Join Bethany on her first Solo Podcast and talks about some of the changes that you can make in your Practice. And how you can evaluate your practice and make sure that you are where you want to be and on a path to get where you want to go.

Date: July 6, 2022

Transcription:

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Bethany Fishbein:

The discussion of why this number is what it is can give us a lot of insight sometimes into leadership issues and how they might be affecting the practice.

Hey, this is Bethany Fishbein CEO of Power Practice and host of The Power Hour Optometry Podcast. And today I am not only the host but I guess also the guest recording, trying to record my first solo episode of the podcast. We did a webinar last week for anybody in the industry to talk about independent Optometry in a post-COVID economy. We’ve been getting some questions, some concerns from clients from prospective clients of how is this recession or what’s going on in the economy going to impact my practice, and the webinar I thought was fantastic. We had great speakers if you missed it and you want to hear it. Email us info@powerpractice.com and we will send you a link to get the download. It was worth listening because I think people are talking about will there be a recession and seeing a recession as a potential problem, something that has to be solved. And the speakers on the webinar really felt that even if there is a small recession, that recession is a time of opportunity for business and they talked about the opportunity to grow, to expand, to time to invest in your business, to make it better because recession is a normal part of the economic cycle and we will even if there is a recession, we will come out of the recession and changes you made to your practice will be will make you even stronger in your recovery.

So I wanted to talk about some of the changes that you can make in your practice and some of the things that you can look for to know what types of changes you might want to make. My topic for today is to talk about the information that can be found in the procedure codes or the billing codes. that you’re using in your practice. And it’s not codes like coding and billing, although there’s tiny bit of that. This is that report you can pull that tells you all of the codes that you’re billing for, services as well as for products. The ones that go to the insurance, the ones that don’t just everything that you’re doing all of the procedures, how many of them you’re doing in a given time period. And there’s a ton of information in there and that’s really what I’m going to talk about. So what I do when I look at these in a practice that we’re working with is I’ll ask them to pull this report for some period of time. Usually, you want to have it for about a quarter. A small practice for six months might be better. A really large practice a month might be enough to give you all the information you need. The amount of time isn’t as critical as the fact that you’re pulling it for a specific period of time. And I’ll tell you that we do this as a service with our clients. We have the service to do this with people who are not our clients. So you don’t have to memorize all of this unless you want to and you can listen and you can do it yourself. But if you want us to do it for you, I’ll give you directions on how to do that at the end of this recording. So anyway, in different software, it’s called different things but it’s usually something like Procedure Code Report, Billing Code Report. And it’s one that again, that tells you how many exams you did, how many frames you sold, how many different kinds of contact lenses you sold, and all of that and so you pull it for a time period. Generally speaking, I like the last quarter, and here’s some of the things that you can look at.

The number one that we look at is the amount of revenue that you collected during that time period. Right. So that’s obvious. Hopefully, people are tracking the amount of money that practice brings in each month. And tracking these numbers helps you know, when you have a good month when you have a bad month when things are going well when things are off. And also just lets you know what to expect. If you do this for a couple of years and you have cycles. Then, you know, okay, it’s always slow in July because typically that’s when I take a two-week vacation. And so as you’re planning and budgeting for the following year, you know that information and you can plan for it either by committing to being a little bit busier in June maybe holding off on a new staff hire until after that month or whatever. But anyway, the the big number, the first number that you want to pull is the collected revenue. After that, we’re going to look at the number of exams. And this should be the number of routine eye exams. However you look at that in your practice, if you code a refraction and 92015 every time you do a routine eye exam, then you might just need to look at the number of 92015 if you use S codes, maybe add those in and you want the total number of exams from that same time period and from that what you want to calculate is revenue per exam. And that’s an important metric to look at. 

Metrics are important and also really unimportant at the same time. No, I shouldn’t say that metrics are not unimportant. They’re super important. But when you hear about what the numbers should be, and what are the averages, the averages are the ones that really are not quite as relevant as everyone makes them out today. We can say that the average revenue per exam is $380 or $360. I forget the latest industry number it’s somewhere in there, which means that if you take your total revenue collected for the time period, you divide it by the number of exams you did during that same period, you end up with a number of revenue per exam. And you look at it to know where you are and where you want to go. So typically, if you’re seeing low revenue per exam, it can mean a couple of things. 

The main one being that you could be making more money with each patient that you see. Lots of ways to do that. Maybe it’s capitalizing on opportunities for medical billing, maybe it’s becoming a better communicator in the exam rooms so that patients are more likely to follow your recommendations. Maybe it’s adding a specialty on to the practice. Whatever it is, we want that number to be as high as possible. So when we see a really low number in that category, those are the things that we’re looking at. What’s the capture rate? What’s the medical testing? Are you doing specialties? Are you taking really low reimbursing insurance plans? Do you have hardly any self-pay patients? Another possibility is are you collecting all of the money that you should be? I remember a practice I was in where this number was just really off and especially after I observed what was going on in the practice which was good communication, a lot of specialty care patients paying out of pocket for services, and a low revenue per patient. That’s a mismatch, right? So I knew something was up there and ended up that the practice was having a problem with billing insurance that the owner was unaware of. So they were not collecting money from insurers for things that they were billing for. Or maybe they weren’t billing for him at all. And that was the issue, but the number should match what’s going on in the practice. practices that have a very high revenue per patient usually are doing a lot of specialties. 

If you see 10 exams in Neuro specialty, Myopia practice and six of those sign up for myopia treatment your revenue per patient is going to be really, really quite high. It’s a good number to track from month to month from quarter to quarter, and whether you’re below average, average, or way above average. The goal is always to have it be higher than it was before. We’re always looking for ways to raise that number. So, revenue per exam is an important number to know about your practice. Watching that number change also lets you know as you start to make changes in the practice. That’s a great one to tell how the changes are working. I’m working with a practice now that had revenue per exam. $218 $220. And as we started working together, that was number one priority, right is to make this number better.

So as they started to implement changes, they said, well, it feels like we’re collecting more. I said how do you know that? Well, the credit card receipts at the end of the day are a little bit bigger than normal. But when we brought it down to revenue per exam, it was really a striking difference. And when that number is higher, it means that the practice has to see fewer patients to make the same amount of money. So if it’s $200, you’ve got to see 60 patients to equal $12,000 or if that’s a week or whatever, right? But if you can increase that number to $400 per patient now all of a sudden you can see either half the number of patients and make the same amount of money or see the same amount of patients and make twice as much money. Whichever way suits your individual goals. We have some clients who have a goal to just make as much as possible, and other clients whose goals are to not work quite so hard and enjoy their day and are happy with the amount they’re making and are after a slower pace. So anyway, that’s revenue per exam. 

