September 18, 2015 – Addressing Stress BEFORE Doctor Burnout

 Dr. Joseph R. Maldonado Twitter_logo_blue1
September 18, 2015
Volume 15, Number 35

Dear Colleagues:

At our last House of Delegates, Resolution 200 was adopted. It calls for MSSNY to develop programs to “assist Physicians in early identification and management of stress.” The programs should concentrate on the “emotional and psychological aspects of handling stress in our professional and personal lives,” and most importantly, when to seek professional help. Resolution 200 was also adopted at the November AMA meeting.  What are we talking about—stress, anxiety, exhaustion—PHYSICIAN BURNOUT.

Physicians are generally hesitant to share their concerns regarding overloads of stress, depression or anxiety for many obvious reasons—stigma, fear of being perceived as weak or a professional failure.  While help through the Committee on Physician Health (CPH) exists for physicians whose coping skills have failed them deal with these stress, support for the rest of physicians coping sub-optimally is limited or often nonexistent.  Our concern is assisting physicians long before CPH monitoring or intensive treatment is required. We are talking about early intervention in physician burnout and what can be done to avoid it.

Sadly, we have all observed varying degrees of burnout in colleagues.  Its prevalence prompted much interest in the physician community. MSSNY’s Physician Burnout Working Group found 750 journal articles published in the last five years, with 87 published (so far) in 2015! They studied several effective programs, including one from the Canadian Medical Association and a private program in North Carolina that includes self-diagnostic tools and multi-media information and a confidential listserv.

MSSNY is looking at a collaborative approach with specialty societies, insurance carriers and large healthcare associations to address prevention strategies that can offer a helping hand long before burnout occurs. A comprehensive program could also be a valuable member benefit to medical staffs and independent physicians.

We will be seeking outside funding as we specify the scope of this important project. MSSNY’s MESF will also be working this critical area.

If you have a personal story to share about burnout and how you dealt with it, MSSNY would like to hear it. You may be able to assist us in this important project.

As Dr. Frank Dowling, a psychiatrist and Councilor from Suffolk County, and a member of the Working Group, said at the Council meeting yesterday, “If a doctor is not happy, his patients are usually not happy.”

I agree with his expert opinion.


Please send your comments to


Council Meeting Notes: September 17, 2015
Council discussed amended resolution 200, which was adopted at the HOD in May and resolved that MSSNY develop a series of programs to assist physicians in early identification and management of stress and that MSSNY introduce a similar resolution at the 2015 The AMA HOD. The AMA adopted a resolution to support these programs.  After discussion at the 9/17 Council meeting, the following recommendations by the working group were approved: MSSNY Council charges the Task Force, at the discretion of the president, with the responsibility of developing the physician burnout program for Council approval. The second approved recommendation expands the Task Force by inviting representation from all MSSNY district medical societies.

  • Dr. Frank Dowling presented information on the AMA Task Force to Reduce Opioid Abuse, which MSSNY has been involved with since the task force’s inception in November 2014. The task force consists of over 20 national medical specialty organizations and eight state medical societies. The goal is to change the dialogue so that physicians are working together to find solutions to the opioid epidemic. Council approved the goals of the task force and the concept of a media campaign, which MSSNY will implement in conjunction with the AMA.
  • Speaker of the House Dr. Geraci-Ciardullo announced the following dates for 2016:
    March 8-Advocacy Day in Albany (Council meeting will be held March 7)
    March 11-deadline for submission of resolutions (early submission of resolutions is encouraged by February 19)
    April 15-17-HOD in Tarrytown
  • MSSNY has sent a letter to Commissioner Zucker to encourage him to send a “Dear Colleague” letter reminding physicians of the March 27, 2016 e-prescribing mandate date. The letter also urged the publication of the “waiver process” as soon as possible to mitigate the potential influx of a significant number of waiver requests to the department in late March. Additionally, the letter urged Dr. Zucker to grant waivers to physicians who, due to their specialty or the voluntary or part time nature of their work, prescribe less than 25 prescriptions a year.

