Dr. Todd Cohen (4:51)

Well, you know, I look at vision plans as the two main vision plans we take as a marketing expense. It drives people in the door. Yes, we're the Facebook moms groups and yes, we get lots of referrals and have some aggressive nice thanking our patients for referring other patients. But the way I look at it is these patients are being driven in by a lot of the vision plans and we all kind of face that it's the necessary beast for those, except for those practices that already have a big following and kind of abandon those. But the way I look at it is how can I take this $65 per reimbursement on average or whatever, wherever you live in the country is bit different and boost it up just by doing the right services. And so I've always positioned myself that I want to have the latest technology. And we all say that, but. But do we all follow that? Do we all make it instituting? I mean, the pract of the matter is, is a lot of practices have, you know, a to Z equipment, but it's collecting dust or it's a coat hanger and they're not implementing it. So you have to have scripting with your staff. You have to have the method of why your staff believes in the quality of care you're bringing and elevating the patient's experience in their comprehensive eye exam. Let's just talk about primary eye care right now. So in my practice where over 95% of our patients get photos, retinal photos, and about 90% of our patients over 40 get visual fields, get OCT, retinal scan, glaucoma screener, they get a macular pigment density looking for early signs or risk factors for macular degeneration. And we also do my biography in every patient. Every patient, whether you're 6 or 66, gets my biography. We'll go into that later about dry eye, but that's where I start. And those tests not only create a higher dollar capture rate for our revenue per patient, and that starts there, but it's also like a farm system for our medical practice. And so if we find something in an OCT screening or a glaucoma screening or whatever the case may be, I will then schedule you appropriately for follow ups. And those follow ups will then come, you know, at the same time, a comprehensive eye exam is coming in three months. That follow up will be with me. And so that again is building your collective hourly Revenue per od.

Eugene Schottzman (7:05)

Okay, so let's go back one more time because we're just going to start at the beginning of the journey. Patient walks into your practice, they're going to go through pre testing. And in that pre testing, how much are they going to pay?

Dr. Todd Cohen (7:17)

So if you're a 40 year old or over, it's about $150 out of pocket for all four of those tests.

Eugene Schottzman (7:23)

And what's your acceptance rate on that?

Dr. Todd Cohen (7:26)

Oh, for 40 year olds and over, we're about 88%.

Eugene Schottzman (7:30)

Okay.

Dr. Todd Cohen (7:31)

But if you're, you know, less than 40 depending upon whatever. So you know, everyone's getting photos and they're paying like $45 and except for those vision plans, they're supposed to pay $39. Whatever.

Eugene Schottzman (7:42)

But okay, so this is, let's just start there. So you've got 88% compliance on a patient paying you $150 before you even see them in the chair. So talk to me about how you do that.

Dr. Todd Cohen (7:56)

Okay, so we have scripting the staff, all the staff is multi, you know, capable to do all the testing. And so. But what I really firmly believe in, Eugene, is when the patient sits down, it really affirms. Just like people have really aggressive pre appointing and patients have become positioned and accustomed to be pre appointed. The same thing happens with medical testing in our practice. So say you're the patient, you come in. Hey, hey, Eugene. How's your kids doing? Yada, yada, yada. How was that trip to Mexico you went out last year? And then I'll say that I want to go over all the testing we did with you today. This is your retinal image. This is picking up early signs of high blood pressure, diabetes. We can see the part of your brain here. This is the OCT. It looks at 80,000 images a second of the back of your eye. We can see early signs for glaucoma up to seven years earlier. Early macular generation. Pictures we cannot see with the photos we can see below the surface. This is your macular pigment score is this number. This is a risk factor along with other risk factors. We can measure it and if it's low, we can talk about eye vitamins. This is your visual field. It can catch early neurological issues. I'll usually use the example of a 38 year old that I caught with a pituitary tumor six months ago. So it kind of like reaffirms and gets rid of the buyer's remorse and really emphasize the fact that, hey, I've been, I've been seeing in The North Shore of Chicago. And my mother in law was guilty of this before I became an optometrist. They're conditioned to see optimize ophthalmologists. They think ophthalmologists are the top of the pyramid. Well, every single patient, I've never had a patient come in who used to come from ophthalmologists and say wow, I've never had an eye exam like this. Every single patient from an ophthalmologist says that because of our thoroughness and, but also on the back end, it builds our practice, it decommoditizes our practice because you know, I'm proud to say that 66% of our revenue on an annual basis is non optical. And so from myopia management to dry eye to medical care to A to Z, that's what's driving our revenue and increasing us every year in our practice.

Eugene Schottzman (9:56)

And we're going to come back to that in a moment. But I'm just, I'm still fascinated by, you know, a new patient walks in the door and I totally agree with you. I think it's fantastic to get rid of the buyer's remorse when you're sitting in clinic. But new patient walks in the door and you have to deliver the news that before they even look in the optical because they're coming in for glasses and maybe contact lenses and an eye exam. And they, and you haven't commoditized the eye exam as far as you know, they could have. You know, their, their idea of what an eye exam is is based off of what they got at Costco last year. Sure. So let's talk about what you say to those patients at the front desk to get the 150 bucks for them to at least say okay, yeah, that seems fine.

Dr. Todd Cohen (10:40)

Okay. So our call center, when they are calling for new appointments, they do start by saying just you know, out of your out of pocket costs are going to be $45 for the retinal screening in addition to your exam co pays. And then when the patients hear the, our technicians are fantastic in terms of their verbiage, in terms of, you know, kind of being excited about the technology that we have. And so then they'll say, hey, you know Eugene, you're over 40. You know, we really recommend, the doctors strongly recommend this and because of abc, why we want to be catching those problems before they become a bigger problem.

