Hello, Bobby. Hey, how’s it going? I’m good man. Fun day.
Yeah. Our EMR went down. Oh
my gosh. I mean, of all the things that have happened, that is like the biggest engagement disaster ever.
So we, uh, we’re we definitely put out all the fires this morning and created this systems. We’ll
see, so what are you? Okay, well, let’s just, I mean, let’s just jump right into it.
So what do you do when your EMR goes?
Well, the first thing, um, is w we were already looking at switching EMR. Um, and we had actually just signed a new deal with a new EMR company. But, you know, if an, our EMR goes down specifically, like, what do you do right now? It’s figuring out, well, what’s the purpose of the EMR, you know, number one, it’s for the patient’s chart.
Right? So, Okay, how are we going to get the patient’s chart? And so we’re going to have to get papers ready? Do we have those papers? And thankfully yes we do. But now we need to get somebody to make all of those papers with all those patients, same with a specific type of patient that they’re coming in for the evaluation keratoconus eval, you know, LASIK consult, cataract evaluation, cataract post-op.
So you have all these different types of evaluations that they could be coming in for. You got all those papers for it. Uh, now we need to make sure we have the doctor marked on there and then the charges that are going to be put on there. It’s not going to go tell the doctors to make sure they put all their findings on there and then put all the charges on there.
And then once they get all the findings in the charges on there, on that paper chart, somebody’s got to put that in Excel. And that Excel document then goes to billing and billing. We’ll be able to see slake mark the charges so we can bill out for the day. And then on top of that, there’s all the engagement images.
So what do we do if a patient comes in for a LASIK consult and we’re getting their a, to pop topography or tomography done, where does that go? So the doctors can see, do we have the technology all set up? So that could be done, you know, are there files created in the one drive and everybody’s important, you know, so it’s.
All of this stuff goes into it and we got it under control. So hopefully we don’t have to do that for long. And
that’s all we have time for folks. Holy cow. I mean, I totally get it. Um, for us, it’s, it’s really not usually an issue with our EMR. That’s the problem. It’s a lot of times it has to do with really just our, um, our, uh, internet.
That’s the problem. Cause we’re, we’re in the cloud for our stuff and yeah. You know, and it might happen maybe once or twice a year. It’s not a lot, but it’s enough, you know, that you have to have something ready to go. And many years ago we just basically fell back to our old paper. Type kind of a exam form that we just got a stack of them in a drawer somewhere.
And we just bang those babies out and start from there and realize that once we’re up and running engagement again, it’s going to be some catch up time plugging that stuff back into the system. But yeah, you’ve got to have something to prepare for because. This is going to happen. It’s not, it’s a, it’s a, it’s a win and it’s not ever going to happen on a easy time
for you.
welcome to the vision of leadership podcast. I’m your host, Ted McEvoy. This podcast is dedicated to helping you find your. Have a better quality of life and become the best leader you can be. Hey, have you subscribed to this podcast yet? Don’t miss an episode. They’re worth every single thing you paid for them, which is nothing because they’re free.
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On episode 102 of this podcast, Chris interviewed Justin Kwan, Michelle Andrews, and Richard Ruth. They pointed out that as a profession, we have done a great job of letting our patients know that myopia is not a big deal. If you can see 2020, there is no worry. It is the high myopes that are. And as they said, that message is tragic.
Any myopia has a higher risk of maculopathy glaucoma and earlier cataract development in the, my site one day clinical trials, only 4% of study participants who got pro clear one days stayed stable in their myopia progression over the three-year period. That means you can confidently say parent by not going to a system geared to slow the myopia.
There is a 96% chance your child’s vision will get worse. This may take away some of the choice your child has in the future as to how they will correct their vision choice. Not fear of the disease associations with my OPA is what best resonates with parents when it comes to my opiate control for their children.
And with Cooper visions my site one day, we now have an FDA approved, single use contact lens to lessen the progression of myopia in our patients. Contact your CooperVision representative to find out more about my site. One day contact. Welcome to the vision of leadership podcast. I’m Ted McElroy. And today I have a really great guest with me, Dr.
Bobby science, uh, who is a graduate of the university of Houston college of optometry. He is residency trained and refractive surgery. And. Take me out of my comfort zone a little bit today. And we’re going to talk a little bit about, uh, treatment engagement and care and things like that. Not all about practice management or a business business education, but we’re also going to discuss some things that I don’t think a lot of optometry for that matter.
Even a lot of health care is doing as we move forward. Currently he is serving. As chief medical officer for your practice there at Parkhurst new vision and also the director for the residency program. Is that not correct? That’s right. Okay. Very good. So welcome to the podcast, Bob. We appreciate you being here with us.
Yeah. Thanks for
having me.
Fantastic. So, um, Bobby, like I said, there’s some things that, uh, that are very unique to your price. Well, not maybe unique, but maybe different from a lot of practices are. And one of those is just the. engagement growth that your practice has had. And can you walk us through how that happened and how you actually scaled your business as, as that growth to,
yeah.
Yeah. So, you know, after finishing up residency, we waited for our daughter Isabella to be born. And then five days later, we came back to San Antonio and that actually from St. Antonio, Grew up maybe like five minutes from where we’re at right now, which is Parker’s new vision in San Antonio, Texas. And so just down the road.
So I feel like this is definitely my hood. Um, and you know, with regards to coming here in the beginning, it was really interesting. You know, where I did, my residency was a very established practice over 20 years old, you know, they had a lot of their systems set in place. And, and even if I felt like if I looked at something in my residency, even though I was there to learn.
I feel like just natural on me is I just want to make things better, the improver. Um, and, uh, and, and in looking at some of those systems, I remember making some suggestions and I think, you know, some of them were heard, but I felt like things kept going the same way they were gone. So I really wanted to end up in a place where I was going to be able to make an impact.
And so coming here to San Antonio and at the time, you know, Dr. Parker’s was here and I remember starting, we had like 17 people upstairs in a closet with like, I don’t know, six, six, 7,000 square feet. We had like eight exam lanes, but they were the tiniest things. And we had a call center, which behind me, we call it the engagement center.
