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Obama Renominates Tavenner to Be CMS Chief


President Barack Obama yesterday renominated Marilyn Tavenner, the acting administrator of the Centers for Medicare & Medicaid Services (CMS), to serve in that post without the caveat of "acting" attached to it.
If the Senate approves her nomination, Tavenner will be the first confirmed, full-fledged CMS administrator since Mark McClellan, MD, PhD, stepped down from that position in October 2006, during the George W. Bush administration. Dr. McClellan's successors either were acting administrators or, in the case of Donald Berwick, MD, who was Tavenner's immediate predecessor, a recess appointment.
As illustrated by Dr. Berwick's CMS history, Senate confirmation can be tough to get when one party has enough votes to filibuster and otherwise stymie a nomination by an opposing party's president. That was the case when Obama nominated Dr. Berwick, whom Senate Republicans portrayed as an advocate of healthcare rationing, a characterization denied by the patient safety expert. Obama had to settle for a temporary recess appointment.
When Dr. Berwick resigned in November 2011, Obama nominated Tavenner. A nurse by training, she came with a well-regarded resume that listed jobs such as group president of outpatient services at hospital giant HCA and secretary of the Virginia Department of Health and Human Resources under former Virginia Governor Tim Kaine. In addition, she had briefly served as acting CMS administrator in 2010 before Dr. Berwick took over.
Her nomination in 2011 did not trigger an outpouring of Republican wrath. House Majority Leader Eric Cantor (R-VA) went so far as to say Tavenner was "eminently qualified" to head CMS. Nevertheless, her first nomination was bottled up in the Senate Finance Committee, and she too became another acting administrator.
Jack Lewin, MD, a healthcare consultant in Washington, DC, and a veteran of organized medicine, told Medscape Medical News that Tavenner's performance so far at CMS should improve her chances of winning over Senate Republicans this time around.
"She has really been a level head who has been juggling an incredible set of circumstances and doing it with amazing decorum and respect," said Dr. Lewin, a former chief executive officer of the American College of Cardiology and the California Medical Association. "That should make her strong in terms of getting confirmed."
Similar to any other president, Obama needs a CMS administrator who is Senate-confirmed, said Dr. Lewin. Otherwise, "it makes things appear unstable and insecure." The lack of a confirmed CMS chief during Obama's first term, he added, made it harder to implement the Affordable Care Act.

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