A good understanding of where your Practice is making money and the costs associated with running a business are important for long-term success. Join Bethany as she shares insights, lessons learned, and tools to improve practice profitability.


January 25, 2023

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Dr.Bethany Fishbein: It’s very interesting to know that the practices that are collecting the most and taking home the most are practices that are embracing eye exams and glasses. 

Hi, this is Bethany Fishbein the CEO of The Power Practice and host of the Power Hour Optometry Podcast, and today it is just me. I wanted to share some observations/realizations that I’ve been having about what creates financial success in a practice. So what this came from is observation of hundreds of practices. We get to interact with a lot of doctors and see all kinds of different modes of practice all kinds of different challenges and all kinds of different measures of success. But what I started to find was a group of high-production doctors, meaning Optometrists who had practices where they or an associate a single doctor in the practice, was generating well over a million dollars in collected revenue. Most of the ones that I spoke to are 1.2, 1.4, and over one and a half million generated by one optometrist, one full-time optometrist. So I was interested to see what these practices had in common. And interestingly, as I spoke to him, there’s really a consistent pattern in what these practices are doing to generate that production and not only to generate that production, but these practices also had very high net dollars. Not necessarily the highest percentage of net compared to our clients across the board, but very often highest number of net dollars highest actual profitability. So they’re bringing in a lot of money and taking home a lot of money. So I want to share what they have in common because you might find it a little bit surprising. 

So for starters, first thing that I saw across these practices is that they emphasize eye exams and glasses. We’ve talked on the podcast before about what are the big pumpkins in your practice and when we talk about big pumpkins a lot of people immediately go towards specialty care, big pumpkins are the myopes, Scleral Lens patient, binocular vision dysfunction functional, vision therapy, whatever it is. But for these practices, they’re big pumpkins, our routine eye exam patients, the patients coming in for eye care, leaving with a prescription for glasses, and ideally getting glasses in the practice. That’s what they look for. That’s what they emphasize, and that’s what they thrive on. So it doesn’t mean that they do routine care all day. We’ll talk about it but it means that they prioritize routine care as a very important part of the practice. And not everybody’s doing this because I talk to a lot of people who view routine exams as feeders for the specialties in the practice. So a patient may come in for routine exam, but the doc is thinking, How do I get them into medical? How do I get them into dry? How do I get them into esthetics? How do I get them into ortho-k? And these Doc’s are really thinking How do I take care of the complaint they came in with, and make sure they leave with their needs taken care of. And if something else comes up that they weren’t expecting, I’m going to treat that also. So it sounds like wording like they do eye exams and glasses and everything else versus a practice that says, we do amazing specialty care and also eye exams like those are the same thing, but they’re not. It’s a mindset where they’re generally doing, what the patient came in for. And very often what the patient comes in for is an eye exam and making sure that their refractive needs are met glasses or contacts. Eye exams get some hate. You hear people talking about specialties as you know, well yeah, this spot is just gonna go to a $40 eye exam. Depending on the insurance, there’s a lot of conversation about the $40 eye exam. And believe me, that is not enough for an eye exam. But what you got to think about in your own practice is how often an eye exam patient is really getting just a $40 eye exam. In most practices, that patient is getting some kind of testing done. Maybe they’re getting a wide-angle retinal photo or maybe they’re getting a photo and an OCT, whatever the testing is, and they’re paying for that. Very often. They’re getting fit with contact lenses, they may order a year supply of contact lenses. Very often they’re getting a prescription for glasses, they may order a pair of glasses they might get two or three pairs of glasses. So as you think about an eye exam, it’s not only the exam, but it’s what that patient is going to do through the entire time in your practice. So these high-performing practices are not refraction meals, they’re not looking to do 24, 26, or 28 exams a day bang them out. They’re prioritizing their schedule to allow enough routine exams and measure how many routine exams day are on their schedule. And for most of these practices, it’s 16 to 18, one at 14, one at 20 but most of the time 16 to 18 seems to be that magic number.

