The Surprising Story Your Numbers Tell: Metrics That Drive Practice Growth with Dr. Chris Wolfe

Summary

Power Hour Optometry

Episode: The Surprising Story Your Numbers Tell: Metrics That Drive Practice Growth with Dr. Chris Wolfe
Host: Eugene Schatzman
Guest: Dr. Chris Wolfe, Founder of iCode Education
Release Date: December 18, 2024

---

Introduction

In this insightful episode of Power Hour Optometry, host Eugene Schatzman welcomes Dr. Chris Wolfe, a seasoned expert in optometric education and practice management. Dr. Wolfe shares his profound understanding of practice metrics that transcend traditional revenue-focused approaches, offering optometrists innovative strategies to enhance practice growth and patient care.

---

Dr. Chris Wolfe’s Background and Expertise

Dr. Chris Wolfe brings a wealth of experience from his eight-year tenure helping doctors and students prepare for board examinations. His dual role as a practitioner—seeing patients three days a week—and as the founder of companies dedicated to optometric education and board preparation, uniquely positions him to bridge the gap between academic knowledge and practical application in optometric practices.

Chris Wolf [02:48]: "When you have the knowledge to manage a disease, but you don't have the way to integrate it into a practice, you're left wavering and waffling."

---

Key Metrics Beyond Revenue per Patient

1. Revenue per Patient vs. Revenue per OD Hour

Dr. Wolfe emphasizes the limitations of the commonly used metric, Revenue per Patient (or Revenue per Refraction). While it provides a snapshot of revenue linked to refractions and related sales (e.g., glasses or contact lenses), it fails to account for time investment and the comprehensive management of ocular diseases.

Chris Wolf [05:04]: "Revenue per patient is incomplete when we think about disease state management."

Instead, Revenue per OD Hour emerges as a more holistic metric, allowing practices to assess productivity by comparing the revenue generated against the time spent per hour. This enables a more nuanced understanding of practice efficiency and potential growth areas.

Chris Wolf [07:29]: "Revenue per OD hour allows me to say, okay, well I might be seeing seven patients in an eight-hour day, but I'm still generating less than a thousand dollars an hour."

2. Comparing Different Service Types

Dr. Wolfe illustrates how Revenue per OD Hour helps practices evaluate the balance between high-revenue services (like refractions) and comprehensive care (such as managing glaucoma or dry eye). By analyzing how different services contribute to overall revenue relative to time spent, practices can make informed decisions to optimize their service offerings without compromising patient care.

---

Patient Lifetime Value and Allowable Acquisition Cost

1. Understanding Lifetime Value

Dr. Wolfe and Eugene discuss the concept of Patient Lifetime Value (LTV), especially contrasting high-revenue one-time sales (e.g., glasses) with ongoing care for chronic conditions (e.g., glaucoma). LTV considers the total revenue a patient generates over their entire relationship with the practice.

Eugene Schatzman [14:30]: "Now that patient has spent $3,000 in my office... that's your lifetime value of that patient."

2. Allowable Acquisition Cost (AAC)

AAC is derived from the LTV, representing the maximum amount a practice can spend to acquire a new patient while remaining profitable. By calculating AAC, practices can strategically allocate marketing and acquisition budgets to attract patients who will provide long-term value.

Eugene Schatzman [15:35]: "So, that patient spent $3,000 in my office... I have $1500 of profit. Now I have to take a discount factor..."

---

Managing Different Patient Types

1. Dry Eye Patients vs. Managed Care Patients

Dr. Wolfe differentiates between patients presenting acute issues (e.g., dry eye) and those with managed vision care plans seeking products like glasses. While the former may offer immediate opportunities for comprehensive care and treatment, the latter represent steady, recurring revenue streams.

Chris Wolf [21:37]: "A dry eye patient is more desirable to a practice because they're problem-aware and ready for the solution."

2. Transitioning Managed Care Patients

With effective discovery and relationship-building, practices can transform managed care patients into those requiring comprehensive care, thereby increasing their LTV.

Eugene Schatzman [23:10]: "The same VSP patient will develop... if you treat them in the right way."

---

Building Effective Processes and Protocols

1. Standardized Symptom Questionnaires

Implementing standardized tools like SPEED or OSDI questionnaires ensures consistent identification of conditions like dry eye, facilitating timely interventions.

Chris Wolf [35:55]: "I use SPEED, but you could use OSDI, there's some DEQ, whatever you like."

2. Tracking and Billing

Incorporating billable codes for specific tests (e.g., MMP9, osmolality) not only aids in tracking clinical interventions but also ensures that these services contribute to practice revenue.

Chris Wolf [38:45]: "There’s nothing better than knowing who’s going to benefit from IPL or RF because you have a patient coming back showing improvement or needing further treatment."

3. Technology Utilization

Dr. Wolfe advises against purchasing advanced technologies without established processes for their integration, highlighting that unused equipment often fails to deliver ROI and can erode a practice’s authority.

Chris Wolf [48:22]: "75% of them aren’t being used... what do you think it does to your identity?"

---

Importance of Prevalence Data

Dr. Wolfe underscores the significance of leveraging prevalence data to set realistic benchmarks and drive clinical protocols. Understanding the prevalence of conditions like glaucoma or dry eye within the patient population enables practices to tailor their services and marketing efforts effectively.

Chris Wolf [26:40]: "If you think about it, a 43-year-old Caucasian male has a significant likelihood of being a glaucoma suspect based on prevalence data."

---

Practical Steps for Practices

1. Adopt Revenue per OD Hour: Shift focus from solely revenue per patient to include revenue per OD hour for a comprehensive productivity assessment.
2. Calculate Patient LTV and AAC: Determine the lifetime value of different patient types and set allowable acquisition costs accordingly.
3. Implement Standardized Protocols: Use symptom questionnaires and standardized tests to ensure consistent patient care and accurate tracking.
4. Utilize Technology Strategically: Invest in technologies that have clear, integrated processes to ensure they enhance patient care and contribute to revenue.
5. Monitor Key Metrics Regularly: Establish a dashboard to track refractions, disease state interventions, and other critical KPIs to inform decision-making.

Eugene Schatzman [42:40]: "If you had a magical dashboard, what would be on that dashboard? Refractions are your wide net."

---

Notable Quotes

• Chris Wolf [05:04]: "Revenue per patient is incomplete when we think about disease state management."
• Eugene Schatzman [14:30]: "Now that patient has spent $3,000 in my office... that's your lifetime value of that patient."
• Chris Wolf [21:37]: "A dry eye patient is more desirable to a practice because they're problem-aware and ready for the solution."
• Chris Wolf [35:55]: "I use SPEED, but you could use OSDI, there's some DEQ, whatever you like."
• Chris Wolf [48:22]: "75% of them aren’t being used... what do you think it does to your identity?"

