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Power Hour Optometry
Great Ideas. Zero Follow-Through. The Missing System Behind Every Failed Practice Initiative
01:02:28
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- [00:00]
A
Foreign. Welcome to the Power Hour, Optometry's biggest and longest running show. I'm your host, Eugene Shotsman, and we got a great show for you today. Before we start, I'm going to ask you something. What is the biggest thing standing between you and your dream practice? And as you ponder that, I have a suspicion that it's not a lack of ideas. You probably have a ton of great ideas. A new service you should launch, an operational improvement. You know, you need to make a revenue opportunity that you might have been missing, something that you've heard somebody talk about or something that you've talked about with your team a couple times. And yet somehow it never quite gets off the ground. Or maybe it did get started, but just like a few months later, everyone's quietly moved on. And the thing is, after years of working with practices on growth, there's a simple pattern that seems to be emerging, which is not that it's a lack of good ideas that causes a problem. It's a lack of execution accountability. Execution accountability isn't just introducing a concept and then checking a couple weeks later and be like, okay, are we doing that? Okay, great. Real execution accountability requires a way to get people to change what they're doing without creating chaos, without the owner constantly chasing everybody, and without every new initiative becoming a flavor of the month. Because ultimately, every intentional improvement you want to make in your practice requires some kind of behavior change. And behavior change doesn't happen because you had a good meeting or went to a great conference or sent an email or told your team that you need them to do this starting tomorrow. It happens when there's a system around it. And that's what the show is about today. My guest today is Jamie Rosen, my co Author of iCare Boss, the Business Optimization Scalability System, and somebody who has spent years putting these concepts into practice in his own practice and in the practices that he has served and supported. So side by side with me, in some cases, Jamie and I built BOSS Business Optimization Scalability system around this exact challenge. How do we take lots of good ideas and turn them into sustained execution inside the practice? And because BOSS isn't just a collection of growth strategies, it's a system for helping practices improve through accountability. People, revenue, patient experience and data all working together. Today we're going to show you what all of this looks like in a very practical way. I'm going to break down the framework that we teach for real behavior change in a practice, the same framework we've put to work in lots of offices, including Jamie's but also lots of clients, members of our accelerator program. My masterclass, the behavior change framework that we teach you, we're going to take you step by step through how to identify the right opportunity, quantify it, decide whether the opportunity is worth pursuing, getting owners in it without question, causing chaos for the practice manager or practice owner, creating the right cadence, observing what people are actually doing, giving feedback. There's a whole mechanism to this whole framework. And then after we show you the framework in the first half of the episode, we're gonna turn it into something that you can apply by showing you how we take some very common problems and practices and pulling them through the framework. So the two problems we chose to focus on are referral systems. Everyone wants more patient referrals, right? So how do you build a real repeatable system that generates more patient referrals? So we say, okay, that system is going to require behavior change. We're going to put it through the behavior change model and show you how that works. And second, let's say there's an operational problem. How do you potentially fix this very expensive leak of when your practice isn't collecting correct out of pocket amounts from patients? Two completely different problems, same behavior change framework. And that's what we wanted to show you today. And I think the important takeaway here is that once you have a system for execution, accountability, behavior change in your practice, you stop depending on good intentions, random follow ups and owner time, more time from the owner, the practice manager, or the personalities pushing every initiative forward. When you stop doing that, you start building a practice that can actually improve itself and actually run itself. And if this resonates with you, listen to the episode. And for more resources, you can go to icareboss.com, you can download free tools, actually you can get access to our masterclasses, learn more about the complete ICARE Boss system, and find ways that Jamie, myself and our team can actually help you implement some of these concepts inside your practice. As always, make sure that you're subscribed on YouTube, Spotify, Apple Podcasts, or wherever you listen. And if you have questions, ideas or feedback, reach out to me@eugene shotsman.com can't wait to hear your feedback on these concepts. Let's get into it. All right, Jamie Rosen, welcome back to the Power Hour.
- [04:41]
B
Good to be back, Eugene. How are you?
- [04:43]
A
Good, good. And it's by request. So a couple months ago we did a session where we dive dove deep into one of the components of the ICARE Boss system and we got a lot of feedback on that episode. And people have been asking you to come back so that we can discuss more of the concepts that are in the book. And of course, what's happened since that episode is the book's been out on the market, which has been really fun.
- [05:10]
B
Yeah, A blast. And, and, and honestly, more, more books sold than I would have anticipated. I, I don't, I don't know quite what the number is, Eugene, but It's
- [05:22]
A
just over 2,000 so far. And this is like the book's been out for less than two months.
- [05:27]
B
Yeah. And, and, and to think about the whole IB system was really just an aha moment by you and I when we've, our first accelerator cohort had indicated that I, I, these are great ideas, but I don't know how to apply them because I'm having trouble managing my people. And we were like, oh my God, you know, the emoji on your phone, hand over the face. And it was really that, that we sort of dug in and said, we can't just give, you know, tools and strategies for just growing your revenue revenue or saving money in the practice, but we actually have to come up with a system to how do you manage your people? And that was really the origin of the iBoss system. Yeah.
- [06:13]
A
And I think that that was like the, oh, because we, we went in saying, hey, there's over 100 different ways to grow your practice and we're going to teach you as many as possible in as little time as possible. And we thought we were delivering value, but what I think we were delivering was more of the infotainment category that you and I both hate, which then turned into a. Okay, but we really want people to implement stuff, so how do we actually make that happen? And so that's when the five systems of the iCare boss were born with. And boss, by the way, for those keeping score, stands for Business Optimization and Scalability System. So what is the point of a system that helps you optimize and scale? The point of that is so that your business can run itself without more application of talent from you and your business can improve itself and grow itself without necessarily you having to work tons more hours or burn yourself or your key members of your team out. And that all happens because there are five components of the ICARE BOSS system all working together. Yeah.
