Hearing Matters Podcast

Navigating Managed Care While Putting Patients First

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What happens when the demands of managed care clash with a provider's commitment to gold-standard hearing healthcare? For Jaysee Soto, owner of Altamonte Family Hearing in Florida, the answer lies in striking a delicate balance between business sustainability and patient-centered ethics.

Growing up in his family's New York City bodega, Jaysee watched his parents build relationships with every customer who walked through their door. Those early lessons in community connection now form the foundation of his hearing healthcare practice, where patients aren't just customers, they're extended family. Working alongside his wife Grace, Jaysee has created a practice environment where comprehensive care is the standard, not the exception.

The podcast takes us through Jaysee's unexpected journey from aspiring lawyer to passionate hearing care professional. That pivotal moment when he first witnessed a patient's face light up upon hearing their grandchild's voice clearly? It changed everything. Now he dedicates himself to creating those transformative moments for his patients, taking a full 90 minutes for comprehensive evaluations that far exceed industry minimums.

But this level of care creates tension when insurance and managed care plans don't adequately compensate for best practices like real ear measurement and extensive testing. Jaysee candidly shares his approach to this industry-wide dilemma: strategically limiting managed care appointments while ensuring those patients still receive quality care, implementing service plans that bridge the gap, and planning for growth that maintains standards while increasing access.

What emerges is a refreshing perspective on hearing healthcare economics. Rather than viewing patient care and business viability as opposing forces, he demonstrates how exceptional care creates its own sustainability through patient loyalty and word-of-mouth referrals. Even patients who initially come through managed care plans often return as private pay patients after experiencing the difference that comprehensive care makes.

Ready to discover what ethical hearing healthcare looks like in action? Listen now and learn how leading with heart can transform both patient outcomes and practice success.

Connect with the Hearing Matters Podcast Team

Email: hearingmatterspodcast@gmail.com

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Twitter: @hearing_mattas

Facebook: Hearing Matters Podcast

Speaker 1:

You're tuned in to the Hearing Matters podcast, the show that discusses hearing technology, best practices and a global epidemic hearing loss. Today on the Hearing Matters podcast, we're joined by JC Soto, owner of Altamont Family Hearing in Florida. Jc's journey into hearing healthcare was not linear, but it was purpose-driven. With a passion for innovation and a heart for helping, he's built a practice centered in ethical care, even in the face of managed care challenges. We're diving into what it truly means to lead with the heart in hearing health care. Jc, welcome to the Hearing Matters podcast.

Speaker 2:

Thank you. Thank you. I'm so excited to be on here and I have to start before anything. I have to start by giving you kudos for building this platform, having this podcast with so many episodes. Whenever I'm going on and just scrolling your content, I'm like this is dedication. I'm excited to be here and I've been trying. I told you a little bit behind the scenes, I've been trying to start a podcast on my own and it's still not live and I got little ones at home and running our practice doing the thing. So whenever I come on and see all this content and the following that you have, I mean I got to give you a round of applause, credit where it's due and thank you for having me as a guest.

Speaker 1:

Thank you Absolutely, jc. I'm humbled. We are a small but mighty team, is what we say, but I've been in your shoes running a private practice and you and I have been connected for a couple of years now. So, honestly, coming from you, thank you so much, that really does mean the world. We're going to have a lot of fun today because this episode theme is ethical care in a managed care world. A lot to dive into today, so let's jump into it. Jc, you once thought that your career would lead to law, or you know a similar field. What ultimately drew you into hearing healthcare?

Speaker 2:

It's a complex one. It's like out of. I say it fell from the sky for me. I always see this story because I started working for a company. Today they're my competitor.

Speaker 2:

It was a large organization that has a lot of retail stores and I started working for them in their call center. But it happened to be in their corporate office, met the right people, networked. I was doing well in there and someone there presented this career choice to me. They said hey, you know what? Do you think about going into an office, becoming a hearing aid specialist? I'm a hearing aid specialist and now have my board certification and I was like I've never seen a hearing aid in my life. Like up to this point, really, I thought that law, like I was on debate teams in high school and like I had this law journey that I thought was where I was going to go and the best thing that's ever happened to me, because I went into an office, I met the provider that ultimately became my sponsor.

