Latest / Becker’s Healthcare Podcast / Navigating Rural Hospital Finance and Revenue Integrity at Opelousas General with Shelly Soileau

Transcript

Navigating Rural Hospital Finance and Revenue Integrity at Opelousas General with Shelly Soileau · Becker’s Healthcare Podcast

• 0:00
  This is Madeline with the Becker CFO and
• 0:02
  revenue cycle podcast, and I'm excited to be
• 0:04
  joined today by Shelly Swalew, CFO of Opelousa
• 0:08
  General Health System. Shelly, thanks for joining me.
• 0:11
  Hi. Thanks for having. It's good to be
• 0:13
  back and speaking with you again. I know.
• 0:15
  I'm so excited for us to chat again.
• 0:17
  It feels like it's been forever, but great
• 0:19
  to have you on the podcast.
• 0:21
  Shelly, before we, keep things off, do you
• 0:23
  mind sharing with our listeners just a little
• 0:26
  bit about yourself, your background, and more on
• 0:28
  Opelousas General?
• 0:30
  Sure.
• 0:31
  I have been with Opelousas General the last
• 0:34
  two years. It's been a fast and furious
• 0:36
  two years, but I've been in health care
• 0:38
  for twenty plus years
• 0:40
  in various roles. I actually started my health
• 0:43
  care career as a Medicare biller slash accountant.
• 0:46
  So I have that revenue cycle background
• 0:49
  as well as the accounting background with me.
• 0:51
  Our facility is a 171
• 0:53
  beds, and we are in Central Louisiana, so
• 0:57
  right in the middle of the state. We're
• 0:58
  kinda like a catchall for some of our
• 1:00
  rural areas that are around us.
• 1:03
  We provide a ton of services,
• 1:06
  ortho, spine,
• 1:07
  pulmonology,
• 1:08
  oncology,
• 1:09
  inpatient
• 1:10
  psych, OB, nursery,
• 1:13
  sleep, cath lab, cardiac rehab, wound care, outpatient
• 1:16
  infusion, as well as all the typical
• 1:18
  hospital services,
• 1:20
  that a hospital
• 1:22
  offers.
• 1:23
  Wonderful. Thank you for sharing. So fair to
• 1:25
  say you guys are busy.
• 1:27
  Yes. Very.
• 1:28
  Well, Shelley, the last time we talked,
• 1:31
  it was actually right after you had started
• 1:33
  your role at Opelousas General. So
• 1:36
  it's been a little bit of time, but
• 1:38
  the last time we did chat, you mentioned
• 1:40
  that patient transportation
• 1:42
  was a glaring issue, particularly
• 1:44
  with your,
• 1:45
  low income elderly population.
• 1:47
  So I wanted to just kind of kick
• 1:49
  things off by checking in to see maybe
• 1:51
  some trends that you're currently following right now.
• 1:53
  Is this still something that's top of mind
• 1:55
  for you?
• 1:56
  You know, what are you looking at from
• 1:58
  the finance lens?
• 1:59
  Yes. Transportation
• 2:01
  is still an issue, and I think it's
• 2:03
  it's very much going to continue to be
• 2:05
  an issue in rural Louisiana because our patients
• 2:08
  either
• 2:09
  don't have transportation
• 2:11
  or don't have family available to them to
• 2:14
  transport them. And I had a great example
• 2:16
  this week. We had a patient
• 2:18
  being discharged to a hospice
• 2:21
  or to hospice, you know, to his home,
• 2:24
  and he had no family.
• 2:26
  He had, he had arrived to the hospital
• 2:29
  via ambulance,
• 2:30
  but
• 2:31
  didn't have a family. We attempted to contact
• 2:34
  the Medicare Advantage Plan that had transportation.
• 2:37
  They said they were coming, then suddenly dropped
• 2:40
  off and wouldn't contact us back. So we
• 2:42
  were about to spend the money to send
• 2:45
  him home in an ambulance
• 2:46
  again because we can't keep him.
• 2:49
  But luckily, the the Medicare Advantage company did,
• 2:52
  in fact, get back in touch with us,
• 2:54
  and we saved that ambulance cost.
• 2:56
  But particularly with our psych patients too, they
• 3:00
  they are discharged and have no way
• 3:03
  of getting home. So we're getting Uber rides
• 3:05
  and taxi rides, or we even call the
• 3:07
  local police
• 3:08
  department to see if they will help us
• 3:10
  bring them there.
• 3:11
  It's it's quite
• 3:13
  common.
• 3:14
  We are talking with the state. I know
• 3:16
  there are Medicaid
• 3:17
  transportation companies. We utilize them as much as
• 3:20
  possible,
• 3:21
  and we're looking for other companies that we
• 3:24
  could use at a reasonable rate,
• 3:27
  to help us with the situation. You know,
• 3:29
  the ambulance companies are not the way to
• 3:31
  go in in some of these scenarios. So
• 3:33
  it's definitely top of mind and, something that
• 3:36
  we're continuing to look at and work on.
