Communication and Consistency

Dr.Bethany Fishbein: I think that if we kept that interest and kept that constant feedback and that desire to improve based on each patient encounter and the outcome of it, practices would in general be better off. 

Hey, this is Bethany Fishbein, CEO of the Power Practice and host of the Power Hour Optometry podcast. Just wanted to start off today with a couple of apologies. First, I apologize for not having podcast content last week. Two and a half years later, COVID finally got me and I was out of commission for a little bit but I am back. So thank you for your patience. Hopefully, you had time to revisit some of the favorite episodes or do something else. And secondly, I wanted to just make a correction on the podcasts that I had done a few weeks ago with Char Watson where she is presenting the Stages of Business Growth. One of my listeners brought to my attention that those stages were initially the work of an author, Les McCann, in his book called Predictable Success. So I just wanted to make sure that he was given credit for the work that he’s done. I did put the links to Les’ book in the show notes and I will go back and just rerecord a little preamble so that listeners know where to find those. Those are good episodes and I just want to make sure that appropriate credit is given. 

Onto today’s podcast. I don’t have a guest and it’s because I wanted to talk about something that’s come up quite a few times in different areas of business lately. I have a client who will remain nameless, who always seemed to do his best work when things were bad. So just like everybody, his business cycles. When he was in a stage of business where things were not going well, his schedule was empty, the bank account was low, there wasn’t money to pay the bills, and whatever it was, that’s when he would call us, his consultants. He’d say, “You know things aren’t going well. And I need to get things back on track.” We would have a conversation about what getting back on track looked like. He would do every single thing that we asked. He would have an incredible couple of months. He’d get things in a good spot again and then we wouldn’t hear from him for a little bit. I always used to tease a little bit and say like, “Do things really have to be bad for us to talk?” Like, “Let’s talk when things are good and make them better.” And this was just kind of his MO. If you’re out there and you know who you are, “Hello!”

So it got me thinking and some other things recently have gotten me thinking about the ways that we practice and run our businesses just a little bit differently when we are in panic mode. And all of the things that we do when we are under pressure to be successful. “Something bad is going to happen if we don’t.”, “I’m worried about this. I need to fix this.”, and  “We can’t go on in this situation.” And we run business, as I said just a little bit differently. And really, if we kept doing all of those things, even when things were going very well we would be much better off. 

I spoke to a practice recently who’s doing incredibly well. And one of the things that impressed me as I talked to this Practice Owner who has a larger than average practice and on a four-day work week and just really putting up some amazing results. As he’s describing what he does to generate these results. Something that impressed me was the tremendous consistency that he was showing in his communication with patients and his communication with staff. His consistent discussions about things being better, for every patient every day, even when things were going well. Which is probably what led him to take off to a much better than the normal level where things are going well most if not all the time. 

So let’s think a little bit about some of the things that as Practice Owners, you do when you’re under pressure to pay a bill, meet payroll, make a payment, keep the bank account in a comfortable level, fill the schedule, or whatever your measures of success are. And whether those are things that even if things are going fine, you can be doing right now. I’ve thought about this for years of my own practice. And I thought about as a startup when you’re empty and the schedule is not full and you’ve got maybe three people or four people on the schedule for the day. And you need things to be better. You want them to be better, quicker, and you’re incredibly motivated and there’s absolutely no complacency because you’re weeks or months into a brand new business and you’ve got to make it work and whatever you need to do, you’re gonna do it. And it starts with the schedule. It’s funny, right? As you grow and as the practices get bigger, you kind of lose track of some of this stuff because you’re not the one answering the phones most of the time. You’re not hearing what patients are saying when they call in and some of these decisions are even being made without you. 

But I’m remembering our first year of practice and this is 2001. And we were motivated, and we had no kids at that point, and nothing else to do, and our practice was not only our business but our hobby, and a lot of the fun that we were having was related to building the business and we got a call. This was after December. And December was a busy month in the practice. You know everybody wants to use their insurance benefit and they’re flex spending. That was still in the use it or lose it days. And we got a call on December 31st. We had planned to close the office at one o’clock because it was New Year’s Eve. But we’re losers. We had no plans. And that morning probably 10:30, somebody called desperate to get their family of four in that day because their benefits were expiring at the end of the year and they were going to lose their exam and glasses benefit if they didn’t come in. And so I answered the phone, which is what I did then and at that point said, “Yeah, absolutely come on in.” and we ended up staying an extra hour or hour and a half whatever it was, and generated probably $1,200 – $1,500 for the business which at that time was a significant percentage of what we did in that month. 

