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Power Hour Optometry
The Economic Forecast & Cost Strategies Every Optometry Practice Needs with Dr. Jason Lake
00:56:50
How will the economy shape your practice in the next five years? In this live-recorded episode of Power Hour, host Eugene Shatsman and industry expert Dr. Jason Lake break down the economic trends and cost management strategies that will define the...
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- [00:00]
Jason Lake
Foreign.
- [00:07]
Eugene Shotsman
Welcome to the Power Hour podcast. It is in its 13th season. It's optometry's biggest and longest running show. I'm your host, Eugene Shotsman and we've got a great show with an amazing guest for you. Today. I sat down with Dr. Jason Lake. He is the general manager of PERC and Optiport and we did a little bit of what we always do when we get together. We talk about numbers and we talk about practice growth. I love Jason's perspective because it's always valuable because he's got a really unique input on all angles of the industry. He's got his own practice, he's also got the thousands of practices who are his members, and he's also got a perspective on all the suppliers he negotiates with that are there for the industry. What made this conversation different, though, is that we recorded it live after hearing a barrage of industry lectures from Economic Trends and Forecasts on Tariffs and Industry Worries and opportunities. Episode today we start by zooming in on the economic forecast that we just heard about that people have spent millions of dollars producing for us. So what we learned and what we share with you, kind of break it down for you, is what's the economy going to do, particularly over the next five years? When's the next recession? What's the outlook for our industry, specifically short term and long term? What is the biggest impact of the upcoming legislation? We talked about inflation, we talked about how it's going to us in the industry. We talk about what these trends mean for most practices. And then in the second half of the show, we actually decided to go deep and deep on a particular number, a very important number, cost of goods. I thought that with all this tariff talk and especially with how worried the industry, the frame vendors, the suppliers are all worried about it, I thought it would be a good opportunity to have a deep discussion about what drives cost of goods, how can you quantify it and what is a good cost of goods. It's not how do you manage it and what are some of the common misconceptions about it. So Jason talks about a lot of that and he also talks about common mistakes that people make when managing cost of goods. So it's a really great opportunity to zoom in and leverage the knowledge that he shares. So obviously the episode today goes both wide and it also goes deep. I hope you enjoy it at the end of the episode if you do find this type of stuff helpful, particularly when we zoom in on data points. I do need you to weigh in on which data points you want to cover in the future. And you can always do that by reaching out to me@eugene shotsman.com or on the Power Hour website directly. You can drop me a note, provide feedback, any questions, and, you know, just enjoy being a resource for you and for the industry. Again, that's Eugene Shotsman.com I always look forward to your feedback and also make sure you subscribe to the podcast so that you get alerted every time an episode drops, whether that's on YouTube, Spotify or Apple Podcasts. And now, now let's go to today's show. Welcome to the Power Hour. We have an amazing guest today. I have Jason Lake with me. And Jason, you have a really unique perspective on the industry, at least in my opinion, because you own a practice, you have given hundreds of practices advice on making their practice more profitable, more productive, more efficient. And then you also have this unique role that you're in as the general manager of PERC and Optiport is that you're constantly talking to vendors, right? You get the sense of what's their reality in the frame, in the lens, in the supporting the industry space. And when we think about our overall, really like the overall industry, of course, the first thing that comes to mind is the eye care office. And we talk a lot on the show about what's the patient thinking, what's the doctor thinking, what's the optician thinking. But sometimes you need to get a bigger view of the industry when you look at everybody who supports and supplies to those, to those particular people. And so this is one of the reasons why I think we found ourselves at the same conference this week at the Vision Council Executive Summit. And for those of you who don't know, the Vision Council consists is a membership organization of a lot of companies that there are some optical retailers, but also there's a lot of companies that support the industry, that do business with all the doctors. And so the Vision Council invests heavily to study the whole industry. And we've talked about some of their research on previous shows. But one of the reasons I thought this would be amazing for us to have a conversation is that, you know, you can sit in the same conference in the same audience. You know, I got a chance to speak a little bit at the conference, but I think as we sat there and we listened to some of the presentations and some of the lectures, I think you and I are probably hearing the same thing, but possibly thinking about different implications on our industry. So I wanted to kind of get your take, big picture overall on, you know, what you heard, what's the industry, where the industry's headed? And then I want to get into maybe a little bit of, you know, and how do we adapt that to the private practice vantage point as well later in the show?
- [05:18]
Jason Lake
Well, a couple things shout out to the Vision Council, what a great meeting. I look forward to this every year. And it's. As an optometrist, it's weird. Like you said, you come into this and you're like, hey, that wasn't part of my DNA. When I ran my practice, I went to the trade shows, Vision Expo, East, West, Heart of America, whatever, and you kind of got to see the finished product, kind of allows you to look backstage and what are we thinking for the industry? How are we looking at it? Every time I get that data, I'm always trying to say, what are the things I can pull out and I can take back to my members and your listeners, you know, so how do we take the lens that world class speakers gave us and how do we apply that to the meat and potatoes? I got to do something now in my practice. And if we can get industry nods and private practice to align, we can go faster. It's about being picking the right partners strategically and, and I think that was the biggest thing I took out. There was a ton of take home. We're going to break down a tiny part of it today. We're not going to have time for all of it. I wish we did, but I think that's the real big takeaway is this is the trends, this is what we think. You got to move faster. And we spend too much time in private practice. I think worrying about the if nots and the whatnot, we now have a perspective we can share to help speed that process up.
- [06:27]
Eugene Shotsman
Well, it's well said. And you know, one of the things I always enjoy is that you're able to adapt the things that you hear at the macro level into the micro. What do we need to actually do today type of model. And in a lot of your membership meetings, I hear you lecture on this. And our joint keynote last year was one of the times I got to kind of see it both backstage and front stage. And I think there's a lot of work that goes into that. But today we heard ITR Economics speak about the next five years in the United States. Now, we all know that there was a report and it was covered on the previous show that was released that kind of said, look, we've got an interesting trend going on. We got more exams happening in the eye care space. We got fewer dollars being spent on frames and lenses in the eye care space, but by a little bit, just a couple percentage points across the board. So the outlook wasn't like, okay, we know that if this is happening then we're going to bounce back immediately. That kind of. So that was one perspective and that perspective was based off of EHR data. That perspective was based off of really kind of that was the reflective retroactive what happened in 2024 perspective. The lecture we both heard today from ITR Economics was fascinating to me because what I heard was the outlook for the next five years. So I kind of want you to break that down for us, Jason.
