This week on the Future Ear Radio Podcast I’m joined by the great Madison Levine – Founder/Owner of Levine Hearing. Madison sat down with me this week to share her motivation and influence for starting her private practice, how she has grown her practice throughout the past seven years, and what she’s doing now to position her practice for growth into the future.
During our conversation, Madison provides a detailed overview of some of the major challenges and milestones she’s encountered across the first seven years of owning her practice. From finding her first patient, to hiring an Audiologist, to expanding her service offering, we discuss it all.
As one of the first Board Certified Hearing Instrument Specialists (BC-HIS) that I’ve had on the podcast, it was really interesting to hear Madison share her perspective on the relationship between Audiologists and Hearing Instrument Specialists, and how the two can work together in a clinical setting. Madison discusses her own practice, where she employs two Audiologists, and how they divide the work week up.
This dovetails into a broader conversation around block scheduling and being strategic with how she organizes her appointments each week. As Madison mentions, being more strategic with scheduling has yielded a breakthrough in efficiency within her clinic, as she’s ensuring that the Audiologists are occupied with tasks that only Audiologists can perform, while she fills the other blocks on the calendar with appointments that non-AuD staff members can handle. This is going to be increasingly more important as she begins to implement entirely new services and offerings into her clinic, such as balance and vestibular services.
We also discuss Madison’s utilization of social media to drive more patients to her practice and how she is always tinkering with the latest social tools to see whether it works.
99 episodes in and I’m still learning about new ways that all types of hearing professionals can be successful now and into the future. Next stop….episode 100.
-Thanks for Reading-
Dave
EPISODE TRANSCRIPT
Dave Kemp:
All right. And welcome to another episode of the Future Ear Radio podcast. I am absolutely excited about today’s episode. I’m joined by Madison Levine. Madison, if you wouldn’t mind, tell us a little bit about who you are and what you do.
Madison Levine, BC-HIS:
Yeah, so I’m based in Charlotte, North Carolina. I am a Board Certified Hearing Instrument Specialist. I opened my practice about seven years ago and I had a little bit of background because my mother had a hearing aid clinic down in Georgia for 30 years. So while I didn’t go into the practice with her, I was already in North Carolina when I decided I wanted to go into the profession. She mentored me all along the way, all the old school stuff. She even got carpal tunnel dribbling your molds. She was doing all the stuff that nobody does anymore.
Dave Kemp:
Right. Well, awesome. Thank you so much for coming on. Let’s just start there. So it’s interesting, this industry seems to be full of people like me that are sort of genetically predisposed to it. So obviously, your mother had a huge influence on your career trajectory, but I’m curious, what was it that made you want to follow in her footpath?
Madison Levine, BC-HIS:
I think it’s such a cool profession for somebody who wants to work with people, but who also is interested in the sciences. There’s such a balance between the two. And I had not really found my calling. In fact, if you had asked me in high school what I wanted to do when I grew up, I would’ve said I want to own my own business. That’s what I really thought of as what my mom did and what my dad did. I didn’t really think about the actual job. And at some point, my husband’s the one who pushed me into saying, you don’t like what you’re doing right now, why don’t you go shadow your mom? And it was this light-bulb moment, oh, maybe I could actually do what she does and enjoy it.
Dave Kemp:
So did you work underneath her for a period of time? Did you just kind of shadow her, observe her? How long was that period of observation before you then embarked on your own path?
Madison Levine, BC-HIS:
Just a couple of weeks.
Dave Kemp:
Really?
Madison Levine, BC-HIS:
I mean, I really had one of those early twenties, flame out, I hate what I’m doing-
Dave Kemp:
Totally.
Madison Levine, BC-HIS:
… quit my job, what do I really want to do with my life? Get out of town for two weeks, shadow her. Okay, here’s what I want to do. And so coming back to Charlotte, figuring out how do I get sponsored and get apprenticed? I called every facility in Charlotte and the ENTs weren’t interested, the franchises were all interested. And so I had basically a pick of where do I want to go to get trained. And I ended up choosing to go with somebody who was more a private practice autobell and who had taught 30 years down in Georgia, South Carolina, North Carolina. And so I felt like if I’m going to go pick who I want to study under, let me pick the guy who teaches. And it was definitely a really good decision, because I think that mentorship, even though it wasn’t my mom, he was wonderful as a mentor.
Dave Kemp:
That’s cool. Okay. So you go, you get your mentorship, you sort of start to learn the ropes, were you then also doing all of the educational coursework to become board certified at the same time?
Madison Levine, BC-HIS:
Well, you have to do it kind of one and then the other. So first I went through the normal state, licensure, apprenticeship, and then you have to have worked for another year or two before you can go take the national board certification, which it seems like, there’s a lot of people and maybe audiologists who have never heard of it. And so there’s some little buzz, like board certified, what is that? They’re making it up or something. But I think it’s just not that well known. Just like you would go sit for your real estate exam or your series seven, you sign up, you better study your tail off and you go sit at one of these facilities and you take your exam.
Dave Kemp:
Gotcha. Okay. So you do that. And you said you started your private practice seven years ago, so this was probably, in totality, what? Was that part of your journey? Was that a year or how long was becoming certified?
Madison Levine, BC-HIS:
It was a couple years. So I didn’t get the board certification until I’d actually already opened my practice.
Dave Kemp:
Gotcha.
Madison Levine, BC-HIS:
Like I said, I knew I wanted to run a practice and there was some hope that maybe the person I was training under, that I might end up moving up within that and maybe even buying one or multiple of those offices, there came a point where I decided that wasn’t the right direction. And so I veered left and just put it out there. And I just started from scratch. So I’d saved pennies for a couple years and startup was pretty inexpensive. I didn’t hire anybody else. It was just me. And literally, people would call, I’d answer the phone, they’d walk in the door, I’d offer them coffee and then I’d appear and take them back to do their hearing tests. So it was like a comedy show, but the people who trusted me in that beginning, they’re all still patient. If they’re here, they’re all still patients. And that’s so cool for them to have trusted me right there in the beginning and see where we are now.
