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Tavenner Picked to Succeed Berwick

By John Reichard, CQ HealthBeat Editor

November 23, 2011 -- President Obama announced his intention to nominate Marilyn Tavenner to succeed Donald M. Berwick as administrator of the Centers for Medicare and Medicaid Services.

Tavenner will serve as administrator on an acting basis during the confirmation process, which would be handled by the Senate Finance Committee. Berwick's resignation is effective Dec. 2. His recess appointment was set to expire Dec. 31.

"Don Berwick did outstanding work at CMS," Deputy White House Press Secretary Jamie E. Smith said in a statement. "It's unfortunate that a small group of senators obstructed his nomination, putting political interests above the best interests of the American people. Marilyn Tavenner is an experienced leader who will build on this incredible record of accomplishment and make Medicare and Medicaid even stronger, and we hope that the Senate will act quickly to confirm her."

It is not clear when the White House would send Tavenner's formal nomination up to Capitol Hill or when a confirmation hearing will be held. Republicans raised such strong objections to Berwick's nomination that he never had a hearing; instead Obama made him CMS administrator through the recess appointment. A Tavenner confirmation hearing could serve as another opportunity for GOP lawmakers to bash the health overhaul law, whether or not they have any strong objections to her taking over Berwick's job.

In an email to HHS staff, Secretary Kathleen Sebelius praised Berwick and said Tavenner has been his partner.

"As the Principal Deputy Administrator at CMS for nearly two years and as former Acting Administrator, she has proved her skill in managing challenges like overseeing the integration of the insurance oversight into CMS and implementing the numerous improvements to Medicare, Medicaid, and the Children's Health Insurance Program,'' Sebelius said. " Marilyn will serve as Acting Administrator after Don's departure, and I know that she will strongly and ably guide the agency at this critical time."

Berwick also sent an email to his staff in which he told them they have "made history together both in implementing the Affordable Care Act and in conducting and improving the crucial ongoing work of our Agency and Department."

The outgoing CMS administrator did not say what his immediate plans are. Berwick is expected to return to his home in Boston and spend time with his family before deciding his next move.

'Smart, Sharp, Fair, Organized'

The 60-year-old Tavenner enjoys a strong reputation as a manager—based both on her career as an executive in the for-profit hospital industry and her tenure as principal deputy administrator at CMS.

Appointed to that post in February 2010, Tavenner has basically served as Berwick's number two. She has overseen the largely successful implementation of the huge volume of regulations that are being issued under the health care overhaul law (PL 111-148, PL 111-152).

Tom Scully, who ran the Federation of American Hospitals before the George W. Bush administration appointed him CMS administrator, said in a profile of Tavenner earlier this year that she was highly regarded among fellow executives. "She's just very smart, sharp, fair, organized," Scully said. "Unlike a lot of people in government, she actually had to run health care day to day for many years."

Scully predicted then that Tavenner would probably be confirmed if she were eventually nominated to head CMS because she is a pragmatic moderate. She has the backing of Virginia Sen. Mark Warner, a centrist Democrat.

Tavenner has a strong knowledge of Medicare and Medicaid reimbursement policy. After her HCA career, she became Virginia's secretary of health and human resources in Democratic Gov. Tim Kaine's administration. She oversaw a dozen health agencies, including the state's Medicaid program.

As overseer of Virginia's Medicaid program, Tavenner earned praise from advocacy groups for protecting patient care during a period of plunging state revenues. But she and Kaine got in hot water late in her tenure for allegedly suppressing an advisory panel's findings that 800 children with serious mental illnesses would be left without adequate care if the state went ahead with budgetary plans to close two facilities that provided psychiatric care.

Tavenner and Kaine have declined to discuss the matter.

Tavenner's business background and centrist politics suggest she won't be the target that Berwick was for opponents of the health care law.

Berwick's past statements praising the British health system made him a high-profile target but there are no indications that Tavenner has such statements in her background.

A nurse at the start of her career, Tavenner rose steadily through the ranks at Hospital Corp. of America. She managed patients, then a nursing unit, then a hospital, then two hospitals, then a hospital division and ultimately the chain's national ambulatory care unit.

Jay Grinney, CEO of the rehabilitation chain HealthSouth, said when he first became Tavenner's boss at HCA she was the CEO of Chippenham hospital in the southern part of Richmond, Va. He put her in charge of creating a merged doctor network with HCA's nearby Johnston-Willis facility. The two facilities had different medical staffs, cultures, and markets. Company insiders doubted she could pull it off. But Tavenner worked through the issues and successfully brought together the two sites. "More than anything it was her tenacity," Grinney said.

"She's tough. She's very tough," he said. "She's just someone who never gives up."

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