Study: Elyria could profit from in-house ambulance services

A study completed last month found that Elyria could sustainably run its own ambulance services program – and maybe even turn a profit – if it is willing to shoulder the high upfront cost. The study by Fitch and Associates of Chagrin Falls examined Elyria's current emergency medical services, or EMS, program run by LifeCare Ambulance, and investigated the feasibility of the Elyria Fire Department bringing those services in-house. According to Fitch and Associates, LifeCare provides excellent service to the city and appears to be fiscally stable, but it estimated that if the city were to invest the roughly $3 million needed to start up its own EMS service, it could possibly profit up to $1.2 million per year. Safety Service Director Chris Pyanowski said that a representative from Fitch and Associates would be at the City Council meeting on Nov. 24 to discuss the study, and it would ultimately be up to Council to determine whether to continue with LifeCare, move all EMS services in-house at the fire department or come up with a hybrid plan. "There is not a plan from the administration or the city to move in any particular direction at this point," Pyanowski said Friday. "... If we were to decide to get involved in the ambulance business, even on a partial basis, it would require some lead time to get things set up. That is part of the reason that we're having a report done now and exploring it and understanding what the costs are. As he says in the report, LifeCare is doing a fine job, they're meeting industry standards and providing a good service. (The study) was to look at all things, because this is a very big need in the community." The study was requested by several members of City Council when the contract was before them in early 2024. The current contract Currently, Elyria is in the midst of a four year contract with LifeCare to provide 24-hour EMS services in the city, with University Hospitals providing coordinated medical direction. For decades, LifeCare provided these services to the city for free, but when the contract came up for renewal in early 2024 LifeCare officials said they needed to start charging a fee for non-transport calls. Non-transport calls are those in which LifeCare is called to a scene but does not transport a patient to the hospital. The company has no way to bill patients or insurance companies for such calls, so LifeCare proposed charging the city $126 per non-transport call, with a cap of $400,000 per year. Elyria City Council agreed to this proposal, and entered into a four-year contract with LifeCare with an optional fifth year in 2028. Pyanowski said that the non-transport cost charged to the city was below the $400,000 limit in 2024 and appeared to be on track to come in below the limit again in 2025. In 2024, Elyria paid LifeCare $303,156 for non-transports, and between January and October of this year the city had paid just $241,668. The Fitch and Associates study reviewed LifeCare's patient care and response times, finding that the company was meeting the needs of the city and was financially stable. However, the study also noted that there are certain financial issues facing EMS providers nationwide. Last year, LifeCare Chief Operating Officer Kim Mason told Council that one major such issue is the prevalence of no-transport calls, which prompted LifeCare to ask for the fee. Mason could not be reached for comment on Friday. "Overall, Fitch found that LifeCare is providing high-quality services to the City of Elyria and are following industry best practices," the study said. "There were no concerns regarding LifeCare's ability to provide high-quality and patient centric care. Estimated financials for LifeCare suggests that the agency should be fiscally sustainable, but it is also recognized that the EMS industry is challenged to maintain fiscal solvency and often require public subsidies." Pyanowski said that LifeCare participated in the study by agreeing to interviews with Fitch and providing records on things like call volume, but the company did not provide its full financial records. Because of this, projected revenue in the study are estimates. Current service All Elyria firefighters are currently trained as emergency medical technicians, or EMT's, and fire crews are dispatched on all advanced life support, or ALS, medical calls. Fire Chief Joe Pronesti said ALS calls are all those which include serious life threatening injuries, and they account for around 45 percent of all medical calls in the city. EMS calls in the city have increased rapidly over the past 10 years, rising from around 3,500 in 2015 to over 5,500 in just the first 10 months of 2025. This includes all medical calls, not just those which Elyria firefighters are sent to. Every Elyria fire truck has all necessary EMS equipment with the exception of a cot on which to transport patients, and every fire crew has at least one paramedic in addition to the EMT trained firefighters. Fitch and Associates noted that both LifeCare and Elyria respond to 90 percent of such medical calls in the city within seven minutes of receiving the call, which is the industry standard according to the National Fire Protection Association. This led the study to conclude that there would be no fall-off in service times if Elyria were to take over the service. The study acknowledged that the startup cost for launching even partial ambulance services was high, as not only are ambulances themselves expensive to purchase and run, but all of the associated equipment is as well. In-house cost and benefit LifeCare always has three available ambulances, with the ability to call a fourth into the field when needed. The study provided a comparison to Elyria providing a similar level of service, which it referred to as 3.5 units in service. Fitch said the initial capital investment for running 3.5 ambulance units 24/7 would be $2,486,673, which includes five ambulances and all necessary equipment. Additionally, the study said that bringing ambulance services in-house would require the hiring of an EMS captain to oversee the program as well as an EMS administrative assistant. Including the salaries of the administrators, EMTs, paramedics and additional annual costs, Fitch said that the city would spend $2,962,250 per year on the EMS program. While this cost is high, Fitch also estimated that the city's revenue from billing for EMS transports would be $4,241,423. Factoring in the maximum of $400,000 the city could have to pay LifeCare per year if it hits the non-transport maximum, Fitch said the city stood to earn up to $1,279,173 per year back in revenue, which could be put into the city's general fund. Costs for other options including 4, 4.5 and 5 unit shifts varied, with a 5 unit shift plan projected to profit under $27,000 per year. "It is interesting to note that the City is currently subsidizing LifeCare at $400k for non-transport incidents," the study said. "In other words, the City could have a similar cost center with greater control, accountability and transparency by providing services through the fire department, if desired." A cost that may not have been fully factored into the study is the staffing component. While Elyria firefighters are currently qualified to fill the needed roles, the department would need to add firefighters to the department to properly meet both EMS and fire protection needs, Pronesti said. Pronesti said he was happy to have estimates and a "blueprint" on how the department and city could move forward, but he also said that he was happy to have the help provided by LifeCare in serving Elyria residents. Specifically, he pointed to the fact that any serious injury call in the city would have at least two paramedics present, one from EFD and one from LifeCare. "The citizens of Elyria get one hell of a service from both Elyria Fire and LifeCare," he said. "Every call, you're either getting a paramedic from one or the other agency immediately, and on the serious calls we work well with LifeCare in a team approach. You have an EFD paramedic working with a LifeCare paramedic, and what I love about it is, it doesn't matter what their shirt says. They are working together and the citizens are benefiting from that." Contact Owen MacMillan at (440) 329-7123 or omacmillan@chroniclet.com.