GMR Solutions NYSE: GMRS reported second-quarter revenue growth and higher demand for its core emergency services, while adjusted EBITDA declined from the prior year as the company lapped favorable revenue estimate adjustments tied to older No Surprises Act claims and recorded IPO-related expenses.
The emergency medical services provider reported net revenue of $1.49 billion for the second quarter of 2026, up 3.3% from a year earlier. Adjusted EBITDA was $284.5 million, down 11.8% year over year, with an adjusted EBITDA margin of 19.1%. The company posted a net loss of $28.3 million, compared with net income of $80.8 million in the prior-year quarter.
Chief Executive Officer Nick Loporcaro said the company completed nearly 1.4 million patient encounters in the quarter, including more than 1 million ground transports, roughly 280,000 ground interventions that did not result in transport, nearly 29,000 911 Nurse Navigation calls, and more than 36,000 air-medical patient encounters.
Revenue Growth Led by Air and Emergent Ground Demand
Chief Financial Officer Brian Tierney said air-medical volumes increased 6.9% from the prior-year period, supported by demand for services and an improved capture rate. Emergent ground transports rose 2.4%, driven by same-store demand, while non-emergent ground transports declined 3.0% as GMR shifted resources toward higher-acuity services.
Same-market revenue increased $53.1 million, or 3.8%, year over year, while new-market revenue totaled $21.3 million. The company opened two 911 systems in markets where it already operates air services, opened three air bases, and signed agreements representing more than $43 million in incremental annualized revenue.
Net transport revenue per ambulance transport increased 1.4% year over year. Tierney said revenue reflected a favorable mix shift toward emergent transport and underlying rate improvement on a like-for-like basis.
However, the company faced an approximately $16 million impact from payer mix changes associated with the expiration of Affordable Care Act exchange subsidies. According to Tierney, some patients shifted from commercial insurance into self-pay, though management said the effect has varied by geography. The company expects an approximately $15 million to $16 million quarterly impact to revenue and EBITDA for the remainder of the year, which is included in its outlook.
No Surprises Act Comparison Affected Results
The year-over-year EBITDA comparison was also affected by lower favorable changes in revenue estimates related to No Surprises Act claims from earlier service dates. Tierney said such estimate changes were approximately $74 million lower than in the prior-year quarter.
GMR recognized about $5 million of No Surprises Act-related estimate changes during the second quarter, compared with approximately $79 million a year earlier. Tierney said the prior-year benefit was tied largely to older claims and that the company now expects future estimate changes to remain in a range of roughly plus or minus $5 million.
The company said it expects to lap just under $100 million of similar out-of-period benefits in the second half that were recorded during the same period last year.
On the expense side, total operating expenses increased 19.4% to $1.43 billion. Employee wages, benefits and taxes rose 24.5% to $925 million, primarily due to $129.6 million in stock compensation expense related to the vesting of stock units associated with GMR’s IPO. The remaining increase reflected staffing improvements and wage adjustments, with average base-unit wages increasing 3.3%.
Maintenance, fuel and other direct expenses increased 21.1% to $136.4 million. Tierney attributed the increase to fuel costs related to the Iran conflict, aircraft maintenance timing, and inflation in supplier costs linked to fuel prices. The company’s guidance incorporates more than $10 million per quarter in incremental fuel costs relative to its pre-year budget assumptions, he said.
Nurse Navigation and Technology Expansion
President and Chief Operating Officer Ted Van Horne said GMR’s 911 Nurse Navigation program processed nearly 29,000 calls in the second quarter, up 50% from a year earlier. The program directs lower-acuity 911 callers to nurses who assess their needs and may guide them toward appropriate care settings or transport options when an ambulance is not clinically necessary.
GMR began serving three additional communities during the quarter, representing 1.3 million covered lives. The program now operates in 29 communities and covers 19.7 million lives, with four additional community implementations planned by year-end.
Loporcaro said GMR serves geographies representing roughly 200 million lives and sees potential to expand Nurse Navigation coverage to 100 million lives over a five-year period. He said the company has observed approximately 150 basis points of margin improvement in markets where it has deployed the program, while also seeing better reimbursement in some cases where nurse navigation is paired with treatment without transport.
The company also highlighted its Concierge platform for coordinating non-emergent transport and its Transport.net technology, which helps request, track and dispatch air and ground ambulance resources. Van Horne said Transport.net is installed at nearly 3,000 Public Safety Answering Points, representing more than 65% of such centers nationwide.
Liquidity, Leverage and Outlook
GMR ended the quarter with $420 million in cash and cash equivalents and $696 million of cash borrowing capacity under its undrawn asset-based lending facility after letters of credit. Free cash flow was approximately $15 million, and net leverage declined to 3.5 times from 4.3 times at the end of the second quarter of 2025.
Tierney said the company expects to reduce net leverage below 3.3 times by year-end and has line of sight to 3.0 times before the end of 2027. Moody’s and S&P upgraded GMR’s credit ratings following the IPO, resulting in a 25-basis-point interest-rate reduction on its term loan facility.
The company reiterated its full-year outlook, forecasting:
- Revenue of $5.89 billion to $6.18 billion;
- Adjusted EBITDA of $1.135 billion to $1.195 billion; and
- Cash used for capital expenditures and aircraft financing equal to 5.1% to 5.3% of total revenue.
Management said the outlook assumes continued transport-rate and volume momentum, a stable payer mix incorporating the exchange-subsidy expiration, and the ongoing effects of the Iran conflict on fuel and related costs.
About GMR Solutions (NYSE:GMRS)
GMR Solutions Inc is a provider of emergency medical services delivering EMS and other essential out-of-hospital care in rural and urban communities. GMR Solutions Inc is based in Lewisville, Texas.
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