- [07:23]
B
And, and I would say the feedback. So keep the feedback coming for those that are listening and have. But the, the feedback has been great. I heard from one doctor who said, you know, holy crap, I wish I had this book 20 years ago, so. And that's super. I mean, the idea here is, you know, helping the industry get better, which I'm passionate about, and I know you are as well, Eugene. And it's, it's kind of cool when you can see that impact. It's really. It's humbling. It's freaking cool.
- [08:01]
A
Well, that's quantifiable too. So just again, for. For those keeping, keeping track, the five systems of the I Care Boss are accountability, revenue, which is where we put all of the growth ideas. And then we have people and we have patient experience and we have data. So those five systems working together and, you know, we've done a deep dive on the people system before, and we've talked a little bit about some components of the revenue system. But those five systems working together in a practice, they deliver significantly better results than just saying, hey, we're gonna try to get more patients in the door. And by the way, I think we do have some data. I know, Jamie, you added up some data from a cohort of practices that we kind of supervised implementing these concepts over the course of last year. And that data just came in. So how'd they do?
- [09:03]
B
Yeah, they did well. It was great. So I wasn't sure, so I looked at the data and I mean, we had a range of. Everybody was up in the cohort, which is interesting because that's not necessarily what we're seeing in the industry. But if we looked at the average between that cohort, which represents, oh, call it 30ish locations, let's call it 30 docks, refractions up almost 20%, 19.7%, and revenue on average up 24. And the highest was up 82%.
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A
Yeah, that. That was wild. But that's so it.
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B
So it is. Like you can, you can. And that's really what I was curious about. And because one of the things that's so important about the iBoss system in my mind is the question out there is for me is, is this repeatable or is it something that I did, unique at Rosen, that, you know, something about my personality versus just the strategies and then the discipline and executing the strategies. And what we're seeing is we're taking against a backdrop of an industry that's flat right now. And from a revenue perspective, and down in refractions, a pretty healthy percentage. Single digit. I think it's single. Single digit. To see this cohort, on average, up 20, refractions 24 revenue is. That's pretty predictable. That, that's. For me, that's reassuring. That we're not selling a bag of goods.
- [10:43]
A
Yeah. And I think that's the, the other part of the whole system, and this is why I think it took so long to perfect is that I don't think we just put ideas down on paper. The whole concept of hey, it's, it's also a toolkit. There are, every single chapter comes with things that you can, you can scan a QR code, go on icareboss.com download the tool, learn to use the tool, apply the tool to your business so that again, it gets out of like our mistake, which was the infotainment mistake, like, oh yeah, this sounds great, I can never do it myself. To the, to the. Okay, like let's make a goal, let's implement. And so with that in mind is actually the topic I thought our audience would enjoy today for like pulled out of the eye care Boss chapters. And so instead of going deep on one particular, we'll call it subsystem. Right. There's I, and again, there's accountability, there's revenue, there's people, there's data, there's experience and the patient experience. And each one of these can be hours and hours of conversation because there's concepts, there's subconcepts, there's things you can do. Well, whatever I thought, okay, if we're going to make the best use of our audience's time and we're going to teach them something that can really help them get out of a problem that they have. I'm going to kind of give you this nugget, Jamie, and then we're going to, we're going to go into it that we surveyed. So we, we took a survey of the people coming to the Icare Boss Live event. So the people who are registered, the event is sold out. Unfortunately for everybody, if you haven't registered, there's always next year. But the, but the, the. We took a survey of the people who are coming to that event and, and we said, hey, where are the biggest areas where you need help? And we kind of asked. It wasn't just a 10 question survey, it was an in depth survey so that we can make sure that the event is, they're placed in the right groups and the event serves them well. By the way, if you are coming to the event, make sure you fill out that survey because it will drastically impact your experience at the event if you do it, if you take your time with it. But the early results from the survey, here's what people keep talking about. It's like I have Ideas. I just can't get my team to do the ideas. We have cool things we want to do in the practice, but we have a problem with what they call accountability or the ability to implement things or the ability to see things through. Or we just get an idea off the ground and then we're kind of off to the next idea and the first idea falls, falls through the cracks and, you know, we thought we had it, but then, you know, a year later we come back, look at those numbers, and nothing really happened. So.
- [13:39]
B
Yeah, yeah. So, and, and, and I think it depends on what you're implementing. But if you're implementing marketing, there still is that. So I can see where you're going, Eugene. It's just the idea of how do we change behavior?
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A
That's it. Like, that's.
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B
Yeah.
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A
And everything is about behavior change. You know, it's like if you want to get better, it's about behavior change. If you want to install a new initiative in the practice, it's about behavior change. If you want to go from being a two location practice to a three location practice, there are a lot of behaviors you have to change. And that's not just on the staff, it's also on you as the owner. And there are a number of systems that you kind of have to activate. But there is a universal process that we outlined in the book. And I learned it from you, Jamie. And that's why I like. And I've now applied it multiple times throughout my career. And our organization uses this a lot. And we've heard this validated from cohort after cohort of our group coaching clients that they hear that once they learn how to adapt this system, they can make behavior change more possible in their practice. And so I thought maybe let's not do like the three hour explanation of this process that. But let's, let's do like a quick. What I think we could do is we could do a quick explanation of the behavior change process. We could then talk about how it links to a few other concepts in the book. And then we can take a few things like I want to X in my practice, and then we put those through the process. So we'll describe the foundation, the framework in the beginning, and then we'll take real initiatives. And I know like one real initiative I wrote down is like, I want to get more referrals, for example, from patients. I want to get more patient referrals. I want to have systems of patient referrals. Okay, cool. We'll take that through the process. There's somebody. Another one I wrote down was, I, I want to stop making mistakes with billing, managed care.
