GMR Solutions (NYSE:GMRS) reported higher first-quarter revenue and profit in its first earnings call as a public company, with executives pointing to demand for emergency medical services, improved collections and operating discipline as key drivers of performance.
Board Chair and CEO Nick Loporcaro said the company’s initial public offering followed several years of refocusing on its “core competency of emergency care.” He described GMR as the largest provider of emergency medical services, serving 5.5 million patients annually and operating in markets representing more than 60% of the U.S. population with one or more of its offerings.
Revenue and EBITDA Increase in First Quarter
GMR reported first-quarter revenue of $1.46 billion, up 6.6% from the prior-year period. Adjusted EBITDA rose 9.7% year over year to $305 million, while adjusted EBITDA margin expanded 59 basis points to 20.9%.
Loporcaro said both revenue and adjusted EBITDA were at the top end of the range the company provided in its S-1 filing. He attributed the performance to same-market revenue growth, revenue from cross-selling and new markets, disciplined cost management and continued optimization of clinical and operating platforms.
Executive Vice President and CFO Brian Tierney said net income increased 179.9% to $106.3 million, compared with $38 million in the year-earlier quarter. Interest expense fell 26.8% to $83.2 million, reflecting a refinancing completed in September 2025.
Total operating expense increased 4.1% to $1.24 billion. Employee wages, benefits and taxes rose 4.8% to $770 million, while maintenance, fuel and other direct expenses increased 6.1% to $119 million. Insurance expense increased 27.6% to $43 million, driven mainly by professional liability-related claims and third-party premium expenses.
Emergent Services Remain the Focus
GMR completed approximately 1.4 million patient encounters during the quarter. The company provided ground medical services to more than 1.3 million patients, including more than 1 million transports and more than 28,000 calls through its 911 Nurse Navigation program. It also provided air medical services to more than 34,000 patients.
President and COO Ted Van Horne said GMR continues to focus on growing core emergent services and pursuing non-emergent services only “where they make fiscal sense.” Patient encounters related to emergent transports and nurse navigation increased 1.7%, while low- or no-reimbursing encounters tied to non-emergent and wheelchair transports, as well as non-transport encounters, decreased 5.2%.
Total emergent transports increased 0.7% during the quarter. Same-market emergent ground transports rose 0.5%, despite what Van Horne described as a less severe and shorter-than-average flu season. Same-market emergent flights increased 1.9%. The company’s weather cancellation rate was 17.1%, down 81 basis points from the prior-year quarter and 220 basis points below the previous three-year average for the quarter.
Non-emergent ground transports declined 7.2% year over year, and wheelchair patient encounters fell 52.8%. Van Horne said the decline was consistent with GMR’s effort to maintain contracts with appropriate reimbursement.
911 Nurse Navigation Expands
Executives highlighted growth in GMR’s 911 Nurse Navigation service, which Van Horne said currently serves 29 communities across the U.S. Another 13 markets are in the implementation phase, which would bring total covered lives to more than 22 million.
During the quarter, nurses navigated more than 28,000 911 calls, up nearly 47% from the prior-year period. Van Horne said that in markets where the service has been implemented, GMR has seen an average 15% reduction in “dry runs” and a 2.5% reduction in total transports.
Van Horne said the program helps direct patients to more appropriate care options and transport modalities, while reserving advanced life support resources for the highest-acuity patients.
Collections, Payer Mix and Guidance
Tierney said net revenue per transport increased 7.9% year over year, driven by a mix shift toward emergent transports and improved air and ground net revenue per transport on a like-for-like basis. He said favorable weather contributed approximately $11 million to revenue compared with the prior-year period.
The company collected about $7 million during the quarter from transports performed between 2022 and 2024 that were related to the No Surprises Act independent dispute resolution process, down nearly $24 million from comparable mature dates of service in the prior year. Tierney said collections from older dates of service tied to IDR largely cleared out in 2025, returning the company to a more normal collection cycle.
GMR also benefited from roughly $16 million in collections from 2024 dates of service tied to implementation of California’s state surprise medical billing legislation. Tierney said during the question-and-answer session that the California catch-up was entirely related to ground services and that investors should not expect a similar large lump sum going forward.
For the quarter, payer mix by net transport revenue was 57% commercial, 25% Medicare, 9% Medicaid, 7% other third-party payers and 2% self-pay. Tierney said the company did not see the expected negative payer-mix effect in the first quarter from the One Big Beautiful Bill Act or the expiration of Affordable Care Act exchange subsidies, though some impact began to appear in April. In response to a question from JPMorgan analyst Benjamin Rossi, Tierney said guidance assumes a $25 million to $30 million total impact from those factors over the last nine months of the year.
GMR issued full-year 2026 guidance for revenue of $5.89 billion to $6.18 billion and adjusted EBITDA of $1.135 billion to $1.195 billion. The company expects total cash used for capital expenditures and aircraft financing to be between 5.1% and 5.3% of total revenue.
Capital Structure and Regulatory Developments
Following the IPO and use of cash on hand, Tierney said GMR reduced total debt and preferred equity by more than $1.15 billion. The actions are expected to reduce annualized term loan interest expense by about $46 million and annualized preferred equity dividend accrual by $73 million. Moody’s and S&P upgraded the company’s credit ratings, and Tierney said net leverage after the IPO was approximately 3.5 times, with expectations to move below 3.3 times by year-end and toward 3.0 times in 2027.
Loporcaro also addressed regulatory issues, saying GMR has engaged with Congress to seek legislation requiring the Centers for Medicare and Medicaid Services to modernize air and ground ambulance reimbursement based on cost data. He said he raised Medicare reimbursement concerns in a February meeting with CMS Administrator Dr. Mehmet Oz.
On a recently released CMS proposed rule regarding Medicaid state-directed and supplemental payments, Loporcaro said early analysis suggests a negative annual impact to GMR of less than $5 million. He added that the company is evaluating the rule’s potential effect on municipal-run systems and the sustainability of their model compared with private providers.
In the Q&A session, Loporcaro said GMR has a “healthy pipeline” of about 12 viable acquisition targets, but emphasized that any M&A would be focused on the company’s core offering and would need to be highly accretive. Tierney said the company’s guidance does not include acquisitions.
Loporcaro closed the call by saying GMR remains focused on operational discipline and innovation in emergency medical services, while thanking frontline staff, support personnel and regional leaders for their work.
