Pennsylvania’s access to telemedicine and telehealth across state lines is stumbling over an FBI background check

The pandemic introduced virtual doctor’s appointments to many patients across the country, including at Jefferson Health, where telemedicine appointments have more than doubled since the start of the COVID-19 pandemic, its program leader said.

But the Federal Bureau of Investigation’s concerns over Pennsylvania law are blocking a pathway many physicians hoped to use to remotely treat patients in other states.

At issue is Pennsylvania’s lack of participation in an agreement among more than 30 states that makes it easier for a doctor in one member state to get licensed in others. Pennsylvania joined the program, called the Interstate Medical Licensure Compact, in 2016 but doesn’t participate due to complications over how it carries out required background checks.

A doctor conducting a telemedicine session typically has to be licensed in the state where the patient is located. Pennsylvania’s status in the compact is getting renewed attention as doctors and patients seek to continue telemedicine access coming out of the pandemic.

“This is a horrible, horrible thing with respect to patient care,” said Judd Hollander, the doctor who runs the telemedicine program at Jefferson. “The physician is stuck with a choice between abandoning their patient, or not violating state regulation.”

Access to health care

Pennsylvania law requires medicine, even remote care, to be practiced in the state where the patient is located. A doctor technically isn’t supposed to even talk on the phone with a patient in another state about medical matters, unless the physician is also licensed in that state.

Yet for many patients, particularly those managing chronic conditions, checking in with a doctor often doesn’t require in-person examinations. Carey Patton, a Center City resident, had to fly back to Philadelphia every three months so a local doctor could monitor an autoimmune disorder called Graves Disease after she went to graduate school at Indiana University in 2018.

Regular blood tests helped her doctor adjust her medication. Dosage changes could have been handled remotely if her doctor had been licensed in Indiana.

“There really was no need for me to be there physically,” said Patton. “Telehealth wasn’t available and would have been really beneficial.”

Telemedicine is especially important for Philadelphia hospitals, which see many patients from New Jersey and Delaware. It helps patients who struggle to walk or lack cars, and reduces costs like parking associated with a doctor’s appointment, Hollander said.

“You may be paying $50 in travel expenses, bridge tolls, and parking to get there,” he said. “There will be some people who opt to use that money for groceries.”

A COVID side effect

When COVID patients inundated health-care systems at the start of the pandemic, Pennsylvania and New Jersey were among the states that temporarily allowed out-of-state doctors to practice within their borders without a state license. This also allowed doctors to engage in telemedicine in states where they weren’t licensed.

As the crush of COVID patients eased and the temporary waivers expired — Pennsylvania’s and New Jersey’s both ended in the latter half of 2022 — physicians sought to keep providing interstate virtual care.

The Interstate Medical Licensure Compact, active since 2017, is an option in other states to do so. The compact allows doctors in member states to get licensed with less paperwork and reduces the processing time from months to as little as a week, said Marschall Smith, the compact’s executive director.

The compact wasn’t founded to help with telemedicine, Smith said, but now about half of its more than 50,000 participating physicians use it for that purpose.

The FBI obstacle

More than 30 states are using federal fingerprint-based records to conduct national criminal background checks on doctors seeking additional licenses through the compact.

But the FBI will not allow the Pennsylvania Department of State, which oversees medical licensing, to use those records for that same purpose. The issue is that Pennsylvania’s state statutes regarding interstate licensing compacts don’t yet meet the FBI’s privacy standards for access to the criminal records, state and federal officials said.

Other member states have met those standards, said Holly Morris, an FBI spokesperson.

The background check questions are also keeping Pennsylvania nurses from using a similar interstate compact to get licensed in other states, which the General Assembly tried to address with a related 2021 law intended to also clear the same issue for the doctors’ interstate compact.

The FBI still isn’t satisfied, Morris said.

The FBI is now working with state and federal agencies “to determine the language necessary for the Department to be able to fully implement and participate in interstate licensing compacts,” said Amy Gulli, a spokesperson for the Pennsylvania Department of State, in an emailed statement.

New Jersey joined the compact last year, said Smith, the compact’s director, and should begin actively participating this summer.

Connecticut and Vermont are the only other states who are part of the compact but are also struggling to get approval for background checks, according to Smith.

Congress could address Pennsylvania’s problem by legalizing the use of fingerprint-based federal criminal records for interstate compacts, Pennsylvania’s Department of State said. A bill introduced in the U.S. House of Representatives in January could solve the issue.

Meanwhile, Pennsylvania doctors, and doctors seeking to practice in Pennsylvania, must follow the standard, slower licensing process. This is how about 43% of Pennsylvania’s doctors hold a license in at least one other state, according to the Federation of State Medical Boards. Nationally, almost a quarter of physicians are licensed in multiple states.

Sarah Schneck, medical director for virtualist medicine at ChristianaCare in Delaware, oversees eight doctors at ChristianaCare’s all-virtual clinic licensed in Delaware, New Jersey, Pennsylvania, New York, Maryland, and Florida.

Delaware and Maryland are active members of the interstate compact, and Delaware doctors received their licenses in Maryland in a matter of weeks, Schneck said.

“It was significantly improved, for sure,” she said. “Much more efficient.”

Getting Pennsylvania licenses, she noted, took months.

State Rep. Jesse Topper, a Bedford Republican who authored the 2016 law that brought Pennsylvania into the interstate compact, is stunned his nearly seven-year-old law still isn’t helping Pennsylvanians. His attempts to address the background check issue have gone nowhere.

“That’s the maddening thing,” he said. “Why is that causing this bureaucratic nightmare with the FBI?”

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