Technology rivers of Change

Canadian eye care industry experts gathered virtually on Monday October 25th to share their views on how technology is impacting eye care.

Representatives from leading organizations including  Bausch + Lomb, Eye Recommend, FYidoctors, IRIS Group, F12.net and newcomer to the Canada, Specsavers, provided a precis on the top important and possibly disruptive technologies they feel will affect eye care within a 3-5 year time horizon.  (Click here for a full list of speakers)

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Roxanne Arnal, a former independent OD practice owner, now Certified Financial Planner© moderated the event including a Q&A panel discussion to address attendee questions. Roxanne set the technology discussion stage with a review of how quickly, over the decades, new technologies reached a saturation point among consumers. Automobiles took decades from innovation to saturation, whereas new technologies, such as tablets, took only a few months – seemingly “in a blink of an eye”.

Here is a summary of the speaker presentations: 

Dr. Trevor Miranda (Cowichan Eyecare) and Ravi Tanna (Professional Relations Manager, B+L  Canada), discussed the threats provided by pervasive technologies including subscriptions and e-Commerce. They emphasize available solutions as opportunities for independent optometry against these threats.  Dr Miranda underlines the important point that innovative products are the differentiating lifeblood of independent Optometry.

Dr. Damon Umscheid (Eyes 360) representing Eye Recommend, cited omni-channel retail as a key driver and offered a nuanced definition of omni-channel versus multi-channel retail. His other technologies discussed were Artificial Intelligence (AI) and Telehealth. Dr. Umscheid concluded on the benefits of independent practice and how the support of Eye Recommend helps independents navigate through the new technology landscape.

Dr. David Schwirtz, VP Innovation, IRIS Group spoke about the evolution of e-commerce from brick and mortar to what he sees as the future. He framed the topic of telehealth related to optometry in a functionality spectrum including Online refraction, remote optometry and telemedicine. Finally, Dr. Schwirtz revealed IRIS’s focus on virtual try on and dispensing technology that keeps the professional and patient at the centre of care.

Naomi Barber, Director of Optometry, Specsavers Canada provided an overview of the international Specsavers organization. She explained how Specsavers looked at the major causes of vision loss and identified that OCT was clearly the technology with the most potential. She explains that a new way of using this existing technology will have the most impact on serious eye health issues, including on Glaucoma, Diabetes and AMD in the next 3-5 years.  Ms. Barber shared the results of an Australian pilot program which Specsavers plans to implement in Canada.

Dr. Alan Ulsifer, FYidoctors | Visique CEO & Chairman of the Board, shared his views on an expanded concept of Omni-Channel, e-commerce and Tele-Optometry. He presented interesting results of a survey of patients on satisfaction levels with “at home exams”. Results broken out by age demographics provided some revealing patient perspectives. Finally Dr. Ulsifer addresses the concept of “Kiosk Optometry”; its history and possible future.

Alex Webb, is the Founder and CEO of F12.net which provides managed IT services to health care and other businesses to offload the risk and complexity inherent in IT infrastructure. Mr. Webb provided a sobering review of cyber incidences in Optometry and outlined the 5 top security challenges in clinics and the spectrum of risks from extortion to unrecoverable business loss. Finally he offers a prescription for a cyber security cultural shift for practice owners.

Upcoming “Changing Landscapes Events: 

November 1:  Selling & Buying a Practice
November 8:  Career Pathfinders: Making Informed Choices

October 25 Event Sponsors include:
B +L Canada,  Clarity Financial Services, Eye Recommend,  FYidoctors/Visique, IRIS GROUP, Specsavers,
Care1,  F12.net, Digital ECP, CRO Online CE, Eyeployment.com


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Canadian Eye Care Business Review and Clinical & Refractive Optometry are pleased to announce a COPE approved (2 credit hours) live CE webinar on Monday, October 29 at 8 PM (EDT):
Myopia Management:  New perspectives. New Opportunities.  
Registration for the webinar is now open.