So thinking about the schedule of some of the things that you’re motivated to do when you’re under pressure your backs up against the wall. Are there times when there are extra patients who would want to come in if you could figure out how to get them into your schedule? And if there are, could you on an ongoing basis not just when you’re in panic mode, adjust your schedule to be more efficient and allow the practice to see one more exam, two more exams, three, or four more exams each day? And if you make that change and you’ve got patients to fill it, if you’re seeing 12 exams a day and you go to 15, that’s a 25% increase in potential business that you can do that day. Right? Not always more exams is the key to success and we’re going to talk about other ways but is the schedule as efficient as it could be? If you could find a way to squeak in a few others while you were desperate? Could you find a way to squeak in a few others when you’re not? And what would that do to the overall health of the practice? 

Some of the other things that we do schedule-wise is looking for opportunities to see family members. A parent brings in a child and you look and you notice that the parent hasn’t had an exam in over a year. They’re your patient too. And in those moments, you say to the parent, “Hey, we have a spot open. Do you want to get your exam out of the way as well?” And some percentage of them will say, “Yes, absolutely.” And bam, you get another exam out of it. And maybe that day, it’s just a copay or photo, or maybe it’s an eyeglass or contact lens order, or a conversation about some other service but it’s done that day. And it’s work in hand like you’ve done it. You build the insurance. You’ve collected the money or whatever. And it just increases the level of success that you have that day. 

Another difference I see in practices when things are tight versus when they’re not is the urgency that the practice has about filling last-minute cancellations and even no-show appointments. When you’re desperate and in panic mode, you’re watching every detail. You’re watching that schedule. And in the morning you see the schedule start to fall apart in the afternoon. And when things are tight, it’s like, “What happened to that two o’clock? What are we going to do? Are we going to fill it?” And not to micromanage, right? Because you’re gonna make staff crazy if you do this. But to either yourself or have someone not just in panic mode but on an ongoing basis looking out for “Can those last-minute cancellations be filled?” and “Are we doing everything that we can to keep this schedule full?”

So just some things to think about right? If you’re doing them when you’re desperate, could you be doing them or should you be doing them on an ongoing basis? Would it make your business better to do them that way? And the answer is probably yes. So then I think about in the exam room and the thing that got me really aware of this was when we were running a lighter patients schedule after COVID. And a lot of practices were doing this, right? Once the office was closed and when things were really bad. And as they started to open up again, a lot of people opened up on a reduced schedule. Where instead of their normal number of patients that they used to see in a day, they were seeing initially half that and then two-thirds, three-quarters, and just building it up slowly. 

And when people were seeing fewer patients by design, one thing that we heard almost across the board from our clients and other people outside our client family was all of a sudden what I’m able to do with each patient increases. And so we were looking at metrics and we’re looking at lower patient numbers with higher per patient revenue. And talking to these doctors and saying, “What’s the difference? What are you doing differently?” And the answer was that the additional time that they had to spend with the patient was allowing them to really have the conversations that elicited patient complaints or concerns that as optometrists we are uniquely qualified to fix. 

So when you think about a packed schedule and the mindset kind of being, “Gotta stay on time. I don’t want people to wait. I gotta get them in and got to get them out. A patient might say something like, “My vision is fine, right?” “How are you doing with your glasses?” “They seem okay.” And if you’re prioritizing staying on track, being efficient, getting that next patient, when the patient says that you say, “Okay, great.” And you go and you do the refraction and whether you find a little change or not, you’re probably not making a strong recommendation to do something different.

When we were seeing fewer patients and feeling the squeeze of fewer patients or not related to COVID or anything at all, but when you’re really focused on, “I need my numbers today to be a certain amount.” The conversation is a little bit different. Right? “How are you doing?” “What are your current glasses?” “I think I’m fine.” “Yeah. Are you wearing the same pair for everything?” “Yeah, I wear these all day.” “What do you do for work?” “I’m a day trader.” “Wow. Are you on multiple computer monitors?” “Yeah, I’m using three monitors all the time.” “And how are they working for that?” “They seem okay. I just have to like lift my head up a little bit or I’m squinting.” Or sometimes patients will even tell you, “I’ve switched to this old pair of glasses that I’ve had since college. I use those for that because the prescription seems better.” “Alright, let’s take a look. Let’s see if we can get you something even better.” 

So having those little extra conversations very often leads you to be able to give a patient a solution for a problem that might not have been big enough that they’re mentioning it first thing in a 32nd conversation. But it’s something that’s affecting them every single day. Another difference in an example like this is when things are really busy and you’re feeling everything’s fine, a little bit complacent, “How are your glasses?” “Great.” Blah blah blah You go through the whole exam, new prescription, everything’s healthy, they’re good to go. 

When you have either a slower schedule or a need to really actively work to create success for yourself on a minute-to-minute basis, you may ask the question, “Are there times when you’d rather not wear glasses?” Everybody’s gonna say, “Yes.” Of course there are times they might not want to wear their glasses. “Well, when are those?” “Well, I don’t want to wear my glasses when I’m skiing, snorkeling, out on dates, or whatever it is.” It’s an opportunity to bring up contacts to a patient even if they didn’t bring them up to you. 

