ACP calls for clearer rules to keep telemedicine working

Clinical Takeaway: Telemedicine works best as a complement to longitudinal in-person care, not a replacement. Physicians should retain authority over when virtual visits are clinically appropriate.

Telemedicine has shifted from an emergency stopgap to a permanent feature of U.S. health care, but the rules built around it have not caught up. The American College of Physicians' updated position paper, its first major refresh since 2015, argues that without clearer federal and state policy, the access gains of the past five years could erode. Medicare fee-for-service telemedicine visits rose 63-fold between 2019 and 2020 and remain well above pre-pandemic levels.

The paper frames telemedicine as a modality of care, not a separate category, and pushes back against models that treat it as transactional. When embedded in established patient-physician relationships, virtual care can reduce travel burden, improve appointment availability, lower no-show rates, and expand access for patients facing mobility, geographic, or socioeconomic barriers. Telemedicine visits are often scheduled sooner than in-person care, and the modality may improve retention in chronic disease management, including for opioid use disorder.

For those benefits to hold, payment policy should reimburse telemedicine, including audio-only visits, at rates reflecting clinical value rather than treating virtual care as inherently lesser. Direct-to-consumer and retail platforms that fragment care, bypass shared decision-making, or prescribe outside established relationships warrant tighter oversight.

On prescribing, the paper supports safe use of telemedicine within ongoing care relationships but urges regulators to tighten safeguards for controlled substances and direct-to-consumer prescribing. ACP backs the Drug Enforcement Administration's January 2025 telemedicine rulemaking direction and calls for standards that require physician-patient identity verification, integration with longitudinal records, and clinically appropriate in-person evaluations when needed.

Licensure remains a major friction point. ACP calls for reducing administrative barriers to interstate practice through expanded compacts and reciprocity, particularly for follow-up visits, ongoing management of established patients, and care for patients who split time between states. Current state-by-state licensing complicates continuity and discourages physicians from offering telemedicine across state lines.

Equity gets sustained attention. About 28% of rural residents and 24% of people in tribal areas lacked broadband meeting FCC minimum speeds as of March 2024. ACP calls for multilingual platform interfaces, accessibility features, sustained audio-only coverage, and broadband infrastructure investment, arguing that telemedicine policy must close digital divides rather than reinforce them.

The paper also flags clinician well-being as underexamined. Telemedicine can reduce some burdens such as commuting and no-shows but can introduce others, including increased portal messaging and after-hours EHR work. ACP calls for longitudinal research on how telemedicine affects clinician workload, burnout, and sustainability across practice models.

"Telehealth represents a permanent shift in health care delivery and system design, expanding access while reshaping how continuity and quality are maintained in clinical practice," the authors concluded.

Source: Johnson D. Ann Intern Med. 2026 May 12. Telemedicine Policy and Practice: A Position Paper From the American College of Physicians