- [07:57]
Jason Lake
I think it's one of the things that I enjoy most about itr. We've had them specifically come at our meetings because it gives our doctors a chance to do long range planning. If there's one thing I think that we need to get to your listeners is stop thinking tomorrow. Start thinking 1 year and 5 year and 10 year goals. I think the biggest thing is there is certainly some uncertainty. Depending on whether you're reading Barron's or Wall Street Journal or whatever. There's uncertainty in the2030s because cyclically we are looking at it's probably going to have some sort of a pullback in the economy. But the overwhelming message today in particular for 2025 through 2029 was super bullish for the industry. I would say if you're the doom and gloomer, you might say, well, if there's going to be pullbacks, specifically the Economist said if you had to pick an industry to go through tough times, and many of us have, we've gone through the Great Recession, we've gone through crashes in 2001, the tech crash. Icare survives and eyewear survives simply because it's a need, not a one. It's a need. I think overall I am incredibly bullish on the industry. One of the specific things, if I even brought it down to one year, really thought that 2024 and he called it last year, is going to be kind of an unusual year. It's not going to follow a lot of patterns. He felt that 2025, and I would agree with him, is what he calls return to normalcy. You had the 2020 slowdown year, you had a ton of capital dumped into the market, 2122, which was great because we sold a lot of stuff. The problem is then we couldn't hire any staff to help us execute that. And so I think when you look at those things, the wage pressure is decreasing. And we'll talk a little bit on some of those things later. I think return of normalcy was it and I think the big take home message I think your listeners ought to get whatever your goals are and what you've done the last three years, plan them more aggressively for 2025 in the next three or four years because for the the bold will be rewarded and it's time to go. Don't be two years late to the party.
- [09:47]
Eugene Shotsman
Right. And I think that was an interesting point is that I think Everybody's saying early2030s is going to be there's going to be some sort of event and there's multiple things that can trigger that event. But that event is going to be of economic pullback across the entire economy. And but things we heard about today and again I think we'll dig into some of these things were employment numbers, inflation numbers, but certainly real GDP growth numbers. That's gross domestic product growth numbers. And the reality is that it looks like for the next five years the economy is going to be on a strong growth path and specifically for our industry, eye care and eyewear is going to be on an even stronger path to kind of leverage that. So I totally understand why you're bullish on that. Before we talk about some of the other numbers, there's this concern about inflation, right. And it looks like in all reality inflation is not necessarily going away and in fact it looks like over the next couple of years it might do the opposite.
- [10:51]
Jason Lake
Well, it was interesting and I appreciate and I think we feel it whether we know it or not. So number one, we're feeling the quit rate is down dramatically for staff. So if you have staff, you know they were quitting if you didn't have the right chips in the vending machine and now all of a sudden they're sticking a little bit more. And so that quit rate is down across all industries. So we're not so willing, make no mistake, there's tons and tons of jobs still available. There's still a shortfall of over 7 million workers. Be very clear is that we were kind of waiting for those who were underemployed stand on the sidelines to come running back that gaps. That gap's been closed. Here's where we are for the foreseeable future. You know, we're in way better shape than a lot of industry. But the reality is is that we're going to figure out with the staff we have how to help them be more productive and we can dive into that as far as you want. But I think that was really the take home for me. When you talk about inflation, the reason I brought that up first, ICARE has an inflation rate of 3.9%. The general inflation rate, CPI in the United States is about 2.7. What that means is it's costing us more to run our businesses than the general public. The reality is most of that's driven by wage costs because as we know, it's the second or third or highest, even if you count doctors, is definitely the highest. It's our highest expenditure. So when you're that heavy in a labor market, when we have wage increases, it affects our bottom lines as an industry way more than other industries. Right. Like we're super high margin, but it's heavily affected because of the human resource that we need to operate the business. So, yes, things are looking better. There was also a belief, Eugene, that inflation's probably not going to take some zero percent again. I mean it's. Yet it's kind of here to stay at a reasonable level. 2 to 4. This is historically still low. We don't think that, but it is.
- [12:37]
Eugene Shotsman
And the perspective I heard, which was actually really interesting to me, was he was actually talking about how he believes that inflation's going to go sub zero next decade. @ some point there's going to be this period of deflation. And I was like, oh, that sounds great. Except the reality is that, you know, when you have inflation, your consumer will want to buy today because the thing will be more expensive next year. Right. When you have deflation, it's the exact opposite. They're going to wait to buy because then it's not. There's no urgency, there's no. And as a marketer, that resonates so hard with me because that's actually true, you know, like I'll make a purchase decision today because I know the price is going up next year. Right.
- [13:19]
Jason Lake
And I, I think that's going to be the big driver over the next few years. That if, you know, you want to find the silver lining, there is an opposite side to inflation. Right. We can say that is going to demand within the industry if you're willing to capitalize and if you can figure out how to navigate the waters, because it's one or the other. Unfortunately, deflation usually comes with a significant recession. People are literally pulling back and holding onto their money. That's a tough time for everybody. As Joe or Jan consumer. It sounds like a great idea. I'd love prices to get cheap. The reality is your 401k and everything are going. They're tanking. It's a symbiotic economy right now. I think this cessation of inflation, the Fed kind of deciding how they want to react to that. I think 2025 should be a normalcy. And I think that. What does that mean for your listener? The reality is that expect normal growth in your practice and normalize it. If you had a practice for 20 years, you were up 8% a year up into including the pandemic, and it's been capitulating wildly over the last four years. I would say if you've traditionally grown 7, 8% and you have capacity to grow, which is a huge thing, then I think I'd go back to 7 or 8%, because I think everybody pulled back. Is it 3, is it 5, is it 10? Kind of bullish on the Internet, that normalcy, to me, for those who act and can utilize resources, it's going to drive their business, it's going to drive marketing, it's going to drive people. People are going to continue to buy. Are you going to be able to service their needs? Yeah.
