© RTL
As waiting times for eye surgery in hospitals continue to grow, three ophthalmologists have begun operating on cataracts directly in their private practice, a move that mirrors broader calls in the medical sector for more flexibility outside hospital walls.
In a group practice near Luxembourg City railway station, eye surgeon Carla Schmartz works alongside two colleagues offering refractive surgery and aesthetic procedures. Since 2022, they have also performed cataract operations, which are traditionally carried out almost exclusively in hospitals.
Dr Schmartz explained that while they still operate in hospital settings, operating theatres there had become increasingly saturated. Before the pandemic, patients were already waiting six to twelve months for a cataract procedure, with delays becoming even longer afterwards, she said.
Faced with these bottlenecks, the three doctors decided to offer cataract surgery directly in their practice, investing in a second operating theatre and all necessary equipment. However, unlike hospitals, private practices cannot bill the National Health Fund (CNS) for the operating room, materials, sterilisation, or support staff. They can only charge the surgical fee itself, meaning cataract operations in private practice are carried out at a financial loss.
Patients, meanwhile, pay no more than they would in a hospital, apart from a €185 pre-operative assessment. To absorb the deficit, the surgeons use a layered financing model: part of their surgical fees go back into covering costs, they negotiate better prices with suppliers, and income from refractive eye surgery, which is not reimbursed by the CNS, helps offset the losses.
According to co-founder Dr Tom Pavant, the practice now performs around 1,500 surgeries per year, roughly 1,000 of which are cataract surgeries. With greater flexibility, he said, waiting times have fallen to two or three months.
A preview of the 'ambulatory shift'
The three ophthalmologists, working together through a cost-sharing model, hope national policy will finally move towards what the government and the Association of Doctors and Dentists (AMMD) call the "ambulatory shift", which would allow certain procedures traditionally limited to hospitals or hospital satellites to be carried out independently in private practices.
Dr Schmartz echoed this logic, stressing that cataract surgery and intravitreal injections could be carried out more efficiently and at lower cost in outpatient settings. She argued that if Luxembourg created an official ambulatory operating framework, its overall cost would be significantly lower than hospital tariffs, because private practices do not shoulder the breadth of activities that hospitals must cover.
Hospitals should keep their essential role
Concerns that expanding outpatient surgery may drain staff from hospitals are not shared by the three surgeons. All three doctors in this practice still work regularly in hospitals and take part in on-call duties, they said. Dr Schmartz and Dr Pavant emphasised that complex procedures and patients with complications will always require a hospital setting.
Pavant added that shifting high-volume, low-risk procedures, such as cataracts, into outpatient clinics would free up hospital operating theatres for more serious interventions, a point also raised by the Hôpitaux Robert Schuman, which recently announced it would begin offering cataract surgeries in a hospital satellite facility at Cloche d'Or next year.
