“All within the state, nothing outside the state, nothing against the State”
–Mussolini anticipating Hilary Clinton

As soon as one of these opens in the same county as a regular county ER, the politicians will blame every bad financial outcome on the new ER and pass laws requiring all ERs to work under EMTALA.

As well, the liability risks of these EMTALA free ERs is almost certainly greatly reduced. For instance, all research seems to find patients’ socioeconomic status as significant in the potential for a med mal suit; with an inverse relationship. I would imagine these EMTALA liberated emergency rooms are serving a specific population. Namely a population less likely to bring a suit following any bad outcome versus a more “traditional” public emergency room population. That’s just a single example of the decreased risk these ERs probably face.

What may limit this kind’ve model (and all practices which try to operate away from Medicare and Medicaid) is the speed at which the Medicare and Medicaid population is growing. How many of these ERs (or in a broader discussion physician practices) can survive without taking Medicare? Not many in any geographic area. Medicare controls too much of the market as a payer and such is only going to grow. The population of non-Medicare/non-Medicaid, insured patients with which to support such ERs is dwindling too quickly to make this type of business model a major player. While nifty, these ERs aren’t going to become anywhere near the norm.

These facilities are better equiped and provide far higher quality and speed of service (the have to, or they fail).

People have no real respect for you when they know they can freely steal from you. This only encourages jackpot justice litigation from low lifes and free loaders, people generally absent at the free standings.