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The Profit-Driving Tech Strategy That Majority of Practices Overlook, with Dr. Sage Hider
00:52:22
Most practices think buying the latest technology will automatically boost revenue — but Dr. Sage Hider says it’s not about what you buy, it’s how you use it.
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- [00:07]
Eugene Schottzman
Welcome to the Power Hour, Optometry's biggest and longest running show. I'm your host, Eugene Schottzman, and we've got an incredible episode for you today. My guest today is Dr. Sage Hyder. He's a clinician. He's been practicing in the same location for 30 years plus. He's been building deep, lifelong relationships with his patients. But he's also been staying ahead of the curve when it comes to medical, optometry and technology. So that's exactly what we're diving into today. How do you make technology work for your practice? And Dr. Heider isn't just bringing in his latest tools because they're shiny. He's definitely a numbers guy. And you're going to hear his formula and how he breaks down, exactly how to decide which tech is worth investing in and what's not. He'll help you justify the ROI and how to make sure that every single piece of equipment in your office isn't just sitting there. It's actually earning money for you, just like another associate would. We'll talk about the must have technologies that every modern practice should be using. The nice to haves that might make a big impact if you use them correctly, and some of the bigger mistakes that doctors make when buying equipment so that you can avoid them. And here's the kicker. Dr. Heider's secret weapon isn't just the equipment. It's actually how he explains the procedures and the technology to the patients. So if you've ever struggled getting patients to say yes to diagnostics or treatments, you need to hear about his approach about communicating value in the exam room. So before we jump in, here's a quick reminder. Make sure you're subscribed on YouTube, Spotify, Apple, or wherever you get your podcasts. And if you have questions, feedback, episode ideas, go ahead and reach out to me directly@eugene shotsman.com or on the Power Hour website. Now let's go to the show. All right, Dr. Sage Hyder, welcome to the Power Hour. Excited to have you on the show.
- [01:51]
Dr. Sage Hyder
Thank you very much, Eugene.
- [01:53]
Eugene Schottzman
Yeah. So I think in order to make sure we properly frame up our conversation about technology today, I'd like you to give a little bit of background on yourself and your practice because I think it's really going to help people understand the context with which you're contributing today and also the context with which you get to see the world through on a regular basis.
- [02:17]
Dr. Sage Hyder
Thank you. You know, I've been very blessed with how I've been able to practice optometry you know, the things that we learned in school, I've been able to use those every single day in my practice. I live in a small town in San Luis Obispo, California. I've been in practice here in the same location for 30 years, and because of that, have had the ability to really see patients for quite a long time. You know, I recently gave a lecture on glaucoma, and the speaker before me, a professor at one of the universities, was talking about, you know, how to treat glaucoma. And one of the participants asked him, well, what happened to that patient? And he said, well, you know what? You have to understand that I'm in a certain setting that I might see a patient for two or three years, and then they. Their insurance changes, they move to a different location, another doctor in the practice gets them. I don't get to follow those. I've been treating the same patients for 30 years. And the first patient I gave my presentation after that was a patient I've been actually treating for glaucoma for 20 years. And so because of that, it has given me some ability to really get to know my patients well. I think my patients are more friends than they are really. Somebody that I don't have a connection with. You know, whether their kids played soccer with my kids or whether we're in Boy Scouts together or on a community board for youth facilities, those are things that we get to know each other very well with. So 30 years in the same practice because we are in your.
- [03:54]
Eugene Schottzman
And your practice is pretty high medical.
- [03:57]
Dr. Sage Hyder
Yes, yes. As Jiska says. Yeah. So because 30 years in the same location, our small town doesn't have a lot of big HMOs. We don't have a big Kaiser hospital next door or a. A big medical facility that we have to refer all the patients over to that come in. And so because of that, we treat, like I said, everything that comes in the door. We were joking earlier that every Friday I get to remove a metallic fed metallic foreign body out of someone's eye. It's the same story every week. That Tuesday, Tuesday they got something in their eye. They were grinding on a lawnmower blade, or actually the last four have been. Seemed like they've been working on their trailers. So welding and grinding on a trailer gets in there on Tuesday, they're miserable. They say, gosh, you know, it's so bad, I couldn't. Couldn't even sleep Tuesday night. And so I said, well, why didn't you come in Wednesday? And, well, you know, I thought it would work its way out. And so Wednesday night, gosh, it was so bad, I couldn't. Couldn't even sleep all night long. Thursday. And I said, well, why didn't you come in Thursday? Well, I thought it'd work its way out. So then, of course, they're in my office Friday afternoon and I'm digging something out. There's a lot of rust. Putting bandage contacts on. Have to come in on a Saturday to see them or something like that. It's just, you know, so every. Every kind of Friday I have. Have that kind of fun routine. I know it's going to happen.
- [05:10]
Eugene Schottzman
I can only imagine that the. The reason. Well, why'd you come in today? Well, you know what my wife made me.
- [05:15]
Dr. Sage Hyder
No, they usually don't want to let it go for the weekend. You know, after three days of being miserable, they don't want to let it go for the weekend. So. And so you talked about, you know, what do I do? A lot of specialty. Like I said, we're an optometry practice that sees whatever walks in the door. I do treat a lot of glaucoma. You know, we're going to talk a little bit about technology today. We were the first office in the entire county, OMD or MD or OB that had some kind of imaging device at the back of the eye. We had the original HRT, Heidelberg retinal topographer back in 2001, and we actually received ours a week before the glaucoma specialist used it.
- [05:54]
Eugene Schottzman
Wow.