Speaker 2:

I got to see you know just the day-to-day lives, like the people that come in the stories, and once you start hearing these stories, I'm preaching to the choir to you. But for those that don't know about in audiology. Once you change someone's life, like once you hear you help me hear my granddaughter, you help me hear these sounds it's just you're hooked, you're hooked and it's. I'm lucky to get to do what I do every day and I never in my life would have thought this would be my career path. Even my family's like how did you?

Speaker 1:

how did this happen? You know what I mean. And it's just it's been the best and I love it a lot well, let's, let's pause there because when you and I connected a couple weeks ago, you were originally from new york, right, your family's from new york. Your mother and father owned a bodega bodegas, yeah. So to me it sounds like you're genetically predisposed to entrepreneurship, it's always, always, always based always. What was it like growing up in a small family business?

Speaker 2:

We were always in the business every single day. My siblings I'm one of four, they can all attest to every single time school was out New York City. My parents didn't want us to be out playing in the streets and going out and doing all these things. So after school often summertime often unless we're going back to Dominican Republic, which is where I'm from my background we were in the bodega. So since I'm like seven or eight years old, I've been a cashier. We're seeing all these lives in a bodega. For those that don't know about New York City, this is where you get your groceries. This is under the building. A lot of people get most of their goods there. So all the people that reside in this building come down. You get to meet all these people, network with all these people.

Speaker 2:

My parents both just you know they were both very extroverted and connected with the people in the community. So we just I just saw this like to me that's been the norm and seeing them do their own thing. So I've always had that bug in my head of when I'm working for someone else, I'm like man, how can I do this on my own? How can I do this on my own? And when my wife and I started dating, even before audiology. Before that, she can tell you anything that I've ever done. I've always thought I've always had this conversation and conflict with myself of like wait, I can, how can I do this on my own? And that's just a chip that I have in my head. So, thanks to my parents.

Speaker 1:

So, growing up in a business, you were then, years later, introduced to hearing healthcare and, to your point, the first time you actually help someone on the road to better hearing. It's absolutely intoxicating. Now, what's also very interesting and seems to be a common theme in hearing healthcare, family practices. And that's what I think is so incredible about what we do, because, yes, there are retail stores out there and a lot of them are wonderful, they provide great care, but there's a lot of family private practices in hearing healthcare. You and your wife, grace, are working together in the clinic. What is it like running a family-centered practice and how has that dynamic shaped the patient experience?

Speaker 2:

Yeah, it's been not like what a lot of people expect. Oh, you work with your wife, that's got to be crazy. How do you do it? Not at all, it's been smooth.

Speaker 2:

Grace is very, also very extroverted. She's actually more I would say even more empathetic than me when it comes to our patients, people that are coming in hearing their stories. Like she is just one that if you met her, I mean she would chat with anyone and she's really, really intrigued in their life story. And those are, at the end of the day, like what we are delivering is not just helping them hear better, it's the relationship experience, the impression that we leave in them whenever they're going is not just oh, I bought my hearing aids at the store, it is. This is my family that I connected to. So I'm very much that way with my patients. I'm invested. I want to know everything. We need to know everything that's wrong so that we can fix it. And in that family is the core. Like that is what most people are going to be complaining about, or their families are complaining about their hearing loss. So they open up and when we hear these stories like you can't help but connect. So I'd say it really empowers the patient of knowing here's these two individuals that are both caring for me. And also, you know just when it comes down to like the ethics and just having peace of mind of like here is this family that's going to be taking care of me, not this manager, not this supervisor that's overseeing, not this person that's trying to make this. You know, commission, and because sometimes that's what you feel at the big, you know retail stores and you can feel it in a small practice too. But you feel at the big, you know retail stores and you can feel it in a small practice too.

Speaker 2:

I'm not saying that the small practice is the only way that you get excellent patient care. I was once working at a retail chain, but I think that it's just the extra little confidence that the patient has where, like you know, you're connecting with two different individuals. And now we have Francesca. She's our front office person as well, and what we look for when we're hiring for this role and as we continue to grow, is someone who has that core Like you have to care.

Speaker 2:

We don't want someone that's just sitting there twiddling their thumbs, clicking their pens and just going through the motions to get that paycheck. It has to be someone that cares, because my brand, reputation, who we are, to the people that we are meeting every day, that's gold. So for me, more than revenue, more than all that because that's ultimately also how you become successful is caring, and you know, that's how you differentiate yourself in the space, because it's a crowded space, but that's our niche, I would say, is that it's small. You're not going to see these seven different providers. It's me, grace, francesca, small team.

