and when patients kind of have to that they like, um, you know, my optician will say, oh my gosh, doctor Stewart has met and they'll say, how many do you have? I said, do you want to see them? Do you want to see my personal collection? And I have a case in here with all of them. And I show them, I'll put on, you know, two different looks and say, I look like a completely different person, right? They're going, yes. I said, that's the benefit of I wear. You don't have to be stuck with the same look for 365 days. I don't have the same look for 365 minutes, right? I've changed my glasses four times. I put in contacts for this and then I'll pop them back out and then see who my one o'clock is and put the appropriate glasses on there. So, yeah, I mean, this is what I was wearing. This is what I was wearing before podcast. Hello and welcome to personal podcast on iCode Media. Today, I had a great conversation with Dr. Jennifer Stewart. She has inspired me in a number of ways from our optical standpoint. But also, I just love her passion surrounding the things that she does. And I love talking to people who have a real passion and a purpose for the things they do. So, please enjoy our conversation. As always, be sure to subscribe to the podcast, write a review, share it with your friends and support those who support us. The most common questions I get include what ophthalmological codes or evaluation and management codes should I use? What ICD 10 codes do I need to build with this CPT code? What CPT codes can be built together and what can't? And my favorite, how do I manage a patient who has diabetes who comes in for a quote unquote routine eye exam? These questions really highlight the confusion and uncertainty that serves as a daunting hurdle for providers makes it more challenging for them to care for their patients and provide those patients with the best opportunity for a lifetime of ocular health and clear vision. That's why we built iCODE Education for this specific purpose. Our mission is to provide optometrists with resources to help you understand disease states, revenue cycles, and billing and coding so that you can put that on autopilot and truly care for your patients. Check out iCODEeducation.com that's E-Y-E-C-O-D-E education.com. We've developed a premier billing and coding bundle that includes all of our billing and coding resources in one place. We also have a 10 discount code just for listeners of this podcast. Enter the coupon code E-Y-E-C-O-D-E-M-E-D-I-A 22 at checkout. We'd love to work with you. Check out iCODEeducation.com. Hello dedicated optometrists. 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Contact your local macuhealth representative for more details. Vision Edge Pro, because your patients deserve the best in iHealth. Go to macuhealth.com and use the coupon code podcast2024 at checkout for special discounts. Well, so the last time we talked, you were just about ready to open your new practice, I think. As we remember, if I was open or not, I couldn't remember. Yeah, you might have been. Yeah, we're like barely open. Yeah. Well, tell me about how the first year's gone then. To me, so it'll be year and February. So we're pretty close. So this is our 10th month, I guess. Yeah, 10th. We're just about to finish our month 10. So it's awesome. Yeah. What has, can you talk about a little bit about like what kind of goals, you know, from a cold start, we're sort of even like a warm start. What kind of goals did you set and how did you track those goals for like the first quarter that you were in business, the second quarter, like, because it's always different. Yeah, tell me about that. So I had no idea what to expect coming from, you know, being in a large practice and buying that as an established practice and then growing that. So I had no idea what to expect. So I had the, you know, the goals that we had set from our business plan is kind of a roadmap of, you know, this is what we think we'll do. I was curious to see how it would go. Being a, yes, cold slash very warm start and having a lot of patience in the area and being here for 15 years, I was curious what we would do. And, you know, my goal, my goal is to see as few patients as possible and generate as much revenue as possible in those few patients and figure out how to do that and not, I never want to see a lot of patients. I don't want to have, you know, I had a busy practice. I had a Ford after practice. I'm good on that. Don't need to do that again. So I want to really maximize our per patient revenue. And that's mostly the revenue. That's probably the number one metric that I'm tracking. So then, like in your mind, just so I can kind of align with what your idea of busy practice is, you know, do you have a number in your mind of how many patients you want to see a day or an hour? I see one an hour and I'm happy. So I would love to stay there. I, you know, I see between four and seven patients a day. Today I have seven and I'm booked out all next week with seven. You know, I'll probably creep that up to 10, but that would probably be where I want to be maximized at. So no more than, you know, I've seen, you know, I could do two an hour. I don't know that I want to or need to. So I want to, I love, I love my schedule right now. And if I could keep this up, I'd be very happy. Do you find that, so like in that hour time period, do you find, like tell me about what that flow looks like from a, from a staff perspective and then from a Dr. Stewart perspective, like what are you doing during that hour of time? So I don't always spend an hour with the patients because some of my friends were like, oh my gosh, do you sit there for an hour? No, you know, I read the room. So some patients want to be in and out. Like we just had somebody call to get in this afternoon. I was able to squeeze him and he said, how quickly can I be out of here? So I know I'm not going to sit there and, you know, spend an hour with him. He really just wants to be in and out, but I spent an hour with one of my patients this morning who had never had an eye exam. So from a staffing perspective, I have two staff right now looking to hire a third. I have my office manager who does everything. And right now she's pre-testing patients for me, although I usually jump in and pre-test if I need to. And then I have an optician. So the optical is super busy. So we're looking to hire a second optician. So from a patient flow standpoint, we don't have a front desk. So I don't have a front desk person. The patients are greeted as soon as they walk in by my optician or my office manager, brought back immediately, started pre-testing is done, and then either my office manager or I does their history. And then we do the exam and then they go out to the optical and that's that's really where the bulk of the time is. So my goal is not to spend an hour with the patient, but to be as thorough as possible and still make sure there's enough time for them to spend the optical. I love the idea of taking the patient immediately when they walk in. And I also love the idea of many people being