Informal Dispute Resolution

I recently received a call from a Director of Nursing asking for advice. She had just had a state survey and thought she understood the outcome when the survey team left her facility. However, when the Statement of Deficiency arrived, the outcome had changed and she disagreed with the findings. The Director of Nursing wanted to know what course of action the facility could take and I recommended the facility may want to consider an Informal Dispute Resolution, or IDR.

The Director stated that she and her administrator had discussed this, but were concerned there could be a chance of retribution or retaliation if they used the IDR process. I told her that the intent of an IDR is to give the provider an opportunity to present their concerns in a fair, consistent and straightforward manner.

The IDR process was developed with the expectation that all parties will act in good faith, treat others with respect and professionalism and recognize that there will be issues of honest disagreement.

As a former Director of Nursing, I understood how she felt. First she should review the Statement of Deficiency to determine if the issued citation was accurate and if the citation details, scope, severity and tags were issued correctly. Also, if there is new information that could be provided to the survey team, the process of IDR requires a new look at disputed citations. It is important to note that the IDR process does not alter or delay the required timetables associated with licensure, certification termination or other adverse action.

The goals of an IDR are to ensure that the Statement of Deficiency and the federal and state data systems accurately identify a provider’s state of compliance relative to the regulations and to resolve differences:

• Outside of formal litigation, thereby avoiding the costs of protracted litigation
• In a timely manner, while the issues and facts are still fresh
• Prior to the entry of the survey results in the federal data system

IDR is a singular opportunity to refute a deficiency for:

• A federal or state survey
• A complaint investigation
• A follow-up survey /revisit

The IDR process may not be used to:

• Delay the formal imposition of remedies
• Challenge revised deficiencies that result from the IDR process
• Challenge any other aspect of the survey process including:
• Scope and severity assessments or deficiencies with the exception of scope and severity assessments that constitute substandard quality of care or immediate jeopardy
• Remedy or remedies imposed by the enforcing agency
• Alleged failure of the survey team to comply with a requirement of the survey process
• Alleged inconsistency of the survey team in citing deficiencies among facilities
• Alleged inadequacy of the informal dispute resolution process

How do you request an IDR?

All requests for an IDR must be made in writing and submitted to your state’s Department of Health. Time is important. A request for an IDR must be made within the 10-day calendar period allotted for submitting an acceptable plan of correction or within the 10 calendar days after the receipt of a state licensing order.

The IDR process itself can be conducted in writing, by telephone or in person.

The request should include the type of meeting requested, how many people will attend from the facility and whether you are going to have an attorney present who will participate in a face to face meeting or telephone conference.

Now the work begins!

A sole statement of disagreement is not sufficient to remove a deficiency. Explain in your written request for an IDR the specific deficiencies under dispute, give a brief explanation of why the deficiency is considered to be invalid and provide documentation supporting why the deficiency is considered invalid. Be sure to include reasons why this information was not available at the time of survey or investigation.

Careful preparation is important.

Preparation for an IDR will require organization and attention to detail on your part. Your packet must include fully completed forms and complete, relevant supporting documentation. You will have only an hour to meet with a reviewer, so you must be very well-prepared.

About the author

Elizabeth Brunner, RN, BS, NHA, is the Vice President of Development for Pathway Health Services. She has worked in skilled nursing and senior care management for more than 30 years. She has been a Director of Nursing for seventeen years, a nursing home administrator and a corporate consultant.

Check our website at www.pathwayhealth.com for a more complete set of tips, recommendations and a flow chart about how to make sure your IDR results in the outcome you want. For assistance with the IDR process, survey prep or managing your survey contact us at consult@pathwayhealth.com or 1-877-777-5463.