Hearing Matters Podcast
Welcome to the Hearing Matters Podcast with Blaise Delfino, M.S. - HIS! We combine education, entertainment, and all things hearing aid-related in one ear-pleasing package!
In each episode, we'll unravel the mysteries of the auditory system, decode the latest advancements in hearing technology, and explore the unique challenges faced by individuals with hearing loss. But don't worry, we promise our discussions won't go in one ear and out the other!
From heartwarming personal stories to mind-blowing research breakthroughs, the Hearing Matters Podcast is your go-to destination for all things related to hearing health. Get ready to laugh, learn, and join a vibrant community that believes that hearing matters - because it truly does!
Hearing Matters Podcast
Can You Build a Patient-First Practice While Still Being Profitable?
Dr. Lindsay Koble takes us on an extraordinary journey from accidental audiologist to successful practice owner in this eye-opening conversation about the realities of audiology entrepreneurship. After a jaw surgery complication left her with a perforated eardrum during college, Lindsay discovered her passion for audiology through her own hearing healthcare experience. This unexpected path led her to build Audiology Always, a thriving practice in her hometown of Auburn, Indiana focused on transparent, accessible care.
Lindsay's career trajectory provides a masterclass in preparation for practice ownership. Her time in an ENT clinic built clinical confidence with complex cases, while her role as a hearing aid manufacturer representative developed her business acumen. Combined with an MBA and farm-raised financial wisdom, these experiences created the perfect foundation for entrepreneurship. "You're never really ready," she reveals, "but if you're confident enough to bet on yourself, that's when it's time."
Financial literacy emerges as the unsung hero of practice success. Lindsay candidly discusses securing her $135,000 practice loan, making strategic equipment decisions, and maintaining conservative financial practices. Growing up on a family farm taught her invaluable lessons about cash flow management - understanding that business has "good seasons and bad seasons" and preparing accordingly. She challenges conventional thinking by accepting Medicare, Medicaid and insurance plans while maintaining profitability through transparent service pricing.
The conversation expands beyond business mechanics to explore the importance of community for practice owners. Lindsay participates in a mastermind group of Indiana audiologists who meet monthly to share challenges and solutions. Her leadership in founding the Indiana Audiology Coalition demonstrates her commitment to advancing the profession through collaboration and advocacy.
Whether you're a seasoned practice owner or dreaming of entrepreneurship, this episode delivers practical wisdom on balancing profitability with patient-centered care. Subscribe to Hearing Matters for more conversations that delve into the business of better hearing and the human stories behind successful practices.
Connect with the Hearing Matters Podcast Team
Email: hearingmatterspodcast@gmail.com
Instagram: @hearing_matters_podcast
Twitter: @hearing_mattas
Facebook: Hearing Matters Podcast
Thank you to our partners. Sycle: built for the entire hearing care practice. Redux: the best dryer hands down. CaptionC all by Sorenson: Life is Calling. CareCredit: here today to help more people hear tomorrow. Fader Plugs: the world's first custom adjustable earplug.
Blaise Delfino, M.S. - HIS:Welcome back to another episode of the Hearing Matters Podcast. I'm founder and host, Blaise Delfino, and, as a friendly reminder, this podcast is separate from my work at Starkey. You're tuned in to the Hearing Matters Podcast, the show that discusses hearing technology, best practices and a global epidemic hearing loss. I'm your host, Blaise Delfino, and joining me today is Dr Lindsay Koble from Audiology Always. A little bit about her clinic. It's a private audiology clinic located in Auburn, indiana. The clinic is owned and operated by Garrett native and resident and our guest, Dr. Lindsay Koble. She grew up on a family farm west of Garrett, indiana. Although she went away for eight years of education, she knew DeKalb County would always be home. In 2017, she married a lifelong friend, Trace Koble, and they planted their roots right across the road from her family farm. That is awesome. Her passion for opening audiology always is to provide her hometown and nearby communities with the most comprehensive and here's the keyword transparent hearing healthcare. Dr Koble, welcome to the Hearing Matters podcast.
Dr. Lindsey Koble, MBA:Thanks, Blaise. What an introduction. Thanks for having me Excited to have a conversation.
Blaise Delfino, M.S. - HIS:So, lindsay, we have so much to unpack today. First and foremost, thank you for everything that you've done and continue to do for Hearing Healthcare. Really, it's so inspiring your social media presence and what you're doing, the storytelling, getting connected with professionals oh my gosh, incredible.
Dr. Lindsey Koble, MBA:Thanks, blaze. I feel like I have evolved through the social media world. You know it really. Social media was out when I was at high school. So you know when I was at high school. So you know when I was playing high school sports and sports stories coming out and then through college, you deal with all the college nonsense and working through social media. So social media has been part of my life. Really. I'm the generation that social media has been part of our life, our whole life, and so when people say you do so well at sharing on social media, I've never known any different and I think transparency is just kind of who I am and I realize that people are looking for a voice to trust and to feel connected to. So it's kind of where I find myself.
