Marilyn Tavenner today told CMS staff via email that she’ll be stepping down as head of the agency at the end of February. Now what?

Many agency watchers we contacted after the news broke expressed hope that the Obama administration will move quickly to name a permanent replacement in an effort to stabilize the agency. CMS Principal Deputy Administrator Andy Slavitt has been tapped as acting administrator.

Gail Wilensky, who oversaw the agency from 1990 to 1992, said that getting a name before Congress within the next six months is critical, otherwise the administration runs the risk of having an acting head up to the 2016 elections.

“That would be unfortunate,” said Wilensky, a senior fellow at Project HOPE. “We had an acting administrator during President Obama’s first term and this isn’t an agency where you want that. It carries a different weight within the department and Congress if you are confirmed versus being an acting head.”

At the same time, said Jeffery Smith, vice president of public policy at the College of Healthcare Information Management Executives, the change offers an opportunity to get a “fresh set of eyes” on some of the key issues on the agency’s plate. From CHIME’s perspective, that certainly means taking a closer look at meaningful use timelines and regulations. CHIME and other industry groups have been pressing policy and lawmakers for more flexibility in meeting Stage 2 requirements.

Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association, said that Tavenner’s departure, coupled with some general turnover in the agency, will create challenges in other areas, including the Physician Quality Reporting System and the value-based payment modifier.

Performance in 2015 for those areas could reduce reimbursement down the road, Gilberg said. In addition, there’s a proposed accountable care organization rule that has yet to be finalized, he said.

Filling her shoes will not be easy. “She’s been a very smart and capable administrator,” Gilberg said. “She was quite good to work with.”

That’s the general consensus among hospital leaders as well. Although Tavenner caught plenty of political heat for the turbulent rollout of the health insurance exchanges, hospital officials who worked with her on a regular basis praised her evenhandedness and ability to get things done.

“As both CMS administrator and deputy before that, Marilyn leaves a legacy of having played a major role in making sure that millions of Americans have access to health coverage,” AHA President and CEO Rich Umbdenstock said in a statement. “

“As a nurse, health care executive and government official, she brought a practical perspective to running a very complex government agency. Her ability to work in a bipartisan manner with legislators and listen carefully to the concerns of hospitals and other stakeholders was key to her effectiveness as a leader," he said.

The word “bipartisan” will be critically important now with a divided government. “I know her successor will have big shoes to fill, and I hope it’s someone with Marilyn’s background and expertise who can work across the aisles in a divided government to get things done and help improve our health care system,” said Kevin Lofton, CEO, Englewood, Colo.-based Catholic Health Initiatives.