Less than half of healthcare providers eligible to use the three-day hospital stay waiver available through the Bundled Payments for Care Improvement initiative actually use it, a recent report shows.

The waiver allows hospitals to discharge Medicare beneficiaries to a three-star or higher skilled nursing facility, without the traditional three-day requirement for skilled nursing coverage. 

A late October report on BCPI released by the Centers for Medicare & Medicaid Services and the Lewin Group found healthcare organizations may be hesitant to use the waiver due to concerns about its risks and possible implications for post-acute care utilitzation.

A total of 71 providers — or 62.8% of all organizations in BCPI’s Model 2 — are eligible to use the waiver. But of those just 29 (27.7% of total providers) used the waiver in the third quarter of 2014, the report showed.

The reasons behind the lack of waiver use could be providers’ fears of the “unintended consequence” of driving up skilled nursing utilization for beneficiaries who could be discharged home, the report found. 

Others interviewed for the report said they had “cautious optimism” for the waiver, but were concerned about its implementation, effect on care partners and potential financial risk if used incorrectly.