28 minute read
Inside Track
Attorney turns medical problem into career
Joe Rivet took a job in health care just to get insurance; now he’s an expert on the subject.
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Danielle Nelson
dnelson@grbj.com
Joe Rivet inadvertently catapulted himself into the health care industry as a teenager and has made a career out of it ever since, recently becoming the founder and principal attorney for Rivet Health Care Law PLC, and an arbitrator for the American Health Law Association.
Born on the western side of the state of Washington, Rivet and his family experienced the ebbs and flows of the lumber and fishing industries.
Rivet’s father worked at lumber mills that were located throughout the region. Prosperity at the time hinged on the domestic and international trade of lumber, which fell victim to the eruption of Mount St. Helens in 1980 when Rivet was a toddler.
“After the eruption, there were thousands of acres of wooded land that were owned by the lumber industry that were wiped out,” he said. “It was just devastating. There was nothing there for the workers to harvest. There was no product to cut down. There was no product to manufacture. There were tens of thousands of acres and not all of them were disrupted. But they were at different parts of their growth cycle, so they weren’t ready to be harvested because it took a lot of time. Those trees took long to grow in order for them to be harvested so just thousands of acres were wiped out, which impacted the lumber industry.”
Despite the devastation, residents still returned to work in the lumber industry because it and fishing were the top two economic drivers in northwest Washington.
Rivet, however, decided he wanted to chart his own course. He worked at a local convenience store and a hotel as a teenager, but he needed health insurance because he no longer was covered by his parents’ policy when he turned 18 at the time.
“I needed to find a job that provided health insurance because I had horrible teeth,” he said. “We didn’t have money for an orthodontist or a dentist. We had state Medicaid for dental, which unless your tooth was hanging by the root there weren’t a lot of options.”
Rivet was able to pay to get braces at 19 after a woman who worked at a local hospital suggested he apply at the hospital for a transporter job. That position ended up being the foundation for a career in the health care industry.
He spent about two years as a transporter, moving people and items throughout the hospital such as in x-ray rooms, emergency rooms, patients’ rooms and administration offices.
Rivet later accepted a position as a registrar, where he registered patients in the emergency department by collecting and verifying their insurance information and having them sign different forms of paperwork. He then took a new position called charge entry specialist.
“I was just entering all of these charges onto patients’ accounts,” he said. “I had no idea what the numbers were, I just knew that they had to balance. But what was behind that were all the codes, coding. They would take a record and put it into a CPT (Current Procedural Terminology) code or a diagnosis code.
“So, over the half-wall partition were all of the coders reading over the medical records from positions and putting them into a numeric value, which were these CPT or diagnoses codes. I thought they were brilliant people because they sounded like doctors and I said, ‘I want to do that.’”
CPT codes describe medical, surgical and diagnostic services that were provided to a patient. To become a coder, Rivet said he had to become certified, so he took some of the study guides that were not being used in the department home with him and began studying.
Rivet said typically to get that credential, a person would have to work in coding for at least three years. So while he was studying, he got the opportunity to become an emergency department coder, which allowed him to do coding for the first time. He later passed his exam on the first try and earned his credential.
Rivet moved on to an auditing role where he did evaluation and management codes for physicians who saw patients in the office, nursing homes or in a medical room at the hospital. He served in that role for a couple of years until he moved to Michigan where his wife’s family resides.
The Washington state native took a medical auditing position at Henry Ford Health System where he audited the bills and services of providers to ensure that their documentation supported the services that were being billed. Rivet later transitioned to a revenue cycle management position at Henry Ford.
He was in charge of revenue for 13 different departments, including hematology, oncology and medical anthropology. Rivet said he was tasked with ensuring that all the charges from both in-patient and out-patient care were captured and charged correctly on patients’ accounts.
While at Henry Ford, Rivet was invited to present at several speaking engagements about evaluation and management services and since has authored three books on the subject.
After spending five years at the Detroit health system, Rivet joined the law firm of Hall, Render, Killian Heath & Lyman as a coding compliance specialist. One of his primary responsibilities was to research reimbursement issues that clients had and share that information with the health law attorneys who would look at it and make the necessary legal decisions.