The other thing before I leave that is to look at the total number of exams compared to the amount of Doctor time you have available. And that is a measure of efficiency. So, let’s here’s an example. He’s talking to a practice owner a couple of weeks ago and this is a very, very young practice. It had been a cold start. So she was really just starting to build up her practice. And what we found is she was in the practice four days a week, had staff there four days a week and staff were there five days a week actually, but for Dr. Days available. And when we looked at the number of exams for the time period, it averaged out to about 18 exams per week. So now she’s seeing 18 exams per week on four Doctor days. Probably, let’s say she’s able to see 12 exams per day, right? And many practices. It’s it’s more than that. But 12 exams per day is on four days. It’s 48 exams per week, and she’s seeing about 18 you can calculate what we call the fill rate, which is what percent of exam spots are filled. And I got to open up my little calculator here, but if she’s doing 18 exams had a 48 That’s a 37 and a half percent fill rate you’re never gonna get 100% Sometimes you can those crazy weeks in December when you double book, but always people are human and even with a few full schedule, somebody’s going to cancel no show at the last minute. A little bit of this is beyond your control. 

But when the number is really low like that, What that indicates is that this practice owner can be way more efficient with her time. She’s saying she felt like she was busy throughout the day. And you’ve been there you can spread four eye exams or five eye exams out almost over the course of the day and feel like you’re not getting anything done in the 10 minutes. 20 minutes 30 minutes in between. So we had recommended for her was to condense her schedule and limit the amount of time that she was available to see patients so block out, I mean, she can really block out half of her time. And instead of four days have two days and maybe it’s two mornings and two afternoons or one full day, three half days. Still a little bit too much one full day two half days. So you can vary the time so the patient’s call, they want to make an appointment. They have days and times to choose from. But there are blocks of time where she’s able to see patients and blocks of time where she’s not seeing patients. And what that does is it allows those blocks of what we used to call focus management time. And in those blocks, she was able to work on the business so she can work on her marketing. She can go out and meet people in the community. She can be involved with the schools. She can train her staff and do the things that are ultimately going to grow the practice and see all of the patients she was seeing plus room for more in half the time. So looking at the exam numbers and the fill rate is a way to let you know if you might be able to block out some focus management time to work on the business. 

Another thing that I look at and practices is new versus established patients the percentage of each and this is one of those again, there’s not black and white answers here about what these numbers should be. Because it’s different for every practice. Maybe not every practice but just as an example. A brand new practice is going to have initially 100% new patients. If we see a practice that’s 14 years old, and still has 100% new patients, we’ve got a problem with getting patients to come back. So for a new practice, the number of new patients the percent of new patients is going to be really high and that’s normal. And as the practice becomes more and more established, typically the number settles out at about 25% new patients 75% established. Now in an established practice, the reason that we look at this is because it can give us a clue for other things going on in the business. So let’s say we have a 15-year-old established practice that has a really low percentage of new patients. The first thing that I would look at in this case is the schedule, how far out is this office booked? Because an established patient who’s already tied to the practice wants to see that particular doctor. They’re willing to wait if they call to make an appointment and they get told next appointment is in five weeks. Not all of them but most of them will probably say Wow, really? Okay, and I’ll schedule it but a new patient that has no established tie to that practice and is just looking on their insurance list are looking on google for the one closest to them on the map. They’re calling because they need an appointment. Usually by the time they’re calling they need it now. They’re on their last pair of contacts their eyes are bothering them their visions blurry something’s going on. So they call and they’re told the next appointment is in for five weeks. And they’re gonna say, Okay, thanks. I’ll call back. And they’re gonna go and call the next one on their list. 

So if the percent of established patients is too high, we want to look at wait time, not wait time in the office, but how long does someone have to wait for an appointment? Sometimes the established patient percentage is too low and when that’s the case, we want to look at the patient experience in the practice. Sometimes we can get this online from looking at reviews and stuff like that. We always see it when we’re observing in the office. If the practice is doing any kind of serving of patients, that’s where the information is likely to lie. So 15 years and you’re still seeing 50% new patients 50% established. It could be just that you’re still growing 15 years in and you expand it and you have a new associate and there’s lots of room to see new patients in the areas growing and then that high percentage of new compared to established is a good thing. But if you haven’t made those changes, and the practice is busy, it’s full but it’s full with new patients coming in for the first time instead of old ones coming back. 

We really want to look further at patient satisfaction. Are there things going on in the office or before or after the visit sometimes things on the back end that are making patients choose to go somewhere else next time instead of coming back to you. Another number we look at here. A lot of practices most practices at this point are doing some kind of optional screening testing. Whether it’s fundus photo, wellness OCT or some other screening. I like to look at the percentage of patients that are getting those screening photos. And it’s helpful as a metric on its own. Obviously, one vast majority of the patients to be getting these, but not only does it tell us about how many people are getting pictures, it gives us an idea about how the practice is communicating with patients when there are services outside of what the plan covers. So a practice that has 95% of patients getting screening photos, just as an example. This is a practice that’s very comfortable talking about fees with patients and presenting patients with the idea that they’re going to be paying something at the time of their visit. It goes beyond the doctor because most of the time this is all handled and all the communication it’s done by staff before the patient ever hits the exam room. If that number is really low, it could be that the office the doctor doesn’t believe in the clinical importance or validity of this test. And if that’s the case, that’s fine. If a doc says oh yeah, I believe in that I wish more people would do it. And they’re sitting at 15 or 20%. 

That gives us an idea that, number one, the staff maybe doesn’t have the information that they need to present it. That might be because the doctor is uncomfortable giving it to them. The doctor is not comfortable talking about things that cost money and therefore the staffs is not comfortable talking about things that cost money. Or sometimes the doctor is real comfortable. The staff isn’t doing it and so, the discussion of why this number is what it is, can give us a lot of insight sometimes into leadership issues and how they might be affecting the practice. As we talk about this, sometimes the doc will say something like, Yeah, I know it’s important. I keep telling them that they need to take them, but we can’t get better than 25%. And when I see that, and then I see another practice in the same or similar geography it 85% or higher. I know that it’s not the patient base. It’s almost never the patient base. But it’s something in the communication, the leadership, the management of that office, the team members are not saying what the doctor thinks they’re saying, or the doctor knows they’re not saying what he wants him to say and doesn’t know how to fix it. So the photos has a number on themselves. tell you how. How many photos you’re doing. And when you’re doing more. It’s better limited by the clinical belief of the doctor and I’m not here to talk clinical. So there are offices that believe fully the patient should have these every single year there are offices that believe that every other year is adequate. Some people want them on any patient who can sit still some people say over a certain age and I as an optometrist as a doctor, I have my own feelings on that but the number not being what the doctor can be, is very often a systemic system in a practice. So looking at these this is it’s kind of like doing an exam right on a patient. The patient comes in they say okay, I’m having headaches and I’m having blurry vision and we know okay, we’re going to do cover tests, we’re gonna do acuity, we’re gonna do refraction. 

