Sean Cavanaugh replaced CMS (Centers for Medicare and Medicaid Studies) head Marilyn Tavenner when she stepped down at the end of February earlier this year after the shaky roll out of the Affordable Care Act (ACA). Mr. Cavanaugh previously served as the Deputy Director for Programs and Policy with CMS where he oversaw testing and development of the latest medical billing and service delivery models.
Because CMS is the most influential government organization in the medical billing and coding field, understanding its director can be important to understanding the future stances the agency may take, as well as its potential leadership.
Besides working with advanced medical billing and coding models in his capacity as Deputy Director with CMS, previously Mr. Cavanaugh worked as the director of health care finance at the United Hospital Fund (UHF). This New York City-based non-profit organization conducts health policy research and supports initiatives with the goal of improving health care in New York.
Before his work with UHF Mr. Cavanaugh was involved at the senior level with organizations including:
- Lutheran Healthcare in Brooklyn
- New York City Mayor’s Office of Health Insurance Access (MOHIA)
- Maryland Health Services Cost Review Commission (HSCRC)
How Long Will Mr. Cavanaugh Remain in his Post?
While Mr. Cavanaugh is currently the head of CMS, it is unknown how long he will remain in this capacity. The official head of CMS must be appointed by the president and confirmed by the Senate. Mr. Cavanaugh’s predecessor Ms. Tavenner was confirmed by the Senate in May of 2013, however before this CMS has been without an official head for almost seven years, in large part due to political wrangling.
Politics will most likely have an impact on Mr. Cavanaugh’s nomination to become the permanent CMS director – that is if President Obama decides to officially nominate him. Mr. Obama waited almost 15 months to nominate his first pick for the CMS head, who Senate Democrats (the majority party at the time) refused to advance. With Republicans in control of the Senate it seems that even the slightest controversy over a nominee’s record could foil his or her chances. Especially hot topics for a prospective CMS director include anything that relates to abortion or the Affordable Care Act.
Delving into Mr. Cavanaugh’s previous employment experience may be helpful in determining his chances for confirmation should he be nominated to become the permanent CMS director:
- UHF – this program focuses on redesigning and restructuring New York’s health care system, especially Medicaid, to make it more efficient and patient-friendly. Recent major initiatives have included emergency disaster relief, improvement in end-of-life care, and pioneering AIDS treatments.
- NYC MOHIA – this initiative aimed to identify specific communities in NYC and its boroughs whose members were eligible for public health insurance programs but were not enrolled. Increasing health insurance coverage was the overall goal of this program.
- Maryland HSCRC – this is a state agency that regulates hospital rates in Maryland as enacted by legislation in 1971. All payer rates are regulated by the HSCRC, including Medicare and Medicaid, according to macro-economic theories of government intervention.
From his past work experience Mr. Cavanaugh has been extensively involved in government health care programs at the municipal, state, and federal levels that promote the broadening of access to health care coverage. While this may not normally be grounds for debate, a CMS director nominee who has the slightest hint of being favorable towards the ACA may be too controversial for the current makeup in Senate. This may in fact be the reason why Mr. Obama has not offered Mr. Cavanaugh’s name to the Senate for confirmation.
However before any political debate can begin, Mr. Cavanaugh – or any other potential CMS director – will need to be officially nominated by the president.