Make 2020 the Best Ever!

Those of us that work in eye care owe it to ourselves to make this the best year ever.  It is 2020!  

New Year’s Day is always a great opportunity to hit the “reset button” and reevaluate how things are going and what adjustments need to be made to reach your goals. I encourage you to find some time to reflect on your life to make 2020 an amazing year.

Studies show that most New Year’s Resolutions fail before Groundhog’s Day but this year, I want you to make it count.  Leadership OD has developed the D.E.C.I.D.E. Method to set meaningful goals that can have a significant impact. (This is not the easy way)

In 2020 - Make it real.
Every year, I try to make one big professional and one big personal goal.  These goals always require sub-goals and tasks and coordination of a team. They will take time but I commit to putting some energy toward them every day.

Feel free to use the D.E.C.I.D.E. Method (and to adapt it) and let me know what it inspires you to do in 2020.

Happy New Year, 

Mike

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Decisive. Determined. Diligent. - The 3 D's

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I became an optometrist because I was captivated when my grandfather told me that the most rewarding thing was “putting on a child’s first pair of glasses and watching their face light up as they see things that they’ve never seen before.”

I have seen that look on a kid’s face and must say that it is pretty cool, but there is another look that is more rewarding to me. It is the look on a person’s face when they first decide that they are going to succeed.

It's a wide-eyed look, with eyes darting around, often surrounded by flip-chart sheets and a sort of "half-smile." They always nod their head a little too. Often they will say, "Yeah, I can do this."

It comes when there is a realization of personal confidence that you have what it takes AND you are willing to do the necessary work. It is a beautiful thing to watch unfold as their face lights up seeing things that haven't happened yet.

Determination comes when things go wrong. Early on, it is easy to give up when things don’t go as planned. I have never been involved with a project where everything happened like it was supposed to happen. Those who are determined to press on regardless of barriers always seem to find a way to win.

And “diligence” is simply “prolonged determination.” We are all subject to burnout and its toxic effects. It is becoming more and more common for high achievers to give up current successes for the thrill of seeking newer ones. Those who are considered “masters” in their field are the ones who continue to hone their craft beyond compare.

At the 2020 Executive Retreat, we will focus on the 3 D’s and how we can all hone our craft at reaching our individual versions of success. It is Jan 9-11 in Atlanta. AGENDA

Keynote speaker, Melissa Hill will teach us all about working through the “Toughness Decision.” She will share her method to overcome her personal struggles and how those lessons can guide us through tough decisions that we need to make.

The webinar message broadcast LIVE from Executive Retreat will feature Dr. Mark Kapperman who will share what rewards diligence can bring in building, developing and leading a team of eye care professionals.

Registration will close next week, so if you are thinking about coming, please REGISTER NOW.

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Practice Management begins in the Exam Room

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To effectively run an eye care practice, many active processes, run by a variety of people have to be coordinated and constantly honed.  It is important to avoid duplication and contradiction in the process.  From Scheduling to Check-in, from Pre-Testing to Exam Room; from Contact Lenses to Optical and to Check-out.  It all has to work together.
Not to mention all the work to be done after the patient leaves to order product and to get paid.  

Where do you start?
Most practices have a set of processes that “evolve” over time.  As times change and as our practices grow, we make changes to our processes.  Sometimes a new employee comes along who “does it a little differently.” Inevitably, these small changes lead to problems in other zones because it is all connected.  In reaction, adjustments are made or breakdowns occur.  

Decrease Variation (starting in the exam room)
There are a multitude of vision tests that can be done to help us with our diagnosis and treatment plan for any given patient.  Some of these tests are typically performed by doctors, others can be delegated to staff members. All variations in technique decrease your efficiency in the exam room method.  

Some examples of exam technique variation are: 

  • Stereo testing on all patients under 17

  • Applanation tonometry if over 50

  • Pinhole if VA less than 20/60

  • Color Vision on all boys - new patients - under 10(*)

All rules of variation are put in for good, logical reasons.  The problem is that we keep adding variations without fully considering the impact on the entire exam flow.  This leads to inconsistencies and discombobulation that spills into every aspect of the practice.

