Developing a Winning Ambulance Company Business Plan

As an ambulance company owner or administrator, developing a multiyear business plan sounds like a daunting process but it is one of the most important processes that is often overlooked when developing a new company. Creating a business plan is equivalent to having a GPS or road map when you travel. As you can imagine, not having one is a sure fire way to get “lost” and lose focus on your core business strategies.

Developing a business plan is an easy component to overlook, especially when there are more pressing operational and financial pressures vying for your attention. The problem with not having a plan, is that as you address the daily challenges of operating the company, it is easy for the operations to spin out of control. A well thought out business plan is designed to get you back on track. I’d like to share 10 simple tips for developing a business plan that I have found helpful over the years.
1. Remember that a business plan is meant to be a fluid document and that you are not writing anything in stone. Your business plan will change and evolve as time goes on. As a foundation, the plan should outline your goals, challenges and where you want to be in 3 to 5 years. The plan should be updated annually to fit different economic circumstances or operational changes. We cannot truly see into the future, so don’t panic about getting it exactly right, instead concentrate on your market, your competitors and your grow strategies over this period. .
2. As a general rule, do not get caught up on the length of the business plan. Most owners think that unless a business plan is 30 pages long, that it is not of any worth. This is the wrong approach; your business plan can be as long or as short as it needs to be. There is no need to pad the plan with unnecessary words or items that don’t need to be there. Keep it clear and concise. It is not the size of the plan that counts, it is the content.
3. Develop the outline for the executive summary. An executive summary needs to be fairly succinct and should enable readers to know what the business is, what the business does and the objectives that you want the company to meet. This is the area of the plan to include your mission statement, if you don’t have one this is a good time to develop one.
4. Business plans are often a way of attracting funding or are part of the loan process. The plan should showcase senior personnel; market differentiators and operational best practices. This approach is the best way to sell potential investors or lenders on the intangible worth of your company.
5. It is critical to provide a detailed analysis of the markets you serve. A good plan analyzes the facilities or municipalities who want to contract for services, analyzes the competition and examines the buying behavior within the target markets. Be thorough in this section and do not simply assume that you have work in a market that is devoid of competition. All markets are vulnerable; the plan simply needs to show that the company can survive when times get tough.
6. The development of a strong marketing plan is essential. You will need to show that you can market your ambulance services and that you have thought about how to increase market share through an understanding of the basic principles of marketing.
7. It is important to include some kind of analysis that looks at your strengths, weaknesses, opportunities, threats: namely a SWOT analysis. This is the time to peel back the onion to examine all the layers of the company. In general, you are only as strong as the weakest link. This section should be an open and honest look at the organization. Most importantly, it demonstrates that you have thought everything through and that you are methodical in your approach.
8. Timing is everything. It is critical to consider the timing of your plan; don’t be overly optimistic, set realistic growth goals and identify achievable milestones. Taking a year over year approach and knowing the timing of contract or RFP opportunities will assist in this process.
9. As a final detail, the business plan will need to demonstrate that you have included a very methodical financial projection over this period of time. The financial plan has to be based on your past financial performance and needs to be accurate. It is easier to project revenue but all expenses need to be included, such as rent, any payroll, insurances, operating costs etc.
10. There is an old saying that a picture is worth a thousand words. This is especially true when developing a compelling plan. Take the time to develop graphics, graphs and insert pictures that tell the story. Finally, include all relevant data such as bank statements, excel spreadsheets etc.
As a final point, the sections outlined in this article should provide a solid foundation in the development of the business plan. Remember that the plan does not have to written in one day, take your time and work on each section over a period of time. This approach will enable you to get to the end result in a way that is achievable and makes the whole process a whole lot less daunting.
About the Author
Michael Shabkie has extensive ambulance business development experience in Arizona, Texas and Colorado, with both the public and private sector. He is currently the Managing Partner for Engage 911. He has served as a key collaborator for EMS system design, developed winning contracting strategies, managed political and public affairs, and acted as an executive advisor on operational processes for both public and private ambulance organizations.
For more information visit:

