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A patient-centered pragmatist may take helm of CMS

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It came as no great surprise last week when Donald Berwick, MD, announced his resignation as administrator for the Centers for Medicare & Medicaid Services. Faced with the near impossibility of being confirmed by Congress, he bowed out a month before the expiration of his recess appointment. The White House then announced its nomination of Medicare Deputy Administrator Marilyn Tavenner as his replacement.


Marilyn Tavenner

Berwick was disliked by congressional Republicans for his support of centralized healthcare delivery and England’s National Health Service model. A former Harvard professor and healthcare think tank founder, he was considered a reformist visionary and policy idealist—which destined him as a target in the crosshairs of the political opposition.

Tavenner, by contrast, is known for her practical, hands-on management style, born out of her background as a nurse turned hospital administrator.

In a revealing profile of Tavenner in The Washington Post, her colleagues at Virginia’s Health and Human Services department, which she headed prior to being called up to CMS, recall Tavenner more for her personality and management style, and less for the policies she promoted. “What always struck me was her attitude of, how will this help the patient?” said Terry Dickinson, executive director of the Virginia Dental Association, in the Post article. “You better be prepared to talk about that when you meet with Marilyn. You can tell what she’s thinking: it can’t be about the dentist, it’s got to be about the patient.”

Long-term care groups have praised Tavenner’s appointment, noting her depth of experience in working with skilled nursing providers. “Marilyn Tavenner is a strong choice to lead CMS because of her reputation as a smart, competent administrator, and because she has a strong working knowledge of how Medicare and Medicaid funding adequacy are both integral to the ongoing ability of SNFs to provide high quality long-term and post-acute care to U.S. seniors,” said Alan G. Rosenbloom, president of the Alliance for Quality Nursing Home Care. “The Alliance looks forward to working with Ms. Tavenner to ensure that regulatory changes such as therapy reforms and payment adjustments are implemented in a manner that ensures stability in the SNF sector.”

Mark Parkinson, president and CEO of the American Health Care Association, offered a similar endorsement: “Marilyn Tavenner shares our commitment for the elderly and I look forward to working in stronger partnership with her in the future.”


Patricia Sheehan

Patricia Sheehan


Patricia Sheehan wrote for Long-Term Living when she was editor-in-chief. She left that...



I have no problem with someone who is resident-centered in providing the necessary care in a long term care setting. However, I do have a problem with a system that is running ammuck and is constantly punishing the provider when they try to do their best in providing care to the residents they serve. Tavenner needs to reverse some of the regulatory actions we have in place, such as the Q.I.S. process. When I heard that this new survey process will double citations on average to nursing homes, I felt the regulatory agency at C.M.S. is out of control and out of their minds.
Just changing a survey process that can double your deficiencies at a nursing home, such as, where I work is ridiculous. We are a five star health care operation and we are now going to get double the citations which then leads to double the work to set in motion the burden on the staff to do more unnecessary paper work. Talk about a waste of our time, energy and money.
I started in long term care in 1978, and there continues to be no end in sight to the every day changes and add ons to our regulatory requirements.
There is no one in this country that I have talked to that see the current survey process as a plus that will change the care we provide today.
We already provide the necessary service to the seniors we care for, but, now at double the misery developed by C.M.S. put on workers.
Tavenner needs to reverse these regulatory processes and I would have no problem going to Baltimore to assist her if she needs it. She can call me anytime...TK..Montana.