Telehealth Isn't Dead—It's Evolving: Why Audio-Only Visits Deserve a Second Look

The Misconception That Telehealth Is a Video-Only World

There's a persistent myth that telehealth means video visits—that if you're not staring at your doctor through a screen, you're not really doing telemedicine. That's wrong, and dangerously so. The pandemic proved video telehealth works, sure, but it also exposed its limits: not everyone has reliable broadband, a smartphone, or the comfort level to sit in front of a camera. The reality is that audio-only visits—yes, plain old phone calls—are not a compromise; they're a legitimate, often superior option for many patients. And the Centers for Medicare & Medicaid Services (CMS) just made that official. In the CY 2025 Physician Fee Schedule final rule, CMS permanently revised the definition of an 'interactive telecommunications system' to include two-way, real-time audio-only communication for any Medicare telehealth service furnished to a beneficiary in their home, when the distant-site practitioner is technically capable of audio-video and the patient is not capable of or does not consent to video (Federal Register, CY 2025 Physician Fee Schedule). That's a big deal, and it's flying under the radar.

Comparing Telehealth Modalities: Video, Audio-Only, and In-Person

Let's get concrete. I'm going to compare three options: standard video telehealth (think Zoom for healthcare), audio-only (phone calls), and traditional in-person visits. I'll evaluate them on four criteria: access, clinical effectiveness, patient satisfaction, and cost.

Now, who is each for? Video telehealth is ideal for patients with good internet who need a visual check—like a rash or a wound. Audio-only shines for routine follow-ups, medication management, and mental health counseling, especially for patients in rural areas or those with limited digital literacy. In-person visits remain essential for acute issues, complex diagnostics, and procedures.

Why Audio-Only Visits Are Underrated

Here's my point of view: we've been so obsessed with the 'next big thing' in telehealth—AI, wearables, remote monitoring—that we've neglected the humble phone call. But the data backs up the value of audio-only. Consider this: as of 2021, 96 percent of U.S. non-federal acute care hospitals had adopted health IT certified under the ONC Health IT Certification Program (ONC/HHS, Report to Congress). That's a testament to how far we've come in digitizing healthcare. But digital doesn't mean video-only. The U.S. Core Data for Interoperability (USCDI) has expanded from 52 data elements in v1 to 94 data elements in v3 (ONC Standards Bulletin 2022-2). That's a lot of data—but none of it requires a video feed.

And think about the patient experience. I've seen too many clinics push video visits on patients who struggle with the technology. The result? No-shows, frustration, and worse health outcomes. Audio-only removes that barrier. It's also a matter of equity: not everyone has broadband, and the digital divide is real. By embracing audio-only, we're not settling for less—we're meeting patients where they are.

What I'd Actually Do

So, after all this, what's my recommendation? It's simple: stop treating audio-only as a fallback and start treating it as a first-class option. For any telehealth program, I'd:

• Offer audio-only as a routine option for follow-up appointments, mental health visits, and chronic disease management.
• Train providers to conduct thorough audio-only visits—it's a skill, not a downgrade.
• Ensure your technology stack supports audio-only securely, with the same HIPAA compliance as video.

And let's not forget the regulatory landscape. The HIPAA Security Rule requires safeguards like access control and encryption (eCFR 45 CFR Part 164 Subpart C). Whether you're using video or audio, you need to protect patient data. The good news is that audio-only visits are just as secure as video if you use a compliant platform. And with the permanent CMS policy change, Medicare now pays for audio-only visits when the patient is in their home and can't or won't do video (Federal Register, CY 2025 Physician Fee Schedule). That's a green light for providers to innovate.

In the end, telehealth isn't dead—it's evolving. And audio-only is a key part of that evolution. Don't let the hype around video fool you. The phone call is here to stay, and it's time we gave it the respect it deserves.

Sources

• ONC / HHS (Report to Congress) - https://healthit.gov/news/onc-outlines-health-it-interoperability-progress-report-congress/
• ONC Standards Bulletin 2022-2 (USCDI v3) - https://healthit.gov/standards-onc-technology/onc-standards-bulletin/onc-standards-bulletin-2022-2/
• Federal Register (CY 2025 Physician Fee Schedule) - https://www.federalregister.gov/documents/2024/12/09/2024-25382
• eCFR 45 CFR Part 164 Subpart C (Security Rule) - https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164/subpart-C