- [15:55]
B
Huge issue. Right Issue. And that one, you know, we looked into this at Rosen pretty significantly, and what most practices find is you don't undercharge the patient 50% of the time and overcharge the patient 50% of the Time because it's hard to interpret what the patient out of pocket is. It's more like 80% you're undercharging and 20% you're overcharging. It's like crazy. So it's meaningful money is the point. So I get. That's a good one.
- [16:24]
A
So, so we're going to just pick, pick a couple and if we have time for more, we'll do more, but we'll just pick a couple. What I'll call like, take home money makers. Like, real opportunity that's on most people's tables. Like, either most people listening aren't going to be like, oh, yeah, I'm absolutely fantastic at generating patient referrals in five different ways every patient visit. Like, no, you're not. So, like, we'll talk about how you do that, but you can't do that without behavior change and accountability. So we have to introduce you to the behavior change and accountability first, which is kind of what the whole concept of ICARE boss is all about, is that you have these systems that work together, that address the people, the data, the, the accountability and the revenue side of your practice. And so let's put it to work, Jamie. Let's, let's talk about your, the behavior change process in maybe like an executive summary style.
- [17:18]
B
Yeah. So I think the, so the, the change management flow starts with the executive team, whoever that is in your practice, taking time to work on the business at least once a month for sure. Quarterly, you're going to use some of the, some of the things you've been doing at least once a month because you're going to stack up a bunch of ideas you have. And so it first starts with just ideating with your executive team, how can we get better? What opportunities are we missing out on? And then going into the detail of looking at how the practice is performing on that particular thing today. And then if you made small changes, like 5%, 10% improvement, how much revenue is that going to bring in the practice and is it worth the trip? So basically brainstorming and then looking at how the practice is performing today, and then what if we got 5% better? What would the impact to our revenue be in the practice?
- [18:18]
A
So I'm going to say back to you. First thing I'm going to do is I'm going to come up with a bunch of ideas with my, as a team, with all the different ways that I can improve the business. Adding dry eye, improving my exam, only improving referrals, getting better at staffing, multiple pair, whatever, right? Like, I'm just all those different things, right? So then I, I did that step one. Step two is then I go look and see what data I have for all those things so I can baseline and figure out how I'm measuring those things and how I'm doing across those things. So if I'm saying I want to get better at dry eye, I might be doing zero dry eye, I might be doing, you know, five cases a month, I might be doing whatever. But like, you know, I have to define what the, the current reality is versus the desired reality. Now, you said then forecast 5 to 10% better. Why 5 to 10% better?
- [19:17]
B
Well, so it's got to be small incremental improvements. It's really hard to get 50% better. I mean, you can do it over years, but over quarters, which is what we sort of are looking at. And over a year, if you're making a 5% improvement in a human performance area, it, you'll see it takes a lot to change behavior. And oh, by the way, guess what word, Most of your staff hates change. They don't embrace it. It's just not inherently human to embrace change. And so by taking the increment, it's incremental improvements that get the practice to optimize the revenue or whatever you're focused on. So that's realistic. Can you get 5% better in a quarter? In a year? You can. That's doable. Can you get 50? That's just not doable. At least in my experience. It's not.
- [20:12]
A
Yeah, but what about. And this is where, you know, I think I want to make sure we clarify what about where you're doing zero of something and you're so like, I'm doing zero dry eye. And I am trying to figure out whether that investment of a, you know, 30,000, 50,000, $90,000 piece of equipment makes sense. Like, what do I forecast? Do I take the rep spreadsheet and say, oh, I will, you know, I'm going to be a gajillionaire because I. Because I'm able to go from here to a fully aspirational.
- [20:45]
B
Yeah, no, I think you have to look at the population of kids. You see, you have to dig into Some work that'll be somebody's work to like how many kids do we see? How many of those, if you have the time, how many of those are statistically how many of those are going to be at risk for myopia? High myopia. Right. And then you start making calculations on what if we can convert 10% of those kids in like dry eye. That's going to be incremental improvements from 0 to 5 to 10% of your kids population is like not nothing is. Depending on how many kids you see could be a lot of money. We used to, we used to look at it from a LASIK perspective and if, and we knew about 2 to 4% of all of our routine exams were interested not in getting new glasses or new contacts, but getting out of contacts or glasses. And so we would have a goal and we would look and we had and we got better at it. We knew our conversion rates from referral to console to Lasik. And so you'll start to get better at it. But we had to take a stab in the, in the dark. And so we, we budgeted how do we convert 5% of our patients into Lasik? That would be.
- [21:57]
A
So it's actually, you answer the question. So whether I'm doing dry eye, I'm doing myopia, I'm doing Lasik, all of those are. I'm going to go. My incremental is. And I'm getting, it's really, I'm going 5% better by saying I'm going from 0 to 5% to 0 to 10%. Not, not like. But, but it's of the candidates for it. Okay, fine. So we've answered that question.
- [22:19]
B
I would say even more important if it's a new line of business because you're going to learn a whole lot of stuff about your people, about what your needs are. So. And the idea here is it's got to be worth the trip. So worth the trip could be you talk to your colleagues about what percent of their patients go into dry eye and you're not going to start there, but you're going to be like if we just get 5% of the way there and then 5% more on the way that we could have double digit growth in myopia management for the next five years. And oh by the way, we may get super surprised because once we understood and learned we actually got 15 better in a year, like that was our experience, we would start to accelerate what worked. And you know, these improvements continued for a long period of time before we
- [23:07]
A
flatline and I've seen the same thing happen with clients is that. But this is where you kind of have to have the change management component because so again, step one, I brainstorm. Step two, I make sure that I can quantify the things I'm trying to change. Step three, I forecast and say if we got 5 to 10% better in this category, whether that's going from 0 to 5 or from 25 to 30 or whatever that is, is it what's the what's the revenue impact? And then you have to decide maybe like force rank all of these things to say which one is worth the trip. And would you include like degree of difficulty somewhere in here in the worth the trip question? Because like to me getting I don't know, 5% better at Fundus photo capture rates seems way easier than getting 5% better at exam only. But exam only is probably has a higher payoff than.
