Q & A With Tom Scully

He's Medicare's defender and its toughest critic. He roots for beneficiaries but works to contain costs. He wants to stop fraud. He would like to see reform for the massive government program, which now covers more than 40 million Americans, make it through Congress this year — in any version.

As administrator of Centers for Medicare & Medicaid Services, Thomas A. Scully is CEO of the largest health insurance organization in the world and the single largest purchaser of health care in the United States. CMS is responsible for the management of Medicare, Medicaid, the State Children's Health Insurance Program and other national health care initiatives.

The organization insures 25 percent of the country's population, processes more than a billion claims a year and contracts with one million providers. CMS is directly responsible for $1 out of every $3 spent on health care in the United States. And, quips Scully, “We generally have no clue where the hell it's all going.”

Appointed by President Bush and sworn into the job in 2001, Scully has since earned a reputation for straight talk and tough rulings in an effort to get a handle on CMS' spending. “When you're in the government, you do the best you can for the taxpayers. That's your job,” he says.

Before taking the reins at CMS, Scully was president and CEO of the Federation of American Hospitals, and previously was a partner in the Washington, D.C., law firm of Patton Boggs. As deputy assistant to the first President Bush, Scully advised the president on health care policy, Medicare and Medicaid payment reform. He also has served on the Board of Directors of Oxford Health Plans and of DaVita Corp., two of the nation's largest health care service providers.

In this exclusive interview with HomeCare, Scully speaks frankly about his “tough guy” reputation, his opinions on current home care hot-buttons and the legacy he would like to leave at CMS.

HC: You are the CEO of the agency with the second-largest budget outlay of the federal government. What do you see as your mission in managing this massive organization?

Scully: As you know, I'm a big advocate of Medicare reform, and I think we would be better off if beneficiaries had more locally synthesized decision-making and they were getting their health care through a Blue Cross plan or through a Cigna. But since we're in charge of running this massive government insurance program, my goal is to … have a better understanding of where we're spending the money.