So what prioritizing exams means is that regardless of the other things that may come up, these practices actively manage their schedule to make sure that they’re still getting let’s say 16 exams a day, 16 exams a day is not a super crazy day. Most of the time Doc’s working eight hours. So if you do exams every half hour, that’s 16 we one time for lunch, so maybe in one hour in the morning you do three, in one hour in the afternoon you do three, and you do two the rest of the day. And that’s your 16. Practices that start to replace those exam slots with other things very often might be unknowingly limiting their income potential for those spots. So it’s common in a smaller practice, especially to see staff tell me something like, yeah, we schedule patients every half hour every 20 minutes, regardless of what it’s for. So let’s say you’re, you’re scheduling patients every 30 minutes for whatever they need. And you’ve seen a patient who needs a glaucoma workup, or they’re going to come back because you’re going to do a dilation and photos because there is something in the retina or they’re going to come in for a consultation for dry eye or whatever it is. So the like knee-jerk reaction is you think, Oh $40 Eye exam versus a glaucoma workup? Maybe again, depending on insurance, etc. You’re getting $60 for the visit $80 for the visual field and $40 for the CT. So $180 versus 40 sounds like the right thing. You can look at it in an opposite way that for that glaucoma patient, the most you can collect in that time spot is that $180. Were for that exam you might get 40 or you might get the testing a contact lens valuation a year supply of contact lenses and a pair of glasses could be $1,200. So you don’t know. But the Docs who are doing this are actively managing their schedules to make sure that they have enough exams, usually 16 to 18 exams per day, regardless of what else they’re doing. And because the exams are a priority, they fit everything else in around it. 

Now, that’s not to say that they’re just doing exams all day long, and they’re not doing any specialty care. They are absolutely doing specialty care. And that’s something that these practices also have in common is that most of them are engaged in one, two, and usually more specialties. They are actively doing myopia treatment. They have an IPL. They fit Sclera Lenses and they do it for a couple of reasons. One is very often that’s enjoyable for the doctor, and the doctor wants to be able to do those things. It would get boring maybe, to only do routine eye exams and refer out everything else. Most of us did not go to school for that. And so to practice to the extent of your license, you know that you can do more for these patients. And so when you find problems, you want to be able to treat them. So some of it is professional satisfaction. There’s also a lot of personal satisfaction in helping someone in that way. When you fit a scleral contact lens you’re taking someone who maybe couldn’t drive, was struggling in school, was struggling at work, and giving them crystal clear vision that they can comfortably drive. They can work with small numbers they can study. So there’s personal satisfaction, and there’s also additional profitability as long as you’re doing it. Well, with that in mind so the docs that are high producing high collecting, know what doing it right means, and I’m not talking about clinically right, I’m assuming that you’re going to do it clinically, right. That’s not, that’s not my point. What I mean by right is that they’re doing the analysis to make sure that the time given to the specialties in the office is going to generate revenue that covers the value of the time. So let’s take that Scleral Lens fit just as an example. And let’s say, again, not talking to fees just because I need a number to work with. Let’s say you’re going to collect $2,400 for that Scleral Lens Fit. So $2,400 You can look at and you say “Wow $2,400 is equivalent to 60 $40 eye exams.” Yes, but again, how many people are just getting $40 eye exams? So what you have to figure out is how much time those patients are taking out of your schedule. And you can think of your time in terms of exam spots or in terms of hours spent. So one of the big things that these doctors do won’t work in these practices is that they analyze their businesses almost constantly to understand the profitability of the practice. And if you want to achieve this is how you get there. So they are constantly looking at their business to understand what’s profitable, what isn’t, of all the things that are which are the most profitable, which are the least profitable. They’re finding that intersection of what’s most profitable, what do they enjoy doing? And then if there’s something that they enjoy doing, it’s less profitable. They’re looking at efficiency. How do we decrease the amount of time that the doctor needs to spend? How do we delegate some of this to staff members? How do we make this work so that we can do this in a profitable way? So part of that business analysis is understanding what profitability is and what something has to generate in order to be profitable for the practice. 

