Administrador de los centros de Medicare y Medicaid Services

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Donald M. Berwick (nacido en 1946) es el administrador saliente de los centros para servicios de Medicaid y Medicare. Antes de su trabajo en la administración, fue Presidente y Jefe Ejecutivo del Instituto para la mejora de la salud) [1] una organización sin fines de lucro que ayuda a conducir la mejora de la salud en todo el mundo.

07 De julio de 2010, Barack Obama nombrado Berwick para servir como administrador de CMS a través de un nombramiento de receso. El 02 de diciembre de 2011, dejó la posición porque estaba claro que los republicanos en el Congreso no permitiría un voto para confirmarlo.

Berwick ha estudiado la administración de sistemas de salud, con énfasis sobre el uso de métodos científicos y la medicina basada en evidencias y la investigación de eficacia comparativa para mejorar el equilibrio entre calidad, seguridad y costos.

[2][3][4] Entre proyectos de IHI son cursos en línea para los profesionales de salud para reducir las infecciones de Clostridium difficile, disminuyendo el número de reingresos de insuficiencia cardíaca o administración avanzados enfermedad y cuidados paliativos.

[5] Berwick dijo que 20-30% del gasto sanitario es "residuos" con ningún beneficio a los pacientes, debido a overtreatment, fracaso para coordinar la atención, la complejidad administrativa y el fraude, y que parte de este problema era debido a regulaciones de CMS.

[6] Los críticos de Berwick han citado sus declaraciones sobre la necesidad de cuidado de salud para redistribuir los recursos de los ricos a los pobres y sus declaraciones favorables acerca del servicio de salud británico. Cito Berwick como diciendo, "la decisión es no o no será racionar la atención, la decisión es si nos va ración con los ojos abiertos".

[7] [8] Berwick dijo que los republicanos habían "distorsionado" su significado: "mi punto es que alguien, como su compañía de seguro de salud, va a limitar lo que puede obtener. Es la forma en que está configurado. El Gobierno, a diferencia de muchos planes de seguro de salud privado, está trabajando en la luz del día. Eso es una fortaleza".

[6] Por razones políticas, la administración de Obama hizo Berwick permanecer evasivas y evitar defender su pasado declaraciones sobre el servicio de salud británico, gastos gorras y cuidados de alta tecnología.[6]                                            
                                                                            Para verlo en Inglesh

Los críticos apuntan a declaraciones como ésta: "cualquier salud financiación plan que es justo, equitativo, civilizado y humano, debe redistribuir la riqueza de los ricos entre nosotros a los más pobres y menos afortunados. Excelente atención de la salud es por definición redistribución".

[9][10] [editar] BiographyBerwick graduó de Nathan Hale-Ray Moodus, Connecticut. Berwick se graduó con una licenciatura de la Universidad de Harvard y recibió un M.P.P. de John f. Kennedy School of Government de la Universidad de Harvard y un M.D. de la escuela médica de Harvard. Completó su residencia médica en pediatría en el Hospital de Boston de niños.

Berwick comenzó su carrera como un pediatra en Harvard Community Health Plan; en 1983 se convirtió en primer vicepresidente del plan de la medición de la calidad de la atención.[11] En que posición, Berwick investigó las medidas de control de calidad en otras industrias como la aeronáutica y fabricación y considera su aplicación en centros de salud.[cita requerida] Entre 1987 y 1991, Berwick fue cofundador y Co-Principal investigador para el proyecto nacional de demostración sobre la mejora de la calidad en la atención de la salud, diseñada para explorar oportunidades de mejora de la calidad en la atención sanitaria. Basada en esta obra, Berwick dejó Harvard Community Health Plan en 1989 y cofundó la IHI (Instituto para la mejora de la salud).

Berwick es profesor clínico de pediatría y la política de salud en el departamento de Pediatría en la escuela médica de Harvard y profesor de política de salud y administración en la escuela de salud pública de Harvard.

[12] Él también es un pediatra, personal adjunto en la Facultad de medicina en Hospital de Boston de niños y un consultor en pediatría en el Hospital General de Massachusetts.

