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AUGEN Diagnostik Centres (ADCs) are one reason private ophthalmologists all over Germany are able to provide better care for their patients with glaucoma. While private German ophthalmologists and glaucoma patients should have been elated at the fast-paced forward march in ‘hi-tech’ innovations, for a while it looked as though the ‘hi-tech’ costs associated with technical advancement were going to leave them behind, without the means to pay – counterproductive to say the least. ADCs provide a solution that works well for patients and doctors alike. ADCs, in their most basic form, are monitoring centres which provide state-of-the-art machinery designed to recognise and evaluate glaucomatous progression. Simply put, the centres provide the machinery and the private ophthalmologists provide the patients. Patient payments are divided between the participating ophthalmologists and the ADC. This set-up makes the buying of instruments economical, as the costs are shared by many doctors. "Surely the most relevant aspect of ADCs is that many patients can profit from innovative ophthalmological technologies, which would otherwise be too expensive. On the other hand, ophthalmologists can make use of costly technologies which would otherwise remain exclusive to large clinics and wealthy office associations," Oliver Schwenn MD told EuroTimes. Dr Schwenn is currently helping to set up an ADC at his hospital. Although there are different ADC models, the Frankfurt ADC is the first one employing a so-called "provider model" in which the hospital provides space, personnel and machinery. Each of the 50-odd existing ADCs follow different, individualised set-up models. Some have their own housing, with rents divided among the participating ophthalmologists. Some do not provide machinery like the Frankfurt centre, but require that the ophthalmologists themselves buy it. Each centre is set up in accordance with the needs of the participating ophthalmologists and the budget and economic plan of the centre. Centres focusing on glaucoma for instance are equipped differently than others that might include diagnostics for diabetic retinopathy. The Frankfurt ADC will start out with a Heidelberg retinal tomographer (HRT) to study papillary morphology, a Humphrey optical coherence tomographer (OCT) for retina/glaucoma diagnostics, a pachymeter to study the corneal thickness and colour photography of the anterior and posterior segment. Some of the older, more established centres have added instruments such as a Laser Diagnostics GDx scanning laser polarimeter which evaluates the nerve fibre layer and a retinal thickness analyser (RTA) which examines the thickness of the whole retina (not specifically the nerve fibre layer) and macular pathologies. The increasingly popular ADCs offer glaucoma patients diagnostics which go beyond the examinations included in the state health budget. Their premise lies in the realisation that glaucoma patients want the best care to preserve their eyesight, even if it means paying for it themselves. Patients must appear for regular check-ups to help keep the disease under control. This implies ongoing expenses the state cannot take on. Dr Schwenn pointed out that most of the instruments are effective in discerning the course of glaucoma progression, not necessarily for diagnosis of glaucoma per se. That is why it is essential that patients continue to appear for regular monitoring, once yearly or every six months in more serious cases, he said. When a patient appears for his appointment at the ADC, a medical technical assistant (MTA), who is trained by an appointed ophthalmologist (Dr Schwenn in this case), receives him and carries out the examinations prescribed by the patient’s ophthalmologist. As the exams are ‘contact-free’, German law does not require that an ophthalmologist performs them. The patient’s ophthalmologist either retrieves the exam results online or receives them on CD. To ensure quality, Dr Schwenn will offer courses to private ophthalmologists to teach them to interpret the test results, as most ophthalmologists will not have had a great deal of experience with some of the newer technologies. It is the ophthalmologist’s job to continue counselling his patient, seeing him at the usual three-month intervals in his office. Why all the added work when a large hospital has its share of patients anyway? Dr Schwenn believes that the ADC will allow for his hospital to build up good relations with the private ophthalmology sector and familiarise patients with their facilities. Private ophthalmologists stand to profit as well, as the exams are part of the so-called German IGeL (Individuelle Gesundheits-Leistungen) exams which fall outside the government flat rate per patient and therefore are more lucrative. Participating ophthalmologists may attract patients to their practice, as well offering innovative ophthalmological technologies. Most centres involve the participation of 30 or 40 ophthalmologists. An ophthalmologist has to join the ADC to be able to schedule exams for his patients, making the ADC, also from a legal viewpoint, an extension of his practice. Patients cannot just walk in - they must be referred. Appointments can be conveniently scheduled online. Each participating ophthalmologist is allotted a certain number of time slots to be used for his patients. Instruments either stand alone or are set up as part of a network, with individual PCs attached to each, offering Windows over a LAN connection. Exam results can be imported into the electronic patient files through a standard interface on the patient’s chip card. Patient privacy is an important issue when transferring patient information online. The patient file is anonymous and split into general and personal information that only a certain code can unite to protect privacy. ADCs were initiated in cooporation with the German Green-Cross. Pfizer/Pharmacia, which market some of the leading glaucoma treatments, support ADCs and are active at the organisational level by raising awareness through information meetings and providing software for ADCs. Their public relations efforts on behalf of ADCs are in part responsible for the almost 1,000 physicians recruited since the first ADC was opened in Munich almost three years ago. . Oliver Schwenn MD |
