A little-discussed aspect of the Berwick era at the CMS was the view of some healthcare provider advocates that the soon-to-depart administrator was not that great at the administrating part of his job.
Outliers: He provided the vision, but maybe not the details
That is, Dr. Donald Berwick was exceptional at developing big-picture, inspirational approaches to overhauling healthcare delivery and payment models, but he was relatively weak at the humdrum task of shepherding rules through the regulatory process.
Such regulatory management has taken on paramount importance since enactment of the Patient Protection and Affordable Care Act last year. Hundreds of thousands of pages of rules are anticipated to fully implement it. The CMS was charged with developing the vast majority of the law's regulations and many of the rules required to date have missed their statutory deadlines.
Some provider advocates—who asked not to be named—blamed the long-time academic and think-tanker Berwick for such delays, on the grounds that he was not staying abreast of the labyrinthine regulatory development process for each of the often-complex measures.
Such a job description appears to better match the newly nominated CMS administrator, Marilyn Tavenner, who has extensive public and private sector management experience.
Now that Berwick is leaving, even close allies of the Obama administration are not exactly running away from such characterizations.
“Clearly, Dr. Berwick is more of a visionary and one of the national and international leaders on quality healthcare,” Ron Pollack, founding executive director of the liberal Families USA, said when asked about his regulatory management skills. “Marilyn Tavenner is a strong manager and administrator, and I think all of those attributes are very helpful for an agency like CMS. So there is an obvious trade in the unique attributes that each of them brings.”
Those skills could remove any lingering doubts about Tavenner among the provider community, which has generally gushed about her.
It remains unclear, however, whether Tavenner's ability to move timely regulations for a Democratic-enacted law will garner her any support among Senate Republicans, who hate the ACA.
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