Author: ecadmin

Eyes Wide Open

Buying-Selling A Practice, Practice, Resources

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Two pressing issues have surfaced in recent discussions with clients—and they’re both very important and closely related. It’s like the two sides of a coin. Heads deals with impossible promises while the flip side, tails, involves managing expectations.

IMPOSSIBLE PROMISES

A client I’ve known for years called to say that he had been approached by a corporate entity to buy his practice. Later, he called me again for a second opinion to make sure he was doing the right thing. The investor buyer had promised to pay the highest price for the practice compared to any other private-sale offers or open-market sales brokered by any firm.

So, is this a legitimate and fully defensible claim? The first and key thing to remember is that if a practice does not go to open market, the price paid by the buyer will be the highest offer that the seller receives, simply because the seller is not accepting other offers. In that respect, this purchaser made a correct claim.

On the other hand, the buyer also suggested that his/her offer would be the highest of any offer—but if a practice does not go to open market, then this is an absurd claim because it cannot be validated. Why? The reason is also simple: if no other buyers are given the opportunity to make an offer, how can anyone prove that the first offer was the best? Impossible promise!

This type of behaviour is prevalent because there is a limited supply of good practices for sale. Corporate investors are very flexible and have a dedicated senior management team soliciting and focusing on practice acquisition. On the other hand, in the traditional health care practice marketplace, the buyers are mostly professionals who are raising families and practicing in various locations. Typically they do not have the time or resources to invest when searching for a practice to buy. These buyers rely upon brokers to introduce them to practice sales opportunities.

MANAGING EXPECTATIONS

On the flip side of today’s eye care practice sales market, it’s about juggling sellers’ expectations. In the normal course of appraising and selling a practice, many parties are consulted. Early on in the process, the seller should seek legal and accounting advice on sale structure and allocation of sale price as shares or assets. In today’s multilayered corporate structuring, we are still finding old management companies, technical service corporations and multiple health care professional corporations, as well as sole proprietorships. Each of these scenarios has different and unique tax implications and, in some cases, complex legal implications.

Vendors often tell us that they’ve consulted with their advisors, so we proceed to the market (and we often consult with advisors at this early stage). However, as we near the completion of an offer to purchase or closing date of a practice sale, sometimes advisors will realize that there may be some last-minute opportunities to affect tax savings for the benefit of the vendor. In many instances, there is no harm to the buyer and, in some cases, there’s actually a significant benefit to the buyer. But the serious dilemma with bringing these matters to light in the final days and hours, is that advisors on both sides start seeking to re-negotiate a contract or even re-enter a conditional period—perhaps when all other conditions have already been removed—and this puts a transaction in serious jeopardy.

Our advice to both buyers and sellers of any type of health care practice is to begin consultations and preparations of tax and legal matters a year in advance of a possible sale and, at the very least, prior to the preparation of the appraisal of the practice. Any delay in making this investigation or process happen with your tax and legal advisors will likely cause significant delays, high fees and could jeopardize the sale of your practice. In short, poorly managed expectations.

IT TAKES TWO SIDES

It is important to not be misguided by an impossible claim to sell a practice at the highest possible price. Be levelheaded. Adopt a well-conceived, balanced and careful plan when you’re in the process of buying or selling a practice. And save that coin for your pocket.

TIMOTHY BROWN

is Chief Executive Office of ROI Corporation Canada’s national professional practice and brokerage firm.

Jackie Joachim, COO ROI Corp

JACKIE JOACHIM

Jackie has 30 years of experience in the industry as a former banker and now the Chief Operating Officer of ROI Corporation. Please contact her at Jackie.joachim@roicorp.com or 1-844-764-2020.

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To Purchase or to Open a Brand New Office: That is the Question

Practice, Resources

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We have helped a number of optometrists either start their own practices or take over ownership of an existing practice. Both come with pros and cons. How do you decide what the best route is for you?

An existing practice is appealing because the patient base is already existing. Appointments are already booked and there is a patient base to re-call from to keep the schedule more or less full. If the owner has done their due diligence leading up to the sale of the practice, then other pieces will be in place. The practice will have kept up with the latest technology, both in diagnostic equipment and their EMR system.