When we work with clients, we go out, we observe in their offices. And, of course, when a patient says, “I’m thinking about getting contacts.” All doctors pretty much  are going to say, “Okay, great.” And fit them with contacts. But the ones who bring up contact lenses when the patient doesn’t initiate that conversation, very often find that patients are interested and all of a sudden an exam goes from just an exam to an exam, and updated glasses prescription, and a new contact lens fit. 

The other piece that is different when we’re in panic mode, is that the doctors tend to be much more invested in what happens once the patient leaves the exam room. In a lot of really successful practices,  a fault that we see is that the doctor does their thing for the patient. They work hard to uncover needs. They make the recommendations. They put care into what they’re doing on the recommending side. The patient goes out to optical or goes out to the front desk and checks out and the doctor never really knows what happened. 

Again, when you’re in panic mode needing to make that next loan payment or bank payment and new in practice, those are the days when the doctor says, “What happened?”, “Did the patient get those glasses?”, or “Did he get the sunglasses I recommended?” Because it’s that need to know what’s going on, right? You start to like need to track everything, which isn’t totally healthy, but it happens. It’s natural. And so now the staff sees that the doctor is so much more invested in what happens. They care about the outcome. “Yeah, Doc. They got both pairs. The regular pair and the sunglasses.” “Okay, awesome.” And everybody knows that we took care of the patients. 

If it’s never asked, the doctor doesn’t know. So they don’t have any feedback to know if their recommendations are working or if they need to tweak them. Right? So maybe the doctor says something to the patient about getting sunglasses but the patient ends up not getting them. If the doctor knows that, they can think, “What did I say? Could I have said something differently? Could I have said something better that would have led to a different outcome?” And then the patient who does get them, if the doctor knows right away they can think, “Alright, what did I say there? What worked and how do I learn from that and incorporate that into the next patient?”

When that loop is absent and there’s no feedback, the doctor says what they say. Whatever happens with the patient happens. Nobody really connects those two things, even though they’re hugely connected, and the doctor can start to get into some bad habits. Because maybe they’re recommending sunglasses, for example, and patients are never getting them. So whatever the doctor is saying, totally isn’t working. But if the doctor doesn’t know that, they’re never going to change it. 

The other thing that can happen is that staff starts to feel like it doesn’t matter. At the end of the month, you talk metrics, capture rate with staff. And they hear, “Oh your capture rate is 40% and we want it to be 60% or whatever.” But it’s tied in in a different way when it’s, “Hey, that guy was a cyclist and he doesn’t have sunglasses. You know I recommended that he get these. Did he get them?” The optical staff knows that filling that prescription is part of the doctor’s care for the patient and it creates a different feeling. 

So that’s something that can absolutely get dropped or lost as practices get consistently successful and become a little bit more complacent about watching all those transactions. Where I think that if we kept that interest, and kept that constant feedback, and that desire to improve based on each patient encounter and the outcome of it, practices would in general be better off. Lastly, in the exam room, I think that when a doctor is very laser-focused on the success of the business and again, the psychology of why that happens when things are bad more easily than when things are good, I don’t really know. But I know that this is true. 

They’re much more likely to also talk about opportunities that the patient may be unaware of. Maybe not a great example because I feel like everyone’s talking about it. Although in my interview with Dr. Monica Jung, she says it’s not the case. But the first thing that popped into my mind was Myopia. That a lot of times when you’re starting that Myopia conversation, you’re initiating a conversation that’s fully different than what the patient or the parent in this case expected. You could do exactly what the parent expects. “My child’s having trouble seeing the board.” “Yep, they’re a little nearsighted. Here are the glasses.” That’s exactly what the parent is expecting to happen and you can do that. 

Bringing up something different takes time. But if and when you know that if you were able to get that patient into a Myopia program that would make the difference between being able to pay your rent this month or not. If you’re bringing it up, then you need to be bringing it up every single time. Once the patient leaves the exam room, guess what they’re gonna get in optical? 

The other thing that practice owners under pressure watch are what happens with the money after the fact. So many things right? Like I’ve been in offices where the normal thing that’s said, “Your glasses or whatever, would you like to pay half?” Right? You got your back up against the wall. You’re panicking about money. You’re not saying that that day. You’re telling a patient, “Your glasses are ___. How would you like to take care of that? and collecting the full payment. You should always be collecting the full payment. 

Obviously, there are exceptions and you need to make an exception for a particular patient in a particular life situation. So be it. But the normal should always be collecting. Doctors under pressure are looking to know, “Was this coded at the highest level it could be coded for the services that I’m providing?” If that $40 between a level three and level four office visit makes a difference in that day or that month to my practice, I better know when I can bill that level four versus that level three because I need that $40. There comes a time where you don’t need as urgently the $40 but keeping the habits from the times when you do, creates a whole new level of success. 

