Two mildly conflicting items that crossed my cyberdesk in the last couple of weeks (and that are elsewhere noted on this site) offered reminders that "reimbursement" seems less and less about money (at least money, per se) and more and more about the substance and content of medicine itself. 
This may seem -- indeed, certainly is -- less than profound, but it's sometimes so easy to get wrapped up in coveragecodingpayment that we forget simple truths that lie at the heart of it all. One such truth is that we should pay for good medicine. Of course, our search for "good medicine" never ends (and never should end). What's interesting, though, is the extent to which reimbursers are joining the quest.
Item: CMS, FDA, and NIH enter a Memorandum of Understanding to collaborate on uses of PET in the clinical testing of cancer interventions. There are several story lines here. One is about personalized medicine. Another is about using technology to assess technology. But the core learning is that this is another example of Medicare chief Mark McClellan's effort to slowly turn his battleship-like CMS on the course of a public health agency. Yes, there will be any number of ongoing dust-ups on how much to pay, etc., for this or that service, but the crux of the CMS mission is unmistakably edging in the direction of good medicine.
Item: The National Committee on Quality Assurance issued its proposed new HEDIS measures, an annual event entirely predictable and almost numbingly routine. For 2007, though, the measures include a new wrinkle: for six patient conditions (five chronic, one acute), HEDIS will attempt to measure whether health plans' spending for care is too much, not enough, or about right. At one level, this, indeed, is about dollars and cents. But context is everything, and, here, the economics seem driven by the clinical, rather than the other way around. In all, one senses that this is not your father's cost-effectiveness.
And so yes, there is at least some degree of conflict between these two items. But the terms on which they're debated seem increasingly lodged in the same lexicon -- one that's less about cost, more about medicine.
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