How do I sell to facilities when just starting out and want to appear capable and experienced?

Without knowing your level of prior experience in the NEMT or home care industries, or any level of experience in the healthcare industry, it’s difficult for me to make targeted suggestions on how to leverage your past experiences as positive advantage for a new business. 

However, keep things in perspective. As an NEMT provider, you are simply the transportation service – no more, no less! Unlike an emergency service, ALS or BLS, where you employ EMTs who are actively involved in rendering care and aide to the patient, as an NEMT provider, you are simply the transportation provider – there should be no direct “hands on” involvement with the patient other than when assisting a transfer to a wheelchair or stretcher – even then, facility staff will typically be available to help accommodate.

When you are first introducing your service to a facility, regardless of prior experience, you want to focus on offering a timely service which, as a new provider with limited demand, should be your primary focus. This is another reason why you want to initially focus on facilities that are close in proximity to you so you can literally exploit your location to aide in a fast response time. Mitigate your lack of fleet size by focusing on close proximity and a dedication to fast response time. 

The other thing you want to focus on is your vehicle. I always stress having the “right” vehicle, especially at the start of your business, which should be a full-size van. This is mission critical because it gives you increased capacity and so much more options. Additionally, full-size vans with a hydraulic lift are 99.99% already ADA compliant which should be leveraged as a key selling point. 

If you have the right equipment, you’re close in proximity, and you’re dedicated to being a timely service, you’re already “ahead of the game.” From there, you “accentuate the positives” – you’re properly insured, your vehicle(s) are properly inspected, and all future drivers will be required to pass background checks, drug screening, and undergo at least two weeks of driver-training (learning from you/senior driver) before being allowed to operate on their own.  

In terms of material to use during your meetings, obviously, I’m partial to the “Executive Welcome Packets” that we create for our one-on-one coaching clients. If we are not working with you directly, you want to ensure your material looks profession in appearance and underscores the advantages I have just outlined. You can definitely use your material as a guide to “structure” your presentations and keep them on point, but I definitely encourage you NOT to attempt to read a scripted sales pits or anything of the sort. 

BE NATURAL! Ask questions to gather more insight into their level of need while offering your service as a legitimate solution - either directly or as a “support service.” Above all else, do NOT be pushy! Share the benefits of using your service, and thereafter, leverage every possible opportunity to remain in front of them to include sending them a thank you letter for the meeting, holiday wishes, congratulations for special achievements, etc. 

This is a very good and important question. It’s a tactical area where many providers quickly flounder in their engagement with facilities. Many providers have no idea how to positively and accurately interact with facilities to bring value to both parties to cultivate win-win situations.

First, it’s critical that you define your “retail rates” – competitive private pay rates that are targeted and sustainable within your local community. Your private pay rates are NOT defined by Medicaid or any type of broker and are typically much, much higher. This is where you do want to conduct local market research to determine the general rates of your competitors.

Second, your retail rates need to be itemized and conveyed to the facility prior to any negotiations so they clearly understand the value for each type of service – ambulatory, wheelchair, and stretcher.  

Third, you need to “signal” your willingness to offer a discount in exchange for volume. For those of you who I work with one-on-one, in your “Executive Welcome Packet” that we create for you to use when meeting and introducing your service to facilities, your retail rates are featured side-by-side your private pay dialysis rates for a reason – to underscore your retail rates while illustrating your discounted rates in exchange for volume. 

On average, most providers will offer at least a 10 percent discount to private pay dialysis patients because they travel at least 3 times per week perpetually. By illustrating this discount side-by-side with your retail rates you’re literally illustrating your willingness to offer discounts which leads to my next point.  

Fourth, you NEED to ensure you’re legitimately receiving volume in exchange for a discount. Just because you establish a relationship with a facility, especially a hospital, large medical center, or HMO, it doesn’t mean you drop your prices! You NEED to specify and articulate anticipated volume?  What does “volume” look like?  Is it 2 trips per week, 5 trips per week, 20 trips per week? What can both parties anticipate over what period of time?

Fifth, the ideal solution is to offer a tiered system. More specifically, the more volume the facility offers, the greater the discount. This is the best way to (1) give incentive to the facility to use you more than possible competitors, (2) ensure you remain profitable and viable without being taken advantage of, and (3) help define your billing cycle.

Some quick side notes. NEVER offer more than Net 30 terms. If the facility pays twice a month, that’s outstanding, but at most, you need to clearly articulate Net 30 terms of the associated discounts do not apply. 

Also, especially in the introductory stages of meeting with staff, do NOT push the topic of formal contracts or service agreements. They don’t know you. They don’t know if you’re reliable, if you’re going to show up tomorrow, etc. Start by demonstrating your worth by offering good service and then, when the time is right, approach the topic of a more formal arrangement via contract or service agreement.

