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The Eyecare BOSS System: Build a Practice That Runs, Optimizes & Scales Without You
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- [00:00]
A
In a self optimizing and scalable practice, you are not the bottleneck, you become the architect. And not every decision has to flow through you because your team has a super clear framework for making good decisions independently. And problems get solved by the right people at the right level. And people who are equipped to handle that turnover becomes rare because you find the right people who love the working environment, who love the things that your practice is good at and, and they can succeed, grow and make a meaningful impact on your business. So in a self optimizing and scaling practice, you're getting the most out of your people, not by being more demanding or pushing them, but by creating clarity around a number of systematic components like expectations, providing systems that set them up for success, aligning people with their natural strengths, but also being able to understand who's a good fit, who's not a good fit. Welcome to the Power Hour, Optometry's biggest and longest running show. I'm your host, Eugene Shotsman, and today's episode is a big one. So if you've been listening recently, you've heard Jamie Rosen and me tease something called the ICARE Boss system. And with our official unveiling happening at Vision Expo east, we have been flooded with the same question, what exactly is ICARE Boss? So today we dig in, we answer that. So again, my guest is Jamie Rosen. He's someone who's built skilled, mentored pressure, tested more practices than most people will ever see in a lifetime. And you know, for the bulk of our careers, Jamie and I have helped build and grow some of the best independent eye care practices in the country. We've identified over a hundred growth levers specifically for optometric practices. We've sorted them into strategic categories. We've coached hundreds of hundreds of successful practice owners while supporting thousands of locations in their growth journey. We've seen successes, we've seen mistakes, and we've developed what we hope can be a shortcut for anyone who wants to grow, scale and optimize their practices. And that shortcut is called ICARE Boss. The icare Business Optimization and Scalability System. Again, business Optimization Scalability system. And the idea is that a systematic operating system for practices can solve some real frustrations that practice owners tell us they feel every single day. Feeling like the bottleneck. Like all decisions depend on you. Chasing great ideas but never being able to fully implement them. Spending money on stuff that never gets done or optimized, managing personalities instead of building leaders, watching things like exam onlys or profit margins just eat away at growth or your profit or just being pulled into constant, like got a minute interruptions in your business. And most importantly, I think building a business that depends on you instead of one that runs without you. Say that again. Building a business that runs without you and that optimizes without you and that scales without you is the goal of the five pillars of the ICARE Boss system. What are the five pillars? Accountability, revenue, people, experience and data. And we talk about that in depth in this episode. We also talk about why some practices stall out and some win. We talk about what it would actually look like to build this self operating, self optimizing, self scaling practice. And we really kind of dig into the various parts. And so if you're really taking notes, you can probably get lots and lots of parts of the ICARE Boss system. But it's also available@icareboss.com the system is built specifically for iCare. It's built for independent practices, multi location groups, emerging leaders, owners who want growth, insanity. So if you've ever thought you, you are capable of more, your practice is capable of more, you're sick of being the bottleneck, the source of a bunch of decisions. Or if you're just like, hey, we're doing okay, but we could be doing better. Or if you want your time back, this episode is for you. And if you're heading to Vision Expo east, you'll hear us go even deeper from the main stage. But if you're listening after Expo, you can definitely find more resources@icareboss.com as always, I want to make sure the show is useful to you. If this sparks questions, pushback, ideas, you need help, reach out, go to Eugene Shotsman.com, power Hour website. Drop me a note. I do respond every single time. And now let's dig into the ICARE Boss system. Jamie Rosen, welcome back to the Power Hour.
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B
Eugene Shotsman. Thanks for having me.
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Yeah, so listen, it's a big day because I'm following a bunch of listener requests. They've heard us kind of tease the ICARE Boss system and some of the ads, and I know that we're unveiling it in a few weeks at the Vision Expo from the main stage, but the reality is that I think we've gotten so many questions about what the heck is ICARE Boss that I thought I'd record an episode on it with you. And just to be really clear, Jamie and I co created a system called ICARE Boss. ICARE Business Optimization Scalability System. So I'm going to say that one more time, Business Optimization and scalability system. And I think it's probably worth the trip to talk a little bit about why the system, why we both thought the system was necessary. Jamie, what do you think? Yeah.
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B
Yeah. So what? Well, I think, I mean left our own devices. I think it's really hard to create a systematic approach to running your business that that also scales. So meaning you don't have to throw it out if you're one location, you got now at five locations. But so it's something that is built so you can continue to rinse and repeat and use the system to really run your business. What I think Eugene, we've both seen is there's, you know, there's a good deal of pain points when you're running your own practice. You have, you have people that you work with that sometimes are in a bad mood, making noise and it could be something you're not really, it could be a miss in the practice. Right. So they're justified in not being real happy. Or there are patient complaints that hit
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you
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ad hoc, right. Not on your time, but on, on the time of the patient. There are those doctors that feel like they really have to handle everything because delegating is super hard. Effectively delegating is super hard and a little scary to hold people accountable. Or there are practices that have a lot of really great ideas but they can't execute on all the ideas they seem to spend money on. The like if this is you, you spend money on a piece of equipment but doesn't get utilized because they're that the tech is introducing the test in the right manner and it can be aggravating. And all this isn't because you have a bad practice or you have terrible people or your patients are the most high maintenance patients in the world. It's just the system isn't addressing all these things so that things are people are accountable and patients have a great experience. And you do not feel like you're pulling your hair out every time you mention a new idea. And for your staff, you know, the flip side that we've seen is staff is just getting their arms around idea number one. That's a great idea. And idea number two now is needs to be implemented and we haven't really finished implementing idea number one. And so we hop from really great idea to really great idea without the cadence of how do we pace ourselves, how do we prioritize. So if you feel like you know any of those are some of the things that you experience in your day to day or when you're not expecting Them. I think that's the reason that we put together this system that addresses the different components of your business. And you may want to talk about what you're seeing with your clients, Eugene as well.
