A few years ago, Galewitz exposed a new hospital practice—using advertising to sell emergency room services, in an attempt to reel in patients who contribute higher profits. Emergency care is some of the most expensive care around, and the hospitals’ selling job ran counter to one of the goals of health reform that the public heard has many times—to keep people out of the most expensive places of care. Now Galewitz dissects this new twist in the medical establishment’s ever-increasing quest for profits by zooming in on Houston, where there are 41 freestanding ERs in the metro area and 10 more on the drawing boards. Nationally, there are more than 400 operating now, double the number four years ago.

Big hospital chains like HCA are opening these add-ons to their product lines in states like Florida, Texas, and North Carolina. Many are also owned by emergency room doctors, who see them as more profitable than urgent care clinics. Why wouldn’t they, when they can do most of the same work and get more money for it? They are growing like “wildfire,” Galewitz reports. Insurers have little power to stop patients from using these facilities, “because by state law [in Texas], they must pay for ER coverage anytime a patient perceives they have an emergency, regardless of whether that turns out to be the case.”

Freestanding ERs have no reason to contract with insurance companies and give their policyholders discounts for their services. Patients apparently like the convenience of these facilities—shorter wait times than in traditional ERs, and if they must pay a copayment of only $50 or $100 to use one, who can pass up the chance to get patched up quickly and pay almost nothing? “You can never have too much care for patients,” Rhonda Sandel, CEO of Texas Emergency Care Center, told Galewitz.

What might come next? It seems owners of some freestanding ERs are worried that insurers will eventually change the game and cut payments to facilities not affiliated with hospitals. So a few have begun to convert their facilities into micro-hospitals with a few beds to treat patients with drug problems or those who are terminally ill.

Shara McClure, a vice president of Blue Cross and Blue Shield of Texas, neatly summed up the dilemma of America’s profit-driven healthcare system: “When they build it, people will come and use it. But they need to know it’s not free.”

Doctors and hospitals hold the keys to the pearly gates of healthcare cost-control heaven, but these reports from Doyle and Galewitz suggest they may not be using them any time soon.

Correction: This post originally misspelled Poplar Bluff. CJR regrets the error.

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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.