August 6, 2025 • 52 mins
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.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
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Welcome back to another episodeof the Hearing Matters Podcast.
I'm founder and host, BlaiseDelfino, and, as a friendly
reminder, this podcast isseparate from my work at Starkey
.
You're tuned in to the HearingMatters Podcast, the show that
(00:59):
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 AudiologyAlways.
A little bit about her clinic.
It's a private audiology cliniclocated in Auburn, indiana.
(01:20):
The clinic is owned andoperated by Garrett native and
resident and our guest, Dr.
Lindsay Koble.
She grew up on a family farmwest of Garrett, indiana.
Although she went away foreight years of education, she
knew DeKalb County would alwaysbe home.
In 2017, she married a lifelongfriend, Trace Koble, and they
(01:46):
planted their roots right acrossthe road from her family farm.
That is awesome.
Her passion for openingaudiology always is to provide
her hometown and nearbycommunities with the most
comprehensive and here's thekeyword transparent hearing
healthcare.
Dr Koble, welcome to theHearing Matters podcast.
Dr. Lindsey Koble, MBA (02:08):
Thanks, Blaise.
What an introduction.
Thanks for having me Excited tohave a conversation.
Blaise Delfino, M.S. - HIS (02:20):
So, lindsay, we have so much to
unpack today.
First and foremost, thank youfor everything that you've done
and continue to do for HearingHealthcare.
Really, it's so inspiring yoursocial media presence and what
you're doing, the storytelling,getting connected with
professionals oh my gosh,incredible.
Dr. Lindsey Koble, MBA (02:36):
Thanks, blaze.
I feel like I have evolvedthrough the social media world.
You know it really.
Social media was out when I wasat high school.
So you know when I was at highschool.
So you know when I was playinghigh school sports and sports
stories coming out and thenthrough college, you deal with
all the college nonsense andworking through social media.
So social media has been partof my life.
Really.
(02:56):
I'm the generation that socialmedia has been part of our life,
our whole life, and so whenpeople say you do so well at
sharing on social media, I'venever known any different and I
think transparency is just kindof who I am and I realize that
people are looking for a voiceto trust and to feel connected
to.
So it's kind of where I findmyself.
Blaise Delfino, M.S. - H (03:16):
Listen social media.
You've got that down to a T.
It's something you grew up inAudiology.
How the heck did you getconnected to audiology?
And I always love to hearorigin stories of how did you
get into audiology.
How did you get into hearinghealthcare?
Dr. Lindsey Koble, MBA (03:34):
I kind of had a bizarre start.
I had a very interesting waythat I found the audiology world
.
So in high school I did thisprogram called Health Occupation
Education.
So in high school I did thisprogram called Health Occupation
Education.
In that program we spent halfof the day our senior year going
to different health care fields.
So we got to shadow a surgeon,a dentist, a physical therapist,
(03:56):
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 medicalfield.
But I haven't quite found mysubject yet that I really love.
So I went to Purdue juststudying general health sciences
, thinking I'm going to figurethis out, thinking maybe
pharmacy, maybe physical therapy.
(04:17):
I played a lot of sports growingup and then I had to have jaw
surgery.
Christmas break of my freshmanyear had to have jaw surgery.
Christmas break of my freshmanyear the surgeon accidentally
poked a hole through my eardrumdoing the TMJ surgery.
So it's like this one in amillion thing you sign off on.
But the hole has healed, I'mall as well.
It took about six months for thehole to heal but in the process
(04:39):
I had to see an audiologist todo a baseline audiogram to see.
You know, here's yourconductive loss.
Now we're getting better.
We're getting better and Iremember 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 anaudiologist.
So I went back to Purdue and Iasked my advisor do you guys
have audiology?
(05:00):
She was like we do.
So I was one of the rare onesthat was in this big speech and
hearing science group and I waslike one of few who knew that I
was going to go to the audiologytrack from the start.
So yeah, kind of crazy story,but an unfortunate event that
was perfect.
Blaise Delfino, M.S. - HIS (05:20):
And I feel like those events are
supposed to happen and I know,you know, we've recorded a
couple episodes today and I liketo know everyone's origin story
, because I'm geneticallypredisposed.
I mean, I had no choice.
Dr. Lindsey Koble, MBA (05:32):
My father's an audiologist.
Blaise Delfino, M.S. - HIS (05:35):
My father's a hearing instrument
specialist.
So, like I knew and it's likenow 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 hadthe tympanic membrane perf, what
was that like going from normalhearing to now?
Oh, I have some hearing lossnow.
Dr. Lindsey Koble, MBA (05:57):
Well, and it was a really kind of
scary time because TMJ surgery Ihad it done on both sides of my
jaw and so the expectations ofwhat comes out of that was what
our primary focus was on.
But then it quickly shifted tothis hole in my eardrum and I
feel like I can't hear and Ifelt so I had like equilibrium
(06:18):
issues.
My balance was a little off,which, like when patients
mentioned that, it's like I canrelate because I had that happen
.
So I think it was that, mixedwith meeting that audiologist
who seemed so happy and she wasso nice Every time I saw her
mixed with like the technologyside in the science side that I
(06:39):
knew I always liked, and thenthrowing in like the humanistic
connection approach, it was justa lot of things that, like my
stars finally aligned in themedical field and I love it.
Blaise Delfino, M.S. - (06:50):
Lindsay , I've obviously been following
your story for quite some timenow your journey.
So, doctor of audiology, yougraduate, you start working out
in an ENT clinic ear, nose andthroat and then later with a
hearing aid manufacturer.
I've got to know how did thoseearly career experiences really
(07:12):
shape you personally andprofessionally and then prepare
you to own your own practice?
Dr. Lindsey Koble, MBA (07:18):
Mm-hmm, such a good question.
And I think my journey is whyI'm where I am and why I have
the confidence to make theselike quick business decisions,
because I have such that vastexperience.
So when I was doing my fourthyear it's such an important time
in a student's life I was thestudent.
(07:39):
I always told people I want toown my own practice someday.
Even in grad school I kind ofknew that.
But my preceptors were reallypushing me to not go to a
private practice in my fourthyear.
Their perception was that thenyou settle and you don't get the
broad clinical experience thatyou can get in your fourth year,
which I have opinions on that.
(08:00):
There's pros and cons.
I don't know that.
I totally agree.
But so I was looking at ear,nose and throat opportunities
for my fourth year.
So I was either going to goreally far from home or I was
going to come close to home.
While I settled on coming closeto home, I had a long term
boyfriend at the time who's nowmy husband, so that all worked
out as planned.
(08:20):
Then I really enjoyed thatspace.
It's a huge ENT clinic here inNorthern Indiana so we saw kids
to adults.
They did cochlear implants,abrs, balance testing.
So I stayed on there for aboutthree years and I think that's
where I got my confidenceclinically.
So you see, really hard hearingtests, like masking, is like
(08:44):
bring it on.
But you just get real confidentin that space with all ages.
You have to communicate withfront office staff, nursing
staff, ent, physicians and becomfortable with kind of that
atmosphere.
That was my core foundation.
Then I knew I loved marketingand I knew I loved working with
(09:08):
people and leading people and sothat was kind of what took me
to step into the sales rep rolewith a hearing aid manufacturer.
So then that role you don'tknow when you're ready for a
role like that.
I think everyone feels like amI qualified?
I was young, like honestly, Iwas young, I had no sales
(09:32):
experience, I was an audiologist, but I knew I liked marketing,
I knew I was organized, I wasdriven, I could work with people
and so I learned the sales side.
They taught it to me.
I had like some innatecharacteristics to do that role
and then they taught me thesales side.
I pursued my MBA.
So I think I learned even moreabout the business side and that
was honestly driven by my bossat the time.
(09:53):
I wanted to grow and I kind ofhad my sights set to grow within
the company.
And he said you know, go getyour MBA, pursue something
better, never like settle forwhere you're at.
So I did that and then I havementorship like that.
Blaise Delfino, M.S. - HIS (10:09):
Oh, he was so I know.
Dr. Lindsey Koble, MBA (10:11):
I know Brian Pecca.
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 andyou're doing all these things,
but don't just be great when youcan 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 atthis, but you can still be
(10:31):
better at this, and so, like,next year, go get it.
And I never took it likepersonally.
It wasn't like he was likeyou're not following through
here.
It was more of like he's like atough coach where it's like,
you know, when your coach isn'tcritiquing you, you've kind of
fallen off the radar.
And so I owe so much of my just, I think, pursuing this field
(10:52):
and shooting for the stars inthis field to his trust in me.
Blaise Delfino, M.S. - HIS (10:55):
And sometimes you have to believe in
someone else's belief in youbefore you believe in yourself
and that accountability and thatmentorship.
You believe in yourself andthat accountability and that
mentorship.
I'm really happy you bring thatup, lindsay, because again you
know, when you invest inyourself as a professional and
as a person, that is going totrickle down then to your
patient care for sure.
Dr. Lindsey Koble, MBA (11:16):
Yes, yes , I think so.
And then I mean once I pursuedmy MBA I had a daughter.
So it was like COVID hit, I wasgetting 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 sayeverything changes when you have
kids and I'm like, no, I'm justgonna be in this.
You know, I love themanufacturing side, I'm just
(11:40):
going to be here forever.
And then once I had my daughterand my territory was the whole
state.
So I was driving a lot.
I live way up in the corner ofIndiana, so I would wake up at
like 5 am, get down toIndianapolis for an 8 am
appointment, see three differentaccounts and then be home by
dinnertime.
And then my husband alsotravels for work.
(12:01):
So we were kind of on this likeone 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 likeif this is your career, go for
it.
But always in the back of myhead I kind of had this thought
of when is the perfect time toopen your own practice, and it
was really kind of like thestars just aligned, and I didn't
(12:24):
think it through a whole lot.
I really came home one day andtold my husband I'm like I think
now is the time to open my ownpractice, and it was.
He was like, okay, what do wedo first?
And it was a couple of dayslater when I told Brian Pekka,
I've made the decision that I'mgoing to open my own practice
and the support that I received.