Eugene Schottzman (11:18)

Love that. That's great. Because I mean there's too many times where patients walk into the practice and you know, the techs are head Pushers, right? And the head pushing goes something like, okay, now look at the green dot over here. Now look at the little house over there. And like, now do this and this over there. And there's not really much value being delivered. And that's such a opportune time to really talk up the, hey, this is a state of the art piece of technology. This is a state of the art piece of technology. And like you said, decommoditize the office. So, I mean, training the text to be able to do that, what's it take? How long did it take you to get your text to become excellent at that? And also, in your new practice that you just bought, where I know you put some technology, how long did it take until the techs changed their behavior and you could collect 150 bucks per before they even sat down in the chair?

Dr. Todd Cohen (12:08)

Well, with the new practice, the new established practice, I should say, I kind of came in and saying, this is the new technology. We got excited about this, the level of care we're able to provide such higher level care. And we had the technicians be the patient to show them all the cool stuff we're able to see. And they were like, wow, this is so cool, doctor. You know, Dr. Smith's been doing this for 36 years, and we've never seen anything more than just a picture of the eye. And so we got them excited, but it took, you know, a couple of weeks. But when I always have an implementation plan, Eugene, when I buy a new piece of equipment, right? Whether it's a new handheld tonometer or whether it's a new camera or something, because that's the problem. Most people do. And when they're talked into, especially this time of year, whenever this podcast comes out. But we're in November right now, and the reps are coming knocking, saying, here's your user tax, write off, user, whatever. And they just want to sell the box. They don't really care about the implementation. And that's the problem. But I presented at a national conference last year, another group I'm in, and I had my. All my staff members in my PowerPoint actually recorded their audio when it came to the scripting. And everyone's like, the room was packed. I mean, they couldn't believe it. But I'm like, this is what you should be doing. It's nothing new to me. But, you know, when you have the scripting and the repeatability, they all say about the gist of the same thing. And I have them all walk through it, even our new hires they go through the whole process, then they have to shadow for a while, then they have a buddy, a technician buddy, and then they get all the verbiage kind of through osmosis.

Eugene Schottzman (13:35)

I love that. That's, that's so. That's fantastic. So now we're in the chair, right? Like now. Now we're in your. And you're talking about. So as you mentioned, you know, you've gone through and when you're presenting the test, you're not just talking about here's what we saw, you're talking about here's what we could have seen or here's what we check for and here's what we screen for. And you gave me a little bit of that verbiage already. Are there any specific tips and tricks that you want to share with the audience about, you know, what's worked in the past and what hasn't?

Dr. Todd Cohen (14:05)

Sure. So I mean, what's worked in the past? I mean, I always say too that like it's very important just to get a second monitor next to the exam room chair kind of for the effect. So that way you're not clicking in and out of your ehr and things like that. But so that's really impressive to kind of see their picture blown up and the images blown up.

Eugene Schottzman (14:26)

And by the way, a second monitor is like a really nice, you know, I don't know, like a 32 inch monitor is like 250 bucks.

Dr. Todd Cohen (14:33)

Yeah, Black Friday, probably $150. But yeah, so that's worked. But what hasn't worked in the past is when we have got a new, a piece of equipment and the staff didn't really know the why behind it as well. There was something we tried out for a while and it's very easy to. There's so much cool technology out there. I mean, there's a new ERG thing I'm looking at, there's the neuro lens thing that's out. There's so many things. But how many, how much time do you have in your exam room to focus on each little subsector of those pieces of technology before the patient's head is spinning like a slot machine not knowing which way is up? And so I'd like to be a master of few versus a master, you know, a little dabbler of many. And it's really hard. And so we tried it out and we just, it just wasn't working. And I returned it after a couple of months because it's just hard. I mean, one of my, my, my buddies in my other study group, we've been together 15 years. He goes, look, he's like, I want to. I have a specialty contact lens practice. I have dry eye. I cannot waste seven minutes about talking about Lutein eye vitamins. I'm only making eight bucks a bottle on. Right. Yeah. Your time is limited with the patients without them feeling rushed and to get that good experience. And so it really is important to figure out the why behind what you're doing and the proper implementation steps because it's. I have four providers for associates plus myself. And so we have doctor meetings every two months. We talk about conversion rates and optical conversion and pre testing and medical testing. We try our best to disseminate the information across all of us. So we all. The patient has the same experience. Is it going to be the same? Of course not. But if I can get there to the 90% approach, that would be great. Across the doctors.

Eugene Schottzman (16:25)

Yeah, we're going to come back to the doctors in a little bit and you know, it still sounds like more than most people do when you're going through all of the imaging. So how long are your exams and how long are you taking? And I mean it sounds like you're doing this consistently across un.

Dr. Todd Cohen (16:40)

So our pre testing, we always time it. Right. So pre testing, if you're going to be a 40 year old and getting all four the Gauntlet as we call it, it's about 16 minutes, 17 minutes or so. Right. But we've actually, I've invested in. We found that with all our ortho K patients we were using the same device that does the mabography and topography. And so I actually bought a second one and actually bought a second retinal camera because I didn't want to have. It was clogging up. Right. And we were running behind and patients were waiting and you know, these kids coming in for ortho K checks, we need to topography and refraction and see them back. And that room was being tied up so I spent the money to double the double those machines. And it's worked out well because of the bottleneck, but it's about 16 to 17 minutes for an adult. For a person like a less than 18 year old that's getting photos. And if you're driving, we really encourage the visual fields and we do my biography that's like not even 10 minutes. I mean they're in and out of there.

Eugene Schottzman (17:36)

So okay, so then how long is. So that's 16 minutes. And then how long is the exam itself when you're sitting?

