Jerry Roche

Wednesday, 25 April 2007 20:00

One-stop shopping

After too many years of leaning on several financial wizards for highly specialized advice, more Americans are turning to one “holistic” wealth manager.

“Holistic service can also be termed full balance sheet advice and guidance,” says Sandro Rossini, senior vice president and regional manager of Wealth & Institutional Management for Comerica Bank in San Francisco.

Smart Business talked to Rossini about how to select holistic wealth managers.

What capabilities are required to support holistic services?

Your provider should have the expertise and the product offering to address both your debt and credit needs as well as your liquid cash and investment needs. You need to get both investment expertise and traditional banking expertise in one house — and, in some cases, from one person.

Take, for instance, a successful business owner who has his net worth tied to commercial and residential real estate, company-sponsored plans and investment accounts. He’s extremely busy, so he needs someone who understands his overall circumstances and who can identify any gaps in his personal finances very quickly. That involves understanding both sides of the balance sheet, how his debts and investments work and how to add value.

How many people typically support that one big client?

While a multitude of people may be required to support the complex needs of a client, everything should be orchestrated by a relationship manager. He or she may call on the support of a portfolio manager to manage the investments, an insurance specialist to support insurance needs, and a financial planner to assess a retirement goal. A trust and estate expert can determine the most tax-efficient way to transfer his or her wealth to beneficiaries or a charity of choice. A good holistic wealth manager can partner with several dozen investment houses and ask them to manage a certain portion of the client’s money.

This is all run through a relationship manager so the client doesn’t have to pick up the phone and call 15 departments.

Where does a holistic financial adviser start?

A financial plan is the first step. This is your financial road map and you want it unbiased. Your adviser should collect and understand all components of your finances put together in a comprehensive way. Then he must prioritize according to your identified needs and your concerns.

For instance, your investments can be highly over-weighted in technology, which could cause your portfolio to drop significantly should the markets pull back. Your adviser has to recommend an appropriate allocation to match your tolerance for risk as well as your time frame for investing. Many people are not as diversified as they believe. For example, investments such as mutual funds may have many of the same stock or bond holdings. Deep analysis should uncover any over-concentration. An over-concentration means greater risk.

Or you may need a line of credit and the adviser will suggest you liquidate a particular holding instead of borrowing. Understanding which route to take means understanding the intricacies of investments and lending, and analyzing the pros and cons of each option as well as your priorities.

A good adviser cannot operate without a broad understanding of financial options.

How does someone choose such an adviser?

The first area is trust, which is an enormous component best built over time.

The second is capabilities. Can you go to one organization, one contact person, for the bulk of the services, understanding that the relationship manager may call on a variety of experts to support your needs?

Number three concerns the credentials of the individual relationship manager. You don’t need an expert in every single discipline, but he or she needs a good working knowledge of the important financial components like credit, cash management and investments.

Your other advisers might know what various organizations can bring to the table. Generally, you may rely on your CPAs, attorneys or even a staff financial planner for direction.

What if I’m not a $100-million-dollar man?

Middle-market clients or business owners don’t have a lot of liquidity. Money is tied up in the business, as it should be. That’s the time to start planning and protecting yourself with things like key-man insurance. What happens if you or one of your key partners disappears? How’s the business going to continue? How about succession? Have you considered a plan to pass the business’s assets to your next generation with the least disturbance to the company and impact on taxes?

Test-drive your financial institutions. They may provide you with research, support and salaried expertise and not make a dime on you today in order to win you as a client down the road, when you want to buy a house or sell the business or have a big liquidity event.

SANDRO ROSSINI is a senior vice president and regional manager of Wealth & Institutional Management for Comerica Bank, San Francisco. Reach him at srossini@comerica.com or (415) 477-3212.

Wednesday, 31 January 2007 19:00

Health/productivity management

When you feel healthy and energetic at work, aren’t you more productive? Don’t you think the same can be said of your employees? Isn’t one of your biggest challenges, then, providing a means for employees to stay healthy or — at worst — avoiding prolonged absences from work?

Smart Business talked to Terry Garrison, a San Francisco-based senior consultant with Watson Wyatt, a global human capital and financial management consulting firm, about ways that organizations can engage their employees in integrated health improvement and productivity management. Incorporating accountability empowers employees and minimizes the impact of absenteeism.