COPE Course ID: 59812-GO      Qualified Credit: 2 hour(s)

Speakers and topics for the webinar include

  • Scott Mundle, OD, President, World Council of Optometry
    • The Challenge of Myopia 
  • Debbie Jones, FCOptom, DipCLP FAAO, CORE/Univ. of Waterloo,
    • Myopia Management from Research to Clinical Practice 
  • Jeff Goodhew, OD, Chief Co-editor Canadian Eye Care Business Review
    • Myopia Control in Practice 

Myopia can no longer be considered a benign condition. It must be addressed as a potentially sight-threatening treatable disease.  Dr Mundle will share the WCO perspectives and plans for a global Myopia awareness week in 2019. All optometrists will understand the coordinated effort toward raising awareness of Myopia as a treatable condition. Dr. Debbie Jones,will review some of the interesting research and clinical studies, and Dr Jeff Goodhew will provide pointers on how optometry can integrate myopia control to patients in the optometric practice.

Presentations will be followed by a panel discussion. Dr. Farrah Sunderji, Calgary, Alberta and Dr. Thomas Gosling, Colorado will join in a panel discussion moderated by the hosts Drs Tina and Jeff Goodhew.  Questions from the audience will be addressed.

The webinar is made possible through the generous support of CooperVision Canada,  Carl Zeiss Vision Canada and HOYA Vision Care.

Pacific University, School of Optometry is the COPE sponsoring organization and administrator for this course.

 

REGISTER


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There are several commonly used formulas for determining the value of a practice. Often the different approaches are averaged together and used as a starting point to begin negotiations. In this discussion adapted from the Webinar Should I Stay or Should I Go, expert panelists Al Ulsifer (CEO FYidoctors), Grant Larsen (CEO Eye Recommend), Daryan Angle (VP IRIS The Visual Group) and Paul Gray (Optometric Services Inc.) discuss three commonly used methods in more detail.

Al Ulsifer, FYidoctors: The most common valuation method that we were seeing years ago is taking one year’s net income, and that can be on a three-year average. There are other considerations as well. A buyer will be cognizant of a practice that decides to not take holidays for the year prior to the sale, for example. So it’s important to have some stability over a period of time. It could be 100% of, or sometimes up to a net of 120% if the practice is growing and showing promise, and then adding on the fair market value of your assets. Assets being equipment, furnishings, lease holds, supplies, inventory. Sometimes it’s a bit of a challenge to assess what is the fair market value of those assets.

We have equipment companies that can go and give an assessment of what the fair market value of optometric technology is. Some folks will look at the net book value of those assets on your financial statements because it is quite a process to truly get an external valuation, a fair market value assessment of all assets in the business.

Our company will use a combination of a couple of different methodologies in a formulaic approach to generate the valuation.

Grant Larsen, Eye Recommend: There are a number of details when you are looking at some of the tangible and intangible items that impact weighted average gross income and how you value.

First, it’s a weighted average, the last 12 months being the most important, usually at about 50%, the second last year being at about 30%, and your third last year being at about 20%. That’s the weighted average of it, and you are relating it to gross income. Once you’ve got that gross income weighted average then you are looking at a number of components that will impact, plus or minus.

Looking at how well your business is run from a net income standpoint, that is an indication of efficiencies and the value of your business. Looking at the reputation of your practitioner and how that matches up with you as a buyer is really critical.

We look at the community as a whole and at the geographic location. We also look at mix of patients—the demographics, and parking and transportation. Consumers’ convenience is becoming very important to them.

Fees, credit policies, a lot of these elements need managing, so they have a dramatic impact on the value of the business, and often times it is the perception of the buyer as to whether these are positive or negative.

The last one is competition, or could be a lack of competition. We think about rural and urban practices and there is no rhyme or reason why one is more valuable than another, especially in Canada. But competition can have a direct impact on whether it is more or less valuable.

Daryan Angle, IRIS: EBITDA is certainly the most accepted evaluation in the public market.

If you take all your revenue coming into your practice and you start to pay out your expenses, wages, cost of goods, the rent, all those things and you get down to the number before you pay your taxes, before you pay interest on any money you borrowed, or before your accountant decides to depreciate or deduct an amount based on assets you have in the practice that is depreciating.

This is an accounting process that, when you are taking a piece of equipment or leasehold, you amortize or you depreciated over time, you take the number before that, before the interest, before the tax, you have your EBITDA, and that is the number that the market uses as an indication of the profitability of your practice.

