September 1,2022
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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.
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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.
Read the Transcription
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.
Read the Transcription
Jennifer Herring: Because I had the visual impairment nobody ever set real expectations so I’ve always had my own.
Dr.Bethany Fishbein: Hi! I am Bethany Fishbein – The CEO of The Power Practice and Host of the Power Hour Optometry Podcast. And this conversation today is really one that is extraordinarily special and personal for me. I am interviewing Jennifer Herring who is a visually impaired marathoner and all around is an amazing person we’ll get to her for a second, but the reason that it’s so special for me is that when I was growing up when I was in college, I randomly got a summer job working at a camp for blind and visually impaired children. It’s called Camp Marcella and Rockaway, New Jersey. And it’s my experience at that camp that made me realize that I wanted to go into the eye care field and really change the direction of my personal and professional life forever. And Jennifer, or as she was known then by her camp nickname, Pickles, was one of the campers at Camp Marcella. So she and I have known each other for what is it, Jen? Probably 35 years.
Jennifer Herring: Yes.
Dr.Bethany Fishbein: And so when I saw you online, posting about your latest running accomplishments, fundraising accomplishments, I knew I wanted to talk and thank you so so so so so much for doing this with me. It’s bringing me all kinds of warm fuzzies already, we haven’t even started yet.
Jennifer Herring: Thank you for having me on this wonderful podcast!
Dr.Bethany Fishbein: My pleasure, last night, I was like going through the camp pictures to try and find a picture of the two of us. Did you actually end up working at the camp for a year or two?
Jennifer Herring: Yes, the first time I was asked to work in the kitchen and then for a couple of weeks when one of the other workers was unable to finish up the year, and then I worked a whole summer in the kitchen and then I worked as a counselor for a full summer.
Dr.Bethany Fishbein: That’s the pictures that I found were from staff training, and it was the two of us out on the blacktop where the basketball nets were and we were learning how to use fire extinguishers. So it might have been the year that you were in the kitchen. But that was the picture I found that had the two of us in it. I’ll email it to you.
Jennifer Herring: Oh, that’s great.
Dr.Bethany Fishbein: Anyway, most of the listeners for my podcast are either optometrist eye doctors, optometry students, and people in the eye care industry. So if you don’t mind, would you share a little bit about your eyes, about your diagnosis, and what your vision is like?
Jennifer Herring: Yes, sure. I was born in the mid-70s. So technology has come a long way since then, so early on the eye doctor would do some even right-ups so what they saw on your eyes. I went to an eye and ear in Massachusetts, for them to help diagnose what was going on in my eyes because there is a family history of eye issues, and my family so they knew that there was something wrong. I’d look close, and I also been like near the television and things like that. So I went there. And early on they said I had a form of juvenile macular degeneration so that went on for years I struggled in school and they did give me glasses, but the glasses kind of made everything to focus but I still couldn’t see the blackboard or had issues with seeing far and also I looked very close and so many years went on and then eventually they went to the eye doctor and they looked in and said your macular eyes are fine. It’s your optic nerve. So then it’s white. So they finally diagnosed it as optic nerve atrophy and cone dystrophy and also nearsightedness. So currently that’s what I go by. It’s also been an issue because my eyes outside look very normal. There isn’t really an indication that I do have an eye problem. So going through school that was kind of hard for me because teachers would put your glasses on and they didn’t understand, even though I was a member of the New Jersey Commission for the Blind and Visually Impaired and they tried to help explain to teachers what was going on, but they really weren’t aware of having these issues. There weren’t many children also who had these kinds of issues in their classes. That was also Camp Marcella came in because when I was eight years old, I went there so I would see other children who had eye issues that we helped each other by can see better than you know, it’s there was a totally blind child then we would leave them around and so it was like a beautiful thing to be part of. We did lots of activities. No one ever set limits for us. We did all the activities and you know I met Bethany and all the wonderful people up there. It was happening every summer because she would just be with other kids and wonderful, caring people who wanted to help and so.
