Re-imagining EMS & NEMT after COVID-19: The Comprehensive Guide

At the onset of COVID-19 in March, we saw on average a drop of 18-40% in transportation requests for service providers. While some areas are rebounding and business is picking up again, the possibility of a second wave or another major event remains high. Now is the time to truly start re-tooling and re-imagining your business to survive and thrive in the world of COVID-19.

Last month, we hosted a webinar with Pinnacle EMS all about the changing face of NEMT/EMS after COVID-19. Learn how NEMT providers can reimagine outdated “turf war” models of business, and instead build healthy networks of providers across a wide range of services. Create a scalable business model by offering wide ranges of services: from wheelchair to Uber/Lyft, without increasing upfront equipment cost.

You can watch the webinar below, or keep reading for a comprehensive guide.

“This is healthcare’s Amazon moment. If you are a provider and think you’re going to go back to your business model solely being based on hospital revenue and not relevant to people who want care at home, I think you will be out of business... I think we were always wondering what the big disruption would be that got us to join the consumer revolution, and I think this is it.” -Stephen Klasko, President & CEO, Jefferson Health

The State of the Industry

Let’s start by talking stats. Based on a survey which included ~500 EMS/NEMT providers across the country, we found that COVID-19 had impacted businesses in the following ways:

18% experiences employee shortages

64% had to quickly implement new service standards & guidelines

73% implemented more flexible workspaces & work from home initiatives

18% offered different types of services

91% experienced a loss of revenue

It’s clear that all service providers were profoundly affected, and continue to be affected by this pandemic. Providers have had to become increasingly agile in order to maintain profitability, and, despite their best efforts, often still experience a loss of revenue.

Areas of Improvement

We found that COVID-19 exposed a lot of gaps in the EMS/NEMT industry, where providers can improve their business model for better disaster response:

• Due to employee shortages, efficient UHU and smart scheduling tools were more important than ever
• Communication during a disaster is crucial. When pivoting to new workflows and procedures, many providers had trouble quickly disseminating information via phone calls or email. FEMA’s COVID-19 guidelines recommend that each provider have a plan enacted for Conventional, Contingency, and Crisis levels of care throughout the care continuum. For instance, at the conventional level you may triage incoming service calls based on medical need, yet at the crisis level only service calls where the individual is in life threatening medical danger.
• Flexible workspaces: Many employees began working from home due to the increased virus spread, which necessitated flexible and secure mobile workspaces.
• With an up to 40% drop in transportation requests, many providers struggled with quickly and efficiently pivoting to new services.

There are three main areas we recommend all EMS & NEMT providers consider when building a business that is disaster-proof and flexible in times of crisis:

• Optimize efficiency through technology & data
• Consider the “pivot”
• Build healthy provider networks

In this post, we’ll be covering how to optimize your efficiency through technology and data. It’s important to build a business that runs as slick and efficiently as possible so that you’re able to pivot to new procedures quickly during a crisis.

Technology

1. Ensure your employees have a HIPAA-secure, reliable way to work remotely. Setting up remote work flexibility for your employees is measurably safer during a pandemic, as it allows them to work from the safety of their own homes. Moving to less centralized technology options can help your business maintain operations without missing a beat in the event of a flood, fire, or other disaster affecting your physical office. Look into:
   undefinedundefinedundefined
2. Embrace automation: Automate tasks in order to lower FTE and manual work without sacrificing business standards.
   undefinedundefinedundefined

Data

Once you’ve streamlined your business with technology to make your operations as efficient as possible, data is where you can really dig in and find your gaps. You may be able to run a business day-to-day by being reactive and taking each call as it comes, but without data you’re flying blind: unable to tangibly measure improvement or identify weaknesses.

“Most of the world will make decisions by either guessing or using their gut. They will be either lucky or wrong.” - Suhail Doshi

While there are countless ways of leveraging data to improve your business, at minimum we recommend looking into the following areas:

1. Find where your gaps are: Use reporting tool to analyze data and create efficiencies. You may want to track and measure:

• UHU
• On-time rate
• Data on patient symptoms & diagnoses to provide better patient outcomes. Here, EMS providers can compare their diagnosis with a hospital’s, validating care accuracy.

2. Predict where to allocate resources

• EMS providers can use predictive modeling software to anticipate where to expect calls
• Analyze volume trends to determine employee scheduling & vehicle deployment

Many EMS and NEMT providers will have already implemented many of the above recommendations. If your business is lacking in any of the listed areas, now is the time to re-tool and increase your operational efficiency so that when a crisis strikes you won’t be caught in a logistical mess.

The Business Pivot

Now that we've discussed the state of the industry and how technology and data can improve your operations, let’s talk about the pivot. During times of crisis, uncertainty, and market tumult, the ability to create a strong business pivot can be a crucial factor in maintaining a profitable business.

A pivot is a quick turn to offer different services or market to another vertical.

