Some hospitals belonging to Tenet Healthcare, another large chain, had seen such a surge in patients using the ER for primary care that they began accepting online appointments to make it easier to use their emergency departments. Is that spike in ER patients a function of the lack of primary care, which health reform was supposed to cure, or is it because of the hospital’s marketing skill? In Baltimore, Saint Agnes Hospital advertises on its website that the urgent-care portion of its ER offers quick treatment of minor ailments such as colds and sore throats. When Galewitz asked about this, a hospital VP explained it was a way to offer more efficient service, though, he added, they do not push their ER as much as competitors, in order to avoid patient traffic jams.

Other hospitals hardly miss a chance to market. Passing through Denver’s airport the other day I saw an ad for one hospital’s ER waiting times. Hmm, prowling for patients even in transit? A bit more research gave a fuller picture of the Denver scene, where promoting waiting times is a way to snag new patients. Would you choose a hospital with a sixteen-minute wait, a ten-minute wait, a seven-minute wait, or none at all? The website of the Swedish Medical Center noted those options for four hospitals that the parents of a sick child might consider. Porter Adventist Hospital says it “posts the most accurate ER wait times in Denver—updated every 15 minutes.” “HealthONE is the first hospital system in Colorado to make both adult and pediatric ER wait time available,” says a promotional blog post for iTriage, a smartphone app that answers health questions. And so the competition goes.

There are so many angles to this story. Where are the insurance companies? Do they condone these practices? Recall, they were the ones slapping high coinsurance and copayments for ER use in an effort to redirect care to cheaper settings? Are consumers willing to pay the price in exchange for a quick diagnosis? The Kaiser/Post story focused on one insurer, Medicaid. What about the rest? What are the relative costs of using the ER to treat bronchitis versus going to the doctor’s office or to an urgent care clinic. One hospital administrator whose facility is not far from Denver told me the cost of an uncomplicated ER visit would be two to three times more for the same service in a doctor’s office or an urgent care clinic. Where are the primary care doctors? Are they turning away commercially insured as well as Medicaid patients? Will more of them magically appear because under health reform the government will pay them a little extra money? And then there’s the biggest question of all: Do we as a country really want to control medical costs—and, if so, who should be responsible for doing it?

Last year, the Akron Beacon Journal previewed this new hospital marketing tool. Yep. Akron is a hotbed for promotions of ER waiting times. A spokesman for Akron General told the paper its door-to-doc campaign was geared at patients “who don’t have to call 911 to come in.” That about says it all, doesn’t it?

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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.