The big metric on this is to know your chair cost and what your chair cost is, is how much it costs. To have your office open, ready, and staffed for a day for an hour or per exam. So if you have a financial statement, you’ve got your P&L. It’s a fairly easy calculation. You don’t count in cost of goods, but you count everything else, all of the other expenses so your occupancy costs your staff cost, your payroll, your marketing, any general office expense, your billers, your accountant, your lawyer everything else except your cost of goods. And if you look at it for a year, you have a large total number. You take that total number and that, give or take is your cost to be open. Whether patients come in or not. Now, obviously that can change over the long term. If you went two months and no patience came in, you’d start to decrease your staff costs. But most of the time, you’ve made these decisions. You’ve selected the place you’re in you’re paying your rent, you’re turning the lights on you’ve got your utilities, you’ve got your computer system, you have your staff, you have your salary or associate salary, whatever numbers are in there. And now you can divide that to figure out what your costs are. For each day. You work. So if you come up with a big number you say there’s $800,000 and I apologize if you can hear my little calculator noise here. Then we say okay by 12 divided by 12 it’s costing you $67,000 a month just to be open. Then if you work 20 days in a month. Now we know it’s costing $3,333 a day to be open. And if you typically work eight hours in that day, it’s costing your practice $416.67 sets to be open for that hour. So that means that whatever comes in in that hour $416.67 is being spent just to open the door, whether patient comes in for that visit or not. Now, you got to put cost of goods back in. So we’re gonna go back to a day calculation, because we don’t need to do this by the hour. But let’s say you have $3,333 is your share cost for each day that you’re open. And your cost of goods is at 25%. Meaning if you sell $100 or if you collect $100. 25 off it right off the bat is going to cost of goods. So that means that just to cover your cost of goods in your chair cost if your chair cost is 3333 for a day, you need to generate $4,444 that day, just to break even. $4,444 If you take out 25% That’s cost of goods, you’re left with the $3,333, and that covers your expenses for the day. 

So now you’ve got this number in mind. We’re looking to generate $4,444 let’s say $4,500 a day. And now you divide it back that’s divided by eight hours. That’s $562.50 per hour that you need to generate not just by patient revenue, but patient insurance, whatever else wherever else money is coming in to cover your cost of being opened during that time. So if you’re a solo Doc, you need to think carefully about how you’re going to spend that hour. If like many people did after COVID You’re doing a 45-minute eye exam and you’re taking insurance that means that you could be collecting just $40 or $50 or even 70 or $80 for that time. And most of the patients that you’re seeing are just generating that amount, then you’re not covering your expenses. You can’t sustain a business on that. If you find that you are taking this insurance, and most of the patients are not just getting $40 eye exams, but the patients with that particular insurance plan. Again doing the analysis they have a decently high acceptance rate they’re doing 90-95% of them are doing a photo. Now it’s not $40 it’s $79. And you’ve done the analysis and you found that 30% of them are contact lens wearers where you’re collecting another $70 And out of those 60% are ordering contacts and you’re collecting. So you start to be able to utilize the data to make decisions about what works during that time. 