Blaise Delfino, M.S. - HIS:Listen social media. You've got that down to a T. It's something you grew up in Audiology. How the heck did you get connected to audiology? And I always love to hear origin stories of how did you get into audiology. How did you get into hearing healthcare?
Dr. Lindsey Koble, MBA:I kind of had a bizarre start. I had a very interesting way that I found the audiology world. So in high school I did this program called Health Occupation Education. So in high school I did this program called Health Occupation Education. In that program we spent half of the day our senior year going to different health care fields. So we got to shadow a surgeon, a dentist, a physical therapist, an optometrist, ob, med surge, all these things and my whole senior year I was like this, ain't it? But I still like the medical field. But I haven't quite found my subject yet that I really love. So I went to Purdue just studying general health sciences, thinking I'm going to figure this out, thinking maybe pharmacy, maybe physical therapy.
Dr. Lindsey Koble, MBA:I played a lot of sports growing up and then I had to have jaw surgery. Christmas break of my freshman year had to have jaw surgery. Christmas break of my freshman year the surgeon accidentally poked a hole through my eardrum doing the TMJ surgery. So it's like this one in a million thing you sign off on. But the hole has healed, I'm all as well.
Dr. Lindsey Koble, MBA:It took about six months for the hole to heal but in the process I had to see an audiologist to do a baseline audiogram to see. You know, here's your conductive loss. Now we're getting better. We're getting better and I remember during one of those appointments I was like what, what is your job title? You seem to love what you do. And she was like I'm an audiologist. So I went back to Purdue and I asked my advisor do you guys have audiology? She was like we do. So I was one of the rare ones that was in this big speech and hearing science group and I was like one of few who knew that I was going to go to the audiology track from the start. So yeah, kind of crazy story, but an unfortunate event that was perfect.
Blaise Delfino, M.S. - HIS:And I feel like those events are supposed to happen and I know, you know, we've recorded a couple episodes today and I like to know everyone's origin story, because I'm genetically predisposed. I mean, I had no choice.
Dr. Lindsey Koble, MBA:My father's an audiologist.
Blaise Delfino, M.S. - HIS:My father's a hearing instrument specialist. So, like I knew and it's like now with Hearing Matters podcast I'd love to just know, like, how did you get introduced to hearing health care? So you have that personal story. Let me ask you, when you had the tympanic membrane perf, what was that like going from normal hearing to now? Oh, I have some hearing loss now.
Dr. Lindsey Koble, MBA:Well, and it was a really kind of scary time because TMJ surgery I had it done on both sides of my jaw and so the expectations of what comes out of that was what our primary focus was on. But then it quickly shifted to this hole in my eardrum and I feel like I can't hear and I felt so I had like equilibrium issues. My balance was a little off, which, like when patients mentioned that, it's like I can relate because I had that happen. So I think it was that, mixed with meeting that audiologist who seemed so happy and she was so nice Every time I saw her mixed with like the technology side in the science side that I knew I always liked, and then throwing in like the humanistic connection approach, it was just a lot of things that, like my stars finally aligned in the medical field and I love it.
Blaise Delfino, M.S. - HIS:Lindsay, I've obviously been following your story for quite some time now your journey. So, doctor of audiology, you graduate, you start working out in an ENT clinic ear, nose and throat and then later with a hearing aid manufacturer. I've got to know how did those early career experiences really shape you personally and professionally and then prepare you to own your own practice?
Dr. Lindsey Koble, MBA:Mm-hmm, such a good question. And I think my journey is why I'm where I am and why I have the confidence to make these like quick business decisions, because I have such that vast experience. So when I was doing my fourth year it's such an important time in a student's life I was the student. I always told people I want to own my own practice someday. Even in grad school I kind of knew that. But my preceptors were really pushing me to not go to a private practice in my fourth year. Their perception was that then you settle and you don't get the broad clinical experience that you can get in your fourth year, which I have opinions on that. There's pros and cons. I don't know that. I totally agree.
Dr. Lindsey Koble, MBA:But so I was looking at ear, nose and throat opportunities for my fourth year. So I was either going to go really far from home or I was going to come close to home. While I settled on coming close to home, I had a long term boyfriend at the time who's now my husband, so that all worked out as planned. Then I really enjoyed that space. It's a huge ENT clinic here in Northern Indiana so we saw kids to adults. They did cochlear implants, abrs, balance testing. So I stayed on there for about three years and I think that's where I got my confidence clinically. So you see, really hard hearing tests, like masking, is like bring it on. But you just get real confident in that space with all ages. You have to communicate with front office staff, nursing staff, ent, physicians and be comfortable with kind of that atmosphere. That was my core foundation.
Dr. Lindsey Koble, MBA:Then I knew I loved marketing and I knew I loved working with people and leading people and so that was kind of what took me to step into the sales rep role with a hearing aid manufacturer. So then that role you don't know when you're ready for a role like that. I think everyone feels like am I qualified? I was young, like honestly, I was young, I had no sales experience, I was an audiologist, but I knew I liked marketing, I knew I was organized, I was driven, I could work with people and so I learned the sales side.