Speaker 1:

A couple of things come to mind. I remember being in private practice and obviously when we connected, I'm like I grew up in a family practice. I also ran the practice with my then fiance, now wife. We got married while we were running the practice and when you talk about the empathy, autumn was very much the same way, like Grace, and that is such a backbone to your organization because patients absolutely pick up on.

Speaker 1:

You, really do care about my hearing health care and we always wanted to make sure it wasn't revolving door. I've been following you on social for quite some time, jc, and just seeing the videos you're posting and the updates, your caring attitude and your sense of humor absolutely always bleeds through social. So the reason I bring that up is because I could imagine as a patient that warm feeling that your patients get when they walk through the door. And you brought up something really important in a not only a crowded industry, there's a lot of competition, which competition is absolutely wonderful because it makes you better. But two, in Florida, a lot of individuals retire there. You have snowbirds, so would you say that you, being a family-owned practice, absolutely is that major differentiator as it relates to the competitive landscape.

Speaker 2:

When you are a small business owner of any kind. Not even audiology, like your connection to your community, is the biggest thing. I mean, when you go to any mom and pop, you know you're meeting the owner, you're seeing them every day like that, having that relationship and going back to back. People look for that, especially the demographic that we serve For the most part. I always say that hearing aids are for people with hearing loss, no matter the age. But a majority of what we see is going to be our geriatric population and they're very much about having that relationship with you shaking your hand, knowing that you're an honest person and that you're not just going to disappear tomorrow. People look for that.

Speaker 1:

Our patients want to know that you're going to be the same provider that they're working with six months from now to even a year from now, and, of course, things change. Life happens. But I'm so proud of you and so excited for you because you're growing and a couple of weeks ago so there's a new journey for Grace as well, which I want you to touch on that.

Speaker 1:

Yeah, yeah, I'm excited for her. Grace had said I don't want to sell hearing aids and your response was it's not about selling, it's about helping. And how do you coach this mindset into your practice culture?

Speaker 2:

Grace is studying right now. She's doing her International Hearing Society book work and hopefully to become a trainee and do what I do and which I think is awesome because, like she was our front office person and just seeing all that and she goes, I don't know. I think I want to do this, like just seeing. I mean it's again. It's infectious whenever you're seeing people that are happy like that and you want to. That's a party, you want to get into that party, right.

Speaker 2:

But her biggest concern was I'm not a salesperson and so, like you mentioned, I'm like it doesn't matter, like we have solutions for every budget or for getting down to the number, but at the end of the day, these people are literally telling you where it is that they have a need, like they are scheduling. You're not knocking on their door. This isn't you know. You're not hounding them for anything. They're coming to you with a problem. You have a solution and I've even told her when it comes to numbers, because that's the big thing. Let's say, someone does want a $5,000, $6,000 hearing aid If their hearing loss is calling for the most support and noise and all these things. That technology exists, it is more expensive, just like if you want the best laptop on the market it's going to be more than the $300 Chromebook their needs, their wants and at the end of the day, it's just presenting this solution to them. And people will remember hey, you remember how you told me that you were at your granddaughter's party or you went to church and you didn't really, you weren't understanding the pastor, you weren't hearing the kids, or you were sitting there, you felt isolated. This little thing here is going to help you because it has X, y, z and that's literally the limit or the extent I think that we should get into when it comes to tech and when it comes to specs and all these things and I am guilty of being the nerd that wants to feature dump and say all the cool things that there is, but at the end of the day, it's just you bring it back. This is what you told me, this is the thing that's going to fix it, this is what that costs. That's it. You're presenting them the solution and then it's up to that person to say you know what? I can only afford X amount, or that. You know. Thank you for providing a solution.

Speaker 2:

And I always say this there are people that come in and unfortunately it happens in our practice. There are people that come in that have so much hearing loss that a hearing aid is not a solution anymore, that they need things like a cochlear implant, that they need, you know, maybe an auditory processing disorder. We need to refer them out. There are people that you don't have a solution for, so sometimes people are really just happy to know oh okay, we, I can't. You know, there is a thing that I can purchase. Yeah, it's pricey, you know all these things, but there is something that I can do to have more quality of life in these situations.

