Telehealth and Telemedicine

The American Academy of Family Physicians (AAFP) defines telehealth and telemedicine as:

Telehealth refers to a broader variety of remote health care services beyond those provided within the patient-physician relationship, such as those provided by nurses, pharmacists, or social workers.

Telemedicine is the practice of medicine using telecommunications technologies to deliver all kinds of medical, diagnostic, and treatment-related services.

Telehealth is different from telemedicine in that it refers to a broader scope of remote health care services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services such as patient health education, social support, and medication adherence.

The AAFP supports the use of telehealth and telemedicine as an effective means of improving health, when conducted within the context of appropriate standards of care. The appropriateness of a telemedicine service should be dictated by the standard of care and not by arbitrary policies. States retain primary authority to establish and enforce standards of care for telehealth, with statutes and regulatory frameworks varying across jurisdictions. In most states, the standard of care for telehealth services is the same as that for in-person care, while allowing for limited variation based on modality, clinical context, or other state-specific requirements. Available technology capabilities as well as an existing patient-physician relationship impact whether the standard of care can be achieved for a specific patient encounter type.

Continuity and Integration of Care

Telehealth technologies can enhance patient-physician collaboration, increase access to care, improve health outcomes by enabling timely interventions, and decrease costs when utilized as a component of integrated care. Responsible care coordination is necessary to ensure patient safety and continuity of care for the immediate condition being treated, and it is necessary for effective longitudinal care. When telemedicine services are provided outside of the patient’s primary care relationship or medical home, the treating physician is responsible for timely communication and follow-up to the patient’s primary care physician or medical home. Patients should be referred to their primary care physician to provide or coordinate their ongoing care.

Direct-to-consumer (DTC), payer-affiliated, or other third-party telemedicine models that operate outside of an established primary care relationship risk fragmenting care, duplicating services, and undermining continuity. Policies should prioritize and incentivize telemedicine delivery within the context of an ongoing patient-physician relationship and a medical home. DTC telemedicine models should ideally focus on a defined set of guideline-based episodic services related to minor acute illnesses that complement but do not replace the patient’s established primary care relationship. DTC telemedicine models should refer patients to their primary care physician or medical home for their comprehensive primary care needs. They should also establish operational protocols that facilitate the timely and proactive transfer of medical records to the patient’s primary care physician or medical home.

Telemedicine services associated with DTC advertising must meet the same standards of medical appropriateness, informed consent, documentation, and follow-up that are characteristic of longitudinal patient-physician relationships. If advertisements direct patients to affiliated prescribing services, such services should support communication and care coordination with the patient’s family physician or primary care physician. The AAFP recognizes that DTC models that combine promotion, prescribing, and dispensing within a single commercial pathway have a strong potential for commercial influence. Such models must ensure that clinical decision-making remains patient-centered and free from inappropriate commercial influence.

Licensure and Reciprocity

The AAFP supports streamlined licensure processes to enable physicians to more easily provide telemedicine services across state lines. The AAFP encourages states to engage in reciprocity compacts for physician licensing, especially to permit the use of telemedicine. Within a state licensure framework, the AAFP strongly believes that patients with an established physician relationship who are traveling outside of the state in which they live should be allowed to be treated via telemedicine by their primary care physician, so long as the physician is licensed in the state in which the patient receives their usual care. Future licensure frameworks should include reciprocity mechanisms to support continuity of care, including enabling patients with an established primary care relationship to receive telemedicine services from their physician while traveling across state lines.

Education

The AAFP recommends medical schools and family medicine residencies provide education to medical students and resident physicians on the unique aspects of telemedicine. Such education and training opportunities should progress through the spectrum of observed, simulated, and actual patient encounters, alongside practice-implementation of guidelines and resources. Given the utility and widespread use of telemedicine services in primary care clinical practice, the AAFP supports family medicine residents being permitted to provide care via telehealth with the same level of supervision from a teaching physician as would occur during an in-person office visit.

Payment

Coverage and payment policies should support the physician’s ability to decide the most appropriate service modality (i.e., audio-video, audio-only, or in-person) for the patient’s care, in accordance with the current standards of care. Additionally, policies should preserve patient choice and not incentivize one modality of care over another (i.e., co-pays should not steer or incentivize patients to select a specific modality of care).

Patients should have access to telehealth and telemedicine services from all geographic locations in the United States and U.S. territories, not limited to health professional shortage areas and non-metropolitan statistical areas. Care should be accessible from sites that support privacy within the care encounter, including a patient’s home or residence.

Telemedicine visits require the same level of work and cognitive effort by the physician and incur the same level of liability as in-person visits. As such, telemedicine services should be paid at parity with a comparable in-person visit. In addition, payment rates should not differ based on the place of service (e.g., home or originating site). Primary care practices often maintain their office presence while also offering telehealth services to meet their patients’ needs. Regardless of the patient’s location, the practice expenses remain the same.

Payment models must also support telemedicine services by addressing the service's role in patient attribution, requiring risk scores include diagnoses captured during such visits, and ensuring quality measures support care delivered via telemedicine visits.

The AAFP supports standardized coverage and payment policies among public and private payers, as variability in policies among payers leads to administrative complexity and burden for physicians and patients.

Equity and Access

As telehealth and telemedicine services expand and are used to achieve the desired aims, outcomes must be closely monitored to ensure that increased use does not widen disparities in care among vulnerable populations, attributed to increased use of telemedicine. Policies should acknowledge the geographical and socioeconomic disparities that exist and could be exacerbated by the improper adoption of telehealth if not explicitly addressed. Broadband internet access is a key social driver of health and is essential to equitable access to care through telehealth and telemedicine. To support equitable telehealth and telemedicine delivery, all patients and practices should have reliable broadband access, in alignment with AAFP's policy on Health Care for All.

(1994) (July 2026 BOD)