UCSF

Objectives

To determine what factors contribute to successful appeals of nursing home deficiencies in the Informal Dispute Resolution (IDR) process.

Design

We merged Centers for Medicare and Medicaid Services' data about IDRs with Online Survey, Certification, and Reporting data about nursing home characteristics. We performed multivariate statistical analyses to predict successful appeals as a function of characteristics of the deficiency being appealed, the survey that triggered the deficiency, characteristics of the nursing home, and the state.

Setting

All nursing homes nationally in the period 2005-2008.

Measurements

Successful appeals were defined as those in which the deficiency was removed or its severity or scope reduced. Independent variables included the Centers for Medicare and Medicaid Services' measures of severity and scope of deficiency, abuse and neglect, substandard care, total number of deficiencies in the survey, whether the IDR was triggered by a survey or complaint, facility ownership and reputation, and state stringency of regulation.

Results

Twenty-six percent of submitted IDRs were successful in 2005-2008. Success was more likely for less severe deficiencies, when deficiencies were triggered by a survey rather than a complaint, and when fewer deficiencies were included in the appeal. Facility ownership and state stringency of regulation were not significantly associated with the IDR success.

Discussion

Overall, 2.6% of deficiencies issued were overturned through the IDR process. Further study is required to determine the appropriateness of these overturned cases and the opportunities they offer to improve the survey process.