Did the patient pay their copay? Was the deductible collected? We get that question a lot when patients have a deductible. Do you collect for it upfront or do you bill them for it later? And you can find out if a patient has a deductible and you can know what the allowable charges are going to be and you can tell the patient, “This is going to be applied to your deductible. So today your balance is.” And many of them will pull out a credit card or FSA card or whatever it is and hand it to you. And you collect that payment now rather than having to go back and bill for it.

And looking for additional opportunities on the way out, when your practices slow and your schedule is empty. Those are the times when you can get over your discomfort with saying, “Hey, when you go back to work, if there’s anybody else in your company who’s looking for an eye doctor, we’d appreciate the recommendation.” Right? And that’s hard. Like I know you could say that to patients. I admire people who do and I know that for me that’s very tough. 

I also know that in a brand new practice. We opened the practice a year ago. Absolutely, I said that because we needed those patients, we didn’t have any. So getting through that 30 seconds of discomfort and just saying it, led to people saying, “Oh, yeah. Alright. Yeah, let me take a couple of extra cards. Are you okay if I take a few of these?” “Sure. Yeah. Yeah, I’m okay. If you take my cards if you’re gonna give them to people.” And then we saw referrals coming in. 

So if we can keep that mindset and do those things, they don’t work any differently when you’re under pressure versus when you’re not. You’re just, when you’re not under pressure, you’re less likely to do them. The last thing that I’ll talk about that Practice Owners under pressure do and some of it comes from nervous anxiety, they can’t sit still. But all of a sudden when there are no patients, the bank accounts are not where you want it to be, the Practice Owner starts to put their eyes on all the things and starts looking around poking around in the office. So that poking around can go into a lot of different areas. 

One of the things that gets looked at when a practice is under pressure and can get ignored when a practice isn’t, is insurance receivables, insurance aging, and patient aging. Right? If there’s lots of money, things are seeming good, maybe you record those numbers as part of your monthly tracking. Maybe you don’t. Many practices, I’m always surprised to find, don’t even look or they count on their billing companies just taking care of it. Suddenly, when things are under pressure, “Where’s the money? Let’s check the receivables.” And almost universally, the Practice Owners will find something. Either something hasn’t been billed at all or there’s a longer delay than they realize between when a service is provided and when it’s being billed for. Right? 

In practices that are freaking out, those things are billed on the day of. Because you know a lot of insurers, especially those that pay electronically, that money will be in your account sometimes days later or usually within two weeks. Practices that are doing well, no problem, no complaints, paying the bills, and making money. It can sit. Sometimes for a week, or two weeks, three weeks, or I’ve seen in practices, where it sat to the point that it hits the timely filing deadline and can’t even be billed. And so doing well is, in this case, the enemy of doing even better. 

So insurance aging. Look at patient aging. Some of the offers or rebates or discount programs on bill payments. A lot of companies have 2%, if you pay by the 10th or this much money off if you pay by the 20th. And is the practice taking advantage of all of those? Most of the time it’s not a giant amount of money. And really none of this is a giant amount of money. But it’s little amounts of money consistently, over and over and over again. 

A panicked Practice Owner will go into their Optical area and find the frames that are due to be returned under warranty for credit and haven’t been returned yet. How long have those been sitting there? All of these things add up and you can do it in a cycle where, “Oh my gosh, things are bad. I’m gonna do all these things. Okay, good. God I’m now better and when things get bad, I’ll look again.” I would propose that if you sit down and think about it in your own practice, what things you could add to this list that I’ve already shared and look at how you can either give responsibility to someone to make sure that they’re being done not when things are bad, but all the time. Can you set up systems so that things are done consistently? Can you be consistent in your own communication, that whether you’ve got 18 patients in your schedule that day or eight, you’re taking the opportunities that you would take if you didn’t have money in the account to make payroll? Can you create checks and balances for things like insurance aging  and frame returns, so that you know on a weekly or monthly basis? Even if you’re not the one handling it, that you have the system to know that all of these things are taken care of? 

If all of those little changes are done and consistent on an ongoing basis, the likelihood that you’re going to have to figure out what to do in panic mode is decreased. Because the likelihood that you’re going to be in panic mode is decreased. Because you’re going to be doing the things that keep the practice successful and make the practice successful when it’s already doing well. These are going to make it even better. Something worth thinking about. 

So that are my thoughts for today. If you want more thoughts, you can find us online at www.powerpractice.com. Feel free to connect with me on LinkedIn, or Facebook, or Instagram. I don’t know. We’re trying to use all this. If you have dreams for your practice that you’d like some help with, please reach out to us info@powerpractice.com. And once again thank you for listening.

