10/19/2026
This is worth a read. Thank you to Page, Wolfberg & Wirth (PWW) for sharing these takeaways, and to Matt Zavadsky for continuing to push our profession to look at what EMS really is and what it can be.
“Who saves money when we do something different?” At Robertson County EMS, we think the answer is our taxpayers and our citizens.
That’s why we’ve invested in our Community Paramedic program. When we meet patients where they are, help them manage chronic conditions, connect them to the right care, and prevent avoidable 911 calls, ER visits and hospital readmissions, everyone wins. Our ambulances stay available for real emergencies, tax dollars go further, and our neighbors stay healthier and at home.
We believe the community paramedic model will keep saving money for Robertson County taxpayers and keep improving the lives of the people we serve. It’s not the EMS of 1988. It’s the EMS our community deserves.
“Wait for something bad to happen, send our most expensive resource, take the patient to the most expensive facility, and pray we get paid.”
As Matt Zavadsky challenged the room today at the Executive Innovation (XI) conference in Hershey, PA: that era of EMS is officially over.
Co-presenting on reimagining EMS and tackling "the left side of the ledger," Matt delivered a masterclass on why our current operational model is facing the clinical and economic definition of unsustainability.
Here are the key takeaways every healthcare and EMS leader needs to hear:
- The 7% Reality Check: A review of over 7 million patient records shows only about 6.9% of 911 calls result in a potentially life-saving intervention. We can no longer build and finance an entire operational model around the most exceptional 7% while sending an ALS crew with lights and sirens to every low-acuity call.
- The "UPS Problem": UPS doesn’t believe its value is brown trucks. Uber doesn’t sell cars. EMS’s core value is not an ambulance ride—it’s 24/7 mobile healthcare navigation, clinical assessment, and community trust. Transport is just one service we provide, not who we are.
- Fixing the Labor Squeeze: Labor makes up 70% to 71% of delivery costs. We cannot solve a structural workforce shortage by simply trying to out-hire or out-spend hospitals. The real solution is allocating human capital intelligently: tiered BLS/ALS deployment, community paramedicine, and 911 dispatch triage.
- Patient-Centric vs. Provider-Centric Scheduling: Call volume predictably drops at 4:00 AM and peaks around 5:00 PM. Static 24-hour staffing models are provider-convenient, not patient-centric. Aligning unit hours with real-world demand curves protects staff, matches clinical need, and dramatically reins in costs.
- The Golden Question for Value: Stop asking "What’s the billing code?" and start asking: Who saves money when we do something different? When you prevent unnecessary ED visits or readmissions through treatment-in-place or navigation, payers, ACOs, and hospital systems win. That shared value is where sustainable revenue lives.
You cannot negotiate value if you cannot quantify it. It’s time to stop giving away clinical value for free and start staffing for the patients we actually serve.
Is your agency still staffing and deploying based on 1988 assumptions, or are you modernizing your ledger for the new healthcare economy?
