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The Cassandra Complex: We’ve Been Warned

In Greek mythology, Cassandra was the beautiful daughter of Priam, the King of Troy. She enchanted the god Apollo, and he bestowed upon her the power to see into the future. Cassandra rebuffed his advances, and, in his anger, Apollo made it so that no one would ever believe her truthful prophesies.

Sometimes I wonder if we eye care physicians haven’t stumbled into a Cassandra complex of sorts, unable to believe or heed the warnings we are given. For years we have been told of the continual threat of declining reimbursement that we live under in the Medicare system. We have generally ignored the warnings and continued to practice as we always have, but then we cry out in dismay when negative changes hit us. The recent announcement by CMS of a 15% cut in cataract surgery fees is a perfect example. The warning that comes with this news is that we are likely to face much deeper additional cuts in the future. Will we heed this prophesy now, and take steps to mitigate the effects of these future changes on our practices, or will we ignore it, and, when it comes to pass, be forced to accept potentially devastating revenue losses?

The continual acceleration of practice consolidation and private equity activity within our profession is another scenario many of us may chose to ignore. There is no doubt that this is a real sea change that will be with us for the foreseeable future. Avoiding strategic planning now, only to find that our practice is isolated from contracts or patient populations because larger entities have taken over care in our region is a real risk. Ignoring this situation now is done at one’s own peril.

What can eye care physicians do to avoid the Cassandra complex? If knowledge is power and power creates influence, then our best line of defense is to educate ourselves on the issues that affect our practices as well as we possibly can. Identifying trends and understanding their potential impact is paramount to being able to recognize and react appropriately to change. This is best done by staying engaged, networking with peers, reading as much of our trade and peer-reviewed publications as possible, and attending as many meetings as is reasonable to keep up on where ophthalmology and optometry are going.

And speaking of informing and educating ourselves, please enjoy this issue’s CollaborativeEYE section. The articles on the impending epidemic of myopia, eye care for veterans, and the effect of artificial intelligence on practice trends contain a wealth of useful information meant to educate and prepare you for the changes the future will surely bring.

— Mark A. Kontos, MD
Co-Chief Medical Editor

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