In 1990 the heavy metal band Queensryche asked its listeners, “Is there anybody listening?”, a lament for not being heard in a world of overstimulation, noise and artificially.

In healthcare in 2025, the answer is yes: someone is listening. But the listener just might be a machine.

Ambient AI is one of the most promising applications of the recent AI wave, in my opinion anyway and possibly that of my guest, Dr. David Canes. Dr. Canes is a Boston-area urologist, owner of WellPrept, and a self-described tech enthusiast.

Recently David put out the YouTube video 11 Ways to Use AI In Your Practice Right Now, which I link to in the show notes. But he’s also the author of “Why AI scribes are changing medicine and the risks you must know.” I’d describe him as an early adopter and enthusiast but with his eyes open to potential shortcomings.

We cover the pros and cons of ambient AI and other forms of AI, and how it is impacting documentation, coding, and the revenue cycle, on this episode of Off the Record. We discuss:

• David’s path into medicine and ultimately urology

• Why he chose to adopt a positive mindset in the use of new technologies rather than fear or resistance

• Ambient AI: How it operates and what a patient encounter looks like using this tech, start to finish

• Positive impacts on provider burnout, charting, E/M professional billing, and CPT

• Cons of the new tech, including hallucinated answers and inaccurate summaries

• Use of generative AI large language models in patient diagnosis

Show notes

• Why AI scribes are changing medicine and the hidden risks you must know: https://kevinmd.com/2025/02/why-ai-scribes-are-changing-medicine-and-the-hidden-risks-you-must-know.html
• 11 Ways to Use AI in Your Practice Right Now: https://www.youtube.com/watch?v=OJLqIU2nbzc

Regular listeners of Off the Record will recall Keisha Wilson, whom I hosted on the program in June 2024 to talk about telehealth as well as her story of entrepreneurship. She was a bright light and a great guest, so I asked her to return to the show a couple months ago.

Keisha accepted, and is here today, but it’s a near miracle.

Eight months ago Keisha suffered an unimaginable tragedy, the loss of her home following a gas explosion and subsequent fire at a neighbor’s home. This included the loss of essentially all but a small handful of her worldly possessions.

Somehow she’s kept her business afloat and managed to stay on top of the many changes in telehealth, SDOH, and more, and even present on these topics at the recent AAPC Healthcon. It felt a bit odd to pivot to these topics but you’d be hard-pressed to find someone more in the know and ready to educate about telehealth and medical coding than Keisha.

Pretty inspiring stuff, and we get into all of it on the program. We discuss:

• The house fire: How it happened, fallout, and dramatic life impacts on Keisha and her mother

• Keisha’s personal experience with social determinants of health (SDOH) including housing instability and food insecurity after the catastrophic loss

• Finding new levels of resiliency and using the experience to fuel her AAPC presentation

• Congress’ extension of telehealth flexibilities through Sept. 30, 2025: What they are, what it means

• How healthcare organizations should be leveraging telehealth in coding and mid-revenue cycle practice

• Telehealth as a tool to address and improve SDOH (medication adherence, transportation and patient scheduling)

• Impact on billing—did you know that moderate medical decision making can be met due to diagnosis or treatment significantly limited by SDOH?

• What’s next for Keisha including the search for a new permanent home—and of course her selection for the Off the Record Spotify playlist.

Show notes

• News coverage of the explosion: https://abc7ny.com/post/crews-responding-explosion-basement-residence-brooklyn-injuries-reported/15245371/
• Keisha’s telehealth e-guide available for purchase (website includes free downloadable resources as well): h⁠ttps://kwadvancedconsulting.com/e-guides/⁠

I’m recently back from the 2025 ACDIS national conference, and as usual flush with the latest in CDI trends, education, and breaking news. And right at the top of my takeaways is a seemingly innocuous classification with big ramifications: admit type.

What makes this a big deal? Some hospitals appear to be playing a bit fast and loose with guidance from the National Uniform Billing Committee (NUBC) in order to classify surgical admits as “urgent” rather than the more accurate “elective.” Doing so removes them from certain PSIs that negatively impact quality metrics and indirect revenue.

My guest is Penny Jefferson, manager of clinical documentation integrity at UC Davis Health. Penny co-presented the session with Cheryl Ericson at the ACDIS conference. On this show we discuss:

• What is admit type, why is it important, and common misunderstandings (admit type is very different than admit status--IP/OP/observation)

• Who is the NUBC, and what are the current rules as they stand around elective, urgent, and emergent?

• Compelling data—deidentified, but real—presented at ACDIS that shows what appears to be clear gaming by some healthcare organizations of the assignment of admit type, specifically opting for urgent over elective

• The dramatic impact this seemingly small change can have on quality scores: Reclassifying an elective procedure as urgent effectively circumvents PSI exclusions, allowing the case to be excluded from elective-only quality measures, such as PSI 10, 11, or 13.

• Possible solutions including Penny’s ongoing work with the NUBC and request for additional rigor

• Optimal way to ensure admit type accuracy in the current climate, from use of coding or CDI staff to additional training for admission staff

• Why is her boss Tami Gomez so awesome, and Penny’s selection for the Off the Record Spotify playlist

For additional reading

• Inconsistent ‘Admit Type’ Reporting May Inflate Hospital Quality Scores, by Nina Youngstrom/Report on Medicare Compliance: https://compliancecosmos.org/inconsistent-admit-type-reporting-may-inflate-hospital-quality-scores