MEDICAL SOCIETY OF THE STATE OF NEW YORK

NEWS OF NEW YORKProv id ing In format ion to Ass i s t Phys i c ians in the State o f New York

InsIde newsClICk ICons to follow MssnY on

faCebook or twItter.

Volume 73 • Number 10 www.mssny.org November 2017

New Medicare cards will be issued in April of 2018 ..................page 2

Are you following us on Twitter & action alerts?..................page 4

Why I am a member of MSSNY- Spotlight Erik Eiting ..........page 7

MSSNY Stress and Burnout Task Force: Solutions ..................page 8

Patient Survey: 95% Satisfied But Want More Time with You

A new patient survey of more than 1,700 U.S. adults found that 95 percent are currently satisfied with their pri-mary care physician, but only 11 percent feel they have enough time with their physicians. That time is crucial to many consumers who have an even bigger concern – cost. Eighty nine percent are fearful that the rising cost of health-care will adversely impact them in the future. Specifically, over half (56 percent) of patients say the cost of prescrip-tion drugs and pharmaceuticals directly contributes to rising healthcare costs.

The Physicians Foundation revealed the results of its second biennial patient survey aimed at gaining a better understanding of how Americans are feeling when they step out of the doctor’s office. The survey gathered responses from a statistically significant national sample of 1,747 U.S. adults between the ages of 27 and 75 who had two vis-its with the same doctor in the past year. Conducted by Regina Corso Consulting in June 2017 on behalf of the Physicians Foundation, a number of the questions from the survey corresponded with similar questions from the Foundation’s 2016 Biennial Physician Survey, in order to compare patients’ and physicians’ outlook on the healthcare landscape.

If a child came to you for career advice and said they wanted to become a physician, would you…?

45%41%

10%4%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Stronglyencourage them

Somewhatencourage them

Somewhatdiscourage them

Stronglydiscourage them

Among physicians, just half (51%) would recommend medicine as a career to their children or other young people.

(Continued on page 6)

Sign Up To Become a Physician Advocacy Liaison Today

Your participation is essential to continue a strong grassroots effort to address all of the issues facing phy-sicians. We encourage you to remain active and reach out to your elected officials to make sure our voices and health care expertise are heard.

PAL responsibilities include:• Educating other members on issues facing physicians,

such as at local county medical society or medical staff meetings

MSSNY’s 2017 Legislative Summary Now Available Online

Many of you are aware that a statute of limitations expansion bill (S.6800/A.8516) passed over the strong objections of MSSNY, the specialty societies, the hos-pital industry and MLMIC. However, working together with specialty societies and other health care advocacy groups, MSSNY was successful in advocating for several public health bills passed both houses.

Moreover, MSSNY’s advocacy together with its allies resulted in scores of adverse bills being rejected by the New York State Legislature and included those that would have expanded the scope of practice for various profes-sions and those that would have imposed unworkable mandates on physician delivery of patient care.

Please click here to see our 2017 legislative summary.

Urge Congress to Extend CHIP Funding: Contact your Federal Legislators TodayOver 350,000 New York Children are covered through

its Child Insurance Program, which receives a substantial portion of its funding from Congress. However, the autho-rization to provide funding to the states for this essential program expired on September 30. While the Senate and House have each advanced separate bills to continue this program, an agreement remains elusive.

Governor Cuomo warned that inaction by Congress has jeopardized health care for the 350,000 New York children covered under the program and urged an extension of Child Health Funding. MSSNY and other Health Provider groups

(Continued on page 10)

(Continued on page 14)

Page 2 • MSSNY’s News of New York • November 2017 November 2017 • MSSNY’s News of New York • Page 3

THERE’S A REASON DR. STIEFEL IS SO SUCCESSFUL. HE’S GOT 3,500 PEOPLE WORKING FOR HIM.When we work as one, staying independent is a healthy option. Work as one

To learn more about athenahealth’s solutions please visit athenahealth.com/mssnyprint

Governor Andrew Cuomo recently announced a series of actions to combat the fentanyl crisis in communities across New York State. Specifically, the Governor is proposing legislation to add 11 fentanyl analogs to the state controlled substances schedule. Moreover, the NY Department of Financial Services issued a circular letter to advise health insurers against placing arbitrary limits on the number of naloxone doses covered by an insurance plan

The press release noted that, while overdose deaths involv-ing opioids in New York increased nearly 35% between 2015 and 2016, fentanyl-related deaths increased nearly 160%. The release further noted that while Fentanyl proper is a Schedule II synthetic opiate, underground labs have tweaked the molecu-lar structure of fentanyl to create new, unregulated chemicals referred to as fentanyl analogs. These deadly cousins are chem-ically similar to fentanyl – and often many times more potent – but are not listed on New York State’s schedule of controlled substances, and therefore not subject to the same criminal penalties.

