“What concerns me is that they are going to take away choice from physicians,” Caroll Neubauer, chairman and CEO of B. Braun Medical, said. “I am afraid that bureaucrats are going to decide what is a good product and what is not a good product versus the physician sitting in front of a patient and deciding that ‘For this patient I think product A is better than product B.'”
Elimination of clinical choices would come, in part, through comparative effectiveness research, the executives said, which would limit reimbursements to products with the best generic cost-benefit outcomes.
Other provisions of the ACA that the executives expect to limit physician autonomy include the Independent Payment Advisory Board, which may cut the growth of Medicare primarily through reduced provider reimbursements, and the Center for Medicare and Medicaid Innovation. The new CMS office was derided by a Patrick Morrisey, a former Republican congressional healthcare staffer, as a new “price control authority” for the agency that will have a “significant impact” on device-makers.
It didn't have to be this way, argued John Bishop, CEO of Cepheid. Instead of the law's path to improved clinical outcomes through weakening physician decision-making authority, he said, a more effective way to improve care quality would encourage physicians and device-makers to work together to identify the medical devices that are both needed and that perform the best.
At this point, such sentiments are water under the bridge.
As Paul Keckley, executive director of the Deloitte Center for Health Solutions, pointed out, the loss of physician autonomy was under way well before enactment of the healthcare law. Enactment of the law just underscored physicians' reduced roles by highlighting their inability to include in the legislation—despite its sprawling scope—either of their two leading priorities: a so-called fix to the physician sustainable growth rate payment formula or an overhaul of malpractice liability.
You can follow Rich Daly on Twitter @MHRDaly.