---

Conclusion

Dr. Chris Wolfe provides a compelling argument for optometric practices to reevaluate and expand their metric evaluations beyond traditional revenue per patient. By incorporating Revenue per OD Hour, understanding Patient Lifetime Value, and strategically managing different patient types, practices can unlock untapped potential, enhance patient care, and drive substantial growth. Implementing standardized processes and effectively utilizing technology further ensures that practices remain both clinically proficient and financially robust.

---

Connect with Dr. Chris Wolfe

For more insights and resources, you can connect with Dr. Chris Wolfe and explore iCode Education through the following channels:

• Website: icodeeducation.com
• Podcast: Search for iCodeMedia on your preferred podcast platform.
• Email: [e-mail]

---

This summary encapsulates the key discussions and insights from the episode, providing a comprehensive overview for those who haven't had the chance to listen.

Transcript

[Chris Wolf]

Foreign.

[Eugene Schatzman]

Thanks for joining me on the Power Hour, everyone. I'm your host, Eugene Shotsman. Quick reminder to subscribe on YouTube, Spotify.

[Unknown]

Or Apple podcasts so you can get updated every time we have a new episode. So for today's show, I bring on a guest who has some pretty intentional perspectives on metrics that you should think about in your practice and how you can use those metrics to grow. And we go beyond the obvious. And just to give a little bit of context, Dr. Chris Wolf runs iCode Education. He also sees patients three days a week. He also founded a company that helps optometrists study for their board. So one thing I found fascinating is how Chris adapted things that you have to memorize for the boards, like prevalence of various conditions, for example, to help determine if you're missing opportunities in your practice. You'll have to listen to the episode to understand what you mean. But we peel back the onion on common metrics like revenue per patient and go much deeper into things like revenue per OD hour. And then we end up discussing patient lifetime value or even allowable acquisition cost per various conditions. We also talk about the appropriate psychology for both the OD and the patient in the chair when you're turning managed care exam, for example, into a complete treatment program for just about any condition. We use dry eye in our example, but I really think it extrapolates well. Anyway, the conversation with Chris was pretty fast paced, and for previous shows I've gotten lots of listeners reaching out and asking for things like exact wording tips with exactly how you say something in the chair. So Chris did exactly that for us. He gave us his wording for certain types of patient conversations that help drive both better patient outcomes, but also better practice revenue.

[Eugene Schatzman]

So I'm excited to hear what you.

[Unknown]

Think of the episode.

[Eugene Schatzman]

And as always, if you want to.

[Unknown]

Reach out, please do so. You can reach me@Eugene Schatzman.com or on the Power Hour website. By the way, the Power Hour is owned by the Power Practice. Power Practice is a premier consulting group. It helps practice owners achieve freedom of time, also helps practice owners solve complex problems, issues in their practice, and grow. And now let's jump into today's show.

[Eugene Schatzman]

All right, Chris Wolf, welcome to the Power Hour. Happy to have you here.

[Chris Wolf]

Hey, Eugene, thanks for letting me jump on. I appreciate the opportunity.

[Eugene Schatzman]

Yeah, well, so I think that you have such a unique perspective on specifically practice metrics and the way that you approach this. And we're going to get into this topic in just a few minutes, but I think it's important for people to understand the vantage point that your perspective is coming from. So, you know, maybe just give everybody a minute or two of your background so that it's clear where all this expertise is gonna, is gonna be founded in.

[Chris Wolf]

Thanks, Eugene. So. Well, I mean, just to give you a kind of a high level overview of where I come from, I spent about eight years helping doctors and students prepare for board examinations. And so that, that kind of helps kind of solidify. Well, we're memorizing this and applying that. And so when you think about like, how do you manage ocular disease? That's what we're teaching people in school and they're preparing for boards. But then how do we actually apply that in practice where there's a comprehensive care model where patients are being delivered to our practice for kind of primary and comprehensive care needs and then managing all of these other disease states is really complex. And so what we found within I code education is that when you don't have, when you, when you have the knowledge to manage a disease, but you don't have the way to integrate it into a practice whereby a patient is 65 years old and has glaucoma suspect risk and has macular degeneration and has dry eye and oh, by the way, they need new glasses and contact lenses and they have a managed vision care plan that they want to use. If you don't have, if you can't do that, then you're left sort of wavering and waffling in a practice. And that's what we really help people with. And so I think my background related to helping people prepare for boards gives me a really deep understanding of the ocular diseases and the binocular vision diseases or disorders that, that we encounter in a comprehensive care practice. And then, and then working and seeing how that works in a practice and practices that do those things well and then practices that struggle with them, we really can kind of find, like, how do we work this into a practice so that the patients have access to the care that we have the knowledge, education and training to provide?

[Eugene Schatzman]

Yeah, so that's, and I think that's fantastic. And one of the things that I want to talk about today is this kind of concept of finding untapped or under leveraged potential in your practice. And what I like about the way that you approach things is that you approach it through data and prevalence. And you know, let's, so let's zoom in a little bit on that. What kind of data should practice owners be looking at? If we're starting to kind of peel back the onion layer by layer. Let's pick one and let's think about some metrics that are relevant.

[Chris Wolf]

Well, one of the things I think is important is that the first thing is I will pick one. But the one that I want to start with is one that a lot of people are already used to, to thinking about, and that is revenue per patient, often called revenue per exam, or I like to call it revenue per refraction. And the reason I think we have to start there is because that's a classic KPI that most people are measuring. Most people can, can think about that data right away, of course, but the downside of just using that is it, is it links all of your services. Anything that's going to generate revenue in your practice, it only links it to a refraction. There's a good thing. I mean, it's a good metric to have, but it links that, that, that refraction largely to the sale of something else. So it's kind of incomplete because what we will see happen is if you only understand that number, then anything that deviates or detracts from your refractions in theory, or the sale of something that can come from the refraction, I. E. Contact lenses or glasses can sort of be looked at as like, well, if, if my number is really high, if I'm selling a really expensive pair of glasses, let's say that number is I, I do a refraction and all I do is comprehensive care. I do a refraction, I sell an expensive pair of glasses, then that number is, let's say, a thousand, right? A thousand dollars. And I'm really excited about that number. If I have to deliver care that doesn't result in the sale of glasses or contact lenses and doesn't rotate or circle around a refraction, anything less than $1,000 seems like, well, I could have been doing, I could been doing the thing that, that drives $1,000. And so, so that number is really important to optometric practices, but it's also incomplete when we think about the disease state management. So that's the first thing we have to think about. The second number that I think is important is how then can I compare, Eugene? The time it takes for me to see a patient for a comprehensive exam, perform a refraction, and then my staff can sell them glasses versus the time it takes for me to perform a comprehensive exam, identify an ocular disease, then see that patient for the ocular disease. What time does it take for me to see that patient for an ocular disease, and how Can I relate the two because they're not, they're not like, they're not easily relatable through the metric of refraction. That make sense?