There’s always debate on insurance billing, Vision Insurance versus medical. Interestingly enough, these practices that are generating $1.3-$1.4 million in revenue per doctor and taking home enough of it to keep them interested and happy. All of them that I spoke to, again, just as a small sample, but all of them are taking vision plans for the eye exam, converting into medical, occasionally, when a patient truly comes in with a medical complaint that they might have scheduled and said oh yeah, I have a vision plan and then they get there and it’s actually a visit for a red eye or pain or sudden vision loss. That kind of conversion, not the kind of conversion of “I’m here for routine eye exam.”. “Okay, you’re 14 you’re on a computer, and do you have any dryness”. “Yeah, my eyes feel a little dry.”.  “Okay, we’re dry and into the medical.” So I don’t know, I thought that all of this was interesting because I think based on all the conversation that I hear, it is not what people expect to be the case. There’s so much focus today. On billing medically and funneling people into specialties, on really reducing reliance, on primary care you need to do these things to people are saying you need to do these things to guard yourself against things like online eye exams and, and things like that. So with that mindset, it’s very interesting to know that the practices that are collecting the most and taking home the most are practices that are embracing eye exams and glasses. Looking at those as the big pumpkins they have additional services. They’ve got technology before the exam. They’ve got profitable specialty centers to funnel patients into from the exam when appropriate, but when they get in, they look at their schedule. They’ve created their schedule, to allow them to prioritize these people coming in for exams and glasses and take care of what they need. Exams, glasses, contact lenses. And then any additional services are secondary, totally interesting, and unexpected. Again, they’re managing their schedule. They are very much understanding that in a practice were the optometrist”s primary role is to be a producer of revenue. So this is not always the practice owner. But maybe the practice owner is in patient care all of their time in the office or maybe it’s not them but it’s an associate. So they want to make sure that during the time the optometrist is producing that they are maximizing production, they schedule around maximum utilization of the optometrist’s time. So they set up their practices so that it shouldn’t be the doc doing 15 minutes of work with a patient and then going back to her office for a little while for another 15 minutes while the staff turns over the room and sets up the next patient. They know that the doctor’s time is money and so they want to allow the doctor to go patient and patient to patient. They spend time on efficiency and on work and on minimizing the other things that the doc would have to do for the patient. So very often, these practices are using staff members or scribes or assistants to take care of the non-doctor tasks. They look at any non-eye exam care and eye exam care very carefully to understand how much time it can be allotted for the revenue is generating, and make sure that it’s scheduled so that it is not taking away from potential higher revenue-generating opportunities. They analyze their business to really understand the numbers and know not only what it costs to be open and what each hour what each patient has to generate, but understanding the statistics on what’s most likely to happen. Once a particular patient enters the exam room, and they make decisions on that data to further drive collections and further drive profitability. This might be an unpopular opinion, but I’m just sharing what I observe. So if you’re interested in an analysis of your practice, please get in touch with us you can email info@powerpractice.com or visit our website powerpractice.com. And thank you for listening. We will speak again soon.

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Dr.Bethany Fishbein: It’s very interesting to know that the practices that are collecting the most and taking home the most are practices that are embracing eye exams and glasses. 

Hi, this is Bethany Fishbein the CEO of The Power Practice and host of the Power Hour Optometry Podcast, and today it is just me. I wanted to share some observations/realizations that I’ve been having about what creates financial success in a practice. So what this came from is observation of hundreds of practices. We get to interact with a lot of doctors and see all kinds of different modes of practice all kinds of different challenges and all kinds of different measures of success. But what I started to find was a group of high-production doctors, meaning Optometrists who had practices where they or an associate a single doctor in the practice, was generating well over a million dollars in collected revenue. Most of the ones that I spoke to are 1.2, 1.4, and over one and a half million generated by one optometrist, one full-time optometrist. So I was interested to see what these practices had in common. And interestingly, as I spoke to him, there’s really a consistent pattern in what these practices are doing to generate that production and not only to generate that production, but these practices also had very high net dollars. Not necessarily the highest percentage of net compared to our clients across the board, but very often highest number of net dollars highest actual profitability. So they’re bringing in a lot of money and taking home a lot of money. So I want to share what they have in common because you might find it a little bit surprising. 