Con sede en Cambridge, Massachusetts, el IHI trabaja para acelerar la mejora mediante la construcción de la voluntad de cambio, cultivar conceptos prometedoras para mejorar la atención al paciente y ayudando a los sistemas de salud a poner esas ideas en acción. Empleando un personal de aproximadamente 100 personas y mantener asociaciones con cientos de miembros de la facultad, IHI ofrece programas que apuntan a mejorar las vidas de los pacientes, la salud de las comunidades y la satisfacción de los trabajadores sanitarios.

Trabajo de IHI está financiado principalmente a través de programas basados en honorarios y servicios y también con el apoyo de fundaciones, empresas y particulares. IHI ofrece becas del programa, investigación y desarrollo, formación profesional y las iniciativas en los países en desarrollo.

Visión de IHI para atención de la salud es una adaptación de los objetivos de mejora seis del Instituto de medicina para el sistema de atención de la salud: cuidado que es segura, efectiva, centrada en el paciente, oportuna, eficiente y equitativa: [13]

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Donald Berwick

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Donald Berwick
Administrator of the Centers for Medicare and Medicaid Services
In office July 7, 2010 – December 2, 2011
President	Barack Obama
Preceded by	Marilyn Tavenner (Acting)
Succeeded by	Marilyn Tavenner (Designate)
Personal details
Born	1946 (age 65–66) New York City, New York, U.S.
Alma mater	Harvard University

Donald M. Berwick (born 1946) is the outgoing Administrator of the Centers for Medicare and Medicaid Services. Prior to his work in the administration, he was President and Chief Executive Officer of the Institute for Healthcare Improvement)^[1] a not-for-profit organization helping to lead the improvement of health care throughout the world. On July 7, 2010, Barack Obama appointed Berwick to serve as the Administrator of CMS through a recess appointment. On December 2, 2011, he left the position because it was clear that Republicans in the Congress would not allow a vote to confirm him.

Berwick has studied the management of health care systems, with emphasis on using scientific methods and evidence-based medicine and comparative effectiveness research to improve the tradeoff among quality, safety and costs.^[2][3][4] Among IHI's projects are online courses for health care professionals for reducing Clostridium difficile infections, lowering the number of heart failure readmissions or managing advanced disease and palliative care.^[5]

Berwick said that 20-30% of health spending is "waste" with no benefit to patients, because of overtreatment, failure to coordinate care, administrative complexity and fraud, and that part of this problem was because of CMS regulations.^[6]

Berwick's critics have cited his statements about the need for health care to redistribute resources from the rich to the poor and his favorable statements about the British health service. They quote Berwick as saying, “The decision is not whether or not we will ration care - the decision is whether we will ration with our eyes open.”^{[7] [8]}

Berwick said that Republicans had "distorted" his meaning: "My point is that someone, like your health insurance company, is going to limit what you can get. That's the way it's set up. The government, unlike many private health insurance plans, is working in the daylight. That's a strength.”^[6]

For political reasons, the Obama administration made Berwick stay evasive and avoid defending his past statements on the British health service, spending caps and high-technogy care.^[6]

Critics point to statements such as this: "Any health care funding plan that is just, equitable, civilized and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition redistributional."^[9][10]

Contents [hide] 1 Biography 2 Nomination and controversy 3 Awards and honors 4 Quotations 5 Selected publications 6 References 7 External links

 Biography

Berwick graduated from Nathan Hale-Ray High School in Moodus, Connecticut. Berwick graduated with a B.A. from Harvard College, and received an M.P.P. from John F. Kennedy School of Government at Harvard University and an M.D. from Harvard Medical School. He completed his medical residency in pediatrics at Children's Hospital Boston.

Berwick began his career as a pediatrician at Harvard Community Health Plan; in 1983 he became the plan's first Vice President of Quality-of-Care Measurement.^[11] In that position, Berwick investigated quality control measures in other industries such as aeronautics and manufacturing and considered their application in health care settings.^{[citation needed]} From 1987-1991, Berwick was co-founder and Co-Principal Investigator for the National Demonstration Project on Quality Improvement in Health Care, designed to explore opportunities for quality improvement in health care. Based on this work, Berwick left Harvard Community Health Plan in 1989 and co-founded the IHI (Institute for Healthcare Improvement).