How can employers engage their employees to become accountable for improving and managing their health?

Most organizations believe they have the power to improve overall employee health and productivity and have, in recent years, provided employees with tools for making health care choices. Although employees seem to appreciate these services and tools, it does not always result in their improved health and work productivity. What is required is an integrated strategy that raises accountability and effectiveness of all stakeholders.

Incentive plans that simply reward people for improving their health often do not result in long-lasting behavior changes or lower health costs. Alternatively, employees are more likely to adopt long-term behavior change if they have a personal relationship with, and are accountable to, someone who can reinforce their self-determined plan for behavior change.

Integrated strategy starts by identifying individual employees with health risks through Health Risk Assessments (HRA) and reviewing medical and pharmacy claims data. Those employees can then be offered the services of a health coach who can offer personalized education about their specific health risks and help tailor a plan to address those risks.

Are there points where health management and absence management intersect that can improve overall program effectiveness?

Our research shows that integrating health and productivity best practices can result in desired health management outcomes and lower health care and wage replacement costs associated with absence. This is where the health coach is again effective by becoming a single point of access to support absence- and productivity-related programs.

Working in tandem with appropriate incentives can enable and support the desired behavior from employees. For example, we know that depression frequently occurs with a variety of physical illnesses and impairments, such as chronic lower back pain, and that people who suffer from chronic or catastrophic health issues are 60 percent more likely to be depressed and have 40 percent higher health care costs. A well-trained health coach can identify confusion and non-compliant behavior; identify whether a root cause is depression; educate the employee on the effects of depression and various treatment options available under the employer’s benefit program; and refer him or her to appropriate mental health resources.

How can internal workplace and HR policy and practices promote health and productivity?

In recent years, employers have become better in managing employee health productivity, but they still have room for improvement. A key component is making managers and supervisors accountable for supporting company health care strategy. To accomplish this, however, you have to have incentives for managers to care about whether people are at work, as well as training and tools to help them follow through on policies.

How does vendor management fit into this new equation?

Many national health and disability carriers use a variety of subcontractors. The result is that some organizations have up to 10 vendors addressing various components of their health and productivity programming.

We recognize that it is rare for employers to find one or even two vendors that meet best practice for all their health-management and absence-management program needs. To address this, we endorse annual summits that engage vendors to discuss the various functions they perform and then collaboratively develop a plan to align and optimize roles and processes. Undoubtedly, organizations that establish strategies to evaluate the effectiveness of their entire vendor continuum will fare better at managing their health and productivity outcomes.

What kind of results will a company that follows these suggestions expect to see immediately and down the road?

Research shows that successful health-and productivity-management programs produce a positive return on investment of 3:1 to 7:1. Typically, it takes 18 to 24 months to see the first positive returns, though some components may produce in a shorter time frame.

TERRY GARRISON is a senior health and productivity management consultant in the Group Health Care Practice at Watson Wyatt’s San Francisco office. Reach her at (415) 733-4404 or terry.garrison@watsonwyatt.com.

Thursday, 21 September 2006 20:00

Caught unaware?

Many companies in the State of Ohio have an obligation to obtain a use-tax account number and file use-tax returns on a regular basis but are unaware of this responsibility. If your company does not regularly review its purchases for potential risk to use tax, it could face mounting financial liabilities and penalties.

“Reviewing a company’s use-tax exposure is most often a specialized service offered only by boutique consulting firms, but it’s part of the overall relationship with our clients,” says Michael J. Stefanek, a partner with Skoda, Minotti & Co. “We work hard to keep clients apprised of things like this that can negatively affect their business. We have also found many nonclients in need of this service. You never know when the hammer’s going to drop.”

Smart Business discussed Ohio’s use tax with Stefanek.

What, specifically does Ohio’s use tax cover?
The use tax is basically a parallel to sales tax in Ohio, imposed on consumers or purchasers of tangible personal property or taxable services that are consumed, used or stored here in the State of Ohio. All companies are subject to a use-tax reporting requirement when a vendor does not charge Ohio sales tax.