To attract top dollar on the open market, the owner will also have invested in keeping the office renovated over the years. They will have implemented a marketing plan that is making sure the right people are aware of all the office has to offer. An up-to-date website, a social media strategy and AdWord campaigns that are driving in new patients at a consistent rate of 20 per cent is all part of this.

However, if the practice owner has failed to keep the practice up date, there is a price to pay: a lower market value. The reality is that an office that is not keeping current and up to date is creating a gap in the marketplace that a competitor can fill. That competitor could be a brand new player that opens in the area or it could be an associate who decides to invest their money in a new space instead of renovating an existing one.

There are many factors that impact this number, but a start-up or new build generally costs anywhere between $300k and $600k.  On the lower end of the scale will be practices who have smaller spaces and number of lanes and use basic finishing materials and mainstream products. On the higher side, practices that have carved out a strategy based on investing in the latest technology, will open in a larger space with multiple lanes and use unique finishing materials and exclusive products.

On the other hand, if you purchase an existing practice, leasehold improvements on their own start around $125k and can go up from there. Now, the biggest thing is to figure out how much needs to be invested in and improved.  If you are generally looking at having to improve everything — from introducing an EMR to revamping the frame strategy, the worth of the practice diminishes substantially. While a case could be made for good will— in this day and age of digital marketing and referrals, that good will is not worth what it once was.

It’s an exciting time when you are venturing into Practice Ownership. It is important to look at all the opportunities and weigh them carefully — both from a financial perspective and a quality of life perspective. Both purchasing a practice and building a brand new one are great options — take the time to figure out which option makes the most sense for you.

CHRISTINA FERRARI

is the co-founder and managing partner of Simple Innovative Management Ideas (SIMI) Inc. and expert Practice Management contributor for Optik magazine. She can be reached at info@simiinc.com

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Staging a Unique Sports Vision Training Experience

Practice, Resources, Specialty Practice

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Dr Jennifer Stewart opened Performance 20/20 in 2016 to meet the needs of youth, recreational, elite, college and professional athletes in her area.

Sometimes the right second practice is not an optometric practice at all. But it’s made possible because of optometry.

This sounds a bit like a riddle, but it makes perfect sense to me. Two years ago, I opened Performance 20/20, a sports
training facility focusing on vision performance as a critical factor in sports performance. I divide my week between
one-two days at Performance 20/20 and three-fours days at Norwalk Eyecare in Norwalk, CT, where I have practiced as an
associate since 2008 and a partner since 2010.

This combines two loves of my life: training for and playing sports, and the joy of helping patients to see and perform better.

I still am passionate about providing primary care, but for me working with Performance 20/20 athletes—not patients—
along with a staff of sports trainers, completes the perfect picture. That, while training to run triathlons, and chasing after
two sons, aged 3 and 6.

Define your Purpose

Performance 20/20 allows me to apply my optometric training and clinical experience in vision perception toward improving
sports performance. But it is distinctly not an eyecare practice. There is no lane here, and instead of a white coat I’m in shorts
and a T-shirt.

Performance 20/20 is a sports training center where we help athletes to achieve full athletic potential by sharpening their
visual system and cognitive skills. Over 90 percent of the information we collect in sports is visual–so cognitive and
visual training is critical to improvement. We think of vision as what we see, but in sports vision it is what we perceive. It’s
about how we process visual information and what actions we take.

We’re not just training the eyes. We’re training our cognitive systems and motor systems to work better together. If you
can be faster at seeing sometime, processing it and making a better decision and action, you’re going to be a better athlete.

Our programs are designed to optimize visual acuity, sharpen coordination, maximize reaction times, increase peripheral
awareness, and expand depth perception. We utilize innovative training and technology to enhance the visual and cognitive
systems of all athletes ranging from youths to professionals. Our trainers will customize a sport specific plan to optimize
performance.

For the athletes we train and who recommend us to other athletes, we provide a unique sports vision training experience.

A Variety of Services

One key is to offer a variety of training options within a clearly defined pathway. We offer private, semi-private, and group
training sessions of up to 4-6 athletes at a time. We also work with teams and sports camps in larger group sessions.

