THE M3 MISSION
When big healthcare organizations outgrow or buy new mobile medical trucks or vans, they often do not have a plan for the old one.
It's usually in good shape, well-maintained, and still functional. It has served the organization and thousands of people well.
Small healthcare organizations need safe, reliable, and functional Mobile Medical Vehicles at a reasonable cost, but do not have the same donor base or revenue to purchase brand-new Units.
Our mission is to be an honest conduit between those two parties.
We provide vehicles that support consistent delivery of care to your target populations, in a maintained and reliable state to keep your staff focused on health care, not vehicle repair.
THE M3 SERVICES
If you have a well-maintained mobile medical unit whose mission is over - we'll buy it.
If you need a safe and reliable but not-new mobile medical unit - we probably have one (or will find one) that is right for you.
If you need help fundraising for that unit - we have a program for you. Our fundraising expert Marcy Heim has raised over $2 Billion in her career.
If you have questions about budgets or operations or maintenance - we'll help you.
If you are writing grants - we'll advise you or in some cases, write them with you.
If you need operations staffing - we'll work side-by-side with you.
If you need maintenance & support for your unit - we'll take care of it (and you) for as long as you own the Unit.
THE M3 VALUES
Our six core team values are
- Valuing People
- Best Effort
We are in pursuit of creating the perfect place to work and to do business. We believe in servant leadership, people before profits, and "we" before "me."
Our Leadership team has been in business for 25 years because of two simple principles: “produce a product we would be proud to own ourselves,” and “treat our customers as we would treat our family.”
We will turn business down if we have to sacrifice product quality and we refuse to be involved with customers, representatives, or individuals that expect us to compromise our ethics or integrity. We may lose business in the short term; however, our long-term, worldwide customer and representative relationships are a strong measure of our success.
And we're huggers. ;-)
I'm new to this whole thing. How do I get started?
The Three Options of Starting a Mobile Clinic
When an organization decides to launch a mobile healthcare (medical or dental) outreach program to serve local and/or statewide communities, there is a lot of work on the road ahead (pun intended). You may become involved in partnering, fundraising, grant applications, or the enviable task of finding the perfect vehicle for your team.
When it comes time to figure out what is available and try to weigh the all your options for acquiring a mobile unit (likely why you've found yourself on our website), there are typically three ways to get a perfect result for your program:
First, it's always an option to explore new vehicles. A new chassis and new interior customized to your clinic floor plan requirements like like a custom home or tailored suit - everything fits just right. However, the drawbacks can outweigh the benefits - fabrication typically takes 6-9 months, costs for large units quickly shoot past the $200K, $300K, and $500K marks depending on the base vehicle and specialty equipment (medical or dental). Costs for added nice-to-have features such as bathrooms, nice TVs and slide-outs pile up as well. You'll have the security of knowing everything is new, and a one-year warranty.
Another, second option is scouring the internet and finding a mobile clinic that the current owners no longer need (medical, dental, or specialty care) and is being sold by the private practice, university, or healthcare system (or a "listing broker.") These vehicles can be available immediately, pending mechanical and equipment repairs. Average costs can range $75-125K depending on vehicle age, mileage, and overall condition of the vehicle and equipment.
The cost savings of buying used over new is usually a major upside, but just like buying a used car in a private party sale, the downsides of this option can easily outweigh any savings. These vehicles are rarely are in the condition promised, and commercial vehicle repairs of generators or slide-outs or leaky roofs can be in the 10s of thousands of dollars.
You will likely do your own inspections, cleaning, repairs, and honestly have no idea whether the vehicle will last 10 years, 2 years, 2 months or 2 weeks once you begin using it daily. Private party sales are suuuuper risky for new programs, in my opinion.
Third, you may find a manufacturer who has a used vehicle they have taken in on trade, and (just to keep you from their competior) offer to build a new interior customized to your clinic floor plan requirements on the used chassis. You end up with a mix of old & new.