Dr. Lindsey Koble, MBA:They taught it to me. I had like some innate characteristics to do that role and then they taught me the sales side. I pursued my MBA. So I think I learned even more about the business side and that was honestly driven by my boss at the time. I wanted to grow and I kind of had my sights set to grow within the company. And he said you know, go get your MBA, pursue something better, never like settle for where you're at. So I did that and then I have mentorship like that.
Blaise Delfino, M.S. - HIS:Oh, he was so I know.
Dr. Lindsey Koble, MBA:I know Brian Pecca.
Dr. Lindsey Koble, MBA:We'll give you a shout out, brian Pecca. He, he was always one of yes, you're doing really great and you're meeting your goals and you're doing all these things, but don't just be great when you can be so good, don't just be great. So he would always, you know, kind of like bring me down to reality of you're doing great at this, but you can still be better at this, and so, like, next year, go get it. And I never took it like personally. It wasn't like he was like you're not following through here. It was more of like he's like a tough coach where it's like, you know, when your coach isn't critiquing you, you've kind of fallen off the radar. And so I owe so much of my just, I think, pursuing this field and shooting for the stars in this field to his trust in me.
Blaise Delfino, M.S. - HIS:And sometimes you have to believe in someone else's belief in you before you believe in yourself and that accountability and that mentorship. You believe in yourself and that accountability and that mentorship. I'm really happy you bring that up, lindsay, because again you know, when you invest in yourself as a professional and as a person, that is going to trickle down then to your patient care for sure.
Dr. Lindsey Koble, MBA:Yes, yes, I think so. And then I mean once I pursued my MBA I had a daughter. So it was like COVID hit, I was getting my MBA, I had a daughter. And then it was like, okay, back to the road After I had my daughter. You know they always say everything changes when you have kids and I'm like, no, I'm just gonna be in this. You know, I love the manufacturing side, I'm just going to be here forever. And then once I had my daughter and my territory was the whole state. So I was driving a lot.
Dr. Lindsey Koble, MBA:I live way up in the corner of Indiana, so I would wake up at like 5 am, get down to Indianapolis for an 8 am appointment, see three different accounts and then be home by dinnertime. And then my husband also travels for work. So we were kind of on this like one week on, one week off taking care of a six month old, and it was just yeah, it was tough and we were still doing it. He was super supportive of like if this is your career, go for it.
Dr. Lindsey Koble, MBA:But always in the back of my head I kind of had this thought of when is the perfect time to open your own practice, and it was really kind of like the stars just aligned, and I didn't think it through a whole lot. I really came home one day and told my husband I'm like I think now is the time to open my own practice, and it was. He was like, okay, what do we do first? And it was a couple of days later when I told Brian Pekka, I've made the decision that I'm going to open my own practice and the support that I received. I am forever thankful for that too. So, yeah, it's just like good people supporting good people and taking a path and the stars kind of aligned. And it was all meant to be really.
Blaise Delfino, M.S. - HIS:So much to unpack there. But when a couple yeah, like probably two and a half years ago, when audiology always was founded you had shared your story in a post of sort of the journey that you've taken, after grad school I went right into private practice and while it was a family practice, the model Lindsay was so different and we had expanded, we opened up different locations. But looking back now I'm like wow, that was really hard. And I'm like, well, everyone's journey is different. You are where you are supposed to be right now, but I could see how you know ENT and then working a manufacturer and then going into private practice. That absolutely catapulted you. That was part of the plan, that was part of your journey. But building a private practice from scratch, a private practice from scratch that is no easy feat.
Blaise Delfino, M.S. - HIS:What really made you of course you know being there for your daughter and your family so important? What was that inside of you that said you know what? Now's the time to take this leap.
Dr. Lindsey Koble, MBA:I think it was. Really you have to get to a point of confidence. And so I always, like I said, it was always in the back of my head that I knew that was something that I wanted to do. But I always felt like, am I quite ready for that? Kind of like when I went from clinic to being a rep, am I prepared for this? Am I qualified for this?
Dr. Lindsey Koble, MBA:And then, after the few years of being a rep, of being a rep, my confidence in myself grew and I recognized when I was a rep, you talk to so many business owners and managers and directors of offices. No one is ever ready. And so when I see people post, how do I know I'm ready to open my own practice? You're never really ready, but if you're confident enough to bet on yourself, that's when it was time and like something hit me. I was literally doing a three hour drive home one day and I was. I think it was kind of like, why am I doing this? Why am I always on the road when I could be home doing this for myself? And it was like if you're going to do this for yourself, you have to place a bet on yourself and just go head first and something. That day must've been a sunny day and it just came home, walked in the front door and told my husband let's do it. So yeah, you're never really ready.
Blaise Delfino, M.S. - HIS:Lindsay, when you were a fourth year student, it was advised go to the medical setting. Maybe do something other than going into the private practice setting just to kind of expand your scope and understanding. But if you were advising students about to enter their fourth year, what do you think they should know about the real challenges of private practice?
