The Bottom Liine Ep. 4

Maximizing revenue per patient, with Terri Ross of APX Powered by Engage

Terri Ross joins us to discuss the training and mindset required to maximize patient revenue from every lead and consult. Terri’s perspective comes from 20 years of managing and consulting in the aesthetics space, though our discussion easily applies to any specialty healthcare vertical. Terri is President of Aesthetics for APX Powered by Engage, and is founder and CEO of Terri Ross Consulting. 



Ken: Welcome back to The Bottom Liine. Today, we’re going to talk about how do we maximize the revenue per patient. And we have Terri Ross from APX Powered by Engage. Terri, why don’t you quickly introduce yourself before we jump into our topic.

Terri: Yo, yo, everybody, how are you? Thanks, Ken and Charlie for having me on. Super excited. This is my jam. Terri Ross I was the founder and co-CEO of APX Platform. Part of that, the founder and CEO, Terri Ross Consulting for about 12 years. And most recently we went through a merger with Engage Technologies and I’m the president of the aesthetic division there.

Ken: Awesome. Well, we’re super excited to have you here. Again, we have we have already talked about various stages of the patient funnel. Basically, how do we get more leads, turn more leads into consults. How to turn more consults into treatment. Today, we’re going to talk more about: we have patients, how we maximize the value of those patients. How do we kind of think about ethically maximizing our revenue from every patient interaction?

What’s the first step?

Terri: So if we’re not going to talk about marketing, you know, where you guys play, which you know, I love you all so much. The first step being really what I teach everywhere is, is the is the training component before I even get into the the how or the why. If you know your team has got to be trained, you know, every role within the organization.

You know, I’m going to focus on aesthetic medicine. That’s where I’ve played for 20 years. But whether you’re in ophthalmology, dentistry, any cash pay business, these methods and philosophies that I’m going to go through are applicable across different verticals. And so, you know, if you think about your front desk, they’re tied to a KPI. Ultimately, that is how do I convert more people to get them in the door?

How do I get them to book a treatment plan? You know, the providers are all tied to a KPI, which is mainly around productivity capacity and increasing revenue per hour, which is what you just asked me. And then obviously your business owners want, bottom line, you know, EBITDA and high profit margins. And so, you know, when we think about that, we we can’t we have to say, you know, we want the patient to come in, but am I going to treat them symptomatically for the one thing that they called for?

Hey, do you offer Botox? Hey, do you offer fillers, whatever that is? Right. Or do we look at our business as a whole holistically and say, I have all of these non-surgical treatments you may offer surgery, I have all these modalities. How am I going to get this client to have the best outcome? And the only way to do that is by look, we have to take a sales approach.

People might not like it. I’m going to use the word sales training, but ultimately, if you are a provider, you’re an educator. That’s that’s what you do. So your obligation to get the patient right, the best outcome and the only way to do that is to be able to really have the ability to bond with me, set that the expectations of that consult, even prior to on the phone, what they can expect when they come in.

Credentialing the practice, credentialing the provider like the why should I come to you versus the competition down the street. And then when I come in, what is the experience and the outcome I’m going to get? And everybody, that’s what I hear. And I want to be a salesperson. That’s not what they came in for. They can’t afford it.

That’s not on us to decide, right? It’s not for me to decide what your pocketbook looks like.

Charlie: Terri. Sales is the most noble profession there is. True or false?

Terri: Listen. Yes.

It is. We could call it. You know, it’s funny because I always ask people, what do they think? What are they what do they think when they hear the word sales? Shocking. And it’s always negative words.

Charlie: What I was going to piggyback, but ken did you say something? You’re not going to change that topic. Are you just kidding?

Ken: No, go. Go ahead. If you had something.

Charlie: One of the things I think about when you say training is it’s like a shift from I’ll focus on front desk for a second, a shift from order taking to helping people get what they’re looking for. So like you said, if someone calls in and asks, what do you charge for a unit for Botox? There’s a lot of other stuff going on in that person’s life and brain That isn’t, “what is

Botox cost per unit,” right? So I think a lot of it is instead of just listening to a question someone asked and then just answering it and then waiting for the next one, you realize that your job is to help people book an appointment or a consultation to understand what they’re trying to accomplish. And then to your point, there’s lots of things that the practice probably offers that are related to that.