I am forever thankful for thattoo.
So, yeah, it's just like goodpeople supporting good people
(12:44):
and taking a path and the starskind of aligned.
And it was all meant to bereally.
Blaise Delfino, M.S. - HIS (12:51):
So much to unpack there.
But when a couple yeah, likeprobably two and a half years
ago, when audiology always wasfounded you had shared your
story in a post of sort of thejourney that you've taken, after
grad school I went right intoprivate practice and while it
(13:12):
was a family practice, the modelLindsay was so different and we
had expanded, we opened updifferent locations.
But looking back now I'm likewow, that was really hard.
And I'm like, well, everyone'sjourney is different.
You are where you are supposedto be right now, but I could see
how you know ENT and thenworking a manufacturer and then
going into private practice.
(13:32):
That absolutely catapulted you.
That was part of the plan, thatwas part of your journey.
But building a private practicefrom scratch, a private
practice from scratch that is noeasy feat.
What really made you of courseyou know being there for your
(13:55):
daughter and your family soimportant?
What was that inside of youthat said you know what?
Now's the time to take thisleap.
Dr. Lindsey Koble, MBA (13:59):
I think it was.
Really you have to get to apoint of confidence.
And so I always, like I said,it was always in the back of my
head that I knew that wassomething that I wanted to do.
But I always felt like, am Iquite ready for that?
Kind of like when I went fromclinic to being a rep, am I
prepared for this?
Am I qualified for this?
(14:19):
And then, after the few years ofbeing a rep, of being a rep, my
confidence in myself grew and Irecognized when I was a rep,
you talk to so many businessowners 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
(14:41):
my own practice?
You're never really ready, butif you're confident enough to
bet on yourself, that's when itwas time and like something hit
me.
I was literally doing a threehour 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 roadwhen I could be home doing this
for myself?
And it was like if you're goingto do this for yourself, you
(15:04):
have to place a bet on yourselfand just go head first and
something.
That day must've been a sunnyday and it just came home,
walked in the front door andtold my husband let's do it.
So yeah, you're never reallyready.
Blaise Delfino, M.S. - (15:18):
Lindsay , when you were a fourth year
student, it was advised go tothe medical setting.
Maybe do something other thangoing into the private practice
setting just to kind of expandyour scope and understanding.
But if you were advisingstudents about to enter their
fourth year, what do you thinkthey should know about the real
(15:40):
challenges of private practice?
Dr. Lindsey Koble, MBA (15:44):
When you're entering your fourth year
.
I think there is a side toconsider of improving your
clinical skills.
That's something to be said.
But if you're interested inopening your own practice, the
skills to be successful are notfitting a hearing aid.
It's not doing a hearing test.
(16:06):
Most audiologists can do that.
The hard parts to practiceownership are managing cash flow
, setting your pricing, managingyour 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?
(16:27):
What equipment to buy?
When to buy equipment?
When to hire?
Those are the things that arenot taught in most programs.
I think some programs arestarting to get better, but a
lot of those things still can'tbe taught from a PowerPoint
presentation or from a textbook.
The only way to get better atthat is either to work in a
private practice and see ithappen day to day, have a really
great mentor who's willing tohelp you understand those things
(16:50):
, or to try to learn it on yourown.
Blaise Delfino, M.S. - HIS (16:52):
I guess Financial literacy so
important.
Thank you so much for bringingthis up, because I really do
want to dive into financing andplanning.
But what gets measured getsmanaged.
And how important in privatepractice to understand what your
key performance indicators arelike help rate, companion rate,
(17:14):
average selling price.
Dr. Lindsey Koble, MBA (17:15):
It's like a three-legged stool.
That's what I was going to sayAverage selling price, so
important.
Blaise Delfino, M.S. - HIS (17:18):
And so why is average selling price
so important, as it relates tocash flow?
Dr. Lindsey Koble, MBA (17:24):
Well, I think for us there's no secret.
We do do managed care, so ouraverage selling price is not
$2,000 or whatever that ASP isset at.
Our ASP is considerably lowerbecause of those managed care
reimbursements and so when youdo accept managed care you have
to make sure you're profitableand oftentimes those of us
(17:46):
successful taking managed careare charging in other ways for
real ear measurement,communication, needs assessment.
So average selling price haslost a little bit of its ground.
In my office it's more ofrevenue per hour is more.
Are we looking at revenue perday, revenue per week?
I kind of have it broken downthat way because we're a little
(18:08):
different.
From making most of our moneyoff hearing aids, we do make
considerable portion off ofservices and managed care.
Blaise Delfino, M.S. - HIS (18:15):
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 (18:26):
you when you're wanting to open a
practice.
There really are a lot ofavenues to small business
ownership.
You have, like, the smallbusiness administration that you
can look at.
Are there any options there?
Some local governments supportnew businesses in their area.
For me, I went to the bank, to alocal bank, and I think what I
(18:49):
learned through that process is,when you're getting a loan from
a bank, they want to knoweverything about your financial
situation.
So they want to know do you owna house?
Do you own a car?
Tell me about your student loandebt, Tell me about your, do
you have credit card debt?
How much do you owe on thatother property you have, or
(19:11):
whatever.
They get to the bottom of yourfinancial situation.
And then we took out $150,000loan.
We had to put in 15,000 of ourown 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 toeven start the process.
(19:36):
So really to me that just showsme the importance of paying off
your debt, owning things andhaving good credit.
You know, unfortunately peoplehave their opinions about credit
, but having good credit helpedus and then having that money
set aside, prepared to open thepractice, we had to have it.
So I think there are thesethings.
(19:58):
You can't just say I want toopen a practice.
There's some financial inputthat goes into it too.
Blaise Delfino, M.S. - HI (20:04):
Going through that process together.
Again, what gets measured, getsmanaged.
So, as you're going throughthis 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 thatprocess correct?
Dr. Lindsey Koble, MBA (20:19):
Yes and, like the other side is you need
this money, you know you needthis money.
The bank needs to know why doyou need this money and know you
need this money.
The bank needs to know why doyou need this money, and so the
bank wants to know what are yougoing to buy with this money.
How much does each thing cost?
And they are going toscrutinize it.
If the bank's giving you money,they're going to make sure that
(20:40):
your numbers are accurate andthat they make sense.
And then they want to knowprojections that your numbers
are accurate and that they makesense.
And then they want to knowprojections.
The bank doesn't know how muchmoney an audiology clinic makes,
so they wanted three-yearprojections for expectations of
profitability, to know that theywere going to get their money
back.
And so it was an activity we'llcall it really to dive through
(21:02):
these numbers to understand whywe're asking for this money, how
we're going to pay back thismoney, to get the bank to agree
that we deserve the money.
You know it was just a lot ofyou.
Don't look at your own financesthat closely, I don't think,
until you're going through aprocess like that.
Blaise Delfino, M.S. - HIS (21:22):
So, yeah, Because we were touching a
little bit on going through aprocess like that.
So yeah, because we weretouching a little bit on fourth
years and coming out andstarting your own private
practice.
We didn't really talk aboutthis when we first connected
Lindsay, but you kind of justbrought it up to me.
You know student loan debt.
So it's like students whograduate with their AUD unless
they're in a position where youknow their family was able to
(21:44):
pay for it in full, and theycome 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 themthat loan when they have over
$100,000 in student loan debt?
I want to be realistic here.
Dr. Lindsey Koble, MBA (22:04):
In my head?
Probably not.
I mean the way the bank wantsto know that you own something
that is more valuable than theloan that they're giving you.
Yeah Well, in my case, theyknew that if I can't pay off
this loan, they took a lien onmy house, and so if you don't
(22:24):
have something like that thatthey're not going to give you
the loan, you have to own more Ithink probably most of the time
than this loan they're givingyou.
That way, they can come get itif you go bottom up on the loan,
and so you know people haveunique financial situations.
(22:44):
You may have a rich uncle who'swilling to support you in this
entrepreneurship journey, but Ithink from the manufacturer
support side, from a bank side,they're going to want to know
what you have if you're notsuccessful with this loan.
So I think that's so importantand super important to be
transparent about with thesestudents coming out who think
(23:06):
they want to own their ownbusiness.
It's hard when you're riddledwith student loan debt.
Blaise Delfino, M.S. - HI (23:11):
Don't put yourself in a financially
compromised situation.
Be patient.
Dr. Lindsey Koble, MBA (23:16):
Be patient and I think that was
something that I had a reallyhard time with After undergrad
at Purdue.
Many of my friends wereengineers, 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 graduateschool, they're all buying
(23:38):
houses, buying new cars, havingkids.
So I felt like I was alwayslike a little bit behind.
But what I would caution peopleto is my husband and I.
We live in a small town.
It is a super low cost ofliving.
Our house is still nothingfancy because we are trying to
set ourselves up for asuccessful long term.
(24:00):
And so I say all that because Ithink when students get out of
graduate school, their firstthought is I want to buy a car,
I want to move to downtownChicago and sometimes you have
to because that's where yourjob's at.
But if private practice is onyour mind, just think about your
decisions a little bit extra.
To think about how can I save alittle extra money to set
(24:24):
myself up for more of thislong-term goal?
And it's hard.
I totally get it that when youcome out of graduate school you
feel a little bit behind yourpeers, but it's worth it to
think twice and live a littlebit under your means for a while
.
Blaise Delfino, M.S. - HIS (24:38):
It's often said live like no one
else will, so you can live likeno one else can.
Dr. Lindsey Koble, MBA (24:44):
And it's hard.
Blaise Delfino, M.S. - HIS (24:46):
It is very hard, especially living
in the day and age we live intoday.
Dr. Lindsey Koble, MBA (24:50):
It's very realistic and things are so
expensive now compared to whenI did this eight years ago, and
I totally get it.
I live in the middle of nowheretoo.
That's super affordable.
So I can only say so much tofind an affordable place to live
.
But I think that set my husbandand I up for a successful
financial future.
Blaise Delfino, M.S. - HIS (25:09):
It's a marathon.
