The recess appointment of Donald Berwick, MD, to the administrator’s position at the Centers for Medicare & Medicaid Services (CMS) last July roiled many members of Congress, and a recent Senate letter to the Obama administration expressing disfavor for Berwick’s continued presence at CMS may have finally lain to rest any chance that he had of a successful confirmation hearing.

The letter, whose principal authors include Sen. Mike Enzi (R-Wyoming), the ranking GOP member of the Senate Health, Education, Labor and Pensions Committee, and Orrin Hatch (R-Utah), the ranking GOP member of the Senate Finance Committee, cite Berwick’s “past record of controversial statements and general lack of experience managing an organization as large and complex as CMS,” which the authors said “should disqualify him being confirmed as the CMS administrator.” The signers also expressed their ire that President Obama had pledged “a new era of transparency in our government,” but the recess appointment of Berwick and the back-room drafting of the Patient Protection and Affordable Care Act of 2010 “both contradict your pledge,” the authors say. A total of 42 Republican senators signed on to the letter.

It appears that Senate Democrats are beginning to think Berwick’s bid to retain the job is in serious jeopardy, given that confirmation would require 60 votes to avert a filibuster, a total Berwick’s supporters largely do not see as likely.

Berwick’s principal deputy, Marilyn Tavenner, appears to be a likely candidate to succeed him, and with her private- and public-sector healthcare administrative experience, lawmakers of both parties have indicated that she could probably be confirmed.

The recess appointment allows Berwick to serve to the end of this year.  The president has nominated Berwick three times, most recently in January. It remains unclear whether President Obama will nominate him for a fourth time, though White House spokesman Reid Cherlin said the administration would not withdraw Berwick’s nomination. 

“The president nominated Don Berwick because he’s far and away the best person for the job, and he’s already doing stellar work at CMS: Saving taxpayer dollars by cracking down on fraud and implementing delivery-system reforms that will save billions in excess costs and save millions of lives,” Cherlin said in a statement.

So what do you think, does Berwick have a legitimate chance at nomination, or is he just whistling past the graveyard?