The Payer Cost of Congestive Heart Failure Management: A case study of cost savings with supportive in-home health care

Why You Should Schedule Your Mammogram We had the chance to sit down with Dr. Joyce Alexandar-Hines, our executive director for the North Carolina PACE center, LIFE St. Joseph of the Pines and asked about her experience with breast cancer. She shared why getting the mammogram on the calendar is so important and why she believes her story is meant to help other women. In July 2023, I had my annual mammogram, and they saw something in my left breast. They said they dont think its cancer, but can you come back in six months? Dr. Joyce says of how her story began. She returned in January for another mammogram and said they needed to do an ultrasound. The lady took a while, reaching for Dr. Joyces lymph nodes as she tried to figure out what was going on. The doctor came in shortly and said they had found a cyst, and they saw something black behind the cyst.  Showing the image to Dr. Joyce, she asked how big it was? They said it was very small, about 3 millimeters, saying she never would have felt it. The next step was a biopsy. Dr. Joyce called her surgeon, scheduling the biopsy for February 20. During that appointment, she recalls lying on the table and the doctor saying, I believe this is going to be a good outcome. I thought he would say I did not have cancer. The following Sunday before church an alert came over my phone letting me know there was a new test result in my records. Immediately it came up: You have ductal carcinoma in Situ. I looked at my husband, and I said, I have breast cancer. I felt numb.  Something told Dr. Joyce to look at her results again and she saw that the cancer had not moved. She considers herself very fortunate.  The surgeon said, It is really small, only 3 millimeters. We got this. We will remove it so you will be cancer free. Dr. Joyce scheduled her surgery for early March to remove the cancer. When she went back for her follow-up appointment, and they let her know she was cancer free. They did recommend sending her to radiation and oncology so she could understand her options.  I went over there and never ever thought I would walk in the cancer center as a patient, Dr. Joyce said.  They helped her learn about her cancer, saying that it was made up of nothing but hormones, offering her the option of radiation treatment or a pill to stop the hormones. Dr. Joyce proceeded with the pill and the radiation, leading to exhaustion (in part due to her being anemic). Radiation was only 5 days, 10-15 minutes each day. The week after radiation, I was so tired I could not keep my eyes open, Dr. Joyce said. She went on to say how scared she was at this time.  At one time I questioned my faith and asked God why this was happening to me. It is now clear to hear that God wants her to talk to people about breast cancer and mammograms. Her staff knew she was sick and out of the office, but they did not know what was going on. So, Dr. Joyce had a meeting and shared her story.  Thank God, because two of my staff members said it had been ten years since their last mammograms, and they went to get them scheduled. A similar situation happened at her church where Dr. Joyce talked about her experience and reminded women in her congregation to get mammograms.  Dr. Joyce remembers giving the ultrasound technician a hard time but went on to say that she saved her life. Dr. Joyce got her a card and gift and went to visit her so she could tell her that she saved her life.  My surgeon said she didnt know how the tech found it, that some of these technicians have different techniques, but somehow her technique found it. Dr. Joyce told her surgeon: No, God pointed her instrument to where it needed to be. He wanted me to be here to do more. Pictured above is Dr. Joyce ringing the bell at the cancer center after her last treatment. She mentioned she has gone back for oncology appointments to make sure she is healing and how she is doing with the pill, if any aftereffects from radiation.  God felt that I needed another chance and I got that. Mammograms are important. Please, everybody. If you feel ANY type of lump, even if you had a mammogram two days ago, go back to the doctor. There are so many advances in breast treatment people are living longer and being cured. Its important to put your health as number one, Dr. Joyce advises.  To find out more about the Mercy Life PACE program and the services that they provide, please call Mercy Life of Alabama at 251-287-8420.

