revenue vs. annual budget??

[DrAsystole]

My municipal agency bills for ambulance transports. The yearly revenue that we take in equals approximately 70% of our annual operating budget. Our political bosses want to know why we dont make a profit. We are a tax supported 9-1-1 public ambulance career service. We do not do inter-facility transfers. The revenue, unfortunately, goes to the general fund not ems. I thought 70% was a decent number for a governmental ambulance which must take every call. Am I wrong? We do about 56,000 runs per year.....about 2/3 are "billable".

Does anyone know if there is a "national average"on revenue vs. annual budget? I welcome any comments or observations. Thanks.

[Woody76559]

We're a little bit smaller than your service. We average about 400 calls per year. For FY '04, our expenses were approximately $180K. This includes salary and supplies. Our income generated from call volume was only $85K. My council was wondering why we cost more than we bring in and what could we do to increase our revenue. The only thing that we can do is to do our own in-house billing which will cost around $10K initially. Then we have to hire a couple new people just for billing and train them. I think all EMS services have this problem an, unfortunately, there is not really a way to increase revenue. Medicare has a cap on how much we can charge for services, so we're stuck with those rates. If you can think of any ways to increase the revenue, let me know because I am curious as well.

[aussiephil]

I think this is an age old problem for all ems services worldwide. The biggest problem is we have to cater for a worst case scenario & as such expenses are high. Imagine the outrage if we were not dispatching multiple resources to an MVA & only sending one to find 4 patients or worse?

We work in a reactive industry & there is no way we can beat this into politicians heads. The only way to force change is for an eminent person to be seriously injured & have an inadequate response.

Are the same questions of profitability put onto police? They have more opportunity to generate revenue than we do.

If you find an answer let me know. :shock:

[emtI4now]

We're a little bit smaller than your service. We average about 400 calls per year. For FY '04, our expenses were approximately $180K. This includes salary and supplies. Our income generated from call volume was only $85K. My council was wondering why we cost more than we bring in and what could we do to increase our revenue. The only thing that we can do is to do our own in-house billing which will cost around $10K initially. Then we have to hire a couple new people just for billing and train them. I think all EMS services have this problem an, unfortunately, there is not really a way to increase revenue. Medicare has a cap on how much we can charge for services, so we're stuck with those rates. If you can think of any ways to increase the revenue, let me know because I am curious as well.

Woody,

Sounds like you've checked into the billing issue. Just curious why it would take 10K to start up the in-house billing? We do about half the amount of runs that you do, and I do all the billing.

Our expenses were around $110K for last year, and revenue approx. $80K. We are funded by the county to the tune of about $30K per year. The rest comes from run-generated revenue. The rest of our operating expenses were subsidized by the city.

[xselerate]

I volunteer for a local service when I'm not at my full time job. Our billable jobs don't add up so we have to do charity events and such. So the situation seems pretty average.

What may be of interest is increasing your billable jobs simple through your paperwork. I've read articles (why does JEMS ring a bell) about simple things that can increase your revenue like having every patient sign the billing portions of you patient care report (or a seperate billing form if you use one). You could always mail bills out to people who aren't billable through insurance, if they pay they pay and if not then it's no worse for you. Other things like proper documentation of necesity of services can vastly improve your billable jobs.

Either way good luck!

[PRPGfirerescuetech]

We're a little bit smaller than your service. We average about 400 calls per year. For FY '04, our expenses were approximately $180K. This includes salary and supplies. Our income generated from call volume was only $85K. My council was wondering why we cost more than we bring in and what could we do to increase our revenue. The only thing that we can do is to do our own in-house billing which will cost around $10K initially. Then we have to hire a couple new people just for billing and train them. I think all EMS services have this problem an, unfortunately, there is not really a way to increase revenue. Medicare has a cap on how much we can charge for services, so we're stuck with those rates. If you can think of any ways to increase the revenue, let me know because I am curious as well.

Your expenses are WAY TOO HIGH for the revenue and call volume. In house billing isnt going to fix that problem. Its like your local walmart employee buying a house in the Hamptons.....too much discrepency.

Start a subscriptionj service, farm out to residents, cut your expenses back to....140k, and you should be able to just about bridge the gap.

[Dustdevil]

I volunteer for a local service when I'm not at my full time job.

Why?

[GAmedic1506]

I do not believe you are that far out of whack, but I would need to have some more numbers. But the problem is that those who control the purse-strings arent happy, and if you want to keep your job, you need to fix that. First and foremost, you have to ask yourself if you are running too many trucks, or are you heavily laden in administrative positions that you do not need. Can you justify what you are spending ? If you can justify it, and you are not wasting any money, then ask your bosses what target they would like to see you hit ? Then come back to the office, and see what it would take to do that:

1. Lay-off employees / supervisors

2. Shut-down some trucks

3. Change your schedule, are you running a traditional 24/48 ? Maybe you could shut down a truck at night, or run peak-hour trucks instead of 24s

4. How are you covering sick-outs and vacations (part-timers or full-timers on OT)

5. How much are you spending on OT

6. What % of billables are being collected, are your bills processed next day, or weeks/months after the call

Ask yourself, If the commissioners asked a private service to come do it for a cheaper subsidy, what would that service do differently to run the company and make a profit. Then present the bosses with what it will take to get to their target, they probably wont have the stomach to make the changes, but you will have done your job.

[ffpm41]

A public system is not going to "make" money. With Medicare/medicade being the way they are, your lucky your getting 70%.

[MEDIC_ONE]

We're a little bit smaller than your service. We average about 400 calls per year. For FY '04, our expenses were approximately $180K. This includes salary and supplies. Our income generated from call volume was only $85K. My council was wondering why we cost more than we bring in and what could we do to increase our revenue. The only thing that we can do is to do our own in-house billing which will cost around $10K initially. Then we have to hire a couple new people just for billing and train them. I think all EMS services have this problem an, unfortunately, there is not really a way to increase revenue. Medicare has a cap on how much we can charge for services, so we're stuck with those rates. If you can think of any ways to increase the revenue, let me know because I am curious as well.

You're stuck at a bad number. 400 runs is just barely enough to justify a fulltime service but not quite enough to cover all your costs. I'd check into getting rid of a few fulltime positions and hire in some part timers and even think about a combination volunteer/paid service before I went to billing myself. Someone else mentioned some interesting issues about improving the accuracy of paper work. I have worked at some services that have improved their revenue just by improving efficiency of paper work. I say paper work becuase its not just all ABN's and run forms its an issue with your billing service's paper work as well. The money is made in the paper work and desk work. Check the efficiency of your billing service. I know of a service that improved collections from 50% to 75% just by switching billing services.