I couldn't possibly agree more. Maybe when you look at the administration which can get money hungry, but in general, most ER's I know would actually be okay with the idea of having a few patients not come in. Granted, this may be different for the contracted physicians, I'm not sure if I've worked with any or not, I've never asked, and most of the time when test are being over done, it's because they come from, say, a Level 1 trauma center, and are adjusting to a less acute facility, it's not been about the money. This is why I love Emergency Medicine (for the most part), volume isn't a huge crisis (stupidity makes sure we have job security!), and it's VERY rare that I hear a physician say, "Well, I'd like to do this test, but I'm not sure if insurance will cover it".
Terrific topic to initiate a conversation about! All, and all....if we could come up with a way that we, as EMS could safely determine if patient's need transported (though, let's get real, 9 times out of 10, our guess is pretty accurate, even if we can't voice it), I think it would actually benefit Emergency Departments. Like, on Christmas Day, when a tonsillitis occupied an ALS crew, and took a room in an ER who's numbers broke an all-time record that day...that's a situation where if EMS could refer instead of transport, it would just make everything better (The crew ended up having to call mutual-aid for a chest pain, which ended up coming to the hospital as a cardiac arrest, because they had to transport a tonsillitis.)