- [24:04]
B
So once once you think it's worth the trip, then you're going to go into refining that whole process. Right. So that is. So instead of running to roll this out what the next step is, you're going to have a smaller group of team of people including who you think would be the point person on this initiative. The point person isn't usually your best person. It's usually somebody that as respect of the practice gets along with, you know, has respect to the doctors, has respect to the. Typically like a manager for the first one. But in that, in that next phase, once we've identified this is worth the trip, your referrals you're getting getting 10% better or getting 10% of your. I'll make it up to make it really easy. Like in a low like this is not high risk. If I could get 10% of my patients to refer two patients. So how many of my patients love my practice? It's probably more than 10%. But I'm just saying can you get 10% to refer you two patients a year that basically that's a 20% increase in your practice volume. Now you're going to go dig into how are we perform. You saw how you're performing now with that referrals is tough to know exactly what you're doing unless you're tracking it. But aspirationally you could say if I can get 10% predictably to refer patients, it's a 20% increase in heads through the door. That is a big number for the practice. That to me is worth, you know, probably hundreds of thousands of dollars. So that's worth the trip. Now I start Meeting with the team, that's my executive team plus the point person. And we're going to start plan. One of the things we're doing is we're going to continue to look at how we're performing during that period of time to identify and refine the goal. So we may look at it and say we're going to refine it back to 7%, we're going to get 7% better at referrals, getting 7% of the patients to refer us to, or you might say 15% of the patients. So that's where you look at the level of difficulty, Eugene, when you start walking through what is, what are the. And this group, you're not rolling it out yet. You're actually looking for like, maybe it could be a month prospectively at I'm looking for the behaviors that I think are going to lead to more referrals. So in your group you're talking about what are the behaviors? Well, you know, you might do some research on it, but you're refining the goal in that step and you're doing some other things. You're identifying who the point person is, what the goal is, and then our presentation to the team when we get to rollout.
- [26:38]
A
Right.
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B
So this is the step that a lot of people skip. They get very excited about an initiative and, and they run to implement it, but they haven't thought through how are we going to measure it, where are we going to get the measurement tools, what's the flow of traffic through the, through the practice that we're going to be able to tell? People are starting to adapt the behaviors of what it takes to get a referral and what is our hypothesis on what those are, what those steps are. So you're mapping that out, what are the metrics? Then you're mapping out what's the cadence of meetings. And then you do your presentation to the team and you're now in rollout mode. Now that you know kind of how you've been performing for a little bit of time, you know what's in it for the practice. If you deliver now, it is full blown implementation. And then we teach you a little bit about what's the cadence of meetings. There are different meetings with different amounts of time that you will need to continue to meet with. And this is what, this is where we thought we would start. We would talk a little bit about, well, how do I integrate that using the IBOSS system? Right, right.
- [27:41]
A
Well, that's, and that's a perfect example of like, okay, so change management has to do with people in many ways. Right. But it also has to do, as you pointed out, with data, because I can't. If I don't have visibility from a measurement standpoint as to whether the change is going well or not, then I don't, you know, then I don't know what I'm doing. They probably shouldn't do the. And I think you would say probably daily visibility depending on the significance of the change. And then the other part of this is accountability. So, like you've got meetings that you've got to have. So what does the accountability system teach? At its core, it teaches you how to set goals for the practice. Right. But in order to set goals for the practice, you have to back up and say, what kind of practice do I want to be? So we teach you how to write a clear vision for the practice. Then we take that three year vision, we turn it into one year goals, and then one year goals break down into quarterly goals, which is nice because you take those quarterly goals and you say, okay, this is the behavior we're looking to change this quarter. And then probably that's the behavior we want to reinforce and get better at the following quarter. Right. Like it's. And so those, some of those quarterly goals. Right. But when you have those quarterly goals, then you can have specific meetings. And then again also another part of the IBAR system, we teach you all the boss meetings you need to have in an eye care practice. So whether it's the daily huddle you have with your team, whether it's the quarterly retreat that you have with your leadership, whether it's the, whether it's the weekly boss meeting where you go through a whole bunch of stuff. And one of the big things that I love and is actually the first place I like to start with practices is, is which solves a large part of the accountability problem in many practices is issues and documenting opportunities in the practice. And so if you have this framework of, hey, behavior change, chances are, when you're mapping out all the steps that you were talking about, Jamie, like, the fact is, I'm not gonna know all the unknowns that happen in the practice when I'm trying to change this. So I, I can anticipate some of them, but my staff should have freedom to raise their hand and say, I found an issue and an issue is kind of an opportunity to improve. And so I'm going to document the issue, I'm going to put it on an issues list, and then that issues list, it, it feels good to me to put something on an issues list, because I know that issues list will be brought up at the next meeting that we have. Now, think of what we just said. We said there's structure, that there are specific structured ways for somebody to raise their hand and say something's not working. I am not going to go interrupt the owner. I'm not going to go interrupt the practice manager. I'm not going to just sit here idle. I'm going to put it on an issues list and I'm going to use that information in the next meeting structure or in the next meeting that we have. So if you don't have the right meeting structure, if the meeting structure doesn't measure your progress towards goals, if the meeting structure doesn't allow you to talk about issues freely, then you're going to be back in this accountability in. In a. We'll call it like a morass of accountability, where all that's happening is the random checkup of, hey, how's that going? Are you getting any dry eye patients this week? Anything? No. No. Okay. Well, you know, okay, let me know if you get anything right like that. That's the. If you don't have that, if you don't have data that you're reporting to at specific meetings, if you don't have a way to look at the issues specific to you, say, oh, the data is not looking so good. Maybe we should make that an issue. Okay, let's dig into that issue. If you don't have a process by which you solve issues, which we also teach you in Icare, boss, We call it the paste framework. I don't think we have time to go into it today. But, like, all of this fits together to say, hey, there's an operating system to roll out change that follows Jamie's process of figuring out what you want to change, then going through, identifying whether. It's like, what's the benefit of rolling out that change, Getting everybody bought in, assigning key people to it, and then tracking, measuring and identifying how you rolled this out to the organization rather than just kind of a random shower thought.