able to do that in the office. That's something that we haven't mastered in my practice yet. It's really a goal that we had a couple years ago. And honestly, we have not been able to achieve it. And I think part of it is because the complexities of kind of diving deep into a lot of different chronic conditions in our practice prohibit us from like basically having the same person with the patient the whole way along. Like my vision would be in a perfect world. Every single person could do every single thing in practice. And so, you know, even if I were seeing twice like seeing 20 patients a day, which by the way, I don't want to see 20 patients a day, I will on a busy day. But for me, you know, my perfect day would be about 16 patients. So it's not, it's not like, you know, when we're talking about how many, like what a busy day looks like, you and I are probably more closely aligned than some people think. I don't want to see 40 patients a day and I don't want to see 30 patients a day. So the, so I think I bring that up to say that like where we've struggled is, you know, if you've, there's so much nuance in a lot of the high level testing that can be done in a comprehensive practice that if, and also like the nuances of selling glasses and taking managed vision care, taking medical care, or taking medical insurance, like that's complicated. And so we've done some things to try to simplify that. But I love the idea of keeping those patients with a very similar person the whole time. Does that always work out? I mean, I know you said you have an optician, but would the goal for you then be to have an optician actually bring that patient back and travel with them? Because in that case, each optician, if you've got to essentially has five patients a day that they have to manage. So we do both. So it depends on the flow. And I also am the third optician. I am equally out there helping people pick out glasses, which patients actually really like. And I love, I love, love, love that part. So I, you know, each one of us can do everything in the office. You know, I do a little less on the optical side and the pretest side, but we will do both. I think it's a little easier for me because I started that way with no front desk. And I think about my old practice, if I were to walk in there and say, we're going to eliminate the front desk today, that's just a big hurdle. It's not insurmountable, but definitely more work. But the benefit of cold starting has been I get to do things over and start fresh on the way I want to do them. And it was a little bit challenging for me. It was my husband's idea. We were developing and designing a front desk. And he said, do we actually need this? I go, of course, you need a front desk, silly question. He said, but why? You know, we don't, we don't have, we only take two managed vision care plans. We don't take medical insurance. We're at a network for everything else. So people don't have cards. We did not plan to have phones up front anyway. We do everything by weave. So all the phones live in the back of the office. And we don't have paperwork. So he said, what exactly does a front desk do? Just sit there and smile and check somebody in. It made me very uncomfortable, but it made me think. So we decided to try it. And we built a backup plan. We wired everything in that front area for a front desk. So there's wiring in those ceiling in case I wanted to put a pendant light. All the wiring is in the wall for a desk with a computer. So my my contractor said, let's, let's just plan for worst case that it doesn't work. It's easier to do that now while we've got open walls. So we had it wired, but a year in patients actually love it. They, they remark that they love just being brought right back and not having to check in and the awkwardness of, you know, waiting while somebody's on the phone. But it took a, you know, we had staff training about it. It was easier here for sure because we started that way. But all of us greet patients, we have a doorbell. So it rings in the back and in the, in the lab. So we know as soon as somebody walks in. And, you know, it's kind of a race for everyone to get up there and, and greet the patient. I love, again, I love the idea of eliminating a front desk. And for me, it's like the perfect time to consider. So we just got, I just got my bid back for my tenant improvement. So I, I'm building a new building. We talked about that last year. And it's actually this, the building is structurally coming together. And, and so I just got from the builder, for my specific space within that building, back some of the bids for it. And as I'm thinking about this, now would be the time to do exactly as you've done is like, if I don't want a front desk, maybe we just leave it off. And I bet it would save, I bet it would save a lot of money actually. I mean, that was my husband appeals to my frugal nature, as we were designing the front desk, you know, there's a cost to design a custom desk and, and, and all within the person that goes with it. And we were, we were in that process. And we actually had our designer was working with a team and we were like, let's just hold off on that. So a lowered my business loan quite a bit. And we haven't blinked. There's not been one moment where I thought, Oh, I wish I had a front desk, we have a seating area. So we, if somebody walks in and we're busy, we just say, you know, if it's a patient who's here early for an exam, we just say, you know, have a seat, we're happy to help you in the optical, but we get a lot of walk ins for glasses too. So I wanted our spaces all windows and we're on a retail street. So I didn't want anyone to feel that we were just a doctor's office that they couldn't walk in and look at glasses. So that, that felt better. People say that they say, Oh, it's just like nice and open in here and very welcoming. And that's exactly what we were going for. I didn't want people to feel they had to make an appointment or that they couldn't just come in and look at glasses because by far our revenue has been greatly driven by walk ins, which it's all by design, but it's nice to see it actually work. So I'm trying to work through the logistics of that. The people that right now sit at that front desk, what do they do? Like in your mind, what do they do? I mean, the front desk could become the back office. So that could become like we have a back office. I don't want people sitting and hiding out in the back office. That concerns me too. That's that is hard. So we have a high out, yeah. You have a small enough space that you can't hide. So I think, you know, and that becomes a, you know, a great way that I think as we're all struggling with staffing and we're all struggling with finding good people as people leave, there's always this panic and quickness to hire and to replace very quickly. And that might allow people to think about the duties that their staff has and not automatically replace somebody because that position was available. It takes time, but that could be a way to, you know, if somebody were to leave, then that