Dartmouth Health Plans to End Its Tele-ICU and Tele-ED Programs for 13 Rural Hospitals in New Hampshire and Vermont, Citing Unsustainable Costs

Telemedicine is often pictured as a patient on a phone talking to a doctor, but some of its highest stakes uses connect one hospital to another. In rural New England, a small hospital's overnight emergency room or intensive care unit can pull in a critical care specialist hundreds of miles away by video when a patient is crashing. Dartmouth Health, the largest health system in the region, says it plans to end the two programs that provide that support to 13 rural hospitals, citing costs it describes as unsustainable. The decision is not yet final, but it has put rural hospital leaders in New Hampshire and Vermont on notice.

What Dartmouth Health announced

Dartmouth Health, the academic health system anchored by Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, notified 13 rural hospitals in mid-August 2026 that it intends to close two telehealth services: Tele-ICU, which remotely supports intensive care units, and Tele-ED, also referred to as TeleEmergency, which supports emergency departments. Audra Burns, a Dartmouth Health spokesperson, said in a statement that the two services are among those whose costs, at the system's current scale and without external support, are simply unsustainable. As of publication, Dartmouth Health had not set a firm date for the services to end and said it would work with the affected hospitals on alternatives first.

What Tele-ICU and Tele-ED do

Both programs run through Dartmouth Health's Connected Care unit, which the system launched in 2012. Rather than serving individual consumers, they connect the clinical staff of one hospital to specialists at another. Through Tele-ICU and Tele-ED, physicians and other providers at Dartmouth Hitchcock Medical Center can advise the emergency and intensive care teams at smaller hospitals that do not have that level of critical care or emergency expertise on site at all hours. Hospital leaders describe the value as expert backup at the moments when a rural facility has the fewest staff on the floor.

Jonathan Billings of Northwestern Medical Center in St. Albans, Vermont, told reporters that the service allowed the hospital to get expert consultation on patients that it might otherwise have automatically transferred to a larger facility. Aida Avdic, chief medical officer of Brattleboro Memorial Hospital, said emergency room clinicians sometimes rely on the support in the middle of the night when fewer people are on the ground.

Why Dartmouth Health says it is ending the programs

Dartmouth Health tied the decision to its finances. The system reported a $63.5 million operating deficit in May 2026, as expenses such as staffing and pharmaceutical costs outpaced revenue. According to the statement attributed to Burns, external funding for telehealth programs that serve rural critical access hospitals is often scarce, yet such funding is what keeps around the clock staffing viable. The programs require 24/7 coverage but, at their current scale, do not reach the volume needed to pay for that coverage on their own, the system indicated.

Which hospitals are affected

The 13 hospitals span New Hampshire and Vermont. Reported Vermont facilities include Brattleboro Memorial Hospital, Grace Cottage Hospital, Southwestern Vermont Medical Center, Mt. Ascutney Hospital and Health Center, and Northwestern Medical Center in St. Albans. In New Hampshire, North Country Healthcare, which operates hospitals in Berlin and Lancaster, is among those affected. According to figures it shared, North Country Healthcare used the services for 211 Tele-ICU patients and 105 TeleEmergency patients in 2025.

How the hospitals are responding

Reactions from affected hospitals ranged from still assessing options to actively shopping for a replacement. Tom Mee, chief executive of North Country Healthcare, said the system is already searching nationwide for a new telehealth partner. Leaders at Brattleboro Memorial and Northwestern Medical Center said they were still working out next steps. Several described the service as something they did not lean on every day but that improved the quality of care when they did, particularly in the smallest and most remote settings.

Why this matters for rural telehealth

The closures highlight a recurring tension in rural telehealth: the hospital to hospital services that arguably matter most in emergencies are often the hardest to fund. Consumer telehealth visits can be billed per encounter, but a standing tele-ICU or tele-emergency line that a small hospital may use only occasionally still requires specialists staffing it around the clock. When a health system carrying a large operating deficit looks for savings, a low volume, high fixed cost program can become a target even when the clinical case for it is strong. Federal support for rural connectivity exists but is limited, which is one reason policymakers continue to revisit programs aimed at rural telehealth.

What happens next

Dartmouth Health has framed the move as a plan rather than an immediate shutoff, saying it will coordinate with the 13 hospitals so alternatives are in place before it finalizes the closures. No specific end date had been announced as of publication. Affected hospitals face a choice between finding another telehealth vendor, as North Country Healthcare is attempting, absorbing the function internally where feasible, or transferring more patients to larger centers when specialty coverage is not available locally. How quickly replacements can be arranged, and at what cost, will determine the practical effect on patients in the affected communities.

Limits of what is known

This is general information about a developing story, not medical or legal advice. As of publication Dartmouth Health had described its intent to close the programs and provided a rationale, but had not published a firm timeline, and the details of any transition plan for each hospital were still being worked out. Facts here are drawn from Dartmouth Health's statement and from regional and wire reporting. Patients with questions about care at a specific hospital should contact that facility directly.