Dr. Todd Cohen (17:43)

We book patients in 30 minute slots. But you got to remember that we're doing a lot of things concurrently, right? I'm doing a myopia management check, I'm doing a red eye check. I'm doing, you know, all these dry eye follow ups on the like two or three of those an hour. So you know, we'll do like three comp exams an hour basically. Or if it's a, you know, mom and two kids, it's easily an 35, 45 minutes, all three of them. But you know, they're in the process together. And so people really don't wait. I mean, we keep a stack of Starbucks gift cards in our front office area for the staff. And if we're running more than five to seven minutes behind, we'll give you a Starbucks car without even asking for it.

Eugene Schottzman (18:21)

Oh, that's brilliant.

Dr. Todd Cohen (18:22)

I'm very type A. Like, I'm the guy at the airport, I'm like, I'm going tsa, I'm at Disney, I'm finding the shortest line, waiting. You know, my wife is like, know, I went to the dentist, I sat there for 45 minutes. I'm like, that's not okay. My time is more valuable. But people are used to waiting. But I'm just very type A when it comes to that stuff. And I, I, you know, I, if I'm running five or seven minutes behind, like, come on, we gotta get going.

Eugene Schottzman (18:44)

So that's, by the way, a great idea. How much were those Starbucks gift cards?

Dr. Todd Cohen (18:48)

$5. So we keep a stack, my $50 with the Starbucks cards. To be honest with you. Maybe we go through them two and a half months. So we're not running behind that much now.

Eugene Schottzman (19:00)

Fantastic. Okay, so you're in the chair, you're finding stuff, you're, you're using this information to opportunity mind. So let's talk about the, the opportunities that you're, you tend to find with patients and specifically the ones that are going to help you drive revenue per patient.

Dr. Todd Cohen (19:17)

Yes. So. Well, I mean, first and foremost, if you're catching something with a, I mean, if you don't have an oct, get one yesterday, you can catch epiretinal membranes so easy, see them back in six months or three months, have more vis, Advanced visual field testing, you know, all those types of things. So that's an easy one. Or if you find any little exudates or leakage in the retina, any deposits, see them back in six months. I mean, glaucoma, so on and so forth. We all know that certain protocols are supposed to follow. But the main thing that really drives a lot of revenue is, is doing my biography and all our pre testing and we've encouraged that. We do it on every single contact lenswear, bar none. And we start the process even if we have a seven year old, we do my biography. We try to be as consistent as we can because it starts the conversation about digital device use with the parents, which then bleeds into myopia. Right. Or you know, when your little kid gets a sty all the time. Well, the reason why they're getting a sty is because meibomian gland dysfunction. The oil is stagnant, it gets infected. The, the glands aren't producing, the oil is not flowing. It's like a backup in the, in the hose there. So those types of things is really like your, like you said, the mining or I kind of call it the farm system where it really generates further testing and further exams. And so if, you know, I don't want to overwhelm the patient their comprehensive eye exam, but we'll definitely touch on it, say oh, your glands, you know, are really. And I have the patient self grade their glands and say what are you thinking? So at the end of the exam, I'll do the handoff, I'll take them to the obstacle. I'll say before we do the, you know, we talked about our things, we're prescribing and we're working on the verbiage to increase our patient capture rate. But in the optical. But first thing they do is they sit them down at the laptop and dispensing and they set up the ocular surface exam. So they set up that quote unquote dry eye exam. But we don't call it dry eye because people, I don't have dry eye. Right. So it's the ocular surface exam that we set up for half our appointment and they'll do more further testing. They, they're told ahead of time there'll be some out of pocket costs with that. The medical insurance will cover some and there's some pocket cost and we'll schedule that before they even pick out their eyewear or the purchase.

Eugene Schottzman (21:19)

Okay, hold on. We just so much here. This is, you know, so first of all, I heard you say you have them grade their. My biography. Yes, talk about that.

Dr. Todd Cohen (21:30)

All right, so you know, any, any device you get, I mean you can just Google like you know, my biography images and things. There's the picture of what it's supposed to look like. There's a moderate and there's a Fear, loss. And so patients are kind of funny. They always think things are worse than they are. And so the picture says a thousand words. It really hits home. I use a lot of analogies. These are like the piano keys. They should be long piano keys. You know, when you leave the cap your toothpaste off, it's kind of crusty. The rest of the toothpaste is ruined. Well, that's what's happening in your glands. They start getting brittle, they break apart, they fall apart. You know, other doctors may have said warm compresses. Well, a warm compress is only like holding a match to a candle far away. It'll soften it, but it won't melt it. And so the good thing is the great news, we have some great solutions for you. We'll talk more about those at the ocular surface exam. And so that, and so the patients say, where do you think you lie between this picture, that picture, that picture. And they always, nine out of 10 times, say, between two and three, I might say they're two. But when it comes, I mean, this is just globally. I mean, we've had patients that isn't aside. Their glands look great, but they function, like terribly. And we're catching them early. And behind the microscope, they're not functioning. So it's function informed. But for the most part, we'll just start the picture for simplicity's sake.

Eugene Schottzman (22:42)

So you show them the picture and you say, this is what a healthy one's supposed to look like. This is what yours looks like. How bad do you think yours is? This is brilliant, Todd. Because honestly, it gets them the commitment. You know, as a marketing psychology, consumer psychology buff, like, I'm thinking you're building the commitment from them. They're the ones who are telling you this is a problem, not you.

Dr. Todd Cohen (23:02)

Right. And like half of our, roughly just under half of our patients that we've done ocular service exams and treatments in the office are completely asymptomatic. Right. So it's just like the patient, you know, might have a pressure, eye pressure of 34. They're not telling us my eye pressure is high. They're not going to feel it necessarily. But we're catching it. We're promoting eye drops, we're having follow ups, scheduling more testing. So it's no different. Meibomian gland dysfunction, which is 86% in dry eye disease, is no different than glaucoma. You're catching it early before people become symptomatic.