So when it came to planningprojections, rent equipment, how
did you figure out what wasrealistic, because obviously you
had deep rooted relationshipsin the industry.
How did that all work out?
Dr. Lindsey Koble, MBA (25:27):
I would say, really that came down to a
couple of really great friendswho are also audiologists,
really all over the country.
Like, as I'm saying this, I'mlike, yeah, they helped and they
helped.
I don't even want to say namesbecause there were so many
people who were superinfluential when I got started
and I just asked you know, whatequipment do you have?
What equipment do I need?
Do we need that $20,000 pieceof equipment or could I get by
(25:51):
with the $5,000 piece ofequipment?
And sometimes you just have tomake hard decisions of maybe I
can buy that in five years, butright now I just need to get the
hearing test done, and this onecan do a hearing test, so let's
go there.
So really it was asking foropinions on equipment and I had
been in enough offices, I hadseen what people have, what look
(26:12):
I wanted to go for as far asequipment, and then you just
start to kind of build yourcosts of what you think all that
equipment's going to cost.
And then when it came toprojections, it is so hard to
project right now in thisindustry, but I knew just
because of how many friends andfamily were asking me about can
I use my Medicare Advantage planwhen you open your practice.
(26:36):
I knew how much of that wasaround this area.
I don't think I quite knew howmuch, but I knew that it was
going to be a portion.
So when I was doing myprojections I was taking into
account those fitting fees, someprivate pay fitting fees and
then you just have to kind ofguess to get going.
And I started super low with myprojections.
(26:57):
I was only going to pay myself$50,000 a year to get going.
That was something else I wassuper committed to right off the
bat.
I had seen so many practiceowners who were like I haven't
paid myself in years and I'mlike I'm, you know, and it's
hard to say I'm just going tomake that work, but that was
important to me to figure out mycash flow, to be able to
(27:19):
sustain my own salary.
So, yeah, it was a lot ofsupport from mentors really to
know what you're doing.
Blaise Delfino, M.S. - HIS (27:28):
And success leaves clues right.
So I mean, even in all theseaudiology Facebook groups, we
learn so much from so many ofthem and the mentorship and not
being afraid to ask.
When it comes to overhead,lindsay, you and I both agree
that keeping that overhead lowis important, but also you were
(27:48):
very deliberate about hiringslowly.
How did you know when you wereready to add another team member
?
Dr. Lindsey Koble, MBA (27:57):
What did that?
Blaise Delfino, M.S. - (27:58):
process look like question.
Dr. Lindsey Koble, MBA (28:06):
Blaise, I always say this is Lindsay
math.
Somebody who's like an industryexpert probably has their
opinion of when is the timeright to hire.
But I knew from learning fromothers as a practice owner, when
you get so busy with theday-to-day clinical tasks that
you don't have any time to spendon marketing or moving the
business forward, something'sgot to give, you got to look at
(28:28):
what you're doing there, and sothat was part of it.
The other part of it was I knew, with how our months were going
, with how much money we weremaking each month, that if I
didn't, if I brought on a secondprovider and I didn't make an
extra dollar from theircontribution, that we just
stayed the same, that I couldafford to hire her with how much
(28:50):
money I was making myself eachmonth.
So I knew, even if we hire herand pay her salary, we're still
going to have some profit leftover, and that has been my
method for hiring both of them.
So I've hired two audiologistsand I hired a second front
office staff person.
And that's the way I look at itis if we the two of us keep
(29:14):
going at the rate that we'regoing and we don't make any
extra money by bringing thisthird provider on.
We can keep continuing and beprofitable.
Same with hiring the front deskstaff, and so of course that's
not how it goes.
When they come on, then we cansee more patients, they make
more money, and so I always takethe safe approach.
(29:37):
I'm always like looking atworst case scenario, but of
course I think you probably wantthem to at least double, triple
the amount that you're payingthem.
Is how I look at it.
Blaise Delfino, M.S. - HIS (29:50):
You have such an interesting story
because you've talked aboutgrowing up on a farm and I've
seen a lot of the posts onsocial media.
You talk about learning cashflow from your parents.
How has that influenced yourmindset as a business owner?
Dr. Lindsey Koble, MBA (30:06):
So I think my parents are super
interesting.
My mom has worked in IT for 40years.
My mom has been in the samecompany for 40 years, so she
always just had this steadyincome.
My whole life she had thissteady income.
Then my dad's a farmer.
Anyone who knows anything aboutfarming it's either raining and
they're mad, or it's dry andthey're mad.
The crops do good.
(30:27):
They're just always mad.
Yeah yeah, it's never right.
The weather and the crops arenever quite right, but so my
whole life I heard my parentstalked about their financial
situation in front of us becauseit was just farming carries so
many financial decisions as afamily.
That was the conversationhappening at the dinner table,
(30:47):
and so I think growing up Ialways understood that there are
good seasons and bad seasons tobusiness, and so when I opened
my own practice, I think alsothat gave me the you know I
don't know if it's confidence orthe comfort that there's going
to be good months and bad monthsand if you prepare accordingly,
(31:07):
the bad months are going tohurt a lot less because you've
prepared and sustained throughsome of the good months.
So I'm in Indiana.
You expect when winter hits wemight have some bad months or
cash flow might be kind of slowgoing through January, february.
Well, if you have a really goodfall and you don't spend all
(31:29):
your money, you don't thinkabout it, you just you're safe
in the background.
And so really I learned thatfrom farming.
You know farming.
You put a lot of money intoyour crops to plant them in the
spring.
Money then gets tight throughthe summer, then you harvest
your crops in the fall, and so Isee kind of that cycle of my
practice and I just I've learned, like I said, I think it's more
(31:52):
comfort than confidence, butjust to prepare and to save on
the back end.
Blaise Delfino, M.S. - H (31:58):
You're very intentional about managing
savings, you know money marketaccounts, building a safety net.
Why is that so important forprivate practice owners today?
Dr. Lindsey Koble, MBA (32:11):
Well, and I think I saw it through, a
really difficult time for manypractice owners was when COVID
hit.
So you know, kind of back tofarming.
The unexpected is bound tohappen at some point.
Blaise Delfino, M.S. - HI (32:26):
COVID was a winter in business.
Dr. Lindsey Koble, MBA (32:27):
Yeah, exactly.
And so I think, being a repduring that time, I saw how many
of the practice owners had tohandle their own financial
situations during that time andI told myself right off the bat,
the best thing I can do ismaybe to short myself in my
salary for a while for the sakeof building the business.
(32:49):
And so, like I said, when Istarted, I was only paying
myself $50,000 because moreimportant than what I was making
was that the business washealthy and that the savings
account was healthy.
So you read all sorts of thingsof how much do I need to have
in the savings account.
Usually they say like threetimes monthly expenses is the
(33:11):
safe route to go.
Again, I don't have perfect math.
I kind of have it in my mind ofwhat I want in my checking
account, what I want in mysavings 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 moneymarket account?
(33:33):
And that's decisions that I'velearned from my peers.
I've leaned into my accountantto 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 tohave a big lump of money sitting
in a savings account when mycashflow is working over here in
(33:54):
this account and I haven'ttouched this account for a year.
Let's move it somewhere whereit's gonna work.
Work for me.
Blaise Delfino, M.S. - HIS (34:00):
I remember to your point and I
love that you bring this up as aprivate practice owner when you
own your own clinic, keeping alump sum in a savings account is
really, in my professionalopinion, not the best thing to
do, because I remember it waslike year one or year two I went
to our financial advisor and Iwas like, hey, we have X amount
(34:22):
and only made X amount.
That's kind of not cool and Iwould advise and I'm sure you
would as well connect with a taxstrategist advisor your
attorneys maybe who are alsotrained in tax strategy, just to
ensure that what you're doingdoesn't have any penalties when
you take it out and things ofthat nature.
Dr. Lindsey Koble, MBA (34:42):
Yes, and I would say I think.
To that point, I would saydon't be afraid to ask the
questions.
Don't feel like you're not agreat business owner because you
need to ask your accountantabout tax savings or because you
go to your bank and youquestion should I have this
amount of money in my savingsaccount.
Ask the question.
They're going to offer youoptions to shift and you don't
(35:04):
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, tosupport your business.
Blaise Delfino, M.S. - (35:16):
Lindsay , I want to dive into
operational wisdom becauseobviously you encompass a lot of
this.
You take Medicaid, third partyVA contracts.
There are some schools ofthought that will say I'm only
private practice and if that'syour model and it's working for
you, fine.
We're not here to say okayalways better.
A lot of owners will shy awayfrom those.
(35:38):
Why was this choice importantfor you and your practice?
Dr. Lindsey Koble, MBA (35:45):
When I opened my private practice, I
opened it in the same countythat I was raised in, so
essentially it's my hometown.
There's like three small townswithin this county, so really
it's kind of a county whereeverybody knows everybody to a
certain degree and I just wantedto take care of people and
really I wanted to take care ofanybody who walked through the
(36:07):
door.
I wanted to be able to helpthem, which, as a practice owner
, is kind of a bold statement,because anybody who walks
through the door needs to beprofitable to a certain degree.
I have my hands in a lot ofthings and I'm not hanging my
hat on any one thing.
And the other thing I will sayis I am always analyzing, and so
(36:30):
at the end of 2024, I left oneof the managed care plans
because it didn't make sense forus anymore.
I left one of the managed careplans because it didn't make
sense for us anymore, and so ifyou're going to do all these
things, you have to see what'sworking, and year to year it
changes.
But at the end of the day, Ijust wanted to take care of
people and it's so fun havinghearing aids be affordable to
(36:55):
people.
But what I would also say iswe're not giving things away for
free.
We're not.
When people walk in here theydon'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, allfollow-up services that we do.
(37:18):
We have a charge set to thatand we're super transparent
about that upfront.
But the affordability of hearingaids through Medicaid or their
Medicare Advantage plan, theiremployer carried plan, makes
hearing aids affordable andattainable up front and so for
us that has worked in our favorbecause word of mouth has spread
(37:41):
super fast for us.