Title: Communication and Consistency 

Description: Dr. Bethany shares her insights on how good communication and consistent discussions with patients and staff, whether a practice is doing well or not, can make a huge difference. 

Dr.Bethany Fishbein: I think that if we kept that interest and kept that constant feedback and that desire to improve based on each patient encounter and the outcome of it, practices would in general be better off. 

Hey, this is Bethany Fishbein, CEO of the Power Practice and host of the Power Hour Optometry podcast. Just wanted to start off today with a couple of apologies. First, I apologize for not having podcast content last week. Two and a half years later, COVID finally got me and I was out of commission for a little bit but I am back. So thank you for your patience. Hopefully, you had time to revisit some of the favorite episodes or do something else. And secondly, I wanted to just make a correction on the podcasts that I had done a few weeks ago with Char Watson where she is presenting the Stages of Business Growth. One of my listeners brought to my attention that those stages were initially the work of an author, Les McCann, in his book called Predictable Success. So I just wanted to make sure that he was given credit for the work that he’s done. I did put the links to Les’ book in the show notes and I will go back and just rerecord a little preamble so that listeners know where to find those. Those are good episodes and I just want to make sure that appropriate credit is given. 

Onto today’s podcast. I don’t have a guest and it’s because I wanted to talk about something that’s come up quite a few times in different areas of business lately. I have a client who will remain nameless, who always seemed to do his best work when things were bad. So just like everybody, his business cycles. When he was in a stage of business where things were not going well, his schedule was empty, the bank account was low, there wasn’t money to pay the bills, and whatever it was, that’s when he would call us, his consultants. He’d say, “You know things aren’t going well. And I need to get things back on track.” We would have a conversation about what getting back on track looked like. He would do every single thing that we asked. He would have an incredible couple of months. He’d get things in a good spot again and then we wouldn’t hear from him for a little bit. I always used to tease a little bit and say like, “Do things really have to be bad for us to talk?” Like, “Let’s talk when things are good and make them better.” And this was just kind of his MO. If you’re out there and you know who you are, “Hello!”

So it got me thinking and some other things recently have gotten me thinking about the ways that we practice and run our businesses just a little bit differently when we are in panic mode. And all of the things that we do when we are under pressure to be successful. “Something bad is going to happen if we don’t.”, “I’m worried about this. I need to fix this.”, and  “We can’t go on in this situation.” And we run business, as I said just a little bit differently. And really, if we kept doing all of those things, even when things were going very well we would be much better off. 

I spoke to a practice recently who’s doing incredibly well. And one of the things that impressed me as I talked to this Practice Owner who has a larger than average practice and on a four-day work week and just really putting up some amazing results. As he’s describing what he does to generate these results. Something that impressed me was the tremendous consistency that he was showing in his communication with patients and his communication with staff. His consistent discussions about things being better, for every patient every day, even when things were going well. Which is probably what led him to take off to a much better than the normal level where things are going well most if not all the time. 

So let’s think a little bit about some of the things that as Practice Owners, you do when you’re under pressure to pay a bill, meet payroll, make a payment, keep the bank account in a comfortable level, fill the schedule, or whatever your measures of success are. And whether those are things that even if things are going fine, you can be doing right now. I’ve thought about this for years of my own practice. And I thought about as a startup when you’re empty and the schedule is not full and you’ve got maybe three people or four people on the schedule for the day. And you need things to be better. You want them to be better, quicker, and you’re incredibly motivated and there’s absolutely no complacency because you’re weeks or months into a brand new business and you’ve got to make it work and whatever you need to do, you’re gonna do it. And it starts with the schedule. It’s funny, right? As you grow and as the practices get bigger, you kind of lose track of some of this stuff because you’re not the one answering the phones most of the time. You’re not hearing what patients are saying when they call in and some of these decisions are even being made without you. 

But I’m remembering our first year of practice and this is 2001. And we were motivated, and we had no kids at that point, and nothing else to do, and our practice was not only our business but our hobby, and a lot of the fun that we were having was related to building the business and we got a call. This was after December. And December was a busy month in the practice. You know everybody wants to use their insurance benefit and they’re flex spending. That was still in the use it or lose it days. And we got a call on December 31st. We had planned to close the office at one o’clock because it was New Year’s Eve. But we’re losers. We had no plans. And that morning probably 10:30, somebody called desperate to get their family of four in that day because their benefits were expiring at the end of the year and they were going to lose their exam and glasses benefit if they didn’t come in. And so I answered the phone, which is what I did then and at that point said, “Yeah, absolutely come on in.” and we ended up staying an extra hour or hour and a half whatever it was, and generated probably $1,200 – $1,500 for the business which at that time was a significant percentage of what we did in that month. 

