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The Cost of Inaction: The Hidden Price You're Already Paying in Your Practice with Dr. Jeff Lewis
00:56:35
Every practice owner understands the cost of making a change, but what about the cost of staying exactly the same?
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- [00:00]
Dr. Jeff Lewis
Foreign.
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Eugene Shotsman
Welcome to the Power Hour, Optometry's longest running and biggest show. I'm your host, Eugene Shotsman. And as we get into today's conversation, quick reminder to subscribe on YouTube, Spotify, Apple or wherever you listen, just so that you know each time a new episode comes out. So you've heard me talk this season about how the data, the industry data that we're seeing is clearly coming at us from two different directions. Number one, our patients, they're more cautious about spending money, so we have to work harder for it. Number two, there's a substantial economic opportunity at the macro level over the next few years for the practices that choose to invest in themselves. And both of these data points require us practice owners, people who work in practices, require us to think about how we take action to move forward. So on today's show, I invite Dr. Jeff Lewis. By the way, Jeff is a well respected consultant, he's a marketer, he's a practice growth expert and has over 25 years in clinical experience. So I invite Jeff Lewis to join me to talk about action. And we take a little bit of a different twist. We don't just talk action, we actually talk about inaction and more specifically the cost of inaction. Now this is a concept that Dr. Lewis developed over the years. And while he breaks it down specifically and precisely for his clients, I thought it'd be very interesting to apply the concept of the cost of inaction at the general sense to a typical practice. So we spend the episode talking about cost of inaction, inaction in answering the phone, inaction and answering it well, inaction presenting well to your patients, inaction in coaching or educating your staff, or inaction in helping your associates do better. We talk about inaction related to patient communication or inaction related to Google Ads or overspending on your marketing or underspending on your marketing. The bottom line is that inaction, which you can think of as being stuck in the status quo, not doing something different, inaction costs you money. And we do some quick calculations during the show and we find tens, even hundreds of thousands of dollars for a typical practice. So as you listen in, maybe, and I'll challenge you, maybe you can quantify the cost of an action for your practice and hopefully it can serve as a motivating factor to help you to take massive action and drive your practice towards your goals. As always, I encourage your feedback. Please go to Eugene Shotsman.com let me know what you think about today's episode. Ask questions, get in touch. Again, it's EugenesHotsman.com or the power Hour website. I love being a resource for you and your practice. And here's Today's show with Dr. Jeff Lewis. Dr. Jeff Lewis, excited to have you back on the Power Hour.
- [02:52]
Dr. Jeff Lewis
I am excited to be here again, Eugene. Thank you for having me.
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Eugene Shotsman
Well, your last episode got rave reviews, so I'm super excited to do this with you. And you know the topic we're going to cover today, this whole concept of cost of inaction. I've heard you lecture on it and I thought it was super impressive material and really interesting perspective. And I kind of realized as you talked that you are truly uniquely qualified in the context of this perspective. And so I'm going to ask you to give the audience maybe just a 45 for those who don't necessarily know you, just 30 to 45 second background on the CV that placed you at this exact moment, at this exact time to be talking about this exact thing.
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Dr. Jeff Lewis
Yeah, I'd be happy to kind of tie this together. And you know, cost of inaction is one of those things that I wish I had known about, like a lot of things I wish I had known about when I started my, when I bought my first practice. And you know, that was 25 years ago. And I've been a serial entrepreneur throughout that period of time and I've owned a couple of practices and along the way have experienced what it is like, I think at every cycle of practice ownership, whether it's feeling like maybe I wasn't running things and the staff was, or listening to phone calls that are happening across the office and having some unbelievable ability to hear over many, many square feet like, and cringe about a conversation that's happening with a patient. But I fell in love and became enamored with really the marketing side of the business, you know, in the overall landscape of business operations early on and you know, at the, in the beginning where digital marketing kind of became something accessible to, you know, small businesses, I found immediate success and hope and developed a passion for the ability to create true, measurable roi. And now fast forward, I've become a marketer and I work with some of the fastest growing and most successful practices in the industry. And so I'm also kind of in the trenches now from a consultancy standpoint for those practices. And so I've had another, you know, another way of dipping my toes into, you know, what is the work that we're doing, how, how does it create a return on investment. But again, most importantly, as of late, I've realized that there Is this, this, you know, this, this component, this, this, this sort of, I think, resistance to inertia that, you know, we call cost versus and somewhat relate some sometimes related to return on investment as well or cost of acquisition. But cost of inaction has become sort of the, a way to kind of interconnect these aspects of the KPIs that we care so much about. And, you know, we're always focused on and, you know, wanting to kind of present and tell a story about the ways that, you know, we can, you know, help these practices that we work with grow.
- [06:16]
Eugene Shotsman
Yeah. And let's zoom in on this concept of cost of an action because I think we talk about, we oftentimes think about costs associated with action and whether it's, I'm going to buy this piece of technology and it's going to cost me X amount of dollars or I'm going to select this building and then I'm going to hire this person. And oftentimes we understand that those costs sometimes have an investment component. But the, the other, the flip side of this, the whole concept of cost of an action. Explain it, please.
