War call-up brings no boost for temp agencies

By Heather Stur, of SBT

Although the war in Iraq has pulled many workers from their jobs, local staffing agencies have not been hit with a large demand for temporary help.
As of March 18, about 2,250 members of the Wisconsin Army and Air National Guard were listed on active duty, said Ann Peru Knabe of the 440th Airlift Wing Public Affairs office at Milwaukee’s General Mitchell International Airport. That’s about 23% of the Guard’s 9,800 soldiers and airmen in the state.
Soldiers and airmen from units in 24 Wisconsin communities currently are serving on active duty with the Army and Air Force.
But with the economy still in a slump, some companies are not replacing employees who have been called to military service, said Joel Schneider, president of SEEK Inc. in Grafton.
"A lot of companies are in a standstill or lay-off mode," Schneider said. "The economy is still tough, so employers aren’t filling positions left by those in the military. Also, many of the people being called up are in supervisory roles, and you don’t replace those with temps."
Not all companies tell staffing services the reason they need temporary employees, Schneider said. Still, SEEK has not had an unusually large number of requests specifically for military replacements.
"If we have 50 temps out there specifically filling the jobs of workers in the military, I’d be surprised," Schneider said.
Express Personnel Services, a Racine-based agency, also has not received many requests for the replacement of employees who have been called up to active duty, said owner Jeff McKeown.
The military issue has hit Express Personnel directly, however. One of its employees, Trever Brehm, was called to active duty with the Army just days after he received a promotion to a lead position in the company.
To help companies that do need workers to replace military personnel, Express Personnel has established its Express Freedom Worker Program.
As part of the program, Express Personnel provides existing clients with replacement workers at a reduced rate. Freedom Workers are provided at Express Personnel’s basic cost, with all temporary and contract staffing fees waived.
The Freedom Workers program will be in effect for at least the next 90 days.
"In today’s tumultuous economy, many employers do not have the time or money to stop and train employees to fill positions temporarily left by armed forces personnel," McKeown said. "With uncertainty about the length of time military personnel might be gone, employers are reluctant to fill vacated positions permanently. And they are obligated to maintain an opening when the military personnel return."

April 18, 2003 Small Business Times, Milwaukee

Today there are 16 million employed caregivers. A1997 study by the National Alliance for Care Giving and AARP put the loss of wages and productivity due to employees taking time off work to deal with problems of their parents or older relatives at $11 billion per year.

Miriam Oriensis-Torres, co-founder of Geriatric Support Associates in Milwaukee, puts that figure closer to $29 billion annually.

"We’ve seen studies that report 42% of full-time employees expect to be providing eldercare by this year. Employers don’t have to feel helpless, however," she says. "Care management firms, county elderly services departments, agencies on aging, community outreach groups and other care providers are willing to help educate you and your workforce. This makes your employees more productive on the job and saves your business money."

Tom Henley, community relations outreach coordinator at The Village at Manor Park, in West Allis, agrees.

"The time to make a critical decision is not in the middle of a critical crisis," he says. With more people in America turning 60 than there are babies being born every day, the time to get started is now."

Talk it over, over lunch

There are several ways to help employees prepare for their own old age (or incapacity) and deal with their parents’ needs, but an effective way, Henley suggests, is to offer a series of brown bag discussion groups. Topics to cover include:

— Why paperwork should be in order (wills, durable powers of attorney, financial records, insurance papers, etc.).

— What you should know if something happens to a parent (where papers are, health history, medication list, names of doctors and preferred hospitals, etc.).

— The importance of having long-term care insurance, what it should cover, when to get it, and questions to ask of suppliers.

— Government programs for the elderly – "There are a lot of misconceptions about what Medicare covers and a lack of understanding of how Medical Assistance (Title 19) works," Henley pointed out. "There are also county-administered Community Option Programs that can subsidize housing expenses, and many county services for the elderly many people don’t know are available."

— Services — non-medical and medical — available that allow people to remain in their homes as long as possible.

— The difference between housing options (independent living, life-care, assisted living, community-based residential facilities, nursing homes, etc.) for when at-home care is no longer desirable or possible.

— Transition to new housing – senior real estate specialists can discuss their services, explain how property liquidators and moving companies can help relieve the burden of moving/disposing of 30 to 50 years of "stuff."

— Safety issues to be alert for, helpful health aids (such as grab bars and raised toilet seats) and even the growing telemedicine field where people can interact with their doctors over the Internet.

— Respite and adult day care options.

— Support groups for caregivers and/or the person beingcared for.

— What a care manager does.

— How to be an advocate for the elderly (or for just your parents).

— Signs that point to the need for intervention.

— How to talk with elderly parents and what you should discuss about their wishes, plans and health care.

— Alzheimer’s disease and other dementia.

Other solutions

Henley also says his facility and others specializing in eldercare can provide training to human resources staff so they can assist employees.

"We can help you develop an eldercare employee assistance program, set up a resource library, provide on-line resource information and give referral assistance," he explains.

Henley notes that "the people most affected by aging parents and older relatives are the 40- to 60-year-old managers – employees you can least afford to have missing work or quitting because they need time to deal with their loved ones’ problems."

