Berwick's Vision Will Continue Under Tavenner

The White House has nominated Marilyn Tavenner to run the Center for Medicare and Medicaid Services (CMS), following the resignation of former CMS Administrator Don Berwick, which is a huge disappointment. She will serve as the agency's interim administrator during the confirmation process. Tavenner has served as CMS' principal deputy administrator since February 2010 and served as CMS' acting administrator between February 2010 and July 2010. During her tenure at CMS, Tavenner has helped oversee Medicare, Medicaid and the Children's Health Insurance Program. She also had responsibility for the Center for Consumer Information and Insurance Oversight (CCIIO) which has been responsible for the health reform waivers issued by the agency.

Prior to working for CMS, Tavenner served as secretary of Virginia's Health and Human Services agency. She also has worked for the Hospital Corporation of America, where she started as a staff nurse and eventually served as president of outpatient services. Then former Governor Timothy Kaine appointed her as Virginia’s Secretary of Health and Human Resources where she oversaw 12 agencies that employed 18,000 people.

Senior HHS Officials highlight some of the immediate benefits of health reform for America's seniors before answering questions from the public:

• Kathleen Sebelius, HHS Secretary
• Kathy Grennee, Assistant Secretary for Aging 
• Marilyn Tavenner, Centers for Medicare and Medicaid Services (CMS)

Many stakeholder groups have praised the nomination of Marilyn Tavenner as Berwick's successor. The AMA released a statement in favor of the appointment saying "she has been fair, knowledgeable and open to dialogue." The AHA said in a statement that Tavenner’s "varied and rich background as a former nurse, health care executive, and government official at the state level gives her a very unique perspective in understanding both the implications of public policy and their implementation."

AHIP gave a simple endorsement saying simply: "Marilyn Tavenner’s proven leadership ability and wealth of experience in both the private and public sectors are invaluable assets to CMS as it seeks to address the many health care challenges facing the nation. We look forward to continuing to work with her to improve the quality, safety, and affordability of health care in America."

However not all groups are in favor of Tavenner. "Scrutiny of Tavenner should be no less intense than of Berwick,” stated Jane M. Orient, M.D., executive director of the Association of American Physicians and Surgeons (AAPS). The AAPS released a statement very critical of her appointment. There is also likely to be continuing scrutiny from Republican lawmakers, despite House Majority Leader Eric Cantor's approval, who said, "Obviously, I'm not in the Senate, so I don't have that vote, but I do think she is qualified."

If confirmed as CMS administrator, Tavenner would also oversee the allocation of an estimated $27 billion in health IT incentive payments. Under the HITECH Act, healthcare providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments.

In remarks to the National Association of Medicaid Directors last month, Tavenner shared her thoughts on how to control health care costs in ways very similar to the ideas Berwick has expressed. "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. She also 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. Politico has also unearthed audio of Dr. Berwick's replacement speaking quite highly of the health reform legislation, which will certainly be an issue at confirmation hearings.

Marilyn Tavenner speaking to the Nashville Healthcare Council in reference to replacing Berwick said,“Whether I'm nominated or not, we would not have a different approach."

The full audio of her statements from Politico is below: