This month's Global Perspectives column reports on the work of the National Organization of German Ophthalmic Surgeons (BDOC). Retina Today interviewed Armin Scharrer, MD, President of the BDOC (as well as President of the Congress of German Ophthalmologic Surgeons or DOC), to provide readers an overview of the role this organization plays in its members' professional lives.

Q: What is the BDOC?
A: The BDOC is the German association of surgical ophthalmologists. Our organization represents the interests of all ophthalmologists with surgical qualifications that exceed consultant standards in clinics and outpatient practices.

Our primary goals are to represent our members in the German health care system and the public and political sectors; to set benchmarks for surgical processes and outcomes to ensure patients receive a high standard of care and treatment; and to negotiate contracts with health insurance companies for our members.

The BDOC was founded in 2003 to keep up with the rapid development of surgical options in ophthalmology. Advances in phacoemulsification and other surgical procedures made it possible to perform traditional inpatient treatments on an outpatient basis. This shift prompted the creation of new requirements for the highly specialized infrastructure in outpatient operating theaters, as well as regulatory and clearing procedures: that is, settlement of remuneration and documentation of operation procedures.

Q: What are the benefits of being a member?
A: Alongside the association of general ophthalmologists, the BDOC represents the special needs of surgical ophthalmologists in both outpatient and inpatient facilities. The BDOC acts as a consultant to political decisionmakers regarding all matters related to ophthalmic operating theaters, as well as surgical training and performance requirements. Furthermore, the BDOC negotiates the conditions of performance and clearing procedures with the health insurance companies that pay for patients' care and treatment. BDOC members are required to treat patients according to the agreed-upon conditions to receive payment from the insurance companies.

Each applicant is required to demonstrate proof of surgical qualifications that exceed consultant status. The applicant's qualifications are verified by a defined number of ophthalmic surgeries.

Approximately 75% of German ophthalmic surgeons are members of the BDOC. Our organization continues to grow, demonstrating the acceptance and recognition among ophthalmologists in Germany of our role in their profession.

Q: Describe the structure of the German health care system.
A: The German health care system is divided into two main domains: inpatient (clinics and hospitals) and outpatient (outside the hospitals). The outpatient domain comprises family doctors, or general practitioners, and specialist doctors. In Germany, hospitals treat patients mainly surgically, while specialists, who practice outside of hospitals, treat patients mainly conservatively. Approximately one in six outpatient ophthalmologists perform surgery in their own operating theaters.

Q: In what specific ways does the BDOC act for its members in the German health care system?
A: The BDOC's activities are focused on negotiating innovative contracts with the health insurance companies for new and special outpatient practices. Our tasks and challenges grow from year to year, and they vary from regional to nationwide contracts. BDOC management has become an important consulting partner to politicians and decision-makers in the German health care system concerning ophthalmic issues.

Q: How has the involvement of the BDOC affected how Avastin is reimbursed and used in Germany?
A: Ophthalmologists in Germany began treating patients with age-related macular degeneration (AMD) with bevacizumab (Avastin, Genentech, Inc.) in October 2005. Once ranibizumab (Lucentis, Genentech, Inc.) was licensed in Germany, it became complicated for patients with AMD to be reimbursed for treatment with bevacizumab. This led to significant delays in treatment because health insurance companies would not reimburse costs for therapy with an unlicensed drug when a licensed drug is available.

To mitigate these issues, the BDOC arranged contracts with several health insurance companies in Germany for its members to settle the details of treatment with either bevacizumab or ranibizumab drawn out and divided by specialized pharmacies for use in more than one patient and reimbursement. These contracts provide patients with wet AMD easy access to bevacizumab and secure “prescribing freedom” and “therapeutic freedom” for its members. Significant savings in the health cost sector are another benefit.

Surgical ophthalmologists in Germany may also use ranibizumab. Health insurance companies are obliged to reimburse total costs for a drug that is licensed. In our opinion, the BDOC has significantly contributed to the continued wide use of bevacizumab.

Q: How does the organization advocate for its members politically?
A: The BDOC is a competent and accepted consulting partner in all matters of ophthalmology. Decision-makers in governmental organizations in the German health care system rely on the BDOC's advice. The BDOC comments on drafts for the health statute book and offers advice regarding the development of regulations, performance specifications, fees, and the fee structure.

Q: What is the BDOC's involvement in setting quality standards?
A: The BDOC, which is a vehicle for modern, highquality concepts and methods of treatment, sets quality standards in its contracts with the health insurance companies. Our standards exceed the general standard. Additionally, we launched a certificate for eyelid surgery.

Q: As President of the BDOC, what challenges do you currently face?
A: Our challenge is to be one step ahead of political changes in the system and to help structure the changes. The BDOC plays an important part in representing German ophthalmologists, and we will continue to be innovative in our work for our members.

Q: What has been the most rewarding aspect of overseeing the BDOC?
A: The most rewarding aspect is the knowledge that our organization has grown from 11 founding members to more than 730 members in only 7 years. I believe this is proof that ophthalmic surgeons in Germany highly value the work that we do. It is also proof that our organization has achieved benefits for our members, which is what we want to do and what we will continue to do.

Armin Scharrer, MD, is the President of the Congress of German Ophthalmologic Surgeons (DOC) and of the National Organization of German Ophthalmic Surgeons (BDOC). He is also a surgeon at the FreeVis LASIK Center Nuremberg-Fürth.