Dave Kemp:
I mean, the reason I’m so excited to talk to you is, you’re truly one of the most impressive entrepreneurs. I feel like I’ve had on this podcast because you started, like you said, from… You just made it happen, right? You just said, look, I want to do this and you did what you needed to do, whether it be the impetus of it all to go down, shadow your mom, then you go, you find this mentor, you go and you kind of get this training and then you go and you become certified and then you launch a private practice.
Dave Kemp:
And this is the thing that’s like, for young people in this industry or really anybody, but the people that are just getting started, I think that there’s this paralysis that can set in, where you’re just like, I don’t even know where to begin because yeah, I would love to start my own practice, but how do I even go about getting my first patient? And how does it cascade from there to where it’s a full on legitimate business? But you’ve done it, and we’re going to get into where you’re taking your business now, but I want to focus on this first portion of it, of how you even got your business off the ground because I feel like that’s got to be one of the most challenging parts of the whole story.
Madison Levine, BC-HIS:
It is. It’s probably the scariest part for anybody, right? Is okay, I’ve spent my own money and now I’m waiting for somebody to call the phone and I’ll tell you a really crazy little side story. I knew I was going to need to do some marketing to get the word out there. And of course, I was going to go take information to all the primary care doctors and all the senior facilities. I did all that. But my very first thing I did was a mailer and it was $3,000 for this mailer. That’s a lot of money. It’s my money, right? And this is just crazy, I sent the mailer, it should have hit, a day goes by, I haven’t gotten any calls. Day two, I’m sitting there at my desk, by the phone, by myself, waiting for somebody and I pull out the mailer and I’m just staring at it. And it’s a brand new business with a brand new phone number. I had reversed two of the numbers.
Dave Kemp:
Oh my gosh.
Madison Levine, BC-HIS:
And I just cried.
Dave Kemp:
Oh my gosh.
Madison Levine, BC-HIS:
I mean, that’s the truth. And I called my husband and he’s been my biggest supporter through everything. And he was not faced. He goes, well, just go get that phone number. I’m like, how? There’s no way I’m going to get that phone number. 30 minutes later, I had that phone number miraculously forwarding to my phone number and I made a couple sales from that mailer and it paid for it.
Dave Kemp:
Wow. That is a-
Madison Levine, BC-HIS:
That’s how creative he is. He’s just like, nothing is a roadblock, he’s like, we’ll just fix it.
Dave Kemp:
But that’s one of those things, it can be so overwhelming that… That’s enough to, I feel like make somebody just throw their arms at me, like what am I doing? So the fact that you kind of persevered through that is amazing. And I feel like a lot of small businesses have those kinds of stories of just crazy things. I know with my parents, in Oaktree, there were all kinds of these really weird serendipitous moments that just happened, that we were back on and I hear these stories and they’re like, we literally, by the grace of God, had this miracle basically occur, that saved the business and let us stay afloat for another month.
Dave Kemp:
And it seems like at that really like, when it’s just a little embryo of a business, you need all the luck you can get and you’re just kind of scrapping by, but I’m curious to hear, what were some of those big kind of watershed breakthroughs for you where it felt like you actually had a step change and now you’re into another, maybe you’ve matured a little bit to the point to where it’s not like you’re on death store every single day as a business?
Madison Levine, BC-HIS:
Totally, I love that watershed moments. There are probably a thousand ways to start a business and all I have is my perspective and others will have different advice, but it’s also how I work in my life is I really believe that cash is king. So I wasn’t going to start a business unless I had saved some money so that I could start it with my money. I didn’t take money from anybody else. And then as I went forward, I knew I would do a piece of marketing and then I would make enough to pay it back and then some, and I’d do another piece of marketing.
Madison Levine, BC-HIS:
And so some might think that, that was slower. I think seeing where we are now and how healthy the business is, there’s no other way I would’ve rather have done it. But month after month, probably month three or four, I had made back everything I put in it. And so from there, I wasn’t actually taking a salary. So I will say I did have a privilege of being married, living like we were in college and just not having any major expenses. So I didn’t take a salary until about month nine. So that was a benefit, for sure. But at month nine, I also hired my first employee. That was a big shift-
Dave Kemp:
That’s a big deal.
Madison Levine, BC-HIS:
… to be able to have a role that I didn’t have to fill and then to really only focus on clinical marketing business development. And when you’re that small, when you’ve got somebody in the front and you’re in the back, you’re doing all those things, you’re doing the accounting, the marketing, the development, that’s it. The next step that happened was, I was able to have two babies in the middle of this and take 90 days maternity leave both times because I decided that’s what I wanted. And so I did it by hiring my first hearing instrument specialist to back me up right before I had my first baby. She carried me through, she filled in for me on my second baby and then hiring my first audiologist in 2020 was a big leap up in terms of capacity for the business. And she’s awesome. So that’s so lucky, you can’t always see how great an employee’s going to be until they get going.
Dave Kemp:
How did you find your employees?
Madison Levine, BC-HIS:
I started sending out blind messages on LinkedIn to people.
Dave Kemp:
Wow.
Madison Levine, BC-HIS:
And she was one of a few that answered and she was definitely the best candidate. Yeah.
Dave Kemp:
It’s amazing.
Madison Levine, BC-HIS:
Lucky.
Dave Kemp:
I mean, I just think, again, it’s kind of like, what I’ve gathered from you, of just kind of observing you and I should say that, when I joined Oaktree full-time in 2016, there was a real small amount of people that were the people on social media at that time and you were one of them. I was just kind of seeing you from a distance and seeing how you were building your business and it was really fascinating because again, that was about five or six years ago, so right as you were getting started and to see what you’re doing with your business today is just so impressive. But I think that it’s really cool to hear how this even begins, because again, I think that, that’s not talked about enough of, how do you even get started? Because I think that the de desire and the demand is there for professionals of all types in this industry to start their own business.
Dave Kemp:
There’s so many different appealing things about it but I think that when you really sit down and you’re like, okay, how am I going to get that first sale? What am I going to do for that? How much of a upfront investment am I going to have to make, to make this work? What’s this whole trajectory going to look like? You have to outline a business plan and all this. And this is, I think, kind of epitomizes one of the things about this industry, I guess, to put it lightly is like, it’s a medical field that’s tasked with having a pretty strong business acumen.