Despite having success in his previous positions at different places, Rivet began to pursue his bachelor’s degree in health administration by taking online classes at Baker College while he was working at the law firm.
Rivet decided to continue his education and went to what was then Western Michigan University Thomas M. Cooley Law School in 2012 to earn his law degree while still working. He attended school mostly part-time and graduated with his degree in January 2017.
During his time in law school, Rivet worked at Wayne State University Physician Group as a corporate compliance and privacy officer for a year. He became the director of fraud and abuse services at Priority Health and then the director of payment integrity at Health Alliance Plan.
After graduating from Cooley, he became the vice president, coding compliance and audit/ EMS compliance officer at a Chicago-based international revenue cycle company called R1 RCM.
“I was responsible for conducting the coding audits for our clients to make sure that the coders were coding the records correctly,” he said. “I was also the EMS compliance officer. The company had bought a billing and coding company and most of our clients were municipalities like the city of New York, the city of Chicago, the city of Philadelphia and many others. I worked with government entities, with the various cities to make sure we were doing things that we were supposed to be doing as far as coding and billing for ambulance services and they were all ground ambulances. We had some air ambulances.”
Rivet spent three years at R1 RCM before its corporate restructure that was accelerated by the COVID-19 pandemic. As a result, many corporate roles were eliminated, including Rivet’s positions in July 2020.
“That was when I said, ‘I am going to take the leap and start my own law practice’ and that was exactly what I did.”
Rivet became a licensed attorney in January 2020 and he opened his Norton Shores-based law firm, Rivet Health Law PLC, in July of 2020, amid the pandemic. He assists clients in understanding coding and billing regulations within Medicare and Medicaid.
“Having my own firm is exciting,” he said. “This is invigorating. My intent is to be a business partner and try to have solutions for providers and really be that foresight, looking forward to proposed rules and regulations and things that could have an impact on my clients.”
JOE RIVET
Company: Rivet Health Law Position: Founder and principal attorney Birthplace: Longview, Washington Residence: Grand Haven Age: 42 Family: Wife; Cindy, and children Corbin (20), Evan (11), Audrey (9) and Adam (8) Business/Community Involvement: Board member of the Young Lawyers Association of the Grand Rapids Bar Association, member of the State Bar Payer Subcommittee, pro bono attorney for the Michigan Indian Legal Service, reimbursement chair for the Michigan Group Medical Association and member of the American Bar Association Solo, Small Firm and General Practice Division Biggest Career Break: “Many years ago when my boss at the time actually moved me into an entry level coding position to code medical records. I didn’t have a credential at that time, I never did it before, but she believed in me and she made the investment to train me and from then on, I’ve just been on this path. Had it not been for that, I don’t know that the path would have led me here, practicing law in health care.”
Corporate restructuring during COVID-19 prompted Joe Rivet to start his own law firm. Courtesy Anna Cillan
Entrepreneur copes with loss by helping others
Miscarriage prompts flower business and avenue for community support.
Danielle Nelson
dnelson@grbj.com
A West Michigan woman is turning her family tragedy into joy by doing something she loves.
Jess Resheske recently opened a mobile flower shop called Blossoms of Joy, where she arranges and sells bouquets of flowers and floral crowns as a way of coping with the loss of her pregnancy, and also as a source of support for women who have suffered miscarriages like herself.
Resheske was supposed to welcome her fourth child in April but she lost her pregnancy in December when she was 19 weeks pregnant.
“I felt her kick on a Saturday and usually when I start feeling movement from the baby, from my previous pregnancies, I feel it constantly, at least multiple times throughout the day. But I just felt that one kick and I didn’t feel anything else after that,” she said.
“I just knew something was wrong. I felt that kick on Saturday and I didn’t feel anything on Sunday, so I just knew something was wrong. My husband tried to calm me down and tried to talk me out of it, but I told him that I needed to make sure that everything is OK. When I went to my doctor’s appointment, they were trying to find a heartbeat with a doppler, but my doctor couldn’t find the heartbeat and then she said, ‘Let’s go take an ultrasound’ and I just knew, I just knew she was gone. And she was.”
Resheske had to deliver her baby who wasn’t considered a stillborn because Resheske was just shy of 20 weeks pregnant.