By all means, if the facility approaches you and brings up the topic of service agreements, then that’s a green light to move forward. In going back to the Executive Welcome Packet, we specifically “signal” or suggest our ability to offer discounts by illustrating our retail rates side-by-side our dialysis rates so we convey the message without having to be pushing or demanding. Once the timing is right to begin negotiations, that is when we offer the tiered system.

This is a very important questions because it involves safety which directly influence the critical topic of LIABILITY!

Can you secure a stretcher with Q’Straints? Technically, yes you can secure a stretcher with Q’Straints. Will it work successfully? Yes – but ONLY in an emergency. Do I suggest or advocate doing it regularly? Absolutely NOT!!

If there is ever an accident and you there is ANY movement of the stretcher and it is discovered you only had a stretcher secured via Q’Straints, you are definitely going to be liable. 

What is the difference between securing a wheelchair and a stretcher with Q’Straints – a great deal! They size, shape, practicality, and ability for one versus the other to move are dramatically different.

Therefore, you want to (1) a wall mounted bracket that is typically mounted to the wheel-well of the vehicle that will lock the stretcher closer to the side of the vehicle, and (2) you want “antlers” that are bolted through the floor that you will slide/glide the stretcher into.

Please refer to the attached image below illustrating the wall mount and antlers.

You will notice the antlers can quickly be screwed in and out when not in use so you can accommodate your wheelchairs.

Bottom line, it is critical that you deploy these type of securing devices for stretchers as compared to only using Q’Straints.

This is a very good question that impacts your business in the early stages of your business, when you’re first starting out and you’re trying to control cost, AND also a very important concern when you’re an established business working to provide continued after hour service to hospitals, emergency rooms, dialysis patients, and more. 

There are many things to first consider as follows:

1.0 . Especially when first starting your business, only paying commission makes total sense because you’re insulated from taking a loss. If there’s no work, not trips, no one gets paid, and you don’t lose. If there’s a trip, everyone gets paid so everyone wins.

1.1. Paying only commission long-term is ALWAYS a losing proposition. As trip volume increases, keeping drivers steadily busy throughout the day, if you’re paying straight commission you’ll lose financially. At that point, it’s better to pay hourly wages.

1.2. The hard part with such a strategy is the transition process. If you’re paying a small number of select drivers only commission when first starting because you need to insulate your business from losing money, that’s great, but trying to get them to switch to hourly wages, an arrangement where they stand to lose in total reimbursement, won’t make them happy. Under such a “sticky” situation, you need to blame the Department of Labor and let them be the “bad guy.” 

1.3. Although it makes complete financial business sense in the early stages of your business, the DOL doesn’t like it when business owners only pay drivers commission. When you’re first starting out with only a couple drivers, the DOL is much more amicable and less of a stickler on the subject, but if you have many employees and you’re still only reimbursing via commission, the DOL will become finicky and will penalize you. I’ve seen this a few times.

2.0. The ideal situation is to pay driver hourly wages during the day and pay commission in the evenings when trip volume decreases. However, by all means, if your evening and weekend trip volume remains large enough to keep staff “on the clock” and receiving hour wages, then continuing to pay hourly wages makes financial sense. 

3.0. The trick is, how do you achieve financial balance where you’re paying your drivers enough money to give them financial incentive to get up off the couch, leave the coffee shop, etc., to go complete and on-call trip? What’s the magical commission rate of reimbursement that gives them enough money while not forcing you to lose money or even experience slim margins?  And remember, it’s not just commission wages that increase. The more you pay in commission the more you pay in unemployment insurance, FICA, taxes, and worker’s comp insurance. 

4.0. The ultimate answer is you need to “run your numbers” and be prepared to pay different rates of reimbursement based on multiple variables to include (1) seniority, (length of employment), (2) the type of service (ambulatory, wheelchair, or stretcher), (3) the day of the week (weekday versus weekend), and time of day (after hours, midnight hours, holiday hours). I know it makes things much, much easier to just pay a standard fixed rate, which is always an option, but such an option can quickly blow your budget or, as a minimum, financially de-incentivize offering after hour work. 

4.1. If I had to offer a single specific number, I would suggest you do two things. First, offer a minimum value – something like $20. This would help “protect” the interest of the driver for trips of smaller value such as a short ambulatory trip.  Second, I would keep the percentage hoovering around 20%, but again, I STRONGLY encouraged you to “run your numbers.” Of course, we all want our drivers earning as much money as possible, but their wages cost us, the business owners, even more when you consider all the labor-associated expenses to include worker’s compensations insurance.