So for starters, first thing that I saw across these practices is that they emphasize eye exams and glasses. We’ve talked on the podcast before about what are the big pumpkins in your practice and when we talk about big pumpkins a lot of people immediately go towards specialty care, big pumpkins are the myopes, Scleral Lens patient, binocular vision dysfunction functional, vision therapy, whatever it is. But for these practices, they’re big pumpkins, our routine eye exam patients, the patients coming in for eye care, leaving with a prescription for glasses, and ideally getting glasses in the practice. That’s what they look for. That’s what they emphasize, and that’s what they thrive on. So it doesn’t mean that they do routine care all day. We’ll talk about it but it means that they prioritize routine care as a very important part of the practice. And not everybody’s doing this because I talk to a lot of people who view routine exams as feeders for the specialties in the practice. So a patient may come in for routine exam, but the doc is thinking, How do I get them into medical? How do I get them into dry? How do I get them into esthetics? How do I get them into ortho-k? And these Doc’s are really thinking How do I take care of the complaint they came in with, and make sure they leave with their needs taken care of. And if something else comes up that they weren’t expecting, I’m going to treat that also. So it sounds like wording like they do eye exams and glasses and everything else versus a practice that says, we do amazing specialty care and also eye exams like those are the same thing, but they’re not. It’s a mindset where they’re generally doing, what the patient came in for. And very often what the patient comes in for is an eye exam and making sure that their refractive needs are met glasses or contacts. Eye exams get some hate. You hear people talking about specialties as you know, well yeah, this spot is just gonna go to a $40 eye exam. Depending on the insurance, there’s a lot of conversation about the $40 eye exam. And believe me, that is not enough for an eye exam. But what you got to think about in your own practice is how often an eye exam patient is really getting just a $40 eye exam. In most practices, that patient is getting some kind of testing done. Maybe they’re getting a wide-angle retinal photo or maybe they’re getting a photo and an OCT, whatever the testing is, and they’re paying for that. Very often. They’re getting fit with contact lenses, they may order a year supply of contact lenses. Very often they’re getting a prescription for glasses, they may order a pair of glasses they might get two or three pairs of glasses. So as you think about an eye exam, it’s not only the exam, but it’s what that patient is going to do through the entire time in your practice. So these high-performing practices are not refraction meals, they’re not looking to do 24, 26, or 28 exams a day bang them out. They’re prioritizing their schedule to allow enough routine exams and measure how many routine exams day are on their schedule. And for most of these practices, it’s 16 to 18, one at 14, one at 20 but most of the time 16 to 18 seems to be that magic number.

So what prioritizing exams means is that regardless of the other things that may come up, these practices actively manage their schedule to make sure that they’re still getting let’s say 16 exams a day, 16 exams a day is not a super crazy day. Most of the time Doc’s working eight hours. So if you do exams every half hour, that’s 16 we one time for lunch, so maybe in one hour in the morning you do three, in one hour in the afternoon you do three, and you do two the rest of the day. And that’s your 16. Practices that start to replace those exam slots with other things very often might be unknowingly limiting their income potential for those spots. So it’s common in a smaller practice, especially to see staff tell me something like, yeah, we schedule patients every half hour every 20 minutes, regardless of what it’s for. So let’s say you’re, you’re scheduling patients every 30 minutes for whatever they need. And you’ve seen a patient who needs a glaucoma workup, or they’re going to come back because you’re going to do a dilation and photos because there is something in the retina or they’re going to come in for a consultation for dry eye or whatever it is. So the like knee-jerk reaction is you think, Oh $40 Eye exam versus a glaucoma workup? Maybe again, depending on insurance, etc. You’re getting $60 for the visit $80 for the visual field and $40 for the CT. So $180 versus 40 sounds like the right thing. You can look at it in an opposite way that for that glaucoma patient, the most you can collect in that time spot is that $180. Were for that exam you might get 40 or you might get the testing a contact lens valuation a year supply of contact lenses and a pair of glasses could be $1,200. So you don’t know. But the Docs who are doing this are actively managing their schedules to make sure that they have enough exams, usually 16 to 18 exams per day, regardless of what else they’re doing. And because the exams are a priority, they fit everything else in around it. 