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B
Yeah. So those meetings are really where the issues are discussed. So in this referral example, one issue that might come up is, well, we don't have anything to hand to the patient to have them refer a patient that might be an issue. And then you talk about it, and then you, you figure out how to solve that. Well, we're not really sure how to. I see that as I observe the staff, the team, they're not comfortable introducing the notion of referring patients and so we have to, you know, so that's an issue. Then we got to solve for that. And slowly but surely you start addressing all the issues and you start to tackle issues. And as you tackle issues, you magic. It's called work. You see that your referrals get a little bit better, and then when you see it get a little bit better, part of the change management system is reinforce that by giving huge compliments to the person that made just a minor change in their behavior to influence the referrals.
- [32:46]
A
Okay, wait, wait, Jamie, we're going to take the referral, since you're on that. And I'm going to put it through the whole system. We're actually going to go through the whole process. We're going to take referrals. You're going to take it one step at a time, put it through the whole system, just like you were saying. And. But we have to take a break first. So right after the break, we're gonna go talk about how you drive behavior change with referrals. Hey there, it's Eugene and I wanna let you in on something. So you've been to conferences before. You come home fired up and then Monday morning hits and it's back to the grind. The ideas don't stick, the plan never gets made, and six months later your practice is in the same place. So I know that pain. I've been to those conferences with you and. And that is not happening at this new event called ICARE Boss Live. You've heard the story of ICARE Boss and now there's an event, Icare Boss Live. It's September 16th through 18th in Cleveland. Two and a half days. We're bringing together 200 of the best practice owners in Icare for a one of a kind event that combines speakers, peer learning, mastermind groups and industry innovation, all designed around one goal. You leave with a 90 day plan and you can actually execute it and get stuff done. And we're going to tackle some real stuff. Exam only rates, revenue per patient, people, problems, leadership, AI and technology, specialty growth, the things that keep people up at night. We're going after it and we're doing it in a room full of practice owners that are just as serious about growth as you are. This is not a conference, it's not a seminar. It's something different. There are only 200 spots, so if you want to be in on this. This is not publicly announced, just on this podcast. Go to thepowerpractice.com click events, click apply now. This is invite only. It's not for everybody. So you have to apply. We'll ask you a few questions, and if it's a fit, we'll invite you to register this event. Icare Boss Live is going to sell out. Do not sit on it. I invite you to apply right now. All right, we're back from the break. I'm here with Jamie Rosen, my co author of Icare Boss, the Business Optimization Scalability System. And Jamie, we're having a really interesting conversation about behavior change, which I think is a critical ingredient to growing any practice. And I think the goal is to show people how to apply it, how to take this framework and to apply it to things people want to see, people want to get out of their practice. So one of the concepts we cover in the revenue system is referrals. And, you know, when you ask practices, hey, how many of your patients come from patient referrals? People typically say, oh, like, quite a bit. Right. And then new. New patients coming from referrals. Yeah, quite a bit. But the, the question becomes, well, how many practices actually have systems in place that they're asking for referrals? And you know, as our mentor Jay Abraham would say, how many people have more than one, how many people have more than two, more than three? Because he has come up with over 100 different ways to ask for referrals and to build referral systems. And so we share some of those in the book, but I think, or the ones that we think apply most closely to the eye care industry. But the interesting part for me is that you can have the greatest system in the world. It still depends on people. And so this is a good example that I wanted to run through and say, okay, well, let's take it from the top. I am meeting with you. We are leaders in the organization of power Hour eye care. And at the Power Hour eye care, in the power eye care world, we see, I don't know, 3,000 patients a year. And currently we have no referral system. So let's quantify this thing. Right?
- [36:47]
B
Yeah. So we did and we said, you know, if we can get 10% of our patients low bar, like 60, 70% of our patients give us five stars. 80% give us five stars when they go to Google. But we're not looking at 80%, we're looking at 10%. And then during our initial investigation, we said, if we can get 10% better, that is super worth the trip. And then when we started to plan for this rollout of the initiative, we lowered it to seven and a half percent.
- [37:23]
A
Okay, hold on. So I'm gonna do it live with you, and I'm gonna say, okay, I'm gonna do seven and a half percent of my 3,000 patients. So that's that work. Sorry. 0.075 times 3,000 works out to 225 patients. Yeah.
- [37:40]
B
And our revenue per exam is.
- [37:43]
A
So. And what am I saying? They can review two or they can refer two patients a piece.
- [37:48]
B
Yeah, two patients.
- [37:49]
A
So two patients apiece. That means I get an extra 450 patients a year from that referral system. And let's say my average revenue per exam at Power Hour Eye Care, I'm not doing anything crazy. Maybe like 400 bucks an exam. So that works out to an extra $180,000 a year in revenue for. For. For referrals. Okay. I would say that's worth the trip, Jamie.