Most manufacturers typically want new unit sales to keep their manufacturing floor running smooth, not rehab projects. They may not try very hard to help you here, or view rehab work as "seconds". In my years working on the manufacturing side, this "upfit" work gets higher profits plus generally plays 2nd chair or fill-in work to the new vehicles for some reason.
Average quotes for interior rework can range $20-200K depending on the chassis condition, extent of interior modifications, required new equipment (medical or dental), and those nice-to-have features like bathrooms, upholstery or slide-outs. Again, you'll get the manufacturer's warranty on the new work (only) and you're stuck with any repairs from that point on.
While one of these options will likely meets your needs and budget, we recommend you buy from a reputable used medical unit dealer. Licensed dealers should have one goal in mind - your team having a safe, comfortable and reliable vehicle for as long as you run your program. Manufacturers work hard to convince you they're the best, but dealers can afford to be honest about the quality of any particular unit.
Dealers who offer significant warranties are your vehicle partners and have a vested interest in not only providing you with safe reliable eqiupment, but helping you maintain it for the duration of your ownership so they can buy it back after you're done. It's a partnership model.
How do I form a 501c3?
Click on this link (https://www.missionmobilemed.com/how-to-start-a-501c3) to view our free video training series about creating a 501c3 organization for a mobile medical or mobile dental clinic.
What are the most important things I need to know about buying a mobile medical or dental unit?
We believe the unit must be the right fit for your program.
Typical clients layer their buying criteria in this order:
- The Unit's current ability to accomplish their stakeholder's mission with significant re-tooling or renovation.
- Availability: total days to delivery.
- Size & Condition
- Financing flexibility for the specific unit
The Resources Page contains more detailed information about what is needed, not need, and program / operations considerations.
There are three basic size considerations: minimum space to provide treatment, ergonomic considerations (people need to feel comfortable and want to work in the space), and where the vehicle will need to travel.
In a self-propelled vehicle, a treatment area of 20' x 8' is considered the minimum, which you can obtain with a vehicle between 26' to 40' without a problem. Single-chair dental operatories are not recommended.
Commercial Driver's Licenses (CDLs)
You may or may not need a Commercial Driver's License for a mobile medical or dental unit.
A CDL is a license a state uses to ensure individuals have been evaluated under uniform testing procedures and possess the basic knowledge and skills to operate a commercial vehicle (trucks, tractor- trailers, buses/coaches).
Technically, if you're driving a vehicle for work, most state laws require a commercial driver's license. However, this is a thinkly enforced requirement. The enforcement begins when vehicles get larger (i.e. more dangerous to surrounding motorists).
Most states require a CDL for any single vehicle that exceeds 26,001 pounds. In some states, the weight is lower. To determine if your driver(s) require a CDL, request a copy of your state's CDL manual, or just call your local DMV.
Drivers are not required to obtain a separate Federal license. Most RV style mobile clinics are under 26,001 pounds and per the weight restrictions do not require a CDL. There are three classifications for vehicles by weight: Class A, Class B, and Class C, and have different licensing requirements for each.
Federal standards require states to issue CDLs according to those classifications:
Class A – any combination of vehicles/trailers with a GVWR (Gross Vehicle weight rating) of 26,001 or more pounds provided the GVWR of the vehicle being towed is in excess of 10K pounds.
Class B – any single vehicle with a GVW of 26,001 pounds, or any such vehicle towing a vehicle not in excess of 10K pounds.
Class C – any single vehicle, or combination of vehicles, that does not meet the definition of Class A or B, but is either designed to transport 16 or more passengers, including the driver, or is placarded for hazardous materials.
Links: The Nevada DMV has provided us a list of all 50 States DMV websites
U.S. Department of Transportation (DOT)
Federal Motor Carrier Safety Administration (FMCSA)
If you have further questions about whether you need a CDL or how to apply for one, fill out the contact form and we are happy to help.
What is the Impact of the Mobile Medical Industry?
Currently, there are an estimated 2,000 mobile clinics located across the country, representing all states and the Washington, DC.
Services include primary care, preventive screening, disease management, behavioral health, dental care, pre-natal care, and pediatric care.