When we work with a practice, the practice is very often having symptoms. I’m not as profitable as I want to be. I’m miserable at the end of the day, I’m having trouble paying my bills. I want to grow and I just want to make sure I’m at peak efficiency is you know, I’m getting older and I just really want to make sure my eyes are healthy. You still have to go through the tests to make sure and so looking at these is like some of the tests that we use in consulting to evaluate what’s going on in the practice that’s probably causing the symptoms. So that’s the fun diagnostic side of this. All right. Something else I usually look at when I’m looking at a practice is I’m just looking at the codes for medical testing. And this is to just get an idea of how committed or interested effective the office is at doing medical testing. And for some offices, we find they’re doing very little. Some offices, we find they’re doing a ton. Sometimes it’s the clinical comfort level of the doctor or it’s a lack of equipment or practice it doesn’t have an OCT, isn’t doing any. And sometimes it’s the thing that I look for when we see that number is really low one. Does the doctor know it again, it’s not something that you can look and have a right or wrong answer very often the answers here prompt further explanation. 

So when that number is really low, I’m asking the doctor, Yeah, you know, you’re hardly doing any medical testing. Is that by choice? And some say yeah, I hate it. I really don’t want to. I have an office down the street. I refer that to Okay, um, and that’s as a practice owner, part of the reason you choose to own your own practice is because you want to be able to make these kinds of choices. And so if they don’t want to do it, they don’t want to do it, and that’s okay. I generally do ask a little bit further about referrals. Where are you sending them? If you see a patient with pressures of 24-25 and you don’t want to be responsible for the medical care of that patient? Where are you sending them? And, I used to be surprised I’m not surprised anymore because we see it all the time. The number of optometrists that say oh, oh, yeah, well, I would send that to my glaucoma specialist, blah, blah, blah. Blah. I really, in that case, encourage an optometric referral. 

One because I support optometry and there’s some other practice in the geography that would be thrilled to have those medical patients and sometimes even better, that practice that’s thrilled to have those medical patients has patients that they don’t love. That maybe the office that’s referring out the medical patients would love to see. So there might be an optometrist four or five miles away that says, Oh my gosh, I would love to see your glaucoma great. And you get to know each other and maybe have lunch. And he say, what don’t you like? See, I can’t stand Pediatrics and the first success really, I love pediatrics. They say anybody under 14 in my chair, I just, I’m anxious about it all day.And so now it’s a relationship where each of you can be helping yourselves and each other by filling up each practice with the type of patients that that doctor loves to see. So when I see that that number is very, very low. Is it a clinical choice? If so, can you refer to somebody within Optometry? And ideally, is there something that that person you’re referring to? feels the same way about that maybe you like that they can refer back to you. Sometimes we see it low and it’s not a clinical choice. I hear it too frequently, that somebody says Well, yeah, I mean, I do it sometimes but it’s really just to make myself feel better. So I don’t really feel for and those of you who are listening and you do bill for it are sitting there going off what but it happens, right people don’t know. And so when somebody isn’t comfortable medical billing, or they just are in the habit where it’s vision plan, Vision Plan, Vision Plan, Vision Plan. Vision, plan, billing all day, and they see a patient where they feel the need to do a medical test. Sometimes the mental process of okay, now I’d have to figure out how to bill for it and just make sure that I’m recording and documenting properly. And I don’t know I don’t know how to do that. It’s too overwhelming and who do I even build it to? If that doesn’t go to their vision plan and I don’t know too much about medical billing. Well, anyway, I’m just gonna get the fields in the picture. I’m sure it’s gonna be fine. And they’re performing the services and not billing for them. Which shouldn’t be it’s fine. 

If doctors want to volunteer it’s a wonderful thing to do. But it’s volunteering for a good cause. And making the choice to volunteer rather than opting out of collecting money for services you’re providing because you don’t have the knowledge to get paid for them. We see it fairly frequently. So it’s, it’s something that we look at a practice that’s doing a lot of these. They’re doing a good job of communicating with their patients. They’re finding appropriately when things need additional testing or additional care. They’re comfortable with how to take somebody who maybe came in for a routine eye exam, find unexpected or unexpected medical finding, they know what to do with it. They can get a patient in for a necessary follow-up and bill for all of that appropriately. So generally, when those are higher in a practice that wants to be actively involved in medical care of patients, those are good numbers to say. 

Something I also look at quite a bit because it’s an area of opportunity for so many practices and we’ve discussed it on the podcast before, although it’s been a little bit of time and it might be time to bring up this discussion again is I do look at how the practice is coding for office visits. And the reason that I look at that is because it’s so common, one of the most common things to find that of practice is just for all medical visits, billing level three office visit codes, level threes, new patient 99203, established patients 99213 Anything from a subcon theme to a complex PVD with sudden vision loss in the other eye in a diabetic hypertensive patient, docs are billing 99213. And again, those of you who are not doing it it’s some like when you know, you know, but we see it a lot that people don’t know. And when we ask the number one thing that people will tell me is yeah, I always feel level threes. Why? Well, I just I’m afraid to be audited. I don’t want to be audited. In a lot of cases, there is a significant difference in payment between a level three and a level four office visit code. 

We actually did a webinar for our clients called Don’t fear the four and it was just broke down. How to know when you could be billing a level four or level even a level five off this was a code because sometimes the difference between a level of three and a level four depending on the insurer is 40, 45, 50, $60. So in a practice that’s doing 100 of these and billing 992 and threes, let’s say they find that half Okay, let’s go 40%, 40% of those could be level fours instead of level threes. So that’s 40 additional visits making 40 ish more dollars per visit. Is $1,600 additional not for doing any additional work just for coding properly for the visit that you did, so it’s not I’m not saying oh everybody needs to up code. I wouldn’t say that. What I’m saying is that the time that it takes to learn to code properly for whatever you’re doing is worthwhile because very often, the most common thing that we see is that optometrists are under coding and investing the time in learning to code correctly, which would fully pass an audit because you’re doing it right can generate 1000s Sometimes 1000s of dollars a month. And this is money that is pure profit, because there’s no additional costs. To do it that way. There’s no additional cost of goods, there’s no additional time required to put a four on the HIC form instead of three. So that money drops straight through to the bottom line. And now is the time if you aren’t confident building level four or level five office visit codes or knowing when you should and knowing when you shouldn’t. It is absolutely worthwhile to invest the time into figuring it out. You think about reps that come into your office and they’ve got this new piece of equipment and they’re trying to convince you to buy it and they’re telling you Oh yeah, you know, here’s the model it can make you $1,600 a month and your payment on it’s only going to be 500 This is $1,600 a month. If your practice is that size and you’re doing 100 office visits, etc. With no additional cost, no equipment, no loan, just the investment of your time to know if you’re doing it right. I’ll throw in a little plug here. If you have fear that you are not coding right. And the thought of an insurance audit keeps you up at night, or you get an envelope that says Aetna or Blue Cross and you don’t know what’s in it. It’s not a check in it, your heart is in your throat as you’re opening up because you’re afraid, now’s the time. We do have a service. It’s called a power audit. 