Berwick is Clinical Professor of Pediatrics and Health Care Policy in the Department of Pediatrics at the Harvard Medical School and Professor of Health Policy and Management at the Harvard School of Public Health.^[12] He is also a pediatrician, Adjunct Staff in the Department of Medicine at Children's Hospital Boston, and a Consultant in Pediatrics at Massachusetts General Hospital.

Based in Cambridge, Massachusetts, the IHI works to accelerate improvement by building the will for change, cultivating promising concepts for improving patient care, and helping health care systems put those ideas into action. Employing a staff of approximately 100 people and maintaining partnerships with hundreds of faculty members, IHI offers programs that aim to improve the lives of patients, the health of communities, and the satisfaction of the health care workforce. The IHI's work is funded primarily through fee-based programs and services, and also through the support of foundations, companies, and individuals. IHI provides program scholarships, research and development, professional education, and initiatives in developing countries.

IHI's vision for health care is an adaptation from the Institute of Medicine's six improvement aims for the health care system: care that is safe, effective, patient-centered, timely, efficient, and equitable:^[13]

• No Needless Deaths
• No Needless Pain or Suffering
• No Helplessness in Those Served or Serving
• No Unwanted Waiting
• No Waste
• No One Left Out

Berwick has published over 129 articles in professional journals on health care policy, decision analysis, technology assessment, and health care quality management. He is the co-author of several books, including Cholesterol, Children, and Heart Disease: an Analysis of Alternatives (1980), Curing Health Care (1990), and New Rules: Regulation, Markets and the Quality of American Health Care (1996).

[edit] Nomination and controversy

On April 19, 2010, Dr. Berwick was nominated to be Administrator of the Centers for Medicare and Medicaid, which oversees the two federal programs.^[14]

An editorial wrote that his policy ideas could cut health care costs.^[15] Conservatives^{[not in citation given]} criticized Berwick, based on comments he made about health care being, by definition, redistribution of wealth, rationing care with "our eyes open" and complete lives system.^[16]

Berwick advocates cutting health costs by adopting some of the approaches of Great Britain's National Health Services (NHS) and its National Institute for Health and Clinical Excellence (NICE). NICE evaluates the costs and effectiveness of medical therapy that is covered by the NHS as guidance for local authorities to decide what to cover. Mark McClellan, who served in the Bush administration, also advocated adopting some of NICE's methods.^[17]

Conservative critics claim that "NICE decides which healthcare people will get and which they won't."^[18] Philip Klein in The American Spectator dubbed him “Obama’s Rationing Man.”^[19] The chairman of NICE called these statements "outrageous lies."^[20]

Senator John F. Kerry defended Berwick against "phony assertions" and accused Republicans of trying "to crank up the attack machine and make his nomination a distorted referendum on reform.”^[21] Former Speaker Newt Gingrich has historically been a Republican supporter of Berwick, however, writing an op-ed in the Washington Post in August 2000 praising Berwick's work.^[22]

Berwick was installed by recess appointment on July 7, 2010 before confirmation hearings were scheduled by the Democratic-controlled Senate committee.^[23] Dr. Berwick could thus serve until the summer of 2011 without a Senate approval. The White House had talked up the possibility of a re-nomination through the fall of 2010; on January 26, 2011, the President re-nominated Dr. Berwick. On March 4, 2011, 42 US Senators wrote the White House and asked for the nomination to be withdrawn. The signers of the letter broke along partisan lines as all were Republicans.

Berwick resigned his position at CMS on December 2, 2011. ^[24] In a speech on Wednesday, Dec. 7, 2011 in Orlando, Florida, at a meeting of the Institute for Healthcare Improvement , an organization he once led, the long-time patient-safety advocate gave a stirring account of his time in government service and the where he believes the future of healthcare is going. ^[25]

[edit] Awards and honors

• Ernest A. Codman Award, 1999
• Alfred I. DuPont Award for excellence in children’s healthcare, 2001
• American Hospital Association, "Award of Honor", 2002
• Fellow of the Royal College of Physicians in London, 2004
• Honorary Knight Commander of the Most Excellent Order of the British Empire, 2005
• Purpose Prize for "enlisting wide-scale cooperation and scientifically-proven protocols to help hospitals improve care and save more than 100,000 lives," 2007^[26]
• The 13th Annual Heinz Award for Public Policy, 2007^[27]