Dr. Lindsey Koble, MBA:When you're entering your fourth year. I think there is a side to consider of improving your clinical skills. That's something to be said. But if you're interested in opening your own practice, the skills to be successful are not fitting a hearing aid. It's not doing a hearing test. Most audiologists can do that. The hard parts to practice ownership are managing cash flow, setting your pricing, managing your insurance contracts. Do we join? Do we not join? Is that one profitable? Is it not profitable? What equipment to buy? When to buy equipment? When to hire? Is it not profitable? What equipment to buy? When to buy equipment? When to hire? Those are the things that are not taught in most programs. I think some programs are starting to get better, but a lot of those things still can't be taught from a PowerPoint presentation or from a textbook. The only way to get better at that is either to work in a private practice and see it happen day to day, have a really great mentor who's willing to help you understand those things, or to try to learn it on your own.
Blaise Delfino, M.S. - HIS:I guess Financial literacy so important. Thank you so much for bringing this up, because I really do want to dive into financing and planning. But what gets measured gets managed. And how important in private practice to understand what your key performance indicators are like help rate, companion rate, average selling price.
Dr. Lindsey Koble, MBA:It's like a three-legged stool. That's what I was going to say Average selling price, so important.
Blaise Delfino, M.S. - HIS:And so why is average selling price so important, as it relates to cash flow?
Dr. Lindsey Koble, MBA:Well, I think for us there's no secret. We do do managed care, so our average selling price is not $2,000 or whatever that ASP is set at. Our ASP is considerably lower because of those managed care reimbursements and so when you do accept managed care you have to make sure you're profitable and oftentimes those of us successful taking managed care are charging in other ways for real ear measurement, communication, needs assessment. So average selling price has lost a little bit of its ground. In my office it's more of revenue per hour is more. Are we looking at revenue per day, revenue per week? I kind of have it broken down that way because we're a little different. From making most of our money off hearing aids, we do make considerable portion off of services and managed care.
Blaise Delfino, M.S. - HIS:One of the big mysteries for new private practice owners. How do I even get a loan? How do I approach financing? What did this process teach?
Dr. Lindsey Koble, MBA:you when you're wanting to open a practice. There really are a lot of avenues to small business ownership. You have, like, the small business administration that you can look at. Are there any options there? Some local governments support new businesses in their area.
Dr. Lindsey Koble, MBA:For me, I went to the bank, to a local bank, and I think what I learned through that process is, when you're getting a loan from a bank, they want to know everything about your financial situation. So they want to know do you own a house? Do you own a car? Tell me about your student loan debt, Tell me about your, do you have credit card debt? How much do you owe on that other property you have, or whatever. They get to the bottom of your financial situation.
Dr. Lindsey Koble, MBA:And then we took out $150,000 loan. We had to put in 15,000 of our own money, kind of to show that we had some skin in the game, and so at the end of the day our loan was $135,000. But we had to have $15,000 to even start the process. So really to me that just shows me the importance of paying off your debt, owning things and having good credit. You know, unfortunately people have their opinions about credit, but having good credit helped us and then having that money set aside, prepared to open the practice, we had to have it. So I think there are these things. You can't just say I want to open a practice. There's some financial input that goes into it too.
Blaise Delfino, M.S. - HIS:Going through that process together. Again, what gets measured, gets managed. So, as you're going through this process of okay, what is our debt to income ratio? What does this look like? How much do we need? You learned a lot in that process correct?
Dr. Lindsey Koble, MBA:Yes and, like the other side is you need this money, you know you need this money. The bank needs to know why do you need this money and know you need this money. The bank needs to know why do you need this money, and so the bank wants to know what are you going to buy with this money. How much does each thing cost? And they are going to scrutinize it. If the bank's giving you money, they're going to make sure that your numbers are accurate and that they make sense. And then they want to know projections that your numbers are accurate and that they make sense. And then they want to know projections.
Dr. Lindsey Koble, MBA:The bank doesn't know how much money an audiology clinic makes, so they wanted three-year projections for expectations of profitability, to know that they were going to get their money back. And so it was an activity we'll call it really to dive through these numbers to understand why we're asking for this money, how we're going to pay back this money, to get the bank to agree that we deserve the money. You know it was just a lot of you. Don't look at your own finances that closely, I don't think, until you're going through a process like that.
Blaise Delfino, M.S. - HIS:So, yeah, Because we were touching a little bit on going through a process like that. So yeah, because we were touching a little bit on fourth years and coming out and starting your own private practice. We didn't really talk about this when we first connected Lindsay, but you kind of just brought it up to me. You know student loan debt. So it's like students who graduate with their AUD unless they're in a position where you know their family was able to pay for it in full, and they come out with zero student loan debt. Is it realistic then to say, like I'm a fourth year student, I have a business plan. Is a bank going to give them that loan when they have over $100,000 in student loan debt? I want to be realistic here.
Dr. Lindsey Koble, MBA:In my head? Probably not. I mean the way the bank wants to know that you own something that is more valuable than the loan that they're giving you. Yeah Well, in my case, they knew that if I can't pay off this loan, they took a lien on my house, and so if you don't have something like that that they're not going to give you the loan, you have to own more I think probably most of the time than this loan they're giving you. That way, they can come get it if you go bottom up on the loan, and so you know people have unique financial situations. You may have a rich uncle who's willing to support you in this entrepreneurship journey, but I think from the manufacturer support side, from a bank side, they're going to want to know what you have if you're not successful with this loan. So I think that's so important and super important to be transparent about with these students coming out who think they want to own their own business. It's hard when you're riddled with student loan debt.
