Sean Tunis: A mysterious figure

Sunday, October 31, 2004

If there’s an unknown quantity among the 10 most influential people in the HME industry, it’s probably Dr. Sean Tunis, CMS’s chief medical officer and its director of the Office of Clinical Standards and Quality.

Tunis joined CMS about 20 years ago, but until he became medical director earlier this year, the industry had little direct interaction with him. What interaction it did have revealed Tunis to take a conservative view of coverage criteria, and a sometimes dim view of the HME industry. At the same time, he has a deep respect for beneficiaries and their needs. Put another way, as a doctor he’s clinically based, but as a bureaucrat he’s motivated to develop policy that is consistent with CMS’ goal to curb utilization.

As medical director, Tunis literally has the power of life and death over providers, depending on where he guides Medicare policy on coverage issues.

As CMS moves forward with competitive bidding, new coverage criteria for power wheelchairs and other reimbursement issues, Tunis must make sure payment doesn’t sink to a level that thwarts innovation and beneficiary access. If he doesn’t, Tunis will make a lot of people angry, including elected officials who support the industry.

On these issues and others, there’s more to the process than Tunis giving a thumbs up or down. Nevertheless, his perspective goes a long way toward deciding the final outcome. Maybe he’ll find a balance when measuring the needs of providers and beneficiaries against those of CMS. At this point, however, it’s anyone’s guess.