Now, that’s not to say that they’re just doing exams all day long, and they’re not doing any specialty care. They are absolutely doing specialty care. And that’s something that these practices also have in common is that most of them are engaged in one, two, and usually more specialties. They are actively doing myopia treatment. They have an IPL. They fit Sclera Lenses and they do it for a couple of reasons. One is very often that’s enjoyable for the doctor, and the doctor wants to be able to do those things. It would get boring maybe, to only do routine eye exams and refer out everything else. Most of us did not go to school for that. And so to practice to the extent of your license, you know that you can do more for these patients. And so when you find problems, you want to be able to treat them. So some of it is professional satisfaction. There’s also a lot of personal satisfaction in helping someone in that way. When you fit a scleral contact lens you’re taking someone who maybe couldn’t drive, was struggling in school, was struggling at work, and giving them crystal clear vision that they can comfortably drive. They can work with small numbers they can study. So there’s personal satisfaction, and there’s also additional profitability as long as you’re doing it. Well, with that in mind so the docs that are high producing high collecting, know what doing it right means, and I’m not talking about clinically right, I’m assuming that you’re going to do it clinically, right. That’s not, that’s not my point. What I mean by right is that they’re doing the analysis to make sure that the time given to the specialties in the office is going to generate revenue that covers the value of the time. So let’s take that Scleral Lens fit just as an example. And let’s say, again, not talking to fees just because I need a number to work with. Let’s say you’re going to collect $2,400 for that Scleral Lens Fit. So $2,400 You can look at and you say “Wow $2,400 is equivalent to 60 $40 eye exams.” Yes, but again, how many people are just getting $40 eye exams? So what you have to figure out is how much time those patients are taking out of your schedule. And you can think of your time in terms of exam spots or in terms of hours spent. So one of the big things that these doctors do won’t work in these practices is that they analyze their businesses almost constantly to understand the profitability of the practice. And if you want to achieve this is how you get there. So they are constantly looking at their business to understand what’s profitable, what isn’t, of all the things that are which are the most profitable, which are the least profitable. They’re finding that intersection of what’s most profitable, what do they enjoy doing? And then if there’s something that they enjoy doing, it’s less profitable. They’re looking at efficiency. How do we decrease the amount of time that the doctor needs to spend? How do we delegate some of this to staff members? How do we make this work so that we can do this in a profitable way? So part of that business analysis is understanding what profitability is and what something has to generate in order to be profitable for the practice. 

The big metric on this is to know your chair cost and what your chair cost is, is how much it costs. To have your office open, ready, and staffed for a day for an hour or per exam. So if you have a financial statement, you’ve got your P&L. It’s a fairly easy calculation. You don’t count in cost of goods, but you count everything else, all of the other expenses so your occupancy costs your staff cost, your payroll, your marketing, any general office expense, your billers, your accountant, your lawyer everything else except your cost of goods. And if you look at it for a year, you have a large total number. You take that total number and that, give or take is your cost to be open. Whether patients come in or not. Now, obviously that can change over the long term. If you went two months and no patience came in, you’d start to decrease your staff costs. But most of the time, you’ve made these decisions. You’ve selected the place you’re in you’re paying your rent, you’re turning the lights on you’ve got your utilities, you’ve got your computer system, you have your staff, you have your salary or associate salary, whatever numbers are in there. And now you can divide that to figure out what your costs are. For each day. You work. So if you come up with a big number you say there’s $800,000 and I apologize if you can hear my little calculator noise here. Then we say okay by 12 divided by 12 it’s costing you $67,000 a month just to be open. Then if you work 20 days in a month. Now we know it’s costing $3,333 a day to be open. And if you typically work eight hours in that day, it’s costing your practice $416.67 sets to be open for that hour. So that means that whatever comes in in that hour $416.67 is being spent just to open the door, whether patient comes in for that visit or not. Now, you got to put cost of goods back in. So we’re gonna go back to a day calculation, because we don’t need to do this by the hour. But let’s say you have $3,333 is your share cost for each day that you’re open. And your cost of goods is at 25%. Meaning if you sell $100 or if you collect $100. 25 off it right off the bat is going to cost of goods. So that means that just to cover your cost of goods in your chair cost if your chair cost is 3333 for a day, you need to generate $4,444 that day, just to break even. $4,444 If you take out 25% That’s cost of goods, you’re left with the $3,333, and that covers your expenses for the day. 

