Blog

Here at Apixio, we’re obsessed with the intersection of data science and healthcare.
We keep up with the latest in deep learning while reading recent studies in Health Affairs and Medicare
regulatory changes. We have provocative opinions – and we encourage real debate. Join us!

How A Veteran Coder Used Apixio’s HCC Profiler to Eliminate Data Entry Error and Double Productivity

Eric Tan, CPC, CCS

A veteran HCC coder, Gloria Rodriguez has seen the pros and cons of many approaches to HCC coding. At the beginning of her career, she “chased” and reviewed paper patient charts. Next, she reviewed electronic records through the EHR system or scanned PDF charts. Gloria currently reviews charts using Apixio’s HCC Profiler application. By using […]

How New Risk Adjustment Technology Affects Coders

Eric Tan, CPC, CCS

Risk adjustment is traditionally done in a manual and inefficient way, as we have discussed throughout this blog series. Coders will comb through thousands of pages of patient charts and look for documented chronic conditions. This process is time consuming and costly, not to mention that it doesn’t make good use of coders’ expertise. Cognitive […]

How We Use Machine Learning to Analyze Patient Data in Medical Records

Eric Tan, CPC, CCS

As we have covered in the first part our blog series, risk adjustment is traditionally done in a very manual and slow way. This process is time consuming and costly, not to mention that it doesn’t make good use of coders’ expertise. Because of these issues, cognitive computing can meet an important need for risk […]

How We Use Technology to Get Risk Adjustment Data Out of EHRs

Eric Tan, CPC, CCS

This is the second in a 4-part series called Intro to Risk Adjustment Technology. As we discussed in the first post in this series, traditional risk adjustment is incredibly manual. Coders will comb through thousands of pages of patient charts and look for documented chronic conditions. This process is time consuming and costly, not to mention that […]

Why Does Risk Adjustment Need Technology?

Eric Tan, CPC, CCS

This is the first in a 4-part series called Intro to Risk Adjustment Technology. Cognitive computing. Machine learning. Natural language processing. Two years ago, few people in the risk adjustment world had ever heard of these terms, and yet today they are becoming synonymous with risk adjustment. What are these technologies? Why do we even need them […]

Results from RISE and Apixio’s Coding Community Survey

Lea Cuniberti-Duran

In January, Apixio’s user research team conducted a coding survey. We recruited coders, QA supervisors, and directors involved in risk adjustment coding via RISE’s mailing list, Facebook groups, and LinkedIn groups. We secured 111 responses, from 52 coders, 23 coder managers, 13 director/executives, and 23 other affiliations. Below are some takeaways: The Risk Adjustment Coding […]

All About MACRA: Four Takeaways from CMS Chief Andy Slavitt’s Speech to the American Medical Association

Anita Joseph

On Monday, Centers for Medicare and Medicaid Services (CMS) Administrator Andy Slavitt addressed the American Medical Association’s 2016 annual meeting. Slavitt usually leverages such opportunities to send highly specific messages— at the JP Morgan Conference earlier this year, he told an audience of healthcare technology executives that interoperability had to be part of their mandate— […]

How New Risk Adjustment Technology is Affecting Coders

Anita Joseph

Technology is transforming risk adjustment, just like it is every other part of society. Instead of people traveling to physicians’ offices and physically scanning their records, technology can get charts quickly and securely. Instead of coders thumbing through thousands of pages of patient charts to find HCCs, technology can identify potential HCCs without anyone lifting […]

Building Physician Engagement Around CMS Risk Adjustment and Clinical Documentation

Anita Joseph

At RISE Nashville this week, we heard over and over that engaging physicians around clinical documentation is a struggle. These feelings echo what statistics have been saying for a long time: in a 2013 survey by the RAND Corporation, physicians described “time-consuming data entry” as a major source of professional dissatisfaction.  Strong CMS risk adjustment is […]

The Path Forward for Healthcare Data is Deeper Insights on Patients and Doctors

Anita Joseph

At this point in time, it’s fair to say that healthcare data has not transformed healthcare the way many people thought it would. We have a lot of healthcare data, for sure, but we don’t make effective use of it. This is largely because efforts to leverage healthcare data have been scattered and unfocused. Are we worried about data […]

Ten ICD-10 Codes for Superheroes

Anita Joseph

It’s Friday, so let’s have some fun. Ever wonder how superheroes explain their on-the-job injuries to doctors? Well we tried to figure that out. After all, even superheroes have to file insurance claims. Scientist Bruce Banner is exposed to gamma radiation, turning him into the Hulk. W88.8: Exposure to other ionizing radiation. Teenager Peter Parker […]