- [14:47]
Eugene Shotsman
And we'll talk about some of the individual practice metrics a little bit later in the show. But I kind of, you know, this is one I wanted to zoom in on because we really should try to reconcile this whole inflation thing with the idea that, hey, we've got two things that are going to be happening. Number one is we heard from Retroactive Data, is that the consumer seems to be trending a little bit towards more budget purchases. But on the other side, we're also hearing that the consumer is likely to get paid more next year. And so that consumer, because we still have a labor shortage, so wage increases are going to go up. And then we're also going to have this whole concept of tariffs, which are probably inevitable. And whether those tariffs are on frames or TVs or whatever the heck comes out of it, seems like everything I buy seems to be made in China or someplace that's going to have more tariffs placed on it as part of the current administration. The reality is that these are things that I think maybe it's going to be part of the expectation of the consumer that things do get more expensive. And maybe in 2025 we won't feel it as hard. But that's where I think the inflation numbers ITR was presenting was, look, it looks like 25 might be an okay year from an inflation standpoint, but it's going to go up and it's going to go up a couple More points over the course of the next few years after that. But it's not so bad because our growth is going to outpace that.
- [16:16]
Jason Lake
Yeah, I think that's the case is you don't get two sides of the same coin. Right. It's opposite sides that you deal with. So you have this, we said it created demand. I think as you are charting and we're going to boil this down so you've got usable items. But from a very high level, I would say if you're running a healthy practice with capacity because of inflation, I would tell you you could probably say 6, 7% increase if you've got the ability to grow. You know, there's factors into that where maybe without the inflation, without people having jobs, you may have pulled that to two or three. So just remember, I think the take home message is two things for inflation. Number one, let's just say it stays at 3%. The number one take home message for all your listeners. If your practice is not growing at greater than 3%, you are actually losing money. I mean, you can pat yourself on the back that you were up a point and a half last year and flat. If you are not growing, you are losing money. And you have to figure out why that is. Is it I don't have doctor capacity, I don't have staff capacity. Whatever it is, when you get these four or five years that run together that are growth, you had better use them and grow at the average, which I anticipate will be good next year. If you do not use them, you're going, it's, it's like compounding interest is you are stuck in the mud and then all of a sudden, well, hey, I can grow five years from now. Well, then the market doesn't want to grow with you. You've got to increase over the next three to five years. Your listeners need to really focus on increasing their market share within their communities or expanding, buying more offices, whatever. And as they do that, to make sure that you're watching that profitability and that you're not getting upside down in that you've got to be outpacing things because there are going to be times you're not going to grow at inflationary rates, you need to get ahead of it.
- [17:54]
Eugene Shotsman
And the other part of it, Jason, which I think is relevant for us to look at, is okay, but I could also, if I don't have capacity in my practice, if I don't have, you know, the doctor coverage or the whatever, if I'm basically maxed out, well, you know the logical next step is just raise price. And we've had clients who have said, I've raised price. And I thought, you know, there was going to be mass exodus and everyone was going to stop, you know, coming in for their eye exams or buying frames and, you know, my capture was going to go to single digits. And the reality is not much happened when you raise price. And if you raise price by, I don't know, inflation's 3%, you raise price by 5%. What do you think is going to happen to the practice?
- [18:33]
Jason Lake
Right, well, nothing. You're just keeping up. Like people don't.
- [18:37]
Eugene Shotsman
The consumer, you immediately go, right, yeah.
- [18:39]
Jason Lake
Yeah, no, no, but I thought you meant the negative.
- [18:41]
Eugene Shotsman
No, but, but, but exactly to your point, it's like, well, what's going to happen in the practice? It's not going to collapse.
- [18:46]
Jason Lake
So let's play with that. Like the usual kitten ball yarn. We had an idea. We're not going to fall away.
- [18:51]
Eugene Shotsman
We get there.
- [18:53]
Jason Lake
So let's talk about raising prices. So in our industry, it's something unique about raising prices. There is a reason that inflation is outpacing. In our industry is outpacing the cpi, a big decider of that is. So much of what we do is capitated. So what I mean is 20% of the average practice is private pay. And I'm probably being a little rich on that. So you have to look at there are things you can raise prices on. Some things are going to have an effect and some aren't. I can raise my exam price to a million dollars an exam. I'm still going to get paid X because of the contracts. I have a vision plans and health insurance. Right. So really, when you're looking for your listeners, where are two things that you could focus on? Certainly you need to make sure you are, you know, you need to go hire a consulting company, look at your average billings, make sure you're maximizing your medical billing. But let's take it down even a grain further, further. Like, let's dive into this and give everybody something useful. The two ways that you primarily make money on vision plans are contact lenses and frames. Because your exam fees are capitated, you agreed to a price and that that's the price. The lenses, you know, you put them in a formula. You need to make sure you're utilizing the best in the formula. But what's great about contact lenses is almost always it's a cash amount. Well, Eugene, great to see you here. On your XYZ Vision plan, you get $150 applied to your contact lens position. That's great. So let's talk about that for a second. When you're analyzing your contact lens vendor, everybody wants to go dailies. Huge effect on cost of goods. We'll get to in a minute. But when you look at that, what is your gross profit dollar? So basically the patient just got a $150 coupon to buy your lenses and then the manufacturer gives a rebate as well. How much am I making from an annual supply? So if the consumer is spending $1,000 for an annual supply and you, the doctor are making $300 on that, yes, 30% is maybe not the best margin, but that's really profitable. And if it's it's a balancing game because there's also a point that you price that contact lens so high that your consumer base is only buying six months worth and you really need to dial into that. We have been trying as an industry with our friends in the contact lens industry for years and years to figure out how to raise annual supplies. The reality is if you're only selling a six month supply and they're leaving you to go online because your contacts are too expensive, you're missing out on half the margin. There is a point that you can price your yourself so high that they're going to go online and get the product. You would be better off pulling that back a little bit. And I think that's some analysis you need to do. Like are there have your staff track like how. I mean you may have to do it manually. How many annual suppliers are we selling every day? And what is the general pushback? I know there was an increase last year in monthly modality versus daily. I suspect that had a lot to do with asp. We've bumped that average sale price of an annual supply of contact lens hits an ouchy point for the consumer. Just like we talk about stepping down sometimes having a way to meet the consumer's demands or patient demands. Do you have a way in a category like daily disposable to meet their demands? If you're talking to them and the patient looks at you and goes gosh, I just, I can't afford XYZ lens. It's $1,200. Hey, you know what? I've got a value minded. Daily disposable may not be quite as comfortable at the end of a long day or low humidity, but it's still a really great product. Now if you do it right, your gross profit dollar on that may not be dramatically differently, but it's going to be dramatically differently in your books because they bought the annual supply versus the six month supply. I hope that makes sense.