Dave Kemp:
If you go and you get the AUD, you’re trained in all of clinical audiology in the field of science, but then it’s like, how do you apply that in a commercial way? How do you make that a viable business? That part of the whole equation right now, I think needs more attention. That’s why I’m so fixated on it. Not saying I’m the solution or anything, but I’m just saying, that’s why I think it’s so interesting is, it’s a really weird dichotomy in this industry that it’s a very business oriented industry really, but it’s populated primarily by medical professionals.
Madison Levine, BC-HIS:
Yeah. It’s hard. It’s hard for them to shift gears. You mentioned a business plan, I’ve written three so far and I’m sure others have done one every single year, but I did my first one, at the end of that first year, I did a second one. And I wrote a new business plan three or four months ago before launching some of the things that we’re doing now. But I think, you graduate with a degree or you get a certification and we all know that’s not the end of learning, right?
Dave Kemp:
Right.
Madison Levine, BC-HIS:
We know we’re going to go CEUs on clinical information, but how are you going to educate yourself on business? Whether it’s looking for mentors or it’s buying, just go buy the top five books on business. I mean, that’s your starting point. But the best advice I could give anybody is the cash flow. I think so many people are not watching their numbers and the data will tell you everything you need to know. I’m checking all of our numbers daily, middle of the day, in the afternoon, I’m looking at everything from how many appointments did we see? What was the revenue? I want to see what appointments did we miss out on because we took these. Probably the biggest shift we’ve had recently is paying much more attention to scheduling.
Dave Kemp:
Interesting.
Madison Levine, BC-HIS:
How we work the schedule will tell us everything about how the math is going to work out.
Dave Kemp:
Yeah. Yeah, no, I think that you’re right, that being able to read a balance sheet is really important. And again, that’s not something that you’re going to really be… Unless you’re going through undergrad or something, and you’re getting that, you’re going to just only be able to probably get that firsthand by being shadowing and getting that mentorship like you said, or actually just having a trial by far and just having to be thrown into it and just be like, okay, here’s how you need to make sure that you’re… Like you said, it’s the cashflow thing. And I think going off of that is the idea of incrementalism and just taking… I think it’s really important to constantly find ways to improve but not try to do so much at once that you overwhelm yourself or you do so much that you’re investing either too much time or too much money in a small amount of time that you’re then in debt or something like that, so I think that… Can you speak to that a little bit about your mentality of just kind of this slow buildup that seems like you’ve been doing?
Madison Levine, BC-HIS:
Yeah. Well, it did feel slow in the beginning, but once I decided how much salary I wanted to take, they say pay yourself first, which is, I don’t think true in a startup. I think that is very wishful thinking.
Dave Kemp:
Right.
Madison Levine, BC-HIS:
And I think a lot of people have this very like, just privileged mentality. You’re starting up a business, you’re probably not going to stop at Starbucks three days a week and you may buy a used sound booth and you might not buy temps the first year. And all of that is okay and you can still run a really effective business and make people really happy by making wise choices with the funds that you have at hand. So I just think a lot of people really get messed up by whether they’re taking a SBA loan, a manufacturer loan, they’re committing to something that they think makes sense but look at, what’s the worst case scenario? Could you survive the worst case scenario and how long? How much cash do you have on the side? And a lot of people are not prepared for that.
Dave Kemp:
Yeah, that’s a good point. So I’m going to categorize your businesses, we’ll call it phase one and phase two. Maybe you would categorize it differently, you’ve had more phases in between, in the beginning and where you are now, but can you maybe walk me through, before we start to get into the different services that you’re starting to incorporate into your business now, can you kind of just give me an idea of a day in the life in your clinic that’s relatively busy? What types of patient visits were you seeing? What was your sweet spot? I’m just curious of the kinds of patient interactions that you had in phase one, if you will.
Madison Levine, BC-HIS:
Yeah. Well, that’s a really good way to do it, to split it up into two actually, I like that. Let me go back one step to where I trained was more rural and we had a lot of people who’d worked in weaving mills, a lot of industrial noise, poor healthcare outcomes. And so we had a lot of profound losses, a lot of BTEs. And so when I opened in Charlotte, I really was expecting more of the same. I wasn’t really prepared for the shift for that phase one, which was, I ended up in a pretty affluent area where I see tons of mild to moderate high frequency hearing losses, that are just age-related, sometimes some noise, but that’s my normal garden variety person. A lot of them are well educated, they’re working. And I think my average age is younger than most. Our average patient age is about 65.
Dave Kemp:
Okay.
Madison Levine, BC-HIS:
And if these people that are still working and feeling like they’re just losing their edge and they want to get it back.
Dave Kemp:
Interesting. Okay. So you would say that the patient demographic that you’re primarily seeing are people that are actually actively coming and seeking you out rather than the quintessential example that we hear the scenario of the wife dragging the husband in because he started up the TV too loud or something like that. It’s not as much that, it’s more of people that are actively coming and seeking you out saying, I think I have an issue, can you help me?
Madison Levine, BC-HIS:
Yes. We got a variety of everything, but I would say that’s my main demographic, which is really interesting that its happened that way. We don’t do that many BTEs anymore. A lot more ricks. I love custom products too. We do a fair amount of IICs. It’s been really fun. We’ve gotten a lot of public figures, especially over the last two years, people have just gotten so excited about, and they’re not celebrities, they’re people that own global companies or something. They’re people that I want as my mentors because I’m so excited-
Dave Kemp:
That is cool.
Madison Levine, BC-HIS:
… to meet, right?
Dave Kemp:
That’s really cool.
Madison Levine, BC-HIS:
And so a lot of them will pick something like an IIC. They’re doing something super discreet.
