Non-Emergency Service needing Patients?

[Dsanders]

I am in the Houston area and have an ambulance service that 2 others and myself have put everything into starting up. We want to have and maintain a service that has the best Patient care possible.

The problem we are having is getting patients. We have currently been trying to go the dialysis route, but we've only been able to secure one patient. I know that dialysis is becoming a rough route when it comes to getting paid from medicare, we are still trying to get paid from a couple dozen runs. We are just a BLS company that truly wants to be known for the quality of care we provide to our patients. We only have units with bigger boxes and refuse to use van ambulances. We could have started any number of business types, but we wanted something that we could give back with. Unfortunately if we do not get more patients we will not be able to keep running. I personally haven't been able to pay myself in a month just trying to keep things rolling. I'm not concerned about making a fortune, just keeping the doors open and myself off the streets. This is truly a company that wants to provide a comfortable professional service to our patients.

So if anybody has ideas or what has worked for them, I'd be extremely grateful. I'm willing to do whatever it takes to get more patients and make this work. I have everything I have invested in this. Thank You all for your time.

[akflightmedic]

I am in the Houston area and have an ambulance service that 2 others and myself have put everything into starting up. We want to have and maintain a service that has the best Patient care possible.

The problem we are having is getting patients. We have currently been trying to go the dialysis route, but we've only been able to secure one patient. I know that dialysis is becoming a rough route when it comes to getting paid from medicare, we are still trying to get paid from a couple dozen runs. We are just a BLS company that truly wants to be known for the quality of care we provide to our patients. We only have units with bigger boxes and refuse to use van ambulances. We could have started any number of business types, but we wanted something that we could give back with. Unfortunately if we do not get more patients we will not be able to keep running. I personally haven't been able to pay myself in a month just trying to keep things rolling. I'm not concerned about making a fortune, just keeping the doors open and myself off the streets. This is truly a company that wants to provide a comfortable professional service to our patients.

So if anybody has ideas or what has worked for them, I'd be extremely grateful. I'm willing to do whatever it takes to get more patients and make this work. I have everything I have invested in this. Thank You all for your time.

Prior to putting everything you have into this venture, what kind of market research did you do? How many competitors do you have? How many long term facilities did you contact and advertise with? How many did you ask for input into what they want from a service provider? How much capital did you set aside for this venture?

Unfortunately, many people who have done what you have just assume it is as easy as purchasing a truck, getting some licenses and off they go! The reality is no one cares what kind of care you give, they care about what service you provide. Doing inter facility transport as a BLS truck means "taxi driver" and that is fine as they are very much needed. Your quality care which you want to be known for is almost nonexistent as it is usually not needed. What is needed is on time, courteous individuals who will deliver on the promises they make to the people and the facilities.

As an owner/co owner, you will always be the lowest paid if at all until the company has profit. Gross revenue minus operating expenses leaves very little net profit at the end of the day-especially in the ambulance industry...which you would be aware of had you done very much research.

Why did you use your own money? Why did you not seek an investor of some sorts, to absorb that cost? If you have a solid business plan, there are tons who would jump on board. Your research should have shown you that you would not have enough money to sustain the project and an investor would be the only way to go. Unfortunately once you get cash flow negative (like you are now), the venture is more risky and only angel investors will come in at this point who will help but only for 50-51% or more.

I do not mean to beat you up here but I am trying to give you food for thought...albeit a bit late.

You need aggressive marketing at this point...which should have been done months prior to actual start date. You need to hit the streets, you need to promote, you need to schmooze. This is expensive and is usually as much or higher than total employee salary in most start ups. You are behind the eight ball, this is not a "nice to do" this is a "must do" if you wish to stay in business. It is going to cost money and you can't cut corners.

[hatelilpeepees]

Some Advice from someone who has been doing this awhile:

1. Get the hell away from Dialysis, don't go back.

2. It's all about relationships, you need to make a friend at a facility. What have you offerred to date ? Are you offerring CPR classes to nursing homes ?

