Volume 3, No. 5
July 2007

New Big George's Store on Stadium in Ann Arbor
Big George's Unveils
Their New Location

777 building in Ann Arbor nears 100 per cent occupancy
777 Building Nears
100 Percent Occupancy

Be Sure To Read BIZ MO's
Regular Feature Writers:

Mike Gould
Small Business & The Internet

Stewart L. Tubbs
The Leadership Secret

Mel Muskovitz
on Employment Issues

Newcombe Clark

Ann Arbor Area BUSINESS MONTHLY magazine brings the reader the latest business news and information important to the businesspeople in Washtenaw County. Each month articles cover real estate, legal, Internet, employee concerns and the climate of business in the greater Ann Arbor area. There is news about company employees and feature articles on local businesses. We cover business news from Ann Arbor, Chelsea, Dexter, Manchester, Milan, Saline, Whitmore Lake, and Ypsilanti.

The Business Of Surgery

By Sarah M. Swanson

Within a relaxing and inviting office at the Michigan Brain & Spine Institute, three orthopedic spine surgeons and three neurosurgeons work side-by-side to help patients with serious health issues affecting the brain and spine such as cancer, scoliosis, traumatic accidents, skull fractures, and many other disorders.

Douglas Geiger, MD, of the Michigan Brain and Spine Institute
Douglas Geiger, MD, of the Michigan Brain & Spine Institute.

This unique group of surgeons along with nearly 30 employees is paving the way as a winning combination of medical expertise and business savvy.

Administrator Jorge Lopez says the combination of orthopedic spine surgeons and neurosurgeons is a rare and unique selling point where patients with spine and brain problems can receive the most complete care available. This gives the practice a competitive edge.

"No other practice as large as we are has this combination of neurosurgeons and orthopedic spine surgeons," says Lopez. "We are one of kind for our size, and I would venture to say that is nationally."

Orthopedic spine surgeon Douglas Geiger, M.D. calls the practice "a good marriage." He agrees that the unique aspect of the group is the representation of orthopedic surgeons and neurosurgeons in one practice.

"The reason it works for us is because we have a lot of respect for each other and for the skills and training we bring," Geiger says. The physicians in this practice point out that traditionally orthopedic spine surgeons and neurosurgeons have approached medicine in their own fashion. In 1993, orthopedic surgeon Mark Falahee, M.D. along with another physician started an innovative practice that meshed neurosurgery with orthopedic surgery; this led to Falahee's current practice where he is one of five principals. A sixth surgeon is employed by the group.

Taking this direction proved to be a benefit for patients as well as a solid business move for the partners. As neurosurgeon Jason Brodkey, M.D. points out, "We blended two totally different trainings and merged it into one practice so we can cover all of the brain and all of the spine for our patients." Brodkey is the managing partner for the practice.

These physicians agree that patient care is the number one priority, but they also realize having an entrepreneur mindset and a good business plan helps them outpace the competition. Lopez, who came to the practice two years ago with a Masters degree in Public Health from the University of Michigan, had the expertise and vision to advance the business in new directions.

"My philosophy is, and the physicians concur, good practice is good clinical care," explains Lopez. "There is a dynamic of balance between the business infrastructure and the clinical practice." Lopez feels in the past the business side of a medical practice was often run by office managers without sophisticated training in business and financial aspects. Lopez was ready to change that.

He took an inventory of the strategic vision of the practice and along with the physicians set sites on a capitalization plan including more accurate testing, better patient services, digitalized x-rays, and a new electronic medical records system to eliminate the need for paper files. He also recognized the importance of creating relationships with outside entities such as financial institutions and IT vendors as a way to help operations run smoothly.

To launch preliminary discussions about the vision of the practice and how to capture it, Lopez organized a one-day retreat where he reported out to the physicians on industry and regional back surgery and pain management trends. The group recognizes that as the Baby Boomers generation ages, more back pain and spine problems will arise. The retreat aimed to identify goals and objectives for the practice and better ways to serve the growing number of patients.