With every general rule, of course, there are exclusions and exemptions. For instance, there is a manufacturing exemption for manufacturers buying materials to be used in a manufacturing process, which is elaborately defined statutorily and in case law.

But if a company buys 20 computers online for its office here in Ohio and the online vendor doesn’t charge Ohio sales tax, that company would owe Ohio use tax for those items. The company must register with the state, obtain a use-tax account number and file use-tax returns on an annual, quarterly or monthly basis, depending on the level of purchases.

The burden is on the taxpayer to report the tax. But, unlike individuals, businesses are a more likely candidate for an audit because bigger dollars are involved.

What are the risks of not filing use-tax returns?
The longer it takes for a company to finally recognize that it hasn’t been paying the tax, the greater the risk becomes. Certain capital-intensive businesses are more at risk than others, especially those making large purchases of materials or equipment.

If a company never filed a use-tax return, the State of Ohio can technically audit back to its first day of business. However, if a company has been filing returns, then there’s a four-year statute of limitation from the date of filing.

For companies that haven’t been aware — or haven’t filed use tax returns — it would be advisable to first assess what their exposure might be. There are courses of action that can further minimize any obligation. If a company determines that it owes money and never registered, it has the ability to approach the state — through an adviser — on an anonymous basis and ‘come clean.’ This voluntary disclosure process is similar to tax amnesty. In this process, the state generally will agree to limit the audit look-back period to 39 months with no penalties.

Are certain companies more at risk for use-tax audits?
The use tax is applicable to every business, but the State of Ohio is aggressively pursuing construction businesses that don’t have an account. It seems more applicable to subcontractors and trade organizations than general contractors, because they’re making a lot more material and equipment purchases. It applies to home-builders and developers as well.

The main area of the state’s focus is the alleged abuse of tax-exemption certificates. Take an HVAC contractor that buys bulk sheet metal to fabricate into ductwork for installation on its construction jobs. The company will typically work for both taxable and tax-exempt customers. It’s not obligated to pay sales tax on the sheet metal if it is ultimately incorporated into nontaxable jobs, but some companies may use the same materials and tools on taxable jobs as well.

Keep in mind that the little things add up. For instance, if a company purchases several small tools or supplies under a tax-exemption certificate, the burden is on the taxpayer to prove to the State of Ohio that one of those tools is used only on tax-exempt jobs. This is a difficult burden to bear for most companies.

MICHAEL J. STEFANEK, CPA, is a partner with Skoda, Minotti & Co. The John Carroll University graduate has more than 13 years of experience in public accounting. His emphasis is on federal, state, and local taxation. Reach him at (440) 449-6800 or mstefanek@skodaminotti.com.

Thursday, 21 September 2006 12:32

Computer science grads

If a business is to keep ahead of its competitors, it had better keep ahead of them technologically. These days, the success of a company is most accurately reflected in the faces of its computer system architects, programmers, analysts, network managers, engineers and IT directors.

And it’s up to today’s educators to make sure that computer graduates are on the cutting edge of technology.

“A Bachelor of Science degree in computer science is not the right major for every job in the computer field,” says Ron Hartung, program chair of the computer science programs at Franklin University. “The field is becoming a little more specialized.”

Smart Business talked with Hartung about the past, present and future of computer education.

What are some of the major fields of study in computer science?
Our curriculum is always changing. There isn’t a single course that’s the same now as it was in ‘91. We offer four undergraduate majors in the computer and information science area: management information systems (MIS), computer science, information technology, and digital communications (Web design and e-marketing).

We find out what kinds of things our students want to do and guide them to the program that takes them in the right direction.

Where is the field of computer science headed, and how can today’s students plan ahead for that time?
It’s abundantly clear that our society cannot live and function without computing. But computer use is becoming focused more on what the user does and less on the older centrally controlled view of computer systems. So in the future, computer scientists will have to be more involved with the rest of the world, in order to find out what users want and need.

Also, the business world is becoming globalized. Because of information technology, we can move just about any job anywhere. We can ship the information overseas and get it back in a heartbeat. So part of the challenge is having a global mindset. And that mindset needs to be a permanent approach for anyone who wants to move their business forward.