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Dr. Jeff Lewis
Well, I think, I think the easiest analogy might be it's a simple analogy that, you know, if, you know, you are at a stage in life where, you know, you've, you've always known that, you know, certain activity was good for you and let's say it's, you know, going to the gym and working out or, you know, you know, developing and evolving an exercise regimen. And it's easy when, you know, things are okay or there isn't so much of a, of a, of a cost of not doing it. But at some point, maybe it's because you've become middle age or maybe you've been to the doctor and, you know, it's been recommended that, you know, or you found out that you had, you know, a certain condition and that, you know, now there was a real kind of, you know, a weightier risk about not going to the gym or not doing something and about it. And I think that that analogy translates to the business world in the way that there are a number of internal factors, internal things that are constantly influx or in motion, and also external influences that are part of what we have to kind of dance with as the life cycle of practice progresses.
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Eugene Shotsman
Well. And, you know, it's interesting that you use that example because it hits relatively near and dear to my heart. It's the, and I've been traveling and speaking in conferences recently, and so I almost feel guilty whenever I Don't make time to exercise. But that guilt, you know, I don't, I haven't, until very recently, I haven't actually equated it with a cost. It was just more of, well, I guess I didn't work out today, I'll try to hit it hard tomorrow type of thing. And what I found is that if I think about it kind of as an equivalent of, well, you know, this inaction that I had is not quite as bad as if I had taken action directly against my goal. Like, you know, eaten, I don't know, a half dozen donuts or something. If I'm trying to be, if I'm trying to keep my body on a healthy track, well, I didn't eat the half dozen donuts. But I also didn't take action towards my goal. And because I didn't take action towards my goal, that actually kind of worked against my goal. And until I started seeing it that way, I really didn't feel like I had increased my motivation. And honestly, I haven't started pushing hard towards a fitness goal until I started looking at it that way. And I kind of give you a lot of credit towards at least opening my eyes to this concept of cost of inaction. And, you know, I don't know, should we start with a simple example that everybody can connect with? What's an example of inaction that happens in practice every single day?
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Dr. Jeff Lewis
Well, I think the, the, the one that like, and we've, we've talked about this in a previous episode, I think, you know, it stands out. It's difficult to get the phones right. You know, we have, you know, we are listening to, you know, and, you know, I personally listen to phone calls all the time on behalf of our clients and work on ways in which we can kind of improve the conversion of those phone calls, at least the appointments that come from those phone calls. And we know that from listening to these calls that anywhere from 25 to 30% of those calls are appointment opportunities. And that's an easy way. One pretty simple area of it has a direct effect on if, if new patient growth or even retaining patients is important. That is a key, you know, when you are already investing in resources to, you know, bring those patients to the phones and then leaving them, you know, and I don't want to say in the lurch, but not able to convert them, you know, it kind of drives me insane. And it is an easy one, I think, to address, although there is, again, this, I think, built in resistance or inertia because it does require addressing it, it does require some operational training and some creativity, perhaps. And that training and whatever we come up with needs to fit with the practice. But I think it's, from what I've observed, it's very easy to let that kind of thing go to where now there's a cost associated with not being able to convert patients who are calling your.
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Eugene Shotsman
And we're going to get into much more sophisticated examples in a moment, but I'm going to try to break this down for a moment for the audience. And again, if you are really interested in. In bettering your phones, we have a previous episode that Jeff and I have recorded specifically focused on phones, and we got a lot of feedback from the audience that it was, it was helpful. Feel free to go back and listen to it. But let me just kind of break this down. So let's say the practice gets 100 phone calls in a week. I'm going to. Well, actually, no, that's too small. Right. What's a good number for a practice to get in a week? 250.
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Dr. Jeff Lewis
Yeah, let's say they're getting 2,000 phone calls, and maybe 25 to 30% of those calls are appointment opportunities.
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Eugene Shotsman
Okay. So let's say in a month, practice gets 2,000 phone calls. Of those, 30% are appointment opportunities. So that's now 600 phone calls. Let's start with the very basics. Let's just assume that you're not answering some percentage of those phone calls, because when we listen to practices, at least, at least 10% and often it's upwards of 35% of phone calls during business hours just don't get answered. People are too busy and people just don't. Don't do it. So of those 600 phone calls you just mentioned. Right. Let's just pretend that 30% of those calls didn't get answered. That's 180 phone calls. 180 phone calls, even if half of them are patients who don't actually show up, that's 90 patients. 90 patients. Times, I don't know, I'm going to make this up and say $350 per average patient, that's $31,000 a month of inaction. And the inaction is simply not answering the phone. You didn't take the action to answer the phone, and you flushed $31,000 down the toilet. So that's a, you know, that's one example, I think. And we can get into what's a good phone call, what's not a good phone call, and, you know, the, in the Episode that we, we discussed, I think we talked about how do you move the needle from turning 70% of your patient opportunities, which is a pretty good number for an average practice, 70% of your patient opportunities into actual patients to 109% of your patient opportunities into actual patients. And that delta, that 39% delta, stands to increase a practice's revenue and bottom line substantially. And that's also a cost of an action. Not taking the action to make your team better to do that is also a huge cost of an action. Anything you want to add on the phones before we zoom in on a couple of the more sophisticated topics?
