Hello and welcome back for another episode of the Future Ear Radio podcast!
For this week’s episode, I had the pleasure of speaking with Jennifer Micacci, Audiologist and Owner of Best Life Hearing Center .
During this episode, Jennifer and I discuss:
– Her backstory, how she ended up in Audiology, and her path to becoming a practice owner
– The noticeable leaps forward that hearing aid technology has taken in the past decade
– Some of the major differences between Jennifer’s experience working inside an ENT office vs. her own private practice
– The rationale behind why she decided on her first location for Best Life Hearing and the considerations that went into expanding to three locations
– The challenges that come from scaling a practice and methods to hone new skills (i.e. cultivating leadership skills)
– The increasing impact managed care is having on Best Life and some ideas that Jennifer is using to help navigate this challenge (i.e. upskilling Audiology Assistants)
– Finding other business owners and entrepreneurs to collaborate with and learn from
– Emerging opportunities and additional revenue generators of the future
As a side note, Jennifer was kind enough to invite me up to the Connecticut Academy of Audiology to speak at their annual conference and deliver the debut version of my newest talk, Notes from the Field: 100 Interviews Later – What I’m Learning about the Future of Audiology. So, it was great to finally have her come on the podcast and share her story!
-Thanks for Reading-
Dave
EPISODE TRANSCRIPT
Dave Kemp
Alright, everybody, and welcome to another episode of the Future Ear Radio Podcast. I’m thrilled to be joined today by Jennifer Micacci. Thank you so much for joining me today. How are you doing?
Jennifer Micacci, Au.D.
I’m doing great. Thanks for having me.
Dave Kemp
Absolutely. So wanted to have you on… as an Audiologist, you know, a practice owner who’s now scaled their practice, from one clinic to three clinics, I thought it would be really interesting to just kind of hear your career trajectory and arc. So why don’t we go back to the Start with your story? How did you find your way into audiology?
Jennifer Micacci, Au.D.
Okay, sort of, in a roundabout way, I had graduated, and maybe a little different than the typical past my undergrad degrees in communication, and had graduated with that degree sort of thinking, I may go into media, journalism type. My, my minor was political science. So I had this real kind of interest in news and news media, things like that, but didn’t find a clear sort of path to get into it. And ended up working retail. So I was in retail management, which is, wasn’t my first choice and thought, you know, I’m not, I’m not doing this for the rest of my life. And decided, you know, I’m gonna, I’m gonna go back to school. But I didn’t know at that point in time, really what I wanted to pursue, so took a couple of years off, and waitressed in a research different pathways. And during that process, I was taking some sign language classes. And in that program, it was a full interpreting program, I knew I didn’t have sort of the personality to be an interpreter, but learn more about Deaf culture in the Deaf world. And in one of those classes, they talked about audiology, and it really piqued my interest. As a young person growing up one of my best friends, her brother was deaf, so it always sort of fascinated me. And he was kind enough when I was in this interpreting program to take me into a Deaf Club, where so I was the only hearing person in, you know, a room full of people who were deaf, who were signing. And so I was the one that had communication issues in that environment. And so it was really eye opening to me, and gave me a different perspective. And so, you know, I started researching programs in the state. And I ended up at southern Connecticut State University, which now has audiology as part of their speech program but doesn’t have a doctoral program. We, you know, UConn is the only one in our state now. But it was a very small program. So we got really individualized attention and I felt like I have sound but I was looking for you know, so was able to kind of foster my my passion and learn what about audiology I enjoyed which it always kind of happened to be hearing aids really had a big interest in and then worked in e and t offices for a long time in the early part of my career stopped when I had very young kids and I actually took about an eight year hiatus from working and during that time contemplated you know, do I really want to go back you know, life was changing and tech not so to give you frame of reference when that happened. digital hearing aids were just coming on the scene. So the white accent so this is a long time. And so hearing you know hearing aids at that point in time, they were really pretty primitives. You know, we had screwdrivers, we had a couple of things that we could change you know we did, we did rely on really are measurements really to show us what those hearing aids were doing. You had to you had to know that so that’s where my background and really him knowing the difference really are me at that point in time. But you know, it was frustrating to work with hearing aids there was only so much we could do for people and feedback was a constant battle and so that technology was not on our side at that point in time what we had what we had and we can help people the best we could. So the e and t I worked for once my daughter was about five going into kindergarten and I had more time My youngest daughter, the e and t, that I have previously worked for needed some help. And he said, you know, you can do any hours you want to do. And like, okay, you know, I might as well he needed some adult mental stuff. And so, and as soon as I got back into it, you know, and again, at that time, we’re talking digitally programmable, programmable, they weren’t even fully digital yet. But just the exciting things now that were happening in hearing aids, I got right back into it, you know, kind of sucked back into it. From there, I worked in EMT for a while and then knew I wanted to do something more. So fast forward to a different position at a private practice. And I felt Oh, this is this is where I want to be. This is where I can practice the way that will help people the most, you know, I really, oh, e and t, you know, serves a purpose. And we’re helping those physicians diagnose very serious medical conditions and things. But the hearing aid the rehab part of it, you just don’t have, at least where I was, you just don’t have enough time to do it the way I would like to do it. So private practice, I really felt like, I found my home there. And then working for someone else. I had thought, hey, I really want to be doing this, or myself.