There is a good argument for not performing stereo on an 84 year old, one-eyed, exotrope, (**) but I would like for you to consider the benefits of keeping the test in the routine for the sake of decreased variation.  This is an excellent exercise that should be completed by the entire team periodically to continuously refine the exam process.  

Consider your scheduling methods.  How much time is spent trying to match a particular type of patient with the corresponding slot in the schedule?  Do you instruct your team to schedule “older patients” earlier in the day because they take longer? (“Besides, they like to get up early.”)  

Consider pre-testing technique.  We all recognize that kids, contact lens wearers, glaucoma suspects, presbyopes, cataract survivors and esophores all have different needs.  But many of our patients fit into multiple categories…..then what? Sometimes more time is spent trying to decide if you need to do topography, then just doing topography.  

Consider exam room technique.  The advent of EHR has made the idea of an exam room scribe become the norm.  By always doing the same tests, in the same order makes it easier and quicker for your in-room support.  Not to mention - more accurate. Develop a system so everyone knows what everyone else is going to do.  

This is just the beginning.  
You can see where the decreased variation helps the exam flow better.  You can also see how it bleeds into other areas of the practice. After the Patient Care zone is addressed to your satisfaction - move to the Front of the House.  

(*Three variations in one)
(**I recognize that you can’t be “one-eyed” (aka monocular) AND an “exotrope” - but sometimes you just have to write things that make your point. Just imagine her prosthetic is misaligned.)

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I am afraid.

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"I’m afraid!  Alright? You want to hear me say it?  You want to break me down? Alright, I’m afraid!  For the first time in my life, I’m afraid.”

-Rocky Balboa on preparing to fight Clubber Lang, Rocky III

Fear is a powerful motivator.  Fear is used to sell us almost everything.  Watching tv commercials or flipping through magazine advertisements shows that a growing number of products are using fear to justify our need for their products.  Safety, health, financial security! Fear sells.  

But fear also paralyzes.  Being afraid is the most common reason that we don’t chase any given dream.  It keeps us from initiating conversations, beginning new ventures, or doing something to get out of our current situation.  

What do you want to do that you aren’t doing because you are afraid?  

So many OD’s want to add a specialty to their practice or invest in a new location, but don’t because of the fear that it won’t work out.  Others are being drained by an unfulfilling job and dream of doing something innovative and new, but can’t muster up the courage to leave the safety net of a steady paycheck.  

I have guided many practices through an expansion or start-up projects and have never seen anyone who was disappointed, even when it was a clear mistake. 

However, I have met a bunch who regretted never taking the chance.

I think that the first step to overcoming your fear is to admit to yourself, then to someone else, that it is holding you back.  It worked for Rocky, it works for us too. 

Want to share?
 I would love to hear what’s holding you back.  

I hope you and your family have a Happy Memorial Day weekend.

Truly, 
Mike

p.s. "You gotta get that look back, Rock.  Eye of the Tiger.  Come on, let's go." - Apollo

Telehealth Update

I recently returned from the annual meeting of the American Telemedicine Association in New Orleans.  This is the 25th anniversary of this organization and they are on the move.

Telemedicine (or telehealth) is defined as the distribution of health-related services and information via telecommunication.  My first memory of practicing telehealth was when my son texted a photo of his friend’s eye from the middle school cafeteria which he described as "funky."

The mission of telehealth is to expand the reach of care to the people who need it.  The biggest market seems to be healthcare systems with small hospitals who need access to specialty care.  The focus of this group tends to be shifting from technological advancements to improving the patient-provider interaction and the quality of that experience.  

Every specialty I could think of was represented and eye care was a very small part of it.  It was standing room only at the Medicare session because the rules about payments for telehealth services are being defined and updated.  Interestingly, the speaker for this session remoted in.  

In eye care, the most “mature” telehealth program seems to revolve around the use of retinal photos to monitor for diabetic retinopathy.  Fueled by affordable retinal cameras and the drive for improved HEDIS scores, many companies exist to match diabetic patient photos with a reader of those images.  Look for robots that can read fundus camera images.

What I also came to realize is that diabetic retinopathy is very well defined and commonly understood by a wide range of professionals. Plus the growth of diabetes ensures a long line of patients needing on-going care.  

