Despite the numerous challenges of operating a Critical Access Hospital (CAH), there is little research examining the perspectives of CAH executives on potential community healthcare options if the CAH were to close. The purpose of this brief is to provide rural health policymakers with a better understanding of what CAH executives think about the viability of various alternatives to closure.

This brief presents the responses of 174 CAH executives (13%) on a series of alternatives to complete closure of a rural hospital. These survey results provide some insight into which healthcare organizations CAH executives believe might be sustainable successors to a closed hospital. Rural Health Clinics, emergency or urgent care centers, and Federally Qualified Health Centers were considered to be the most viable.

Since the survey was completed, policymakers continue to consider legislation that might enable rural free-standing emergency departments. Most recently, the Centers for Medicare & Medicaid Services released the Community Health Access and Rural Transformation model that "aims to continue addressing disparities by providing a way for rural communities to transform their health care delivery systems by leveraging innovative financial arrangements as well as operational and regulatory flexibilities."

In conclusion, it is likely that concern for rural hospital viability will increase because of COVID-19. As such, developing sustainable new models and assisting fragile rural hospitals is even more urgent. More research is needed to understand how and when a hospital should consider transitioning to a new healthcare model/provider type. Policymakers should also consider mechanisms to develop and provide advisory technical assistance on transitioning to sustainable healthcare delivery options for CAHs at high risk of financial distress or other CAHs potentially facing complete closure.