rev bras ortop.2015;50(4):361–362
w w w . r b o . o r g . b r
Editorial
The
American
dream
O
sonho
americano
Recently,wehadtheopportunitytoattendanothercongress oftheAmericanAcademyofOrthopaedicSurgeons(AAOS).
Weobservedthatsomeoftheexuberanceofthefamous exhibition stands, which had always been grandiose and demonstratedtheeconomicpowerofthesystem,hadgone. Thisyear,theyweresomewhatmoremodest,withthe excep-tionofoneortwocompanies.
Somethingthatcaught ourattention wasthe frequency withwhichthetopicofcostwaspresentinthescientific pro-gram.
ThereductioninincomecausedbyObamacare, the new healthcareremunerationsystem,andbytheeffectsof com-pliancehasprofoundlyaffectedthebehaviorofournorthern colleagues. The astronomical earnings to which they had alwaysbeenaccustomedhavebeensignificantlyaffectedby thesetwonewdevelopments.
Obamacare establishes closed packages for payment of medicalprocedures,includingfeesand materials.Thus, an arthroplastyprocedureisworthX,includingthedailyratefor thehospitalstay,materials,medicationsandmedicalfees.
Initially,therewasgreatdifficultyindividingthismoney up,i.e.indecidinghowmuchwasduetobepaidtoeachparty. However,beforelong,inventivenessmotivatedbyprofitled ourcolleaguestotakepartofthecostfrompatients’comfort andsafety.
Iflesswerespentonhospitalstaysandconsequentlyon medications,thefinancialresultwouldbemorefavorablefor fees.
Thebiggestexample ofthis proposaloccurred during a symposiuminwhichaproposaltoperformtotalknee arthro-plastyasanoutpatientprocedurewasputforward.Yes,really, thepatientwouldbeadmittedinthemorning,wouldundergo the operationand then would be released inthe evening! Puttingthisincontext,forsmaller-scalesurgicalprocedures suchasarthroscopy,osteotomyandcorrectionofdeformities, releaseonthesamedayisnotevendiscussed.
Inthismanner,therewouldbeareductioninhospitalcosts andmoremoneywouldbeleftovertobedividedup.
This idea was defended in scientific presentations by namesthathavegreatlyinfluencedandcontinuetoinfluence ourtraining.
Theso-calledfast-tracksystem,i.e.asetofmeasuresthat speeduppatients’stayinhospitalenvironments,hasalready started to appear in some paper published in journals of respectablelevel,accordingtotheimpactfactorcriterion.
TheRBOhasnotyetreceivedanyarticlesonthisnewtrend. Compliance,whichissomethinginventedbythemedical industry,whichhassaidthatitistiredofpayinggratuities tophysicians,hasgivenrisetosignificantreductionsin earn-ings forsomeofourAmerican colleaguesandhasbeenan importantfactorcausingprotests.
Theinterestingpointisthatforeachpresentationatthe congress, the speakercited four or five relationships with companies supplying surgical materials, which were also publishedintheprogram.Theserelationshipsarecertainly financial,althoughdisguisedastechnicalconsultancy.
Thecompliancelaw,whichhasbeen widelyreportedin the lay press, needs to be understood as a law that was enactedtopunishphysicianswhoreceive moneyforusing onetypeofmaterialoranother,andnottopunishthisasa formofcorruptioninduced bythe industrytolaunch their material.
Thenumberofspeakerswhopresentedtheirrelationships withtheindustryclearlynegatedthecharacteristicofhonesty thatthispunitiveattitudewasintendedtogive,sinceitserved onlyforsomepeople.
Thus,costbecamethesubjectofthescientificprogram.It ledmanypeopletobelievethatreleasingapatientonthesame dayonwhichheunderwentkneearthroplastyissomething thatismodern,correctandup-to-date.
Wehavealreadyimportedmanythingsderivedfrom Amer-ican medicalpractice and weare on the wayto accepting Obamacare.Healthinsurersare alreadypresentingpackages forpaymentofproceduresinseveralstates.
362
rev bras ortop.2015;50(4):361–362withthecompaniessupplyingsurgicalmaterials.These com-paniessoontookupthefascinatingideaofcompliance.
NevertheSBOToranycommitteedefendedthedoctor’s remunerationfortheuseofsurgicalmaterialsandneitherthe indicationofunnecessarysurgeries.Thispracticeisacrime incivilsocietyandveryseriousmedicalinfringementonthe analysisofSBOT.
Thesecompaniesareexchangingtheirhonestandhealthy relationshipwithphysicians,whoare theirreal consumers andpartners,forarelationshipwithsupplementary health-carecompanies,whicharetheirpayers.
The deterioration in the relationship between surgical materialsuppliersandphysiciansisclearlyseeninthe dif-ficultyinobtainingsponsorshipforourcontinuingeducation programs.Thishasledtosuspensionofseveralofour tradi-tionalcongresses.
Ourrelationship withsuppliers ofmaterialshasalways beenveryproductive.Ithasenabledadvanceswithin ortho-pedics, brought modern materials and important speakers
to Brazil, enabled training course abroad for many Brazil-ians and provided sponsorship for our journals and our congresses.
Therefore,wewillbewaitingforgoodsensetoprevail,for patientstoberespectedandforthecompaniessupplying sur-gical materialto understandthat the onlypossiblewayto surviveisfortheretobeasolidpartnershipwiththemedical profession,inthewaythatithaslastedformanyyears.
LetusforgettheAmericandream.
GilbertoLuisCamanho RevistaBrasileiradeOrtopedia E-mail:gilbertocamanho@uol.com.br
Availableonline20July2015