Dave Kemp
Okay, I want to I want to just take a quick pause there and comment on two things. I want to unpack that last point. But first, I just want to make a comment, because a couple episodes ago, I had Dave February on from Starkey. And, you know, I just kind of going off what you said about this, the technology and the leap that it took between sort of the eight year hiatus before and after. And I think that’s just a very interesting point. Because, you know, in some of the previous conversations that I’ve had on this podcast, about what, you know, retailing, hearing aids and selling hearing aids in the 90s, and the early 2000s, were like, versus what it’s like now, I think that, especially for some of the younger professionals, like, I don’t think that they’re that like it, it’s appreciated, or, you know, that point of just how much better off it is, you know, in this whole like industry, given that the technology has progressed to the point to where it’s just so night and day different. And I think that the way that would like translate into market data or something like that would just be the patient satisfaction rate. But I just think about this job and how challenging it must have been when the product was so inferior to what it is today. Which is like kind of to your point, it was almost like shocking, when you came off your hiatus to see how dramatically better it had be had become.
Jennifer Micacci, Au.D.
Yeah, no question. And I, when I think back and I take students from UConn here, and I’ll kind of always give a little history lesson on hearing devices, because it really when I sit back and think about it, it’s mind blowing, that that the advances that we have had in technology, and I feel really grateful to, to have seen all of that makes me feel a little old, some of it, it is it’s hard to kind of explain to students sometimes exactly what we were working with and how we would have to even order hearing aids, you had to know a lot about what that hearing aid did the order the correct type, you know, technology at the time for the patient sitting in front of you. You had to be really familiar with the circuitry of you because you were ordering the circuit that you want it you were ordering the matrix that you needed, and it wasn’t where you could just hook it up to a computer or show it that the audiogram that you have, and you’re you know, obviously I knew that to some degree now, but it was I think you you almost had to know more.
Dave Kemp
Well, I think that it’s it’s very interesting, like how that has all been, I think we look at like the today’s landscape and you can just see that like to your point, it goes all the way to matching people to the proper solution. And so, you hear a lot of these adages that, you know, I think are kind of becoming outdated, which is a good thing, but it’s like, you know, people that buy a pair of hearing aids and they put them in the desk drawer and they never use them again and you know, some of these like notions of how they’re essentially alluding to the hit or miss you know, ratio of patient satisfaction. Some people may be, you know, you were able to match them to something that was that worked well but like, Man, there was a lot of feedback with that, you know, and so there’s just so many things that gave people a reason to, to abandon the old pursuit of this. And I think that is a big reason why there’s still this negative connotation that people have with this whole, this whole model. And everything is because a lot of it’s rooted in previous generations past experiences. And I think it’s important for for all of us to recognize that progression and appreciate where it is now, because I do think that, like, it’s so dramatically advanced in every regard. And I think that that’s a really positive aspect of the technology, if you will. Absolutely.
Jennifer Micacci, Au.D.
And just as you were talking about that, I’m thinking, you know, we didn’t have Rex, back, then we were dealing with either, you know, traditional behind the ears with custom earmolds, or it so occlusion, where people would, you know, normal lows or near normal lows, again, it was hard to get them to get help, because as soon as you put those hearing aids in way, it was hard to deal with that occlusion. So we can help just a greater range of people now because of the technology that we have. And yeah, see, I’m, you know, nightmares about feedback and trying to control it. But you learned out, you know, learned a whole lot about how hearing aids work, and in a lot of that stuff, you know, translates to the products that we’re working with now. And in a lot of ways experience, experience matters.
Dave Kemp
Yeah. So the other point, I wanted to kind of unpack that you were making was, you know, the, the point you made about the transition from working in an EMT to a private practice, and you said, I just didn’t feel like I had the amount of time or the autonomy to sort of facilitate the kind of rehab treatment that you had wanted? Can you unpack that a little bit and just describe maybe what specifically was in you know, when you’re operating in something like, you know, call it like, you know, obviously, this is generally generalizing, but like a standard D and T clinic, versus what that was like, when he moved into a private practice? Was it just so dominant with like, the diagnostics and you were like turning people out? Or can you just speak to that a little bit? I find that interesting.
Jennifer Micacci, Au.D.
Yeah, sure, I can talk I worked in is two different offices that were fairly similar in the way that they ran, I think it’s fairly standard with most e and t offices where you, you have your own schedule, but the physicians can bring back a stat test, anytime. So we would call it that, you know, the chart would, back when we all had paper charts, the chart would be in the box, you know, so we would sometimes have now, five or six charts, people waiting to be tested while you’re trying to do a hearing aid fitting. But you know, you got all those people waiting to have tests, and the physicians relied on our test results to do what they needed to do. So it was just kind of this constant pressure to move things along. And you know, even if you wanted to spend more time it was difficult to get at.
Dave Kemp
That’s interesting. Okay, so then, kind of going back to your story of you, you make this transition, you start working at a private practice, where does Where do things go from there?
Jennifer Micacci, Au.D.
So it was so nice to have a schedule that was all yours. And you’re in? And I guess depends on the private practice that you’re working at, you know, I happen to have a, you know, a boss, who, who, while she wanted a full schedule, I was free to modify it as I needed, and was able it and it just felt like even the normal appointment time that we had there allowed for a whole lot more counseling to happen. And you were you were the professional right? So they weren’t seeing somebody else after you who was then going to talk to them about the hearing loss it was you that was counseling them about their hearing loss and the effect and and their need for hearing aids. Were sometimes in the e and t office while we could have a short conversation and they would ultimately go back to the e and t who was the one that would that make that stronger recommendation. So it was unusual now to have that conversation with a patient. And so, you know, I had to learn, I think better counseling techniques. And we’ll learn how to do the sort of motivational interviewing in the beginning of the appointment to get what the patient needed out of that visit. And then you know, where are we going with it and making that up? He shouldn’t have, you know, partner in their care. And knowing that you are the one responsible for that they’re not going to somebody else after they see you who is then going to do some of this work. And I just love the fact that while you might have your next appointment waiting, you didn’t have multiple people waiting. See you and there wasn’t there wasn’t that pressure.
