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Business Sustainment Strategies Amid the Pandemic

Glantz, Gordon

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doi: 10.1097/01.HJ.0000717140.83017.e3
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In the Sea Islands of South Carolina, the town of Beaufort—with its Southern charm and architecture—has been honored with a plethora of best place to live awards from various publications. And nestled in the Lady Island section of the town with a population of just over 12,000 is Beaufort Audiology and Hearing Care, owned and operated by Monica Wiser, MA, CCC-A.

Shutterstock/3DJustinecase, audiology, financing, coronavirus.

She feels she has a niche with a personal touch that her competitors cannot consistently provide since she does not see herself as a businesswoman using hearing tests as a vehicle to drive revenue.

“I didn't go into the field of audiology to sell products,” said Wiser, who chose what has become her calling back in her sophomore year of college after the epiphany that being a starving artist in Los Angeles might not be a wise choice. “There is a critical difference between providing hearing aids and providing hearing care, and our profession is lost if we don't continue to provide that difference to patients in need.”

Wiser estimates that there are approximately 30 hearing aid practices within a 25-mile radius of her practice. Most, she said, are chains, groups, or ENT practices with their own dispensing audiologists.

“Consider also the numerous retail stores selling OTC devices and online hearing aid sales,” said Wiser. “We do not contract with third parties or manufacturers for referrals, and we do not pay for endorsements. So, all things considered, it is somewhat miraculous that we are doing as well as we are.”

Particularly during the pandemic.

If anyone would know, it is Will Diles, who has been a licensed hearing aid dispenser since 2011. His family has been in the hearing care industry since the 1930s.

“I was born into this business,” he shared. “My parents are both audiologists. My grandfather owned a hearing aid dispensing practice for over 40 years, and my great grandfather was an executive with a major hearing aid manufacturer.”

Diles and his family have seen a lot during the decades, but this current situation stretches the bounds of reality.

“Running a business is challenging during the good times,” said Diles, who is also a private practice consultant with Pivot Hearing, the other arm of the family business. “Many owners either do not have the business acumen or the bandwidth to truly manage their businesses, even when things are business as usual.

“When COVID-19 came to heightened attention in the middle of March, we slowed down our office traffic so that we could focus on seeing patients for emergencies with curbside service. We quickly realized how essential hearing care is to the population we serve and ran traditional and digital marketing campaigns letting our community know that we were open and able to care for them safely.”

And while he had encountered countless threats to his hearing care business over the decades, such as out-of-the-industry players (Johnson and Johnson, Panasonic, and Bausch + Lomb), consolidation, OTCs, and managed care, he found COVID-19 to be an invisible enemy.

AUDIOLOGY AT GROUND ZERO

With her business in the midst of moving out of the uptown section of Minneapolis, which was near ground zero of the protests following the death of George Floyd, Kim Fishman, MA, was literally at the epicenter of the COVID-19 outbreak in a large metropolitan city. At the time, her practice, Chears Audiology, was already embroiled in a landlord-tenant issue that was prompting a move.

“We had a new lease come upright during COVID-19,” she said. “The landlord was not willing to renegotiate. I did everything I could to be in the city, but it just didn't work. The model wasn't right.”

It was all part and parcel of the dark side of the business that clouds good intentions.

“I just want to stay in business and help people,” said Fishman, adding that she is mortified at the prospect of working for a Big Box store selling hearing aids.

IMPACT ON REVENUE & OPERATIONS

As for their practices, COVID-19 threw a steady diet of curveballs and screwballs at Wiser and Fishman.

“We were closed for six weeks until we felt we had adequate supplies and a good protocol in place before reopening,” said Wiser. “We paid our assistant for three of those weeks, and she claimed unemployment for the other three. We got her back on payroll immediately after we reopened and now we are so busy that we hired an additional part-time employee.”

While audiology practices were not considered essential in Minnesota, Fishman remained open, operating almost as a dining establishment by treating patients curbside for services such as wax removal and cleaning out/refitting hearing aids.

“Some wore masks and some refused,” she said. “It's amazing how political everything has become.”

She found herself doing it all—booking appointments, handling the money part, etc.,—while dealing with family members who tested positive for the virus.

And the chaos in the city led directly to a merchandising issue since a major part of Fishman's practice is earmolds—particularly for musicians and motorcycle enthusiasts—which suffered a serious backlog.

“That really impacted us,” she said. “There were earmold delays, and they are a big part of my business. It's huge for me. Custom-made ones were delayed, affecting people with profound hearing losses. I tried different labs. We were told they were hung up at the border. Plus, our post office was set on fire [during the protests]. That affected us after the move because we didn't get our mail, which was being lost.”

Diles, whose dispensing business in Santa Rosa, CA, is similar but not quite the same, said that they also took quite a revenue hit. “But we kept our team assembled so that we were able to meet all hearing needs that came our way,” he said. “We didn't need our entire staff in the offices to handle the lower volume at the time, but we still felt it was important to keep our team together and ready to return to normal activity, so everyone remained paid.”

PATIENT-CENTERED BUSINESS MODEL

Amid the pandemic, Wiser believes that others have come to appreciate the more personal business model. Her enhanced sensitivity toward her patients largely stems from her growing up with hearing loss—having had to wear crude in-the-ear amplifier for 20 years—and being treated differently because of it.