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Dr. Jeff Lewis
No, I think that's good. I think we could move on to, you know, the next one, let's say.
- [14:20]
Eugene Shotsman
And, you know, I don't, I don't know exactly where you want to go. Do you want to go inside the practice or do you want to go before even the phone rings?
- [14:28]
Dr. Jeff Lewis
Yeah, I mean, so we have, we have external factors, for sure. We can talk about the, you know, the economic environment or competition. You know, I think a good one maybe within the practice, because most the numbers are staggering. I mean, I think I heard you mention them the other day, and I don't think I thought about them for a while. But the number of how many patients in the average practice are coming in with either signs of dry eye or outright symptoms of dry eye or difficulty wearing contact lenses, et cetera. And many practices, I think, have adopted the, you know, are comfortable with the idea that, yeah, you know, we have ways of managing these patients. Some have invested in, you know, the technology to, you know, have a deeper conversation about it and, you know, to treat, you know, beyond sort of the bare minima. But there, there is, and, you know, you and I talk about it all the time and, you know, there's a, there's a significant, I think, another cost of inaction associated with leveraging the tools that we may have dabbled in. We may have purchased that. My biographer, but it's collecting dust or it's covered up in the other room, or we haven't talked to the associates about talking to patients about it, or we haven't really worked on the script for how we're going to talk to the patient about it. And then the transition. Maybe we haven't gone as far as hiring a champion that can have the conversation about there's the treatment that Dr. Lewis recommends and so forth. So I think the dry eye example is great. And yeah, we probably hit on that a little bit more.
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Eugene Shotsman
Well, you just said A lot, Jeff, because in all reality, there's at least four points that you just touched on that are really, you know, that there's inaction that leads to significant cost. So in the four, I'll summarize them, and let's dig into each one of them. So one of those points is just not having the conversation with the patient. Just simply not spending the time. That's inaction. Right. Not spending time with the patient or not spending the time to have the conversation with the patient or introducing the topic in a subpar way. I would categorize that as one. Another one is not. Is not investing in the staff. Right. And is not investing in your team to be able to communicate the value of that procedure or that. Or that treatment. I think number three is not teaching your associates. Right. Plenty of scenarios where one doctor is standout. Oftentimes the owner and then the associates, well, we just can't get them to do anything. And then the fourth is the process, the inaction to establish a proven process that ultimately maximizes the value of whatever investment you've made in the practice, whether that's time or resources or equipment. The reality is that all of those deciding that you're going to treat dry eye patients and you're going to have a dry eye protocol ultimately puts you in the driver's seat to say, okay, if I can set those four things up, then I've got real opportunity to optimize this business opportunity that, that I've invested in already. So let's start with the not talking to the patient enough, and let's just calculate the cost a little bit here. But, you know, for example, what, what. When I'm in the. When I'm in the patient room, Jeff, what could be happening? Or what. What's the inaction? What's the point of an action on the patient?
- [18:07]
Dr. Jeff Lewis
Yeah, So I think that, you know, having the conversation, having the. The, you know, asking the questions, you know, caring, you know, and translating that care into, you know, an inquisitive conversation, one that is, you know, you're ready to educate the patient on, you know, what. What you see what, you know, what a protocol might look like, just, you know, even raising. Raising the issue. I think it's all. It's easy to not see a symptom yet. You see the signs. But if, you know, they're not complaining, is it worth having that conversation? So that is a true cost of, you know, in action because you just miss the entire, you know, opportunity.
- [18:49]
Eugene Shotsman
Right, Right. And of course, the. Even the. Well, you Know, I see something here and if you want, my staff can set up a consultation for you. That's a, that's a subpar conversation. Right. What we know is that if the doctor says, and we've had other guests on the show who have talked about 80% acceptance and treatment plans and what we know is that if the optometrist presents the issue and presents a level of concern and says, hey, this is, you know, this is what I see. This is why I'm concerned. And I really. And I'd like to schedule a follow up visit for you, even if it's, you know, whatever you call it, the dry eye workup visit or however the flow works. But I'd like to schedule the follow up for you because I'm a little bit concerned. That's a different conversation than, well, you know, we have the stuff that could potentially help you out and you know, maybe Susie at the front desk and, you know, we can talk to her and see if you want to set up a time. We know that that's a less than 10% acceptance of a treatment plan when delivered without confidence, when delivered without a process, and when delivered without, like you said, kind of a clear link to the patient's, to the conversation you just had with the patient.
- [20:12]
Dr. Jeff Lewis
Yeah. And I think that there, and it goes beyond like the patient leaves and there's also, there's also an opportunity to, you know, again, we know that this is a, you know, dry eye is, you know, super prevalent. And so, you know, imagine the cost or the missed opportunity, you know, which is also like a cost of, you know, we can go through the math. You know, you're, you're better at the math than I am. But you know, we could, we could work through the math on that.
- [20:41]
Eugene Shotsman
But there's also, let's do it. Let's, let's give the audience a reason to listen. So. Okay, so an average dry eye patient is going to spend how much?
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Dr. Jeff Lewis
I don't know.
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Eugene Shotsman
Let's say.
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Dr. Jeff Lewis
Yeah, let's, yeah, let's use 2000.
