911 contracts

[nremtp]

How competitive is the 911 field? I want to start a 911 ambulance service and tender for contracts but how competitive is this market? We have found a consulting company who are prepared to offer their services and help us set up and get our first EMS contract but what I want to know before I spend money and make the move is exactly how competitive is the tender process?

I would be setting up in Texas because this is where my school is and this is where I am going to be licensed.

[Dustdevil]

For the life of me, I cannot imagine why anybody would want to do this. Do you have significant business management experience? Do you have endless funding to get you through start-up and the lean times that will plague you from the beginning? Those are the very first things you will need before you even think of doing this.

Anyhow, unfortunately, if there is any place that a fly-by-night, mom & pop operation can get a 911 contract, it is Texas. :? That's a good location to smoke this pipe dream of yours. The market is VERY competetive in most places. Although, there are a lot of rural places where they can't seem to keep a provider. But when you find those places, you can't get too excited, because if you look hard enough, you will see WHY nobody wants to provide service there. The local government is run by idiots or cheapskates or both. Basically, if you can find a market where neither the big boys (AMR, Rural Metro) nor the local government are providing the service, there is a good reason for it, so be scared. Be very scared.

But yeah, you can find some place to get a contract there if you have enough start-up capital and the gift of BS. They won't pay you enough to run a quality service, and they'll nit pick the hell out of you over every little thing, as if they are experts on EMS and you are just there to kiss their arses. The people you transport won't pay their bills because rural people have no insurance and can't afford a $500 taxi bill. Medicare will take six months to pay you maybe 40 percent of what you bill them. People will complain to the city council that you take too long to respond, that your sirens disturb their horses, that your ambulance station devalues their property, that your drivers are rude, that you charge too much, that your ambulances drive business away from their restaurant, etc... And then there are the multitude of complaints that will actually be earned by your people because you are forced to hire nimrods just to keep the trucks staffed. You will have to go back to the city/county government at least twice a year asking for more money, and they will rightfully tell you that you should run your business better so you don't have to keep nickle-and-diming the taxpayers. And all the volunteers, whose hobby you took away, will band together to tell the city/county how they provided the citizens a better service for 30 years for only half the money you are charging. Then you'll be on your arse, still owing the money you borrowed to start this abortion in the first place.

Best of luck! :wink:

[nremtp]

WOW reality sucks! Is it really that bad? I have extensive business experience prior to EMS. What do you do when citizens fail to pay? You can't refuse to transport them next time surely. If they don't have insurance who foots the bill?

Are contracts not put out to tender then? Or do you have to find an area that doesn't have appropriate cover and say "we'll cover this area"?

I will ask our consultant the appropriate questions once I am over there but I thought a bit of friendly free advice could be found on here.

It seems the best advice is DON'T BOTHER!

[Just Plain Ruff]

I think DUST As usual hit the nail right on the head.

I have two friends who tried to start ambulance services in Missouri and Kansas and they lost everything when everything that dust said happened.

One was a service who provided non-emergency services in our area and he was unable to help himself from being a jerk and divider in our community.

The other tried his hardest to provide a quality service, hire quality people yet he didn't have enough money to pay more than 6 months of bills.

My adivce is if you really are serious about doing this is three fold

Whatever amount you think you need to start this service, triple it and then double it again. So if you think it you need one million to start this company then you will actually need 6 million.

Don't buy used ambulances from services - they will more than likely have been run to death and will be maintenance nightmares.

Start small, think big - don't try to tackle a service area that needs 20 ambulances to cover it well. Try a area where you would need 2 - 3 trucks to start.

Work with the established service in the area. Try to get agreements with them for 911 back up and also calls that they don't want to transport such as long distance transfers - anything over 200 miles one way would be good to go after. that way the current 911 service can keep their trucks in district while you transfer the long ones.

Hire a competent supervisor or manager to run the day to day things like personel matters, supplies and such and you can spend your time keeping the company afloat.

have a million dollars in reserve just in case - your total now is 7 million if you are following my logic.

Have another 500K in a expense account so you can have fluid cash to pay for a new ambulance when one of your crews total it in a wreck - you could go out and purchase the new rig the day the crash happens that way it will keep your service uninterrupted.