position doesn't get filled. And you start to slowly transition people into different roles. What question should I be asked? So I really want to do this. I really want to get rid of this desk. What question should I be thinking about to, because I, because I immediately go to like, there's a person that sits there all the time, and she's great. And she's very organized. And she makes sure that everybody has the things that they need when they come in. But you're, to your point, that could be done in some back office place. And it could be done like by somebody else. But, but again, like she makes sure it's all done when the patient comes in. So what would I have to do to make sure she could do that? But then also say, Hey, Jennifer, welcome to the practice today. So I'm so glad to see you. Hey, let's get you on back because she knows where you need to go. Hey, I know that you have your, you're picking up your glasses today, or I know that you've got an appointment with Dr. Wolf. Let's head on back. And then there's maybe another place that they go to start. You could, you know, you could make her the concierge. And she might be in the back, like we have a back where my office manager sits. We have a big TV with it's like, we call it our, you know, our, our, kind of our home base and we have cameras. So we can see where, you know, if people walk in, we don't have a big space so we can hear. But she sits back there and she's the one manning weave and texting and making sure all the patients are confirmed. And although I help to pulling insurance, making sure that's all verified, but then when a patient walks in, she hops up front and is able to greet them. So she might be the person that does all of that. And she might say, you know, when, when there's nobody walking in, she's in the back and she's got a space, but, you know, somebody walks in and she's the concierge and she just directs. And that was my vision was that I didn't need somebody to direct people where to go. Anyone can direct and it might not be that they're seen immediately. It might be that they're 10 minutes early, but they're greeted and they're seated and it can be anyone that does that. It doesn't have to be, you know, a front desk person. So it's a hard shift. I think for me, you know, it was just the way we started and it's, it took a little time because my office manager came from my former office. She was with me for 15 years and we had a huge front desk with four people. So to go from that to zero was, you know, we talked through a lot. So we spend a lot of time before we open talking through all the scenarios. Like, what if this happens and how do we do this? And if three people walk in at the same time, what do we do? And so I think a lot of it, you could even brainstorm with your team and say, this is something I'm thinking about. Let's think through all the scenarios and how do we work that out? And when do when do patients do things? You know, do we need them to fill out paperwork when they come in? And if 80% of them fill it out ahead of time that that eliminates a lot of that problem, I mean, or do we actually need paperwork? Like, we have nothing. We don't send anything. We don't send anything to the patients for them to fill out. When they make an appointment, we collect all their demographics, whether they make the appointment themselves online or they make the appointment on the phone or they walk in, we're collecting that. So then to hand them a form, then to collect their insurance, their information we have already, we look ahead of time to see if we're in network for the vision plans they have. And we text them before they come in. And then we do all the history in the exam room. It takes, you know, one to two minutes. So it becomes kind of thinking, we've always done things the same way because that's how we've always done them. But is that the most efficient way? And are we creating more work to fill the people we have? Or are there ways to make that smoother and more efficient and then start to eliminate? So that's why it works for us is that there's nothing that needs to be collected. Yeah. Yeah, I think, I mean, we're on the path of that. I think it's part of part of me wants to actually like bring them into the office for the very first time and not prepare them that there's not going to be a front desk just to see the reaction. I mean, that's not that's not a good, you know, that would be nice and it wouldn't be good business practice. But but you almost kind of, because you almost wonder if it's and then from a doctor's perspective, like, is that a safe zone for them, right? We've gotten complacent in like, Hey, I'm back here doing something. So I'm, this is it where like, like for me, we're going to, you know, I have, we'll have an expanded kind of doctor's office for me and and the associate doctors in there. But but like, do I hide out back there? You know, do I hide out there when it would be better for me to be maneuvering around the space just constantly present, even if I'm not with a patient? I don't know. I mean, I, I look at like, I try to be productive outside of my patient care. And so, but I do both, you know, I mean, I have like, right now we're doing this, but I can hear them and we do everything by laptop. So we don't have desktops at all. I have desktops in the, in the consult rooms, but each one of us has a laptop. So we're truly mobile. So my, my front, my manager will bring her laptop up front if my opticians at lunch, she's like, I'll just work up front so that if somebody walks by, but it just doesn't look empty. So we, everyone has a laptop and I go up there sometimes, you know, I'll say it's, well, today it's raining and gross out. So I'm going to hide back here, but I will grab my laptop and go sit up front too and just for a change of scenery. And I like to be visible and I like to hear what's going on. And so I think that's, and that's been a positive from my staff was that they have this flexibility of working wherever in the office and they don't, they're not tied to a desk and they're not tied to a space. My optician will work in the lab or she'll bring her laptop out to the optical. So that's been really nice because they can be anywhere and I can be anywhere. So I'll go sit up front too. The downside of that is I can't hide when, when reps come in. I love my reps, but sometimes I need, you know, appointments are good. So if I'm upfront, sometimes or a patient will see me and say, Oh, while you're up here, you know, can you, so I won't sit up there long, but it's sometimes nice because I love seeing people when they pick up their glasses and we miss that. A lot of times we don't see that part of that experience. So I love being up there to say, Oh my gosh, let me see. I remember when we picked those out. I can't wait to see how they look. And so I, I help on that aspect too. And I couldn't do that if I was sitting back here all the time. Cooper vision and the AOA have joined forces in a groundbreaking initiative to transform how optometrists treat children with myopia. The myopia collective