[edit] Quotations

• "Some is not a number. Soon is not a time." (slogan for IHI's completed 100K Lives Campaign, now slogan for IHI's 5 Million Lives Campaign in progress)^[28][29]
• "We are guests in our patients' lives; and we are their hosts when they come to us. Why should they, or we, expect anything less than the graciousness expected by guests and from hosts at their very best. Service is quality."^[30]
• "We are not hosts in our organizations so much as we are guests in our patients’ lives."^[31]
• "Some say that doctors and patients should now be partners in care. Not so, I think. In my view, we doctors are not our patients' partners; we are guests in our patients' lives. We are not hosts. We are not priests in a cathedral of technology."^[32][33]
• "You could have protected the wealthy and the well, instead of recognizing that sick people tend to be poorer and that poor people tend to be sicker and that any health care funding plan that is just, equitable, civilized and humane must, MUST redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is, by definition, redistributional."^[34]

The quote "What can you do by next Tuesday?" is frequently credited to Berwick but seems to have been coined by the authors of Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians, which they wrote under the IHI aegis.^[35]

[edit] Selected publications

• Berwick DM, Cretin S, Keeler EB. Cholesterol, children, and heart disease: an analysis of alternatives. New York: Oxford University Press, 1980. ISBN 0-19-502669-1.
• Read JL, Quinn RJ, Berwick DM, Fineberg HV, Weinstein MC. Preferences for health outcomes. Comparison of assessment methods. Med Decis Making. 1984;4(3):315-29. PMID 6335216.
• Berwick DM, Weinstein MC. What do patients value? Willingness to pay for ultrasound in normal pregnancy. Med Care. 1985 Jul;23(7):881-93. PMID 3925259.
• Murphy JM, Berwick DM, Weinstein MC, Borus JF, Budman SH, Klerman GL. Performance of screening and diagnostic tests. Application of receiver operating characteristic analysis. Arch Gen Psychiatry. 1987 Jun;44(6):550-5. PMID 3579501.
• Berwick DM. Continuous improvement as an ideal in health care. N Engl J Med. 1989 Jan 5;320(1):53-6. PMID 2909878.
• Perrin JM, Homer CJ, Berwick DM, Woolf AD, Freeman JL, Wennberg JE. Variations in rates of hospitalization of children in three urban communities. N Engl J Med. 1989 May 4;320(18):1183-7. PMID 2710191.
• Berwick DM, Godfrey AB, Roessner J. Curing health care: new strategies for quality improvement. A report on the National Demonstration Project on Quality Improvement in Health Care. San Francisco: Jossey-Bass, 1990. ISBN 1-55542-294-2.
• Berwick DM, Murphy JM, Goldman PA, Ware JE Jr, Barsky AJ, Weinstein MC. Performance of a five-item mental health screening test. Med Care. 1991 Feb;29(2):169-76. PMID 1881269.
• Berwick DM. A primer on leading the improvement of systems. BMJ. 1996 Mar 9;312(7031):619-22. PMID 8595340.
• Berwick DM. Quality of health care. Part 5: Payment by capitation and the quality of care. N Engl J Med. 1996 Oct 17;335(16):1227-31. PMID 8815948.
• Brennan TA, Berwick DM. New rules: regulation, markets, and the quality of American health care. San Francisco: Jossey-Bass, 1996. ISBN 0-7879-0149-0.
• Berwick DM. Developing and testing changes in delivery of care. Ann Intern Med. 1998 Apr 15;128(8):651-6. PMID 9537939.
• Leape LL, Berwick DM. Safe health care: are we up to it? BMJ. 2000 Mar 18;320(7237):725-6. PMID 10720335.
• Berwick DM. A user's manual for the IOM's 'Quality Chasm' report. Health Aff (Millwood). 2002 May-Jun;21(3):80-90. PMID 12026006.
• Leape LL, Berwick DM, Bates DW. What practices will most improve safety? Evidence-based medicine meets patient safety. JAMA. 2002 Jul 24-31;288(4):501-7. PMID 12132984.
• Berwick DM. Disseminating innovations in health care. JAMA. 2003 Apr 16;289(15):1969-75. PMID 12697800.
• Berwick DM, Jain SH. "The Basis for Quality Care in Prepaid Group Practice," in Toward a 21st Century Health System: The Contributions and Promise of Prepaid Group Practice. Alain C. Enthoven & Laura A. Tollen eds. San Francisco: Jossey-Bass, 2004.
• Berwick DM. Escape fire. Designs for the future of health care. San Francisco: Jossey-Bass, 2004. ISBN 978-0-7879-7217-2.
• Leape LL, Berwick DM. Five years after To Err Is Human: what have we learned? JAMA. 2005 May 18;293(19):2384-90. PMID 15900009.
• Berwick DM, Calkins DR, McCannon CJ, Hackbarth AD. The 100,000 lives campaign: setting a goal and a deadline for improving health care quality. JAMA. 2006 Jan 18;295(3):324-7. PMID 16418469.
• Berwick DM. The science of improvement. JAMA. 2008 Mar 12;299(10):1182-4. PMID 18334694.
• Berwick, DM, Jain SH, and Porter ME. "Clinical Registries: The Opportunity For The Nation." Health Affairs Blogs, May 2011.