3. Don't shy away from the "hood". Medicare/Medicaid pay the same amount no matter where the patient comes from whether it be the nastiest nursing home, or the one that looks like a Ritz Carlton.

4. Go talk to the largest non-emergency provider and ask them if they will roll calls to you when they are busy ? Every service has days when they cannot handle the call volume no matter what size they are ?

5. Go to the local 911 service and ask them to roll the non-emergent calls or long distance transports that they do not want to run.

6. Visit THE NIGHT SHIFT. NO ONE EVER MARKETS THE NIGHT SHIFT. Take some $5.00 pizzas to the ER or nusing home around 11pm.

7. Move your station so that you are on-campus or nearly on-campus of a large facility, and let them know you are closest.

8. Post your ambulance at the ER bay, not at your station.

I got hundreds more, PM me.

Edited June 14, 2011 by hatelilpeepees

[Dsanders]

I apologize for failing to mention a few more details. This venture was presented to me through one of the other co-owners that is a combat medic veteran and worked with another company. I was under the impression that he had everything handled and together. Things were put in front of me with everything sounding like what has been said; get a truck, permit and run. Unfortunately, I was wrong. So this is where I'm at now. I know that I can only blame myself for not doing the research, this is a field in which I didn't know much about and thought it was that easy. I would have done a ton more research and gotten things together before this point if I had any idea, that's my fault. Either way, I am still at the point of just needing one more dialysis Patient to keep the doors open. Then We can restructure to make things right.

Prior to putting everything you have into this venture, what kind of market research did you do? How many competitors do you have? How many long term facilities did you contact and advertise with? How many did you ask for input into what they want from a service provider? How much capital did you set aside for this venture?

I apologize for failing to mention a few more details. This venture was presented to me through one of the other co-owners that is a combat medic veteran and worked with another company. I was under the impression that he had everything handled and together. Things were put in front of me with everything sounding like what has been said; get a truck, permit and run. Unfortunately, I was wrong. So this is where I'm at now. I know that I can only blame myself for not doing the research, this is a field in which I didn't know much about and thought it was that easy. I would have done a ton more research and gotten things together before this point if I had any idea, that's my fault. Either way, I am still at the point of just needing one more dialysis Patient to keep the doors open. Then We can restructure to make things right.

You need aggressive marketing at this point...which should have been done months prior to actual start date. You need to hit the streets, you need to promote, you need to schmooze. This is expensive and is usually as much or higher than total employee salary in most start ups. You are behind the eight ball, this is not a "nice to do" this is a "must do" if you wish to stay in business. It is going to cost money and you can't cut corners.

By aggressive marketing and schmoozing. What is acceptable in this field. If at all possible I could use an example. I am not afraid to talk to people and know a fare amount about sales(bartended/waited tables through college. If you can sale a $40+ entree to someone that will shi*t it out in a couple of hours, you can sale about anything). I am open ears and will take everything I get from your replies to heart, but please refrain from criticizing the lack of forethought we have had. We cannot go back in time and does no good in making this work. Thank you all again for your input.

[akflightmedic]

My suggestions revolve around answers.

1. What is your coverage area?

2. How many competitors do you have in that area?

3. How many LTC facilities are there?

4. How many Rehab centers?

5. How many dialysis centers?

6. Hospitals...have you approached them?

7. What is your monthly overhead?

8. How can you tighten up expenses now in order to free cash for marketing?

9. Who is going to do your marketing while you are actively working on the truck?

On and on...these are basic things which you NEED to know in order to know the market you are attempting to serve.

In addition to marketing, you need aggressive billing practices and a full time person and quality program to track these things. It will quickly get out of hand and then you will be behind yet again.

As far as what is acceptable, you need to be in these people's faces every day. You need to learn their names, you need to visit them. Gifts, food...all of that is nice but you can not keep that up. It comes down to how personable, how approachable you are when you enter their facility and talk about your service. I am sure they have seen and heard it all as it is my understanding that ambulance services are quite easy to start in Texas and many fail for fraud, mismanagement, no money, etc. So these facilities do not want talk, they do not want BS, they want someone to do a good job...that comes down to how believable you are, how you can sell it, and how you can live up to it.