aims to unite our profession and its allies to challenge the status quo and elevate the standard of care for children with myopia. Everyone is invited to become a member of the collective. By joining, you pledge to act in slowing childhood myopia progression. Membership includes regular updates and information about the collective's efforts, access to educational opportunities and resources, and insights from the ambassador optometrists who advocate for community policy and changes supporting the collective's mission. Click the link in the show notes to join the collective today. One of the challenging things with patients is that when they invest in a really high quality pair of glasses and customized lenses, occasionally it can be difficult to keep those lenses clean, scratch free, and smudge free. Now we have the ability with Crazal Sapphire HR lenses to offer our patients a best in class anti-reflective coding that is also resistant to scratches, smudges, and deposits. This means that patients spend more time enjoying clear and comfortable vision and less time caring for their lenses. So remember that you can provide patients with the best in quality, best in class, transparency, clarity, durability, and UV protection in a single Crazal Coding. If you want to learn more about Crazal Sapphire HR, contact your SLOR account executive or visit SLORPro.com/crazal. Yeah, and I've often thought I don't have as much passion for the optical as you do. But I've thought I could do this. If I really wanted to do it, I could do it, and we've built systems in place, so I don't really have to plug in the numbers. We've got virtual assistants that will do all of that stuff for taking the patient's benefits or not benefits, and this is what we've recommended. And all I'm doing then is like, "Hey, this is something that we're thinking about with your glasses, and all we have to do then is put in that information for the cost of the glasses." Everything's already calculated, and then the virtual assistant can submit everything. So that's pretty flexible for us. But yeah, I mean, I even just think about like, I've been thinking about our optical as well. I kind of do, I think we need to do a field trip with my optical team to maybe your office. But even like I mentioned this, yeah, I've mentioned it before. Like the men's clothing store that I go to, I walk in there and like those people know, I mean, it is selling, but it's selling in a way that like they identify what I'm gravitating towards. So, you know, if I like to touch stuff, so like I'll touch a shirt, is that a shirt that I would like to feel for? And then immediately they get it, and they're like, "Oh, you should see this, and try this on." And half the time, let's say half the time the stuff they suggest, I don't even get, maybe even more than half the time. But like, will I always get one more thing than I had come into purchase? Yeah, almost always. And so like, if I were out there, I would probably do the same thing. Like you see, you just watch people like they sort of pause on something or look at something or, "Hey, did you see these new frames?" They're amazing. Like, this is not an advertisement, by the way, Jennifer. But did you, have you put on a pair of meta-glasses? Have you put on a pair? I haven't. So like, it's, so you've got kids. And one of the things that I love to be able to do for me, like I don't wear my meta-glasses everywhere, but they, for me, I love to listen to music. And I generally like to listen to podcasts, although I'm a little bit on a departure from sort of like the customary podcast I would listen to for some other reasons, but I won't go into them here. But like, I want to go to my kids' games, but if I've got AirPods in, then no other parents are going to come talk to me. And I kind of look like a jerk. But if I have those glasses on, I can listen to music or I can listen to a podcast, and somebody comes over and says, "Hey, Chris, what's going on?" And I can, I don't have to do anything else. I could just sort of like pause it. They don't even know. And, or I don't. And they have the music still going on, but I'm having a conversation. Like, for me, that's amazing. And then imagine, like, again, this is down the road, but imagine, like, you have this whole, I'm going to get old at some point. It's going to be harder for me to recognize people's like names or remember their names. And like, imagine you get like a heads-up display that says, like, "This is Jennifer Stewart, and she likes long walks off the short piers and, you know, like, I'll like this stuff." And so, like, but, but like, that's pretty cool. And so like, right now, I'm not out there doing that. But imagine that, that any one of the brands that you loved, and you do this, right? Yeah. That's what I do. And you're out there and you're like, "Hey, have you checked this out? Like, this frame designer designs these frames from their bedroom in this little community?" And they, like, how could a picture be like, "Oh, I'm not putting that on." Yeah. People love it. And so we, we've kind of developed a way when people come in, we don't want to bombard them. You know, we've all been in storage where like, "Whoa, give me some space." So we just welcome people and give them the opportunity to know. We're happy to let you look for a little bit if you need help. We're here, and we just kind of watch and give them a little space and time. And if they're lingering over something, we'll go over myself included and say, you know, "This line is this." So my goal is storytelling. And every, every brand out there, we had, we might have shared this when we first did our first podcast, but I had the frame wraps come in and do a training with each of my, with my staff, each brand. And most of them, honestly, had never been asked to do that by any of their accounts, which is such a shame in my book. Some of them were like, "I don't, I don't know what you're asking me to do. I was like, just come in and tell me about your, your products. I don't want to look at frames. We already have them. But tell us, tell us about your company. Tell us about the process of design. Tell us about the materials." And, and you know, some of them are really good at it and are used to being asked. And there were a couple that said to me, "I've never been asked to do that." And I was like, "Oh my gosh, that is such a shame and such a missed opportunity because all we do is look at them and go, "Okay, you know, what's the minimum I have to buy? What's my return rate?" But using them because they know this is what they're taught. And they want to share that information. And I, I say to them, "We're both in the business to sell frames, both of us. The more frames I sell, the better you're going to do." So let's work together to make sure that we know the most about your frames so that we can talk about it. So everyone in the office, myself included, is tasked with knowing three quick facts about each brand so we can rattle them off. You know, this line is made here. They use this type of acetate and they're known for