- [22:22]
Eugene Shotsman
Well, and it's a loyalty thing too, because if a patient buys everything from you and they associate you with, okay, I need to go there, I need to buy that. Part of it is loyalty. The other part of it is it's a little bit of marketing because you have to train the patient. And what, what I think my takeaway from that is that we have to create the options, but we have to be able to present the options well to the patient as well. Which is really, like I've said this in the previous show, is that we just have to work a little bit harder for the same dollar. The consumer isn't just showing up and saying, here, let me just throw cash at you like they did in 21 when the government gave them free cash. So then they came in and gave us free cash. Right.
- [23:06]
Jason Lake
I think that is so such a great point. When you look, people think, oh, they're pulling back. Listen, it's not that they're pulling back. Did you show them value? And that's really what you said is I encourage people like there are tools out there. And if you have a formulary, contact lenses, you need to shop online to the, to the biggest providers and you need to be able to look at your patient go, hey, I know it's pricey. We were about the same price as they and that's great. If that's too much, let's step down here. But for whatever reason, I've got some theories. For whatever reason, the general public has equated the value in particular of contact lenses with whatever they're pricing it online. And you've got to be real to that. And I think pointing it out and being competitive and keeping an eye on it, I think it's a dangerous game. We were talking about raising it, raising your price, $10 a box on a product that they can get online for $80 cheaper. There is a rough number and it's a theory, but I think people are loyal to about 20 bucks differential. That is the Jason Lincoln proven theory.
- [24:07]
Eugene Shotsman
But you might need some data to prove that.
- [24:09]
Jason Lake
That's more of a, you know, a rhetorical statement perhaps, but I do think it's something you just need to be mindful of. I want to flip something there that you said though. I gave two things that you could really focus in on and knowing your business. Frames. And why are frames so important? So when we look at frames, the data is us that the customer is really or the patient, the customer, however you want to approach it, whether it's retail or in your office, they are looking at some value options. Now that doesn't mean fashion is not doing great. That doesn't mean you can't be in high fashion, high end frames. But what the consumer is pushing back and telling us is that some people are looking for a value minded option. That is where it is so key that you have not only your lens data set up within the vision plans to maximize reimbursement by category, which you just need to sit down, do the math. You need a good, better best. You also need a frame that's good better best. If your patient is waffling and they don't want to buy an amazing brand like Prada, that's okay. Hey, we have, we have these, these, we have a Ralph Lauren or Vogue frame over here that's super cool. It's going to probably cost you a little bit less. And it values where you are like, listen, I wear my glasses to watch tv. Totally get that. That's a fantastic thing. Let's find you a more value approach. What I find is when I go into private practice, really good offices now, we're gonna, we're gonna take the best 20%. The really good ones are really good at stepping up the value proposition I can count on. I bet I wouldn't say one hand, but there's not many that know how to step down. Your opticians can sell the premium. Do they know how to sell, do they know how to save the sale? And I think that's what that budget's telling us is, listen, you don't make as much. Would you rather make something or nothing? And I think that's for your listeners is the take home. Look, look at your lens portfolio. Look at your frames. Are you well represented in your demographic?
- [26:00]
Eugene Shotsman
I'm sure there's a hundred of them out there, but you got any techniques off the top of your mind as to how to save the sale? If you're coaching an optician, oh yeah.
- [26:09]
Jason Lake
Gosh, we could do this for hours. Couple different things is number one I would tell you it's the handoff is key. And I know probably your listeners have heard this, you know, 3 million times, but I think that the patient needs to hear something three times. I finish a refraction, I look at them and it's like, okay, Mrs. Jones or Mr. All right, looks like, you know, we've got a little bit of an increase in your near power, the power that you need to see better I've got this here and I always show them at the end. This is your old, new. Would you like to see better? Would you like to update your frames, your glasses to see a little bit better? And 90% of the time that seals the deal. Well, yeah, I guess I do want to see better. Great, let's start talking about it. I'm looking at your glasses here. I'm like, okay, I use Verilux. Like hey, I got a Verilux, the causal coating. And these turn dark when you go outside. Yep. Okay. Transition great. So I write it all down on the prescription that goes to my optician. Finish the exam, the health part, we review it. Optician comes in, I'm like, yeah, Mr. Jones wants to update his glasses. I repeat it a second time, Merrillux. Cause I'll transition 90% of the time. I will tell you, my patient will tell me when they want to step down. Like you got a value proposition. My job as the doctor is to ask the question, does that sound okay? Yep. Okay, great. If they want to step down, if you've got a great relationship, they're going to say, hey, you got anything a little bit cheaper? Absolutely. When that optician comes in, I'm setting them up. I'm looking at him going, hey, you know what, Mr. Jones here, you know, really likes his old glasses. He's looking for maybe a pair that, you know, a little more value minded. Can we maybe step down, step down to the X, you know, this particular progressive. And I'm also thinking, try this particular frame line on him. Hey, I think there's some frames he's really going to like in this particular line. That sounds salesy, I get it. You can say it however you want to say it. But if you just had a key to an optician to say, hey, they're looking for something a little more valuable that should send off a bell on your optician, that when they get it out, they repeat it the third time. Yeah. Dr. Lake recommended a Verilox progressive and a Crizal anti glare in a transition. He said you were looking more value. We want more value. Like in your frame line, is there specific things you're wanting and then you're catering to that? You heard their demand and then you were doing it. But hearing it three times is magical. Having the optician repeat what you should have heard in the exam room and having keywords with your team like value. You don't want to say cheap, obviously it's marketing one on one. But hearing it three times and me empowering the Optician to put them in a value brand means that, well, Jason, the doctor trusts that it's still a really good brand. He's just saving me a couple bucks. Empowering them with a couple quick sentences will really do a good job. Now the hint for the optician. Read the cues. Like if they're looking at stuff and you see them flinch, it's easy to step down the frame. Hey, I got a frame that's just like that. It's a, it's, it's, it's a B brand. It's not a name brand, but it looks real close. Let me go grab it. Big thing is, is when you come to lenses and stepping down, tell me what you're using your lenses for. Well, I do XYZ activity. Okay. This is still a really good lens. You're going to have a little narrower corridor on your computer. Like if the patient is really looking for value and you explain that there's a little bit of a trade off here. It's still really good. They're going to make the decision whether they want to spend that money or not. What? When a patient comes in, sometimes they just don't have the money, which is totally cool. I get it. That's all of us at times, sometimes they just don't know the value. And that's their job is to figure out, what do you value? Like, aka I don't want to pay you $400 more for a brand name when you know the Kirkland vodka is the same as Grey Goose or whatever. Right. Probably a terrible comparison, but that's really what they're telling you. You've got to tell them why, to your point.