Don't use consulting companies as a crutch- there is a saying in consulting "if you are not part of the solution there is plenty of money to be made in prolonging the problem" that is soooooooooooooo true. If the consulting company you use can't solve your problems they will have no issue in prolonging it and bleeding you dry. I've seen it happen. More money went to my friends consulting company he used than he paid out in salary, supplies and gas for the entire time he ran the service.

don't hesitate to ask for help.

Those are just a couple of the items that I found out by being close friends with two who tried to do what you are trying to do.

[JPINFV]

Dust, since government jobs are almost considered impossible to lose and cheap ass conservatives [/me raises hand to being conservative] love government to be as small as possible, wouldn't a private company that is willing to do the right thing with employment practices [good pay, requires high education] going to be needed to help raise the standards in EMS?

[pyroknight]

Can privates do the job better than government? Yup. Is it easy? Nope. 911 is a loser business for the reasons Dust pointed out. The money is made in the interfacility transports and even that has many of the issues previously mentioned (plus more difficulty in hiring personnel because all the hotshot young EMS providers want to run 911).

[nremtp]

I am considering purchasing an existing business with established contracts etc. This will reduce the risk and I am more likely to get an investor visa. I think finance companies are more willing to lend to existing businesses as well as they have a proven track record.

[paramedicmike]

My question would be why the existing service is up for sale. Are they losing money? If they were making money the service would probably not be up for sale. Which then leads to questions surrounding the circumstances leading to them losing money. Which then leads to why would you want to buy it?

Dustdevil hit pretty much every nail on the head. I admire your drive for wanting to do this. I do, however, question your sanity at the same time.

Best of luck if you decide to pursue this. It would probably make an excellent book!

-be safe

[paraloco]

a proven method for success in private service is to start out with 2-3 truck. Make some contacts at the facilities. Tell them that you don't want, or can't handle all the calls coming out of there. "Just give me some of them." Years ago, when a big private service bought up most of the mom&pop outfits in Houston, they made most of the admin type people sign no-competition clauses. There were a few low enough on the totem pole that they didn't have to sign one, but knew how to run an ambulance service. They started out small. They told the hospitals and nursing homes that when the big guy inevitably cut his number of units, and response times were affected predictably, that they could step in and provide timely, courteous service. And they did. You can get rich nipping at the big guys' heels.

[nremtp]

My sanity lol The only way I can get a visa is if I get an investor visa which means investing a minimum of $150,000 in an american business (either a start up or existing business).

I can't get a visa if I just want a job as a Paramedic as immigration don't consider Paramedics "professional" or "in demand". Nurses on the other hand.......

So my only option is to purchase or start an ambulance service. Buying a service that already has contracts and a cash flow will make life a lot easier.

I am particularly looking at California but the Cali Medic board is annoying. Not only do you need to register as a Paramedic with the State but also with each individual region you intend to work in. This is bereaucratic bullsh*t gone mad! Why register three times and obtain three licences? (NR, Cal, region)

I have asked one of the sellers about 35 comprehensive and in depth questions about his/her business but have yet to hear anything back. I don't even know the name of the company! I have also emailed the AAA (ambulance not autos) but have not heard anything from them. Do you guys have some kind of public holiday going on?

In the UK it is easy, you buy some ambulances and approach the discharge manager/bed manager at the local trust with your proposals. Private hospitals, you approach the matron. But who do you approach in US hospitals? I wouldn't know where to start. That's why I'm considering purchasing a company with existing contracts. Also, the outgoing owner provides training, there are already competent staff in place and money is already coming into the business.

A start up might require 6 months capital before money starts coming in. If Cali Med (I think that's the name for Medicare in California) are as bad as I've heard, they will take months to settle invoices and staff don't work for free!!!

EMS work is simply a case of applying for the contracts when the board put them out to tender, compete with everyone else for the work. I plan on starting off with IHT work to get some staff and money coming in and then once the business has a track record, we can apply for the 911 work.

Is there anywhere I can go for specific advice on starting an ambulance company? The AAA haven't been very helpful so far.