this. This, you know, I don't stand up there and give each patient a 15-minute spiel about the company and the history. But I, we give a little bit and patients respond so well to that because they've never had that. They're just given 10 pairs of glasses and say, "Which one do you like?" And they're like, "I don't, what's the least expensive one?" Right? When we don't give them any other information, the only thing they know to go on, and we know this with contact lenses, the only thing they know to do is ask the cost. But if you've given them an experience and a tie and kind of an emotional connection to these frames, it's incredible what you can do. And we've done it with all the lines we have. I have two of my own lines so I've created two of my own designs and work with two different opticians to, to hand make both lines. They're all named after local landmarks. So people, I mean, that's, you know, if you can have a frame that has your street on there and it was designed by your own optometrist, I mean, that's a story that has paid dividends in bringing people in. They're all customizable. We put their initials on the temple, whatever they want. So it's just being a little bit different. And I like being out there and doing it too. And I wear, you know, I wear, today I've worn four different pairs of glasses because I, I mean, I take it a little a step further than most. Do I look at my patient's schedule? I look at who's coming and whatever I think, you know, based on their age or their, you know, gender or what I think, you know, we kind of have a sense of what people are buying. I'll put on a frame that I think will spark their interests or be something they like so that they can see it on me. So first thing, yesterday, I asked Chad GPT, I said, I want my opticians to be, so we used to do that. What you're talking about, we used to do it. We've just gotten away. We've gotten bad habits. We all get in our optical. And so I asked my, I asked Chad GPT, I want my opticians to become an expert in one frame line in the office, each optician. What types of information should I have them research? And then it says empowering your opticians to become experts in a specific frame line is a great way to enhance their confidence and ability to serve patients. Here's information. Number one, brand background and philosophy, three bullet points underneath there about what they should be looking for. Material and construction, design features, target audience, product range. There's five others below that. And so what I did, hopefully, it will resonate because we had some meetings about just kind of recently, just some things about the practice and what we're doing and where we're going. And so I assigned them that task to say, pick out one frame line that you like and answer these five questions considering these bullet points. And by the way, tomorrow is not very busy because I'm not in the office. The next day is not very busy because I'm not in the office. And we're going to talk about this at our next office meeting next Wednesday. And so I'm hoping now I'm kind of seeing it's a little bit of a test because I want to see like take it seriously, you know, because so I think that's part of it. That was the first point I would make. So kudos to you for doing that. And I would say that probably our conversation last year was a little bit of, of responsible for me thinking about that. I know it was a long time ago, but you know how things get to, to, to, in your mind. But the other thing I was going to bring up was, oh, you made a point of, of telling the story, changing your glasses. Oh, yeah. Did you ever go to the Vision Institute when you, when you were in school? Did you ever go do you remember the guy? So I don't remember who it was. It wasn't Walt West. I mean, Walt was there. Yeah, but there was another guy there that was like, he would peg patients. He actually, I think he worked in Walt's office or something. And he would sit there and he would go through the day and he would, he would like type, he would, he would figure out what type that patient was, like what kind of experience did they want to have? Is that where you got that or, or is this something that's more recent? I think it's just always, you know, I've always been big in the in the exam room about mirroring the patient and mirroring the way that they respond and how they, you know, some people want to be in and out. Some people want all the attention and, and mirroring. And we taught, we, I taught my team that too, you know, not, everyone doesn't want the same experience. So just being very cognizant of how that is and how people want to spend their time. But yes, taking it set further, we, we've been, you know, we're very lucky that we have the time and the opportunity to really analyze the optical and know, you know, we all know what our top selling frames are of each brand and I'm getting better of even knowing their names. My optician can like rattle them off. But we're starting to see patterns emerge and, you know, for anyone who's been in practice long enough, even with all that data, you can start to think about it. We just get so busy, we don't have the time to think about it that way. And again, we don't think, you know, we're thinking, we're going in the exam room, we're thinking, you know, cup to disk ratio, pressure, we're thinking family history of glaucoma and multifocal contacts and dry eye. We're thinking all on the clinical side and not many of us are thinking, you know, looking at, I'm a 43 year old woman and what type of frame do I typically like? Well, we know what most of them are buying and, you know, I tend to wear that. So yes, I had two women this morning who were in their forties and I put on a very specific frame for both of them. One of them feature that do you actually put like a thing that says like, Dr. Dr. Stewart is wearing this like that would be pretty cool. I know Jess will tell them and they, they know I'll come out and I'll say, Oh my gosh, like you have great taste. That's the frame I was wearing. I have a case of glasses back here and we will what we're also big on is, is teaching them to build an eyewear wardrobe and not to say, you know, you just wear one pair. And when patients kind of have two that they like, you know, my clinician will say, Oh my gosh, Dr. Stewart has met. And they'll say, how many do you have? I said, do you want to see them? Do you want to see my personal collection? And I have a case in here with all of them. And I show them, I'll put on, you know, two different looks and say, I look like a completely different person, right? They're going, yes, I said, that's the benefit of eyewear. You don't have to be stuck with the same look for 365 days. I don't have the same look for 365 minutes, right? I've changed my glasses four times. I put in contacts for this. And then I'll pop them back out and then see who my one o'clock is and put the appropriate glasses on there. So yeah, this is what I was wearing. This is what I was wearing before our podcast. But again, like it's a different, it's a different