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I have often promoted the benefits of using assistants to maximize productivity and to eliminate some of the tasks often delegated to the business owner who is also usually a service provider. I know some of you may think that using an assistant probably isn’t realistic for you. Let me try to convince you otherwise. More than half of all states allow for the use of an audiology assistant. Go to https://www.asha.org/advocacy/state/ and check out the specifics of your state licensure law. If you are an audiologist and your state won’t allow the use of an assistant, consider partnering with a hearing instrument specialist (HIS). HIS and audiologists work side by side in 25% of hearing healthcare practices today.

Think of the things you do each day that don’t require your education and expertise. A patient walks in while you are testing a new patient and is having difficulty pairing their phone to their aids. What do you do? Stop and help? I hope not since the scheduled new patient won’t be too happy about waiting. Or, a long time patient stops in because their hearing aid isn’t working. You evaluate the aid and find out it’s just a blocked wax guard. Do YOU really need to handle wax guards or can you train someone with lesser expertise to handle such a simple task? Consider the many tasks involved in fitting a patient who is getting hearing aids for the first time. Think of the time involved for orientation, performing outcome measures, pairing to a smart phone and perhaps teaching the patient how to use their new accessories. Unfortunately, many people skip the outcome measures which can be a critical error in the patient gaining the greatest benefit from their technology.

Wouldn’t it be nice to shorten that time for the fitting in half and let an assistant do the orienting, pairing and explaining the accessory? Think how much more productive you could be if you didn’t have to do Everything. The concept of using assistants has been endorsed by every professional organization for the past forty years. I have used assistants in my practice for over thirty years and they have been instrumental in my success and are a big part of patient satisfaction.

Sometimes, change is necessary. I hear colleagues sharing how overwhelmed they are seeing patients and trying to run the business. One actually shared that she didn’t have time to pay her bills. Yikes!! Don’t fight it! Embrace the concept of using an assistant to complete the tasks that don’t require your time and spend your time generating revenue and solving the big problems.

Employee retention seems to be an especially hot  topic since the pandemic.  According to the Harvard Business Review, 57% of workers are open to looking for a new job and their studies contend that only 32% of employees are satisfied with their current position.  Let’s face it, the post-pandemic workplace faces new challenges but we need to figure them out because constantly hiring and training new employees is expensive, time consuming and can put strain on business.

Effective employee retention can save an organization from productivity losses. High-retention workplaces tend to employ more engaged workers who, in turn, get more done. Engaged employees are more likely to improve customer relationships, and teams that have had time to coalesce also tend to be more productive.

I have read that 80% of turnover can be attributed to bad hiring decisions. With those numbers in mind, every potential new employee should be screened to determine if they are really an appropriate candidate for the job.  A bad hire is truly worse than waiting to fill a position because it is difficult to eliminate one’s position, not to mention the disruption created by training a new employee.   Tackling turnover by modifying your candidate screening process represents an enormous opportunity for any business regardless of size. There are many screening tools on the internet.  We use the PXT Assessment (https://www.pxtselect.com/Home.aspx) and it has been very helpful in hiring the right employees. 

Once a qualified candidate has been hired, what is the best way to retain them?  I would start by paying above average salaries and offering a good benefit program.  I managed a high employee retention and I always thought it was due to the compensation plan, but that strategy doesn’t seem to work as well in 2022.  Employees are more interested in additional paid time off and flexibility in work hours – not as easy to do when you are running a practice and accommodating patients schedules but it can be done.

Make sure you are letting employees know that you appreciate them and show interest in their families and their personal lives.  I have some of my Mother in me and tend to notice the mistakes more than the successes. This practice can kill motivation and job satisfaction. I’ve read that most employees would rather get a word of praise than a raise.  Bottom line – little things matter.  

We have morning team meetings to discuss the plan for the day and also to highlight unique or important patients and to discuss where we are in reaching our goals.  Employees like to feel like a member of a team and that their contribution is important. Encourage input and feedback from everyone. 

Offer the opportunity to grow.  Employees do not want to feel like they are “stuck in a rut” or like they are at a dead end with the company.  Show your employees that you trust them by giving them responsibilities that allow them to grow. Provide ample continuing education opportunities. Hire from within wherever possible, and give generous promotions at appropriate times.

Employees are not mind readers and sometimes have no idea what an employer expects of them so provide very specific job descriptions and meet with each employee at least once a quarter to discuss job performance. 

Improving employee retention is a big step towards increasing the profitability of a practice and can make life much easier and less chaotic for the business manager or owner. 

Number 1 – Forget About Competing with TCPs and OTCs

Hearing aid sales in Big Box stores like Costco and WalMart are here to stay! While the hearing aid market isn’t growing very rapidly, the share that Big Box stores have is the fastest growing segment of the hearing aid market. The Hearing Review estimated that Costco’s US market share to be around 11% of total sales, with the retailer’s year-on-year unit growth increasing at an estimated 20-25%.  I don’t know about you, but I would do cartwheels if my practice experienced that kind of growth! What’s even worse is that Big Box retailers don’t have to invest money getting prospects for hearing aids because each store has thousands of prospects coming every day that are exposed to their hearing aid department.  

