Kenneth Kaufman: Protectionism is not a strategy

Kenneth Kaufman: Protectionism is not a strategy Written by Kenneth Kaufman, Chair, Kaufman, Hall & Associates, LLC | June 09, 2015 | Print | Email Ultimately, a strategy designed to thwart change and innovation is futile. In our economic society, consumer preference will prevail. A new analysis shows the incredible speed and intensity of Uber's encroachment on the traditional taxi industry. In just 15 months, between January 2014 and March 2015, Uber's share of business ground transportation increased from 14 percent to 47 percent, while the traditional taxi share fell from 86 percent to 52 percent, based on expense reports submitted through Certify software.[1] At an unprecedented pace, consumers are voting with their feet for the overall experience and frequently lower prices of Uber. This is not just a shift in carriers; it is also a shift in dollars from one set of providers to another. Like most industries faced with a drastic loss of income, the taxi industry is not taking this change lying down. Some taxi companies are following Uber's lead and offering apps for riders to schedule pick-ups. However, the taxi industry appears to be focused less on reinventing itself to better serve consumers and more on using regulation to protect their existing business. Despite heavy protests from the taxi industry, Uber has made significant inroads across the country. The last major battleground appears to be airports. In New York, a new Taxi and Limousine Commission proposal would prevent Uber vehicles from meeting riders within established pickup areas at LaGuardia Airport. According to the Commission, the rules are designed to protect consumers "while leveling the market playing field."[2] In Chicago, the Mayor's office recently announced it is not planning to allow Uber to serve the city's airports, alluding to Uber's efforts to "game the system," an apparent reference to widely reported tactics that Uber drivers use to escape detection while picking up passengers at major airports.[3] One attraction of Uber for air travelers is the ability to bypass long airport taxi lines. A representative of Chicago taxi drivers commented, "Even though the waits are very long, O'Hare is the place where we know we can make money… We've already had plenty of money taken from us on the streets of Chicago. We can't allow it at the airports."[4] Similar stories are pervasive in healthcare. One example involves independent freestanding emergency departments (IFEDs). Like hospital-affiliated EDs, IFEDs are staffed by physicians and are open 24 hours a day. Unlike hospital EDs, IFEDs limit their services to minor emergencies. Although IFED prices are similar to those of traditional EDs, IFEDs tap the desire of consumers to have emergency care closer to home and to avoid the long waits of traditional EDs. The number of IFEDs is growing dramatically. Nationwide, the number has increased from about 145 in 2009 to more than 400 in 2014.[5] Since 2010, 145 IFEDs opened in Texas, which was the first state to license freestanding EDs not operated by hospitals.[6] First Choice Emergency Room, the nation's largest freestanding ED company, increased its locations from 14 in 2012 to 67 in 2015.[7] An industry analyst said that First Choice works at "the sub-ZIP code" level to identify locations that provide desired demographics, traffic, and visibility.[8] Legacy forces have opposed regulatory changes that would relax restrictions on non-hospital-owned EDs. In California, where a proposed bill would allow distressed hospitals to be replaced with IFEDs, a California Nurses Association representative called IFEDs "a fraud on the public" because they do not provide the same level of emergency care as hospital EDs.[9] A similar bill in Illinois designed to permit an IFED to replace a closed hospital met with opposition that pointed out there are 10 hospitals within 10 minutes of the proposed IFED site. A similar example involves nurse practitioners, who play a key role in efforts to enhance access and lower costs. Between 2003 and 2014, the pipeline of new nurse practitioner graduates increased 180 percent—from 6,611 to 18,484. Between 2013 and 2014, growth was 15.3 percent.