Reducing Avoidable Hospitalizations Due to UTIs Urinary tract infections (UTIs) remain a significant driver of care complications and hospital admissions each year in the United States, especially for older adults. As the second most common type of infection, UTIs are very common in the U.S. In fact, about 10 in 25 women and 3 in 25 men will experience UTI symptoms during their lifetime. In older adults, UTIs are the third leading cause for hospitalization for infection and impact many home health care patients each year. Further complicating the picture for this patient population is the fact that symptoms of a urinary tract infection in older populations often present atypically, especially in those with Alzheimers and other forms of dementia. To avoid costly hospital stays, its important to follow current evidence-based practices to identify and manage UTIs in elderly populations. Common UTI SymptomsCommon risk factors for UTI in older adults include previous history of UTI, multiple comorbidities, exposure to infectious pathogens (more common in long-term care facilities), reduced immunity (common with aging) and urinary catheter use. Of identified infections, Escherichia coli (E. coli) is the most common cause. Monitoring for the following signs of UTI in older adults can support proactive diagnosis: Classic UTI SymptomsBecause UTIs affect different parts of the urinary system, symptoms might present differently:          Infection in the kidneys can come with back or side pain         Infection in the bladder can come with pelvic pressure, lower belly discomfort and frequent, painful urination         Infection in the urethra can come with burning during urination and possible discharge         In cases of severe infection, fever and chills, nausea, vomiting, and abnormal urine odor can be late symptoms.         For some older adults, these classic symptoms might be harder to recognize because of a suppressed immune response. UTI Symptoms Specific to Older AdultsFor older adults, symptoms might also include: Mental status changes like confusion or unusual behavior         Incontinence         Agitation         Lethargy         Falling         Urinary retention         Decreased mobility         Decreased appetite How to Avoid UTIs in Elderly Populations Late signs of UTI are cause for alarm, with 25% of sepsis cases attributable to UTIs. Some tips for helping prevent UTIs in vulnerable populations include: 1. Understand common risks in older adults.A persons health history can reveal a lot about their likelihood of experiencing a UTI. For example, diabetes can impact the immune systems response to defense against germs. Bladder incontinencecommon in older populationscan also increase the risk of a UTI. 2. Encourage adequate fluid intake.Research supports increasing hydration (if not on a fluid restricted diet) as a strategy for reducing risk of UTI. Staying hydrated can also help improve immune response. 3. Avoid urinary tract irritants.Coffee, alcohol, highly acidic foods and carbonated soft drinks are common urinary tract irritants that should be avoided during a UTI. However, if someone is prone to UTIs, its best practice to avoid these irritants in general. 4. Encourage proper hygiene.In addition to taking daily showers, regularly changing underwear and washing clothes consistently, those who require incontinence briefs should change several times a day. 5. Avoid urinary catheters.Catheter-acquired urinary tract infections (CAUTIs) are a significant source of infection and related healthcare costs each year in the United States. Initiatives to reduce the use of catheters have shown large reductions in the rate of infection. Reducing Avoidable HospitalizationIf a UTI does occur, partnering with a home health provider that prioritizes a strong evidence-based UTI protocol can help ensure patients avoid hospitalization. At Amedisys, our UTI protocol includes advanced molecular testing for rapid identification of urinary pathogens with more accurate results and targeted treatment recommendations. In addition to proactive management of UTI symptoms, our nurses provide education on proper hygiene, symptoms of UTI to watch for and measures to prevent UTIs. This includes support for coexisting conditions that increase the risk of UTI, with resources like our home health diabetes care program to help patients lead healthier lives.  To help prevent UTIs in your patients, we created a resource highlighting just what you need to know so that you can do your job more efficiently. Download and print out a copy of Reducing Avoidable Hospitalizations Due to UTIs.

What Are the Four Stages of Congestive Heart Failure? A diagnosis of congestive heart failure can feel overwhelming. If you or a loved one has recently received this diagnosis, you may have many questions. Learning more about congestive heart failure can help you understand what to expect. It can be especially helpful to understand what the four stages of congestive heart failure are, along with your options for care. Understanding Congestive Heart Failure: An Overview Congestive heart failure, also called simply heart failure or CHF, is a chronic health condition caused by weakened heart muscle. If healthy, your heart squeezes with enough force during each heartbeat to pump enough blood for your body to function normally. In congestive heart failure, blood is not pushed out of the heart with enough force, causing other health problems. According to the Centers for Disease Control and Prevention (CDC), more than 6 million adults in the United States have congestive heart failure. People who are smokers, have obesity, coronary artery disease (CAD), valvular heart disease, diabetes or high blood pressure are all at increased risk for CHF. Congestive heart failure can cause many symptoms that lead to poor quality of life. These symptoms include:  Shortness of breath Swelling of body tissues due to fluid buildup Chronic coughing and/or wheezing Decreased appetite and nausea Fatigue Elevated heart rate