Speaker 1:

Well, we always say listen twice as much as you speak, right, and this is really bringing me back because the importance of the front office staff. I always say that the patient care coordinator is the most hearing healthcare professionals. I know, I'm going to say it and I am a hearing healthcare professional too. The front office staff is the most important physician in the clinic, because how can you do a hearing test, fit hearing aids, without that most important team member, greeting the patients, getting them signed out, things of that nature?

Speaker 2:

It's the first impression too.

Speaker 1:

It's that impression, it's the impression, oh my gosh, and I'm so excited for Grace and your team because she started. She knows that first line of defense of I know what these patients are going through. I know what they're asking when they call. I know that they're going through that grieving process. Maybe they've accepted their hearing loss and they're at the point where, like, yes, I need to do something about it. She knows the importance of having a spouse or a third party coming with them. Forget, you know, not because it increases help rate Sure, it does. But the most important thing is that patient is bringing a third party with them for that emotional support. Jc, I would always tell patients when we would bring them to the audiology suite. First thing I would say is Mr Soto, it's a pleasure to meet you today. I want you to know that I am not here to sell you anything today. My goal is to help you make an educated decision regarding your hearing health care.

Speaker 1:

And you know what you could visibly see on that patient's face go from like this to Relief yeah, yeah, you just took it off, you just it's that reframe and I don't know if the patient went to X, y and Z hearing center and I don't know if they felt like they were trying to be sold hearing aids. Yes, there is a transaction, but I'm so excited for this next gen of hearing healthcare professionals. Love what you're posting online. I love it because it is helping your community, but also so many others make educated hearing healthcare decisions and I learned this and, as I'm sure you have, the importance of caring, truly caring. If you take care of your patients, your patients take care of the business. I heard that very early on and then, when you actually see the Pareto principle in effect, you're like, oh my gosh, we have so much word of mouth.

Speaker 2:

I was having a hard time considering do I get into social media? Or putting I mean I'm putting a lot of time and effort into it. By the way, I go by the bald hearing guy on social media. If you guys, if you have a cell phone, follow me. The whole goal of that because I was like is our target demographic? Let's say for the most part, that the geriatric population on TikTok not so much Facebook, yes, instagram some Is it worth putting all this time in? Because again, I got a family, I'm running my business, I'm doing these things.

Speaker 2:

The goal was normalize having conversations about hearing healthcare. Sometimes. My videos are funny, sometimes they're educational sometimes, but it's just getting people talking and I am. I'm still growing it and I'm trying to put the time in, but I'm. I love that I'm seeing families come in and younger people come in and say my dad needs to come see you, my mom needs to come see you.

Speaker 2:

I had someone come from two hours away, two and a half hours away, and it was. I saw that you're the best at this and I want to come to you and I told this person because she needed help. She did move forward with some help, but I told her I'd be happy to do the evaluation. I'll give you some options. I think it may be in your best interest to find a provider that's closer to you, because hearing aids are. It's not just like you bought the laptop and I'll never see you again or I'll see you when I buy a new one. No, we see our patients every three to four months. There's annual hearing evaluations. There's programming adjusting it. There's annual hearing evaluations. There's programming adjusting it's a lot.

Speaker 2:

So I had to tell her, like I wouldn't want you to go home and go. Oh no, I got to go back to Orlando to see JC and she said no. And this is the thing. Like I'm humbled. I actually have a hard time, you know, sharing this. But she shared like no, like I've seen everything that you're doing online. But I mean, when this person left, I was almost doing a backflip. If I was not 255 pounds, the backflip would have happened, because I was really excited and I'm still like that. It's still crazy to be two and a half hours like that. That's that made my day.

Speaker 1:

Yeah, that's, that's impact. And, JC, just keep doing what you're doing. And when we initially connected and we were talking about what is the story that we want to tell to the Hearing Matters podcast community, it came down to the managed care landscape. There's a lot of hearing care professionals today that are either bundling, going unbundled. How are they managing managed care? How are they letting the patients know exactly what their plan encompasses? So let's talk about the managed care landscape. You've been open about the ethical dilemma that it presents. Share what that looks like day to day in your clinic.

