It’s called an IDR – Informal Dispute Resolution, or IDR. And it’s one of the many services we provide at Primaris. Episode 55 is a detailed look at the IDR background and process with Carmen Woodward, Primaris senior program manager, and Quality Talk host, Jodie Jackson Jr.
Missouri nursing homes have an opportunity, under state law, to refute citations issued by the state Department of Health and Senior Services. And that’s where Primaris comes in, as the state’s contractor for Informal Dispute Resolution.
On to Episode 55.
1:46 – Carmen’s background: Nursing, providing care in nursing homes, physical therapy, also and LPN, RN, wound care nurse, assistant director of nursing, and long-term care surveyor with the Missouri Department of Health and Senior Services.
Since July 2011, Primaris has held the state contract as the IDR service provider.
5:07 – Carmen describes the IDR process and the things a surveyor looks for and can note on a statement of deficiency: prevention/treatment of pressure ulcers (bed sores), foot care, resident rights, and more.
If a long-term care facility receives a statement of deficiency (SOD), staff can contact Primaris directly to schedule a conference to review the deficiency. The timeframe: The facility must contact Primaris within 10 calendar days from receiving the SOD to request an IDR. Primaris then schedules a conference within 10 working days, unless facility requests extension, then has 10 days after the conference to write a formal recommendation to DHSS.
Why don’t facilities request an IDR?
8:17 - Carmen: “We hear a misconception that there’s a fee or cost involved in requesting IDR with Primaris.” But the only cost to the facility is their own travel and time for the conference. Or if the f facility chooses its own legal representation, that cost is borne by the facility. There’s also a fear of retaliation. Mostly, they feel that they don’t have the time.
The SOD is a public document that is posted on the Medicare.gov website, called Nursing Home Compare, the federal, five-star rating system for nursing homes. Consumers can look at that rating to determine which one to use. Staffing, quality of care, and inspections are all calculated in scoring method. If something isn’t accurate, “you have nothing to lose by disputing that, because that could be overturned.”
'Other positive outcomes.'
Carmen: “There are also other positive outcomes.” Depending on the scope and severity of a deficiency – the level of harm or an allegation of a pattern throughout the nursing home – “that can also be lowered, which can help the nursing home as a result of IDR.”
13:22 – Primaris has a 20 to 25 percent recommended overturn rate. DHSS has agreed 95 percent of the time. The Statement of Deficiency is public record, but the IDR process and records are not.
17:27 – Both parties – facility representatives and the state surveyor - are invited to participate in a “sharing of information,” an informal setting, in a telephonic conference or in-person at Primaris.
Primaris provides IDR services to Missouri nursing homes as a subcontractor to the federally-designated Quality Improvement Organization for Missouri, the TMF Quality Innovation Network-Quality Improvement Organization (QIN-QIO).