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82 CFO / FINANCE MD Anderson Points to Epic Implementation for 77% Drop in Adjusted Income By Akanksha Jayanthi H ouston-based MD Anderson Cancer Center reported a 76.9 percent drop in ad- justed income for the 10 months ended June 30, a downfall it largely attributes to its Epic EHR implemen- tation project. In its agenda book and schedule of events for the University of Texas board of regents' meeting held in August, the health system reported a $405 million decrease in adjusted in- come as compared to the same time period the previous year. "The $405.0 million (76.9 percent) de- crease in adjusted income…was pri- marily attributable to an increase in expenses combined with a decrease in patient revenues as a result of the implementation of the new Epic Elec- tronic Health Record system," accord- ing to the agenda book. The finance committee indicated ex- penses had increased due to a high- er number of full-time employees, which required increased salaries, wages and payroll-related costs; sal- ary increases and increased premi- um sharing rates; depreciation and amortization expenses related to the completion of several large projects; and other facility management and software projects. Additionally, the agenda mentions an increase in consulting expenses "pri- marily related" to its Epic go-live, such as professional fees and services. This isn't the first time MD Ander- son has pointed to its Epic imple- mentation project as a significant element of downward finances. In a May board of regents' meeting, the health system said costs related to the Epic implementation led to a 56.6 percent drop in adjusted in- come in the seven-month period that ended March 31. In both instances, the health system said it anticipated a "material impact to revenues and expenses" due to the implementation. "The post implementation strategy will focus on clinical productivity and operational efficiencies to return to normalized operations by year-end," according to the report. MD Anderson went live on its Epic EHR in March. n Baystate Health System to Lay Off 300 Employees By Tamara Rosin S pringfield, Mass.-based Baystate Health will lay off roughly 300 people as a result of a projected $75 million budget shortfall, according to the Boston Business Journal. The reduction, which will eliminate approximately $40 million in ex- penses, represents 2.4 percent of Baystate's 12,500-person workforce, according to the report. The health system will still face a $15 million budget gap after the layoffs. "We'll continue our work to address this gap and do all we can to pre- serve jobs," Mark A. Keroack, MD, president and CEO of Baystate Health, said in a press release, ac- cording to the report. Baystate's budget shortfall is mul- tifactoral, with causes including lowered reimbursement from Med- icaid and a math error caused by Boston-based Partners HealthCare, which will lead to Baystate losing $23 million in Medicare payments from the federal government, ac- cording to the report. n Why Billing After Death Is Complicated By Kelly Gooch D eath is inevitable. However, the ad- ministrative aspects of dying — bill- ing for appropriate services aer the date of death, trying to correct an incorrect date of death or trying to prove that claims of one's death were premature — can be more complicated than people realize, said Ronald Hirsch, MD, vice president of the Regulations and Education Group at Accretive Health's Accretive Physician Advisory Services. Dr. Hirsch recently made this statement while discussing the topic in an RAC Monitor report. Below are two examples he offered of the complications involved aer death. Dr. Hirsch recalled an incident in which a hospitalized patient improved and was dis- charged with home health services. He said in the report that the home care agency ini- tiated a plan of care. e patient died a week later. When he submitted a claim, indicating the date of service as the date that he reviewed and signed a copy of the plan of care for that patient, it was denied, along with a notation that the patient was dead on that date of ser- vice, the physician said. "It is true, but billing rules required that I billed with the date I ac- tually reviewed and signed the form, not the date on which the care plan was developed," he wrote. Dr. Hirsch also referenced a similar dilemma in which an unnamed hospital indicated they had difficulty with their Medicare Adminis- trative Contractor. He said in the report that the hospital had processed a claim associated with a patient who died at their facility, but the funeral home listed an incorrect date of death on the death certificate. e claim was denied because the hospital did not have the correct information. "e funeral home cor- rected the death certificate, the MAC updated its system and the Social Security office up- dated. But the claim is still not being approved for payment because the Medicare common working file had not been updated. Accord- ing to the MAC and the Social Security office, this can only be done via a family member re- questing the correction," Dr. Hirsch wrote. n