[Eugene Schatzman]

Well, so how's that different than like revenue per doctor hour or something?

[Chris Wolf]

Well, that's what you need to, that's what you need to know. You need to know revenue per doctor hour because it allows you to compare apples to oranges, right? So the, the thing that a lot of people think about is incomplete which is revenue per patient or revenue per, per refraction. But what they should be thinking about is that plus revenue per OD hour. So imagine that I'm seeing. I, I, I want to maximize the revenue per patient, right? I want to see one patient one time a year perform one one refraction and sell a really expensive pair of glasses. That's awesome. But let's say I, I only want to a select number of patients where I'm going to see let's say five patients a day or seven patients a day. And I, I want to really give that patient a customized experience. But wait, I'm, I'm in the office for eight hours a day. So if I'm in the office for eight hours a day, seeing seven patients, giving them a really great experience, they're buying a nice pair of glasses. Then my revenue per refraction super high, right? Let's say it's thousand dollars, seven grand if I'm seeing seven patients. But the problem is that, you know, at some point we're going to cap out, we're going to think about other ways to grow and we may not actually be serving our patients entire needs. When you look at prevalence data, and that's where revenue per hour, revenue per OD hour comes in play is it allows me to say, okay, well I might be seeing seven patients in an eight hour day, that each one of them is generating $1,000. But I'm still only, you know, in that eight hour day, I'm generating less than a thousand dollars an hour. What? Well, what could there be a model where I see, where I see, let's say 12 patients a day, I can still give a really good, a really good experience to that patient who I'm giving a refraction. But I'm also seeing an additional five patients a day where I'm diving deeper into their dry eye or deeper into their glaucoma. And it's not detracting from the original experience I'm giving to the patient, but it's also adding to the revenue that I'm producing over the Entire. And that's why revenue per OD hour is important. And so maybe now Instead of generating $7,000 a day, I'm generating $9,000. So my, my, my per hour revenue is higher, but how do we actually capture that? And so that's kind of the second piece that I think is really important because now I can compare how much revenue am I generating per hour in any timepiece. Let's say also, Eugene, that those extra five patients only took me 10 minutes of time.

[Eugene Schatzman]

Right.

[Chris Wolf]

So each, so now I'm generating $2,000 for an additional five patients where each of them took 10 minutes of time. Would I deny that extra revenue? And most importantly, would I deny those patients from having that disease managed in our office? Right. And that's why it's helpful.

[Eugene Schatzman]

I see how that starts driving decision making inside the office as well. And how you get to kind of select, well, you know, what kind of practice do I want to run? But ultimately I have to optimize for something. And so obviously every metric has a competing, has another metric that kind of competes with it for priorities. So it sounds to me like you're kind of arguing for optimizing for revenue per OD hour as a potential metric to look at, especially if you've got owners who practice inside the practice, potentially. But then you also, I also wonder, you know, there are practices out there that really do want to maximize revenue per patient, and they focus on like, outsiderx and things like that where they really value their optician's time and, or they really leverage their optician's time and almost not so much the optometry time. So, you know, I think there's obviously competing priorities in almost any practice. Right?

[Chris Wolf]

Yeah, absolutely. And I don't think that One of those KPIs is more important than the other. I think it just allows us to get different perspective on what the business is doing.

[Unknown]

Sure.

[Chris Wolf]

And, and so like, you know, they do play into each other, but I wouldn't say one is more important. But, but what is, what's important about the second is that a lot of people, Eugene, don't think about it. You actually have to like to kind of pull it out of them. Well, they'll say, they'll say things like, well, I could have spent if, if I've got to manage a patient with glaucoma as an example, moderate glaucoma. It's not, it's not necessarily easy to manage mo moderate glaucoma if you don't have systems built around that. But they'll say, well, I, I could have generated if it took me, let's say, 30 minutes of, of my time, I'm, I'm going to go on a higher end, right, Just so we can kind of tilt it on the side of, of, in favor of, in favor of the refractive care, right, so I'm going to tilt it in favor of that. But let's say it took. Takes me 30 minutes for a comprehensive exam. Takes me 30 minutes to manage a complex patient or you know, complex patient who has, who has moderate glaucoma. Well, what a lot of people will say is, well, I could have done the same thing. I could have just provided another comprehensive exam and on average, I would have generated more money on average. But what I would say is, well, if you're not, if you're looking at time and actually if you look at time even in those half hour increments and you're doing all the things that our clinical practice guidelines recommend that we ought to be doing for a patient with moderate glaucoma, namely visual fields, gonioscopy, octs, and you're doing them within that half hour or less, the revenue per hour is almost as, as good in most cases, and in many cases it's better than, than what you're generating for that half hour of time providing an exam and refraction. And so it allows us to, it allows us to the little thing in the back of our brain that says the old, my main value is I get to sell you a pair of glasses, right? I'll take a, I'll take a managed vision care plan that doesn't pay me very well griping about it. But I have the opportunity to sell you a pair of glasses which is now the big, the big piece which is in the back of our minds all the time. And it allows me to say no, if I'm, if I'm spending a half hour on average with these patients and my Capture rate is 60% or 40%, I can know how much, how much revenue I'm actually generating on average for that, for that amount of time. And then I can compare it to the amount of time I'm spending with the patient who has glaucoma.

[Eugene Schatzman]

Well, and then interesting is that the glaucoma patient is going to return multiple times. So if you think about revenue per patient over time or as I like to talk about a lifetime value of a patient, you're probably going to get more from the glaucoma patient or the moderate glaucoma patient over time. And that of course then drives another business metric that I love, which is allowable acquisition cost. Because if you think about what, tell me about that. So imagine, you know, if I have a patient who just spent $1,000 in my office and they spent that thousand dollars on glasses. Well, let's think about this. They're likely to come back in the next 18. So let's just say they're going to come back. We'll go, best case scenario, they're going to come back in a year and they're going to be around for four years.

[Chris Wolf]

But you know the average though, so pause on that because you know the average time that, so let's say best case, they come back in a year. But what's the average time they come back for a new pair of glasses?

[Eugene Schatzman]

22 months.

[Chris Wolf]

Right, 22 months.

[Eugene Schatzman]

So we know that and we know that data. So I'm giving you high end average. But so, but actually let's go with your 22 months. So and the average patient sticks around for maybe four years, but it really depends on what kind of practice you're running. If it's rural versus urban versus you know, with a suburb and let's just call it four years. So okay, fine, that patient will be back three times in the next four years in that number. So okay, so now that patient has spent $3,000 with me and assuming that they buy the same, the same high end thousand dollar glasses every time they come back. Now that basically means to me, okay, what is my allowable acquisition cost for that patient? I have to pick a percentage of my profit. So what's my profit? Well, I have cost of goods and those glasses and lenses, let's just call them, I don't know, 30%.

