Entering 2014, physicians will find that the Affordable Care Act has dramatically changed how to practice medicine successfully. Shifting from fee for service to value-based medicine is no small undertaking. Emphasizing preventive medicine will almost certainly benefit patients. Simply providing a specific health care service, however, will no longer ensure practitioners' compensation. Not only will physicians have to prove the benefit and value of their efforts to payers, but clinicians must satisfy their patients as well. Determining the costs of providing quality glaucoma care and improving both clinical and surgical efficiency will become mandatory if physicians are to thrive in this new era of health care. The question is how well the medical community will rise to the challenge.

In his book Great by Choice, Jim Collins introduced the business philosophy of the “20-mile march."1 It advocates having clear, concrete, intelligent, and rigorously pursued performance mechanisms to keep a business on track. The 20-mile march creates two types of self-imposed discomfort: an unwavering commitment to high performance under difficult conditions and restraint under favorable conditions. Specifically, a business must set clear performance markers and impose constraints on itself that are

  • appropriate to the specific enterprise
  • largely within the business' control to achieve
  • set in a proper timeframe (ie, long enough to manage yet short enough to have teeth)
  • followed with high consistency

By completing a 20-mile march, no matter what challenges and unexpected shocks business owners encounter, they will prove to themselves and their companies that performance is not determined by their conditions but mainly by their own actions.

Interestingly, according to Collins, organizations that commit to the 20-mile march have a significant edge in volatile environments. When times are tough, he wrote, these businesses tend to be a bit more ambitious than their competitors. Conversely, under more favorable conditions, winners commonly leave growth on the table to ensure that they will not be caught overextended. In support of his philosophy, Collins cited businesses successful over the long term such as Southwest Airlines, Stryker, and The Progressive Group of Insurance Companies. My impression is that the same principles apply to the business of medicine as well.

This edition of Glaucoma Today focuses on the Affordable Care Act's impact on glaucoma management. We are fortunate to have experts in this area weigh in on this important matter. Ultimately, how physicians adapt to changes will determine the success of their practices and their patients' outcomes. I hope that the wisdom shared by this month's contributors will assist GT's readers significantly in this endeavor.

Steven D. Vold, MD
Chief Medical Editor