I came across some data compiled for Medicaid reimbursement for emergency department visits from 2011. You can download the .pdf file here. There was also some information from 2008 and the rates hadn’t changed much.
For each category, the payments are broken down into CPT codes depending on intensity of service.
A 99281 code is essentially a nurse visit – no doctor involvement and hardly ever used
A 99282 is a simple case with no or minimal physical exam – such as an asymptomatic patient needing a medication refill or perhaps a simple sunburn.
A 99283 is a straightforward case with little medical decisionmaking such as an ear infection, a strep throat, or a UTI
A 99284 case requires more decisionmaking with some lab tests being ordered. Perhaps a patient with a sprained ankle, a patient with minor abdominal pain, or a patient with asthma needing nebulizer treatments.
A 99285 is a case requiring high medical decisionmaking, multiple tests, and likely hospital admission. Consider cardiac chest pain, severe abdominal pain, suicidal patients, patients with low blood pressure, etc
A 99291 is a “critical care” code, meaning that the patients are in danger of dying or having severe health issues. Consider patients requiring CPR, multiple drug overdoses, uncontrolled psychiatric patients, patients with arrhythmias, etc.
Finally 99292 is an “extended critical care code” meaning that if a doctor spends more than 90 minutes stabilizing a patient, then the doctor gets paid this amount in addition to the 99291 amount.
What does this data show you?
Based on their payments to physicians, New York and New Jersey seem to put very little value on the lives of their citizens. They’ll pay doctors as little as $58 to save your life and spend up to an hour and a half keeping you alive. Malpractice insurance costs more than that. Hell, parking your car in a garage in the Greater NY area to go to work in the hospital costs more than that. Rhode Island is even worse. It pays emergency physicians a whopping $29 to provide up to 90 minutes of critical care. Michigan and Wisconsin are also on the list of pathetic payors.
When patients who get their new Medicaid “insurance” cards under Obamacare wonder why they can’t find anyone to provide them care, the fact that many states pay doctors less than the cost of caring for Medicaid patients would be one of the reasons for this lack of access.
Remember: Healthcare insurance doesn’t guarantee you access to medical care any more than automobile insurance guarantees you access to a car.