In response, the legislation proposes to add the following 11 fentanyl analogs to Schedule I of the controlled substance sched-ules of New York State Public Health Law §3306: AH-7921; Acetyl Fentanyl; Butyryl Fentanyl; Beta-Hydroxythiofentanyl; Furanyl Fentanyl; U-47700; and Acryl Fentanyl (or Acryloylfentanyl); N-(4-fluorophenyl)-N-(1-phenethylpiperidin-4-yl)isobutyr-amide; Ortho-Fluorofentanyl; Tetrahydrofuranyl Fentanyl; Methoxyacetyl Fentanyl. The 11 substances are already listed on the federal schedule of controlled substances. The legisla-tion will also give the New York State Health Commissioner the authority to add to the state controlled substances schedule any new drugs that have been added to the federal schedule.

Moreover, the new DFS circular letter advised that health insurers “should provide coverage for naloxone on an outpatient basis when prescribed to an insured by an authorized provider, as they would for any other prescribed drug, subject to the terms and conditions of the health insurance policy or contract. In addition, naloxone should also be covered on an inpatient basis when medically necessary.”

Governor Proposes Legislation to Combat Synthetic Fentanyl Use

Risk Management TipsMLMIC’s Risk Management Tips pro-

vide guidance to support physicians and facilities in their ongoing efforts to improve the quality of patient care and reduce liability exposure in the prac-tice of medicine.

Download a copy of Risk Management Tips – Volume I and Volume II.

For guidance regarding a specific situation, please contact MLMIC’s Risk Management Department at (800) 275-6564 or click here.

CMS Mailed Letters to Physicians Regarding New Medicare Cards

CMS, through the Medicare Admin-istrative Contractors (MACs), recently mailed letters to all Medicare fee-for-ser-vice providers about our work to assign new numbers known as Medicare Ben-eficiary Identifiers (MBIs) and issue new Medicare cards to Medicare beneficiaries beginning in April 2018.

Our top priorities include:• Ensuring your Medicare patients

have continuous access to care; and• You have the tools and information

you need for a smooth transition. Starting in June 2018, you can look up your patients’ new Medicare num-bers through your MACs secure web portal.

Carefully review the letter and accom-panying fact sheet and find out how to prepare to accept the new number beginning in April 2018. Your letter will contain specific information for your MAC. You can also view a sample letter and print-friendly fact sheet.

Review the new Medicare card design here.

Page 2 • MSSNY’s News of New York • November 2017 November 2017 • MSSNY’s News of New York • Page 3

Choosing medical liability insurance is about trust. Knowing that you have the resources, guidance and expertise to support you…today and tomorrow. So, at a time when others are struggling, MLMIC stands strong, and you can count on this:

Commitment to responsible pricing at cost, with a history of providing dividends

Unparalleled claims, risk management and legal services

The experience and expertise of the largest malpractice carrier in New York State

Put your trust in MLMIC.Visit MLMIC.com/physicianor call (888) 996-1183 today.

* The 20% dividend applies to policyholders insured on May 1, 2017 and who maintain continuous coverage through July 1, 2017 and is based upon the annual rate of premium in e�ect on May 1, 2017.

SAVE 20% when you are insured by May 1st*

MLMIC STANDSBEHIND YOU

Proudly endorsed by more than 60 state, county medical and specialty societies

GET A QUOTE TODAY.visit

MLMIC.com

Page 4 • MSSNY’s News of New York • November 2017 November 2017 • MSSNY’s News of New York • Page 5

Colleagues:I am very excited to

announce that the Medical Society of the State of New York has entered into an agreement with the law firm of Garfunkel Wild P.C. to represent MSSNY as gen-eral counsel. Specializing in health care law, they main-tain offices in Great Neck (Long Island) and Albany.

In fact, the Albany offices are managed by three partners that have extensive high-level back-grounds within the regulatory and administrative services of the State government. Therefore, all MSSNY members will have access to legal services on a statewide basis.

With over 80 attorneys, Garfunkel Wild will be able to serve all of our members’ needs from medical school to retirement. As part of our agree-ment, MSSNY members, if eligible, will receive a discount on regular bill-ing rates.Full Service Firm

Garfunkel Wild can help our mem-

bers negotiate, draft, and review all types of agree-ments, from employment contracts, wills, and real estate agreements, to shareholder and operating agreements, to managed care/third-party payor participation agreements, to billing and other ven-dor agreements. Moreover, the firm’s attorneys can work with our physicians

to develop, implement and supervise corporate compliance programs, to prepare for and defend against both routine and more complex audits, investigations, and reimbursement appeals, and to protect our licenses before professional licensing boards.

I look forward to a long-lasting rela-tionship with our new law firm. This is a premier MSSNY member benefit.

It is important to know that we have a firm with decades of health care experience to walk beside us in our good times and times of need.