- [29:47]
Eugene Shotsman
Well, and it's a good reminder for the patient that, you know, and I always think about this as, you know, you're going to have this on. You're still probably going to pay for your Netflix account, you're still probably going to pay for your pet, whatever, all these other things. But you're going to have this thing on your face for 16 plus hours a day. Right. And that's the thing that you're going to invest in for the next year. It's like a dollar a day or something. But if you're spending 350 bucks, well.
- [30:13]
Jason Lake
TV is an interesting comparison. And I'm going to get the network. My wife picks our tv and so, so, but she curates the selection to.
- [30:21]
Eugene Shotsman
Well, Netflix just went up. I remember when Netflix was like $8. Well, Netflix just raised price. They had a record subscriber growth and they just raised Price. They just announced the raising price for their cheap ad supported plan by something like 20% or maybe 15%. And they're now like their top end premium plan is 25 bucks a month. I remember when Netflix was like, you know, whatever, 6 99.
- [30:43]
Jason Lake
I mean, you were a blockbuster just before that. Right, right. But here's the truth.
- [30:48]
Eugene Shotsman
I was getting the DVDs by mail.
- [30:50]
Jason Lake
No, no, it's a great point. So let's, let's riff on that a little bit. So when you're talking about Netflix, do you notice the timing of when they do that? They will have. I think there's, I hope it's on Netflix. If not, just insert favorite show that you watch on Netflix is shrinking the new show. That's a series, right?
- [31:06]
Eugene Shotsman
Squid Games. That's the, that's the timing.
- [31:08]
Jason Lake
Right.
- [31:08]
Eugene Shotsman
They got a new.
- [31:09]
Jason Lake
Or it's Yellowstone for Paramount. Or it's. Well, yeah, I really want that. Like $24 doesn't matter if you want to see what Rip's doing on Yellowstone. Right. And I know they're on Paramount or Hulu or whatever they're on, but if you personalize it. Wow. You know, I, you tell me. How about your day? Well, I'm running multiple monitors. You really need a second pair of glasses. And they look at you and go, I don't know if I want to spend that. I'm like, okay, the trade off is you're going to be looking at the ceiling all day with you picking your chin up. That's physics, man. That's not like a malfunctioning lens. That's how, you know, light bends in a lens. That is always the key to any budget decisions. Can I personalize it? And if it is just asking questions. Our young doctors, I say the same thing to them all the time. Well, I don't do sales. Okay. I can be a car salesman. I get it. What I tell them is ask questions. And I say the same for the optician. Like, my favorite questions are open ended questions. And I talk too much and we both talk fast. By the way, your setting on this podcast is not 1.5. It's just how Eugene and I talk together. It's not like the chipmunk should move it to 1.5, but I sit with them and I ask a question. Like, I say, okay, you finished the exam. And I talk about primary. Tell me about your sunglasses. And I just go, then shut up. You're going to watch that patient have this debate. You know, I don't have good sunglasses. I really love Sunglasses? Yeah, can I get sunglasses too? My personal favorite. How many monitors do you work on? Two monitors. Listen, are you spending a lot of time having to pick your chin up to get to the progressive to actually see? Yeah. You would really benefit from a pair of computer glasses, something you leave at your desk. The whole, you know, you explain how that works. I have a really high second pair rate because I asked those two questions. I have a really high transistence rate because I asked the question, do you want your lenses to get dark when you go outside somewhere? Transitions is like, you know, they hate that. But that is a quick easy question. I train my doctors to do and they bump their transitions five or six points. Are you selling something? No, you're asking open ended questions. You the doctor, your job is to serve them. That transcends budget. Now maybe they make a cut on the frame or maybe they don't, you know, they hey, I just can't afford the premium xyz. That's fine, we're still going to meet your needs. Here are some of the minor trade offs you're going to deal with. But listen, I'm really fro and our value brand, like we have a save the sale that we probably use 5% of the time. They'll just go now, man, I want to go to big box retailer. I shouldn't name names. So I'm not going to name them. Right. I'm going to go to big box retail and I'll have a deep sigh. And I've been doing this long enough that I know the patient like here's the deal. My value brand is the same price and it's way better than theirs. And they'll laugh at me. And they go, you have a value brand. Like why have you never mentioned. I go because you never asked for it. And being able to just be clear, go, the trade offs are here. You're telling me you're going to wear them to watch TV and go to bed in case of your armageddon? It's really going to work fine for that. Understand if you want to increase your wear time and do XYZ things, you're gonna have to go back up the value chain. But for what you're asking for, yeah man, this is cool. I sell one, it's better than anything you're gonna get at big box retailer. And you know, I'm gonna back it up with my warning and you know, charming demeanor and smile or whatever you say on that. But I think the problem is sometimes young doctors and our opticians, they Personalize it. Well, I wouldn't pay for that or I don't have that money, so I wouldn't do it.
- [34:26]
Eugene Shotsman
Right.
- [34:27]
Jason Lake
And number two, they. You have to be really careful because you never want somebody. You don't want the money to be an embarrassing issue. Oh, you just want more value. Just. Okay, no problem. Maybe you had something going on. This. The number of times people have told me my kids getting braces this month, and I'm like, yeah, dude, I had three daughters. Like, I actually could have bought a really nice car for what I have dumped in orthodontics. Empathize, sympathize, and like, there's no. There's no shame in buying a value product here. No, it's still awesome. It's still our service. It's what we do. You kind of dive into that. You got to humanize it that that will to serve will supersede any value equation ever. And sometimes the best you can do is. Is maybe do that, save the sale, and you know darn well it's still better than anything that's out there on the market. You still serve the patient, you still did your job, and you can feel good. At the end of the day, I will tell you, you line me up a day of people that I can fix their problems. No matter what it is, whether it's glaucoma or whatever, they. That is a very fulfilling day for me. It's fulfilling for the staff. The days that suck are you're either not going to let me solve the problem or you're not even going to tell me what the problem is. Let me get to it. Those days suck. They're no fun. Like, when I'm helping you solve. Maybe that problem is you don't have enough money for what you want, then let me solve it in the best way possible. And we should take great pride in that. I know that sounds a little pie in the sky soft, but it's true.