Is the educational community clear on curriculum requirements for its computer students?
Computer scientists used to be people who wrote little bitty standalone programs. Now they’re much more about integrating multiple pieces into bigger systems; fitting them into an infrastructure of a business.

That’s a big part of a multi-faceted, vibrant debate.

As educators, one of our mantras is that computer science is more than just programming. Students have to know how to program and much more.

Is that why some schools are offering entirely new courses, like software architecture?
Our curriculum pays a lot of attention to enterprise architecture and enterprise systems. We also teach trade-offs — that is, looking at economic value equations in terms of how we build computer systems. Those are the high-level skills, but you still need software engineering, development and basic business skills.

We can’t fully replicate all the experience that students need in the real world, but our programs are based on teaching people architecture, because we think that’s where business is going.

What are the other obstacles that graduates face?
From an educational point of view, a big problem is getting into the field for the first time, because a lot of companies are still looking for specific skills and years of experience. So we’ve instituted what is called a ‘practicum,’ which is a simulated business that has all the normal job functions that you would have across the computer science spectrum.

The practicum is done to an industrial standard in a real way rather than in the abstract setting of a college classroom. It’s an attempt to fully simulate a state-of-the-art, well-run business.

In the end, all the things the students did — their projects, evaluations, progress reports — will get bound together into a CD-ROM portfolio that they can show prospective employers.

Given that the field of computer science is evolving almost by the day, what continuing education is available?
This is a field that requires lifelong learning. Whatever you learn in school will change within a few years. Maybe not a lot, but computer scientists will still have to grow and change with it.

One of the options we offer is called a ‘subsequent degree.’ In that program, we can teach computer programming to people who are degreed in other fields, because computer sciences cross through so many different domains.

Computer science is a continuously growing field. The jobs are out there, and in demand. They aren’t going away.

RON HARTUNG, Ph.D., is program chair of all the undergraduate and graduate computer science programs at Franklin University. Reach him at (617) 947-6139 or hartung@franklin.edu.

Thursday, 21 September 2006 05:41

E-mail and the courts, Part II

E-mail, unheard-of in the business world before the mid-’90s, is now its leading method of communication.

Along with e-mail’s benefits, however, come increasing risks and responsibilities — all focused on the actions of employees who create, send, forward or save electronic communications. For this reason, business concerns should establish a strict set of standards for all employees. Failure to adhere to those legal policies places both the company and the individual at risk for legal or financial liabilities — not to mention potential public embarrassment.

“This area of law is in its infancy,” says Dan Albers, a partner in the Intellectual Property and Litigation departments at Barnes & Thornburg LLP. “The law is evolving because there’s not a lot of precedence.”

Smart Business asked Dan Albers about privileged correspondence and the admissibility of e-mails in court.

Legally, what is the purpose of labeling e-mails like ‘Attorney-Client Privileged,’ ‘Not Public Data’ and ‘Trade Secret’?

If you label an e-mail, it at least allows you to show the court your intent at the time, so you’ll have more of an argument. It’s also easier to find those e-mails and try to protect them when they’ve been labeled for purposes of litigation.

It’s very important that ‘Attorney-Client Privileged’ communications be labeled and be maintained in a privileged way — meaning that people not responsible for legal decision-making do not receive those e-mails.

‘Not Public Data’ or ‘Trade Secret’ e-mails contain proprietary information. Most courts have said that, in order for something to be treated as proprietary (a trade secret) the company must have taken reasonable measures to protect it from public dissemination. One of the ways you do that is to have instructions that certain kinds of information will always be labeled, and the dissemination list would always be limited to those people who would be involved in using that information for a business purpose.

The absence of both these labels can also have the opposite effect. Opposing counsel might ask how the originator expected an e-mail to be treated in a confidential manner if it wasn’t properly labeled.

What is the value of maintaining e-files in their original form?
If you’re going to use them in any substantive way in litigation, you need to maintain them in their original form to get them into evidence. Just like any other document, you need to show the original or a copy that has not been changed in order to have a basic foundation for getting it into evidence. If you cannot make that showing, there may be an inference drawn against you that you’re liable.

What can corporations do to help prevent being taken to court for abuse or misuse of electronic-based communications?
The most important thing is to have a corporate policy in place and have it incorporated into your employee manual.