[Chris Wolf]

What do you think that's fair?

[Eugene Schatzman]

Fair?

[Chris Wolf]

Yeah, that's fair. So but then you have to include your staff costs, right?

[Eugene Schatzman]

Of course. Right. Well, so I, but I don't know my staff costs. I can't necessarily attribute them to every single transaction. So I'm going to say, okay, I've got my, I've got my staff, maybe I'll attribute the OD production cost, so maybe I'll take 20 or something and attribute my OD production cost to that. So I've got 30% for materials, 20% for OD, trying to make it easy. So 50%. So that patient spent $3,000 in my office or I'm assuming that the lifetime value of that patient is $3000. I now have. So I probably have $1500 of quote profit. Right. This is Variable. A variable cost. Meaning we're what would. Minus our variable cost. This is incremental cost. If a new patient walked in tomorrow and I didn't have to do anything extra, I didn't have to pay more rent, I didn't have to pay more utilities, I didn't have to pay more front desk, that patient just walked in the door. That patient would be worth an extra fifteen hundred dollars to my practice over the next four years. Now I have to take a discount factor and say, how big of a discount factor and how aggressive do I want to be? And how confident am I that that patient's actually going to stick around for four years? And how confident am I that the patient's going to come back in general? And so I have to pick a number, right? And usually marketers pick a number anywhere from 10 to 25% of that profit to say, okay, well, that's your allowable acquisition cost. So now I got $1500. So let's go on the low end. 10. I can spend $150 to acquire that patient. Now, if I'm really confident that that patient is going to come back, and if I'm really confident, so I'm really confident in my recall, and I may be even more confident that that patient is going to come back more often, not 20. And I'm pretty confident that I can retain them for a while, and I'm pretty confident they're going to buy every single time they come back. And then maybe I'll shoot for like 20% in my allowable acquisition cost. But in, but in general, you know, most practices are, okay, 10%, but flip that whole equation for your glaucoma patient. Do the same, you know, do. Do the same marginal cost analysis on your glaucoma patient. So, you know, my visual field, what does it cost me to run?

[Chris Wolf]

Oh, well, you've already acquired the. I mean, so you've acquired marginal cost.

[Eugene Schatzman]

Zero. Right. Any other testing? You know, there's no click fees. Right. So zero. Maybe just staff time, but you know, whatever. You still have some OD production potentially that you would pay for. So now I'm dealing with 80% margin on probably something relatively similar to maybe not quite a thousand dollars, but let's just call it a thousand dollars. And how often is that patient going to come back in the next four years?

[Chris Wolf]

Yeah, I mean, they're going to come back. They're going to come back. Let's say the moderate glaucoma patient. Let's say they're a stable moderate glaucoma patient. And, and they're very stable. Let's say it's every six months, right? Every six months. They're, they're going to be back like clockwork. Yeah, like clockwork. Not, they're not waiting until they're, they're glad. And now this, that's interesting because it will actually mess up your revenue per patient a little bit. So like, let's say, you know, you see that patient back in that system and, and annually you provide a refraction for them just so that you can make sure that when they want, if and they do, if and when they do want new glasses, they're, they have an Update 8 prescription. And so you know, you see them at one, you know, six months, then you see them again in a year. Now you're doing another refraction. You see them in another six months, you do another year. Well, they're getting refractions every year, but they may not even be thinking about because if the average is 22 months, they may get two refractions before they actually buy one pair of glasses. So that metric, now you're looking at revenue per or you know, capture rate and you know, you talk to people and their Capture rates are 70, 80%. But in this model, your capture rate might not be 70, 80%. It might be 50%, might be 40, might be 30%. And that still could be really good.

[Eugene Schatzman]

Right. Which might be completely fine because if you and I always talk to practices with, with high medical, high incidence of medical patients, you know, you're, you expect your overall capture rate to be lower. But this is where the lifetime value of the patient, which is different than revenue per patient, but lifetime value of the patient could actually be higher because medical patients tend to come back in a more reliable fashion. And then of course you do the allowable acquisition cost and what you could spend to acquire that patient profitably for your practice is actually a lot more than the high end glasses patient, which is what we're all after. Right. So it's kind of a little bit of a dichotomy. Interesting too.

[Chris Wolf]

Yep. No, I think that that's, that is not clearly, I mean as you talk about it, it's clearly something that I haven't thought about is the acquisition cost of that. But it's, it's applicable for sure.

[Eugene Schatzman]

No. And you know, if anybody has space in their schedule, then you should be thinking about patient acquisition. And if you're intelligently thinking about patient acquisition, then you should be thinking about, well, what should I be willing to spend profitably in my practice to fill that slot. And, you know, arguably you just look at the marginal cost of what, what's the incremental cost? What does it cost me in addition to bring a patient into the practice to be able to perform a procedure? And how much risk do I have and how likely, how likely am I to retain that patient?

[Chris Wolf]

When you work with people. Sorry, I'm not trying to take over the interview, Eugene, but when you work with, with people, I call it the dopamine hit. But I'd love to hear your experience on, you know, let's say we, let's say two. What is your sense about two patients walk into the office, brand new patients to the office. One of those patients in a comprehensive care practice, one of those patients has a complaint of, let's say, you know, we'll use dry eye, but let's say they have a complaint of a dry, scratchy, gritty eye or even a red eye, just an acute red eye. That's a brand new patient versus a brand new patient who has a managed vision care plan and wants and is thinking about buying new glasses. I will tell you as much. Well, do you think there's a difference in how those, how those practices see those patients approach those patients and value those patients?

[Eugene Schatzman]

Well, I think that if you do the right amount of discovery, you can take the managed care patient and you can turn that patient into a dry eye patient as well, some percentage of the time. Right. If you do a good job of taking the time to go through and understanding everything that you could serve that patient, everything that your practice offers that could ultimately serve the full, the full spectrum of everything that patient needs. I do agree with you that a, quote, dry eye patient is more desirable to a practice because they're predisposed and they're there and they have the problem and they're more likely to, and they're more likely to say yes if we present them with a treatment plan because they have a problem and they're problem aware and they, you know, and they're ready, they're ready for the solution. Right. That's why I think practices treat that patient as more desirable. But I also think that if you're playing the long game, which, you know, I think all of us are, you know, if we've been around for a while, we try to play the long game of business. If you're trying to play the long game of business, the reality is that that same VSP patient will develop if you treat them in the right way. And if you do all the Discovery work correctly in your practice. You know, you're not just there for a quick, you know, spin and grin. Plus you know, like you go, go check out the optical. If that's not your approach, which most practices it's not. Right. Like you're trying to take care of the patient in the most preeminent way possible. In that case, that patient can also become, can, can have high lifetime value. It may just take some serious work, some sales cycles and some time to get there.