You can see what it is now, but that was about the size of our entire clinic. Um, and people in closets, we, we switched to closet in the billing office. It was very different. Um, then, and what I realized then was, you know, Mike, my first day here, I was just like, Hey, we could do this, this and this. And, and, and we could make it better.
And Dr. Parker said at the time it was like, that sounds great. We should do that. Okay, great. When you made a few changes, made the system better, um, and we’ve just continued to do that and, and now really have gone from. You know, at the time, you know, two doctors to now having 11 doctors. Um, and so we have now a S surgical fellowship.
We have an optometry residency. We have, um, our, we have definitely grown a ton. We, this space now is 40,000 square feet. Um, and like you said, now with both the clinic and the surgery center close to about a hundred employees now, Um, really we’ve just been, I think what we started at and the reason why we grew so much is because we are so hyper-focused on what we wanted to do of those why behind not only the, what we were doing, but also the why.
And I think that’s really led to a. Some big growth for us. I think if you go back and look, when I first came here to San Antonio and I would talk with outside doctors about what we did, they were like, Parker’s new vision. What’s that? Who’s that. Um, and now we’ve just gone out really and just educated the community, um, all, all doctors about what we do here.
And it’s really led to, uh, a significant growth over the past five. So you talked
about your, why, so what was that, why and how did you translate this to your team as you continue to grow bigger
and bigger? Yeah, I think in the beginning it was really, um, Dr. Parker and myself, we were sitting down and, you know, Simon Sinek, you know, has the start with the why.
And that’s, that’s really what we tried to do there. If, hopefully, if you were to ask anybody here, you know, they said, Hey Bobby, what do y’all do there? We say, we do vision and correction for important guests of referring optometrists. Okay. So primarily what we do is vision correction for important guests.
So, so that was really big, you know, in going out saying like, okay, what do we want to do? Okay. We’re not going to be a practice that goes out. And does a trabs on in stage glaucoma patients, right? We’re going to focus on doing cataract surgery and refractive cataract surgery. You’re going to do that really well.
And we’re gonna do refractive surgery really well. You know, LASIK, ICL, smile, you know, PRK, uh, refractive lens exchange. We’re going to do that really well. And I think that the middle one there for important. Like, we’re going to treat these people, like, as they ought to be treated. Right. Which is like, they’re our moms and our family members and saying, we love our moms and we love our family members.
Right. They’re going to come in and we’re going to treat them with customer service. Right. Like really like, like we’re going to, we’re going to compete with Ritz Carlton on customer service. Right. And so I think. When you were able to simplify it, we division correction for important guests of referring optometrists.
So I think it’s really, really important saying that, you know, our model is that we believe the primary care optometrist in the community should be the one seeing this patient because they’ve established a connection with the patient, right? We’re not here to try to steal your patient. You know, we’re not here to have an optical in our practice.
Like. Primarily just doing vision correction. And the big part of that is because we need optometrists in the community to participate in the pre and the post-op management of these patients. I think if you, if you look at our, our kind of R R Y so transitioning, like, like that’s what we do and why we do it is really because we believe everybody deserves to see.
Right. Whether you’re here in the U S or outside the United States. And so for every laser procedure that we do here on a patient, we actually donate for procedure to be done. And so we think everybody deserves to see great. So if we do a LASIK patient, great, we’re going to donate for a procedure to be done outside of the United States.
And I think that. And I think we see this, especially right now with getting it, being more difficult to hire people right now. If you can get buy-in from your people, like, and they fully understand the why, and we’re celebrating guys, we just, if you look at, you know, this past year, we were able to help 4,000 people see.
Like that’s fun. And I think you get people coming in, they believe in the why they’re motivated to keep doing what they’re doing. And I think, you know, starting with that, what, and the why, and translating it over, I think it’s really helped with even overall, like our culture.
That’s amazing. And, and so when you’re, when you’re doling out this message to your team, how do you actually get that message to them?
What’s the mechanism that you use to actually get it out to them? We’re going to get, we’re going to dig into the, some of the, maybe the, a house a little bit.
So I think, you know, the first thing was you had to come up with that, right? So. You know, the message and the PowerPoint. And we actually just took a half day off from we, we just said, look, we’re going to commit to doing some training and we’re going to focus on, you know, customer service training, but really the, the hallmark of the half day off is we’re going to create extreme clarity on what we want to do going forward and the why behind what we want to do.
Um, and so I would say that was the first thing is taken off. Uh, so we put some chairs up and we had all of our staff over there. Um, on both the clinic and the surgery center side, brought them all over and then we just delivered them the message there. Um, and, and doing it through like a PowerPoint. We also showed them a little bit of the Simon Sinek.
The why, like start with a why we, we showed them a little bit of that video too, as well, and went into that. And I think telling them stories, like, just being able to, to like tell our team how they’ve impacted. Real patients in like, I think back to, you know, we, we, we go on mission trips here. So, um, we actually send our resident optometrists and our surgical fellow every year, we pay for them to go to Mexico on a mission trip, um, so that they can go use their skills over there.
And the other thing that we do is our employee of the year. Last year, we also paid for her to go down there too as well. She was a scrub tech and help out. And it’s just, it’s an awesome moment to be able, just to use all of your skills in a, in a scenario like that, I’ve gone quite a bit and being able to use, you know, some Spanish that I know and being able to help these patients who are walking in.
Um, you know, I remember this minus 20 Dr. Miles that came in Marie. Uh, and I, and I shared this story, like she came in and asked her, what’d you do? What do you do, Maria? And she said, basically nothing. And I’m like, oh, you mean like, nothing, like scroll on Snapchat and Facebook. And she was like, no, I literally can’t see.
I had a pair of glasses before they broke. Now. I don’t have anything. I literally can’t see. And you, you be sharing that story about Maria or this, you know, the grandma who’s been hand motion in both eyes and having cataract surgery to be able to wake up the next day and see, they really get to see the impact like that, what they’re doing here and like what an impact it’s made for us to be able to support these trips and the patients that they’re impacting because of them coming to work and being able to do what they do.