Dave Kemp
Yeah, that’s interesting. So basically, the patient flow was more manageable, you felt like you could dedicate more time I mean, in your, in your eyes, what is a proper hearing aid fitting allotment of time, that initial visit?
Jennifer Micacci, Au.D.
In my office, we do an hour, I think that can vary based on if it’s a new user versus a
Dave Kemp
brand new patient. Right,
Jennifer Micacci, Au.D.
right. versus somebody who’s worn hearing aids for a long time. That certainly will vary. What you know, in terms of doing the programming and the verification, and some education around whatever new product that they are, using an hour is what we a lot. We also we have audiology assistants here. So there are times if we have a really full schedule, and we need to shift some of the duties of the fitting to not the actual programming. But in terms of instructing them to put them in their ear and take them out and show them how to use the volume control how to set up their Bluetooth. We will use audiology assistance for a lot of that stuff. So if we have to shorten the appointment, they can kind of take over and do some of the the non ideological stuff. That’s
Dave Kemp
really cool. Okay, we’ll come back to that piece. But going back to your story about so you’re at the practice, when did you become the was it this practice that you bought? Or did you end up starting your own practice? When did you become a practice owner.
Jennifer Micacci, Au.D.
So the practice that I worked in, is not a first location of best life. But it is one of the the locations that I took, okay, while I was working there, my mother got very ill. And as I was with her, it was a very wet illness, and she passed away within five months of getting sick. And it was one of those life events that changes you. And I remember thinking at the time, you know, I’m not getting any younger. She was 68 when she died. And I was 49. And I thought, and her mother before her head also died at 68. So I just had this thought process if I only have this many years left on this planet, what do I want to do with the rest of my life and, and private practice ownership was something that I always wanted, but sort of was a little bit nervous to take the leap and is, it’s a scary thing. But at that point in time, I said, You know what, either I’m going to do it now, or I’m not going to do it at all. And so when I came back to work after being with my mom, I said to the owner at the time that I was going to be leaving and start my own practice, and add them, you know, started to investigate what I needed to do to do that. Did a lot of prep work. But I always say no matter how prepared you think you are, it’s gonna be an adventure. And it was Yeah. Did I fully answer your question?
Dave Kemp
Absolutely. No, I think this is it’s really interesting. You know, I just I think that there are these kind of like life moments that happen that change your whole perspective. So you go off, you strike off in, you’re going to do your own thing. Where Where where’s the first location of best life where in Connecticut?
Jennifer Micacci, Au.D.
So we’re in Wallingford, Connecticut. And I had done a lot of research around location looked at multiple towns. And my my kind of theory is if there’s one, good private practice, Connecticut towns are not huge in general. And it would be hard to compete against another really good established private practice. So I really wanted to go somewhere where there was not that. So Wallingford happened to have a big rehab hospital that had an audiology department for like 30 plus years, that a few years before had closed the department. And so I knew there were a lot of people looking for a new home, new, you know, new audiology and kept coming back to Wallingford as really a good place. You know, I’d had some people tell me Well, you know, other people have tried things there and it hasn’t really worked. What I said, You know what this is, it’s a, it’s a good sized town with a need for Audiology. So this is where I landed. And it was close enough that a lot of my, you know, former patients could follow me. I’m just thinking back in my mind, I don’t know about that time period, it was certainly stressful. But, you know, I wouldn’t change anything for the world. It was it was character building was that?
Dave Kemp
Well, so I was gonna ask, like, you know, what, what really stands out in your mind? If you kind of chronicle this period, right. So what what really stands out about like, maybe some of those initial fears before you even took the plunge, when you were doing your due diligence to decide, you know, like, if this is going to work or not, you know, and then maybe those first few formative years of, of owning a clinic and what stands out in terms of some things that maybe were challenging or things that you really were surprised by some success stories, you know, whatever it might be, when you think back to this period, when you were just sort of getting your feet underneath you. What stands out in your mind?
Jennifer Micacci, Au.D.
Initially, of course, you’re thinking, Well, anybody, I’ll open the doors, Will anybody show up? You
Dave Kemp
know, yeah, for sure.
Jennifer Micacci, Au.D.
