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 2,900 ambulance services 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 2,900 companies that employ about 164,300 workers and generate $16.7 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

                                  Mar 19, 2024 - Moderate Sales Growth Expected
                                  • Ambulance service industry sales are forecast to increase at a 5.89% compounded annual rate from 2022 to 2027, faster than the growth of the overall economy, according to Inforum and the Interindustry Economic Research Fund, Inc. Industry employment and average wages for nonsupervisory employees increased slightly during 2023, according to the US Bureau of Labor Statistics.
                                  • The average retail price of diesel decreased about 5 cents per gallon during the seven-day period ending on February 26 according to the US Department of Energy/Energy Information Administration. The small movement in recent weeks, except for a 21-cent increase in mid-February, contrasts sharply with the volatility of the weeks prior to that, according to FreightWaves. Since a 2 cents-per-gallon increase on December 25, 2023, the changes up or down, besides the 21-cent increase, have ranged from negative 4.8 to positive 3.5 cents a gallon. The 5.1-cent move during the seven-day period ending on February 26 was larger than those other recent changes.
                                  • Unexpected ambulance bills remain common in some areas despite the passage surprise billing laws intended to curb the problem, according to the Denver Post. Colorado law, for example, offers some protection from surprise bills to people with state-regulated insurance plans, but even they could still receive a larger-than-expected bill if an ambulance provider is a public entity. The federal No Surprises Act, which limits the circumstances where patients can receive a bill for a larger amount than their insurance covers, doesn’t apply to ground ambulances. Most ambulance providers haven’t reached agreements with insurance companies on in-network rates, and since they have the option to bill patients for whatever their insurance didn’t cover, it doesn’t create a strong incentive to get into their networks, according to Adam Fox, deputy director of the Colorado Consumer Health Initiative.
                                  • A partnership forged with a telemedicine provider may boost rural ambulance service. The partnership created by the state of South Dakota and Avel eCare telemedicine provider will connect EMS volunteers or employees to board-certified emergency physicians and registered nurses right inside the ambulance via video link. Experts say that many ambulance services rely heavily on volunteers, many of whom are also volunteer firefighters. Some volunteers don’t go out on calls very often, so the tool will help make them feel more confident in their treatment.
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