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

                                  Coronavirus Update

                                  Nov 1, 2021 - New COVID-19 Cases Decrease
                                  • Demand for ambulance services may decrease again if the number of new COVID-19 cases continues decreasing. The US reported an average of 72,000 new cases per day during the week ending October 29, according to data compiled by Johns Hopkins University. That's down 58% from the most recent high mark of 172,500 average daily cases on September 13. Case counts have fallen in every region, most sharply in the South, where the delta wave hit hardest over the summer. Vaccination rates have also risen in recent months, albeit more slowly than when the shots were first rolled out. Nearly 58% Americans were fully vaccinated by the end of November, according to the Centers for Disease Control and Prevention. Many experts initially suggested that herd immunity would occur when 60-70% of the population gained immunity, that estimate rose to 85-90% after COVID's delta variant took over this summer. Some experts say that herd immunity isn't possible at all.
                                  • 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 US Department of Health & Human Services (HHS) has renewed the Public Health Emergency (PHE) declaration for COVID 19 for another 90 days, beginning on July 21 (the date the PHE was previously scheduled to expire) and extending through October 20, 2021. Industry stakeholders should remember that HHS retains the discretion to terminate the PHE at any time.
                                  • 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 in January 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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