‘When she was born, I got to hold her right away,” she said. “They wrapped her up and I held her. I couldn’t spend as much time as I wanted to with her, but I spent a couple of hours with her. Since she had passed, it was better to have her in a cooler room just because things start to diminish pretty quickly. And since we wanted to do an autopsy, we wanted to preserve her and try to find out what happened.”
Unfortunately, the doctors could not figure out what went wrong, but before Resheske and her family left the hospital the next day, they were able to spend more time with the baby and hold her before saying their final goodbyes.
“We went home with a little box with her footprints, what she was in while we were holding her, and we ended up having her cremated, so we have her ashes in a little urn,” she said.
Although Resheske had the support of her friends and family as she grieved, she searched the internet for support groups and for people who had a similar story to hers, but there were not many.
“After losing Joy, the type of grief and pain (I was) in was just unthinkable,” she said. “You don’t even know if you are going to feel OK again. Of course, I have my three other children, but every child is your whole world and when you lose one of those children that you have hopes and dreams for, your whole world comes crashing down. I couldn’t see past it. I just felt hopeless, sad and really in a dark place.”
Resheske said three months after she had lost Joy, in March, she was watching a show on Netflix, and she saw someone making flower crowns for someone’s wedding and suddenly she got this overwhelming feeling of conviction to start a flower business.
Making flower bouquets was a personal hobby, but now Resheske wanted to make it a business. More importantly, she wanted to create a place where women and families who have suffered a miscarriage, or knows someone who has, can go to for support.
Resheske created bouquets of flowers on April 29, which would have been her due date, and delivered them to Boven Birth Center at Holland Hospital as gifts to the new mothers.
She and her husband recently bought a trailer that she is using
CONTINUED ON PAGE 15 Jess Resheske uses her business, Blossoms of Joy, as a starting point for discussion about pregnancy losses. Courtesy Blossoms of Joy
Just like you, we’re here for your employees.
Office guide highlights costs, benefits of remote work models
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fice space marked by an open floor plan that encourages small group collaboration may pay $155-$225 per square foot depending on the quality of the space.
Additionally, tenants wanting a more traditional build-out with private offices and dedicated conference rooms may end up paying $168-$243 depending on the quality and complexity of such an office space.
New York City holds the title as most expensive city for office fit-outs in 2021 ($233 per square foot), followed by the San Francisco Bay Area ($175 per square foot). At the other end of the spectrum, the south and southeast sections of the U.S. are the cheapest areas in which to build. The three Texas markets of Austin, Fort Worth and San Antonio rank as the cheapest major markets for office construction this year.
Rantala said Midwest “second-tier” cities like Grand Rapids are great places to build an office fit-out compared to coastal cities in New York and California, or even in Chicago. Comparatively, the cost of constructing a new office in a city like Grand Rapids is more manageable.
Occupiers considering transforming future office space with less density, increased technology implementation and a focus on sustainability and wellness will want to consider the costs and benefits of these office trends.
Partially remote workforce
Over half of corporate employers expect employees to work from home two days a week on average, and 72% of employees want to continue working from home, even post-pandemic, according to the latest JLL research.
With any given employee not in the office two days a week, fewer companies will provide every employee a permanent and dedicated desk. Instead, some future office designs will place a greater emphasis on custom collaboration and community spaces, with a smaller share of the office footprint dedicated to standard workstations.
In this scheme, the workstations that remain will generally be available on an as-needed basis, rather than dedicated to employees with a oneto-one ratio. Mobility-focused offices without dedicated seats are nothing new, but are expected to become more common, or be incorporated as one element of the larger overall office design in more projects, JLL said.
From a cost perspective, this means a more carefully designed and customized office that meets the needs of multiple overlapping users on any given day. On a persquare-foot basis, the cost of a mobility- and collaboration-focused office design will generally be higher than a standard layout with primarily dedicated workstations. On the other hand, some occupiers may consider slightly smaller footprints given that fewer employees will be using the office at the same time. The right balance will depend on each company, but a reduced footprint could potentially offset a higher cost per square foot, leaving the total capital cost of a project unchanged.