Your operating expenses isn’t the number you want to use because it’s fairly common for practice owners to use their practice in creative ways to reduce the taxes you pay. Salary, running expenses, personal expenses like cellphone, automobile uses, other type of expenses that you can put through the practice which are not directly related to the operations of the practice and the buyer will not have to pay once they acquire that business.

Those are all things that you want to pull out of that EBITDA number when you are looking at adjusting your business for sale, as well as non-recurring expenses. If you changed your carpet last year, you are not going to do that every year, so you want to remove that from your EBITDA calculation when you go to sell your practice because it’s not something the buyer is going to have to do every year, and they are going to reap the benefit of the profitability of not having to have that expense.

When you make these adjustments you get to an adjusted value or adjusted EBITDA value, and then you apply to that value a multiplier. The negotiations around that multiplier relates to different factors—is it too isolated to recruit associates, is it big precisely because there is no competition? There are so many factors involved but that’s going to affect the multiplier that you applied to the EBITDA as well as what you adjust to. You may get creative in terms of what you think is a non-recurring expense, but that becomes a point of negotiation between your advisers and you, and the potential buyer.

That is the simple version of the adjusted EBITDA evaluation, certainly the one we use at IRIS, and it’s one that follows a lot of the rigorous accounting principles that you need for a public markets and one that we are very familiar with.

Paul Gray (OSI): The price needs to be fair to both parties, in particular if they are going to continue the practice together. I think it’s worth pointing out as well that some of the sales difficulties disappear when the practice is sold to an associate who has the benefit of familiarity of having worked in the practice for one or three years in advance, and as you’ve worked them in the practice, and you worked them in the management structure, and the staff interaction and so forth, the trust develops both clinically and interpersonally.

It also allows the purchasing practitioner to have a real sense of what their dollars per patient or their real revenue per patient that they generate in the practice actually is and it makes the calculation about affordability much easier. The practice must be reasonably priced to ensure that the purchaser is going to receive enough net to fulfill their financial obligations, their lifestyle obligations, taxes on their net earnings, loan payment schedule, student loans and so forth.

 


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On Monday June 4th 2018 Canadian Eye Care Business Review hosted a panel discussion entitled: Should I Stay or Should I Go? Exit Strategy Considerations.

Drs. Jeff and Tina Goodhew, independent practitioners from Oakville, Ontario, guide the discussion an expert panel of Canadian Optometric opinion leaders actively involved in optometric practice transactions.  Panelists included:

  • Dr. Daryan Angle  – VP Business Development IRIS (Part of the NewLook Vision Group)
  • Dr. Paul Gray – Director and President of the Member Relations Committee, Optometric Services Inc.
  • Jackie Joachim, Chief Operating Officer, ROI Corporation
  • Grant Larsen, CEO, Eye Recommend
  • Dr. Al Ulsifer, CEO & President, FYi doctors

The webinar provide a comprehensive discussion of factors that indpendent optometric practice owners ought to consider as they approach the important decisions around exiting their practice.  Topics covered include planning, use of a business broker, importance of assembling a trusted team of advisors, various valuation methods and the roller-coaster psychological aspects of a sale transaction.

 

The countries two leading practice aggregators,IRIS and FYi doctors, provided the benefit of their perspectives as did the two leading independent  OD networks, Optometric Services Inc. and EyeRecommend.

The webinar is packed with solid practical tips and information: essential for any practice owner that has selling their practice even remotely on the horizon.

You may watch the video slide show and audio above, or listen to the audio only from the links below.

 


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Join Drs. Jeff and Tina Goodhew, Co-Editors in Chief of Canadian Eye Care Business Review, as they host a live webinar on practice exit strategies for Optometrists. They will be joined by five panelists:

  • Daryan Angle, OD (IRIS The Visual Group)
  • Paul Gray, OD (Optometric Services Inc.)
  • Grant Larsen (Eye Recommend)
  • Al Ulsifer, OD (Fyi doctors)
  • Jackie Joachim COO (ROI Corp)

Like many optometrists, your practice is your most valuable asset, representing a significant portion of your retirement savings. Once you decide to sell your practice what do you do next?

This webinar will cover the key things you need to consider when selling your practice, including:

  • Planning in advance
  • Determining the value of your practice
  • Finding a buyer
  • Structuring the Sale
  • Tax planning

The webinar will be held JUNE 4th,  8 PM EDT.

