In early December 2011, Donald M. Berwick, MD, MPP, who had headed the Centers for Medicare & Medicare Services (CMS) since July 2010 stepped down from his post in anticipation of being denied an extension of his term by the U.S. Senate. To replace him, the White House nominated Marilyn Tavenner, then principal deputy administrator for the Medicare program.

Two years later, former Virginia Governor Tim Kaine (D) appointed her as Secretary of Health and Human Resources for the state, a position currently held by AAOS fellow William A. Hazel Jr, MD. In this role, she presided over 12 agencies that employed 18,000 people.

In 2010, Ms. Tavenner joined the Obama administration as Medicare’s principal deputy administrator. Since then, she has played a vital role in overseeing Medicare, Medicaid, and the Children’s Health Insurance Programs.

Policy agenda
According to the Washington Post, Ms. Tavenner is not well known for a specific policy agenda. As Virginia Health Secretary, she listed her top five priority issues as assisting the uninsured, mental health services, Medicaid reform, aging, and work force issues. She has stated her opposition to turning Medicaid into a block grant program and believes that “the only way to stabilize costs without cutting benefits or provider fees is to improve care to those with the highest health costs.”

Ms. Tavenner, however, doesn’t seem to have a grand vision for reforming health care or a particular policy agenda for Medicare and Medicaid. Her background as a nurse and a hospital administrator in the private sector may provide her with an outsider’s perspective in Washington, but it is her government service that will give her an understanding of how to get things done.

Endorsements
Since being tapped by the White House, Ms. Tavenner has received numerous endorsements from physician and industry groups. In a public statement, Peter Carmel, MD, president of the American Medical Association, endorsed Ms. Tavenner’s appointment saying, “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.”

Richard Umbdenstock, president and CEO of the American Hospital Association, also expressed public approval of Ms. Tavenner, noting that her public and private sector experiences would give her a “unique perspective” on policy development and implementation.

Trade groups, including America’s Health Insurance Plans, the Alliance for Quality Nursing Home Care, and the Federation of American Hospitals, have endorsed her nomination, as has the Association of American Medical Colleges.

More important, however, are the bipartisan endorsements she has received from policymakers. House Majority Leader Eric Cantor (R-Va) has worked with Ms. Tavenner for 15 years; he told the Associated Press that she is “eminently qualified” to run Medicare. According to Department of Health and Human Services Secretary Kathleen Sebelius, Ms. Tavenner’s “deep knowledge of [CMS’s] efforts to implement health reform” makes her the right person for the position.

The Journey Ahead
Despite being endorsed by a multitude of stakeholders, the highly partisan climate in Washington, D.C., makes Ms. Tavenner’s confirmation far from guaranteed. According to Jane M. Orient, MD, executive director of the Association of American Physicians and Surgeons, “Scrutiny of Ms. Tavenner should be no less intense than that of Dr. Berwick.”

Congress has failed to confirm a CMS director since October 2009. Dr. Berwick, for example, was nominated to run Medicare in April 2010, and President Obama issued a recess appointment to him on July 7, 2010, with no confirmation hearing scheduled. Although the confirmation process should be smoother for Ms. Tavenner than it was for her predecessor, Senator Orrin Hatch (R-Utah), the ranking Republican on the Senate Finance Committee, pledged to “carefully scrutinize” her to “gain an understanding of her views of Medicare, Medicaid, and the president’s health law.”

Madeleine Lovette is the communications specialist in the AAOS office of government relations. She can be reached at lovette@aaos.org