So
when you’re developing your why, how much. Input. Do you take from your team to craft this? Why or how much of this really is? This is, and I want to say this in a negative way, but top driven because let’s face it, it has to be a vision of a leader to put you in, put in place. So how much of this is their role?
How much of this is your role,
et cetera? Yeah, I think it’s, you know, I would say, I mean, if I was talking to somebody, I would just think it’s like the executive leadership who’s who’s coming up with this message, because I think if you asked this leader, this leader, this leader, they could have different.
So I think it definitely on this one, it’s, it’s coming from the top. Like, what do you envision for this clinic and the impact that it’s going to make? And maybe it’s not there’s this clinic, maybe it’s other. Like, what does that look like going forward? So I would definitely say that’s top driven, but I think like in, in all of this, I think, you know, having mentors or other people, you value their input from and saying like, look, this is what I think, what are your thoughts there?
I think it’s always good to have, you know, other, uh, input or values coming in for people, especially if they’re strong in discernment, for example. Um, I think that could be very valuable to it.
So your, you mentioned your mentors. Um, if you don’t mind, uh, tell us, uh, about few of your mentors and, and what they have done and how they’ve
impacted you.
Yeah. You know, I think that, um, there’s a few, I think, you know, one thing that I felt like. Come in here. So I felt like in my residency, I learned that term. So I think if you go back to school, like when I was in school, um, there’s a doctor in Houston, her name is hung Chang, and she was just like, get to the point.
Meat and potatoes taught me a lot of really awesome things, especially on like how to teach. Like how do you give people applicable stuff that they remember and cut out the fluff. And I think a lot of when I teach, I copy what she taught me there. So she was really impactful. Then I went to my residency and all of the doctors there.
Extremely valuable to like my doctor, my, uh, eye doctor learning skills, you know, uh, gelato trees over there. But I mean, all of them like Julie, no Darcy and, uh, Chris Ali, Dr. Wade, uh, Dr. May all of all the doctors over there are really valuable, but I think once you start getting into the business side of things, so I do teaching with cam K.
So Kyle Cheatham, um, is the one who leads that. And he was really influential with regards to changing the way my mindset was with regards to like, maybe even my position. Like, I, I used to really think, like I wanted to be like the doctor, like I wanted to meet the doctor and reading the E-Myth was really helpful for me and understanding like, wow, I would be able to impact more people if I could just teach other people what has been taught to me.
And I think that was really impactful for me saying like, okay, I don’t really necessarily need to be the one, seeing all the patients, I can see the patients if I need to, but if I could teach other people how to see these patients, then we’re going to be able to take what we’re doing and replicate it.
And the other areas and really be able to impact a lot more patients. How was really helpful. It’s always been helpful and just understanding kind of like what business books to read some principles, um, and just those, those kinds of stories that mentors like that share, uh, and you just continue to learn.
And then of course, Dr. Parker is, I feel like I’ve learned so much from him with regards to the, not only the surgical side of things, but definitely the business side of things. Um, and practice management, little things on customer service. Like I think just being so hyper aware. On extreme customer service.
Uh, I’ve really learned a ton from too as well. So
you’re, you’re talking about your teaching, how much, um, of your time is spent in the educational side of what you do and how much of it is in direct care of your guests?
Yeah. Good question. That kind of depends on just like doctors being out. Um, but I would say overall, like now, like if you look at this upcoming week, Um, I probably only help out in a clinic when I’m absolutely needed.
Versus if you fast rewind two weeks ago, I was in the clinic full time, um, because we had a doctor out that whole week, but I would say most of my time right now, I don’t know, 10% is in the clinic right now versus 90% being involved in just helping the clinic run and teaching and making sure we got systems set up.
How did you realize you were way more passionate about that than you were about the guest?
Yeah, I think, I think it’s just being, I think it’s being like, I think it’s just being aware of what the impact is that you could eventually make. And I think that for whatever reason, I like teaching, like I like learning.
If you look at strength finders, I think number one is learner. So I love learning things and being able to teach them. And I think that if I can continue to learn new things, Marketing or lead management or whatever we’re about to talk about, you know? And then I can teach them to other people it’s like, great.
Okay. That system is up and running. Let me go learn something new. So then I can teach that and have other people learn it. And other people learn it and execute it well, too, as well. So I think it was just over, over time. It’s not that I don’t like seeing patients cause I’ll see patients all day long. If I need to.
I just think I can impact the organization more if I’m not seeing patients.
Right. Okay. So you take this organization from 17 to a hundred. Was it more important to build. That infrastructure to take care of the guests or did the infrastructure come around because there were just so many people that you had to take.
Yeah. Yeah. It’s like, you know, you start doing a really good job and take care of people. They want to tell all their friends and then all their friends are coming in and you’re like, whoa. Okay. Um, so I think that there was, there was a point, you know, want to like maybe a year and a half in where we’re starting to see like, okay, there’s a much bigger demand.
Um, you know, I remember, I mean, even when I first got here, I think in the first few months, you know, if you wanted to book cataract surgery, we’re booked out like two months. So even with me coming in and seeing all the cataract evils and adding more cataract develops the schedule, it was like, we still are booked out on in San Antonio is limited on.
And then we, you know, we started seeing more patients and they started telling more people. And so I would say that we took care of people really well. And then word of mouth, you know, really started helping to grow it. And then about 18 months, then we started seeing like, okay, if we really want to get to where we want to get to.
And we think that we can continue to scale this really, that we’re dismissing, it’s more doctors and we could train the doctors. We can definitely do that. Um, let’s start building the infrastructure so that we could support this patient demand, which we think we can get to. Um, so I think that taking care of patients first and seeing where our, where we were already at, you made it a really easy decision to say like, okay, I think we can get over.
Yeah, cause I think
it’s a really delicate balancing act. I mean, and we’re kind of going through this in our office right now, um, where we would like to do some new things, but we need more people. And as you, and we all know right now, I mean, for those of us that we were listening to this in the very, very far future, uh, we’re in a really bad situation for trying to find people and find good people at that.