[10] However, the growth of the profession has been accompanied by struggles to achieve legislative authority for fully independent practice. Currently, 29 states limit the scope of practice for nurse practitioners and require that they have either on-site physician supervision or a contractual relationship with a physician,[11] which generally involves a fee. Pennsylvania is one state requiring a contractual agreement between nurse practitioners and physicians. Bills recently introduced in the Pennsylvania House and Senate call for an end to that requirement with the intent to "provide more accessibility and more affordable healthcare" in rural communities, according to State Representative Jesse Topper. The president of the Pennsylvania Medical Society, however, expressed concern about the lack of oversight of nurse practitioners, saying that "the physician should be the leader of the team because of the education, knowledge, and clinical experience that they have."[12] Ultimately, a strategy designed to thwart change and innovation is futile. In our economic society, consumer preference will prevail. Consumers will not choose to wait in a long line to ride in a bumpy taxi when, with the touch of a button on an app, they can be met promptly by a nicer car—often at a lower price. Similarly, people with a minor emergency in the middle of the night will not choose to travel to a hospital emergency department when they can receive treatment faster in a more congenial environment closer to home. Nor will consumers choose to visit a physician's office for a routine matter that can be handled by a nurse practitioner in a retail clinic or through an app. Consumers are rarely moved by exhortations to protect the income stream of legacy providers whose services they find inconvenient or that they no longer desire. In addition, the regulatory tide inevitably will turn toward accommodating innovation. After a period of operating outside the existing regulatory framework, Uber's regulatory battles have been fierce, but they have achieved notable success. Uber currently operates in 163 cities and metropolitan areas throughout the U.S., and in 57 other countries.[13] As of January 2015, 17 U.S. cities and four states have passed ordinances that favor Uber.[14] A similar momentum exists in healthcare. Proposed regulations related to IFEDs are designed to relax restrictions rather than heighten them. In the past four years, seven states have adopted full-practice authority for nurse practitioners. Today, 21 states and the District of Columbia have that model of regulation. Also within the past few years, a growing number of patient advocacy groups, employers, hospitals, and others have endorsed legislation providing full-practice authority for nurse practitioners.[15] The core rationale for resisting innovation is less about consumer benefit than economic protectionism. Efforts to use regulation as a weapon to fight healthcare innovations usually are presented as protecting the quality of patient care. However, when innovations support quality, have the potential to reduce healthcare spending, and represent enhanced consumer access and convenience, efforts to resist them are more likely rooted in protecting existing income. It comes down to this: Here is what Uwe Reinhardt, one of the smartest economists in the country, says about efforts of legacy providers to resist change and innovation. His comment pertains to doctors and nurse practitioners, but applies far more broadly. It can't be said any better: "The doctors are fighting a losing battle. The nurses are like insurgents. They are occasionally beaten back, but they'll win in the long run. They have economics and common sense on their side."[i]The unsustainability of healthcare spending in the U.S. at almost 18 percent of total GDP means that healthcare must change. The unprecedented advances of the Internet economy suggest the potential for that change. Although the healthcare system is much larger and more complex than the taxi industry, the rise of Uber at the expense of legacy taxi companies shows how rapidly change can occur when a new business model creates significantly increased value for the consumer. In such an environment, protecting the status quo is futile. Legacy entities would better serve their communities' interests and their own economic interests by dedicating their available energy, talent, and capital to being part of healthcare's reinvention. Protectionism is not a long-term strategy. Your comments are welcome. I can be reached atkkaufman@kaufmanhall.com. The following column was republished with permission from Kaufman Hall. It was originally featured on Kaufman Hall's blog, found here. [1] Certify: "Sharing the Road: Business Travelers Increasingly Choose Uber." April 7, 2015. https://www.certify.com/2015-04-07-Sharing-the-Road-Business-Travelers-Increasingly-Choose-Uber[2] Rivoli, D.: "Uber Cars Getting Pushed Out of LaGuardia? New TLC Proposal Would Place Uber Outside the Airport's Passenger Pickup Areas." AM New York, April 29, 2015. http://www.amny.com/news/uber-cars-getting-pushed-out-of-laguardia-new-tlc-proposal-would-place-uber-outside-the-airport-s-p-1.10344638[3] Spielman, F.: "Emanuel Nixes Uber Attempt to Make Airport Pickups." Chicago Sun Times, June 2, 2015. http://chicago.suntimes.com/news/7/71/655756/emanuel-nixes-uber-airport-pickups[4] Spielman (June 2, 2015).