Dr.Bethany Fishbein: it’s funny when you said that it makes me realize we work with a lot of visually impaired people in the practice. And sometimes we’re talking to parents of kids with low vision or people with low vision and one of the things that I’ve always talked about, is that a vision problem is not like a mobility issue where somebody has a limp or uses a wheelchair or has always an outward sign of having a disability. And so we talk a lot about people, especially kids, but older people too. Who are losing vision later in life that they’re struggling and there’s no way for people around them in the grocery store or server at a restaurant or anything to know that they’re having trouble which makes vision difficulties a little bit more complex? Nobody’s offering to help because they don’t know that there’s a problem. And I’m realizing as you’re saying it that that’s probably a lesson that I learned from you and your friends talking about it because as you describe it, I’m aware now that that’s almost always how I say it. So that’s something I picked up from you.
Jennifer Herring: Yeah, it’s a hidden handicap. It’s like I’ve gone through kind of life, You have this burden but I also don’t see it as something positive because I met so many people with compassion other amazing people who are just keep going you know, a lot of my friends I met at Camp Marcella everyone’s still going and so you can still lead a good life. Even if you have a hidden handicap like this.
Dr.Bethany Fishbein: For sure. So tell me we kind of lost touch for a while because I knew when you were a kid at camp and then like most of us at camp we lost touch and it was really when Facebook started to gain popularity that we got back in touch. So talk about what you did after you finished high school. Did you go on in your education? I know you’re working now. What do you do?
Jennifer Herring: Yes. Well, I’m currently a software engineer. I’ve been working in the computer field now for over 20-25 years. Now. And way back in high school to like told me there wasn’t as much technology and so they were kind of leery about me going to college. I only had a monocular some of the early things. I also had glasses that had a monocular on them, but they didn’t work as well. Like I said they would make it clear but I still couldn’t see everything far away. They weren’t really pushing going to college, but I thought I could I did well through school. So I went to the University of Delaware and I majored in computer science. I got a BS in computer science and I was on the Dean’s List and I did well I think I did better than in high school even because I don’t know if that’s also a part of our skillset. But I’ve always been very structured. I felt like it was always my job in school even though I had to concentrate I had to work harder because I couldn’t see so I always had to ask for extra help a little bit. So I’ve always been pretty structured. So I went to college and so I did well doing that, and I also ran intramural track and five K’s. So I did that. And then I got my first job. I got some help with the New Jersey Commissioner for the Blind and Visually Impaired, offered assistance to help find my first job, and then from there I did well and never had a bad review at any of my jobs but I moved back closer to home a couple of times just to be with my family. And so I’ve been doing that now I worked at Lockheed Martin for a little while, which was very interesting. And now I work for a company that handles the Medicare Medicaid claims for New Jersey. So I do a lot of programming for those systems.
Dr.Bethany Fishbein: And are using any technology or talk about what you’re using to make the computer and stuff like that accessible for you.
Jennifer Herring: I do the looking close into the screen. I’ve tried some of the other technology they have with the closed-circuit TV and things like that. But now then I’m working at home so when I worked in the office, I would have a lot of people wondering, Why is my face and my screen? and I mean, I’ve been doing it for 25 years. I’m just used to that. It’s just my personal preference, but I know others use the talking technology that you can use in me I have my iPhone and I can look close, and I made the font bigger. So yeah, a lot of the bigger font. I do that on a lot of the applications, it’s on my home laptop. So, fortunately, I looked low so you know they always told you not to do I mean I’ve been doing it for 25-30 years almost. But that’s just my personal preference.
Dr.Bethany Fishbein: And that’s another piece of education that we’re giving to parents, especially of kids with low vision telling the parents telling the teachers that they were raised saying don’t put your head up in your phone. Don’t get that close to the TV. Don’t get that close to the book. And for somebody who needs that working distance to be able to see it. It is absolutely appropriate and healthy and necessary for them to do that. So we provide that as well.