April 18, 2003 Small Business Times, Milwaukee, By Kay Falk, for SBT

Data: Hospital-owned clinics charge more

By Charles Rathmann, of SBT

Health care provided by clinics associated with hospital groups in southeastern Wisconsin is significantly more expensive than care provided by clinics with no hospital affiliations, according to data gathered by Independent Physicians Network (IPN).
The Milwaukee-based group coordinates care for patients on behalf of health plans.
The cost data covers a variety of health care institutions and also reflects actual payments made by public insurers such as Medicare and Medicaid, as well as by private insurers.
The data compares the costs of providing care in hospital-owned facilities with the costs of care in freestanding clinics in the region during 2002.
Most available health care data, including information collected by the State of Wisconsin Department of Health and Family Services, reflects only published rates. Just as a manufacturer’s suggested retail price might not reflect what consumers pay for a new car, insurers negotiate discounts on the standard rates for clinical and hospital care.
Figures on what is actually paid for care are protected by confidentiality agreements. However, according to IPN chief executive officer Charlette Heyer, the group, which includes 1,000 physicians in southeastern Wisconsin, is still able to break down cost figures by type of institution.
According to the figures released by Heyer’s organization, payments made for the same procedures can cost almost four times as much in a hospital-owned clinic than in a freestanding clinic.
While figures compiled for release do not encompass every condition or procedure, figures released in previous years covering a variety of different medical procedures exhibit a consistent pattern of higher costs at hospitals and hospital-based clinics.
Industry insiders point to a variety of reasons for the significant disparity, including the greater leverage major hospital groups have in negotiating compensation from insurers and higher overhead.
"Yes, hospital-based services have higher prices than clinic-based," St. Joseph Regional Medical Center chief operating officer Rick Hart said. "MRI, for example. In a clinic, you will treat outpatients who arrive on time and only during business hours and who may have very special types of testing. In a hospital setting, you may need to have 24-hour call, seven-days-per-week service. You need to treat patients who are unconscious, who need IVs, etc. Many will be inpatients for whom no extra payment is given, so the payment from outpatients may need to be subsidized."
Health care consultant Sara Stanton of Waukesha-based Stanton Healthcare Management said the limited scope of the data makes it difficult to make conclusions, but she agreed with Hart that the different overhead structures are a factor in care costs.
"Hospitals and managed care agree on prices for services," Stanton said. "Volume of patients is a determinant in those discussions also."
Dr. Susan Turney, medical director of patient financial services for the Marshfield Clinic, offered an outsider’s view of the data. The northern Wisconsin entity is the largest private group medical practice in Wisconsin, with 591 physicians and 4,365 other employees. The group does not serve the southeast Wisconsin market.
Turney, who serves on the board of directors for the Wisconsin Medical Society, said the selection of procedures and services covered in the data released by IPN may reflect a bias.
"Obviously, by presenting this data, they are trying to make some sort of point," Turney said. "It is very difficult just seeing this sheet alone. It is hard to compare costs when they are provided at different types of facilities."
Turney stressed that hospitals and clinics bill very differently for their services, and often, historical relationships with insurance organizations can influence payments made for various procedures and services.
"The billing mechanisms and the payment mechanisms vary by the site," Turney said.
According to Heyer, the figures reflect all payments, including facilities charges. Hospitals have a greater degree of leeway in determining what to bill for services, according to Heyer.
"For a physician, you can only bill for what services that are performed," Turney said. "With hospital billing, a lot is already bundled into the payment mechanism. At a physician’s office, I am not going to bill you for an ACE wrap and a bandage and taking your blood pressure – that is all part of the office visit. In a hospital, they still have the opportunity to recover some of their cost by billing for other, extraneous things."
According to the IPN data, payments to hospitals have not come down as hospital groups have gained the ability to perform basic procedures in a clinic environment.
"Some of the cost is based on historical precedent," Turney said. "Care has transitioned from an inpatient to an outpatient setting. We know that many people have cataract surgery used to be a week in the hospital. They now go through the procedure and are released same day. There is a lot more cost with an inpatient stay."
According to Turney, reimbursement levels have in some cases not dropped to reflect the lower costs of procedures.

April 18, 2003 Small Business Times, Milwaukee

You and your parents need a Plan B for care

By Kay Falk, for SBT

A very important question you need to ask yourself and the elderly relatives you’re close to is: Who’s going to make decisions about your health care and finances if you can’t?
According to Julie Short, an attorney with Vance Wilcox Short & Short who specializes in elder law for clients in Jefferson and Walworth counties, you can save money and reduce stress and heartaches if you plan ahead.
"At a minimum, you need to set up both health care and financial powers of attorney," she stressed. "For example, if a parent or you suffer a stroke or if you are in an accident that even temporarily results in legal incapacity, someone else will have to make health care and financial decisions for you.
"If you have no durable health care or financial power of attorney designated, someone close to you has to get a court order to be appointed as a guardian. That process is time-consuming, stressful at an already stressful time, and costly, often more than $1,000," Short said.
Short points out that Wisconsin has a statutory health care power-of-attorney form you can download from the Internet, and that many hospitals and even doctor offices have the forms, as well as lawyers.
"This form is readily available at no cost, and includes provisions to address life-sustaining procedures," she notes. Because it is a legal document, she recommends that you consider reviewing the form with an attorney.
To establish a financial power of attorney, someone who can make financial decisions if you’re incapacitated, you definitely need an attorney.
"There are many strategies to fit various financial situations, and you want to be very careful about designating a trustworthy person," Short notes. "A specialist in elder law can be very helpful in seeing that your wishes can be carried out if you’re not able to be in charge."
Some of the services an elder-law attorney offers include:
— Making you aware of the pros and cons of annuity, long-term care and Medicare supplemental insurance plans. "There are many options and increased flexibility in today’s insurance offerings. Most elder-law attorneys have low or no-fee first appointments that you can use to discuss these options," Short explains. "Too many people are scared into buying a plan by insurance sales rhetoric. It’s often wise to let an independent person explain options and evaluate the plans before you sign."
— Alerting you to state and federal government benefits. For example, many people don’t know they could qualify for SeniorCare prescription drug assistance. A good elder law attorney is familiar with those benefits.
— Helping with estate planning to reduce tax consequences and more easily transfer assets following death.
— Creating a contingency plan for small business owners. "If you die or are temporarily incapacitated, are you comfortable having your business partner, spouse or child make decisions for you?" Short asks. "It’s important to establish a plan, a clear tool that lets all parties understand what you want to happen. Succession planning can set up a buyout or repurchase formula for survivors. This makes it easier on who’s left, and allows them to concentrate on continuing the business."
— Assessing contracts for various living options, such as those required by assisted living or nursing homes. "You need to know your rights," Short says. "If your loved one has Alzheimer’s, you don’t want to have the care facility kick he or she out because of new symptoms that require more attention and care. There are state codes that address these issues, and an elder care attorney can help you make sure all steps have been taken. Sometimes it’s just as simple as assuring special diets and other needs are included in the contract."
— Clarifying the law on transfer and sale of assets. "There’s a lot of misinformation that, if you follow it, can lead to tax penalties, regarding selling assets to obtain state and federal benefits," Short said.

