Journal of the American Medical Directors Association
Original StudyWhat Factors Contribute to Successful Appeals of Nursing Homes' Deficiencies in the Informal Dispute Resolution Process?
Section snippets
Data
We obtained CMS data about all IDR requests submitted between 2005 and 2008 by all nursing homes in the United States. The data included facility identifiers, the original deficiency (or tag) being disputed, its scope and severity, and the outcome of the IDR. The scope of the deficiency refers to the number of residents affected by it, and the severity refers to the degree of harm inflicted. The outcome of the IDR could have been one of the following: complete removal of the deficiency, scope
Results
Table 1 lists descriptive statistics for the sample. The average nursing home requested an IDR for 3.81 deficiencies during the 4 years we studied. It succeeded (namely, the deficiency was either completely removed or its severity and scope reduced) in 26.4% of appeals.
Table 2 presents the results of the multivariate analysis. Odds ratio (OR) for dichotomous variables compare the odds for the indicated category with the odds of a reference category (eg, nonprofit facility with the reference of
Discussion
The IDR is a relatively new policy initiative implemented by CMS to streamline the process that nursing homes can use if they choose to appeal deficiencies issued by state surveyors. Little is known about how it works. A previous study5 examined nursing homes' decisions about whether to avail themselves of this mechanism. In this article, we examine what influences their success, once the IDR has been requested.
We observe an overall success rate of 26%. Absent a gold standard against which to
Conclusions
Whether a 26% success rate overall is reasonable is a matter of judgment. Some may view it as indicative of responsiveness to the concerns of nursing homes. Advocates10 have raised concerns that the IDR process further weakens a regulatory process that has been criticized by the General Accounting Office as inadequate to ensure adequate levels of quality.11, 12, 13, 14, 15 Others, in contrast, may argue that overturning a quarter of the deficiencies is a high rate, raising questions about the
Acknowledgments
We acknowledge the State Directors of Licensing and Certification offices for insightful comments.
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Cited by (0)
This work was funded by the National Institutes of Aging Grant AG027420.
The authors declare no conflicts of interest.