One of many examples: “I had a 4.0 GPA when I applied for the communicative disorders program, yet I was told the program might be ‘too difficult for me’ based on my degree of hearing loss. I didn't let that deter me, and I graduated at the top of my class at CSUN [CSU Northridge]. I also graduated at the top of my class in grad school at San Diego State University, and was designated as the Outstanding Graduate Student in the department.”

Wiser could cite numerous other examples from her lifetime—and from many of her patient's—illustrating how people with hearing loss are still misjudged.

“Because hearing loss is an invisible disorder, people make assumptions when they encounter someone with hearing loss,” she said. “They are deemed less intelligent, less informed, less capable, and even antisocial.”

Wiser considers word of mouth as her primary form of marketing, as well as written articles—two of which have been published since the pandemic began.

“COVID-19 has greatly affected the older population whom we serve,” she said. “In addition to the higher risk of complications, they are more isolated. Those in assisted living facilities were locked down for two months without the ability to even socialize with other residents. When they were finally released, they could only go out for health care visits. A woman who came to our office a couple of weeks ago could not get her hearing aids in because her nails were too long. I ended up giving her a manicure because she was not allowed to go to a salon. It made me wonder how many other scenarios are limiting their ability to carry out basic tasks and I offered to give an in-service to the staff on hearing aid maintenance.”

It may not be the most cost-effective method, going above and beyond the call of duty, but Wiser remains resolute during this time of crisis.

The business model goes beyond just Wiser having first-hand experience with what her patients are going through.

“Everyone on staff has some experience with hearing loss at a personal level,” said Wiser. “My medical assistant's daughter has been wearing hearing aids since infancy. Our new office assistant has been wearing hearing aids since her early 40s. Our only other employee is my husband who does the books, and he has lived with my hearing loss for over 25 years. So when it comes to hearing care, it's not just a job; it's personal. I know that sounds cheesy, but it's true.”

FINANCING OPTIONS & FINE PRINTS

Tucker Worster of HearWorks offers another perspective on sustaining audiology businesses amid the pandemic.

Business models can either be care- or business-centric, he explained. With regard to care-centric practices, he said: “It's tough to retrain the behavior. The patient-first mantra can be effective over time, but it also leaves the practice exposed from a cash flow perspective. My experience is that it is a continuous behavior-changing process and not a one-time conversation. Smaller, greener practices should align themselves with a group or manufacturer that has an incentive in the practice's financial success.”

Worster's 14 years in the hearing industry started with two multinationals in GE Capital's CareCredit and Sonova, where he says he was fortunate to work for some incredible leaders and innovative entrepreneurs.

“Four years ago, I was recruited to start and co-own AuDStandard (now HearWorks) with two of the industry's most successful retail operators,” he said. “After owning AuDStandard outright last year, I made my first acquisition (of what will be multiple) this February and HearWorks is the result.”

Along the way, he believes he has been able to see a larger picture, one that has proven to be helpful in these unique and stressful times.

An example is financing options available to small businesses (government programs on small business loans), particularly with pros and cons and the large ramifications of fine print that can doom a business owner.

Worster says that getting a loan via the Paycheck Protection Program (PPP), Small Business Administration (SBA), a manufacturer, local bank, or credit union is viable, with the risks depending on loan terms and decision control.

“For example, SBA loans over $25K require SBA permission prior to executing many key business decisions,” he said. “Decisions that, as an owner, I may not want to leave up to someone I don't know.”

Worster added that manufacturers have typically been the recipient of many of these requests, but they too have slowed their lending and most decisions are now being made overseas for those loans attractive and large enough to even make the cut.

“For most practices, the SBA/PPP terms though are simply too good to pass on,” he noted. “As COVID-19 persists, I would strongly advise practice owners to take the maximum they are comfortable with and if they don't need it, they can pay it back.”

“These programs provide a way for many hearing clinics to keep their operations running and their bills paid,” said Diles. “Use every resource at your disposal to get through this challenging time, knowing that there are much better days ahead.”

BUSINESS POSITIONING & MARKETING

Positioning a business while adapting to recent changes and limitations may require some creativity.

“The biggest change will be private pay patient acquisition,” noted Worster. “While COVID-19 has equaled the playing fields a bit in certain areas, the market is simply too competitive, and there are too many entities fighting for the same private pay patients. This is the time for hearing health care professionals to take inventory of where they are and where they want to go… If practice owners choose, this could be their greatest moment.”

“The first key is the mindset of the practice owner,” Worster noted. “The mindset must shift from being fearful of the unknown to becoming resourceful in navigating these challenging times. The need to be smart by assigning tasks that aren't their strengths to others. Practices then need to create massive influence in their marketing through digital marketing strategies, social media, and creating a patient journey that can take patients from where they are to where the practice needs them to go.”

Diles echoed the benefits of having creative digital strategies.

“The logistical challenges and changes to consumer behavior brought on by COVID-19 are the latest obstacles but they won't be the last,” he said. “With creative, intelligent, data-driven strategy combined with quick execution, we are confident that private practices are positioned to get through this latest threat and thrive for years to come.”

And like many others, Wiser is keeping a hopeful mindset.

“Two unexpected, but positive, things have come from this pandemic,” she said. “First, due to the effects of masks on speech, people with normal hearing are becoming more aware of the challenges of living with even a slight hearing impediment. As a result, some are becoming more sensitive to people with hearing loss. The second is that patients are much more appreciative of in-office care. Video consults, remote programming, manufacturer hotlines, and even curbside services are not sufficient. People need to be treated in person to get the full benefit of their hearing aids and our services.”

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