I'm butting in late but "facility evaluation and management" and "physician evaluation and management" are two TOTALLY different things. The facility such as a hospital, is billing a certain level of evaluation and management based on the resources used by the hospital. The hospital itself determines the criteria for each level because every hospital is different, some are smaller, some are bigger, have more costs, less costs, in a rural area, in an urban area, are 24 hours, are not 24 hours -- there's a lot of different factors. This is why if you have ever been to the ER yourself, you get EOB's and/or bills from BOTH the facility and the physicians who treated you. Facility evaluation and management has nothing to do with "history, exam, medical decision making" -- that's for the physician. The hospital has to make money too, right? Well that's how the facility E/M's come into play. You get seperate bills for any labs and/or testing performing on you, because when the hospital determines "facility E/M criteria and fees" they cannot include any services that are seperately reimbursed. This is why the hospital fees outweigh the physician fees -- they incur WAY more costs. A portion of the facility E/M could include, the electric, the lab runner, the supplies, your gown, the TV hanging on the wall, the phone in your room, the meals you eat anytime you want -- all of those are fixed costs into the associated fee-- but there are many variables, how long you are there, how much of the resources you use, etc. Physicians don't create their "own criteria" because, they don't incur nearly as many costs, typically the fee schedules are predefined, fee for service (most of the time, unless capitated) there's no variables, are reasonable and customary, the physicians are providing the medical service and cognitive labor (not the electric or the phone line). There's just too much! And don't worry about the hospitals charges "way too much" they are definitely accountable for their fees through many ways beyond belief, even though they create their own. Just think of it this way, say the hospital spends $10B per year (total guess, I have no idea) each and every single patient ENCOUNTER is a percentage of that cost. It's a lot more complex, but that basically sums it up.
Here is a good link that can help you better understand:
http://www.ahacentraloffice.org/ahacentraloffice/images/EM_Coding_Report2.pdf