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A
Yeah. And I think, you know, we have both in our work, we've both helped hundreds and hundreds of practices. And I think the reality is that every time I ask a question of what are some of your biggest issues, there's a pattern of answers that shows up. And while people often say, oh, it's a people problem or it's a patient problem, what they often don't say is that there are some underlying issues that can be identified in almost every single practice. And so I'm going to challenge the audience to think about it this way. So if I asked you to think about why it is that you're in practice, what you were hoping to accomplish when you decided to run a business or own the practice that you're in, or be a key contributor to the success of the practice that you're in and like, think about what that dream really looked like. And now let me just give you a layer that if I could ask you to envision a self operating practice, a practice that runs itself and resolves its own problems and it does not require you, whoever you are in that practice, to necessarily stop what you're doing all the time and whatever and go solve this issue, go solve that problem, go do that problem. And that's operating practice. Now let me take it another level up, which is a self optimizing and self scaling practice. So what if that self operating practice, if you went on vacation for six weeks, I think most people can't even imagine what that looks like as business owners is like. But if we went on vacation for six weeks, how would that practice run while you were gone? And now what if that practice would scale and would make improvements and optimize and innovate and bring in new things and be able to continuously be, drive every and hit on all cylinders all the time. So that's like the whole concept behind scaling and optimization. It is a practice, when I think about that, those terms, it's a practice that has the systems to be able to grow without necessarily relying on key person syndrome or key person talent. It's also a system, it's also a practice that can continuously innovate, bring in new ideas, try new things and continuously get better and better without necessarily again, one person being the police officer who's hounding the crap out of everybody and trying to, you know, trying to drive Compliance to a standard that people don't necessarily understand.
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B
Yeah, I think, I think the goal is how do you. There's always going to be some friction within any business. Whether it's a practice that has one location or whether it's a practice that has 50 locations. There's always going to be some friction. The question is what if, if there was a system that could minimize the friction, make things predictable. So frictionless. Predictable like. And when I say predictable, meaning you're not got a minute meeting by your staff like in between patients. If you're the doctor or owner of the practice, or if you're the manager of the practice, you're not always interrupted with the same types of questions over and over again. That distracts you from doing what you want to do. And then I'd say the other part of the component of this system is to really again not only innovate, right? That's new ideas, new equipment, new testing, new procedures, but it's also optimizing. And we spend a lot of time on optimization things that when you think of them as an idea, it's a great idea. But we don't really have the ability to get better, consistently get better, have the entire team consistently get better. And that's a whole myriad of anyway. So that, that, that would be the reason that we came up with this system because we felt that when we looked at in and spoke with practice owners and operators, it seemed to be the one thing consistently that didn't happen, that there wasn't a systematic approach to running the business. And not just theoretical concepts or concepts that, that you need to figure out how to apply to your business and your size business and your scale of business and quite frankly our industry so you don't have to retrofit in the industry. We specifically built this system for the eye care industry essentially.
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A
So we're going to get into the specifics of what the system entails and what the five pillars are and we're going to go, go through some of them in some level of detail. But I just want to make you the promise of what happens when you apply a scalability and optimization system to your business. And I think the promise goes something like this. Number one, you get more of your time back because the time you deploy becomes a choice, not a resource that's constantly pulled in every direction that's by various fires in the practice. And the self optimizing and scalable practice is you are not the bottleneck, you become the architect and not every decision has to flow through you. Because your team has a super clear framework for making good decisions independently. And problems get solved by the right people at the right level and people who are equipped to handle them. So number one is time, number two is growth. So what happened if your business could grow systematically with dozens of proven strategies, again, without you having to be the muscle or the only gasoline in the, you know, that that powers that engine. So if you think about predictable growth, which we talk a lot about, and a series of proven levers, and actually Jamie and I came up with over 100 growth levers when we started thinking about it. And this was kind of like Allah, our friend and mentor, Jay Abraham, that there are really three ways to grow practice. More patients, more those patients coming back more often, and then bigger transaction size. Those are your three ways to grow practice. And within those three ways, we've identified over a hundred different growth levers. But you have to know which ones to apply when. And one of the mistakes that we made, even when we were trying to teach these growth levers, we were trying to teach practice owners growth levers. But what we realized is they can't pull those growth levers without having a system in place for execution. Right.
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B
And a way to prioritize. So that's another key component. So, and we'll talk about this, but you, you basically become disciplined to list all the issues in your practice and we'll get into that. Right? So you never lose the issue, you never lose the grid idea, but you systematically decide which idea is worth tackling now. And a lot of that has to do with what the return on investment is like, where, where do you want to spend time on, you know, stepping over dollars to pick up nickels, like you. So there's a component where you, you assess what this, just by getting a little bit better, what impact that has to the practice. And therefore you prioritize. So what happens is you have great ideas, you list those great ideas. In other words, you're not racing to implement things one after the other after the other. You're taking a systematic approach and finding we're going to tackle the biggest revenue driver for the practice or the biggest profit opportunity for the practice. And we're going to beat that to death before we move to the next, the next one. And that's part of the prioritization that you're, that this system kind of hopefully forces you to do.
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A
Yeah, and I, you know, you keep hearing the word system because that is exactly what it is. And so kind of going back to those four, four promises for you if you implement a system in your practice that, that, that helps you optimize and scale you get your time back, your growth becomes a function of predictability. And then let's talk about your people. Your people become key members of like, what would happen if people took ownership of practice performance in your business Instead of managing personalities and conflicts, you could develop leaders and you know, who fits in the business and who doesn't. And there's a shared vision that gets everyone to kind of elevate above the mundane day to day stuff and understand what their bigger purpose is. And they either fit into that purpose or they don't. And turnover becomes rare because you find the right people who love the working environment, who love the things that your practice is good at and then they can succeed, grow and make a meaningful impact on your business. So in a self optimizing and scaling practice, you're getting the most out of your people not by demanding them, but not by being more demanding or pushing them, but by creating clarity around a number of systematic components like expectations, providing systems that set them up for success, aligning people with their natural strengths, but also being able to understand who's a good fit, who's not a good fit. And the last part, the last kind of promise that we, that we make in the system is that your processes, right? Like what if you, like if you think about every meeting that you have in your business, what if your team left the next staff meeting really excited, like just with absolute clarity about their priorities, understanding what role they're playing for the next week or for the next day. And instead of, you know, and you think about like the process of having a good meeting, that's just one of the things that happens in a practice, in a self optimizing and scaling practice. The practice runs on process, on data, on alignment and accountability. And every decision helps create forward momentum and just creates a whole bunch of opportunities to execute rather than just hot air pushed around a room.