For a referral to an elder law specialist in your area, you can contact the Wisconsin State Bar Association at 608-257-4666. Other resources are available at its Web site at www.wisbar.org.

April 18, 2003 Small Business Times, Milwaukee

Pediatric urgent care clinic survives first year

By Charles Rathmann, of SBT

While parents with howling sick or hurt children often cool their heels in the waiting rooms of hospital emergency rooms on weekends, a clinic on Milwaukee’s west side is quietly serving children in need of after-hours medical care – at much lower costs to patients and insurers.
Kids Urgent Care, a service offered by pediatricians Dr. Noemi Prieto and Dr. Gary Nordyke at Southeastern Pediatrics & Adolescents Clinic, has made it through its first year at the corner of 86th Street and Capitol Drive.
The clinic is open until 6 p.m. on Saturdays and Sundays.
As the number of patient visits increases to the point where the urgent care function begins to break even, Prieto looks forward to extending hours further.
Two years ago, a liquor store stood on the site where Prieto and Nordyke built a 13,000-square-foot clinic with the help of a $1.13 million loan from the Milwaukee Economic Development Corp.
"People ask, ‘Why did you invest a million in that corner? I tell them we are who we are because our patients made us," Prieto said. "The urgent care function came up when we kept hearing and seeing so many patients being taken to the emergency room unnecessarily."
Adding the weekend hours for urgent care was not without risk. At least one other team of respected local physicians had gone the urgent care route and hit the wall after being open a few months beyond Prieto’s current benchmark.
Prieto said she would like to add to the evening and weekend hours, but until the practice sees the requisite volume of urgent care patients during existing hours, she is taking a wait-and-see approach.
Although the clinic serves patients from as far away as River Hills, Menomonee Falls and Germantown, she recognizes that the clinic’s foundation is the northwest side of the city of Milwaukee.
Prieto accepts every type of public and private payer insurance, and she estimates that about half of her caseload consists of government-based insurance. Hospital-owned clinics typically require their physicians to steer clear of government insurance patients receiving Medicare or Medicaid, or the hospitals financially penalize physicians if their public payer caseloads eclipse certain percentages.
"We do take care of anything and anyone that walks in our door," Prieto said. "From our office, I had grown and gotten all my experience. I wanted to give something back."
Giving too much too soon can lead to business failure, so Prieto is counting on a go-slow approach to keep the practice from overextending itself with urgent care. Unlike appointment-based practice, which yields a relatively predictable return per physician hour, urgent care volume can run hot to cold.
"We started out staring at a lot of ceiling tiles," Prieto said. "We are still on our way there. It is nice to tell you we saw 35 patients in a day, vs. three patients in a day like we used to. We would like to see that number go up so we can expand the urgent care function to the weekdays."
However, a smart approach to distribution and an aggressive stance in acquiring other practices could help her enterprise from meeting the fate of the Harambee Medical Center, which closed its doors about four years ago. The Harambee clinic was a venture of physicians Wayman Parker, Eugene Pruitt and John Silkey.
Covenant Health Care System helped with grant writing and renovation of the facility at 2373 Dr. Martin King Jr. Dr.
According to Silkey, Prieto is doing a few things differently than the Harambee trio did.
"I think she is going about it the right way," Silkey said. "She is not duplicating equipment or space in order to provide the urgent care. The other thing is that if you expect to be successful, you need a busy private care practice, because a lot of what you are going to see in your urgent care will be your own patients."
Silkey said his was the only practice located at the urgent care clinic, which limited the volume of patients prone to use the urgent care function.
"My private practice was there," Silkey said. "But we duplicated rooms. I had five exam rooms for my private practice during the day, and then we had an additional four rooms for urgent care, which brought the initial number of rooms to nine. It was a waste of money, because we had to get a much bigger place. Everything we did there we could have been done in half the space, and that would cost less as far as overhead."
The practice also did not generate revenue from the entirety of the 6,000-square-foot building, according to Silkey.
"We had the upstairs and the downstairs we were paying rent on – but never did anything with the downstairs," Silkey said. "It needed renovation before it could be leased out. It never became income-generating. … Noemi, she is using the property well, so it will generate income."
Prieto also is taking a different approach to generating volume for her urgent care clinic.
Seven physicians and 10 physician assistants are associated with her clinics, building relationships that can feed the urgent care center. Prieto has taken an aggressive approach, purchasing or opening three other clinics in the metro area and building relationships and awareness among pediatricians.
"It started with just a practice here on Capitol," Prieto said. "Then, 10 years ago we opened a second location in Franklin. From there, I opened up a third location in South Milwaukee about five years ago. Two years ago, the Teamsters clinic on Bluemound asked us to do pediatrics. Then, 14 months ago, another senior pediatrician call me. He was ready to retire."
Prieto’s clinic bought out the practice of Dr. Anthony Coe, who operated a clinic north of 35th Street and Wisconsin Avenue in Milwaukee.
"The numbers are the power," Prieto said. "That is why I did what I did six or seven years ago when I saw the Aurora and Covenants buying everybody left and right. I only wish more of the pediatricians would feed (the urgent care center), vs. continuing to feed the monsters even more."