Intel and Apixio Release Big Data Analytics Whitepaper

Anita Joseph

Today, Intel released a whitepaper profiling Apixio’s innovative application of big data analytics to the healthcare space, through its risk adjustment application HCC Profiler. The whitepaper describes how Scripps Health used HCC Profiler to review 21,000 Medicare Advantage charts with increased accuracy and productivity. As Linda Pantovic, Scripp’s Director of Compliance and Performance Improvement said, “The […]

Five Intriguing Themes from the Latest Medicare Advantage Stats

Anita Joseph

The Better Medicare Alliance, a health insurance trade group with 43 members, recently published a series of research fact sheets on the government’s Medicare Advantage (MA) program. These fact sheets explore MA’s influence on primary care, chronic care, and overall quality, as well as the demographics of the MA program.  They provide an interesting, and […]

Handling the Hype Around Interoperability

Anita Joseph

“We are deadly serious about interoperability,” said Centers for Medicare and Medicaid Services chief Andy Slavitt at the JP Morgan Healthcare Conference, “technology companies that look for ways to practice ‘data blocking’ in opposition to new regulations will find that it won’t be tolerated.” Epic, athenahealth, and other major players involved Slavitt’s blunt words have […]

Ten ICD-10 Codes That Influenced Harry Potter

Jamie Urborg

In honor of Alan Rickman’s passing, we thought it appropriate to celebrate his talented turn as Hogwarts Potions Master Severus Snape. Here are 10 ICD-10 diagnoses that influenced the magical world of Harry Potter. 1. In The Order of the Phoenix, Dudley Dursley punches Harry in the side of the head and small white lights pop in […]

So You Don’t Have Time to Read the CMS RADV Audit Proposal

Anita Joseph

Last week, CMS proposed expanding the risk adjustment audit program to cover all Medicare Advantage (MA) plans, every year. This is because they believe that mistakes in the diagnosis data that MA organizations submit to CMS lead to a drastic misallocation of resources–some plans are overpaid for their patients, and some are underpaid. CMS currently […]

Understanding Healthcare’s Data Problem: 2015 Tech In Review Edition

Jamie Urborg

Understanding the full state of the patient is a difficult task for physicians when 80% of data is tough to access. What does it mean to only have 20% of all possible info? Play the latest version of our 20% game… 2015 has come and gone, and 2016 is here. But before we move on, let’s […]

Ending the Quality Wars

Anita Joseph

Quality has been a fraught concept in healthcare for many years. What does “high-quality” healthcare mean? Is it a lower mortality rate? Is it patients being able to get a next-day appointment with a specialist? Is it ensuring patients are satisfied with their hospital stays? A Hospital’s Perspective on Quality For many hospitals, high quality health […]

Apixio’s Top Five Blog Posts of 2015

Jamie Urborg

It’s been a big year for us! We crunched the numbers and found the five most popular blog posts this year. 1.  Top 5 healthcare Podcast Episodes of 2015 2. Quality is both the problem and the solution to our healthcare system’s ills 3. The hidden cost of medical scribes 4. An ICD-10 Holiday Special: When “Ho, […]

Ten ICD-10 Codes that Changed Star Wars

Anita Joseph

Star Wars: The Force Awakens took in a mind-boggling $517 million at the international box office this weekend. Because Star Wars and ICD-10 are both things we at Apixio nerd out about, here are the top ICD-10 diagnoses that changed Star Wars. 1. Revenge of the Sith, Obi-Wan Kenobi Cuts off Darth Vader’s Legs: S88.011A and […]

Quality is Both the Problem and the Solution to Our Healthcare System’s Ills

Mark Scott

It’s a sad paradox that the Unites States leads the world in GDP, scientific discovery, and innovation, but lags in the delivery of healthcare. According to the OECD, the U.S. spends almost twice as much on healthcare delivery than countries like Canada, Germany, Sweden, and the U.K. Despite the 2x spending, the outcomes we achieve […]

Top 5 Healthcare Podcasts of 2015

Anita Joseph

If 2014 was the year of Snapchat and 2013 the year of Instagram, 2015 was the year of the podcast. Podcast are digital audio files that can be downloaded to a computer or smartphone. Everyone from Goldman Sachs to Shaq has a podcast these days, including many notable healthcare organizations. But if you totally missed […]

An ICD-10 Holiday Special: When “Ho, ho, ho!” turns into “Oh, no, no!”