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B
So, and I know this may seem a little esoteric, so I think it's a good time to like dive into the pillars and start talking a little bit about each one so you guys get a little bit more meat on the bone, if you will.
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A
Yeah, so five pillars, let's go. Accountability system, revenue system, people system, experience system, and data system. These are all the subsystems that make up the overall operation of your business. Now you're going to hear some concepts and I think Jamie and I talk about this a lot, is that no ideas are new ideas. We either made mistakes and learned from some of our mistakes, and we learned from some of the people who have been really successful by working with thousands of practices coast to coast. And we've also all read a lot of business books. The key part is, as Jamie said, all of these ideas we've tried to select and sift through and really try to pressure test the best ideas that ultimately fit into what creates scalability and optimization in the eye care space specifically. So some of the ideas you're going to hear, you're going to be like, oh, well, you know, that's a Stephen Covey concept. Absolutely it is. And some of these ideas are going to say, oh, that's like a, that might be like a Gino Wickman thing, is like, absolutely on Jay Abraham. And I'm blanking on a few other authors that we. Daniel Kahneman, we used some of his behavior change stuff. And yeah, it's like, there's Ram Sham,
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B
there's the Covey Institute for Disciplines of Execution. These are all the things that, you know, foundationally, I mean, for me, foundationally gave me good to great, built to last. Like, these are all things that struck me as super useful, but they were so hard for me to put into, fit into the eye care space. And so what we tried to do is take a lot of these concepts and a few, a few of our own as well, and put them into a system that you're hearing about. So the first one is accountability, which Eugene sort of talked about. Maybe talk a little bit more about what is covered in the accountability system.
- [21:30]
A
Well, yeah, so I think in the accountability system, there's four parts. Cadence, issues, vision, and rocks. And so why is this important? Well, let's start with the concept of issues. You cannot free up your time unless your team feels confident that they don't have to pull you aside and say, hey, just a minute. You got a minute? Like you were saying earlier, Jamie, hey, got a minute? Like, I, I got to run this thing by you. Can I give this guy this refund? Or this thing happened or this supplier is like, like all of those things need to go on a list. Call it the issues list. Easy enough. And that list needs to have a process by which you review that list and you resolve those issues. So we teach you a model. We actually call it paste. And we teach you. We teach you a very specific model for how you actually resolve issues in your business and how often you meet to resolve issues in the business. But the whole concept is, you know, we. And by the way, I guess I'll, I'll Cover the concept of paste. When you have a giant issues list, we actually, we talk about people that say, listen, you need to make sure that everybody in the organization has a chance to contribute to the issues list. If the issues list is small, that means your team is not engaged. I actually, there was a, there was a meeting that I showed up to on one of my teams in my organization and you know, there were like six things on the issues list. And I was like, oh, you guys are, you guys don't have a lot of things on the issues. Listen. And they're like, oh yeah, we're firing on all cylinders. We're doing great. And I was like, I just want to pause and make sure that you understand that's not what that means. If you are not surfacing issues every single day, that means that you are not thinking in a self improving type of thing. So I need to help, we need to pause and to think about how it is that you identify opportunities for improvement every day, every step of the way. And then you go through this framework that we, that we kind of develop, that's called paste. Prioritize, analyze, collaborate, execute and document. Jamie, document thing was brilliant. I think you added that at some point, which is that, you know, you can solve issues over and over again, but if you're not writing it down, then it does not become the institutional knowledge. Right, right.
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B
It becomes tribal method of training, meaning the, the training happens after somebody makes an error. Uh, which isn't a really good way to, to run a practice versus having a disciplined process. And the. I think the other thing that's great about the issues is what's so interesting when we kind of run through this with practices, is that you start to see things that come up as an issue. Um, and we go through a process of reviewing all the ish open issues at the. On a quarterly cadence. But a lot of those issues aren't issues. They're just, they're they're like the distraction of the day. Um, so they get listed on the issues, but they are not worked on intentionally. They are not worked on because you as a team decide if that issue really hits the top five, three to five issues for either the meeting or the goal for the quarter, the goal for the year. And all that is guided thematically by the vision, which is part of the accountability system. Your practice is internal compass, essentially. So maybe speak a little bit about that.
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A
Yeah. And the thing about, like, if you think about how you get people to surface issues, right. Like one of the ways you get people to Surface issues is you say, well, what's standing between us and our goals? Or what's standing between us and success? And the only way that somebody can answer that question honestly is if they actually understand what success looks like. And so we actually, and we even developed a little AI tool that helps you write your vision. That's that, that. But we teach people how to think about making, creating a clear vision for your, for, for your practice. And there's really like three components and there's the, that the, the boss vision actually follows a concept that I learned from Cameron Herald, which is like having a super clear, vivid explanation of what the future of your business looks like. And you write it in present tense and you say, you know, so on December 1, 2028, my business will have x number of ODs, x number of dollars. Actually there's a whole bunch of things that we teach it, but you got to write it as if it's in the present tense and say you. And then when people read it, they can read the present tense document. And that's your kind of future three year vision, right? And then you say, okay, you now pair that three year vision with a, with what Jim Collins calls the bhag, right, the big hairy audacious goal. And you also then take that and say, which is like way out in the future. But you got to like kind of have. If you never aim for the moon, I guess you're always going to. What's the quote? If you never aim for the moon, you always end up eating dirt or whatever. So the, and then there's, and then you get into execution and you say, okay, well I know what the three year vision looks like. So now let's work that backwards and back into a one year plan which gets really, really tactical. And that's where the vision becomes like, you look at the plan and you're like, okay, so what's going to help us? What's going to keep us from going from $2.2 million to $2.6 million this year? And like, you know, let people talk, let people say, well, we don't have enough ODs or we don't have. Okay well let's just dig into that issue just a little bit. Or like, let's write that down as an issue. And then like later when you dig into that issue, when you actually do the a, the analyze part of the issue, like, well, do we really not have enough ODs or do we not have enough support for the ODs to be able to do the, to do their Work like, what do you mean by we don't have enough food? And when you analyze, you identify all of the different ways that you could potentially solve that issue, and eventually somebody takes that as an action item. But, Jamie, I wanted to circle back because you said quarterly. Absolutely true. There does need to be a quarterly structured meeting. But this is also what we teach you in the cadence part of the ICARE boss system, in that the cadence part also tells you, listen, there are lots of different meetings that you need to be having on a regular basis that cost your company money if you don't have them correctly, and they cost your company money if you're not really communicating with your. With your team. And there are certain meetings you got to have daily, there are certain meetings you got to have weekly, there