It was the middle of the night at Chippenham Hospital in Richmond, Va., 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 recalls. “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.”
Swanson and Tavenner worked together for 13 years in Virginia hospitals. As she rose from ICU nurse to top hospital executive, he saw much of the pragmatism and quick-thinking that he’d seen in the emergency room years earlier. “If there was a problem,” Swanson says, “Marilyn would take care of it.”
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 current CMS administrator Don Berwick submitted his resignation. Republican senators had pledged to block Berwick’s confirmation, and his recess appointment was set to expire at the end of the year.
Berwick and Tavenner have taken markedly different paths to the same job. Berwick spent decades writing, thinking and speaking about overhauling America’s health care system. His sweeping policy ideas, celebrated by many, 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 the United States.
Such a situation is unlikely to play out with Tavenner, whose health-care experience lies much more in management than policy. In interviews this week, former colleagues describe 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,” says 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 within 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 a hospital chief nursing officer to chief executive officer.
“It’s a big jump at a kind of high profile hospital,” he says. “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-Virginia Gov. Tim Kaine appointed her to run the state’s Health and Human Resources department.
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,” says Jill Hanken, health-care attorney for Virginia Poverty Law Center.
Much of her work largely 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. When she came into office, she listed five areas she’d focus on in an interview with the Medical Society of Virginia Foundation: 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, and less 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,” says Finnerty.
“What always struck me was her attitude of, how will this help the patient?” says 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 was particularly impressed by a visit that Tavenner paid him during her tenure as Health and Human Resources Secretary. He was in Southwestern Virginia, a poorer area of the state near Appalachia, running a temporary dental clinic to see many patients with oral health problems that had gone long-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,’” says Dickinson, who followed through on the request. “She would help us moving patients around. 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.”
Tavenner joined the Obama administration in April 2010 as Berwick’s deputy principal administrator. In health policy circles, her nomination to head Medicare was widely expected by the end of the year. She’s been a relatively quiet presence in the agency, so far never testifying before Congress.
Although its unclear what reception she’ll get in confirmation hearings, Republicans have so far 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 judgement.”
Already, it seems, Tavenner’s nomination is on a markedly different path than her predecessor’s.