Jamie Urborg

The holiday are upon us, which means gifts, family, friends and plenty of tasty treats. Let’s not forget though that through the rush of preparing and celebrating a number of injuries can occur. To keep you safe through the holidays, keep in mind the following ICD-10 codes. Hanging bright lights on your roof so you […]

The Hidden Cost of Medical Scribes

Anita Joseph

When medical scribes first came to prominence, many in the healthcare community thought they would be a temporary solution. Scribes work alongside physicians and enter necessary information into the electronic medical record (EMR) while physicians work, relieving them of the burden of documentation. The thinking was that as physicians became accustomed to using EMRs they […]

Hats Off to CMS for Considering More Generous Risk Adjustment for Dual Eligibles

Anita Joseph

Last week, the risk adjustment world received promising news from the Centers for Medicare and Medicaid Services (CMS). CMS Underpaying for Some Dual Eligibles Cheri Rice, the Director of the Medicare Plan Payment Group authored a letter revealing that CMS underpays health plans who serve large numbers of “dual eligibles,” or low-income seniors and disabled […]

Understanding Healthcare’s Data Problem: Album Cover Edition

Jamie Urborg

In healthcare, developing strong patient diagnosis and treatment recommendations takes time, resources and data. As patient data grows at an exponential rate, comprising an expected 25,000 petabytes in 2020, healthcare organizations are faced with the challenge of extracting and uncovering the value in their patient information. Unfortunately, 80% of patient data is unstructured in form, and inaccessible without […]

The Data Analyst Will See You Now

Anita Joseph

NPR recently wrote an article about a project NYU medical school students are required to do entitled, “Health Care By the Numbers.” In the project, students are given access to a massive data set with more than 5 million patient records. They are asked to analyze the records to draw conclusions about care quality. The […]

Trick or Trauma – An Apixio Halloween Special

Jamie Urborg

Witches, ghosts and zombies, oh my! The spookiest time of year is just a day away, and we want to make sure you are well prepared for this year’s Halloween celebrations. In helping you avoid any bizarre injuries and potential disasters we’d like to share our unnervingly real 2015 Halloween ICD-10 guide. Here’s a list […]

Understanding Healthcare’s Data Problem: Global Landmarks Edition

Anita Joseph

The U.S. produces over a billion clinical care documents annually, but nearly 80 percent of the data they contain is unstructured and therefore difficult to access, assemble, understand, and use. If we could access and take advantage of this unstructured data, it would be a sea change for healthcare, leading to improved the care delivery, […]

Understanding Healthcare’s Data Problem: How Well Would You Do With 20%?

Jamie Urborg

In healthcare, the information needed to provide high-quality care is difficult to access. In fact, more than 80% of the information about your medical care is written in hospital and physician office records; it is “unstructured” and generally tough to retrieve. This means, doctors often work with incomplete information about their patients when making decisions. […]

Three Reasons Why Diagnosis Codes Should Be the “Single Source of Truth” for ACOs

Anita Joseph

Last week, the Centers for Medicare and Medicaid Services (CMS) announced that it reduced the Medicare Accountable Care Organization (ACO) awards for 65 organizations by $41 million due to poor quality performance. ACOs are groups of doctors and hospitals who are collectively responsible for the quality and cost outcomes of a group of patients. This […]

Risk Adjustment: Healthcare’s Secret Weapon

Mark Scott

Did you know that nearly 60 million Americans are covered by an insurance plan that requires “risk adjustment”? Why is risk adjustment important and how can it drive healthcare to a quality level we expect from consumer products like our smartphones? It’s important first to understand what exactly risk adjustment is. Risk adjustment is used […]

Practice Based Evidence: The Cure to the Ills of Evidence Based Medicine

Darren Schulte, MD

We are at a crossroads in our collective quest to improve healthcare delivery. For decades, thousands of academic studies have been conducted to tell us what might or might not work in patient care. Like clockwork, what was truth yesterday is overturned with the latest study. Women should take estrogen supplements to help prevent chronic […]

10 Jokes Only Data Scientists Will Understand

Jamie Urborg

We’ve crunched the numbers, and from the data we’ve collected, there’s a high probability you will get a laugh (or two!) from our list of 10 jokes data scientists will understand: 1. There are two kinds of data scientists: 1) Those who can extrapolate from incomplete data. 2. In data science, 80 percent of time spent […]