And there’s a whole podcast episode just on this and I’ll link to it in the show notes but what it is a friendly audit meaning that we’re looking at some of your charts 10 charts selected at random or can be a little bit less than random if we’re concerned about something specific and looking at the charts exactly as an auditor would except for the part we’re not real auditor. So if we find that there’s a problem in documentation, that the documentation doesn’t support the coding and you would not pass an audit. All that happens is we tell you and we tell you how to correct it. And now you know. Whereas if there is truly an audit, and an insurance company is doing that, they can look and say yeah, your documentation didn’t support those codes. And over the last three years, you’ve done this many of these codes at a difference of this much per claim and can cost you 10s of 1000s dollars. So if insurance coding is something that’s a stress factor for you you think maybe you’re coding too aggressively. Maybe you just don’t know but you would like to know what would happen in case of an audit. 

The Power Audit is a great way to do that and you can get that information on our website powerpractice.com All right, two more things. And then I’ll, I’ll finish here but another key diagnostic test that I look at to see what might be going on in a practice is looking at the capture rate and the capture rate most of the time can be calculated by the number of frames sold divided by the number of exams. And this is another one, you hear all these different numbers thrown out of what your capture rate should be. The following question to ask especially when somebody throws out a number that feels unattainably high is to say how can how are you calculating that? Because you want to make sure that you’re comparing apples to apples. There are practices and even practice management consultants. That say I’ll tell you how to get a 90% capture rate. And when he asked about how capture rate is calculated, they say, well we ask every patient when they make the appointment, are they intending to get glasses, and so out of that we count up all the ones that say yes, and out of those 90% of them actually end up getting glasses. Okay, great. But what about all the other ones that said no, or I’m not sure. Those count too. 

So when our team looks at capture eight, we’re looking at the number of frames sold. So acknowledging that a patient putting new lenses in their old frame is a sale but we don’t count it as frame capture, the number of frames sold divided by the total number of exams and that percentage gives you capture rate. And we have practices that do have really high legitimate capture rates, sometimes 100% or higher. And those practices have obviously a great system within the practice to sell glasses to their patients, but to get numbers 100% or anywhere near it very often, they are also filling outside our access. A practice that has a unique line that no one else carries a practice that has the most comprehensive selection of children’s frames that people come from all over just to be fitted. You know something really unique about the optical practice in a ski town that does a tremendous number of sunglass sales. When we look at capture rate as a percentage of the exams done, it’s going to be really, really very high. A practice where the capture rate is really low. We need to do a little bit more looking. 

Sometimes it’s in the communication between the patient and the doctor, between the doctor and the patient. It is common. It’s happened a number of times that I’m observing in an exam room with a doctor and I hear them say something like, Yeah, I’m finding a little change in your prescription. But it’s real small. I think it’s fine for you to keep your glasses the same this year and we’ll see you back next year and see where it is. Right and maybe some of you listening have said that yourself or I hear yeah, your prescription changed a little bit. We’re going to increase the power of your contacts by half diopter are you wearing the glasses? No, just pretty much at night. All right. I think it’s fine to leave those as they are. Right. So think about it this way, shift your brain a little bit. Can you imagine a new patient coming in? Let’s say they’re minus 115 and telling a new patient who’s never worn glasses, okay. I’m gonna get your contacts for the day you’re gonna be able to see really, really, really clearly and then I’m going to make glasses for nighttime that are a little bit blurry. Okay? You would never say that, right? Or you would never say to a patient if you’re prescribing glasses for the first time you would never say: yes, so I’m going to want you to wear something that’s a little bit off from what your actual prescription is. So let me write this out. And here’s your regular prescription, but we’re gonna go just a little bit a little bit off from that. Right, we would never really think to prescribe glasses that don’t give the clearest vision possible. But when you’re in the exam room and you’re telling your patient the prescription changed a little bit but it’s not that much of a change. You don’t need to change your glasses. That’s exactly what you’re telling them. You’re telling them. I’m fine and I could make your vision better, but I’m going to choose not to this year. And when you say it that way it sounds silly almost. But really isn’t that what you’re saying? And I’m not talking about making change for the sake of change. And I’m not talking about a patient who has the exact same power or truly doesn’t notice a change in prescription. But I am saying that when there is a change in prescription even if it’s a small change, when it lets the patient see better, especially when the patient can appreciate that difference, then that is absolutely worth prescribing and letting the patient make the decision on whether to get those glasses or not. But since they give clearer vision right why wouldn’t they. 

Capture rates tells me about the communication in the exam room. And then the other thing to look at if the capture rate isn’t where you want it to be, is about sometimes the mix on a frame board, are you selling what your patients want to buy? Do you have the right products? Do you have the right price points? Is your staff able to give the patient the information to understand why they should buy glasses at your office compared to anywhere else? Is it a seamless experience? And those are things we look at when we’re specifically looking at capture rate as well. Sometimes offices that have a high capture rate are really really good at lots of other things. That’s a good sign. Sometimes offices with a low capture rate are really really good at something else to the exclusion of selling glasses. So this happens a lot in an office. Let’s say that that’s focused on myopia treatment, that at the conclusion of the exam, the doctor is so focused on getting the patient into the next steps of myopia treatment that they don’t think they kind of neglect to talk about also giving them the clearest vision. So prescription changed and all of a sudden you’re launched into, you know, the axial length and the eyeballs get longer and there’s things we can do about it. And here are the options for treatment and we’re gonna set up a consultation and I’d recommend this and here are the next steps. And the patient leaves with all kinds of information about myopia treatment. And they also leave with vision that was just as blurry as it was when they came in and even if the patient is being filled with worth okay lenses or something. We want to have glasses that they can see out of for those days when they have the flu and they can’t wear their lenses for a couple of nights or they go to a Boy Scout camp and the parent doesn’t want them to wear the lenses that during that time because it’s their camping and it’s dirty, or whatever it is we want them to have up to date properly sized as clear as possible glasses that they can see. So there’s a million other things that we look at but the last piece that I want to talk about today is also looking at the number of specialty care services that the practice is providing because one of the biggest problems I guess, but also one of the biggest opportunities that we see is in practices that are just starting or just dabbling in specialty care regardless of your area of specialty that you’re interested whether it’s aesthetics myopia in many cases, there’s equipment and stuff required or wanted to be able to provide that type of care. And in some cases, the cost for that equipment is quite high. 

So in a practice that’s not seeing the profitability that they want to see. What we want to make sure is that they are doing enough of the specialty care, to justify the amount of to justify the amount that they’ve invested in the equipment needed to provide that kind of care. And so, when I see those numbers, you know, they have it could be anything I don’t want to start product names, but you know, any piece of equipment that allows them to do specialty care. I want to make sure that the practice owner is aware of how much of that specialty care they need to be doing to offset the cost of the equipment. And if they’re not doing enough that they have a plan of action, to be able to do more to get to enough and then get to a point where the clinical care that they love and they’re passionate about is also driving profit to their business. Because that’s what lets all of us continue so hopefully, this is my first time doing a solo episode. 

Hopefully, this is good information for you to have as you’re looking at your practice and ways that you can evaluate your practice and make sure that you are where you want to be and on a path to get where you want to go. If this is something that you’re interested in doing, or having done for you or discussing further to see where specific areas of improvement lie in your practice, and where you can make changes to improve your profitability to improve your communication, to improve your leadership to improve patient care. Please drop us a note at info@powerpractice.com And our team of coaches would love to talk to you about it. Thank you so much for listening!