So thinking about the schedule of some of the things that you’re motivated to do when you’re under pressure your backs up against the wall. Are there times when there are extra patients who would want to come in if you could figure out how to get them into your schedule? And if there are, could you on an ongoing basis not just when you’re in panic mode, adjust your schedule to be more efficient and allow the practice to see one more exam, two more exams, three, or four more exams each day? And if you make that change and you’ve got patients to fill it, if you’re seeing 12 exams a day and you go to 15, that’s a 25% increase in potential business that you can do that day. Right? Not always more exams is the key to success and we’re going to talk about other ways but is the schedule as efficient as it could be? If you could find a way to squeak in a few others while you were desperate? Could you find a way to squeak in a few others when you’re not? And what would that do to the overall health of the practice? 

Some of the other things that we do schedule-wise is looking for opportunities to see family members. A parent brings in a child and you look and you notice that the parent hasn’t had an exam in over a year. They’re your patient too. And in those moments, you say to the parent, “Hey, we have a spot open. Do you want to get your exam out of the way as well?” And some percentage of them will say, “Yes, absolutely.” And bam, you get another exam out of it. And maybe that day, it’s just a copay or photo, or maybe it’s an eyeglass or contact lens order, or a conversation about some other service but it’s done that day. And it’s work in hand like you’ve done it. You build the insurance. You’ve collected the money or whatever. And it just increases the level of success that you have that day. 

Another difference I see in practices when things are tight versus when they’re not is the urgency that the practice has about filling last-minute cancellations and even no-show appointments. When you’re desperate and in panic mode, you’re watching every detail. You’re watching that schedule. And in the morning you see the schedule start to fall apart in the afternoon. And when things are tight, it’s like, “What happened to that two o’clock? What are we going to do? Are we going to fill it?” And not to micromanage, right? Because you’re gonna make staff crazy if you do this. But to either yourself or have someone not just in panic mode but on an ongoing basis looking out for “Can those last-minute cancellations be filled?” and “Are we doing everything that we can to keep this schedule full?”

So just some things to think about right? If you’re doing them when you’re desperate, could you be doing them or should you be doing them on an ongoing basis? Would it make your business better to do them that way? And the answer is probably yes. So then I think about in the exam room and the thing that got me really aware of this was when we were running a lighter patients schedule after COVID. And a lot of practices were doing this, right? Once the office was closed and when things were really bad. And as they started to open up again, a lot of people opened up on a reduced schedule. Where instead of their normal number of patients that they used to see in a day, they were seeing initially half that and then two-thirds, three-quarters, and just building it up slowly. 

And when people were seeing fewer patients by design, one thing that we heard almost across the board from our clients and other people outside our client family was all of a sudden what I’m able to do with each patient increases. And so we were looking at metrics and we’re looking at lower patient numbers with higher per patient revenue. And talking to these doctors and saying, “What’s the difference? What are you doing differently?” And the answer was that the additional time that they had to spend with the patient was allowing them to really have the conversations that elicited patient complaints or concerns that as optometrists we are uniquely qualified to fix. 

So when you think about a packed schedule and the mindset kind of being, “Gotta stay on time. I don’t want people to wait. I gotta get them in and got to get them out. A patient might say something like, “My vision is fine, right?” “How are you doing with your glasses?” “They seem okay.” And if you’re prioritizing staying on track, being efficient, getting that next patient, when the patient says that you say, “Okay, great.” And you go and you do the refraction and whether you find a little change or not, you’re probably not making a strong recommendation to do something different.

When we were seeing fewer patients and feeling the squeeze of fewer patients or not related to COVID or anything at all, but when you’re really focused on, “I need my numbers today to be a certain amount.” The conversation is a little bit different. Right? “How are you doing?” “What are your current glasses?” “I think I’m fine.” “Yeah. Are you wearing the same pair for everything?” “Yeah, I wear these all day.” “What do you do for work?” “I’m a day trader.” “Wow. Are you on multiple computer monitors?” “Yeah, I’m using three monitors all the time.” “And how are they working for that?” “They seem okay. I just have to like lift my head up a little bit or I’m squinting.” Or sometimes patients will even tell you, “I’ve switched to this old pair of glasses that I’ve had since college. I use those for that because the prescription seems better.” “Alright, let’s take a look. Let’s see if we can get you something even better.” 

So having those little extra conversations very often leads you to be able to give a patient a solution for a problem that might not have been big enough that they’re mentioning it first thing in a 32nd conversation. But it’s something that’s affecting them every single day. Another difference in an example like this is when things are really busy and you’re feeling everything’s fine, a little bit complacent, “How are your glasses?” “Great.” Blah blah blah You go through the whole exam, new prescription, everything’s healthy, they’re good to go. 

When you have either a slower schedule or a need to really actively work to create success for yourself on a minute-to-minute basis, you may ask the question, “Are there times when you’d rather not wear glasses?” Everybody’s gonna say, “Yes.” Of course there are times they might not want to wear their glasses. “Well, when are those?” “Well, I don’t want to wear my glasses when I’m skiing, snorkeling, out on dates, or whatever it is.” It’s an opportunity to bring up contacts to a patient even if they didn’t bring them up to you. 

