Trips per Vehicle Hour in NEMT: How to Count It and What Is Realistic

How to count trips per vehicle hour

Trips per vehicle hour = completed one-way trips ÷ vehicle hours

The division is easy. What you put on top and on the bottom decides whether the number means anything.

On top: completed one-way legs. MTM Health’s standard agreement, in the January 1, 2023 version Pennsylvania posts, defines a trip or trip leg as one-way transportation from the pickup to the destination drop-off (section 1.I). A ride to the clinic and the ride home are two trips. Leave out:

• No-shows and late cancellations. They took time but produced no trip. Leaving them out is what lets the number show the lost hour. Track them separately as a no-show rate.
• Escorts and attendants. MTM’s agreement has you carry the member and one escort or attendant as requested (section 2.FF). The escort rides along on the member’s trip and is not a second trip.

On the bottom: every hour the van is out with a driver. Count from clock-in to clock-out: the drive to the first pickup, waits, breaks in the van, and the drive home. You pay for all of those hours, so they belong in the count.

Example. A driver clocks in at 7:00 and out at 3:30, which is 8.5 hours. The van completes 10 legs and has 1 no-show. Trips per vehicle hour is 10 ÷ 8.5 = 1.18.

Figure it per van and per week. One day swings too much with cancellations and long appointments.

Why public transit numbers look higher

Public transit uses a narrower count. The Federal Transit Administration’s National Transit Database (NTD) divides passenger boardings by vehicle revenue hours, and three of its rules push the result up:

Rule	NTD (demand response)	Your NEMT count
Who counts as a trip	Every passenger who boards, including personal care attendants and companions	Each completed member leg
When the hour starts	At the first passenger pickup, running to the last drop-off	At clock-in
What is left out	Garage runs, lunch breaks, fueling	Nothing: every paid hour counts

The FTA’s 2025 policy manual sets these rules for demand response service, and its glossary (updated May 6, 2026) leaves deadhead out of revenue hours. Use the NTD as a rough yardstick, not a target.

What realistic levels look like

Public demand response, 2024

Demand response is the public service most like NEMT: a van goes out when a rider calls and takes them where they need to go. Here is what NTD reporters carried in report year 2024:

Group	Trips	Hours	Trips per hour
All demand response services	139.7 million	72.6 million revenue hours	1.92
Rural reporters	35.4 million	16.6 million revenue hours	2.13
Services where over 90% of trips are ADA paratransit	42.5 million	25.8 million revenue hours	1.65
Services that also report all vehicle hours, counting garage runs	82.9 million	56.3 million total vehicle hours	1.47

The middle half of agencies ran between about 1.5 and 2.7 trips per revenue hour. The last row is the closest to how you count, and it is already down to 1.47. These services also share rides by design, which a one-rider NEMT van does not. See NEMT vehicle utilization for more on the same data.

Long rural medical rides

Vermont’s program for older adults and people with disabilities is a closer match to much rural NEMT work. About 69 percent of its rides are for health care, including dialysis, cancer treatment, and adult day programs. In state fiscal year 2024, its nearly 130,000 rides used over 104,000 vehicle hours, about 1.25 rides per vehicle hour. The average ride took 45 minutes and covered 23.9 miles (Vermont Agency of Transportation testimony, April 2, 2025). See rural NEMT.

The one-rider math

For a van that carries one rider at a time, the ceiling is simple. Add up every minute a trip ties up the van, then divide 60 by it.

Minutes per trip, from leaving for the pickup to the next trip	Trips per hour at most
30	2.0
40	1.5
45	1.33
60	1.0
75	0.8
90	0.67

Real days run below the ceiling, because of gaps between appointments and the first and last drives of the shift. The trips per day calculator works it out for a whole shift.

By type of service

Service	What it adds to each trip
Ambulatory, in town	Short rides and fast boarding. Often your highest number, and the easiest to share.
Wheelchair	Ramp or lift time and securement at both ends. Virginia requires four securement straps plus a shoulder and lap belt for each wheelchair rider (member manual, June 2026).
Stretcher	Loading and unloading with a crew. Count staff hours as well as vehicle hours. See stretcher van requirements.
Long-distance or rural	Long loaded miles and long empty returns. Expect a low trip count and judge it by pay per hour instead.

How scheduling moves the number

Faster driving barely changes it. The gaps between trips change it most, and broker rules decide how small those gaps can get.

• Early arrival does not buy time. MTM Health in Virginia counts a pickup as on time from 15 minutes before to 15 minutes after the scheduled time, but a member does not have to board before the scheduled time. Georgia’s NEMT manual (July 1, 2026) says the same, so plan the next trip from the scheduled time, not your arrival.
• Wait rules set the cost of a no-show. Georgia does not require a wait of more than 10 minutes after the scheduled pickup. CareOregon requires at least 15. Fewer no-shows add trips. See how to reduce NEMT no-shows.
• Will-call returns hold a van. MTM Health in Virginia requires the vehicle within 45 minutes of the call that a member is ready. Keep a van near busy clinics in the afternoon instead of sending each one back. See will-call trips.
• Shared rides add trips without adding hours, within limits. In Virginia, no member on a shared ride should stay in the vehicle more than 45 minutes longer than the average direct trip, unless authorized. See NEMT multiloading.
• Empty miles cost time and are not paid. CMS says miles with no member on board generally cannot be paid (SMD 23-006, September 28, 2023). Start each trip near where the last one ended. See deadhead miles.
• Standing orders make the day predictable. Dialysis and therapy riders at fixed times let you build chains of trips that fit. See NEMT standing orders.

Read trips per vehicle hour next to revenue per vehicle hour. A van running long stretcher or rural trips can post a low trip count and still earn the most per hour. The NEMT KPIs guide shows how to track both each week.