Dr.Bethany Fishbein: So you mentioned that you ran in college and really I want to talk about your running but I remember when you were younger, there was awards that we used to give out at the campfire, right so they ended the session we always had a closing campfire and then there were different awards for the kids and you were always kind of almost guaranteed recipients of the Super Girl award for your extraordinary athleticism.
Jennifer Herring: Yeah
Dr.Bethany Fishbein: I don’t think any other girls at Camp stood a chance to win that when you were there in that session. So when did you figure out that you had some ability in specifically running?
Jennifer Herring: Yeah, it’s an innate thing. I think nobody introduced it to me from a young age even like in gym class since you didn’t really have to see well for the gym teacher would say okay, we have to run around the field or inside the gym. I did the Presidential physical fitness test. I love to do all that jumping and running. And so it started just innately, I am blessed that was born with a passion that I love to be active, you know, and I tried to let other people know how to just whatever you can do just walk whatever. Find yourself something that can help you be a good even new track and cross country in high school and the coach helped me because one of the teachers wasn’t nice to me one time with the understanding that I couldn’t see the board. So my coach talked to him because he didn’t want to have his runners upset. So he talked to one of the teachers to explain. I just always loved running and luckily too I wasn’t a superstar. I got my varsity letters all four years and I was captain senior year for track and cross country but luckily I was good enough but not superstar so I didn’t burn out I didn’t get injured. I took care of my body properly. So I mean, what do you got to keep going now? 20-30 years later, 35 years later, so I started to helping people.
Dr.Bethany Fishbein: Right? Yes, you’ve been running ever since. And not only are you a runner, but you’re also a marathon runner, and not only are you a marathon runner you’re really fast. how many marathons have you done at this point?
Jennifer Herring: 39 marathons
Dr.Bethany Fishbein: 39 And what spurred this podcast am I reached out to you is you just posted on Facebook that you got back from your 19th Boston Marathon?
Jennifer Herring: Yes.
Dr.Bethany Fishbein: Amazing. I did one once. And afterward, I said one and done. And I realized about maybe 20 minutes into the first one that this is something that I was never going to experience again. So 39 is extraordinary. How old were you when you did your first one? Do you remember?
Jennifer Herring: Yeah, I was 28 and I did New York. That’s one of the most special ones to do. It’s like you’re a rock star the whole time. There are just people cheering and that’s why to people come from all over the world and get along and just people are cheering there is music and you can’t get lost in your strong woman pretty buddy and I always make friends you know you talk to people and everyone has different reasons that they’re doing the run. So that’s always special and charities if there are people raising money, it’s a really special thing, I always said I do marathons and then I started in that first marathon I qualified for Boston and so that’s how I got involved with starting to run the Boston Marathon.
Dr.Bethany Fishbein: My first and only marathon I finished in six hours and 10 minutes. How did you do in yours?
Jennifer Herring: Ah, that one I was, I did 3:35 for the first year, And I know of course over the years now I’m slowed down but it depends on your training and everything. so sometimes you need to get some more training in but my best was 3:22 there so I run then in New York and then 3:26 in Boston, it’s my elder best one.
Dr.Bethany Fishbein: Do you run them to be fast? Like, are you going for time or you’re going for the experience?
Jennifer Herring: Yeah, it’s always been an experience for me because I was aware of the Boston Marathon and then the qualifying standard and I need to know that I would get that the first time I really wanted to I had read books about it. All the legends and running and eventually, I met Kathrine Switzer, you know, reading all the history of the Boston Marathon and everything. I really wanted to run it, but I didn’t know so yeah, I guess it’s the joy of running. They all talked about the joy of running and I think I have that. Moreover, then even in high school, too, I guess for life because I had a visual impairment nobody ever set real expectations. So I’ve always had my own, at least gone on my own pace through life now, and I hope everyone can do that because that way people set too high expectations or something. And so you should just go along and do it. You can do your six hours. I mean, that’s wonderful to some people never do it. Yeah, those three can be happy with that. It’s just the satisfaction of completing it. And the experience you have.