When we work with clients, we go out, we observe in their offices. And, of course, when a patient says, “I’m thinking about getting contacts.” All doctors pretty much  are going to say, “Okay, great.” And fit them with contacts. But the ones who bring up contact lenses when the patient doesn’t initiate that conversation, very often find that patients are interested and all of a sudden an exam goes from just an exam to an exam, and updated glasses prescription, and a new contact lens fit. 

The other piece that is different when we’re in panic mode, is that the doctors tend to be much more invested in what happens once the patient leaves the exam room. In a lot of really successful practices,  a fault that we see is that the doctor does their thing for the patient. They work hard to uncover needs. They make the recommendations. They put care into what they’re doing on the recommending side. The patient goes out to optical or goes out to the front desk and checks out and the doctor never really knows what happened. 

Again, when you’re in panic mode needing to make that next loan payment or bank payment and new in practice, those are the days when the doctor says, “What happened?”, “Did the patient get those glasses?”, or “Did he get the sunglasses I recommended?” Because it’s that need to know what’s going on, right? You start to like need to track everything, which isn’t totally healthy, but it happens. It’s natural. And so now the staff sees that the doctor is so much more invested in what happens. They care about the outcome. “Yeah, Doc. They got both pairs. The regular pair and the sunglasses.” “Okay, awesome.” And everybody knows that we took care of the patients. 

If it’s never asked, the doctor doesn’t know. So they don’t have any feedback to know if their recommendations are working or if they need to tweak them. Right? So maybe the doctor says something to the patient about getting sunglasses but the patient ends up not getting them. If the doctor knows that, they can think, “What did I say? Could I have said something differently? Could I have said something better that would have led to a different outcome?” And then the patient who does get them, if the doctor knows right away they can think, “Alright, what did I say there? What worked and how do I learn from that and incorporate that into the next patient?”

When that loop is absent and there’s no feedback, the doctor says what they say. Whatever happens with the patient happens. Nobody really connects those two things, even though they’re hugely connected, and the doctor can start to get into some bad habits. Because maybe they’re recommending sunglasses, for example, and patients are never getting them. So whatever the doctor is saying, totally isn’t working. But if the doctor doesn’t know that, they’re never going to change it. 

The other thing that can happen is that staff starts to feel like it doesn’t matter. At the end of the month, you talk metrics, capture rate with staff. And they hear, “Oh your capture rate is 40% and we want it to be 60% or whatever.” But it’s tied in in a different way when it’s, “Hey, that guy was a cyclist and he doesn’t have sunglasses. You know I recommended that he get these. Did he get them?” The optical staff knows that filling that prescription is part of the doctor’s care for the patient and it creates a different feeling. 

So that’s something that can absolutely get dropped or lost as practices get consistently successful and become a little bit more complacent about watching all those transactions. Where I think that if we kept that interest, and kept that constant feedback, and that desire to improve based on each patient encounter and the outcome of it, practices would in general be better off. Lastly, in the exam room, I think that when a doctor is very laser-focused on the success of the business and again, the psychology of why that happens when things are bad more easily than when things are good, I don’t really know. But I know that this is true. 

They’re much more likely to also talk about opportunities that the patient may be unaware of. Maybe not a great example because I feel like everyone’s talking about it. Although in my interview with Dr. Monica Jung, she says it’s not the case. But the first thing that popped into my mind was Myopia. That a lot of times when you’re starting that Myopia conversation, you’re initiating a conversation that’s fully different than what the patient or the parent in this case expected. You could do exactly what the parent expects. “My child’s having trouble seeing the board.” “Yep, they’re a little nearsighted. Here are the glasses.” That’s exactly what the parent is expecting to happen and you can do that. 

Bringing up something different takes time. But if and when you know that if you were able to get that patient into a Myopia program that would make the difference between being able to pay your rent this month or not. If you’re bringing it up, then you need to be bringing it up every single time. Once the patient leaves the exam room, guess what they’re gonna get in optical? 

The other thing that practice owners under pressure watch are what happens with the money after the fact. So many things right? Like I’ve been in offices where the normal thing that’s said, “Your glasses or whatever, would you like to pay half?” Right? You got your back up against the wall. You’re panicking about money. You’re not saying that that day. You’re telling a patient, “Your glasses are ___. How would you like to take care of that? and collecting the full payment. You should always be collecting the full payment. 

Obviously, there are exceptions and you need to make an exception for a particular patient in a particular life situation. So be it. But the normal should always be collecting. Doctors under pressure are looking to know, “Was this coded at the highest level it could be coded for the services that I’m providing?” If that $40 between a level three and level four office visit makes a difference in that day or that month to my practice, I better know when I can bill that level four versus that level three because I need that $40. There comes a time where you don’t need as urgently the $40 but keeping the habits from the times when you do, creates a whole new level of success. 