So you know, then you get intothe situation of now we're
getting busy, is busy,profitable, and so that's where
we're now kind of at thiscrossroads of.
We have three awesome providers.
Our schedules are constantlybooked.
(38:03):
So of course, 2025 to 2026, Iwill be making some decisions on
things, because you have to dowhat's best.
You can't just keep seeingpeople because that's the nice
thing to do.
You have to treat people to thetop of your ability and so you
can't just be busy and do thatwell.
Blaise Delfino, M.S. - HIS (38:24):
How do you balance profitability
with patient-centered care,especially with third party
payers?
Dr. Lindsey Koble, MBA (38:30):
We charge.
Like I said, we have to charge.
You have to charge for yourreal air measurement, your
communication needs assessment,all of your supplies.
You have to charge for yourreal air measurement, your
communication needs assessment,all of your supplies you have to
charge.
We don't shorten ourconsultation appointments, we
don't shorten our fittingappointments, but we I think
it's kind of a combination of weare in small town Indiana, my
(38:52):
rent is low, our cost of livingis low, so you, you know, maybe
my staff has paid a little lessthan somebody who lives in LA,
of course, but so our overhead,I think, is probably lower than
most probably one of the lowerin the country.
But the plans are all differentand so there are definitely some
plans where it's like makingthat little bit of money that we
(39:16):
make on that fitting fee is notprofitable, and so that's where
we have to start looking at istaking care of that patient
actually a detriment to ourpatient care over here?
And that's where I'm looking atgoing into 2026.
I think it's a balancing act,you know, and people, when
(39:36):
you're an audiologist, you justwant to take care of people and
people are so appreciative ofaffordability.
But affordability and keepingthe lights on, don't always go
hand in hand.
So yeah, you have to do whatmakes sense.
Blaise Delfino, M.S. - HIS (39:53):
And implementing service plans.
Lindsay, I will tell you fromour experience once we started
to do that and we kept it soreasonable.
But again, I want to keep thisaccessible to patients,
affordable to patients, but alsoI need to make sure that my
practice is profitable enough soit can continue to support the
(40:14):
community.
You need to be aware of what'sgoing on, you need to have a
pulse on your business.
But when you put patient carefirst, the Pareto principle is
absolutely happening in yourpractice, where 80% is coming
from 20%.
The word of mouth that's superexciting stuff.
Dr. Lindsey Koble, MBA (40:33):
Yeah, yeah, and that's what I remember
.
When I was first gettingstarted I actually met with a
community mentor who owns herown business nothing in the
medical field related, but shehad been her own business owner
for years and years and she saidI will tell you one thing If
you just take care of people,you will be successful.
That pops up in my head all thetime Just take care of people
(40:56):
and it will work.
And it does.
But to that point kind of whenyou're looking at how do you
manage these third parties andbe profitable and manage your
time, we are right in the mix oftrying to figure out how to
utilize audiology assistants inthe best way possible.
So Amanda, who's been with mesince the start, carries the
(41:19):
title of my office manager, butwe have since hired a second
patient care coordinator and sotwo days a week when that other
patient care coordinator isthere, amanda is now seeing some
of these hearing aid checkwalk-in type appointments.
That way it doesn't take timeaway from our providers who are
making doing revenue generatingappointments.
(41:40):
So we're kind of in this reallypivotal period of we're at the
2.5 year mark, so we reallyhaven't had anyone who has hit
their three year end of warrantyperiod yet and so we're trying
to show them that's hiding, it'ssuch a crazy period but we're
trying to show them.
We see them back, for usuallyit's like a four month and then
(42:02):
a six month and their annualvisit then six month and annual
again.
So we're really working hard toshow them how valuable our
services and how valuable we areas a partner and for longevity
of your hearing aids, howimportant that is.
And then I think, if we can doit correctly when their end of
warranty comes up, to offerservice plans and packages for
(42:25):
the end of warranty period, Ithink we're going to find that
may be a really pivotal thingfor our practice.
You know, currently we offersmall service plans at the end
of their one year service visit.
Most people actually in ourpractice choose to pay as they
go, which we offer small serviceplans at the end of their one
year service visit.
Most people actually in ourpractice choose to pay as they
go, which we have a charge for,an office visit charge.
(42:46):
But I think the end of warrantyvisit might work well for us.
Blaise Delfino, M.S. - HIS (42:48):
But I think so.
I mean I will from experience.
We implemented the end ofwarranty and I will say we
implemented the Dr Jill dollar aday.
Yeah, again, it might not befor every practice, but for
where we were demographically,lindsay, it worked incredibly
(43:09):
well.
There were months where 10, 11,12 patients enrolled yeah, and
that's net profit, which thenyou can put back into your
business.
You can continue to providebest patient care.
We are both on the samefrequency here in terms of
investing back into the businessand how important that is.
As a private practice owner,sometimes it can feel like
(43:31):
you're on an island, but you'veobviously built a great support
network your banker, accountant,fellow owners.
How has community helped youavoid feeling like you're on an
island?
Dr. Lindsey Koble, MBA (43:48):
I would say I do a couple different
things.
So I have we call ourselves theIndiana Masterminds, but
there's a group of I thinkthere's five of us in the group.
We're in a text message chainso we usually text every single
day about something and thenonce a month we meet on a Friday
morning and we just we kind ofgo around and each of us say
something that's on our mind, aquestion that we have, and we
kind of share what we're doing,what works.
(44:10):
So I think, just not notclosing yourself and feeling
like you're the only one goingthrough this, which I think is
what you know.
What I do online is I try to betransparent, to make people
feel like what you're goingthrough everyone else has
probably been through or is alsogoing through.
So I think you know, go to theconferences.
(44:31):
Since I was a student I've goneto AAA, ada you know Odd Boss
has such a great conference andso find your people and don't be
afraid to kind of reach out tothem and make a little network
to pass ideas back and forth to.
I think people think thatprivate practice and audiology
is so competitive, which some,you know it has been a little
(44:54):
bit, but if you find the rightpeople it's not.
Yeah, if you find the rightpeople, it's not, and so you
just have to be open to sharing.
I think the other side is whenyou know you're trying to
connect with a mentor orsomebody and it's really
one-sided of you're justgrilling their brain on their
information or to utilize theirpractices.
(45:16):
If you want kind of thisworking relationship, you have
to give a little too.
So I think be conscious of thatwhen 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 (45:30):
And when you are running a practice,
leaning into mentorship, asking, asking is free.
Lindsay, you've donated so muchof your time today.
I just have one more question,and this is a very important
question because this is hugeindustry news.
Here I mean seriously.
You are resident elect of theIndiana Audiology Coalition and
(45:53):
helped plan its first big event.
Tell me what drives yourpassion for advocacy and how can
other professionals getinvolved.
Dr. Lindsey Koble, MBA (46:02):
I think Erica Person who owns Flex
Audiology down in Lawrenceburg,indiana.
When Erica moved here fromMinnesota she used to practice
in Minnesota.
I remember she asked me doesIndiana have an audiology group
to be a part of?
And I was like no, not really.
We kind of had like a speechand hearing group, but we never
(46:24):
had our own audiology group.
They used to years ago and thenit kind of dissolved and so
really it was Erica's idea.
We kind of worked together.
We had a really great group ofinitial founders who most of us
were practice owners.
A couple audiologists who workfor manufacturers joined us and
(46:44):
kind of doing the legwork to getgoing.
But really it was just we hadthis idea and we had the passion
to do it.
Because Indiana is just so graywhich there's pros and cons to
having a state that doesn't havereally set in stone policies,
sure, but also it leaves a lotof room for encroachment of our
(47:09):
scope of practice.
And so we just knew that, asthings are evolving and changing
, we really need thisorganization, are evolving and
changing, we really need thisorganization.
And so it just took startingplanning a really great first
conference where we had such anawesome turnout of audiologists
from all over the statehospitals, ents, a couple from
(47:30):
university, we had really greatpresenters and just to bring
together the state of Indianaand to fuel that camaraderie
that we really need just whensomething comes up unexpected,
we now have this foundation tomove forward, to support our but
now we have this corefoundation together to move
(48:00):
forward year to year.
And so when Erica was startingit, it just made sense for me to
be president elect to kind ofgo down this road with her and
then next year as president.
You know we're just we havesuch a great group that we know
kind of the the board that wehave right now is going to be
the same board that we had lastyear.
We need to get our legs underus to get going for a couple of
(48:22):
years, and then I just thinkwe're in a really good place.
Blaise Delfino, M.S. - HI (48:26):
Thank you so much for your advocacy
efforts and Dr Person and it'ssuper exciting.
I mean, when I saw thisannouncement online, I was like,
oh my, this is incredible.
Dr. Lindsey Koble, MBA (48:36):
Yeah, something we've never had, we
really needed, and now we justhave the chance to get involved
with ADA, aaa, asha.
When they have things that comeout, we can speak to our
Indiana audiologists and kind ofcome together as a group to
decide how we want to handlethat in our own state and we're
in a fun spot to really progressaudiology in Indiana.
Blaise Delfino, M.S. - (48:58):
Lindsay , thank you so much for joining
us on the Hearing Matterspodcast.
If you could leave ourlisteners with one thing today,
one golden nugget, what wouldthat be?
Dr. Lindsey Koble, MBA (49:08):
One golden nugget.
I would probably tell them tochase your dreams, which sounds
so cliche, but I would say ifyou are passionate about
anything in this industry, gofor it, whether that's being the
president of your stateorganization, whether that's
working for a manufacturer,being the director of a hospital
, a Mayo Clinic type office.
(49:29):
Do all of the right things andnever quit chasing your dreams,
because you will attain them oneday if you never give up.
Blaise Delfino, M.S. - H (49:37):
You're tuned in to the Hearing Matters
podcast.
I'm your host, blaise Delfino,and today we spoke with Dr
Lindsey Koble from AudiologyAlways, auburn, indiana.
Keep hearing and listening,well, and until next time, hear
life's story.