"We're dynamic from a growth and entrepreneural perspective," states Brodkey. "It's all about patient care and surgery. That is number one." He acknowledges the group is also "shaking and moving" in making the practice a regional presence, looking at the future of multi-specialty practices as the cost of solo practices rises, and examining market trends. Strategy and planning are key to moving ahead.

Additionally, the physicians recognize that having a dedicated staff including three physician assistants (PAs), nurses, medical and x-ray technicians, billing specialists, schedulers, clerks, and receptionists plays a strong role in their success.

"It's a very happy working environment," says Falahee. "We're not like ivory towers. The door is always open for our people." The physicians strive to communicate with all of their employees. Geiger says running the business means also being responsible for their employees' livelihood.

"Everyone who works here is closely tied to the surgeons," he says. "We have a lot of long-term employees." A recent 3000 square foot expansion of the office was done not only to serve patients better; employee privacy and comfort were factored in as well.

Additionally, the practice has invested in state of the art equipment to better their business. Fallahee says, "We're not just grinding it out. We are interested in new techniques and what others are doing and learning." Fahalee has a special enthusiasm for new inventions and products. Neurosurgeons Geoffrey Thomas, M.D. and Martin Buckingham, M.D. have been trained to use the high-tech Cyberknife at St. Joseph Mercy Hospital, an advanced robotic radiation device that treats cancer without limiting the patient's mobility.

One of the most exciting changes to the Institute's practice is the ditgitalized x-ray unit which was added in 2007. This mammoth piece of equipment weighing 3000 pounds has revolutionized the way x-rays are taken and viewed. Traditional x-rays take 13-15 minutes to develop and are bulky to transport. Digitalized x-rays can be viewed by the physicians within seconds or sent via computer to other locations. Doctors can see the images on their Notebook computers or on large screen monitors mounted in some of the rooms at the Institute. Digitalized x-rays can be adjusted and rotated, thus minimizing the need for retakes.

A full-color wall mural of a beach scene complete with palm trees helps patients feel less intimidated during the x-ray procedure. Additionally, patients can remain standing which is beneficial for those experiencing pain upon bending or laying down.

Buying the digitalized x-ray is an example of how the small corporation is outpacing the large because "we are able to make decisions and act quickly," says Geiger. "We talked about it and had it up and running in a fraction of the time a hospital would." This practice is the only one of 30 in their building with the digitalized x-ray machine, and according to Geiger is another example of thinking forward, remaining competitive, and doing what is best for the patient.

In other changes, the physicians recognized the need to more effectively respond to referring physicians and patients. They tightened up their communication processes, and employed three PA's to help with their patient load. The practice also expanded their offices. While the main office remains on the St. Joseph Hospital campus serving Ypsilanti and Ann Arbor, satellite locations have been added in Chelsea and Brighton. Geiger stresses the importance of "getting out of the backyard" and being physically closer to their referring physicians and patients as another avenue to maximize their business strategy.

Additionally, Brodkey, who is Board Certified in Pain Management, spends one day a week in an office with a doctor specializing in pain management. This is yet another example of how the Michigan Brain & Spine Institute strives to bring a myriad of benefits to their patients. Brodkey feels that working with people with chronic pain means understanding all of the options for treatment including medications, needle treatments, and spinal cord stimulation. Brodkey says, "Adding this spectrum is something other practices don't have."

Brodkey explains that without this knowledge care can lead to disconnect for patients. Doctors want to be able to work closely with patients who may be frustrated by their pain levels and who could be at risk for drug tolerance, dependence, or addiction. As part of this pain group, Brodkey meets with a pain doctor, case workers, addiction specialists, psychologists, and rehabilitation specialists to ensure there is a plan of action for chronic pain patients. With this in place, Brodkey says, a patient's outcome is markedly better.