Dave Kemp:
Cool. All right, so let’s start to get into where you’re taking your business now, again, I think that, when we were kind of chatting a little bit beforehand, I get so excited when I get a chance to speak to people like you, who are really, I think, seizing the opportunities that are presenting themselves in these new exciting directions, that I think hearing healthcare is broadly moving in. And for a long time, we were in this period where you could kind of see this tidal wave coming, where you knew that something was on the horizon, that was going to be this forcing function of like, you’re going to have to start to do things that truly differentiate you in a world where just a straight up hearing aid clinic, that’s kind of becoming commoditized. I think that, if there’s anything that’s really truly under a threat from the big-box retail expansion, online hearing aids, OTC, it’s a single one trick pony, I think, that just doesn’t even do best practices per se.
Dave Kemp:
It’s just like, you come in and I’m going to fit you with hearing aids, with the fit that comes with the device itself. And so I get excited because I think that there’s so much more opportunity out there in these things that were constantly this narrative, that’s like, there’s all these threats. These things really aren’t threats in my opinion. So long as you’re willing to take it upon yourself to research what opportunities are out there and how you can pursue those. And so as somebody that’s actually living this, you can speak to it much better than I can. Can you just kind of walk me through what the opportunities are and the avenues that you’re going and what your sort of due diligence process was when you were vetting these and trying to understand, is this right for me?
Madison Levine, BC-HIS:
Yeah. I loved earlier, you said something about Chicken Little and the sky is falling. That’s what everybody says. And if you’re on these Facebook forums, there’s so much doom and gloom.
Dave Kemp:
Oh my gosh. It’s the worst.
Madison Levine, BC-HIS:
I think a lot of it is coming from people that are looking at being towards the end of their career too. And they are scared about the changes. I just always kept such a positive outlook. I really believe that positivity attracts more positivity. So for example, I really do not believe in looking at last February and then saying, well, this February’s going to be low because every February’s low. I think that’s ridiculous. And when I actually look in my last seven years, every trend I thought was there, then wasn’t. Last June was my lowest month of 2021. This June is our best month ever. If I had said, might as well vacation in June because we don’t buy hearing aids then.
Dave Kemp:
Right.
Madison Levine, BC-HIS:
So that’s what people do. Even my mother did that, she would say December, nobody buys hearing aids in December. So she’d kind of take them on off.
Dave Kemp:
Pack it in.
Madison Levine, BC-HIS:
Yeah. And I just don’t believe in that. I think if you believe you’re going to have a good month, the you’re going to do the things to make that happen. And that’s a side note, I do a lot of marketing. That’s a passion of mine. But as far as the services that we’ve added and why we have done it, I think you were right on, on those retail centers that are just churn and burn, not even best practice. I think they should be scared because they are not that different than the thing you’re going to buy on the internet.
Dave Kemp:
Exactly.
Madison Levine, BC-HIS:
So somebody can choose to pay more money to walk into one of those and get whatever that is. I don’t think those places are going to survive, I think we’re going to see a huge… I think they’re going to die. I mean, the only thing I can imagine is, almost you’ve got these little service centers that’ll service your vacuum and repair it for you. I mean, you could be a little repair shop for hearing aids, but if you’re not leaning into the medical model of owning your whole credentials, I want to practice to the full scope of my credentials. And I want the audiologist working for me to practice their full scope as well because the patients deserve it.
Madison Levine, BC-HIS:
And because they actually need all those services. And I think we’ve done ourselves a whole disservice by boiling down what we all do down to this little tiny thimbleful, so that the community doesn’t even know who to call when they get vertigo. They don’t even know that if they’re in radiation or chemotherapy, that they should be having their hearing screen before and during. The doctors are busy, so I’m not blaming them for not referring more, but we have not done a great job of educating consumers ourselves so that they know that they can come to us for all these things that we can do.
Dave Kemp:
Yeah. I mean, I have said it before, I think that a large part of this is the narrative, it’s the perception that’s really been created around the profession as a whole of being synonymous with hearing aids. And you know what? Hearing aids are great. They’re a medical Class I, Class II, FDA grade medical device, and they serve a really important purpose. But again, to your point, if that’s the only thing that people associate you with, you’re dramatically reducing the surface area of what you could be doing. And this is why I think this resurgence of vestibular, and I think this whole new avenue into cognition, the whole like, beyond just the peripheral auditory system and once you start to go into the central auditory system, there’s so much here.
Dave Kemp:
And again, that’s where I kind of am at the point where now that I’m seeing the viability of these new entryways into these different revenue generating opportunities, I roll my eyes at the idea and this notion of like, you’re undersiege by Costco or by whatever online hearing aid retailer exists, because that’s assuming that you’re providing the exact same level of care of all these different people. And it goes back to the value proposition. And this is something that I feel like you do unbelievably well and you really understand, this is something that it really resonates with you, is to say, I have to be different. I can’t look myself in the mirror and say that I can charge a premium for a set of hearing aids that I know are the exact same type of device that they can get elsewhere.
Dave Kemp:
It might just be white labeled. So what am I doing to warrant somebody to come in and see me and pay out of pocket or whatever that might be? And this is like that, where the rubber is meeting the road kind of thing. And I think that what’s exciting is, there are so many different examples of what you could do, not even necessarily just all these new avenues, but getting back to best practices and being able to demonstrate to a patient, here’s the value that I’m providing you. There’s a lot of low hanging fruit in that regard, I think.
Madison Levine, BC-HIS:
Oh, I agree on the best practice [inaudible 00:30:21]. So there’s so much conversation around that, right? And what is the thing that everybody talks about? Real ear, right?
Dave Kemp:
Yep.
Madison Levine, BC-HIS:
I love real ear and we do it on every patient and I think we’re shooting ourselves in the foot by only naming that one thing all over the internet, all over everywhere. That’s the buzzword. And I’m going to tell you that they’re going to figure out a way to get real ear in your home and send a device home. And then if you pinned your entire worth on that one thing, I just think that’s a mistake because what is best practice? So many things besides that one.
Dave Kemp:
Yes.
Madison Levine, BC-HIS:
And so, yeah, I believe that we should not be intimidated at all by competition. Competition is awesome. I’m a little bit of a capitalist, so I believe in that and all it does is make me do some little brain flips and think about, okay, so what can I do to add another service to add value? And I don’t think we need to operate from a place of fear. I think that’s obvious to your patients when you do that. Confidence is the key to everything. So back to kind of the services that we’re adding. So for one thing, I went and put a little personal sound enclosure in every one of our rooms, which I’m thrilled about because it gives us such an ease to say, well, let’s just check. Let’s just go ahead and throw you back in the booth.
