The American dream

Editorial The American dream O sonho americano Recently, we had the opportunity to attend another congress of the American Academy of Orthopaedic Surgeons (AAOS). We observed that some of the exuberance of the famous exhibition stands, which had always been grandiose and demonstrated the economic power of the system, had gone. This year, they were somewhat more modest, with the exception of one or two companies. Something that caught our attention was the frequency with which the topic of cost was present in the scientific program. The reduction in income caused by Obamacare, the new healthcare remuneration system, and by the effects of compliance has profoundly affected the behavior of our northern colleagues. The astronomical earnings to which they had always been accustomed have been significantly affected by these two new developments. Obamacare establishes closed packages for payment of medical procedures, including fees and materials. Thus, an arthroplasty procedure is worth X, including the daily rate for the hospital stay, materials, medications and medical fees. Initially, there was great difficulty in dividing this money up, i.e. in deciding how much was due to be paid to each party. However, before long, inventiveness motivated by profit led our colleagues to take part of the cost from patients' comfort and safety. If less were spent on hospital stays and consequently on medications, the financial result would be more favorable for fees. The biggest example of this proposal occurred during a symposium in which a proposal to perform total knee arthro-plasty as an outpatient procedure was put forward. Yes, really, the patient would be admitted in the morning, would undergo the operation and then would be released in the evening! Putting this in context, for smaller-scale surgical procedures such as arthroscopy, osteotomy and correction of deformities, release on the same day is not even discussed. In this manner, there would be a reduction in hospital costs and more money would be left over to be divided up. This idea was defended in scientific presentations by names that have greatly influenced and continue to influence our training. The so-called fast-track system, i.e. a set of measures that speed up patients' stay in hospital environments, has already started to appear in some paper published in journals of respectable level, according to the impact factor criterion. The RBO has not yet received any articles on this new trend. Compliance, which is something invented by the medical …