Members Only: Your Patients Can Save Up to 75% on Prescriptions
With the rising cost of generic and name brand medications, your patients could all use some help these days!  The New York RX Card, MSSNY’s newest Member Benefit, is a 100% Free and 100% confidential point of sale prescription discount card that can save your patients up to 75% on prescription medications!  It is free to everyone with no minimum nor maximum uses, no age or income requirements, no enrollment or approval process and it is accepted at over 68,000 pharmacies, nationwide!

This card will provide you with Rx medication savings of up to 75% at more than 68,000 pharmacies across the country including CVS/pharmacy, Duane Reade, A&P, Hannaford, Kinney, Kmart, Pathmark, Stop and Shop, Target, Tops, Waldbaums, Walgreens, Walmart, Wegmans, and many more. We encourage you to give cards to friends and family members. This card is pre-activated and can be used immediately!

The NYRX Card works on lowest price logic, to guarantee the best prices on medications.  It won’t lower co-pays or replace existing insurance, but in some cases the New York Rx price is even lower than your patients’ co-pay!  It can be used during the deductible periods in Health Savings Accounts and High Deductible Plans, lowering out-of pocket-expense on prescriptions. Medicare Part D recipients can use the card to discount their prescriptions not covered on their plan as well as receive discounts on medications not discounted when in the “donut hole.”

The NYRX Card is pre-activated and ready to go with no personal information taken or given. NYRX will mail as many cards you desire, directly to your office, with display stands. The cards typically are placed at the patient check out area. Some doctors also place them at the check in area. Contact for your cards! 

Concerned about Transition to ICD-10? Website May Be Helpful
The following website should be helpful to any physician or his/her office practice staff that is concerned about the transition from ICD-9 to ICD-10 diagnosis coding: you haven’t done so already before October 1, 2015 either you or your staff should crosswalk 10, 20 or 100 of your most common diagnosis codes that you use in your practice, today. Please be sure that if the ICD-10-CM diagnosis code contains the word left or right in its description, you should still include the LT and/or the RT modifier(s) when submitting your claim(s).  In addition, please be sure that your medical documentation contains the data to support the ICD-10-CM diagnosis/specificity selected. 

Dr. M. Monica Sweeney Named Vice Dean for Global Engagement and Clinical Professor and Chair of Health Policy and Management at SUNY Downstate

  1. Monica Sweeney, MD, MPH, FACP has been appointed vice dean for global engagement and clinical professor and chair of the Department of Health Policy and Management in the School of Public Health at SUNY Downstate Medical Center.

In these positions, Dr. Sweeney will provide leadership for the School of Public Health’s many globally-engaged teaching, service, and research activities both locally and internationally. As chair of the Department of Health Policy and Management, she will lead a department whose student enrollment is among the largest in the School’s five Master of Public Health degree tracks.

Dr. Sweeney’s most recent position was as the assistant commissioner for the Bureau of HIV/AIDS Prevention and Control in the New York City Department of Health and Mental Hygiene. Prior to that time, she served as medical director and vice president for medical affairs at the Bedford Stuyvesant Family Health Center in Brooklyn. Dr. Sweeney is the immediate past chair of the SUNY Downstate Council, and served on the Presidential Advisory Council on HIV/AIDS (PACHA), and as president of the Medical Society of the County of Kings. She has been a member of the board of directors of several prominent organizations, and has served as Co-Chair of the Physician Advisory Council of the New York State Department of Health AIDS Institute, and as President of the Clinical Directors Network.

In the fight against HIV/AIDS, Dr. Sweeney led the New York City Department of Health and Mental Hygiene’s prevention and control efforts for several years. Her service on the Presidential Advisory Council on HIV/AIDS resulted in new initiatives to control the disease globally.

New Dates for NYS Workers’ Comp Board’s District Dialogue Meeting
The New York State Workers’ Compensation Board’s District Dialogue meetings previously scheduled in Brooklyn on 9/22 and Manhattan on 9/23 have been rescheduled in recognition of Yom Kippur.

The new dates and times of the District Dialogues are as follows:

Brooklyn District Office
12:00pm – 1:00pm 
111 Livingston Street
Brooklyn, NY 11201
22nd Floor – Room 1917

Manhattan District Office
12:00pm – 1:00pm
215 West 125th Street
New York, NY 10027
Room 511

We apologize for any inconvenience this may have caused and thank you for your patience and understanding. We hope you are able to attend to hear the latest updates on BPR initiatives and discuss topics of interest to you during the Participant Dialogue Session.