In all of our services, we work in three steps:

ASSESS Establish a baseline.
We assess cognitive and motor skills and formulate a baseline to build from. We compare that baseline to their peers in sports skills and age groups.

ANALYZE Define purpose.
We ask the athlete: Why are you here? What do you want to achieve? With the baseline set, we can define goals in objective terms.

ACHIEVE Design a plan.
From this information, we can design a personalized improvement plan to achieve stated goals.

When we succeed in building cognitive skills and motors skills, we see enhanced performance. Athletes tell us that time
seems to slow down on the playing field. They are better able to concentrate and they make better decisions. Most of all, they
realize their performance has improved, and they enjoy playing the sports they love even more. It’s great to be
a part of that success.

Work in Free Space

One key to making rapid progress with athletes is to work in a free space where you can simulate their competitive
environment as realistically as possible. Unless you are training competitive computer gamers, conducting sports
vision training solely on a computer screen limits your ability to incorporate, for example,
exercises in movement and balance. With an open space, the athlete can move fully and naturally, as with the goalie pictured
here.

Further, an open space allows flexibility to set up sports-specific environments. We easily and readily can change
from ball game sports with targeted areas on walls, to skating, where training involves balance, focus and
concentration.

While we use computer screens, like the Senaptec Sensory Station, we have avoided mounting them on walls. Instead,
sturdy tripods provides the flexibility we need to set up for any sport.

Having said that, I know space is costly, I have colleagues who conduct training in a spare exam lane, but having more space
allows you to be creative.

 

Locate in a Sports Environment

From a business point of view, context and location are big contributors to our success.

When I was exploring a location for Performance 20/20, our real estate agent suggested Twin Rinks in Stamford, CT, a
mega-sports facility includes two NHL-regulation ice skating rinks and a host of training facilities. I had found a perfect
home. I rented a 700-square-foot space within a 10,000 square-foot facility that includes a strength and conditioning
center, a chiropractor, a physical therapist and many others.

The space is filled with athletes of all ages, from New York Rangers pro hockey players to youth sports. We have figure skaters on track for the Olympics, and lacrosse goalies looking to excel on their middle school teams.

Clear Windows Tell the Story

With our prime sports location, our windows help to tell the story. Kids and their families pass by and see athletes
working on visual training exercises, agility exercises, ball work on walls, etc.

They see the process and it generates interest. Many parents will poke their heads in to see what we do then schedule
individual or group sessions in coordination with practices and lessons their kids already have in the building.

Follow a dream

For me, Performance 20/20 fulfills a dream 10 years in the making. I ran Division 1 track and field in college, and I
continue to train for triathlons and road races.

In 2015, my husband and I took a leap of faith to follow our dream. He left his field of financial consulting to help me
plan and open Performance 20/20. We had a soft opening the following year and were in full swing by 2017. Today,
we have two to three sports trainers on board, and we have worked with youth, elite, college and professional athletes
in a wide variety of sports.

At the start, we built a “wish list” of equipment we wanted so as to be fully equipped. We soon saw that we didn’t need it all at once, that we could build as we go.

You truly can begin with just four empty walls and assortment of basketballs and tennis balls plus some charts commonly
used in vision training. Adding a system like the Senaptec Sensory Station is a big addition, but it can take your training
effectiveness up a notch.

We have looked at opening more locations, and our research indicates that we likely could do so in our same geographic
area. Choosing a site is sports-specific. Our first training center is located in a skating complex, and we work with a
lot of hockey players and figure skaters. We have looked at opening another center in a baseball training facility, where we
would have access to baseball, softball and lacrosse players.

It is important to note that referrals work both ways. I may mention to patients in my eyecare practice that I have a
sports vision training facility–but, more often, athletes training at Performance 20/20 or their parents will say, “Oh,
you’re an optometrist, can I come to you for an exam?” Many now do.

In sports and performance vision training, as in life, your passion drives your success. If you are doing something you
love and doing it to the fullest, good things happen.

JENNIFER STEWART, OD

is chief vision officer and founder of Performance 20/20, a sports and performance training facility in Stamford, CT.
Dr. Stewart is co-owner of Norwalk Eye Care in Norwalk, CT. She is a former Division 1 track and field athlete who still holds two college records. She is a competitive age group triathlete and competes in trail and road races. Dr. Stewart resides in Connecticut with her husband, who is an Ironman All World Triathlete, their two young boys, and their rescue dog.