You need more $$$.

[Richard B the EMT]

Part of the reason one company I used to work for "went under", was, Under the Carter Administration, Medicare stopped paying for dialysis ambulance trips, which then was roughly 75 percent of our caseload.

[NYCEMS9115]

Advertisement... Company name on Business Cards, Pens, Pads, Post-its, & Calendars. Maybe on rulers, mugs, and magnets... Have a website... Go to Senior Centers to do free Vitals/BPs... Go to Primary Care/Internists... BP screenings for Church Parishioners... It's going to take a lot of money... It's not an easy business to start or run.... Good Luck...

[NYCEMS9115]

I run 11 BLS & 3 ALS (1 EMT & 1 EMT-P) during the day M-F; 1 BLS & 1 ALS on the overnights Sun-Sat. On Sat during the day there's 5 BLS & 2 ALS. On Sun during the day there's 3 BLS & 1 ALS. The day tours are 13 1/3hrs. The overnight tours are 8hrs. That's a lot of $$$..

(This is not the salary) Say the EMTs are paid $10 and the EMT-Ps are paid $20 & you want to run one ALS (EMT & EMT-P) crew 24hours; looking at pay for the 24hrs, it is $720 on salary alone. For BLS it's $480. This doesn't include: health benefits, time-off, fuel, insurance, supplies, equipment, communication, & other costs; just to run 1 Ambulance 24hrs. Daily Operating costs are a lot. You're going to need more than 1 HD patient (that's only 1RT transport 3x week; for 6 transports).

Hopefully, the HD patient has MCR (Medicare), most should but for EMS/PHC, it's MCR Part B we want. MCR Part A doesn't cover Ambulance Transportation. If you do get Doctor's Office and Clinics to call you for patient transportations to their office(s); you hope they have MK (Medicaid) because MCR doesn't pay for Ambulances going to Doctor's Appointments. Also, for Non-Emergency Transports, a PCS (Physician Certificate Statement) mush be filled, signed, printed, & dated by a Healthcare Practitioner stating/certifying that the patient is Ambulance necessary. If you're luckily enough to get Hospital Discharges; in NYS, the PCS must be generated but there is a NYS MK Pilot Form (which is a pink form) that is sent from NYS MK and the Hospital Practitioner (SW, MD, RN/CW, PA, NP) must sign before the Ambulance Company will get paid (this is to verify that the Hospital called for Ambulance Services & MK sends it months later). Reason being; a patient can not call for Non Emergency Transportation. For Emergency Calls going to an ER; anyone can call. In addition, for MCR patient(s), if there's a transport where the drop-off is out of your coverage area: you will have to collect for mileage. MCR will pay the base rate and 1 mile traveled; any additional miles traveled must be paid for by the patient or their Representative at the MCR discount rate of $7/mile...

That's just the Entitlement Programs. How about them HMO/CMO/PPO/EPOs? For Emergencies going to the ER, not a big deal but for Non Emergencies; most need Prior Authorization. The Caller (Health Facility) must call the patient's insurance and request for Authorization to get Ambulance Services. It can be a difficult task. They have to prove necessity to the HMO (it is up to the Private Insurance if excessive mileage will be covered). Hospital to Hospital (IFT/Interfacility Transport(s) are not covered by any Insurance (for the most part); it's a Bill Hospital (I owe you) because of the DRG (Diagnosis Related Groups); continuity of care (care has not been completed by the first/sending Hospital; care needs to be continued at another Hospital due to capabilities). You can not bill the patient for these types of transports. You can not bill a patient who has insurance; where the Services provided are covered by their plan...

Medical Coding & Billing Personnel should be on staff; billing can get really crazy and confusing...

Sorry for being a mood killer...

Check out this new article from JEMS; it's little bit old. My company has been dealing with this for months (really for years)...

http://www.jems.com/article/ems-insider/ambulance-billing-reimbursement-update

Click onto to the CMS link on Ambulance Fee Schedule...