If you have any questions, please contact

Cucumbers Causing Salmonella Poona; Four Cases in NY to Date
CDC, multiple states, and the U.S. Food and Drug Administration(FDA) are investigating a multistate outbreak of Salmonella Poona infections. This investigation is ongoing. CDC will provide updates when more information is available. 418 people infected with the outbreak strains of Salmonella Poona have been reported from 31 states, an increase of 77 cases since the last update on September 9. New York has had 4 reported cases. Epidemiologic, laboratory, and traceback investigations have identified cucumbers imported from Mexico and distributed by Andrew & Williamson Fresh Produce as a likely source of the infections in this outbreak.

Several recalls of cucumbers that may be contaminated with Salmonella have been announced as a result of this investigation. The type of cucumber that has been recalled is often referred to as a “slicer” or “American” cucumber and is dark green in color. Typical length is 7 to 10 inches. In retail locations the cucumbers are typically sold in a bulk display without any individual packaging or plastic wrapping.

Consumers should not eat, restaurants should not serve, and retailers should not sell any of the recalled cucumbers. If you aren’t sure if your cucumbers were recalled, ask the place of purchase or your supplier. When in doubt, don’t eat, sell, or serve them and throw them out.

As of September 15, 2015, a total of 418 people infected with the outbreak strains of Salmonella Poona have been reported from 31 states. Among 290 people with available information, 91 (31%) report being hospitalized. Two deaths have been reported from California (1) and Texas (1). Please see the Timeline for Reporting Cases of Salmonella Infection for more details. 

CMS Releases 2014 QRURs and PQRS Feedback Reports
On September 9, 2015 CMS released the 2014 Quality and Resource Use Reports (QRURs) and 2014 Physician Quality Reporting System (PQRS) Feedback Reports. The 2016 PQRS and Value Modifier (VM) payment adjustments are based on 2014 reporting. For groups with 10 or more PQRS-eligible professionals (EPs) that are subject to the 2016 Value Modifier, the QRUR shows how the VM will affect Medicare’s 2016 payments to physicians. VM cost and quality scores will also be provided in the QRURs for other practices even though they are not yet subject to the VM. If physicians or group practices feel an incentive payment or penalty was performed in error they must file an Informal Review by November 9, 2015.

2014 EHR and QCDR Data Issues

As reported in the September 3, 2015 Advocacy Update Issue, CMS discovered various errors with the  2014 Physician Quality Reporting System (PQRS) data submitted by vendors on behalf of EPs and group practices that reported via electronic health records (EHR) and qualified clinical data registries (QCDR). CMS has stated there will be no need for physicians or group practices to submit a PQRS Informal Review request.

Because of the errors, the EHR and some of the QCDR data is inconsistent. Due to these errors, CMS will not post PQRS performance data for the affected practices on Physician Compare.  However, determination of PQRS and Meaningful Use payment will not be affected because they are based solely on whether the practice successfully reported rather than on their actual performance—simply receiving the data will allow CMS to deem a physician or group practice as successful for purposes of avoiding a payment adjustment in 2016 or for receiving a 2014 incentive.

For the value modifier, which involves calculating actual quality scores in addition to determining whether quality measures were reported, CMS has acknowledged the vendor data errors may create problems. Specifically, CMS will not be able to accurately calculate the PQRS portion of the Quality Composite Score. Instead, the quality score will be based solely on the claims-based outcomes measures and the Consumer Assessment of Healthcare Providers and Systems Survey, if applicable.

2014 PQRS Data Submission Problems

The AMA is aware of instances in 2014 where physicians and practices mistakenly registered for the PQRS group practice reporting option (GPRO) submission mechanism and/or at the last minute their EHR vendor would not support their preferred submission mechanism.  These groups or individuals, will have to file an Informal Review by November 9, 2015. We have been told this only affects a very small percentage of EPs and practices.