- [05:55]
Dr. Sage Hyder
Being in a practice that has three doctors, I've had three partners my whole career. I've retired. Two partners, two younger partners have come in. We can afford to have a piece of equipment like that because we can split that between the three of us, and that's part of what we do. But we're going to talk a little bit about how to make that happen just in a single office and what that looks like. So, you know, we talk about technology. I'm not a technophile, I'll tell you that right now. I have a 1965 Mustang. I'd rather drive that than some newer car. I do have an electric car, a Chevy Bolt. So wired up my electrical outlet in my car, so. Or my garage, so I can charge that up in there.
- [06:35]
Eugene Schottzman
Nice.
- [06:35]
Dr. Sage Hyder
But. But, you know, I don't have WI fi connected lighting. I don't have, you know, surround sound speakers everywhere. I don't. I'd like to, but it's just not something I do. I can walk over, turn on a switch, turn off the switch. And so I'd like.
- [06:51]
Eugene Schottzman
But you know, that does actually bring, from a practice standpoint that kind of brings things into perspective because you see a lot of patients, you probably got a lot of your technology out of need. And I've heard you talk a little bit about how we use. And one of the things that prompted the episode is the ability to intelligently justify whether or not your office needs technology or is ready for a piece of technology. And really that's kind of what you were just mentioning getting at is the, you know, what's the what, what's the difference between something that you really need and something that is kind of a, you know, it's an okay, nice to have type of thing. And you know, how do you even start by going through those decision making processes?
- [07:34]
Dr. Sage Hyder
Yeah, you know, that's interesting because, you know, I, like I said, I'm not a big technophile, but I do like technology that improves patient care. It improves patient care, it improves the ability to treat them and it makes the flow in the office work very well. So having some technology I think is very, very important now what is essential and what is not essential. You have to justify that for yourself. You know, you got to think about how it's going to cost you. Can you afford to do technology? Can you afford new instruments? There's always a way to do that and we're going to talk about that a little bit more. But just taking something, you know, as simple as a fundus photograph. When I first moved into the practice here in 1994, we had a Polaroid Canon camera that sit a patient down, get them. It was a supposedly non mydriatic, but usually had to dilate them to get a good image in there. You took little Polaroids, you put the film in, you pulled the film back out, you waited for it to expose and see if you actually got a good image of what you were looking at. And that worked. That was 1994. We had that technology. It was getting more and more difficult to get the film. As you know, they stopped making Polaroid film for quite a while. So we couldn't get filmed. So, you know, in 2005, got my first digital camera. It was amazing. It was an OptaView rental camera. It could align itself, take photos. You had them digitally right there. You could upload them into your computer and into your software. They would have the ability to do collages, 3D, you know, stereotypic photos. Really kind of neat technology. And then of course we move on to things like wide field imaging. I don't know anybody who's practicing nowadays that does not have some kind of wide field imaging camera. Whether it's an optimap or a Zeiss or whatever's out there. It seems like everybody I talk to has one now. They're expensive and you know, just getting a camera like that, you kind of have to think of how you kind of make that work. So when you ask me, how do I justify getting a piece of equipment, is it good for patient care, is it financially going to be successful? And then when I evaluate some type of equipment, I always have things in my mind. Ease of use. Ease of use, I think is one of the most important things. Is it easy for the staff to be able to get a good picture? If you have a camera that you can't get a good picture of, it's worthless. I can't get data that I can use. So staff has to be able to use it. So ease of use for staff, ease of use for the patient. If something's difficult for a patient to use, it's not going to be successful. Patients don't like doing the instruments. They complain about them all the time. They don't want to do a second one if you need to get some other data or repeat it in the future. So ease of use is very, very important. And then like I said, good data. If you don't get a good image, you don't have good data. And you don't have good data, you don't have good treatment in that. And so evaluating any piece of equipment, that's what I kind of think about is what data is it going to give me and how easy it for the patients and the staff to use that. So, you know, ophthomap comes around, they have these big gigantic old original, first, first generation optimaps that took up a whole room. I looked at those that, geez, this doesn't make sense. You know, they're very expensive. You know, what kind of patients are going to really go for that? As things got smaller and technology got better, I did, I invested in my first Daytona. So I've got a Daytona Optimap. We got that in about 2014. And that's an expensive piece of equipment. You know, you're looking at probably about $100,000 for back then was pretty expensive. And how do you make $100,000 piece of equipment work for you? So we were talking earlier about kind of looking at the numbers here. You want me to go through some numbers here?
- [11:26]
Eugene Schottzman
Yeah, let's do it.
- [11:27]
Dr. Sage Hyder
Okay. So if you get A hundred thousand dollar piece of equipment. Right now we looked AT loans, a five year loan on that at 6%. You can get a 6% loan from one of the good lending sources like Vision, One credit union, or through one of the other local banks. I kind of check some things out like that, $100,000, 6% interest, five years, gonna be a payment of $2,000 a month. Okay, $2,000 a month sounds like a lot, you know. So if you're doing $2,000 a month, each patient is going to pay you about $40. If you're doing this as a screening, okay, if you're using as a medical device, you're going to get probably about the same thing through Medicare Blue Cross Blue Shield. So you're going to probably get around 35 to $40 per image that you're going to do on that, which means you need to see about 50 patients in order to pay for that piece of equipment. So in my office I see 13 patients. I see about 20 patients a day. 20, 21 patients a day. 13 are usually at full exams. Full exam is going to be either a VSP exam, a Medicare exam, something like that. It's not an office call, not a retinal check or something like that. So just my exams that I see 13 a day. And we have a capture rate for fundus photos or a screening photo of about 80%. So actually we're closer about 90%. Now patients really, really like this technology. So if you're 80%, you're doing pretty good on that. That means you're seeing 10 patients a day that you're getting an image out of. Okay, so 10 patients a day, they're paying you about $40 for that. You have to see 50 patients in order to pay off that loan. So if you're doing 10 days or 10 patients a day, that's five days of seeing patients, that's one doctor, five days of seeing a patient to pay for that. Now I only work four days a week, so that's five days. I work 16 days a month. So the first five days go right into paying for the piece of equipment. Then I've got 11 days of now that paying me. Now you have to think about that. You're gonna have to hire some staff. And whether your staff can use, utilize your current staff or if you have to hire more staff for that a staff is going to cost you, you know, you know, 35,000, 37,000, 40,000 depending on where you are. But that's asking me to do multiple things on that, so if I'm seeing my 11 doctor days of just profit on that, doing that over the years. So that's $44,000 or $404,400 per month that I'm getting profit on that. You look that over the years, $53,000 in profit for having a piece of equipment is already paid off in those first five days.