"There is a lot more to operating on a patient," he says. "You have to know when to get pain doctors, when to operate, and when to follow-up with other doctors."

Lopez adds that the Institute has its own consortium of practitioners who specialize in back care including acupuncturists, chiropractors, a physical therapist, and other clinicians. He asks, "At what point do you decide you have exhausted treatment and need to go to the next level? All of these practitioners have an appreciation for each role. Then the patient is educated and aware of all of the steps. This multi-specialty approach keeps the practice ahead of its competition by offering their patients options, a plan, and hope for recovery.

Falahee says, "There are three things our business offers. One is immediate access. We get you into the system, and we don't abandon you. The PA's can do the initial evaluations and follow you even after you leave the office. Two is you will get high quality multi-specialty care. We have conferences each Wednesday with neurosurgeons, orthopedic spine surgeons, pain doctors, nurses, the rehab doctor, etcetera to discuss cases. Three is what you see is what you get. The same doctor evaluates you, discusses the plan, and does the surgery. This is comforting to the patient."

The physicians at the Michigan Brain & Spine Institute, including orthopedic surgeon Jeffrey Pinto, M.D., recognize with their combined expertise, training, backgrounds, and state of the art practice they can handle nearly any brain and spine health issue. Looking toward the future, Geiger considers whether the practice should engage in more marketing strategies; the practice already utilizes an informational website (www.mibrainandspine.com).

However, Geiger says, "We've been fortunate to rely on word of mouth, reputation, and patient referral. The strongest marketing piece you can have is to do a good job and have people talk about it. In the end, the person who benefits the most is the patient."

Lopez admits that at times the job is stressful. The physicians' schedules and the office pace can be hectic. Lopez stays busy reporting to the surgeons, looking into the infrastructure, maintaining relationships with staff, and even recently fixing a broken window that could have endangered employees.

"You do what needs to be done. Personally it's being mindful of putting things in balanced perspective and having a sense of humor," he says, pointing to a rock on his desk that says simply says BALANCE. Lopez says the surgeons and the staff are like family. They watch each other's back and work as team.

As for the future, Falahee sees more consolidation of specialties as surgeons and non-surgeons merge into "one-stop shopping for patients." This philosophy will capture more aspects of the market and will evolve as practitioners find new ways to deal with rising health care costs and the need for multi-specialty practices.

The Michigan Brain & Spine Institute with its unique group of surgeons, new technologies, mindfulness toward total patient care, and strategic vision for business growth is proving to be a forerunner in the trend for business smart, multi-specialty health care of the future.

"I love my job," Lopez says, "And I am fortunate that we have such a great group of physicians and Board members which makes working for and with them professionally and personally rewarding."

Communicating With Customers In 2007

By Mike Gould

We live in an era of increasing channels of communication: email, the web, smartphones, and all the other technical marvels we use are constantly clamoring for our attention. But ultimately, business is about people talking to people - vendors talking to buyers, service providers helping clients, and all the other transactions that make up the business environment.

To find out what local businesses are doing that is new and different in the way of customer communication, BizMo talked to four business people in different sectors of the local economy.

"The more information, the better" - Ted McMullen
Ted McMullen is Vice President and Director of Leasing for McMullen Company, now in its fourth generation of Ann Arbor real estate, with projects ranging from downtown to the original development and ownership of Briarwood Mall. Currently, McMullen Company owns and manages over one million square feet of commercial office and apartment properties.

When McMullen first got into business in Ann Arbor, he asked local brokers what he could do to best serve their needs.

"They all said, 'The more information you can give us in the simplest fashion, the better'. The way that things went in the past was that you would only give out a small bit of information, just enough to drive a phone call, and from that phone call your goal was to get them out to visit the property, and to talk them into why they should be in that property."