However, there is still a good deal of disagreement about how much of an eye exam can be provided by distance providers.  The technology continues to improve and patients’ desire for this type of interaction is becoming stronger. I am confident that there is a way to deliver high quality eye care that is safe and effective for our patients.  

Stay tuned - this is going to be exciting!

I will keep you posted, 
Mike

Accommodative Spasm Survey

My wife was recently approached by one of the trainers at our local health club, “Why didn’t you tell me that your husband was an eye doctor?”  

I’d like to think that her answer was, “I just don’t like to brag too much about that.”

The young woman went on to explain that she had just been to a local optometrist and didn’t know what to do.  She continued by saying that she had been having trouble driving and thought she needed glasses to help with that.  In addition to working at the gym, she is a full-time college student and admits to being on her phone “all the time.”

She said, “He told me that my problem was not distance vision, but that I used my phone too much and he gave me glasses to wear when looking at my phone or working on my computer.  But the glasses MAKE MY VISION WORSE.”

She went on to ask my wife - in the gym, “What should I do?”

Discussion:
While this story is third hand, I have heard it enough over the years to discern what I think is going on.  The trainer is experiencing accommodative spasms (aka computer vision syndrome, digital eye strain, etc.) Basically, the examining optometrist diagnosed that she does so much near work that her eyes can’t always focus in the distance very well.  

She would have “liked” some glasses that correct her distance vision when driving during these spasms, but the optometrist felt it best to relieve this near strain as a long term solution.  My guess is that the glasses have some low plus power.

This dilemma has several components: clinical, marketing and professional relations.  

Please complete this short (three question) survey to let me know the best way to handle this situation.

Thanks for helping,

Mike

p.s. To see the results of the survey, CLICK HERE.

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Will you just shut up?

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I like to talk.  

Sometimes I find myself talking about things that nobody cares about but me.  It is not unusual for me to be in the middle of a riveting explanation only to realize that friendly face is looking back at me with a completely blank stare.

I am not the only one.

Most optometrists talk too much.  We do this out of a desire to better serve our patients in three different ways:

  1. We want them to know everything they “need” to know about their condition.  

  2. We want them to know all of the options that can treat this condition.  

  3. Most of all, we want them know how smart we are.  

What do our patients need to know?  

I heard a leadership consultant recently present on being more effective in meetings.  My favorite point that he made was to “tell them what they need to know - not everything that you know.”  The reason most meetings are unbearable is that we give our report then why we are reporting and how we know the information that is in the report.

Similarly, there is an art to educating your patients without over-educating them.  I recommend practicing this art by limiting what you tell them to what they need to know. Then asking if they have questions.  

If your patients never have questions, you are over-educating.

Which choice do they “like” best?

Almost every condition comes with treatment options.  It is a slippery slope when you start offering your patients all of the available choices to remedy their condition.  From vision correction to prescription medications to therapy solutions - it is our job to offer what we derive as a single, best option for this person.

Without getting wrapped up in the difference between “recommending” and “prescribing,” become diligent in offering one best solution for each patient’s unique situation.  To make strong choices for your patients, you need to use the clinical findings AND what you know about the patient as a person.

And to know who the patient, you have to LISTEN.

Like us, most patients like talking about themselves.  

They don’t like answering a bunch of health questions about every condition ever known, but they do like talking about their lives.  They like talking about hobbies, kids, work and sports. Getting a patient to talk about what they love is both easy and gives you a lot of information about how they use their eyes.  (It also makes them like you.)

Ask open ended questions about how they spend their day.  When they answer, say “Wow, that sounds really neat.”  And ask another question.  If you will listen instead of thinking about your next question, you will be better able to make strong recommendations before you know it.  

Patients know you’re smart, they just want to know you care.   You can show them you care by showing that you hear them.

Let us hear from you: How do you make sure your patients know that you are listening to them?  


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A Lifetime of Watching Movies and the lessons from it........

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I grew up in a small Southern town that had one movie theater.  Almost every Friday, a new movie came out.  As a teenager, our theater was upgrade to a “Cinema,” which meant we had 4 screens, all playing different movies.
 
