Why is our telehealth utilization declining?

Post-pandemic telehealth utilization has declined from 40% of visits to 15–20% nationally. The decline is not patient-driven — patient satisfaction with telehealth remains above 80%. The decline is driven by provider scheduling preferences (in-person slots fill first), reimbursement uncertainty for certain payer/service combinations, and incomplete workflow integration requiring double-documentation in separate systems.

Provider scheduling preference is the most significant structural driver of declining telehealth utilization. Scheduling staff default to in-person appointment types because that is what existing scheduling templates display as available slots. Telehealth appointments require a deliberate scheduling decision — selecting a different appointment type, confirming the patient has access to video technology, and sometimes using a different scheduling workflow. In practices without designated telehealth scheduling templates, telehealth only happens when a patient specifically requests it. Since most patients do not know to request it specifically, and since schedulers do not proactively offer it for appropriate visit types, in-person scheduling fills the schedule by default. The utilization decline from 38% to 17% is not patients reverting to preference — it is scheduling behavior reverting to pre-pandemic defaults.

Reimbursement uncertainty compounds the scheduling preference problem. CMS telehealth flexibilities from the COVID-19 Public Health Emergency expired in phased rollouts from 2023 through 2025, and the resulting coverage rules require tracking service location, originating site qualifiers, and modifier requirements that differ by payer, service type, and geography. Billing staff uncertainty about correct coding for telehealth encounters — where an incorrect modifier can result in claim denial or downcoding — leads to conservative behavior: when in doubt, schedule in-person where the billing rules are known. This uncertainty is concentrated in small practices without dedicated billing staff who can maintain expertise in rapidly changing telehealth coverage rules.

Telehealth utilization percentage looks like a supply problem: not enough telehealth visits are being scheduled. The underlying reality is a demand routing problem: patients who are clinically appropriate for telehealth — routine chronic disease follow-ups, medication management visits, behavioral health sessions — are being scheduled in-person by default because the scheduling interface routes them there. The utilization metric does not distinguish between patients who declined telehealth when offered and patients who were never offered it. This distinction is critical for intervention design: if 85% of in-person visits for appropriate telehealth indications were never offered telehealth, the intervention is a scheduling template change, not a patient persuasion campaign.

No-show rates by visit type are almost never compared between telehealth and in-person in routine reporting. Published data consistently shows telehealth no-show rates 25–40% lower than in-person rates for the same visit types and patient populations. A practice that moved behavioral health follow-ups to telehealth could reduce no-shows by 35% for that service line — but this calculation is invisible if telehealth and in-person visit types are aggregated into a single no-show rate for reporting.

Implement designated telehealth scheduling templates for clinically appropriate visit types: medication management, behavioral health follow-up, chronic disease follow-up for established patients, test result review, and care coordination. Templates that make telehealth the displayed option for these visit types — rather than an option requiring a deliberate override — shift scheduling behavior without requiring staff retraining or patient persuasion. Practices that implement this template change typically see telehealth utilization increase from 17% to 28–35% within 90 days for the targeted visit types.

Develop a payer-specific telehealth billing guide for coding and billing staff that maps each commercial and government payer's current telehealth coverage rules, modifier requirements, and originating site requirements in a single reference document updated quarterly. This removes the uncertainty that drives conservative in-person scheduling and enables accurate billing for telehealth encounters without requiring individual staff members to track policy changes across multiple payers. Single-platform telehealth integration with the EHR — eliminating the double-documentation workflow — is the highest-priority infrastructure investment for practices where documentation friction has been identified as a provider adoption barrier. The AMA telehealth policy framework and FAIR Health telehealth utilization benchmarks provide specialty-specific targets for evaluating telehealth program performance.