[5] Draper, E.: "Freestanding ERs Draw Patients, Critics and Legislation." The Denver Post, March, 6, 2014. http://www.denverpost.com/news/ci_25349086/free-standing-ers-draw-patients-critics-and-legislation; Herman, B.: "When the Tiny Hospital Can't Survive: Free-Standing EDs with Primary Care Seen as New Rural Model." Modern Healthcare, Sept. 27, 2014. http://www.modernhealthcare.com/article/20140927/MAGAZINE/309279952[6] Etter, L.: "The Texas Approach to Emergency Treatment." Bloomberg, May 15, 2015. http://www.bloomberg.com/politics/articlesss/2015-05-15/the-texas-approach-to-emergency-treatment[7] Adeptus Health Inc.: U.S. Securities and Exchange Commission filing, June 20, 2014. http://www.sec.gov/Archives/edgar/data/1602367/000104746914005759/a2220427zs-1a.htm; First Choice Emergency Room website: Locations. http://www.fcer.com[8] Ghose, C.: "What Makes First Choice ER Tick?" Columbus Business First, Aug. 29, 2014. http://www.bizjournals.com/columbus/print-edition/2014/08/29/what-makes-first-choice-er-tick.html[9] Etter, L. (May 15, 2015).[10] Salsberg, E.: "The Nurse Practitioner, Physician Assistant, and Pharmacist Pipelines: Continued Growth." Health Affairs Blog, May 26, 2015. http://healthaffairs.org/blog/2015/05/26/the-nurse-practitioner-physician-assistant-and-pharmacist-pipelines-continued-growth/[11] American Association of Nurse Practitioners website: "State Practice Environment." http://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment/66-legislation-regulation/state-practice-environment/1380-state-practice-by-type[12] Gordon, E.: "Pa. Bill Would Allow Nurse Practitioners to Work Independent from Doctors." Newsworks," March 23, 2015. http://www.newsworks.org/index.php/local/healthscience/79826-pa-bill-would-allow-nurse-practitioners-to-work-independent-from-doctors[13] Uber website: Our cities. https://www.uber.com/cities[14] MacMillan, D.: "Uber Laws: A Primer on Ridesharing Regulations." The Wall Street Journal, Jan. 29, 2015. http://blogs.wsj.com/digits/2015/01/29/uber-laws-a-primer-on-ridesharing-regulations/[15] Taynin Kopanos, DNP, NP, Vice President, State Government Affairs, American Association of Nurse Practitioners, personal communication, June 4, 2015.[16] Tavernise S. "Doctoring, Without the Doctor." The New York Times, May 25, 2015. http://www.nytimes.com/2015/05/26/health/rural-nebraska-offers-stark-view-of-nursing-autonomy-debate.html © Copyright ASC COMMUNICATIONS 2017. Interested in LINKING to or REPRINTING this content? View our policies by clicking here. To receive the latest hospital and health system business and legal news and analysis from Becker's Hospital Review, sign-up for the free Becker's Hospital Review E-weekly by clicking here. Some Simple Ways Of Making Money Online - Get The Tools I Use I would like to share some of the very simple ways I use in making money online. The methods may not be new to some members here. For the sake of those who are new to the tactics of making money online, I have prepared an eBook and tools to help them get started. Both blackhat and whitehat methods can be used for the systems but I prefer the blackhat way because it makes my work easier, faster and makes me easily dominate Google and other search engines which many internet marketers have ignored. I have divided the strategies into two and I will try to explain them to the understanding of the average internet marketer. I have also provided download links and virus scan for those tools I use. 1. FOREIGN LANGUAGE INTERNET NICHE MARKETS Foreign language internet niche markets are the online niche markets with audience that use languages other than English to browse the internet. Examples of the languages are Spanish, German, Chinese, Italian, French, etc. The foreign language niche markets are still very profitable. Even if a person cannot speak those foreign languages, it is still very possible to create foreign language websites with ease. In order to be able to easily make money from the different languages, I did the following: a. I got article grabber software. The software can scrape articles from all the major article directories including ezinearticles. I only load keywords into the text file and the software goes to work scraping articles from the whole web. The software does not collect resource box. Therefore, if you want to always put the author's link in all articles