So, you know, like in your typical office, To be able to get somebody from the beginning to the end and do it smoothly. You got to make sure you have enough people to do that in the right way. And of course, clinic wants more texts and, you know, optical wants more opticians and you know, then you gotta have somebody answer the phone and it just, and it starts snowballing after a while.
And, uh, the other challenge is how much is too much and how much is too little and, you know, uh, Right now my team, and I’ve said this to are in our office meeting on last Wednesday morning. Um, our team is working better right now than it is worked in a long time. And it’s not that they weren’t badly over the last year or so, but for right now, man, we are really just rocking and everybody’s getting along great.
And it suddenly dawned on me. Because they don’t have enough time to sit around and look at what’s ugly about the practice. Now that’s a good thing and a bad thing. It’s a good thing in that they can focus on what’s important, which is getting things done. It’s bad that maybe we do have a little bit of a problem.
That’s not quite going so well, but you know, when you’re. How do you decide for your business that it, are you relying more on your team to tell you this is something, are you looking at numbers? What are the, what are the metrics that you’re, you’re monitoring, monitoring to be able to make sure you’re putting the right people in the right place?
Um, I think, you know, definitely you’re hearing your team, but I felt like if you were listening to our team all the time, I feel like everybody always wants another person. Right. I mean, maybe that’s just here in San Antonio, but I
think it makes a problem better than.
You got it all the way. So I think that’s one thing we learned actually learned early on is we were overstaffed in a few departments and the productivity was not as high as you would think.
Like we still have the same problems with the, you know, more people. And I think early on now it’s like, okay, if we’re going to bring somebody on, what is that going to do? Like, how is this person going to be investment? Cause like, if we’re going to invest in bringing up somebody who’s good on. Great. And how was that going to make sense for the practice?
And I think right now, I think now that we have the lead management system that is really helpful for us in figuring out, you know, let’s say for example, let’s just take a cataract eval for example. Cause we, we do quite a bit cataract surgery here. We can look and we can see let’s look over the past five weeks.
How many cataract evils are. And then let’s look at our percentage because it’s really interesting. It’s going to be fun to talk about, you know, if somebody is, has a cataract, they have decreased vision what’s percentage chance that they come in. Cause you would think it would be a hundred percent. Like if somebody can’t see cause of a cataract, you would think all of those patients come in, but they don’t.
Right. So then we have to look engagement okay. How many leads are. And then what’s the percent chance that they’re going to convert to an actual consult. And so then you can start making up numbers. Okay. Well, that’s the number of consults that we would actually need to see in a week to keep up with the leads, because if we’re not, then we’re going to get overbooked and that’s kind of where we’re at right now in our clinic.
So now that we’re overbooked, okay, well, what’s the number. What’s the percent chance that somebody who’s going to come in for a lead is actually going to schedule. And then you look at those numbers, cause then you’ll know how many surgeries you’ll need to, you know, how many surgery days you’ll need to have.
So I think it starts from the leads and being able to engagement upstream, what is that going to look like? How many of those leads are going to become patients, then how many of those patients are going to become surgeries? Because then once you know, how many surgeries and you know, how many post-ops, you’re gonna see on average, and then you can build the clinic schedule out that way.
So I think it’s been really helpful for us to now have this lead management software. So that’s really allowed. To kind of see what’s coming in the future. Cause if you see a Leeds plummet, okay, well, that’s interesting. Why is that happening? You can ask a lot of questions there, but it helps you allocate resources appropriately by focusing on.
So now
you’re getting into something that I don’t think a lot of your rank and file our doctors talk about, which are leads. And what does that mean and how do you, what are you tracking and what, what mechanism and what does that do for your practice in the first place? I mean, you just talked about. You got these people, who’ve got an eye problem.
They know they’ve got an eye problem, but yet they’re not scheduling surgery. So how does all this fit together to make you have a well-oiled machine, so to speak?
Yeah, I think, you know, one thing it’s important to understand, like our practice is a, is a surgical practice and like a referral center. So in our case, We’re constantly getting new patients all the time.
We’re not a practice. Who’s seeing a patient every year for their annual eye exam because we think the optometrists in the community should be doing that. But I think there’s a lot of lessons that you can learn from kind of this kind of system in your own practice. Because I think about this all the time, because like, if, if we look at let’s take a cataract patient versus a Lasix.
Uh, cataract patient has a, there’s a higher percent engagement chance that if you get a lead, meaning that somebody has filled out, you know, a Facebook ad or a Google ad, or maybe they’ve just gone to our website and they filled out, um, a LASIK self test or cataract quiz, like when we’re, when anybody is filling out any of that information, we get them in as a lead.
And the question is, can we take that lead and book them for another. Now you think of the cataract, for example, cataract patient, when we see these patients, right. And they’re usually referred in by doctors, right? A lot of optometrists in the community, PCPs retina doctors, when we’re getting these leads in, it’s going into right now, we use Salesforce for that.
But basically there’s a, you’ll, you’ll see this as a CRM often referred to, and the question is really like, can you get that patient to book them for a, for a consult. Now cataracts have a higher percent chance of converting for a patient because they have a problem. LASIK patients have less likelihood to come in and on top of all of this, the Harvard business review, they they’ve, um, they’ve actually done some research on this, looking at leads over a three-year period.
And I think it was like 15,000 leads and the, some of this information is shocking. Like number one, you want to call somebody within five minutes of getting that. Five minutes, five minutes. Cause if you wait from five minutes to 10 minutes, it decreases by 400% chance that you’re going to call that lead and get them in for an appointment.
That’s somebody. It’s. So do you have systems in place to let your team know that, like we just got an, a lead, like, are there sirens and alarm bells going off? Like we need to call this patient right away. Cause that’s when you have the peak interest of the patient or are they going to forget about it a week later and get sucked into the busy-ness supply and then, oh yeah, I need to go do that, but I’ll do that later because I got this and this and this and this and this to take care of.
And so with the, with our lead management software, we have the ability to track. And, and track like, are we calling them the amount of time that we need to, are they converting? Is there a certain person that’s on the phone? That’s like saying maybe something that is causing patients not to come in for their consultation.