MEDICAL SOCIETY OF THE STATE OF NEW YORK

NEWS OF NEW YORK

Medical Societyof the State of New york

Charles Rothberg, MD, PresidentPaul Hamlin, MD, Board of Trustees Chair

Philip A. Schuh, CPA, Executive Vice President

coMMUNicatioNS aNd PUBlicatioNS Maria Basile, MD, MBA, Commissioner

NewS of New yorkPublished by Medical Society

of the State of New York

Vice President, Communications and EditorChristina Cronin Southard

csouthard@mssny.org

News of New York StaffManager, Communications Division

Julie Vecchione DeSimonejvecchione@mssny.org

Roseann Raia, Communications Coordinatorrraia@mssny.org

Steven Sachs, Web Administratorssachs@mssny.org

Susan Herbst, Page Designer

NEWS of NEW YoRkADVERtiSiNg REPRESENtAtiVES

for general advertising information contactChristina Cronin Southard

Phone 516-488-6100 ext 355csouthard@mssny.org

the News of New York is published monthly as the official publication of the Medical Society of the State of New York. information on the publi-cation is available from the Communications Di-vision, Medical Society of the State of New York, 865 Merrick Avenue, P.o. Box 9007, Westbury, NY 11590.

the acceptance of a product, service or com-pany as an advertiser or as a membership benefit of the Medical Society of the State of New York does not imply endorsement and/or approval of this product, service or company by the Medical Society of the State of New York. the Member Ben-efits Committee urges all our physician members to exercise good judgment when purchasing any product or service.

Although MSSNY makes efforts to avoid clerical or printing mistakes, errors may occur. in no event shall any liability of MSSNY for clerical or printing mistakes exceed the charges paid by the advertis-er for the advertisement, or for that portion of the advertisement in error if the primary or essential message of the advertisement has not been totally altered or substantially rendered meaningless as a result of the error. Liability of MSSNY to the ad-vertiser for the failure to publish or omission of all or any portion of any advertisement shall in no event exceed the charges paid by the advertiser for the advertisement, or for that portion of the advertisement omitted if the primary or essential message of the advertisement has not been totally altered or substantially rendered meaningless as a result of the omission. MSSNY shall not be li-able for any special, indirect or inconsequential damages, including lost profits, whether or not foreseeable, that may occur because of an error in any advertisement, or any omission of a part or the whole of any advertisement.

PreSiDeNT’S cOlumN

Charles Rothberg, MD

Do you follow MSSNY and MSSNYPAC through its various social media plat-forms, including Twitter, Facebook and Instagram?

If you do not already, please make sure you do.

There are a myriad of activities occurring at both the state and federal government levels that impact on a daily basis how we deliver care to our patients, as well as how patients will be covered for this care.

MSSNY and MSSNYPAC “tweet” out about 12-15 alerts each day sharing insightful articles regarding emerging details on legislation addressing a sig-nificant number of health care issues.

We also regularly tweet/post about important educational programming that MSSNY provides for its mem-ber physicians, such as emerging public health threats, enhancing immu-nizations, assuring our veterans receive necessary mental health services and appropriate pain management.

And we tweet/post about the need for physicians to contact their state and federal legislators on critical pieces of legislation where your voice could make a critical difference in the outcome.

Virtually every MSSNY weekly E-news contains one or more “action alerts” on key pieces of legislation before the State Legislature or the US Congress. MSSNY’s monthly News of New York contains valuable information as well.

However, since we find that redun-dancy in messaging is essential in getting physicians to take action on these key issues, we also regularly repeat these messages through our social media platforms.

Which is why we urge you to follow us on Twitter, Facebook and Instagram.

mSSNY-PAcAre You Following Us? I Hope So!

(Continued on page 10)

Page 4 • MSSNY’s News of New York • November 2017 November 2017 • MSSNY’s News of New York • Page 5

If you imaginedyou could change the world, you’re ready for AgeWell New York.

THE WAY TO AGE WELL IN NEW YORKPe rsona l i z ed , easy t o unde rs t and , easy t o l i v e w i t h Med i ca re Advan tage P resc r i p t i on D rug P l ans

agewel lnewyork .com

718-696-0206 TTY/TDD 800-662-1220

$0 or low cost Plan Premiums

AgeWell New York, LLC is a HMO plan with Medicare and Medicaid contracts. Enrollment in AgeWell New York, LLC depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Premiums, copays, co-insurance and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. AgeWell New York complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. AgeWell New York complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. AgeWell New York cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. AgeWell New York 遵守適用的聯邦民權法律規定，不因 種族、膚色、民族血統、年齡、殘障或 別而歧視任何人。ATTENTION: If you do not speak English, language assistance services, free of charge, are available to you. Call 1-866-586-8044 (TTY: 1-800-662-1220). ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-586-8044 (TTY: 1-800-662-1220). 注意：如果您使用繁體中文，您可以免費獲得語言援 助服務。請致電 1-866-586-8044 (TTY: 1-800-662-1220).H4922_ ImaginePNP4002 Accepted 08112017

Section 5005(b)(2) of the 21st Century Cures Act amended Section 1932(d) of the Social Security Act (SSA) requires that effective January 1, 2018, all Medicaid Managed Care and Children’s Health Insurance Program providers must enroll with state Medicaid programs. The SSA requires that the enroll-ment include providing identifying information including name, spe-cialty, date of birth, social security number, National Provider Identifier (NPI), federal taxpayer identification number and the state license or cer-tification number.