[edit] References

1. ^ Galewitz P. Local hospitals and doctors join forces to improve health care, restrain costs. Kaiser Health News. 2009 Jul 22. Accessed 2009 Jul 25.
2. ^ Rethinking Comparative Effectiveness Research.
3. ^ Interview with Donald Berwick. Katherine T. Adams, Biotechnol Healthc. 2009 June; 6(2): 35-36, 38.
4. ^ Carmichael, Mary (March 29, 2010). "Five Things You Should Know About Donald Berwick, the New Medicare/Medicaid Chief". Newsweek. http://www.newsweek.com/blogs/the-human-condition/2010/03/29/five-things-you-should-know-about-donald-berwick-the-new-medicare-medicaid-chief.html.
5. ^ Who Is Don Berwick and What Will He Mean for Reform? By MAGGIE MAHAR March 30, 2010.
6. ^ ^{a b c} Health Official Takes Parting Shot at ‘Waste’ By Robert Pear, New York Times, December 3, 2011
7. ^ Rethinking Comparative Effectiveness Research. Interview with Donald Berwick. Biotechnology Healthcare Magazine June, 2009
8. ^ National Center for Biotechnology Information Biotechnology Interview Questions & Answers - Not PHP file as previous citation
9. ^ Obama Nominee Donald Berwick's Radical Agenda by Ben Domenech, May 12, 2010
10. ^ 'Death panels' were an overblown claim – until now By Michael Tanner | Published: 05/27/10 at 12:00 AM | Updated: 05/27/10 at 2:06 PM
11. ^ Feder BJ. Thomas Pyle, 67, innovator in 1980s health care plans. New York Times. 2007 Jul 21
12. ^ Report: hospital medication errors commonplace. Talk of the Nation, National Public Radio. 2006 Jul 28. Accessed 2009 Jul 25.
13. ^ Institute of Medicine Vision and Values [1]
14. ^ White House. President Obama Nominates Dr. Donald Berwick for Administrator of the Centers for Medicare and Medicaid Services. 10 April 19.
15. ^ Editorial, "Donald Berwick, a nominee well-suited to trim the fat on health care", The Washington Post, June 29, 2010
16. ^ Obama's cynical recess appointment of Donald Berwick, By Ruth Marcus, The Washington Post, July 8, 2010; 2:50 PM ET,
17. ^ The Evidence Gap: British Balance Benefit vs. Cost of Latest Drugs, By GARDINER HARRIS, New York Times, December 2, 2008
18. ^ Anderson, Jeffrey H (2010-04-29). "Not NICE". The Weekly Standard. http://www.weeklystandard.com/blogs/not-nice. Retrieved 2010-06-04.
19. ^ Klein P. “http://spectator.org/archives/2010/05/13/obamas-rationing-man” American Spectator. 2010 May 13.
20. ^ Official Defends British Health Service Against ‘Outrageous Lies’, By GARDINER HARRIS, New York Times, August 21, 2009
21. ^ Milligan S. Kerry comes to defense of nominee to run Medicare, Medicaid programs. Boston Globe. 2010 May 14.
22. ^ Newt Gingrich, High-Tech Cure for Medical Mistakes American Enterprise Institute August 2, 2000
23. ^ Pear, Robert (July 6, 2010). "Obama to Bypass Senate to Name Health Official". New York Times. http://www.nytimes.com/2010/07/07/health/policy/07recess.html. Retrieved August 19, 2010.
24. ^ Pear, Robert (November 23, 2011). "Obama’s Pick to Head Medicare and Medicaid Resigns Post". New York Times. http://www.nytimes.com/2011/11/24/health/policy/dr-donald-m-berwick-resigns-as-head-of-medicare-and-medicaid.html. Retrieved December 13, 2011.