Blaise Delfino, M.S. - HIS:Don't put yourself in a financially compromised situation. Be patient.
Dr. Lindsey Koble, MBA:Be patient and I think that was something that I had a really hard time with After undergrad at Purdue. Many of my friends were engineers, construction managers, nurses, you know. So they were going out making $70,000 and I was still in school making $0. Then when I got out of graduate school, they're all buying houses, buying new cars, having kids. So I felt like I was always like a little bit behind.
Dr. Lindsey Koble, MBA:But what I would caution people to is my husband and I. We live in a small town. It is a super low cost of living. Our house is still nothing fancy because we are trying to set ourselves up for a successful long term. And so I say all that because I think when students get out of graduate school, their first thought is I want to buy a car, I want to move to downtown Chicago and sometimes you have to because that's where your job's at. But if private practice is on your mind, just think about your decisions a little bit extra. To think about how can I save a little extra money to set myself up for more of this long-term goal? And it's hard. I totally get it that when you come out of graduate school you feel a little bit behind your peers, but it's worth it to think twice and live a little bit under your means for a while.
Blaise Delfino, M.S. - HIS:It's often said live like no one else will, so you can live like no one else can.
Dr. Lindsey Koble, MBA:And it's hard.
Blaise Delfino, M.S. - HIS:It is very hard, especially living in the day and age we live in today.
Dr. Lindsey Koble, MBA:It's very realistic and things are so expensive now compared to when I did this eight years ago, and I totally get it. I live in the middle of nowhere too. That's super affordable. So I can only say so much to find an affordable place to live. But I think that set my husband and I up for a successful financial future.
Blaise Delfino, M.S. - HIS:It's a marathon. So when it came to planning projections, rent equipment, how did you figure out what was realistic, because obviously you had deep rooted relationships in the industry. How did that all work out?
Dr. Lindsey Koble, MBA:I would say, really that came down to a couple of really great friends who are also audiologists, really all over the country. Like, as I'm saying this, I'm like, yeah, they helped and they helped. I don't even want to say names because there were so many people who were super influential when I got started and I just asked you know, what equipment do you have? What equipment do I need? Do we need that $20,000 piece of equipment or could I get by with the $5,000 piece of equipment? And sometimes you just have to make hard decisions of maybe I can buy that in five years, but right now I just need to get the hearing test done, and this one can do a hearing test, so let's go there. So really it was asking for opinions on equipment and I had been in enough offices, I had seen what people have, what look I wanted to go for as far as equipment, and then you just start to kind of build your costs of what you think all that equipment's going to cost. And then when it came to projections, it is so hard to project right now in this industry, but I knew just because of how many friends and family were asking me about can I use my Medicare Advantage plan when you open your practice. I knew how much of that was around this area. I don't think I quite knew how much, but I knew that it was going to be a portion.
Dr. Lindsey Koble, MBA:So when I was doing my projections I was taking into account those fitting fees, some private pay fitting fees and then you just have to kind of guess to get going. And I started super low with my projections. I was only going to pay myself $50,000 a year to get going. That was something else I was super committed to right off the bat. I had seen so many practice owners who were like I haven't paid myself in years and I'm like I'm, you know, and it's hard to say I'm just going to make that work, but that was important to me to figure out my cash flow, to be able to sustain my own salary. So, yeah, it was a lot of support from mentors really to know what you're doing.
Blaise Delfino, M.S. - HIS:And success leaves clues right. So I mean, even in all these audiology Facebook groups, we learn so much from so many of them and the mentorship and not being afraid to ask. When it comes to overhead, lindsay, you and I both agree that keeping that overhead low is important, but also you were very deliberate about hiring slowly. How did you know when you were ready to add another team member?
Dr. Lindsey Koble, MBA:What did that?
Blaise Delfino, M.S. - HIS:process look like question.
Dr. Lindsey Koble, MBA:Blaise, I always say this is Lindsay math. Somebody who's like an industry expert probably has their opinion of when is the time right to hire. But I knew from learning from others as a practice owner, when you get so busy with the day-to-day clinical tasks that you don't have any time to spend on marketing or moving the business forward, something's got to give, you got to look at what you're doing there, and so that was part of it. The other part of it was I knew, with how our months were going, with how much money we were making each month, that if I didn't, if I brought on a second provider and I didn't make an extra dollar from their contribution, that we just stayed the same, that I could afford to hire her with how much money I was making myself each month. So I knew, even if we hire her and pay her salary, we're still going to have some profit left over, and that has been my method for hiring both of them.
Dr. Lindsey Koble, MBA:So I've hired two audiologists and I hired a second front office staff person. And that's the way I look at it is if we the two of us keep going at the rate that we're going and we don't make any extra money by bringing this third provider on. We can keep continuing and be profitable. Same with hiring the front desk staff, and so of course that's not how it goes. When they come on, then we can see more patients, they make more money, and so I always take the safe approach. I'm always like looking at worst case scenario, but of course I think you probably want them to at least double, triple the amount that you're paying them. Is how I look at it.