Then came HBO and VCR’s.  My dad loved that one monthly fee allowed him to collect hundreds of movie titles on VHS tape, with no commercials!  It was a little work, but well worth it to have easy access to all the movies HBO ever showed.  (Those tapes were the main part of my inheritance.)
 
We all know about the well-chronicled rise and fall of Blockbuster video/DVD rental business.  We know how Netflix came along began mailing DVD’s, then streaming movies directly into the home. 
 
Your age dramatically influenced your relationship with Blockbuster Videos.  For me, it was a weekend ritual.  I remember many Friday nights roaming around the store looking for something to grab me.  Two for the kids, two for the whole family and a scary one for daddy after everyone went to bed. 
 
We lived through the transition from VHS to DVD and tried to see the added benefits of BlueRay.  It was during this time of Blockbuster domination, that many of us were investing in home theater systems.  Big screens, big sounds and for some – big, fancy chairs! 

Netflix introduced me to downloading movies and to the frustration of “buffering.”  I always took it personally when my family blamed me for the random pauses in a movie while it buffered.  As much as we hated pauses, grainy pictures and other troubles; we stopped our visits to Blockbuster. 
 
This trend continued so much that now my kids rarely even look at a tv, but instead watch their phones and laptops constantly.   As I am sure you can imagine, this bothers me.  They seem to be satisfied watching their choice of movie on whatever screen they are holding.

Saved by The Incredibles! 

Pixar’s movie, The Incredibles came out in 2004 and was a big hit in our house.  My kids were in elementary school, we saw it in the theater and of course, bought the DVD.  My son was even Dash for Halloween, twice.   
 
By the time that The Incredibles 2 came out in 2018, both of my kids are in college and wanted to relive the glory days by going to see it on the big screen.  To gear up for the event, we dug through our library, and found the DVD.  We realized the DVD player still worked and decided we would watch it.  Amazingly, the sound system was still connected to the DVD player so we went old school and LOVED it! 
 
Great picture, crisp sound and the room even shook!  I was blown away at how good it was.  How did we give up on this? 

It is another example of "easy beating good."


 In our practices, we sometimes convince ourselves that our patients are willing to deal with a little inconvenience since the quality of our care is so good.  It is important that we are careful with this line of thinking. 

In my experience, most practices have a problem with wait times.  What’s worse is that most practices don’t think it’s a problem or they say it out of their control.  My advice is to find a way to measure how long patients are in your practice and keep working to improve it. 

Keep watching this blog for more conversations about making visits to your practice "easier" for your patients.  
 
I was not invited to go to the Cinema to see The Incredibles 2, but the kids said it was good.  I couldn’t get much out of them about the details, but there was something about JackJack that you didn’t make sense unless you had seen the DVD – which they had!
 
(Did you know Netflix still will mail you a DVD?)

Look forward to seeing you soon, 
Mike Rothschild, Leadership OD

p.s. This is an interesting article about a Michigan mom arguing for a return to the "good old days."

The Season of Candy Corn (Re-Visited)

Four years ago (to the day) we published a blog called The Season of Candy Corn. It discussed the "seasons" of an eye care practice and how to manage the ebbs and flows that naturally affect our practices.


Seasons of a year have a certain rhythm that affects our annual routines.  Those rhythms evolve with time. 

But what about the seasons of a career in the profession?  Seasons of a lifetime?

I am happy to announce the revival of Leadership OD!
 

Many things will be familiar to the Leadership OD that you remember.  We will continue the tradition of the Executive Retreat every January and you will be seeing regular blogposts again.  We will continue to focus on creating a vision that you can achieve for your practice that fits your unique values and dreams.  

But now, Leadership OD's primary focus will be primarily on developing the next generation of leaders in the eye care industry.  

The face of eye care is changing, as is the face of leadership.  Vertical integration is the norm and the technology natives rule.  

The Leadership OD website has not been updated in a while, but it has been there this whole time.  Watch for new content, new initiatives, new directives and a new purpose.

I know it has been a while since we talked, but I would love to get an update from you.  Let me know what you've been up to and how Leadership OD can be there for you.

Truly yours, 
Mike Rothschild, Leadership OD

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It Ain't Got No Compression!

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I enjoy cutting my grass. 