The company should have access to all e-mail and electronic communications for company purposes at any time.

Whenever the company believes that it is likely to be involved in litigation, there must be some form of memorandum to the appropriate people to maintain electronic files.

The most important thing is to not destroy what would or could be relevant electronic discovery. If it’s destroyed, any favorable information will be unavailable. And you would much rather be able to respond to the substance of an e-mail, because it’s almost impossible to disprove any inference that an e-mail was destroyed for no reason.

Finally, employees should not publish in e-mails their conclusions about relationships with other companies, or potential litigation such as patent infringement, copyright infringement or legal liability. Crafty lawyers will get those e-mails into evidence, and their effects will be almost impossible to overcome.

Is copyright protection an important legal issue when it comes to electronic communications?
It depends on what material is being used and what it’s being used for. If you want to cite particular portions of copyrighted material that you think are relevant — with the source — that’s probably fair use and not a copyright violation.

But when a person takes copyrighted material — for example an article or product brochure — and sends it out across an entire business for the uses of carrying on the business, that could be a violation. Because it’s not being transmitted publicly, though, the question is, how is the copyright owner going to know it happened?

Copyright protection should be on the alert list for people who are responsible for use of internal Web sites, and they should discourage full use of copyrighted materials.

DAN ALBERS is a partner in the Intellectual Property and Litigation departments at Barnes & Thornburg LLP. Reach him at (312) 214-8311 or dalbers@btlaw.com.

Wednesday, 20 September 2006 10:39

IT shared services

"Shared services" in a business context means converging or streamlining functions to ensure the efficient and effective delivery of services -- including information technology.

IT shared services typically fall into two categories: operations, such as the data center management, network services, help desk and maintenance; and project-based, such as applications development and systems implementation.

Smart Business talked to Matt Keelan, consulting manager and IT director for Avvantica Consulting, LLC, about factors to consider relative to IT shared services.

What are IT shared services?
IT shared services are the centralization, standardization and consolidation of a company's IT functions. These IT functions often get fragmented as a company grows -- especially through acquisitions when it inherits another company's people, processes and technology. When you consolidate, you get economies of scale, more buying power, shorter vendor contracts and better service. The keys to a successful shared services implementation include a strong technical infrastructure and well defined SLAs (service level agreements).

Elaborate on what you mean by SLAs.
The use of SLAs represents the key difference between shared services and a centralized function. The reason is that SLAs require the provider and consumer of the services to work together to agree on key service attributes such as quality, speed, cost, etc.

As a result, an SLA essentially becomes an 'internal contract' between IT and its internal clients for those services that are to be provided. This contract needs to be negotiated and executed similar to any other formal business agreement. It should clearly define the services to be provided, the time frames within which they are to be provided, quality levels, costs, etc.

For example, 'three-nines availability' (or 99.9 percent uptime) is a common SLA for software systems. This is easily measured by dividing the number of minutes the system was actually available by the number of minutes promised in the SLA.

Do SLAs impact the cost of IT shared services?
Yes; service levels related to IT largely depend on the investment made in a company's technical foundation or infrastructure. This investment should be directly related to two key factors. First, the recovery point objective (RPO) is the amount of data you're willing to lose due to an equipment failure. It's the maximum time between the last backup and the time of failure.

Second, the recovery time objective (RTO) is the elapsed time between the failure and when systems are back on line.

The shorter the RPO and RTO, the greater the required investment. In the end, it is a business decision whether a company needs a 'bronze,' 'silver' or 'gold' level of service. As an example, a bronze level may mean an outage of a week or more while temporary office space is found and new equipment is ordered. At the other end of the spectrum, a gold level of service could mean an outage for as little as five minutes. Depending on the size of the company, the silver and gold service levels usually require a significantly higher investment relative to bronze.

What impact does the technical foundation have on shared services?
Technology 'enables' shared services and determines the SLAs that it can offer. For example, server and network monitoring tools can identify issues and alert IT in time to resolve them before business hours. This greatly impacts the availability (up time) that IT can support. Monitoring tools also allow just a handful of system administrators to manage literally hundreds of servers on a world-wide network. Other enabling technologies include SANs (storage area networks), which centrally store all of a company's electronic information, and auto-loading tape drives, which allow for the unattended backup of terabytes of information. SANs and auto-loaders also reduce the cost of system administration and greatly simplfy disaster recovery.