So with the Big Box piece of the hearing aid market growing so fast and with TPCs taking away market share, how is a private practitioner supposed to compete?  The truth is there is NO WAY that an average practice can compete with BigBox and TPC pricing.  I don’t care which buying group you belong to or what manufacturer you work with, it’s impossible to maintain a profitable practice and be able to sell hearing aids at these low low prices.  Big Box and TPC, devices often sell for less than hearing healthcare professionals pay for similar products.  I estimate that an average practice would need to see three times as many patients as they currently see to make up for the reduced margins. Where will those additional patients come from?  It’s already incredibly expensive ($300-500 per patient or more) to attract a new patient via traditional marketing. Few practices can afford to spend three times more on marketing efforts with the hope of gaining a small number of new patients.

Perhaps the answer is not in waging a price war, but in creating a practice that focuses on the providing the very Best in Hearing Healthcare.  Not everyone wants Cheap when it comes to their hearing healthcare. There are patients that are willing to pay for quality care – our expertise, an amazing experience, over the top service and a commitment to 100% patient satisfaction.  A top quality practice and professional is still attractive to consumers who want “The Best” and we shouldn’t give up and try to compete with low priced competitors on their level.  We need to Add Value to every patient encounter.  For instance, if a person comes in and has a bundled service plan do you say, “It’s Free Today,” or… “The normal cost for this service is $95 but you won’t have to pay that fee today because you have a bundled service plan with us. There is a strong relationship between excellence in hearing healthcare, benefit, and improvement in quality of life derived from better hearing. Benefits always outweigh price in this industry, so instead of lowering prices, perhaps the focus should be on adhering to a protocol consisting of a comprehensive test battery including measures of loudness discomfort and speech-in-noise testing and in depth real-ear measurements to ensure that patients are getting optimal benefit from their hearing aids. Price is what you pay but value is what you get! 

At the conclusion of 2021, I found myself absorbed in the painful but necessary process of analyzing year end data trying to assess the health of the business.   While the numbers were better than the previous year, they weren’t what I would have liked. Hoping to uncover some hidden revenues, I wondered how I could increase the profitability of this business. Business experts contend there are in fact only four ways to increase the profitability of a business: 

• Increase the number of customers
• Reduce expenses
• Increase the average sale per customer
• Increase the frequency of sales per customer

While completing my AuD degree, I conducted a time study of the types of activities audiologists in various types of practice settings perform on a daily basis. Data revealed the audiologists spent more than one third, and probably closer to one half, of their work days performing minor, time consuming tasks that could have been performed by lesser qualified individuals.  It would seem that delegating those tasks to support personnel would allow professionals to see more patients; potentially generating more revenue, which logically could lead to an increase in profitability. Most other medical and allied health professions have well developed technician positions – physicians, nurses, optometrists, physical therapists, occupational therapists, dentists, veterinarians. Just imagine how many more patients you could see if you didn’t have to clean hearing aids, complete order and repair forms, set up testing procedures, troubleshoot equipment, teach patients how to clean, insert and remove hearing aids. Not to mention demonstrating how to use remote controls, wireless accessories, t-coils, rehab programs, loop systems and other assistive devices.   With this type of assistance, the professional can spend more time providing patients with vitally needed services such as family counseling, outlining realistic expectations, performing speech in noise testing, or assessing central processing function.  

The use of support personnel in hearing healthcare practices is still considered by some to be controversial despite the fact that the concept has been endorsed by every professional hearing healthcare organization for the past forty years! With the burgeoning need for hearing healthcare services and a potential shortage of qualified professionals, the best way to increase productivity and profitability of a business may be to hire support personnel.  I have heard rumblings from colleagues that their state license will not allow them to use support personnel.  In fact, I have found just the opposite to be true.  

I was forced to add support personnel to my practice many years ago. The steady growth of the practice and the lack of audiologists in the small community in which my business is located necessitated the need to hire support personnel to perform tasks that did not require the education and expertise of an audiologist. However, as the practice continued to grow, it became evident that the use of support personnel improved productivity, service accessibility, quality of patient care, and patient satisfaction.  

While the concept of using support personnel is not widespread, a review of practices today indicate support personnel are being used successfully in a variety of practice settings including the military, the VA, educational institutions, hospitals, industrial settings, and private practices. In fact, using support personnel can provide valuable assistance to professionals by increasing patient contact hours, reducing wait time and improving patient satisfaction.

The hearing healthcare professional must maintain the clinical authority and legal responsibility over the support personnel and is morally responsible for these individuals.  The hearing healthcare professional must also  ensure that good quality of patient care is maintained.  Adequate and continual training is also essential.

Examples of the types of services an assistant can perform after appropriate training and demonstration of competency include: 

Many business experts report that Lack of Funds is the #1 reason for small business failure. When I review many years of business, I have to concur that my biggest stresses have been when cash flow dried up.  Nothing worse than having more “month than money” or not having enough cash to pay myself.  I extremely dislike working and not getting paid.  These types of incidents are commonplace in the life of a business owner and sometimes timing creates the shortfalls but after the business is established (let’s say a year), there should be enough funds to pay bills and yourself – as long as the business is being run properly.