Blaise Delfino, M.S. - HIS:You have such an interesting story because you've talked about growing up on a farm and I've seen a lot of the posts on social media. You talk about learning cash flow from your parents. How has that influenced your mindset as a business owner?
Dr. Lindsey Koble, MBA:So I think my parents are super interesting. My mom has worked in IT for 40 years. My mom has been in the same company for 40 years, so she always just had this steady income. My whole life she had this steady income. Then my dad's a farmer.
Dr. Lindsey Koble, MBA:Anyone who knows anything about farming it's either raining and they're mad, or it's dry and they're mad. The crops do good. They're just always mad. Yeah yeah, it's never right. The weather and the crops are never quite right, but so my whole life I heard my parents talked about their financial situation in front of us because it was just farming carries so many financial decisions as a family.
Dr. Lindsey Koble, MBA:That was the conversation happening at the dinner table, and so I think growing up I always understood that there are good seasons and bad seasons to business, and so when I opened my own practice, I think also that gave me the you know I don't know if it's confidence or the comfort that there's going to be good months and bad months and if you prepare accordingly, the bad months are going to hurt a lot less because you've prepared and sustained through some of the good months.
Dr. Lindsey Koble, MBA:So I'm in Indiana. You expect when winter hits we might have some bad months or cash flow might be kind of slow going through January, february. Well, if you have a really good fall and you don't spend all your money, you don't think about it, you just you're safe in the background. And so really I learned that from farming. You know farming. You put a lot of money into your crops to plant them in the spring. Money then gets tight through the summer, then you harvest your crops in the fall, and so I see kind of that cycle of my practice and I just I've learned, like I said, I think it's more comfort than confidence, but just to prepare and to save on the back end.
Blaise Delfino, M.S. - HIS:You're very intentional about managing savings, you know money market accounts, building a safety net. Why is that so important for private practice owners today?
Dr. Lindsey Koble, MBA:Well, and I think I saw it through, a really difficult time for many practice owners was when COVID hit. So you know, kind of back to farming. The unexpected is bound to happen at some point.
Blaise Delfino, M.S. - HIS:COVID was a winter in business.
Dr. Lindsey Koble, MBA:Yeah, exactly. And so I think, being a rep during that time, I saw how many of the practice owners had to handle their own financial situations during that time and I told myself right off the bat, the best thing I can do is maybe to short myself in my salary for a while for the sake of building the business. And so, like I said, when I started, I was only paying myself $50,000 because more important than what I was making was that the business was healthy and that the savings account was healthy. So you read all sorts of things of how much do I need to have in the savings account. Usually they say like three times monthly expenses is the safe route to go.
Dr. Lindsey Koble, MBA:Again, I don't have perfect math. I kind of have it in my mind of what I want in my checking account, what I want in my savings account, and then in my head, once it goes beyond that, then you make the decisions of do I put it in my investments, my personal investments, do I move it to a business money market account? And that's decisions that I've learned from my peers. I've leaned into my accountant to take their advice. But when you look at it again, it took me like a year to really learn this stuff. But it doesn't make sense to have a big lump of money sitting in a savings account when my cashflow is working over here in this account and I haven't touched this account for a year. Let's move it somewhere where it's gonna work. Work for me.
Blaise Delfino, M.S. - HIS:I remember to your point and I love that you bring this up as a private practice owner when you own your own clinic, keeping a lump sum in a savings account is really, in my professional opinion, not the best thing to do, because I remember it was like year one or year two I went to our financial advisor and I was like, hey, we have X amount and only made X amount. That's kind of not cool and I would advise and I'm sure you would as well connect with a tax strategist advisor your attorneys maybe who are also trained in tax strategy, just to ensure that what you're doing doesn't have any penalties when you take it out and things of that nature.
Dr. Lindsey Koble, MBA:Yes, and I would say I think. To that point, I would say don't be afraid to ask the questions. Don't feel like you're not a great business owner because you need to ask your accountant about tax savings or because you go to your bank and you question should I have this amount of money in my savings account. Ask the question. They're going to offer you options to shift and you don't know unless you ask. Google's only good for so much, I think leaning on your banker, your lawyer, your accountant, all these people that you've made relationships with, to support your business.
Blaise Delfino, M.S. - HIS:Lindsay, I want to dive into operational wisdom because obviously you encompass a lot of this. You take Medicaid, third party VA contracts. There are some schools of thought that will say I'm only private practice and if that's your model and it's working for you, fine. We're not here to say okay always better. A lot of owners will shy away from those. Why was this choice important for you and your practice?
