Navigating Rural Hospital Finance and Revenue Integrity at Opelousas General with Shelly Soileau

Summary

Podcast Summary: Navigating Rural Hospital Finance and Revenue Integrity at Opelousas General with Shelly Soileau

Becker’s Healthcare Podcast | April 11, 2026
Guest: Shelly Soileau, CFO of Opelousas General Health System
Host: Madeline, Becker’s Healthcare

---

Overview

In this insightful episode, Madeline welcomes back Shelly Soileau, CFO of Opelousas General Health System, to discuss the unique financial and operational challenges facing rural hospitals in Louisiana. The conversation explores persistent obstacles such as patient transportation, payer trends, workforce issues, and innovative strategies for revenue integrity and smart growth. Shelly offers a transparent, actionable perspective shaped by her extensive healthcare finance background.

---

Key Discussion Points and Insights

1. Background on Opelousas General (00:30)

• Shelly highlights her 20+ years in healthcare finance, starting as a Medicare biller accountant.
• Opelousas General: a 171-bed hospital in central Louisiana, serving as a critical access point for surrounding rural communities.
• Broad spectrum of offered services: “Ortho, spine, pulmonology, oncology, inpatient psych, OB, nursery, sleep, cath lab, cardiac rehab, wound care, outpatient infusion...” (00:41)

---

2. Ongoing Challenges in Patient Transportation (01:28–03:39)

• Persistent transportation barriers for low-income, elderly, and psychiatric patients.
• Reliance on ambulance rides, inconsistent responses from Medicare Advantage transportation providers, and alternative solutions like Ubers, taxis, or even local police.
• Memorable moment:

  “We had a patient being discharged to hospice… he had no family… We attempted to contact the Medicare Advantage plan that had transportation. They said they were coming, then suddenly dropped off and wouldn’t contact us back… Luckily the Medicare Advantage company did get back in touch with us and we saved that ambulance…”
  — Shelly Soileau (02:09)

• Active discussions with state and local transportation companies to find sustainable, affordable options.

---

3. Financial Trends and Payer Behavior (03:39–05:26)

• Heightened focus on payer behavior and reimbursement due to the hospital’s vulnerability to small policy shifts.
  • “A small change in denials, a small change in a managed care policy… can move our margin very quickly.” (04:10)
• Denials and medical necessity scrutiny are daily priorities, especially with MUE edits and payer policy changes.
• Medicaid exchange volatility:
  • UHC exiting as a managed care contractor, leading to patient uncertainty and potential increases in uncompensated/charity care.
• Workforce cost containment:
  • Ongoing need to recruit locally without overspending.

---

4. Data-Driven Solutions and Teamwork (05:44–06:45)

• Hiring of a new revenue cycle director to address denials and identify process improvements.
• Upgrade of software systems to analyze denials and reimbursement trends more effectively.
• Data analytics drive decision-making:

  “Data tells the story. It doesn’t tell the whole story, but it always gives you a picture of what’s happening in your organization.”
  — Shelly Soileau (06:08)

• Focus on service line margins to find revenue opportunities without compromising patient care.

---

5. Smart Growth and Innovation (07:05–08:38)

• Smart growth emphasizes margin stabilization and care access over expansion.
• Consideration for a Level 2 NICU at the south campus to enhance offerings.
• Pioneering wound care technology:
  • First in Louisiana to use “applicor” technology—patient’s own fat cells are molded and inserted in wounds for faster healing.

  “We did our first patient, I think, three weeks ago, and he is doing exceptionally well. And there is reimbursement from the Medicare side. It was just FDA approved…”
  — Shelly Soileau (07:41)

• Broader revenue integrity strategy: charge capture, documentation improvement, medical necessity, front-end authorizations—“the easiest new revenue we can capture, that we’ve already earned, but we just haven’t collected it efficiently historically.” (08:27)

---

6. Essential CFO Mindset for 2026 (09:23–10:47)

• Shelly advocates for a mindset of “calm urgency with intentional data-based decision making.”
  • Key quote:

    “Everyone looks to the CFO and the CEO, but they look to us… If the CFO is nervous… it penetrates down [throughout] the hospital.” (09:33)

  • Balance between being honest, fact-focused, and setting a stable organizational tone.
• Operate as if capital is expensive and margins are fragile:

  “Healthcare changes so quickly… I try to always be calm but urgent and intentional when making decisions.”
  — Shelly Soileau (10:37)