Emergency room or urgent care clinic?
Just the check-in process at a hospital emergency room can cost $50, and the whole visit for even a simple malady can run into thousands of dollars. By contrast, an entire urgent care visit can cost as little as $50.
Of course, while walk-in clinics should be an attractive option for those concerned about containing health care costs, some situations require the resources an emergency room provides.
According to Dr. Noemi Prieto, who operates an urgent care clinic for children at 85th St. and Capitol Drive, some pediatric problems cannot be handled at a walk-in clinic.
"Any parent that sees a child that is listless, nonresponsive, any difficulties breathing, persistent vomiting and diarrhea – those must go to an emergency room," Prieto said. "An asthma attack, once the parents have done their basics at home, should go to an emergency room. Ingestions – putting things in their mouth like children always do – have to go to an emergency room. I just had a little boy here who had stuffed a couple of pearls in his ear. We sent him to the emergency room."
Dr. Tom Luetzow, president of American College of Emergency Physicians’ Wisconsin Chapter, said parents can have difficulty deciding whether an emergency room or an urgent care clinic is the best option.
"It is so person-dependent," said Luetzow, who, until recently, served in the emergency room at Waukesha Memorial, but now is practicing at a Lake Mills clinic that offers an urgent care function. "Some people do, some people don’t. And sometimes you don’t know. When does chest pain become heartburn and when is it a heart attack?"

April 18, 2003 Small Business Times, Milwaukee

Cardiologist says neurons in heart can foster better business decisions

By Charles Rathmann, of SBT

The term “licensed technology” generally elicits images of computer software. But a licensed technology employed by a Shorewood cardiologist is designed to help business owners and managers use a different kind of software – the human heart.
Dr. Bruce Wilson is a licensed personal training licensee for HeartMath, a technology developed by the Institute of HeartMath (IHM), Boulder Creek, Calif.
While the thought of wellness technology developed in California encouraging people to explore their feelings may trigger certain biases, IHM’s system of tracking heart rhythms and using biofeedback to manipulate physical and emotional states is backed up by stacks of research.
The base collection of software and hardware retails for about $300. Group training is also provided directly by HeartMath.
Wilson, who initially was interested in using HeartMath tools to help with rehab of cardiac patients, found the tool also was excellent for hospital personnel.
Wilson plans to use HeartMath training for members of his staff at the Heart Hospital of Milwaukee, a 32-bed MedCath Corp. facility under construction in Glendale.
Wilson, who will be chairman of the hospital board, sites dramatic increases in employee retention and customer satisfaction tracked by an Illinois hospital using the training program.
According to Wilson and IHM literature, the Delnor Community Hospital in Geneva, Ill., had measurable business results after sending 40% of its staff to HeartMath seminars, including:
— A 20% reduction in employee turnover among employees attending the seminar;
— Improved customer satisfaction from the 73rd percentile to the 93rd percentile;
— A No. 1 ranking in employee satisfaction based on Sperduto and Associates’ national database of more than 300 health care organizations.
Wilson stumbled across the research supporting the new technology in medical journals in 1997. The fact that the institute was exploring the root causes of the stress that triggered or exacerbated the cardiac problems Wilson was treating intrigued him.
“They were talking about the vocabulary that makes up relationships,” said Wilson, who at the time was chief of cardiology at Columbia Hospital in Milwaukee. “I wound up attending a three-day seminar with 30 people. As soon as I started hearing the science behind it, I knew this was big.”
The science Wilson was so impressed with was IHM research that studied electrical impulses sent from neurons in the heart to the brain. Those impulses, IHM materials claim, are responsible for the brain’s release of stress hormones and have a direct effect on the brain’s higher thinking functions.
Extra beats and variations in heart rhythm that accompany stress, according to the studies, increased release of cortisol – the main human stress hormone – and inhibited release of other beneficial hormones, including dehydroepiandrosterone (DHEA).
IHM used its findings to develop a variety of products for an associated for-profit venture, HeartMath LLC. Those products include a proprietary heart monitor and software tool that allows individuals to monitor their heart rates and get biofeedback information on how successful they are in locking in a healthy, stress-free rhythm.

“Quackwatch” doctor is skeptical of HeartMath
By Charles Rathmann,of SBT

A physician who maintains a Web site on “quack” medicine takes a dim view of the science behind HeartMath and the Institute for HeartMath.
Dr. Steven Barrett of www.quackwatch.com said that when he first found out about the claims made by developers of HeartMath technology, he “decided it was not appropriate.”
Barrett posted HeartMath and the Institute for HeartMath (IHM) on his Index of Questionable Treatments and Index of Questionable Institutions.
“I didn’t understand what they were talking about – the meaning of the words,” Barrett said, adding that while heart rate may be manipulated with the help of a the type of biofeedback machine HeartMath LLC sold, maintaining a steady heart rate without the machine was difficult.
“Hooked up to a biofeedback machine, there are certain mental maneuvers that can have an effect on pulse,” Barrett said. “But there are so many other things that influence heart rate. Where is the evidence that anything you do in terms of attempting to regulate the heartbeat can cause it to stay regulated or that there is any clinical value? A study on something like this would probably have to span a number of years.”
Science of the Heart, a booklet circulated by the HeartMath Research Center, outlines the results of studies involving Heartmath technology. Barrett took a dim view of the journals the studies were published in.
“If they go out of their way to publish crappy and inconclusive studies, you may assume the good studies don’t exist,” he said.
However, more important than the credibility of the journals, Barrett said, was whether or not research focused on worthwhile data.
“There is a lot of literature on relaxation, but there is not a lot of evidence that they influence health,” Barrett said. “Everyone has ways of relaxing. Most people don’t need therapy to know what helps them relax.”
Dr. Bruce Wilson, the local cardiologist who has bought a training license from IHM, said research conducted to date consists of short-term pilot studies. However, Wilson said seminars and tools sold by HeartMath have more to do with management and performance enhancement than medical therapy.
Wilson refers corporate groups interested in HeartMath training to IHM, focusing most of his own efforts on training the staffs of medical institutions.
“I think the whole hospital program is aimed at stress reduction for the staff and retention,” Wilson said. “The turnover rate in the nursing profession is very high. And as you know, we are having a real nursing shortage by now. I am not selling this to hospitals as another therapy for people with rheumatoid arthritis. … When people hear about it, they are getting it from a guy whose business it is to understand this physiology. My credential is what allows people to accept the technology.”