Tips for Writing Your Ambulance RFP Responses

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Owning an ambulance company today is often a tale reminiscent of David versus Goliath. As an owner or operator of an local ambulance company, you are faced with many challenges each and every day. Aside from ensuring you have the staff, the vehicles and the equipment to respond to ambulance calls, you are also responsible for growing your business by increasing market share.
Often times, you are faced with competing against one of the large national providers that have unlimited resources and a team of proposal writers dedicated to responding to RFP’s. The question many ambulance company owners are faced with is: How can I compete against Goliath and be successful?

Get Your Slingshot Ready

Developing the resources to respond effectively to a Request for Proposal should occur well before a RFP is released to the market. Many times, companies wait until the last minute to start gathering the resources necessary to develop a proposal. My advice revolves around the simple premise that “every day is a day we need to submit a proposal.” This means that your company should create a Proposal Database that contains graphics, pictures, company background information and documents that are standard to each and every RFP process. If you have responded to proposal requests in the past, each response should be located in a single electronic folder that will allow for easy “cut and paste” options.

Examples of documents that are usually required in a proposal include:

· Company background and formation documents

· Pending litigation

· Professional references
· Two or more years of audited or reviewed financials
· Certificates of Insurance (COI)
· Overview of clinical  and billing practices

· Overview of operational practices and protocols

· Administrative and operational organizational charts

It is never too early to have these developed and saved into your Proposal Database. Developing these resources during a time when no proposals are pending provides your company with the ability to refine the message and edit for pertinent content. The best time to develop your proposal or work with a professional proposal writer is when there is no pressure of an impending submission deadline.

Write an Amazing Summary

There is an old saying that you can’t judge a book by its cover, but when faced with a multiple responses from several ambulance companies, each consisting of 200+ pages, you better believe that your proposal is judged by its first page. Most evaluation committees are faced with the painful scenario of having to read 200+ pages of different companies’ proposals. It is well known that many evaluators only read the first page and then start skimming. The executive summary or cover page should give a high value overview of your proposal, hitting all of the discussion points explaining your company is the only choice for their community or facility. Having that information on one page makes a great first impression and says to the client “we are professional and we are trying to be helpful”. It’s one of the easiest things you can do to set the tone for the remainder of your proposal.

Be Clear and Concise

Other than Chinese water torture, nothing makes the evaluator’s mind go numb like endless shop-talk, buzzwords, and information that isn’t requested nor has any impact on the request. Most evaluators will view 200+ pages of your proposal as punishment if you make them read more than they need to. If you can answer the question in one paragraph why make them read four? Be clear and concise; make sure that you stick to the points that are necessary to convey the information to the evaluator. Simply remember that “less is more” so long as you answer the questions.

Answering the Hard Questions

In my opinion there is never such a thing as a “stock request for proposal.” What’s the point in spending the time writing a proposal if you’ve answered questions the proposal didn’t ask for, or worse, didn’t answer the questions they did ask? As simple as it sounds, you must answer their questions. The easiest way to be eliminated from the competition is by not answering their questions. No matter how mundane or irrelevant, you have to assume they asked the questions for a reason and they’re judging you on the responses you provide.

References, References, References

The best way to prove to the evaluation team that your company is the clear choice to meet their needs is to show them examples of your success. Dispel any doubt that they might have regarding your ability to fulfill the project by listing three to five contracts of the same caliber that you completed and have strong similarities. Detail those similarities so that the client can say “oh, that’s just like ours”. If the next sentence from the evaluator is “I like what they did here” you have a great chance of being a finalist.

Telling the Story While Selling the Company

Are RFP’s won on price alone? The simple answer is usually not. Ambulance companies in a competitive market fall into the trap that pricing is the greatest differentiator between the competitors. If pricing is your sole focus, you tend to have two problems: there will always be a company that underbids you and you’re not focused on bidding the RFP but are worried what the competition will bid on the proposal. This narrow focus skews your pricing and sets you up for failure.