For example, if a physician cur-rently participates in a network with a Medicaid managed care plan that provides services to, or orders, pre-scribes, or certifies eligibility for services for, individuals who are eli-gible for medical assistance, the physician must enroll with New York State Medicaid.cOmmON eNrOllmeNT QueSTiONS:

To check on your enrollment status, please call CSRA at 1-800-343-9000.

Practitioners may also check the Enrolled Practitioners Search func-tion at: emedny.org.

If you are already enrolled as a Medicaid fee-for-service (FFS) pro-vider and are listed as active, you will not have to enroll again.

If at one time you were a FFS provider, and your enrollment has lapsed (no longer actively enrolled), you may be able to keep your origi-nal Provider Identification Number (PID), also known as MMIS ID, by reinstating.

Practitioners who do not wish to enroll as a Medicaid FFS billing pro-vider may enroll as a non-billing, Ordering/Prescribing/Referring/Attending (OPRA) provider. The enrollment form for this function is attached.

Enrollment in Medicaid FFS does not require providers to accept Medicaid FFS patients.

If you are not actively enrolled, please go to: emedny.org and navi-gate to your provider type. Print the Instructions and the Enrollment

NYS Health Insurance Exchange Announces Updated Enrollment

Numbers and Plan Options for 2018

The NY State of Health, New York’s Health Insurance Exchange, issued a press release announcing that more than 4 million people have signed up for health insurance coverage through the State Exchange. Of these 4 million, over 2.8 million were enrolled in Medicaid, with the remaining divided between a Qualified Health Plan (227,796), an Essential Plan (682,800) and Child Health Plus (346,067).

The press release further noted that “Most Marketplace consumers qualify for financial assistance to pay for coverage. Among QHP enrollees who qualify for tax credits, premium costs for the most pop-ular silver plan will be about the same or lower compared to last year.”

In mid-October, the NY State of Health issued a press release highlighting consumer insurance options for 2018 for the open enrollment that begins on November 1 and will continue until January 31, 2018. There are 12 insurers offering “Qualified Health Plans” in the individual marketplace, 15 insurers offer-

Managed Care Network Physicians: Medicaid Provider Enrollment Requirement

(Continued on page 10) (Continued on page 12)

Page 6 • MSSNY’s News of New York • November 2017 November 2017 • MSSNY’s News of New York • Page 7

Overall, do you believe physicians are…? Among physicians –Which of the following best describes your current practice?

53%

31%

16%

52%

28%

19%

0%

10%

20%

30%

40%

50%

60%

At full capacityfor seeing patients

Overwhelmed and overworked Have time to see more patients and

assume more dutiesConsumers Physicians

How much ability do physicians have to significantly influence

do physicians have to significantly influence the healthcare system?

13%

26%

31%

20%

11%

5%

12%

24%

30% 29%

0%

5%

10%

15%

20%

25%

30%

35%

A great deal A good deal Somewhat Little Very little

Consumers Physicians

the healthcare system? Among physicians – How much ability

And, what best describes the time that physicians are ableto spend with patients? Among physicians – Which best describes the time you are

28%

37%

24%

11%

16%

33%38%

14%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Time is always limited Time is often limited Time is sometimes limited

Generally have all the timethey need to provide thehighest standards of care

Consumers Physicians8

able to spend with patients?

To what degree is patient care today adversely impacted

treatment protocols, Electronic Health Record designs, etc.? Among Physicians – To what degree is patient care in your

party authorizations, treatment protocols, EHR design, etc.?

24%

36%

31%

8%

1%

39%

33%

18%

8%

2%0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

A great degree A good deal Somewhat Little Not at all

Consumers Physicians

by external factors such as third party authorization,

practice adversely impacted by external factors such as third

Patient Survey: 95% Satisfied But Want More Time with You

WhAT Are The biggeST TAkeAWAYS?Results show that 95 percent of Americans are satisfied

with their primary care physician, but only 11 percent feel they have enough time with their physicians. That time is crucial to many consumers who have an even bigger con-cern, cost. Eighty nine percent are fearful that the rising cost of healthcare will adversely impact them in the future. Specifically, over half (56 percent) of patients say the cost of prescription drugs and pharmaceuticals directly contributes to rising healthcare costs.

For a deeper look at these findings and others you can review the entire report here. iNTrODucTiON AND meThODOlOgY

• The Physicians Foundation commissioned Regina Corso Consulting to conduct a survey of healthcare consumers to evaluate their attitudes on four major areas –the phy-sician-patient relationship, the cost of healthcare, social determinants and lifestyle issues.

• This survey was conducted among 1,747 U.S. respon-dents who are between the ages of 27 and 75 and

have seen the same doctor at least twice in the past 12 months.

• This survey was conducted online between June 19 and 30, 2017.