- [20:54]
Eugene Shotsman
2000 is a low number because I think that a good, what we know is that once a dry patient's in treatment, they're going to come back again and again and they're also going to refer someone. So 2000 is a low ball number. So we're going to use 2000. Okay, so if average doc sees 15 patients a day, how many of those patients are going to be dry candidates? Candidates. Not, not, not accepted a treatment plan.
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Dr. Jeff Lewis
Ballpark, like half of them.
- [21:21]
Eugene Shotsman
Okay, so let's just say, let's just say seven a day. Seven a day times 20 times 20 days, whatever. Seven a day times. We'll call it four day workweek. Sixteen. Sixteen days a week. Or sorry, 16 days a month. That works out to one hundred and twelve patients a month. Okay, so it's one hundred and twelve patients a month that are candidates. Now you got two choices. You got deliver. Deliver the. Do everything you're supposed to do so that 80% of the patients. And we'll go through the other points of an action, but 80% of the patients accept the plan versus 10% of the patients accept the plan. So I'm going to call that the delta is 70%. So the cost of an action is 70% of 112. So times 0.7 works out to 78 patients. So I got 78 patients times $2,000. Now this number sounds crazy, but it's $156,000 per month is your cost of an action. Multiply that times 12. That's almost $2 million.
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Dr. Jeff Lewis
Yeah.
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Eugene Shotsman
$1.8 million is your cost of an action to not do the four things Jeff told to. Jeff mentioned in the, in the beginning. And that's just with the dry eye patients. Right. And again, we think the difference. 80%, 10%, whatever, pick your own numbers. Right. But this whole concept of what's that costing me not to take action is the, is the big premise here. So. Okay, so let's kind of bounce through the other three and work through the rest of this example here. So we've got the doctor. The doctor will call it the I'm concerned conversation. The doctor saying, I need to see you back for a consultation. Then we've got the staff. So sometimes the patient's handed off to the staff. What does the staff do? What should we be doing? What's the point of an action that we should be maximizing?
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Dr. Jeff Lewis
Well, staff. It's a great opportunity to build another layer of rapport. Staff that's been well trained and educated and also passionate. Maybe they're incentivized to have that conversation and to take it a step forward and to own the next step. The next step in that conversation, oftentimes the inaction is that, you know, the staff isn't really sure about what's happening. They haven't actually seen what goes on in an IPL treatment. They're not aware it's something the doctor does in the other room. Or they're, they're really not. They haven't been well educated. So it comes down to, you know, an operational inefficiency or inaction.
- [23:58]
Eugene Shotsman
Yeah, you know what, I found that super interesting. And I heard this actually from somebody who works in an office. I was at a conference and I sat down and I was an office manager at the, at the table, at lunch and I, and I had asked her about her experience with ipl and it was exactly what you just said. She said, you know, I didn't realize I had dry eye until I got some treatment and I felt a lot better and you know, the doctor treated me for free and I just, I'm so frickin happy about it. And I didn't realize what these things did. And now I tell all the patients about it. And she's an office manager, right? Or she, she's a manager in the office. And maybe she's, you know, maybe she's not the office manager, she's just a manager in a mid sized office. And I, I found that to be interesting that you know, developing champions oftentimes requires time and it doesn't just require a little bit of a conversation. It might require an example. It might require, you know, sort of a hands on type of stuff for the staff so that they're, they're bought in. And the other thing that I found, and I think this is so true in pretty much every part, it's not just in specialty services, it's you know, in the, in the frames that practice or that, that pay, that get recommended and that kind of thing is that the staff find themselves in a place where, well, if I don't have $2,000 to spend that I'm not going to really pay. Assume that the patient does right, and the patient might not have the $2,000 to spend on this. I'm really going to kind of shy, tell them to kind of shy away from that because I connect with the patient. The patient's like me, I wouldn't spend $2000 on it. They won't spend $2000 on it. So breaking through that mindset is extremely important. We probably do a whole show on that. That's, that's separate. But the reality is that the staff can sometimes be your biggest barrier subconsciously without themselves even knowing.
- [25:56]
Dr. Jeff Lewis
Yeah, yeah. I love the example of, you know, the staff having had an experience with a procedure and it could be as simple as like if you have a specialty contact lens practice and you want a champion for that, you know, you, maybe you find your, your, your INR specialist but you know, have them put on the lens themselves like teach the, you Know, do it. I just had, actually for the first time, I'm slightly embarrassed to say, but I just had my first experience with ipl. I had had a procedure last week and I got to experience it. And you know, there were certain aspects of it that I did not expect, I hadn't thought about because I haven't done one and I hadn't had one done to me. But, you know, I know a lot about it and it immediately transformed my, you know, my opinion, my enthusiasm, my perspective to where I felt, you know, obviously the, the, you know, I felt a little better immediately, but the experience itself, you know, immediately turned me into a champion. And I think we have those and I think that, you know, we were, I want to, I just want to interject this as well. We were talking about, you know, the, we added up the dollar value of the cost of inaction for the dry eye patient. But you know, and you had mentioned that. Yeah, that's just dry eye. Like, what about the other opportunities within the practice, whether it's a specialty spectacle lens or contact lenses or myopia management or any of these specialties, but missing out on that amount of revenue that has an interconnected effect, a trickle down effect on how we make decisions. Because think about the cash flow that we all have to dance around and think about the extra amount of revenue and what that could have done to enhance these other, these, these, these other areas. Adding another specialty or, you know, opportunities to, you know, move or, you know, reallocate resource, you know, maybe even marketing resource, you know, in some cases.