Dr. Lindsey Koble, MBA:When I opened my private practice, I opened it in the same county that I was raised in, so essentially it's my hometown. There's like three small towns within this county, so really it's kind of a county where everybody knows everybody to a certain degree and I just wanted to take care of people and really I wanted to take care of anybody who walked through the door. I wanted to be able to help them, which, as a practice owner, is kind of a bold statement, because anybody who walks through the door needs to be profitable to a certain degree. I have my hands in a lot of things and I'm not hanging my hat on any one thing. And the other thing I will say is I am always analyzing, and so at the end of 2024, I left one of the managed care plans because it didn't make sense for us anymore. I left one of the managed care plans because it didn't make sense for us anymore, and so if you're going to do all these things, you have to see what's working, and year to year it changes. But at the end of the day, I just wanted to take care of people and it's so fun having hearing aids be affordable to people. But what I would also say is we're not giving things away for free. We're not.
Dr. Lindsey Koble, MBA:When people walk in here they don't think we're this, like you know, low on the totem pole, low cost place. People are willing to pay. We charge for communication, needs assessment, we charge for real ear measurement. We charge for all supplies, all follow-up services that we do. We have a charge set to that and we're super transparent about that upfront.
Dr. Lindsey Koble, MBA:But the affordability of hearing aids through Medicaid or their Medicare Advantage plan, their employer carried plan, makes hearing aids affordable and attainable up front and so for us that has worked in our favor because word of mouth has spread super fast for us. So you know, then you get into the situation of now we're getting busy, is busy, profitable, and so that's where we're now kind of at this crossroads of. We have three awesome providers. Our schedules are constantly booked. So of course, 2025 to 2026, I will be making some decisions on things, because you have to do what's best. You can't just keep seeing people because that's the nice thing to do. You have to treat people to the top of your ability and so you can't just be busy and do that well.
Blaise Delfino, M.S. - HIS:How do you balance profitability with patient-centered care, especially with third party payers?
Dr. Lindsey Koble, MBA:We charge. Like I said, we have to charge. You have to charge for your real air measurement, your communication needs assessment, all of your supplies. You have to charge for your real air measurement, your communication needs assessment, all of your supplies you have to charge. We don't shorten our consultation appointments, we don't shorten our fitting appointments, but we I think it's kind of a combination of we are in small town Indiana, my rent is low, our cost of living is low, so you, you know, maybe my staff has paid a little less than somebody who lives in LA, of course, but so our overhead, I think, is probably lower than most probably one of the lower in the country.
Dr. Lindsey Koble, MBA:But the plans are all different and so there are definitely some plans where it's like making that little bit of money that we make on that fitting fee is not profitable, and so that's where we have to start looking at is taking care of that patient actually a detriment to our patient care over here? And that's where I'm looking at going into 2026. I think it's a balancing act, you know, and people, when you're an audiologist, you just want to take care of people and people are so appreciative of affordability. But affordability and keeping the lights on, don't always go hand in hand. So yeah, you have to do what makes sense.
Blaise Delfino, M.S. - HIS:And implementing service plans. Lindsay, I will tell you from our experience once we started to do that and we kept it so reasonable. But again, I want to keep this accessible to patients, affordable to patients, but also I need to make sure that my practice is profitable enough so it can continue to support the community. You need to be aware of what's going on, you need to have a pulse on your business. But when you put patient care first, the Pareto principle is absolutely happening in your practice, where 80% is coming from 20%. The word of mouth that's super exciting stuff.
Dr. Lindsey Koble, MBA:Yeah, yeah, and that's what I remember. When I was first getting started I actually met with a community mentor who owns her own business nothing in the medical field related, but she had been her own business owner for years and years and she said I will tell you one thing If you just take care of people, you will be successful. That pops up in my head all the time Just take care of people and it will work. And it does. But to that point kind of when you're looking at how do you manage these third parties and be profitable and manage your time, we are right in the mix of trying to figure out how to utilize audiology assistants in the best way possible. So Amanda, who's been with me since the start, carries the title of my office manager, but we have since hired a second patient care coordinator and so two days a week when that other patient care coordinator is there, amanda is now seeing some of these hearing aid check walk-in type appointments. That way it doesn't take time away from our providers who are making doing revenue generating appointments.
Dr. Lindsey Koble, MBA:So we're kind of in this really pivotal period of we're at the 2.5 year mark, so we really haven't had anyone who has hit their three year end of warranty period yet and so we're trying to show them that's hiding, it's such a crazy period but we're trying to show them.
Dr. Lindsey Koble, MBA:We see them back, for usually it's like a four month and then a six month and their annual visit then six month and annual again. So we're really working hard to show them how valuable our services and how valuable we are as a partner and for longevity of your hearing aids, how important that is. And then I think, if we can do it correctly when their end of warranty comes up, to offer service plans and packages for the end of warranty period, I think we're going to find that may be a really pivotal thing for our practice. You know, currently we offer small service plans at the end of their one year service visit. Most people actually in our practice choose to pay as they go, which we offer small service plans at the end of their one year service visit. Most people actually in our practice choose to pay as they go, which we have a charge for, an office visit charge. But I think the end of warranty visit might work well for us.