Madison Levine, BC-HIS:
That’s the best practice, is instead of putting it off because, oh my gosh, we didn’t schedule the booth for today, but it seems like they need it. Let’s just make it easy. And people tease about this thing. Some people think that it’s a beginner booth and then you graduate to buying yourself a big $10,000 booth or something. They work great. That’s the first thing, we bought an irrigator and we’re probably going to buy a couple more. They are quick and easy. And again, you get better results for a patient and you can quickly and efficiently get them through an appointment without having to send them to the ENT to come back to you. Of course, we’ve added balance and we’re right in the heat of that right now. So we’re seeing our first patient for real next week.
Dave Kemp:
That’s awesome.
Madison Levine, BC-HIS:
So this morning, our fourth year was getting spun around.
Dave Kemp:
Love it.
Madison Levine, BC-HIS:
And that to me, it’s so much for us. It’s not just being able to say, hey, here’s another service that we provide. How many of our patients are struggling with dizziness, imbalance and vertigo? My patient base is already going to be my best referral source for that added revenue stream without even having to go out and market, that’s the first place we’re going to start, right? So how can you take your existing patient base and what else can you offer them that they want? And they would go somewhere else to get that they can get it from you.
Dave Kemp:
Yeah. I mean, there’s a lot here that I want to touch on. So I think first of all, this idea of best practices, a lot of it is actually a more optimal patient experience. It’s the way that you’re making them feel and everything that you’re touching on, we’re going to put you back in the sound booth here. You know what? I also offer these balance services for you so that we can look in… Dizziness is one of the most pervasive things out there. Falls are gigantic, it’s like the number one modifiable risk out there for older adults over 65. And so these things are really obvious to me because I think ultimately what it comes down to is, if you put yourself in this patient’s shoes, it’s a different experience. It doesn’t feel like I’m not really listening to, or I’m not being heard.
Dave Kemp:
How many of these people come in and they leave and they’re like, I didn’t feel like this actually treated the root of the issue? They were just trying to fit me with a hearing aid. And so what I’m ultimately getting at here is, if you do all these things, what it amounts to is, it’s a totally different perception that they have of you. And I think, part of why I’m so bullish on this move more toward the medical side of things is, how different is that conversation when you do this battery of tests? You run them through these diagnostics and then you tell them objectively, this is why you need a hearing aid. It’s a lot different than just initially starting the conversation, often being like, all right, let’s see, cosmetically, this would look good on you. And it’s like, you’re not actually getting to the root of the thing. And there isn’t this sort of implicit expectation that you’re going to walk out of here with a pair of hearing aids. We’re going to just figure out why it is that you’re even coming in here in the first place.
Madison Levine, BC-HIS:
Yeah, exactly. No, you’re so right about that. Their experience is everything. And I have a dear friend who is a registered dietician and we talk a lot because she has built up her practice, she has dieticians and therapists under her. And what she’s really pushed into is more of a neurological standpoint. She’s gone to all kinds of trainings that you wouldn’t think a dietician would go to, but she’s realized that what she does is a form of therapy. The way she’s communicating with patients on a weekly basis. I don’t think that we are leaning in enough to our therapy skills. And I don’t know if I’m stepping on any toes of like, what I’m… I’m not saying real therapy is part of our scope or something, right? But I mean, you go to some seminars and some things where they teach you about sales, right?
Madison Levine, BC-HIS:
And I think some people hate that word. They vilify it, they imagine the used-car salesman and all that. But really what you’re doing is learning the skills to communicate with people, to create trust. You’re learning how to mirror them. I mean, I noticed some of this may just be just part of me, but I noticed when I’m talking to people, if they’re leaning forward, I’m leaning forward. If they’re leaning back, I’m leaning back and I don’t even do it on purpose. But when you get out of your own head, the thing you’re trying to sell them, what you’re trying to get them to do and you start really looking at the patient and looking at them and thinking about them like, what are they here for? What do they want from me today? How can I listen to them and address their pain point? Everybody wants to work with you. It’s not hard, not magic.
Dave Kemp:
Yeah. I mean, I think it’s just all again, it’s this whole notion of, you are… It goes back to, what’s your point of differentiation? And I’ve written about this, have presented on it. And the thing I always come back to is this quote. And I quote this all the time. It’s this guy, Dr. Christopher Schwartzer, I think is what his name is. And he said, I’m kind of just freewheeling here. I can’t remember exactly verbatim, but the gist of it is, in a world where the device itself is becoming commoditized, that implies that the demand for expertise will go up as well, because you’re basically making it so that the actual facilitation of the device itself is really low friction. And so the provision of knowledgeable expertise is what becomes in such high demand.
Dave Kemp:
And this is like, I think at the root of it all, is if you can figure out how to effectively be a provision of expertise, whether if you’re an AUD, figure out how to use your education. That’s what you have that really differentiates you. If you’re like yourself and you’re a hearing instrument specialist, that you’re, oh, just a powerhouse business woman, like you are, where you’re figuring out, okay, I want to hire an audiologist so that I can have them facilitate these things within my business, then do that. So I think that, again, it goes back to this notion of, look at the competitive landscape and kind of create almost a checklist of like, what do you think is going through the mind of the leadership team at these big-box retailers? It’s volume. It’s churning and burning. So they’re trying to make it so that, that’s their priority.
Dave Kemp:
And you know what? That’s great. Honestly, there’s a lot of people that are probably really happy with the set of hearing aids that they get from those types of places. But you have to understand that if you are going to create a very similar service than that, you can’t charge a thousand dollars more than them and just expect that people are going to pay that. And so I think that it comes back to this whole notion of like, well, what are you going to do different? And this is where again, I think it’s going full circle, is like, a few years ago, I didn’t know the answer to this. And now I’m starting to see these answers, sort of just materialized before my eyes. And so it’s like what you’re saying now, it’s like, we’re going to start to implement balance into our business. So can you walk me through what that specific one has been like for you?