- [28:05]
Eugene Shotsman
Well, that's a really good point because the cost of an action also creates, limiting, it creates a bunch of limits for everybody else, including that same staff, you know, including the staff that wants a raise or wants some additional training or, you know, whatever, whatever benefit you can potentially offer with your $2 million of newfound revenue simply from, you know, being able to get people to accept the treatment at a, at a higher rate, you know, and, and you make a really good point is that you, as a marketer, you, you got to go through an IPL procedure and you did it as a marketer. And that makes you a better marketer now and a better advocate and a better resource for your client that, you know, I'll probably perform that on you, which is phenomenal. Right. But it also, you know, and you're, you're thinking from, from the marketer's perspective, but also think about the impact that it has on everybody who works in the practice, which I think brings us to one. I Just wanted to close the loop on the whole associates concept is that, you know, I, and I, I've done this training, you've done this training. But the question becomes, okay, well, I have an associate who is just not doing, you know, the inaction is that I don't, I don't have the inaction. The associate has the inaction, which ultimately is, okay, well, you have the inaction because ultimately you're not engaging the associate in a way that ultimately supports that. But how do you deal with that, Jeff?
- [29:39]
Dr. Jeff Lewis
Well, you know, that's a, that's, you know, that's another episode probably, so we'll have to plan that. But yes, like, I think that requires action on the part of internal operation, training, communication, you know, case study, like sitting down one on one. And, you know, most associates these days, you know, most of the practices that, that, that I have, like, direct experience with, you know, have some sort of incentive, you know, for associates to. But that's not always what motivates people. Not, you know, it may not be that, you know, the, the monetary incentive is, is the end all, be all, but it's important to find out what it is and to be able to, you know, present and make it a, you know, a, A project that, you know, that feels like everyone has, you know, an oar in, in the water, that we're, we're going down the river together and that we have, you know, we're in this together and we, you know, we see we need a little bit more paddling this way, we need a little move a little bit that way. And so I think that there's tremendous opportunity and, and that often is an easy one to not act upon because there's resistance to talking to colleagues about, like, performance. And, you know, I, I didn't get a lot of training about, you know, how to motivate, you know, someone, a salesperson, because it becomes like almost a sales conversation. And we all want to, you know, avoid sounding like we're selling. And so, you know, it's. It is fraught. And a lot of these costs of inaction or these, like, getting stuck in, you know, this low inertia state, you know, they have real, there's real resistance, you know, around them. Like, you know, not. Not saying that they're easy to break through, but they do have a significant enough cost where the motivation to get through that inertia or break through that resistance, I think is, you know, very much worthwhile.
- [31:38]
Eugene Shotsman
Well, and I think that's so true. And the reality is, and I've had this conversation several times, but, you know, you talk to a doctor, says, I just don't understand why my associates don't do this. And. And you end up in this. Well, when was your last time you guys had a meeting? Oh, well, you know, we meet once a month or whatever. Okay, and what do you guys do at that meeting? Oh, well, you know, we catch up and we talk about stuff and it's like, okay, well, what KPIs do you review together? And what data points and what, what, what's your process for chart review? And what's your process for observing each other and, you know, providing each other feedback and that kind of stuff? And then you end up in a place where it's like, well, you know, it was uncomfortable, so we stopped doing it or we never did it. And this discomfort. I'm not saying that inaction is like, you know, it's. There's good reason for why inaction exists in so many practices. It's just that we're. I think what our hope is during this episode is to kind of prime our audience to think about, well, okay, this exists, and, well, what can we potentially do to motivate you to take action? Because we have to realize that the cost of this inaction, of doing the same thing that you've always done the day before, the month before, the year before, is going to cost you more this year than it did before, given all the data that's coming out. And quite frankly, the cost, in all reality, the cost of the missed opportunity is huge. So we're going to take a quick break, and when we come back, I'm going to really try to push you, Jeff, to talk about specific examples of action and inaction. And then we're going to kind of contrast inaction versus action, and we're going to talk about things people can really do right away. We'll be right back.
- [33:35]
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- [34:30]
Eugene Shotsman
All right, we're back with the power hour and Dr. Jeff Lewis in the studio. So I'm excited to kind of continue the discussion on this cost of inaction. Hopefully, we're helping the audience see a different perspective on standing and getting stuck. Really, as you described it, is that, you know, we want to make sure that we realize that everything, that everything we do has a consequence, but we also realize that everything we don't do has a consequence. So I wanted to use the next part of this episode to talk a little bit about, you know, cost of an action in context of the actions you could be taking and you could be taking instead. And in some cases relative to patient acquisition, you know, think about what's out there in the market that's not in your chair and how do you do it?