Dr.Bethany Fishbein: And you mentioned that people out there fundraising and over your running career, you’ve done fundraising or done marathons for I think, some different causes, right?
Jennifer Herring: I’ve done well, one part there’s a lot of unfortunately cancer in my family and then other loved ones and friends that have been touched by cancer. So I’ve done a story with my father in 2007. He was diagnosed with a brain tumor in November of 2007. And so I told them that I was going to run the Boston Marathon for him in 2008. So they tried to do things for him, but it wasn’t working. But he held on till the day I came home and I handed him the Boston Marathon medal that you get when you finish the marathon. And that evening, he passed away. It was just a wonderful thing he did for me because he hung on because I had told him I did that marathon for him. So I do a lot of charities that are related to brain tumor research. I’ve done several in New York, and run a lot of races in Central Park. And then there’s a American Cancer Research. I’m doing a race in Philly. So I’ve done some fundraising for them in Philly, and then there’s Fred’s team. I’ve done the New York Marathon and then of course for the visual impairment I’ve done the Boston Marathon pretty much I guess, I think about 10 to 15 of the Boston Marathon races I’ve raised money for Team with a Vision which raises money for the Massachusetts Association for the Blind and Visually impaired and they support and rehabilitation services for people in society that have visual impairments there. So that’s how I feel it’s the overall good thing for me and for everyone, you know, for helping people.
Dr.Bethany Fishbein: Absolutely! So when you race with Team with a Vision, what’s involved with that? Do you fundraise? Are you running with other visually impaired people? What does that mean, to be part of that?
Jennifer Herring: Yes, it’s a group of blind and visually impaired runners and guides and they start fundraising about six months out they have you set up a web page where you can go to fundraise, which says the Boston Marathon was twice in six months. Now, I did it back in October. So that’s the last one I set up. And then for this one, that was just in April, I donate it and then I informed other people to just go to the main web page that GivenGain, they set up many fundraisers. So Team with Ovation was one of those on there and told them when race week comes along about the Friday before the Monday Boston Marathon, you go up there, they have different activities to get together. So you can meet other people that are blind or visually impaired and then the guide under are solely charity runners to that raise money also, and then they have dinner then you get your bed that you wear for the race. And that’s a wonderful thing too. So when I run in the marathon, people are saying “Go Team with a Vision!” so it’s publicized more. So people wonder what is that now look it up and hopefully they can either join the team to run and raise money or just donate or cheer even is wonderful too. That helps that helped me a lot too.
Dr.Bethany Fishbein: Just hearing people cheering for you on the course.
Jennifer Herring: Yes
Dr.Bethany Fishbein: Yes, that’s awesome! And you mentioned people go up with their guides, but you don’t usually run with the guide, do you?
Jennifer Herring: I have a couple of years? You know, Unfortunately, Tom was a racist. There have been some things that have been so you know, in some cases I always go back and forth, whether it’s better if something goes wrong, it’s better to have someone with me because you know like when I’m on the course I feel kind of sheltered because I know where I’m going. There are people all along, you can get help but if there’s something where they say the race is over or something and you’re still out there or something, I would need help to get back or just to make sure nothing goes wrong, but I run with guides and they help because I do have to slow down go into like the water stops and things and they do help to say okay, you’re making a left turn coming up. So instead I go along on my own and just kind of rely on the other runners. Sometimes, it’s better and I’ll always welcome someone to run with me. I’ve always been Ms.Independence. It’s hard for me to always have somebody helping, but they’re wonderful too.
Dr.Bethany Fishbein: And they have to find one who’s fast enough for you like I would offer but.
Jennifer Herring: Yeah, well some friends
Dr.Bethany Fishbein: or you could stroll along with me.