• 3:39
  Wow. What an example. I really appreciate you
• 3:41
  sharing that, and I'm sure that that will
• 3:42
  resonate with with many of our listeners, particularly
• 3:45
  in maybe some local areas.
• 3:48
  Are there any other trends that you're keeping
• 3:50
  a close eye on right now,
• 3:51
  just as we are now full swing into
• 3:53
  2026?
• 3:55
  Yes. Definitely. The biggest,
• 3:57
  trend and shift I'm watching is payer behavior
• 4:00
  and reimbursement.
• 4:03
  In our area, we don't have the volume
• 4:05
  or payer leverage to absorb swings
• 4:08
  like some of our larger systems can. So
• 4:11
  a small change in denials,
• 4:13
  a small change in a managed
• 4:15
  managed care policy, or or overall reimbursement rules
• 4:19
  can move our margin very quickly.
• 4:21
  So on a day to day basis, we
• 4:23
  are focusing on our denials and medical necessity
• 4:27
  scrutiny,
• 4:28
  specifically around the MUE edits and any other
• 4:31
  payer edits we can.
• 4:33
  One payer tightening that up can certainly create
• 4:36
  a a quick cash crunch for us, so
• 4:38
  that is crucial in our in that department.
• 4:42
  We're also focusing
• 4:44
  on Medicaid
• 4:45
  and the Medicaid exchange program. Here in Louisiana,
• 4:48
  UHC is no longer one of our managed
• 4:50
  care contractors,
• 4:52
  so all of our patients are having to
• 4:53
  select a different
• 4:55
  coverage.
• 4:56
  And that's that's causing uncertain uncertainty
• 5:00
  as far as
• 5:01
  if the payer is going to sign up,
• 5:03
  if it's going to turn into a charity
• 5:05
  care or uncompensated
• 5:07
  care type of scenario.
• 5:09
  And always workforce cost is always something that
• 5:13
  we're keeping our eye on to try and
• 5:15
  ensure that we can recruit locally or as
• 5:18
  local as possible, but not
• 5:20
  spend an absorbent amount of money on recruiting
• 5:23
  those nurses or clinicians.
• 5:26
  Right. And with all of these unknowns and
• 5:28
  just everything you just detailed to me, how
• 5:30
  do you and your finance team really sit
• 5:32
  back and and try to come up with
• 5:34
  solutions? You know, I know that
• 5:36
  no one has a crystal ball and there
• 5:38
  are so many what ifs, but what are
• 5:40
  some ways that you guys are really working
• 5:41
  together to try to attack to try to
• 5:42
  tackle these issues?
• 5:44
  Well, I just hired a really stellar revenue
• 5:47
  cycle director who is helping us in the
• 5:50
  denial and medical necessity scrutiny quite a bit
• 5:53
  and uncovering a lot of opportunity there. So
• 5:56
  we're
• 5:57
  we've added some capabilities
• 5:59
  within our software system to give us better
• 6:02
  data to analyze trends as far as denials
• 6:05
  and things like that go so that we
• 6:07
  can
• 6:08
  try to get ahead of it and and
• 6:11
  get the reimbursement that we actually
• 6:13
  deserve and performed.
• 6:16
  But our team is always in data.
• 6:18
  It's it's important. Data tells the story. It
• 6:21
  all it doesn't tell the whole story, but
• 6:22
  it always gives you a picture of what's
• 6:24
  happening in your organization.
• 6:26
  So,
• 6:27
  our team is always looking at service lines.
• 6:30
  What are their what are their margins looking
• 6:32
  like, and where can we squeeze out a
• 6:34
  little bit more there without harming patient care
• 6:38
  or or cutting anything important to the patient,
• 6:41
  but that would help us
• 6:42
  increase, you know, overall profitability.
• 6:45
  Right. It sounds like you guys are really,
• 6:47
  you know, keeping your eye on the ball,
• 6:48
  so that's good.
• 6:50
  I wanna shift gears a little bit, Shelley,
• 6:52
  and ask you where you're looking at maybe
• 6:53
  some of the biggest opportunities for smart growth
• 6:56
  this year. Is anything come to mind when
• 6:58
  you think of that or,
• 7:00
  any partnerships,
• 7:02
  acquisitions? What's that look like to you this
• 7:04
  year?
• 7:05
  So for us, smart growth is more about
• 7:08
  stabilizing our margin and access to care more
• 7:11
  than chasing, you know, shiny expansion. But we
• 7:14
  do have some things in the works that
• 7:16
  we are
• 7:17
  looking at, with regard to
• 7:20
  additional,
• 7:22
  reimbursement, I should say. We are looking at
• 7:24
  the possibility of a level two NICU at
• 7:27
  our South Campus.