- [14:07]
Eugene Schottzman
And you know what's interesting is that if the lifespan of that thing is a little bit longer than the five years that you've projected here, then it becomes, then the profit number becomes even bigger in the sixth, seventh and eighth year. Right?
- [14:21]
Dr. Sage Hyder
That is exactly right. Then you're getting all profit on that. And like I said, even if you had to hire a full time staff in order to do this for you, at $37,000, you're still making $16,000 a year just by having this piece of equipment in there. Now it's gonna be more than that. Like you said, I've had my Optimap for since 2014, so I've had it for 11 years. It's still running. Well, they keep coming in telling me that I have to upgrade it because it's, it's outdated and it's, you know, gonna break down and you know, I'm gonna have to do that someday. But right now that thing is gonna.
- [14:53]
Eugene Schottzman
Drive that thing right into the ground.
- [14:55]
Dr. Sage Hyder
Just, just. Yep, just, just making profit and being very, very reasonable to do that. So like I said, I don't know anyone who doesn't have that technology in their office right now.
- [15:03]
Eugene Schottzman
And what's interesting is that, you know, you mentioned staff, but that staff person isn't fully allocated to that one piece of technology because of the ease of use. Now let's, and we'll talk about other pieces of technology and maybe run the formula, run the numbers on them as well. But I did want to ask, you mentioned you guys have a really high capture rate on fundus photos. What is, what's a tip or a secret or what do you guys do in order to make sure that that capture rate somewhere between 80 and 100%?
- [15:32]
Dr. Sage Hyder
You know, it's pretty interesting. I'll tell you the truth. Fundusphoto has been the best practice management tool that I've actually had. When I can show it to a patient, I can pull up an image from 2014 and an image today and do that comparison. Patients are astounded by that. You know, I talk through my patients. Everything that I do, I tell my patients, if you're going to see me, you're going to put up with my philosophies. My philosophies are, I believe patients are intelligent enough to understand what I'm telling them. They have a different education than me. I have a different education than them. They know things I don't know. I know things they don't know. But I think my patients are intelligent enough to understand what I'm telling them. So I tell them a lot. I pull up a fundus photo, I say, look, this is the optic nerve that plugs directly into your brain. It's got 1.1 million nerve fibers going directly from your eye to your brain. Now, here's what I'm looking at. I'm looking at the shape of this. I'm looking at color contour. This looks very good. Here's an artery come bringing blood in. Here's a vein bringing blood back out. If you're a diabetic, we're looking for aneurysms on the tips of the vessels. We're looking for hemorrhages. You know, I show them the thickness of the arteries. And the older people saying, yep, your arteries are starting to get a little bit narrow. How's your blood pressure doing? You've been taking your meds. You talk them through what you're seeing. You know, here's the macula. This is where macular degeneration occurs. Oh, yeah, my mom had macular. Well, let's look at this. We have an auto fluorescent image. Nothing showing up on there. It looks nice and smooth today. You know, and being able to compare that year to year, patients love that. So once a patient's done it, they always do it again. It's one of those things that go, you know, should I do that every other year? I'm like, you go to the dentist every year. You get an X ray every year. You're going to wait two years to see if something happened wrong. You know, it's like, okay, that kind of makes sense on there. So I think that's what, you know, the first year, no, we were 50% capture rate on that. Got up to 60, 70. So we're really right about 90% right now in our practice, because you utilize the tool properly. You teach the patient, as you're training the patient there, you give them the information. Why would they not want that? You look at something go, hey, let's look at this little spot right here. You have a, you know, a little hole, an old tear, an old scar. Let's look at that five years ago, you have a nevus. Let's See if that thing's growing at all. You know, we talked about this has a potential, very low potential of, you know, converting into melanoma because of the size of it. It's got Drusen on the top of it. And you can look at those things over the years. They love it. They love that technology just as much as I do on there. I'm kind of passionate about that because.
- [17:58]
Eugene Schottzman
No, that's awesome. And I think that you care. And I bet it makes patients come back more often because, you know, I don't want to skip my exam because it's not just that my prescription didn't change. It's that I got to get that scan and see if. If. If the stuff I can't see is changing on me.
- [18:15]
Dr. Sage Hyder
Exactly. You know, I have patients all the time. I don't understand. They say, come, say, gosh, this is the best exam I've ever had. I know my colleagues are doing a really good job. I know the same education as me, they're doing the same quality care as me. They just don't tell a patient what they're doing. And so when you're doing, whether it's a basic contact lens exam, this is what I'm looking for. I'm looking for damage from the contact lens. I'm looking for oxygen starvation. I'm looking for this, I'm looking for that. They understand what you're doing. They have more value in what that does, and they're willing to pay that little extra money to get the optimap or the imaging.
