For the last few years I have refused to put real money into telehealth, and I was right to. Every time I started thinking about upgrading my virtual visit setup, Congress would let the Medicare telehealth flexibilities drift toward another cliff edge, kick the extension a few months down the road, and leave me wondering whether the way I billed a video visit in March would still be valid in April. There was even a stretch late in 2025 where the flexibilities actually lapsed during the government shutdown, which is exactly the kind of thing that makes a solo doc decide to keep his head down and not invest in anything that might evaporate. You do not pour money into a workflow that the federal government might unplug on a Tuesday.
That calculus changed this winter. The Consolidated Appropriations Act, 2026, which President Trump signed on February 3, extended the Medicare telehealth flexibilities through December 31, 2027, ending the lapse and replacing the parade of short, nerve-wracking extensions with something close to a runway. On top of that, the CY2026 Medicare Physician Fee Schedule made several telehealth policies permanent, and behavioral and mental health telehealth now keeps its permanent audio-only allowance with no geographic originating-site restriction. So here is my honest, slightly skeptical read on solo practice telehealth in 2026: it is finally stable enough to invest in deliberately, but that is precisely the moment a solo practice is most at risk of overspending, because stability is exactly what the bloated platforms will use to sell you things you do not need.
What the durability actually changes for a lean solo setup
The honest answer is that it changes less about how I practice than it changes about how I plan. The visit types that worked on video last year still work this year, and the ones that needed hands on the patient still need hands on the patient. What is different is that I can now make a two-year decision instead of a two-month one. When the flexibilities were month-to-month, every telehealth choice was provisional, and provisional choices are how you end up with a duct-taped setup that nobody ever consolidates. Now that Medicare telehealth has a clear horizon through 2027, I can sit down once, decide how I want virtual visits to flow through my day, and stop relitigating it every quarter. That is the real gift here, and it is worth a lot more than any feature a vendor will try to upsell on the back of it.
I want to be careful about the word permanent, though, because it is doing a lot of work in the marketing emails I have been getting. Some pieces of telehealth policy genuinely are permanent now, particularly on the behavioral and mental health side, where audio-only is allowed and the geographic originating-site restriction is gone for good. The broader physical-health flexibilities, the ones that let any Medicare patient be seen anywhere via telehealth, are extended through the end of 2027, which is durable but is not forever. If you are a solo internist like me, you should plan as if the general telehealth window has a 2027 expiration date and build accordingly, while treating mental health telehealth as the one corner of this that you can lean on indefinitely.
The telehealth setup a solo doctor actually needs
When I think about telehealth tooling now, I start from the same anti-bloatware place I start from with everything else, which is to ask what the single job is and then refuse to pay for anything beyond it. The job is reliable, HIPAA-compliant video that lives as close to my chart as possible so that a virtual visit does not cost me three extra context switches and a separate login. That is it. I do not need a branded virtual waiting room, I do not need patient queue management, I do not need group-visit breakout rooms or a multi-provider scheduling grid, because I am the only provider and the only person running the queue. Every one of those features is built for a practice with staff I do not have, and paying for them is just paying to feel like a bigger operation than I am.
What I would actually look for, if I were choosing today, is an EMR that handles telehealth natively so the video launches from inside the patient's chart and the documentation and coding stay in one place. The integration matters more than the video quality, frankly, because the video is a solved problem and the workflow friction is not. The deeper point is that a stable policy environment is not a reason to go buy a dedicated telehealth platform on top of whatever you already use. If anything it is a reason to consolidate, because now that virtual visits are a durable part of solo practice technology rather than a temporary experiment, the cost of running them through a clunky second system compounds month after month in a way it did not when you were only doing a handful of visits a quarter.
Audio-only is the quietly underrated part
The piece of all this I am most glad to see made durable is the audio-only allowance, and not for the reason vendors push it. Audio-only is not a worse video visit, it is a different and genuinely useful thing for a certain slice of patients, and the ones who benefit most are exactly the ones who struggle with technology: older patients, patients without smartphones, patients whose rural broadband cannot hold a video stream. For mental health that allowance is permanent now, and for the broader set of services it runs through the current extension window. A plain phone call, properly documented and properly coded, is sometimes the most patient-centered telehealth I do all week, and it requires no platform investment at all because I already own a phone. The skeptic in me appreciates any improvement that costs zero dollars to implement.
Documentation and coding, which is where solo docs actually lose money
Here is the part nobody upsells you on, because there is no shiny feature to sell. The thing that determines whether telehealth is profitable for a solo practice is not the video tool, it is whether your documentation supports your codes and whether the right place-of-service codes and modifiers land on the claim. The payer rules around this still shift more than I would like, and audio-only in particular has its own coding nuances that are easy to get wrong. What I want from my system is not a fancier camera but the boring, unglamorous ability to apply the correct codes based on encounter type and to flag a mismatch before I close the note rather than two weeks later when the denial arrives. If you are going to spend money anywhere on telehealth in 2026, spend it on getting the documentation-to-billing path tight, because that is where the leak is.
The bottom line for 2026
I talked through most of this with another solo doc a couple of weeks ago, a family medicine guy two states over who had been just as gun-shy about telehealth as I was, and we landed in the same place. The extension through 2027 is real, the permanent mental health pieces are real, and that is enough certainty to finally stop treating virtual visits as a temporary patch and start treating them as a permanent, deliberate part of the practice. But deliberate is not the same as expensive. A stable policy environment is the moment to simplify and commit, not the moment to go shopping for an enterprise telehealth suite you will use at ten percent of capacity. Decide how virtual visits fit your day, run them through the leanest path you can, document them properly, and let the bigger practices buy the bloatware. The whole point of being solo is that you get to skip it.