Read the Transcription

Bethany Fishbein:

The discussion of why this number is what it is can give us a lot of insight sometimes into leadership issues and how they might be affecting the practice.

Hey, this is Bethany Fishbein CEO of Power Practice and host of The Power Hour Optometry Podcast. And today I am not only the host but I guess also the guest recording, trying to record my first solo episode of the podcast. We did a webinar last week for anybody in the industry to talk about independent Optometry in a post-COVID economy. We’ve been getting some questions, some concerns from clients from prospective clients of how is this recession or what’s going on in the economy going to impact my practice, and the webinar I thought was fantastic. We had great speakers if you missed it and you want to hear it. Email us info@powerpractice.com and we will send you a link to get the download. It was worth listening because I think people are talking about will there be a recession and seeing a recession as a potential problem, something that has to be solved. And the speakers on the webinar really felt that even if there is a small recession, that recession is a time of opportunity for business and they talked about the opportunity to grow, to expand, to time to invest in your business, to make it better because recession is a normal part of the economic cycle and we will even if there is a recession, we will come out of the recession and changes you made to your practice will be will make you even stronger in your recovery.

So I wanted to talk about some of the changes that you can make in your practice and some of the things that you can look for to know what types of changes you might want to make. My topic for today is to talk about the information that can be found in the procedure codes or the billing codes. that you’re using in your practice. And it’s not codes like coding and billing, although there’s tiny bit of that. This is that report you can pull that tells you all of the codes that you’re billing for, services as well as for products. The ones that go to the insurance, the ones that don’t just everything that you’re doing all of the procedures, how many of them you’re doing in a given time period. And there’s a ton of information in there and that’s really what I’m going to talk about. So what I do when I look at these in a practice that we’re working with is I’ll ask them to pull this report for some period of time. Usually, you want to have it for about a quarter. A small practice for six months might be better. A really large practice a month might be enough to give you all the information you need. The amount of time isn’t as critical as the fact that you’re pulling it for a specific period of time. And I’ll tell you that we do this as a service with our clients. We have the service to do this with people who are not our clients. So you don’t have to memorize all of this unless you want to and you can listen and you can do it yourself. But if you want us to do it for you, I’ll give you directions on how to do that at the end of this recording. So anyway, in different software, it’s called different things but it’s usually something like Procedure Code Report, Billing Code Report. And it’s one that again, that tells you how many exams you did, how many frames you sold, how many different kinds of contact lenses you sold, and all of that and so you pull it for a time period. Generally speaking, I like the last quarter, and here’s some of the things that you can look at.

The number one that we look at is the amount of revenue that you collected during that time period. Right. So that’s obvious. Hopefully, people are tracking the amount of money that practice brings in each month. And tracking these numbers helps you know, when you have a good month when you have a bad month when things are going well when things are off. And also just lets you know what to expect. If you do this for a couple of years and you have cycles. Then, you know, okay, it’s always slow in July because typically that’s when I take a two-week vacation. And so as you’re planning and budgeting for the following year, you know that information and you can plan for it either by committing to being a little bit busier in June maybe holding off on a new staff hire until after that month or whatever. But anyway, the the big number, the first number that you want to pull is the collected revenue. After that, we’re going to look at the number of exams. And this should be the number of routine eye exams. However you look at that in your practice, if you code a refraction and 92015 every time you do a routine eye exam, then you might just need to look at the number of 92015 if you use S codes, maybe add those in and you want the total number of exams from that same time period and from that what you want to calculate is revenue per exam. And that’s an important metric to look at. 

Metrics are important and also really unimportant at the same time. No, I shouldn’t say that metrics are not unimportant. They’re super important. But when you hear about what the numbers should be, and what are the averages, the averages are the ones that really are not quite as relevant as everyone makes them out today. We can say that the average revenue per exam is $380 or $360. I forget the latest industry number it’s somewhere in there, which means that if you take your total revenue collected for the time period, you divide it by the number of exams you did during that same period, you end up with a number of revenue per exam. And you look at it to know where you are and where you want to go. So typically, if you’re seeing low revenue per exam, it can mean a couple of things. 

The main one being that you could be making more money with each patient that you see. Lots of ways to do that. Maybe it’s capitalizing on opportunities for medical billing, maybe it’s becoming a better communicator in the exam rooms so that patients are more likely to follow your recommendations. Maybe it’s adding a specialty on to the practice. Whatever it is, we want that number to be as high as possible. So when we see a really low number in that category, those are the things that we’re looking at. What’s the capture rate? What’s the medical testing? Are you doing specialties? Are you taking really low reimbursing insurance plans? Do you have hardly any self-pay patients? Another possibility is are you collecting all of the money that you should be? I remember a practice I was in where this number was just really off and especially after I observed what was going on in the practice which was good communication, a lot of specialty care patients paying out of pocket for services, and a low revenue per patient. That’s a mismatch, right? So I knew something was up there and ended up that the practice was having a problem with billing insurance that the owner was unaware of. So they were not collecting money from insurers for things that they were billing for. Or maybe they weren’t billing for him at all. And that was the issue, but the number should match what’s going on in the practice. practices that have a very high revenue per patient usually are doing a lot of specialties. 

If you see 10 exams in Neuro specialty, Myopia practice and six of those sign up for myopia treatment your revenue per patient is going to be really, really quite high. It’s a good number to track from month to month from quarter to quarter, and whether you’re below average, average, or way above average. The goal is always to have it be higher than it was before. We’re always looking for ways to raise that number. So, revenue per exam is an important number to know about your practice. Watching that number change also lets you know as you start to make changes in the practice. That’s a great one to tell how the changes are working. I’m working with a practice now that had revenue per exam. $218 $220. And as we started working together, that was number one priority, right is to make this number better.

So as they started to implement changes, they said, well, it feels like we’re collecting more. I said how do you know that? Well, the credit card receipts at the end of the day are a little bit bigger than normal. But when we brought it down to revenue per exam, it was really a striking difference. And when that number is higher, it means that the practice has to see fewer patients to make the same amount of money. So if it’s $200, you’ve got to see 60 patients to equal $12,000 or if that’s a week or whatever, right? But if you can increase that number to $400 per patient now all of a sudden you can see either half the number of patients and make the same amount of money or see the same amount of patients and make twice as much money. Whichever way suits your individual goals. We have some clients who have a goal to just make as much as possible, and other clients whose goals are to not work quite so hard and enjoy their day and are happy with the amount they’re making and are after a slower pace. So anyway, that’s revenue per exam. 

