Thriving in the Face of Disruption: Cultivating Resilience in Tough Times

• Learning Objectives

After this course, participants will be able to:

• Discuss how to track business activity which will provide a snapshot of the hearing care practice.
• Explain why the patient experience is critical to a hearing care business' success.
• Describe three ways to make the patient experience something that patients will remember.

Introduction

There have been discussions of disruption in our profession lately and there is no doubt change is ahead. There are many obstacles that we seem to be looking at today and wondering if we can overcome. I have colleagues ask me, "should I stay in this profession?" When you have the education and experience what else would we do? There are still opportunities that exist to grow your practice. During this course, I want to share how you could help your practice or your position in audiology thrive. Disruption does not necessarily mean chaos. Disruption means it is time for a change. 

Consistent Tracking

Many clinicians do not track their business activities. Numbers don't lie. Numbers tell the truth and give you a story. With this benchmark, you can make the best decisions for your practice. I am hoping to share simple ways to track your business activity. The truth is, business is business, no matter what business you're in. There are key elements you have to measure and monitor to ensure that your business is focused on success. Now, I know that most hearing healthcare practices consist of one professional and one support person. This can be a challenge with limited time and resources. However, you can sustain a successful practice if you are measuring, monitoring and focusing on profitability. There's no secret to business; there are only three ways to grow any business:

• Increasing purchases from new patients
• Getting patients to purchase more frequently
• Increasing the dollar value of every single sale

Patient Experience

Leading the way are major hospitals which have spent a lot of money creating excellent patient experiences. Healthcare and insurance companies are starting to reward pay-for-performance. They want patients to be happy. I sent a friend to an ENT recently, and her appointment was at 9:00 a.m., I texted her at 10:00 a.m. and said, "How's it going?" She says, "I'm still waiting for him to come in." That may be acceptable in my town because there happened to be only two ENT surgeons in my community. However, in a bigger market, and especially in the market of hearing healthcare where people can go anywhere to get hearing aids, the patient experience has to stand out as something spectacular. We don't know what percentage of hearing healthcare practices focus on the patient experience. I can tell you that the ones that do are the ones that stand out in the crowd. Patient experience is a way to make your practice thrive, and it's a way of standing out in the sea of hearing healthcare providers.

Track Business Activity

There are no secrets to business. The key is spending time on your business. In the average practice, most professionals spend their time visiting with patients. The fact is, if your practice is typical and has one professional and one support person, you have to designate time on business tracking, or it won't be successful. You won't see your practice grow to be profitable. Perhaps that means two hours a week that you have to spend looking at your numbers, measuring the critical components of success, outlining a marketing plan, making sure you're staying connected to your patients and measuring patient satisfaction. You should make this a priority to keep your business on track. It's just as important to work on your business as it is to work in your business.

The true secret to business, if there is one, is tracking numbers and performance. You are not going to connect with every single patient nor will you make every single patient happy. However, you have to track these things to make sure that you're monitoring these key components of success. If you don't know where you're going, chances are, you will not get there. Tracking your numbers is vital, so businesses do not become off-track. It's a way of measuring and monitoring where your business is heading. The difference between surviving and thriving in business is tracking key indicators of the industry. 

KPI

We monitor our business with key performance indicators (KPIs). KPIs are the key elements of the business that add profitability. I am going to share with you key aspects you should measure to make sure your company is headed in the right direction.

Inbound calls converted to appointments. Do you know how many times the phone rings at your practice and how many of those calls are converted to an appointment? It's been said that in this industry, the average phone call coming in costs an average of $320. That's a lot of money. You want to make sure that when someone calls your office that the call is converted to an appointment. In my practice, we aim for 90% of calls being converted to appointments as a standard. You can hire a call tracking company (i.e., Call Source) who will record calls and monitor which form of advertising the call originated from. Often the staff member answering phones are not prepared to answer common questions. A helpful resource for your staff members is to provide a generic script that answers the most frequently asked questions. 

