OMAHA, Neb. (AP) — Nebraska Medical Center in Omaha will lay off 38 workers by the end of the year and won’t fill vacant positions as it adjusts to health care reforms.

The hospital announced the decision Tuesday, citing reducing costs, changes in the marketplace and a reduction in the growth of Medicare spending.

The center has about 5,200 employees. Spokesman Paul Baltes says it’s the first time in 10 years that it has cut jobs.

He says the hospital has been working for years to reduce costs. With a slowing of the increase in Medicare funding, the efforts are “being accelerated.”

A few staff members will see their hours reduced. Hospital officials say they’ll work to place workers in spots within the system and at partner organizations.