Thank you to our partners.
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Welcome back to another episodeof the Hearing Matters Podcast.
I'm founder and host, BlaiseDelfino, and, as a friendly
reminder, this podcast isseparate from my work at Starkey
.
You're tuned in to the HearingMatters Podcast, the show that
(00:59):
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 AudiologyAlways.
A little bit about her clinic.
It's a private audiology cliniclocated in Auburn, indiana.
(01:20):
The clinic is owned andoperated by Garrett native and
resident and our guest, Dr.
Lindsay Koble.
She grew up on a family farmwest of Garrett, indiana.
Although she went away foreight years of education, she
knew DeKalb County would alwaysbe home.
In 2017, she married a lifelongfriend, Trace Koble, and they
(01:46):
planted their roots right acrossthe road from her family farm.
That is awesome.
Her passion for openingaudiology always is to provide
her hometown and nearbycommunities with the most
comprehensive and here's thekeyword transparent hearing
healthcare.
Dr Koble, welcome to theHearing Matters podcast.
Dr. Lindsey Koble, MBA (02:08):
Thanks, Blaise.
What an introduction.
Thanks for having me Excited tohave a conversation.
Blaise Delfino, M.S. - HIS (02:20):
So, lindsay, we have so much to
unpack today.
First and foremost, thank youfor everything that you've done
and continue to do for HearingHealthcare.
Really, it's so inspiring yoursocial media presence and what
you're doing, the storytelling,getting connected with
professionals oh my gosh,incredible.
Dr. Lindsey Koble, MBA (02:36):
Thanks, blaze.
I feel like I have evolvedthrough the social media world.
You know it really.
Social media was out when I wasat high school.
So you know when I was at highschool.
So you know when I was playinghigh school sports and sports
stories coming out and thenthrough college, you deal with
all the college nonsense andworking through social media.
So social media has been partof my life.
Really.
(02:56):
I'm the generation that socialmedia has been part of our life,
our whole life, and so whenpeople say you do so well at
sharing on social media, I'venever known any different and I
think transparency is just kindof who I am and I realize that
people are looking for a voiceto trust and to feel connected
to.
So it's kind of where I findmyself.
Blaise Delfino, M.S. - H (03:16):
Listen social media.
You've got that down to a T.
It's something you grew up inAudiology.
How the heck did you getconnected to audiology?
And I always love to hearorigin stories of how did you
get into audiology.
How did you get into hearinghealthcare?
Dr. Lindsey Koble, MBA (03:34):
I kind of had a bizarre start.
I had a very interesting waythat I found the audiology world
.
So in high school I did thisprogram called Health Occupation
Education.
So in high school I did thisprogram called Health Occupation
Education.
In that program we spent halfof the day our senior year going
to different health care fields.
So we got to shadow a surgeon,a dentist, a physical therapist,
(03:56):
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 medicalfield.
But I haven't quite found mysubject yet that I really love.
So I went to Purdue juststudying general health sciences
, thinking I'm going to figurethis out, thinking maybe
pharmacy, maybe physical therapy.
(04:17):
I played a lot of sports growingup and then I had to have jaw
surgery.
Christmas break of my freshmanyear had to have jaw surgery.
Christmas break of my freshmanyear the surgeon accidentally
poked a hole through my eardrumdoing the TMJ surgery.
So it's like this one in amillion thing you sign off on.
But the hole has healed, I'mall as well.
It took about six months for thehole to heal but in the process
(04:39):
I had to see an audiologist todo a baseline audiogram to see.
You know, here's yourconductive loss.
Now we're getting better.
We're getting better and Iremember 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 anaudiologist.
So I went back to Purdue and Iasked my advisor do you guys
have audiology?
(05:00):
She was like we do.
So I was one of the rare onesthat was in this big speech and
hearing science group and I waslike one of few who knew that I
was going to go to the audiologytrack from the start.
So yeah, kind of crazy story,but an unfortunate event that
was perfect.
Blaise Delfino, M.S. - HIS (05:20):
And I feel like those events are
supposed to happen and I know,you know, we've recorded a
couple episodes today and I liketo know everyone's origin story
, because I'm geneticallypredisposed.
I mean, I had no choice.
Dr. Lindsey Koble, MBA (05:32):
My father's an audiologist.
Blaise Delfino, M.S. - HIS (05:35):
My father's a hearing instrument
specialist.
So, like I knew and it's likenow 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 hadthe tympanic membrane perf, what
was that like going from normalhearing to now?
Oh, I have some hearing lossnow.
Dr. Lindsey Koble, MBA (05:57):
Well, and it was a really kind of
scary time because TMJ surgery Ihad it done on both sides of my
jaw and so the expectations ofwhat comes out of that was what
our primary focus was on.
But then it quickly shifted tothis hole in my eardrum and I
feel like I can't hear and Ifelt so I had like equilibrium
(06:18):
issues.
My balance was a little off,which, like when patients
mentioned that, it's like I canrelate because I had that happen
.
So I think it was that, mixedwith meeting that audiologist
who seemed so happy and she wasso nice Every time I saw her
mixed with like the technologyside in the science side that I
(06:39):
knew I always liked, and thenthrowing in like the humanistic
connection approach, it was justa lot of things that, like my
stars finally aligned in themedical field and I love it.
Blaise Delfino, M.S. - (06:50):
Lindsay , I've obviously been following
your story for quite some timenow your journey.
So, doctor of audiology, yougraduate, you start working out
in an ENT clinic ear, nose andthroat and then later with a
hearing aid manufacturer.
I've got to know how did thoseearly career experiences really
(07:12):
shape you personally andprofessionally and then prepare
you to own your own practice?
Dr. Lindsey Koble, MBA (07:18):
Mm-hmm, such a good question.
And I think my journey is whyI'm where I am and why I have
the confidence to make theselike quick business decisions,
because I have such that vastexperience.
So when I was doing my fourthyear it's such an important time
in a student's life I was thestudent.
(07:39):
I always told people I want toown my own practice someday.
Even in grad school I kind ofknew that.
But my preceptors were reallypushing me to not go to a
private practice in my fourthyear.
Their perception was that thenyou settle and you don't get the
broad clinical experience thatyou can get in your fourth year,
which I have opinions on that.
(08:00):
There's pros and cons.
I don't know that.
I totally agree.
But so I was looking at ear,nose and throat opportunities
for my fourth year.
So I was either going to goreally far from home or I was
going to come close to home.
While I settled on coming closeto home, I had a long term
boyfriend at the time who's nowmy husband, so that all worked
out as planned.
(08:20):
Then I really enjoyed thatspace.
It's a huge ENT clinic here inNorthern Indiana so we saw kids
to adults.
They did cochlear implants,abrs, balance testing.
So I stayed on there for aboutthree years and I think that's
where I got my confidenceclinically.
So you see, really hard hearingtests, like masking, is like
(08:44):
bring it on.
But you just get real confidentin that space with all ages.
You have to communicate withfront office staff, nursing
staff, ent, physicians and becomfortable with kind of that
atmosphere.
That was my core foundation.
Then I knew I loved marketingand I knew I loved working with
(09:08):
people and leading people and sothat was kind of what took me
to step into the sales rep rolewith a hearing aid manufacturer.
So then that role you don'tknow when you're ready for a
role like that.
I think everyone feels like amI qualified?
I was young, like honestly, Iwas young, I had no sales
(09:32):
experience, I was an audiologist, but I knew I liked marketing,
I knew I was organized, I wasdriven, I could work with people
and so I learned the sales side.
They taught it to me.
I had like some innatecharacteristics to do that role
and then they taught me thesales side.
I pursued my MBA.
So I think I learned even moreabout the business side and that
was honestly driven by my bossat the time.
(09:53):
I wanted to grow and I kind ofhad my sights set to grow within
the company.
And he said you know, go getyour MBA, pursue something
better, never like settle forwhere you're at.
So I did that and then I havementorship like that.
Blaise Delfino, M.S. - HIS (10:09):
Oh, he was so I know.
Dr. Lindsey Koble, MBA (10:11):
I know Brian Pecca.
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 andyou're doing all these things,
but don't just be great when youcan 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 atthis, but you can still be
(10:31):
better at this, and so, like,next year, go get it.
And I never took it likepersonally.
It wasn't like he was likeyou're not following through
here.
It was more of like he's like atough coach where it's like,
you know, when your coach isn'tcritiquing you, you've kind of
fallen off the radar.
And so I owe so much of my just, I think, pursuing this field
(10:52):
and shooting for the stars inthis field to his trust in me.
Blaise Delfino, M.S. - HIS (10:55):
And sometimes you have to believe in
someone else's belief in youbefore you believe in yourself
and that accountability and thatmentorship.
You believe in yourself andthat accountability and that
mentorship.
I'm really happy you bring thatup, lindsay, because again you
know, when you invest inyourself as a professional and
as a person, that is going totrickle down then to your
patient care for sure.
Dr. Lindsey Koble, MBA (11:16):
Yes, yes , I think so.
And then I mean once I pursuedmy MBA I had a daughter.
So it was like COVID hit, I wasgetting 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 sayeverything changes when you have
kids and I'm like, no, I'm justgonna be in this.
You know, I love themanufacturing side, I'm just
(11:40):
going to be here forever.
And then once I had my daughterand my territory was the whole
state.
So I was driving a lot.
I live way up in the corner ofIndiana, so I would wake up at
like 5 am, get down toIndianapolis for an 8 am
appointment, see three differentaccounts and then be home by
dinnertime.
And then my husband alsotravels for work.
(12:01):
So we were kind of on this likeone 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 likeif this is your career, go for
it.
But always in the back of myhead I kind of had this thought
of when is the perfect time toopen your own practice, and it
was really kind of like thestars just aligned, and I didn't
(12:24):
think it through a whole lot.
I really came home one day andtold my husband I'm like I think
now is the time to open my ownpractice, and it was.
He was like, okay, what do wedo first?
And it was a couple of dayslater when I told Brian Pekka,
I've made the decision that I'mgoing to open my own practice
and the support that I received.
