Hospital reform, outpatient care and MVZ regulation: Rarely has health policy dealt with so many future issues with long-term effects at the same time as it currently does. DOG Secretary General Professor Dr. Claus Cursiefen speaks in an interview about ophthalmology’s view of the reform plans.
The interview was conducted in October 2023 for the current DOG annual report.
Professor Cursiefen, in 2023 an incredible number of changes were made in health policy. How does the DOG get involved in these issues for the relatively “small subject” of ophthalmology?
Professor Cursiefen: Ophthalmology is sometimes misunderstood from the outside as a “small subject”. However, we treat diseases of the most important human sensory organ, as this is essential for a self-determined life, especially in old age. Therefore, the task and position of the DOG go beyond the purely numerical significance of ophthalmology. We communicate this in the interests of our patients and the…
subjects again and again.
The DOG has been actively addressing relevant issues for high-quality ophthalmic care for the population in politics for a long time. In particular, we enter into direct dialogue with members of the Bundestag at our annual parliamentary evening. We also maintain contacts with decision-makers in the local government and the responsible ministries. In addition, we actively participate in the political discourse with statements and press releases.
In 2023, the DOG was particularly active in the discussion about the Federal Ministry of Health’s (BMG) reform proposals for outpatient care, hybrid DRGs and hospital reform. In order to gain a greater voice among the various players in the healthcare system, we work in a coordinated manner with all ophthalmological associations, including the Professional Association of Ophthalmologists, the Federal Association of German Ophthalmic Surgeons, the German-speaking Society for Intraocular Lens Implantation and the Association of Ophthalmological Chair Holders. However, especially in times of change, we need to further strengthen our presence in the capital and are therefore working on a concept for a permanent representation in Berlin.
The central topic in 2023 was hospital reform, which has the self-declared goal of establishing needs-based, sustainable care in Germany. In your opinion, will this be successful for ophthalmology with the current plans? From the DOG’s perspective, what should be taken into account when designing the reform?
As of October 2023, it is hardly possible to make a final assessment of the specific effects of all reform projects currently underway. The future framework conditions and, above all, their effects are only known to a limited extent. Nevertheless, I am convinced that we can fundamentally look optimistically into the future for ophthalmology and (university) eye clinics.
Outpatient care is the second major component of the reform and is closely linked to the hospital reform. How much outpatient care is (still) possible in ophthalmology?
Ophthalmology is a pioneer in outpatient care and can actively contribute to the current discussion based on its own experience. We treat the majority of our patients on an outpatient basis, even in eye clinics the number is more than 85 percent. When it comes to cataract surgery, over 90 percent of the procedures are carried out on an outpatient basis. Of all hospital beds in Germany, eye patients occupy less than 0.4 percent of the beds. These figures show that outpatient care is by no means a novelty for us. Other medical specialties are nowhere near as advanced as ophthalmology when it comes to outpatient care.
We support the BMG’s efforts to further advance this development. Our goal is to prevent undesirable developments that could be triggered by unsuitable framework conditions. Because ophthalmology is already so outpatient, reforms must differentiate between different specialties and adequately take into account the significant advances in ophthalmology in all decisions.
From the DOG’s point of view, what requirements must an outpatient treatment meet if it is oriented towards the well-being of the patients?
Three aspects are essential for this: It is crucial that outpatient surgical procedures are adequately financed. This is the only way to maintain the quality of care. This applies to the costs of the outpatient surgical procedures themselves as well as the associated (including outpatient) maintenance costs. This particularly applies to strabismus operations, where inadequate funding could lead to shortages in care. In addition, doctors must continue to have the opportunity to admit patients as inpatients in the future if medical and/or social factors require this.
Secondly, outpatient follow-up care must be guaranteed without any loss of quality. To achieve this, structures must be created for the treatment of postoperative complications in order to ensure the best possible patient care. The third and final point concerns clinic-associated competence structures: outpatient care must not endanger such existing structures. Particularly in the case of rare and complex diseases, the dismantling of these structures would result in an irreparable loss of quality. This could jeopardize the care of patients with multimorbidities, children and other special needs. Together with other ophthalmological associations, we are therefore committed to maintaining ward-associated ophthalmological care in Germany.
The third and final point concerns clinic-associated competence structures: outpatient care must not endanger such existing structures. Particularly in the case of rare and complex diseases, the dismantling of these structures would result in an irreparable loss of quality. This could jeopardize the care of patients with multimorbidities, children and other special needs. Together with other ophthalmological associations, we are therefore committed to maintaining ward-associated ophthalmological care in Germany.
With a view to stable outpatient care in ophthalmology, the regulation of medical care centers (MVZ) is in the public focus
moved. The DOG has repeatedly raised this issue for many years. How do you assess the current plans for greater regulation?
The DOG has already clearly positioned itself on investor-controlled medicine in ophthalmology. In principle, there is nothing wrong with medicine also following economic principles. However, we must prevent excessive developments, especially if they come at the expense of patients – keyword “cherry picking”. Despite all the specialization, we have to critically question when large investor-owned networks point out bluntly that, for example, they no longer treat children. If this were done for economic reasons, it would not only distort care, but would also be highly questionable from an ethical perspective. We are also critical of the fact that the returns generated by international corporations in German ophthalmology divert significant amounts of financial resources from the healthcare system. We therefore demand transparency for patients as to whether they are being treated by a doctor employed by a group practice or by an independent ophthalmologist. This is particularly important because only an independent doctor can give an “independent second opinion”. For the quality of care for our patients and their wide freedom of choice, it is essential that young ophthalmologists have the opportunity to set up in private practice. Monopoly-like structures hinder this freedom.
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