Eugene Schottzman (23:36)

Yeah. So in that particular environment. So you get them, you get them to Grade their. What else happens? You know. So you, I heard you say we have some great solutions. You're going to have an ocular surface exam. Now let's talk about what percentage of your patients take you up on that ocular surface exam when you find something.

Dr. Todd Cohen (23:58)

Oh, well over 80%. They're booking it right there.

Eugene Schottzman (24:00)

Okay. So just make sure. I want the audience to hear this, to understand the power of this. So you're doing a biography on every patient. What percentage of patients end up, end up needing some sort of, let's say, end up needing an ocular surface exam.

Dr. Todd Cohen (24:19)

Of all the patients we see. So I mean, obviously over a certain age group. Right. So we're not going to do like, we're not going to schedule an ocular surface exam for a four, right?

Eugene Schottzman (24:29)

No, and I.

Dr. Todd Cohen (24:30)

But let's say all adults, right. I mean, so of all the. My biographies you do, I would probably say that, I mean, MGD is like so common. Right. It's the easiest thing. You have to externally market it sitting dormant in your practice right now. So I would say, you know, at least 60 to 70% of those patients will end up coming in for an ocular surface exam.

Eugene Schottzman (24:52)

So 60 to 70% of your adult patients are going to walk back in for an ocular surface examination. Just think about how powerful that is for a practice. If we're just thinking about revenue per patient and you know, I talk to practices all the time and they think about all the different levers they can pull. I just want to pause and recognize how powerful this lever is. If you're able to get a patient to commit to coming in for an ocular surface exam, all of a sudden you know, what's your, what's your revenue at an ocular surface exam before you've sold them dry eye treatment?

Dr. Todd Cohen (25:25)

Before I sold them any products or.

Eugene Schottzman (25:26)

No, yes, before you sold them anything. Right. They just literally what's. What do you charge?

Dr. Todd Cohen (25:30)

We're billing the exam like a 99214 plus external photos, plus inflamma dries. And then, you know, I'm charging them like we do a comprehensive dryer report that's a hundred dollars out of pocket. So you could just say by the medical fees only, what we. Obviously they're deductible, all that kind of stuff. So you could say on average you're collecting 220. $203. Maybe after insurance. 180, I don't know, somewhere around there.

Eugene Schottzman (25:56)

160% of your patients who are comprehensive exams.

Dr. Todd Cohen (25:59)

Right. And that's before you sell them eye drops or vitamins or products. And then then from those patients have ocular surgery exams. Then they'll come back at the patent. We have this whole patent, this flowcharts are. But they'll come back for the treatments and then so we start the treatments and then obviously the sky's the limit. But I do want to impress upon the audience here, Eugene, is that one of our ophthalmologists, that is huge in terms of they do 70% of their IOLs are premium IOLs, which is unheard of. The national average is like 12 to 15%. So basically what we and I've modeled my practice to how their sales process works. And what he does and his ophthalmologists do is they leave exit stage left. What was that from a cartoon? Exit stage left, right. So we talk about what I'm prescribing for you, Eugene, and then say, okay, I'm going to have my patient education coordinator. We're going to take you to our dry eye suite, which is our a really nice 400 square feet in our office with the spa chair and all that kind of stuff. I say we're going to go in there and then so and so is going to come and talk to you about the different treatments. Our staff is all our patient education coordinators are all well versed on. I hardly ever talk price with patients. Hardly ever, unless they're a longtime patient. I'll go into it, but. And I have my spiel. But our office staff, all three of the patient education coordinators have the same exact way to respond to patients when number one question, what is it? Is it covered by my insurance? Right.

Eugene Schottzman (27:22)

Yep.

Dr. Todd Cohen (27:23)

So they have ways to say and talk about that. And we give historical data about, you know, the income or mammograms for 30 years either. And you know, the insurance isn't always in our best interest when it comes to being proactive and things. And so we have the whole spiel. So then the education couriers will sign them up. So our staff doctors do not talk about price because let that be explained to them. And then they can talk about payment options and so forth with it.

Eugene Schottzman (27:47)

Well, it's easier to control what you're because I, you know, I'm sure you could do it, but I'm sure. But it's easier to control what your associates do because your associates aren't really going to want to talk about price. They didn't get into medicine to become salespeople. So the. And they certainly didn't come to work for you, to be salespeople. So it's actually a pretty wise move to have your patient coordinators trained on a sales process. Right. So let's just. I'm going to follow the train on the dry eye side, and then I'm going to maybe come back and talk about some of the other things. But. Okay, so we've got a whole bunch of patients coming in for an ocular surface exam.

Dr. Todd Cohen (28:24)

Right.

Eugene Schottzman (28:25)

Talk to me about that. What is that like in your practice? Because, you know, you got to give them some value for the 235 bucks that. That they came in for. And then also, what are the solutions that you guys are presenting for them?