How are IT personnel impacted by shared services?
Shared services greatly reduce the redundancy found in a fragmented organization. Instead of each location building its own IT department, shared services can leverage fewer system administrators across multiple locations and reduce the number and level of IT personnel required in the field. A more centralized group can also afford to hire personnel with a greater level of skill and experience, since their costs are shared by the larger entity. For the individuals in the IT shared services group, there are typically greater opportunities for professional growth and development.

Are IT shared services for everybody?
They're not. Many companies have regional operations that work just fine on an independent basis. Shared services may make sense if you have highly-redundant IT staff and services, many contracts with the same vendors, or if you're a public company that struggles with the high cost of compliance with the Sarbanes-Oxley Act (SOX). In the final analysis, the decision should be based on the requirements of the business supported by a comprehensive cost/benefit analysis.

MATT KEELAN is consulting manager and IT director for Avvantica Consulting. Reach him at (214) 379-7920 or MKeelan@AvvanticaConsulting.com.

Thursday, 29 June 2006 12:07

When financial institutions merge

What happens when your bank merges with or is aquired by another bank? Do you panic? Or do you try to stay in touch with your account officer and sort things out together?

“Every organization has a unique culture,” says David Janus, president of First Merit Bank’s Cleveland Region. “If I were a business owner, I’d give myself a chance to see if the new bank is a fit or not. You won’t know right away, unless you had previous experience with that particular bank.”

Janus spoke with Smart Business about the sometimes daunting experience of seeing your favorite financial institution involved in a merger or acquisition.

How are bank mergers/acquisitions different than corporate mergers/acquisitions in other industries, or are they?
The motivation for the corporate takeovers you read about in the newspaper is probably the same as the takeover for a bank: increasing market share, lowering expenses, earnings-per-share growth, acquiring specific products or geography. I don’t think the banking industry and other industries are much different from each other in this regard, because they all address the same constituents — that is, their shareholders.

If I am a commercial customer, and I hear or read that my bank is involved in a merger/acquisition, should I be concerned?
Near and dear to most companies’ hearts — especially middle-market companies — is what’s going to happen to their credit relationship. For small to mid-sized companies, the bank can be their sole source of financing. Don’t overreact. Most people tend to think the worst: ‘I’m going to lose my line of credit,’ ‘I’m going to lose my loans.’

Make sure you talk to your relationship manager and his or her boss. You want to know information about the other bank and its reputation. Sure, there are going to be a lot of ‘I don’t know,’ answers because they really don’t know. These company integrations take time to iron out all the issues.

Banks in general need more customers to grow their business. They don’t merge or acquire another bank to kick customers out. That’s counterproductive.

You may, however, be in an industry or business — like a parts supplier to the auto industry — that’s higher risk in the current economic environment. So you may need to know how the new bank views your business. It helps if you know multiple people in multiple positions at the bank. The credit guy knows your business well and knows you well, and he or she may be in the best position to be your advocate and to give you the benefit of the doubt during difficult times.

How important are bank/customer relationships?
Bank/customer relationships are the most important thing. Merger or no merger, you need to have a relationship with the bank. If you know your relationship manager well and you know the team leader or regional manger, you’ll be as informed as you can be. It’s the companies who don’t have deep, ongoing relationships who are kind of left in the dark.

What are some of the advantages and disadvantages of banking with an institution that has gone through a recent merger?
One advantage may be new product and service offerings the combined bank may have. For instance, if your company needs to do a lot of international business, it’s a benefit to you if your regional bank is acquired by one with international services and foreign offices.

On the other hand, banking with a bigger bank has the potential to be more expensive on some fronts, while product offerings may be more standardized and less customized. Another concern I often hear is that people feel like a number at a big bank. Well, I know first hand a lot of relationship managers at big banks who made customers feel like they were dealing with a small bank because they provided great customer service and good communications.

Are the changes after a merger more likely to be of a systemic or personal nature, or does it vary widely depending on the institutions?
I would ask my account officer how he envisions the merger impacting my relationship with the bank. Is your relationship in jeopardy? Will it cost you more? Are same products and services going to be available?