To reference an industry example, a transportation provider in Hillsboro, Oregon has been able to quickly pivot their service offering during the pandemic. In addition to normal NEMT services, the company has been working with local hospitals to conduct COVID-19 home testing as well as post-surgery home health services. In response to COVID-19, many states are broadening their scope of practice for EMS providers. EMS WORLD RECENTLY REPORTED that Indiana is now allowing EMS providers to administer over-the-counter pain relievers, user bronchodilators, and provider other additional services. Other states now allow paramedics to begin offering rapid COVID-19 blood tests. If you haven’t already, all NEMT/EMS business owners should stay up to date on the changing scopes of practice in their states of operation. Due to easing restrictions, you may be able to provide far more services than pre-pandemic.

Looking ahead, we can view a significant trend in EMS/NEMT toward mobile integrated healthcare and community paramedicine. As our healthcare system becomes more decentralized and focused on the healthcare-at-home model, providers can begin providing at-home care options to low risk patients: administer flu shots, provide COVID 19 tests, and more.

VectorCare recently surveyed 400 NEMT and EMS providers around the United States. An alarming 91% of all providers reported a loss of revenue due to COVID-19. When disaster strikes and your typical services decrease in demand, brainstorming new ways of pivoting and adding verticals can keep your business afloat.

All About Service Networks

“In order to ensure quality care for every patient, healthcare organizations need a more comprehensive NEMT solution that can be leveraged for all use cases, levels of care, and modes of transportation.”-Beckers Hospital Review

More and more, hospitals & healthcare systems are looking to partner and work with providers who provide a comprehensive solution to their needs. Healthcare systems don’t want to call one provider for CCT, and another for Wheelchair & Gurney Van services. They want a one-stop-shop. This is why many states and systems prefer to go the broker route, but working with a broker can be expensive. Healthy networks allow you to compete with the one-stop-shop experience that a broker provides to your clients, without breaking the bank.

Healthy networks work by allowing you to form relationships with other providers in your area who perform complementary services to your offering. By partnering with them, you can offer additional services to your customers with no upfront cost on your end.

Below is a quick illustration demonstrating how a successful network partnership might work:

Let's say that a hospital sends a request to you for a Wheelchair/Gurney Van transport (for example). When you receive the request, all of your current vehicles are out on other calls at that time. Additionally, you prefer to not take wheelchair requests as they aren’t as profitable for your business, but you’d like to maintain the contract and good relationship with your customer.

Instead of declining the request or using your resources to complete it, you can simply ping the request to all of the local providers within your service network that perform wheelchair services. If you’re using a sophisticated patient care logistics solution like VectorCare, this takes less than a minute. A provider in your area (green) accepts and fulfills the ride, possibly even giving your company a referral fee in return.

This provider network model allows you to:

• Become a “one-stop-shop” for your clients by offering a wider range of services
• Seamlessly scale operations up or down based on demand
• Develop healthy relationships with local providers
• Move the industry to stop dependence on brokers
• Provide a better customer experience
• Leverage your network and be able to pivot when disaster strikes
• Protect yourself from financial fallout when request volume plummets

One of VectorCare’s customers, Mission Ambulance, was able to deploy this partner strategy to create a network of 7+ providers in their area. This allowed them to offer a better customer experience and increase their business volume but 15-20%. To read more about Mission, VIEW THEIR SUCCESS STORY HERE.

If you’re unsure about where to start looking for potential network partners, a great place to start is a SWOT analysis (pictured below). Map out your business’s strengths, weaknesses, opportunities, and threats in your area. Discover where you have gaps in your offering, and seek out local providers who can fill those gaps so you can better position your business as an all-in-one solution to customers.

An Example: Staffing Networks

Within their Pandemic Operations guide, FEMA recommends that EMS providers prepare to cope with a workforce reduction by fostering a network of alternate and nontraditional workers to be called to volunteer should the surge of patients warrant it.

FEMA recommends contacting local medical reserve corps, community emergency response teams, junior colleges, people with transferable skills (such as bus drivers) and more to form a community of individuals ready to fill in the operational gaps should there be a surge.

Though not everyone can volunteer as a paramedic or driver of course, supplemental volunteers may be able to help: answer phones, triage calls, prepare meals, decontaminate gear, or whatever is needed.

What we’ve identified as ways to build partnerships between other service providers, you can use to create and build a network of emergency staffers.

1. First, revisit your SWOT Analysis and identify your gaps, and your workforce limitations,
2. Next, find others to help, and bring them in to help as needed.
3. Create shareable workflows to train new volunteers, and make sure there is a notification software, a website, or social media account where you can reach all the members in your network instantly.

Conclusion

There is no doubt we’re living in unprecedented times. COVID-19 has certainly rocked many industries including the EMS and NEMT industry, and none of us are quite sure how this is going to play out or when it will end.

That said, we need to stay in motion and re-tool our businesses as we move forward. If you have an efficient EMS/NEMT business that relies on AUTOMATION, TECHNOLOGY, AND DATA-DRIVEN INSIGHTS, you can be certain that you’re making the right operational decisions. By combining those three aspects with a healthy partner network, you can ensure that you’re putting your business in the optimal position to:

• PIVOT AT A MOMENTS NOTICE
• Be Ready to scale up or down without a huge financial cost or risk
• Run efficiently and drive decisions with data, not guesswork
• Come out of this experience with a tighter ship and more solid business

Onward!