April 18, 2003 Small Business Times, Milwaukee

Wisconsin business leaders foresee sluggish growth

By Harry Dennis III, for SBT

As this article is being written, war in Iraq has begun. Hopefully, by the time you read it, our incursion will have been successfully concluded, or in that phase where its principle objective of eliminating Saddam Hussein’s regime as a threat to the free countries of the world has been accomplished.
TEC International has developed a well-respected index, The TEC Index, that is administered in survey form to more than 5,500 chief executives in the United States, 520 of whom are located in Wisconsin. This is done each quarter.
The results of the first quarter are in. This month I would like to detail how Wisconsin CEOs view our world compared with their colleagues nationwide.
The results are interesting, to say the least. I make this observation in the face of a commonly held belief that “we, in the Midwest, are different.” Also, I’m only reporting certain answer category highlights, so the percentages in response to each question will not total 100%.
In terms of the current economic health of the US, Wisconsin CEOs are no different than their nationwide contemporaries; 60% see the growth as stagnant, and 34% see it as slow and steady.
For the full 2003 year, again, there are no differences. Seventy-six percent see the numbers coming in between 1 and 3 percent. In terms of specific business plans for the remainder of the year, again, there are no differences. Fifty-two percent expect to further cut operating expenses, and 52% are modifying their business strategy. Only 17%, in both cases, do not believe that the economy will affect their business plans.
The picture regarding personnel staffing is more convoluted. Thirty percent of the entire survey sample expects to increase staffing by 1 to 5 percent over the next 12 months. However, half as many Wisconsin CEOs compared with CEOs nationwide expect to increase staffing by more than 5%. Thirty percent of both groups see no change in staffing over the next 12 months.
Decisions regarding capital expenditures are similar for chief executives in Wisconsin and nationwide. Thirty percent expect increases in the 1 to 10 percent range. Seventeen percent see decreases of similar amounts, and another 35% see no change from last year.
Projected sales revenues show some differences between the Wisconsin and nationwide sample. Forty-four percent of the Wisconsin group expects sales to increase by less than 10%, while 33% of the nationwide group expects this. Likewise, 22% of the Wisconsin group see increases in the 10 to 20 percent range, while 27% of the nationwide group expect 10 to 20 percent growth. Ten percent of both groups report no expected change in revenues.
Roughly 86% of both samples identify these two strategies as most critical to long-term success: repositioning the company to accelerate growth, and recruiting and hiring top talent.
There is no disagreement between either group in supporting President Bush’s efforts to cut taxes: 62% agree, 20% oppose and 14% are undecided.
Regarding economic stimulus actions, there are some similarities and differences. About 60% of CEOs nationwide and in Wisconsin want to see income tax reductions for all earning brackets.
Interestingly, 32% of Wisconsin CEOs voted for tax reductions weighted more to middle and lower income brackets, while only 13% of CEOs nationwide did so.
Likewise, and far more striking, only 8% of Wisconsin CEOs support payroll tax reductions compared with 33% of the nationwide CEO sample. About a quarter of both groups want to see estate and dividend taxes reduced.
Regarding the war in Iraq, 16% of both groups expect it to have a mild positive impact. However, 63% of the nationwide CEOs expect a mild negative impact, compared with 48% of Wisconsin CEOs. Not surprisingly, over two-thirds of both groups supported the war effort before it became reality! On a similar note, both CEO groups rank Iraq and North Korea as presenting the most danger toward the US.
Roughly 60% of both groups support an increase in government powers of surveillance. But in terms of preparing for a potential terrorist attack, three quarters of both groups see nothing other than “business as usual.”
The final question of the TEC Index Survey asked respondents to indicate which industry will rebound fastest in 2003. There was a close match between Wisconsin and nationwide CEOs: biotechnology was ranked first; information technology second; and retail, manufacturing and professional services third.
Let’s face it, surveys are surveys and just that. They give us a clue of the future, but only that.
I continue to be impressed by the fact, as witnessed by a recent international conference of TEC colleagues that I attended representing more than 7,000 TEC members from 15 countries, that we in Wisconsin are highly respected for our continuing ability to successfully compete in spite of adverse circumstances.
China notwithstanding! Until next month, good fortune to all our Wisconsin enterprise!

Harry S. Dennis III is the president of TEC (The Executive Committee) in Wisconsin and Michigan. TEC is a professional development group for CEOs, presidents and business owners. He can be reached at 262-821-3340.

April 18, 2003 Small Business Times, Milwaukee

Recalibrating the standard
Four years later, a look at the Vendor and the Business Resource