- [35:48]
Eugene Shotsman
It makes perfect sense. Now I'm going to. After the break, we're going to come back to a new idea slash segment that I want to try, which, you know, you have this, as you mentioned, charming demeanor. And so we're gonna try to apply that charming demeanor to the thing that people love the most, which is numbers. And I'm gonna see if we can make numbers sexy and try to try to break something down in a way that truly inspires action for people at this point in the year.
- [36:13]
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- [37:07]
Eugene Shotsman
All right, and we're back on the Power Hour, and I've got Dr. Jason Lake with me. And this is a segment that I want to try. And this is one of the things that I think we all struggle so much is nobody really loves. There's a small population that just absolutely loves to look at their numbers every single day. But there's also a general population of us. Say, okay, there's a couple metrics I'm going to track in my practice, and that's going to kind of give me a good idea of how to keep it going. I think most of the listeners have heard me talk about the fact they can't manage your business based off of the balance in your bank account. But I think there's this other component where if we deep dive into one metric or maybe one or two metrics on a show, one of the things I want to try is to make that metric a little bit sexier by understanding the levers that you can pull in your practice behind that metric and kind of go backstage and kind of go really do the full show of the metric and really understand where we're at. So let's pick one. And the one that is top of mind for me. And you tell me if you want to talk about this or do you want to pick a different one. But I've heard you talk about cost of goods. I also just. We both just sat through lectures where people are, where the industry. I mean, the frame vendors, I mean, they're seriously sitting there in the room and they're hearing people talk about tariffs, and the reality is, I mean, they import their stuff. They're going to have to do something with that. Who's going to pay for it? Who's going to pay for it? Right. So there's going to be some sort of change in cost of goods somewhere when you think about practices. So let's talk about cost of goods.
- [38:39]
Jason Lake
So, because I like to be funny, I'm going to tell you an anecdote before we get into this. My wife says that I have a gift for making the complex simple and the simple complex. And then she'll say another comp. That's a compliment sandwich, right? You say something nice, say something mean. So she's really trying to say is you're trying to explain to me something like taking out the garbage to the kids and you lost them at the third, you know, algorithm of why you pick up the trash can so I can get off the deep end. So you got to keep me honest on this. So the basic question you started with was who pays for tariffs? My personal feeling, for starters is I don't think tariffs are going to be as that was backed up by the economists we heard. I don't think they're going to be massive, but I think they're going to exist. And people like the Vision Council are out there right now. That's what they do. They go lobby in Washington, D.C. we know that there are places like probably China that are going to have a higher tariff just based on the political environment that we're living in. Ultimately, who pays the cost? So if you are the importer, you're passing it on to the manufacturer. If you're the manufacturer, manufacturer, you're passing it on to the frame people. The frame people passed on the od. The od, try to pass that on the consumer. So what really happens overall is everybody's eating a little bit of it. Not everybody gets to be exempt from it. Now there's just natural inflation that takes place. Two wage increases even with tariffs. He specifically said wage increases in staff and labor in general are going to be the biggest driver of inflation. So we got to get real. Let's talk about cost of goods and how do we combat it? So we talked a little bit earlier about raising prices. Absolutely. Roll up your sleeves. I think we should probably spend time teaching your listeners how to get the data first and then make meaningful. Like you can't change something unless you measure it like that. That's just hope, right? And so I think this is where we need to look at. So Eugene and I were talking earlier off the air, and I said, well, it's the end of the operational year, right? And there's, you know, for many practices, I'm going to wave my shame finger. As my kindergarten teacher would say, you should not look at your numbers a year. But it happens far too often. You know, if I have a passion is training people how to run their business. The number, the first two numbers they look at because they. They don't look at all of them, but a lot of them. You look at your labor costs and you look at your cost of goods. And we need that. We're going to dive deep into cost of goods and why it's. It can be. It can lead you down the wrong roads if you don't know how to understand it. Okay, I'm going to give three examples. Maybe not three. I don't know. Tell me when I get to three. We'll do some I have done in my life. I used to do a lot of practice valuations and helped a lot of people in a prior life. We still do that just a little bit differently. You can have a practice with a 32% cost of goods that is actually structurally, economically healthier than a practice with a 20% cost of goods. So people. Jerry Hayes, I don't know if you're listening, Jerry, the father of metrics, I think kind of when I got through school in 98, he was the guy putting it out. He was kind of the first guy to, from what I saw anyway, the first guy to really capture what your metrics should be. He said, well, here's the number you ought to be at 24% cost of goods or whatever that is. And at the time, that was probably relevant in today's world, cost of goods is as functional on your demographic and how you run your practice as the number itself. And really what drives it more is having a strategic partner. But we'll get to that. So let's go back to our original example. So how could a practice with 32% cost of goods be healthier than one with a 20%?
- [42:06]
Eugene Shotsman
That's what I'm wondering.
- [42:07]
Jason Lake
Okay. See? Keep you on track.
- [42:09]
Eugene Shotsman
Yeah.
- [42:10]
Jason Lake
There's a practice in one of our groups who shall remain nameless. And I spent a lot of time helping this person with their numbers. I was looking at their cost of goods was always high. And what finally made sense is, number one, you can't look at just cost of goods. I started looking at this practice deeply, and what I figured out is, you know, the average practice is about half professional fees, half retail. This practice is about 70 to 75% retail. And of that, the vast majority was contact lenses. So this practice was doing like a crazy number of dailies. Like, I was super jealous, right. Just killing it. But the complaint she would give me is like, gosh, my cost of goods is so high, I don't know why. And I go, well, it's because you're so successful. And she kind of cocked her head and looked me like I was nuts. And I go, well, here's the deal. You. You make a ton of money selling daily disposable contact lenses. The margin on contact lenses is not as good. It's about, on average, if you're one of my customers, you're averaging about 42% margin. Right. If you buy a frame for $10 or $50 and sell it for 150, that's a, that's a 67% margin. Right. That's not how contact lenses work. That's just the industry. It's the way they work right now.
