partners, in some instances.

We needed to find a partner that could do some extended business office work for us. It was honestly, at that time, it was critical to our success. I don't even remember how bad the receivables were. I'm quite sure it was somewhere in the $35-40 million range that we utilized an extended business office via Aspirion [formerly ARx]. We had to have staff who were ready to hit the ground running, not people that I had to train. I needed people who knew Medicare and new Medicare HMO and new Blue Cross and to just jump in and start working and help us with this massive backlog of receivables. Honestly, I don't think we would be where we are today had that not happened.


To accommodate your staffing challenges, did you have to change your model? Did you approach the whole model? Or did you keep your staff mostly on-site?


It's really interesting for us because we did not have the technology infrastructure to send people home. It took us several months to get there. We had partners using remote desktops and we even had some partners that in the beginning were using their own equipment—remoting to the Citrix connection and getting through applications so we had some major challenges there. We've changed since and most of my staff is hybrid.

My coding staff is in a hybrid model as well as my billing collections department. We’ve transitioned to a hybrid program and are actively working on getting full remote based on a specific role. But the nice thing was, again, as we think about some of the things that we did over there that year-long year and a half, and 2020, and into 2021, is when we use our extended business office through Aspirion [formerly ARX]. They worked as our employees, and we made sure to send them the data.

But if we had processes that needed to be done in our host systems, the extended business office does it in the host system, just like if they were sitting in the office, or one of my partners working from home.

And again, it's critical to our success, because we have to ensure we're working together to reach the same goal—regardless of the team. As we started thinking about an extended business office, that was the number one priority for me, we were limited on resources and couldn’t spend an exorbitant number of resources either.


I recently had the opportunity to listen to you speak in Georgia. You stated something I found extremely interesting—that employers are no longer choosing their employees but instead employees are choosing us. Has that belief amended your approach to bringing on new talent to join you at Mercyhealth?


It's really interesting. As we've gone through interviews, I asked my questions as one does during the introduction, but my typical statement has been modified. My typical statement to anyone I'm interviewing is, “look, I know what the workforce is like, I know that you can go anywhere. Tell me what you're looking for and ask questions. You're interviewing me just as much as I'm interviewing you.”

I collaborate with my team extensively on retaining the employees we have. My number one goal is to be in a workplace where people want to come to work. I want people that want to be here. I want them to feel valued. I want them to feel innovative. I want them to feel appreciated.


During that same panel discussion, you also mentioned something else that intrigued me. You were talking about the standpoint that we teach our employees how to do a specific job, but we don't teach them how to work from home. It’s not only about education, but as you pointed out—something that we don't talk about a lot as an industry as we've moved to this remote workforce— the mental health toll that it typically takes on an employee. Is that accurate?


It's very accurate. I do multiple meetings throughout the month. I do what we call rounding with individual departments. I do it with all of my leaders, supervisors, and above. And every month, we're talking about different things. Recently, we were talking about burnout—it goes directly to your question because we had some major challenges when we went to the hybrid program because we had people that were signing in all hours of the day and night, answering emails at two and three o'clock in the morning.

We had to put some guardrails in and at first people were pretty upset about it. But as we started to go through the process and talk to our leaders, we talked about the worst thing we can do is have someone who can't disconnect. I'm very blessed. I have an office in my home, my children are grown so I have an extra bedroom. You know, not everybody has that. Some people are working in, you know, an actual bedroom and so they have a door, and some people might be working at a table in their dining rooms. And we have to encourage people to disconnect to make sure that they're making time for themselves and their families because otherwise, honestly, they'll go somewhere where it is a priority. Just like in any great relationship, it all boils down to communication.


Is there anything that you have specifically done to keep that communication open with your staff and just being an open door or resource for them?


All of my staff, over 500 of them have my cell phone number. They all know they can text call or email me anytime. I have what's called VP luncheons and so those lunches are only allowed for staff members. No management is allowed to attend so that they can feel comfortable about what they want to talk about. They can talk about anything—their dog or cat, or they can tell me how much they don't like their manager or whatever. I make it a point to be as available as I can for them because I learn a lot by listening to them. And generally, most people want to do a good job. They have great ideas, so I stay available.


It's a great thing, especially in today's environment. So, for those who may not have experience with outsourcing, what do you look for in a partner and company?


Obviously, the cost is number one, but that's everywhere, right? So, we got to make sure we get the best bang for our buck. But really, and truly, what we were specifically looking for was someone who could not only help us work accounts but help educate and make us better. And by that what I mean is, anybody who has been in revenue cycle for any period knows that there are challenges, right? You get a new electronic health record upgrade, and something breaks; you put a new contract in your system, and something now all of a sudden doesn't write off correctly as expected.

We were looking for a partner who would collaborate with our team continuously—not let's do it once a month or whatever. A partner who would literally meet with us, as often as we wanted to talk about what is being found, where trends are, what system issues that need fixing, and potentially help educate some of our newer staff on some of the processes. This is where Aspirion shines more than anybody that I've ever worked with.

I remember in the early stages; we went live in May of 2020 if memory serves me right. In the very early stages, we were meeting every single week. We had issue logs. We were talking about the things we were finding. We were having open discussions about what was going on, and asking do you know this is happening—is it a system problem, or do we need to involve IT? We had another organization that was working with some of our physician receivables, and that didn't happen.

It’s extraordinarily important because not only was Aspirion helping us clean up the backlog, but they were helping us get better for the future. It's been a great journey! I don't think that the Mercyhealth revenue cycle would have been able to get where we are today. We're hitting our cash targets—we just blew it out of the water. We ended our fiscal year—we reduced our days in AR by 34 days, in one year, that's unbelievable.


Is there any advice you would give to someone new to their position from a management or leadership perspective not only from your experiences but as we continue to change to a new remote or model staffing model?


There are several things that I think leaders in general need to be super hyper-aware of.

 Tell me how I can

I tell my staff this all the time, don't tell me why, tell me how I can. That is the biggest thing we talked about because the revenue cycle is the dumping ground— it always has been right, whatever the front end does it's our problem to fix it and get it out the door and get paid for it. But that doesn't mean that you're chained to not making improvements. So, we do a lot of work to bridge the gap between clinical IT and revenue, IT and billing and talk through the appropriate terminology to fix some of that. Tell me how I can, that's the big thing.

Always look at a process with fresh eyes

Step back away from what you know and look at a process with fresh eyes. Think outside the box so you can find the solutions.

Read everything you can about recruitment

Read about recruitment. It doesn't even matter if it's the healthcare industry. You may be competing with Chick-fil-A—a brand new Chick-fil-A that opens near one of your hospitals. They're paying $1 more an hour, so I have to figure out how do I recruit those people and make sure that they're happy, which is a big challenge.

Focus on employee engagement

It's a new world that we're in. We have to start considering our staff and everything that we do. Whether that means that you've got to teach your leaders how to have a hybrid environment or recognize when your staff is about to burn out and get a partner—such as Aspirion—to help to relieve some of the burdens. You have to be aware of what's going on. Without that, you're going to be in a vicious cycle of losing staff, then recruiting staff and training staff. And let's be honest, our staff is our number one most important commodity that we have.

To learn how Aspirion can augment your revenue cycle management team, contact us today! 


Tags: Staff Training, Revenue Cycle Management


Written by Aspirion

Since 2008, Aspirion has offered a growing array of RCM services for hospital, health systems, and large physician groups looking for better results in managing their most complex reimbursements. Aspirion has been and continues to be a trusted partner to many of the most prominent providers in the U.S.