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Myopia Control is Now Easier to Get Into

Differentiation | Business Strategy, Practice, Products | Services | Industry News, Resources, Specialty Practice

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According to the Brien Holden Institute the number of global myopes will reach 2.5 billion by 2020.  While the alarming incidence rates, severity and sight-threatening consequences are often reported in the context of Asian populations, Canada is not immune to the myopia epidemic. Myopia is not just an issue in the high Asian populations in our urban centers.

A Canadian pilot study in a suburban area by M. Yang et al. (Univ. of Waterloo) reports an increasing rate of myopia from 6% in 6-8 year olds and 29% in the 11-13 year cohort, and that 35% of myopic children were uncorrected.  Canadian Optometry needs to be ready to answer the call.

“MYOPIA AND OPTOMETRY: IT’S OURS TO OWN.
Scott Mundle, makes the case for Optometry to take the lead in Myopia Control before others do.

Click Here to View Article.

Historically, the treatment options included the use of specialized contact lenses using Ortho keratology, atropine eye drops and lifestyle counselling. Ortho-K has garnered loyal advocates and remains a very useful tool in the armamentarium of the eye care practitioner.

New Convenient Modalities are Welcomed Additions
More recently newer medical device options, specifically indicated for myopia management, offer more familiar choices device options in the form of spectacle lenses and soft contact lenses.  Do these new treatment options offer a possibility of broadening the number of optometrists that engage in myopia management? Only time will tell. But the addition of well researched, clinically effective, practical, and well-accepted modalities is a welcome development. addition.

Bifocal and Progressive spectacle lenses have, of course, been widely used by practitioners for many years, and there are many studies which have evaluated their efficacy.

Dr. Farah Sunderji, Calgary, has done an excellent job of summarizing the historical use and clinical results of traditional spectacle lenses in a recent article in Clinical & Refractive optometry.

Her review of studies using traditional bifocal and progressive spectacle lenses shows a limited efficiency in the use of such lens designs, except in a relatively small sub-set of children with near esophoria.

New Specifically Designed Spectacle Lenses Now Available
Dr. Sunderji also documents the extensive design analysis and clinical assessments of new lens designs for myopia management.

These new spectacle lens designs have their basis in the widely accepted causal theories of myopia, including the accommodative lag (AL) theory and the peripheral defocus theory that hyperopic blur on the periphery of the retina stimulates myopic onset and progression.

ZEISS MyoKids Pro, a customized PAL design specifically for myopia management, was developed from extensive design analysis of various PAL designs. This analysis points to lens design with more negative horizontal mean power gradients adjacent to the near zone are more effective. Also, beyond standard PALs, this new lens design coupled with advanced technology facilitates optimization for children’s unique facial characteristics.

ZEISS MyoVision Pro, based on the peripheral defocus principles, is a good choice for childing currently wearing single vision lenses looking for the easy wearing and adaptation properties of Single Vision Lenses.

The use of new spectacle lens designs provides a familiar and comfortable option to eye care practitioners wishing to engage in myopia control and offer an opportunity to bring more ECPs into the arena and supports long-term benefits to patients and their families.

FOR MORE INFORMATION:

New Spectacle Lens Designs Specifically for the Management of Juvenile-Onset Myopia
Farrah Sunderji, OD

This article is available as a complimentary COPE-Accredited Course online at Clinical & Refractive Optometry made possible by an unrestricted education grant from Carl Zeiss Canada Ltd.

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A Unique Perspective on Practice Appraisal

Buying-Selling A Practice, Finance|Wealth, Practice, Resources

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I was reminded of an article I wrote a few years ago about a unique situation. Our company was engaged to appraise the practice of an optometrist who was preparing for her retirement. While I was meeting with her, I mentioned that I needed a new pair eyeglasses and I also wanted to purchase a pair of prescription sunglasses.

I performed the appraisal when the practice was closed—which is the usual and customary process for all business appraisers—and while meeting with the owner I asked for her permission to book an appointment to attend her practice as a new patient for an examination and new glasses. She agreed.