- [35:21]
Dr. Jeff Lewis
Yeah, you know, I. I love this topic. I love that, you know, any of these, you know, areas that we've discussed, you know, so far, whether it's dry eye or, you know, improving doctor production, they. They do have interesting, like, kind of downstream ROI effect because we, you know, by addressing them, you know, first of all, treating more dry eye patients is really good for everyone. It's good for the community. It's good for, you know, the. It's just. It's an overlooked issue. And, you know, you end up feeling a lot better when you can own that part of or own that type of specialty. But looking at patient acquisition and patient behavior, a lot of where I spend a lot of time looking at what is the patient behavior that is, like, what types of decisions, what literally are patients typing in when they're looking for the services that our practices provide? And so there's a funnel that starts with search. There's, you know, a conversion along the way. There are conversions along the way. So, you know, someone, you know, finds you. I know you've covered this on other podcasts, but, you know, the idea is that, you know, you are found. Do your, you know, digital properties convert, whether they're coming in through your Google business profile or they're landing on your website or they're calling you. We are ideally tracking where those conversions are coming from. And many of them, oftentimes, the vast majority of these conversions are phone calls. And, you know, we talked a lot about phone calls. We won't, you know, belabor that point, but we know that by listening to phone calls, we do. We understand, you know, the percentages and the breakdown. We know, you know, whether a patient found you from a digital property and they were calling because they were just checking on their glasses, we can eliminate that, like that number. And again, you start with a large enough data set. Now we're talking about, you know, we mentioned 25 to 30% of those patients are appointment opportunities. More than, you know, maybe 70% are existing patients. And, you know, that's important because if you didn't show up, then you've left yourself open. You know, by not acting to optimize those properties, you've left yourself open to competition. But, you know, a significant percentage of those patients are new and they've made it all the way to a phone call. And now we already know that, you know, based on, I mean, we can, we can generalize about the market, but I think for us, it's really important to kind of, you know, drill down on what are the conversions rate, conversion rates associated with the new patient or the existing patient. But ultimately we can say that new or any patient opportunity that's coming through properties that you've invested in optimizing, that they can be. They're associated with a revenue per patient number, and we can get to an actual dollar amount that gives us a very clear distinction between what we may have spent for that marketing dollar. And this is. We're talking about organic traffic now. I mean, PPC is another thing, but does that, does that align? Yeah.
- [38:46]
Eugene Shotsman
So I think what you're saying is, go spend. I'm making this up. But you spend $2,000 and you get. I don't know what somebody spends. Give an example of one of your clients. Somebody spent $5,000. What can you attribute to it?
- [39:02]
Dr. Jeff Lewis
Yeah. So I think, you know, average case, if someone is spending $5,000 and, you know, they're, they're. Their digital properties are, you know, are being optimized in, you know, the most efficient and according to best practices that, you know, we're probably, you know, in the 10x range of, you know, what we're generating for, you know, for that. For that marketing spend.
- [39:27]
Eugene Shotsman
Perfect. Let's just play this out for a second. And this is where we go to the cost of inaction. I'm Going to bring it back to the simple example at the beginning of the episode, right? I, Eugene, said, okay, I'm going to exercise. And so I decide that instead of, okay, so I'm going to go act, I'm going to go spend some amount of time exercising. Well, today I decided to exercise for six minutes. I could have spent 60, but I spent six. I could have spent 30, but I spent six. So what's the benefit I'm going to get? Well, I'm going to get more benefit than if I didn't do anything, but I'm not going to get as much benefit as if I would have spent 30. And there's probably for a guy like me, you know, I'm not a, you know, I'm not a bodybuilder. So there's probably some diminishing return somewhere, right? I don't know where it is. Not a personal trainer, but maybe at the hour and a half mark, maybe at the two hour mark. I don't know where the, where the diminishing returns is for a guy like me. But you know, I, I bet that there's a clear proven scientific benefit between that 6 and that 60 or maybe even between that 6 and that 30 that I absolutely could, that, that I absolutely should be investing in. So this kind of, to translate back to your example. Well, look, you know, there's, I think all the digital marketing tools and capacity and strategies have diminishing returns somewhere, right? You can't dump $200,000 into SEO in a, you know, in, in a rural community with, you know, I don't know, 5,000 people and expect to see any sort of return on investment. But every single digital marketing strategy has some sort of return on investment. And that return on investment, finding the sweet spot of that diminishing returns, it's almost as bad as it's almost bad to, it's definitely bad to spend too much, but it's probably just as bad to not spend enough because in that particular case you've got a cost of an action problem there as well. Right?
- [41:44]
Dr. Jeff Lewis
Yeah. Yeah. And I think that that translates also to the other side of this. And you know, this, there's again, there's going to be diminishing return for the pay per click or for paid campaigns, whether it's Facebook ads or Google Ads, for example. I mean, it's a little bit of a different animal. And as technology has evolved and one of the things that I'm super excited about is that because we've been able to, thanks to our ability now to Integrate with, with the EHR and to be able to see like a schedule. Now we've gotten to this place where PPC can be resistant to cost of inaction in that when you say ppc.
- [42:35]
Eugene Shotsman
What do you mean?
- [42:36]
Dr. Jeff Lewis
Pay per click? Advertising. So you're, you're spending money to show up, you know, in the advertising section of like, of search results.