- [18:48]
Eugene Schottzman
And I think you hit the nail right on the head, because in today's environment, patients are looking for value, and value could be, you know, I think some of us are feeling it in our optical by saying, hey, you know, we're spending. We're seeing fewer dollars being left at our optical or patients pulling out their credit card and not being as excited to hand it over for larger amounts. And so we're seeing the number of dollars being spent go down, but we are seeing the number of exams go up. And so creating value during that exam could naturally translate. And I'm going to. To something like. And I'm going to take this doctor's recommendations, whether it's in the optical or whether it's with a different treatment plan. But to your point, them understanding that they're getting value out of that exam requires you, the provider, to be able to communicate that value. And it's not just, you know, I've seen this happen so many times, and, you know, I've gone in for, for secret shopper exam type of things where I go in and it's the. Okay, so this is a picture of the back of your eye and everything looks good.
- [19:55]
Dr. Sage Hyder
Yes.
- [19:56]
Eugene Schottzman
And that's what the, you know, that's what I hear. And you're like, man, like, you know, compare that to what you just said, Sage. I feel that, that the patient would understand the value, you know, infinitely more out of, out of a conversation like that. When they're, when you get a chance to invite them into your thinking process as you're going through the exam.
- [20:18]
Dr. Sage Hyder
Right, right. And I think that's. That's what every piece of tool should be. Every tool. Is that exactly what. It's a tool and it's for patient care. They don't understand why they're doing it. Why are we doing it ourselves, you know, so, yeah, so I think that's.
- [20:31]
Eugene Schottzman
And so we should link every tool.
- [20:32]
Dr. Sage Hyder
To some kind of fundus camera. Right. Have you been in any offices recently that don't have some kind of fundus camera?
- [20:38]
Eugene Schottzman
I don't think so, no.
- [20:39]
Dr. Sage Hyder
No, that's basic. And we've all made that work. Correct. So. So other technology, you know, I do treat a lot of glaucoma. We talked about that. I think it's indispensable to have OCT in ocular coherence topography. You know, again, we started with our original HRT Heidelberg retinal topographer way back in 2001. After that kind of technology wasn't kind of where we needed it. We wanted to do more retinal things. We see a lot of patients with macular degeneration and cystoid macular edema, things like that. We got our first stratus, Zeiss stratus. And I bought that used. We couldn't kind of justify the full price of that. How often are we going to be able to use that? Because you can't do that on every patient. You know, there's going to be a very select patients you can do that on. So finding a used piece of equipment was great. And I look back at the images of that and oh my gosh, they were terrible compared to what we have now. But they were so good. At the time when you had a patient, you just kind of didn't know why a patient wasn't seeing well. And you put them on the stratus and they had a vitro macular traction that you can look at and you go back and you look in the eye and you go, geez, I just can't see that and so having that technology when a patient comes in is like they're not seeing well and you can't figure out why they're not seeing well. You have to have something that can do that. So like I said, we bought our first one used, literally bought it for about $20,000 when they were, when they. On that time they were $120,000, you know, for a brand new one. We got it from ophthalmology group that had moved up to the. They moved up to a series. So we got the Stratus. I use that for about five years. Ended up selling it to a friend of mine who had no imaging device. So sold to a friend so she had something that she could use. As we moved up the ladder, we moved up to a Optos at the time, bought a company that had oct. We got that it was so much better technology than the Stratus, but it still pales in comparison to what we have now. You've heard me talk before. I may, I'll make my confession here. I am a brand ambassador for visionics. There's Solix October. Probably the best thing I've ever had in my office. It's like taking that old one megapixel camera and now having a thousand megapixel resolution. Everything you can see in there. I had a patient last week came in and he came in and said, you know, I'm just not seeing well in my left eye. It seems like there's this fuzzy area kind of near the center. And I'm thinking, oh, he's probably got a PVD and a floater in there or something in the way. And I look and there's just nothing. I cannot see anything wrong with it. Try to take a little beam slit to look through the back. I said, let's just pop them on an oct. Sure enough, he's got a nice central serous, not real elevated high, but an RPE detachment. It's in there. And showing him that again, showing him pulling it up right in front of say this is why you're not seeing well. Look at this. Here's your right eye. That looks perfect. Here's your left eye. This is what it looks like. They go, oh, wow, that just does not look the same. And so having that kind of technology is just again, just revolutionize how we treat things. Because now I know, hey, there's no blood underneath there. We know. He's. I said, look, this is usually comes on when you're stressed. He said, this is the most stressful time I've ever had in my life. I said, okay, so you need to find. To get rid of that stress. And if it doesn't go down, we have to look at some treatment options. But most of the times he's resolved, let's do it again in a month and see what it looks like. And, and of course, you know, he wants to come back once that done again and make sure. Because he knows what's going on in there now. So he, he's comfortable going, okay, I can live with a little bit of blur. I know what's going on, and I'm not stressed about it anymore. And that's stressful. All of a sudden, you can't see out of one eye very well. And it was just, it was a great, it was great to have that technology. So, you know, I think most offices don't have an OCT unless they're really treating a lot of glaucoma or retinal diseases. But again, how can you make that affordable? You know, a new, new, new OCT is going to be 80 to $100,000. Again, maybe you find a used one, you know, but we go through the same numbers. Go through the same numbers. Let's say you get an $80,000 Oct. That's going to cost you $1,500 a month with a loan, okay? You're going to get paid about $38 with Medicare, okay. Or Blue Cross or Blue Shield, which means you got to see about, you know, there's your 10 patients a month that you have to see, right, to make this thing pay off. So 10 patients a month, you have to do some kind of oct. Now, if you're in an area that's. If you're in an area that has a big HMO and a patient comes in and you say, gosh, you know, this is just not making sense. There's something going on here. You know, we have a couple options. I've got the instrument right in the room next door. You can pay private, pay for this $50, $40, whatever you want to charge the patient. Or I can send you into Kaiser and you'll get in there in the next, I don't know, a couple weeks or months or I don't know how long they're backed up in there and they can figure out what's kind of going on. Now, what patient wouldn't pay $40 to figure out what's going on with their vision? You know, and so I think the one thing we always worry about is, oh, I'm not a provider for their insurance So I have to send them someplace. Well, why? You know, I've got the technology right here. I can find out right now within five minutes what's going on in the back of your eye, why you're not seeing. And it'll only cost you 40 bucks at a private pay or $50, whatever you want to kind of do on that. And so could you have 10 patients in a month that you can do that? Yeah. Okay. Whether they have insurance that you can use or whether they don't have insurance you can use, you can do that. Back in the olden days, I had friends of mine who, you know, three or four of them would go together and buy one Oct and would travel around from office to office. And every, you know, they have it for a week and then three weeks later they have it again. So they'd schedule all their glaucoma patients during that week and use that. Now it only costs you a third amount of the money to do that. You know, there are ways to do this. So.