That’s the biggest fear. The challenge in the beginning was getting credentialed with the insurance companies. And I figured I have the time I’m going to, I’m going to do it myself. And I did do a lot of it myself, but I did it one after a very stressful month, get other people involved. But, you know, I went to Kim Cabot’s boot camp, I learned. And I had, in my previous positions, I immersed myself in the insurance piece of it. I felt like it was my duty to know if I was talking to a patient about their benefit, it was my duty to know as much of as much as I could, about what they could expect to be paying. And so I really had a long history of working with either the insurance company directly, or with our billing department on the billing, it was something that I really felt was important to know, even though it’s, you know, it’s not fun. It’s not a fun part of what we do, but I think it’s important. So even with all that background in it, it was a challenge. Uh huh. Very stressful. I got I remember, I got shingles during that point in time. And the doctor looked at me, he said, Are you under any stress? Oh, yes, I thought. Okay, your shingles to everyone who come in, if you’re 50 or over. So that was the biggest challenge going into it getting credentialed with the insurance companies, because of course, the first question people ask is, you know, do you take my insurance, and we still deal with that challenge, we can go there later with managed care and all that. And marketing, you know, learning how to market your business. I had, I had someone it was actually at one of the manufacturers. When I was talking about starting up the business. Somebody at one of the manufacturers had given me some really good what I think is really good advice. He said, get yourself some used equipment, and spend your money on marketing. And I thought really does make a lot of sense. So I did exactly that, you know, I found a use booth that fit my space perfectly, I was able to find some really good audiometer tympanometry or OES used, but still in great shape. And so the investment in the equipment wasn’t an outrageous and then I could take the funds that had and invest into marketing and then I fell in love with marketing, you know, I really enjoy that aspect of it. So that’s been a fun part of building the business is learning more because as we know, if we knew exactly what worked all the time, everybody should be doing. So it’s like it’s, it’s a moving target. Or she and you know, it’s fun when things work and not so fun when they don’t. But that’s all part of our business ownership and part of what I love about it.
Dave Kemp
Yeah, so, okay, so you kind of you crossed that threshold. You establish yourself you know, you you kind of become capable of of I can or I guess taking insurance, or certified, if you will. And then you also start to market your practice and, you know, go down the route of starting to drum up business. So then you kind of progress in, where does your your story then kind of lead? I know you have multiple clinics now, what was that period, like between getting to the point to where you were ready to expand.
Jennifer Micacci, Au.D.
So I opened the practice in April of 2019. And if you think about the time period between 2019 and out, and now we had something called COVID. So about a year into it, I had two things happen. One is we had a fire in our building, and my entire space got flooded. So I had to close down for like a week. And I thought that was just awful. But okay, we closed down, we got it all dried out back in business. And we were, we were actually having a really good sort of, I remember his March at the time. And then this, we started hearing about this thing called COVID. And as it got deeper into it, and then okay, in a month after that blood, I had to close the practice down, are COVID and was a scary, you know, scary time, I was only a year, a year old practice. And you didn’t know, you know, everybody, I’m sure has that memory of that period of time where you just didn’t know what was going to happen. And when you close the doors, When could you open them again, you just didn’t didn’t know. And at that time, I was taking a lot of third party because I was at New practice. And I was trying to get people in the door. And so it was actually a little bit of a saving grace, because third party payments are lagging, right, they pay you about after the trial period. So I had money coming in from the third parties to at least pay my bills. And at that time, it was just me and one staff member. So it was manageable in terms of the bills. got through about two months, about two months, we could open the doors, and I never stopped marketing during that time period. You know, I was kind of looking at all of the different advice and looking at other sort of crises that have happened in our history. And while you feel like you want to shut the spigot off, because you don’t want to pay for the marketing. Everything that I was reading about history of this kind of thing was don’t stop, do some marketing, in some fashion, we obviously couldn’t do it all the traditional way and market the same things. Well, we could still let people know we were out there. So I did I continue to market. And so as soon as we could open the doors, which is about two months later, and I never really I came to the office every day, I talked to patients on the phone every day, I went out, you know, to the car and gloves and masks and did repair. So I never fully just shut the doors and you can’t communicate with us. But as soon as we could open the doors and be fully operational people were more than willing to come back in. So you know, you breathe a little sigh of relief. And I think in that period, we were kind of tricky to transitioning out of the isolation periods and dealing with COVID, we now had protective gear and things like that. Then sort of went full steam ahead with the marketing and had explosive growth between then in 2021 2021 was an amazing year for a lot of people. Because we had that demand build up we had people recognizing that they had hearing loss because of the masks. We had all of these factors and 2021 was this incredible year for us in I was exciting. Be nice if it was like that a hurry or not. But it did, you know, allow me to think okay. Do I want to do more than this? And then that practice I told you that I had been working at I found out that, you know the owner was interested in selling and he had an eye and I knew it was a great practice. I knew a lot about it. So it just made sense to me. Yet another practice in another town in Estonia that he basically said he wouldn’t sell one without the other. And so Okay, what the heck? Once another one? Yeah, and, and this is another case of where as as much work as you think it’s gonna be? Yeah, it’s gonna be way more way more than that. So the the business transaction of actually purchasing those two additional offices took a took a lot of time, I’m gonna say a good seven, eight months to kind of get through that, you know, with the financial piece of it, the legal piece of it, all of it. And it was, you know, certainly there were times when I said, Oh, my, what am I doing? What am I doing? And why am I doing this? You know, you do sort of have to think about why am I doing this? Because that is the thing about scaling, right? Does it make sense? Yep, you have this one? Office that seems to be chugging along pretty well, you know, why? Why would you do this? And certainly, that went through my head. But I felt like I knew this this other office. And I think my thinking was, that’s probably going to fall into corporate hands if I if I don’t take it over. And I would like to see it stay in local, independent practice. But that is the challenge of having multiple locations, how do you keep that independent local feel, when now you have multiple locations, you’re in different. And none of the locations are very far apart? No, our farthest one isn’t, it’s maybe a half hour in, we’re about a half hour from each other. But it’s still a lot of what I did to build up the Wallingford location was local networking, you know, talking to other business owners and working with the local physicians and things like that. Being in the local newspaper, and now Okay, now, I need to do that times three, and you’re one as the owner, you’re one person. So how do you get your staff to care enough to also want to do those things? And that I’m finding? Well, there are a lot, there are a lot of challenges in doing this, that’s one of them, is keeping that local feel when you, on the other hand, want to create systems, so that we’re all doing a lot of things the same way. You want to keep that each office has its own.