Let’s go look at that because we have our phone system tied into that. So you can look at the call summary for the, for the, um, our engagement center team. That’s calling out on those. And so I really think, you know, one thing that. Good. Keep in mind in this. Cause it, you know, I don’t know that necessarily all doctors are running Facebook ads or Google ads.
Um, but if you are, and you should have a system to be able to track that and are they converting? Cause the other thing is you’ll be able to see like who’s actually, who’s actually becoming a. Right. Are you paying all this money to get all these names, but then none of them come over as patient. Right? I always just find that interesting.
Cause they always give you reports. Something like cost per click. And it’s like, I want to know what’s the cost per patient or what’s the cost per surgery patient. And I, I think that you can translate this over in, like, let’s say we’re talking about a doctor who does a lot of routine eye care and they’re seeing these patients, you’re out, you’re out, you’re out over and over again.
If somebody doesn’t have a problem, what’s the percent chance that one year later, like almost exactly one year later, they’ll come back in for an annual eye exam. Can we
just for the heck of it? Yeah. I’m going to guess somewhere around 10%.
Okay. Well, I’ll just tell you that we, in this Harvard business review, it basically says that you need to call all of your leads six times.
Right. Persistence pays off. And I just think about that. Like, if we’re trying to get people in, like I’m going to transplant myself into primary care. I would be calling these people six times to try to get them in because there’s data that shows that it pays off or do we just call them or send them texts one time and then just say like, oh, I hope they come in for their annual eye exam.
I think it’s really interesting when we start dealing with leads and the type of leads that you’re getting, because, you know, you might not be getting them from, you know, Facebook or Instagram or YouTube or whatever source or PCPs. But you have a whole patient population. If your database that you saw a year ago and they should be treated as leads.
And one year later, if you’re going to bring them in for examine how you treat those patients. I
mean, so as I’m sitting here, you’re talking, I don’t live in a small town. It’s about 25,000 people, you know? And I can’t tell you how many people come up to me. At a grocery store or something, a Publix and go, oh, wow, Ted, Hey man.
I’ve just been thinking I need to come in and get my eyes examined. You know? And I I’m, you know, when I say, yeah, I’m still there and not once. I mean, okay. I do occasionally, but you’re, you’re basically compelling me now to just rip my cell phone out of my pocket right there and call my office Saturday afternoon and say, You know, Bobby just saw me at the grocery store and he says he needs to get an eye examination.
Can you please call him on Monday and get that set up right in front of them. So that way they know, I mean business and they know it’s important to me that they come in, but on top of the. That there’s some sort of mechanism in place that that’s going to take place. Now, the next step is, of course, if I do that in front of them, then that gum at somebody by recalling them on Monday morning, because you know now, but I mean, you know, you started talking about a CRM, which is a customer relations management system.
It’s literally something as simple as what I just went through. I mean, you know, you don’t have to. Yeah, a subscription to Salesforce or whatever else is out there. You can do this on a spreadsheet. You can do this on all sorts of ways. So how did you guys get started with a CRM and, and what were the, um, sort of mutations that went through to get you to where you are?
Yeah. I mean that, that we could probably talk for two hours about that, but I’ll definitely cut it down. We started with an Excel document. So all of our leads came into an Excel document. So you put them in the Excel document, what type of appointment they’re requesting and then, you know, their phone number.
So I think you could start with an Excel document really easily. Patient’s name their, uh, phone number, date of birth, and what type of appointment you want to bring them back in. But one of the things that the problems with the Excel sheet. There, even though there was a spot for, like, for you to say, like, did you call the patient?
I couldn’t confirm that that was actually happening. And for me, I was like, I want to be able to see that because there was a point in time where we had doctors saying I’m referring these patients and like, nobody’s getting called. Like, it looks like they’re being called and somebody was just putting that they were calling and they weren’t.
And so that started happening. I know, shocking. Right. Um, I was like, you know what or so, so we went this. We initially thought about creating our own CRM. Like let’s just create this. And we had somebody on our it team kind of contracted out that said, I think I can create this no problem. And we tried to go down that path and very early on, it was like, this is not going to get us to where we want to get to in the amount of time that we want to get into it.
So we said, you know what, we’re just gonna, we’re going to invest in Salesforce. And I, I probably spent a whole year of my own time, probably like 85% of my one-year, uh, Getting Salesforce configured, like everything that we would want to get it set up for. And I don’t think that you need to get there. I feel like if somebody is listening, they’re like, wow, I definitely don’t have the time to do that.
You can start very easily with, for example, lead management. I think actually, if you were to get Salesforce honestly in and just use it for lead management only, I don’t think it would be that bad. Like I don’t think it would be that expensive and it’s not that hard to get set up with regards to, with regards to just calling somebody six times.
Figuring out your T and supported to do that. Um, but whether you do Salesforce or you do an Excel sheet, as long as you have somebody who’s doing it, I think an Excel sheet is probably the first way to start, but if you want it to have somebody and make sure that there’s accountability, well, then, you know, we like Salesforce, but there’s others that are out there like that.
And
now I’m presuming just from the discussion we’ve had today, 90% of your guests are first time and one and done type. When I say one and done, I mean, once the procedure’s over, they’re going back to their primary care doc, but I’ve got to understand that probably there is a 10%. That sticks around and does stuff with you guys because it’s necessary.
So do you use your lead management system to, to maintain that 10% as well? And how do you use that system?
Yeah, I think that with the, with the people that are key that are continuing to come back, there’s different ways that we’ve had it set up to where let’s say, for example, you have a dry patient that you want to do.
To your care level flow on and they decide at whatever reason, they do not want to book it. At that time, you can create tasks in there to say like, Hey, follow up with this person in 10 days or in two weeks or two months or three months to ask them about this procedure. So there’s different ways that you can mark their statuses so that, you know, Hey, look, I need to call all these people who have, you know, came in for dry, evil, but have not done this dry eye treatment.
So that. Don’t lose these patients to follow up. Like you’ve paid to get them as a lead and as a patient, like no need to waste this patient who in your office. So there are ways that we have this set up, uh, whether it be dry treatments or LASIK or cataract surgeries that we can follow up on these leads that we’ve.