are certain meetings got to have quarterly, and there's certain meetings you got to have yearly. I don't think we have enough time to get into the details of that, but I will mention that there was one doctor that I talked to once who was, like, really frustrated with the fact that his associates weren't really. Weren't really. That their revenue per patient was low and they weren't necessarily recommending specialty services at the same rate that he was. And I'm very frustrated. And I said, well, you know, what's your cadence with those particular doctors? He said, what do you mean? Well, how often are you meeting with those doctors? And he said, well, we go out to lunch, you know, like, every couple months. I said, well, right. So, but when is your business. What's your. What's your cadence with those people? And he was like, I guess I didn't really think of that. And I was like, well, shouldn't you be meeting, talking about numbers? Talking. We'd give you the exact agendas of what you should be talking about. Setting goals, specifically comparing numbers, identifying issues. Like, these are all things that need to be happening on a regular basis. And the last part of that, which I think is kind of that before we go into the next pillar, the last part of that is rocks. And so that's a Stephen Covey concept where you think about, like, what are the big things that every person in the organization can take responsibility for? And when we talk about rocks, we don't just talk about, like, hey, we have a big goal to go from 2 million to 2.6 million. That's our rock. And that's like, everybody's around that rock. Kind of take that rock and break that down. So, for example, if part of that rock, if the way that you're going to get to 2.6 million is you're going to add dry eye to your business. Well, let's take that and say, okay, well what does adding dry eye to my business really look like? What are the steps involved in doing that? Oh, well, we have to research treatment protocols. Okay, that could be somebody's rock. Oh, we have to think about what the marketing looks like. Well, that can be somebody's rock. Oh, we have to look at patient education materials. Oh, that can be somebody's rock. And then all of those rocks ultimately add up to the big thing, which might be one of the three ways that you're actually going to get from 2 to 2.6 million.
- [30:16]
B
Yeah, exactly.
- [30:18]
A
Yeah.
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B
So, yeah, so I think it, it the, the rocks focus the group not necessarily on effort, but what are the real constraints to our growth? So that, and you're breaking those down and you're attacking those on a, well, monthly and quarterly basis. But it's broken down into quarters. So that, that is all under. So you become super familiar with how this all fits together and works in that first pillar.
- [30:56]
A
Yeah, accountability. The second pillar, we actually couldn't find anything that aside from our friend Jay Abraham, that was really like business books had been written around this from a systematic approach. There's a lot of marketing books out there. But the second pillar, which is revenue, we like to think of this is the part that's truly really adapted to eye care and eye care growth. And as I said before, you know, we heavily borrowed the concept from Jay Abraham that there's three ways to grow a practice. One of them is to drive more new patients or to drive more patients in the door. Another is to get those patients to spend more in the practice. And number three is to get those patients to come back more often. And so with that in mind, we have a number of concepts that we kind of unveil in the Icare boss system. Again, this is like a three hour episode in itself, just focusing on the revenue system. But we teach you to think about the lifetime value of a patient and we teach you to think about allowable acquisition cost, which, you know, we call blank check marketing. We talk about the approach to marketing as a science and not necessarily as a brochure. We teach you how to create authentic content, which in the world of AI is becoming more and more valuable. Then we actually dig into, Jamie, your favorite subject, which is the exam only patients and the exam only problem. We talk about phones and phone capture rates and then we also cover strategic reactivation Inside of the, inside of the revenue system. And that's not even all we actually there's, there's more because we, like I said, we came up with over a hundred different growth levers that can potentially be pulled in a practice. But the big ones I think require a lot of focus. And as Jamie said earlier, it's not shiny object to shiny object time, it's prioritization time.
- [32:55]
B
Yeah. Which ones are the biggest bang for the buck. So in the. And I would say the revenue system is where we get a combination of. Well, I'd say it's in many ways it's the optimization system. In many ways it is. How do we take. And so if you think about it, if we just get incrementally better and we'll teach you the concept and it's really easy to apply because we'll apply it to everything from frame board management to exam only to premium product to conversion to myopia management, conversion into dry eye, conversion into Lasik if you happen to have an ophthalmology arm to your practice. And the idea behind the revenue system is how do we get, you know, 3 to 5% better? So let me backtrack. So a lot of practice struggle with, you know, I want to grow this one area a million dollars. And the reality is you need to find three to five little areas that lead to that million dollar revenue. And you would be amazed. And we go through the math in this because it is pretty staggering what impact the we have to your revenue. If you got just 10% of your. Is one example, 10% of your patients to that love you and probably would refer to you, but they don't know to refer to you because you never asked. And we don't have a formalized system. And we had that. We didn't have a formalized system. By making a formalized system. If you look at the impact of getting 3 to 5% better in exam only, for example, that means the patient comes in thinking they're going to buy high purchase intent. Chief complaint. I'm not seeing as well as I used to. I'm not seeing well at nighttime. I broke my glasses, I lost my glasses, I ran out of contacts, my contact prescription expired so I have to renew it high purchase intent. Yet many of the practices that we see that haven't been through this system are batting like 50% on a patient that thinks they're buying new eyewear from you on the well vision as an example. And how do we take three to five areas in our practice and just get 5% better. And it is staggering how that accelerates the growth of the practice. So two patients, 10% of your patients that love you, just refer two patients because you have a formalized referral system or two formalized referral systems or four formalized referral systems. And just getting two patients a year from 10% of your patients. You start doing the math and looking at your average revenue per exam. It's a staggering number. It's a really big number for practices. So the revenue system really focuses on ways that we can grow. And the easiest way to grow is when you're underperforming on a particular metric or introducing something new to the practice. And again, it really all comes down to if you just, if you were to list ideas under, you know, increase the number of patients, how do we do that? What are three ideas? Referral would be one of those. They increase the new patients. How do we shorten the time between visits? Well, reactivation is a system that if done properly, can really improve how frequently I come back to you. Left to my own devices, I don't come back to you. Compelling reactivation. And there's more than just one prong of reactivation. It's not your overdue for an eye exam. There are a lot of other areas. Has a pretty staggering effect. If you just shorten the revisit time between visits by three months. It's a pretty amazing number. And then the other is the, the increase in the average transaction size. So if you think about it, and you're at a 50 or 60% exam, only if I get an additional 10% of those patients to buy eyewear when they think they're going to be buying eyewear. Right. So we're not talking amount of eyewear, but just an increase, 5% increase in that, in that particular, you know, multiple pairs. For example, or exam only has a, has a dramatic overall increase in the average basket size. So you just got, having the patient go from I'm just getting an eye exam that I get reimbursed from the SP or iMed or river by whatever, 50, 60, whatever the reimbursement is to. Now they actually buy a pair of glasses and let's just say it's $250. It has a staggering impact on your average ticket. So those are kind of thinking about the revenue system, the three ways to grow, and how we kind of retrofit the concept into really tangible concepts in the eye care space.
