About this episode
Dominic, 17 years in the industry and now on the broker side in Nashville, says Tennessee charges $1,000 per vehicle per year for a stretcher permit and requires an EMS director to inspect the vehicle first. Nashville hospitals including HCA, Vanderbilt, and Ascension bought their own ambulances after private companies could not staff discharges, then outbid those companies for the same drivers. A non-emergency stretcher run bills $120 to $140 against roughly $700 for a private ambulance, which is why discharge work keeps moving from ambulances to NEMT.
Key takeaways
- Tennessee requires a $1,000 annual permit per stretcher vehicle plus an EMS director inspection covering ADA certification, stretcher type, and tie-downs before a provider can run stretcher trips.
- A non-emergency stretcher run charges $120 to $140 where a private ambulance charges about $700, but the vehicle needs two staff aboard, not one, to be legal and workable.
- Hospital discharge math drives the demand: a hospital pays $200 to $300 to move a patient out, then refills that bed at $500 to $800 a day for a three-day minimum stay.
- HCA, Vanderbilt, and Ascension bought their own ambulance fleets, pay drivers more, and run mostly intra-facility trips, so private operators lost staff while still owning the discharge work.
- No national NEMT wheelchair company exists, only regional players. Dominic says state licensing, brick-and-mortar requirements, and health system relationships are what block anyone from scaling nationally.
Chapters
- 0:00 <Untitled Chapter 1>
- 0:33 How TNCs (Uber/Lyft) impact ambulatory NEMT today.
- 3:09 Discussing autonomous vehicles and robo-taxis in the NEMT future.
- 7:46 The consolidation of the ambulance industry.
- 10:48 Hospitals buying their own ambulance services.
- 12:04 NEMT's role in taking hospital discharge business from ambulances.
- 17:49 What's blocking NEMT businesses from going national?