Tracking candidates fit with aids. Converting candidates to hearing aids patients is the number one way to help your practice grow. In our industry, the average percentage is less than 50%. Overwhelmingly, patients walk away without the help they need and deserve. There are a lot of opportunities, but too often we waste them because we're not monitoring them. I guarantee that there are opportunities in every one of our practices, opportunities that we can handle better. The goal should be to convert at least 70% of patients that need help to pursue treatment with hearing aids. That could be a considerable change in the profitability of a practice. We know that patients, especially new patients that come to your office for help have often waited six to eight years to make that appointment. We know that they often live in denial which is a barrier for them to receive treatment. Having a friend or family member attend the appointment makes the patient more likely to take advantage of your advice by 60%. When scheduling their appointment, encourage them to bring someone along to the appointment. As I mentioned earlier, your help rate or close rate should be between 70 to 75%. In most cases in hearing healthcare, our help rate is calculated by the percentage of patients who need hearing aids versus the percentage of patients that purchase them. 

Be able to look a patient in the eye and give them a good reason why they should go ahead and get that help today. Tell the patient and their family member why you are the best person to help them with their hearing problems. As a profession, I believe we are not comfortable convincing people and overcoming those common objections we hear every day.

ASP. Another KPI to track is the average selling price (ASP) per patient. In our country, the average based on the industry standard is $4,240 a pair. If you can get your ASP higher than that, this usually means more profitability for the business. Keep your cost of goods less than 35%. The lower your cost of goods, the higher your profitability. If your cost of goods is higher than 35%, there are only two reasons for that; either you're not charging enough, or you're paying too much for your cost of goods. If you're not charging enough, then raise your prices. The only other way is by lowering your cost by going to your manufacturer and negotiating your price. If you're buying from a network, make sure you're receiving the services that you're paying for because if you're buying hearing aids through a third-party, you are paying for those services.

Tracking Insurance Reimbursement

Insurance reimbursement is often very low compared to the billed charges. There are insurance companies that have hearing aid programs which state you can't bill over and above their reimbursable or the customary rate. You want to make sure that you're not giving away the best technology and being reimbursed less than what you're paying.

Track Referral Sources

You want to make sure that those referral sources are staying consistent or growing. If all of a sudden you see a referral source stop, you want to go to visit or call the practice or source. Keep these relationships strong because it will provide a steady stream of patients to your clinic. 

Who is a Candidate?

You need to determine who is a candidate and that definition needs to stay the same across all providers in your practice.  In my practice, we determined that anyone with thresholds higher than 25 dB at more than two frequencies is a candidate. This does not mean we're going to fit every patient with a mild loss. However, we need to list them as a candidate, and if we didn't help them, that goes against our help rate. In my practice, anyone who has hearing aids that are four years old and older is considered a candidate for new technology. Do we upgrade them all? No, we only upgrade about 50% of patients with four-year-old aids to new technology. We accomplish this by letting them listen to new technology.

Patient Experience

Patient Referrals

Patient experience has been proven to increase patient referrals. Patients are more likely to tell someone else if they're happy with you. People stay with you longer if they are satisfied. The patients who love the patient experience and have a favorable impression of you and your practice are going to have higher patient satisfaction. Why is this important? They're going to tell more patients about you and the experience that they had. I've read that by 2020, the patient experience will be the number one reason that someone chooses their hearing healthcare provider. That's just another reason to focus on the patient experience. Plus, these people that love your patient experience are going to tell more patients, and that's a great way to spread the word through a patient referral program. A patient referral program has to be a well-defined program and intentional. In my practice, we put five cards in our pocket every day, and every employee does the same. By the end of the day, we have to hand out those five cards. 

Initial Impressions

How do you greet your patients? People want to feel welcome. If someone comes into your home and you're on the phone and don't even look up and say hello, they're not going to feel very welcome. The same is true of your practice. If your receptionist isn't warm and welcoming, this could give a new patient the wrong impression of your practice. You need somebody to be friendly and welcoming. We started a new program in my practice that when we have a new patient coming in, we book 15 minutes ahead of that appointment. We block that time out ahead of a new patient so that the professional can be waiting at the door for the new patient. We want those patients to know that it's a big deal to us that they are coming in today. We ensure their first impression is a pleasant one.