Dr. Todd Cohen (28:37)

Okay, so we'll say, okay, you know, the staff technician will take them back. We'll do upper and lower. My biography where in the screening we used to do lower. We'll do a noninvasive tear breakup time. We'll do the oil layer, the oculus chirograph does a whole assay of tests. In our other location, we have the tear check that does a whole assay of tests. And then they'll do the inflamma dry, looking for inflammation. And the noninvasive tear breakup time, look at the quality. So our staff is explaining all these as they're doing them. And then they'll go in the exam room, we'll do a comprehensive slit lamp exam. We'll go over the results, talk about the inflammation, talk about how dry eye. It's actually called dry eye disease because it gets worse if you don't do something about it. They can affect your vision. You kind of ask the patient, oh, is your vision kind of blurry in the morning or evenings? Yeah, it kind of is. Oh, that's dry eye. And did you know that, like, 75% of how we see isn't the lens in our eyes, the ocular surface? And so if there's little spots on the window, you're not going to see as well. And so then we'll go into that and we'll talk about the importance of nutraceuticals, whether it's an omega 6 or omega threes products. We'll talk about different eye drops we prescribe and recommend. And so typically we come back in three weeks, and then we'll remeasure their inflammation, check how things are going. And at that time, we'll either schedule them for treatments and talk about, you know, our IRPL Lipiflow, BLfax radiofrequency. Um, sometimes, like this patient drove an hour away and she actually needed two amniotic membranes, so we did one amniotic. I'm like, I'm not touching you until we get your ocular surface better. Because I don't want to do any treatments until we kind of make your eyes a lot less inflamed. And so we did one, and three days later I did another one. But this is a brand new patient. I texted her, checked in with her, and she actually brought her, her husband for the Fox goes. I used to have that. I used to, had to have my husband meet you. Your communication is amazing. I feel so confident in your career. And so it's that extra level of caring that really makes your practice, you know, move forward. And I'm sure this lady is going to be a broadcaster of our practice one day. So.

Eugene Schottzman (30:38)

So I love that. But you, so you're saying you start with products for typically your protocols, you start with products for a few weeks.

Dr. Todd Cohen (30:45)

Well, typically, if they have like, inflammation, we're going to do a short course of steroids. And so in that case, you have to see them back three weeks afterwards. Well, at least that's our protocol to check their eye pressure, check the inflammation and kind of educate them on that. So that's the reason why I've had some colleagues of mine across the country, you know, if they're, oh, I don't want to do anything, it's okay. Here, here's some warm compresses and blood scrubs. Come back and see me in four months. Come back in four months. Hey, Eugene, how are those working out for you? Okay. We tried your way, now let's try mine. Right. So I'm concerned about your eyes. Let's take a more proactive approach and get this problem fixed, you know?

Eugene Schottzman (31:22)

Yeah, I love that. So let's talk about the. And actually, one question I didn't ask is. So you tend to present a treatment plan for every patient after you're doing your battery of tests.

Dr. Todd Cohen (31:36)

Yeah.

Eugene Schottzman (31:36)

And everyone's unique.

Dr. Todd Cohen (31:37)

I mean, for the most part, most people get most of them, but not everybody. Obviously there's different factors. Right.

Eugene Schottzman (31:42)

So what percentage of patients end up doing something?

Dr. Todd Cohen (31:46)

I would say that over. I would say about 65 to 70% of people are scheduling their treatments at the conclusion or at the three week follow up. Now, there's lots of different, varying factors. I want to wait till my HSA restarts. I want to wait. I'm going on vacation in the summertime and you're in the Midwest. Also, people want to make sure they're golfing every Single day they can. So what we've like our fall and early spring are backloaded with treatments because people postpone them to the when it's not as sunny out. So there's lots of different issues and things. But I do have a protocol and we use a couple digital marketing solutions that really help reactivate those patients. So in our system it shows that how many people had an ocular service exam and never followed up with treatment or never scheduled up is called like a, you know, kind of follow up with those people to kind of react. We have to think of our practices. I'm a business owner first and then an optometrist second. Right. And so you have to really look at your practice in terms of how to. As a sales process. As much as we don't want to say it, but that's what you're recommending. This is what you invested in technology and your practice in. And to be honest, this is raising your level of comprehensive care and your relative per patient value. Like I always say, our rel. Our patient revenue per patient is the sum of our quality of care we're giving. And that's what I've always conveyed to my associates because I don't want like this new associate I have for my new practice that I acquired. She came from a retail location. She's never done a drop of medical in her life. I had her shadow me and my other associates for a full month. I paid her for a full month because I want her to get to get on the same train that we all are on. And now she's super comfortable. She's doing IPL treatments in my second office. She's doing lipiflows. It's fantastic. So to say it can't be done is a falsehood. So.

Eugene Schottzman (33:41)

Well, and that's actually a really interesting point is that it seems to me, and I've heard this pattern throughout, some of the things that you've described is that you invest a lot of time and energy into making sure that your staff and your associates are educated. I want you to talk a little bit more about that and how you verify. You know, I imagine that you teach someone something and then, you know, 90 days later they forget that you taught them this. I've seen this in my business, I've seen this in my client's business is that there's always a need to kind of double check, re, verify and remind people that this is in fact what they're doing. You know, what we found on. And different jobs are different. Right. So what we Found, for example, in the call center, actually have data on this, is that if you don't remind a call center employee every two to two and a half weeks of exactly what the expectations are, they start losing some of the habits. And so we in our call center try to remind people every day. And if that's not possible, then every two days, because we're like, we don't want you to get that two and a half weeks. And, you know, kind of just drop one of the. If we're asking you to do 10 things, then, you know, you get, you get to nine at two and a half weeks. And then I'm sure in other positions, you know, there's this kind of unwritten business rule of 90 days is when you really need a hard reset to remind yourself what the expectations of whatever you're doing are, whether you're a business owner or an optometrist or a practice manager. And so how do you do that? If you're investing in education for your, for, for your associates, for your team members, for your techs, what, what are some of the best practices you found?