Madison Levine, BC-HIS:
Yeah. We did partner with the American Institute of Balance as a Center of Specialty Care. And that was big, because I haven’t done partnerships like that. I hadn’t done buying groups and those kinds of things. And so I did vet it very well. Some of my mentors around me all had great things to say about them and had either worked there or used them themselves, so that gave me a lot of confidence. And I will say after having come back from training last week, I was so impressed. They’ve really thought through every piece, as far as giving you everything you need, kind of on a platter. It is a lot, a lot, a lot. So I don’t think anybody should dip their toe in.
Madison Levine, BC-HIS:
I think if you’re going to do it, you got to be prepared. It’s like giving birth, that’s what it feels like, pushing a rock up a hill because it breaks everything. It changes the way that we have done business. Insurance is going to be much more heavily used for vestibular than it was for hearing aids. Training up my whole team, some of whom have experience and balance and some are getting their first experience. It’s a huge investment. It’s a lot of equipment. We went all the way with a rotary chair and everything, but I’m not scared at all. There’s so many people to help.
Dave Kemp:
If you had to boil it down to a single bullet point, what was it that ultimately sold you on this? Was it, I’m going to be able to see more people? Was it, I’m going to potentially make my business such a different… It’s going to be perceived differently in the eyes of my current patients that they would not only be eligible for these vestibular services, but it would make the conversation of hearing aids that much easier, maybe all of it. I’m just curious of like, again, as a business woman like yourself, what was it that ultimately made you want to pursue this?
Madison Levine, BC-HIS:
You kind of said it in your second statement, credibility.
Dave Kemp:
Yeah.
Madison Levine, BC-HIS:
That’s it. I think I’ve spent a lot of years bringing little baskets of cookies to primary care doctors and making zero headway. I know that other people have successfully done that. I’ve done a lot of other things successfully. I don’t know why I have spent countless hours. I’ve hired people. I’ve done it myself. I’ve just really struggled. And some of it might be because we have a behemoth ENT in town. It was very easy for them to refer anything and everything to. But I think that this is going to be a major shift in how we’re seen and pulling us out of what started as a retail hearing aid clinic, what turned into audiology dispensing and what now is moving into full audiological services.
Dave Kemp:
So as a hearing instrument specialist, what role do you see yourself playing? Again, kind of take off the business owner hat, but from a practical standpoint, what is that line of demarcation of what audiologist can do and what an instrument specialist can do in this realm of the science?
Madison Levine, BC-HIS:
It’s a little tricky when you look at insurance billing. We’re going to need to make some decisions here in the near future about what types of appointments, who gets, right? I have one other HIS here and I have an apprentice right now. I have two audiologists and a fourth year. So we’ve got kind of an even split. Obviously, we can do everything hearing aid-related, but as we move into billing more insurance for vestibular, we’re probably going to be also pursuing other hearing aid-related billing codes that we haven’t in the past.
Dave Kemp:
Interesting.
Madison Levine, BC-HIS:
So we’ll see kind of how it goes, because maybe the audiologist can bill for a hearing exam and I can’t. We’re going to have to figure some of that out, but that’s a really good question.
Dave Kemp:
So going back to what you were saying earlier about the scheduling aspect of things, is this kind of cut to that? Is that now you have to be really specific with how you’re going to assemble your days and what you’re going to stack, back-to-back and that kind of thing?
Madison Levine, BC-HIS:
Yeah. My husband owns dental practices. He didn’t in the beginning, but at this point, he does. And so he got a whole education on how to do so many columns, got maybe one doctor and multiple hygienists. And that’s been really helpful to kind of compare that model to ours.
Dave Kemp:
I love that, I love that. Actually, I’ve used that as an analogy before, and you probably are way more knowledgeable with this whole analogy than I am, but I actually think we should be probably looking at the dental, kind of the construct of a dental office. There’s a lot that I think you can learn there, of how maybe the practice of the future in audiology and hearing healthcare might be designed.
Madison Levine, BC-HIS:
Yeah, absolutely. That’s the next step, is taking one provider and having more audio tech help for that provider. Gyl Kasewurm was just sharing recently that she had a provider that just did 200,000 in a month, in revenue.
Dave Kemp:
Wow.
Madison Levine, BC-HIS:
And it’s like, I want to do that. And I asked her, oh, okay, first of all, how did you fit that in the schedule? I know he’s good and everything, but how did you schedule that? This is where we need to act like other professions. And I say we, I mean, I don’t know if I’m speaking more to audiology or HISs here, but where you take who is the most qualified person in the room, let them only do the things that only they can do. If someone else can do it, then let someone else do it. So number one, we are block scheduling, which my husband pushed and pushed and I hated the idea because I didn’t want patients to be upset, if they want to come in Tuesday and we tell them, you can’t come in at 10 o’clock, but nobody’s on the schedule for 10. We’re just holding it for a hearing evaluation. I want to give it away. I can’t.
Dave Kemp:
That’s interesting.
Madison Levine, BC-HIS:
So we have to block schedule for revenue generating appointments. And then the second part of that is, how can we split up appointments so that the most qualified person only does what only they can do? And we’re moving into that next week. I’m excited. We’re blocking off some appointments. So this is probably old hat to some people that have done it forever, but I’ve always done my whole fitting, sit down, do real ear, do programming and then teach them everything about the hearing aid in process. And we’re going to split that out into a hearing aid orientation appointment with a tech, right? And multiple things we’re doing with other appointments to split it up too. And so what am I going to do? I’m going to give myself back 45 minutes in every fitting. How many hours am I going to get back a week where I could either be producing or doing business development?
Dave Kemp:
Yeah. I mean, I think this is a really important topic, is this whole idea of how do you actually design a practice built for the future? I hear so much, and I’d be curious to get your thoughts on this, really the biggest threat everybody seems to have are these third party insurance companies. And because obviously, the reimbursement rates seem to be going down and down and down and it’s just really not even viable and what I always wonder and it seems like it’s so variable, is look, at the end of the day, you have to look at the patient acquisition cost. And so how much money do you have to spend to get somebody to come into your door? And so if you understand that a lot of these people, you’re not actually spending a dime, they’re coming in through their insurance, in my mind.