One of the biggest causes of lack of funds is that the owner or manager is not carefully reviewing the numbers. You need to know how much revenue the business needs to generate each month or each quarter to cover expenses and then you develop a plan of how you will generate the revenue.  I know most business owners have more than enough to do because they are seeing patients, managing employees, trying to run a business and more, but knowing how much the business needs to generate to be profitable and establishing prices that make that happen are ESSENTIAL for positive cash flow. In most cases that I have seen, the business owner doesn’t really know the cost of operating the business and they set their prices too low. Making changes to pricing without knowing costs is like jumping into a body of water without having any idea how deep it is.  Very risky!  It doesn’t matter how much revenue the business generates if there isn’t enough left at the end of the month to cover bills or to pay yourself.

If you are busy and only have time to track a couple things – have every professional track (what I call) their Help Rate. This ratio is determined by dividing the number of patients who purchased hearing aids by the total number of patients who were tested and needed hearing aids. Industry trends indicate that the typical Help Rate of a professional is less than 50%. Imagine what helping an additional 10-20% of patients improve their hearing will do for business, not to mention helping improve more patient’s quality of life.  If you want an easy way to improve profitability, start tracking Help Rate and then commit to improving it. Most office management software makes it easy to track opportunities. 

Another important number to track if you dispense hearing aids is Cost of Goods Sold. This number shouldn’t be based on what you feel is appropriate or what your competitors charge, it should be based on what on your costs and the cost of operating your business. Business metrics would suggest that cost of goods sold (and don’t include what you are paying towards a loan if you have a supply agreement) should be 35% or less of total gross revenue.  

If financial anxiety is weighing on you, start by identifying the specific issues keeping you up at night. Whether the problem is credit card debt or upcoming bill payments, pinpointing where the problems lie is the first step towards improving cash flow and profitability. 

I recently had to face a situation that I had hoped I would never have to face again. In late 2008, after a big expansion at my office and the subsequent crash of the stock market, I found myself with a large payroll, bills to pay and NO CASH. I recall shedding some tears and sharing with my husband that I had no clue what I was going to do. He looked at me with that very unemotional gaze, and calmly responded, “You know exactly what you need to do.” He was right. I knew what I needed to do, but it wasn’t what I wanted to do.

If you have ever been in that situation you understand that very painful feeling of having to do what is right for the business even though that isn’t what you really want to do. Fast forward almost 12 years to today, and unfortunately, while I worked hard to minimize debt and to accumulate a healthy cash flow since that time in 2008, I found myself in the very uncomfortable position of determining what I would have to do in my business if this pandemic lasts much longer. The Corona Virus and consequent shut down of America made me realize I may have to again make some tough business decisions. Since I have been through tough times in business before, I know that the answer was just the same as it was in 2008.

The answer is in the Numbers.

While times are very tough, the only way to monitor and guide a business is by analyzing and monitoring the numbers. You can’t guess how well the business is faring. You will know what you need to do and the decisions you will need to make to keep your business afloat when you dig into the numbers. As a business owner, I have become a numbers fanatic because looking at data is critical for making quick decisions and in this unprecedented time when the world has basically shut down, it is critical to make quick decisions that will insure the long term health of the business.

The first thing to look at is CASH. How much ready cash do you have on hand right now? I’m not talking accounts receivable because you don’t know when you will get that money. Payments may slow down and some insurance companies may delay payments because of a shortage of staff or whatever. I’m not talking about money you may get from loans or possible grants. Don’t count on money you don’t have. Deal with the Facts and that is the cash you have on hand right now.

The second thing to look at is what bills do you have on hand that have to be paid Now. Keep in mind some lenders, credit card companies, landlord, etc are willing to delay payment and give you terms. Try negotiating terms if you can. I would advise not to build up debt on high interest credit cards as those fees can bury you and the business.

After that analysis is completed, how much do you have left in Cash when you pay the bills that you have to pay NOW? What are your Fixed Expenses – expenses that occur each and every month that have to be paid. Examples of these may be utilities, car payments, mortgages or rent (again, try to negotiate terms if you can), insurance payments, etc. Look at the cash you have left after paying bills due now and how much do you have left to pay fixed expenses and determine how many months you can stay afloat.

Employee payroll isn’t a Fixed Expense. It’s a variable cost that is dependent on how long you will be able to cover the cost of employee wages with the cash you have on hand. At some point, you will run out of cash and you will have no choice but to furlough employees or to take a cut in salary yourself or borrow money. While loans and promises of funds from PPP are hope they are not cash in the bank. You have to deal with the facts – cash, bills due, fixed expense, etc.

Most of us, don’t always have a lot of time to really dig into the key financial numbers when we are busy working IN the business. Now is the time to work ON the business. I apologize if this blog is too elementary for some. While I am all about hope and know that we will come out of these times better, as a business owner, I have to deal with the facts and make business decisions based on these facts. These critical decisions are emotional but to maintain a healthy business that will live on into the future, the actions we take today can’t be based solely on emotion, they have to be based upon the financial facts of the business.

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