• Notes for reading charts and tables: if a chart or table has an “*” –that indicates the response was less than 0.5%. If it has an “—” –that indicates there was no response. Percentages may not add up to 100% due to rounding. Unless otherwise indicated, bases for all slides are 1,747 healthcare consumers.

• Data are weighted by age, income, gender and region to reflect a nationally representative sample of U.S. resi-dents between the ages of 27 and 75.

• Data from physicians are based on The Physicians Foundation 2016 Survey of America’s Physicians con-ducted by Merritt Hawkins in September 2016.

• Data reported from patients in 2016 are based on The Physicians Foundation 2016 Patient Survey conducted by Harris Poll, a Nielsen company, in February 2016.

(Continued from page 1)

(Continued on page 7)

Page 6 • MSSNY’s News of New York • November 2017 November 2017 • MSSNY’s News of New York • Page 7

Which of the following do you do? Please select all that apply. Also, please remember that your answers are completely anonymous.

31%

23%

17%

9%6% 5%

47%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Drink wineand/or beer

at least a fewtimes a week

Drink alcoholat least afew times

a week

Smokecigarettes

daily

Smokecigarettes

once a weekor more, but

not every day

Smokemarijuana

Haveunprotected

sex with someone notyour spouseor partner

Noneof these

Which is closest to what you tell your doctor about your lifestyle?

80%

17%

3% 1%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

I always tellmy doctor the

truth aboutmy lifestyle

I slightlyexaggeratewhat I tellmy doctor

I exaggeratewhat I tell my

doctor

I greatlyexagerrate what I tellmy doctor

While all of these may be important, which one would you say is most important to the future of healthcare delivery and which one is least important?

36%

21%17%

15%12%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Ensuring patientsand physicians

are truly partnersin care

Having thephysician be

the main decisionmaker when itcomes to care

Ensuring healthcarestakeholders

work togetherto make thehealthcare

system easierto understand

Recognizing the effects of poverty

on healthcarecosts

Other healthcareprofessionals needto provide support

to physicians so theirquality of life doesn't

impact their quaity of care

Most important

(Continued from page 6)

Patients only

Name: Erick Eiting, MD, MPHSpecialty: Emergency MedicineMSSNY Member Since: 2007Q: Why are you a mSSNY member?A: “I don’t always give much thought to why I joined MSSNY or why I am a member. I honestly just write the check without even think-ing about it, and I believe that all physicians should do the same.

That said, waking up recently to find out about the massacre in Las Vegas was a reminder of why join-ing organized medicine is so important. Physicians are advocates. We spend our days advocating for our patients, trying to make them or keep them healthy. But advocacy can’t end in the office.

As an emergency physician who has worked in some of the busiest trauma centers across the country, I am no stranger to violence, particularly gun violence. I have cared for patients who have died in front of me as a result of gun violence. I have worked in hospitals where clinicians and staff have been injured or killed as a result of gun violence. There is only so much that I can do to save a life. The real effort needs to occur on the advo-cacy front, fighting to end this violence and eliminating the need to come see me in the first place.

Organized medicine helps us to better advocate for our patients and our colleagues. Healthcare is an incred-ibly dynamic field. Without MSSNY and other organized medicine groups fighting on behalf of patients and phy-sicians, we will never end up with the change we need to see in healthcare.”

Dr. Erick Eiting

MEMBERSPOTLIGHT

Successful Fall ConferenceWe changed the format for our Fall Conference this

year and held it via a WebEx webinar on October 16. It was a great opportunity to join in for those of you who had been unable to attend the Conference in the past. It was wonderful to have Kim Moser the AMA Alliance President join us.

SAVE (Stop America’s Violence Everywhere) Day was held on Wednesday, October 11. In light of the recent shooting in Las Vegas we encourage our members to read Dr. Rothberg’s editorial in the October 6th MSSNY E-News: “Gun Violence: Everyone’s Problem”. The Alliance plans to look more closely at the labeling of gun violence as a public health issue by the AMA and ACP.

The Alliance will continue to urge Governor Cuomo to veto one-sided medical malpractice expansion legislation.

We also remind our members that our next in-person meeting will be our Annual Meeting, which will be held March 22 and 23 at the Adam’s Mark Hotel in Buffalo. Please mark your calendars.

AlliANce

Page 8 • MSSNY’s News of New York • November 2017 November 2017 • MSSNY’s News of New York • Page 9

In May of 2016, the MSSNY created a Stress and Burnout Task Force. This Task Force was charged to formulate a strategy and plan of action to fight burnout and reduce stress among the constituents of the MSSNY. The following article is the fourth of a miniseries that addresses the following topics: the problem of burnout, current state of the State (burnout survey), solutions at the individual and organizational level, and opportunities for advocacy.

Physician Burnout – Systemic/Organizational Issues and Solutions – A Roadmap for Leaders

Previous articles in this series examined various aspects of physician burnout, including: the definition of burnout; the endemic nature of burnout among physicians; the impact of burnout on institutions, organizations, patients, and physicians and their families; and, in broad strokes, the drivers of burn-out among physicians in New York State and elsewhere in the country.