How to Access the Reports and File an Informal Review

In order to access the portal to review reports and/or file an Informal Review, an EIDM account is required. CMS transitioned the portal from the Individual Access to CMS Computer Services (IACS) to the Enterprise Identity Management System (EIDM) on July 13, 2015. The IACS system is now retired, but current PQRS and VM IACS users, their data, and roles have moved to EIDM, which is accessible from the portion of the CMS Enterprise Portal at The EIDM system provides a way for business partners to apply for, obtain approval for, and receive a single user ID for accessing multiple CMS applications.

For more information on 2014 feedback reports and how to request them, see: How to Obtain a QRUR. 

MSSNY President Jos. Maldonado MD Receives Hispanic Health Leadership Award
Dr. Maldonado will receive the Hispanic Health Leadership Award from the National Hispanic Health Foundation (NHHF) and the Foundation of the National Hispanic Medical Association (NHMA) on December 3. The award is presented to “outstanding individuals who have served in significant leadership roles and have improved the health of Hispanics and other underserved populations.”

The award will be presented at the 12th Annual Hispanic Health Professional Student Scholarship Gala at the New York Academy of Medicine in New York City in recognition of Dr. Maldonado’s leadership and vision.

The goals of both the NHHF and NHMA are to improve the health of Hispanics and the underserved, to eliminate health disparities, to support Hispanic health services research and to advance culturally competent quality health care and diversity in the workforce. The vision of the NHHF was to develop this scholarship as the nation’s premier fund to encourage Hispanic health professional students complete their career goals.

Since 2005, the NHHF has awarded $585,000 to 175 outstanding Hispanic health professional students throughout the United States for exceptional academic performance, leadership and commitment to the Hispanic community. 

Touro College of Osteopathic Medicine Awarded NAACP Community Service Award
The National Association for the Advancement of Colored People (NAACP) Mid-Manhattan Branch has honored the Touro College of Osteopathic Medicine (TouroCOM) with its distinguished Community Service Award. The award was presented for TouroCOM’s commitment to training osteopathic physicians with an emphasis on practicing medicine in underserved communities and to increasing the number of underrepresented minorities and African Americans in medicine.

TuroPhoto Credit: Hubert Williams: TouroCOM’s Executive Dean Robert Goldberg, DO, surrounded by students, faculty and TouroCOM Community Board Members and partners, accepting the NAACP Mid-Manhattan Branch’s Community Service Award.

“TouroCOM has excelled in its commitment to expanding educational opportunities and careers in medicine, science, research and technology to underrepresented minorities and African Americans while also establishing linkages and programs for elementary and high school youth,” said Geoffrey E. Eaton, president of the NAACP Mid-Manhattan Branch.  “We salute your place in history and trumpet your achievements.”

“This is an award that was earned through the unified efforts of our students, faculty, staff and administration,” said TouroCOM Executive Dean Robert Goldberg, DO.  “It would not have been possible without the wisdom, guidance and support provided by our wonderful community advisory committee, led by Dr. John Palmer.  This recognition proves that with will, determination and fellowship, amazing things can happen!”

Among TouroCOM’s accomplishments noted at the luncheon were its success with MedAchieve, an after-school mentoring program for underserved Harlem high school students interested in medicine; Mentoring in Medicine, another program that brings high school students to TouroCOM’s anatomy labs and inspires them to pursue careers in medicine; and the Fund for Underrepresented Minority Students, which has held successful fundraising events in Harlem to fund scholarships for underrepresented minorities to attend the medical school.

Tourette Association Sponsoring Free Conference for Physicians in Ithaca

The Tourette Association of America / New York Centers of Excellence Consortium in partnership with Weill Cornell Medical College is offering a no-cost medical education conference for physicians and allied health professionals on Saturday, November 14, 8am-1pm Hilton Garden Inn Ithaca—Ithaca, NY. To learn more, visit the Tourette Association website. For questions, email Register here.

The conference will be offered through the Association’s partnership with the CDC, and has been approved for AMA PRA Category 1 Credit(s)TM*. Leaders of the New York Centers of Excellence Consortium have planned a practical update for providers on the recognition, diagnosis, treatment and management of Tourette Syndrome, other tic disorders, and commonly associated conditions (including ADHD and OCD).


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