Dave Kemp
Yeah, it’s kind of the wire adoxa cool, it’s like you’re trying to keep the, the like the, you know, the feel in the vibes of of the original best life Hearing Center. But once you scale it, you sort of have to delegate, you have to give up some of that control. And the byproduct of that is that, you know, maybe there are some inconsistencies that you’re not crazy about. But it’s it’s almost the trade off of of growth, right? And I guess that’s probably one of your biggest challenges is, how do you have the right, you know, hire the right personnel have the right group that is bought into this, whatever you would kind of however you would, like distill down the essence of best life Hearing Center. And then like, what, how do you embody that more or less?
Jennifer Micacci, Au.D.
That is 100%, the biggest challenge, you know, it’s been about a year since I’ve had all three. And we’re still working on creating those systems, because the other two, the other two, even though they have the same owner function very independently. And so they each did things very differently. And then very different from what we were doing here. So it has been a work in progress to get everybody on the same page in terms of all of the processes. And I, you know, I learned quickly that I needed to have some patience around that, because I wanted everybody to do the same thing we were doing right away, you know, and be including, so I use counselear as my LMS. And they were using something different. And so when I transitioned and kind of threw counselor at them, you know, there’s there’s a learning curve there that I didn’t quite appreciate, appreciate because now I had been using it. And so I needed to take a step back and because it’s it’s such a great system, but you have to know how to enter the information so that it’s usable on the other end and and I would say that still that I learned things about counselor every day that we can utilize that maybe we’re not so that’s been challenging on many levels, and then conveying to the staff. You know, having this vision in Your mind is not enough, you have to communicate it to the staff all the time. And when you’re also a clinician, and not just an owner, you know, when you have a busy patient schedule, on top of trying to run three offices, it did get to be too much for me. So I hired an office manager, which has helped tremendously to help streamline things because she can be places when I can’t be. And she, you know, that’s her total focus is operations. So that was a huge, a huge stress reliever for me to have that other person that can do a lot of the things that I was doing,
Dave Kemp
for sure. I mean, the, every time I have these conversations they sort of bring to mind past episodes. And the one that’s really coming to mind right now is the conversation I had with Jason Lane Decker, who has a chain of clinics in Minnesota, and kind of a similar trajectory started out single location multilocation. And I think what was very interesting about his story was how he has, and I’m sure you felt this, too, is like, you, you’re not just a clinician, but you’re an entrepreneur, and you know, so much of that side, like kind of starts to take over and dominates your, your time and your energy and all that. And, you know, a lot of that is like, as you scale, it’s about becoming a leader. And so you have to figure out like, a, it’s a like, all things with becoming an entrepreneur, which is you kind of almost have to teach yourself everything, you have to be self taught for so much, you know, it’s, that’s, I think one of the biggest aspects of it. And so, you know, he was talking about how he cultivated, really like the in fostered leadership, and you know, how challenging that was, because it, you know, innately wasn’t really the kind of person that was drawn to that, but you’re sort of thrust into it. And so, you know, he had a lot of really interesting insight around how he was able to sort of foster that he, you know, made it an effort to, like, read a lot of these different books. And, you know, so much of it, though, was like, really actively working on his communication style to his team. And I just find this to be really interesting about, you know, again, you’re, you’re not just an audiologist, but you’re like this, you’re also on this career arc of becoming more and more of this entrepreneur and all that comes with it. And it’s, you take on a lot. And it’s not something that you read out of a textbook, you sort of have to, you have to sort of experience it and learn from those experiences. And I just find that that element about private practice is so interesting, because every person you talk to, there’s a lot of similarities, but everybody kind of had to strike out and learn this stuff on their own. And it’s just fascinating to me to hear how people sort of teach themselves this stuff, when you have to kind of almost seek it out and just figure out a way to like, acquire that. That skill set more or less. Yeah,
Jennifer Micacci, Au.D.
