By Trudy Lieberman

This summer, Phil Galewitz of Kaiser Health News wrote an intriguing piece published in The Washington Post about hospitals that market their emergency room services to potential customers. The story narrative seemed out-of-whack with the conventional wisdom about hospital ERs. How many times during the run-up to health reform and during the Great Debate itself did politicos and advocates tell us that reform was necessary to keep people out of the ER, where the cost of care is sky high? Reform, we were told, was going to channel people to cheaper places for medical services. It seemed so logical. Last year, though, there were signs that logic had not won. ER use had not declined in Massachusetts, on whose reform law federal efforts are modeled.

Galewitz’s story was so offbeat and yet so timely that it inspired us to create a new series, “CJR’s Assignment Desk,” where we will feature reporting that can be replicated across the country by local reporters who are trying to tackle health care—sometimes a daunting task in this era of limited journalistic resources. The emergency room disconnect seemed like an ideal candidate for our series debut. This story can be done by good, old-fashioned observation and connecting the dots with what you see. Observation is an important reporting tool that of late has taken a back seat to data mining as the reporter’s technique of choice. Almost every community has a hospital, and most hospitals have emergency rooms. What’s happening with them makes an interesting read, and highlights one reason why health care costs are so difficult, if not impossible, to control.

Galewitz reported that hospitals are using “aggressive marketing of ERs to increase admissions and profits.” What a surprise! That’s the name of the game in the new world of hospital conglomerates: reel in the patients wherever you can find them. Medicaid recipients have been a juicy target, although states have been trying to trim ER visits as a way to cut their Medicaid costs. Anthony Keck, South Carolina’s Medicaid director, told Galewitz: “Many hospitals are actively recruiting people to come to the ER for non-emergency reasons. When you are advertising on billboards that your ER wait time is three minutes, you are not advertising to stroke and heart attack victims.” Are hospitals trying to lure Medicaid patients and others to the ERs to treat them for minor illnesses?

It would seem so. HCA, the country’s largest for-profit hospital chain, launched a major ER marketing campaign in Virginia, Texas, Florida, and other states using billboards and smartphones to tell potential customers—or, rather, patients—the average ER waiting times. So if your child has an earache, you can pick which hospital will see the kid quickest rather than visiting the family doc in the morning. That’s tempting indeed, and while it might be the latest thing in consumer information, it might not be the best thing for the health system.

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.

Trudy Lieberman, a journalist for more than 40 years, had a long career at Consumer Reports specializing in insurance, health care, health care financing and long-term care. She contributes to the Columbia Journalism Review where this post first appeared.