Dr. Todd Cohen (35:14)

I mean, I take my staff, all my associates out to dinner every two months, not just to sit down and have drinks with them, but we actually go through our revenue per patients, our individual metrics, right? So like rising tides rate all ships raise all ships. So, like, you know, I'm. My revenue per patient is always going to be the highest. I don't know one owner out there that isn't the highest compared to their associates. It's getting pretty close. But. And what we say is like, look, you know, Doctor, so and so, you saw, you know, 200 exams this last two months. For example, let's see, how many ocular surface exams did you generate from that? Why wasn't the percentage there? Because we can easily track that and say, let's talk about. Hey, and they like to learn from each other. Hey, Emily, what do you tell your patients to get the ocular service exam? Hey, what do you do? And they group text all the time. And things without, you know, where the force, you know, we have a group text, but that's really important to hear from each other because they like to be in a team environment and help each other out, even though they're on their individual islands of their days of their practice, of the week, when it comes to the technicians, same type of thing, you know, we've gotten a lot of feedback. We brought the visual, virtual visual field into our new practice, and people love that. And we got a Lot of feedback from the staff. But you're right, it needs constant reminding. And my operations manager is phenomenal about setting, you know, weekly, biweekly monthly goals. And the staff at our staff meetings have, understand the reason behind that. It's not for the revenue number at the bottom. It's about the quality of care and making us unique. And I think subliminally, I think they understand that's their job security. Right. Because we're not at a 5 a dime optical, just turning and burning glasses all day long.

Eugene Schottzman (36:53)

So, yeah, I mean, I think everybody benefits, including your patients when you decommoditize your practice. And certainly no better way to do that than by providing really high level of care and for the patient. This is where I think you guys do something special that most practices really struggle with, which is that you're able to explain what you're doing in a way that makes a lot of sense to the, to the patient. So, you know, I've heard you even just in this short conversation and certainly others that we've had since your client. You know, I heard some of these things even when you were telling my team during your onboarding how, how, how you do certain things. I found some of your analogies quite fascinating. And I'm curious, do your associates, you know, like, do they steal your analogies? Do you tell them what your analogies, there's like a script that you hand to people and you say, these are Todd's, you five top, top 25 analogies. How do you do it?

Dr. Todd Cohen (37:49)

They've heard it enough. They've all heard it enough because they all shadow. I mean, they, they, I mean, they've all shadowed me back when they started. And we talk about things and we just re. Emphasize that at our doctor's meetings too. The power of prescribing and strong recommendations is humongous. It's really, really great. And, and not to be crass, but I'm like, if a patient doesn't experience that stuff, doesn't appreciate that stuff, my practice, there's plenty of places down the street that they're happy to go. And we're happy to say that because we're trying to bring in this technology to raise a level of quality of care. And there's some patients that are adamant. I don't want to do photos. Okay, then you know what, I'm sorry, there's other practices. You're not allowing us to practice at the highest level and catch eye diseases. And I kind of joke with patients. I don't care about your prescription I can easily fix your prescription. I can't fix a hole in your retina. Right. So we want to catch things early. And so those may not be the practice for us. And you know, when you're young and you're starting off or you're a new practitioner or a new practice, you want to every, every button. The chair is important, which is true to some extent. But you know, you can easily raise your prices, get rid of a third of your patients and have the same or greater revenue. And we've always had that. I mean, our, you know, practice is not, you know, all of our medical exams obviously add to our bottom line, majorly in our treatments. But, but you know, we do anywhere in our main Practice, anywhere from 2,300 to 2,600 comp exams a year, which isn't a lot, but what we're doing with those exams and the conversion is how I much rather practice. Right.

Eugene Schottzman (39:20)

Yeah. And it's very impressive what you're doing in terms of revenue per patient on those. So going back to kind of some of our original discussions. Okay, so one area where it seems like you really drive revenue per patient is your dry eye, which obviously is fed by all of the high quality imaging that you do up front and then the value conversation you have with the patient around that. Now let's talk about the other side of the equation, which is, you know, kids. So you've got, I think you call it orthokay practice. And you know, I think what we're finding is that patients are actually calling it myopia management more often than they're calling it orthokay today. I think that, you know, we're seeing a pretty sizable bump in demand around myopia management. And I'm curious what you've learned as you've added this to your practice and what, what's working for you.

Dr. Todd Cohen (40:12)

Okay, so I really found you have to really say myopia is a disease. You know, I tell patients to Google myopia epidemic. And I talk about how screen time kids aren't playing outside like they did when we were young. Natural sunlight, they're on iPads at home, they're up iPads at school. And our eyes weren't meant to look up close like that. And that's cream more nearsightedness. The low hanging fruit is the adult myopic patients. They don't want their kids to be a minus six like they had or don't want to have Lasik like they had and couldn't see the clock in the Morning. But when it comes to myopia management and we are using myopagic more because of the different soft lens options, the ortho k options, the atropine, but you know, it's very interesting and I've learned that hey, you never should prejudge your patients, right? Like there's a, there's this lots and lots of patients, the husband and wife, the parents always take their prescriptions. We try our best to save the sale. They're always going to ABC online getting eyeglasses every year. Right. We try, we've not try, try not to pre appoint them because we don't tie up our time, you know, but regardless, whatever. But when it comes to their kids being at a disadvantage from learning possibly or having a disease or a way to help their kids not be myopic or things to be proactive, I mean a lot of these parents, I mean these learning centers, these sylvan learning centers, the Kumons are all over the place, right? Math nasiums. Everybody wants your kid to be at or above where they should be in terms of academic status or whatever their aptitude is. And so when it comes, when you relate this to affecting learning, you know, affecting sports performance, affecting their lifestyle, they will always not more than that. Their pain point is their children's success, especially with some of these first generation kids that are here, you know, Americanized citizens and they will pay the 3,000 for whatever the case is for the ortho K or myopia management. It's really interesting. But they also want data, right? They also like patients like to hear that other patients, what their other patients experiences are. They don't want to say oh this is a, they're not an island. This is the first time I've heard about this. It is which is mind boggling to me because it's upsetting that some of these kids come in here and it's like oh my God, they're minus seven and they, you know 10, you know, 10 year old is terrible. They could have been avoided. But you know, when you're presenting something new that isn't so new, but the first time they heard it, they want data, they want studies. And so we're able to have a digital marketing solution where they QR code something in the office, they get the studies and again we put them on an auto drip campaign to follow up with them. And so it really gives affirmation to what we're talking about, the exam. It's not hocus pocus. We're talking about this magic fairy Dust to get rid of their kids myopia. There's studies behind it and the reasoning behind it. And so that's the buy in from the patient's psychology of the parents.