And I imagine almost always the the outcome or the solution to providing the solving for what that person is concerned about isn’t one thing, right? There’s going to be a lot of different stuff. And that’s not you mentioned the word ethically earlier Ken. it’s unethical to not understand what people really want and show them what it’s going to take to get there.

I think it’s unethical to not take the time to do that and to say, oh, it’s, you know, $11 per unit. And then they get Botox and then they’re out. And you haven’t even learned what they’re really trying to do, Right. So the training, I think, is also huge. And it’s just like an awakening or a different it’s a it’s a mentality shift to think about what your job is differently and that’s how you actually serve people versus just answering the question.

So I’m a big believer in all that.

Ken: So the sales mindset is important. When does that play out in the real world? Is that when the caller is on the phone? Is that during the consult is that – you just want to get them in one treatment upfront and then you try to upsell more things? When does that happen?

Terri: Look at this. I’m going to I’m going to show this like, this is crazy. Like this is it, like this is this. And they’re like, this is one of my courses. And I love the question. I show it because I didn’t write because I was bored and had nothing to do. I wrote it because, you know, with all due respect, the space is just uneducated and it’s fragmented and that’s okay.

I’m grateful that I have a job and I’m humbled to do so. And I love educating so much. But, you know, we’re worried that the turnover in this space is so high and it’s high for kind of what Charlie just said, because we don’t take the time. We know we need a front desk. And I hate to say that a guest relations patient, concierge, whatever it is, that’s the one of the most important roles in the company, right?

When we think about where Liine plays in and I, you know, I admire and respect what you guys do so much and it’s so in line with what I teach is that people have a marketing budget they’re paying to get that lead in the door, which is very expensive, by the way. And if the team isn’t trained, they don’t even know what the procedures are.

Features benefit. Somebody calls and says, Do you have Ulthera? They don’t know that it’s skin tightening. They say no, but they might have three other things. That’s just fucking crazy, right? Because they just weren’t taught. So if we can just take a step back and say, look at I have a business, even if you’re a provider, you’re an entrepreneur, that’s what you chose to do.

You own a business, you want people, your team is your greatest asset or your biggest expense. So if you’re going to hire them, why don’t you invest in something that’s going to get you an ROI versus looking at it like, Oh God, you know, my team’s fine and you’re just kind of okay with the status quo because that’s what half the businesses are.

You know, the the average med spa does around $1.5 million. That is not a lot of money. So how do we get to the three, five, ten, right, with double digit multiples that we want for an exit. And the only way to do that is to have an efficient business, Right. And to have high profit margins. And the only way to get that right is say, I’m going to invest in my team and I’m going to look at Charlie and he comes in in this way that I want to keep.

Do I want a patient one time or do I want a patient for life? Because you know, what I teach too, is people buy anything, a car, a sofa, your house, college, whatever it is we buy for an emotional reason. So if you don’t value the time in the consultation to get to know me, how long has it been bothering me?

What have I done? You know, in the past? Did it work? Did it not? How committed am I to not feeling this way? I just came back from training a beast of a provider. Three practices and 15 years in business. And he’s like, Terry, I’ve studied you and I. Repetition is good and I use your words. And if we can, you know, really embrace the model.

People are happier, they have better outcomes, they trust you, they want to come back. And ultimately that leads into increased revenue, period. It’s a very simple philosophy. If we’re willing to just say, I’m willing to take the time to learn it and do it different.

Charlie: I have a question that pops in my head I haven’t asked you before. What about like recruiting? I know the labor markets hard or whatever, but what are some of the characteristics that are really important? I would imagine coachable is one because basically what we’re saying is most people that if you’re a practice owner that you have or that you’re trying to hire to come in, whether it’s somebody at the director of first impressions level or in the back office, you know, they don’t have training.