“I’ve had a few clients that have gone to reducing their space because of remote working opportunities … but what I think is happening is, even though some of the staff is working remotely, you’re changing your space to accommodate more of the collaboration, conferencing, having some of those amenities, that you’re almost making up for the space that you lose by having people removed, so you’re almost staying where you’re at,” Rantala said. “I’ve got a feeling the square footages will stay where they’re at, but it’s what type of space is being built in there.”
Technology support
Another critical piece of an office where employees work from home a couple days a week is a greater need for technology. While makeshift remote setups worked during the pandemic, a permanent shift to virtual collaboration will require a re-imagination of the technology setups in many existing office designs today.
The cost implications of reformatting technology will directly depend on both the scope and the quality of the technology being integrated into a workplace. Within each project budget, the share of spend being dedicated to technology is expected to grow for most companies over the coming years.
Anyone planning to build or renovate an office this year should carefully reconsider any technology budget based on past assumptions, and exercise caution before relying on benchmarks from previous years. JLL forecasted the quantity of technology in an average office will continue rising, which will mean increased complexity to support a more robust technology suite.
Wellness and sustainability
The shift toward sustainability and wellness in office design and construction was in place long before the pandemic, and only accelerated because of it. While many pandemic-specific safety measures will subside this year along with the health risks from COVID-19, an increased awareness and focus on health and well-being will be permanent.
The most straightforward markers from the design and construction perspective are the common certifications that office fitout projects seek, including LEED and WELL certifications. The upfront cost of any sustainability or wellness certification generally includes both higher construction costs and a fee to apply for and receive the certification.
“When you go through the whole LEED and WELL certification process, there are additional costs to upgrade your building, but in the long run those upgrades usually pay for themselves anyway,” Rantala said. “So, I think there’s a lot more buildings that are going toward some type of certification for sure.”
For purely wellness or health-focused features, the return on investment cannot be quantified in dollar figures, but it will have positive returns in employee health, engagement and retention, he said.
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Furniture industry panel discusses supply chain issues
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but we were spending about 255 hours a week just on figuring out where shipments are for our customers.”
He said the company fasttracked technology upgrades so it could see real-time information on shipments, freeing employees to do other things. But the underlying problems — rising logistics costs, customers needing their materials and the receivables billing cycle stretching out — are not going anywhere.
“We don’t see this ending anytime soon,” he said. “If we’re looking for any type of relief, it’s going to be at least the second quarter of 2022, as we see it right now.”
Most important lessons
Dunlap asked Sparks, Brand and Williams to share how they addressed the most important lessons they’ve learned during the pandemic.
Sparks said her company confirmed its long-held belief that relationships and being proactive matter, as well as putting in place inventory agreements and forecasting models to be able to better handle the long lead times.
“Every day is a new day and a new battle, so you really don’t know what you’re coming into, but the more prepared that we can be and the more options we have in place to plan for the unexpected, we can pull through,” she said.
Brand said figuring out how to help customers mitigate logistics delays has been a top challenge.
“The first thing we’re suggesting on the short-term basis is increase your safety stock, lengthen your lead times, and try and look for transit time improvements,” he said. “And then long-term … we’re going to start to see, and we have started to see, especially in automotive, nearshoring and reshoring … (of) product supply.”
Williams added he’s learned the leadership team of his large company has to be closely involved and cannot delegate as much right now in order to be proactive and protect its customers. He said the work furniture division has to be careful about stretch supply — sourcing farther away instead of nearby — and cashflow. He said it has been helpful to leverage the knowledge and expertise of all of Leggett’s different businesses, such as the automotive or bedding groups, and using its own foam division as a supplier instead of going elsewhere.
Dunlap asked two panelists to address how they are coping with product price increases.
Boenigk said her company at the time of the symposium was working to negotiate with the U.S. General Services Administration to obtain permission to do temporary commodity and fuel surcharges until things calm down, rather than an annual across-the-board price increase that wouldn’t cover rising costs. She said this request was necessary because Neutral Posture has so many government contracts and can’t just make its own decisions about price increases. GSA did allow fuel surcharges in 2008-09, she said, and her commercial customers understood it was temporary and went along with them.
