TURNING POINTS: Citizens Memorial’s Gary Fulbright Urges Healthcare Policymakers, “Pay Us Appropriately”

CHE welcomes Gary Fulbright, CEO of Citizens Memorial Hospital, for this week’s installment of Turning Points. Fulbright has spent 39 years at Citizens Memorial and was one of the first hospital employees. In his role as CEO, he has led expansion initiatives, implemented new healthcare technologies, and introduced new specialties to the hospital, all while keeping the comfort of the community in mind. He will retire at the end of the year.

This transcript is lightly edited for clarity.

Chief Healthcare Executive™: You’re retiring from Citizens Memorial Hospital at the end of the year—do you have a “to do” list of things to finish before your last day?

Fulbright: What I plan to do, as I prepare for retirement, is pass along the knowledge that I have gained. I've been here 39 years and was here a few months before the hospital opened. So, I do have a lot of knowledge in the organization and want to be sure to pass that along to employees that will still be here, and make sure that they can be successful.

Also, we have a construction project, and I will be working with our other leaders on planning for that, with the financial projections and also the plans for the new construction.

CHE: You’ve been at Citizens Memorial since the beginning. What are the most important changes you have seen in your time at the hospital?

Fulbright: A lot of changes. We had around 80 employees initially, and now we have over 2,000. The 2,000 does include our clinics, long-term care and home care services in addition to the hospital. We offer a lot more services, we have a lot more buildings.

There's just a lot of changes with technology and with people. Looking at our physicians, we have many specialties now. Originally, we had just family practice. We’ve been able to offer a lot more services here and give people in our community a lot less reason to have to leave to find care.

CHE: If you could select one major healthcare advance that you knew would be important as soon as it happened, what was it and why?

Fulbright: I've seen a lot of them. I've been around for quite a while, so the CAT scan was a big deal once upon a time. MRI was a big deal once upon a time. PET CT was a big deal once upon a time. We started with mobile services for those and then obtained our own equipment. That's just an example.

Also, some equipment for surgery. We've got a robotic system for orthopedic surgery that's very well received. That's something we've just acquired in the last year or two. Also, robotic surgery for urology, and for other surgical procedures. So, lots of technology. Probably one of the bigger changes is the electronic health record. We started that in 2002, and that's a major change that impacts all the clinical areas.

CHE: Running a hospital in a smaller community has become more challenging over the past decade. What can policymakers do to help stabilize the finances of rural healthcare delivery?

Fulbright: I think the major thing is to pay us appropriately. Often, it seems like the payments are determined based on what the government can afford to pay, as opposed to what it really costs to provide services.

One thing that we're dealing with, in the last few years, as many other providers are, is increasing wage pressure. With nurses and other staff, we've increased wages, but the increase in payments from Medicare and Medicaid haven't really kept up with the wage increases. We are in an area with quite a few retirees and so Medicare is a big part of our business now along with quite a bit of Medicaid.

CHE: What was the biggest challenge you faced early in your career, and what did you learn from it?

Fulbright: When I started, hospitals were still under cost reimbursement. I had one year of cost reimbursement and then it became prospective payment. It was kind of interesting for me because I only had one year of cost reimbursement, and many of the others had decades of cost reimbursement. And so, they thought the world was going to end because of no cost reimbursement.

Actually, the prospective payment [system] made more sense to me. I was able to adjust to that perhaps easier than some who had been on cost reimbursement for so many years.

CHE: How has the expansion of technology affected care delivery at the hospital? Is technology mostly a benefit, or does it have its downsides?

Fulbright: I think it's mostly a benefit. We've seen some nice improvements in clinical areas, like I mentioned earlier with orthopedics, urology, and so forth.

Of course, there is an expense portion of that. It does take quite a few capital dollars to purchase the equipment that you need. But we've been fortunate to stay fairly current with our technology, in fact, be ahead of others in our area with technology, and our physicians really appreciate that. [That is appreciated] also by the staff and by the community.

CHE: What are the most important lessons from the pandemic?

Fulbright: I think probably the most important thing is to be agile. We are a large enough system that we have nice resources, we have a lot of well qualified staff that are very proactive, but yet we're not too big to where we can't move quickly.

For instance, when the monoclonal antibodies came out, one week after we received our first doses, we were able to begin infusions already. If you've seen southwest Missouri, we're in the news quite a bit with high COVID cases. So, our monoclonal antibody [infusions], we're doing quite a few of those. We did 40 last week, and by Wednesday of this week, we already did 40. That was just one area where we were able to adjust quickly. I feel like we did some other similar things to adjust quickly to the pandemic, and to try to take care of as many people as we realistically could.

CHE: What advances do you see at Citizens Memorial Hospital in the next five years?

Fulbright: I mentioned earlier about a construction project. We're planning to replace our inpatient beds with new beds, new rooms, and also increase our size of our emergency room, operating room, and also cardiology area. Those are nice improvements.

I think we'll continue to recruit physicians and bring in new specialists that will help give the community more reason to stay here when they need care.

CHE: What advice do you have for someone considering a career in healthcare administration?

Fulbright: Healthcare is a lot of hard work, but it's very rewarding. I think someone kind of has to have that mindset going into it.

It's been very rewarding for me in my roles, and as I observed our previous CEO, to see people develop when we hire them and place them in certain positions and then see them flourish and do well. That's very satisfying to see people, or employees in the organization, improve their skills and provide great service.

CHE: What are you looking forward to in retirement?

Fulbright: Well, we got four grandkids. We have twin grandsons that are two years old. They live in our town and I look forward to spending a lot of time with them. I plan to golf a little bit more and plan to farm a little bit. That's kind of in my background. So, I think I'll stay busy and enjoy my time.