- [26:44]
Eugene Schottzman
So I know you do a lot of glaucoma, but, you know, on what percentage of a typical, like if a, if someone sees 12 patients a day, 15 patients a day, what percentage do you think are good candidates for an oct?
- [26:58]
Dr. Sage Hyder
Well, you know what? That's exactly right. Somebody who says, somebody who has, you know, who's obviously a suspect for glaucoma would be a good one. There's been a lot of studies that amlodipine damages the ganglion cell complex and increases glaucoma progression in patients who have no other symptoms or no other reason to have glaucoma. How many of our patients are taking amlodipine for high blood pressure? You say, geez, you're on this medication that I think I looked IT up as 40% higher risk of developing damage to your ganglion cell complex. You say, gosh, you know what, you're on a high risk medication. We should do this imaging so we have a baseline, and even if we do that every two years to look for any damage on there, we'll know if amlodipine is going to do some damage and why, again, why did you wait two years? You're on a medication that can cause you to lose your vision, make you go blind. So let's do a scan. You know, you're on plaquenil looking for toxicity. You're on amlodipine, you're on all these methotrexates. There's a lot of medications out there, patients are taking that have lots of very Significant retinal toxicities. That kind of make sense to do some baseline screenings and do those things yearly. So those are great candidates for an oct. You know, a patient who says, gosh, my mom's gone blind from my mom's getting these shots in her eye. They don't know it's for. Usually my mom's getting shots in her eyes. Well, yeah, that's macular degeneration. Oh, yeah, that's what he said. She's got macular degeneration. So should we catch this way before you have any problems with that? Yeah. How can we do that? We have an instrument that can do that, that can take scans, take a thousand slices through the back of the eye. It's like an mri. Essentially, it's an mri. Thousand slices in the back of the eye that builds a three dimensional topographical thickness map of the back of the eye. Why wouldn't I want that for 40 bucks or 50 bucks? You know, so patients that are at risk, you know, family history, they always say, gosh, you know, I did that 23andMe, and it says that I've got four risk factors for macular degeneration. Well, we should start doing this again. Look for that, you know, and so who else would be a good candidate? You name them.
- [29:03]
Eugene Schottzman
Yeah, well, and I think you're, you, you bring up a really good point. Is that. It is, it is interesting to think about the number of patients where it's absolutely medically necessary.
- [29:13]
Dr. Sage Hyder
Right.
- [29:14]
Eugene Schottzman
And maybe that pool is a little bit wider or a little bit deeper than we, than we necessarily always think. And you're absolutely right. You know, if somebody is on blood pressure medication, I mean, almost instantly, you're, you're arguing, hey, you got to, you got to get them in, you got to, you got to put them, you got to get an OCT done.
- [29:34]
Dr. Sage Hyder
Right, Right. And so I think that's an important thing. You can tell the patients, look, you pull up a study right there in front of them and say, look, here's what it says. 40% higher risk of losing vision from loss of ganglion cell complex. And if you start having that, we're going to catch it before you go blind, get you off that medication, on something different.
- [29:52]
Eugene Schottzman
And do you bill for that medically?
- [29:54]
Dr. Sage Hyder
Yes. Oh, certainly.
- [29:55]
Eugene Schottzman
Yep.
- [29:56]
Dr. Sage Hyder
Certainly. Again, if they have an HMO or something that you can't, then you ask them, hey, would you like to do this? It just makes sense to do this kind of testing so I can bill that medically on a lot of my patients. But there are patients, there's a few that have HMOs that I can't do that.
- [30:10]
Eugene Schottzman
Got it. Makes perfect sense. I think that's great, Sage. And when we come back, I'm going to ask you a little bit more about other glaucoma treatments and other technology that you have in the office. I think this is an interesting conversation as we think about how you make sure that everything in your office is earning money for you and that it's not just. And like you said, kind of the criteria for bringing technology into the office is not just about the economics, but the economics are pretty important. We'll be right back.
- [30:39]
Dr. Sage Hyder
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- [30:47]
Eugene Schottzman
Mistakes, and trying to build a team.
- [30:49]
Dr. Sage Hyder
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- [31:33]
Eugene Schottzman
Hi, welcome back to the Power Hour. I'm here with Dr. Sage Heider. And, you know, I am really enjoying this conversation. And one of the reasons why is because you've got such an unassuming attitude about the patients that you treat and how much you care about making sure that they're fully educated. But the other part of it is that you have this almost like highly disciplined, meticulous attitude about making sure that this technology is like another associate just earning money for you in the office. So let's go through. I know I want to make sure we cover some of the big ones. So what other technology have we not talked about that we need to when it comes to generating revenue and doing so in a smart way for your office?
