Local Ambulance Company Operating at a Loss

December 18, 2025 by Ann Wishart

At the Dec. 11 Middlefield Village Council meeting, Community Care Ambulance Director of Customer Relations Chris Brook said the organization has taken multiple steps to keep the nonprofit financially viable.

CCA has a contract for emergency transportation and treatment with Middlefield Village and Middlefield Township. The organization also has separate contracts with Andover, Ashtabula and Oakwood, Brook said.

However, a number of challenges have emerged that threaten CCA’s ability to remain budget-neutral in the Middlefield area, he said.

Brook said the Ohio No Surprise Billing Act, which went into effect in 2022, limits CCA’s ability to collect payment for services.

“We can’t send bills anymore,” he said in a phone interview Dec. 13, explaining that if the cost of a service call exceeds what Medicare or a patient’s insurance company pays, CCA is prohibited from billing patients for the balance.

The act also allows insurance companies, including Medicare, to determine what constitutes a “reasonable” cost for each emergency medical services run, he said.

Since the law was enacted, insurance companies have significantly reduced reimbursement rates for transporting and treating patients, regardless of the actual cost to CCA, Brook said.

“The cost to run a transport is different from Ashtabula or Cuyahoga,” he said. “There are so many variables to what it costs.”

Medicare recently required EMS organizations to submit data detailing the cost of their service runs and Brook expects those figures to come out soon, he said.

Then, everyone will be able to understand what it actually costs to run an EMS operation, Brook said.

The number of emergency medical technicians entering the workforce has declined since the COVID-19 pandemic, Brook said, adding CCA had to raise its salaries by 14% to compete for qualified personnel.

That increase was possible because of CCA’s size, but smaller departments face financial limitations, he said.

“Townships do not have enough money to pay their people. There are no volunteers anymore,” he said.

If smaller fire departments cannot offer competitive wages and benefits, trained paramedics will seek better compensation elsewhere, Brook said.

“Everybody’s stealing (paramedics) from everyone else,” he said.

CCA also has mutual aid agreements with fire departments in Parkman, Farmington, Mesopotamia and Troy townships, Brook said.

“They all struggle. A lot of departments are having a difficult time with coverage,” he said. “Mutual aid is not a problem when it is mutual. We call other departments to help us. The problem is, when a township EMS shuts down, when they have no EMTs or paramedics (at the station), we become the primary (service) for areas not paying for it.”

With limited insurance revenue available, Brook said CCA has taken steps to reduce the financial strain, including performing vehicle repairs in-house, becoming more creative with scheduling and minimizing overtime.

Despite those efforts, the Middlefield operation is currently running at an annual loss of about $72,500, Brook said.

He emphasized the village is a strong financial partner, providing CCA with a yearly subsidy of $124,317, but CCA costs about $197,000 per year to operate.

While it is not a problem, yet, because the company is sound, the costs of equipment and staffing continue to increase, Brook said.

“We’re not going away,” Brook assured council members and residents.

During the meeting, Middlefield Fire Capt. Tony Yeropoli said he agreed with Brook’s assessment, adding CCA is the only ambulance service reliably staffed with paramedics 24 hours a day, seven days a week, year-round.

As a result, CCA frequently responds to emergency calls outside its contract area when township departments are unable to respond due to staffing or equipment limitations, Yeropoli said.

CCA is morally obligated to answer mutual aid calls, he added.

“In a medical emergency, you’re stuck,” Yeropoli said.

As an example, the captain said Parkman Township Fire Department operates an ambulance, but transport time to the nearest hospital, University Hospitals Geauga Medical Center, is 15 to 20 minutes. If the crew transports a patient there, it may have to wait until a bed is available.

If another call comes in during that time, a request for mutual aid is issued and often falls to CCA, Yeropoli said.

Brook recommended representatives from CCA, fire departments and EMS services from the village and surrounding townships meet to discuss potential solutions.

“Everybody cares about the patients. Times are different, now. We have to adjust for the safety of our residents,” he said.

In 1994, the boards of trustees for Ashtabula County Medical Center and Memorial Hospital of Geneva — now University Hospitals Geneva Medical Center — approved a proposal to create a not-for-profit, full-service EMS and medical transportation organization to better serve Ashtabula County residents, according to CCA’s website.

Since its inception, CCA has exponentially grown and now provides 911 services, hospital transportation and nursing facility support throughout Northeast Ohio. The organization employs over 270 certified critical intensive care providers, paramedics, advanced and basic EMTs, emergency medical dispatchers, wheelchair technicians and support personnel that care for thousands of patients each year.