[Chris Wolf]

Yeah, I mean I, you're, you're articulating the point that I would make. I actually think that you know, a patient and I kind of tilted my hand by saying that that patient with the acute problem was a dry eye patient, but I probably should have articulated it better that like they just have a problem, right? They have a problem that it's not related to a refraction and then they just need you to take care of it. I think most people, because they haven't, they're not aware of the fact that like that patient has all. They're aware of the acute problem. Right. But they're like ah, the acute problem, I'll just solve that problem and then go away. You know, I want to get to the patient that, that could buy glasses. But I couldn't agree with you more that, that, that both of those instances, whether that's a patient that comes in and says I have dry eye, I needed you to do something, people will be like yeah, I'm going to take care of the dry eye. But it's, and that's where the next KPIs that you and I have discussed briefly before is okay, that patient that does come in with a managed vision care and is primarily concerned about needing new glasses. You said if you do your, what was it? Your detection. Detection, your discovery work. I like that, I like that term. So if you, if you, if you think about that patient and what their likely diseases that they have are, right. Just based on prevalence data and, and I always like to joke that, that we didn't memorize for BOARDS prevalence data just so we could get BOARDS questions, right. We memorized those things so that we could actually apply it to our patient population and know, okay, a 43 year old Caucasian male sits down in front of me, what's he most likely to have? And I'll tell you if you look at, if you think about it like we could start rattling off prevalence data and I've done this like 12.7% of patients over the age of 40 have macular degeneration 2.1% actually have glaucoma. And we look at all the glaucoma risk factors, you can easily Caucasian patients over the age of 42.1%. Beaver Dami study So if you look at all the risk factors that go into that patient having glaucoma, you're probably thinking that patient's a glaucoma suspect at least 10% of the time. And probably if you, if you really apply it completely, you could get higher numbers and any other ethnicity that is not Caucasian, that number goes up. BEAVER DAM EYE STUDY so, so you start to, you start to whittle those things away. Dry eye. You know, we talk low end, 35% of the population over the age of 35, but if you throw in meibomian gland dysfunction and Demodex, now we're talking probably 70%. And so you have these conversations in front of an audience and everybody's like, yeah, all my, you know, all these patients have dry. And then you look at metrics about, okay, well how many, how many anterior segment photos do you build per refraction blank face. Nobody has any idea. Okay, well how many visual fields do you, do you run? Because, because if, if you, if you all agree with me that 10% of the population over the age of 40 that's Caucasian has, is, is a glaucoma suspect, then all you have to do is look to our clinical practice guidelines to say, well, clinical practice guidelines tell us for glaucoma suspects, they get an annual gonioscopy, an annual visual field, an annual oct. Right? That's what they tell us to do. So it's not me telling you that. And so everybody would say, nobody would argue with that, right? Nobody, nobody argues with that. So why aren't you doing 10 visual fields for every hundred refractions you do? Like, why, why isn't that a metric that you're looking at, right? So anyway, that's what's really fun is to actually look at that as a KPI and I, that's sort of peripherally related to what we were talking about. I don't know how to.

[Eugene Schatzman]

This is great and it's kind of brilliant if you think about it. And the prevalence data is really like, that's the real benchmark, right? To say, well, okay, so I saw X number of patients in my practice and X number of percentage of them were over 40 and I treated 5% of them for anything to do with dry eye. But you know, the prevalence Data says that 75% of them had something that I could have helped them with, like you said, blepharitis, demodex or dry.

[Chris Wolf]

My bowing gland is function.

[Eugene Schatzman]

Right?

[Chris Wolf]

Yeah.

[Eugene Schatzman]

But in some, in some capacity I could have helped them. So let's talk more about that. So how does it, how do you make that practical? How does somebody actually take action?

[Chris Wolf]

Well, really, it comes down. I think the first thing is it comes down to belief. So, so when we work with people, I mean, it seems kind of silly and sort of like Tim Robinson or Tony Robins, but, but really it comes down to like, what's your identity? And if you think that, if, if your identity is that I'm just an optometrist or, you know, yeah, I can do some dry eye, but I don't have all the widgets, you know, I don't have the rf, I don't have the low level light, I don't have the ipl. You know, I, I'm just, you know, so, so the first thing is like, if patients pick up on that, so it's, it's kind of this, like, no, I'm the best place for dry eye in my community. A patient has dry eye, I'm not gonna, I'm gonna be able to identify it. I'm gonna be able to take care of it. And believe me, optometrists are that way. They just need to have the identity like, solid that I do not want a patient to walk into my practice with dry eye or meibomian gland dysfunction is their identity. Like, that can't happen, that I'm going to miss it. Right. Like if, if that's their core, that's the first starting point. Like, I'm not going to miss this. When a patient comes in needing glasses, I'm going to pull this lamp away and I'm going to be able to. I, I've already identified some, some symptoms or signs andor signs where I can confidently say, you know, Eugene, great news. I've got a new prescription for you today. And that's going to make you see better up close because you're 43. I don't know. How old are you?

[Eugene Schatzman]

40.

[Chris Wolf]

40. Okay, you're 40 because you're 40. And, and that's good. I'm going to make it a lot easier for you to see your computer during the day. That's going to help with the headaches. But, you know, you were also telling me that your vision fluctuates a little bit and you rub your eyes. And, and, and so the. What I'm seeing in my clinical exam is that etcetera etc. You know, you've got telangiectetic vessels, you got stagnant oils in your tears. And the most common reason for this is that you've got an overgrowth of microorganisms. So I'm going to start you on warm compresses and lid scrubs and I'm going to see you back in a month. Like, that's the practical. Like. And you have to believe that if you don't do that, Eugene next year is going to come back in, or in 22 months is going to come back in for another pair of glasses, and then in 22 months is going to come back in another pair of glasses. And at some point down the road, Eugene's eyes are going to be so uncomfortable that he's tried all the other things. Artificial tears, he's gone here, he's bought this stuff on Amazon. But his, his disease state is so bad now that it's really hard to manage. And if I wasn't, if I wasn't really paying attention to the easy stuff, it's going to be really hard for me to pay attention to Eugene when he's got, you know, mild neurotrophic keratitis and three plus SPK or even two plus SPK and, you know, four plus telangiectatic vessels and no meibomian gland gland secretions. That's a lot harder of a case. Right. But if I believe that it's important, if my core identity is Eugene is not coming into my office at 40 years old with, with even early dry eye or early meibomian gland dysfunction that I will miss and not be intentional about finding and following and managing, then, then at some point Eugene is going to have a worse disease state. And so I, I think that's the, that's the first step. Right, the first step.

