Dartmouth Health expects to end its Tele-ICU and Tele-ED services, a move that would affect five Vermont hospitals and more across the region.
They “are two services whose costs, at our current scale, without external support, are simply unsustainable,” Audra Burns, a spokesperson for the New Hampshire-based health network, told VTDigger. The network, which has two affiliate hospitals in Vermont and its flagship academic medical center minutes across the border in Lebanon, New Hampshire, is the second-largest healthcare provider to Vermonters.
Burns declined to comment on how much the two services cost Dartmouth Health.
Tele-ICU and Tele-ED are two of the nearly 20 kinds of remote healthcare that Dartmouth provides. Both are designed to give rural hospitals access to specialists at Dartmouth Hitchcock Medical Center.
A representative for Grace Cottage Hospital, in Townshend, which uses the Tele-ED services, confirmed that Dartmouth Health told the Vermont hospital Friday of its decision to close down the services and is now working through the timeline for that.
The remote intensive care unit services connect Dartmouth’s intensive care physicians and critical care nurses with a patient’s bedside team, so rural hospitals can care for patients needing acute care and so clinicians can do more high-level, continuous monitoring. Dartmouth Health says the service reduces mortality rates and the length of stay in the ICU. The network also says it reduces the need for a patient to be transferred — allowing them to stay in a less-expensive local setting.
Northwestern Medical Center in St. Albans and Southwestern Vermont Medical Center, a Dartmouth affiliate in Bennington, both use the network’s Tele-ICU, according to materials Dartmouth Health shared with VTDigger in 2025. Dartmouth Hitchcock, in Lebanon, also uses its own service internally to help avoid staff burnout and improve safety and quality of patient care, the Tele-ICU medical director told the New Hampshire Union Leader when they launched the service line in 2019. Three other New Hampshire hospitals use Dartmouth Health’s Tele-ICU.
The remote emergency department services are meant to help providers with higher-level care and documentation as they transport an emergency patient, transfer a patient to a higher-acuity hospital or treat them in a smaller hospital setting.
In promotional materials, Dartmouth Health called the service “a life-saving connection.” The health network says it reduces transfers, staffing costs and the need for more expensive temporary clinicians. The network also says the service helps open up emergency department capacity.
In Vermont, Brattleboro Memorial Hospital, Grace Cottage Hospital in Townshend, Southwestern Vermont Medical Center and Mt. Ascutney Hospital and Health Center, a Dartmouth Health affiliate in Windsor, all use the service, according to Dartmouth Health’s 2025 list.
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Just last Friday, Grace Cottage’s CEO Olivia Sweetnam told Vermont regulators that the hospital’s ability to use Dartmouth Tele-ED is a “really valuable partnership for us.”
All the providers in the 19-bed critical access hospital’s emergency department are physician assistants or nurse practitioners. The Dartmouth Tele-ED relationship established access to an emergency physician’s guidance if needed.
“It really is a huge letdown and surprising,” Dr. Jennifer Zweig, Grace Cottage’s chief medical officer, told VTDigger on Monday, saying the hospital didn’t have any inkling before Friday that Dartmouth intended to shutter the service.
Still, she does not think it will affect access in the hospital. Dartmouth Health’s Tele-ED model uses in-house physicians during regular working hours but transfers remote coverage to the South Dakota-based telehealth provider Avel eCare on nights and weekends, Zweig said. It’s likely that Grace Cottage will switch to using Avel full-time, at least for now.
“It’s not quite as efficient, and it’s not quite as personalized,” Zweig said, adding that Dartmouth Health was able to expedite patient transfers to the medical center and send its helicopter if needed.
In Grace Cottage’s emergency department, there is a video monitor and a button that providers can push to speak with a nurse or physician at the medical center, who can talk through critical decisions or do documentation as the on-site staff attend to a high-need patient.
Accessing the remote emergency doctors has been an essential piece in the small, rural hospital’s limited budget.
“It’s essential because I don’t think that we could afford to have that coverage in house,” Zweig said. “It’s hard to attract board-certified emergency room physicians to work at rural critical-access hospitals. I think they’re drawn to the higher-acuity, busy EDs.”
In May, Dartmouth Health reported an overall $63.5 million operating deficit, as expenses — things like staffing and pharmaceutical costs — outpaced the hospital’s revenue, the Valley News reported.
Burns cited these “significant financial challenges” as the impetus to evaluate the cost of continuing the Tele-ICU and Tele-ED services.
“External funding for these telehealth programs that often serve rural critical access hospitals, but rarely reach the scale to account for the 24/7 staffing required, is often critically scarce, yet is vital to maintaining these services,” she wrote in a statement to VTDigger.
“As the nation’s most rural academic medical center and health system, we are steadfast in our commitment to deliver exceptional care to the farthest corners of our service region. Our sustainability during challenging financial times will require changes and new approaches to this important care model,” she added.
Burns said the health network will “be working closely” with the hospitals that rely on these services to make sure that alternatives are in place before Dartmouth Health finalizes its closures.
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This story was originally published by VTDigger and distributed through a partnership with The Associated Press.
