Are Free-Standing ERs a Rip-Off?

The rise in ERs not directly attached to a hospital is a relatively new phenomenon in the healthcare system. Recently, I have spoken to many patients about their thoughts on these ERs, which has prompted me to consider the reason they have popped up on many street corners in affluent neighborhoods.

Most patients tell me they would not use these ERs for "true" emergencies such as severe chest pain, abdominal pain or significant trauma, but would go to an unaffiliated ER facility for more typical ambulatory care problems such as a cough, fever or nausea. People I've talked to like the convenience of an ER in the neighborhood, and the advertised wait times that give the patient quick access to medical care. However, at what cost do these ERs deliver on this convenient, quick access?

A consistent experience of my patients are the exorbitant bills they receive for a co-pay or deductible from these free-standing ERs. Patients think that because these facilities are located in their neighborhood, they are just "glorified" urgent care centers that will treat their minor medical complaints conveniently and quickly. Patients may feel better initially after their treatment but the real pain is coming in the form of their dreaded ER bill. 

Should patients be aware that a designated ER facility delivers, by definition, a higher level of service, and therefore is contracted with Medicare and other third-party payers to be reimbursed at significantly higher rates than urgent care centers? Do free standing ERs fill a significant medical gap in our delivery system? Or, do they represent medical opportunism designed to lure people into a facility that delivers a higher profit margin to its owners?

Since many patients only consider in-hospital ERs, "real" ERs, and because of the similarity between neighborhood ERs and urgent care centers, I believe the rise of the neighborhood ER was intended primarily to increase the profit margin for owners at the expense of patients who lack the knowledge of the medical billing system. I also believe that the same greed that established these facilities will lead to their demise in the near future.