Another Kind of Desert

By: Dr. Gary Anderberg

By: Dr. Gary Anderberg

April 27, 2023 — We all know about deserts — vast, sandy, and dry. The concept of a "food desert" (a neighborhood with no reliable food suppliers) is now widely used, but the idea of a "healthcare desert" is relatively new. Joe Paduda explains in a recent Managed Care Matters post (Medicaid, workers' comp claim severity, and healthcare deserts - Managed Care Matters (joepaduda.com) ) why this concept is important and why those of us in the workers' comp business need to be aware of what is happening. Joe's post provides a solid discussion, but here is a quick overview:

• Hospitals are in a financial bind after COVID-19, especially in those states which have not elected to work with Medicaid.
• Hospitals are few and far between already in those eleven states, but —
• Without Medicaid, more hospitals will have to close, taking their ERs, O/P facilities, and trauma units away.
• Today the majority of working populations in some 40% of US counties are more than an hour* away from a trauma center. This situation will be getting worse as more and more rural/far suburban hospitals close.

Joe has included a map of currently underserved areas in his post. Do you have facilities in any of those blank areas? Add to this the fact that doctors and nurses are retiring in record numbers everywhere, and we have the making of a whole new kind of desert.

Are you or your claims team monitoring facility closures and critical care availability around your more rural locations? Historically, we have worried about directing injured employees to the best clinicians and facilities. Now, in some locations, we must be concerned about the basic availability of care — any care. There is, of course, no large-scale, one size fits all solution for this growing issue. Each non-urban locale has its specific issues and potential remediations**, and any good claims administrator is always reviewing contracting operations to try to maintain coverage. The key is being aware and thinking ahead with your comp team wherever appropriate care is not just down the street.

*When injury strikes, the "golden hour" can be the difference between recovery or disability (or death).

**Run-of-the-mill injuries that can be managed by family care providers or urgent care clinics are not usually the problem. Major, potentially disabling injuries and specialty care may call for contingency planning, as well as top-quality PT and other RTW services. Medical transportation and telemedicine may be concerns as well.