Eugene Schottzman (43:05)

So, and I want to come back to two points that you made and I want to go to this sales cycle. One first is, you know, it doesn't sound like patients necessarily make the decision on the spot every single time.

Dr. Todd Cohen (43:19)

Mostly not. Yeah.

Eugene Schottzman (43:20)

Okay. So different than dry eye, because dry eye, you kind of get the, you get the buy in pretty quickly and you get them to take care of themselves. But how long does it typically take before you between when you first presented in the exam room to when a patient begins treatment?

Dr. Todd Cohen (43:37)

I try my best because all the parent knows, Eugene, is that, oh, my kids complain they can't see the board. They have no idea the kid went from a minus one to minus three. They don't have a phoropter at home. Right. So I try to really sit down with the parents at the comp exam, talk to them about it. And I at least want to schedule a training appointment with our staff to make sure the kids can do it ahead of time. Whether it's a soft contact lens solution or an ortho K solution, I will schedule that. So I will try my best for them to schedule something during, hey, winter break is a great time. Let's bring in Susie during winter break to train it. She doesn't have to wake up for the bus at 7am So I try to get the appointments because I tell the patient, I'm not having you pay for anything up front unless we can make sure that, you know, little Mary can get her contacts in. And so that gives the patients, the parents that, you know, they don't want to spend all this money and then all of a sudden they can't put the contacts in. So we do that.

Eugene Schottzman (44:35)

So this is kind of another brilliant move. Like this is another brilliant human psychology ninja move. It's called the foot in the door technique. But, you know, you're giving them a freebie. Is this right? Like you're not charging for this?

Dr. Todd Cohen (44:46)

No, I don't charge for. We do the training as a freebie because now look, if people come in looking for an ortho care myopia consultation, because they're coming in for that, we do want to charge. We charge a few hundred dollars for that appointment. But that easily gets applied to their treatment. Right, because they're still taking the staff time, the doctor's time and stuff. But that gets applied to their Treatment I don't. There should be no free consultations. Right? But, but they gotta have something wet. But the foot in the door. Yeah. And the cool thing is, is as long as we pick a lens, the staff gives a lens, we get their KS and their measurements. This quasi close the kid can be, oh my God, I can see the TV in your exam room without down the hallway, without even having glasses on. I mean, the kids always smile ear to ear. And what we usually do is we put a little comfort drop in their eye to make it a little less freak out. You know, some of these kids are super sensitive, so. But yeah, so we do that. The foot in the door and then the parents can see they do it. And I said, look, our stab is fantastic. We've never had a patient not be able to get them in. So it gives them the assuredness that they can do it.

Eugene Schottzman (45:44)

So then you do the training and then talk to me about the process from. Okay, so now they're, I mean, what kind of patient, what kind of parent, you know, and I know as a father of a nine year old girl, what kind of parent would be the, you know, the negligent jerk who says, well, you know what, honey, you're gonna have to take that out and you can never have that again. I want you to be half blind again. You know that's right. Let's go with that then.

Dr. Todd Cohen (46:06)

Okay then if that's the case, what we'll do is we'll get your kid glasses today and we'll go in the optical. But I want to see them back for a complimentary five month follow up. The reason being is the insurance gives us a six month prescription guarantee. So your prescription changes six months will change the lens for free. Which is another reason why value add, why you should buy your eyewear from us. Right? And number two is we always do five months because invariably they change this appointment. And if it's a lot of these labs insurances, if it's like six months in a day, they give us a hard time, we can fight it, but it's just easier. Five months and then we recheck their prescription. Hey, you know what, Bob? Your daughter's eyes changed by another 0.5 or 0.75. We really need to address this sooner than later before they become really bad. And then what I also do, it's really hard for patients who are emmetropic or have no prescription to understand it. So what I'll do is I will take them in the waiting room and I will put a Plus two over their eyes. This is how your daughter sink, which is a negative two in a prescription. This is how you're seeing. Really? I have no idea. This is how your daughter's walking away now. Don't you feel bad? You know, and that's how it kind of is. But because of parents, a lot of parents, the first time they got glass when they're 40 years old. For readers. Right. So, you know, by and large. So that kind of.

Eugene Schottzman (47:14)

This is brilliant. I mean, I think the. And one of the questions I. I want to ask is obviously there's a little bit of a cycle. Right. Like not every patient accepts it. And when you present the treatment plan, obviously some people go the. I have to talk to the other parent all the time, you know, think about it, whatever. And so when they're thinking about it, you've got some solutions. You're sending them videos, you're sending them all kinds of things that help educate them more about their. Their patient, that their. Their kid's disease.

Dr. Todd Cohen (47:45)

Yeah. And we follow up too. And if we haven't heard from them in a month or six weeks afterwards, our staff will reach out to them just like any car salesman. Hey, Jean, you still thinking about that Honda? You know, that type of thing where it's just front of safe, top of mind, right? Yeah.

Eugene Schottzman (48:00)

And what I love about you, Todd, is that you're not afraid to call it sales, because you're absolutely right. We're all business owners first. And we have to, because if we weren't in some way business owners, we wouldn't have patients to take care of. Right. Some of us have, you know, better, better skills that we're honing or are honing more skills as business owners. And some of us kind of have fewer skills that we're honing and that as a result, you know, there are certain things that we want to watch out for in our business. Now, going back to the myopia management component, what percentage of your patients accept treatment or go with a treatment plan?