Speaker 2:

So the conversation in audiology for a lot of us is how do we get out of these managed care plans? What some of these plans are paying does not justify the level of healthcare that we want to give to our patients. It's usually like the minimum per state and the patient does not always know this and this is the tough thing. Like it's not the patient's fault, they are ignorant to you know, whenever they're coming in, what the highest level of hearing healthcare is. Things like real ear measurement that we preach all day, every day. For those that aren't in audiology, that is a way to validate, to objectively know that a prescription is being met. Things like hitbox, things like going the extra mile in the hearing evaluation, not just what is the minimum legally required thing per your licensing boards, per your state right? So whenever an insurance plan or these managed care groups, whether it's a discount plan, an insurance plan, whenever they're telling hey, mr Patient, you have XYZ benefit for hearing aids, often and this is not always often, it's just they're taking all of these extra services, they're taking it out of the pricing that they're charging the patients for the hearing aids and they're paying, of course, the providers less than what the provider would to our patients.

Speaker 2:

So this becomes why does Mr Smith, who's paying us directly for the hearing, who's paying us for the highest level of care, getting the same level of care as Mrs Robinson? I don't know, let's just say a name right. Who came through this insurance plan? Who's not paying for these things? Is it morally correct to give this person all of this extra care without charging that person for it? And if we are charging, how much are we charging?

Speaker 2:

And then this whole back and forth this is I'm trying to simplify it as much as I can is a dilemma that we have where many providers are wanting to get out because they say you know what, at Altamont Family Hearing, I want to give the highest level of hearing health care, and this is what that looks like.

Speaker 2:

And if these plans are not they're not going to compensate us for that then, instead of providing less than optimal care, we either have to pass those costs on to the patient or we have to choose to no longer see those patients For someone starting new. This is where I was going in the beginning. If someone's starting their practice today, I say you almost have to join all of these managed cares because you're trying to get your foot in the door. You're trying to get in your community, you're trying to get patients to review you on Google. And you know, you got to pay bills, you got to pay rent, you got to pay the license, you got to pay insurance, you got to pay your staff, all these other things, and in the beginning.

Speaker 1:

A private pay patient is going to cost you more than a managed care patient, correct?

Speaker 2:

Absolutely, absolutely. The patient's going to call their insurance. They're then going to say, hey, I need hearing aids in my area. Here's, you know, altamont Family Hearing. They're going to pass that ball to us. It didn't really cost anything to the practice to acquire this new patient which could be a cheerleader in your community for you. That's how I started, that's how I'm sure most do, but there does come a point where you're investing in better equipment, you're investing in better things, and these things lead to better outcomes, and then you start going wait, I want to do this for everybody, which is the dilemma that I am in right now and I'm sure a lot of practice owners like.

Speaker 2:

We network a lot with people on LinkedIn and this is a very common theme amongst professionals of do we just all leave them? Amongst professionals of do we just all leave them? And that's a tough one, because there's a lot of people. What about that patient who has access to Medicare and Medicaid, which would fully cover hearing aids? You're saying I'm not going to see that person? That person either has to go somewhere else, or there are scenarios that people travel from like an hour away because they can't find a provider, because providers are opting out.

Speaker 2:

There are people that legitimately cannot afford these services. Let's say, if they're on a government program like Medicaid, so do they not get hearing health care? If everybody opts out, how much can we explain, how much can we try to make our case to these insurance plans for them to increase what they're paying for or to pay appropriately for the level of health care that every patient deserves? Is that really going to happen? Like? That sounds good on paper. It sounds good on a podcast.

Speaker 2:

How many people would it take to fight that fight, for them to go? You know what? You're right. I can only control my domain, which is Altamont Family Hearing and the level of health care that we have here and that is where I'm at with this fight is who does it make sense for us financially to see and that sounds horrible, to say it right, like as I'm saying this now sounds like money, greed, transaction, all these things that could be a trigger. But I'm supporting staff, I'm supporting my family and I want to be the best I don't want to be. I don't want to deliver service because we're getting paid an amount for it and then it just, you know it goes back to like what is really the right thing.

Speaker 1:

You know what's the right thing. I'm so thrilled that we're having this conversation because we have to have these tough, challenging, hard conversations, because we are looking to move the needle in hearing healthcare as it relates to access, affordability, best patient care. We know that a small percentage of hearing care professionals are implementing best practices, specifically real ear measurement. That's why, at Hearing Matters, we're connecting with professionals from outside the industry to learn what they're doing, to say, hmm, how can we change up our models a little bit when you are working with a patient? And this just goes to show how much you care about your patients the fact you're having this conversation because practices all across the United States are experiencing this. So what are some of these solutions?

