At the recent WCRI conference, I attended a session titled “Hospital Closures and Impact on Outcomes,” presented by Bogdan Savych, senior policy analyst at WCRI. The discussion focused on how hospital closures are affecting workers’ compensation and highlighted a reality that is easy to oversimplify but much harder to fully understand in practice.
Hospital closures are often framed as a crisis of access. But as Savych emphasized, the story is far more nuanced. Care is not simply disappearing. It is shifting. And that shift is fundamentally changing how injured workers receive treatment, how far they must travel, and how employers need to think about care delivery.
One of the most important takeaways from Savych’s research is that “not all hospital closures are the same.” Some hospitals shut down entirely, while others eliminate critical services such as inpatient or emergency care but continue offering outpatient services.
That distinction matters more than most people realize.
Access to Care Is Changing Shape, Not Just Disappearing
When people hear “hospital closure,” the natural assumption is that access to care disappears. But the data Savych presented tells a different story. Even in areas where hospitals fully closed, workers were still receiving care. In fact, about 24 percent of workers in those areas still received emergency care on the day of injury.
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The issue is not that care stops. It is that accessing that care becomes more difficult.
As distance increases, utilization patterns change. In areas where hospitals are farther away, only about 17 percent of workers accessed hospital-based emergency care. That drop reflects what Savych’s findings make clear: access is not just about availability, it is about usability.
This reinforces a broader theme seen throughout the conference. Having providers available on paper does not guarantee real-world access if workers face practical barriers like travel distance, time, and inconvenience.
That same idea came through clearly in the Access to Care panel discussion, where availability on paper often did not match real-world access.
When Hospitals Close, Care Moves Elsewhere
As Savych explained, “workers still have to get their care, but perhaps not in an emergency room setting.” That single point captures the core shift.
Care is not disappearing. It is relocating.
The data showed increases in office visits, physical medicine, and other services delivered outside hospital settings. Injured workers are turning more frequently to urgent care centers, physician offices, and ambulatory surgical centers, with a corresponding decrease in hospital-based care across multiple service types.
This is exactly what was highlighted in the Employer Panel session, where employers described taking a much more active role in directing care and reducing friction across the claim.
Distance Becomes the Real Cost
One of the clearest impacts Savych highlighted is increased travel distance.
Workers are already traveling significant distances for care, especially in rural areas. For specialty services, average travel distances can exceed 30 miles, and in some cases more than 60 miles. Hospital closures add to that burden, even for more routine care.
As Savych noted, hospital closures increase the distance to medical care, and that added distance introduces real friction into the system.
This is not just an inconvenience. It affects how quickly workers receive care, how consistently they follow treatment plans, and how engaged they remain in their recovery.
Surprising Finding: Costs and Outcomes Do Not Change Much
Perhaps the most unexpected insight from Savych’s research is what did not change.
Despite increased travel distances and shifts in care delivery, there was no strong evidence of increases in medical costs, indemnity costs, or disability duration.
At first glance, that seems counterintuitive.
But as Savych explained, this may be driven by what he described as “setting effects.” While workers are traveling farther and, in some cases, receiving more care, a larger share of that care is being delivered outside of hospital settings.
And that matters.
Hospital based care is typically more expensive than care delivered in physician offices, urgent care centers, or ambulatory surgical centers. As care shifts into these lower cost settings, it can offset the impact of increased utilization or added travel burden.
So while the system is clearly experiencing more friction, the overall cost impact remains relatively stable because where care is delivered is changing.
That said, this ties into a broader trend seen in the WCRI cost data session, where rising claim costs are being driven less by simple utilization changes and more by complexity, pricing, and high-cost cases.
The Real Impact Is on the Worker Experience
If costs are not significantly changing, then where is the real impact?
According to Savych’s findings, it is the worker experience.
When care becomes less convenient and more fragmented, it introduces friction at every step. Workers may delay care, miss appointments, or struggle to navigate a more complex system.
As Savych emphasized, increased distance makes the care less convenient. That inconvenience may not immediately show up in cost data, but it has the potential to influence outcomes over time.
This aligns with a broader theme across multiple sessions, including the Complex Perspectives panel, where system changes, workforce dynamics, and infrastructure shifts are all contributing to a more complex claims environment.
What This Means for Employers
The takeaway for employers is not simply that hospital closures are a problem. It is that the model of care is evolving.
As care shifts away from hospitals and into a more distributed network of providers, employers need to adapt their strategies accordingly.
This may include:
- Being more intentional about directing care
- Building relationships with non-hospital providers
- Supporting transportation and access
- Improving coordination across multiple care settings
It may also include exploring newer options such as telemedicine. While Savych noted this as a potential avenue for employers to consider, he also made clear that it was not directly analyzed in the study and remains an area for future research.
Many employers have already faced these challenges in rural environments. But as Savych’s research shows, hospital closures are accelerating the need to operate this way more broadly.
What Matters Going Forward
The biggest takeaway from Savych’s session is that hospital closures are not simply reducing access. They are redistributing it.
Care is moving from hospitals to outpatient settings, from local providers to more regional ones, and from centralized systems to more fragmented networks.
- For workers, that often means more effort to receive care.
- For employers, it means more responsibility to guide that care.
- And for the system as a whole, it reflects a broader shift already underway.
Access to care is no longer just about whether providers exist. As Savych’s research makes clear, it is about how the system functions in real life.
And that is where this conversation is headed.
Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%. He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors. IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.
Contact: mstack@reduceyourworkerscomp.com.
Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/
Injury Management Results (IMR) Software: https://imrsoftware.com/
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