Um, hoping to get him on the podcast. And if he happens to be listening, there’s a doctor named Bavesh Patel, who is a, um, he really more of an endocrinologist up in Chicago. And I know him through business accelerator and he uses his lead management system, which I thought was really unique. Very similar to what you were talking about in that if he’s got somebody who’s come in for a say, like, Thyroid disorder.
He, first of all, starts them off with the process of bringing them into the practice and, you know, getting them introduced through the lead management. And then after he’s had that initial consultation with them, he puts them into another funnel of the lead management system. Hey, uh, you know, we talked about these particular medications and I think it’s really important that you, you said you want to think about it, so how’s that going?
And it sorta just tickles them with a email or something like that, and then they either respond or don’t when that response doesn’t come back. Another email goes out, or maybe it’s a text message or maybe it’s a phone call or something like that. Then once they get them into the treatment system, he literally says, you know, these new medications, we start on, how’s that going for?
You? You have any kind of side effects and what kind of results are you getting? He wants to get that kind of information from him. And as he’s telling me this, and he and I are sitting there talking and I’m going, oh my God, Like every glaucoma patient I’ve got should be in this every dry eye patient I’ve got should be in this.
Every you name, it should be in something like this. Now this was six months ago and I’m still just talking about it. So I’m going to put myself out there on the air. That really puts a lot of pressure on me to actually implement this now. But, but the fact is it would, it would transform our practices where we would be way more effective, way more profitable and in the better way, not just because it’s just money for money.
We’d have really happy people that we were taken care of by doing these kind of things.
Yeah. The, the, I think for me, I’m just a big believer on like education, like education is the key. So the question. How do we get these patients educated as much as possible before they come in and then before they come in the next time and before they come in the next time.
And so there are, and that’s kind of what I talked about is like, one of the reasons why we went with Salesforce is I just want us to be an elite organization and we’re not necessarily competing with other doctors in San Antonio, but like competing with the best organizations that are. You know, so for example, if you sign up for Netflix, you get an email right away.
And then, you know, if you sign up for what, you know, whatever golf.com they’re sending you emails about, this is how to fix your swing, you know, and a month later it’s like, did he fix your swing? You want to focus on your pudding. Here’s how to do that. And it’s really cool within Salesforce or any CRM.
Cause, cause we looked at others that are out there too as well. But if you have, you know, Uh, cataract patient who has not booked, or if you have a dry eye patient who has not booked any kind of thing that you wanted them to, you can put them in funnels that tickles them, like day one, you get this email and day three, you get this email on day 14, you get this one in month two, you get, look, Hey, here’s a new treatment.
Uh, and I think that’s, that’s really where the opportunity lies is to get these patients who have come in to see. That, you know, we know not every patient continues to come back to see us, but how do we rescue them to bring them back in? And I think if we’re educating them, if we’re providing them value and these systems will allow us to add value to them, then they’re going to value us and they’re going to continue to come back and see us.
Okay. So
you’ve sent them 700 emails prestigious, right? Yeah. How do you, how do you know what’s being effective? Um, I mean, One of the things I’m presuming is if they’re not unsubscribing, even if they’re not even opening it. Yeah. You’re still in front of them.
The, and I’m trying to keep this as, um, big picture as possible because like, honestly, if you’re willing to pay for this, like it’s definitely available.
You can set people off on journeys. Like if you open the email, do this, and if you, uh, respond to this text message, then send them this email. And if they don’t respond to this text message, send them this email. And then the other thing that can happen is you, you can rate patients. So like if they click on this email, they get a certain amount of points.
And if they respond to. Text message. They get a certain amount of points that they watched this video, they get a certain amount of points and you can see where they are on how active they are in their journey versus how not active they are. And we haven’t gotten to that level yet. I know it’s available.
We’re just trying to set up the infrastructure on being able to send out the emails and text messages, but that is for sure coming. So hopefully when we text next time or talk next time, we’ll we’ll have that. But yeah, there definitely are systems for you to be able to. Check in with the dry eye patients who have clicked on every single thing that you’ve sent them, it’d be like, Hey, how’s it going?
I saw you clicked on this. I know this happens because when we were looking at EMR, I clicked into this one, um, EMR email that they sent me and watched a certain video. And she called me like within five minutes after watching that video and I’m like, oh, they’re doing the same thing. This is, this is great.
This is.
That’s amazing. Um, and I, and, uh, I’m gonna say more about this in a moment. All of these things that Bobby’s talking about. Um, he’s covering a lot of this at CECO, this coming year in new Orleans, which I want to, we’ll hit a little bit of that in just a minute, but I want to really dig into something else, which is the area that I’m going to step out on alleged for, which is more on the treatment side of things.
Um, yeah. You recently posted a short article in Helio about dry eye flares and how that is affecting our patients basically sort of synopsize it as best I can. That’s not a word I just made up. Basically it’s, you’ve got this patient, you’ve been doing a great job taking care of them and suddenly, boom, they are in trouble.
They’re they’re in pain and it just, everything seemed like it was going so well. They spent almost a thousand dollars on all of these different treatments and now suddenly they’re not happy anymore. What do you do now? So take us through that kind of journey of what that’s like for them.
Yeah. I think, you know, one thing is, you know, so we, we have a drive.
This is one of the things we started when I first got here to San Antonio, it was like a dry ice center. And it was mainly just because there was nobody who was really doing dry. In San Antonio that I was aware of. And I just wanted to be a resource again for the community. You know, like it’s something that I learned in my training.
I can share, I can help these patients out. But one of the things that I saw that was very interesting is that there were patients who had had treatments, let’s say with another provider and they were doing really, really, really well. And then boom, they would hit a flare and they would come in to see us.
And so I think one thing just to be aware of is like the dry eye that we see is mostly referred in dry eye either by the patient themselves. Like I’ve tried everything I need to come in or the doctor’s like, I’ve tried everything, let me send them in. And so we’re definitely skewed towards this, like advanced.