Needless to say, when I arrived for my appointment during normal business hours the staff did not know who I was and that we had performed an appraisal for this practitioner. I had a wonderful experience as both a new patient and a purchaser of two pairs of glasses.

Then as now, it occurred to me that as a professional practice appraiser and broker— seldom do I meet the staff—nor do I attend the practice during regular operating hours for obvious, confidential reasons. I realized how much I had learned about the wonderful office environment that this owner had built and the incredible staff that she employed. I wish, as a broker, that my team could have this experience with every practice they visit.

From this visit, I had obtained two points of view—one as an appraiser/broker—the other as a patient. This was and still is an extremely rare circumstance. In completing the appraisal, it was now impossible for me to ignore the excellent service I had received as a patient. In addition, the staff provided me with the following:

• An email containing a simple, online patient survey within 24 hours of my appointment, which I completed,
• A second email thanking me for completing the survey—it arrived within minutes of the survey completion process,
• A third email asking whether I would like to be contacted in the future by email, telephone or by text message for upcoming appointments—I found this very useful as I prefer text messaging.

What incredible patient communications! All of this had transpired within 24 hours of my new patient examination. Needless to say, this remains one of the best patient experiences I have ever had in a professional health care practice.

My dilemma at the time was how do I ignore my experience as a patient when I finalized the appraisal as a professional? Frankly, I could not and did not. This practice was exceptional. I was thoroughly impressed—if all appraisers and brokers could have the new patient experience in their client’s practices they would know much more about how a practice operates and what the patient experience is like.

Essentially, I was an ‘undercover patient’ (much like retailers employ undercover/false shoppers to gauge customer service) and as such learned a great deal more than the traditional, after hours appraisal process.

My company to this day is still trying to decide how or even if it is practical to use ‘undercover patients’ to learn more about our clients’ practices in order to prepare a more empirical practice appraisal. Obviously, we cannot simply act as an undercover patient each and every time we appraise a practice. But I still think about it—maybe as a practice owner you should as well.

Jackie Joachim, COO ROI Corp

JACKIE JOACHIM

Jackie has 30 years of experience in the industry as a former banker and now the Chief Operating Officer of ROI Corporation. Please contact her at Jackie.joachim@roicorp.com or 1-844-764-2020.

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The Company You Keep May Define Your Career Path

Career Options, Human Resources, NextGenOD, Talent Acquisition

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“Associate with persons of good quality if you esteem your own reputation; for it is better to be alone than in bad company.”

Attributed to George Washington

One aspect of corporate optometry that every potential young OD should understand is that the brand of the Optical retailer with whom you associate can possibly define your career success.

Corporate ODs need to understand that the company they work with has a lasting impression on their career, particularly if they are associated with it for more than five years.

Reputation by Association

An optical retailer brand may have strong brand name awareness and a great consumer reputation, but the manner in which the corporate optical retailer portrays itself to the eye care community will reflect upon you.

As such, the potential corporate OD, should be aware of the positive and negative connotations of a corporate optical brand and make this a key factor in your search for a position.

Like almost every consumer brand, retail opticals also have a level of brand awareness and brand reputation. Associating with a retailer with low levels of brand name awareness may not have any particular downside but a brand with good recognition and reputation throughout the country may also be a great way to jump start your career.

Additionally, the employer brand can provide a strong foundation for networking with other companies and help you make your next career move.  However, you need to be aware of the downside.  Broad brand name awareness is not necessarily positive if the brand is associated with negative attributes, such as shoddy service and bargain basement pricing.

You want to be associated with a corporate optical that has opportunities to grow clinically and learn the retail optical business. As an OD, the more experience you have the more value that you can provide to that company and potential employers.

Don’t get stuck always doing just routine eye exams. Many corporate opticals have the latest technology and encourage the medical model and have leadership positions for ODs as regional ODs. Its up to you to delve into the growth opportunities that an affiliation with a corporate retail brand may provide.

Your name in the industry and community has great value that you should foster and protect. Carefully linking yourself to corporate opticals with a positive image can boost your personal name as an OD. Being affiliated with a specific corporation can be prestigious and have more hidden value than one might imagine! Working with a high-profile company that is expanding creates great opportunities for growth.  It is up to you as the OD to see this potential!

