Mercyhealth's Kimberly Scaccia on her top revenue cycle strategies for 2021, what keeps her inspired

Kimberly Scaccia began as vice president of revenue cycle at Mercyhealth last March, and she has helped the health system navigate the COVID-19 pandemic, while striving to motivate, inspire and listen to members of her team.

Before joining Mercyhealth, she was director of the healthcare practice at Baker Tilly, a national management consulting firm, and she also was a manager in healthcare at KPMG.  

Early in her career, Ms. Scaccia worked at Roseville, Calif.-based Adventist Health and Halifax Health in Daytona, Beach, Fla.  She has more than two decades of experience in healthcare and technology services.

Ms. Scaccia told Becker's Hospital Review she's focused this year on technology, analytics and building her revenue cycle leadership team. She shared the challenges she faces as a female leader, how she stays inspired and her 2021 daily mantra.

Editor's note: Responses were lightly edited for length and clarity.

Question: Who had the biggest influence on your decision to go into healthcare?

Kimberly Scaccia: I was a paralegal/legal assistant in my 20s. I got tired of working for law firms and landed a job as a legal assistant inside a hospital. That small system got acquired by Adventist Health, and of course, when that happened, they did not need in-house legal counsel anymore. They said, "Here is your choice of positions." One thing led to another, and I started working for the chief nursing officer and the chief financial officer. That is really what began my career in healthcare. I loved what I did as an assistant, but I had a revenue cycle director who saw something in me and encouraged me to go back to school. He recruited me into a technology coordinator position and made me stretch my abilities. He always told me with enough time and money anything is possible.  His name was Dan Wolcott, and he would be the one who made me see my potential in healthcare and started me down my career path.

Q: What is the greatest challenge you face as a female leader?

KS: For about nine or 10 years in my career, I always felt like I could say something, and a man next to me could say the same thing, and his opinion would be taken at face value more than mine. It was a true struggle. And it isn't until the past two years or so that my challenges were very different. Part of this was my own self-awareness. Moreover, here at Mercy, though, we have numerous women leaders. I had not experienced that anywhere else.  Having a lot of women in leadership, we're all strong, educated, and of course, opinionated.  This last year my challenge has been to take it all in, to become even more self-aware of how I am perceived and ensure that I don't overpower anyone else simply because I am pushing what I believe. Sometimes we have to agree to disagree, and really learn to listen with open ears and minds to all opinions to ensure we come to the right decision for the organization.  

Q: How do you stay inspired on hard days?

KS: I had a wonderful opportunity to take a course with national speaker and motivator Michael Allosso. His mantra that day was that as a leader, you are always on stage. For me, staying inspired means I always have to remember I'm always on stage, regardless of how I feel, regardless of what happened yesterday, last night or this morning. It is my job to be inspired to keep my team motivated too — even when the days are long and hard, and we don't hit the cash goal — to lift them up and talk about the good things and how we are going to make it. For me, staying inspired may be a book, it may be meditation, but most of the time, I stay inspired  knowing I am the one who has to keep that team motivated and moving.

Q: What is your daily mantra?

KS: In 2021, my daily mantra is, "My breath is my anchor, my anchor is my breath." I do a lot of yoga, and I have found a peace, serenity and a quiet mind in breathing and taking the time to listen. It goes back to the idea of being able to not only feel inspired but be inspiring.

Q: Hospitals are now required to post standard charges, including payer-specific negotiated rates, for 300 services online. How have you prepared?

KS: The challenge is that we have an extraordinarily large EHR, and they were not ready, so we had to utilize an external vendor for a lot of things. We've done a lot of training, a lot of testing, and we've also done a lot of complaining to our electronic health vendor about the applications not working. I've said from day one this is another example of the government putting undue administrative burdens on hospitals and healthcare systems for no value. The only people who are going to get value out of this are the insurance companies. They're the only ones who are going to win anything out of this because a patient first is going to go where their doctor tells them to, and second, if they are shopping for services, they are going to call. Even with the information online, as an estimate, it clearly states that a patient should call.  We cannot give a patient an accurate estimate without validating and verifying everything, and patients don't know how to do that. 

Patients don't know how to tell us if they are in a managed care plan PPO plan or if they have met their deductible requirements. We at Mercy have done everything we can to prepare for it. We're in Illinois and Wisconsin, so we've stayed in contact with the Illinois and Wisconsin hospital associations as well. We have a large group of IT folks who have been involved with the Epic application all year and who honestly are some of the best IT people I've ever worked with. We're in compliance, but it's one of those things I think will sit out on our website, with very few hits, and is going to be a waste of time, resources and money.   

Q: Have you seen more use of charity care funds during the pandemic due to unemployment/people losing insurance with their jobs?

KS: Absolutely. It's somewhat tapered off in the last two months because people are getting back to work, but we worked very hard in the beginning of the pandemic. We have two trauma centers, so if a patient had a major trauma incident, and say they lost their job three weeks ago, we had ability to work through different programs to pay for the Cobra health insurance, which would pay for their healthcare. We've worked to streamline our charity care processes. One of our facilities is in a high Medicaid utilization area, so we worked hard in the early months of the pandemic to ensure we were proactively looking at accounts that maybe didn't have coverage or had high amounts due on their accounts and reaching out to patients and talking about different options. We even hired a Medicaid eligibility vendor so we could keep up with those volumes in that location. Those patients who did lose their jobs and Medicaid was an option, that vendor could then assist them to get all the paperwork completed in Illinois.

Q: What are your top revenue cycle strategies for 2021? 

KS: My No. 1 strategy is to continue to bring in the technology we need to be a high-performing organization. When I first got here, there were a lot of things that were not being done. And as I started to dig in, I found out that as the hospital systems merged over the last several years, and merged their electronic health records,during that process, decisions were made to not do things from a technology perspective,simple things, like having a paper process for all the charity care applications and not having it scanned into the system. A lot of the Epic modules that are available from a technology perspective that really sort of move you into next level of performance were not installed here from a revenue cycle perspective. So, we've done some of that groundwork in 2020, and already in 2021, we're bringing in two new Epic applications 

Along that same pathway, from a strategic perspective, is the analytics. The one challenge a lot of organizations face is a lot of places have a piece of the puzzle. We can see a piece of our revenue cycle in our EHR. We don't see everything that happens on the front, or all the time that goes in from a time and attendance perspective. We don't have the ability to track costs due to additional ancillary systems. So, we're putting a lot of time and energy — not only from a revenue cycle perspective, but from an overall organizational finance perspective — into analytics. We're going to be looking outside our electronic health record and bringing in all systems so we can get a good picture of our performance.

Also, but not least, growing and building my leadership team. I joined Mercy in March at the beginning of 2020, right at the beginning of the pandemic. My leadership team has completely changed. There are only two directors in the entire almost 500-employee revenue cycle team who are the original leaders. And even those two are in new roles. So, this year for me, building that leadership team and building that inspiration and that ability to be on stage and motivate our teams and build up our staff so they want to be part of a high-performing organization, for me, personally, that is one of my personal goals for 2021.


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