REGISTER NOW for the Live Webinar.

Register

 


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On Monday March 5th 2018 Canadian Eye Care Business Review hosted a panel discussion entitled The Perfect Fit, Finding and Keeping Great People. Drs. Jeff and Tina Goodhew, independent practitioners from Oakville, Ontario, guide the discussion of current best practices with three subject matter experts in the HR field. Jan van der Hoop and Tim Brennan of Fit First Technologies and Kelly Hyrcusko of SIMI (Simple Innovative Management Ideas Inc.) share their views on the subject. The webinar is rich in practical tips and advixe for eye care professionals on a wide array of topics from candidate screening to best practices in onboarding a new employee into your team. New data driven objective decision models are discussed which can help in providing better insights into candidates and improve hiring success rates.

The webinar was sponsored by eyeployment.com, Simple Innovative Management Ideas, and Optik Magazine.

Click to watch the video recording, or listen to the audio below.

 


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Location is arguably one of the most important decisions that can make or break the success of your new practice. The following conversation among independent OD offices that have been recently establish is excerpted from the Start Me Up Webinar Panel hosted by Jeff and Tina Goodhew on October 18, 2018.

 Panelists:

   

   

Jeff Goodhew: Michael, as far as timing goes, what type of research did you do in finding your location in Edmonton?

Michael Kreuzer (Practice in Edmonton, AB, opening January 2018): It’s an interesting and complicated question because I had two other bids on places before finally determining my end location in the city.

Key things to me were a demographic that had a lot of growth and a lot of younger people moving to it. My current location is on a retail street which has experienced tremendous growth over the past 5 to 10 years The area is under-represented in terms of optometrists. Those were two key factors.

If you find a good commercial real estate broker they should be able to help you with identifying key market demographics. My broker for instance had sent me locations of other optometrists in the city within 1km to 5km radius away. Based on that information you can piece together a decent spot that you can stake for your own.

Another important factor in the location is price. In these high density urban areas in Edmonton there is a pretty big fluctuation in terms of the asking price per square foot. One key piece of information I got from my adviser was to keep in mind that a huge cost that you can control upfront is your overhead,  –  the cost per square foot. Being aware of that and not overspending on your real estate is a great way to get started on the right foot.

Jeff: Your broker obviously went above and beyond. You are saying your broker was the one that sort of mapped out where the competition was, not yourself.

Michael: I was aware of the competition but he definitely went above and beyond, and with that information it allowed me to focus my energy in other aspects of looking at places. That’s the benefit of having a great team from the start, you can piggyback off of the services of other professionals who are way better at this than when you are starting and you have panned in so many different spots. It was a really big help.

Jeff: Laurie, how did you choose where to open your practice back in 2015?

Laurie Capogna (Family Eye Care, Niagara Falls, ON): Niagara Falls isn’t all that large of a city, so I thought about using a real estate broker but in the end, I didn’t. I ended up myself driving around finding every vacant building that was available. I had a bit of a dilemma, at first I really wanted to buy a building. I’d never leased before, I’d always owned the building I was working out of. When I saw there really wasn’t anything available, I started looking into plazas, and I looked at the new ones and the older ones. Based on what was available I actually just took something that I liked and  because it was in the same plaza as a Shopper’s Drug Mart. [Leasing here] actually proved to be very, a very good decision because I can’t tell you how many patients come in say, “I love your location and I see you here all the time and I’m in this plaza all the time.” I didn’t realize the benefit to being in a retail location because I’d always been in a medical building before.

Jeff: Agata, you opened in a highly competitive neighborhood in Toronto. What did you look for when you opened your practice?

Agata Majewski (Owl Optometry, Toronto, ON): In the city, I think it’s very hard to find a place where you don’t have an optometrist next door. My location is at street level in a very family friendly neighbourhood. There are four or five schools surrounding me. I knew the area I wanted to be in and I was driving by and saw this space for lease, which was an old variety shop. It’s a small space but it’s street level and most of our patients are just coming in off the street, I didn’t have to advertise.

Jeff: Can any of you comment on opening a new practice in a medical building versus a sort of street level traditional retail location? Does anyone have an experience around that?