- [38:15]
B
Okay. Right. And so now we're. Now I'm going to be the point person, and for the next four weeks, I'm just going to try and observe my people systematically to see what they're doing now and make myself convinced that I'm good on the seven and a seven, seven and a half percent. And then I start, start, start coming back with some, you know, what. How are we going to track it? So now I'm developing how we're going to track this thing on it. And when I say track this thing, it's manually. I mean, it's like you're. You have to know where you're at on. I'm the lead. I got to know where we're at at all times on referrals. How many referrals have we had today, Jamie? If Dr. Shatzman asked me, I'm gonna, I'm gonna be able to tell him how many referrals we had today. What's our goal for referrals per week, per day? I'm gonna put that in the break room, so I'm ready. And what's our meeting cadence of meetings? That we're gonna talk to our staff? When you roll something out, if you are used to running from idea to no prep and rollout, what happens with your people is they learn that if they just, you know, lay low, don't say a whole lot, this, too, will pass, whatever the this is. And so by laying out the meeting cadence, you are basically setting the tone that we are going to be really, you know, dogged about getting after this goal because it means a lot to the organization. I'm also aligning incentives because my people, if they're going to help contribute to $180,000 of incremental revenue I have. There's got to be something in it for them. That's the other thing I'm doing. And then when all those things, those I's are dotted and T's are crossed, we are now ready for the rollout. And the rollout is letting your people know what the goal is, why we're doing this. And that would be. Dr. Schatzman would be talking to his team. Everybody's in this meeting in the company.
- [40:17]
A
And I would say something like, by the way, if I'm talking about referrals, I'm saying, look, as a team, we're all united behind the premise that we are the best eye care provider in our area. We strive to provide the best possible service. We strive to make sure that we take care of our patients like no other. We have some amazing technology here that most of our competitors don't have or don't use. And in most of the eye exams, we have a ridiculously good reputation. We have services around dry eye and myopia management. So we have all these great things that we can offer to a patient that your typical corporate chain can't. And we really do believe that it is our responsibility to take care of our patients in the best possible way. And so, by the way, that's another concept in the eye care boss book called preeminence that both Jamie and I learned from Jay. Jay Abraham. But because we believe this, it is also our responsibility to make sure that the loved ones and the friends of the patients that we serve have an opportunity to experience this same exact thing. And we're truly sorry.
- [41:32]
B
And I think aside from why this is a fit with the practice, which is what the, you know, owner is talking about to the team, I would also be chiming in a little bit with. And guess what? We have no formalized referral systems. So we're going to start with this particular referral system of this particular segment of your. Of who you. Who your population is. So it could be age, it could be by what they spend, it could be how frequently they come back to the practice. You pick and you. And you're going to have more than one, because our goal for you guys to have at least five different referral systems. But the point is you're going to start with one. And. And so that. So this. This meeting with staff is going to go through. That was the why, which is super important. The why is really very important. And Eugene kind of nailed that. And then the fact that there's an opportunity here. And then what's the main cadence of meeting? So we're going to meet every day for five minutes. We're going to have a weekly 30 minute. So we're going to pay you to come in early five minutes. So the day that's mandatory, we're going to pay you. It's part of your salary or your, your pay for the week, your 40 hours that you work. It's 30 minutes of the weekly review and then we're going to have monthly reviews. So that's the end quarterly. Right. And our goal is to get to 7% by the end of this quarter. So that's. And then those questions, right. You're gonna obviously pause for questions and your team's gonna be sort of like a little dazed. I think if you don't have you take this approach, usually it's pretty well received and they're on board. So then we talked about the fact that work. The small team that did the pre rollout preparation is going to continue to get together on a weekly basis during the L10. And one of the things they're going to go over in that 90 minute meeting is or the hour meeting. I've heard people have morphed it to an hour, but we recommend 90 is. How's it going on referrals, Jamie? And I'm going to say, well, I've been watching and really everybody's super uncomfortable with referrals. We have to help them with what words they have to use. So that let's drop that as an issue because we're off track. And we're going to talk about that for 10 or 15 minutes until we get start riffing on all the different components that we didn't get in our pre meeting prep that we need to get in place. Now does that make sense? And then we're going to take that back to the team. Right. And if you had to get cards printed out, that might take a week or, or 10 days or whatever, but then we're gonna roll that out in our 30 minute weekly review next week. What we're gonna try to do is use these referral cards and I set up a Google Docs. So you just hand me there's a list, you just put the name of the patient and how many referral cards did you give them? And I put them in the Google Doc. And if and what we created was a card that the patient that's referring puts their name on it. On the other side of the card is the referring patient's name, that referral patient, the patient referring. So patient one is our patient and that patient has agreed to be in the referral program. And they're giving this card to their neighbor. The neighbor's name goes on that card and it gives the neighbor. I think we get 20% off an eye exam or something. That was not a whole lot of money.
- [45:15]
A
I think there was a specific dollar amount I think is what we tested that worked out well.
- [45:19]
B
So and then when that patient comes back in, I put them in the Google Doc and I can tell what we've made on, on that referral, for example. So that wasn't. We didn't have that in the pre meeting prep because we didn't know that we didn't know. But we worked through it in this issues list and we came up with five things and next week we might have another five things. But that's how the weekly leadership meeting goes. So they don't necessarily spend the entire 90 minutes on referrals, but they might spend 30 minutes on at the beginning and.
- [45:50]
A
Right. Especially if it's not working. Right. Like it's an issue. It's not working. Okay. And this is where again, the, the joy of having a practice that is self optimizing and self scaling for the owner is in this case, if my practice is running on the boss system, I sit back, I, Dr. Schatzman sit back and I let my team talk and brainstorm ideas rather than me saying, well no, no, no, you guys have to do it this way and you have to do that because it's now my problem, it's no longer my problem. We've all committed to solving this problem together. And then you start pulling people in and having them come up with solutions. And the truth is that, you know, maybe I think I know better and maybe we might even go with my solution. But my team reaching that solution because they reached that solution, not because I told them, gives them the opportunity to be way more bought in, into the implementation.
