Should We Accept This Resident? A Governed Admission Decision
An accept-or-decline decision should be assembled from nine governed inputs — clinical fit, staffing capacity, incremental labor cost, payer economics, comparable historical outcomes, current census, building capability, regulatory constraints, and expected contribution margin — each traceable to a named authoritative source and time-stamped at the moment of decision. Regulatory and capability constraints act as hard gates. The remaining inputs produce a recommendation with its exceptions named; a human accepts or declines, and the record retains who decided, on what, and when.
Exception flags
An exception that is not named is an exception that becomes a variance nobody can explain a quarter later. Each flag below stays attached to the decision record.
Closing the loop
The decision is only half of the record. After discharge, actual reimbursement, actual labor, actual length of stay, denials and readmission are reconciled against the pre-admission expectation in the same definitions — per field, with lineage. Governance first. Intelligence second. Execution last.
https://seniorcre.com/resident-lifecycle-record/admission-decision