Addressing the triple aim of patient outcomes, quality and cost, we find:
- Mobile clinics are improving access to care with up to 6.5 million visits annually. Mobile clinics mainly serve the uninsured (60%) and the publically insured (31%), and generally operate in low-income communities.
- Overall, mobile health clinics in the United States are getting more bang for their buck in providing quality care at a lower cost. The average return on Investment for mobile health is 12:1. That means for every $1 spent, $12 are saved.
- Mobile Clinics provide cost-effective prevention services that help people live long and healthy lives. On average each mobile health clinic saves 65 quality adjusted life years every year of operation. This means that each visit they save on average $1,600 due to this prevention.
- Mobile Clinics provide accessible care at a cheaper cost to the healthcare system than Emergency Department visits. It is estimated that each mobile clinic results in 600 fewer Emergency Department visits every year. This means that each visit to a mobile clinic saves on average $200 (approximately one fifth of an emergency visit).
How NOT to select a vehicle or service provider in the Mobile Healthcare Vehicle Industry
Have you ever gotten bids from three contractors or auto mechanics and presumed that they are all equally qualified and capable so you selected the lowest bid?
How did that work out for you?
We all know someone who has been burned by selecting the low-cost provider (“LCP”) or been in that situation ourselves. If you’ve experienced it once, you probably won’t seriously entertain a low bid again without serious considerations - you understand there are reasons behind a low price, like less-qualified workers, sub-standard materials or inexperience with the task at hand.
In the world of professional services where accountants, lawyers, valuation experts and others are usually recommended in a group of three, the buyers of services make the same assumptions about capabilities and often suffer the same result as the person who chooses to work with the “cheapo” electrician.
The LCP exists in every industry and for certain items, the LCP is a perfectly reasonable solution. However, the LCP is particularly challenging in the mobile medical vehicle space because it is difficult to immediately identify how or where the LCP is lacking - and once the money is gone getting it back is impossible.
History shows buyers of LCP vehicles and services are not receiving the same quality, and those buyers will usually arrive at that understanding at the worst possible time - the day that vehicle is being relied upon to support your patients.
I’ve heard that story many times from folks who believed that they were getting a great deal only to wind up spending multiples of the perceived savings cleaning up the mess left behind. You may ask - how does the LCP operate?
- Some use certain the vehicle as a loss leader - i.e. "giving you the vehicle" and charging you hefty fees for the upfit or renovation work. They are really interested in selling you fab work, and any problems can be blamed on the base vehicle that you got "for free."
- Some will advertise premium services but hire inexperience (read: cheaper) staff to actually service your account. If you can't get a call back from a manufacturer or broker, ring the bell - a classic example of “you get what you pay for.”
- Some are simply buying your cash flow. For whatever reasons, they are behind on cash and like many small businesses "rob Peter to pay Paul" - use this period's cash flow to finance last period's losses. You may wonder why they weren’t profitable in the first place.
- Some are trying to ditch their vehicle without paying for needed repairs. They aren’t regularly involved in a particular area of the market or niche and don't have the cash to perform the work, so they price the engagement to “sell the problem". They might even bill you for the “extra” time it took to get things in working order!
Some are operating as sole-practioners because they choose to, and thus have low overhead. Working from their kitchen tables (with great intentions) and happy to pick up any commission they can get, their cost structure is essentially zero. These are the lowest-cost providers. But because they aren’t with a company, they don’t have access to data bases and research capabilities, finance instruments, and that will compromise the veracity of their work and the risk to their clients. And remember that while they’re working on an assignment that is critical to your patients, their primary objective is to pay the light bill.
When you have a problem, will they be able to be responsive (even with the best intentions?) If they do land a new job in the industry, what happens what you have questions or help with updates or maintenance?
The ultimate cost of selecting a unlicensed and non-professional dealer based on price can be very high - for example when deliverables that were believed to be nothing more than extra paperwork suddenly need to be pulled from the desk drawer - exposed as deficient for the "one time" it was prepared.
Or delays in completing title transactions, DOT filings or helping you with State audits. These all result in more time and money spent then if it was just done right the first time.
