Q&A with Kenneth A. Samet
"Levey Live," appears each Tuesday from 12 to 1 p.m. Eastern time. It is a live, moderated discussion offering washingtonpost.com users the chance to ask questions directly of the people who make the news and the people who report it. Your host is Washington Post columnist Bob Levey.
Bob's guest was Kenneth A. Samet, president of the Washington Hospital Center, a 907-bed facility in Washington, D.C. Samet is also the executive vice president and chief operating officer of Helix/Medlantic Inc., a $15 billion health care integrated delivery system.
Samet, the Washington Hospital Center's president since 1990, received his master's degree in health services administration from the University of Michigan in 1982, and has been active in the health-care field ever since.
Bob Levey is away for this discussion. Filling in for Bob as guest host was Vic Sussman, Live Web Programs Editor for washingtonpost.com.
Good afternoon, and welcome to “Levey Live.” As you’ve read above, our guest, Kenneth A. Samet, governs Helix/Medlantic, a nonprofit health care system comprised of five nursing homes and seven hospitals around the Washington-Baltimore area. In addition to the Washington Hospital Center, Helix/Medlantic’s members also include the National Rehabilitation Hospital and five community hospitals in Baltimore. This adds up to 4,500 doctors, 65 primary-care physicians’ offices. Helix/Medlantic is now larger than Johns Hopkins Medical Center, Georgetown University Hospital and the George Washington University Medical Center.
Vic Sussman: Mr. Samet, Helix/Medlantic grew very fast and aggressively. Health care experts say this makes for tricky management, given that you’ve got to ride herd on two big, disparate work forces and a sprawling mass of care units. What’s your strategy for smoothing over the corporate culture gaps and getting the medical and support staffs to work in tandem?
Kenneth A. Samet: That is clearly one of the real challenges that we are focused on as we bring together the largest integrated health care system in this region. We were helped in merging our respective cultures because we came together over two years ago in a partnership called BWHealth that let us get to know each other's organizations without the immediate pressure that comes with a full merger. Our employees and medical staffs have been very supportive because they appreciate the tremendous challenges we face in the health care industry, and understand that regionally integrated health care systems give us our best chance for long-term success.
Fort Washington: Are doctors acquiescing to patients' demands for a quick fix when they just prescribe a drug and send the patient on his way? It seems that you have to return repeatedly with the same complaint before being thoroughly evaluated. Or is that just the trend in "modern" medicine? Or is it a matter of doctors getting kickbacks from drug companies for prescribing their chemicals?
Kenneth A. Samet: I believe strongly that the great majority of physicians in our metropolitan area are of the highest quality and do not utilize prescriptions to simply "send patients away." If you don't feel comfortable that your personal physician is taking the time to listen to your health issues, then I would suggest you consider utilizing a different physician.
Vic Sussman: How can a system comprised of several hospitals and nursing homes be called a nonprofit? Isn’t the idea to make money?
Kenneth A. Samet: Helix/Medlantic is not only called a nonprofit, but it lives the mission behind being a nonprofit everyday. This can be seen in the over $50 million in free care that was provided last year at the Washington Hospital Center alone. We are governed by a board of community representatives who donate their time to what they believe to be a very important community goal providing the highest quality health care to those living in our region. We have no shareholders. While it is true that we need to earn a return on our operations, all of these dollars are reinvested in our facilities, new technology or hiring the finest clinical and support staff available.
Washington, D.C.: Now that managed care has widely penetrated the health care market, what do you see for the future of costs for care?
Kenneth A. Samet: I believe we will see a rise in health care costs over the next five-year cycle that will be greater than the level of increase we have seen these last three to five years. Driving this increase are astronomical increases in new drug costs, the continued aging of the population and the costs associated with chronic care for those that our medical system would not have been able to keep alive only a few years ago. We are a country that demands new technology, but we must recognize that it comes at a steep price.
The Washington Hospital Center is often called a “teaching hospital.” Would you explain that term?
Kenneth A. Samet: The Hospital Center trains over 225 residents and fellows in a comprehensive array of medical specialties. Our teaching programs are a mixture of integrated programs with some of the area's universities as well as a number of stand-alone training programs based at the Washington Hospital Center. The Hospital Center treated over 40,000 inpatients last year. This is significantly larger than any of the other university hospitals and thus makes the Hospital Center a fabulous training site. In fact, across the country, many of the strongest teaching hospitals are not university-based hospitals.
Alexandria, Va.: I very recently read of a report indicating that there were more Americans who sought treatment from "alternative" medicine sources than from conventional last year. What are your thoughts on this trend and is it yet affecting the medical status quo?
Kenneth A. Samet: I prefer to use the term, "complimentary medicine." I believe that there are examples where certain non-traditional treatment approaches have proven helpful from either a physical or mental standpoint to certain patient populations. I do not see this, however, as an "alternative" to our traditional health care system, which is viewed around the world as the best mankind has to offer.
Vic Sussman: The old joke is that a hospital is a terrible place for a sick person. And everyone has a hospital horror story ranging from being overcharged for ice and aspirin tablets to having a loved one die from a staph infection or a doctor error. What are you doing about conditions like this?