I am forever thankful for thattoo.
So, yeah, it's just like goodpeople supporting good people
(12:44):
and taking a path and the starskind of aligned.
And it was all meant to bereally.
Blaise Delfino, M.S. - HIS (12:51):
So much to unpack there.
But when a couple yeah, likeprobably two and a half years
ago, when audiology always wasfounded you had shared your
story in a post of sort of thejourney that you've taken, after
grad school I went right intoprivate practice and while it
(13:12):
was a family practice, the modelLindsay was so different and we
had expanded, we opened updifferent locations.
But looking back now I'm likewow, that was really hard.
And I'm like, well, everyone'sjourney is different.
You are where you are supposedto be right now, but I could see
how you know ENT and thenworking a manufacturer and then
going into private practice.
(13:32):
That absolutely catapulted you.
That was part of the plan, thatwas part of your journey.
But building a private practicefrom scratch, a private
practice from scratch that is noeasy feat.
What really made you of courseyou know being there for your
(13:55):
daughter and your family soimportant?
What was that inside of youthat said you know what?
Now's the time to take thisleap.
Dr. Lindsey Koble, MBA (13:59):
I think it was.
Really you have to get to apoint of confidence.
And so I always, like I said,it was always in the back of my
head that I knew that wassomething that I wanted to do.
But I always felt like, am Iquite ready for that?
Kind of like when I went fromclinic to being a rep, am I
prepared for this?
Am I qualified for this?
(14:19):
And then, after the few years ofbeing a rep, of being a rep, my
confidence in myself grew and Irecognized when I was a rep,
you talk to so many businessowners 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
(14:41):
my own practice?
You're never really ready, butif you're confident enough to
bet on yourself, that's when itwas time and like something hit
me.
I was literally doing a threehour 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 roadwhen I could be home doing this
for myself?
And it was like if you're goingto do this for yourself, you
(15:04):
have to place a bet on yourselfand just go head first and
something.
That day must've been a sunnyday and it just came home,
walked in the front door andtold my husband let's do it.
So yeah, you're never reallyready.
Blaise Delfino, M.S. - (15:18):
Lindsay , when you were a fourth year
student, it was advised go tothe medical setting.
Maybe do something other thangoing into the private practice
setting just to kind of expandyour scope and understanding.
But if you were advisingstudents about to enter their
fourth year, what do you thinkthey should know about the real
(15:40):
challenges of private practice?
Dr. Lindsey Koble, MBA (15:44):
When you're entering your fourth year
.
I think there is a side toconsider of improving your
clinical skills.
That's something to be said.
But if you're interested inopening your own practice, the
skills to be successful are notfitting a hearing aid.
It's not doing a hearing test.
(16:06):
Most audiologists can do that.
The hard parts to practiceownership are managing cash flow
, setting your pricing, managingyour 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?
(16:27):
What equipment to buy?
When to buy equipment?
When to hire?
Those are the things that arenot taught in most programs.
I think some programs arestarting to get better, but a
lot of those things still can'tbe taught from a PowerPoint
presentation or from a textbook.
The only way to get better atthat is either to work in a
private practice and see ithappen day to day, have a really
great mentor who's willing tohelp you understand those things
(16:50):
, or to try to learn it on yourown.
Blaise Delfino, M.S. - HIS (16:52):
I guess Financial literacy so
important.
Thank you so much for bringingthis up, because I really do
want to dive into financing andplanning.
But what gets measured getsmanaged.
And how important in privatepractice to understand what your
key performance indicators arelike help rate, companion rate,
(17:14):
average selling price.
Dr. Lindsey Koble, MBA (17:15):
It's like a three-legged stool.
That's what I was going to sayAverage selling price, so
important.
Blaise Delfino, M.S. - HIS (17:18):
And so why is average selling price
so important, as it relates tocash flow?
Dr. Lindsey Koble, MBA (17:24):
Well, I think for us there's no secret.
We do do managed care, so ouraverage selling price is not
$2,000 or whatever that ASP isset at.
Our ASP is considerably lowerbecause of those managed care
reimbursements and so when youdo accept managed care you have
to make sure you're profitableand oftentimes those of us
(17:46):
successful taking managed careare charging in other ways for
real ear measurement,communication, needs assessment.
So average selling price haslost a little bit of its ground.
In my office it's more ofrevenue per hour is more.
Are we looking at revenue perday, revenue per week?
I kind of have it broken downthat way because we're a little
(18:08):
different.
From making most of our moneyoff hearing aids, we do make
considerable portion off ofservices and managed care.
Blaise Delfino, M.S. - HIS (18:15):
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 (18:26):
you when you're wanting to open a
practice.
There really are a lot ofavenues to small business
ownership.
You have, like, the smallbusiness administration that you
can look at.
Are there any options there?
Some local governments supportnew businesses in their area.
For me, I went to the bank, to alocal bank, and I think what I
(18:49):
learned through that process is,when you're getting a loan from
a bank, they want to knoweverything about your financial
situation.
So they want to know do you owna house?
Do you own a car?
Tell me about your student loandebt, Tell me about your, do
you have credit card debt?
How much do you owe on thatother property you have, or
(19:11):
whatever.
They get to the bottom of yourfinancial situation.
And then we took out $150,000loan.
We had to put in 15,000 of ourown 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 toeven start the process.
(19:36):
So really to me that just showsme the importance of paying off
your debt, owning things andhaving good credit.
You know, unfortunately peoplehave their opinions about credit
, but having good credit helpedus and then having that money
set aside, prepared to open thepractice, we had to have it.
So I think there are thesethings.
(19:58):
You can't just say I want toopen a practice.
There's some financial inputthat goes into it too.
Blaise Delfino, M.S. - HI (20:04):
Going through that process together.
Again, what gets measured, getsmanaged.
So, as you're going throughthis 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 thatprocess correct?
Dr. Lindsey Koble, MBA (20:19):
Yes and, like the other side is you need
this money, you know you needthis money.
The bank needs to know why doyou need this money and know you
need this money.
The bank needs to know why doyou need this money, and so the
bank wants to know what are yougoing to buy with this money.
How much does each thing cost?
And they are going toscrutinize it.
If the bank's giving you money,they're going to make sure that
(20:40):
your numbers are accurate andthat they make sense.
And then they want to knowprojections that your numbers
are accurate and that they makesense.
And then they want to knowprojections.
The bank doesn't know how muchmoney an audiology clinic makes,
so they wanted three-yearprojections for expectations of
profitability, to know that theywere going to get their money
back.
And so it was an activity we'llcall it really to dive through
(21:02):
these numbers to understand whywe're asking for this money, how
we're going to pay back thismoney, to get the bank to agree
that we deserve the money.
You know it was just a lot ofyou.
Don't look at your own financesthat closely, I don't think,
until you're going through aprocess like that.
Blaise Delfino, M.S. - HIS (21:22):
So, yeah, Because we were touching a
little bit on going through aprocess like that.
So yeah, because we weretouching a little bit on fourth
years and coming out andstarting your own private
practice.
We didn't really talk aboutthis when we first connected
Lindsay, but you kind of justbrought it up to me.
You know student loan debt.
So it's like students whograduate with their AUD unless
they're in a position where youknow their family was able to
(21:44):
pay for it in full, and theycome 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 themthat loan when they have over
$100,000 in student loan debt?
I want to be realistic here.
Dr. Lindsey Koble, MBA (22:04):
In my head?
Probably not.
I mean the way the bank wantsto know that you own something
that is more valuable than theloan that they're giving you.
Yeah Well, in my case, theyknew that if I can't pay off
this loan, they took a lien onmy house, and so if you don't
(22:24):
have something like that thatthey're not going to give you
the loan, you have to own more Ithink probably most of the time
than this loan they're givingyou.
That way, they can come get itif you go bottom up on the loan,
and so you know people haveunique financial situations.
(22:44):
You may have a rich uncle who'swilling to support you in this
entrepreneurship journey, but Ithink from the manufacturer
support side, from a bank side,they're going to want to know
what you have if you're notsuccessful with this loan.
So I think that's so importantand super important to be
transparent about with thesestudents coming out who think
(23:06):
they want to own their ownbusiness.
It's hard when you're riddledwith student loan debt.
Blaise Delfino, M.S. - HI (23:11):
Don't put yourself in a financially
compromised situation.
Be patient.
Dr. Lindsey Koble, MBA (23:16):
Be patient and I think that was
something that I had a reallyhard time with After undergrad
at Purdue.
Many of my friends wereengineers, 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 graduateschool, they're all buying
(23:38):
houses, buying new cars, havingkids.
So I felt like I was alwayslike a little bit behind.
But what I would caution peopleto is my husband and I.
We live in a small town.
It is a super low cost ofliving.
Our house is still nothingfancy because we are trying to
set ourselves up for asuccessful long term.
(24:00):
And so I say all that because Ithink when students get out of
graduate school, their firstthought is I want to buy a car,
I want to move to downtownChicago and sometimes you have
to because that's where yourjob's at.
But if private practice is onyour mind, just think about your
decisions a little bit extra.
To think about how can I save alittle extra money to set
(24:24):
myself up for more of thislong-term goal?
And it's hard.
I totally get it that when youcome out of graduate school you
feel a little bit behind yourpeers, but it's worth it to
think twice and live a littlebit under your means for a while
.
Blaise Delfino, M.S. - HIS (24:38):
It's often said live like no one
else will, so you can live likeno one else can.
Dr. Lindsey Koble, MBA (24:44):
And it's hard.
Blaise Delfino, M.S. - HIS (24:46):
It is very hard, especially living
in the day and age we live intoday.
Dr. Lindsey Koble, MBA (24:50):
It's very realistic and things are so
expensive now compared to whenI did this eight years ago, and
I totally get it.
I live in the middle of nowheretoo.
That's super affordable.
So I can only say so much tofind an affordable place to live
.
But I think that set my husbandand I up for a successful
financial future.
Blaise Delfino, M.S. - HIS (25:09):
It's a marathon.