look. We think about it totally differently, you know, so I think, you know, I don't expect every again, I don't expect everyone to go to the deck that that we do here. Or, you know, I'm always my, I'm on a one woman crusade to get people to just be invested in their optical and think a little bit. And I'm glad to have inspired you a couple months ago to think about it too. Yeah, yeah. Well, yeah, I think, you know, obviously we you and I have talked about maybe a little bit about some of our disagreements or we've sort of had battles, maybe I'll call battles lovingly back and forth on Adam's podcast related to some of the things we disagree about. But but certainly you've inspired me to take our optical to kind of rethink our optical again. So again, my parents, you know, my dad was not is an optometrist. He's retired. My my mom was like a master optician, like, oh, and a wizard with the stuff that you're talking about. And we've sort of departed a little bit, not not dramatically, but a little bit. And and so I want to sort of re envision that in our new space. And I've got probably nine to 10 months to sort of do it. And and so yeah, I would say that that's inspiring to me about the things that we're talking about. And so thanks for that. It's pretty cool. Actually, to listen to you, it's pretty cool to hear you say. So I want to I want to dig into a couple of topics that I want to ask you about independent strong. So one of the things I wanted to ask you about was, was you made a comment on you know what your best sellers are. How often do you track things like turn rates and things like like what types of products you're going to have in the office? How often you do that? Every day. I know what we've sold every day and I reorder every week. So I think one of the other things that happened. You do it. You do that. I do mostly. Yes. So I, you know, I pay I pay my bills and I want to know exactly what was ordered. So I do that. I know I usually meet with my optician every Friday. If we haven't caught up during the week, which we usually do, but I know exactly. Like I know what streams we sold this morning. I've already added them to carts if I want to reorder them. So what I've done here, which is different than I've ever done before, is is the frequently frequent reordering of our best sellers. And I often buy two or three at a time. You want them in the office. If they're going to sell, we had an issue where we ordered our best seller. I usually was buying two and somehow our rep ordered three for me. And I was like, Oh, she said, I'll send you an RA. I'm like, Oh my gosh, you know, if it was any other frame, I would have sent it back. But I said, all right. So I said to my optician, here's your challenge. I want them all gone by the end of the week. Can you do it? And she did it. You know, it's, it's she loved the challenge of selling them. I mean, it's a great frame and we sell it a lot, but I'm watching that all the time and I'm always tracking what we're selling and what we're not selling. You know, I, I'm often a little, I say I'm a little too quick sometimes to make judgments on what's not selling. They always, my team is like, give it like sometime. So I'm like, Oh, you didn't sell your out, but we've been really fine tuning. We spend a lot of time fine tuning what's selling and tracking. I use frame turn by specs to look at turn rate. And the turn rate for the different types of frames we have. So our Buffalo horn frames range from 1800 to 2100. I am not expecting the same turn rate on those. That would be lovely. But I don't expect the same turn rate on those that I would on, you know, a Tom Ford or a Garrett light. So for me, it's looking at the appropriate turn rate for the frames and knowing, you know, if they're selling at the level, they should be. We're always watching pricing, you know, raise it. We're typically raising our pricing pretty often. If they're selling that quickly, then we're raising them and finding that that sweet spot of when they slow down. And then we know we found the right price. So I'm truly watching it a lot. You know, again, with, you know, with four to seven patients a day, I know how many frames we're selling. So it's a little easier for me, but it's, it's really been working well. We reorder so often. And I think that was not the way I've always been. And I think so many practices get in the mode of waiting for the wrap to come in and then filling in the frame board and then a missing out on selling their bestsellers right away. And B, we have these huge bills and then these huge returns. And there's just all this accounting nightmare. For us, it's been easier just to keep track and reorder. You know, sometimes I reorder twice a week. Like I've placed two Garrett light orders this week. So which hopefully not a third this week, but two so far. Yeah. Okay, then, then, there's a couple things that you said in at the beginning as far as your goals. So you'd be happy with 10 patients a day, but you'd be set, you'd be set maybe, but you'd be satisfied with seven. And then you're trying to maximize your per patient revenue. When you consider your per patient revenue, I'm assuming that means revenue per refraction. Yes. And, and then, I mean, if you don't mind sharing your numbers, go ahead. If you do, that's okay too. But like, is there a percentage more that you want to get to if you're not want don't want to share specific dollars? But is there like a percentage more of where you are now versus where you want to be? And then if you're at that point, how do you know? Okay, what's the next level? Like, is is in your mind? Is there a maximum that you could achieve? And, and then once you hit that at seven, does that then mean you go to 10? And if you're at 10, and you hit your maximum and you're at 10, are you happy in perpetuity? Or does it have to go up because businesses have to grow? So I will say we're about three times a national average on per patient revenue. So typically, you know, based on the numbers I've seen, I would like to see how high we can go and how high I don't know what the ceiling is. And I don't know, I will say this is very more than I could have ever imagined. And every month, I'm like, oh, is this the month that like our numbers fall and that, you know, are my metrics change and 10 months in, you know, it's easier to have that when you have a lower patient count. And then as we've been getting busy, I was like, oh, is that going to change that? But we've been very consistent. So it's been great to see that. And I think as we change our business model, I just hope to go up to a manageable point and not I don't want to keep adding staff and doctors to create a machine. I would rather have less patients and still be able to take care of those. So I think my goal would be to maximize the day and then just hire more opticians to help with that flow versus more techs and more doctors. Eventually, I do want another doctor because I'm here most of the time now. And I love it. You know, that's one of my goals is not to be here all the time. Right now, I really