Confusion and problems with thinking Sudden weight changes  The Four Stages of Congestive Heart Failure ExplainedCongestive heart failure is a progressive disease, meaning it does not go away or reverse course and gradually worsens over time. The American Heart Association has defined four stages of congestive heart failure, beginning with pre-heart heart failure or stage A, through the final or end-stage of heart failure. Stage A: Pre-Heart Failure People diagnosed with Stage A heart failure dont have a problem with their hearts structure but are at risk for developing the later stages of heart failure. Treatment at this stage is focused on preventing new problems. Patients are educated on healthy lifestyle choices that can help prevent coronary artery disease and sometimes may be prescribed medications that reduce their risk for developing heart problems. Stage B: Asymptomatic Heart Failure In Stage B heart failure, the heart has begun to show signs of structural changes. For example, this can be an enlarged left ventricle (a section of the heart), along with a decreased ejection fraction (EF), which measures how much blood the heart pumps. In Stage B there are not any symptoms of heart failure (and there have not been in the past). Treatment at this stage includes preventing symptoms from beginning and treating with medications called beta blockers and ace inhibitors (or angiotensin-receptor blockers) as appropriate to reduce the rate of heart structure changes, as well as lifestyle changes that will prevent worsening of further structural changes in the heart. Treatment may also include surgery, such as coronary artery bypass grafting (CABG) or valve replacement if it is determined that a blocked coronary artery or defective heart valve is the cause of structural changes in the heart. Stage C: Symptomatic Heart Failure Stage C heart failure results in symptoms of heart failure, either in the past or currently. Treatment at this stage includes reducing or controlling symptoms and improving quality of life. It can also work to control any other health conditions that can worsen heart failure. Medications that reduce extra fluid in the body and other complications of heart failure may be added. In some cases, implanted devices such as a pacemaker or cardioverter defibrillator, may be used to support the heart. Stage D: End-Stage Heart Failure During Stage D, or end-stage heart failure, symptoms are uncomfortable and always present, even during rest. Treatment in this stage includes improving quality of life, reducing symptoms, reducing trips to the hospital and making end-of-life goals and plans. For some, a heart transplant may be an option. Early-Stage Heart Failure: Knowing Your Options For those living with Stage C heart failure, day-to-day care can sometimes feel challenging. Hospitalizations may be a worry, and managing stability and quality of life at home requires lifestyle changes, medications and a good plan of care. Home health support for heart failure can help you learn how to monitor symptoms and manage your condition at home, avoiding hospital stays. Home health care can provide: Education about medications and lifestyle modifications to reduce the risk factors and help promote clinical stability. Proper diet and nutrition information Techniques for improvements in strength and mobility Daily exercise routines Help to monitor vital signs Monitoring heart failure symptoms Weight monitoring and management Tips on what to do if symptoms worsen  These supports and resources can help improve your quality of life and reduce symptoms during Stage C heart failure. End-Stage Heart Failure: Knowing Your Options Because heart failure is not reversible, end-stage heart failure can escalate the need for decisions about care and end of life if you havent already had these conversations with your loved ones and care team. People living with end-stage heart failure often have symptoms and problems that can lead to hospitalizations and emergencies.Understanding the four stages of heart failure and discussing your long-term goals and wishes in the early stages can help you avoid unwanted and potentially unnecessary treatments. Palliative Care and Heart Failure Palliative care is a helpful option for those living with heart failure. The focus of palliative care is on quality of life, symptom management and setting goals for care so that your wishes are honored, and your treatment matches what you desire.Palliative care can be started at any stage of a diagnosis. As you progress into the later stages of heart failure, you may meet more often with your palliative care team to discuss symptom management and to plan for possible changes to your health and care. The palliative care team can also help you decide when to begin hospice care during Stage D heart failure. Hospice Care: Compassion During the Final Stage During hospice care, people living with heart failure transition from aggressive forms of treatment to comfort-centered, end-of-life care. An interdisciplinary hospice care team helps patients and their families to manage heart failure at home as best as possible. Specialized hospice care for heart failure can further support those in end-stage heart failure, with evidence-based guidelines and best practices to keep patients as comfortable as possible where they most want to be. During end-stage heart failure, hospice care provides: Pain and symptom management Caregiver support Emotional and spiritual support End-of-life planning (also called advance care planning) Bereavement support 24/7 nurse availability for emergencies Psychosocial support Assistance with activities of daily living Respite care  Managing the Four Stages of Congestive Heart Failure with Amedisys  If youre not sure where to begin with heart failure care at home, an Amedisys care center near you can help. Whether you enroll in our home health heart failure program, meet with a palliative care team or are considering hospice, contact Amedisys Hospice at 251-343-0989 for more information