The dismantling of so-called Net Neutrality rules regulating service providers that connect consumers to the internet may have unintended consequences for the rapidly growing telehealth industry.

Telehealth, or telemedicine as it is also called, refers to virtual healthcare provided remotely by a doctor, nurse practitioner, registered nurse or other medical specialist. Employers that provide telehealth services to employees are able to reduce absenteeism caused by the need to visit a doctor physically, enhancing employee productivity while reducing overall healthcare expenditures.

In 2017, 71% of employers with 500 or more employees offered telehealth services, up sharply from the 59% that offered it the prior year, according to a study by Mercer. These numbers may go down in the aftermath of the Net Neutrality ruling, which is perceived to have a disproportionate impact on consumers in low-income and rural areas.

Companies in these regions are a key target market of telehealth providers, given the significant distance an injured or ill employee must travel to obtain adequate healthcare. “Reliable broadband connectivity is needed for telehealth services to thrive for all patients and healthcare facilities,” says Mary Kay O’Neill, M.D., senior clinical advisor at Mercer Health and Benefits.

The repeal of the Net Neutrality law effectively allows giant internet service providers (ISPs) to slow down broadband connections for low-income content customers to provide greater bandwidth to more financially valuable forms of content, such as streaming television. “The ISPs can play favorites among different entities that deliver content,” says O’Neill. “Large healthcare systems in primarily urban areas will have an unfair advantage over smaller, rural ones.”

This disparity can have a dire impact on telehealth services like behavioral health. “Employees receiving smoking cessation, weight management, psychological counseling and other forms of behavioral assistance need these telehealth services to be readily available, due to the coaching and frequent back-and-forth texting and FaceTime that occurs to help the person through the day,” says O’Neill. “If this is interrupted, no one benefits.”

The ruling introduces other broadband access concerns. For instance, high-speed internet connections are needed to link personal medical devices and wearable sensor technologies to remote telehealth providers. A case in point is the use of a personal glucometer for diabetes management.

“When the reading exceeds a certain threshold, the information automatically uploads to a database in a cloud, where a nurse can access it remotely,” says O’Neill. “If the data doesn’t upload in time, not only is this dangerous from a patient safety perspective, it is a wasteful use of a healthcare facility’s money.”

She adds, “This is one of the hottest things in healthcare software right now, but it depends on connectivity.”

Forced to negotiate for bandwidth, small rural hospitals may decide to curtail their telehealth programs and invest their financial resources in other areas—to the detriment of companies and people that truly benefit from the service.

What’s the solution? “Really this is a tough one to solve,” O’Neill says. “I would urge rural citizens to urge their legislators to take actions to ensure we don’t have a two-tier system in which lower-income people in rural regions get the short end of the stick.”

Read our feature on telehealth, “Virtual House Calls.”