Ritesh Patel (See & Be Seen Eye Care, Liberty Village, Toronto, ON): While we were actually going through the process of where we wanted to open, we created a matrix, and the matrix consisted of the four or five things that were most valuable to us. One of the things on that list was being around family physicians and practitioners, because in Ontario you can consider them a “feeder system” to just have patients come through the door whether it happens to be a diabetic or red eye or annual exams, or children, whatever it may be. In our case we are retail ground floor setting in a relatively high traffic area, but we also happen to be in the same building as 12 to 15 family physicians as well. You don’t necessarily have to choose one versus the other.

Jeff: Anyone else have any comments on location before we go on?

Howard Dolman (Dolman Eyecare Centre, New Hamburg, ON): We are in a very rural setting, a small community and the vast majority of patients drive to our clinic, and so the amount of parking that you have in a rural setting is important as opposed to being in an urban setting where being closer to transit and having easy access for your patients to get to you. That’s certainly one consideration to think of in terms of location.

Tina Goodhew (Abbey Eye Care, Oakville, ON): If you are in the process of still trying to look at an area and you don’t have a broker yet, you can also check with city hall and they often have plans on what their growth and demographics of a neighborhood is.

One of the other tips we give you is to plot your competition. The final thought I have here is that even the location within your location is extremely important. What I mean by that is, we are in a mall that we have been in for 12 years but for 10 of those years we were at one side of the strip and two years ago we renovated and expanded and we moved to the centre of this strip that happens to be in front of one of the driving entrances, and we’ve found that out traffic has jumped significantly. People said that they didn’t know that we were in the mall previously even though we’d been there for 10 years! Again, location within the location is very key as well.

 

Click here to listen to the entire webinar 

 


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Canadian Eye Care Business Review is hosting the “Start Me UP!” Webinar October 16, 8 PM.

Join a panel discussion of ODs in various stages of independent practice start-up from planning/building phase to the first
3-5 years in practice.

Hosts:
Drs. Jeff and Tina Goodhew,
Co-Editors of Canadian Eye Care Business Review will host the webinar with panelists.  

Our Panelists Include:
Dr. Laurie Capogna, Family Eye Care, Niagara Falls, ON
Dr. Michael Kreuzer, Edmonton, AB Opening January 2018
Dr. Agata Majewski, Owl Optometry, Roncesvalles(Toronto), ON
Dr. Ritesh Patel, See & Be Seen Eye Care, Liberty Village, Toronto, ON
Dr. Todd Ruhl, Flamborough Family Eye Care, Waterdown, ON

By some accounts the glory days of independent Optometry have faded, yet the dream of professional independence and practice ownership persists.  Learn from your colleagues as they share strategies, challenges and successes as they build the practice of their dreams.

Please reserve your virtual place by registering online.

There is no cost to register thanks to our Sponsors:

 


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Canadian Eye Care Business Review is proud to announce that registration is now open for their first webinar; “The Future of Independent Optometry”.  The webinar will be available live on Monday May 29th from 8 PM to 9PM EDT.

This format will provide optometrists across the country an opportunity to hear from a group of Canadian thought leaders on topics critical to the future of independent optometry.

Drs. Jeff and Tina Goodhew,
Co-Editors of Canadian Eye Care Business Review will host the webinar with the following panelists:

Dr. Daryan Angle
Executive Vice President Chairman of the Board, IRIS The Visual Group, Waterloo ON

Mr. Ken Barbet
Eye Recommend, Chief Executive Officer, Calgary AB,

Dr. Altaz Shajani
Practice Owner, North Vancouver BC

Dr. Sheldon Salaba
Practice Owner, Hamilton ON

Dr. Al Ulsifer
CEO and President, FYidoctors, Calgary AB

The questions that will be addressed include:

  • What is the impact of supplier side consolidation on independent eye care?
  • Why are independents selling out to larger groups? Fear or opportunity?
  • What are the risks and opportunities in moving from retail to medical?
  • How should independents create great customer experiences and loyalty?
  • How do solo practitioners manage the risk in today’s environment?

We are excited to have a discussion such as this on a very important topic, one that is top of mind for many in the industry.
There is no-cost to register. Please reserve your virtual place by registering online:

We look forward to your active engagement.


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