- [32:18]
Dr. Sage Hyder
Great. Well, I think we kind of hit the big ones. You know, the big Ones I always think about some kind of retinal imaging, some kind of fundus photo, some kind of oct. You need that in there. But then the third one, very important one that we all have some type of technology is some type of visual field analyzer. You know, we have these big giant ones that sit in our exam rooms or sit in our testing rooms that patients have to pull themselves up to. Sometimes they're difficult people in wheelchairs, older patients, younger patients, sometimes are not real accurate on them. I've recently incorporated in my practice a virtual reality headset. There's a company that I also work with, micromedical devices. I became first introduced to them years ago when I needed a pachymeter. And my first, my pachymeter I bought, I have a pacmate, or it's a palm scan pachymeter. It's fantastic, nice, easy to use, takes 25, very, very quick immeasurements, averages very, very accurately. One of my favorite little tools that just did not cut cost a whole, whole bunch. We need those obviously in glaucoma treatment to know what their corneal thickness is. But a visual field instrument, they came out a couple years ago with the VF2000. It's a virtual headset. Patients literally just strap it on. They've got a little button in their hand. Has, has been a really great addition to my practice. It's one of those instruments that again, gives a wow factor to the patients. They put it on and go, wow, look what Dr. Heider's using. He's using like modern technology. Instead of putting me in that big clunky thing that I hear goes. So I'm just gonna push the button whenever I hear that thing move. And you get these crappy visual fields because they're not paying attention. They fall asleep in them. They take too long. I'm just pushing it every time I hear it move because I think there's.
- [34:09]
Eugene Schottzman
Going to be a light, right? My favorite is that the staff forget to turn off the light. You know how many times I've seen that?
- [34:14]
Dr. Sage Hyder
Yes, exactly right. You got all this reflection coming from behind you. They get distracted by the movement on there. So I incorporated the VF 2000, a great instrument that's about a third the price of a full size visual field machine. And so it's great, you can do it in the exam room. So my staff takes the patient into the exam room, checks their vacuities, checks their pressures, said, hey, we're going to do this test to pop it on right in the exam room. So you don't need an extra. You don't need an extra testing room for it or frees up the testing room for somebody who's getting an OCT or doing something else. They have all the. All the standard and more visual fields, whether it's for ptosis, whether you want a neurological 32 type of style or 242 type of style, central 10 degrees. And they're. They're really kind of a neat, neat tool. So I thought, gosh, my older patients probably wouldn't go for this. You know, they're probably going to be, oh, this technology. I don't want to kind of do that. I asked every patient, hey, how was that? Was that difficult to use? Oh, no. Gosh, that thing was so easy to use. So remember I said earlier, a technology has to be easy to use. My staff, it has to be easy for use, and the patients have to be easy for use. One thing I really, really love about the VF2000 is the eye tracking ability. You look off center a little bit, it pauses. As soon as you refocus, it keeps going. You look off center, it pauses. You look forward. The tests are highly, highly reliable. You just don't see a lot of false positives, a lot of false negatives. You don't see fixation losses because it eliminates all that to get you a very, very clean, clean test. And so having a test that's repeatable, that the patient can do well, subjective testing are terrible. We've done this for years. Looking at, did you get a trial lens in the way? And there's a big defect there. Did the patient just fall asleep enough? Whole upper lids droop down, and you can't see anything up in there. Trying to do a glaucoma test on that. So, you know, again, this is like a third of the price of a big standard type of analyzer.
- [36:21]
Eugene Schottzman
Well, and how do you bill for it?
- [36:22]
Dr. Sage Hyder
How do you bill for it? What can't you.
- [36:24]
Eugene Schottzman
Let's. Let's do your. Let's do your math.
- [36:25]
Dr. Sage Hyder
Okay, let's do the math. So I looked this up. Payment that I was making on this is $199 a month.
- [36:34]
Eugene Schottzman
Okay.
- [36:35]
Dr. Sage Hyder
Okay. So we're not even in the realm of the equipment we've been talking about. So $199 a month. Again, $40 is what you're gonna get paid by most insurances. That means you need five patients a month to pay for this thing. Five patients a month. Okay. Versus 50 patients a month for the other things we're looking at. If you Have a visual field analyzer or something like that. That's Gonna cost you $50,000. You need 25 patients a month to be able to do that. And most people don't have 25 glaucoma patients or neurological patients or ptosis they're going to be referring for. I don't think most people are doing that, especially in the cities where you have big HMOs and stuff. So five patients a month, again, if they've got an HMO, you say, Gosh, you know what, we can do it right here in the office. There's two testing we need to do to treat your glaucoma. We need to do the OCT. It'll cost you $40, $50. We're going to do a visual field. It's going to call you $40, $50. You're going to charge the patient $100 to get your glaucoma managed right here in my office right now. Or we can send you off. And you don't know who you're going to see. Every time it's going to be a different doctor and it's going to take three months to get in to do that. Okay, so, you know, again, if they've got private pay, offer them to private pay a reasonable price for a reason for great technology. So, you know, who else are you going to use that for? You're going to use that for your plaquenil patients again, right? Your plaquenil patients need a 10 dash, two, you know, a baseline, and then after five years they need to have that yearly, you know, and so using that on any of your plaquenil patients, your hydrofox, hydrochloroquine that you're taking on that for, for their lupus and their rheumatoid arthritis, I mean, see a lot of patients on those types of medications. So you're going to do your 10, 2 visual field. You're going to do an OCT. You can do an auto fluorescent imaging with your, with your imaging device, your camera. That's a standard, standard protocol for somebody who's on glacomy.
- [38:30]
Eugene Schottzman
And how many, how many glaucoma patients are you seeing on a monthly basis?