- [37:50]
A
Yeah, and I think you're absolutely right, Jamie, because if you think about kind of the Whole concept of, look, if I could get. If I could take revenue per patient and improve that by 20%, and I could get 20% more patients to come in, and then I could get those patients to come back 20% more frequently, I have grown the practice by 75%. That means I've taken a $2 million practice and made it a $3.5 million practice. And so you kind of think about that and you're like, well, yeah, like, we don't have to grow by 20% each of those categories, but it all stacks on itself. It becomes exponential. And I completely agree. There's just so much in the revenue system. I think we've done an episode on, like, one of these things in the past, and we can talk about it for hours, but when we come back from the break, we're going to go through the other three pillars of the ICARE boss system. I'll see you right back here on the Power Hour. All right, we're back on the Power Hour. My friend Jamie Rosen with me, and we are talking about the I care boss system. So prior to the break, we talked about the reason why practices need a system. Some of the problems we have been able to solve by having practices deploy the system in small batches, and also what some of the pillars really look like. And so up until this point, we've covered the accountability part because that's a big part of what you need to impact change. And we've talked about revenue, which is ultimately a giant driver for optimization for practice and driver for growth. But, Jamie, when I speak on stage, one of the things I frequently do is I ask practices to fill out a quick survey, like, live and poll, And I say, what's the biggest issue in your practice? Every single time, without fail, for the last two and a half years, the number one thing, almost always and almost every audience is, is that people is a problem. And, you know, when you dig into that, the whole concept of my people are a problem takes on multiple different shapes. And so the people system in itself has really kind of tried to address it from the ground up, as opposed to trying to put a band aid on, you know, how do I get my people to be more productive? Or how do I get my people to follow directions, or how do I get them to stop calling off or whatever those things are.
- [40:19]
B
Yeah. And be and become engaged. So, you know, I think that if you think about it, you know, the people that you work with are kind of the central nervous system of. It's like, it's the really important component yet it's probably the area that most of us struggle the most with. And so part of the people system is really starting with some kind of foundational steps. And, and we also. So foundational steps means we talk about core mindsets. So what are the, you know, what are the non negotiable behaviors? So we're talking about like it's kind of like Maslow's hierarchy, like this is food and shelter. Core three to five non negotiables. We're not self actualizing at the top of the pyramid, we're food and shelter. So what are the three to five we talk about and have? And this is where you actually brainstorm on your own and you also facilitate with your team. But what are the three to five non negotiable behaviors in the practice? And we use those when we're hiring, when we're coaching, when we're letting people go. And we also have our people, you know, review how we're, how we're doing in living up to the point core mindsets. Because it's one thing for me to say you got to do the three to five, it's another thing for me not to be participating in those three to five core mindsets. So we have to model that as well. So we talk about having you develop your 3 to 5 kind of non negotiables. And those are called core mindsets if
- [41:56]
A
you want to take. And those are like rules of engagement. And those rules of engagement also help you understand which is another part of the people system is how to develop leaders. Right? Because the people who are high on your core mindset, right, when we actually give you like a one minute quick assessment of what you're, you know, like in one minute you could determine who belongs in your practice, who needs coaching, who doesn't need coaching, like you. You will know once, once we share this with you. But then there's also a more robust component which is we actually give you a calculator that you can use to assess people not just on the core mindsets, but also on various elements of their contribution. So the quality of their work, the quantity of their work, the reliability and overall dependability. And when we look at those, when we look at kind of the whole factor and we even provide people with tools when they're leveraging the system is like when you look at that core factor, when you start stacking your team and you basically grade everybody, you'll almost always get into a four force rank situation. And I, I recently did this with my team where like, you know, the supervisors, before they force rank their teams, they kind of say, well, yeah, you know, the Susie's great. She's awesome. You know, she's really good. She helped out with this thing. But when you start really saying I on a scale of X to Y, does this person truly exhibit this core mindset every single day, every single time? Because if not, can't give them the top grade. Okay, fine. They're in the middle. Okay, great. And then on a scale, when I asked one, is this person 100% reliable consistently relative to other people, does this person do more work than others or less work than others? And you start kind of force ranking across all the different categories, and all of a sudden you realize, where are your top performers? Where are your bottom performers? And then you start saying, where do I draw the line? Because below the line, on that spreadsheet, inside of that tool, below the line, those are the people that you either have to performance into a manageable position in your organization, or you got to performance them out of the organization, because not everybody's going to be a fit. But that's also the spot where you can start poaching future leaders. And we actually have a whole section on leadership development as long as those people want to lead. Because I think you're the one, Jamie, who's constantly talking about how you just can't always take your best optician and make them your office manager.
