Nursing homes appeals of deficiencies: the informal dispute resolution process.

Objective: Nursing homes that are not meeting quality standards are cited for deficiencies. Before 1995, the only recourse for a nursing home was a formal appeal process, which is lengthy and costly. In 1995, the Centers for Medicare & Medicaid Services instituted the Informal Dispute Resolution (IDR) process. This study presents for the first time national statistics about the IDR process and an analysis of the factors that influence nursing homes' decisions to request an IDR.

Design: Retrospective study including descriptive statistics and multivariate logistic hierarchical models.

Setting: US nursing homes from 2005 to 2008.

Participants: Participants were 15,916 Medicaid- and Medicare-certified nursing homes nationally, with 94,188 surveys and 9388 IDRs.

Measures: The unit of observation was an annual survey or a complaint survey that generated at least one deficiency. The dependent variable was dichotomous and indicated whether the annual or a complaint survey triggered an IDR request. Independent variables included characteristics of the nursing home, the deficiency, the market, and the state regulatory environment.

Results: Ten percent of all annual surveys and complaint surveys resulted in IDRs. There was substantial variation across states, which persisted over time. Multivariate results suggest that nursing homes' decisions to request an IDR depend on their assessment of the probability of success and assessment of the benefits of the submission.

Conclusions: Nursing homes avail themselves of the IDR process. Their propensity to do so depends on a number of factors, including the state regulatory system and the market environment in which they operate.