Kenneth A. Samet: While there are examples of tragic situations that can develop in one of our nation's hospitals, I have no reservations in stating that those are extreme, outlier situations. The stories of those whose lives have been saved because of the expertise of physicians and nurses in those same hospitals happen every day. In terms of the "overcharging" issue, we must all remember that we created a charge structure for hospital services in such a way that those who could afford to pay would help to defray the costs of care for the 40 million Americans who are not able to do so. We, as a society, have made it a right that all Americans can obtain health care, and so we should not be surprised that we also created charging mechanisms to support this lofty goal.
We’re at the halfway point in our conversation with Kenneth A. Samet, president of the Washington Hospital Center. You may continue to submit questions and comments for the next 30 minutes.
Washington, D.C.: What would be your suggested process to encourage one's company to offer more than one managed care health plan? My company offers an indemnity plan and a CIGNA POS that many physicians are not members of, especially pediatricians. It would be helpful to have another managed care option, i.e. a PPO.
Kenneth A. Samet: There are several key aspects an employer considers when selecting possible health insurance carriers for their employees. While cost is certainly one factor, the attractiveness of the benefit to the employees is very important as it impacts recruitment and retention. Given that, you should share your views with the director of human resources for your company, who should be considering all aspects of the health benefit plan your company offers.
Vic Sussman: What led you to a career in health services administration? When other kids were thinking about becoming firefighters or baseball players, were you having childhood dreams of running a hospital?
Kenneth A. Samet: I still have dreams of being a baseball player. I just can't seem to hit a curve ball. My hopes are now focused on my son, who already shows more talent than I did. I became excited about health services administration as a career as it allowed me to balance my interest in both business and clinical issues. I am pleased to be able to say that I have never regretted my decision.
My family and I were recently visiting a relative in your hospital and noticed signs talking about putting the patient first. Can you tell me about this?
Kenneth A. Samet: We have utilized the simple, but critically important, "patient first" slogan to focus all 5,000 employees throughout the Washington Hospital Center on what is really important; on what we should be thinking about at all times; and to help us all in those trying and complicated moments to solve problems from a patient's perspective. The Hospital Center has always been recognized as one of the highest quality medical facilities. Our goal through our "patient first" program is to combine world class customer service with the highest quality medical care. I am pleased to say that our recent patient surveys tell us we are accomplishing this goal.
Vic Sussman: Do you think popular television shows like “ER” and “Chicago Hope” paint an accurate picture of hospitals and emergency rooms? A friend of mine who is an ER doc says he watches these shows when he needs a good laugh.
Kenneth A. Samet: I like your friend already! I think it is hard to watch shows like "ER" and "Chicago Hope" and take them seriously if you really understand how hospitals work. Having said that, whenever I criticize "ER" to my wife, she looks at me with amazement that I would question what she knows to be true, having just seen it on television.
How do you think the projected nursing shortage will affect health care in Washington?
Kenneth A. Samet: I am actually concerned about not only the projected nursing shortage, but also shortages in other technical and support areas. We depend on our nurses to be of the highest caliber, as they serve as the backbone of the health care system of this country. What we are seeing are conflicting career opportunities for individuals who might, in years past, have "automatically" become a nurse. Those opportunities are offering higher pay and a more regulated set of work hours, which helps to improve overall quality of life. We must not lose sight of the relationship between pressuring the expense side of our health care system and its impact on our ability to attract the brightest individuals into this important profession.
Vic Sussman: The name “Helix/Medlantic” hardly trips off the tongue. Any plans for a name change?
Kenneth A. Samet: We are just completing a comprehensive naming project that included our board, medical staff leadership, employees and community representatives to assist us in creating the right name for our new company. We want this name to clearly speak to the kind of organization we are one that focuses on providing the highest quality care throughout the region. I believe we will officially announce our new name over the next 30 to 60 days.
Washington, D.C.: What should I be looking for in the event my loved ones need a nursing home to take care of them? I keep on reading about how the staff is not properly trained at other homes. This seems to be a nationwide problem.
Kenneth A. Samet: While there are some nursing homes that have experienced poor quality issues, there are many more nursing homes that you would be very comfortable having your loved one in. You should first visit the home. You will learn a lot simply by walking around and observing how the staff interacts with the patients. Are the patients active and engaged? Or are they simply left to sit in their rooms? Is the home clean (from a sight and smell standpoint)? Ask about staffing ratios and ask to see the latest quality surveys done by the joint commission or the state regulatory authority. These should give you a good baseline understanding of the nursing home you are considering.
Vic Sussman: Surely, working around hospitals must occasionally give you a stiff dose of existential dread. So how do you take care of your own health? Are you a devoted exerciser or a junk food junkie?
Kenneth A. Samet: Unfortunately, I qualify under both of your categories. Depending on the month, I am either very focused on exercise and health or I've managed to let the stress of the world make me into the best junk food eater I know. If you keep several suit sizes you can manage this less than wonderful approach. This of course is not endorsed by the medical staff at the Washington Hospital Center.
Many thanks to Washington Hospital Center president Kenneth A. Samet for being our guest today on “Levey Live.” Please join Bob Levey again next Tuesday at noon, when his guest will be Virginia’s director of transportation, Shirley Ybarra. Bob Levey also appears on washingtonpost.com every Friday at 1 p.m. with “Levey Live: Speaking Freely,” an open-agenda forum where you can ask questions or make comments about anything in the news or on your mind.