Patient population train. Right. And one thing what’s that train wrecks. Yeah. Yeah. And actually they were just talking about that and they were like, yeah, but the tri workups just take, so, yeah, because they’ve had a lot of things anyways, so, but one thing that like, you know, with, with regards to that, I think the flare education that’s really come out, um, in the past, you know, 12 to 18.
That that talks about, you know, what percentage of our patients have flares. It was this really interesting question. Cause I started thinking like, okay, well, huh, okay. In my practice, what percentage of patients have flares? I don’t know, 20, 20, 20, 20% maybe. Uh, and it was really interesting going into clinic that week.
And we had a patient who was referred in and she was like, she had been doing really, really well. And, but, but when she came in, she was like, I just, this is not going well for me. I don’t even know how much longer I could live like this. And I was kinda like, oh, wow, those are very strong words. We need to help her as much as we can.
Um, and at the time we put her on that’s when I stupid, had just come out and we put her on that, just that’s all we added was a steroid drop to her for like two weeks. And then she came back and kind of had this mentality of like, I can’t remember why I was here. Like, why did my doctor send me over. And I just thought it was so fascinating because it was like, Hey, she had a flare.
We helped her with her flare and now she’s, she’s doing good. And she’s, she’s back with her doc. But it was like seeing that one patient, I thought it was really interesting because then we, you know, we see these patients and they’re like doing really well. They had a procedure done and they’re doing well, and they’re just here because now they have symptoms.
Right. But, but they think like I spent a thousand dollars or $2,000. I spent so much money on all this stuff and like I was doing well and now I have. Oh, I knew my doctor. I had, he probably didn’t know what he was doing. I need to go see somebody else for a second opinion. Yeah. And what I wrote in that article was I just think that flares are leading to a lot of second opinions with dry eye patients, where really, I think if we educate them ahead of time, Hey, look, we’re going to do these treatments and we’re going to do these procedures.
And even despite doing this right, there is a chance that you’re going to have any flare because this is an inflammatory condition. And just like asthma, just like we’re more familiar with uveitis or allergic conjunctivitis, like with any of the Ms. Like any of these conditions, there are flares, right?
Dry is no different. So even us doing this, there’s going to probably be a point in time where you’re going to have a flare here. Oh, man. I feel like I’ve regressed and that’s okay. Because now we have something that can treat that and we understand it more. And I think it’s all about setting expectations, especially being in a surgical practice expectations all day long is what we got to be talking to our patients about.
And if you set the expectations and then go through that, they’re like, okay, this is an expectation versus, you know, if they do the procedure and they have it, you know, a month or two later, they think it was a complication. And I knew I shouldn’t have spent that money because now I’m feeling the same thing that I did before.
Um, so it’s been. I think that
expectation is the thing that gives us into so much trouble with dry eye anyway, because you know, let’s face it, the majority of what we aim to do with dry as well here, here’s a handful of hydrops try these, this will take care of your problem. And none of them work. And then now they say, well, okay, I just can’t be fixed.
Or maybe it’s some other type of thing. But if you start off with, you know, it took you 40 years to get to this point. It might not get better in a week. We’re gonna, we’re gonna work on some things. I gotta be honest with you. It’s a process. I’m going to try this and it might fail. And if it does, we’re going to try something else.
And if that fails, we’re going to try something else we’re going to keep on until we figure this out. And if I, for some reason, can’t figure it out. I’ve got people that I work with regularly and they can help me figure this out because that’s really the ultimate goal here is to get you to happy life and not like you said, I don’t know how much longer I can live with.
Yeah. Yeah. I think one of the things that with dry patients. You know, one of the questions I asked them, like on a scale of one to 10, 10 being the worst dry ever possible, where are you at today? You know, I feel like my level is usually seven to 10 is what we see in our clinic. And, you know, it’s kind of interesting.
Cause then I’ll ask them like 20 years ago, if I’m seeing a 60 year old female it’s like 20 years ago or where are you? And then they say, you know, uh, 20 years ago I was at a zero. I didn’t have this at all. Okay. So I draw out a line and I’m like, okay, over these 20 years, you’ve gone from zero to seven.
Okay. Can you imagine what the next 20 years are going to look. And they kind of like, look at me, like, what are you trying to say here? And I tell them like, you know, look, our goal is, if you’re at a seven right now and we get you to a six and we can keep you there for the next 20 years, you know, in 20 years we’re gonna be doing high-fives and car wheels.
Okay. So our goal, like we can’t solve, you know, 20 years of 60 years of dry eye or 20 years, whatever the number is, you know, in a few weeks. But what we’re gonna do is we’re going to do everything we can to maximize like your, how you’re feeling. That’s not going to be going from a seven to it. Okay, but that is, we’re going to do everything we can to get you better.
And then we’re going to try to just keep you there. So if you come back every three months or six months and say like, nothing’s changed once we get you feeling a little better. That’s great. Awesome. What we do not want is for this to get worse. And I feel like setting expectations there too has been really good.
What a
way better way to explain it than to just here’s a bunch of hydrops. See how this works for you. I mean, you know, again, and I’ve, and I was guilty of that at some point in my career. I, I openly admit that to a whole bunch of people right now. And I know there’s a lot of people who are still doing that.
Heck I catch myself doing every now and then still. Um, but
we’re big believers on words. You know, like, you know, we’re, we’re going to do the cataract surgery. We’re gonna put a scalpel, like instead of incision, we use opening, I mean, words like constantly thinking about how can we get better with our words.
That’s great. So in the last little bit, I want you to talk about some of the new frontiers in surgical intervention for whatever level it needs to be, or, or higher level treatments, um, you know, on corneal cross-linking, those kinds of things. Just give us sort of a brief overview of what you guys seeing, coming
down the pipe, you know, with regards to cross-linking it’s like, thankfully, now we have an FDA approved procedure, which is epi-off cross-linking, but I think a lot of people.
R I think still we’ve done a lot of webinars on keratoconus. And I think still there are many doctors who don’t know that there’s an FDA approved option for keratoconus patients and, you know, Talk about this at CECO. And we try to talk about this as much as we can, but really it’s, the optometrists definitely has a role in all of these anterior segment surgeries.