- [44:25]
B
Yeah, right. Isn't that the Peter Prince you ascend to your level of incompetence, which, you know, is something that I've. I've ascended my people to historically. But this. So we do. So we give you a little bit about on the leadership side. So really helping you to identify your leadership ability. Are you a visionary? Are you an operator? Are you one of the few executives. I remember taking a class from Chet Holmes, and he talked about the fact that, you know, basically 10% of the population are super strategic. Like, they're. They're 10,000ft in the air at all times. And. And then there's like. Like 87% are in the weeds all the time. There's not a strategic bone in their body, but they're really good at executing. And then there's like 3% that are the talented, super strategic, but they have the ability to get into the weeds. And this is kind of just your personality, but we help you assess. Are you the visionary? Are you the operator? And we talk about that as it relates to leadership development. And we also talk about the promotion trap, which is, you know, if you're good at one thing, it does not necessarily mean that you have the skills to be good at a different thing. And we talk about in the. In, in the zone. We talk about the zone of genius, which is another concept that, you know, it may not be that you're the greatest executor, but just to realize that and have your team aligned. And we also then talk about managing your people. That was what Eugene went through, kind of, you know, are you. You know, are you doing this and exhibiting this all the time, or are there areas that you could be. Could you be more consistent? We also talk about the four types of employees that we tend to have and which ones are super detrimental to your growth as a practice. And we backstop that with the notion that, you know, you cannot wait for the resignation letter to come in before you start recruiting. So we talk about how you constantly need to be backstopping your key people and the number of people you need so you're never not recruiting. And we talk about ideas on how to build that muscle so that you're not like, giving your oh, my God emoji. When somebody that's a key employee says, I'm now leaving, and you're like, how am I going to replace that person? You know how you're going to replace them. And how do you force rank your staff so that you're replacing the bottom performer consistently before that bottom performer hands you their letter resignation? And we get into the reality of what happens when you lose one of your team members. And it's. It's this downward spiral that we talk about, that that means you have to always be backstopping your key look, your key positions in your practice.
- [47:37]
A
Yes.
- [47:37]
B
So you're always recruiting and building that muscle. That's a lot of the people system, I guess. The other thing I think that's worth mentioning is we really depict a process for change management. So this is a little bit of Daniel Kahneman. So if you think about it, the most important, the only, there's one component that's super important to allowing people to change their behavior. And that one thing is feedback. So that the team fit calculator helps with structuring that feedback. But we talk a lot about without that feedback and creating an organization that learns from one another and then identifying what's the biggest bang for prioritization, what's the biggest bang for our buck. That thing we're going to change and then how we actually introduce that new initiative and how do we support that initiative is all about the change Management process that we have put again pulled together. And a lot of, you know, Daniel Kahneman was one of Nobel par is in economics, behavioral economics, but he was actually a behavior psychologist, a PhD. And so he talks a lot about system one and system two. And we get into that detail to understand the difference between making fast decisions and making slow decisions. And the benefit of making slow decisions. That all is in the change management system. Maybe add a couple more.
- [49:15]
A
Yeah, my favorite part of the change management system is like a Jamie Rosen quote that I use all the time. I actually talk to people about this all the time. And I think this is something you taught me. And I like hearing you say it over the years over and over again is like, man, I really was making a mistake. And I bet a lot of people who are listening to this are making the same mistake, which is that we look at, many of us are numbers driven and we look at the numbers and then we share those numbers with our people and we say, guys, we got to get better. We gotta, we got. We need to make an improvement to this metric. And what I think I learned from you, Jamie, is that you do not manage the metric. You manage the behavior behind the metric. And so how you manage the behavior behind the metric is part of the ICARE boss, you know, people system. But I also think that there's a component to this where you just, you, you have to realize that people aren't like, I hear this all the time from practice owners when they say things like, well, my people, I just need to get my people to care more or to take more ownership or to do it. Like oftentimes it's not that people don't care, it's that they don't have the systems or the process or the support to be able to take the right initiative in your business or to be able to really make the meaningful changes. And if you, and you know, like, you, you maybe tell a quick story of like, behavior change, effective behavior change that you've witnessed, or some of the
- [50:44]
B
practices, you know, I would say, generally speaking, if you're well, so it's twofold. One is the realization that many times your people don't know what behavior leads to the metric. So in the iBoss system, in the people system, we spend a lot of time with the notion and we have tools to help you do this, but we spend a lot of time with the notion that you need to be observing. And when I say you, someone needs to be accountable for observing. And if you were to look at your performers across the Board, you have some people that do certain things really well, and then the rest of the group doesn't do it near as well. And that could be anything from exam only to myopia management to just being a good teammate, really. And to the extent that you can. So awareness is first. They have to know how they're performing, right? So that's the first thing. Then you and your team start to figure out what is the behavior, the best behavior that leads to the goal that we have. So let's just say exam only. Like, the best behavior is doing a really good handoff, handing that patient off to the optician. And we found that, you know, the optician has a question that they can ask that opens the door for them to explain all the doctor's recommendations. The doctor has to give a good handoff. Like, those are critical components if you're trying to convert patients right, they think they're going to buy, but they walk. Why? Not a good handoff, not a good introduction by the optician. There are certain behaviors. So what are those behaviors? For example, you know, one behavior that we found was with a practice was that if I started the interaction after the doctor handoff with the question of, would you like me to explain the doctor's recommendations or do you have a budget in mind? It opens the door for you actually to. Because 95% of the patients are going to say, no, I want to hear the doctor's recommendations. So it's like a tangible example. 5% are going to say they have a budget in mind. And then all you got to do is find the way to hit their budget. 95% are going to say, I'd rather hear what the doctor's recommendations are in more detail. Because the doctor did the handoff. And if the patient at the end of the day says, wow, that's very expensive, because the doctor recommended a bunch of things, then it's easy to say, well, you know, what kind of, what budget do you have in mind? And then all you have to do is hit the budget. But that, that, that critical component gave the optician the license to explain all the doctor's recommendations. Whereas with. We didn't ask that question and we explained all the doctor's recommendations, the patient's eyes glaze over, they look at their watch and they say, I gotta go. Cause they know it's gonna be super expensive. That's just one. One behavior. But we had enough. I was just gonna say we had one other, an optician that was really good in multiple pairs. And what we learned in observing her because it's really hard for your people to articulate what they're doing well or what they're not doing well unless you're giving them feedback. But one optician we observed never went to the dispensing counter before. They had at least two pairs of glasses in their hands for the patient, and she was doing. And it was something we could all learn from. So observation allows you to take the variability of performance in your practice and make it tighter grouped to make it tighter group towards your best performer. They may not get to be your best performer, but by observing and being able to articulate the behaviors and being able to. For your people to articulate the behaviors when they're what? When they're observing somebody creates an environment where people spur on really good ideas, they try new things, and your practice learns from one another. That's the most important component, the ability for your practice not to have one person directing everybody, but for them to be able to learn from one another.