Which Corporate Opticals have a strong employer brand?

Be careful not to pre-judge this based on your own bias.

You can better understand brand image with a few objective inputs such as analyzing the number of vacancies on optometry job websites. Ask your fellow eye care professionals including opticians and sales reps. There are corporate optical brands that have ODs asking for new positions or on a waiting list for a potential future opening!

What if my Corporate Optical doesn’t have the strongest Employer Brand?

If you are affiliated with a company that is either negative or unknown, consider how you can use your education and experience to illustrate your importance within the organization and create opportunities for success.

Illustrate your accomplishments, work ethic and ability to adapt from or even redefine the image of that brand.  For example, suggesting an action plan that can create a positive image for the company in the optical community or even a better approach to OD engagement and retention.

To gain recognition from other companies in the industry consider strategies like blogging, video blogging, writing for industry journals and posting content on LinkedIn. LinkedIn is underutilized among Corporate ODs but it has powerful potential.

Participating in the Corporate Optometry Facebook group will help you connect with current and past Corporate ODs at the same company. Your affiliation gives you an opportunity to connect and build your own name in the industry.

Recruiters are looking for candidates that are currently affiliated with well known corporate opticals. They search out these candidates because they know the good standards that those companies have for their affiliated Optometrists to deliver great results and actively recruit quality entrepreneurial ODs.

Choose your brand affiliations wisely!

MARIA SAMPALIS

is the founder of Corporate Optometry, a peer-to-peer web resource for ODs interested to learn more about opportunities in corporate optometry. Canadian ODs and optometry students can visit www.corporateoptometry.com to learn more.

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Empathetic Goodwill

Buying-Selling A Practice, Finance|Wealth, Practice, Real Estate, Resources

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In the usual course of our business we are asked to assist when a sudden disability or death of a health care practitioner/owner has occurred.

The initial reaction and concern from the disabled practitioner, staff, family or advisors is that the practice is going to suffer without the presence of the principal owner and that patients will seek other providers. Most conclude that a business disaster is imminent. Much to their surprise, history proves them all to be incorrect.

Our first advice is to install a professional locum practitioner to attend to the patient needs. This is critical and not to be ignored. As difficult as it may be to accept this advice, it has to be business as usual for the preservation of the practice to assure the staff that their jobs are secure and that all practice financial obligations can be met. A short, temporary closure of 3 to 5 days is understandable and expected but after that the practice must be open for regular business hours at all costs!

And then a very unusual phenomenon begins to reveal itself.

Empathetic goodwill is our descriptor to explain why people go out of their way to show support for the business and the business owner.

Once the initial shock of the tragedy or the situation is absorbed, we often find that the staff begins to show incredible support for the business and they actually go above and beyond the call of duty. This is a natural empathetic response that happens after people adjust to the new norm. A norm where you, the principal, are no longer present.

We also learn that patients may show extra enthusiasm for helping your practice through the tribulations and they respond by honoring appointments.

Once some time has passed, usually about a month, we see that the practice with the support of the staff, the loyalty of the patients, and the aid of a professional locum, is actually doing as well and on some occasions even better than it did under the guidance of the previous owner. Yes, better than when you, the principal, were present!

This phenomenon can be further explained by the fact that people genuinely care and want to help those in need.

The summation of this discussion and this article is to suggest that if something terrible should happen to a business owner, you will be shocked, amazed, and surprised at how their staff’s loyalty and their patients’ support impacts the business in an incredible way. Your practice remains vibrant, productive, and is able to meet its debt and overhead obligations. The long-term result of taking the actions outlined here is that when it becomes necessary to sell the practice, it will have held its true monetary value.

TIMOTHY BROWN

is Chief Executive Office of ROI Corporation Canada’s national professional practice and brokerage firm.

Jackie Joachim, COO ROI Corp

JACKIE JOACHIM

Jackie has 30 years of experience in the industry as a former banker and now the Chief Operating Officer of ROI Corporation. Please contact her at Jackie.joachim@roicorp.com or 1-844-764-2020.

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