AMA: Telehealth Policy Cannot Function on Deadlines and Extensions

For nearly four years, the viability of Medicare-funded telehealth has hinged not on clinical efficacy or infrastructure investment but on arbitrary congressional timelines. The latest deadline, January 30, once again threatens to dismantle a vital pillar of modern care delivery if policymakers fail to authorize permanent legislative protections. While telehealth utilization has matured past its emergency roots, policy continues to treat it as provisional. This mismatch is not only structurally unsustainable but fiscally shortsighted.

The recent American Medical Association (AMA) issue brief presents an inflection point. Rather than restating the value proposition of virtual care, the document directly challenges the budget scoring logic that has constrained legislative action. By questioning the Congressional Budget Office’s reliance on static cost models, the AMA reframes the debate from short-term expenditures to long-term health system returns. For healthcare executives tasked with steering capital allocation and digital strategy, the brief offers more than policy advocacy. It also articulates a framework for recalibrating what counts as value in Medicare innovation.

Scoring Flaws Are Policy Failures in Disguise

At the heart of the AMA’s argument is a flaw that healthcare CFOs and CIOs will recognize instantly: outdated assumptions embedded in cost models that fail to reflect current clinical workflows or utilization trends. CBO’s estimates tend to discount longitudinal benefits like reduced readmissions or deferred emergency department visits, precisely the domains where telehealth is proving most impactful.

A 2023 study from Health Affairs found that Medicare beneficiaries who engaged in hybrid care models that included telehealth had significantly lower total cost of care than those relying solely on in-person visits. Despite this, current CBO scoring practices continue to treat telehealth as an additive expense rather than a tool for substitution and efficiency.

The gap between financial modeling and clinical reality is not merely academic. During the most recent federal government shutdown, which temporarily disrupted the Medicare telehealth waiver, national fee-for-service telehealth visits fell 24% within 17 days, according to Brown University researchers. In several states, the decline approached or exceeded 40%. These are not fluctuations—they are system-wide vulnerabilities triggered by policy inertia.

The Clockwork Instability of Temporary Waivers

Perhaps no other healthcare modality suffers from the policy whiplash that defines Medicare telehealth. Congress has now extended virtual care flexibilities five times since the end of the COVID-19 public health emergency, often in final-hour negotiations that leave health systems scrambling and patients uncertain.

For rural providers and digitally enabled practices that have built infrastructure around virtual care delivery, this cycle imposes financial and operational strain. According to a 2024 report by the Office of the Inspector General (OIG), nearly one-third of surveyed providers reported delaying or reducing investment in virtual care services due to concerns about regulatory stability. This hesitancy is not just a growth inhibitor. It is also a direct threat to care access in areas where broadband-enabled visits are the only realistic option for timely specialist consultations.

More troubling is the chilling effect on innovation. Venture-backed telehealth platforms and hospital-at-home initiatives face diminished investor confidence when reimbursement structures remain at the mercy of congressional calendars. This is not a technical limitation; it is a policy failure with cascading consequences across access, equity, and system preparedness.

Toward Durable Legislative Modernization

The AMA’s call for a new scoring paradigm is not merely a procedural request. It is a demand for Congress to modernize how it evaluates the tools of modern medicine. To that end, the association proposes an updated scoring methodology that incorporates real-world utilization data, peer-reviewed clinical outcomes, and actuarial modeling that extends beyond annualized cost.

This aligns with growing momentum across federal agencies to institutionalize virtual care. The Centers for Medicare & Medicaid Services has issued multiple rulemakings over the past two years aimed at integrating telehealth into core payment models, including the Medicare Shared Savings Program and certain bundled payment arrangements. Yet without legislative clarity, these rules remain provisional.

What’s needed is not another waiver but a reclassification: one that recognizes telehealth as a permanent mode of care delivery embedded within the standard of care. Until this happens, every extension functions as both a policy deferral and a signal to market actors that long-term investment in virtual infrastructure may not pay off.

Leadership at the Intersection of Finance and Access

For healthcare executives, the telehealth waiver is a strategic variable. Capital decisions around digital front doors, EHR-integrated video platforms, and workforce models all hinge on predictable reimbursement. More importantly, population health strategies that depend on remote monitoring, chronic care management, and behavioral health integration lose traction every time policy resets the rules.

As the January 30 deadline nears, the question is not whether Congress will act. It’s whether it will finally align financial stewardship with clinical progress. The AMA has provided a legislative and analytical path forward. What remains is for federal leaders to treat telehealth not as a temporary emergency measure, but as the infrastructure backbone of a system that claims to prioritize access, equity, and efficiency.

The current cycle of temporary authorization is not a policy stance; it is a policy stall. And the cost of continued delay will not be measured in dollars alone.