I can totally relate to what you’re saying about Jason. I also really just devoured books on business, on leadership on motivation. Always could talk about whatever book I’m reading, I’m just reading traction. You familiar with that one. And I also had a really great group of practice owners. I saw at the time when it was just the Wallingford office, I was with IR Q, before IR Q. And, you know, aha merged. And right now I’m with CQ partners, but starting with the IR Q, we had this group of practice owners that started meeting actually during COVID, sort of my lifeline to be like, Okay, what’s happening out there, you know, with other people, it was really it was an important part of that time in the practice development. And so make created some really strong relationships with other practice owners, people you could rely on for advice or to just commiserate with, you know, in the moment, and that that group, every week, we met every week via zoom, and there was always a topic around mostly leadership, leadership motivation. We talked a little bit about the nitty gritty, the operations and marketing things, but it was really a lot of that leadership development. And so this group, a lot of the same people continue to this day, every Friday, you know, at noon we meet and so cultivating relationships like that has really helped me I’m also in one of Don hymens entree audiology groups with these amazing practice owners that have been doing this a whole lot longer than me. And, you know, I have learned so so much from them also. And that’s been hugely important for me to not be just in this little bubble, trying to figure it out on my own, to know there is support out there. And people can lead you in the right direction. And even in other aspects of what I would have to do. So say, when I was going through the legal stuff with with the practice acquisition, you know, I just found this really great lawyer who feel like I could not have gone through this without her, she just was so smart in that things that I could never have known on my own. Yeah, and same thing with my account. And like it took thing, I’m on my third account, and because I was just never comfortable, now has someone I really can rely on and trust. So knowing that just the relationship, he’s have all the other segments of what you do are so important. That you don’t, you don’t you can’t do it alone, you got to find good people to do it with you know,
Dave Kemp
now I find that really interesting. And like, again, there’s so many stories like this of during the pandemic, people sort of found ways to, to collaborate in like you said, commiserate. And I think that a lot of people like kind of held on to a lot of that. And I think that that’s been a positive byproduct of it is these groups that I think are pretty pervasive in this industry now have, you know, these small networks of like minded, you know, individuals that are in similar situations across the country that can share a lot of their experiences. And again, it’s I think, this whole notion of like, people all can kind of relate to these things. You know, managed care is a perfect example of it. Right? Like, I think everybody is kind of going through this right now of figuring out how do you adapt to that. But it’s a it’s an example. That’s a visceral example, that, I think, is the epitome of like, you could, you know, try to figure this out on your own shirt. And I’m sure many people have been will. But I think a lot of people are working together in a sense of like, what is the right approach, given my circumstances given, you know, the, because again, it’s not a universal thing. And I think that’s what’s pretty, pretty cool about what I feel like I’m observing in this industry right now, which is, I haven’t been in this industry all that long. I mean, I joined oak tree full time in 2016, or 2017. But it really does feel. And I guess the pandemic maybe was the the marker of like, when this shift really felt like it took effect, but it feels like there’s a sense of collaborative fitness, across the professionals, particularly the audiologists that, you know, are doing a lot of this mind melding and sharing of experiences. And so I think that, again, it’s rising tide lifts all ships, but you know, I think everybody can, doesn’t need to think of each other as competition, I think that there’s a lot of good that can come from just simply putting yourself out there and saying, These are the challenges I’m facing, who else is facing similar challenges? What are you all doing to kind of solve these things?
Jennifer Micacci, Au.D.
Yeah, that’s exactly right. And I know you and I had talked at one point about, you know, being a member of your state organization. And so even at the state level, where truly some of us could be competition with each other. There, there’s a lot of that, you know, collaboration happening, even with people in your own town or, you know, your towns over. But we being part of the state organization, and knowing that we’re all working toward the same goals, and there’s enough people with hearing loss out there for everyone to service that I will try to kind of foster some of those connections sometimes. But that’s why I do feel like it’s important for me to be part of the state organization. And we’re a small state, you know, we we say we’re small, but mighty, you know, our state organization has been really solid. You know, we had Dr. Cathy, Alix had started it. And she was the president for many, many, many years and recently passed the torch. But there’s been just a core group of people that have kept this organization strong and kept it going. And now we’re in the situation where we’re needing new, younger audiologists to take part and they have been and it’s been so nice to see their input and their perspective. And now they’re, you know, we’re planning our next one. On prints, and they’re taking, you know, a leadership role in that conference planning. And just having that different perspective and seeing them also have that collaborative feel. It’s it’s so nice. And we have also a strong you know, we have employed a lobbying group as your state organization does to keep an eye on audiology issues. You know, we have a strong lead on the governmental side of things, which is also so important these days with scope of practice issues and things like that. So, yes, join your state organization. And they always need help. Yeah,
Dave Kemp
I mean, I’ve, with my job, I’ve, I’ve traveled to a lot of State Academies. Thank you for the invite to the Connecticut Academy and the invite to speak up there. Because I will say that I was very impressed with, like you said, it’s a small but mighty group, it seemed like it was, I mean, it was a pretty crowded room. For being a small state, there were quite a few audiologists there it was, in all honesty, one of the better state run academies that I had attended. So kudos to you all, you’re definitely doing the right thing. And I’m, I’m with you that I think that it’s, you know, as somebody that’s part of the younger cohort, I personally feel that it’s very important for young people to be engaged in this stuff. Because I think that a, you know, it’s a great way to meet and network with everybody in your state. But I think it gives you the opportunity to establish yourself in your voice, your generational perspective, the way that a 30 something or a 20, something, you know, a young professional is going to be thinking about this industry is going to be a lot different than somebody that’s, you know, maybe at the tail end of their career that isn’t thinking about what this space is going to look like in 10 to 20 years. And so I think that it’s just, in my opinion, a really awesome way to establish yourself in your community, as somebody that is engaged in wanting to progress things forward. Because I think that, you know, to your point, it’s gonna get to the point to where you’re, you’re kind of the the heir apparent, more or less of who’s going to assume that role of leading the charge and, and so again, I, I’ve just become very invested in this whole notion of like, because I speak to so many different audiologists in different parts of their career that all speak very positively about the effect that getting involved has had on their career. The last episode I just did with Tish, Gaffney, you know, she really attributes so much of her career success, to the fact that when she was really young, she got involved in what was NAFTA, which was the predecessor of student Academy of Audiology. I didn’t know that until I talked to her. But it’s, you know, one of those things where you just can, I think it just sets you up for things that you won’t really realize are going to be secondary benefits of doing those are the types of doors that it’s going to open. So again, that’s my, that’s my testimonial of why I think it’s important to be engaged in this stuff, because it really, I think it really does lend itself to future career opportunities that you, you can’t predict.
Jennifer Micacci, Au.D.