enjoy it. I've never seen patients five days a week in my life. So this is the first time, but with the patient count, it's quite manageable. And I still have time to do things like this. So I think my goal is just to keep doing what I'm doing. If we stayed like this forever, I'd be very happy. You know, it's a really nice way to practice. I look forward to coming in. I don't feel stressed. My team, we do need another optician. That's the the optical does get very busy with walk-in. So that will take a burden off my team, having one more staff. But I, you know, I would love to push the envelope of how high we can go for our per patient revenue without increasing the patient count. And my goal for 2025 already is I've been looking at our, at our price points and frame turn does a great job of breaking that up into, you know, what you're selling in each price point. And I, you know, there's some glaring opportunities in areas where we don't have any frames in that price point. So my goal is for 2025 or to fill those in, move the other frames up in price point and then add some higher price points as well to keep pushing that up. But, but you know, you can't, that being said, it's, it's very easy to say, well, I'm just going to add, you know, a very expensive frame line, but that comes with a lot of training. So we're ready for that. And we're going to expand what we do have because that's working well. And we know the story. So to anyone who thinks, oh, you just throw in, you know, high end frame line, it takes some work. And yes. But I would encourage people to, to add something uncomfortably high, because anything after that now looks like a great value. So we show everybody our buffalo horn first, every single patient, whether they have managed care, you know, a vision plan, you know, whether we think they're actually going to buy that buffalo horn, that's where we start. And sometimes that's where we end. And oftentimes it's not. But that helps us set the tone of, you know, instead of starting with the lowest price and then going up, going down as much easier and people, you know, we have a lot of people who have said not yet, you know, can you put that? This is my first pair of glasses. And they do come back. And we've had a number of people who have fallen in love with the buffalo horn said, you know, not right now. Let me do my first pair, but it stays in their mind. And they come back for that second pair. So that's really my goal is to start moving towards more of that high end bespoke feel. And because I wasn't sure how that would go, you know, you're still no matter how much I love it, there's still kind of that worry is that what people are going to respond to with all the competition we have. And it is sustainable here. And it's been very well received. Well, I, you know, the other question, and maybe I have to come back, we'll have to do a year to recap too, because do you have a plan for when these patients come back that now they're in for their second exam with you? And they have just purchased a very nice or multiple, very nice glasses that are very good quality. So they're probably not crazed and scratched. And and they they take care of them like any other piece. Have you, have you considered how to address that when when the patient comes back in? What what are your I mean, I know that's kind of already your culture is like, hey, you can always add, you know, like once for me, maybe I'm answering my own question for me, like if I go to the Ben's Clother store, I don't have to get all new stuff every year. It's like, I can just pick out a few new pieces here and there that just sort of match within the rest of the the wardrobe I have. And then you just sort of retire. But are you intentional about that? And what can we what can we who don't think like you do gain or change the way we think about those patients who are they're coming back for their glaucoma evaluation and a comprehensive exam, right? I saw maybe six months ago or four months ago, and they got a nice pair of glasses last last year. And their prescription hasn't changed. How do we communicate with those people? Think what we do first is we will show them multiple pairs and say, this might be not now. This is, you know, I know that you're not going to do all these. And we put all that information into the computer. We even take measurements on every pair that they've picked out. And then we'll, you know, we'll remind them when they pick them up. You know, I know you got your buffalo horn, your custom beautiful piece. But remember that now, a gym sunglass Christmas is coming up. So, I've got it set aside. And so we have it all written when when they come into dispense, that's all in the notes. So we take careful notes about all the frame they frames that they've liked. So that A, if they do come back, we can quickly order it. But B, anyone can remind them. So, and we were very, we worked very hard to say, yes, this might be what you do today. And, you know, I've had a number of first time progressive wares. And just this morning that happened, you know, first time progressive wares. And we, you know, showed her sunglasses as well. And she's like, well, you know, I'm not quite there. We're like, absolutely. You know what? Let's think about it next year when you've really been wearing your progressives. And you notice that you now want to wear them more and you want some sunglasses. So we try and plant the seed early that maybe it's not today and maybe it's in six months. And maybe we leave a note in the computer in six months to say, you know, how are you doing? You know, I know now it's six months from now, we're starting against the spring. Just want to check in on your sunglasses. And if you're interested in sunglasses, we've got those here. So we even set pre we use weaves. So we set all these pre selected tech. So we type those out when they're here and set or not a reminder to us. But we pre write the text to say, hey, it's just from luck. Just want to see how you're doing with those sunglasses. You know, I got a new pair of glasses in that I thought you would like. So we will either, I mean, I don't remember anything. My optician remembers every person it's a skill is not when I have. She's good about when a frame comes in, she'll remember a person that she thinks will like it. I could never do that. So my office manager and I will we'll write out texts and we just pre save them. And then it goes right out on that day. So that's a way to do it. And I don't expect, you know, I mean, we have people that will get multiple pairs, but then we have some people are like, I'll just do this for now. But we just set the tone to say, we're here, we're here when you want. And I think you just can't plan that they're not going to do it. You know, a lot of people and myself included, we get so defeated, you know, you pick out a few pairs and they're like, yeah, I'll just do one. And it's like, oh, you just feel the sense of like, I spent all this time. I was just happy with one. Yeah, I did what I have to reset my expectations sometimes. And I'm