- [43:19]
Eugene Shotsman
But the absolute number of dollars you're making, more.
- [43:22]
Jason Lake
Yeah, yeah. So it's, it's a little fool's cold. She was worried about that. And I said, well, don't be. You need to sell more glasses, certainly to make it a well balanced portfolio in your practice. But the reality is that's healthy for you because of what you sell and you have such a high contact lens. You're doing a great. This. It just is what it is.
- [43:38]
Eugene Shotsman
Don't get, you know, and it's probably, I'm going to guess that it's probably more of an urban demographic. It is a younger demographic.
- [43:46]
Jason Lake
Second side, let's talk about. It's. It's a Mr. 20%, we'll call it. Okay, Mr. 20%. I'm looking at his practice, incredibly successful and was loving life that he was 20%. And I had to come up and just go, hey, man, I, you know, you're asking my opinion. You know, I. Is the baby ugly? Yes. Here's why. I noticed that your, your len Capture rates about 30% and you're about 60 or 70% professional fees, which is great practice. The medical model, certainly. I do as well. You're great at the medical model. You're just really bad at retail. And in reality, your cost of goods should be about 22 or 23%. Why would it be higher? Because you suck at selling things. Like if, if you don't sell anything. You know, I think you and the great Jamie Rosen spoke Last week, about the exam only. Jamie's favorite quote about the exam only. You know, exam only suck, but the margins are good. It is truly 100% profit, right? And so you're looking at this data and going, I mean, I know that you read the journals and they say that 20% is good. Like this. This is a disaster. Like, I can come to your practice tomorrow and help you make a ton more money. That's why you can't just look at one number in cost of goods. As you all know, let's get dirty. You're going to get on your QuickBooks and you're going to run, like, all the things you paid for your contact lenses, your frames, your lenses, divided by all the money you brought in. It's pretty simple, right? An average practice, 25, 26% is what I like to see. But I would tell you, average practices are just that. That's about half of them. And there's always the more medical you go, the more it tends to drop. The more contact lens you go, the more it tends to rise. It's a general. It's a general theory. Now, then you need to dive in even deeper. So they do that. And what I would tell you is I think cost of goods needs to be tracked three ways plus that one. You need to take your total contact lens spin and divide it by the total amount of money you collect in contact lenses. You need to take your total frame spin divided by the total frame collections. And same for ophthalmic lenses. The reason you do that is it's going to shine a really bright light on how you choose to practice. So what is. You know, I mentioned earlier, the category, like a really nice running practice, does a lot of dailies. I'm seeing about 42% profitability out of that category. And yours may be different. If you do. Here's the funny part. You do monthlies. I've had people go, oh, look, my contact lens number is great. I'm like, no, it's not. You don't sell any dailies. Like, you're too profitable because you're not selling the more expensive product.
- [46:12]
Eugene Shotsman
42% profitability means you got 58% cost of goods, right? Is that what you're saying? So it's okay that you have 58% cost of goods.
- [46:20]
Jason Lake
It just is what it is.
- [46:21]
Eugene Shotsman
But that's. But because you segment it out. So what? I, I'm just going to say it again, make sure I got it. You're saying, okay, we got this cost of goods number. That number can Be elusive. And it, and it might vary a little bit by the kind of practice that you run. And so it doesn't quite mean as much unless you take it and segment it out. And then you segment it out by frame ophthalmic lenses and contact lenses.
- [46:42]
Jason Lake
Yeah. And, and here's the thing is people are like, what the heck's the axon on? You're just blathering on them, collecting data. Well, you know what's great about QuickBooks and that's probably 98% of accounting size software. You can go backwards. So go back and run in your software, get that total contact lens collected, total frame, the total dollars collected, not charged. And go back and historically trim that almost always.
- [47:06]
Eugene Shotsman
That's by the way, an important. I just want to make sure we didn't miss it. That's an important distinction. Collected, not charged. Because I think that depending on how you run your books, it's really easy to make that mistake.
- [47:16]
Jason Lake
Yes. And it's. And you've got to find in your software where it's at. So let's say you go back and do that and you did a three or five year look back and you could probably do this in under an hour. What does your trend tell you? Almost always, I could be wrong, but almost always the greatest opportunity is in frames. And I joke with people. The frame vendors always go, why do you say that on stage? I go, what's real easy? You're like the fifth or sixth biggest bill I pay. Like, I don't understand. I go, well, the biggest bill is who gets the most heat. Are almost always the ophthalmic lens manufacturers. Because it's the biggest bill the doctor pays. It's the one that want to get lower. Right. Number two is almost always your distributor. Your contact lens company are using number three because your frames are more fragmented, those bills are smaller. Nobody pays attention to them. It is the urgent emergent. I'm out of money this month. I want to pick on the number one. Well, you're billing up because you sold more. So I think if you go back and trend and again, I think that's maybe something we need to work on. The future is coming up with a realistic window of what we can see on those. But even something like ophthalmic lenses can vary. Like if. Because you're me, my population, everybody in my office. At this point in my career, I haven't taken a new patient in a decade. They're like 80 or 90. So everybody's in progressives. All these socials like, oh, My goodness, why is your Perlens? You know, your sales are so good. I go, because everybody wears a progressive. My patients are old. But, you know, I always tell them, I said, you're selling a lot of single vision. That's great. Why? I said, because people get older if they're doing it right. And sometimes you just are where you are and you need to trend it over time. So I think, yes, you need to be in a group and you need to be in mastermind groups and comparing that with your peers, but you need to really be training yourself and you need to look back at least three years. And during COVID I used to say, go three years with COVID It's been so all over it. Maybe your action item is to just get your data for six months and compare it to where you were the year before. But what was 24 versus 23? And then how do you build that 25? One last caveat on that. The number one bookkeeping mistake that I see that screws up cost of goods. That happens more often than not. The way that manufacturers rebates are built today. They are built that. It's. It's kind of proof of concept. And what I mean by that particular contact lens companies, almost all deals are based on rebates. I do X amount of business with Alcon. Alcon sends me a rebate check once a quarter or whatever that is you. Generally speaking, that person gives it to their officer. Hey, put that in the QuickBooks account. They record as revenue. If you want to really get terrible data, go back and look at where those rebate checks are. They should be recorded as cost of goods. What I mean is you make your deposit, you put that in the line item cost of goods. So if it's a contact lens rebate cost of goods, contact lenses would be actually deposit. You just pick that category. And the reason is, is that rebates, by their nature are there to give you a true cost of goods. I have people come to me all to, oh, my gosh, my contact lens. Cost of goods are out of whack, something's wrong. And I literally, nine times out of ten, go, where'd you put your rebate? I don't know. Did you put your rebate in? No, my team did. I'm gonna tell you where they put it. They put it under revenue. And it's not revenue, it's negative cost of goods. And because you do that, you think you suck. And actually, if you go back and do that, you're going to find actually that you're probably doing a pretty good job because you picked the right strategic partner. You just didn't do the math right at the end. That's huge. It really. It's a big deal.