---

Notable Quotes & Memorable Moments

• “Ambulance companies are not the way to go in some of these scenarios.” (03:21)
• “A small change in denials… can move our margin very quickly.” (04:10)
• “Data doesn’t tell the whole story, but it gives you a picture of what’s happening.” (06:08)
• “We were the first ones in the state to use… wound care technology… Our first patient is doing exceptionally well.” (07:41)
• “Operate like capital is expensive, but our margin is fragile, always.” (10:11)
• “Calm urgency… that’s something that could span across all types of roles.” — Madeline (10:47)

---

Timestamps for Key Segments

• 00:30 — Shelly’s background and overview of Opelousas General
• 01:28 — Transportation challenges for rural/elderly patients
• 03:39 — Current finance and reimbursement trends affecting rural hospitals
• 05:44 — Data-driven approaches and new team leadership
• 07:05 — Smart growth strategies and new clinical innovations
• 09:23 — The CFO mindset needed for 2026’s healthcare landscape

---

Takeaways

Shelly Soileau’s conversation offers an inside look at how rural hospitals are adapting to rapid changes in finance, payer relationships, regulation, and care access. Her pragmatic, data-driven approach—combined with sincere leadership—illustrates both the complexity and resilience of rural healthcare systems in today’s challenging environment.

Transcript

[A]

This is Madeline with the Becker CFO and Revenue Cycle Podcast and I'm excited to be joined today by Shelley Swallow, CFO of Appaloosa General Health System. Shelley, thanks for joining me.

[B]

Hi, thanks for having. It's good to be back and speaking with you again.

[A]

I know. I'm so excited for us to chat again. It feels like it's been forever, but great to have you on the podcast. Shelly, before we kick things off, do you mind sharing with our listeners just a little bit about how yourself, your background and more on Appaloosa General?

[B]

Sure. I have been with Appaloosa General the last two years. It's been a fast and furious two years. But I've been in healthcare for 20 plus years in various roles. I actually started my healthcare career as a Medicare biller accountant. So I have that revenue cycle background as well as the accounting background with me. Our facility is 171 beds and we are in central Louisiana, so right in the middle of the state. We're kind of like a catch all for some of our rural areas that are around us. We provide a ton of services, ortho, spine, pulmonology, oncology, inpatient, psych, ob, nursery, sleep, cath lab, cardiac rehab, wound care, outpatient infusion, as well as all the typical hospital services that a hospital offers.

[A]

Wonderful. Thank you for sharing. So fair to say you guys are busy.

[B]

Yes, very.

[A]

Well, Shelly, the last time we talked it was actually right after you had started your role at Opelousis General. So it's been a little bit of time. But the last time we did chat, you mentioned that patient transportation was a glaring issue, particularly with your low income elderly population. So I wanted to just kind of kick things off by checking in to see maybe some trends that you're currently following right now. Is this still something that's top of mind for you? You know, what are you looking at from the finance lens?

[B]

Yes, transportation is still an issue and I think it's very much going to continue to be an issue in rural Louisiana because our patients either don't have transportation or don't have family available to them to transport them. And I had a great example this week. We had a patient being discharged to a hospice or to hospice, you know, to his home. And, and he had no family. He had arrived to the hospital via ambulance but didn't have a family. We attempted to contact the Medicare Advantage plan that had transportation. They said they were coming, then suddenly dropped off and wouldn't contact us back. So we were about to spend the money to send him home in an ambulance again because we can't keep him. But luckily the Medicare Advantage company did in fact get back in touch with us and we saved that ambulance, but particularly with our psych patients too. They are discharged and have no way of getting home. So we're getting Uber rides and taxi rides or we even call the local police department to see if they will help us bring them there. It's quite common. We are talking with the state. I know there are Medicaid transportation companies. We utilize them as much as possible and we're looking for other companies that we could use at a reasonable rate to help us with the situation. You know, the ambulance companies are not the way to go in some of these scenarios. So it's definitely top of mind and something that we're continuing to look at and work on.

[A]

Wow, what an example. I really appreciate you sharing that and I'm sure that that will resonate with many of our listeners particularly and maybe some more rural areas. Are there any other trends that you're keeping a close eye on right now, just as we are now full swing into 2026?