like, oh, that's good. Yeah. It's about beliefs. And I just, you know, it's about beliefs and and and I like when I look at at your belief system around glasses, you know, there's no reason that we all shouldn't have the same belief system. We've just abdicated that belief system to someplace else. And it's just like, you know, I've got a very strong belief system about what what my value is to my my community. And I just need to I just need to really think about how that applies with with glasses, right? That's a nice one. You know, I think I truly enjoy it's not some people. It's like, you know, the thought of doing all that is like, I'd rather like do anything else. For me, it's enjoyable. And it shows, you know, I don't mind. I enjoy being out there and I enjoy showing off what we've done and patients have responded. I don't expect that everyone will have that love. But I think, you know, we also do and I will not take credit for this. This was not my training. My petition is really good about a Monday through Friday pair and a weekend pair. She uses that phrase a lot to get people to think about again, maybe multiple pairs for their looks and to say you can go a little funky on your weekend pair. And then you've got your classic Monday through Friday pair and people resonate. You know, if you say, well, you've got, you know, if we use terms that they understand and you make it fun, I listen and sometimes I joke, I'm like, man, these people don't know what hit them. She's so good at it. And like, you know, I'm like watching them. I'm like, oh, they have no idea like that she's doing this and making it this fun experience. And I will say, you know, I've had many opticians over the years and a lot of it comes down to personality and really enjoying selling glasses. And I think sometimes we have people on our teams that it's a chore and it's a job to, oh, like, I have to get up again and they're not going to buy and, you know, they're just a pain and they, you know, I've done, I've done, it's your turn, you know, hiring the right person who looks at it as an exciting task is so important. And I've learned that with Jess, like she truly loves what she does and really loves styling people and gets very excited to do that. And I've had team members in the past that like, oh, you know, it's time Chris needs a new pair of glasses and they're like, oh, he's not going to buy this year. I don't even want to waste my time. And so I think a lot of it is personality driven, but, you know, a true, she's very extroverted and is really loves beautiful eyewear too. So, but I think, you know, being okay that they're not going to do everything today and, but, you know, giving them the options and not just showing one pair. And we pre-select. So I think I mentioned this last time, but we pre-select frames while the patients in the exam room. So as soon as they come in, when they come out, we've pre-selected and curated a selection for them. And that always includes sunglasses. Does that mean every patient buys sunglasses? Absolutely not. But we're putting that thought in their head that, oh, I never even thought I needed prescription sunglasses or I never even considered that, you know, there's a difference in sunglasses. So we go through the motions and make it feel like everybody's buying this at the same time and go through the education because that will help down the road. Maybe it's next year. They're like, oh, you know what, I remember you mentioned sunglasses. These are fine. So they sure want to do sunglasses. So putting all those, you know, go through all your treatment plans and go through all the different eyewear they needed every visit. If they do it all, awesome. Celebrate that and be very excited. If they don't, don't feel like it's a failure, but you're putting, you're planting that seed and making your job down the line easier. Yeah. Yeah. Awesome. Okay. So I was going to ask you about independent strong, but I got to be respectful of your time too. So tell me a little bit about, tell me a little bit about independent strong and what's your goals or purposes for that? Thank you for asking. So independent strong is a jobs and publication aimed at independence, so not just independent optometrists, but also opticians and independent practices. I'm the professional editor. I'm entering my third year. I think next year will be my third year. Time flies. And I'm, I love putting together articles about topics of for independence and really understanding different ways that we can be independent. We feature a lot of practices who have become more independent. Maybe that's by dropping insurance or people who have cold started after being in corporate and really just giving the independent practices a voice and some ways to be better business people. We are hard at work on our 2025 agenda, which is crazy. You know, I work like three or four months out. So we're already working on, you know, February and March of 2025. So it's an online only publication. It doesn't come in paper, but it's really a great. I think we put together a lot of great content on all different topics. You know, it's not just optical, so it's not has nothing to do just with optical in 2024. And we'll extend a little bit into 2025. I did a series on cold starting kind of from, you know, the why and how through my process and we'll finish up probably in January or February, although it never finishes. So I'm trying to figure out when do I stop? We were talking about that, like, because I could keep going every month. There's a new topic. So we'll probably wrap up that and it's become kind of a series and cold starting. But it's a really great, it's a great publication. You know, please check it out. And if you ever, if anyone ever has any content they like or ideas for things that have not been covered, feel free to contact me. I'm always looking for ideas and making sure that we're covering all the topics that independence face. Jennifer Stewart, thanks so much for doing this again. It was great. And I will follow up next year because I think I think it'd be fun to hear how year two goes. Thank you. We'll do a video tour. We'll like, make sure there's no patience in here and I'll take everyone on a tour around and and maybe we'll watch Jess in action. Maybe she could sell you virtually sell you a pair of glasses. Yeah, that'd be awesome. That'd be awesome. Thank you for having me. It's been a real great pleasure and I'm excited to be here. You're welcome. Thank you. Hey, if you enjoyed this episode, make sure to subscribe to us on Apple Podcasts and our YouTube channel, both linked in the show notes. Now, here's something exciting. We're giving away a one year subscription to comprehensive optometry simplified. All you have to do is leave us a review on Apple Podcasts. Take a screenshot and email it to me at questions@icodeeducation.com. We'll put that in the show notes as well. We'll be selecting a winner on December 15th. So don't miss your chance to get access to this valuable resource. Thanks again for listening. I can't wait to see your reviews. [Music]