that are not yours, the software cannot work for you. No credit will be given to the authors. b. I created a language translation script in order to be able to translate the articles scraped by the article grabber. The script can translate articles into more than 22 major languages of the world. Some of the features of the script are: - It can translate multiple articles at the same time. Averagely, it translates about 100 articles into any language under 5 minutes. - The script is able to do this job very fast because it can bypass Google anti-bot checker. The script deceives the Google anti-bot checker into thinking it is a human visitor using the translation tool. But sometimes, it is caught by the Google anti-bot checker and errors are displayed. Whenever this happens, I wait for about 5 minutes and the script goes to work again. Of course, there are autoblogging plugins that can do language translation. But they do not give the flexibility which I need. Autoblogging plugins do not allow you to download the translated text files for use in any way you want. For instance, creating HTML websites or for other different uses. Hence, I created the script and it has served me well. I have created a lot of blogger blogs, wordpress blogs and normal HTML websites for the different foreign niches. Now, I have 2,147 blogger blogs under different gmail accounts. I did not use the same gmail account because I did not want Google to poke their nose into whatever blackhat tactics I was doing. I outsourced most of the blogger blogs creation. The guys only created the blogs and installed the blogger theme to use. I did not use any of the default blogger theme because in my own opinion they could not fetch me good adsense money. I then used Bloghatter to drip feed the foreign language articles I got through the script. About 2 to 3 articles are automatically posted to the blogs each day. I don't post more than 3 in order not to be flagged by Google as spam blogs. Out of the thousands of the blogger blogs I have, Google has only deleted 33 so far. For the blogger blogs, I use different adsense accounts. I did not link the gmail accounts of those accounts together. If not, Google would ban all the accounts. In addition, I login to those adsense accounts using different IP addresses. I do not use proxy. Though I make good money from those blogger blogs, I do not depend on them for money making. I really depend on them for backlinks to my main money sites which I also created for the different foreign languages. I also use them for linking to and from 20 different web 2.0 sites and 100 different social bookmaking sites. This is in addition to blog commenting which I do with scrapebox. I have a Wordpress Spanish article directory containing more than 20,000 pages on different niches. So far, more than 200 authors are registered. Those authors also add Spanish articles to the directory. I used articlesss theme and plugins to do this. The money I make from the article directory is mainly through adsense and and sometimes from Clickbank. I also created different money websites in different languages like German, Portuguese, French and Chinese. For instance, I use the German websites to make money through Amazon technology products. The technology niche in German makes good money. The French are always interested in fashion. I have not been able to really exploit other foreign languages because the ones I manage are really enough to focus on. I have prepared a 77-page eBook that can help those who are interested in testing the waters in the foreign language niche markets. Using the tools above, I was able to create different sites in different languages even though I could not speak them. 2. MILITIA OF AUTOBLOGS WITH THOUSANDS OF WEB PAGES OF UNIQUE CONTENT I introduced the multi-level translation feature into the language translation script where it can translate English articles to many languages and back to English. The script also exploits Google translation tool by also deceiving Google anti-bot checker by behaving like a human visitor. The Multi-leVel translation feature translates articles through 3 language levels before translating back to English. This is the way I create thousands of web pages with unique content. Of course, there will be grammatical errors but I don't care. I don't care if visitors can read or not. I have created a militia of autoblogs in 217 niches with this system out of the 400 niches I have noted down for autoblogging. Most of the niches have less than 50,000 searches per month but traffic is very constant from the search engines. I only drip feed articles to each of the blogs. Everything has been set on autopilot. I don't spend money on promotion other than scrapebox blast and some social bookmarking with BMD. As at now, I have more than 225,000 English web pages of unique content for the militia of autoblogs. 