So whether you’re talking about cross-linking, which has a zero day global period, which means that a much risk can be involved in the post-op period. And we probably shouldn’t even call it post-op we should call it a follow-up period because you have the ability to build nine, nine and nine two codes for these patients.
We know that in keratoconus, these patients, we really just need to treat them more like glaucoma. Right. And we’re following them for progression. And I think that too, oftentimes with keratoconus, we start thinking like we got their vision better. Great. And then we just play that game every year. Versus if in the very beginning we could document progression and get them cross-linked and get their cornea strong.
Then these patients are going to live much happier lives later on. Cause we know keratoconus progresses. So I think if we talk about that, you know, and what’s coming down the pipeline, I think epithelial on cross-linking we’re still two to three years away from that. So I think right now, Keratoconus.
It’s just understanding, Hey, cross-linking came out five years ago, the insurance coverage is better and you can totally be involved in that is on the keratoconus free keratoconus front with regards to refractive surgery. We’re really close to the launch of the Evo ICL. The ICLs, the implantable calmer lens.
Uh, I would say when I’m talking, usually given the surgical talk, I probably get the most questions on the ICL. Uh, cause many people also don’t know that’s the thing. Uh, the ICL is used from minus three doctors in myopia to minus 16 doctors in myopia with four doctors of astigmatism correction. So if you have a patient who’s a minus 12.
For access 180, they could actually have surgery, right? It’s not LASIK. It’s the ICL. It’s a lens that goes just beneath the surface of the eye. And the new one that’s about to come out has actually a finished station in the middle of it. So it’s going to have a lens with a circle right in the middle of it that allows aqueous to flow through it.
It’s the lens used everywhere outside of the U S except for the U S and I think that is going to be a, I think that’s going to, I think a lot more doctors will know about the ICL because there’s going to be a lot more patients getting ICLs. And again, we’re going to need optometrists to be able to co-manage the ICL.
And, and on that front, we’re also going to need to know about this kind of stuff. So when we can talk about this, because I promise you, our guests are going to know about it before they get to our chair, uh, it is, there is no longer this. You get to explain stuff to them for the first time anymore. It just doesn’t happen anymore.
Yeah. So, you know, the ICL, it’s a lens place just beneath the surface of the eye. Again, it’s only used for myopia and myopic astigmatism. So not for hyperopia, but these patients, I think who come in, especially, I mean, key map you’re you’re minus fourteens or minus fourteens, minus twos, access 180 or whatever it is, you know, that are having difficulty finding contact lenses even to fit their.
Uh, there are definitely going to come in or anybody who has thin corneas or anybody who has a goofy topography, you can do the ICL procedure on, um, as well. So I think that we’ll see a lot more education on this and we’ll see a lot more patients coming in and requesting it to as well.
That’s great. So, um, as we kinda wrap up here, what would you want to make sure that before we walk away that our audience.
Here’s you say, this is, this is the big take home message for, for Bobby sands. Hmm.
I would, um, I would just encourage everybody to keep learning. I know that’s simple, but I think that all of these things that I’ve done maybe over the past five years has really just been going out and reading and learning and putting some extra work in outside the business hours to learn.
Whatever system it was. And to be able to make a decision, then go big impact. A lot of people like you can totally do this. I feel like too often times maybe you’re listening to somebody and it sounds just too complicated. And I would just suggest, like, if, if you can’t learn it on your own, find somebody who has done what you’ve done, like what you’re wanting to do and just ask them for help.
Like, I wouldn’t be where I am today without the people that have really impacted me. And it wasn’t them like spoon-feeding everything to me, but they helped set, set me in the right direction. Then I was able to go out and learn these things and then be able to impact. You know, an organization like this.
So I would just say you’re totally capable of doing it. So even though maybe this text message, email thing sounds hard, or maybe this lead management system sounds hard, like there are ways that you can, uh, either technology that you can invest in that simplifies the process, um, or maybe, you know, after CECO, you’ll learn more about like, Personality testing any of this stuff, you can learn it.
And it’s, I think it’s a lot of fun because if you can impact, you know, if you can impact the lives of others, whether that be your staff or patients, like that’s ultimately why we’re doing what we’re doing.
Okay. I got one second. Last question. All right. So you’re, um, your, all this stuff, you just talked about some amazing, but does that just happen or are you literally scheduling time to do those kinds
of.
Yeah. Yeah. Like that’s a good point. If the whirlwind, right. The whirlwind, if the hairball, there you go. If you are not, if you do not have time set aside for that, you know, you’re not going to be able to do it. So I think that, you know, one thing I’ve done is just, you know, when we have two daughters and my wife, you know, when they go to sleep, like that’s my time before.
Um, but you know, other people, it might be in the morning, so yeah, I’m definitely a big fan of actually scheduling time. It’s take, for example, something like, we have been wanting to schedule time with our team leads, and we’ve said that over the past, like six months and like finally now we’re like, okay, we’re putting time on the schedule, like this has to happen.
And so I think if you do not put time on the schedule, then it will, this you’ll get sucked into the whirlwind or the hairball, and you’ll just continue to do the things you’re doing. So if you want to do it, you got to make time to do it. That’s
the, uh, couldn’t have said it better myself. I’m glad you put it that way.
Uh, Bobby’s saying it’s very happy to have you here with us. Um, this will not be the last time you’re going to be on this show. I guarantee it, uh, just as a plug again, he’s going to be speaking multiple, multiple times at CECO, uh, in new Orleans, come to new Orleans, grab yourself some and I have a big time where this Bobby can’t wait to see you there.
Thank you.
All right. My
pleasure.
That was great. That was amazing. That was fantastic. That’s the most fun I’ve had in about three weeks, cause like every three weeks.
Cool. Yeah. Um, so, uh, how much time do you have left, where you gotta rush back in and go do something else?
I mean, clinic has going right now though. They’ll come grab me if they, uh, if they.
Well, Hey, go grab yourself something to eat, maybe a catch, a couple quick cat nap and, and, uh, enjoy your day. Thank you.