Until very recently, most of the physician burnout research and literature focused on strategies that individual physicians could employ to help reduce the effects of burnout. However, many observers of the current healthcare ecosystem believe emphasis on the individual may be tantamount to “blaming the victim” (1). This belief has given rise to an evolving view that we must look with a critical eye at the causes of burnout intrin-sic to our professional work units, systems and organizations, and the broader health care environment. Over the past several years, Dr. Mark Linzer and Dr. Tait Shanafelt, and their respec-tive colleagues, have made important contributions to our understanding of how these dynamics contribute to physician burnout by identifying the various drivers as well as strategies for mitigation (2, 3).

There is mounting evidence that burnout and loss of well-being among physicians and the concomitant loss of joy and purpose in our work, diminishes patient safety, patient satisfac-tion and the quality of care (4). These factors, coupled with an increase in physician turnover, early retirement and/or aban-donment of direct patient care, contribute to a public health crisis that should capture the undivided attention of our orga-nizational and institutional leaders (5). This makes the issue of burnout as “burning” (pun intended) as the financial pressures that healthcare institutions need to overcome. In a previous article (6), we showed based on a survey of NYS physicians that the majority of stressors emanate from organizational or sys-temic roots. [Figure 1]Figure 1

This leaves plenty of room for improvement in terms of identifying ways of either eliminating or mitigating them. As mentioned by Shanafelt and Noseworthy, the imperative to address these issues goes beyond any economic advantage; it is a moral imperative (7).

While it is always important to identify the causes and rea-sons to intervene, the purpose of this article is to share with healthcare leaders what could be a simplified roadmap for their institutions to follow and guide them in the adoption and imple-mentation of burnout-reducing interventions.

Figure 2 gives an overview of concepts involved in addressing organizational /systemic contributions to Burnout.Figure 2

A comprehensive (even though it does not claim to be) roadmap can be found in the article by Shanafelt and Noseworthy (7).FirST: “We cAre AbOuT YOu”—ADOPTiNg PhYSiciAN Well-beiNg AS AN OrgANizATiONAl vAlue

Knowing that an institution cares about the wellbeing of its employees does matter. It need not be one of the core values of the institution, but stating it, inquiring about it and, more importantly, acting on it, sends a strong message to physi-cians and staff and boosts productivity.

This may take form in circulated statements, town hall meetings, leadership rounds and, most importantly, in report-ing the state of burnout to the leadership and medical staff on a regular basis.

Hence, the second measure.

MSSNY’s Stress and Burnout Task Force

Rank Description % Responses1 Length and Degree of documentation 65.99% Requirements2 Extension of workplace into home life 58.27% (E-mail, completion of records,...)3 Prior Authorizations for: Medications/ 54.74% Procedures/Admissions4 Dealing with difficult patients 51.89%5 EMR functionality problems 51.05%6 CMS/State/Federal laws and regulations 44.33%7 Lack of voice in being able to decide 40.39% what good care is8 Hospital/Insurance company imposed 38.87% Quality Metrics9 Dealing with difficult colleagues 31.49%10 Requirement for increased CME/ 31.49% Maintenance of Certification

Organizational Intervention Conceptsfor Burnout Reduction

• Overcome the medical culture of endurance • Leadership style and concern is effective• Establish: Wellness Initiative Strategic Planning

Work Group• Include human factor issues in healthcare delivery • The Quadruple Aim Framework: • Costs, Quality, Patient experience, and Fourth

Aim: Experience of providing care.• Understand the front line problems: • Anonymous survey to learn key pain points • Round table discussion of findings • Leadership commitment to action.• Encourage stronger administrator/physician part-

nerships, with participatory management (see Responsibility Matrix)

• Use clinician wellness and career satisfaction metrics

• Tie these into quality of care, reduction of malpractice, errors and patient satisfaction.

• Organize completion of all mandatories, regulations• No reporting of seeking mental health care on: • licensure • malpractice carrier • credentialing applications or renewals. • Confidentiality in seeking help

(Continued on page 19)

Page 8 • MSSNY’s News of New York • November 2017 November 2017 • MSSNY’s News of New York • Page 9

Real estate agents affiliated with The Corcoran Group are independent contractors and are not employees of The Corcoran Group. Equal Housing Opportunity. The Corcoran Group is a licensed real estate broker

located at 660 Madison Ave, NY, NY 10065. All information furnished regarding property for sale or rent or regarding financing is from sources deemed reliable, but Corcoran makes no warranty or representation

as to the accuracy thereof. All property information is presented subject to errors, omissions, price changes, changed property conditions, and withdrawal of the property from the market, without notice.