The other thing before I leave that is to look at the total number of exams compared to the amount of Doctor time you have available. And that is a measure of efficiency. So, let’s here’s an example. He’s talking to a practice owner a couple of weeks ago and this is a very, very young practice. It had been a cold start. So she was really just starting to build up her practice. And what we found is she was in the practice four days a week, had staff there four days a week and staff were there five days a week actually, but for Dr. Days available. And when we looked at the number of exams for the time period, it averaged out to about 18 exams per week. So now she’s seeing 18 exams per week on four Doctor days. Probably, let’s say she’s able to see 12 exams per day, right? And many practices. It’s it’s more than that. But 12 exams per day is on four days. It’s 48 exams per week, and she’s seeing about 18 you can calculate what we call the fill rate, which is what percent of exam spots are filled. And I got to open up my little calculator here, but if she’s doing 18 exams had a 48 That’s a 37 and a half percent fill rate you’re never gonna get 100% Sometimes you can those crazy weeks in December when you double book, but always people are human and even with a few full schedule, somebody’s going to cancel no show at the last minute. A little bit of this is beyond your control. 

But when the number is really low like that, What that indicates is that this practice owner can be way more efficient with her time. She’s saying she felt like she was busy throughout the day. And you’ve been there you can spread four eye exams or five eye exams out almost over the course of the day and feel like you’re not getting anything done in the 10 minutes. 20 minutes 30 minutes in between. So we had recommended for her was to condense her schedule and limit the amount of time that she was available to see patients so block out, I mean, she can really block out half of her time. And instead of four days have two days and maybe it’s two mornings and two afternoons or one full day, three half days. Still a little bit too much one full day two half days. So you can vary the time so the patient’s call, they want to make an appointment. They have days and times to choose from. But there are blocks of time where she’s able to see patients and blocks of time where she’s not seeing patients. And what that does is it allows those blocks of what we used to call focus management time. And in those blocks, she was able to work on the business so she can work on her marketing. She can go out and meet people in the community. She can be involved with the schools. She can train her staff and do the things that are ultimately going to grow the practice and see all of the patients she was seeing plus room for more in half the time. So looking at the exam numbers and the fill rate is a way to let you know if you might be able to block out some focus management time to work on the business. 

Another thing that I look at and practices is new versus established patients the percentage of each and this is one of those again, there’s not black and white answers here about what these numbers should be. Because it’s different for every practice. Maybe not every practice but just as an example. A brand new practice is going to have initially 100% new patients. If we see a practice that’s 14 years old, and still has 100% new patients, we’ve got a problem with getting patients to come back. So for a new practice, the number of new patients the percent of new patients is going to be really high and that’s normal. And as the practice becomes more and more established, typically the number settles out at about 25% new patients 75% established. Now in an established practice, the reason that we look at this is because it can give us a clue for other things going on in the business. So let’s say we have a 15-year-old established practice that has a really low percentage of new patients. The first thing that I would look at in this case is the schedule, how far out is this office booked? Because an established patient who’s already tied to the practice wants to see that particular doctor. They’re willing to wait if they call to make an appointment and they get told next appointment is in five weeks. Not all of them but most of them will probably say Wow, really? Okay, and I’ll schedule it but a new patient that has no established tie to that practice and is just looking on their insurance list are looking on google for the one closest to them on the map. They’re calling because they need an appointment. Usually by the time they’re calling they need it now. They’re on their last pair of contacts their eyes are bothering them their visions blurry something’s going on. So they call and they’re told the next appointment is in for five weeks. And they’re gonna say, Okay, thanks. I’ll call back. And they’re gonna go and call the next one on their list. 

So if the percent of established patients is too high, we want to look at wait time, not wait time in the office, but how long does someone have to wait for an appointment? Sometimes the established patient percentage is too low and when that’s the case, we want to look at the patient experience in the practice. Sometimes we can get this online from looking at reviews and stuff like that. We always see it when we’re observing in the office. If the practice is doing any kind of serving of patients, that’s where the information is likely to lie. So 15 years and you’re still seeing 50% new patients 50% established. It could be just that you’re still growing 15 years in and you expand it and you have a new associate and there’s lots of room to see new patients in the areas growing and then that high percentage of new compared to established is a good thing. But if you haven’t made those changes, and the practice is busy, it’s full but it’s full with new patients coming in for the first time instead of old ones coming back. 

We really want to look further at patient satisfaction. Are there things going on in the office or before or after the visit sometimes things on the back end that are making patients choose to go somewhere else next time instead of coming back to you. Another number we look at here. A lot of practices most practices at this point are doing some kind of optional screening testing. Whether it’s fundus photo, wellness OCT or some other screening. I like to look at the percentage of patients that are getting those screening photos. And it’s helpful as a metric on its own. Obviously, one vast majority of the patients to be getting these, but not only does it tell us about how many people are getting pictures, it gives us an idea about how the practice is communicating with patients when there are services outside of what the plan covers. So a practice that has 95% of patients getting screening photos, just as an example. This is a practice that’s very comfortable talking about fees with patients and presenting patients with the idea that they’re going to be paying something at the time of their visit. It goes beyond the doctor because most of the time this is all handled and all the communication it’s done by staff before the patient ever hits the exam room. If that number is really low, it could be that the office the doctor doesn’t believe in the clinical importance or validity of this test. And if that’s the case, that’s fine. If a doc says oh yeah, I believe in that I wish more people would do it. And they’re sitting at 15 or 20%. 

That gives us an idea that, number one, the staff maybe doesn’t have the information that they need to present it. That might be because the doctor is uncomfortable giving it to them. The doctor is not comfortable talking about things that cost money and therefore the staffs is not comfortable talking about things that cost money. Or sometimes the doctor is real comfortable. The staff isn’t doing it and so, the discussion of why this number is what it is, can give us a lot of insight sometimes into leadership issues and how they might be affecting the practice. As we talk about this, sometimes the doc will say something like, Yeah, I know it’s important. I keep telling them that they need to take them, but we can’t get better than 25%. And when I see that, and then I see another practice in the same or similar geography it 85% or higher. I know that it’s not the patient base. It’s almost never the patient base. But it’s something in the communication, the leadership, the management of that office, the team members are not saying what the doctor thinks they’re saying, or the doctor knows they’re not saying what he wants him to say and doesn’t know how to fix it. So the photos has a number on themselves. tell you how. How many photos you’re doing. And when you’re doing more. It’s better limited by the clinical belief of the doctor and I’m not here to talk clinical. So there are offices that believe fully the patient should have these every single year there are offices that believe that every other year is adequate. Some people want them on any patient who can sit still some people say over a certain age and I as an optometrist as a doctor, I have my own feelings on that but the number not being what the doctor can be, is very often a systemic system in a practice. So looking at these this is it’s kind of like doing an exam right on a patient. The patient comes in they say okay, I’m having headaches and I’m having blurry vision and we know okay, we’re going to do cover tests, we’re gonna do acuity, we’re gonna do refraction. 