Visual impression. What do patients see when they enter your practice? I went to a practice recently, and it was gorgeous. I went back, and I was taking pictures of my office I noticed some flaws. There were nicked walls and desks that looked cluttered. I encourage you to go into your practice tomorrow morning and take some pictures. View your surroundings from a patient's point of view because then you'll know how warm and welcoming your environment is. Consider serving refreshments because everybody loves refreshments. We send mugs home with our patients, and we want them to use those cups every day so that other people see the name of our practice. 

My office is called Professional Hearing Services, and I pride myself in providing each patient with the "PHS Experience." The patient experience is fast becoming the next competitive battleground in healthcare and is the way to separate yourself. I have gone to extremes to make the patient experience something special in my practice. You don't have to go to this extreme, but you want to do a couple of things that separate you from the average practice. Make sure to provide fun reading materials for your waiting area. I find that the books in our community are the things people like to read. Be warm and welcoming, have a greeter if you need to. 

Virtual impression. Everything is virtual, take a look at the hearing aid technology. Manufacturers are designing product lines with the patient experience in mind. We can now track wear time and various environments the hearing aids are worn in. When someone comes in, and I'm adjusting hearing aids, I put it on a big screen to show patients exactly what I'm doing. I had a patient come in recently, and states "I don't want these things, they don't work." I asked him to have a seat and told him, "I just want to open up the program and look at what's been happening here." I said, "Look, you haven't even worn these an hour a day." He said, "How do you know that?" I counseled him, and he agreed that he was going to give it a try. Three days later, I get this emergency phone call from the same patient. He says, "Dr. Kasewurm, I need to talk to you about what I did last night. Well, I went to the casino with some guys and was able to hear!" Invite patients to see what goes on and make them know that what you're providing as a hearing healthcare professional is not the same type of care and service they can receive on the internet. If you have a video otoscope, let them see their eardrums. The virtual impression often speaks for itself, so include your patient's in the virtual experience. If your state laws allow for telehealth practice, consider integrating this into your practice portfolio. 

Offer loyalty programs. If someone is upgrading to new hearing aid technology with you, consider giving them an extra year warranty or discount. Simply let them know it is a big deal that they have stayed with you because people do have a choice. We did a focus group with patient referral programs and discovered that patients do not need you to send a gift or anything special. We made donations for a while to the Starkey Foundation every time a patient was referred. We made donations in their honor. Think outside of the box on how to connect with new and current patients. That's how you survive in these disruptive times, connecting with your patients so that they will never leave. We give the top 20% of our patients that have been the most loyal my cell phone number. I say to the patient, "If you're having any trouble, you text me." It has never been abused. Service is everything. Good isn't good enough when it comes to service. Make sure your patients are telling everyone they know about you. If they're unhappy, you can bet they are, right? Make sure they're happy and that they're telling everyone. Promote your online reviews as well. This is a great way to show the quality of your practice to potential new patients.

Send thank you cards. As a provider, you notice when a patient does not show up. If a patient misses their six-month visit, call them up and let them know you took notice. I know colleagues that do not book six-month follow-up appointments. This is because they are the sole provider of the practice and do not have the bandwidth to see as many patients. Audiologist assistants can perform hearing aid cleanings and checks in between programming appointments. Of course, that's specific to your state licensure laws. 

Newsletters. This content can be in the form of a physical or electronic mailer. If you're not telling your patients about new technology, guess what, everybody else is. Along with your newsletters provide offers to your patients. It's all about the service. 

Patient Feedback

At our practice when patients have worn their hearing aids for six months, we send them an opportunity to provide feedback about their experience and our customer service. We ask our patients to go online and give a review because that's how the majority of patients decide who to see when looking for a provider. When it comes to health care providers, I do the same. I look for a provider and see what people say about them. Take steps to make that a positive discussion with your patients. You cannot make every patient happy, but you can do your best with each patient.

