NEMT vs EMS: The Value of an EMS Operation
Non-Emergency Medical Transportation (NEMT)
Non-Emergency Medical Transportation (NEMT) operations are medical transport companies that transport patients with limited or no mobility for non-emergency needs such as wheelchair transport or stretcher transport for dialysis treatment, doctor appointments, family travel, and more.
NEMT Basics
Requirements
NEMT employees do not need to be licensed EMTs or Paramedics, and they do not provide Basic Life Support (BLS) or Advanced Life Support (ALS) services. The NEMT industry is not as highly regulated as the Emergency Medical Service industry and you do not need to be approved through the state to provide transportation. Most states simply require that the driver has a valid driver’s license.
Vehicles + Equipment
NEMT operations use vehicles such as sprinters, passenger transit vans, and minivans to transport patients. These vans can be basic with regular seats or they can be outfitted with wheelchair lifts, ramps, or stretchers to accommodate patients that need it.
Challenges of NEMT
The NEMT industry has some critical challenges or limitations that can make it less than ideal for some business owners.
Congested Market
Because the NEMT industry is so lightly regulated and it is relatively easy to enter, certain markets can be oversaturated with NEMT companies. In some markets, Medicaid is even allowing Uber and Lyft to transport patients. This can create a tough environment for NEMT companies to be profitable; often resulting in NEMT companies giving up profits in order to stay competitive in the market.
Limited Services
NEMT operations have limited verticality when it comes to providing a variety of services. The lack of licensing and regulation makes it easy to enter the NEMT space, but that same lack of licensing prevents NEMT companies from providing broader medical care to patients and prevents them from accessing additional revenue streams such as disaster relief, events, advanced care, and more.
Billing
One of the most important challenges of NEMT operations relates to the billing. Services provided to patients must be approved through a Medicaid Broker. NEMT companies cannot bill Medicaid directly. They must go through the broker and will receive a percentage of the total cost billed to Medicaid.
The biggest challenge with a broker is that prices can vary. The broker sets the maximum price for a service, but NEMT companies have the freedom to bid a lower cost to cut out the competition. Prices for services will also vary between brokers and different states.
These challenges result in lower revenue and lower profits per patient for NEMT companies compared to Emergency Medical Service (EMS) operations.
Emergency Medical Services (EMS)
Emergency Medical Service (EMS) companies are medical transportation companies that transfer patients to doctor appointments and hospitals. These operations provide both Basic Life Support (BLS) and Advanced Life Support (ALS) services in many different capacities.
EMS operations can provide any transportation service in which a patient has a procedure. This includes many services NEMT companies offer, including but not limited to dialysis, doctor and hospital transport, and wound care. This does NOT include simple doctor checkups or follow-ups, vacations, or other basic transport not involving a medical procedure.
EMS Basics
Requirements
Employees for EMS companies are held to a higher standard than NEMT companies. EMS employees must have a valid EMT or Paramedic license in the state of operation. The EMS company itself must also have an approved EMS business license to operate. Licensures and requirements for EMS can vary by state. Our team can help you through the application process and connect you with the right resources to get the licensing needed to operate in your state of choice.
Vehicles + Equipment
EMS operations most commonly use combination sprinter vans or transit vans with regular seats and wheelchair capabilities, as well as traditional ambulance box trucks to provide services. These vehicles, especially the ambulance box trucks, offer more space and capability to service different types of patients and locales.
Because EMS companies are licensed and qualified to provide BLS and ALS services, they must also be equipped with medical supplies, defibrillators, and other equipment. The specific requirements for supplies and equipment can vary by each state.
The Benefits of Converting Your Operation to EMS
There are some attractive benefits to transitioning from a NEMT business or starting an EMS business outright.
Billing
Let’s start with the biggest and most important benefit of operating as an EMS company instead of a NEMT company: the billing.
As an EMS operation, you can bill Medicare directly for any services provided involving a procedure such as dialysis, wound care, MRIs, or any other medical procedure. You DO NOT have to go through a broker or other third party that will take a cut out of your revenue.
Additionally, Medicare sets the prices for each service or procedure in a market. These prices are fixed for all EMS companies in that market and cannot be negotiated. The price is the price! This means that not only do you capitalize on the full rate of the service, but other EMS companies in your market are not able to underbid you to steal your business based on the price of the service. Your ability to maintain customers is entirely dependent on your customer service, sales ability, and quality of care.
Increased Services
The other huge benefit to operating an EMS business is the wider range of available services and revenue sources that you can provide. Having an EMS license with EMTs and Paramedics on staff allows you to diversify beyond non-emergency transportation and provide other services such as:
Disaster and Weather Relief
Emergency 911 Services
Sporting Events
Movie Sets
And More!
“As an EMS operation, you can still provide many of the same non-emergency services as a NEMT business but with added access to additional revenue streams and profit potential!”
The available market share for EMS businesses is much higher than NEMT businesses. Due to the increased licensing and training requirements, expansion of potential services, and the ability to bill Medicare directly, you can expect much less congestion in the market and many more opportunities to increase your revenue and maximize profits.
Requirements to Upgrade to EMS
Converting a NEMT business into an EMS business does come with some challenges and extra requirements. To get your EMS operation up and running you will need to understand and prepare for the following:
Applying for an EMS business license approved through the state of your choice
Finding a Medical Director (if applicable)
Developing required protocols for your business
Understanding and meeting the EMT licensing requirements for your employees
Expanding your vehicles and equipment, including medical supplies
Understanding the billing process, prior authorizations, and patient care reports
And so much more!
This is not a comprehensive or complete list of the items you must consider when starting up an EMS business. There are many considerations and nuances that will depend on your specific state and your specific business needs.
However, this does not have to be a daunting or exhaustive process! Our team here at Route Consultant can hold your hand through each step of the process to ensure you are prepared and ready to launch the next phase of your entrepreneurship journey.
Reach out to our team today to learn more about the differences between NEMT and EMS and the benefits that an EMS business model can provide you.