So now you’ve got this number in mind. We’re looking to generate $4,444 let’s say $4,500 a day. And now you divide it back that’s divided by eight hours. That’s $562.50 per hour that you need to generate not just by patient revenue, but patient insurance, whatever else wherever else money is coming in to cover your cost of being opened during that time. So if you’re a solo Doc, you need to think carefully about how you’re going to spend that hour. If like many people did after COVID You’re doing a 45-minute eye exam and you’re taking insurance that means that you could be collecting just $40 or $50 or even 70 or $80 for that time. And most of the patients that you’re seeing are just generating that amount, then you’re not covering your expenses. You can’t sustain a business on that. If you find that you are taking this insurance, and most of the patients are not just getting $40 eye exams, but the patients with that particular insurance plan. Again doing the analysis they have a decently high acceptance rate they’re doing 90-95% of them are doing a photo. Now it’s not $40 it’s $79. And you’ve done the analysis and you found that 30% of them are contact lens wearers where you’re collecting another $70 And out of those 60% are ordering contacts and you’re collecting. So you start to be able to utilize the data to make decisions about what works during that time. 

There’s always debate on insurance billing, Vision Insurance versus medical. Interestingly enough, these practices that are generating $1.3-$1.4 million in revenue per doctor and taking home enough of it to keep them interested and happy. All of them that I spoke to, again, just as a small sample, but all of them are taking vision plans for the eye exam, converting into medical, occasionally, when a patient truly comes in with a medical complaint that they might have scheduled and said oh yeah, I have a vision plan and then they get there and it’s actually a visit for a red eye or pain or sudden vision loss. That kind of conversion, not the kind of conversion of “I’m here for routine eye exam.”. “Okay, you’re 14 you’re on a computer, and do you have any dryness”. “Yeah, my eyes feel a little dry.”.  “Okay, we’re dry and into the medical.” So I don’t know, I thought that all of this was interesting because I think based on all the conversation that I hear, it is not what people expect to be the case. There’s so much focus today. On billing medically and funneling people into specialties, on really reducing reliance, on primary care you need to do these things to people are saying you need to do these things to guard yourself against things like online eye exams and, and things like that. So with that mindset, it’s very interesting to know that the practices that are collecting the most and taking home the most are practices that are embracing eye exams and glasses. Looking at those as the big pumpkins they have additional services. They’ve got technology before the exam. They’ve got profitable specialty centers to funnel patients into from the exam when appropriate, but when they get in, they look at their schedule. They’ve created their schedule, to allow them to prioritize these people coming in for exams and glasses and take care of what they need. Exams, glasses, contact lenses. And then any additional services are secondary, totally interesting, and unexpected. Again, they’re managing their schedule. They are very much understanding that in a practice were the optometrist”s primary role is to be a producer of revenue. So this is not always the practice owner. But maybe the practice owner is in patient care all of their time in the office or maybe it’s not them but it’s an associate. So they want to make sure that during the time the optometrist is producing that they are maximizing production, they schedule around maximum utilization of the optometrist’s time. So they set up their practices so that it shouldn’t be the doc doing 15 minutes of work with a patient and then going back to her office for a little while for another 15 minutes while the staff turns over the room and sets up the next patient. They know that the doctor’s time is money and so they want to allow the doctor to go patient and patient to patient. They spend time on efficiency and on work and on minimizing the other things that the doc would have to do for the patient. So very often, these practices are using staff members or scribes or assistants to take care of the non-doctor tasks. They look at any non-eye exam care and eye exam care very carefully to understand how much time it can be allotted for the revenue is generating, and make sure that it’s scheduled so that it is not taking away from potential higher revenue-generating opportunities. They analyze their business to really understand the numbers and know not only what it costs to be open and what each hour what each patient has to generate, but understanding the statistics on what’s most likely to happen. Once a particular patient enters the exam room, and they make decisions on that data to further drive collections and further drive profitability. This might be an unpopular opinion, but I’m just sharing what I observe. So if you’re interested in an analysis of your practice, please get in touch with us you can email info@powerpractice.com or visit our website powerpractice.com. And thank you for listening. We will speak again soon.

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