Those who worked with Carolyne Davis when she ran the Medicare program remember her as a soft-spoken but take-charge leader who brought sensitivity to a difficult bureaucratic job. Davis, who was administrator of HCFA (now the CMS) from March 1981 to August 1985, died last month in her New Jersey home. She was 71.
Davis presided over the enactment of the Medicare prospective payment system, which has guided federal reimbursement of hospitals ever since.
"She had a tough job trying to change a huge bureaucracy," said Dan Bourque, who worked for Davis as HCFA's deputy administrator from 1982 to 1984. "Carolyne had a soft-spoken nature to her (but) when things got tough she got tougher. She dug in."
A nurse as well as an administrator, Davis was one of the few clinicians to run the agency. Before President Reagan appointed Davis to her HCFA post, she served as associate vice president for academic affairs at the University of Michigan. Previously she ran the school's nursing program.
Davis "came to HCFA from a very different background," said Jack Ebeler, who served as Davis' special assistant at HCFA and is now president and CEO of the Alliance of Community Health Plans in Washington. "She understood patient care and I think brought that to the policy table in a very positive way."
Having held the top Medicare post longer than any other administrator, Davis saw her share of political battles. President Reagan's White House Office of Management and Budget was heavily involved in healthcare policymaking, putting her in the difficult position of reforming and improving a complex system with the watchful eye of budget hawks overhead.
"It was not an easy environment to work in," Bourque said.
Born in Penn Yan, N.Y., Davis held a doctorate in higher education administration and a master's degree in nursing. After leaving HCFA in 1985, Davis joined the accounting and consulting firm Ernst & Young as an international healthcare adviser.
In 1994, Davis chaired an Institute of Medicine panel that explored the relationship among nurse staffing levels, patient care and workplace injuries suffered by nurses. The IOM's study found that hospitals and nursing homes need to adjust how they deploy and train nursing staffs but also concluded that enough nurses existed at the time to meet national needs.