Did the patient pay their copay? Was the deductible collected? We get that question a lot when patients have a deductible. Do you collect for it upfront or do you bill them for it later? And you can find out if a patient has a deductible and you can know what the allowable charges are going to be and you can tell the patient, “This is going to be applied to your deductible. So today your balance is.” And many of them will pull out a credit card or FSA card or whatever it is and hand it to you. And you collect that payment now rather than having to go back and bill for it.

And looking for additional opportunities on the way out, when your practices slow and your schedule is empty. Those are the times when you can get over your discomfort with saying, “Hey, when you go back to work, if there’s anybody else in your company who’s looking for an eye doctor, we’d appreciate the recommendation.” Right? And that’s hard. Like I know you could say that to patients. I admire people who do and I know that for me that’s very tough. 

I also know that in a brand new practice. We opened the practice a year ago. Absolutely, I said that because we needed those patients, we didn’t have any. So getting through that 30 seconds of discomfort and just saying it, led to people saying, “Oh, yeah. Alright. Yeah, let me take a couple of extra cards. Are you okay if I take a few of these?” “Sure. Yeah. Yeah, I’m okay. If you take my cards if you’re gonna give them to people.” And then we saw referrals coming in. 

So if we can keep that mindset and do those things, they don’t work any differently when you’re under pressure versus when you’re not. You’re just, when you’re not under pressure, you’re less likely to do them. The last thing that I’ll talk about that Practice Owners under pressure do and some of it comes from nervous anxiety, they can’t sit still. But all of a sudden when there are no patients, the bank accounts are not where you want it to be, the Practice Owner starts to put their eyes on all the things and starts looking around poking around in the office. So that poking around can go into a lot of different areas. 

One of the things that gets looked at when a practice is under pressure and can get ignored when a practice isn’t, is insurance receivables, insurance aging, and patient aging. Right? If there’s lots of money, things are seeming good, maybe you record those numbers as part of your monthly tracking. Maybe you don’t. Many practices, I’m always surprised to find, don’t even look or they count on their billing companies just taking care of it. Suddenly, when things are under pressure, “Where’s the money? Let’s check the receivables.” And almost universally, the Practice Owners will find something. Either something hasn’t been billed at all or there’s a longer delay than they realize between when a service is provided and when it’s being billed for. Right? 

In practices that are freaking out, those things are billed on the day of. Because you know a lot of insurers, especially those that pay electronically, that money will be in your account sometimes days later or usually within two weeks. Practices that are doing well, no problem, no complaints, paying the bills, and making money. It can sit. Sometimes for a week, or two weeks, three weeks, or I’ve seen in practices, where it sat to the point that it hits the timely filing deadline and can’t even be billed. And so doing well is, in this case, the enemy of doing even better. 

So insurance aging. Look at patient aging. Some of the offers or rebates or discount programs on bill payments. A lot of companies have 2%, if you pay by the 10th or this much money off if you pay by the 20th. And is the practice taking advantage of all of those? Most of the time it’s not a giant amount of money. And really none of this is a giant amount of money. But it’s little amounts of money consistently, over and over and over again. 

A panicked Practice Owner will go into their Optical area and find the frames that are due to be returned under warranty for credit and haven’t been returned yet. How long have those been sitting there? All of these things add up and you can do it in a cycle where, “Oh my gosh, things are bad. I’m gonna do all these things. Okay, good. God I’m now better and when things get bad, I’ll look again.” I would propose that if you sit down and think about it in your own practice, what things you could add to this list that I’ve already shared and look at how you can either give responsibility to someone to make sure that they’re being done not when things are bad, but all the time. Can you set up systems so that things are done consistently? Can you be consistent in your own communication, that whether you’ve got 18 patients in your schedule that day or eight, you’re taking the opportunities that you would take if you didn’t have money in the account to make payroll? Can you create checks and balances for things like insurance aging  and frame returns, so that you know on a weekly or monthly basis? Even if you’re not the one handling it, that you have the system to know that all of these things are taken care of? 

If all of those little changes are done and consistent on an ongoing basis, the likelihood that you’re going to have to figure out what to do in panic mode is decreased. Because the likelihood that you’re going to be in panic mode is decreased. Because you’re going to be doing the things that keep the practice successful and make the practice successful when it’s already doing well. These are going to make it even better. Something worth thinking about. 

So that are my thoughts for today. If you want more thoughts, you can find us online at www.powerpractice.com. Feel free to connect with me on LinkedIn, or Facebook, or Instagram. I don’t know. We’re trying to use all this. If you have dreams for your practice that you’d like some help with, please reach out to us info@powerpractice.com. And once again thank you for listening.