As a student in optometry school, I was able to help pay the bills by cutting grass for a few local Memphis families.  I have always said that if this optometry thing doesn’t work out, I can always open a lawn care company. 

But as a busy professional, I was forced to give up the weekly summer task and I hired someone to care for my lawn.  I am fairly particular about my lawn, so I have had several individuals help with my lawn.  Coincidentally, my son, Samuel became a teenager at a time that a lawn care change was needed and we decided it was time for him to learn.  He was happy to learn that I would be working beside him to assure he is not missing any steps. 

 Rothschild and Son Lawn Care has functioned for a few years without too many dilemmas until the blower stopped working recently.  It’s a nice blower.  Samuel and I compared the various solutions of repairing the blower or buying a new one.  We decided that getting it repaired was the best option. 

I tried to fix it myself but failed to even get the plastic cover off of the unit.  I called the manufacturer and was disappointed in the advice they gave me.  I Googled small engine repair but these companies don’t worry as much as we do about their social media presence.  I finally “asked around” and was able to find someone with a great local reputation who could “fix anything.”

I enter the repair shop to find all types of shiny new lawn care equipment on display.  I also see a section of refurbished equipment available too.  I am carrying a big backpack blower but don’t know where I should go.  Finally, across the showroom, I see a desk with two men, chewing something and looking at me. I cautiously decide to approach them. 

As I walk up to the desk, their expression never changes, nor the pace at which they chew whatever it is that is in their mouths.  Are they eating breakfast?  Is that gum?  I smile and ask the gentlemen how they are doing.  The small one replies, “Alright.  What can we do for you?”

I explain my dilemma and he startled me by sternly asking, “Well, are you going to let me see it?”  Suddenly I realized that I will not be experiencing a high level of customer service. 

I smile nervously and say, “Sure, help yourself.” 

He takes my blower away, leaving me to fumble around while the big one continues to watch me and chew.  I ask him if I should just wait.  He shrugs his shoulders.  I wonder over to the blowers to see how much a new one costs.  I become an expert at blowers and continue to look around.  This is taking longer than it should and I am getting a little more tense.

I see the repairman return with my blower to announce, “It ain’t got no compression,” then he stares at me.  Obviously it is time for me to respond with some course of action.  He is looking at me, waiting – what do I say? 

Finally I reply, “I don’t know what that means.” 

He said, “9 times out of 10 that means somebody ran pure gas through it and 9 times out of 10 the carburetor has gone bad but it could also be bad coils.”  I still don’t comprehend what he is saying so I continue to look at him.  Then finally he asks, “Do you want to buy a new one?”

I ask, “Is that my only choice?”

He replies to me with a tone that shows I have irritated him with my stupid question, “I mean, I guess I could charge you $30 to see exactly what’s wrong but 9 times out of 10 a new carburetor is almost as much as a new blower and it will take me about a week to know anything.” 

I have a rule to not make a financial decision when I am excited, angry or drinking and this guy made me angry.  I asked him if I could think about it.  His disgusted departure away from my blower suggested that he was fine with my decision to leave. 

So I thought about it.  I calculated the time I had invested in the repair, the various places I could buy blowers, the business lesson for my son and calmly made a decision.  But this made me think about how easy it is for us to operate our practices like this “repair” shop.

We work there every day and know how things are supposed to operate, but is it clear for someone coming in the first time?  Are we ready to receive people when they enter the doors to our practice?  Do we ask them what they need, when we already know?  What about our beautiful frame boards that we make people pass to check in? 

I also began to think about how we communicate the testing we do to our patients.  We do a lot of very complicated, technical work that can be tough to understand.  We just don’t have time to explain it completely to everyone, so we tend to stop trying.  Is our process making our patients feel safe during their time with us?

Sometimes we express concern and explain it to the patient by gravely saying, "Your pressure is a little high today and the visual field may have changed some."  Not everybody knows why that matters.  Most people don't know the difference between progressives and transitions yet we talk to them like they should.  

And what about your recommendations?  Are you making it clear what you think your patients’ need or are you leaving it up to them to make uneducated decisions? 