- [42:46]
Eugene Shotsman
So yeah, you pay, you pay every single time you. Not just when you show up, you pay when somebody clicks on it.
- [42:51]
Dr. Jeff Lewis
Exactly.
- [42:52]
Eugene Shotsman
And there's a cost to that click. And oftentimes if you don't link that click, I think oftentimes people say, well, I'm spending, pick a number, $500 on Google Ads or PPC. And how did you pick that $500? Well, I don't know that. Just that's what, what I picked. And is that too much? Is that too little? Is that. So we have to go down the next path, which is to say, okay, well, what's the, what's the cost per conversion, to your point? And the conversion could be a phone call, the conversion could be a scheduled appointment. The conversion could be something else. Well, and if the cost per conversion, I mean, I, I think the data showed that on Google Ads, most recently, I think last three months, it's been averaging around, I call it like 20 bucks for a, for a typical eye care patient, maybe a little bit less. And so that cost per conversion for, for a typical eye care patient, now remember, that's not a patient in your chair yet. That's a patient who made a phone call or a patient who scheduled an appointment. There's of course going to be a conversion rate that you have to follow. If you're terrible at picking up your phone, that, that conversion is going to be less valuable to you than if you're good at picking up your phone. If you're, if you, if you're, and one of the points to your, I think to your point, Jeff, one of the key value propositions is that if you, if your schedule is full for the next three weeks, you probably shouldn't spend any money on Google Ads because that Google Ads patient wants to get in within the next few days. And there's some studies published on exactly when, but let's just call it when, you know, under 72 hours is when that patient wants to get in. And if the answer is they can't find a slot on the schedule to support that want, then they may not, they might click back and see if somebody else has an appointment because that patient is really far down the funnel. And they really, you know, they really don't want to schedule something three weeks out. So your point, the innovation that you're talking about is actually, you know, kind of helping offset that cost of an action. It's helping to solve the problem of exactly how many minutes a day should you actually be working out? Because if you look at the schedule and you say, okay, I got 27 appointments this week that are available, you would spend differently than if you said. If you looked at the schedule and said, I have three appointments this week. In fact, you would spend zero on Google Ads if you had three appointments available. And you would spend a lot more if you had 27 until they filled up. And you would look at the schedule and you'd say, okay, great, I've got those filled. I'm looking at next week now. So point being is that I would absolutely spend. If I had the next three days, I had 27 appointments left, I would absolutely spend $20 for each of those appointments to fill those, because the doctor's already going to be there, the staff's already going to be there, the rent's already paid, the lights are already on. You know, like my cost, my. My marginal cost to bring that patient in the door is relatively low. Right. I would pay an incremental cost to bring that patient in the door. But, you know, my. Sorry, my variable cost is very, very low to bring that patient in the door. And I would pay a little bit, knowing what my pay, what my average per patient volume is. And this is what, when we related back to cost of inaction, I think what I'm hearing you say is that not doing something like that, not thinking of it that way, is really the inaction that you're describing.
- [46:32]
Dr. Jeff Lewis
Right, exactly.
- [46:35]
Eugene Shotsman
So, you know, let's now take it a step further and go back to our earlier example of. Now it's not just a typical eye care patient. Now it's not just your, you know, patient who's going to show up and you're going to put them in glasses and you're going to go through your regular capture rate, and on average, there is going to be a $350 patient. Right? Because again, you think about, and we've talked about cost of acquisition before, but let's do the calculation of cost or in action, if I left those 30 appointments open, okay, fine. If I left those 30 appointments open, that's the inaction. I didn't do anything. I didn't go spend the money to go fill those extra 30 appointments a week. Okay? So what does that cost us? Well, 30 appointments and I had $350 per, per patient. So it's $10,000 that week, $40,000 that month. Now, if you really want to talk about profit in this case, which I'm not sure that we need to talk about profit, but if we did, okay, so let's say that in that particular case, those 30 appointments would have cost me $20. Times 30 appointments, that's another $600. Right. So that's $600 I would have paid to get that $10,000. And then off of that $10,000, I would have probably spent $3,000 on frames and lenses and I would have maybe had to spend, I don't know, another, what, $2,000 on my optometrist or my staff and that kind of thing to, you know, incrementally, if they even get paid for production, maybe my optometrist is there no matter what happens. But worst case scenario, let's just call it like 50% of those dollars. So 4,000, $5,000 drop straight to the bottom line per week. If you had 30 appointments available that week, that's 50. If that's $5,000 per week times, times four, that's tough. $20,000 a month, that's just cost of an action.
- [48:48]
Dr. Jeff Lewis
Right.
- [48:49]
Eugene Shotsman
And at the same time, if you're not using the sophisticated approach of looking at your schedule and you're spending, and I've seen this happen far too many times, people do this with, with marketing all the time. They say, well, I'm just going to set a budget and I'm going to roll with that budget. So I'm going to spend $3,000 on Google Ads. Okay, great, you're spending $3,000 on Google Ads. But then your appointments are too far, your book too far out. So because you're too far out, you're not wasting those $3,000 of Google Ads. So not managing that and not reducing that might be costing you the cost of an action. Three grand, you know, or maybe some percentage of that three grand. So I think this is where the sophistication comes in to think about what are you doing deliberately and then what are you not doing deliberately that you could be doing that? Because for every single lever or for every single opportunity, there's a lever that you can pull to solve that problem.
