Ambulance Services

Industry Profile Report

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

Industry Overview Industry Structure, How Firms Opertate, Industry Trends, Credit Underwriting & Risks, and Industry Forecast.

Call Preparation Quarterly Insight, 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

                                  Coronavirus Update

                                  Apr 23, 2022 - New COVID-19 Cases Increase Again
                                  • Demand for ambulance services may increase again if the number of new COVID-19 cases increases increase again. New COVID-19 case rates increased in late April, with the seven-day rolling average increasing to roughly 46,000 on April 22, up from 30,000 cases per day on April 8, according to a New York Times COVID-19 case tracker. Experts note that the American population has different vaccination rates, levels of previous exposure to the virus, and degrees of underlying health conditions, so the trajectory of new cases could vary. Cases were rising in 38 states on April 22 and were climbing fastest in Washington, DC, Michigan and New Hampshire, where they have more than doubled since the beginning of April.
                                  • Demand for ambulance services may decrease again if the number of new COVID-19 cases continues decreasing. The seven-day average of new covid-19 cases was about 425,000 on February 1, down from nearly 800,000 for the seven-day period ending on January 16, according to data compiled by Johns Hopkins University. Hospitalizations are also declining. Experts note that the American population has different vaccination rates, levels of previous exposure to the virus, and degrees of underlying health conditions, so the trajectory of new cases could vary.
                                  • 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.
                                  • The No Surprises Act included in the coronavirus stimulus package passed in December 2020 includes air but not ground ambulances. The Act, which took effect on January 1, 2022, bans surprise medical bills in emergencies as well as those from out-of-network providers who treat insured patients at an in-network medical facility. Research published in 2020 found that 79% of all ground ambulance rides could result in an out-of-network bill. The study was based on a large national health insurer’s claims data from 2013 to 2017. Another study, published in 2019, found that 86% of ambulance rides to hospital emergency departments resulted in an out-of-network bill for patients with private insurance, a far higher rate than from other physician specialists encountered in an ER visit, including ER doctors and anesthesiologists.
                                  • The Department of Health and Human Services announced is providing $1.48 billion for ambulance services from the Provider Relief Fund. The $1.48 billion is an addition to the $350 million that ambulance services had received from the federal government since the beginning of the pandemic, for a total of $1.83 billion.
                                  • EMS personnel are at a higher risk of dying from COVID-19 than other healthcare or emergency services professionals, according to an analysis conducted for industry news site EMS1. Researchers estimate that the number of EMS personnel COVID-19 related deaths is about three times higher than that for nurses and about five times higher than that for physicians. EMS professional fatalities were highest in New Jersey (36% of fatalities), New York state (22%), and Pennsylvania (8%).
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