13 rules for texting patients without landing in trouble

Texting works better than anything else your practice does. Patients open it, answer it and show up because of it. It is also the least governed channel most practices run, and the rules underneath it have been moving for two years. On Jan. 6, the FCC's Consumer and Governmental Affairs Bureau issued an order pushing the effective date of the "revoke-all" consent provision to Jan. 31, 2027, the second delay for a rule originally set to take effect in April 2025.

The delay is not a reprieve. Most of the FCC's 2024 revocation rules have been enforceable since April 2025, the major carriers have blocked unregistered business texting from 10-digit numbers since February 2025 and HIPAA has never carved out an exception for a message because it was short. Statutory damages under the Telephone Consumer Protection Act still run $500 to $1,500 per text, and plaintiffs' firms have found health care.

The encouraging part is that almost every exposure here comes from a handful of fixable operational habits rather than from texting itself. Consent that lives in one system, opt-outs that only travel one direction and a reminder line nobody monitors cause most of the damage. Here are 13 rules to work through before the 2027 date arrives.