So when it came to planningprojections, rent equipment, how
did you figure out what wasrealistic, because obviously you
had deep rooted relationshipsin the industry.
How did that all work out?
Dr. Lindsey Koble, MBA (25:27):
I would say, really that came down to a
couple of really great friendswho are also audiologists,
really all over the country.
Like, as I'm saying this, I'mlike, yeah, they helped and they
helped.
I don't even want to say namesbecause there were so many
people who were superinfluential when I got started
and I just asked you know, whatequipment do you have?
What equipment do I need?
Do we need that $20,000 pieceof equipment or could I get by
(25:51):
with the $5,000 piece ofequipment?
And sometimes you just have tomake hard decisions of maybe I
can buy that in five years, butright now I just need to get the
hearing test done, and this onecan do a hearing test, so let's
go there.
So really it was asking foropinions on equipment and I had
been in enough offices, I hadseen what people have, what look
(26:12):
I wanted to go for as far asequipment, and then you just
start to kind of build yourcosts of what you think all that
equipment's going to cost.
And then when it came toprojections, it is so hard to
project right now in thisindustry, but I knew just
because of how many friends andfamily were asking me about can
I use my Medicare Advantage planwhen you open your practice.
(26:36):
I knew how much of that wasaround this area.
I don't think I quite knew howmuch, but I knew that it was
going to be a portion.
So when I was doing myprojections I was taking into
account those fitting fees, someprivate pay fitting fees and
then you just have to kind ofguess to get going.
And I started super low with myprojections.
(26:57):
I was only going to pay myself$50,000 a year to get going.
That was something else I wassuper committed to right off the
bat.
I had seen so many practiceowners who were like I haven't
paid myself in years and I'mlike I'm, you know, and it's
hard to say I'm just going tomake that work, but that was
important to me to figure out mycash flow, to be able to
(27:19):
sustain my own salary.
So, yeah, it was a lot ofsupport from mentors really to
know what you're doing.
Blaise Delfino, M.S. - HIS (27:28):
And success leaves clues right.
So I mean, even in all theseaudiology Facebook groups, we
learn so much from so many ofthem and the mentorship and not
being afraid to ask.
When it comes to overhead,lindsay, you and I both agree
that keeping that overhead lowis important, but also you were
(27:48):
very deliberate about hiringslowly.
How did you know when you wereready to add another team member
?
Dr. Lindsey Koble, MBA (27:57):
What did that?
Blaise Delfino, M.S. - (27:58):
process look like question.
Dr. Lindsey Koble, MBA (28:06):
Blaise, I always say this is Lindsay
math.
Somebody who's like an industryexpert probably has their
opinion of when is the timeright to hire.
But I knew from learning fromothers as a practice owner, when
you get so busy with theday-to-day clinical tasks that
you don't have any time to spendon marketing or moving the
business forward, something'sgot to give, you got to look at
(28:28):
what you're doing there, and sothat was part of it.
The other part of it was I knew, with how our months were going
, with how much money we weremaking each month, that if I
didn't, if I brought on a secondprovider and I didn't make an
extra dollar from theircontribution, that we just
stayed the same, that I couldafford to hire her with how much
(28:50):
money I was making myself eachmonth.
So I knew, even if we hire herand pay her salary, we're still
going to have some profit leftover, and that has been my
method for hiring both of them.
So I've hired two audiologistsand I hired a second front
office staff person.
And that's the way I look at itis if we the two of us keep
(29:14):
going at the rate that we'regoing and we don't make any
extra money by bringing thisthird provider on.
We can keep continuing and beprofitable.
Same with hiring the front deskstaff, and so of course that's
not how it goes.
When they come on, then we cansee more patients, they make
more money, and so I always takethe safe approach.
(29:37):
I'm always like looking atworst case scenario, but of
course I think you probably wantthem to at least double, triple
the amount that you're payingthem.
Is how I look at it.
Blaise Delfino, M.S. - HIS (29:50):
You have such an interesting story
because you've talked aboutgrowing up on a farm and I've
seen a lot of the posts onsocial media.
You talk about learning cashflow from your parents.
How has that influenced yourmindset as a business owner?
Dr. Lindsey Koble, MBA (30:06):
So I think my parents are super
interesting.
My mom has worked in IT for 40years.
My mom has been in the samecompany for 40 years, so she
always just had this steadyincome.
My whole life she had thissteady income.
Then my dad's a farmer.
Anyone who knows anything aboutfarming it's either raining and
they're mad, or it's dry andthey're mad.
The crops do good.
(30:27):
They're just always mad.
Yeah yeah, it's never right.
The weather and the crops arenever quite right, but so my
whole life I heard my parentstalked about their financial
situation in front of us becauseit was just farming carries so
many financial decisions as afamily.
That was the conversationhappening at the dinner table,
(30:47):
and so I think growing up Ialways understood that there are
good seasons and bad seasons tobusiness, and so when I opened
my own practice, I think alsothat gave me the you know I
don't know if it's confidence orthe comfort that there's going
to be good months and bad monthsand if you prepare accordingly,
(31:07):
the bad months are going tohurt a lot less because you've
prepared and sustained throughsome of the good months.
So I'm in Indiana.
You expect when winter hits wemight have some bad months or
cash flow might be kind of slowgoing through January, february.
Well, if you have a really goodfall and you don't spend all
(31:29):
your money, you don't thinkabout it, you just you're safe
in the background.
And so really I learned thatfrom farming.
You know farming.
You put a lot of money intoyour crops to plant them in the
spring.
Money then gets tight throughthe summer, then you harvest
your crops in the fall, and so Isee kind of that cycle of my
practice and I just I've learned, like I said, I think it's more
(31:52):
comfort than confidence, butjust to prepare and to save on
the back end.
Blaise Delfino, M.S. - H (31:58):
You're very intentional about managing
savings, you know money marketaccounts, building a safety net.
Why is that so important forprivate practice owners today?
Dr. Lindsey Koble, MBA (32:11):
Well, and I think I saw it through, a
really difficult time for manypractice owners was when COVID
hit.
So you know, kind of back tofarming.
The unexpected is bound tohappen at some point.
Blaise Delfino, M.S. - HI (32:26):
COVID was a winter in business.
Dr. Lindsey Koble, MBA (32:27):
Yeah, exactly.
And so I think, being a repduring that time, I saw how many
of the practice owners had tohandle their own financial
situations during that time andI told myself right off the bat,
the best thing I can do ismaybe to short myself in my
salary for a while for the sakeof building the business.
(32:49):
And so, like I said, when Istarted, I was only paying
myself $50,000 because moreimportant than what I was making
was that the business washealthy and that the savings
account was healthy.
So you read all sorts of thingsof how much do I need to have
in the savings account.
Usually they say like threetimes monthly expenses is the
(33:11):
safe route to go.
Again, I don't have perfect math.
I kind of have it in my mind ofwhat I want in my checking
account, what I want in mysavings 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 moneymarket account?
(33:33):
And that's decisions that I'velearned from my peers.
I've leaned into my accountantto 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 tohave a big lump of money sitting
in a savings account when mycashflow is working over here in
(33:54):
this account and I haven'ttouched this account for a year.
Let's move it somewhere whereit's gonna work.
Work for me.
Blaise Delfino, M.S. - HIS (34:00):
I remember to your point and I
love that you bring this up as aprivate practice owner when you
own your own clinic, keeping alump sum in a savings account is
really, in my professionalopinion, not the best thing to
do, because I remember it waslike year one or year two I went
to our financial advisor and Iwas like, hey, we have X amount
(34:22):
and only made X amount.
That's kind of not cool and Iwould advise and I'm sure you
would as well connect with a taxstrategist advisor your
attorneys maybe who are alsotrained in tax strategy, just to
ensure that what you're doingdoesn't have any penalties when
you take it out and things ofthat nature.
Dr. Lindsey Koble, MBA (34:42):
Yes, and I would say I think.
To that point, I would saydon't be afraid to ask the
questions.
Don't feel like you're not agreat business owner because you
need to ask your accountantabout tax savings or because you
go to your bank and youquestion should I have this
amount of money in my savingsaccount.
Ask the question.
They're going to offer youoptions to shift and you don't
(35:04):
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, tosupport your business.
Blaise Delfino, M.S. - (35:16):
Lindsay , I want to dive into
operational wisdom becauseobviously you encompass a lot of
this.
You take Medicaid, third partyVA contracts.
There are some schools ofthought that will say I'm only
private practice and if that'syour model and it's working for
you, fine.
We're not here to say okayalways better.
A lot of owners will shy awayfrom those.
(35:38):
Why was this choice importantfor you and your practice?
Dr. Lindsey Koble, MBA (35:45):
When I opened my private practice, I
opened it in the same countythat I was raised in, so
essentially it's my hometown.
There's like three small townswithin this county, so really
it's kind of a county whereeverybody knows everybody to a
certain degree and I just wantedto take care of people and
really I wanted to take care ofanybody who walked through the
(36:07):
door.
I wanted to be able to helpthem, which, as a practice owner
, is kind of a bold statement,because anybody who walks
through the door needs to beprofitable to a certain degree.
I have my hands in a lot ofthings and I'm not hanging my
hat on any one thing.
And the other thing I will sayis I am always analyzing, and so
(36:30):
at the end of 2024, I left oneof the managed care plans
because it didn't make sense forus anymore.
I left one of the managed careplans because it didn't make
sense for us anymore, and so ifyou're going to do all these
things, you have to see what'sworking, and year to year it
changes.
But at the end of the day, Ijust wanted to take care of
people and it's so fun havinghearing aids be affordable to
(36:55):
people.
But what I would also say iswe're not giving things away for
free.
We're not.
When people walk in here theydon'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, allfollow-up services that we do.
(37:18):
We have a charge set to thatand we're super transparent
about that upfront.
But the affordability of hearingaids through Medicaid or their
Medicare Advantage plan, theiremployer carried plan, makes
hearing aids affordable andattainable up front and so for
us that has worked in our favorbecause word of mouth has spread
(37:41):
super fast for us.
