“Good Enough” Documentation Is No Longer Good Enough 

Hospital margins may appear stable but are expected to be fragile in 2026. Vizient’s New Margin Math shows this stability masks pressures, including rising costs, more complex patients, workforce shortages, payer dynamics, and policy challenges. These factors threaten sustainability without proactive intervention. 

Given today’s rising complexity and costs, settling for “good enough” documentation now translates directly into financial risk and missed strategic opportunities. 

Documentation is no longer routine – it’s a primary driver of operational and financial resilience.  

Why Documentation Matters More Than Ever 

Vizient’s analysis highlights multiple forces reshaping hospital economics in 2026: 

• Higher acuity and utilization: Demographic shifts, especially an aging population, are increasing utilization and clinical complexity, which raises both inpatient and outpatient care needs. 
• Shifting reimbursement mix: Reliance on Medicare, Medicare Advantage (MA), and commercial payer negotiations, along with policy changes like evolving site-neutral payments and expiring subsidies, has increased reimbursement volatility. 
• Rising non-labor costs and workforce constraints: Labor costs remain high, supply and specialty drug costs outpace reimbursement growth, and workforce shortages strain capacity. 
• AI and technology can reduce waste, but only if workflows are redesigned rather than added to existing processes. 

Lapses in accurately capturing severity, risk, and interventions do more than just threaten coding and revenue; they undermine a hospital’s overall strategy for surviving industry headwinds. 

Accurate coding starts with documentation that captures patient acuity and clinical complexity, including not only the principal diagnosis but also all relevant comorbidities, complications, and interventions that affect resource use and reimbursement. 

With rising acuity and reimbursement pressures, incomplete documentation risks revenue losses tied to care intensity. Precision coding supports revenue integrity. 

Documentation must be prospective, not retrospective. It must anticipate payer’s expectations and denial triggers before submitting a claim. Real-time clinical documentation integrity, integrated with care teams, ensures clarity at the point of care.

This means switching from reactive to proactive workflows. CDI specialists should engage during care, not after discharge. 

• Implement triggers and alerts to identify ambiguous, missing, or insufficient documentation as cases progress. 
• Provide educational opportunities that enable clinical teams to use coding language effectively without compromising clinical judgment. 

Post-discharge reviews, algorithms, and AI are no match for complete, accurate, and consistent documentation during the patient’s admission. While payers can enhance their audit strategies and tools, they cannot erase or modify our real-time documentation once the record is solidified. 

Vizient’s analysis shows that technology, especially AI-assisted tools, reduces administrative burden and waste when integrated with redesigned workflows for clinicians and revenue teams. 

This means: 

• Add intelligent automation to routine documentation, like drafting clinical summaries or structured data, to reduce burden and improve consistency. 
• Integrate real-time feedback among EHRs, CDI, and coding systems to find gaps early, not later. 
• Align documentation tools with data goals to ensure analytics reflect clinical realities and support insights. 

Without a tech foundation, documentation is siloed, inconsistent, and error prone.  

Are Your Current Documentation Efforts Future-Ready? 

The trends Vizient highlights, fragile margins, rising acuity, and shifting payer pressures, are realities shaping executive priorities across health systems. 

Documentation must move beyond compliance and serve as a lever for financial and operational success, shaping organizational adaptability in a changing environment. 

As a Physician Advisor, my charge is clear: documentation must amplify the true clinical story, comprehensively and precisely, to protect financial sustainability in 2026 and beyond. 

• Precision in coding ensures accurate acuity capture and protects reimbursement. 
• Complete, accurate, real-time documentation is the strongest defense against evolving payer audits, serving as an “insurance policy” that prevents denials and strengthens revenue integrity.
• Effective tech integrations improve efficiency and reduces documentation errors and waste.

Review your organization’s current documentation practices now. Identify gaps, set measurable improvement goals, and develop a targeted action plan to align documentation strategy with anticipated financial and clinical challenges. Assign dedicated leadership to oversee progress and routinely measure results to ensure sustainable margin resilience in today’s evolving healthcare landscape.