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Ophthalmic surgeons fight to maintain funding in Germany
Surgeons seek a deal that will give them fixed reimbursement for outpatient surgery and prevent funds from going elsewhere.
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NUREMBERG — Ophthalmic surgeons here are up in arms over a new law proposed by the German Ministry of Health. At the 12th Kongress der Deutschen Ophthalmochirurgen here, plans were being formulated among several ophthalmic organizations to deal with the law’s implications, especially those for outpatient surgeons.
“This is not the final law yet, but it’s probably going to be approved this way. That’s the feeling,” said Dr. med. Michael C. Knorz, in an interview with Ocular Surgery News. Surgeons at the meeting here planned to approach health insurance companies with a proposal to maintain funding within ophthalmology, and to get fixed rates of reimbursement for surgery.
The new law proposes these changes:
All health care spending will be under a single, capitated global budget. Spending will be determined not by the number of procedures performed or the number of patients seen, but by the amount budgeted by the government.
General health insurance companies will be responsible to maintain and pay for hospital care. Previously these expenses were shared between state governments and the insurance companies.
In the past, health insurance companies have dealt with physicians through an association, the Kassenärtliche Vereinigung, which represented all physicians in fee negotiations. But now insurance companies will be allowed to deal directly with physicians. “This means that, for physicians in general, their position will be weakened, because a single physician is obviously not as powerful as the association was,” Dr. Knorz noted.
Move to outpatient surgery
Another aspect of the new law that especially affects ophthalmology is that cataract surgery will now be an outpatient procedure by definition. This means that a physician must justify to the insurance company any case done on an inpatient basis — or he or she will not be paid.
This part of the ruling will have implications for ophthalmologists, hospitals and patients, Dr. Knorz said. First, the number of hospital beds in ophthalmology departments will be decreased. As a result of this, government funding for the hospitals will also be lowered.
“When they reduce the number of beds, they lose a lot of money,” Dr. Knorz said.
In addition, patients with private insurance may be affected. Many private health insurance policies cover only hospital stays. With cataract surgery moved to strictly outpatient status, it would no longer be covered by these private insurance plans.
Fighting back
In several meetings here, ophthalmic surgeons decided on a common strategy to fight the proposed changes. The Vereinigung ophthalmologischer Praxiskliniken (VoP), the association of German outpatient ophthalmic surgeons, will ask insurance companies for two basic concessions. First, they want the money taken away from hospitals for inpatient cataract surgery to remain within ophthalmology, rather than move to other specialties. Second, they want to agree on a rate schedule in deutsche marks, instead of the point system used for most reimbursement in Germany.
Dr. med. Klaus Lucke, president of the VoP, said the group wants to cooperate with the hospitals in its effort to maintain funding within ophthalmology. Even though most cataract surgery in German is now done on an outpatient basis, very little — perhaps 1% or 2% — is done in hospitals. The VoP hopes that hospitals will see the value of doing more outpatient surgery in hospital facilities.
The VoP has grown in 2 years’ time to have about 220 members, according to Dr. Lucke. Although the group is relatively small, its members are responsible for about 60% of Germany’s cataract surgery and about 90% of all outpatient surgery. At the meeting here it was decided that the VoP will negotiate with insurance companies with the backing of the full 7,000-member Berufsverband der Augenärzte Deutschlands, the professional organization of all German ophthalmologists.
Dr. Knorz is cautiously optimistic about the outcome of negotiations. “We control a surgical procedure [cataract surgery] that is in high demand, and we have the chance to negotiate directly with the insurance companies, which actually helps the ophthalmic surgeons,” he said.
For Your Information:
- Dr. med. Michael C. Knorz can be reached at the Klinikum Mannheim, 68135 Mannheim, Germany; +(49) 621-383-3410; fax: +(49) 621-383-3803; e-mail: knorz@eyes.de.
- Dr. med. Klaus Lucke can be reached at the Tagesklinik Universitätsallee 3, D-28359 Bremen, Germany; +(49) 421-2012-80; fax: +(49) 421-2012-851; e-mail: TKU_Bremen@compuserve.com.