After graduating from high school in 1969, she received a scholarship to attend a three-year program at Roanoke (Va.) Memorial Hospital, where she earned a nursing degree in 1972. She spent the next six years as a staff nurse, first at the University of Virginia Medical Center in Charlottesville and then at Southside Regional Medical Center in Petersburg, Va., before she became a nursing supervisor at Community Memorial Hospital in South Hill, Va., a role she held from 1978 until 1981.
At that time, she and her husband, Bob, both eager to return to school, moved to Richmond where they enrolled at Virginia Commonwealth University. Calling herself an “eternal part-time student,” Tavenner juggled marriage, raising three small children and school, eventually earning a bachelor's in nursing in 1983 and a master's in hospital administration in 1989.
Tavenner began her 25-year career with HCA in 1981 when she applied for a job as night-shift supervisor working 11 p.m. until 7 a.m. at Johnston-Willis Hospital in Richmond. That's where she met Edna Loving, the director of nursing who interviewed her for the job.
“She had a very gentle way about her,” Tavenner said of Loving, with whom she had a dinner a few weeks ago. “She was practical. So she was one of my biggest nursing mentors.” Tavenner moved up the ranks at Johnston-Willis, becoming director of nursing in 1986 and CEO in 1993.
“For people who say women can't have it all, Marilyn is the exception,” Grinney said. “She did it all, and always did it with a sense of grace and a sense of humor and a sense of purpose.”
While moving up in her career, Tavenner never lost sight of her small-town roots, something that has not gone unnoticed by providers in rural communities. “Our company is primarily focused on providing care in smaller community hospitals,” said William Carpenter, chairman and CEO of LifePoint Hospitals, which has about 60 hospitals across the country. “We work very diligently to be the voice for rural healthcare. Marilyn understands the unique healthcare needs of rural communities and has been a top supporter of our efforts. We're grateful for that.”
That could help her when she goes before the full Senate, where small states, many of them predominantly Republican, have a disproportionate voice. Kaine—who is not a member of the Senate Finance Committee—said he's heard from members in the upper chamber that Tavenner's hearing is not likely to be controversial.
“If you want someone who cares about patient care, you want Marilyn Tavenner,” he said. “If you want someone innovative on costs, you want Marilyn Tavenner. If you want someone to be effective, you want Marilyn Tavenner.”
For her part, Tavenner hopes to send a clear message to Congress about the kind of working relationship she would like to have if she's confirmed. It's one that emphasizes the problem-solving mentality that her colleagues and superiors have come to admire.
“We may not always agree. We certainly won't always agree,” Tavenner said. “But if you can bring a problem to me, then I'll try to solve it, and I'll try to solve it directly. You may not get the answer you want, but you'll get a yes or a no.”
She will have several opportunities to answer tough questions directly at her hearing, which comes days after Senate Finance Committee member Chuck Grassley (R-Iowa) demanded information on the communication between the CMS and a financial consulting firm after the firm told clients that the CMS is changing course on a planned cut to Medicare Advantage payments and instead plans to offer an increase to Medicare Advantage plans next year.
But that's likely to be a sideshow on her way to confirmation. Tom Scully, who served as the head of the CMS from May 2001 until December 2003, echoed Kaine's sentiments that Tavenner has what it takes to be confirmed.
“She's apolitical in a good way,” said Scully, now an attorney with the firm Alston & Bird. “She's supportive of the administration, but she's not overly political. So I think the Republicans like her as much as the Democrats do.”
Her Virginia background will also play to her advantage during the confirmation process. While the vote will take place in the Senate, House Majority Leader Eric Cantor (R-Va.) has signaled support for her confirmation. Though unavailable for an interview, he issued a statement in February calling Tavenner “eminently qualified to be the administrator of the Centers for Medicare and Medicaid Services.” Recalling his days in the Virginia Legislature, Cantor said Tavenner was “an individual with a wealth of knowledge about the complexities of the healthcare system and she came forward with solutions that actually made sense.”
In her interview with Modern Healthcare, Tavenner said she's looking forward to outlining her vision for the CMS at her confirmation hearing, which includes serving as a “business partner” with both Congress and the healthcare industry. She also plans to discuss how the CMS is preparing for the launch of state health insurance marketplaces in 2014 and the various delivery system models—mostly through the CMS Innovation Center—that reduce costs.
“There are hundreds of things you can do inside CMS, for sure,” she said. “But one of them—one thing I've been trying to convey—is this issue of (having an) open-door policy, (being) approachable, accessible. I've always wanted to do that throughout my career,” she added. “It's even more important in CMS.”