25. ^ Ahier, Brian (December 8, 2011). "Remember the Patient". Healthcare, Technology, and Government 2.0. http://ahier.blogspot.com/2011/12/remember-patient.html. Retrieved December 13, 2011.
26. ^ Civic Ventures. Five social innovators over age 60 receive $100,000 Purpose Prize (news release). 2007 Sep 4. Accessed 2009 Jul 25.
27. ^ The Heinz Awards, Donald Berwick profile
28. ^ "Campaign". Institute for Healthcare Improvement. http://www.ihi.org/IHI/Programs/Campaign/. Retrieved 2010-05-13.
29. ^ "Overview of the 100,000 Lives Campaign". Institute for Healthcare Improvement. http://www.ihi.org/IHI/Programs/Campaign/100kCampaignOverviewArchive.htm. Retrieved 2010-05-13.
30. ^ "The Permanente Journal, Volume 3 No. 1" (PDF). Kaiser Permanente. Winter 1999. p. 9. http://xnet.kp.org/permanentejournal/winter99pj/insides.pdf. Retrieved 2010-05-12.
31. ^ Berwick, Donald M., MD, MPP (2002). "Escape Fire: Lessons for the Future of Health Care" (PDF). Commonwealth Fund. p. 54. http://www.commonwealthfund.org/usr_doc/berwick_escapefire_563.pdf. Retrieved 2010-05-12.
32. ^ Berwick, Donald M., KBE, MD, MPP, FRCP (London), FRCGP, FRCPS (Glasgow) (November 25, 2008). The epitaph of profession. British Journal of General Practice. doi:10.3399/bjgp08X376438. PMC 2629825. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2629825.
33. ^ Berwick, Donald M., KBE, MD, MPP, FRCP (London), FRCGP, FRCPS (Glasgow) (2008). "The epitaph of profession" (PDF). British Journal of General Practice. p. e4. http://www.aha.org/aha/content/2009/pdf/bjgp_08_JohnHuntLecture_Berwick_AOP1.pdf. Retrieved 2010-05-12.
34. ^ Berwick, Donald M., MD (8). "Transcript: Dr. Donald Berwick's Speech to the British National Health Service". Kaiser Health News. http://www.kaiserhealthnews.org/Stories/2010/July/07/berwick-british-NHS-speech-transcript.aspx. Retrieved 2011-09-20.
35. ^ Beresford, Larry (April 30, 2010). "Don Berwick and End-of-Life Care". The Growth House Blogging Portal: Larry Beresford. TypePad. http://growthhouse.typepad.com/larry_beresford/2010/04/don-berwick-and-endoflife-care.html. Retrieved 2010-05-13.

[edit] External links

• Institute for Health Care Improvement
• Dr. Berwick at Harvard Medical School
• Donald Berwick at the Institute of Medicine of the National Academies
• Donald Berwick at WhoRunsGov at The Washington Post
• Appearances on C-SPAN
• Works by or about Donald Berwick in libraries (WorldCat catalog)
• Money-Driven Medicine a documentary featuring Dr. Donald Berwick based on the book by Maggie Mahar

Blog posts

• Who Is Don Berwick and What Will He Mean for Reform?, Maggie Mahar, TheHealthCareBlog, March 30, 2010. Blog post citing WP:RS sources favorable to Berwick
• Obama Nominee Donald Berwick’s Radical Agenda, Ben Domenech, RedState.com, May 12, 2010. Blog post citing WP:RS sources unfavorable to Berwick
• In a Surprise Move, Administration Appoints Berwick to Head CMS By Maggie Mahar, TheHealthCareBlog, July 2010. Analysis of White House decision to appoint Berwick to top job in CMS, favorable to Berwick.

Political offices
Preceded by Marilyn Tavenner Acting	Administrator of the Centers for Medicare and Medicaid Services 2010–2011	Succeeded by Marilyn Tavenner Designate