Speaker 1:

You know we talk about knowing what your cost per hour as a clinic owner is so important. So let's just say that your cost per hour is $250. To break even, just keep your door open. You have to make sure that you're making at a minimum $250 an hour. Right, for those tuned in who are unaware of what a cost per hour is as it relates to the clinical aspect of it. So, jc, what you're saying is balancing the desire to provide comprehensive care, like real ear measurement, like hit boxes, you know when reimbursement doesn't really support it. How is your team?

Speaker 2:

handling this.

Speaker 1:

Yeah, yeah.

Speaker 2:

We have two buckets. When that phone rings, it is is this a person that came from our marketing efforts that found us on, whether a mailer, whether Facebook, whether our website, whichever? Is this person coming to us because they found us, let's say, organically online and they're looking for the best hearing health care that they can get? Or has this person reached their insurance and their insurance said, hey, go to Altamont Family Hearing?

Speaker 2:

We do split these two appointments and one of the things that we have to strategize in you know, talking about billable hour and staying afloat because I want to be in business for a very long time is how many of those, how many patients that come in through insurance, through those managed care that we have to respect those contracts and see them through those plans. How many of those can I see in a week? One, two. It used to be five, six, now it's one or two and these numbers dwindle because we do have a priority for those that are not coming in through those channels. The amount of time so we have an hour and a half hearing evaluation for both parties this is one that I'm still battling with.

Speaker 1:

I believe it's a serious investment of time. It's a lot, but why is that depth of care so important to you? I?

Speaker 2:

think the audio has to be one of the most important things. Like, I made it 50% yeah, let's say about 50% of it. There's the fitting with RealEar. But first you got to find out to get those targets. We got to do the whole test. No-transcript person's in that party. When that person's on the cruise ship, the graduation Thanksgiving table how well are they going to be able to understand speech in the presence of noise? How much do I need to reduce this noise in order for them to do well, if they can, if they have the ability to do so, to do well in that environment? That information helps me find out what's the best thing for them. That's how I know what's the right hearing aid to choose.

Speaker 2:

Like so many times there's people and I'm sure you've heard this, you've been in the industry longer than me and you have your family in there. I'm sure you've heard of people say like, oh, hearing aids are crap. Or I hear these hearing aids don't work. Or I have this friend who bought this hearing aid and spent X amount of dollars and this thing doesn't work. There's so many reasons why that could have been. Like I don't and I hear that in my community too. I don't understand it, because that's not what we see in our office. Like our patients are coming in, they have the opportunity to say this is good, this is bad. We have over a hundred five-star Google reviews and this is I'm not just saying this to toot our horn. What I'm trying to say with this is we are taking more time than what is legally required. We are doing more than what is the minimum. All that extra information means better data, better decisions for the provider to make the choice for the patient, the best choice for the patient, and then better outcomes.

Speaker 2:

I've had like two returns in the last I don't know three years maybe. Like we do not have returns. That is not a thing here. Like someone has to pass away or exchanges happen, like sometimes someone could say I don't like this, right, you know I don't want this aid, or we try something different. Returns like that is and my wife Francesca can attest like that is not a thing that happens in our office.

Speaker 2:

But we are putting it all like I am invested in every way the delivery, the test. I'm trying to be the best. I'm not trying to be, eh, but that takes time. But patients know that like they feel that they know when it's just like oh, mr Smith, you're coming in, just drop off your hearing aids and in 10 minutes we're going to clean them and check and give them back to you. The reputation is every time people come. We reputation is every time people come, we're sitting down and we're invested in you. That time costs money. Time is money.

Speaker 2:

So then this just goes back to like that whole managed care split and everything else. Like this is where it becomes difficult, because the more that I'm providing, the more difficult it is to justify the minimum that some of these plans are paying. And that's the. What do I want to be? Do I want to be the guy that's just doing a bunch of hearing aids through managed care or having a higher quality visit for the patients that are coming in who value their hearing and are choosing us to help them with their problem?

Speaker 1:

Let me ask you, because I love different models in business and there are specific models that work better in certain parts of the country, but the number one model is caring. Caring is number one, but I've learned personally when we were in private practice. We also ran into that dilemma as well, and it's more or less. I think it's such a great conversation to have because it shows that you're aware of your KPIs, your key performance indicators, that you're looking at that dashboard, because, jc, what I'm hearing is I'm not hearing billable hour from you. I am hearing I want to help as many patients as possible while also building a sustainable business that remains active for my patients to hear the best that they can. There's nothing wrong, in my professional opinion, with that thought process. I'm curious to know what your thoughts are on.

