Don Harvey tells Liz French that when lives are at stake, you have to compete on more than just price.

From a pure business standpoint, an ambulance company and an emergency room management company don’t have much in common, but from a patient’s perspective, they have everything in common. In fact, recent studies conducted by the Institute of Medicine and the American College of Emergency Physicians indicate that from the roadside to the bedside, a seamless process not only improves the patient experience, but outcomes as well.

Don Harvey

AMR operates in 36 states and the District of Columbia, and its 18,000 EMTs, paramedics, and other professionals transport nearly 4 million patients per year. It has 156 contracts to provide 9-1-1 services and does inter-facility transportation for more than 5,500 hospitals and healthcare facilities. EmCare has contracts with 377 hospitals and independent physician groups. Combined, the companies’ 24,000 employees serve communities in 40 states. Its physicians, EMTs and other clinicians touch more than 10 million patients per year—the equivalent of one every four seconds.

EMSC was formed in February 2005 to buy EmCare and AMR from Laidlaw, most known for yellow school buses. Laidlaw bought AMR and EmCare in the late 1990s but decided to divest its healthcare assets and focus solely on transportation. Following the company’s IPO, management, employees, and public shareholders own approximately 22%, and Onex, a Canada-based capital investment firm, owns approximately 78%.

Guidelines for growing
As part of Laidlaw, AMR and EmCare enjoyed primarily organic growth, but when the company came under new ownership, it began investigating strategic acquisitions. When seeking acquisitions, EMSC takes a very calculated approach: the company in question has to a) operate in markets EMSC doesn’t already have a presence, b) operate proximate to existing EMSC locations, enabling the company to further penetrate certain markets, or c) provide another aspect of healthcare to complement EMSC’s ambulance and ED management services.

In the past year, EMSC has acquired several small ambulance companies that met the first two criteria, and it’s now focused on finding companies that fulfill the third. About two years ago, the company broke into the hospitalist business and has since built up a clientele of about 32 hospitals. In November 2006, EmCare acquired Clinical Staffing Solutions (CSS), a hospitalist management company. Located in Newton Square, Penn., CSS provides hospitalist and specialty unit coverage in 24 programs at 13 hospitals and outpatient facilities in Pennsylva-nia and New Jersey.

In July, the company announced the purchase of Englewood, Colo.-based Air Ambulance Specialists, Inc. (AASI). The company will continue to operate under its own name as a subsidiary of AMR. “A fixed-wing ambulance service is a natural complement to our extensive ground ambulance network,” said Harvey.

Empowerment through education
Whether EMSC grows organically or through acquisition, it’s value proposition—high quality clinical care—keeps it moving forward, and as in any service company, much of the value proposition lies in the expertise and performance of the employees. One of the key talking points at almost every management meeting, the COO explained, is how to deliver the proper training, information, and tools to employees, especially considering that healthcare regulations change from state to state. “Our employees need to have certain skills and competencies no matter where they are, but we develop additional training programs to address local nuances.”

EMSC has found the Web to be a useful training tool at the national level for both subsidiaries. When an employee completes an online training module that is not mandatory, he or she receives what Harvey calls a merit badge. The company keeps track of each employee’s progress, and those who have earned the most merit badges move up the ladder quickly. “We are encouraging additional education and training by providing promotional opportunities to those employees first,” said Harvey.

For EmCare, which is divided into six regions, training at the local level is executed by regional directors and site medical directors. Regional directors engage in daily discussions with site medical directors, helping them identify weaknesses and providing them with the tools they need to get the job done. But if a particular site continues to struggle after receiving direction, the company calls in back-up. “We’ll send in a regional or national team to evaluate of all processes used in that part of the hospital, come up with viable solutions, and help the site medical director execute those solutions,” said Harvey.

AMR has regional and national resources to draw on in times of need as well, and Harvey added that mannequins are located at many AMR sites for employees to practice emergency techniques during down time.

To increase the value proposition, EMSC gives decisionmaking authority to employees who are closest to the customer (typically a hospital, hospital system, city, or municipality). “That allows our staff to make on-the-spot decisions that best suit the customers’ needs,” said Harvey.

Education and empowerment have enabled the company to grow its monetary value and service value. Although it is not the lowest priced vendor in all markets, it certainly provides the most bang for the buck. “When people’s lives are in your hands every day, you have to compete on more than just price,” Harvey concluded.