DERMOTT, Ark. – This is National Rural Health Day, and rural health centers in Arkansas and across the country are requesting that Congress stabilize the funding for their programs.

Rural health providers say lawmakers have funded rural centers on a month-to-month basis through a continuing resolution for several months.

Federal money accounts for a substantial portion of the budgets of rural health centers, and they say long-term funding is needed to smoothly run their operations.

Allan Nichols, CEO of Mainline Health Systems in southeast Arkansas, says all of his group's 17 clinics provide care for mostly poor and often uninsured patients.

"You put your organization at a lot of risk if they don't come through,” he states. “And that makes it really hard to extend yourself and try to meet the unmet needs that continue to grow in these rural communities."

This is the last day of the current continuing resolution, and if Congress doesn't act, funding could be suspended or cut off.

According to the National Association of Community Health Centers, community health centers serve one in five rural residents across the U.S.

Nichols says without consistent sources of funding, it can become particularly difficult to serve the needs of a rural population.

"You're scared to step out on a limb and hire those people because when you hire them, if the funding goes away you can let them go,” he explains. “But they have families, they're leaving jobs to come to your job. You got to be pretty sure before you commit to these people. "

Nichols says his clinics have to work smarter to serve the growing rural population in Arkansas, using technologies such as Telehealth, which extends the reach of doctors and nurses further into rural communities.

"There is no answer for health care that community health centers aren't a core part of the solution,” Nichols states. “There is none, because we're delivering care what others have left. And if these people deserve care and if they're going to get it, then we've got to deliver it."

National Rural Health Day is endorsed by the Community Health Centers of Arkansas and its national organization to highlight the challenges faced by rural community health centers.

Some anesthesiologists hope this is the year Tennessee passes legislation to allow Certified Anesthesiologist Assistants to practice in the state.

Assistants are authorized to work in 20 states but not in Tennessee.

Sasi Duggirala, certified anesthesiologist assistant and managing partner at Harmony Anesthesia in Atlanta, a former Tennessean, said the state's shortage of anesthesiologists as well as Certified Registered Nurse Anesthetists delays surgeries. He is advocating for licensure of certified assistants to increase the number of anesthesia providers, saying it would ultimately improve patient care.

"After coming out of COVID, there's been just a huge backlog on necessary procedures and surgeries that need to be done," Duggirala pointed out. "The mid-level anesthetist coming only from CRNA pool is just not enough to fill that gap."

Last year, Senate Bill 453 would have allowed certified assistants to practice in Tennessee but the bill stalled in the House. Some Tennessee Certified Registered Nurse Anesthetists opposed it, claiming the assistants lack the comprehensive training of nurse anesthetists. Backers want to see the bill reintroduced.

David Ryan Diehl, certified anesthesiologist assistant at Diehl Anesthesia in Atlanta, explained his son was born with a congenital disorder requiring prosthetics. The family receives support from the Jordan Thomas Foundation in Nashville. Diehl said new legislation would allow him to practice anesthesiology in Tennessee.

"Legislation needs to be passed that allows us to practice there, to bill insurance, Medicare, Medicaid, all those types of things, and for the groups to be reimbursed," Diehl outlined. "Also for us to be insured there as well, to practice."

Dr. Richard Duncan, orthopedic surgeon and medical director of the Center for Advanced Bone and Joint Surgery at Watauga Orthopedics in Johnson City, Tennessee, pointed out both Certified Registered Nurse Anesthetists and Certified Anesthesiologist Assistants can administer anesthesia during surgeries. He highlighted their extensive training, and suggested Tennessee institutions could offer such training as an additional educational benefit.

"A Certified Anesthesia Assistant is a person that has a bachelor's degree with some prerequisites that they have to have, and testing that they do," Duncan explained. "Once they're admitted into their training, it's 24 to 28 months of didactic training, and then clinical training."

Duncan added the critical shortage of anesthesia providers affects hospitals, surgery centers and patient care across the board.


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Oregonians who are ready to leave the hospital but still require care do not have enough places to go, affecting providers and patients at all levels.

The average hospital stay has increased to nearly five days, according to the Hospital Association of Oregon. With nowhere to send discharged patients, hospitals can end up boarding them, which hurts hospitals financially and means fewer beds are available for people who need them.

Sen. Deb Patterson, D-Salem, was part of a task force which released 10 recommendations to address the problem. She said a top priority is presumptive eligibility for Medicaid, so people who likely qualify do not have to wait for their applications to be processed in order to receive care, which would also benefit providers.

"Long-term care facilities need to be assured that the patients they're accepting, they already have their insurance in place," Patterson explained.

Increased reimbursement rates for adult foster homes are high on the list for the task force, as well as continued funding for guardians. Guardians are court-appointed positions who make decisions for adults found incapable of caring for themselves because of dementia or other health problems.

The task force, which included representatives from hospitals, nursing homes and union leaders, said expanding medical respite is also critical. The programs provide short-term residential care for people experiencing homelessness who do not need a hospital to recover from an illness or injury.

Patterson stressed not having access to places to heal can be deadly.

"I would really advocate for funding for medical respite because we do not want to see people dying on the streets," Patterson emphasized.

Another issue contributing to the backlog of patients is staffing shortages in Oregon's skilled nursing and long-term care facilities. Patterson noted the state is collaborating with Future Ready Oregon to grow the health care workforce, including certified nursing assistants. She added another bill is in the works for spring, focusing on entry-level positions in long-term care.


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January's cold temperatures in Missouri and across the nation can pose risks for those with heart conditions.

The American Heart Association has tips on staying heart-healthy in winter - including dressing warmly to reduce strain on your heart, and avoiding overexertion during activities like shoveling snow.

St. Louis Physician, Dr. Ravi Johar, is a board member of the American Heart Association. He said snow shoveling is a leading cause of winter heart problems, especially for men in their 50s and 60s.

He stressed that cold weather constricts blood vessels, increasing the heart's demand for more blood during exertion.

"So you have a combination of the body needing more blood to the heart and getting less flow through it because of the cold weather," said Johar, "and that unfortunately can lead to a heart attack - and it's one of the most common times that you do see a heart attacks occurring, is at that time of the year."

Other winter tips from the American Heart Association include eating balanced meals with fruits, vegetables, lean proteins, and whole grains - and limiting alcohol because it can make you feel warmer than you are, raising the risk of hypothermia.

While it may be very comforting to enjoy a hot cup of cocoa or apple cider in the winter, heart health experts warn these drinks are often loaded with sugar - which can be dangerous for the heart if you drink too much.

Dr. Johar added that exercising in winter can be very beneficial.

"Exercise at any time of the year will increase your immunity," said Johar. "So during cold and flu season, having a little bit better immunity is always beneficial. You do need to make sure you have enough fluids, you need to stay hydrated even though you don't feel quite as thirsty cause you're not sweating as much, it's real important to make sure you stay hydrated."

The American Heart Association emphasizes that people should pay attention to symptoms like chest discomfort, dizziness, or unusual fatigue, and seek medical help if needed.