- [54:41]
A
Because I think that's the system. That's what I was trying to get at is that it is not just that, you know, there is one oracle within the practice that knows everything. It is that there's a systematic approach. And when you even said the words observe, well, there has to be a systematic way for someone to observe behavior. When somebody is a top performer, or when somebody is a bottom performer, or when somebody's in the middle and they want to get better, there's gotta be a systematic observation process which is all part of the system. So that's all part of the icare boss system. Now, again, we could probably spend another three hours on people, but let's talk about the other two systems. We've got experience and we've got data. So when we think about experience, we talk about patient experience. And the truth is that, you know, especially in the age of AI, especially in the age of telemedicine, like, patient experience cannot. This is like one of those things where you really have to make sure that philosophically, your whole team is aligned on a extremely tight and extremely consistent patient experience that delivers better than something like a kiosk can, that delivers. And, you know, because I think there are patients who are like, I get a benefit of not having to wait and not being, you know, not being hassled. And so the experience cannot feel like a hassle. I go to when I live in Cleveland, and so when I go to the Cleveland Clinic, because that's really my only choice for, like a physical. It is a horrid experience every freaking time. The appointment is always late, the doctor is always rushed. The pavement, the labs that I have to go do is like six days away and at the most inconvenient time possible. And there's always a line. There's always like, the doctor never feels like they have time for me. They're like, they. One guy went to print out something for me and he was like printing out a Wikipedia page at a printer that like jammed and like, then like, the nurse had to, like, I had to wait another 15 minutes for the nurse to unclog the printer so that like, they could give me a Wikipedia page that I didn't even want. I just couldn't leave. Like, it's just like an awful, awful, awful bureaucratic experience. And what we try to teach you in the eye care boss system is to recognize that you have a chance to set a very intentional experience in your practice. And so we teach you about things like the power of wow, which we learned from Disney and we, we talk about and several other actually really impressive consultants who worked with Starbucks and Ritz Carlton and a few other, a few other really well known brands that are great for service culture. So we teach the power of wow. We teach the service culture. There's a. And, and then there's like a whole scientific way to map your patient journey.
- [57:29]
B
Yeah, that, that's, that was so tangible for me. But when we, if you map out, if you had your, if you just like had post up notes, big, you know, you know, big easel, sort of post that stick to the wall and you would go through every moment of truth that a patient has from the time they enter the door to the time they go through pre testing or, or actually we'll spend some time on the front desk. Like, you know, is the person at the front desk greeting you, you know, like with the phone to the ear and this. Or is it a pleasant. A greeting and you go through all the moments of truth? I mean, we came up with 27 steps in the patient journey. From the time I made an appointment to the time I walked in the door, I walked out to the door with my new eyewear. There are about 27. And we chunk some of these steps together. 27 steps. What we learned is that through an regression analysis, analytics, we learned that it's so first, it's really hard for your people to focus on 27 things. They can't do 27 things really well. But it was interesting to learn that actually there are five of those steps in the 27 step journey that are disproportionately impactful to the patient satisfaction. And I'll keep that as a tickler for you guys to learn when, when we see you in at Expo. But those. So there are five that are disproportionately. If you did those five things, just those five things really well. So that is the patient to those five things says I agree, I slightly agree or strongly agree, you would be performing from a satisfaction level at a 97%. They call it Ambassador Score. But it's like an NPS. So we do the journey mapping and what's. Was what, what was super interesting to me is what didn't show up in what was the most impactful. So I'll give you a hint of what it isn't. But what didn't show up in was the, the exam that, that didn't show up in one of the critical things in the patient journey. So I'll leave it hanging out there. It probably would be in the book. But the point is it's really interesting and counterintuitive. And when you start looking at the complexities of our business in terms of what we have to do for patients from the time they walk in the door or they make the appointment to the time they leave with their eyewear, there's only five that are disproportionately impactful that really trigger with patients whether you did it or whether you didn't do it.
- [60:12]
A
All right, and thank you for the teaser, Jamie. I think now you got everybody's attention. And then I just want to touch on data because I think that data is kind of three components. It's understanding the types of metrics that you have in your practice, but not just like for the purpose of understanding, hey, these are operational metrics and these are marketing metrics, and these are financial metrics. Like, we're not just talking about that. What we're saying is you have to develop a data driven culture in the business. And I think this is where Jamie and I have seen eye to eye. I think really from like our first meeting several decades ago, it was like, man, like, we both agree that data should drive all decision making and we'll let the data do the talking. And I think with this is where, you know, we recommend having a culture where you've got a consistent review. There are some metrics you look at daily, some metrics you look at weekly, some metrics you look at monthly. We tell you what those are. We also talk about how you use data to drive behavior change. We already covered Some of that and this in. In this episode, but get deeper into that and then we actually get into, like, why we think some metrics are more exact. So, like, you know, the, the example we've used in the past and the example I'll keep zooming in on because it's probably familiar to our audience at this point, is exam only, right? Like, capture rate is an imprecise metric because there are multiple behaviors that drive capture rate. You could have multiple pair sales that drive capture rate, you could have outsider X that drive capture rate, and you could have a whole bunch of other behaviors that are truly exam only, like patient walking out the door without buying anything that drive capture rate. So that's an imprecise metric because there's multiple behaviors that drive that metric. Exam only has a series of behaviors that you can observe and measure that ultimately that's a more precise metric. So we identify a whole list of metrics in those three categories. Operational metrics, financial metrics and marketing. Marketing metrics that help you understand and kind of marketing growth metrics that help you understand what you really need to focus on in the practice. But again, all of that is with the overtone of you have to have a culture that is data driven in every single way.