By Jerry Stapleton, for SBT

It’s been more than four years since I wrote my first column for these pages. In my inaugural piece, entitled "Death of the salesman," I spoke with passion about the need for a fundamental transformation of the salesperson away from traditional selling, which I called Vendor/Problem-Solver selling.
The basis for my argument was simple: traditional selling had become obsolete and was no longer bringing value to customers or to the salesperson’s own company. "A salesperson, in order to contribute value, has to be viewed much differently by customers" I said. "He or she has to be viewed as a Business Resource." I then went on to define the difference between the Vendor/Problem-Solver and the Business Resource.
The theme of "Selling as a Business Resource" has been – and remains – the foundation of every column I write, my recent book and my consulting work. This hasn’t changed.
What has changed – or, more accurately, evolved – as a result of my firm’s ongoing work in the trenches with salespeople, is some (not all) of how I define the difference between "Vendor/Problem-Solver" selling and "Business Resource" selling. I’d like to re-calibrate, so that we retain a reliable standard for what we mean by "Business Resource."
And, like I did four years ago, I ask the questions: How do your salespeople sell? And, in turn, how do their customers perceive their value?
First, we must accept the premise the customers perceive the value of salespeople based on how they sell, not what they sell. Subconsciously, customers place salespeople somewhere on the pyramid shown in Figure 1.
For salespeople to create value for their customers – and their own companies – they must act in a way that causes customers to place them in the Business Resource part of the pyramid.
Whether a salesperson is likely to be viewed as a Vendor or a Business Resource can be determined by looking at nine dimensions of the salesperson. Some of those dimensions are proficiency-based, others are mindset-based. Either way, they are what define the salesperson. Figure 2 summarizes the dimensions. I briefly expand on them below.
1. Mode – Operating in "seek mode" is almost synonymous with being a Business Resource, while the "tell mode" of operation is what defines the Vendor/Problem-Solver. Traditional salespeople believe that their job is, in its simplest form, to educate and inform customers. As a result, they "seek" only long enough to find an opportunity to tell. But "tell" is their basic mode of operation.
2. Control – Can we control a customer’s purchasing process or buying cycle? Technically, no. Can we influence it? Absolutely yes!
The Business Resource attempts to influence the customer’s process by steering the customer to next steps. That can come down to something as simple as what the salesperson says at the end of a customer interaction. Where the Vendor might say, "What would you like from me?" (Where the answer, incidentally, is all too often the familiar, "Why don’t you send me a proposal!"), the Business Resource is more inclined to say something like: "Based on what we’ve talked about, may I suggest how we might proceed from here?" That’s steering, compared to the Vendor’s preference for reacting.
3. Self-perception – "The customer is always right" is an outdated Vendor mindset. (It’s still a valid service mindset.) It’s a result of the salesperson seeing himself as an advocate for the customer.
Such customer advocacy usually translates into the salesperson taking on the role of free technical resource for the customer or pushing the home office for better pricing.
The Business Resource sees herself as an advocate for both companies, seeking truly mutually valuable relationships with customers. Vendors feel like they’ll win customers’ favor by extending resources to them without asking for much of anything-even information-in return.
4. Focus – "Selling is about finding and meeting needs," says the Vendor. The Business Resource, on the other hand, understands that customer needs come from the customer’s business issues.
Where the Vendor is guided by the principle, "The more I focus on the customer’s needs the better I can serve that customer," the Business Resource is guided by the principle, "The more I focus on the customer’s business the more value I can bring that customer."
5. Awareness – "Find the decision-maker!" It’s a phrase that everyone in selling seems to live by. Not so the Business Resource. Why? Because the Business Resource has a high level of "organizational awareness." As a result, he or she knows that, because of political realities that exist in every company, "decision-maker" is a meaningless term.
The Business Resource deciphers each account’s political structure, making determinations about which contacts have, for example, a high title but low influence, or which ones have a low title but high influence.
6. Credibility – In order to be successful a salesperson must establish credibility with customers. The Vendor/Problem-Solver looks to his own technical competence as his source of credibility. The Business Resource seeks to establish "executive credibility," which requires not only technical competence, but a broad base of business competencies as well.
7. Decisions – The Vendor works on gut feel and instinct when assessing a sales situation and making decisions about it: "This one’s in the bag, I can feel it!" The Business Resource – mostly because she sells with a process – relies on objective criteria for her decision-making. She never stops asking herself three fundamental questions: 1. Should we pursue this opportunity? 2. Can we win it? Will it be good business?
8. Value orientation – How a salesperson perceives the value of his or her own offering has everything to do with how the customer will perceive its value.
Customers perceive the value of the Vendor’s offering as "price plus value-added goodies" because that’s how it’s communicated to them by the salesperson – "total cost of offering."
When customers assess the value of a Business Resource’s offering they perceive, instead, the aggregate value of doing business with the salesperson’s company – "total value of relationship" – because that’s how it’s communicated to them.
9. Accountability – When the Vendor loses a sale he or she says, "We lost because … (fill in the blank with "price," "our company’s poor reputation," etc.]".
The Business Resource takes full responsibility for winning and losing. If, for example, the Business Resource "loses on price," she immediately concludes that either she failed to communicate value in a compelling enough way or she failed to recognize earlier in the sales cycle that the customer would never buy on anything but simple purchase price, so she should cut her losses. In short, the Business Resource always says, "I was outsold!"

These are the nine dimensions of the Business Resource salesperson. Where do your salespeople – or you – weigh in on these dimensions? The answer will tell if you’re ready to participate in this new era of selling or will be left on the sidelines.

Jerry Stapleton is president of Stapleton Resources LLC, a Waukesha-based sales force effectiveness practice. He can be reached at 262-524-8099 or on the Web at www.stapletonresources.com.