Folkert said The BOLD Companies is dealing with increases by communicating with customers, shortening the quote window, providing documentation of materials cost increases to customers, and using forecasting. Some of its costs are single-digit increases, and the double-digit increases tend to fall under the company’s project-based work, which poses less of an issue, he said. He said to manage expectations, BOLD Companies, for instance, might offer customers a product price increase of say, 5%, and then pricing will go up again in a month, or it can offer to increase pricing higher upfront, then have costs stay stable for two or three months.
Addressing racial equity
Dunlap asked Williams and Boenigk to describe how they are addressing diversity, equity and inclusion (DEI) within their organizations.
Williams said it created a strategy last year within its executive team and is implementing it across the company through the work of five pillar teams. The strategy includes DEI targets across all relationships, in its core and with suppliers.
Boenigk said her company has high levels of internal diversity, with about a 50/50 male-female ratio, 40% white employees, 33% Hispanic/Latino and 27% Black. She said the harder problem to address is getting government contractors to fulfill their obligations to do business with small and diverse businesses, and getting corporations to source from diverse buyers, as both entities tend to use all sorts of loopholes to say on paper they engage in supplier diversity practices, when in fact, they don’t.
“I think there’s still a lot of work to be done on the supplier diversity side of things,” she said. “… Everybody says they have a supplier diversity program, but what are they truly doing and how much are they truly spending with small businesses?”
Nearshoring, reshoring
Dunlap called on Brand, as the owner of a supply chain management company, to share whether he’s seen a shift in nearshoring and reshoring toward North America and, specifically, to Michigan.
“I thought we’d see a lot more of it with the tariff impact — that whole purpose was to drive this reshoring initiative,” but what has actually happened, Brand said, is a shift from manufacturing in China to other parts of Asia such as Thailand and Vietnam. But he said he’s hopeful that as higher logistics costs and tariffs continue with no signs of softening, manufacturers will begin to nearshore and reshore.
Dealing with OEMs
Dunlap’s final question went to Sparks — “How would you describe today’s OEM supplier relationship climate?”
Sparks said some industries tend to value either strategic partnerships or transactional relationships, and the office furniture industry tends to lean toward the former, more collaborative approach — treating suppliers as if they are just as valuable as customers, which they are.
“The better the relationships you have, the stronger your business is on both sides,” she said. “That goes back to the first question … with the supply chain issues that we’ve all been facing, and the disruptions we’ve had, you need partners throughout the channel to make sure that your supply chains are robust so that our end customers can deliver to their end customers, day in and day out.”
The full Michigan Furniture Industry Symposium webinar — including comments from Deirdre Jimenez, president and CEO of the Business & Institutional Furniture Manufacturers Association, and Justine Burdette, vice president of technical services at The Right Place and regional director at the Michigan Manufacturing Technology Center-West, is available at bit.ly/youtube MFIS.
Advisers see bright future for real estate
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building in or relocating to Grand Rapids. Acrisure, an insurance brokerage company from Caledonia, is building its new headquarters at Studio Park in downtown Grand Rapids.
The building is currently under construction and expected to be completed in the second half of 2021. The company also is pledging to donate $15 million to Spectrum Health Helen DeVos Children’s Hospital.
Spectrum Health is building an eight-story office building north of downtown Grand Rapids. It will connect this eight-story building the Brass Works Building it bought for $24.7 million. It will house 1,500 employees. Construction of the new office building is expected to start in the fall of 2021.
Transaction volume in the western Michigan region was down 74.6% year-over-year in Q1 2021. Over $7 million worth of office properties sold in Q1, down from $29.9 million in Q4 2020. The median price per-squarefoot was $141 in Q1 2021, which is a drop from $165 in Q4 2020 and $196 in Q1 2020.
According to Integra Realty Resources, cap rates in the central business district ranged from 6%-6.5% and ranged from 7.5%9.5% in the suburbs in 2020. Cap rates are expected to increase between 1-24 basis points along all asset classes and in the CBD and suburbs in the next 12 months.
Despite capacity limits and mandated closures last year in Michigan due to the pandemic, the West Michigan retail sector is thriving, especially in corridors with Class A properties.