Blaise Delfino, M.S. - HIS:But I think so. I mean I will from experience. We implemented the end of warranty and I will say we implemented the Dr Jill dollar a day. Yeah, again, it might not be for every practice, but for where we were demographically, lindsay, it worked incredibly well. There were months where 10, 11, 12 patients enrolled yeah, and that's net profit, which then you can put back into your business. You can continue to provide best patient care. We are both on the same frequency here in terms of investing back into the business and how important that is. As a private practice owner, sometimes it can feel like you're on an island, but you've obviously built a great support network your banker, accountant, fellow owners.
Blaise Delfino, M.S. - HIS:How has community helped you avoid feeling like you're on an island?
Dr. Lindsey Koble, MBA:I would say I do a couple different things. So I have we call ourselves the Indiana Masterminds, but there's a group of I think there's five of us in the group. We're in a text message chain so we usually text every single day about something and then once a month we meet on a Friday morning and we just we kind of go around and each of us say something that's on our mind, a question that we have, and we kind of share what we're doing, what works. So I think, just not not closing yourself and feeling like you're the only one going through this, which I think is what you know. What I do online is I try to be transparent, to make people feel like what you're going through everyone else has probably been through or is also going through. So I think you know, go to the conferences. Since I was a student I've gone to AAA, ada you know Odd Boss has such a great conference and so find your people and don't be afraid to kind of reach out to them and make a little network to pass ideas back and forth to.
Dr. Lindsey Koble, MBA:I think people think that private practice and audiology is so competitive, which some, you know it has been a little bit, but if you find the right people it's not. Yeah, if you find the right people, it's not, and so you just have to be open to sharing. I think the other side is when you know you're trying to connect with a mentor or somebody and it's really one-sided of you're just grilling their brain on their information or to utilize their practices. If you want kind of this working relationship, you have to give a little too. So I think be conscious of that when you're trying to network in the audiology space. But more than anything, nobody's alone, I don't think.
Blaise Delfino, M.S. - HIS:And when you are running a practice, leaning into mentorship, asking, asking is free. Lindsay, you've donated so much of your time today. I just have one more question, and this is a very important question because this is huge industry news. Here I mean seriously. You are resident elect of the Indiana Audiology Coalition and helped plan its first big event. Tell me what drives your passion for advocacy and how can other professionals get involved.
Dr. Lindsey Koble, MBA:I think Erica Person who owns Flex Audiology down in Lawrenceburg, indiana. When Erica moved here from Minnesota she used to practice in Minnesota. I remember she asked me does Indiana have an audiology group to be a part of? And I was like no, not really. We kind of had like a speech and hearing group, but we never had our own audiology group. They used to years ago and then it kind of dissolved and so really it was Erica's idea. We kind of worked together. We had a really great group of initial founders who most of us were practice owners. A couple audiologists who work for manufacturers joined us and kind of doing the legwork to get going.
Dr. Lindsey Koble, MBA:But really it was just we had this idea and we had the passion to do it.
Dr. Lindsey Koble, MBA:Because Indiana is just so gray which there's pros and cons to having a state that doesn't have really set in stone policies, sure, but also it leaves a lot of room for encroachment of our scope of practice.
Dr. Lindsey Koble, MBA:And so we just knew that, as things are evolving and changing, we really need this organization, are evolving and changing, we really need this organization.
Dr. Lindsey Koble, MBA:And so it just took starting planning a really great first conference where we had such an awesome turnout of audiologists from all over the state hospitals, ents, a couple from university, we had really great presenters and just to bring together the state of Indiana and to fuel that camaraderie that we really need just when something comes up unexpected, we now have this foundation to move forward, to support our but now we have this core foundation together to move forward year to year. And so when Erica was starting it, it just made sense for me to be president elect to kind of go down this road with her and then next year as president. You know we're just we have such a great group that we know kind of the the board that we have right now is going to be the same board that we had last year. We need to get our legs under us to get going for a couple of years, and then I just think we're in a really good place.
Blaise Delfino, M.S. - HIS:Thank you so much for your advocacy efforts and Dr Person and it's super exciting. I mean, when I saw this announcement online, I was like, oh my, this is incredible.
Dr. Lindsey Koble, MBA:Yeah, something we've never had, we really needed, and now we just have the chance to get involved with ADA, aaa, asha. When they have things that come out, we can speak to our Indiana audiologists and kind of come together as a group to decide how we want to handle that in our own state and we're in a fun spot to really progress audiology in Indiana.
Blaise Delfino, M.S. - HIS:Lindsay, thank you so much for joining us on the Hearing Matters podcast. If you could leave our listeners with one thing today, one golden nugget, what would that be?
Dr. Lindsey Koble, MBA:One golden nugget. I would probably tell them to chase your dreams, which sounds so cliche, but I would say if you are passionate about anything in this industry, go for it, whether that's being the president of your state organization, whether that's working for a manufacturer, being the director of a hospital, a Mayo Clinic type office. Do all of the right things and never quit chasing your dreams, because you will attain them one day if you never give up.
Blaise Delfino, M.S. - HIS:You're tuned in to the Hearing Matters podcast. I'm your host, blaise Delfino, and today we spoke with Dr Lindsey Koble from Audiology Always, auburn, indiana. Keep hearing and listening, well, and until next time, hear life's story.
.jpg)