- [49:44]
Dr. Jeff Lewis
Yeah, yeah. And you know, there's data all along the way. And so going back to the, you know, the dry eye patient, you know, and you know, you know, kind of aligning with what we were Talking about in terms of this technology opportunity and how things are evolving now, we have the ability to, or we, you know, we are developing, we basically now have the ability to see where those patients are in your database. So, you know, reactivation becomes now an area that we can associate with cost of inaction because we can much more directly or target in a targeted way, look at the segments of where those, where those patients exist already. And that I think is like, you know, another type of holy grail because, you know, we're not talking to those segments currently in a very efficient way. But, you know, as we, you know, now are able to like it, it sort of, I think, highlights another area of, of, you know, cost of inaction because we know that those campaigns or when we reach out to patients that there is, there are, there is data associated. We know how many, how many of those patients will open, we know how many click. And so we can kind of figure out, right, we can figure out pretty, pretty specifically like what, you know, what the cost or what the cost of each of those kind of activities associated with.
- [51:12]
Eugene Shotsman
Yeah, and that's another great point you bring up. If practices that are not doing strategic reactivation, you're just think of your database of patients 13 months to 60 months or so since last exam. And I lecture on this very regularly. It's a pad topic near and dear to my heart. It's the easiest found money in any practice, I think maybe outside of the phones, but it's the, it's, it's definitely in the contenders for top three easiest points of found money in any practice. But strategic reactivation is very different than what you're doing for general recall. General recall is sending the same message and it's sending the same message in various intervals. So those various intervals are, you know, and it's true that if you got the. I've been the recipient of the Macy's emails where you get the same email, you know, oh, it's our flash sale and it's our Flash sale is starting our flash sales, ending our flash sales tomorrow. It's just the same thing over and over again. I'm going to unsubscribe as quickly as I possibly can. And so the reason the software that most people use doesn't necessarily work well as a full reactivation tool is because they're cognizant. They don't want your patients to unsubscribe. So because they don't want your patients to unsubscribe, they're not going to send the same message. Over and over and over again and piss off your patients. But they only have one message to send. The message is, it's time for your eye exam, Dr. Lewis. So that message has to be spaced out substantially. And if that message is spaced out substantially, and most of the time that message doesn't actually go to anybody after 30 months. The reality is that you've got to have a different approach to reactivate those patients. But the data shows, and the data you're referencing is actually extremely compelling, that up to 22% of those patients between 13 and 60 months since last exam can be brought right back into your practice with a strategic reactivation strategy, which oftentimes involves segmented, thoughtful, intelligent, varying campaigns. So you're definitely sending them something different every single month, which is not necessarily all about a, hey, it's time for your eye exam. It's something that adds value, but reminds them, in addition, that, you know, it's pretty good to get your eyes checked out, whether it's because your eyes are an indicator of your overall health, or whether it's because there's new fall fashions for your face, or whether it's the risk of a specific disease. But all of these are things that are different from the month before, which then does not lead to a high unsubscribe rate, which then keeps these people on your list. And what we know from a marketing standpoint is if you're able to communicate with them every month. Every month, Every month, but with different messaging, that leads to a high percentage of those patients coming back in, which to your point, is a huge, huge, huge cost of inaction. If you're not doing that in the hundreds of thousands of dollars for every practice, even some of the smallest practices we've looked at, and in some cases for some of the larger practices, millions of dollars is, is the cost of an action for not leveraging strategic reactivation.
- [54:34]
Dr. Jeff Lewis
Yeah, exactly. Yeah, it's huge.
- [54:37]
Eugene Shotsman
Yeah. So I think, you know, we've covered a lot here as we've, as we've tried to frame this topic as, you know, cost of inaction is something we have to get away from the comfort of, you know, doing what we did last week, last month, last year, and think towards the opportunity that exists within the day to day of what we're already doing and just, you know, do something that's a little bit uncomfortable, but really just question things a little bit more and really focus hard on trying to quantify and look at the metrics that everybody should be in, in their practice. Any closing thoughts? As we wrap up today. Dr. Lewis?
- [55:18]
Dr. Jeff Lewis
No, I think that was. No, I think we, we covered it pretty well. I think it's a great topic and really happy that we had the opportunity to discuss it with the audience.
- [55:31]
Eugene Shotsman
All right, well, thank you, as always, for being on the Power Hour and grateful that you're able to share some of your time with us and the listeners and look forward to all the listener feedback that's going to come from this one and let us know what we should talk about next time. Thanks, everyone. Thanks for listening to today's Power Hour episode. The Power Hour is actually owned by the Power Practice. Power Practice is a premier consulting group who helps practices achieve freedom of time, confidently solve practice issues and grow their practices. They do this by having coaches and OD consultants, people who have actually done it, been there, and they're ready to help. You want to learn more, go to powerpractice.com there's a bunch of free tools there. You can also get a whole bunch of information and decide whether it's right for your practice. Again, if you're looking for more time, you're looking to solve complex practice issues or grow the Power Practice might be right for you. Go to powerpractice.com to find out more.