- [46:42]
B
And so in this hypothetical boss meeting, somebody in the room, and it wasn't me, the point person, it wasn't Eugene the doctor, it was one of the other staff said, hey, I know, why don't we try looking at the chief complaint and when the patient is coming back to have their eyewear delivered, we're just going to say address that chief complaint. How is that vision in the distance that you were complaining about? Great. Well, if you know anybody else that has that kind of problem, we'd love to see them. And here's my card to refer them to in the referral card basically. And we would come up with that in this because we didn't have it in the pre meeting but now we're in it and we're seeing the realities of it. And so that would be something I would then roll out and we would. Then how are we going to track it? You know, we have to answer those questions. How are we going to incentivize it? What are the incentives? Are they aligned? And that same process continues week in, week out, if that helps. I hope that helps.
- [47:46]
A
Yeah, no, that's exactly Other issues that
- [47:48]
B
pop up that you're going to address in this meeting.
- [47:53]
A
Yeah, and I think that's. Jamie, that's exactly it. That and I don't know that we have, we have nearly enough time in this episode to go through all the different referral methodologies and technologies that are available to handle it. But what we just described is a simple process of behavior change that sounds like okay, we should get more referrals but that being implemented in a way that actually sticks in a practice using cadence of meetings, using an explanation of the why and getting your people involved.
- [48:25]
B
And, and this is what we cover in the I when if you enroll. It's shameless plug. But the point is we would spend an entire 90 minutes on how do you come up with IDE ideation on different segments in your practice to refer so that, so there's a lot there and you can read the. And in the book I'm sure we have examples but, but, but that's how these two things, the revenue and the constantly ideating, checking how the practice is performing now, checking on what 5 to 10% improvement gets the practice then going through arriving at this is worth the trip. This is going to be an initiative and spending the time to to do the pre meeting prep before the rollout and then the rollout with everything that we just sort of talked about in terms of what are the important incentives, what's the meeting cadence, why in the heck are we doing this in the first place? And then how the meeting cadence follows. So hopefully that becomes more crystal clear to people listening. Yeah, that was the intention.
- [49:39]
A
This is great for a new initiative. Now I think in the a few minutes that we have left today I wanted to quickly run through and just pick an operational problem. So you mentioned earlier that you think that people are generally under billing and cash out of pockets not being collected that should be collected at the time of exam. And I know you've seen data inside of a lot of practices, a lot of locations that support that hypothesis. So let's say you were going to take that operational problem, which is very different than a, a sexy new initiative that, you know, that's, that's got a lot of dollars dangling from it because, you know, again, whether it's referrals, dry eye, myopia management, whatever those things are, it's kind of like, okay, we really get excited about implementing that. This is like, I want to get better operationally and I want to, and I want to not let opportunity sit on the table or, you know, burn in a. Burn in a dumpster versus what I could potentially be doing. So let's talk about that one.
- [50:42]
B
So that was, and this is a problem in a lot of practices. Why? Because our systems are not fantastic at calculating what the patient out of pocket is for all the various managed vision. Well, vision care programs. You guys see, we, that we all see. And so that if that, so in this situation, if we were to address that, we would first be curious. I've never, I heard this podcast and I heard that one practice was their experience was they were under charging patients 80% of the time of the, of the missed charges. If I went back and graded the managed care 80% of the time we're undercharging, 20% of the time we're overcharging. You have to rectify both. It just happens to be a really painful experience when the patient shows up to pick their eyewear and you're like, I kind of missed the calculation and you actually owe me more. So that aside, first thing we would do is identify how we're performing now. So that would be whoever. And it probably isn't the operations, probably isn't the manager of the location that's going to be riding point on this. It could be somebody in whoever bills for you, but they're going to spend some time and the point person that's on the floor will do the same thing. They'll lean in and they'll try to look, start going through third party claims and doing the math and seeing are we under billing or over billing, Overcharging. None of them are good. You want, you, you want to be charging the exact amount. You don't want to overcharge, you don't want to undercharge. But generally third party prep, they're not real sensitive to you undercharging their beneficiaries as much as they are overcharging. So both are important. And you would start digging in to identify how's the practice performing today and then you would Validate what the. If we were to correct the overcharges, which is important to do, and correct the undercharges, what's the net revenue gain for the practice and is it worth the trip? In my experience, people do not look at this or they eat it and they don't track how much they're eating. So that would be the next step, right? Is this going to be worth the trip? And then if it's worth the trip, then you're going to start to develop tools in your pre meeting prep. And the same, you're going to go through the same elements. What's the cadence of meetings? Why are we doing this? What are the incentives for a job well done? What does that look like? And what's the goal? How much better are we going to get? 5, 10% better, perhaps? And what tools do we need to create? I mean, I've seen practices create tools that are just these auto calculators that are just simple Excel spreadsheet things that people keep open on their desk to auto calculate what the frame out of the, out of pocket would be. You may find that you have some opportunity to change some of the pricing of your frames because you're under, you're not making enough money as you get into that, into that drill. But that's, that's, you just keep following the, the facts and the irritants and try to eradicate all the irritants through developing tools or better behaviors. It's the same process. Right. So is that helpful, Eugene, or.
- [54:04]
A
Yeah, that's. So that's exactly it. And what I was trying to, what I was trying to highlight is that operationally it's the same thing. It's, you quantify it. Once you quantify it, you understand how big the opportunity is. Once you understand how big the opportunity is, you commit, you commit a key person to it. You go through a rollout plan, you observe behavior. Now one thing we didn't need, I think you, you, you said it multiple times, but I just, I don't think we highlighted it enough is that behavior change only happens when there is feedback. One way to look at feedback is looking at the numbers on a weekly basis. Another way to look at feedback is to, and we believe that your point person, and when Jamie was my point person on referrals, he said it a couple times. I just want to point this out for everybody is that he said, I would observe, I would observe, I would observe. Now we teach that you don't just observe and like just kind of sit in the room and, you know, play on your phone while you're. While you're there, you fill out an observation form that is tailored for the standard of what that behavior looks like. So you define the standard, and then you say, okay, now I'm observing for behaviors that closely lead to that standard. And then once you have that figured out, then once that standard, you observe what that standard being followed, whether the person said what they were supposed to say and on and on and on, which then allows you to articulate to someone whether what feedback you want to give them is. When I was observing you, you did this. When I was observing you, you didn't do that. But it also gives you another advantage. Right, Jamie? Yeah.
