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A rural ophthalmologist is calling attention to British Columbia’s fee-for-service model, saying the current structure discourages specialists from performing certain procedures.

Dr. Marius Scheepers, who has worked as an ophthalmologist since 2010, originally trained in South Africa and the U.K., and has been practicing in B.C. for over 10 years. He is currently based in Trail.

“Under this fee-for-service model, it’s important to keep fees contemporary,” he said. “When fees are too antiquated or too low for certain procedures, those treatments are the ones that are underperformed and underutilized.”

Scheepers said that some ophthalmologists have struggled to perform certain treatments, in part due to the rising cost of certain drugs and the outdated fee structure.

“We established an economics committee… and we looked at all our fees for the various procedures. We found that some procedures were severely underfunded. One fee stood out as extremely well-remunerated: the injection for macular degeneration, diabetic macular edema and retinal vein occlusion.”

Avastin, originally developed to treat colon cancer, is widely used for eye conditions such as macular degeneration and diabetic macular edema because it is a significantly cheaper alternative to on-label counterparts like Lucentis and Eylea. The differences between prices are as followed:

• Avastin (off-label use): Typically $15 per dose

• Lucentis (on-label use): Around $300 per dose

• Eylea (on-label use): Over $1,000 per dose

These drugs are injected into the eye to reduce fluid buildup and stabilize blood vessels.

The British Columbia Society of Eye Physicians and Surgeons, established in 1979, did not have an economics committee until 2018 or 2019, said Scheepers. This led to outdated billing codes and the undervaluation of certain procedures.

“If you do not belong to the provincial Retinal Diseases Treatment Program, you have to pay for Avastin yourself, and payment is now under a two-tiered system, one for those ophthalmologists who are allowed to join the program, and those who are excluded from the program,” said Scheepers.