Paul L. Wexler, Licensed Associate Real Estate Brokeroffice: 212.836.1075 l plw@corcoran.com l www.healthcare-properties.com

Fabulous Fifth Avenue Medical OfficesOpposite Central Park

800A Fifth Avenue (at 61st Street)950 SF and 4,293 SF +/- for LEASE

Separate Medical Entrance on Fifth Avenue • On-Site Attended GaragePrivate Garden • Close to All Transportation

1050 Fifth Avenue (between 86th & 87th Streets)1,890 SF +/- for LEASE

Spacious Medical Office • Includes Procedure Room with Recovery Area Ideal Space for All Surgical Specialties • Close to All Transportation

39845_NYCountyMedicalSociety_8.5x11.indd 1 9/19/17 5:22 PM

Page 10 • MSSNY’s News of New York • November 2017 November 2017 • MSSNY’s News of New York • Page 11

The BankAmericard Cash Rewards™ credit card

for Medical Society of the State of New York.

Grocery store and gas bonus rewards apply to the first $1,500 in combined purchases in these categories each

To apply visit: newcardonline.comUse Priority Code VACN54.

cash back on purchases everywhere, every time

cash back at grocery stores

cash back on gas

1%2%3%

▼ For information about the rates, fees, other costs and benefits associated with the use of this Rewards card, or to apply, go to the website listed above or write to P.O. Box 15020, Wilmington, DE 19850. The 2% cash back on grocery store purchases and 3% cash back on gas purchases applies to the first $1,500 in combined purchases in these categories each quarter. After that the base 1% earn rate applies to those purchases.

† You will qualify for $100 bonus cash rewards if you use your new credit card account to make any combination of Purchase transactions totaling at least $500 (exclusive of any fees, returns and adjustments) that post to your account within 90 days of the account open date. Limit one (1) bonus cash rewards offer per new account. This one-time promotion is limited to new customers opening an account in response to this offer. Other advertised promotional bonus cash rewards offers can vary from this promotion and may not be substituted. Allow 8-12 weeks from qualifying for the bonus cash rewards to post to your rewards balance.

By opening and/or using these products from Bank of America, you’ll be providing valuable financial support to Medical Society of the State of New York.

This credit card program is issued and administered by Bank of America, N.A. Visa and Visa Signature are registered trademarks of Visa International Service Association, and are used by the issuer pursuant to license from Visa U.S.A. Inc. BankAmericard Cash Rewards is a trademark and Bank of America and the Bank of America logo are registered trademarks of Bank�of�America Corporation.

©2016 Bank of America Corporation ARPH45XW-05132015 AD-06-15-0544

The cure for the common card

$100cash rewards bonus

after qualifying purchase(s).†

Between Twitter and Facebook, we have over 3,000 followers, but that only rep-resents a small fraction of all New York physicians.

We have the ability to immediately avail ourselves of important infor-mation, right at our finger tips. Let’s take advantage of these tools to help improve the health care climate in New York State.

And speaking of “a small fraction of New York State physicians,” it is imper-ative now more than ever that more than a small fraction of physicians sup-

port MSSNYPAC. As we head into another critical elec-

tion year where the Governor, the Attorney General, the Comptroller and 213 state legislative seats are all up for grabs, MSSNYPAC needs resources to help elect candidates who will be responsive to the concerns of physicians and the patients who depend upon our care.

And we are being badly outspent by interests directly opposed to our own, by special interests who want to increase malpractice lawsuits against us, by special interests who want endanger patient care by expanding the scope of

care that they are legally permitted to provide, and by special interests that want to minimize the ability of physi-cians to be our patients’ best advocates.

We must make a stand.Please join or increase your contribu-

tion MSSNYPAC today by clicking here. And please stress to your colleagues the importance of being part of these efforts.

Be a part of making a difference in care delivery in your community. Do it today!

The future you save may be your own.

mSSNY-PAc(Continued from page 4)

form. At this website, you will also find a Provider Enrollment Guide, a How Do I Do It? Resource Guide, FAQs, and all forms related to enrollment in New York State Medicaid.

As a point of information, under 42 CFR 455.104 defines the following providers as excluded from the defini-tion of “disclosing entity”:

• Solo practitioners such as an indi-vidual physician, psychologist, or chiropractor.

• Group of individual practitioners, such as a group of cardiologists, or a group of radiologists.”

Therefore, physicians do not need to complete Section 5.

If you have questions, please contact Regina McNally at rmcnally@mssny.org.

sent a letter to Congress urging them to not allow CHIP funding and insurance subsidies to expire. MSSNY joined the medical societies of Arizona, California, Florida, Louisiana, New Jersey, North Carolina, Oklahoma, South Carolina, Texas in a letter to Congressional lead-ers urging that legislation be enacted to extend CHIP funding for 5 years.

Please urge our Representatives and Senators to put aside partisan differences and reach an agreement to continue this important funding. You can contact your federal legislators here.

(Continued from page 1)Extend CHIP Funding

Managed Care Network Physicians

ARE YOU UP TO DATE ON YOUR DUES?

www.MssnY.org

(Continued from page 5)

Page 10 • MSSNY’s News of New York • November 2017 November 2017 • MSSNY’s News of New York • Page 11

For more information:please visit docbookmd.com or contact us at 888.447.3707 © Copyright 2017 Scrypt, Inc. � Last updated Sep 2017

DocbookMD is free with your Medical Society of the State of New York Membership.