Try this approach: instead of focusing on the price, focus on your company. Be sure you communicate what makes your company the new, unique and perfect choice for the community. You want the evaluators to come away from reading your proposal thinking “they seem like the perfect fit for us” which is a much better takeaway than “well, they submitted an average proposal but they’re the cheapest”.

The million dollar question that you need to answer in each and every proposal is “why are you the right choice for this contract? It may sound elementary, but the answer to this question is never simple. It takes a well thought out plan of development and execution.

About the Michael Shabkie 

Michael Shabkie has extensive ambulance business development experience and has also served as a key collaborator for EMS system design, developed winning contracting strategies, managed political and public affairs, and acted as an executive advisor on ambulance industry operational processes for both public and private ambulance organizations. For more information visit:

Should Ambulance Companies Partner with Accountable Care Organizations?

Is is your ambulance company integrating with the regional Accountable Care Organizations (ACO)?  How is it affecting service delivery in your area? 
The Patient Protection and Affordable Care Act of 2011 provides for the establishment of Accountable Care Organization (ACO) contracts with Medicare by January 2012. As stated in the Affordable Care Act, the ACO promotes accountability for a patient population, coordinates items and services under part A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery. A quick lesson on the specifics of this groundbreaking legislation is available in this great Wiki article. 

A Look into the Future of EMS – Today

Forward thinking hospital systems and their local ambulance providers are exploring ways to reduce the expense of transporting patients to the Emergency Department for non emergent care as well as developing strategies to curtail readmission of patients once they are discharged from the hospital. The need to integrate the local ambulance provider into the regional Accountable Care Organization (ACO) is critical.

As it relates to managing patient readmission, hospital systems or the ACO should be looking to contract with local EMS organizations to provide the “at home” follow up of patients within 72 hours of discharge. The concept is that specially trained Paramedics would ensure medication compliance, take a baseline assessment of the patient and set up or confirm any follow up appointments the patient may have. 

Additionally, the ambulance company or first response agency could be tasked with the coordination of other transportation needs a patient may have. It is my recommendation that the Provider should establish sub-contracts with local taxi companies, wheelchair companies as well as other ambulance providers. 

 An Unfunded Mandate?

It is stated that the compensation mechanism comes directly from the ACO with Federal monies allocated for the development of the ACO. 

Essentially the ACO should pay an assessment fee for each patient follow up. This will generate a substantial additional revenue stream for the EMS agencies but will result in an overall savings of Medicare money related to unnecessary readmission for failure to comply with discharge instructions. 

The motivation for the hospital to allocate this funding is to reduce readmissions (thus reducing penalties) and to ensure a high performing ACO. 

The current system of reimbursement for transporting a patient as the only funding stream for an EMS agency could be coming to an end. EMS agencies wouldn’t just be compensated for moving the patient to the highest level of care: The emergency department. They could be compensated for care that really will benefit patients and make the healthcare system more efficient.

What Can Your Company Do?

First and foremost, EMS agencies need to start working with their local hospitals to develop an understanding of the ACO concept. The best mechanism for this is to develop a task force or committee that includes members from the EMS and Hospital System. Initial discussions should include the EMS role in alleviating emergency department overcrowding through better triage at the 911 dispatch center, paramedic initiated treat-and-release programs, and transportation to alternate destinations.  

Additionally, organizations that manage to achieve seamless patient information exchange through the integration of data, stand to gain an insurmountable advantage and unparalleled opportunity in the fast-moving healthcare landscape.

This is potentially a win-win for both EMS and the Hospital system. If the leaders making the decisions understand the opportunity and are willing to throw out preconceived notions of how the system should work, then we are in for a very exciting time in the EMS world.For more information visit Michael Shabkie at