And so what do you think experience, I mean, obviously, if they know about the procedures and treatments, that’s probably a plus. If they’re it’s going to be easier for them to put together a treatment plan. But what are like the biggest things that are most important to succeed, do you think, in some of these roles?

Terri: Yeah, I mean, I think if we’re thinking about, again, guest relations front desk, you know, somebody’s solution oriented quick on their feet, look, I can coach and teach anyone can learn the procedure. Yeah, it might be hard harder. I would prefer somebody with experience, but you know people can look at that role and then I’ll get to the provider level as I don’t know, you know, not not a very important role within the organization.

Right. Maybe. Maybe they’re not paid a lot.

Charlie: The unsung heroes of the business model.

Terri: You get it. At their set, they could be such a high contributor. And again, that relationship building. So I think somebody who is just adaptable and and willing to learn and values, values, customer service and values, the ability to say, I’m willing to spend a little bit more time on the phone. Right. To get a qualified patient in the door.

Nobody has time for lookie-loos. And then I’m sitting in the provider chair wasting time because I can’t afford it, because the person in the front didn’t ask enough questions. It’s like this vicious cycle, right? And if we just look at the funnel or look look at look at the steps, it’s very simple. If, if and only if.

And that’s what we talk about. Look, Charlie, you’re in sales. You know, innately we can’t make people want to feel like a salesperson and or serving. And I love the word we’re serving. We’re providing value. Right, to do that. This is not about me. It’s about you. It’s about them. And and so I think those those are some of the characteristics.

Otherwise, people just take a job and flock in a, you know, 8 to 5 and leave her and don’t don’t, don’t care because they don’t know the why behind why does it matter or they’re not tied to anything that’s going to, you know, get them a different outcome.

Charlie: One thing I’ve found recently in my experience is more on guest relations of first impression experience at the front. But they like it when a lot of times the staff, they get really excited when they get training because they feel like if people, human beings, if you’re doing a job and you feel like you don’t know what you’re doing, that is not fun and it’s not comfortable and you don’t feel good.

So just by saying like, this is why you’re supposed to do this, some people are resistant to training, so it’s not 100% of the time. But I think largely if you’re a practice owner, like your team wants training and if you you will bring that to them, that there’s going to be other benefits to just culturally of conveying that you want to invest in their success and even them just feeling better about, you know, what it is that they’re that they’re doing.

Terri: Well, 100% makes you feel confident and confident. I think that the next thing we have to think about is then how do we hold people accountable? And it’s one thing to take a training and people do it. It’s another it’s another to execute the plan and then practice and practice and practice until you get the outcome you’re looking for versus I took it.

You’re like, I did it. You know.

Charlie: We’ve accomplished something. Is the biggest driver of that you think I mean obviously some some reward and compensation and incentives and stuff. What’s the why do most people suck at accountability? Are they just not willing to, like, have their conversations when it’s like this person, It’s clear what the expectations are. They know it’s important and they’re just neglecting it?

Or why? Why are most people bad at accountability? You think in a practice?

Terri: I think kind of back to where I started in the beginning and I think that no, I don’t think I’ve been doing this for a long time. It’s the lack of education. So even if somebody is a practice manager and and look, I was a managing partner of a men’s bar, so I get it. And I don’t I don’t talk from a place of I’m above you or I read a book and I pretend I know what I’m doing.

I did do it and I had to learn it. I had I came from corporate managing sales teams. I had a med spa in Beverly Hills that sold to a big place in four years. But I had to I had to figure it out too. What I wasn’t willing to do was not hold people accountable. But I also came from big fortune 500.

So people don’t. And you’re a manager and you don’t even know what you’re doing. You don’t know what KPIs, right. We should be looking at or how do I coach my team? Because because they never sold anything either. And I hate to say it, but again, you’ve never educated, you’ve never coached, you’ve never closed, you’ve never qualified. If you’ve never done those things, it’s just an uncomfortable place to be.