April 18, 2003 Small Business Times, Milwaukee

Roundy’s corporate headquarters will return to Milwaukee

Downtown Milwaukee retail and residential development is expected to get a boost from corporate relocation of Roundy’s Inc. to east Wisconsin Avenue from Pewaukee.
The corporation announced April 14 that between 500 and 550 corporate employees would be housed in a facility being developed by Irgens Development Partners at 875 E. Wisconsin Ave. The corporation will lease 120,000 square feet of the 206,748-square-foot building, which is 90% leased.
The Roundy’s employees will be relocated from the Pewaukee headquarters and from Roundy’s facilities on Burleigh Street in Wauwatosa and on Holt Avenue on Milwaukee’s south side. The corporation’s distribution operations will remain at the Burleigh Street facility, which is adjacent to Highway 45.
While the new downtown office will provide more efficient operations for Roundy’s, corporate CEO Robert Mariano said quality-of-life issues were also at play in the decision to locate downtown. "The city of Milwaukee is absolutely the right place for our home office," said Robert Mariano, Roundy’s CEO. "There is so much here for our employees," he said at a downtown press conference announcing the move. "Many people just don’t know all the great things this city has to offer."
The employees will move into the new office structure is stages this fall. There will be no remaining corporate presence in Pewaukee, Mariano said.
Milwaukee Mayor John Norquist, noting that Roundy’s got its start in downtown Milwaukee, called it a "great day for the city." He said the presence of the Roundy’s employees "will fuel more development," including retail and residential development.
"Employees of Roundy’s will enjoy the good life of downtown Milwaukee," said Norquist, noting the many restaurants, shops and cultural amenities nearby. The 875 building is adjacent to O’Donnell Park and a stone’s throw from the Milwaukee Art Musuem, with its Calatrava-designed addition.
People who call on the corporate office from around the world will also enjoy those amenities, Mariano added.
When asked about Roundy’s retail presence in downtown Milwaukee, Mariano told those attending the press conference that another announcement related to its presence in downtown Milwaukee isn’t far off.
CG Schmidt is building the eight-story office tower for Irgens Development and will lease 4,000 square feet of space in it. Also signed as a major tenant is Artisan Partners, which will lease more than 54,000 square feet of office space in the building.
Mariano said Roundy’s considered several locations before settling on the downtown Milwaukee site. He called the cost to lease the facility "a wash" compared to what the company is paying for its current spaces.
He said employees expressed some concern about getting downtown and about parking. The company may address the traffic situation by adopting work shifts.
The Roundy’s home office, on Roundy Drive, was built in 1985 and now houses more than 200 employees. It moved to that location after being based on Burleigh Street in Wauwatosa, where it moved to in 1954 from Milwaukee. The company was established in 1872 at the corner of Water and Clybourn streets downtown, then moved to 241 N. Broadway 13 years later.
The corporation now has $4 billion in annual sales and supplies more than 800 supermarkets in 14 states from eight distribution centers. In addition, Roundy’s operates more than 80 Pick ‘n Save and Copps Food Centers. The company is owned by investment funds controlled by Willis Stein & Partners, Chicago, and employs more than 14,000 people.

April 18, 2003, Small Business Times, Milwaukee, by David Niles, SBT Editor

Questions to ask regarding elder care

According to Jenny and Steve Rayl, co-owners of the Home Instead franchise in the greater Milwaukee area, the in-home care-providing field has grown along with the senior population.
“Not all non-medical services have the same standards, or provide extensive training to their employees. So while we encourage you to get a third party involved in caring for your loved older adult – for another set of eyes and ears that provide personal attention and ease your caregiving burden – it’s wise to ask questions before you sign an agreement,” Jenny says.
The Rayls suggest you ask potential providers:

— How do you check backgrounds of your employees?
— Are your employees bonded and/or insured?
— Do you provide employees with workers’ compensation coverage?
— Do you withhold social security and all taxes, or am I responsible for that?
— How do you train employees?
— What are your rates and minimum hours of service? How often do you bill for your services?
— Do rates change for evening, weekend or holiday services? Can you provide 24-hour care, seven days a week?
— Do I need to sign a contract?
— Can I adjust the schedule once it’s started?
— Do I get to help choose the caregiver, or at least meet the person in advance?
— Does the same caregiver come each time, and can we change caregivers?
— What happens if the caregiver is sick?
— Does your office have a supervisor on call at all times?
— What type of records do you maintain in the home to keep us informed?
— If I have a complaint or problem, whom do I talk with?
— Are you a local or national company?

A common belief of today’s business leaders is that they have little or no control over their insurance premiums. The fact is there are sound risk management strategies that you can utilize to lower your costs immediately as well as for the long-term.
To accomplish that, you have to appreciate that it is more than just the premium you pay that affects your bottom line.
Your total cost of risk is comprised of much more than your annual premium. It includes deductibles and indirect losses such as downtime, damaged equipment/product, overtime, etc.
In my last Small Business Times article, we looked at the concept of total cost of risk and how you can affect it through a strong safety program.
Once you have established an effective safety program and you are witnessing fewer and/or less severe claims, you are ready to begin taking control of your insurance program.
In today’s hard insurance market, it is becoming more and more difficult to create an insurance program that fits your budget. There are three important steps in creating the ideal insurance program:
1. Gain an understanding of your critical risk factors.
2. Determine your level of risk tolerance.
3. Tailor your insurance program to fit your needs.

1. Identify your critical risk factors. What are your critical risk factors? Depending on your type of business, your critical risk factors are the things you do in your business that are most concerning to underwriters.
Those are areas that may expose you to catastrophic losses or simply contribute to a frequency of losses. Today, underwriters are scrutinizing your risks more carefully. There may be exposures in your business that do not contribute heavily to your revenue or profit, but create a great concern to underwriters.
Once you identify your critical risk factors, you can start to create a plan to minimize their impact, utilizing three different approaches: a) avoid risk, b) transfer risk and c) minimize risk with safety.
For instance, you may be a contractor that spends 1% of your time on scaffolding, and for that reason an underwriter may elect to pass on quoting your business. If you can avoid such risk factors, you may be able to open up opportunities that will greatly reduce your insurance premium.
Another option is to create a strategic alliance with another company that you may be able to outsource that portion of your business and effectively transfer the risk to others.
Your safety program should address and measure these factors in order to control and prevent future claims. Be aware of all your risk factors and measure them so you can determine areas of improvement.
2. Determine your risk tolerance. Once you have an understanding of your critical risk factors, you can begin to measure your risk tolerance.
In a hard market, it becomes imperative for you to begin retaining a greater portion of your risk.
You can increase your deductibles or self-insure parts of your business. We utilize a four-level risk hierarchy approach that gives companies a perspective on the types of insurance programs available to them and the opportunity to reduce their premiums by increasing their portion of the risk.
The four levels of the risk hierarchy represent different insurance programs that increase in risk at each level: guaranteed cost, insured retention, captive program, and self-insurance.
Level 1: Guaranteed cost: A guaranteed-cost program is one in which risk is transferred to an insurance company for a specified premium, or "guaranteed cost." The majority of companies fall into this first level.
Start-up companies and small to mid-size businesses may not have the financial capacity to assume much risk. Transferring risk with a small deductible is a sound approach at this level. As your company grows in financial strength and your ability to tolerate risk increases, deductibles can be increased to reduce insurance premiums.
Level 2: Insured retention (large deductible): At this level, you have established a proven safety-and-loss control program and are financially secure enough to support a loss-sensitive plan.
With an insured retention plan, actual losses impact the total cost of risk more than the insurance premium. As your comfort level grows, you can increase your retention level. With the increase in risk comes the potential for higher returns.
Level 3: Captive program: A captive is an insurance company established for the purpose of reinsuring the risks of its owners.
While it is true that most companies simply ignore this option by raising their retention level higher and higher until they become qualified to self-insure (Level 4), captives do have some advantages. These may include, among others, providing insurance coverage not otherwise available, allowing for recapture of investment income, and gaining greater control of claims handling.
Level 4: Self-insurance: Self-insurance is the highest level in the risk hierarchy. Companies operating at this level assume 100% of their risk up to a certain threshold (e.g., $1 million).
Excess loss insurance is purchased to protect against a catastrophic loss above the threshold. Loss control and claim handling services are purchased independently. Few companies are able to assume this degree of risk.
While you might find these levels self-explanatory, the distinctions between the levels are not widely understood or appreciated. We find that there may be a greater reliance on insurance market savings than sound risk management principles in a soft market. By clearly understanding the difference between the levels, you will be able to plan more effectively and increase your risk tolerance level.