- [50:36]
Eugene Shotsman
So let me do two more quick things. Number one is, do you want to benchmark, normalize it? I mean, I heard you say contact lens cost of goods, on average, we should be looking at 58%, right? Let's talk about frames and lenses just for a moment.
- [50:50]
Jason Lake
You know what? I. When we started this conversation, I thought to myself, I want to go back and look because that that number is going to vary. It's so relevant contact lenses because remember how you get paid by. If you look at the industry, like 78% of people, I think are covered by vision plans. And what do we say about contact lenses? They are a capitated amount, Eugene. You have 150 to spend. So that is the easiest measurement that I can look at across the industry. If it's high, the numbers high, you probably do dailies. Numbers low, you probably do too many monthlies that I can normalize. But let's look at lenses. So if I'm only single vision lens, right, what's my lab bill gonna be? Really, really low? What if I'm 60% VSP, my lab bill is going to be really, really low. And the reason is, is because the way that you contractually do that BSP pays your lab rate. There is no specific way to do it. What there is, is a way to do it. I think that's something that we'll dive in the data you and I were working, maybe we'll come up with a range. I got some ideas, but I don't want to say them because I want to make sure that they're valid. That's another show, right? You have to one more time.
- [51:50]
Eugene Shotsman
That's it.
- [51:51]
Jason Lake
I think it's important that we go back and we look at that. We say, okay, what's your lens cost of good. What's your frames cost to good? Because frames are going to capitulate wildly with the type of frames you got. If you are buying a value frame for 12, that's frame faxed at 52, you're selling for 150. Which frame cost a good. Looks like 10%. You're amazing, Eugene. How many sales did you miss because you didn't put any premiums in? You know, I have this conversation with customers all the time. Like, listen, guys, I know that you think you can build an entire dispensary on private label and value frames. That's great and it makes the numbers look good. But I promise you there's patients that coming in that want high fashion, they're going to want the Pradas and the Gucci's and things like that. And if you are not doing those things, you're missing those sales. That's why you have to have a portfolio. If you are a high end practice, guess what happens to your cost of frames. Goes through the roof. Right. I think what we need to come up is a standard deviation and I bet we can have that a future show where I can, I've got enough.
- [52:44]
Eugene Shotsman
Data, we can dive in or conditional logic, you know, if you are like this or if your demographics like that, you know. So I think that's, that's a really, really good point. And you know, as you think about it, that the strongest point is look at it over time because these things tend to creep up. They don't change overnight. You don't go. Your cost of goods doesn't go up by 5% overnight, but it does go up by 5% over three years. And that 5% is money straight to the bottom line.
- [53:09]
Jason Lake
Yeah. And sometimes don't even, you know, we just sent somebody somewhere in that palpitation because they did this number after they listened to this podcast and like, oh my goodness, my cost of goods are up five points in specific. Let's say, let's pick on contact lenses. Right. Well, did you switch from doing monthlies to dailies? Yeah. Well, look at that denominator. You just, you know, you went from selling $500,000 worth of contacts to a million dollars worth of contacts. And yeah, Your margin decreased 10%, but who cares? It's a half a million dollars. Right. And so I think everything is contextual. So I mean, I don't want anyone to get palpitations. That's not cool. I think the key is, is that you look at it and what's really great, you know, as we know I'm a huge proponent of mastermind groups is that you're sitting in a room full of people that maybe you. I was in one mastermind group for like 15 years and I loved everyone in it. They're like still some of my best friends. But there was only three practices I really paid attention to on things like this because I had. It was a friend of mine in Lake Havasu was probably one that shared a similar somewhat rural demographic that I shared. There was a guy in east Texas I looked at and I kind of looked at his stuff a little bit because he was A little more rural. I didn't really pay attention to dear friends, but they were in super ritzy part of Denver. But that does not translate to Orangeburg, Missouri, Brother. It just doesn't. Like it's a different demographic. And so I used all of them for ideas. But when it came to benchmarking things like that, I would take, like, practices, like demographics. Right. It doesn't mean you're not going to learn and think, well, I can move that number like they do a little, but you got to be careful who you're comparing to. Comparison is the thief of joy.
- [54:41]
Eugene Shotsman
But my mother told me that's a good point. And I think the interesting part there is that if you track it over time and you understand what levers to pull to do that, I think we've done enough of that on cost of goods. What we should do, Jason, I'm kind of thinking about this is we should pick a metric and we should really do a deep dive on that metric. And actually, I'm going to ask the audience to suggest a metric or two that, you know, you really just want broken down. And really, when I say broken down, I'm saying let's go deep. Let's understand what moves that metric, what kind of considerations. And if you've got, if that one's high for you, what you could be looking at, if that one's low for you, what you can be looking at, what operational changes can you make to support it? I just wanted to talk about this one today because quite frankly, the tariffs thing seems to have the whole industry a little bit scared. And really, I mean, I understand that. And it's, you know, there's. As soon as. As soon as the new president signed the first executive order on anything, there's already war rooms and large corporations going on to freaking out about, you know, plan A, plan B, plan C. We don't have that in our. I'm sure the large corporations in our industry do, but the people listening to the podcast who are in private practice, I. We don't really know how to react to that, but I do think that this is one for us to watch. So, Jason, thank you so much for joining me today. I think this has been a great conversation. I look forward to future ones.
- [55:59]
Jason Lake
Looking forward to you, Eugene. Thank you, bud.
- [56:01]
Eugene Shotsman
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 practice 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.