CALAIS – Calais Regional Hospital, like other small rural hospitals across the state, has changed the way it operates in order to offset some of the dramatic cuts in Medicare reimbursement from the federal government.

The change was effective the first of the year.

Although the hospital has been licensed for 49 acute-care beds, on any given day for the past three years the average number of patients in the hospital has been around 12.

So, like many of Maine’s small hospitals, caught between declining Medicare payments and escalating operation costs, Calais Regional decided to look at the “critical access” federal designation. Hospitals designated as critical access facilities are entitled to higher federal and state reimbursements.

Calais Regional joins hospitals in Lincoln, Blue Hill, Boothbay Harbor and Greenville that have been relicensed as “critical access” facilities.

Two years ago, Calais Regional was awarded a state grant and hired a Portland-based consulting firm to look at whether the hospital qualified to become a critical access facility.

The reason for the change is rooted in the problems small hospitals have faced in the recent past because of the cuts in Medicare and Medicaid reimbursements.

In the past few years, Medicare reimbursements have been about $1.2 million a year less than it cost the hospital to provide services. And by 2002, Medicare payments to Maine hospitals are expected to drop by more than $30 million as a result of 1997 federal legislation.

That federal legislation was changed in November 1999. “With the change, we should pick up the bulk of that” $1.2 million, said Ray Davis Jr., the hospital’s chief executive officer.

In order to qualify for the new status, Calais Regional had to:

. Be located at least 25 miles from the nearest other hospital. Calais Regional is more than 35 miles from Down East Community Hospital in Machias and more than 100 miles from Eastern Maine Medical Center and St. Joseph Hospital in Bangor.

. Be open for emergencies around the clock. Calais Regional has a 24-hour emergency room.

. Use no more than 15 beds for acute care at any one time, and 10 swing beds.

. Have an annual average length of stay of 96 hours or four days.

During the past three years Calais Regional has fallen within those guidelines unofficially. The average length of stay at the hospital has been 3.8 days for more than three years.

“So what we’ve essentially done is adjust our license to reflect the activity in the hospital,” Davis said.

The change in designation, Davis said, would not affect the care needed by long-term patients.

“That is still here. That’s a whole separate entity and is not counted in that,” he said. And Davis said the change in designation should not affect staffing.

“I just think that this is a great opportunity for the hospital and the community to help us broaden the ability to serve the public,” he said.