The COVID-19 pandemic forced the American healthcare system to run a telehealth experiment it had been avoiding for decades. In the space of about six weeks in spring 2020, CMS waived geographic restrictions, relaxed HIPAA enforcement for certain communication platforms, extended RPM reimbursement flexibility, and allowed physicians to prescribe across state lines. Utilization of virtual visits went from roughly 0.1% of Medicare visits in 2019 to over 32% at the peak of the emergency period.
Six years later, the experiment has largely concluded. Some of what happened during those emergency years turned out to be permanent. Quite a bit of it didn't. And there are a few things that should have survived, based on the outcomes data, but got wound down anyway for reasons that had more to do with politics and institutional inertia than patient care.
What Stuck: Video Visits as a Standard Option
Video consultations are now a routine part of primary care and several specialties. The numbers have settled well below their pandemic peak — Medicare telehealth visits currently represent around 8-10% of total Part B visits, depending on the quarter and specialty — but they're not returning to pre-2020 levels. Patients who were resistant to virtual care before the pandemic largely converted during it, and the majority of them prefer having the option available even if they use in-person visits for most encounters.
The specialties where video visits have found the most durable footing are psychiatry and behavioral health, dermatology, and follow-up chronic disease management. These aren't surprising. All three share a profile: the primary clinical value is in the conversation or visual assessment, not in examination that requires physical presence. Psychiatry in particular has seen dramatic shifts — a JAMA Psychiatry study from 2025 found that patients who switched to telehealth for ongoing psychiatric care during the pandemic had no statistically significant difference in clinical outcomes compared to those who returned to in-person care, and substantially higher appointment adherence rates.
What Stuck: Relaxed State Licensing Flexibilities
Many states have maintained interstate practice compacts or bilateral licensing agreements that were accelerated or expanded during the emergency period. The Interstate Medical Licensure Compact (IMLC) has grown substantially since 2020. This matters practically for RPM programs that monitor patients who travel seasonally or move between states — a physician monitoring a patient's blood pressure remotely across state lines needs licensure clarity, and that's become meaningfully easier to manage in many multi-state practices.
What Didn't Stick: The Broad Prescribing Flexibilities
The DEA's emergency authorization to prescribe controlled substances, including buprenorphine for opioid use disorder treatment, via telehealth without an in-person visit became one of the most clinically important pandemic-era flexibilities. Access to opioid use disorder treatment expanded substantially. Outcomes data from 2021-2023 showed no increase in diversion rates and meaningful improvements in treatment retention.
When those flexibilities were wound down, treatment access contracted again. The DEA's final telemedicine rules for controlled substances prescribing remain restrictive relative to what the evidence supported. This is the clearest example of a policy reversal that doesn't align with the clinical data.
What Didn't Stick: Audio-Only Visit Coverage
During the emergency period, CMS covered audio-only telephone visits at the same rates as video visits, acknowledging that a substantial portion of the Medicare population lacked reliable internet access or video-capable devices. That parity has since been reduced — audio-only visits are reimbursed at lower rates and with more restricted indications.
The equity implications are real. Elderly patients, rural patients, and lower-income patients are disproportionately those without access to the technology required for video visits. A payment policy that effectively prices them out of telehealth access is a policy that increases care disparities.
What the Settled State Looks Like
Telehealth is now a permanent feature of American healthcare delivery, not a temporary accommodation. It's no longer operating under emergency rules, and the ongoing policy environment is shaped by a tension between providers who want expanded access and payers who are concerned about utilization increases without corresponding outcomes improvements.
The practices that have integrated telehealth most successfully aren't those that treated it as a replacement for in-person care — it's not. They're the ones that used it to extend care reach: more frequent, lower-intensity touchpoints for chronic disease patients, better between-visit continuity, faster responses to acute concerns that don't require physical examination. That model, combined with remote monitoring for the patient population that needs it most, is where the durable clinical value lives.