Emergency Services
Anyone who has ever had to dial 9-1-1 understands the value of a prompt and professional response in an emergency situation. But speed is only part of the equation in a medical crisis. While seconds can make a difference in the well-being of the sick or injured, it's the quality of care that carries the biggest impact on a positive outcome.
Empress Ambulance Service, based in Yonkers, New York, has built a solid reputation for both timely response and superior patient care. With its credo of "so many people are riding on us," Empress has grown to become one of the largest and most respected private providers of ambulance service and after-care transportation in New York State.
Things haven't always run smoothly and successfully for this emergency medical service provider. In 1996 the company was forced to declare bankruptcy. An unscrupulous CFO embezzled thousands of dollars from the company coffers. Empress resuscitated its operations and emerged from bankruptcy in 1999 with stable vital signs and a 100 percent growth in volume.
By 2003, its renewed health and vitality led the Westchester County Regional EMS Council to honor Empress as the State Agency of the Year.
The problem, said Empress Vice President Michael Minerva, was that despite its rapid growth the company was still operating like a family owned business. "Our infrastructure did not keep pace with our growth in operations," said Michael.
"Management was spending time putting out fires instead of driving the workforce. Morale was suffering and productivity was sluggish. We needed to establish tighter controls and procedures to keep up with the growth that was taking place in the field."
Empress initiated its recovery with the help of management consultants from the George S. May International Company. Empress originally charged May International with the task of stabilizing billing and collection processes.
A closer examination, however, revealed that operations in the Empress fleet maintenance facility and in its sister company, American Transit, required treatment, too.
What was to be a simple procedure to revive billing and collection turned into a six-month project that realigned the company from top to bottom.
Family Business
CEO and president Lenore Minerva purchased the fledgling Empress Ambulance Service in 1984 as a sister organization to American Ambulet, a family business launched in 1976 and now known as American Transit.
At the time, Empress had a fleet of four ambulances. Today the company boasts 40 ambulances, 10 paramedic response vehicles or "fly cars" and a staff of 200 with the Minerva family solidly at the helm.
Lenore's son, Michael, took over as senior vice president in 1997 after overseeing American Transit for a number of years. Son Daniel is director of operations and also manages the company's support services and supply division. Lenore's youngest son, Mathew, operates as director of American Transit.
Following Lenore's vision of expanding the business beyond 911 emergency services, Empress has grown to become the premier provider of non-emergency transport services in New York State.
Basic Life Support (BLS) ambulances transport patients from hospitals, health care facilities and private residences with two certified emergency medical technicians on board to maintain quality care during transport.
Advanced Life Support (ALS) provides transport between hospitals, trauma centers and special care units for patients requiring more critical care, such as EKG monitoring, IV therapy and advanced airway management. A specially trained Level IV paramedic and a certified emergency technician staff each ALS vehicle.
Empress also provides stand-by service at large-scale events throughout the Hudson Valley. Empress medical staff has treated heat stroke, bee stings, minor injuries and more urgent cases for Yonkers Raceway, the New York Philharmonic, and at events such as the PGA Golf Championship and The Buick Golf Championship.
The Empress Network
Yonkers is home to Empress corporate headquarters and its busy 911 dispatch center. The 24-hour communications center houses one of the most advanced computer-aided systems in the region and answers over 16,000 emergency calls for service each year. The company also provides emergency services in neighboring Yorktown, Mt. Vernon, the Village of Pelham and the Town of Pelham.
Yonkers
In Yonkers, emergency calls are initially answered by the police department, which then forwards callers to the Empress communications center. After dispatching an ambulance, dispatchers return to the caller to provide a calming influence and pre-arrival instructions in such things as CPR, childbirth or bleeding control.
Empress has accelerated its response time by adopting the nationally recognized System Status Management System, which places ambulances in high-demand areas throughout Yonkers instead of in one central location.