The pandemic forced many businesses to shutter their windows, but through the first quarter of 2021, openings are outpacing closures.
National tenants not currently in the market and local entrepreneurs still are looking for space in West Michigan.
“Overall, I think we’re turning the corner,” said Bill Bussey, senior associate broker of retail. “When stores close, somebody wants that site. We don’t have many vacancies in the area … Manufacturing and retail have been a blessing for us. Plants are expanding and gaining employees. That in turn is driving retail because people have more to spend.”
Bussey pointed to the vibrancy of major retail corridors like Woodland Mall on the corner of 28th Street and East Beltline. He attributed the success to its sharp tenant retention and judicious leasing practices.
“We do a lot of team meetings and stuff like that that’s just changed the way business operates, and retail is no exception,” Bussey said.
“Because of the way things are changing, a lot of people decided to call it quits, but so many more are still opening up.”
More and more restaurants are going to have drive-through lanes and will continue to offer curbside pickup even postpandemic.
“Curbside pickup is great if you can’t have a drive-through, so that’s going to continue,” Bussey said. “If you think about a full-service restaurant, they would never do that before COVID, but it’s gotten so common that they have to do it now.”
New restaurant entrants to the market include Wahlburgers, which is opening a location in downtown Grand Rapids this summer in the new Residence Inn by Marriott. This will be the third location in Michigan.
Condado Tacos opened in February on Bridge Street, just west of downtown. This is its fourth Michigan location, but the first outside the Metro Detroit area. Loretta’s Deep Dish has opened in downtown as well. The Chicago-style pizzeria is a new restaurant concept by the founder of HopCat and the tiki bar Max’s South Seas Hideaway. The new restaurant is located in the basement of Max’s on Ionia Avenue SW.
In 2020, some breweries merged or closed, but seven new ones are opening in West Michigan. Brewery Nyx will be the first gluten-free brewery to open in Michigan, planning to open this month June just south of downtown Grand Rapids at 506 Oakland Ave. SW.
Saugatuck Brewing Co. is expanding to a third location. The company purchased Creston Brewing after it closed in March 2020, and Saugatuck plans to keep the Creston name.
Entrepreneur copes with loss by helping others
CONTINUED FROM PAGE 12
as a shop to sell her flowers at the Zeeland Farmers Market on Saturdays throughout the summer. She also is setting up pop-up shops in her driveway.
She began selling flowers at the farmers market on June 5 and every week Resheske said she will have different fresh bouquets of flower assortments that are in season, including pansies, roses, daffodils and daisies. She said she will not have a lot of flower crowns at the farmers market, but she’ll make them for specialty orders for events such as weddings, baby showers and birthdays, among other events.
This summer, Resheske said she is getting her flowers weekly from Walker but expects to grow her own flowers next year in her backyard after the completion of their home, which they are currently building.
In addition to selling flowers, Resheske said Blossoms of Joy is an awareness campaign. She will have information about her story and her contact information for anyone who needs support as they grieve a lost pregnancy while she is at Zeeland Farmers Market.
“Being someone who they can talk to is huge,” she said. “A lot of people, when you tell them about your loss, they say, ‘I am sorry for your loss,’ and you just don’t want to talk about it because it is sad. I get it. A baby passing is not the circle of life. It is not the norm. Having an innocent new life taken is not the norm, and people don’t know what to say and they don’t know what to do. Instead of having that conversation being ignored or kept quiet, saying, ‘I am sorry for your loss, do you want to talk about her (or him?) Do you want to tell me about her (or him?)’ — just opening a conversation instead of shutting one down might help someone who is grieving. Some people don’t want to talk about it, and they can say, ‘No, but thank you for offering.’ At least there is an opening, a door to have that support. That is my start right now with Blossoms of Joy, with the flowers and sharing my story, to see if I can help connect.
“With COVID and all the restrictions, I can’t figure out how to put a support group together, but definitely in the future I intend to have a safe space for other grieving moms in the West Michigan area to go to and be able to grieve the loss of their baby with other moms who have gone through the same thing, to be able to create that community that no one wants to be a part of but there is one and it is bigger than we know. I just want to have a safe space or have that one person you can call.”
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