The LCP model is not sustainable. When everyone competes on price, it becomes a race to the bottom and the LCPs are usually the first ones there, so there is a good chance that they won’t be around when issues arise.
Can you imagine selecting your doctor on the basis of price? Don’t make that mistake when you need other professional services because you rationalize that it “isn’t really that important” or “it’s just a formality” or “they’re all the same.” Dig a little deeper.
If you receive a fee estimate that appears too good to be true, it usually is... and remember that there’s a reason why you don’t buy important things at a dollar-store.
If you're curious about more differences between acquistion costs and total costs, we're here to help you and your team.
What should I budget for Maintenance Costs?
Maintenance for a commercial vehicle is expensive - $2,000 to $5,000 per year minimum.
Speciality systems like shore power distribution, vaccums, or AV/IT compound the problem. One director of a program which has used vans for 17 years reports that maintenance costs are highly dependent on the age of the van. To control costs, industry veterans emphasize that it is important to find someone who "is in love with the van" and will take meticulous care of it. "You have to stay on top of the maintenance."
Brakes, tires, transmissions, engines - everything is more expensive in a commercial vehicle.
If possible, find a vehicle provider that provides lifetime maintenance as part of their service offering.
In a nutshell, what are my options for mobile units?
- Buying a box truck or RV and outfitting it yourself with power, lighting, finishes, and spec. equipment
- Ordering a self-contained specialty vehicles from 1 of the 7 major US manufacturers
- Purchasing a pre-owned self-contained specialty vehicle from a private party
- Purchasing a pre-owned self-contained specialty vehicle from a dealer
Both new and preowned vehicles are built on an RV chassis or a commercial truck chassis A commercial duty coach (bus) or trailer could also be designed, engineered and built for dental or medical services.
A trailer is not self-propelled and would need a tow-tractor for logistics.
If our org is a 501c3 Non-Profit, do we have to pay sales-tax on the vehicle?
By any measure, the sales tax puzzle faced by nonprofits both on the selling and purchasing side is far more complex than first appears. There are many circumstances in which a nonprofit is required to pay or collect sales tax on a particular transaction or in general. In both cases, sales tax requirements might exist despite a general IRS exemption.
Here are some typical areas of confusion regarding nonprofits, sales tax, and mobile medical vehicles:
Which 501 (c) organizations are exempt from paying sales tax?
Any can potentially be required to sales tax.
Tax-exemption applied to nonprofits means that in most cases the sales tax for certain sales is waived for transactions relating to the charity’s “charitable mission.” In some states, exemption from paying sales tax depends on the nature and volume of the sales activities by the non-profit.
In many states, if a non-profit vendor is engaged in business and making sales of taxable items or services, the non-profit is obligated to collect just like any other vendor. In some cases in states that might excuse collection under other circumstances.
It is incumbent on nonprofits to understand state-specific rules and their implications for transactions within a specific jurisdiction.
How do nonprofits prove they’re tax-exempt?
By providing exemption certificates and other documentation.
To substantiate tax-exempt status, a nonprofit must present a business with a valid, timely, and accurate certificate of sales tax exemption for each applicable jurisdiction. The burden of keeping records of exemption certificates in case of an audit lies with the seller. Common exemption certificate activities include certificate verification, storage, associating transaction with certificate, and managing expiration and renewal notifications.
Whether or not nonprofits have to pay sales tax on taxable purchases depends on the state and local tax rules that apply to that transaction. The research to determine whether or not sales tax is due lies with the nonprofit. Even though the federal government awards federal tax-exempt status, a state can require additional documentation to honor it.
For example, in Illinois companies who qualify as exempt according to the IRS cannot assume that their exemption qualifies them for exemption from sales tax at the state level. In the state of Illinois, “…organizations must obtain an exemption identification number (an “E” number) to qualify” for a state sales tax exemption.”
Sales Tax Exemption Certificate Validity Checklist:
Seller name / address (we'll make sure the name listed on the certificate matches the name on the customer account)
- Buyer name/address (same)
- Current date
- State of exemption
- Sales tax registration number
- Type of exemption claimed
- Type of property purchased
- Type of nonprofit
- Customer signature (some states require an “authorized” signature, either a board member or executive director)
Only state-approved exemption certificate forms are permitted.