On the personnel level, mergers typically don’t impact all the way down to the account level. Chances are you’ll have the same account officer, because the new bank needs someone to service your account. What may change is the credit guy or regional and senior managers.

Also, there will probably be a different product offering. You may fit well into a product that your new bank has, so you might able to save money. Or, the new bank may have a higher fee schedule.

DAVID JANUS is president of First Merit Bank’s Cleveland Region. Reach him at (216) 694-5658.

Monday, 26 June 2006 09:49

Weight-loss surgery

The number of people treating their obesity with a procedure known as bariatric surgery has increased dramatically in recent years. In 1999, fewer than 30,000 bariatric surgeries were performed in the United States. By 2003, it had climbed to more than 100,000, according to a study by the Journal of Managed Care.

Unfortunately, only about 9 percent of U.S. adults with private insurance are eligible for bariatric surgery, mainly because some health insurers have excluded it as a covered benefit.

Even more important, bariatric surgery may translate into financial benefits to health-care-conscious corporations if it results in fewer future medical expenditures — which it has been shown to do.

“Bariatric surgery is growing rapidly,” says Walter J. Chlysta, MD, FACS, and medical director of Akron General Medical Center’s Bariatric Center. “More people are considering it, and more and more are having it.”

Smart Business talked with Chlysta about what bariatric surgeries are available, what they can do and how it might impact upon the companies the patients work for.

Why bariatric surgery?
Overweight or morbidly obese patients tend to be more susceptible to other health problems, like diabetes, hypertension and sleep apnea. A lot of them have personal issues, like they can’t take their kids to amusement parks and ride the roller coaster with them. They’re embarrassed or they feel that their kids are embarrassed of them.

For most patients, it’s not a vanity issue. Most are genuinely concerned about their health or how their obesity is affecting their family.

What bariatric surgeries are most common?
With gastric bypass surgery, the stomach is partitioned off into a small pouch, and the intestines are divided and rerouted. So you not only eat less food, but the food you do eat does not get absorbed as well.

Lapband surgery inserts an adjustable band across the top of the stomach. You create a small pouch at the top of the stomach. As opposed to gastric bypass, lapband only works by one mechanism: restriction. It’s not as effective as gastric bypass, but it is the safest procedure.

Gastric bypass surgery takes two to two-and-a-half hours, and lapband takes 45 minutes to two hours.

What are the side effects?
There are side effects, mostly good. Many obesity-associated diseases are resolved completely or improve dramatically with weight loss, whether it’s surgical weight loss or medical weight loss. These diseases include Type II diabetes, high blood pressure, sleep apnea, arthritis, urinary stress, incontinence and many others. There is a decreased risk for certain cancers, stroke, coronary disease, and congestive heart failure. Patients who have conditions like congestive heart failure or emphysema where the damage is already done to the heart and lungs still usually improve with weight loss. This is not because the damaged heart or lung tissue is repaired with weight loss. It is because there is less work for the heart and less restriction on the lungs. These patients see increased mobility, less shortness of breath and overall improvement of their health. These people are able to function better ... to take fewer sick days off work, to be more productive. Any business manager would be concerned about those issues.

What are the risks?
Just like any surgery, there’s a risk. The risk also depends on patient and his or her health problems. If they’re young, healthy patients, there’s less risk. If the patient has marginal lungs, marginal pulmonary capacity or has had prior heart attacks, then the risk is increased. There’s healing issues too: if someone is a smoker or diabetic, they’re more likely to get infections.

But the benefits outweigh the risk by far, and you try to tailor the surgery to the patient.

What, generally, is the postoperative prognosis?
First of all, the weight is likely to stay off. Bariatric surgery is the best way to lose and sustain weight, and that’s been proven. Just 10 percent to 20 percent of postoperative patients will have a significant weight gain, and that’s variable.

Patients have to take calcium and B12 vitamins or they can run into problems. The long-term issues are nutritional issues, but as long as you take your supplements, the vast majority of people are OK.