"Today, with people being busier, the advantage is being able to give them as much information as possible," said McMullen. He related the story of a woman who showed up to view a property and knew as much about it as he did. She said that she did much of her research in the wee hours of the night, and greatly appreciated the opportunity to check out the space online before visiting it.

This means of pre-sale communication is via the firm's website (URL below). Going to the site, you can click on a button named "Properties" to view current listings. Selecting a property brings up a detailed page with everything a prospective renter would need to know before a site visit. This attractive site was created by Design Hub of Saline, a company which also provides press releases and other media assistance. The site links to listings provided by CPIX, a commercial property information service. McMullen uploads information about properties to CPIX, and that data is then available from within the website. Out-sourcing this sort of technical help is very common in the businesses BizMo talked to.

McMullen sends out occasional email newsletters to brokers: "We don't like to load their inboxes on too frequent of a basis... The challenge is that we have buildings and suites that are so unique and being able to educate the people out there - the more they know, the more they can accomplish."

As with most technological issues, there are always new challenges to address. McMullen is working to improve their listings in Google by considering how to improve the SEO (Search Engine Optimization) of their site, thus moving up in the Google rankings. They have considered AdWords, but are leaning towards improving their organic (i.e., non-paid-for) rank.

"Target who you want to communicate with and get the message out to them in a timely manner"- Jeanne Murphy
Jeanne Murphy is the Marketing Director for Yeo & Yeo CPAs & Business Consultants. In her years with the firm, she has seen a growing reliance on Internet activities to communicate with their clients. She stresses the importance of e-mail: "Not that we've cut out the [US Post Office] mail piece, because mail pieces are important at various times, but it could be a week later by the time the client finally gets the information."

With the timeliness of email, Yeo and Yeo can instantly update clients whenever new tax law is enacted, for instance. Email "bursts" are targeted at the various segments of their business: construction clients, health care, etc. In all, they have seven different newsletters that they send out on an irregular basis.

"We try not to bombard our clients with e-mails, but just get them what they need when they need it. Everyone gets too much information from too many sources, so we want our clients to know that when they receive something from Yeo & Yeo, it's pertinent."

Murphy stressed the importance of targeting: "I find that the most effective communications are those e-mails that are sent to a targeted audience; it reaches who you want to receive the message, who really needs to see the information and gets it to them in a timely fashion." She added that with e-mail sent to specific groups of clients, it avoids spamming everybody with irrelevant content.

Yeo & Yeo's website, www.yeoandyeo.com, is in a period of transition, with more effort being put into online applications. "We have an online tax guide to find information on various tax issues for individuals and businesses. On the website are financial calculators so an individual can analyze such purchases as buying or renting, or how much car he or she can afford. There is a retirement spending calculator, and there are 15 different calculators that help you consider the various options open to you." Their current site will be going through a redesign to enable more interactive capabilities for their clients and the public.

Murphy acknowledged that keeping a website current is a big job. "Websites are a bigger task than I think most people realize." Yeo & Yeo's marketing department is charged with the job of keeping the site up to date. They have a content management system for making content updates to the site, but for web work involving links and images, they rely on an external company.

"We're trying to put as much functionality up there as we can" - Rhonda Foxworth
Rhonda J. Foxworth is Assistant Vice President and Marketing Officer for the Bank of Ann Arbor, and BizMo interviewed her at their beautiful new branch office on Ellsworth Road. Again, the focus of communication is the bank's website.

"We're continuously looking for ways to improve the interactivity of the website, so people can play with it and get answers to their questions. We don't see it as replacing the branches or our people, it's just that customers now demand all touchpoints. We're starting to look more aggressively at online applications so that people can apply for loans and open accounts online."

It wasn't always thus, Foxworth said: "Right at the beginning the banks said, 'we can't possibly do that online'. Now some of the bigger national banks push the technology and push the regulators and smaller banks can benefit from what [the larger banks] have learned."

