CHICAGO — It's not news that the payment reform movement is making its way into the private sector, but a recent study has sparked fresh concerns that payers are driving clinical decision making in a direction that might blunt utilization to the detriment of patients and industry. Joe Almeida, CEO of Covidien (Dublin, Ireland) said during a press briefing at AdvaMed 2014 that he sees "a growing collection of disturbing data" suggestive of the notion that pay-for-performance and risk-based reimbursement are "making it more difficult for clinically appropriate but costly technologies to gain coverage."