Yorktown
A unique arrangement in nearby Yorktown pairs Empress with the Yorktown Volunteer Ambulance Corps and the Mohegan Volunteer Fire Department.
An Empress paramedic response unit, staffed by two paramedics during the day and one at night, responds to emergency calls simultaneously with the volunteer forces. If advanced life support is necessary during transport, Empress paramedics accompany the patient to the hospital on board the volunteer ambulance.
Mt. Vernon
Mt. Vernon has entrusted Empress with its emergency care since 1985. In this community of 75,000, Empress provides a dedicated Advanced Life Support (ALS) ambulance to answer emergency calls. The ALS is supplemented by a fleet of System Status Management Units positioned throughout the region to speed response time. Emergency calls are dispatched through the Mt. Vernon Police Department with overflow calls routed directly to the Empress communications center.
The Pelhams
In 1998, the Village of Pelham and the Town of Pelham signed on Empress as the exclusive provider of 911 ambulance service. Empress operates one ALS ambulance stationed at the centrally located Pelham fire house. The ambulance responds to calls in the two communities along with emergency medical technicians and first responders. Dispatching is a combined effort between the Westchester County Fire Control and the Empress communications center.
Influencing Cashflow
While Empress successfully coordinated superior patient care throughout the state, billing and collection procedures for all of its locations proved to be a more complicated case. One of the first tasks that May International consultants tackled was streamlining billing among all four locations and establishing more aggressive collection practices.
Unfortunately, May International had to address more than operations within Empress to positively influence cash flow. May International consultants also had to change the mindset of Empress patients.
Like many emergency service providers, Empress has to contend with patients who refuse to pay their bills because of the common misunderstanding that the service is paid through tax dollars.
"We have to educate patients that emergency transport is a billable service, just like a visit to the doctor's office."
Working with employees who have direct patient contact in the field and those who follow-up with patients on the phones, May International consultants helped Empress reorganize its billing and collection procedures for a 15 percent savings in billings company-wide.
"Improved billing is a win-win situation for Empress and for the communities we serve," said Michael. "Minimizing unpaid transports means Empress can afford to provide the quality service it's known for."
May International consultants also reviewed operations in the Empress vehicle maintenance facility, which provides preventative maintenance and repair for all Empress and American Transit vehicles.
"May International consultants reviewed all of our processes and procedures and helped us find ways to cut costs by 10 percent. The garage averages about $3 million in volume each year, so that 10 percent yields a significant savings to our bottom line."
May International consultants also streamlined operations in the Empress and American Transit finance departments and significantly reduced a two-to-three month lag time in closing the books at the end of each month. Now all records are reconciled and books are closed by the 10th of the following month.
Management Improvments
For all of the operational changes that May International set in motion at Empress, says Michael, even more beneficial to the company were the changes in infrastructure.
"The cost savings were a bonus. The real benefit to the company was in learning how to be better managers. May International consultants helped drive home the point that employees are our most valuable resource. Now we're communicating more with employees through communication boards and newsletters. Team building exercises have boosted morale and improved accountability throughout the departments. When disciplinary action is necessary, we have a plan in place to help employees fix the problem instead of just pointing out the mistake. This is now a much happier place to work."
Finding out how each department operated was the first step when May International consultants began their overhaul of Empress Ambulance Service and American Transit's management structure.
Using flow charts, the consultants identified the organizational structure and work flow in each department and uncovered stumbling blocks in the system. The consultants next defined goals and objectives for each department and provided a road map on how to achieve those goals.
"The May International consultants didn't just tell us what needed to be done, they helped us implement the changes. The key was thorough follow-up," said Michael.
"The ultimate goal for this project was to improve cash flow and profitability. We accomplished those goals and anticipate an annual cost savings of $1.8 million through increased productivity, better employee morale and improved quality of work," Michael continued. "We look forward to much success in the future as we continue be a major force in the ambulance and para-transit industries in the Tri-state area."