Other technologies are being considered: "We're investigating blogging to see how that might work out, either in a looking at putting a business-to-business and business-to-consumer application on our site to help build community with our clients. We're not sure how that might apply· but some of the larger banks are doing it; Wells Fargo has 3 blogs targeted at different groups, so we're looking at taking some of their best practices, especially in the technology realm."

"Search engine marketing is another area we're looking to apply - we're doing some Google AdWords tests now· trying to see what it takes to drive some traffic to our site." The bank is out-sourcing this in a novel way by talking directly to Google at their downtown Ann Arbor office. Search engine optimization (SEO) is also being worked on: "As technologies change and search engine algorithms change, we need to make sure we stay on top of that. We have a good IT staff and we're attempting to do this in-house, at least until we reach a point where we realize we need to take it to the next level."

Their SEO efforts are mostly succeeding; if you search on "bank Ann Arbor" they come up first. "But if you search on "mortgage Ann Arbor", that's where the big players start popping in, especially in the paid results", Foxworth said.

The bank also carefully watches the statistics on their web hits, learning which pages are the most popular, for instance: "We're getting better on using the stats to help drive the search engine phrases, and make decisions on page content."

There is a staff of four technicians who maintain the bank's technology infrastructure, including the website, their intranet and their email. "I think they're excellent, because they keep things like spam [under control] - we don't get that much."

When asked about hardware such as PDAs, Foxworth responded: "Our president, Tim Marshall, is one of those early adapters, and he has a great vision for how technology needs to be an integral part of the bank - he's always pushing us." Part of the plan is to keep data in digital format as much as possible; all their printers have scanners built in and documents are shared in PDF format.

"There's a whole lot of new media out there ... and people don't understand" - Larry Eiler
Larry Eiler is Chairman and CEO of Eiler Communications, a marketing, public relations, and investor relations firm headquartered in Ann Arbor. And Eiler is one high-tech-using guy. He readily admits not being a total techie; he may not understand all the nuts and bolts details hidden behind our modern technologies, but he is expert in using them and leveraging them for his clients.

"There's a whole lot of new media out there, webcasts, podcasts, blogs, and people don't really understand what they all are yet. So we're trying to show the way in terms of PR with new communications to reach very targeted audiences."

"An example is my podcast, which I have been doing with Dr. Robert Pasick ... of Leaders Connect. We have been doing this since 2005 and we interview business leaders about all the good businesses that there are in Michigan. We keep hearing all this negative stuff about the automotive industry, but there are a lot of good companies in life sciences, in IT, that have great stories to tell... The podcast for this is called "Innovations in Business - you go on there and you can hear all these good reports about Michigan businesses. This is one new way to specifically reach media."

"Another new way is blogs; we have a blog on our website where people in our firm write about different topics ... and generate a discussion. I had a discussion going with a bunch of people over the last four or five weeks about where media are going, the very topic you're writing about - what's happening with print media, broadcast media, and what's happening with all these new techniques. We feel we need to play a leadership position in explaining what these new media are because the benefit of them is that they allow you to reach very targeted audiences."

Eiler Communications is also heavily involved in SEO; they recently worked with Pure Visibility, an Ann Arbor-based company specializing in website optimization and pay-per-click management, to revamp their website. Using SEO to analyze and target your audience, Eiler says, is really going to help your marketing efforts to influence people to buy a service or product.

Eiler doesn't dismiss older communications technologies still in use: "The Internet will never supplant newspapers and TV and radio, but it will augment it and it's instant information that is available all over the world in one second."

On the hardware front, Eiler is deeply invested in his Treo smartphone; he uses it to take notes in meetings, keep his calendar, and of course, make phone calls. "This has changed my thing a lot; I've been using it for several years. I think I'm on my third version of it."

Eiler sees his mission as helping clients get a handle on the business uses of the new communications technologies. As he says: "Technology just keeps propelling us along and people's ability to understand how to apply the technology lags what the technology can really do."

Websites mentioned in this article: