MD Anderson Cancer Center lost another $58 million in December, a continuation of mounting operational deficits that caused it to slash its payroll by about 5 percent last month.

The December loss brings the cancer center's operating deficit to nearly $170 million four months into its fiscal year 2017, well above the $21.4 million shortfall that leaders projected for the September-December period in the budget approved in August. The four-month loss followed a $266 million loss in fiscal year 2016.

"There are always monthly fluctuations, especially in December," said Dan Fontaine, MD Anderson's chief financial officer and executive vice president of administration. "We're not yet seeing the appropriate balance of revenue and expenses, but hopefully we'll see the benefits of the cost-saving steps we've taken, including the workforce reduction and attrition, as we move into the spring."

Fontaine acknowledged this week that MD Anderson would need to do something more to reduce expenses if revenues don't recover, but said that "at this point in time there are no plans for a second workforce reduction."

The world-renowned cancer center announced in early January it was cutting roughly 1,000 jobs, 778 of them by layoffs, the rest through attrition. They said the cuts would save the institution about $120 million - a little more than it lost in the first quarter of the new fiscal year.

MD Anderson leaders at that announcement attributed the financial difficulties mostly to the launch of a new electronic record-keeping system, launched in March, whose steep learning curve has been known to hurt productivity. But they said those issues were largely behind them, characterizing the cancer center as "95 percent up to speed" now. They noted that the operating losses declined to $9 million in November from $41.5 million in September and $60.9 million in October.

December's spike suggests MD Anderson's financial woes are rooted deeper, said Vivian Ho, a health care economist at Rice University.

"It's going to be very challenging for MD Anderson to address all the factors," Ho said. "It's the introduction of electronic medical records; it's insurance providers pushing them out of networks because their prices are so high; it's the movement toward higher deductibles and out-of-pocket costs causing patients to go elsewhere; it's the slowdown in the Houston economy leading to fewer people with rich insurance and employers deciding to cut on their health care benefits."

Dr. Thomas Buchholz, MD Anderson's physician-in-chief, said the changing health care landscape is definitely causing much of the cancer center's financial difficulties. He said insurers often don't cover cancer treatment after MD Anderson doctors provide it and that higher deductibles and co-pays are increasing the hospital's bad debt. He also said that more patients are going to the elite cancer hospital for an initial diagnosis, then closer to home for treatment, where the greatest revenue is generated.

But MD Anderson officials acknowledged those trends don't explain December's $58 million loss since they've been occurring since well before then. They also said the new electronic record-keeping system is no longer a major contributor to the deficit.

December is considered a slow month in health care, particularly cancer, because many patients delay appointments until the holiday season is over. But MD Anderson's financial records show that December's gross patient revenues represented a slight increase over November's numbers and that its overall operating losses in the Decembers of 2013, 2014 and 2015 averaged only less than $2 million.

The 2017 budget anticipated a $3 million positive margin for December.

Fontaine downplayed the December losses, arguing that it's not uncommon for one month to be out of whack because insurer reimbursements can fluctuate depending on that month's types of insurance billed and the coverage provided for certain treatments. He emphasized he is more interested in trends evident over a number of months.

"I certainly hope December is the outlier, not November," Fontaine said. "January through March will give me a better feel. In today's day and age, I don't like calling numbers until I see them, but there's been more patient activity every January I have been here. I have the sense that was the case this January, too."

Though operating losses are an important indicator of a hospital's health, MD Anderson is still in the black overall, thanks to other revenue streams, such as state funding and philanthropy. Following the layoffs, it now has 19,830 employees.