[Eugene Schatzman]

So it's really that shifting that mindset. And by the way, I think I've interviewed four people on the show who have really echoed the same exact point, is that it really is about making sure that you see your relationship with the patient in, in a way that ultimately allows you to be a formal authority on, on this topic as opposed to just making some recommendations and hoping they buy something. This is a, this really, you know, and even the way you delivered it, it was with authority, right? Like you just, hey, you know, so I'm prescribing this, I'm prescribing this, I'm prescribing this. And you're going to do this, this and this, right? And I think Paul Karpicki was on the show and he said, and I love when he said it, he said, this concerns me. I have a concern. When a doctor is concerned, all of a sudden you want to, like, you perk up a little bit. And so, you know, that language is like, okay, this is a concern that I have. And so I'm making, you know, I'm not making a recommendation. I'm just telling you what to do about this particular concern. I'm prescribing the following treatment. So I think that that's the, you know, that that is a mindset shift, as you called it. And I think it makes perfect sense, Chris, that, that we would start there, but where do we go next?

[Chris Wolf]

Yeah, so the next thing that, that you, that you do is you say, okay, well, I'm bought in, but how do I know if I'm making any, any movements? So the first thing is like, okay, well, what are the things that. I talk about this all the time. Like, what can you not turn away from? So remember, if we're, if the patients are largely delivered into our practices through a comprehensive exam and refraction, then what questions do I ask that patient? If it's, if it's about dry eye, we can do a whole other set with glaucoma and macular degeneration because they' very prevalent. But if it's dry eye, I'm sure people are getting sick of, of dry. We could do the same thing for anterior basement membrane dystrophy, by the way, like, or keratoconus. But, but, but if we're thinking about dry eye, we're thinking about, like, what questions? Because, because guess what, with, with the coding rules that we have from 20, 21 and beyond, there's no counting HPIs, there's no counting review of systems, there's no, there's no counting past family social histories. You ask the history that is important for you to manage the patient. You ask the medically appropriate history. Well, guess what, if I've got a disease state that is prevalent in 70% of my population, right? Even if it was 35% of my population, then I'm going to ask at the comprehensive exam the questions that are that matter for that disease state. And I just want, I want questions that, like, I can't turn away from. This is the other part of it is like, so the second step you asked is like, how do I. What's the next action you really need to think about? What's the, what are the questions that I'm going to ask or question that I'm going to ask during a comprehensive exam that if I get a yes to, I don't even care about anything else. So. So one for. For dry eye. There's four questions in my. In my practice, and these are not groundbreaking. If you talk to any other expert, they're probably going to tell you the same thing. It's. Do you ever use art drops in your eyes? Are your eyes ever red? Does your vision ever fluctuate? Are your eyes ever gritty, burning, or itchy? But those are the four questions, and you have to believe those. The answers to those questions for symptoms are so important that when you pull the slit lamp away, you will act. And it's. And the action isn't going to be here. Eugene, try these artificial tears. The. The. The company just dropped them off yesterday. And if they don't work, let me know next year or give me a call or whatever. Like, that can't happen, right? It's. Eugene, this is the next best step because you had one of those things. I cannot. I will not turn away from it. This is the next thing we're going to do. And. Okay, here's the next key. I will see you back in one month or two weeks or it doesn't matter. Like, you're so committed that that patient has a problem that you're going to act. And that's why those questions are so important. They're not important. The questions that I gave you are not important. Like, you shouldn't steal those questions. In my opinion. Whatever the question has to be is, it has to be. The answer has to be so important to you that you will act. Right? You will act on that symptom. So you got to build that list of questions that you're asking those patients at the comprehensive exam so that when you see a yes, you have to do something. Because guess what? If you. If you don't believe in those questions that much, what's going to happen? You're going to get behind. And so the next patient's going to come in, and you got two patients long, and you're like, well, I can get to this next year. Same thing happens with visual fields. Like, the reason our visual field utilization is so low is because, you know, Sally's gone and our visual field tech is gone. So I'm going to do it next year. Or. Or the machine, it's kind of cumbersome, and I'm running behind. Let's just get it next year. So it has to be that important. So that's. That's Step two, you gotta have questions on your intake or from your text that when the, when the patient responds positively to those questions, you are going to own that. Own that. The responsibility for doing something about it.

[Eugene Schatzman]

Got it. So, and when you talk about that, you know, owning that responsibility, let's just get. Actually, I'm, I'm curious. When you bring that patient back in two weeks and a month, what, what happens at that, what happens to that exam?

[Chris Wolf]

Yeah, great. I mean, a great question. If we're talking about dry eye, right, talking about ocular surface disease, then I would, I would have a much more. So the, the, the thing I think you're getting at EU is the idea that there is a distinctly different exam for a problem focused exam than a comprehensive exam. And what a lot of offices or a lot of doctors who have, are kind of in this comprehensive, focused care where we do everything one at one visit and only do what we, what we need to do at that visit. And you know, if it's dry eye, I'm gonna, I'll dress it a little bit, but I'm gonna do it all at that visit. If it's glaucoma, I'll get it all at the visit. What you're asking about is how is this, this next follow up, diving deeper. And, and so in my practice, what it looks like is I'm looking for specific things. I'll look for a, like a standardized symptom score. I use speed, but you could use osdi, there's some deq, some whatever you like. But a standardized symptom questionnaire allows me to dive deeper. I can talk more about why I like that further if you'd like. But, but that's different. That feels different for the patient. It is different. We get lab tests, so we get tier chemistry tests with MMP9s. We look at osmol, we look at lactoferrin, we look at my biography, right? We look at its structure. And all of those, by the way, Eugene, have billable codes which then become trackable. If I'm thinking about metrics and KPIs, about how many of these am I finding compared to a refraction? And then all we talk about. And then I look for. So I'm looking for tier volume, I'm looking for tier instability. I'm looking for any other signs of inflammation. And then I want to see what those oil glands look like, right? So I will express oil glands. And I'll also look at secretions, right? So the difference between secretions and then expressions, I'm Looking for other, like, masqueraders. Right? So we're looking for things like, you know, lid apposition, ectropion, entropia, and we're looking for things like, you know, incomplete LID closure. And honestly, these are things that I wouldn't normally do on a comprehensive exam because they're not that high yield. But there are some things in the comprehensive exam that are high yield. That again, when you. That even if the patient doesn't have symptoms, that you're like, we got to do something about this. So that that's how it feels different to the patient. That's how it is different in our practice. But we're intentional because we're looking for things that, like, if I have a positive MMP9 finding, my treatment approach is going to be different in a patient who has, let's say, you know, has obstructions in their meibomian glands and a positive MMP9 finding. I know my treatment will be different for that patient than one who just has, who doesn't have, you know, other signs of inflammation. But a lot of people don't think through like that, you know, okay, well, if I see this, this is what I'm likely to do. Or if I see this, this is what I'm likely to do. So I encourage that as well. We actually work with people on, on building that, building that out.