3. Insurance program adjustments. The final step in the process is integrating all the knowledge and resources you’ve gained and utilizing it to create the ideal program. You are now in a position to review all the components of your program.
Ensure that limits and coverages are appropriate. In a soft market, underwriters were more willing to throw in additional coverages and limits; however, today those enhancements can be costly. Select the most appropriate plan based on your risk tolerance level. Compare the cost to retain risk versus insuring your risk.
Perhaps the most difficult decision you will face will be determining your liability limits. The umbrella and excess insurance markets have taken on some of the most significant price increases. Factors you need to consider are: What do my customers require? What is my company’s net worth? What makes me feel comfortable?
This is a personal decision with no precise formula. Making changes or reducing your coverages should only be done after a careful examination with your trusted advisors. This will allow you to effectively create and manage an insurance program that works for you.

Mike Natalizio is CEO and president of HNI Risk Services, a full-service insurance agency located in New Berlin, www.hni.com.

April 4, 2003 Small Business Times, Milwaukee

Commentary, By David Niles, SBT Editor

Those who want to see redevelopment in Milwaukee to help restore the city’s economic viability and national stature must be shaking their heads at recent development-related announcements.
One was called a "major victory." The other was termed an effort to help the less fortunate.
Neither will help the city but, rather, would provide additional incentives for people and businesses to move out to the suburbs and stay there.
The "major victory" was the recommendation of a Southeastern Wisconsin Regional Planning Commission study committee that no new lanes be added to I-94 within the city or to I-43 in the city and Glendale.
The other stifling recommendation is that development in the Park Freeway corridor be required to incorporate low-income housing and that any development provide "living wage" pay scales and health insurance.
They may be noble recommendations, but they are ill advised and would only serve to further impoverish the city.
Let’s talk about the freeway first. No community can thrive without a good transportation system; these days that means a good Interstate expressway system. While this paper supported the shortening of the Park Freeway in downtown Milwaukee, we at the same time support expansion of the main expressways that feed the community – I-94 and I-43.
Opponents of widening the expressways within the city argue that an expanded capacity would require that too many homes and business buildings be razed, would encourage more sprawl and would lead to greater air pollution.
The loss of homes and business properties is an incredibly real issue to those who occupy those properties, and a real issue to the city which garners tax income from the land. But any development involves a cost; we believe the cost in this case is worth the gain that an expanded freeway system would return to the city.
On the issue of sprawl, there is no doubt that suburban development accelerated with the development of the Interstate system in Milwaukee many years ago. Opponents of expansion say more lanes would just make it easier for people to leave the city. In other words, they believe artificial barriers should remain to prevent people from living and working where they want to. By not expanding the freeway, their logic goes, it’s more difficult to leave the city — never mind what people want to do.
Tragically, failure to widen the freeway in the city will not only make it difficult to head west and north, it will also make it more difficult for those who live outside the city to drive in for work, entertainment or any other reason.
The "New Berlin Wall" separating the city from the suburbs would only be reinforced.
On the air pollution issue, yes, more driving leads to more pollution. But there are ways to stem that – greater use of carpooling and intercommunity buses, among other conservation methods.
Ironically, Milwaukee was settled by both Native American peoples and by Europeans because of the great transportation afforded by its rivers and Lake Michigan. One has to wonder how the city might have developed had the anti-development forces defeated development of the St. Lawrence Seaway, the dredging of Milwaukee’s rivers and harbor, and the very creation of the harbor.
But what of greater mass transit now? Sure, work on rubber-tired systems. But leave rail out of the picture – it’s simply not realistic at this time in Milwaukee.
So now let’s look at the Park Freeway land. A group known as Good Jobs and Livable Neighborhoods wants development on the land to be burdened with costly regulations, including a requirement that at least 75% of jobs created by the developments provide a "living wage" and health insurance. Residential development should also include affordable housing.
Let’s say you’re considering the development of a new facility for your business. Would you welcome the additional regulatory and financial burdens? Or would you say "Forget it" and develop elsewhere? Probably elsewhere. And that elsewhere could well be the suburbs, leaving the Park Freeway land idle, generating little property tax income for the city and no jobs for anyone.
Then there would be an even greater need for affordable housing, and an even greater need for tax dollars to fund such housing.
On the other hand, how about just letting market forces determine what’s best for Milwaukee? We’d have a stronger, more prosperous community for everyone.

April 4, 2003 Small Business Times, Milwaukee