Dave Kemp:
And trust me, this could just be my own activity, I don’t know. It seems like maybe the way in which that patient is flowing into your office is just, it’s not conducive. And so you have to use, and I know that a lot of this is stipulated around what kind of professional has to facilitate the care, in terms of it being reimbursable. But it seems to me, if you have something that looks, again, more like a dental office, you’re only seeing the dentist for five minutes, and you’re seeing the hygienist for 95% of the time, what’s the analogous thing in our industry to that because that seems to be something that we need to figure out and I think that you’re definitely getting there with, it comes down to how you schedule it, and then you’ve got to use some of these support roles within the profession in an effective way, I think. But I could be wrong, I don’t know it. I know this is a huge hot button issue.
Madison Levine, BC-HIS:
The insurance part’s hard. And so I don’t have strong advice because I know that every region is so different, and so maybe I’m not… Maybe it’ll be harder for me at some point. It hasn’t happened yet. Maybe I’ve been blessed with an overabundance of confidence or something, I think. My dad always was like, you can do anything. If they can do it, you can do it. Not that I don’t have my doubts and have my times and all that, but I believe that people will private pay for things if they believe that it’s worth it. And I believe that you have to test what the market will bear. And if the market will bear it, then that’s the cost of that item. So if insurance comes in and sweeps up every business in Charlotte, so everyone has the same coverage and they all know that they get some discounted product or something, maybe it’ll be more of a problem for me.
Madison Levine, BC-HIS:
But right now, people who come in with some kind of third party benefit, a TruHearing, or a hear.com or whatever it is, they come in, they have a fantastic experience, they trust us and we give them the option, we would love to help you with what we’re available to help you with. You can go talk to your insurance and see who might accept and be a network for this benefit. I don’t know what the discount is. I don’t know what products they might provide. I would love to help you. And I think if you’ve done a really good quality job, the vast majority of them are going to pick you. Now I am in a more affluent area, so I might be also a little tricked by that. I know in other areas, people are going to have more issue where they’re going to have to go where they can get the cheapest care.
Madison Levine, BC-HIS:
But I don’t think you have to lean into that. I think you can test it and see, if I present them the option because I see on these forums, people will say, a patient came in with TruHearing today. I let them know that they could get hearing aids for half the price somewhere else. And you’re like, do you even know that? If you’re not a member of TruHearing, how do you even know how much your products are? Why did you just send the patient somewhere else? Why didn’t you give them the option to choose the higher value care?
Dave Kemp:
Right. Or why don’t you come up with a way to where those patients can be seen in a cost effective manner for you because you’re matching them to the appropriate type of labor? And it seems like, again, there’s very few businesses that I can think of where its makes sense to be turning people away from your business. So I’m sympathetic to the whole thing and I’ve heard both sides and it’s like I’ve heard every single aspect of it, but it’s just something where it’s like, it’s not really going to go away. So it seems like, how do we actually kind of live with this? And I don’t know. I think you have the right approach though, which is to say, again, it goes back to your value and making that an upfront expectation and not necessarily turning them away, but doing expectation setting upfront. So I don’t want to lecture people on how to do all that. I’m just truly curious of, is it actually more of a business model issue than it is anything else? I don’t know.
Madison Levine, BC-HIS:
I’ll also say this, one of the best lessons I’ve ever heard is, don’t spend out of your own pocket. So just because you think somebody’s going to want to go get something cheaper somewhere else, or you look at someone and you assume that they can’t afford the best, you’re wrong. You have no idea. You do not know who has money and who does not have money. And you don’t know what is motivating their financial decisions. When I was in rural areas, people financed premium hearing aids all day long because they wanted the best. And here we are in this area and it doesn’t matter if they’re more affluent in general, you can’t look at somebody and assume, you’re probably going to want to look at this side of the page. You don’t need to worry about those more expensive options. Are we trying to actually help them hear their best? Or are we trying to just figure out what’s the easiest sale to make? Right? So yeah.
Dave Kemp:
So we’ll change topics here, kind of to wrap things up here, I would be remiss not to talk to you about social media. You’re awesome at it. But again, I think that, what’s really interesting that’s going on right now, another thing that I think is awesome and really interesting to kind of watch unfold is the creator economy within our niche medical industry. It’s like, again, going back to how it’s like, I knew you from afar, years ago, just based on how you were kind of presenting yourself online on the different social channels. And now it’s like, we’re seeing all kinds of new ways in which you can reach people, whether it’s through these new forms of social media, but I’m just curious to kind of get your thought process on the power of using a platform to brand yourself, to build your business. Can you just share a little bit about your experience in how you view social media as being a business development tool?
Madison Levine, BC-HIS:
Yeah. Well, I think it’s just that, I think it’s a tool in your tool belt. So I wouldn’t stake everything on it or on just one medium within it, but I think if you’re ignoring it completely, that you’re missing a whole set of eyeballs and a lot of people will PPO it and say, well, over 65 crowd isn’t on Instagram. So why would I do that? Or they certainly think they’re not on TikTok, but who are we trying to reach? Not just the patient themselves, but also their children and their grandchildren who are helping them make decisions.
Madison Levine, BC-HIS:
I get patients from social media. It’s part of why I do it. Part of it, it’s the branding. So if somebody wants to go look me up, they’re going to find some of that. And you have to ask yourself, what is your brand? Maybe you don’t want to do some of these funny videos that I’m doing. I’m sure some people look at them and they’re like, that is so unprofessional. They would not, would a venture into it. And I get that. But it’s really more me. I’m a little bit silly and I’m really myself with patients. I’m appropriate, I don’t use things with cuss words. I don’t do crazy inappropriate dances or anything. It’s just funny stuff. And frankly, if you’re boring, nobody wants to watch you.
Dave Kemp:
Right.
Madison Levine, BC-HIS:
So you’ve got to be interesting enough and you have to be at least a little bit on trend or else, all you’re going to do is just put out boring content and you should be doing something else with your time because it’s not going to pay you back.
