Health care providers across Pennsylvania will soon have alternative options when determining how to configure their hospitals after the Pennsylvania Department of Health released guidelines on three new “innovative care models” at a news briefing Wednesday in Harrisburg.

Acting Secretary of Health Keara Klinepeter described the three new potential options for hospitals — micro-hospitals, tele-emergency departments and outpatient emergency departments — and outlined what defines the assistance they can provide to a health system.

“The primary purpose of these innovative delivery models is to provide options, to help preserve and increase access to safe, high quality care in areas that would otherwise be medically underserved,” she said. “These innovative delivery models will give many rural hospitals flexibility to address historical challenges, so that they can maintain access to care in their local communities.”

Outpatient emergency departments, she explained, consist of outpatient locations of a hospital that offers only emergency services at a location outside of the grounds of a main licensed hospital.

Micro-hospitals, also referred to as innovative hospital models, offer acute care emergency services and maintain facilities for at least 10 inpatient beds.

“It’s a very small footprint, 10 inpatient beds, with a narrow scope of inpatient acute care services, but does not necessarily offer surgical services,” Klinepeter said. “We’re shrinking the footprint of the hospital with a micro-hospital, so that we’re maintaining access to care in the community, but at a reduced operating cost, which is significantly beneficial to the hospital, and thereby the community.”

Tele-emergency departments, or tele-ED, are emergency departments in acute care or critical access hospitals that are staffed by advanced practice providers, such as nurse practitioners and physicians assistants, 24/7, with a physician available at all times remotely, but not physically present in the emergency department.

A statement from the state DOH elaborated that rural hospitals will be the focus of tele-emergency and outpatient emergency department expansions, but that any hospital that is eligible and follows specific guidelines can take advantage of the micro-hospital model.

“Hospitals in rural areas have a harder time with recruiting and maintaining staff and supporting inpatient services than hospitals in urbanized areas, due to location and patient population and volume,” the guidelines read. “These innovative models allow rural hospitals to overcome some of those challenges and maintain emergency care in rural communities.”

The configurations will be subject to criteria, including patient volume, geographic location, and minimum staffing and services.

Guidelines published on the DOH website elaborate that to operate an outpatient emergency department (OED), the main licensed hospital needs to offer general acute care services; the OED must also be included as an outpatient location under the license of the hospital and must be located within a 35-mile radius of the main licensed hospital, and the OED must be located in a rural area.

The main hospital also must continue to meet the statutory definition of a “hospital” by devoting 51% or more of its total beds to inpatient care. The main licensed hospital and the OED also must be under common legal ownership.

Other guidelines, including updates to the definition of “micro-hospital,” were also provided online on the DOH website, along with a chart determining eligibility and types of care provided in each new or updated model.

Tom Bisignani, CFO and Interim CEO of Regional Hospital of Scranton, explained that at the campus of Tyler Memorial Hospital in eastern Pennsylvania, care transitioned from an inpatient hospital model to a 24-hour emergency department with outpatient services to prevent the hospital from closing.

“We were still able to provide services that the community demands, and it’s been widely successful,” Bisignani said. “Operating the ER as a campus of Regional Hospital of Scranton allows Tyler to remain open without inpatient beds.”

Klinepeter said communities can expect an ongoing discussion with health care facilities in their areas.

“Our hope is that folks like Tom are going to be a good resource if there are other hospitals or health systems out there that are considering this outpatient ED model,” she said. “We would encourage hospitals to have that good collaboration, but they’re also welcome to come to us. We’re happy to talk them through the concept and how they might go about implementing it in their community.”