- [55:42]
B
Well, you start to learn who is do.
- [55:44]
A
Who.
- [55:45]
B
Who is it that's doing it so well that all you have to do is point your. Your worst performer at them. Meaning, hey, I want you to observe, you know, Janice, who. Who does the best job of referrals or best job of pricing and see what she does and tell me what you see differently. The other thing that I would go into. So you. You have. You start to emulate, and this is what makes this fun for your team, because you start to become a learning kind of culture. We learn from one another, which a lot of practices don't highlight. But it's super powerful because. Because you on. On Bonozy, you do have somebody performing really well at some things and really poorly at some things, and the ability to identify what that person that's doing it really well does differently than the person does for it poorly is. Is money for your practice. Because what happens is the performer that's the worst gets a little bit better over time, and you start to shrink the variability which improves your performance. The other thing that we didn't mention is. And, oh, by the way, because we're figuring this out on the fly and we're using the PACE system, we continue to document the process so that once we have perfected it, we have the steps that we go through. So if I want to open up a new location and there's new people in there, we have a document that outlines how do we get referrals, what are the steps? We have, the critical steps we have to take to get referrals. It's documented. You don't have to reinvent the wheel or what's the critical steps we need to do to make sure that we don't undercharge or overcharge patients on their patient out of pocket. It becomes standard operating procedure for the practice. So the D In paste is document. And that's super important because how many times have I solved the problem in one location only to have it pop up in a different location? Who knows? It could be three months later, it could be the next day, it could be next year. And I got. And we're. They're trying to reinvent the wheel in their meetings that they have with their team because they didn't know we solved it in location one and we didn't document it for the entire organization. So I hope that makes sense.
- [57:51]
A
Yeah, exactly. And that's. I think that that's sort of the crux of how all these systems work together. This is why I wanted this episode. And there's a kind of. Exactly what. What. What I think turned out in the episode is that we kind of showed that, okay, we touched on. We started by saying we want to have positive behavior change towards a revenue goal. So we started with. We started talking about revenue growth. Okay, great. Then we said, okay, well, we need to have behavior change. So we're now in the people system. And in order to make that behavior change work, we're going to have to do some leadership development, which is also in the people system. Who is that person? And then from there, we have to set some goals and we have to hold people accountable. And we have to have a way to document issues and have the right meetings, which is in the accountability system. But we also have to be able to measure our success, which is in the data system. And ultimately, we're also observing the patient experience, which is an experience system, because we want to be adding to the experience rather than subtracting it. So this is how it all works together. And hopefully this is why I think, like, this is to kind of articulate the point that you made in the very beginning, Jamie, is that if I just taught you, like, five different ways to ask for referrals in your practice, you would feel completely infotained. You would be like, oh, yeah, that's a really cool idea. I going to tell my manager that she should. That we should have the team saying the following things at a point of dispense, and it will be. And by the way, like, I have zero expectations for whether that's actually going to work, because that's going to go in that list of shower thoughts that the staff are kind of ducking on a regular basis. Right. Like, we could infotain you and give you those five things, but instead, I think we went through this process and saying, this is a systematic approach. This is what your practice needs. Is it Needs. Need systems. Which is. Which is hopefully a quarterly commitment or a regular commitment at a specific cadence to help implement some of these things. And as a. As you said, Jamie, I think there's ways to. Ways to do this yourself, I think, evaluate the process, evaluate the systems, and there's also ways to get help. So, Jamie, always so good to have you on the show. I think we're out of time for today, but this is like, I wanted to think of a concept to demonstrate how all the systems work together, and it just kind of came together so nicely in this episode.
- [60:15]
B
So thank you, and what a pleasure to. Thought so.
- [60:18]
A
Just reading my mind and getting it. It's like we wrote a book together or something.
- [60:24]
B
Yeah, go figure. Hopefully that was helpful and feedback is good for us. So hopefully this landed well with your listeners. And if there are questions or you're stuck on an issue and you'd like us to do this, like, I don't know, maybe quarterly, just take an issue that you're interested in pursuing and you've been struck. You know, we can kind of have you hot seated if you're. If you're brave enough to come on this or just give us your problem and we could just sort of riff through.
- [60:55]
A
That's actually. That's a great idea we can do. I was thinking of doing this at the live event. Jamie is doing a little bit of, like, Q and A hot seats. We have some time on the agenda for people that just kind of step up to the microphone, ask. Ask a question, and then we. We try to work through the problem together. But maybe we can invite a couple people to send a couple issues to us at the show, and then we. We can work through those ideas. We can get some detail from those folks, and then we can work through those issues live on the air with the next system that we. That we showcase.
- [61:32]
B
And it would be interesting to see if we did this over the course of time with somebody that the listeners could see how their. How their development goes. Like, how. What are they seeing in terms of revenue growth? What are they seeing in terms of problems that we can kind of work through? It would be really like a little bit of a longitudinal study on, you know, somebody going through this process.
- [61:53]
A
Yeah, you would really have to be a good. A good, loyal listener, which. And I'm grateful for everybody who listens, for sure, but I think you'd have to be like, oh, okay, like this part. Part 17 of this longitudinal study six years later, you know, whatever.
- [62:08]
B
Maybe not that longitudinal, but yeah.
- [62:11]
A
All right, Jamie, thank you so much for being on the Power Hour. Always, always great to have you on the show.
- [62:16]
B
Yeah, I'm really honored to be on. Thanks, Eu.