When we work with a practice, the practice is very often having symptoms. I’m not as profitable as I want to be. I’m miserable at the end of the day, I’m having trouble paying my bills. I want to grow and I just want to make sure I’m at peak efficiency is you know, I’m getting older and I just really want to make sure my eyes are healthy. You still have to go through the tests to make sure and so looking at these is like some of the tests that we use in consulting to evaluate what’s going on in the practice that’s probably causing the symptoms. So that’s the fun diagnostic side of this. All right. Something else I usually look at when I’m looking at a practice is I’m just looking at the codes for medical testing. And this is to just get an idea of how committed or interested effective the office is at doing medical testing. And for some offices, we find they’re doing very little. Some offices, we find they’re doing a ton. Sometimes it’s the clinical comfort level of the doctor or it’s a lack of equipment or practice it doesn’t have an OCT, isn’t doing any. And sometimes it’s the thing that I look for when we see that number is really low one. Does the doctor know it again, it’s not something that you can look and have a right or wrong answer very often the answers here prompt further explanation. 

So when that number is really low, I’m asking the doctor, Yeah, you know, you’re hardly doing any medical testing. Is that by choice? And some say yeah, I hate it. I really don’t want to. I have an office down the street. I refer that to Okay, um, and that’s as a practice owner, part of the reason you choose to own your own practice is because you want to be able to make these kinds of choices. And so if they don’t want to do it, they don’t want to do it, and that’s okay. I generally do ask a little bit further about referrals. Where are you sending them? If you see a patient with pressures of 24-25 and you don’t want to be responsible for the medical care of that patient? Where are you sending them? And, I used to be surprised I’m not surprised anymore because we see it all the time. The number of optometrists that say oh, oh, yeah, well, I would send that to my glaucoma specialist, blah, blah, blah. Blah. I really, in that case, encourage an optometric referral. 

One because I support optometry and there’s some other practice in the geography that would be thrilled to have those medical patients and sometimes even better, that practice that’s thrilled to have those medical patients has patients that they don’t love. That maybe the office that’s referring out the medical patients would love to see. So there might be an optometrist four or five miles away that says, Oh my gosh, I would love to see your glaucoma great. And you get to know each other and maybe have lunch. And he say, what don’t you like? See, I can’t stand Pediatrics and the first success really, I love pediatrics. They say anybody under 14 in my chair, I just, I’m anxious about it all day.And so now it’s a relationship where each of you can be helping yourselves and each other by filling up each practice with the type of patients that that doctor loves to see. So when I see that that number is very, very low. Is it a clinical choice? If so, can you refer to somebody within Optometry? And ideally, is there something that that person you’re referring to? feels the same way about that maybe you like that they can refer back to you. Sometimes we see it low and it’s not a clinical choice. I hear it too frequently, that somebody says Well, yeah, I mean, I do it sometimes but it’s really just to make myself feel better. So I don’t really feel for and those of you who are listening and you do bill for it are sitting there going off what but it happens, right people don’t know. And so when somebody isn’t comfortable medical billing, or they just are in the habit where it’s vision plan, Vision Plan, Vision Plan, Vision Plan. Vision, plan, billing all day, and they see a patient where they feel the need to do a medical test. Sometimes the mental process of okay, now I’d have to figure out how to bill for it and just make sure that I’m recording and documenting properly. And I don’t know I don’t know how to do that. It’s too overwhelming and who do I even build it to? If that doesn’t go to their vision plan and I don’t know too much about medical billing. Well, anyway, I’m just gonna get the fields in the picture. I’m sure it’s gonna be fine. And they’re performing the services and not billing for them. Which shouldn’t be it’s fine. 

If doctors want to volunteer it’s a wonderful thing to do. But it’s volunteering for a good cause. And making the choice to volunteer rather than opting out of collecting money for services you’re providing because you don’t have the knowledge to get paid for them. We see it fairly frequently. So it’s, it’s something that we look at a practice that’s doing a lot of these. They’re doing a good job of communicating with their patients. They’re finding appropriately when things need additional testing or additional care. They’re comfortable with how to take somebody who maybe came in for a routine eye exam, find unexpected or unexpected medical finding, they know what to do with it. They can get a patient in for a necessary follow-up and bill for all of that appropriately. So generally, when those are higher in a practice that wants to be actively involved in medical care of patients, those are good numbers to say. 

Something I also look at quite a bit because it’s an area of opportunity for so many practices and we’ve discussed it on the podcast before, although it’s been a little bit of time and it might be time to bring up this discussion again is I do look at how the practice is coding for office visits. And the reason that I look at that is because it’s so common, one of the most common things to find that of practice is just for all medical visits, billing level three office visit codes, level threes, new patient 99203, established patients 99213 Anything from a subcon theme to a complex PVD with sudden vision loss in the other eye in a diabetic hypertensive patient, docs are billing 99213. And again, those of you who are not doing it it’s some like when you know, you know, but we see it a lot that people don’t know. And when we ask the number one thing that people will tell me is yeah, I always feel level threes. Why? Well, I just I’m afraid to be audited. I don’t want to be audited. In a lot of cases, there is a significant difference in payment between a level three and a level four office visit code. 

We actually did a webinar for our clients called Don’t fear the four and it was just broke down. How to know when you could be billing a level four or level even a level five off this was a code because sometimes the difference between a level of three and a level four depending on the insurer is 40, 45, 50, $60. So in a practice that’s doing 100 of these and billing 992 and threes, let’s say they find that half Okay, let’s go 40%, 40% of those could be level fours instead of level threes. So that’s 40 additional visits making 40 ish more dollars per visit. Is $1,600 additional not for doing any additional work just for coding properly for the visit that you did, so it’s not I’m not saying oh everybody needs to up code. I wouldn’t say that. What I’m saying is that the time that it takes to learn to code properly for whatever you’re doing is worthwhile because very often, the most common thing that we see is that optometrists are under coding and investing the time in learning to code correctly, which would fully pass an audit because you’re doing it right can generate 1000s Sometimes 1000s of dollars a month. And this is money that is pure profit, because there’s no additional costs. To do it that way. There’s no additional cost of goods, there’s no additional time required to put a four on the HIC form instead of three. So that money drops straight through to the bottom line. And now is the time if you aren’t confident building level four or level five office visit codes or knowing when you should and knowing when you shouldn’t. It is absolutely worthwhile to invest the time into figuring it out. You think about reps that come into your office and they’ve got this new piece of equipment and they’re trying to convince you to buy it and they’re telling you Oh yeah, you know, here’s the model it can make you $1,600 a month and your payment on it’s only going to be 500 This is $1,600 a month. If your practice is that size and you’re doing 100 office visits, etc. With no additional cost, no equipment, no loan, just the investment of your time to know if you’re doing it right. I’ll throw in a little plug here. If you have fear that you are not coding right. And the thought of an insurance audit keeps you up at night, or you get an envelope that says Aetna or Blue Cross and you don’t know what’s in it. It’s not a check in it, your heart is in your throat as you’re opening up because you’re afraid, now’s the time. We do have a service. It’s called a power audit. 

And there’s a whole podcast episode just on this and I’ll link to it in the show notes but what it is a friendly audit meaning that we’re looking at some of your charts 10 charts selected at random or can be a little bit less than random if we’re concerned about something specific and looking at the charts exactly as an auditor would except for the part we’re not real auditor. So if we find that there’s a problem in documentation, that the documentation doesn’t support the coding and you would not pass an audit. All that happens is we tell you and we tell you how to correct it. And now you know. Whereas if there is truly an audit, and an insurance company is doing that, they can look and say yeah, your documentation didn’t support those codes. And over the last three years, you’ve done this many of these codes at a difference of this much per claim and can cost you 10s of 1000s dollars. So if insurance coding is something that’s a stress factor for you you think maybe you’re coding too aggressively. Maybe you just don’t know but you would like to know what would happen in case of an audit. 

