Guides
How to rank NEMT service lines by contribution per staffed vehicle hour
Rank NEMT service lines yourself: a worksheet using contribution per staffed vehicle hour, with empty legs, wait time and late cancellations counted in.
What to take away
- No honest ranking of service lines by profit exists, because the answer depends on your load times, your empty miles and your payer mix. Anyone publishing one is ranking their own operation.
- What travels is the measurement. Rank your own lines by contribution per staffed vehicle hour and the order will surprise you.
- The hour, not the trip, is the denominator. A well-paid trip that occupies a vehicle for ninety minutes can rank below a modest trip that takes twenty.
- Count the empty leg and the wait against the line that caused them, not against overhead. Overhead is where unprofitable work goes to hide.
- Cancellation exposure belongs in the ranking. A line with a high late-cancellation rate consumes hours it never pays for.
This page does not rank services. It gives you the worksheet that ranks yours, because a ranking built on somebody else's geography, wage level and contract terms is worse than no ranking at all: it looks like evidence.
Why the trip is the wrong unit
Ask an owner which work pays best and you will usually hear a per-trip figure. The per-trip figure is what the invoice says, and the invoice does not know how long the vehicle was occupied.
What one booking consumes
- Drive to pickup
- Arrival to secured passenger
- Loaded drive
- Unload
- Empty drive to next
- Will-callunknown wait
- Stretchersecond crew member
Two bookings with identical invoices can consume very different amounts of the only thing you have a fixed supply of, which is staffed vehicle hours.
The worksheet
For each service line you run, over a period long enough to include a bad week, collect five figures from your own records.
Apparent value vs worksheet exposure
Line
- Standing orders
- Volume and predictability
- Will-call returns
- Good headline price
- Long-distance transfers
- Large invoice
- Stretcher
- Highest per-trip figure
- Ambulatory one-offs
- Easy to deliver
What inflates apparent value
- Standing orders
- Low tolerance for lateness
- Will-call returns
- Unbilled wait time
- Long-distance transfers
- Vehicle removed most of a day
- Stretcher
- Two crew for entire occupancy
- Ambulatory one-offs
- Heavy empty mileage
What the worksheet exposes
- Standing orders
- Will-call returns
- Long-distance transfers
- Stretcher
- Ambulatory one-offs
- Revenue recognized for that line, net of anything you were not paid for.
- Total minutes of vehicle occupancy attributable to it, from leaving the previous location to being free for the next booking.
- Crew minutes, which is occupancy multiplied by the number of people aboard. Stretcher work diverges from wheelchair work here.
- Direct costs that belong only to that line: fuel on those routes, consumables, any equipment used solely for it.
- Hours consumed by cancellations and no-shows on that line, where the notice came too late to fill the slot.
Then compute contribution per staffed vehicle hour as revenue minus direct costs, divided by the sum of occupied hours and hours lost to late cancellation. Rank on that.
What usually inflates its apparent value
- Standing orders
- Volume and predictability
- Will-call returns
- Good headline price
- Long-distance transfers
- Large invoice
- Stretcher
- Highest per-trip figure
- Ambulatory one-offs
- Easy to deliver
What the worksheet exposes
- Standing orders
- Low tolerance for lateness; a single delay disturbs a whole clinic sequence
- Will-call returns
- Wait time nobody is billed for
- Long-distance transfers
- A vehicle removed from local work for most of a day
- Stretcher
- Two crew for the entire occupancy
- Ambulatory one-offs
- Heavy empty mileage between scattered pickups
The right-hand column is a prompt for what to measure, not a verdict. Your own numbers decide the order.
Three adjustments that change the ranking
Empty mileage. Attribute the empty leg to the booking that created it. A line that sends vehicles to the edge of your service area and leaves them there is consuming hours that a trip-level view assigns to nobody.
Three adjustments that change ranking
- Attribute empty leg to the booking that created it
- Measure load time by mode and access type
- Weight payer speed, not just margin
Load time by mode. Measure it rather than estimating it, separately for ambulatory, wheelchair and stretcher, and separately for door-to-door versus curb-to-curb. The differences are large enough to reorder the table. The dimensions these categories come from are set out in the guide to what a service actually consists of.
Payer behavior. A line that pays reliably in a short cycle is worth more than the same margin arriving slowly, because slow money is money you borrowed to replace.
The administration of the public benefit varies by state, as the Centers for Medicare and Medicaid Services transportation page explains. Ask your own payers about their cycle instead of assuming one.
What you can do with the answer
Once the lines are ordered, three moves are available and they are not equally good.
Raise the price of the low-contribution line at renewal, with the measured minutes as your argument. This works better than it sounds, because facilities rarely know how long their own access arrangements take.
Change the line rather than the price: tighten the cancellation window, define the wait rule, move a door-through-door commitment down a rung where the patient's situation allows it.
Or decline the line. This is the option owners resist and the one that most reliably improves the business, provided you decline before you have built a schedule around it.
Which move you can make depends partly on the constraints in the licensing and compliance material and on what your fleet can physically do, which is covered in the vehicles and premises guide.
Where the numbers come from
Occupancy minutes come from dispatch records, not memory. Crew minutes come from payroll. Direct costs come from your books. General guidance on what a business should keep is in the Internal Revenue Service page on business records.
Whether your system can produce occupancy by line is a question for the finance and dispatch tooling. If it cannot, a paper tally for one month will do.
Crew cost per hour comes from your own payroll. That figure is also the one that decides what you can promise, which is why staffing is treated as a design decision in the hiring and training guide.
What not to claim
When you use this analysis in marketing or in a proposal, describe what you measured and over what period. Presenting an internal contribution figure as an industry fact is the kind of claim the Federal Trade Commission's advertising guidance for small businesses exists to discourage, and it is also simply untrue.
Common questions
Which line is most profitable for most operators?
There is no such line. The distribution of load times and distances in your own service area decides it, and two operators in the same city can get opposite answers.
Do I need software to run this?
No. One month of hand-tallied arrival and departure times per trip is enough to rank your lines. Software makes it repeatable, not possible.
What if a low-contribution line is the one my main account cares about?
Then it is buying you the account, and you should say so explicitly in your own accounts rather than pretending it pays for itself. Price the relationship, not the trip.
How often should I redo this?
When your mix changes, when you add a vehicle, or when a contract comes up for renewal. Doing it more often than that produces noise.