3. NORMAL HTML WEBSITES I did not want to stay with blogs alone. Therefore, I used xsitepro to create some html sites in about 30 niches using the article grabber and the language translation script. So far, these websites have about 140,000 unique content pages. Again, they contain grammatical errors but I don't care about that. Google keeps sending about 400 unique visitors daily to each of the sites and I keep making adsense and clickbank money. The websites performed badly with Amazon. I think it was because of the niches I chose. I have scraped more than 750,000 articles so far from the article directories. The articles are from about 637 different profitable niches over which I took time to do some research. I have discovered that my websites and blogs containing grammatical errors make more money through adsense than my other whitehat sites with human-written articles. I notice that when my visitors read the pages, they get pissed off and just click those adsense ads in order to visit those pages that could give them good content they need. The html websites have always performed better for me in adsense. PROBLEMS All is not a bed of roses. There are a lot of problems faced with my system. I will try to explain them so you know what you are doing if you decide to try it. 1. Management of the autoblogs - It is a real nightmare managing the more than 200 autoblogs. It is not an easy task updating all plugins, changing affiliate links, upgrading wordpress, etc. Very time consuming. But I think the money from them pays off multiple times. 2. Security - The autoblogs are always subjected to security risks. Therefore, I am always prepared for the worst in case anyone infiltrates into my server. I have all types of security plugins installed but the threat is always there. 3. HTML sites - Changing anything on the html sites has not always been an easy task because of the average of 4,500 pages on each site. Changing any line of code on the sidebar means re-uploading all the website pages altogether. This consumes time. Also, the money coming in pays off multiple times. FINAL NOTE These are some of the ways I make money. If you want to try them, do not expect thousands of money to be coming in immediately. It takes time. Though you can be making several thousands of dollars per month, I do not guarantee that you will make money with my system. I have only shared some of the strategies and the same tools I use. Making money with them depends on several factors which I think you already know. Download links:1. Article grabber - http://www.mediafire.com/?fgcpfp4y14yppry Virus scanhttp://www.virustotal.com/file-scan...32864d0000e0f89cfe7cb6546a901e9640-1293474943 2. Language translation script - http://www.mediafire.com/?qf49ih9i459c9e2 3. 77-page eBook - http://www.mediafire.com/?auva9l41kbqoee8 License keys for translation script. One key per line: 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 Weekly Wrap Up: Gravely Concerned By Dan Olmsted I hate to beat a dead horse, but when the supposedly dead horse is the fact that – contrary to the American Academy of Pediatricians-- mercury in vaccines causes autism, I'm afraid I'm going to have to go on beating it. In a sick way, the new AAP statement condoning the use of mercury in infant vaccinations worldwide has handed us a dream of an issue. The idea that mercury vaccines have no relationship to autism, and therefore nearly 100,000,000 children should be vaccinated with them every year into infinity, certainly concentrates the mind and reminds us of what we are fighting for, or rather against. The AAP statement is an affirmation of one by a WHO advisory group with the telltale moniker of SAGE, which reported earlier this year it was "gravely concerned that global vaccine discussions may threaten access to thiomersal-containing vaccines without justification. SAGE reaffirmed thiomersal-containing vaccines were safe, essential and irreplaceable components of vaccine programs, especially in developing countries." Well, they are not safe, not essential and not irreplaceable. They are dangerous; they cause autism; we can improve world health outcomes without them. In fact we can ONLY improve health outcomes without them. Thanks, SAGE and AAP, for reminding us what the stakes are here and WHO we are fighting for the future of the human race. In case we needed a New Year's resolution worthy of our time and effort, we in the rebel alliance don't have to look very far.