Speaker 2:

So you're at this typical war that I have right now.

Speaker 1:

Okay, have you considered once Grace and this might be a great case study once Grace gets her license, because I've heard other practices hiring audiology assistants you're in a great position because you have a family member that works there. She's learned from you and you from her. Have you thought about having her start with taking care of all those third-party patients, and what would that model look like?

Speaker 2:

That is right now my goal that annuals, as our annual patients so even those that have purchased from us privately, probably in the beginning, helping me doing those updated annual tests and the managed care, because that's going to expose her to a lot of tests early on and, like anything else, I'm an experienced she has to get in there and that would also free me up so that we can have a better split of hey when someone's coming in saying I want to hear the best that I can and you know they're a direct patient, not a managed care patient. That way we can give priority Because I will say, going back to experience, I've been doing this over 10 years. I have way more continuing education hours than is required by my state licensure. Every single time I'm renewing I want to know I'm the nerd there. I'm going to research as much as I can and because of that experience people are going to have more from me in the beginning of what's the best choice of the hearing aid for me. So that way we can make sure that the patients that are coming in looking for that they're scheduled with me and then as she grows, as she has experience, then we'll see where that splits and where we go, but I think that'd be awesome.

Speaker 2:

One more thing I wanted to touch on when it comes to the managed care thing, we have a bundled service, so a lot of practices that that's, I would say, a majority of what I hear. I know people are unbundled. That means when people are trusting Altamont Family Hearing and purchasing hearing aids for our current model for five years, we're cleaning, checking, adjusting, annual testing, reprogramming, you know, hit boxes, real ear measurement all these things that we do is included in the pricing that they're paying. For those that are coming from managed care, we do have service plans. Another ethical split is, let's say, mrs Smith came in for hearing aids.

Speaker 2:

We offered what was recommended for hearing loss within her plan, and then we go hey, in order to have these services that we think is the gold standard and for you to have the best hearing that you can achieve, it's going to cost X amount of dollars on top of what you've paid that business entity because that's not us. And then the patient goes well, why don't I just get them from you? This happens all the time, this happens almost every day and we have to explain to patients. Well, because I am contracted within this insurance plan and you've come to me through this insurance plan legally, per my contract, altamont Family Hearing cannot service you directly.

Speaker 1:

I think there's new hearing healthcare professionals who, when they enter the field of hearing healthcare, they're so excited and then, when you do own the practice you're looking at okay, well, what does the fitting fee look like? Is this matching my billable hour? How many patients do I need to help to ensure that from that financial aspect, it makes sense. So I think you have a great way to handle and manage the managed care. At the end of the day, we're saying here this is a human being across from our table and what I'm hearing from you is I want to help everyone hear better. When we were in practice full time. My mother and father are still running the practice, but I would call up the different managed care organizations and I would ask okay, per the contract, what is included? Because if you are offering a service plan, then you know from a legal standpoint and JC and I are not providing any legal advice here by any means, just make sure you call the insurance companies that you are credentialed with.

Speaker 1:

Specific to managed care, but we would outline okay, managed care A includes X, y and Z. Well, but then it goes back to the ethical aspect of this is within my scope of practice. But let's look at the bright side, because we have to face the brutal facts right. The bright side is that when you start to help your patients hear better, we say hear a life story. That news spreads like wildfire within your community. So to me you have a model set in place. Once Grace starts fitting hearing technology, she'll be able to see those managed care patients. If 20% of your gross revenue is fitting fees and if that can support your payroll and then 80% is private pay rocking and rolling, but that's not always the case.

Speaker 1:

We have some clinics that are 50-50, 60-40. So right now, we're sort of just. This has been a conversation, though, that our industry has had for many years, and I've learned. I feel as though, but I've also learned that what is your market response and how are you going to manage your specific model, because everyone's hearing healthcare model is different. But I've learned and you've learned. If you give more than what you receive and you take good care of your patients, your patients are going to take care of your business time and time again, but that just, and I believe, I believe I've been feeling that.

