Sunday, September 6, 2015

Tavenner Revolves from Botching PPACA to Heading AHIP

Former HCA executive Marilyn Tavenner headed the Center for Medicare/Medicaid when it rolled out complex insurance exchanges intended to stem rapidly rising healthcare costs.  Oddly, her botching exchange implementation got her the adulation of health insurance companies.  Tavenner is now the chief lobbyist for America's Health Insurance Plans, a heavyweight group of major health insurers.

The bulk of Tavenner's career and expertise is on the provider side, which traditionally viewed insurers as a necessary evil.  HCA's 2004 10-K stated:

Marilyn B. Tavenner was appointed President — Outpatient Services Group in January 2004. From February 2001 to December 2003, Ms. Tavenner served as President for the Central Atlantic Division of the Company. From February 1996 to January 2001, Ms. Tavenner served as President of the Richmond Market of the Company. From April 1993 to January 1996, Ms. Tavenner served as Chief Executive Officer of CJW Medical Center
Rick Scott's Colombia bought HCA in 1994.  Tavenner was CEO of two hospitals in Richmond's Southside, Chippenham Hospital and Johnston-Willis Hospital.  In February 1996 she rose to President of the Richmond, Virginia Market. This promotion occurred while Rick Scott improperly incentivized physicians and committed other frauds.  The Miami Herald reported:

The doctor payments were among 10 different kinds of fraud identified by the Justice Department in its 10-year probe of the company, records show. Three years after Scott left Columbia/HCA, the company admitted wrongdoing, pleading guilty to 14 felonies -- most committed during Scott's tenure -- in addition to paying two sets of fines totaling $1.7 billion.
Scott tucked his tail and resigned from HCA in 1997.  Scott blamed the illegal behavior on underlings, a reflection of his abusive management practices.  The Justice Department investigation ran for ten years, starting under President Bill Clinton.  It culminated in 2003 under President George W. Bush.  Despite the record $1.7 billion in fines, no individuals were charged for their role in HCA's chronic, excessive illegal acts.  As a result Florida has a governor who'd be a convicted felon in another era.  Note that Richard Rainwater, a bundler for W., bankrolled Rick Scott's Columbia from the get go.  Salon reported:

In 1987 Rainwater and Scott partnered, and with the initial purchase of two hospitals in El Paso, Texas, formed the Columbia Healthcare Corp. They took their company public and used the money to buy hospitals at a fast clip, focusing on dominating specific markets by buying several hospitals in a region and closing the poor-performing ones. They slashed costs, cutting jobs and hours, and bought bulk supplies at discount. Wall Street rewarded them. By 1994 they had enough capital to buy Scott’s original target, HCA.
The $1.7 billion settlement mentions illegal behavior at HCA facilities in Florida, New York, and Georgia,as well as in Nashville, Tennessee, the site of HCA's home office.  Illegal physician incentive payments are not specified location wise.  Tavenner, as head of a Richmond area hospitals, would've been most likely to have committed this offense.  This is an educated guess as no individuals were charged with crimes in Columbia/HCA's widespread felonious behavior

HCA's greed taint resurfaced in 2006 when a consortium of private equity underwriters (PEU) took the company private.  Bloomberg reported:

HCA Inc., the largest U.S. hospital chain, agreed to a $21.3 billion buyout offer from Bain Capital LLC, Kohlberg Kravis Roberts & Co., Merrill Lynch & Co. and HCA co-founder Thomas F. Frist Jr. Including the buyers' assumption of $11.7 billion in debt, the total value of the sale will be $33 billion, the company said today in a statement.
KKR and company announced the deal in July, with deal closing in November 2006.  Marilyn left HCA before the deal was even announced, ostensibly to serve Virginia citizens needing affordable healthcare.  I observed in 2007:

Ex-HCA high up Marilyn Tavenner will soon use a privately funded health care reform study as an "internal working document" to change the State of Virginia's health care system. Just as ex-Halliburton CEO Dick Cheney used a meeting with energy chief executives to set our national energy policy and kept it secret, so plans Marilyn with the approval of Democratic Governor Tim Kaine. But wait, this isn't the first time an ex-for profit leader, now in a governmental role, crafts health care changes behind the watchful public eye. 
Tom Scully, former head of the for-profit hospital lobbying group, brought us the Medicare Prescription Drug Program in a similarly opaque manner as the head of the Center for Medicare and Medicaid. Tom stifled a subordinate’s higher cost estimates in an apparently illegal move.

So what can Virginia expect from Marilyn? Let’s hope it’s more than Tom delivered. During the prescription drug program’s development, Mr. Scully negotiated for his future employment. Is anyone surprised he landed as a health care lobbyist alongside ex-Senators Bob Dole-R and Tom Daschle-D? He also snagged a Senior Advisor role in a private equity firm with a large health care portfolio which happens to include a national Medicare Part D plan sponsor.
The revolving door path is well worn in today's Government-Corporate Monstrosity.  Marilyn Tavenner's elusive past, that other bloggers are yet to find, does exist.  Although it was difficult to find a start date for Tavenner's Virginia HHS role.  Several public pieces from January and February 2006 listed her in that role.  Also her SEC insider status with HCA ended 12-31-2005.

Tavenner did not study directly under greed and leverage boys.  She likely faced job elimination as PEU barbarians circled HCA's gate.  However, she likely learned in public service they get what they want and it's government's role to facilitate their massive profiteering. 

Practical PPACA implementer Marilyn endured her public flogging over the hapless insurance exchange rollout.  That silence, servitude and public acquiescence garners favors to be cashed in later.

Tavenner's solely the chief insurance lobbyist making $2 million a year, having resigned from LifePoint Hospitals' board.  Her door has revolved from.

"She has been in healthcare her whole life. She is not a politician. She is a healthcare practitioner."
Not any more.  She's a lobbyist for profits over people.  Nothing symbolizes better the beneficiaries of healthcare reform, its planners and profiteers.