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Nominee to head Medicare viewed as a pragmatist

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What Erik Swensson remembers most about working with incoming Medicare head Marilyn Tavenner is when they brought a woman back from the dead.

It was the middle of the night at Chippenham Hospital in Richmond, where Tavenner worked as an intensive care unit nurse in the 1980s. Swensson, the on-call surgeon, got notice around 2 a.m.: A woman had arrived, after suffering massive blood loss, and was pronounced dead.

“That’s about as tough of a case as you get, a girl who was thought to be dead,” Swensson recalled. “Marilyn was very supportive in everything, asking what we were doing, whether I was going to take her back to surgery. We came up with a game plan, and it was right on target. We used about 60 units of blood, but [the patient] ultimately walked out of the hospital.”

Swensson and Tavenner worked together for 13 years in Virginia hospitals. As she rose from ICU nurse to top hospital executive, he saw plenty of the pragmatism and quick thinking that he had seen in the emergency room. “If there was a problem, Marilyn would take care of it,” said Swensson, who is now chief medical officer with the hospital chain Capella Healthcare.

On Wednesday, the White House nominated Tavenner to run the Center for Medicare and Medicaid Services. The announcement was made at nearly the same time that the center’s current head, Donald M. Berwick, submitted his resignation. Republican senators had pledged to block Berwick’s confirmation, and his recess appointment was to expire at the end of the year.

Tavenner joined the Obama administration in February 2010 as Medicare’s principle deputy administrator. In health policy circles, her nomination to head the agency was widely expected.

It is unclear what reception she will get in confirmation hearings. Republicans have reacted cautiously to her nomination. “This is a name that should be sent up to the Senate,” Sen. John Barrasso (R-Wyo.), a vocal Berwick critic, said in an interview. “She should appear and answer our questions on her views on Medicare, Medi­caid and the president’s health-care law. Then people can make a reasoned judgment.”

Tavenner has been a relatively quiet presence in the agency, never testifying before Congress.

She and Berwick have taken markedly different paths to the same job. Berwick, a pediatrician who taught at Harvard’s schools of medicine and public health, spent decades writing, thinking and speaking about overhauling America’s health-care system. His sweeping policy ideas were celebrated by many but also became a major political liability. In blocking his confirmation, Republicans seized onto Berwick’s comments about the British National Health Service as a possible “example” for other countries to follow.

Such a situation is unlikely to play out with Tavenner, whose health-care experience lies much more in management than policy. In interviews in the past week, former colleagues described her as a patient-centered manager, a hands-on medical professional equally comfortable in the board room and the emergency room. And in contrast to Berwick, Tavenner isn’t associated with a grand vision for health reform or a particular policy agenda for Medicare and Medicaid.

“With Marilyn, you present the information, then she makes a decision, and you move on,” said Patrick Finnerty, who served as Virginia’s Medicaid director under Tavenner. “She doesn’t make promises she can’t keep. There are differences of opinions, and she would try to work through those. She’s straight with folks but always respectful.”

Tavenner began her career as a nurse in two Virginia hospitals owned by the Hospital Corporation of America, one of the country’s largest hospital chains. Swens­son, who rose to serve as chief of surgery, recalls sitting on the board that promoted Tavenner from chief nursing officer to hospital chief executive in 1993.

“It’s a big jump at a kind of high-profile hospital,” he said. “We all knew her, and there was a question, ‘Do we go with Marilyn, not having been a CEO before?’ I remember her talking to us, and her saying, ‘You know me, and I can do the job. This is where I want to be and the people I want to work with.’ ”

Tavenner was an apparent success as CEO: In 2004, she was again promoted, this time to serve as HCA’s president of outpatient services, her first national position with the company. She left two years later, when then-Gov. Tim Kaine (D) appointed her to be Virginia’s secretary of health and human resources.

Many who worked with Tavenner in that capacity recall a practical state official with an open-door policy who liked to see meetings end with a defined course of action. In the midst of a recession, advocates remember her standing up for safety-net programs. “She was a pragmatist, and a lot of that was, I think, forced on her by the budgetary situation,” said Jill Hanken, staff attorney for the Virginia Poverty Law Center.

Much of her work fell in line with general trends in state health policy, such as increasing enrollment in the Children’s Health Insurance Program and improving care coordination in Medicaid.

In an interview with the Medical Society of Virginia Foundation when she came into office, Tavenner listed five areas on which she planned to focus: assisting the uninsured, mental health services, Medicaid reform, aging and workforce issues.

Her colleagues tended, however, to recall Tavenner more for her personality and management style than for the policies that she pursued. “One of the things she’s really good at is being respectful, respecting different views and being willing to listen,” Finnerty said.

“What always struck me was her attitude of, how will this help the patient? ” said Terry Dickinson, executive director of the Virginia Dental Association. “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.”

Dickinson recalls Tavenner visiting him when he was running a temporary dental clinic in southwestern Virginia to see patients with problems that had long gone unchecked. It was mid-July, and the open-air tent was sweltering.

“She came, and the one thing she said was, ‘Next year, when I come back, I want you to put me to work,’ ” said Dickinson.

He followed through on the request. “She would help us move patients around,” Dickinson said. “This is not inside a nice, air-conditioned place, it was usually raining, but she was not one to complain. She was just making sure patients got to the right place.”

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