Demonic system we live under truly

These are gilded age tier horror stories our grandchildren will shudder about when they read them in history books, assuming climate change hasn’t destroyed us by then

Oh, fun. I work for this exact company. It’s acadian, bee tee dubs, and it is endemic throughout texas, louisiana, mississippi, and just got into tennessee. To say that it’s surprising patients haven’t died is less of a shock statement and more of the reaction that regulators should have. The sad part? The stupid company is one of the better ones when it comes to training and procedures. We hire constantly because of turnover. As one of our 911-side employees told me, she is pretty senior at three years.

The article doesn’t go into much detail, but the big meat of the revenue for the company is the so-called ‘medicare transports.’ If you aren’t aware, many people on medicare who go to the hospital can’t really go home easily. If they are ‘bedbound’ then medicare will pick up the tab for an ambulance to take them from hospital to home. I don’t know the exact number, but for a ‘basic’ transport medicare pays out something like $1,000-$2,000. A typical transport takes less than two hours if it’s a good drive or the patient is complicated to move (and bariatrics are a nightmare). Standard insurances will also sometimes pick up the cost of an ambulance, but I think we all are now aware of how stingy insurances can be with paying.

Depending on where you are working for them, starting pay for the EMT (basic level) is $13-$17, the ECA (someone who can only drive, not write the medical report) is $11-$14. Paramedics are a fair bit higher, I think starting is $21-$26.

I’ll use max and min numbers for the thought here. So for a two hour call, the company is going to pay a max of $100 to the employees, and pocket $900. That’s about standard, but let’s just go off of hours. We run about 4-6 calls a shift (of 10-12 hours for most of us), and they love to use ECAs as much as possible because they’re cheaper {there’s a policy about ECAs needing to get their EMT license within 6 months, but they don’t really give a shit}. So $31 for the EMT/ECA pair per hour, and a 12 hour shift means they are paying out $372 in wages per shift, pocketing (4calls x $1000/call) $3628. We have (in my region) 3-4 supervisors per 30-50 trucks, typically, and 4 or so dispatchers. The ambulances we use are the mercedes vans, with some older chevys and a couple of new ford type vans. We have very few of the old box ambulances. I think 10 or so of our ambulances are reserved for the two areas we provide 911 services in, the rest are ‘transport’ shifts. The ambulances typically get used until they completely fail, because the shop does a good job at keeping them running until >300k miles. The shop also does all of the work to equip the ambulances, so they keep costs down for setting them up. The old box style ambulances were (I think, I’m recalling conversations with fire EMS services for their cost) around $200k-300k to set up. I think our van styles are more in the range of $100k-150k. Break that down into 5-10 years of service, and that’s $30k a year, or less than $100 a shift for the ambulance.

We don’t use up very much equipment. Oxygen is required on 1/4 of calls or less, and a single bottle will last days. The only big equipment turnover is gloves. The 911 side obviously goes through IV supplies and such at a steady rate, but I don’t know costs/numbers for that off the top of my head.

So $3628 for one ambulance’s shift x 20 ambulances operating for a total revenue of $72560 a day, just from transports (and the $1k-1.5k gets bumped up to $4k-6k for complicated, paramedic level calls, so that’s another complication to add in that I can’t really account for as I don’t know the frequency of those calls). Subtract the cost to run those ambulances ($100 x 20 = $2000), the wages of the supervisors (reasonably going to say $50 an hour as a super overestimation) [$50/hr * 4 supes * 24 hrs = $4800], the dispatchers [again, going to way overestimate at $30/hr] {$30/hr * 4 dispatchers *24 hrs = $2880}, and the shop employees ($35/hr x 6 techs x 24 hrs = $5040). There are a few administration types (a secretary, a big ‘region manager,’ a medical ‘keep people sharp’ type, and maybe one or two others I’m forgetting, but let’s reasonably say they are all way better compensated at put them at $7,500 a day. That takes $22220 away from that $72560 number, leaving us at a cool $50,340 per day profit. I’m sure that gets chipped away by the investment cost of equipment, software licensing, the bigger company management that oversees all the regions [IT, managers, etc.], overhead of the areas where they store supplies, ambulances, and the office space accompanying those, but again, that’s per day, and is just one of their dozens if not hundreds of regions. The dispatchers are shared among many regions.

The company is up to the usual corporate shenanigans to hide its wealth. As an example, for some ungodly reason an ambulance company now also has a security business side, by purchasing a security system company.

I’m sure I could keep spitballing and telling more about how things work, but it really boils down to one key takeaway. If you’ve been around a major city and seen the absolutely ramshackle vans that have ‘XXX’ ambulance on their side, now you know why. The business is amazing if you get a flow for the medicare billing. Those humpty-dumpty vans can bring in thousands per day of profit, and I guarantee the people in them are barely scraping by.