[Eugene Schatzman]

Well, what I heard you say that I think kind of what was even kind of the opener for this whole thing is that at the comprehensive exam, you didn't say something like, it looks like you have some symptoms related to dry eye. I'm recommending an eye, a thorough dry eye examination, and my staff will give you some information about it up front if you want to schedule it. Right. Like at that point, it's a choice, and that's a choice that you're not really that behind. And I. So with your whole concept of the mindset, you said, I'm going to tell you to do X, Y and Z, and I'm going to. And I would like to see you. Or you said, and I'm going to see you back in a month. Month. And that's your, you know, that's your dry eye exam. Build medically and potentially a treatment protocol that that then follows.

[Chris Wolf]

Yeah, it's kind of a Jedi mind trick. You know what I mean? You're just like, and I will. And I will see you back in a month. And the reality is, the reason that you do that is it's really in the patient's best interest that you're removing, you're removing this sort of like decision point. If you think about like, you know, business made simple. Don Miller. Right. Like, I'm sure you, you know all about what he does and you're, you're removing this like, barrier of like, well, I have to analyze whether or not I should come back or how do I come back? What's the steps? If, if it's, if this is okay, how do I know it's okay? Should I just use these drops and I'm feeling better and so I'm done, I don't have to come back? Like, no, I, I don't care if you're feeling better. And I don't, I mean, I do care, but, but like the, the decision point on whether or not you should come back, it's not about your symptoms because there's so much more, again, I believe there's so much more to dry eye than a patient's symptoms. So I'm removing that barrier for them. And you, you would be shocked at how many times that script right there again, and it's, it's a script, but that script right there gets bumbled around. And if you haven't really thought about it and practice it and said it over and over and over again, like, doctors will try it and they're, and they're kind of like, like they just are just not comfortable with it. Right. The other thing it does is it forces you to get better because those patients will come back and a lot of them won't, will be marginally or minimally better. So imagine I give you artificial tears and you, you say, yeah, this is a little bit better, but it's not totally better. But, but I don't really have a scheduled follow up, so I'm okay, you know, I'll just wait till next year.

[Eugene Schatzman]

Right. 22 months later.

[Chris Wolf]

Yeah, 22 months later. Right. So. But what it does is it delivers those patients back into your office. And if you want to build a dry eye specialty or a dry eye sub area of your practice, we call them pillars. Like, there's nothing better than to know who's going to benefit from IPL or RF or Restasis or Zydra or CEQA or maibo, whatever it is, than being forced with a patient who's coming back saying, yeah, this is better, but I'm only about 50% better. And then you're seeing signs of inflammation and staining and stagnant meibomian glands and you're like, okay, well I gotta do something, you know, I mean, I Gotta do something else. And so that's, That's. I'll tell you, Eugene, that is. I don't know that anybody. I'm sure other people have thought about it, but it's such a critical part of building that pillar because you have no other option to get better in those scenarios is to find something else that's going to work for the patient. So anyway, those are the two reasons, one for the patient and one for the doctor.

[Eugene Schatzman]

Yeah. And I think, you know, let's go back to the. How do I know if I'm doing it? Well. Well, probably it has to do with looking at that prevalence data and then looking at some data inside of your practice. So let's be crystal clear about that. Let's talk about the data that everybody should constantly be monitoring the practice. So if I had a magical dashboard that I could potentially look at every single day, in your opinion, Chris, what would be on that dashboard?

[Chris Wolf]

Well, you'd look at refraction because that's your. That's your wide net. If you think about this from a marketing standpoint, it's your funnel. Right. So refractions. Tell me how many patients I'm seeing who are being delivered in the office for some amount of time, because mostly those patients are, as we've talked about before, the first time a patient enters in, and anytime after a year, a year or longer, that patient's going to have a comprehensive exam and refraction, so that the denominator has to be the refraction. That tells me how large the pool is. Then we look at disease state. So in this case, if I wanted to look at dry eye as an example, and let's say I didn't have any other fancy stuff, all I have is an anterior segment camera. Maybe all I've invested in is a. My biographer, which, by the way, is a fancy anterior segment camera. And, and I only do that anterior segment imaging when the patient. Now it's not. You don't have to do that. But, but like, let's say that, that our protocol in our practice, that's not mine. My protocol, by the way. But I'm saying, like, let's say you're going to build a protocol in your practice where you see something during the comprehensive exam and then you identify it and you have that patient back for the, for a dry evaluation. And the only thing you do is my biography. Well, that has a code. 92285. Right. So anterior segment imaging. So my biographer, right now there's a T code, I think that's still available, but it's not really paid. So it's still. It still is recog anterior segment imaging. And so in any case, that now becomes a trackable point. So if in my protocol, I'm saying like, all right, comprehensive exam, I see you back for some 99 code based on, you know, based on whatever you do and whatever your MDM is for that patient or time. But the trackable thing is, is the anterior segment camera. So now I can say, well, Eugene, you've already told me. So let's say we go out a month. And now our protocol is I will see you back in one month. I will see you back in one month. That's part of our vernacular. And that's exactly the habits that we perform in the. In the comprehensive exam. In two months, you know, I should. I should be perform like in two months later, I should be performing 30, 35 anterior segment imaging for every 100 patients that I saw. If I've. If I've done that well, right, and now if I haven't, well, I can sit back and say, well, what did I do wrong? Like, was I not as forceful about the anterior segment as, as forceful as I should have been for the ocular surface disease follow up? Was I. When I say forceful, was I waffling? Did I waffle? Well, maybe we could do this or maybe we could do that, or was it just a process problem? Like, you actually saw a lot of those patients for anti. Like, I know I did a lot of. I. I can go back and look at my schedule. Well, I've seen 30. 30 patients for ocular surface disease. What happened? Well, we didn't bill it. I'll tell you. That happens a ton too. We never build it. Okay, so you didn't even generate any revenue from it, so that happened a lot too. Yeah. Oh, it happens a ton. It happens a ton. And so. So you can kind of try to pinpoint where the problem is if you've actually are following through with the metric. Or you might say, listen, I mean, I have this all the time. Like, should I buy a. Should I buy a new widget? Like, let's. I want to buy an ipl. Okay, well, should you buy an ipl? I don't know. How many anti. Segments. Do you have an anti or segment camera? Yeah. How many anterior segment images do you do every month or even every. Every time? You know, your ratio of anterior segment images per refraction? I don't. I don't know. Maybe I do it once a week. You're not buying the IPL right? You're not buying the IPL yet because you got it. You got to use the technology you have. So let's build a process so that you're doing these things you can show the patient. Then that will feed the next thing that you, you. That you invest in. So that's how you. That's how you make the numbers work. That's how you understand the numbers. It's why those numbers are important. And you can do the same thing. So let's say I wanted to add testing like osmolarity and inflammatory. So now. Okay, well, now I'm up to the point where I'm doing 30, right? I'm doing that. My 30 per. Per 100 refractions. Great. Or maybe it's not even 30. Maybe it's 10, right? Like, 10 would get you way above most practices. Like if, when we look at these numbers, Eugene, most, Most time, like the refraction. The anterior segment to refract imaging to refraction ratio is less than 2%. It's less than 2%. Yes, yes. And that's with actual practice data. That's like if, if you sent me your data and we analyze that data, it's less than 2%. So, so, but let's say we get it to 10%. Then I might be saying, okay, Eugene, it's time to add a, you know, osmolarity and inflammatory. Let's invest in that technology. Because every time you doing the anterior segment camera now, I'm going to do those two tests. And by the way, it's not to make more money. It's to take better care of the patient. Because now I can be more strategic about what type of ocular surface dysfunction you have and what treatment is most likely to. To benefit you. Then we run that for another 90 days, right? And, oh, by. Oh, now. Okay, well, what. This is weird. I. I've got my, my ocular surface. I'm doing my anterior segment camera. But, you know, but I'm, I'm. I don't have the same number as anterior segment cameras as I have for osmolarity. Why is that? Oh, well, well, you know, Jenny, who's doing the test, she just stopped doing them, you know, and we never really caught her on doing it. So that it gives you another point to say, like, these three should be really closely tied. So my ratio for refractions for each one of those tests now should mirror each other. And when I buy those tests and I implement them into the protocol, I know exactly what to expect. Because people be like, well, how long do, do you think rep, I can pay this off? I was like, you don't have to wonder, like, you know, exactly like every ocular surface evaluation, we're going to do these other two tests. That means I'm going to bill this many, so I'm going to pay it off in this many months.