And then you have owners just being like, Hey, did we hit our number? Did we hit our number? How many patients do we see today? How much money did we make then it becomes, Oh shit, we’re now. Now it’s not this great quaint med spa or plastic surgery practice. I’m tied to goals, but it is still a it is still a business.

And so I think, again, I can’t I just can’t really stress enough. I just don’t I think that if you haven’t if you haven’t invested in training your team, in finance, in sales and whatever it is, so they can elevate their role to understand. I even find this with big companies selling a laser or an injectable. I came from that world, so I can talk about that too.

You’re so much more empowered, right? If you’re trying to sell this laser for 300 grand, but you don’t know shit about the business and you don’t even know what to ask. But I’m trying to get you to buy this laser. But yet I don’t know what kind of patient you see, if the equipment’s going to sit there in the corner.

If your capacity is 50% or 80, we have bigger problems here.

Charlie: Yeah, I think there’s a lot of there’s a lot of that going on. 300 grand. We have financing, though.

Terri: Right.

Charlie: Also, when you’re talking about training, they’re like, there’s education that if you’re especially if you’re a medical provider and you own a practice like you haven’t ever had any, you know, you don’t you have no background and experience with with the sort of just guts of business, right? So you’ve got to take it upon yourself to also get education on that, that that example of like, you know, if you’re if you’re the business owner and you don’t really know what goes into the numbers, but you’re just like, this number is below where I want it to be, and then you get upset and you try to hold your team accountable.

They’re going to know that you don’t know what the hell you’re talking about. And then that’s not a good situation to be in. So you got to you’ve got to take it upon yourself. In addition to doing the training for your team, that you have to understand what all these metrics mean and and whatnot. And I bet a lot of people that even people that are willing to do the training, a lot of times I think I see, hey, I’m paying this company to do training so I don’t have to mess with this.

And so then that happens. They come back and it doesn’t stick because they’re not they can’t get it into the bloodstream, you know what I’m saying? Yeah, I bet that happens a lot.

Terri: It does. I mean, you know how many P&Ls I’ve looked at, how many shitty Excel spreadsheets I analyze.

Charlie: I actually would be really interested to see some of that stuff.

Terri: It’s a hot mess. Then you really need a drink when you’re looking at that.

Charlie: Yeah, yeah, yeah. I good. Because I was looking for a reason to drink.

Terri: Well, I don’t know. What time is it there? It’s probably somewhere to drink. It is a little red.

Charlie: It’s nice. East Coast. We’re a little ahead. We can start a little earlier.

Terri: I love it.

Charlie: Ken. How far off track are we here?

Ken: No you’re, you’re perfect. I did want to bring it back to the provider side. We’ve talked about the front desk. How much of this problem is front desk versus provider? What does the provider need to know and what training might they need or what’s their mindset.

Terri: I mean, candidly, it’s all the same. I think look, as a, as a provider, that’s what I say. And I do use this word. Your obligation is to help someone get the result and the outcome they’re looking for. Just like if I went in and I always use this analogy on stage, if I had cancer, right, I’m going to get testing and bloodwork and labs and MRI’s and diagnostic tools, I’m going to get an assessment.

So I what what do I have? I’m not going to get half of the damn treatment. Hey, no, I’m not going to get a discount on my chemo. I’m not going to if you want to come back kind of thing, that that doesn’t happen. Right. Have cardiology, dentistry, OBGYN, it doesn’t matter why in this space and it really kills me.

Why in the esthetic space do we, you know, put these notions patient can’t afford it. That’s not what they’re here for. That’s not what my job is. It is what your job is. If you’re an RN, a PA, an NP a doctor, and whatever you are, I have a problem. Even if it’s fine lines, wrinkles, belly fat,

I have a whole bunch of stuff probably going on. And if you offer several things within that, your med spa or plastic surgery practice when I come in, the provider should right there. There should be fundamental things in place from a process perspective, Right? Are we starting with a cosmetic interest questionnaire so that the client can check all the things that may interest them?

