I know a couple of you guys on the forum have been involved in this industry as transport providers, and I'm interested in hearing your thoughts. How do you guys typically get your business - is it primarily arranged by the patients themselves, or are you working with medical staff? Do you use any sort of online marketplace to get business, and if you do, what's your experience been like there?
szeis4cookie said:I know a couple of you guys on the forum have been involved in this industry as transport providers, and I'm interested in hearing your thoughts. How do you guys typically get your business - is it primarily arranged by the patients themselves, or are you working with medical staff? Do you use any sort of online marketplace to get business, and if you do, what's your experience been like there?
EMTs and Paramedics with private ambulance companies typically run as a business, having contracts with hospitals and facilities to do specific work like medical transport and even 911-level response. Any "Small" thing like an individual who needs an ambulance cot for their doctor's appointments would just go through their billing department.
Do you mean like a home-health care CNA/RN or something like that?
Neither.
Its broker driven. You have to have an ongoing relationship with the brokers in your state, and it’s hard to develop. It’s a monopoly
John Welsh will be checking in shortly. His story is a success story, mine is not.
It took me a year to develop the relationship with the brokers before I could get any business. My contract with the broker was over 200 pages long. Once I developed the relationship, it went very very well for a while.
But I was in GA. GA failed to adopt the ACA Medicaid expansion. This made NEMT transport not profitable for the brokers in rural areas (who deal in $50 million dolllar statewide contracts). They pulled out, and I was out of business.
You are in VA. VA expanded Medicaid, so there is business. But expect a long road to developing business. Also, realize the bidding for the brokers is annual contracts. Once you have a relationship with a broker, everything could end quickly if they are not the low bidder for the statewide contract the next year. Also expect serious pressure from the existing providers. They will not want to share any of the available business.
It a good business, with very good potential cash flow. But you are not ultimately in control of your business. The brokers are. If they change their rates, areas covered, contracts, etc they will stop doing business with you without any notice.
Also...
Urban areas are generally the territory of taxi companies who have the resources and dispatch capacity to pick up short rides quickly. They license several of their drivers for NEMT, and add it to their existing work load. You won’t compete with them in urban areas.
The opportunity is in rural areas.
In reply to GIRTHQUAKE :
NEMT and EMT are completely different.
In reply to szeis4cookie :
You know I sent you a PM. I got yours back.
As I wrote, since your questions of software platforms and improving the supply/demand efficiencies requires more questions and understand on both our parts, this is probably better for a phone conversation rather than chapters of text written here.
In reply to szeis4cookie :
I went pretty far down the software platform rabbit hole
Didn't change the fact that the brokers hold all the cards. I was incredibly efficient. Didn’t save my business.
I know nothing other than I think Uber is getting involved with this somehow or other or something very similar.
I'd love to get into it as rides can be pretty thin on the ground at times although I heard the uptake from patients is low.
And another. Not sure if this is at all what you're looking for. 
There’s no way I’d want to drive NEMT services for Uber.
Thanks everyone for your insights, especially Paul and John. This forum is a well of knowledge that has no equal on the Interwebs.
Full disclosure, I'm not actually looking to drive, but had been considering an offer to work for a software company on the industry (I took the offer). Paul, if it's not too much to share, about how long ago was your brush with the industry? You mentioned ACA and Medicaid expansion, so within the last few years?
What I'm trying to get my arms around is general dynamics of the industry from the drivers perspective. It sounds from the responses here that it's highly fragmented and location-dependent.
Yes, both Uber and Lyft are getting into the NEMT business by partnering with hospitals or insurers to take the rides that require the least added services. It's an interesting development for sure. Jury is still out on whether that's a good or a bad interesting I think.
In reply to szeis4cookie :
I closed my business 4 or 5 years ago after doing it for a few years.
Yes, it's highly fragmented and location dependent. But the common threads for all of the transport providers is that they were A) Independent contractors, B) Soliciting business from large brokers who bid for annual state contracts, C) Providing medical services impacted by the ADA, the ACA, HIPAA, and various other federal guidelines (which means they have a lot of restrictions which taxis and ride-sharing companies do not have). Most also provide transport service that is not broker dependent as a side gig (so, they also may solicit directly with patients, hospitals, etc.)
Hospitals and insurers don't generally contract for rides. Brokers bid for annual contracts.
I am not sure what software solution you will be working on. My drivers pretty much didn't need anything other than their smart phones and a good GPS. Dispatch was the biggest problem I encountered. The best software solutions in the market at the time that I found were developed by NEMT providers themselves, then sold to other NEMT providers. The need was to be able to batch download the data from the broker's databases (which varied), identify which rides were feasible and profitable, divide them by drivers, schedule them, and distribute the data to the individual drivers in driver-specific format that was HIPAA compliant. Then track the cars, document the services, and communicate to the drivers how much they were making on the rides. Most drivers are independent contractors, and the HIPAA compliance becomes a really big challenge. (when the data leaves the broker, arrives to the provider, and is distributed to the driver it keeps changing companies, and it ALL has to be HIPAA compliant).
Lyft and Uber's mapping and locating capabilities are light years ahead of any of the NEMT software systems, but they are not HIPAA compliant, and would need to develop the whole system for batch downloading the ride info from the brokers and distributing it to their drivers (who would have to have federal background checks and be HIPAA compliant in how they handled the data).
It's a big challenge- good luck!
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