Yeah, I could tell a personal story on that note. So when I started on the board at the Academy, I was working at the e and t office and was on the board with someone who had previously worked at the e and t office, and she knew that I wouldn’t would want it to sort of get out of there and want it to be in private practice. So when she heard of a practice opportunity, she and it was somebody else on the board, you know, kind of steered her in my direction. And so having that connection, and that was one of the things about private practice that I thought it’s it’s hard to get into a job at private practice, because people will usually go the networking route, as opposed to posting an ad. And so that was, that was the way I got into a private practice was that you know, somebody I knew somebody introduced me and said, you know, she’s interested and that’s how that worked out for me. And I’ve seen that happen in that space. And I think there is a part of there was always a part of me that wants to have a legacy of helping the profession and, you know, that’s why I take UConn students. I like to teach them and I think what you were saying about, you know, young people bringing new perspective It’s nice to have that balance of having the young people with new perspectives. And then the I don’t want to use the word old people.
Dave Kemp
But seasoned vets,
Jennifer Micacci, Au.D.
there you go, I like it. But, you know, having that historical perspective, just the mix of the two is really great. And, and I think that especially helps when, when we’re looking at the legislation, and how it may affect us, you know, the season’s seasoned vets, as you call us, you know, we might not we may have a bigger awareness of our certain piece of legislation may affect us based on history. So it is, I think it’s really important to have that mix of people. And I think we have that now in Connecticut, which is really, really nice.
Dave Kemp
That’s cool. So as we come to the close here, you know, where you’re at now versus where you were, you know, from the beginning, it’s really cool to hear the progression. So what does 2024? Like? What are the things that you’re excited about? What are kind of the, you know, I know, we’ve talked about managed care being, you know, an obstacle a challenge, even But where’s, you know, we’re kind of at the start of the year, like, what, what’s on your forecast for for your clinics? And what are you what’s kind of top of mind for you right now,
Jennifer Micacci, Au.D.
I would say it does have to do with managed care, I was crunching some 2023 numbers last week, because you know, numbers will always give you perspective that maybe didn’t, aren’t aware of, and looking at our managed care. So we currently take four different managed care lands. And in crunching the numbers, we discovered that 50% of our time goes to managed care patients, and it accounts for 15% of our revenue. So that was really eye opening. And, you know, looking at what we’re taking, I’m going to reduce the number from four companies to two companies. And, you know, it’s always part of what I’m doing to see how we can manage managed care better. It just discussed that is going to continue, and it’s going to be ongoing to figure out how we do that. But that perspective that we’re spending all of this time with this man with these people with me in his care that of course, we want to help and many of them are patients we have seen for a very long time that probably started out or did start out private pay, and because of their change in insurance. So, you know, you certainly want to continue to see those people. It’s, there are so many factors, you know, when you’re looking at what plans do I take? What plans don’t I take, but it has to work for you. You know, it has to the numbers have to make sense. So we’re drilling down on that and how to fine tune that a little bit. We’ll be working on continuing to work on our processes and systems. Hiring, I just have one position open right now. But looking at our hiring processes. There’s so many things in 2024. But I’ll just say it’s always a work in progress. Like I know, there’s no destination, we’re going to reach and say, Okay, we’re done. You know, it’s always gonna be continual. So, you know, I’ll do it for as long as it. I enjoy it. At
Dave Kemp
this. I think that that whole notion of managing managed care is probably like, if you had to boil down, you know, what the most popular topic would be at like AAA or something like that. I bet that would probably fill a room. You know, fuller than Yeah, right. And that is the interesting thing that there is no silver bullet. I mean, it’s to your point really hard to just say, Well, I’m just not going to see managed care patients, because what about all of your existing patients and all of the collateral damage that could do to your brand? Not to mention that it’s just not consistent with most providers like that they’re in the business of helping people. So it’s very, very challenging. But for me, again, this all kind of comes back to how do you reconcile with that notion that’s such a stark, you know, the like a shocking statistic 50% of your time, is dedicated to a segment of your customers that represents 15% of your revenue. So like, That, to me is where I think that over the next few years, the market will have to sort this out. And I think that, you know, one of the ways that will be very interesting to watch is how you can sort of employ or deploy Like, audiology assistance and some of these different types of labor, and I just keep thinking that you have to find efficiencies. And that seems to be one area that there’s a lot of potential. But can you share maybe why that’s not as simple as it is, I mean, how much of that? Again, this is probably oversimplifying, but the the analogy that I always think about is the dental model, right? You only see the dentist for a small portion of time, when you go in to get your teeth cleaned, and you get the X rays, you’re primarily engaging with the hygienist. So what’s the analogy to this industry? Is there an equivalent where you as the audiologist can go and you can spend a little bit of personal time with that patient who you’ve really enjoyed working with over the last, you know, 10 years. But you’re not having to dedicate that whole patient visit? Can Can that I mean, is that like viable? Or where does that all like, thinking breakdown? In your opinion?
Jennifer Micacci, Au.D.
I think that’s absolutely viable. And it is, it’s the model that we’re transitioning to here. You know, I referenced it a little bit when I was talking about the hearing aid fitting, but we do much like the dental model, if someone is coming in strictly for a hearing aid cleaning, they see the assistant. I think the challenge that I have, and where you know, we’ll be exploring how other people are doing this is charging appropriately, and screening at the front desk, who needs to see the assistant and who absolutely needs to see the audiologist? And so that because sometimes there’s some confusion there. And patients can be confused about why is this appointment more than this appointment? So there’s a lot of patient education that goes around making them aware that it’s similar to a dental model that if you’re coming in for the cleaning, the assistants are trained to work with your hearing aids in that way. But they’re, they’re not going to be programming the devices in any way or you.