Dave Kemp:
Yeah. I mean, I just think that again, it’s like, you got to just find whatever works for you, whatever you’re comfortable with. I think there’s lots of different avenues. And I think it’s just really interesting that now we’re seeing all these different types of creators, people that are putting out really educational content on an Instagram page and they use stories really effectively. They pull their patients. I just think that again, I was in college when Twitter was launched, when Instagram was launched, so-
Madison Levine, BC-HIS:
How old were you?
Dave Kemp:
I’m 32. So I’m-
Madison Levine, BC-HIS:
I’m 34.
Dave Kemp:
Okay. So we’re right around the same age. So it’s like, I kind of saw the early stages of it, where it was hard to really understand how this would all be used in a business setting. And then Facebook came around and it was like, okay, well, Facebook’s been around, but Facebook advertising became a really big thing.
Dave Kemp:
And then you started to see how different kinds of professionals could use a channel like Instagram. And then now you have TikTok. And personally, I like to use my stuff in a B2B setting. So I use Twitter and LinkedIn, are primarily mine. I can’t figure out what I personally would use TikTok for, but if I were a practicing professional, I think it’s an unbelievable way to show off the irrigator or to give people an idea of the different kinds of vestibular services that you present and get… It’s a new form of search engine optimization of like, look, if you’re dizzy, come and see me and understand that… That’s actually how a lot of people get their information today.
Dave Kemp:
So I think it’s a matter of just kind of, you shouldn’t be dismissive of it just simply because you feel like I’m not hip enough to do that because I think there’s probably something that could work for you that you would be comfortable with. But I think that a lot of it just comes down to trying to understand what you would use it for and kind of outlining a game plan instead of just shooting from the hip a little bit. Is that kind of how your experience has been?
Madison Levine, BC-HIS:
I agree. Yeah, I agree. Totally. I mean, I’ve done the shooting from the hip.
Dave Kemp:
So have I.
Madison Levine, BC-HIS:
It is what it is. Sometimes something works and other times it doesn’t, but I think if you don’t plan, then you won’t get consistency. I’m still testing things out but that’s how I am with the business, with everything, is I love looking at the data and then making observations and then pivoting. So I disappeared for about a month when we moved into this office. I just couldn’t look at social media. This was a lot to take on. We moved from 1,000 feet to 4,000. We built it out and did all this stuff. So I’ve been back on for seven days. And I decided, I promised myself I was going to post every day until I couldn’t anymore. I don’t really have a plan except… So I do like to batch some reels and I may use Canva for my regular [inaudible 01:02:41].
Dave Kemp:
Canva’s awesome.
Madison Levine, BC-HIS:
And so, I mean, it gives us all the tools we need. So I batch them. When I have time, I’ll sit down and do five reels. When I have time, I’ll make 10 Canva posts. And then on a certain day, if I feel like doing something fresh, I can do it, and if I don’t, then I just post what I had. So I don’t have that much thought as far as, today’s going to be real ear, tomorrow’s going to be dizziness, I just know that I want there to be variety of what’s hitting people. And I’ll tell you the coolest thing about it is, all my friends and family know what I do now. And they are our best referral source.
Dave Kemp:
Yeah.
Madison Levine, BC-HIS:
And if they didn’t see the social media, they really wouldn’t know what I did. So just reaching even your small pocket, it’s going to be important so that they can send you people.
Dave Kemp:
Yeah, yeah. I mean, I think we’re very much on the same page with this. And again, I think it’s just like, for the people that are listening, is just to say, there are actually, I think a lot of really effective ways to use different forms of social media. I think it’s progressing in a way that there’s just more and more in to your point. There’s been a massive democratization of the tools used to create these things. Again, when I was in college, you had to know how to use Final Cut to be able to post a video online, now, TikTok has more sophisticated video editing software and anybody can do it. So it’s the barrier of creating content’s gotten so low, so really anybody can do it. And I think it’s just a matter of, again, figuring out whatever’s going to work for you because I think that to… You’re a testament to this, is like, there’s actually real tangible things that can benefit your business as a whole.
Madison Levine, BC-HIS:
Yeah. I agree completely. So it’s a mix of everything, right? But I guess the takeaway from all these, none of it is easy. Maybe I make it look easy sometimes, I don’t know. It’s not, it’s hard. And I’ve had these periods in my business where startup mode was all in, all day, every day. Some nights, 11, 12 at the office doing things. And a couple years in, there were periods of, wow, this is getting easier, I’ve got a lot of help. I can cut out at three in the afternoon and vacation more. And now here we are, where I’m putting everything back in again.
Madison Levine, BC-HIS:
But with the vision that in the next month or two, my load’s going to get a lot lighter, but I’m making that investment right now. So it’s not all easy. You got to try a little bit of everything. I mean, I just really believe in mentorship. So listening to things like your podcast, you have excellent people come on and-
Dave Kemp:
Thank you.
Madison Levine, BC-HIS:
… you can learn so much just from listening to mediums like that, besides going in like, go buy five business stocks.
Dave Kemp:
I’m personally of the mind that I have a blue ocean mentality, I don’t have a scarcity mindset. I think that there is so much room to go around. And I think that we’re all better off if we collaborate. I think that we can all learn so much from one another of what’s working. I just don’t think that we’re threats to one another. I think the industry and there’s so many people that need this kind of help in these services. And so I think, again, going back to just the fact that you’re really challenging yourself to grow your business and take it into new directions, so that ultimately, you can see and help more people, I think is really admirable and really cool. And a lot of that comes from figuring out what’s working from others. And so I think that there’s a lot of power in people collaborating, in having an open dialogue of just saying, here’s what’s working for me, what’s working for you? What can I learn from you and apply in my business? What can you learn from me and apply to your business?
Madison Levine, BC-HIS:
Yeah, I agree completely.
Dave Kemp:
Awesome, Madison. Well, thank you so much. Thanks for everybody who tuned in here to the end. This has been an awesome chat and we will chat with you next time. Cheers.
Madison Levine, BC-HIS:
Right. Thanks, Dave.
