President Barack Obama’s choice of Marilyn Tavenner as administrator of the Centers for Medicare and Medicaid Services – to replace Dr. Donald Berwick, whose recess appointment was set to expire at the end of the year – is more likely to survive the Senate confirmation process relatively unscathed.
A Harvard-educated pediatrician, Berwick won praise and the backing of major healthcare groups for his academic work, which focused on cutting the cost of care while improving quality and patient experience. Republicans took exception to his praise of Britain’s National Health Service as an “example” for the United States to emulate. Others accused him of supporting “rationing” healthcare services, a claim Berwick rejects. “Every bone in my body, as a physician, even as a person, is to get everything (patients) want and need and to help them at every step,” he said. “I have gone to the mat to get a last-ditch bone marrow transplant for a child with leukemia…and they are telling me I’m rationing? They haven’t met me.”
White House officials said, “Before entering government services, Tavenner spent nearly 35 years working with health care providers in significantly increasing levels of responsibility, including almost 20 years in nursing, three years as a hospital CEO, and 10 years in various senior executive-level positions for Hospital Corporation of America.”
According to Ezra Klein, “Tavenner’s healthcare experience lies much more in management than policy. Former colleagues describe her as a patient-centered manager, a hands-on medical professional equally comfortable in the board room and the emergency room. And in contrast to Berwick, Tavenner isn’t associated with a grand vision for health reform, or a particular policy agenda for Medicare and Medicaid. ‘With Marilyn, you present the information, then she makes a decision, and you move on,’ said Patrick Finnerty, who served as Virginia’s Medicaid director under Tavenner. ‘She doesn’t make promises she can’t keep. There are differences of opinions, and she would try to work through those. She’s straight with folks but always respectful.’”
Tavenner started her career as a nurse at Virginia hospitals owned by the Hospital Corporation of America (HCA). Tavenner met with success, rising from chief nursing officer to CEO. In 2004, she was again promoted to HCA’s president of outpatient services, her first national position with the firm. She resigned two years later, when then-Virginia Governor Tim Kaine tapped her to head the state’s Health and Human Resources department.
Tavenner has already won the American Medical Association’s (AMA) backing. “We have worked extensively with her in her role as deputy administrator, and she has been fair, knowledgeable and open to dialogue,” AMA President Peter Carmel said. “With all the changes and challenges facing the Medicare and Medicaid programs, CMS needs stable leadership, and Marilyn Tavenner has the skills and experience to provide it.”
Senator Orrin Hatch (R-UT), the ranking Republican on the Senate Finance Committee, said that the panel would thoroughly scrutinize Tavenner, but did not say he opposes her nomination. Despite Hatch’s mild comment, Tavenner is expected to face some difficult questioning because Senate Republicans have not overtly endorsed her. According to a Republican healthcare lobbyist, “I can’t imagine a lot of support for her,” noting that the high-profile CMS role “always gets sucked into the controversy of the day.” Ultimately, Tavenner is likely to be confirmed for the CMS post.
Tavenner is widely seen as a pragmatic administrator who will not rock the CMS boat. “The only way to stabilize costs without cutting benefits or provider fees is to improve care to those with the highest health care costs,” she said. Tavenner also said she opposed Republican efforts to turn Medicaid into a block grant that would limit the amount of federal funding states can receive for the program. “That approach would simply dump the problem on states and force them to dump patients, benefits or make provider cuts or all the above,” she said. Tavenner “brings continuity in terms of implementing the mission,” said Len Nichols, director of George Mason University’s Center for Health Policy Research and Ethics.