If we purchase a mobile medical unit, who will train us on operation of the vehicle systems (e.g., generator, wheelchair lift, shore/site power)?
Our client services team will deliver the vehilce and train your team to use every feature on the unit. We plan to spend 1-2 days on-site, driving, parking, set up, water fills, waste dumps, and every other feature. We will stay with until you are satisfied and come back if you ever need to train new staff or need a refresher.
Who will train us to operate the vehicle?
We will source local driver training options for your team and provide vendor recommendations. We're currently working on a Certified Mobile Medical Unit Operator Course but it is not currently available.
Is there a service department?
Yes. We stand by our products, and respond to every call, 24 hours a day. With specialized technical knowledge and unmatched expertise, our Client Service Team members talk directly with your staff to determine the problem and provide immediate solutions. Nothing is more important to us than keeping our customers on the road.
At times, when a problem cannot be solved over the phone, we utilize a 24/7 service call from our Dynamic PC service partnership with Penske. We may also dispatch an M3 Service Technician to help remedy the situation as soon as possible.
We can service specialty medical vehicles and trailers at our facility in North Carolina, including pick-up and delivery services during holidays or scheduled down-time with a gauranteed return date.
We coordinate preventative maintenance and repairs through a flex-maintenance contract with Penske Truck Centers, a nationwide fleet maintenance company. If Dynamic PM is in your purchase order, we will make your appointment, handle all negotations and pay your bill. Your only responsibility is to drop off and pick up the unit.
If you are not a Mission Mobile Client - call us and discuss our Dynamic PM (Preventative Maintenance & Repair) Packages or see below for a comprehensive list of contacts to aid your DIY efforts:
For chassis service, you can contact the manufacturer:
IF you have a Freightliner, click here
IF you have a Ford Chassis, click here
IF you have a GMC Chassis, click here
IF you have a Chevrolet Chassis, click here
IF you have an International Chassis click here
For Generator service, you can also contact the manufacturer:
Atlantic Detroit Diesel Allison, click here
John Deere Worldwide, click here
Kohler, click here
Who do we go to for repairs?
Similar to maintenance and service, we condut repair operations for specialty medical vehicles and trailers at our facility in North Carolina, including pick-up and delivery services during holidays or scheduled down-time with a gauranteed return date.
Alternatlvely, we coordinate repairs through a flex-maintenance contract with Penske Truck Centers, a nationwide fleet maintenance company. If Dynamic PM is in your purchase order, we will make your appointment, handle all negotations and pay your bill. Your only responsibility is to drop off and pick up the unit.
Or, if we believe the condition is warranted, we will work with the unit manufacturer to conduct the repair.
Will you introduce us to service providers in our area?
Absolutely. If you do not choose the Dynamic PM (Preventative Maintenance) options, our client service manager will research and vet service providers in your area, and provide an opinion of which is your best choice.
How is a specialty vehicle constructed differently compared to a normal box truck or RV?
For a medical coach, rarely is a "consumer" motorhome chassis or body used as the base. You'll often hear of recreational vehicles and entertainment coachs referred to as "cardboard palaces" but specialty vehicles contain heavier body structure, bigger engines, and commercial- or marine-grade components.
For example, Winnebago Commercial Shells have steel backing in the walls and ceiling, Thermo-panel® sidewalls, and interlocking joints for added durability. The metal substructures embedded into the sidewall provide solid attachment points to keep cabinets and appliances mounted securely in place which are not available on consumer models. Also, a Ford V-10 Enginer in lieu of the consumer V-8.
An RV is designed to be used 15 to 20 weekends per year by a family of four. The HVAC (heating, venting and air conditioning—climate control), plumbing, roof, floor and wall structure, generator, engine and transmission are not commercial duty. A commercial vehicle is designed to be used 365 days per year. Think of the door on your house--could it stand being opened and closed over 100 times per day, 300 days per year? Not for long-- wear and tear will soon take its toll on your entire house if used as a commercial building.