Dr. Todd Cohen (48:36)

I mean, I mean, like, over. I'm kind of an anomaly because when we talk about just my personal patients, I mean, I get. I usually they're like slam dunk. They're getting the extra topographies done that day after the training, and I'm ordering lenses that day. But I'm kind of an anomaly when it comes to that. But I would probably say, I mean, I think relatively speaking because of the cost and everything, I would say we're about 40, 50% the day of the comp exam. And maybe we pick up another 20%, 25%, like a month later. I would say, you know, there's still those parents, but we document it. We say, okay, I'm documenting. Because this kind of resonates with the parents too. I'm concerned about little Susie. I'm documenting in her chart that her prescription changed by this much. We presented these options for you. So kind of put the onus on them too and send them home with information, you know, and things like that.

Eugene Schottzman (49:29)

But yeah, that's good. By the way, with the pricing, have you found at all. I'm just curious, on financing, has that been a thing? Whether for dry eye or myopia management, have you seen an increase in patients wanting to use financing?

Dr. Todd Cohen (49:45)

Like, I mean this year's been brutal. I mean our, our annual supply contact lens rates is always north of 72, 74%. And we're like in the 60s. And I think a lot of it is because people are buying onesie twosies of boxes. And we've had a lot of patients, our long term patients. You have to be careful with the financing because you don't want to get burned, right? Take two credit cards and you store them securely and all that kind of stuff. But we've had patients, I'm like, look, like this woman, but she's, her daughter's getting married. I'm like, look, she's like, I can't do it. I said, I don't want you missing out on the $300 rebate that is, you know, $30 less per box or whatever the case may be. So let me just get your credit cards and we charge them monthly. So 100% to your point. I've never seen more of that. And I've been in practice since 2001, so have my own practice for 18 years. I've never seen more of it than we've seen this year.

Eugene Schottzman (50:35)

Well, interesting. And that's probably true for the higher ticket sales too.

Dr. Todd Cohen (50:40)

100. I mean, when it comes to the dry eye packages, you know, we have patients that are literally like, if we, we give them a, a prom paid discount, this is the price a la carte. This is the price all at once. This is the price over payments. And they're like, I don't understand the mindset. But it's all about cash flow management for them and different credit card billing cycles. And you know, most of the, my country, unfortunately. What was it, Eugene, that they got hit with a $2,000 medical bill? They couldn't even pay it or something like that. It's pretty, pretty pathetic. And so always sad that people don't have the savings for those types of rainy day situations. And so when it comes to those things, I mean, they're paying me like 200, $200 more for the treatments because, you know, they're not getting a discount because they want to spread out overpayments. Also something to that which we've instituted because this ophthalmologist was doing it. The ophthalmologist was saying, oh, it's this price. If the technicians do Lipiflow and it's an extra $300 if I do it, it's the same treatment. Lipiflow is so easy to do. And people are like, oh, I want you to do it. I mean, it's not like magic sauce here. Anybody can do it once you're trained by Johnson Johnson, for example. But we start doing it with the IPLs. And we had three patients this past week that my associate, they paid her more to do the ipl. And our staff's done hundreds and thousands of treatments. But this, the patient's inherent value feels if a doctor's doing it, it's. And so what the heck, why not? Right?

Eugene Schottzman (52:05)

So, yeah, right. Like, that's actually, that's a freaking great technique too, to increase revenue per patient. Even though I think what most patients probably don't realize is that since the doctor is doing few of them, they may not actually be the best person to do that treatment.

Dr. Todd Cohen (52:18)

Oh, yeah. I'm like, I, you know, they're like, you don't do it. I'm like, I barely know how to turn the machine on. I mean, our staff is so well trained and that's not my good use of time. But in that doctor, I mean, that doctor, our associates is doing them herself. She's generating revenue, and it literally takes her five to seven minutes while she can be doing it while a comp exam is being worked up anyway. But we do have certain dry eye days, so the schedule is that way. So our staff gets in that mindset and they try to create continuity of care. So if Mary Jane always gets treated by Michelle, then Michelle's always that person because they schmooze in the back and they talk about stuff and they build that rapport so they try to like, keep the same treatment.

Eugene Schottzman (52:54)

Yeah, I love this conversation. I feel like we could probably peel back more and more layers in future episodes as well. I think this gave people enough value to start thinking about what, you know, how do you treat your entire patient flow as a potential revenue Generating entity at every single step. And also, how do you maximize the patient benefit? I mean, really, this is what you're talking about, is maximize the patient benefit, maximize the value to the patient, but also get paid for doing it. As a final thought, any, any final thoughts of anything that we didn't cover. I know, you're just, you're full of analogies. You're full of. Full of golden nuggets, as I like to call them. Anything else you want to share with the audience for today?

Dr. Todd Cohen (53:36)

I mean, always the, you know, and I credit my original study group from 15 years ago that we took together. It's like smarter, not harder, right? Invest in technology, have an implementation plan. The rewards will follow. Train your staff, get your staff buy in, and really, you know, choose the path you want to. I mean, optometry gets a knock on a lot of pessimists on some of the, the, the Facebook groups and things like that, but really, I mean, look, you can decommoditize your practice, especially in financially economical, trying times these days, and, you know, keep doing what you love, what you're passionate about, and your practice will continue to thrive.

Eugene Schottzman (54:15)

I love that. Thank you so much, Todd, for joining us on the Power Hour today. Fantastic conversation. Glad to have you on the show.

Dr. Todd Cohen (54:21)

Thank you. My pleasure.

Eugene Schottzman (54:22)

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