CMS chief Dr. Berwick to step down Dec. 2

Deputy Administrator Marilyn Tavenner's nomination for the top post will require Senate confirmation, a process that Obama bypassed for Dr. Berwick.

By Doug Trapp — Posted Nov. 23, 2011

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President Obama on Nov. 23 nominated Marilyn B. Tavenner to be the next administrator of the Centers for Medicare & Medicaid Services.

Donald M. Berwick, MD, the current CMS chief, will serve his last day on Dec. 2, according to a letter he sent to agency staff. He has been administrator since July 2010.

"Our work has been challenging, and the journey is not complete, but we are now well on our way to achieving a whole new level of security and quality for health care in America," Dr. Berwick wrote.

Dr. Berwick made a central goal at CMS his three-part aim of improving health care for individuals, improving population health and lowering health care costs. "He infused a deep commitment to patient-centered care into all the [CMS] innovations and was a tireless advocate for reforms that improve patient outcomes and patient experiences of care," said Debra L. Ness, president of the National Partnership for Women and Families, a health care advocacy organization.

As his successor, Tavenner's "distinguished career in health care and deep knowledge of our efforts to implement health reform make her the right person for this job at this moment in history," Health and Human Services Secretary Kathleen Sebelius wrote in a Nov. 23 letter to staff.

The change in CMS leadership was expected. Obama appointed Dr. Berwick, a pediatrician, on July 7, 2010, during a congressional recess, meaning that the nomination did not require Senate approval. Obama did so to sidestep what many predicted would be a difficult Senate confirmation process. However, the move meant that Dr. Berwick's appointment would have expired at the end of 2011. Although the president officially renominated him for the job in February 2011, nearly all Republican senators said they would not support him, making it impossible for Dr. Berwick to receive the 60 votes needed to overcome the threat of a Republican filibuster.

Because her appointment is a traditional one, Tavenner must be confirmed by the Senate before she can take the official post, although she may remain acting administrator until then.

Sen. Orrin Hatch (R, Utah), one of the most vocal critics of Dr. Berwick's recess appointment, said he welcomed the opportunity to return to the regular nomination process. "Any nominee to a federal agency with this much power and authority over the lives of millions of Americans must be carefully scrutinized," Hatch said. He is the highest-ranking GOP member on the Senate Finance Committee, which will consider the nomination before the full Senate takes it up.

Tavenner has been principal deputy administrator -- second-in-command at CMS -- since February 2010. Previously, she was Virginia's health and human resources secretary from 2006 to 2009 during former Virginia Gov. Tim Kaine's administration.

Tavenner spent the majority of her career -- 25 years -- at the Hospital Corp. of America. She left in 2005, at which point she was in charge of developing a national strategy for freestanding outpatient services, including physician recruitment and real estate development, according to her CMS biography. Tavenner has a bachelor's of science degree in nursing and a master's degree in health administration from the Virginia Commonwealth University.

Tavenner's combination of federal, state and private health care experience will serve her well as CMS administrator, said Patrick W. Finnerty, Virginia's Medicaid director from 2002 to 2010. He said Tavenner listens carefully to all positions on an issue and is not biased by her hospital administration experience. "What I saw for four years consistently was absolutely no preference for any provider," he said, noting that she also is a former practicing nurse with direct patient care experience.

Dr. Berwick was the first permanent CMS administrator since Mark B. McClellan, MD, PhD, stepped down in October 2006. The agency was run by a string of interim chiefs between then and July 2010.

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