So you know, then you get intothe situation of now we're
getting busy, is busy,profitable, and so that's where
we're now kind of at thiscrossroads of.
We have three awesome providers.
Our schedules are constantlybooked.
(38:03):
So of course, 2025 to 2026, Iwill be making some decisions on
things, because you have to dowhat's best.
You can't just keep seeingpeople because that's the nice
thing to do.
You have to treat people to thetop of your ability and so you
can't just be busy and do thatwell.
Blaise Delfino, M.S. - HIS (38:24):
How do you balance profitability
with patient-centered care,especially with third party
payers?
Dr. Lindsey Koble, MBA (38:30):
We charge.
Like I said, we have to charge.
You have to charge for yourreal air measurement, your
communication needs assessment,all of your supplies.
You have to charge for yourreal air measurement, your
communication needs assessment,all of your supplies you have to
charge.
We don't shorten ourconsultation appointments, we
don't shorten our fittingappointments, but we I think
it's kind of a combination of weare in small town Indiana, my
(38:52):
rent is low, our cost of livingis low, so you, you know, maybe
my staff has paid a little lessthan somebody who lives in LA,
of course, but so our overhead,I think, is probably lower than
most probably one of the lowerin the country.
But the plans are all differentand so there are definitely some
plans where it's like makingthat little bit of money that we
(39:16):
make on that fitting fee is notprofitable, and so that's where
we have to start looking at istaking care of that patient
actually a detriment to ourpatient care over here?
And that's where I'm looking atgoing into 2026.
I think it's a balancing act,you know, and people, when
(39:36):
you're an audiologist, you justwant to take care of people and
people are so appreciative ofaffordability.
But affordability and keepingthe lights on, don't always go
hand in hand.
So yeah, you have to do whatmakes sense.
Blaise Delfino, M.S. - HIS (39:53):
And implementing service plans.
Lindsay, I will tell you fromour experience once we started
to do that and we kept it soreasonable.
But again, I want to keep thisaccessible to patients,
affordable to patients, but alsoI need to make sure that my
practice is profitable enough soit can continue to support the
(40:14):
community.
You need to be aware of what'sgoing on, you need to have a
pulse on your business.
But when you put patient carefirst, the Pareto principle is
absolutely happening in yourpractice, where 80% is coming
from 20%.
The word of mouth that's superexciting stuff.
Dr. Lindsey Koble, MBA (40:33):
Yeah, yeah, and that's what I remember
.
When I was first gettingstarted I actually met with a
community mentor who owns herown business nothing in the
medical field related, but shehad been her own business owner
for years and years and she saidI will tell you one thing If
you just take care of people,you will be successful.
That pops up in my head all thetime Just take care of people
(40:56):
and it will work.
And it does.
But to that point kind of whenyou're looking at how do you
manage these third parties andbe profitable and manage your
time, we are right in the mix oftrying to figure out how to
utilize audiology assistants inthe best way possible.
So Amanda, who's been with mesince the start, carries the
(41:19):
title of my office manager, butwe have since hired a second
patient care coordinator and sotwo days a week when that other
patient care coordinator isthere, amanda is now seeing some
of these hearing aid checkwalk-in type appointments.
That way it doesn't take timeaway from our providers who are
making doing revenue generatingappointments.
(41:40):
So we're kind of in this reallypivotal period of we're at the
2.5 year mark, so we reallyhaven't had anyone who has hit
their three year end of warrantyperiod yet and so we're trying
to show them that's hiding, it'ssuch a crazy period but we're
trying to show them.
We see them back, for usuallyit's like a four month and then
(42:02):
a six month and their annualvisit then six month and annual
again.
So we're really working hard toshow them how valuable our
services and how valuable we areas a partner and for longevity
of your hearing aids, howimportant that is.
And then I think, if we can doit correctly when their end of
warranty comes up, to offerservice plans and packages for
(42:25):
the end of warranty period, Ithink we're going to find that
may be a really pivotal thingfor our practice.
You know, currently we offersmall service plans at the end
of their one year service visit.
Most people actually in ourpractice choose to pay as they
go, which we offer small serviceplans at the end of their one
year service visit.
Most people actually in ourpractice choose to pay as they
go, which we have a charge for,an office visit charge.
(42:46):
But I think the end of warrantyvisit might work well for us.
Blaise Delfino, M.S. - HIS (42:48):
But I think so.
I mean I will from experience.
We implemented the end ofwarranty and I will say we
implemented the Dr Jill dollar aday.
Yeah, again, it might not befor every practice, but for
where we were demographically,lindsay, it worked incredibly
(43:09):
well.
There were months where 10, 11,12 patients enrolled yeah, and
that's net profit, which thenyou can put back into your
business.
You can continue to providebest patient care.
We are both on the samefrequency here in terms of
investing back into the businessand how important that is.
As a private practice owner,sometimes it can feel like
(43:31):
you're on an island, but you'veobviously built a great support
network your banker, accountant,fellow owners.
How has community helped youavoid feeling like you're on an
island?
Dr. Lindsey Koble, MBA (43:48):
I would say I do a couple different
things.
So I have we call ourselves theIndiana Masterminds, but
there's a group of I thinkthere's five of us in the group.
We're in a text message chainso we usually text every single
day about something and thenonce a month we meet on a Friday
morning and we just we kind ofgo around and each of us say
something that's on our mind, aquestion that we have, and we
kind of share what we're doing,what works.
(44:10):
So I think, just not notclosing yourself and feeling
like you're the only one goingthrough this, which I think is
what you know.
What I do online is I try to betransparent, to make people
feel like what you're goingthrough everyone else has
probably been through or is alsogoing through.
So I think you know, go to theconferences.
(44:31):
Since I was a student I've goneto AAA, ada you know Odd Boss
has such a great conference andso find your people and don't be
afraid to kind of reach out tothem and make a little network
to pass ideas back and forth to.
I think people think thatprivate practice and audiology
is so competitive, which some,you know it has been a little
(44:54):
bit, but if you find the rightpeople it's not.
Yeah, if you find the rightpeople, it's not, and so you
just have to be open to sharing.
I think the other side is whenyou know you're trying to
connect with a mentor orsomebody and it's really
one-sided of you're justgrilling their brain on their
information or to utilize theirpractices.
(45:16):
If you want kind of thisworking relationship, you have
to give a little too.
So I think be conscious of thatwhen 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 (45:30):
And when you are running a practice,
leaning into mentorship, asking, asking is free.
Lindsay, you've donated so muchof your time today.
I just have one more question,and this is a very important
question because this is hugeindustry news.
Here I mean seriously.
You are resident elect of theIndiana Audiology Coalition and
(45:53):
helped plan its first big event.
Tell me what drives yourpassion for advocacy and how can
other professionals getinvolved.
Dr. Lindsey Koble, MBA (46:02):
I think Erica Person who owns Flex
Audiology down in Lawrenceburg,indiana.
When Erica moved here fromMinnesota she used to practice
in Minnesota.
I remember she asked me doesIndiana have an audiology group
to be a part of?
And I was like no, not really.
We kind of had like a speechand hearing group, but we never
(46:24):
had our own audiology group.
They used to years ago and thenit kind of dissolved and so
really it was Erica's idea.
We kind of worked together.
We had a really great group ofinitial founders who most of us
were practice owners.
A couple audiologists who workfor manufacturers joined us and
(46:44):
kind of doing the legwork to getgoing.
But really it was just we hadthis idea and we had the passion
to do it.
Because Indiana is just so graywhich there's pros and cons to
having a state that doesn't havereally set in stone policies,
sure, but also it leaves a lotof room for encroachment of our
(47:09):
scope of practice.
And so we just knew that, asthings are evolving and changing
, we really need thisorganization, are evolving and
changing, we really need thisorganization.
And so it just took startingplanning a really great first
conference where we had such anawesome turnout of audiologists
from all over the statehospitals, ents, a couple from
(47:30):
university, we had really greatpresenters and just to bring
together the state of Indianaand to fuel that camaraderie
that we really need just whensomething comes up unexpected,
we now have this foundation tomove forward, to support our but
now we have this corefoundation together to move
(48:00):
forward year to year.
And so when Erica was startingit, it just made sense for me to
be president elect to kind ofgo down this road with her and
then next year as president.
You know we're just we havesuch a great group that we know
kind of the the board that wehave right now is going to be
the same board that we had lastyear.
We need to get our legs underus to get going for a couple of
(48:22):
years, and then I just thinkwe're in a really good place.
Blaise Delfino, M.S. - HI (48:26):
Thank you so much for your advocacy
efforts and Dr Person and it'ssuper exciting.
I mean, when I saw thisannouncement online, I was like,
oh my, this is incredible.
Dr. Lindsey Koble, MBA (48:36):
Yeah, something we've never had, we
really needed, and now we justhave the chance to get involved
with ADA, aaa, asha.
When they have things that comeout, we can speak to our
Indiana audiologists and kind ofcome together as a group to
decide how we want to handlethat in our own state and we're
in a fun spot to really progressaudiology in Indiana.
Blaise Delfino, M.S. - (48:58):
Lindsay , thank you so much for joining
us on the Hearing Matterspodcast.
If you could leave ourlisteners with one thing today,
one golden nugget, what wouldthat be?
Dr. Lindsey Koble, MBA (49:08):
One golden nugget.
I would probably tell them tochase your dreams, which sounds
so cliche, but I would say ifyou are passionate about
anything in this industry, gofor it, whether that's being the
president of your stateorganization, whether that's
working for a manufacturer,being the director of a hospital
, a Mayo Clinic type office.
(49:29):
Do all of the right things andnever quit chasing your dreams,
because you will attain them oneday if you never give up.
Blaise Delfino, M.S. - H (49:37):
You're tuned in to the Hearing Matters
podcast.
I'm your host, blaise Delfino,and today we spoke with Dr
Lindsey Koble from AudiologyAlways, auburn, indiana.
Keep hearing and listening,well, and until next time, hear
life's story.
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