- [62:30]
B
And we do talk a little bit about the concept of lead indicators versus lag indicators. And in this case, most of the data system is lag indicators. But we talk about the importance of lead indicators, because lag indicators, you can't do anything about that time already happened. Lead indicators are what we're trying to develop as business people that predict whether the future is going to be on track with some of our financial goals or unit goals. So we talk a little bit about that as well in the data system. So we talk about the lead indicators, the lag indicators, and it's the connection between the behaviors, again, that we talked about a little earlier, the connection between the behaviors that set us up to hit our lag indicators. And to some degree, what are you looking at as a lead indicator for your business? Because if you have a lead indicator, I'll give you an example. Let's say you have a goal for number of exams per day and you're looking on a Thursday at what Monday holds. That's a really good lead indicator of if we're going to hit our revenue goal, because I. And our conversion goal, because that indicator means we got at bats because patients are coming in. And the idea is to be able to have a playbook where if your lead indicator is not shaping up that aligns with your goals. And we'll get. It's a little esoteric, but it'll make sense when you go through it. But if your lead indicator is not lined up with your metrics, what do you do? What playbook do you have to drive? In this case, let's say it was a number of exams on Monday. What is the playbook to fill the book on Monday? And you start getting really good at having that playbook when your lead indicator is not setting you up for the right lag data point. I hope that makes sense.
- [64:36]
A
Yeah. And I think, you know, there's also things like, hey, what's your phone capture rate? That's not a metric that most people measure, but that phone capture rate is an input to ultimately the number of patients that you're going to see. Because if you don't handle that metric correctly, then you're literally just eliminated a piece of the funnel of how many other what's possible inside of your practice.
- [64:59]
B
Yeah. And. And the marketing indicator, that's another one. Because what Eugene was talking about when we were saying that we were aligned from the day we first met was, you know, a lot of times, for example, in marketing, you are looking at a lot of the data that I was receiving a long time ago was on impressions. Well, impressions don't do anything for me. I think I joked with Eugene that if you wanted to get paid in impressions, then I will pay you impressions. But most people like to get paid in dollars.
- [65:29]
A
Actually, this was. This was the best. I really need to pause here because this was one of the best lessons I ever learned as a marketer. And I made my team. I literally, like, absolutely made my team go through the same torture that Jamie put me through. I think at some point. And this is a long time ago, right? Like, not everybody, not every business has a Facebook account, whatever. And like, we were debating whether Rosen Eye Care needed to have a Facebook account. And Jamie asked me and said, well, so Eugene, traditionally, like, how do people measure success of a Facebook account? And by the way, like, it's still a dubious question of, like, whether or not Facebook is good for driving appointments into. Into eye care practices. And that could be its own show. But at that point, Jamie. Jamie astutely asked me and says, so, Eugene, how do we. How would we measure success? And I said, well, you know, there's this concept of, like, engagement on Facebook and that's like the views, likes and shares. And, you know, a lot of people measure success with. On Facebook with engagement metrics. And Jamie said, to me and said, so do you guys take payment in engagement? And I remember just sitting there and I was like, that is such a great, like, you know, like we didn't know each other that well, but like, that was like such a great statement and I used it in training conversations with my team all the time when I'm like, okay, so like, what's the, you know, what's the measure of success for this thing you want to do for the client? And they'll like, give me some esoteric crap and like, okay, so like, did you want your paycheck to be on that metric as well? And you know, people are like, oh, wait, no, I get it. Okay, got it. So I think this is where you get down into the stuff that matters. And again, that's where ICARE Boss was kind of built the data system into data that actually matters. That drives, but that moves the needle. But I hope kind of going through this system and we did go through five pillars. There's a lot, I mean we really probably could do like a four day seminar on this and not get through it. So I think trying to compress this to one episode, I think is, is was both aspirational and hopefully helpful to people. My I, I think the other key section that I should probably mention is that neither Jamie nor I subscribe to the idea of infotainment. Like, we did not do this for any reason other than to help practices win. Because I do not want to be associated with infotainment. The reason I do this podcast and the reason I love having Jamie on the podcast is because we want people to take action, want people to use the information and specifically inside the ICARE Boss system to take action to get better and then tell us how you got better so we can feel good about the fact that the system helped you. And that's kind of the, that's the idea behind it. And again, we absolutely believe that you can't do any of these things in isolation. You can't just look at your data in isolation. You can't just like work on your people in isolation. You can't have growth without accountability systems. And that's why when we like, and we debated this ad nauseam and look at like, are there 12 different levers or systems, subsystems, and we kind of got down to five because we thought five is a good number of pillars that people can execute. You can have an action plan within each of the five pillars. You can take step by step by step by step action across the board. And then we, and, and Then that actually leads you down the path of implementation and taking action in a systematic approach, not just chasing the next shiny object.
- [69:12]
B
Yeah, and I would just echo that. A lot of practices that I've been in study groups with, et cetera, you know, have methodically, sort of over the course of time, grown. But being in a study group, you know, not without a lot of pain. And the idea here is we kind of put this together with the idea that if I would have had this system, um, could I have moved faster in my business? And if we tried to answer with yes, if it was a no, it's not in here. It was a yes, it is. It takes some discipline, for sure. And it takes work. Don't get me wrong, this isn't the easy button. Um, but the hope is that this compresses the time it takes for your practice to go from whatever you want, wherever it is now, to wherever you want it to go, versus just trying to figure it out on your own. So the idea is this system is something that, as I talked with a lot of larger practices, was something they would look back on and say, I wish I would have, I wish I knew then what I know now kind of thing. So it's really, how can we fast track your success? Is the, is really how this was developed? Yeah.
- [70:31]
A
And I think if people want to learn more about the Icare Boss system, they can do one of two things. Number one, they can show up to Vision Expo and hear us talk about this on the, on the main stage. We've got a couple CES that we're doing on this. And number two, if you're listening to this episode after Vision Expo 2026, then you can go to icareboss.com and get some information on the system, the tools, the resources, a bunch of free resources that we're going to make available to people. But the key part here is we want, we believe that there is not necessarily an established system for practices to scale and optimize. And we hope that by putting this out there, more practices can win and we can see more patients and be more profitable and deliver a greater level of success to the entire industry.
- [71:25]
B
Yeah, that's the goal.
- [71:27]
A
So thanks for joining me. I think this has been a really, really action packed episode and hopefully I'll look for feedback to hear, to hear how it was received.
- [71:38]
B
Yeah, well, I hope your listeners got something out of it that would be fantastic. So let me know.