[B]

Yes, definitely. The biggest trend and shift I'm watching is payer behavior and reimbursement. In our area we don't have the volume or payer leverage to absorb swings like some of our larger systems can. So a small change in denials, a small change in a managed managed care policy or our overall reimbursement rules can move our margin very quickly. So on a day to day basis we are focusing on our denials and medical necessity scrutiny specifically around the MUE edits and any other payer edits we can one payer. Tightening that up can certainly create a quick cash crunch for us. So that is crucial in that department. We're also focusing on Medicaid and the Medicaid exchange program here in Louisiana. UHC is no longer one of our managed care contractors. So all of our patients are having to select a different coverage and that's causing uncertainty as far as if the payer is going to sign up, if it's going to turn into a charity care or uncompensated care type of scenario. And always workforce cost is always something that we're keeping our eye on to try and ensure that we can recruit locally or as local as possible, but not spend an absorbing amount of money on recruiting those nurses or clinicians.

[A]

Right. And with all of these unknowns and just everything you just detailed to me, how do you and your finance team really sit back and try to come up with solutions. You know, I know that no one has a crystal ball and there are so many what ifs, but what are some ways that you guys are really working together to try to tackle these issues?

[B]

Well, I just hired a really stellar revenue cycle director who is helping us in the denial and medical necessity scrutiny quite a bit and uncovering a lot of opportunity there. So we've added some capabilities within our software system to give us better data, to analyze trends as far as denials and things like that go, so that we can try to get ahead of it and get the reimbursement that we actually deserve and performed. But our team is always in data. It's important. Data tells the story. It doesn't tell the whole story, but it always gives you a picture of what's happening in your organization. So our team is always looking at service lines. What are their margins looking like, and where can we squeeze out a little bit more there without harming patient care or cutting anything important to the patient? But that would help us increase, you know, overall profitability.

[A]

Right. It sounds like you guys are really, you know, keeping your eye on the ball, so that's good. I want to shift gears a little bit, Shelly, and ask you where you're looking at maybe some of the biggest opportunities for smart growth this year. Has anything come to mind when you think of that or any partnerships, acquisitions? What's that look like to you this year?

[B]

So for us, smart growth is more about stabilizing our margin and access to care more than chasing, you know, shiny expansion. But we do have some things in the works that we are looking at with regard to additional reimbursement. I should say we are looking at the possibility of a level 2 NICU at our south campus. We've also. We were the first ones in the state to just utilize some. It's applicor. It's wound care technology where the patient. You take fat cells from the patient and re. Take a picture of it. I'm not saying it right because I'm not clinical, but it basically takes a person's cells, takes a picture of it, and then you. It molds the cells a certain way. You put it in the wound, and it's supposed to heal the wound faster. And we did our first patient, I think, three weeks ago, and he is doing exceptionally well. And there is reimbursement from the Medicare side. It was just FDA approved, I believe, early this year or last year. So we are really hoping to expand that where we can. But overall revenue integrity this year is our growth strategy. Tightening on our charge, capture our clinical documentation, obviously, medical necessity, edits and workflows and front end authorizations. That's the easiest new revenue that we can capture, that we've already earned, but we just haven't collected it efficiently historically.

[A]

Right. Wow. It is so interesting to hear that example you shared just with the technologies that are coming out. I mean, isn't it just fascinating?

[B]

It is. I wanted to be in the procedure, but obviously I couldn't. But it is really, we are very excited about it. It's going to help our patients tremendously. And we do have a lot of wound in this area with diabetes and things like that.

[A]

Yeah, no, and I mean, just think where we'll even be in the next three to five years. So that's a great example to kind of wrap us all up here. When you think about like maybe a mindset that CFOs really need to hone in on this year just to navigate some of the industry uncertainties, what, what should that specific mindset be? Where do you think CFOs need to be focused?

[B]

I would say calm urgency with intentional database decision making. And the reason I say calm urgency is because everyone looks to the CFO and the CEO, but they look to us. They gauge our reactions and they gauge our, I guess, mood in that day. And then if the CFO is nervous or showing anxiety about something, then the whole hospital, it, it penetrates down. So always, you know, my philosophy is my, my very close leaders always know when I'm nervous. But calm urgency with decision data making, it allows teams to know that I'm here for them. I'm going to give them the truth. I will always give them the facts and I will name the facts and then we'll outline our next steps on how to address things and improve our financials. So my mindset is operate like capital is expensive, but our margin is fragile always because health care changes so quickly and we, you know, obviously always make decisions based on ROIs and that kind of thing. But mindset is important because it, it sets the tone for the rest of the hospital. So I try to always be calm but urgent and intentional when making decisions.

[A]

Calm urgency, I feel like that's something that could span across all types of roles in industry. So some very good advice there, Shelley. Well, Shelly, again, I want to thank you so much for joining me. It's been such a pleasure to connect with you again and kind of break down some of the things going on right now in the industry, but really appreciate it and I look forward to connecting with you again soon.

[B]

It was great. Thank you for having me again.