Informal Dispute Resolution Process for Nursing Homes' Appeals of Deficiency Citations

Nursing-homes are inspected annually by states and those not meeting minimum quality standards are cited for deficiencies. They can appeal these citations through the Informal Dispute Resolution (IDR) process, a precursor to a more costly, formal appeal. There are no studies examining the use of IDRs by nursing-homes. This study was designed to determine what influences nursing-homes' decisions to submit an IDR. OSCAR data on102,962 deficiency citations for 15,918 nursing homes nationally in 2005-2008 were merged with information about their IDR submissions, facility, markets and state characteristics. We estimated random effect a logistic model predicting whether a deficiency citation is appealed or not. The average nursing-home submitted 0.9 IDRs. Nursing-homes were more likely to appeal citations resulting from the annual survey than from resident complaints (OR=1.16), and more likely to appeal severe deficiencies (G level or above OR=1.58; abuse and neglect (OR=1.11). They were more likely to appeal if they were in a more competitive market (OR=1.08) or a market of higher socio-economic characteristics, suggesting more demand for higher quality (OR=1.05 for $10,000 increase in median income and OR=1.02 for 1% increase in high school graduates). Non-profit (OR=0.83) and Government (OR=0.69) nursing homes were less likely to appeal than for-profit.