60% of patients said they did not know the practice offered things because we don’t talk crazy, right? It’s just and then we’re wondering why we don’t make the money we want. And then they’re clamoring around, How do I get more people? How do I get more people? What the fuck? Why don’t you nurture the ones you have? Come on now, right?

Nurture the ones you have. And the only way to do that is if I’m a provider. And I believe that’s what I say. I cannot make you believe that that’s what your role is. So if you feel salesy. So I just came off this training and this is what I said and I love the way you said that, Charlie.

I go, I want you to think about it differently. What if you didn’t tell the client what they needed? Would you feel bad about that? Would you go home and feel good about yourself? That right? You only sold that Botox or that one syringe and I use this. It’s a disservice. It is a disservice to the patient because you didn’t tell me and then I’m going to go other places.

So the same the provider role, these rooms are tied to KPIs. They need to make a certain amount of money. So when I pushed the money conversation, yes, because it’s still a business. And if you’re trailing behind that, why are you not doing the right procedures, not the right gross profit? You’re taking too long in the role. You’re twiddling around doing the wrong things, whatever it is, there’s a reason for that.

And then if you change your mindset because you also embrace this philosophy that I am a medical provider, this patient came in for whatever the problems are. They checked off the CIQ and I am going to treat this patient differently and I’m going to say what you can expect when we’re together for the next 30 minutes. Terri is I really want to get to know you so that we build this treatment plan so that you can get the outcome you’re looking for.

And then you take me down this series of questions, questions You’re not right. I teach this whole communication model. If you ask me the right questions and I tell you how I feel, I’m ultimately going to be, you know, vulnerable, sharing with you all these things that is going to allow you to say, okay, based on what I heard you saying, they’re my words.

If I feel like shit and fat and I’m going to go to Cabo and I’m single and I’m swiping and I’m not, whatever it is, I need to say miracle, right? If you’re good at asking me questions the way I teach it, I’m going to tell you all the things so that you’re going to be able to say, Well, Charlie, Mary, you said you feel this way.

You don’t want to feel that way anymore. So then my recommendation for you is ABC one, two, three, and here’s why that simple. And then I’m like, Oh shit, of course I want all that. Yeah, I love that.

Charlie: Questions, questions, the right ones. People tell you what they how they actually feel, and then that’s just it’s over from there, right? And you’re not making anybody do anything and some people still aren’t going to do it. That’s okay.

Terri: But. Right.

Charlie: Yeah. Yeah. Well, now with Terri’s in there, I mean, she’s never literally no one’s ever walked out without paying. I love that. The, the I’ve heard Terri’s stuff a lot of times. If you never heard Terri live, it’s phenomenal treatment plan. Concept is what we’re talking about here where you’re just you again you’re listening to what people actually care about and what they need.

And then you are serving them by telling them how you’re going to solve that. It’s it is literally that simple. And if people get over themselves and focus on that, you’re going to feel better about what you do. And that’s a huge piece of of, you know, getting more revenue per patient, which again, that’s like a side effect.

That’s what there’s not a lot of things where like if you do the right thing, then you also make more money and this is one of them.

Terri: I love it. I love you. Right? It is a side effect. I was like, I should just put the money aside, put the goals aside, just put that shit aside. Just do the right thing. Literally do the right thing. If you do the right thing, you’re going to have a better end result. Just yeah.

Charlie: Word up. Ken bring us home.

Ken: Very cool. Yeah, I know we’re about out of time here, so let’s, let’s put a bow on this, but this has been very helpful. Very glad you’re here, Terri. I guess let’s let the people at home know where they can find you.

Terri: Oh, I love it. Ping me, ding me. My email is My Instagram is Terri Ross Consulting. I have a podcast as well in touch with Terri and you can check out I know that’s a lot a lot a lot of ways there, but please find me really. I appreciate this so much.

You guys are amazing. Appreciate the time. Appreciate talking about something that we’re both so passionate about. And I know, as we said earlier, really this just goes across any vertical. So thank you guys so much.

Charlie: Thank you, Terri. So fun we’ll do it again.

Terri: All right, ciao.