In a commercial vehicle, there are welded outriggers/floor joists on the chassis that supports the floor. Rather than wood studs, two-inch square aluminum studs, 16-inch on center are used, which makes the vehicle more durable and stable.
Commercial units have drive train requirements more like semi-trucks than passenger vehicles. These drive trains will last from 500,000 to 1 million miles before major work needs to be done.
A freight truck would be similar chassis and set up to most cab-and-chassis units; however the business end would be a nightmare. From electrical to plumbin, freight truck boxes are not made for modification. Coverting a box truck to a medical or dental would be akin to finishing a basement - nothing you touch or try to connect to is designed for nor capable of sustaining the end result you're trying to accomplish.
How long does it take you to respond to a breakdown?
Through Penske, our teams have access to more than 750 shops across the U.S., Mexico and Canada, with over 8,000 technicians and customer service representatives on call.
They offer ASE-accredited and Certified Technicians
We love Penske because they leverage a network of more than 18,000 emergency providers to offer you 24/7 roadside assistance.
No matter where you are, our processes ensure consistent customer service at all locations, or we'll come get the vehicle ourselves. MIssion Mobile and every Penske shop has access to the complete maintenance history of your vehicle throughout its life.
Do you give flexible service options?
We are the most flexible group of people you'll ever work with.
You can purchase a vehicle with our without Dynamic PM. We'll support you either way and still help you with repairs and maintenance as best we can.
The only difference would be risk - with Dynamic PM we take all the cost and time risk, and without it your program takes all the cost and time risk.
What are typical repair costs and are parts available?
The answer we all hate: it depends.
Roadside service for flat tires can be $500-$1,000.
New engines can be $30,000 installed.
New transmissions $15,000-$20,000K installed.
We've seen damage from roof leaks cost $10,000+ And so on, and so on.
Parts are typically available. None of the base engines, transmissions, slides, or finishes are unique or hard to source.
This is not like my car--whom do I call when I have a flat tire?
With Dynamic PM, your units will have instruction stickers mounted in the vehicles with locations and contact information fo local area service depots and roadside-assistance.
Without Dynamic PM, we can help you find a program that is right for you and advise where to mount this information for permanent and easy reference.
Does the climate or weather where we live matter?
Adequate insulation is important. In extreme cases, you can power the vehicle (plug it into shore power) to prevent freezing. Freshwater and wastewater tanks and lines must be prevented from freezing.
In warmer climates, the heating system is used on winter mornings to knock off the chill, but when a few warm bodies are added to a small space the AC quickly becomes more important.
A hot climate with high humidity may require an oversized HVAC system to maintain comfort. Luckily, a specialty vehicle typically has 2-3 times the HVAC capacity required for the space becuase they are nortoriously difficult to insultate and opening the doors create significant airflow. You may insulate the floors (after-market) if temperature control becomes an ongoing issue for your program.
What is "shore power"?
The term "shore power" is a marine term. When docked, boats do not run their engine instead connecting to a dockside electrical plug-in to feed power to the boat's electrical system. When parked, specialty vehicles can operate the electrical system from the generator or plug into facility 50-80A outlet designed for that use.
The on-board systems will function properly and consistently with or without shore power. If the vehicle is consistently at the same location, arrangements for the site provider to provide shore power saves fuel and increase the life of your generator. If you need to control the climate overnight or store the unit for an extended period, shore power allows you to maintain heat to prevent freezing or excess humidity in the unit during downtime.
Running the generator during operations is not cost prohibitive --1 to 2 gallons of fuel per hour -- but the cost to replace the generator can be upwards of $10,000.
Most facilities are not readily equipped with this type of connection and required an electrician to connect them. The cost for this work will vary - often $400-$2,500.
Usually the cost of the electricity on location is born by the host (e.g., school), so a mobile program may offer to have the connection installed for them. Additional benefits include the absence of generator noise and vibration during the day. It's safe - shore power lines are grounded to the facility outlet and not affected by rain or other wet conditions.