Dave Kemp
Let me ask you this question really quick. When it comes to that patient education piece, do you find that the patient education is more warranted, or I guess, in more demand by the patience of those that are already existing patients and accustomed to this model, versus the people that are brand new, not accustomed to this model, and maybe they’re more receptive to it, because it’s more consistent with other health care models, like the dental model?
Jennifer Micacci, Au.D.
I’d say that yeah, that you’re spot on there that people that we have seen for a long period of time that we’re used to coming in to seeing the audiologist, even if they’re just coming in for a cleaning, you know, they like to chat with you, they like to be social with you. And if if you’re not doing much more than cleaning their hearing aid, then it makes sense to transition them to the assistant. But there will be some pushback sometimes, you know, so there is training on the staff level. And, you know, I think it’s important on the part of the audio audiologist to assure them, you’re you’re seeing someone who is more than capable of doing what you need them to do, they are in great hands, and I will see you at your annual or whatever it will be. And we are we’ve successfully done this in Wallingford and Cheshire in the other location. We’re currently training and audiology assistant there. So that model can be consistent in all three offices. And so that the charges can be consistent in all three offices, that kind of thing. And I do think that’s the future because we have to deal with this lower reimbursement we have to deal with seeing more people and effectively using our time so that we can remain profitable, you know, and be able to help as many people as possible at the same time. So I think that is the future.
Dave Kemp
Yeah, I that’s sort of the the sense that I’ve been gathering is that it’s the fact of the matter is, is that it’s not going away, it’s only going to become more pervasive in terms of whether it’s managed care, or just insurance, broadly speaking, I think that this is just sort of part and parcel with like, the way that things are moving where this is a benefit. And, you know, I think that here in this period of time right now, it’s really challenging because it’s so it’s so inverted versus the existing model, which has really been lower patient volume, higher profitability per patient. And so I think that model is totally inverting right now. So it’s painful, but I think the other side of this and I don’t know how it will shake out, I don’t know if like the revenue opportunities are going to just be I think what’s undoubtedly going to happen is there’s just going to be more people that are engaging with this model. Now to De those patients are less profitable on a per patient basis because of the low reimbursement rates, and because of the pervasiveness of managed care, but I think that what will become interesting to see is, are there other ways to generate revenue from those patients, you know, maybe it will be things like new treatments like linear or something that’s for totally different kinds of, you know, symptoms that are, you know, pretty consistent with a lot of the patients where, you know, in the past year, predominantly just, you know, facilitating treatment for amplification, maybe in the future, you’re also doing a lot of treatment for tinnitus. And, you know, so again, I just think that it’s not yet to be seen what that’s going to look like. But I think that what is the exciting aspect of this is that more people are coming into the office. And I think what will be really interesting in like, a few years is, how can you monetize those people for lack of better words, in a way that isn’t egregious? You know, it’s just, I think that again, like maybe the best place to be looking are some of these adjacent healthcare industries to see, because this has already happened in their industries. You know, what, what did dental do when when this all kind of transpired? Well, they, they started to diversify into different little ancillary add on services, you could get your teeth whitening, you know, you could do these different kinds of services that, you know, you could buy more or less when you came into the office. So, I think that it’s just sort of, it’s hard to, you know, I always take a optimistic viewpoint, but I can see how it’s like, you know, it’s easier said than done. But it does seem to me that there is a light at the end of the tunnel here. In the sense that I personally think that imagine the inverse of this, imagine if, you know, less people were coming in, and your profitability was getting slashed. You know, the reason that the profitability is getting slashed is because so many people are coming in now. It’s, it’s, you know, like economies of scale, more or less. Yeah,
Jennifer Micacci, Au.D.
you’re, I think, what you were talking about in terms of adding services, that’s been something been working on. Also, you know, in Wallingford, we’ve been doing more and more Saruman removal, and that we, in this office, we haven’t have a nice space to do it. And in the other office is a little more challenging, challenging to figure out where we can offer full, you know, irrigation, suction, annual Saruman removal. It’s harder to do it in the other offices, but I’m trying to figure out a way because I think that’s something here that people have been, they’ve had bad experiences elsewhere, they the convenience of being able to do it, right, when you see it, and not having to reschedule an appointment to send them out to do. It’s that has been one of the things, you know, the add on ancillary services that you’re referring to. And I am always looking for things like that. Because I also agree with you that is what we shouldn’t be, we should be audiology specialty care, that’s what we are. And that’s obviously been a topic in the industry that, you know, hearing aids alone are probably not going to do it for you in the future. But there are so many opportunities out there. I think my channel, my challenge is all there’s all these shiny objects, right? And I need to focus. And the fact of the matter is, we also want to be really good at hearing aids, because there’s also a lot of non great hearing aid care out there. And so we want to be the place that’s known when you go there. You’re going to get specialized care, we’re not just popping verse fit devices on your ears, you know, and have a nice day. So I also want that to be our primary focus, because we know we’re good at that. But I am always looking for, you know, other services to add, because I think you’re right about that, you know, we need to look at what is specialty care mean, and what should we be offering
Dave Kemp
then agree more. Well, Jennifer, this has been a really interesting and fun conversation. Thanks so much for coming on today. I’ve really enjoyed hearing your story. So thanks for everybody who tuned in here to the end. We will chat with you next time. Cheers