[Eugene Schatzman]

Well, you're talking about doing it the smart way because the. You're already doing, you already have a process to identify those patients. I think a lot of people buy the widget and then say, now I'm going to build the process to identify those patients. And I agree with you 100%. It's the right approaches. Build the process, identify the patients, make sure you've got the patient population, and then after you build the process, buy the widget, because then that'll give you instant roi, rather than this thing having a really good chance of just sitting in a closet and collecting dust while you wait around to build the process.

[Chris Wolf]

Yeah, and, and I, well, you probably have seen the data. I, I keep quoting 75%, but I think there was a survey recently done about, you know, optometrists who have technology that they purchased within the last so, so long, like 75% of them aren't being used, you know, and, and that's a huge problem. And, and what do you think that does when, when you buy something that, that you think, oh, I'm gonna, this is gonna be great for my patients and I'm gonna make a lot of money. And then it sits in the closet. What do you think it does to your identity?

[Eugene Schatzman]

Well, Right. It erodes the confidence. Right?

[Chris Wolf]

Yeah.

[Eugene Schatzman]

It changes and it puts another block in between you and that mindset.

[Chris Wolf]

Absolutely. I can't. I, I'm not the best place for dry eye in my community because I couldn't make IPL work when Johnny down the street's making it work, or at least I think he is because he's a Kol and he talks on the stage and blah, blah, blah, blah, blah. But, you know, if you look his numbers, actually, and we have, we've looked at some big Kol numbers. I, I don't share the, the names, but we've looked at some big Kol numbers and they're not much better than the average odd. They just, they just get a lot of love.

[Eugene Schatzman]

Interesting. And, you know, my, my, my final kind of perspective on this, Chris, is if you're thinking about numbers and using those numbers to kind of drive adoption of both technology and process in the practice. And we, we really, we did talk about Revenue per patient. We talked about revenue per OD hour. Is there any other metric, any other metric that is highly relevant to a practice that we should potentially be looking at, or any one of these metrics that we've already talked about should be the primary one that we look at outside of, as you mentioned, refractions being the denominator.

[Chris Wolf]

Yeah, I mean, I think probably the one that's the most key for me is revenue per OD hour. I mean, I think it just tells you how productive you are. I mean, you can look at like, AR and that sort of thing, and I think that's really important. Right. But that gets a little bit more nuanced because you can monkey with ar. Like, you can have a bad staff that monkeys with ar. Right. Oh, it's getting paid. Write it off. Right. Like, that's. Yeah, but, but I think the, the kind of the, the main driver is got to be revenue per OD hour. It really does.

[Eugene Schatzman]

Yeah. And I think that's a, that's a really big, big point. And if you're not measuring that in your practice, obviously there are mechanisms to do that. And it's not, you know, it's just math. Right. Like, you just have to be able to keep track of things and, and it's just math. But, Chris, I really look forward to continuing the conversation. I think we'll probably have one on, on your show. Tell people how to find you and I'll put some of the information in the show notes as well.

[Chris Wolf]

Yeah, you can find us. We do a weekly podcast, actually on our channel. We do a week, a podcast twice a week at icodemedia. You can just search any of your podcast apps, icodemedia. Also, you can find [e-mail] that's e y e c o d e education dot com. Thanks, Eugene, for allowing us, for allowing me to come on.

[Eugene Schatzman]

Yeah, it's definitely a pleasure and I enjoyed the conversation.

[Chris Wolf]

Me too. Thanks.

[Unknown]

If you're enjoying the Power Hour, you might be asking yourself, what can I do today in my practice that's going to make an impact? So over the years, the practice coaches and consultants at the Power Practice have helped thousands of practices improve. And they often start with one thing, and that's a proprietary methodology called the Practice Profitability audit. For about $2,400, they look at all of your practice numbers and they stack them up against where a practice of your size could and should be. It takes about a week for them to do, and because they're so experienced, they know what your potential looks like. And they're often able to take that $2,400, multiply it several times over and hand it right back to you in found profits in your practice in months, not years in months.

[Eugene Schatzman]

But you get to keep the much.

[Unknown]

More profitable practice for years afterwards. But here's the best news. I'm going to tell you how you can have the practice profitability audit completely free. See, we're really trying to get people onto the show website, which is, by the way, powerpractice.com and then you click the Power Hour podcast button. The reason we want you there is because I want the audience participation, I want to hear your feedback and I want to know how to make the show better for you so you can interact with us, send us your feedback, offer your suggestions, and for a limited time when you go there, you can also request a practice profitability audit for free. Right? We're going to cover 100% of the cost, but only for five people per month.

Month.

And five people per month is all we really have capacity for. Because this is a resource intensive audit and the practice power practice coaches are generally busy serving their clients, but for five people a month, they've agreed to cover 100% of the cost. So it's totally free to you. So again, take action immediately in your practice. Go to powerpractice.com click on the power Hour podcast, interact with us, but also request a practice profitability audit today.