What is the impact of documentation gaps on risk adjustment and population health reporting?

• A. Gaps can understate ROM/SOI, leading to underestimation of risk and biased population health metrics
• B. Gaps can overstate ROM/SOI, leading to overestimation of risk
• C. Gaps have no impact on risk adjustment
• D. Gaps only affect length of stay

Answer: (A)

Documentation gaps reduce the capture of diagnoses that drive Risk of Mortality and Severity of Illness. ROM and SOI rely on coded conditions to reflect how sick a patient is and how likely they are to have adverse outcomes. When documentation is incomplete, important comorbidities or acute issues may not be coded, leading to lower severity and mortality scores. This undercoding translates into an underestimation of overall risk and produces biased population health metrics that don’t accurately reflect the true mix of illness in the population. While it’s possible to imagine scenarios where documentation would inflate risk, gaps more often depress risk scores rather than raise them. And these gaps affect risk adjustment, not just length of stay, since LOS is influenced by many factors beyond the coded risk.