The Power Audit is a great way to do that and you can get that information on our website powerpractice.com All right, two more things. And then I’ll, I’ll finish here but another key diagnostic test that I look at to see what might be going on in a practice is looking at the capture rate and the capture rate most of the time can be calculated by the number of frames sold divided by the number of exams. And this is another one, you hear all these different numbers thrown out of what your capture rate should be. The following question to ask especially when somebody throws out a number that feels unattainably high is to say how can how are you calculating that? Because you want to make sure that you’re comparing apples to apples. There are practices and even practice management consultants. That say I’ll tell you how to get a 90% capture rate. And when he asked about how capture rate is calculated, they say, well we ask every patient when they make the appointment, are they intending to get glasses, and so out of that we count up all the ones that say yes, and out of those 90% of them actually end up getting glasses. Okay, great. But what about all the other ones that said no, or I’m not sure. Those count too. 

So when our team looks at capture eight, we’re looking at the number of frames sold. So acknowledging that a patient putting new lenses in their old frame is a sale but we don’t count it as frame capture, the number of frames sold divided by the total number of exams and that percentage gives you capture rate. And we have practices that do have really high legitimate capture rates, sometimes 100% or higher. And those practices have obviously a great system within the practice to sell glasses to their patients, but to get numbers 100% or anywhere near it very often, they are also filling outside our access. A practice that has a unique line that no one else carries a practice that has the most comprehensive selection of children’s frames that people come from all over just to be fitted. You know something really unique about the optical practice in a ski town that does a tremendous number of sunglass sales. When we look at capture rate as a percentage of the exams done, it’s going to be really, really very high. A practice where the capture rate is really low. We need to do a little bit more looking. 

Sometimes it’s in the communication between the patient and the doctor, between the doctor and the patient. It is common. It’s happened a number of times that I’m observing in an exam room with a doctor and I hear them say something like, Yeah, I’m finding a little change in your prescription. But it’s real small. I think it’s fine for you to keep your glasses the same this year and we’ll see you back next year and see where it is. Right and maybe some of you listening have said that yourself or I hear yeah, your prescription changed a little bit. We’re going to increase the power of your contacts by half diopter are you wearing the glasses? No, just pretty much at night. All right. I think it’s fine to leave those as they are. Right. So think about it this way, shift your brain a little bit. Can you imagine a new patient coming in? Let’s say they’re minus 115 and telling a new patient who’s never worn glasses, okay. I’m gonna get your contacts for the day you’re gonna be able to see really, really, really clearly and then I’m going to make glasses for nighttime that are a little bit blurry. Okay? You would never say that, right? Or you would never say to a patient if you’re prescribing glasses for the first time you would never say: yes, so I’m going to want you to wear something that’s a little bit off from what your actual prescription is. So let me write this out. And here’s your regular prescription, but we’re gonna go just a little bit a little bit off from that. Right, we would never really think to prescribe glasses that don’t give the clearest vision possible. But when you’re in the exam room and you’re telling your patient the prescription changed a little bit but it’s not that much of a change. You don’t need to change your glasses. That’s exactly what you’re telling them. You’re telling them. I’m fine and I could make your vision better, but I’m going to choose not to this year. And when you say it that way it sounds silly almost. But really isn’t that what you’re saying? And I’m not talking about making change for the sake of change. And I’m not talking about a patient who has the exact same power or truly doesn’t notice a change in prescription. But I am saying that when there is a change in prescription even if it’s a small change, when it lets the patient see better, especially when the patient can appreciate that difference, then that is absolutely worth prescribing and letting the patient make the decision on whether to get those glasses or not. But since they give clearer vision right why wouldn’t they. 

Capture rates tells me about the communication in the exam room. And then the other thing to look at if the capture rate isn’t where you want it to be, is about sometimes the mix on a frame board, are you selling what your patients want to buy? Do you have the right products? Do you have the right price points? Is your staff able to give the patient the information to understand why they should buy glasses at your office compared to anywhere else? Is it a seamless experience? And those are things we look at when we’re specifically looking at capture rate as well. Sometimes offices that have a high capture rate are really really good at lots of other things. That’s a good sign. Sometimes offices with a low capture rate are really really good at something else to the exclusion of selling glasses. So this happens a lot in an office. Let’s say that that’s focused on myopia treatment, that at the conclusion of the exam, the doctor is so focused on getting the patient into the next steps of myopia treatment that they don’t think they kind of neglect to talk about also giving them the clearest vision. So prescription changed and all of a sudden you’re launched into, you know, the axial length and the eyeballs get longer and there’s things we can do about it. And here are the options for treatment and we’re gonna set up a consultation and I’d recommend this and here are the next steps. And the patient leaves with all kinds of information about myopia treatment. And they also leave with vision that was just as blurry as it was when they came in and even if the patient is being filled with worth okay lenses or something. We want to have glasses that they can see out of for those days when they have the flu and they can’t wear their lenses for a couple of nights or they go to a Boy Scout camp and the parent doesn’t want them to wear the lenses that during that time because it’s their camping and it’s dirty, or whatever it is we want them to have up to date properly sized as clear as possible glasses that they can see. So there’s a million other things that we look at but the last piece that I want to talk about today is also looking at the number of specialty care services that the practice is providing because one of the biggest problems I guess, but also one of the biggest opportunities that we see is in practices that are just starting or just dabbling in specialty care regardless of your area of specialty that you’re interested whether it’s aesthetics myopia in many cases, there’s equipment and stuff required or wanted to be able to provide that type of care. And in some cases, the cost for that equipment is quite high. 

So in a practice that’s not seeing the profitability that they want to see. What we want to make sure is that they are doing enough of the specialty care, to justify the amount of to justify the amount that they’ve invested in the equipment needed to provide that kind of care. And so, when I see those numbers, you know, they have it could be anything I don’t want to start product names, but you know, any piece of equipment that allows them to do specialty care. I want to make sure that the practice owner is aware of how much of that specialty care they need to be doing to offset the cost of the equipment. And if they’re not doing enough that they have a plan of action, to be able to do more to get to enough and then get to a point where the clinical care that they love and they’re passionate about is also driving profit to their business. Because that’s what lets all of us continue so hopefully, this is my first time doing a solo episode. 

Hopefully, this is good information for you to have as you’re looking at your practice and ways that you can evaluate your practice and make sure that you are where you want to be and on a path to get where you want to go. If this is something that you’re interested in doing, or having done for you or discussing further to see where specific areas of improvement lie in your practice, and where you can make changes to improve your profitability to improve your communication, to improve your leadership to improve patient care. Please drop us a note at info@powerpractice.com And our team of coaches would love to talk to you about it. Thank you so much for listening!

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