Exclusive Interview with the Researcher: Hannah Neprash on Ambient AI Scribes

Exclusive Interview

A new JAMA Health Forum Perspective by Hannah Neprash, PhD, and Paige Nong, PhD,  explores the unintended consequences of the increasing use of ambient scribes for health care billing. Learn more in this exclusive interview with Hannah Neprash. 

Q: How might ambient AI scribes affect overall health care spending?

A: The big hope for ambient AI scribes is that they will reduce the massive documentation burden that clinicians currently face. If successful, ambient scribes may reduce health care spending by reducing burnout-related clinician turnover. However, the ubiquity of billing tools within today's ambient scribe offerings suggests that they may actually increase health care spending. Many ambient scribe vendors purport to enable higher-intensity billing through more complete documentation. Relatedly, some ambient scribes advertise the ability to maximize the number and severity of diagnoses recorded, yielding higher risk-adjusted payments for organizations participating in value-based payment.  

Q: What other unintended consequences are you anticipating from the increased prevalence of AI scribes?

A: It will be really interesting to see what happens to clinician productivity (i.e., visit count). If scribes meaningfully reduce documentation time, clinicians may be able to add additional visits to their schedules. Given the cost of ambient scribes ($300-500 per user per month), organizations may pressure clinicians to increase visits in order to recoup costs. Another unintended consequence could be an erosion of patient trust in clinicians, as surprise bills make health care even less affordable. For example, this could happen if ambient scribes convert preventive visits to problem-based visits - which the patient may not learn about until they see a higher-than-expected bill. 

Q: What should policymakers and health care leaders take away from this analysis? 

A: Given how widespread ambient scribes already are, I'd say this horse is already out of the barn! Policymakers need high-quality evidence about what happens to health care spending after ambient scribe adoption - and whether any increases in spending represent high-value care, upcoding, or something in between. Payers have the tools to combat upcoding, though these can be politically unpopular among clinicians. However, the alternative may be passing spending increases through to consumers and taxpayers.