Jennifer Herring: Well, sometimes they have to lie so you can only go up to 11 miles with the person they have this switch off for races and there are all levels to of ability. So there are faster runners, and there’s a guy who runs like 235 marathons and blind, and then there are slower runners that it seems like there’s a whole gamut. So if someone does want to help a guy and there are other associations that they set up, there’s United in Stride, it’s called in America. It’s spread out in different states where you can sign up on the website United in Stride and find if you want to assist a visually impaired runner, and then now I see there’s a team tethered together. And that’s another one that I see is set up. So if there are runners that want to assist, and they have that just even to take a vision curbar out for a run race, which is you know.
Dr.Bethany Fishbein: Cool! I will put those websites in the notes when we put the podcast out. So if somebody’s interested in doing that, maybe they can get matched up with somebody in their area. Were you in Boston at the marathon, the year of the bombing? Was it twenty 2013 Oh my god.
Jennifer Herring: Yes. Well, I have the associated story with being going to visually impaired because I finished about 15 minutes before the bombs went off. And I was around the corner about 600 feet around the corner. I guess from there, we had a family meeting area where the team was the Vision Group would meet after the race, and there happened to be a seeing-eye dog there waiting for his person to come. And so of course, since he wasn’t working, I wasn’t petting, but I just kind of kneeled down, Just this was my 10th Boston Marathon. So, of course, I love dogs and I was talking to the dog and I felt, I finished my 10th Boston Marathon and it was a beautiful day, that day too and finally because usually, it’s very cold and windy in that area. So yeah, I just usually want to get going and then all of a sudden I heard a noise and an echo sound like a backfire and I was like, okay? and the dogs heard it too. And then it was a little bit of time and then it happened again. And the dog started shaking. So we’re only what is that noise and Josh Warren who had introduced me to Team with a Vision. He had asked me to join the team couple of years back, He said, I don’t know that doesn’t sound good. So my mom was in the hotel in the Prudential Center there I always told her to stay put because I didn’t want her ever wandering around. She called and she said there was a bomb something was going on at the finish line and to get back to the room. So I got up from there and you know me while the dog was shaking, and so he knew the dog knew something was bad. And I had to get back to the hotel. And luckily, I got back then before they started shutting the doors you couldn’t go in, it’s just horrible there. And then actually, a beautiful thing that just happened is that this was a second Boston Marathon they had the Power Elite Athletes Division and one of the women participating in it. Adrianne Haslet – She was affected by the Boston Marathon bombing. She was a ballroom dancer, she lost her leg and she decided she wanted to run the Boston Marathon again after she had done it in 678 hours I think a couple of years ago. So she participated in this past last week, the Boston Marathon and she was just ready. I mean, it was beautiful to see she was so happy because she trained with Shalane Flanagan. She had won the New York Marathon. She’s a professional runner, and she had her as her support. I saw her at the starting area. I could feel the smile, I couldn’t see but I thought we were on the running scene and what was going on and just to know how happy she was and she finished in I think a little over five hours. So it was like a three-hour improvement. And she posted and has been so happy since joy. Yeah, I was even though you’re part of a horrible thing, but she’s turned it into something beautiful in her life. So that was very nice to see firsthand. I always miss out on things. So it was kind of like right there. I was fortunate to just be in the presence of that.
Dr.Bethany Fishbein: I really I think that message or theme has come through and a bunch of different stories that you’ve shared today about your experience of taking something that maybe people would consider a negative and finding the positive side or finding the beautiful things in a situation. So that’s a very positive message for today. You know, I think for anybody who’s listening if they are inspired to do something positive, I will share the links to Tethered Together to United in Stride for somebody who’s looking to give us their time for somebody who may be looking for a wonderful place to give their money. I’ll share links for the Team with a Vision and also for Camp Marcella, which although it’s a little bit different now is still helping blind and visually impaired kids in New Jersey and is still a special place to me, and Jen I know for you too. And I’m really grateful that your running career and my vision career have put us back in touch and given us the opportunity to reconnect all these years later. Thank you so so so so so so much for talking. It was great to have this conversation with you.
Jennifer Herring: Thank you Bethany and you are wonderful too, I’m honored to talk with you.
Dr.Bethany Fishbein: I am the one who is honored here and for everybody out there, Thank you so much for listening.