Tavenner, the Anti-Berwick?

Phrases such as "practical-minded" and "consensus-builder" are used a lot when friends and colleagues of Marilyn Tavenner talk about the No. 2 administrator at the Centers for Medicare and Medicaid Services.

Tavenner, who has served as a nurse, HCA executive, and Virginia health secretary, was nominated by the Obama administration last week to replace Donald Berwick, MD, as administrator at CMS.

By most accounts, the low-key and soft-spoken Tavenner will not bring to the top job at CMS the "visionary" status that Berwick enjoyed among the healthcare intelligentsia. The comments of Tavenner's friends and colleagues, however, suggest that she is a highly competent expert in healthcare administration who is also not laden with the issues that made Berwick's tenure contentious. Berwick assumed office as a recess appointment by the Obama administration nearly 18 months ago. He leaves CMS on Dec. 2, weeks before his term was to expire. Republicans vowed to block his confirmation.

"She is not going to be a bomb thrower. She is not going to be tossing political hand grenades," says Virginia State Sen. Edd  Houck, D-Fredericksburg. Houck worked with Tavenner when she was secretary of Virginia Health and Human Resources from 2006 to 2010 under Democratic Gov. Tim Kaine.

"I keep coming back to the same word, she is so pragmatic in working toward a mutual result that if folks would let that attribute come through they would find that she is a true professional," Houck says. "She has been in healthcare her whole life. She is not a politician. She is a healthcare practitioner."

Although she served under a Democratic governor, Houck says Tavenner worked well with Republicans in the Virginia Senate. "Marilyn was agile and sensitive to the partisan differences. She was politically astute," he says.

Erik Swensson, MD, the CMO at Capella Healthcare, has known Tavenner for 26 years and saw her rise in the ranks from nurse to CEO at what is now HCA's CJW Medical Center in Richmond, VA. Since then, Tavenner has served as a regional executive for HCA.

"She is very comfortable in her own shoes. She knows who she is. She knows what she wants to do but she also understands how to get things done and what things can and cannot be," Swensson says.  "CMS is in an extremely difficult setting given the politics of the country. But for somebody who has taken care of patients, dealt with physicians one on one, dealt with hospitals on multiple levels, and on the private side and the state side and now on the federal side, she is one of the very few people who would have that experience."

Swensson sat on the board at Johnston-Willis Hospital when Tavenner applied for the CEO job.

"We had more-senior applicants, but I remember when Marilyn had her time before the board she said 'You all know me. I know you. I know what this hospital needs. I know what it takes to run it. I know I haven't been a CEO before but I can do this job and I won't let you down,'" Swensson says.  "She said it with sincerity that we knew Marilyn had, so we gave her the job, and she didn't let anybody down."

Later, when Johnston-Willis merged with nearby Chippenham Hospital, "Marilyn brought them together and without much rancor," Swensson says.

"She saw who the players were and she saw what their issues were and she talked to them and got things resolved. It wasn't like Marilyn was coming in with Marilyn's vision of 'this is what you have to do.' Her attitude was 'let's find out how we are going to get it done.'"

Laurens Sartoris, president Virginia Hospital and Healthcare Association, has known Tavenner for years, and says that while she brings a formidable level of expertise to the job, she is not a mere policy wonk or a technocrat.

"When you use the term technocrat there is almost a pejorative sense to it," he says. "To be a technocrat and try to run something means you probably get lost in the weeds. Marilyn doesn't get lost in the weeds. Not that there isn't an important place in the world for policy wonks but I would never characterize Marilyn as someone with her head in the clouds."

In many respects, Sartoris says, Tavenner reflects the character of the people in rural Henry County in western Virginia, where she was raised. "Her feet are very firmly planted," he says. "She is also a person of few words. She doesn't talk to hear herself think and for a long time she has been used to getting to the nut of the problem and trying to address it without a lot of the other distractions that may surround it."

"It is the way she has always been. See a problem. Analyze it. Come up with an approach you are going to take and make the decisions," he says. "Considering the job she is going into, decision making is an important part of process with all those different pots boiling on the CMS stove right now."

Sartoris declined to speculate on the suggestion that Tavenner was picked because she provides a sharp contrast to Berwick.

"I can't say why the White House picked her, but I can tell you why I would pick her," he says. "Marilyn has the necessary management skills to deal with a large and extremely complex organization and be a quick decision maker, using appropriate analysis of the appropriate facts presented. That is the Marilyn I have known for a long time."

Houck says he believes Tavenner could flourish at CMS if Congress will give her the chance. "If they could lay aside the partisanship and work with Marilyn, I think they will find she is very easy to work with in terms of trying to get a mutual agreeable result," Houck says. "But I am not sure that is part of the equation in Washington these days."