- [38:34]
Dr. Sage Hyder
You know, a typical day, I'm seeing probably three to four, whether they're suspects or they're treated. So, you know, in a month I'm seeing probably more than that. Okay, so let's say four. I'd see four a day, three to four a day, and for 16 days a month. There you go. So I'm seeing you know, 50 to 60 patients, probably about 50 glaucoma patients a month. Okay. And then I have two partners, they're probably doing about the same thing. So, you know, I'm lucky. Being in a partnership, we can kind of take a piece of equipment like that. And it's just not all on me. But I've made you see how it works with just one doctor. So if you have one doctor paying for an OCT needing, you know, 10 patients a month to pay for it, you have three doctors in a practice or two doctors in practice, that really makes that a lot more a reasonable type of thing.
- [39:26]
Eugene Schottzman
And with this, I just did your numbers. So you've got, if you're saying you got 50 glaucoma patients or suspects or whatever that you're running a visual field on and your reimbursements, on average 40 bucks and you're talking about $2,000 that you just brought in revenue and you spent 199 in cost to do that. That's pretty good ROI.
- [39:51]
Dr. Sage Hyder
I think you figured that one out. That's exactly, exactly right. So let's say you're seeing half that many patients, you know, or even a third that many patients. You're still going to pay for this thing.
- [40:01]
Eugene Schottzman
Yeah.
- [40:02]
Dr. Sage Hyder
You know, it's ease of use, great data and cost effective that you can have in your practice. Anybody can have that in their practice.
- [40:08]
Eugene Schottzman
And so, yeah, that makes perfect sense. I love it. What, what else? And you know, in, in terms of other technology, whether it's must have or nice to have. What else ROI is nicely in your practice?
- [40:23]
Dr. Sage Hyder
Well, I think those are the must haves that you kind of have to have to have in there. I think a really great. We were just talking about on break is anterior segment camera. Anterior segment camera. Like I said, I was at a billing seminar years ago and the speaker said, wow, this is one of those things that Medicare has not dropped the reimbursement on a whole bunch because it does not get billed a lot. They're very inexpensive. Nowadays you can essentially get a mount for a, a camera for your from your phone that you can mount on a slit lamp ocular and take a photo. And they're very, very easy to use. They're impressive to patients. You can download it right into your ehr so that for the price of a mounting device in your own cell phone, that's a great thing. So somebody's got a lesion that you kind of go, that's a little suspicious. It's, you know, maybe changing. You ask the patient, Gosh, did that change? I don't know. I think it's changed a little bit. You take your baseline photo. You do that once a year. You can actually even use that for a fundus camera. If you can focus your slit lamp through the ocular into the retina, you can take a photo. So you can bill it as a fundus photo. You can bill it as an anterior segment photo. Those are great instruments. So an anterior segment camera is a really inexpensive way to go to be a good profit on that.
- [41:46]
Eugene Schottzman
And I think you're absolutely right. From a technology standpoint, it's something that impresses patients. And I also think from a case acceptance or treatment plan acceptance standpoint, it helps with certain subspecialties, right?
- [42:00]
Dr. Sage Hyder
Yes. Yeah. We talked about dry eyes a little bit. If you have an anterior signal camera and you can express the meibomian gland so the patients can see what's kind of coming out of those. You show them and they go, wow, that's not good. Is that. Well, no, here's why we have to do these treatments. And whether that treatment is doing some laser treatment or whether that's doing just, you know, something else, they understand that there's something wrong there, and they're willing to do treatments for that. So it can. Even though you can't really bill for that, you're doing that in order to present other treatments on that, you know, So I don't. I don't think you can really build a fundus photo for meibomianitis, but you can do it for, obviously, lesions on the lids and things like that. So corneal foreign body. You take a photo of a foreign body before you remove it to prove that it's there. That's actually billable. I don't typically do that, but especially.
- [42:53]
Eugene Schottzman
Well, I was going to say that seems like Friday foreign body.
- [42:56]
Dr. Sage Hyder
I should be doing that every Friday.
- [42:58]
Eugene Schottzman
Let's bump your reimbursement by 40 bucks every time.
- [43:00]
Dr. Sage Hyder
Yep, exactly right. There's another one. Gonioscopy. You know, I found myself not doing gonioscopy for about 10 years, and I thought, why am I not doing this on every one of these patients as a glaucoma suspect? And you do those annually. There's an extra Medicare patient, extra $12, but it takes you how much time? And everybody's got a gonioscopy lens in there because we had to buy them in school. So we have that other technology, I think, you know, the once the needs and the wants. We're talking about pet chemistry. You have to have a pet Chemistry. If you're going to do any kind of checking somebody for glaucoma because you have to know their central corneal thickness is. Corneal topography I think is a great one. I don't think that's a need. It is a. Is it a want the patients that you're just not clearing up? Well, they're young, you know, there's no retinal diseases. Is there, you know, a change in their sil. Do they have keratoconus? You kind of need to do that though. Most of the OCT now can do that with corneal mapping corneal thickness. So corneal thickness map of the. With an OCT can actually show you corneal thinning and show early signs of keratoconus. So there's another reason you can use that OCT and get that to pay off. But a corneal topography is great. You have irregular astigmatism if there's some, you know, cones starting to form in there. If you're fitting specialty lenses, you kind of need one of those. But you can't really get it paid for that, you know, unless they do have something irregular that you can build it for. But if they're high myope and you're doing scleral lenses, they have a lot of sil. You know, you can't get paid for it, but you kind of need it. So that's an instrument you might buy that won't necessarily pay for itself by doing the imaging, but will pay for itself by doing the treatments.
- [44:44]
Eugene Schottzman
Right, by enabling the treatment plan.