Advisory board. I try to hold a board meeting at least twice a year. I select between 10-12 patients from various backgrounds and invite them to lunch. We have an agenda which asks probing questions: 

• I want to know what you think about this business.
• How's our service?
• Are you happy with how you're hearing?
• How are you treated?
• Is the voice that answers the phone friendly?
• Are you put on hold too much?
• What are your friends saying about us?
• What are they saying about our marketing?
• Have you seen it everywhere? 

Large corporations pay their advisory board. You do not have to do that. Simply invite patients to lunch and ask what they think. Be sure to have an agenda. Make sure the meeting is no more than 90 minutes long and send them a thank you for their time. It won't always be positive. For example, I was planning to move to a new location and was ready to sign on the dotted line for a piece of property which I thought was fabulous. A person on my advisory board said, "What do you think of this location?" I said, "I think it's great." He disagreed and thought the location was terrible. He said to me, "It's too hard to get in and out of, and it's by the oncology center. What do you have to do with being sick?" They saved me from a huge mistake. If you ask your patients what they think and they're very likely to tell you.

Focus groups. If you attend a meeting or manufacturer training and learn about new technology consider forming a focus group. Call your patients who have worn hearing aid technology for at least three or four years and invite them to test-drive this technology. Phrase it as a focus group instead of a hearing aid trial. People appreciate that and they will feel special. When they feel special, what are they going to do? They're going to tell their friends and relatives and other people about it.

Satisfaction surveys. Surveys are sent out to our patients five months after being fitted with new technology. If somebody says they're dissatisfied with something, you can bet we're on the phone asking patients why. We're scheduling them to come back in, and we let them know that their satisfaction is paramount and a considerable part of our success as a business. If you would like a copy of our satisfaction survey, please reach out to me, and I would be happy to provide you with one. We also have a separate survey for TNS patients. Get their opinion, and then take those answers to heart and use them to make your business better. Sometimes you need help. Sometimes you can't do it all, and that's where the audiology or hearing healthcare assistants come into play.

Clinic Staff and Support Personnel

Audiology assistants. Assistants are an integral part of my practice and contribute very much to patient satisfaction and profitability. Before pursuing an audiology assistant, check your state licensure laws and regulations. We get a ton of visits in our office every day and most of the visits are handled by audiology assistants. Audiology assistants can be a valuable resource in a practice because they can improve your service, increase productivity, and reduce the time you're spending on paperwork so you can really focus on solving problems and generating revenue. 

Hearing instrument specialists. In one out of five offices, a hearing instrument specialist and audiologist work hand-in-hand together. It's a great way to do business today, so make sure that you're concentrating on patient satisfaction, solving problems, and focusing on helping patients. There have been cheap hearing aids available everywhere for a long period of time. This is not something new in our profession. I'm not intimidated by it and we can all work together. There are still people that want help in the form of a professional.

Support staff. A great staff leads to a strong foundation for quality care. Ensure your staff is friendly and well-informed. Whoever is answering your phone needs to know about technology. They need to know why your practice is special and why people should come here. When someone walks in and is dissatisfied, they must be able to solve that problem. Empower your staff to solve problems, empower them to fit in a patient that comes on the wrong day if you have an opening in your schedule. Empower them to help you and don't make them come to you and ask for every little thing. 

Conclusion

I am pushing to improve and looking at new ways to reach our patients by focusing on the patient experience. The advantage that an independent audiology practice has is focusing on best practices, the experience, and individualized customer service. Solutions don't come in the form of just a device. It takes a professional with a caring approach, listening skills, assistive devices, and problem-solving with the patient when the first idea does not work. Think of your services as the whole package and not just a device to help people hear in a noisy world. 

Price is what you pay; value is what you get. If we're adding value to every patient encounter, we will not have to worry about the future. We will know that our patients will stick by us. By tracking your business activity and improving the patient experience, you will be able to bring quality to your practice. The difference in surviving and thriving in business is tracking those key indicators of the business and making sure we're staying on top of where the business is going. Like you, I still love and believe in what I do. I believe in better hearing, and I know if I apply what we have discussed in today's course my business will thrive and so will yours.