Speaker 2:

So in year five, we're, of course, seeing patients that we saw in 2020, who, most of the majority like that is why I'm still in business is managed care in the beginning, right, like they, especially through a worldwide pandemic and that's a whole other subject for a whole other day, right, but, like so, a lot of these people came in. They got to know me, they got to know what I stand for, they got to know what it is that we're providing and their second time around, like these people, are now in five-year technology. Many, you know those would be out of warranty. Those that are considering new are going. Now they know me and now they're giving us an opportunity directly versus and they're a little more informed, because now they know that could have been their first hearing. And now they know, oh man, I didn't realize that I'd be coming this often.

Speaker 2:

I didn't realize that the end was every year, because how many people don't come into the office? You know, I'm sure you heard this like oh yeah, I got these hearing aids four years ago. When was your last hearing test? Four years?

Speaker 1:

ago.

Speaker 2:

And what are you talking about? What are you talking about? So, and these are things for those that don't know no, no, I get my eyes tested every year. I go to the dentist. You know, you got to get your cleanings and all this. I mean, this is part of your healthcare overall. It is every year, it is not just every time that you're purchasing a hearing aid. So these people are now giving us the opportunity directly, which I think would be in our growth plan, would be okay. Now, if Grace is seeing this arm of our business and I'm, you know, still busy seeing patients privately that just means to, you know, as those patients keep coming in for upgrades, hopefully they, some of them give me an opportunity, and not just Grace, but you know it just means growth and scale, so helping more people.

Speaker 1:

And at the end of the day, that's the reputation. Helping people I'm excited for that estate right. Every market responds differently to the same product and or service. It's demographics and I think, the old tune of well, everyone just drop out. We learned you put your horse blinders on what is best for the patient, what is best for our practice, if the goal is to build a sustainable business and you know your numbers and helping patients who present with managed care because at the end of the day, it's not their fault, it's not like, oh, you chose x, y and z managed care. So I'm sorry, mr smith, I can't help you learn to manage it.

Speaker 1:

This is where it gets fun and exciting, because, my goodness, maybe Mr or Mrs Smith has a friend who needs hearing technology and they go, they purchase privately from you A lot of us, we fit that same or similar product right, but how do we get that information out there? I almost wonder too, jc, you know, because, again, this is how the Hearing Matters podcast started. You create a media vertical specifically for your managed care patients and you invest time, effort and energy into creating some sort of video format for these patients, because I'm all about transfer of information, process of duplication. Let media do the rest for you, especially for those follow-ups, for the cleaning videos, things of that nature.

Speaker 1:

Getting creative with the managed care is best for your patients helps your top and bottom line. Top and bottom line of business is people. Jc, you've been so gracious with your time. I really appreciate you joining us on the Hearing Matters podcast. My final question for providers tuning in who really do feel the tension between care and cost what is your message to them when it comes to staying ethical, staying passionate and staying in the fight?

Speaker 2:

At the end of the day, I think the and this is the conversation that I continue to have with myself. I hope this advice helps you as well is why do we do what we do? And it's to help people hear better. That is, sometimes we get lost in compensation and the cost of living is going up every single day. Every single person's feeling it. We can get hung up on numbers and all these other things, but, like you said before, the more people that you help, the more that you're going out there like that's gonna come back to you and I really believe in that. Like I've been experiencing that in my life and there has never been a point in my life that I've helped somebody, that I've just selflessly put love and energy into a person, that somehow that did not come back.

Speaker 2:

And I do think that when it comes to this, there's a lot of frustrations and if you're sitting there, sitting here, crunching numbers like me and going like man, this just doesn't make sense. Or we feel like we're getting beat up by these managed cares. Sometimes, like at the end of the day, it's like listen, this person that's coming into your office is trusting you, connecting with you, and they know people. You're going to help them Over time. Somehow that's going to come back to you. But yeah, just coming back to the root like this is why we do it. It's helping people and they're trusting you for that. Help Educate them and then over time you know that somehow that revenue is going to you, know it's going to multiply because they know a person, they're in a church, they have a family member and if none of that happens, you just made that person's day, you just helped them reconnect.

Speaker 1:

Jc thank you so much for your honesty heart and your leadership. You know conversations like this are what push hearing healthcare forward and remind us of why we do what we do. To learn more about JC and his clinic, visit Altamont Family Hearing. That's A-L-T-A-M-O-N-T-E familyhearingcom. And until next time, hear life's story.

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Blaise M. Delfino, M.S. - HIS

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