Daniel Flora, Medical Oncologist and Medical Director of Oncology Research at St. Elizabeth Healthcare, shared a post on Substack:
“The 14-Day Rule: When Bureaucracy Delays Cancer Care
There’s a Medicare rule that makes no sense in modern oncology.
If a patient is hospitalized and a biopsy is done, we cannot order molecular testing until 14 days after discharge because Medicare will not cover it.
That means a patient with newly diagnosed cancer, still recovering from surgery or biopsy, has to wait two weeks before we can even start the process of identifying targetable mutations. By the time the test is ordered and the results come back, treatment can be delayed by a month or more.
This policy was written decades ago to prevent duplicate billing, long before next-generation sequencing even existed. Today it only hurts patients. Most hospitals are not equipped to bill for these tests, so nothing gets ordered.
Cancer does not wait 30 days. Neither should we.
It is time for CMS and our professional societies to fix this outdated rule and allow oncologists to order the tests our patients need, when they need them.”
More posts featuring Daniel Flora.