In Case You Missed It…Five Essential Healthcare Tweets From Last Week

Anita Joseph

Did you get busy with work and forget to scan your healthcare Twitter last week? Well, the cheat sheet below should have you covered. Read on to discover what policy experts, writers, and venture capitalists were talking about on the interwebs. Dan Diamond and Bob Kocher disagree over the implication of the Bureau of Labor […]

Why Digital Health Companies Will Fail Without Risk Identification Analytics

Darren Schulte, MD

Payers are the real customers for healthcare technology, and they care about cost. It’s well understood that having great technology is an essential starting point for any tech company. But the companies that ultimately succeed will have also identified and executed a business model on which to achieve strong growth. In healthcare that means having […]

An ICD-10 Guide to Game of Thrones

"Varys"

The sixth season of HBO’s Game of Thrones doesn’t start until April 2016. But rejoice, GoT fans: winter is coming in the form of ICD-10 codes. Tomorrow, U.S. health providers must start using a massive new set of International Classification of Diseases (ICD) codes called ICD-10. These alphanumeric designations are given to every diagnosis and cause of […]

We Don’t Know What We Don’t Know About Your Personal Health…and That’s a Problem

Mark Scott

In the U.S., the Health Story Project has estimated that we produce 1.2 billion documents related to clinical care each year. Big data experts generally agree that 60-80% of the clinical data in those documents can be found in the unstructured annals of patient records and physician encounter notes. I know what you are thinking […]

What’s Wrong With Physician Coding?

Darren Schulte, MD

Today physicians are increasingly dissatisfied with the practice of medicine, especially primary care providers. According to Merritt Hawkins’ 2014 Survey of America’s Physicians, 44% of doctors plan to cut back on patients seen, retire, work part-time, or seek a non-clinical jobs. This comes at exactly the wrong time. It is predicted that we will have […]

A Data Science Defense of ICD-10

John Schneider

This fall, healthcare organizations are going to have to start using a new naming convention for conditions patients have. The current ontology being used in the U.S. is the ninth revision of the International Classification of Diseases (ICD-9), and it’s 40 years old. There is a newer version of ICD codes which is around 20 […]

EQ vs IQ: Cognitive Computing and the Emotive Physician

Anita Joseph

Working at a technology company that has developed a cognitive computing platform, it’s hard to not ponder whether in ten years a computer will have your job. Skills I’ve worked very hard to master, like knowledge accumulation and recall, reading, and analysis are ones that platforms like ours find as easy to complete as setting my […]

Apixio Featured in Forbes

Mark Scott

Today, Apixio was featured in a Forbes article for its role in the transition to ICD-10. Author Robert J. Szczerba discusses anxiety in the healthcare world over ICD-10, writing, “The ‘new’ ICD-10 codes have been in use in much of the developed world for years, however, unlike those countries, the U.S. isn’t paying providers to implement the […]

Mind the Gap: Where Evidence-Based Medicine Fails

Darren Schulte, MD

Evidence-based medicine (EBM) is a popular approach to helping physicians make appropriate care decisions. It has gained tremendous popularity within the medical community; in a 2013 survey, 75% of health system chief medical officers said that EBM had gained some acceptance in their organization. EBM can be a very valuable way to provide treatment guidance […]

10 of the Most Bizarre ICD-10 Codes

Jamie Urborg

The ICD-9 to ICD-10 transition date is looming, and provider offices are cramming to get up to speed on the new code set. It is a struggle because ICD-10 is more complicated and extensive than ICD-9. The number of diagnosis codes in the ICD-10 set is four times larger, about 68,000, up from 14,000 in […]

A Key for Effective Population Management: Use of Proper Risk Adjustment Data

Darren Schulte, MD

The way that America pays for healthcare is changing completely. We are moving away from a “fee-for-service” healthcare system, where clinicians are paid for every service provided, to a “fee for value” one where teams of clinicians are paid to keep individuals healthy in a cost-effective way. Studies have shown that “fee-for-service” payment incentivizes too much […]

Introducing the Apixio Blog

Mark Scott

Today we’re launching our blog! American healthcare is at an important crossroads, and there are no shortage of big problems to solve. How do we represent patients’ clinical lives online with efficiency, accuracy, and security? How will recent moves in the insurance market affect how consumers get care? What is the future of risk-based contracting? […]