- [44:46]
Dr. Sage Hyder
Exactly. And then you can show it to the patient, say look, this is why we're going to do this treatment plan. And so that would be one. I have friends that are doing a lot of EOGs and EOGs have been really electro ocular grams have been shown to be very successful, very important in glaucoma. Showing that there actually is nerve damage going from the eye to the brain so the optic nerve gets damaged. You can show that on eogs. I haven't quite incorporated that in my practice. I'm thinking about it. Talking to some friends who are utilizing it is another tool. I'm just trying to think if that would actually make better patient care versus just something I'm going to build. And so me, I have to justify that in my mind that it's going to give me better patient care. So. So there's things like that. What other instruments do you see being used at kind of once?
- [45:35]
Eugene Schottzman
Well, you know, and I, and I think one of the things that we. That we should probably wrap up with. As you're, as you're kind of thinking through this is just one more time, let's go through the criteria. Is there a particular number of dollars from an ROI standpoint? And then you talked about ease of use for staff, ease of use for, for your, for, for yourself, and ease of use for your patients. Right. What are the things that you've said no to over the years? Or what are some things you've tried? Then you're like, ah, this was a mistake. Take it, ship it back, maybe. Or maybe, you know, like, everybody's got a closet full of old technology that you know, and maybe you don't because you, you take such a meticulous approach to, to acquiring it. But what if you had a closet, would be sitting in it?
- [46:24]
Dr. Sage Hyder
Actually, I have, I have a 2001 HRT sitting in my room that I just finally decided. I, I'm just actually going to take it to the dump. Nobody wants this thing. And we haven't utilized it in about, we haven't utilized in about seven, eight years. And it's kind of taking up space and so. But that was a great technology at the time. Again, passing things on to other people. If I had my, like I said, my original Stratus that I sold to a friend got a great deal. I think I bought it for 20,000 and she bought it for me for about 6,000 and. But I got definitely my money's worth out of that. There's not a lot of technology that I just haven't been happy with and sent back. But I did at one time have four different OCTs in my office trying them all. And so when I, when I, when I decided to buy the Solix, I had four different instruments in the office at the same time. And it was mostly about staff was having difficulty getting images. Patients couldn't get a good image. My criterias were ease of use. I needed a ganglion cell complex thickness map. That was kind of the one that I thought needed to be done. The old instruments didn't have that. And then repeatability and oh, and the last one was normative data. You have to have normative data in an instrument that shows what age, gender, normal should be and where your patient is outlying that or within the normal range of those things. And so I think those are important instruments to look at. So a criteria would be, hey, how does this compare to everybody else? How does it compare for that patient over time? So the repeatability on that, the cost, is it going to be feasible to do That I don't think I've ever sent an instrument back that I didn't like. I didn't buy it because I didn't think I needed it. So like I said, at this point, I think, you know, looking at optometry and practicing in modern setting, in a modern, you know, scope of practice, we all need a camera, we all need an oct, we all need a very good visual field analyzer, we all need a pechemmeter. An anterior chamber segment, anterior segment camera would be a really good one. But you have to see if that's going to be feasible in your practice. Corneal topographer, depending on what you're doing, there's a lot of tear film app, tear film analyzers. And again, if you have a practice that's going to do a lot of dry eye, you need a tear film analyzer. And I think that's probably the next instrument that I might be looking at, some kind of laser to be doing treatments for dry eyes, I think would be very, very beneficial. Unfortunately, there's a practice around my area that got one and I've had several referrals from that. Not referrals. I've had several patients come from that office to see me because they felt like they were being pushed into getting a treatment that wasn't justified and cost too much. So I think if you have, if you're going to do that, if you're going to do a dry eye clinic, that you have to have some kind of imaging device that says, look, this is where you're dry. Here's what your tear film looks like, here's your meibomian glands, here's what's going on. And so this treatment's been shown to fix that problem. Now, that would justify it to a patient's mind that they're going to spend $1,000 to have three treatments over the next two months and justify that. And so again, that would be an instrument that you probably couldn't bill for, but would drive the treatment plan that you would then be billing for. And that would be something that would be, most of the cases, a private pay type of situation.
- [49:57]
Eugene Schottzman
So, and sage, I think, you know, and I'll, I think we can end on this, is that no matter what instrument you get, you'll be more successful with it if you can take the sage hider approach of let's actually talk to the patient and explain and educate all the details, rather than just taking the image or utilizing the instrument and saying, okay, everything looks good and kind of moving on. So I think it's not just about the technology. It's about how you are, how you use the technology to drive return on investment. But in addition to that, how you use the technology to add to the wow factor in your practice, to increase patient loyalty, get your patients to come back more often and probably refer others because they're so dang impressed with not just the tech that you used, but what you explained to them after you use that technology.
- [50:55]
Dr. Sage Hyder
Right. You know, you look at a phoropter and a phoropter has not changed in, I don't know, 100 years. We have some electronic ones. You know, they're fancy. You know, I don't know if patients get a lot out of that. But you see the other stuff, that's what you're here for. You know, refraction is refraction. But teaching somebody about the health of their eye, you know, I said earlier that I thought my patients were intelligent enough to understand what I tell them. I think that's mostly true, you know, but the second half of that philosophy is my patients, they're the only ones in charge of their own healthcare. So if you don't give them the correct information, they can't take care of them.
- [51:28]
Eugene Schottzman
Well said. Dr. Sage Hider, thank you so much for joining me on the Power Hour today. It's been great having you on the show. Thanks for listening to today's Power Hour episode. The Power Hour is actually owned by the Power Practice. Power Practice is a premier consulting group who helps practices achieve freedom of time, confidently solve practice issues and grow their practices. They do this by having coaches and OD consultants, people who have actually done it, been there, and they're ready to help. You want to learn more, go to powerpractice.com there's a bunch of free tools there. You can also get a whole bunch of information and decide whether it's right for your practice. Again, if you're looking for more time, you're looking to solve complex practice issues or grow the Power Practice might be right for you. Go to powerpractice.com to find out more.