PHYSICIAN SPOTLIGHT: Augustine E. Agocha, MD, PhD
Director, Congestive Heart Failure Care Program, St. Joseph’s Hospital
TAMPA - If it is true that practice makes perfect, Augustine Agocha may be on the verge of delivering a flawless performance at St. Joseph’s Hospital.
Agocha, board-certified in cardiovascular disease, joined HealthPoint Medical Group in February with the prime directive of establishing the Congestive Heart Failure Care Program at St. Joseph’s. It is a task he has undertaken at three other hospitals in his 20 years as a cardiovascular disease specialist, and an undertaking that he is enjoying more than ever.
“I was looking for a program like this,” Agocha said of St. Joseph’s, BayCare Health System’s flagship facility in Hillsborough County. “This is my area of expertise.”
“When you get to the level where I perform, you absolutely look for people who are supportive and committed to a program. ... St. Joe’s and HealthPoint are prepared to present a program than can be a national example of how to get it right at a community-based hospital,” said Agocha, 48. “We’re creating something that is durable (and) the the administration has been exceptional.”
Much of what Agocha is building at St. Joseph’s is a bridge that connects the hospital’s inpatient and outpatient programs, and he is using education and organization as his engineering tools.
“Heart failure is a term that a lot of doctors, not just heart patients, don’t understand,”Agocha explained. “It is the only cardiovascular disease in which the diagnosis is actually increasing in frequency (because physicians) are doing a much better job with all the other heart diseases,” such as hypertension and diabetes, he said. An aging population accounts for those differences. “Because we are becoming better at treating these (cardiovascular) conditions, patients now live long enough to develop heart failure. ... They don’t die of a stroke in their 50s any longer because of their hypertension. They live long enough for the hypertension to burn out and over the years they lose heart function,” he said. “It’s a good thing, but there’s also a down side to it.”
Heart failure is the “single-most expensive condition that Medicare pays for and it is the most likely reason why a patient over age 65 is admitted to the hospital,” Agocha said.
Increased emphasis in programs to manage congestive heart failure cases “comes from the overall impact on patients’ lives, and on the overall cost of health care,” he said. The question becomes “How do we manage the cost and improve the quality of the care that is delivered?” Agocha said.
Hospitals like St. Joseph’s are “trying to get ahead of the train that is coming” with the rise in congestive heart failure, or CHF, among the baby-boom generation, Agocha said. Making sure CHF patients are treated successfully in the hospital and do not have to be readmitted is essential to the success of the program, Agocha said.
“It used to be that hospitals, when patients walked out their door, their role was over. What Medicare is now saying (to hospitals) is ... ‘That patient belongs to you for 30 days after you discharge them.’ This is a new game for hospitals,” Agocha said, and “there are going to be significant penalties if rates of readmission exceed the national average.”
“What we’re trying to do is to help build and coordinate a care system that looks after patients intensively during that 30-day period, and make sure that when they are discharged they are seen very quickly to make sure they have filled their medications, that their home care is what it should be, and that they are doing all the things they should to stay out of the hospital,” including physical rehabilitation and coordinating care with primary care physicians,” Agocha said. The CHF Care program is the “communications hub” that ensures “everyone is on the same page and moving in the right direction” with inpatient/outpatient care, he added.
Teaching his colleagues, as well as patients, is “a huge part of my role” as director of the CHF program, Agocha said. He is overseeing the compilation of reading materials, as well as lecturing to primary care physicians and nurses.
Agocha is drawing on his extensive experience in structuring CHF programs. He created and oversaw programs at the University of South Carolina School of Medicine in Columbia, the Dorn VA Medical Center, also in Columbia, and the Deborah Heart and Lung Center in Browns Mills, N.J. In addition to his professional training, including two cardiology fellowships, and both residency and internship at Yale University School of Medicine, Agocha earned his MD and PhD simultaneously in seven years at the State University of New York School of Medicine and Biomedical Sciences in Buffalo. In 1991 he was the first African-American to graduate from the Medical Scientist Training Program, he said.
Agocha is a native of Nigeria, and lived there with his four siblings. During that time, more than 1 million people were killed in the Biafra War. Agocha’s father, an educator, was in the U.S. to complete his graduate studies and worked to get his wife and family to America. He succeeded when Agocha was 6 years old. However, seven years later, the elder Agocha died of cardiomyopathy, most likely caused by a virus, he said. He was only 45 years old. That tragic circumstance was Agocha’s first exposure to a hospital environment and a catalyst to his career path.
His mother took the family back to Nigeria, and as the children graduated high school, they were sent to the U.S. to continue their education. “The greatest challenge in my life has been living up to the expectations to be good enough to be my father’s son. I was not alone in meeting this challenge,” Agocha said. “Of my five siblings there are two physicians, a lawyer, a psychology professor and an artist. Between the five us we have accumulated five bachelor’s degrees, two MDs, three PhDs, two law degrees, and two MBAs,” he said, adding that one of his goals is to finish the MBA he started at Temple University in 2004.
Agocha’s wife, Andrea, is a native of Jamaica and a nurse, whom he met and married when he was at Yale. They have three daughters, Celine, 14, Aren, 12, and Grace, 6, and live in the Tampa suburb of Lutz , where Agocha indulges his creative interests in photography and contemplative writings about nature.