Ambulance Services

Industry Profile Report

Dive Deep into the industry with a 25+ page industry report (pdf format) including the following chapters

Industry Overview Current Conditions, Industry Structure, How Firms Operate, Industry Trends, Credit Underwriting & Risks, and Industry Forecast.

Call Preparation Call Prep Questions, Industry Terms, and Weblinks.

Financial Insights Working Capital, Capital Financing, Business Valuation, and Financial Benchmarks.

Industry Profile Excerpts

Industry Overview

The 3,000 ambulance service companies in the US provide ground or air transportation for patients in need of medical care. Companies typically have contracts with communities and government agencies to provide 911 emergency transports. While the majority of services are provided during emergency situations, ambulances may also be used for non-emergency transport.

Dependence on Third Party Reimbursement

Ambulance service companies provide services to patients, but receive the majority of payments from a variety of third parties, including government organizations, insurers, and managed care organizations.

Risk of Malpractice

Because ambulance service providers provide urgent medical care, companies are exposed to the risk of malpractice.

Industry size & Structure

The average ambulance service provider operates out of a single location, employs 56 workers, and generates $5-6 million annually.

    • The ambulance service industry consists of about 3,000 companies that employ about 168,400 workers and generate $16 billion annually.
    • The industry is concentrated at the top (the top 4 firms account for about 33% of industry sales) and fragmented at the bottom.
    • Large companies include AMR, Acadian Ambulance Service, and Air Methods.
    • Some ambulance service providers operate regionally, and most serve a limited geographical market.
                                  Industry Forecast
                                  Ambulance Services Industry Growth
                                  Source: Vertical IQ and Inforum

                                  Recent Developments

                                  Nov 12, 2022 - Diesel Price Remains Elevated Even As Gasoline Price Decreases
                                  • Gasoline prices have dropped as much as a dollar a gallon since early summer but the price of diesel has remained high, and ambulance services that rely heavily on diesel-powered vehicles are feeling the pain. The cost of diesel has increased over 40% over the last year while the price of gasoline has increased 11%. Diesel prices are high because the fuel is scarce worldwide. Oil analysts say that there are not enough refineries operating worldwide to meet demand. Demand for diesel and its price could fall, however if much of the world slides into a recession next year, as some economists and policymakers are expecting.
                                  • Ambulance services may soon face even higher fuel costs. The Organization of the Petroleum Exporting Countries and allies (OPEC+) agreed to slash output by two million barrels of oil a day. Experts say that move may boost already-high global energy prices. The production cut is the biggest from the group since April 2020, signaling its intent to keep prices high after enduring seven years of a relatively subdued market. OPEC+ members called the decision a technical response to a flagging global economy, especially in China, where COVID-19 restrictions have hurt oil demand. Experts note, however, that there is considerable uncertainty about how deep the cut in oil production will go. Most OPEC+ members regularly fall short of their production quotas because of low investment and will not trim production much if at all. Richard Bronze of research firm Energy Aspects estimates that the actual cut will be about one million barrels a day.
                                  • The US Department of Health & Human Services (HHS) has renewed the Public Health Emergency (PHE) declaration for COVID 19 for another 90 days, beginning on October 13 (the date the PHE was previously scheduled to expire) and extending through January 11, 2023. HHS will provide states with 60 days notice prior to the termination of the PHE. Prior PHE renewals gave HHS the discretion to terminate the PHE at any time. Waiver of cost-sharing for medical and behavioral telehealth services by health insurers is likely to be extended again by insurers.
                                  • A Centers for Medicare and Medicaid Services (CMS) waiver authority included in the American Rescue Plan Act of 2021 authorizes reimbursement to ambulance services for treatment in place delivered to Medicare beneficiaries during the public health emergency. The Act also provides additional funding for the Provider Relief Fund for rural EMS.
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