As for aftercare, some people can tolerate things well and some can’t. Many patients don’t need it. They have the surgery, they lose the weight, they move on. A few need continuing support. If they need help, it’s there. We have a support group that means once a month, and we have an online support group on Yahoo. We provide access to a bariatric coordinator and dieticians by phone or with an appointment if needed. Dieticians, physical therapists and psychologists are available for consultations.

WALTER J. CHLYSTA, MD, FACS, is medical director of Akron General Medical Center’s Bariatric Center. Reach him at (330) 344-6000 or wchlysta@agmc.org.

Thursday, 30 March 2006 05:01

Alternative dispute resolution

In the legal world, alternative dispute resolution (“ADR”) is any means of settling disputes outside the courtroom. Because of overcrowded court dockets in many states, both mandatory and voluntary ADR programs are becoming more common.

The two most frequently used forms of ADR are arbitration and mediation. Arbitration is a simplified version of a trial. Either both sides agree on one arbitrator, or each side selects one arbitrator, and the two arbitrators elect a third to its panel. Arbitration hearings can take a few hours or a couple of weeks. The opinions are not public record. Mediation is less formal. It’s used for resolving a wide gamut of case types.

“The size of a dispute does not say whether it’s going to court or mediation,” notes Tom Allen, a partner and head of the Reinsurance Practice Group at White and Williams. “For instance, mediation played a very big role in huge cases between various governments and Microsoft.”

Smart Business asked Allen more about alternative dispute resolution, and here’s what he said.

In your experience, what are the most common kind of disputes that corporate managers seem to face?

Any kind of a dispute involving contracts, ranging from a contract to sell something or a contract to buy a business — which is always very dicey — to a contract of insurance. Corporations are also involved in employment disputes of all kinds.

What are the most common ways of settling those disputes?

If it’s enough of a dispute, the most common way is to go to court. That gets you involved in a very formal process that is a pathway to resolution. However, courts are expensive; they can take a long time; and there is a bit of uncertainty about whether you’ll really get a knowledgeable resolution.

What are “alternative dispute resolutions”?

Many court systems use alternative dispute resolution as part of their bag of tricks. The most common forms of ADR are arbitration and mediation. Arbitration is a binding process that should be faster, more economical and better than going to court. When you go to arbitration, you try your case in front of one or three arbitrators, and they issue a binding decision. In the mediation process, both sides present their cases to a mediator who tries to work a resolution in the form of a compromise. There is now an industry of capable and experienced mediators who are very, very good at working out disputes.

Are mediators and arbiters lawyers?

Most of the mediators are lawyers.

Arbiters sometimes come from the industry that is involved, so you should get a more knowledgeable fact-finder than a judge or a jury. For instance, if an arbitration clause is written into a reinsurance contract, the arbiter is likely to be involved in the reinsurance industry. Arbitration has a huge advantage over litigation, because it’s more efficient.

How often are contract or corporate lawyers needed for ADRs?

In arbitration, it’s pretty common for both the outside lawyer and inside (corporate) lawyer to be heavily engaged and to take part, just as they would for a lawsuit in court. For mediation, companies often use outside lawyers, too; but sometimes the dispute is less elaborate and formal, so an in-house lawyer or even the businesspeople themselves can handle it.

How do you determine what kind of dispute resolution is the best?

Whether a matter should go into mediation really depends on an assessment whether the parties to the dispute have a substantial overlap of shared interests. If they do, you can capitalize on those interests and work out a resolution. If the relationship between them doesn’t matter — if they’ll never see each other or do business with each other again — then mediation is less likely to be chosen.

With ADR, can both parties come away happy?

If a lawsuit or arbitration goes all the way to verdict, I’d say there’s usually a happy and an unhappy side. A judge simply doesn’t have the power to issue a verdict that’s a sensible compromise. In the litigation and even in the arbitration system, there are lots of pressures to settle.

Mediation is a little bit of a different animal, because the mediator is trying to capitalize on the shared interests of the parties. Some of those professional mediators have a bag of tricks that is dazzling when they employ them. The key is that the mediator is free to be creative to put together a solution. Very often, both sides walk away from a mediation feeling that it was a good process.

TOM ALLEN is a partner at White and Williams LLP and head of the firm’s Reinsurance Practice Group. Reach him at (215) 864-7001 or allent@whiteandwilliams.com.

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