• 7:28
  We've also we were the first
• 7:31
  ones in the state to just utilize some,
• 7:34
  apple it's AppleCore. It's wound care technology
• 7:38
  where,
• 7:38
  the patient you take fat cells from the
• 7:41
  patient
• 7:42
  and retake
• 7:43
  a picture of it. I'm not saying it
• 7:45
  right because I'm not clinical. But it basically
• 7:48
  takes a person's cells, takes a picture of
• 7:50
  it, and then you
• 7:52
  it molds the cells a certain way. You
• 7:54
  put it in the wound, and it's supposed
• 7:56
  to heal the wound faster. And we did
• 7:58
  our first patient,
• 7:59
  I think, three weeks ago, and he is
• 8:01
  doing exceptionally well. And there is reimbursement from
• 8:04
  the Medicare side. It was just FDA approved,
• 8:07
  I believe, early this year or last year.
• 8:09
  So we are really hoping to expand that
• 8:11
  where we can.
• 8:13
  But overall,
• 8:14
  revenue integrity
• 8:15
  this year is our growth strategy.
• 8:18
  Tightening on our charge capture,
• 8:20
  our our clinical documentation,
• 8:22
  obviously,
• 8:23
  medical necessity edits and workflows, and front end
• 8:26
  authorizations,
• 8:27
  That's the easiest
• 8:29
  new revenue
• 8:30
  that we can capture
• 8:32
  that we've already earned, but we just haven't
• 8:35
  collected it efficiently historically.
• 8:38
  Right. Wow. It is so interesting to hear
• 8:40
  that example you shared, just with the technologies
• 8:43
  that are coming out. I mean, isn't it
• 8:44
  just fascinating?
• 8:46
  It it is. It was I I wanted
• 8:48
  to be in the procedure, but, obviously, I
• 8:50
  couldn't.
• 8:51
  But it is it is really we are
• 8:53
  very excited about it.
• 8:55
  It it's it's going to help our patients
• 8:57
  tremendously. And we do have a lot of
• 8:59
  wound care in this area with diabetes and
• 9:01
  things like that.
• 9:02
  Yeah. No. And I mean, just think where
• 9:04
  we'll even be in the next three to
• 9:05
  five years. So that's a great example.
• 9:08
  To kind of wrap us all up here,
• 9:09
  when you think about, like, maybe a mindset
• 9:12
  that CFOs really need to hone in on
• 9:14
  this year just to navigate some of the
• 9:16
  industry uncertainties,
• 9:17
  what what what should that specific mindset be?
• 9:20
  Where do you think CFOs need to be
• 9:22
  focused?
• 9:23
  I would say
• 9:25
  calm
• 9:26
  urgency
• 9:27
  with intentional
• 9:29
  database decision making.
• 9:31
  And the reason I say calm urgency is
• 9:34
  because everyone looks to the CFO
• 9:37
  and the CEO. But they they look to
• 9:39
  us, they gauge our reactions, and and they
• 9:41
  gauge our
• 9:43
  our, I guess, mood in that day. And
• 9:45
  then if the CFO is nervous or or
• 9:49
  showing
• 9:50
  anxiety about something, then the whole hospital, it
• 9:53
  it it penetrates down.
• 9:55
  So always,
• 9:57
  you know, my my philosophy is my my
• 10:00
  very close leaders always know when I'm nervous,
• 10:02
  but calm urgency with decision data making. It
• 10:05
  allows teams
• 10:06
  to know that I'm here for them. I'm
• 10:09
  gonna give them the truth. I will always
• 10:11
  give them the facts. And I will name
• 10:13
  the facts, and then we'll outline our next
• 10:15
  steps on how to address things and improve
• 10:18
  our our financials.
• 10:19
  So my mindset is operate like capital is
• 10:23
  is expensive, but our margin is fragile always
• 10:25
  because health care changes
• 10:27
  so quickly.
• 10:29
  And we, you know, obviously always make decisions
• 10:32
  based on ROIs and that kind of thing.
• 10:34
  But mindset is important because it it sets
• 10:38
  the tone for the rest of the hospital.
• 10:40
  So I try to always be calm, but
• 10:43
  urgent and intentional
• 10:45
  when making decisions.
• 10:47
  Oh, calm urgency. I feel like that's something
• 10:49
  that could, you know, span across
• 10:51
  all types of roles in industry. So Yeah.
• 10:53
  Some very good advice there, Shelley. Well, Shelley,
• 10:56
  again, I wanna thank you so much for
• 10:57
  joining me. It's been such a pleasure to
• 10:59
  connect with you again,
• 11:01
  and kind of break down some of the
• 11:02
  things going on right now in the industry.
• 11:04
  But, really appreciate it, and I look forward
• 11:06
  to connecting with you again soon. It was
• 11:09
  great. Thank you for having me again.