Periodically, we have to take a look at the path through our practice through the eyes of our patients.  Many like to use “secret shoppers” but I prefer to just talk it out with the entire team.  Compare how you want it to be with how it really is and fix what you can.  The path begins with communications with the practice prior to their visit and continues until all of their eye care needs are completely met. 

If you look away from your customer service strategies too long, you will be more like the small engine repair shop than you care to admit. 

Truly yours,
Mike

p.s. To see an example of what I consider to be acceptable service in small engine repair,Watch This.

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Don't Get Bullied

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Are they trying to bully you too?

When mail comes from an insurance company, I expect it will be a check and checks make me happy.  But when it is something else, it always seems to be something that makes me unhappy.  I have found that “news” from a third party payer is rarely good. 

In the recent months, some insurance companies have been sharing some news with me that I, at first, thought was good.  They let me know that compared to “other physicians within my specialty,” I bill at a higher level.  This is good to know.  I feel like we deliver high quality care and accept a lot of complex cases.  We are diligent, we work hard and here’s proof that we do it better than others.

But the letter was not to congratulate me on my diligent care, it was to threaten me.  The letter went on to say that they are going to keep watching and if I don’t fall in line with everyone else, they might be forced to investigate.  They then said that this investigation would be disruptive to my business and if they catch me doing wrong, I would be in big trouble. 

We work hard to make sure that we are billing appropriately.  We take classes, read updates, and use software within our EHR to ensure that our coding is correctly done.  We don’t do unnecessary tests, we incorporate testing protocols and we do what is right for the patient, every time.  We utilizeRevAssure, which audits a sampling of our records every month and incorporate changes based on feedback from our specialist. 

So, here is the journey through my reaction to this bullying letter:

  1. Pride – “Thanks insurance company for acknowledging our excellent work.”

  2. Disappointment – “Hey, you’re not being cool about this.”

  3. Fear – “I don’t want my business disrupted or to be punished”

  4. Doubt – “Maybe we should start billing with lower codes?”

  5. Awakening – “Hey, wait a minute, they are just trying to scare me, and it worked.”

  6. Anger – “I am from the South and I will whip your ass, bully insurance company.”

  7. Realization – “This is just an intentional, controlled tactic to reduce their expenses.”

  8. Defiance – “They are not going to scare me into breaking the rules for their benefit.”

  9. Self – Confidence – “We work hard to do it the right way and we do it well.”

  10. Dedication – “Let’s use this as an opportunity to stress to the team the importance of billing.”

  11. Commitment – “We will stay focused on doing it well with the partners we have in place.”

  12. Welcoming – “Come sip some sweet tea while you investigate all you want. Sorry about #6.”

Here is the lesson: Don’t back down just because a bully comes knocking. Do be ready to stand up to him by making sure you can back up your billing with solid documentation.  Bullies are less scary when you are ready to stand up to them - just be ready.

Keep up the good work, 
Mike

p.s. I am sure that I am not the only one receiving these letters. Share your story here.

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Debra Turco - Metrics Webinar

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"What gets measured, gets done."  

Peter Drucker is often credited with this old business acumen, but my research is far less clear about who said it first.  Another variation of this wisdom is "If it can be measured, it can be managed." 

The point is that for a long time, we have known that consistent measurement of our business performance is critical to making it better.  If we want our practices to be more profitable, we must begin by measuring our profitability.  

One problem: For many of us, it is harder than it sounds.  We know we need to do this, we just aren't sure where to start.  While there are countless services that promise to make it easier for us, the fact is we usually just need a little help getting started.  

In this Featured Presentation, we have Debra Turco, who is the Office Operations Manager for a large, multi-doctor practice in Toronto.  Her practice is a member of Leadership OD and her input in our our small group discussions has been invaluable.  We were thrilled when she agreed to teach us how to really use metrics in managing practice performance.

In this presentation, Debra explains the importance and value of using metrics in the management of the practice.  In simple to understand details, she explains what information matters and how to get it.  Then she describes what to do with the information to make an actual difference in the practice.  

Please enjoy, 
Mike

p.s. If you want to see the oldest quote I could find about measuring your work,
-CLICK HERE-

 

Featured Presentation: 
Using Metrics to Grow Your Practice

Non-members may register for most online events for a small fee.
LOD Member? Watch Here