Are you using DocbookMD yet?

DocbookMD, a HIPAA-secure communication solution for physicians and their care teams, is offered

as a free benefit through Medical Society of the State of New York. Designed by physicians, for

physicians using smartphones and tablets, it allows you to send HIPAA-compliant messages bundled

with photos of x-rays, EKGs, wounds, and more. Just as if you were sending a text.

Page 12 • MSSNY’s News of New York • November 2017 November 2017 • MSSNY’s News of New York • Page 13MSSNY-ad-141211.indd 1 12/11/14 5:16 PM

Dr. eNg hONOreD bY brOOklYN bOrOugh PreSiDeNTOn September 24, Dr. Lisa Eng received a citation from Brooklyn

Borough President Eric L. Adams in recognition of her outstanding contributions to the community.

“Brooklyn is the proud home to a large and vibrant Chinese community, and it is a time-honored tradition to recognize the outstanding contributions made by members of the many diverse ethnic groups that call Brooklyn home, adding their cultural riches to our borough’s special quality of life,” said president Adams.

“On behalf of all Brooklynites, I salute Lisa Eng, D.O., board certified in obstetrics and gynecology, who has been in private practice since 1995 and is the owner of New Life Medical and The Birthing Center of New York,” said Adams. “I applaud Dr. Eng for continuing to have a positive impact on the lives of others.”

The citation was conferred at the 2017 Autumn Festival in Brooklyn Bridge Park.

Dr. Lisa Eng (third from left) poses with fellow honorees at the 2017 Autumn Festival

ing “Essential Plan” coverage and 5 insurers offering coverage in the “Small Business Marketplace”.

As a reminder, physicians are urged to review the “NYS Provider & Health Plan Lookup” tool (pndslookup.health.ny.gov/) to confirm the accuracy of the net-work listings of health insurers across the State. In some cases, physicians have been erroneously listed as participating with certain health insurers or health insurance products. In other cases, there are inaccurate practice locations listed. If you see an inaccuracy, click on the “Contact/Report an Error” tab on the site’s home page to report it.

(Continued from page 5)

memberS iN The NeWSNYS Health Insurance Exchange for 2018

Medicaid Fee-for-Service Providers Dispense Brand Name Drug when Less Expensive than

Generic ProgramClick here for the latest updates for Medicaid

FFS providers dispensing brand name drugs when less expensive generic is available. Changes are effective October 19, 2017.

Please visit the website for additional, up-to-date information.

Page 12 • MSSNY’s News of New York • November 2017 November 2017 • MSSNY’s News of New York • Page 13

Page 14 • MSSNY’s News of New York • November 2017 November 2017 • MSSNY’s News of New York • Page 15

This organization receives financial support for offering this auto and home benefits program.1 Discounts and savings are available where state laws and regulations allow, and may vary by state. To the extent permitted by law, applicants are individually underwritten; not all applicants may qualify.Coverage provided and underwritten by Liberty Mutual Insurance and its affiliates, 175 Berkeley Street, Boston, MA 02116.©2015 Liberty Mutual InsuranceValid through February 24, 2016.

For a free quote, call 800-524-9400 or visit https://www.libertymutual.com/mssny

Client #2179

As a member of the Medical Society of the

State of New York, you could receive exclusive

savings on auto and home insurance from Liberty

Mutual.1

Along with valuable savings, you’ll enjoy access to benefits like 24-Hour Claims Assistance.

Reporting PQRS has never been more important. The penalty for not reporting is, at a minimum, - 2.0% but it could be more. Understanding the rules can be confusing but is necessary.

Attention MSSNY Members! Save $104

Use Code mssnypqrsat the time of submission and receive a discounted

submission rate of $195

Avoid Medicare Penalties

Visit Covisint at: www.pqrs.covisint.com or contact them at 866.823.3958 for more information.

AGRAWAL, Prema; Hyde Park NY. Died February 23, 2017, age 80. Dutchess County Medical Society.ALEXANDER, Steven K.; Fayetteville NY. Died August 14, 2017, age 81. Onondaga County Medical Society. ALTERMAN, Marvin R.; Point Lookout NY. Died September 03, 2017, age 81. Nassau County Medical Society.ANGHELIS, Basil; Poughkeepsie NY. Died June 02, 2006, age 81. Dutchess County Medical Society.ANZILOTTI, Michael; Pelham NY. Died September 23, 2017, age 89. Bronx County Medical Society.BALCHUNAS, Anthony P.; Westminster CO. Died September 22, 2016, age 96. Medical Society County of Westchester.GHADIMI, Hossein K.; Naples FL. Died September 01, 2017, age 95. Nas-sau County Medical Society Inc.”SOLOMON, Sanford Philip; Great Neck NY. Died September 04, 2017, age 83. Nassau County Medical Society.WADLER, Gary I.; Great Neck NY. Died September 12, 2017, age 78. Nas-sau County Medical Society.ZALEZNAK, Bernard David; Port Saint Lucie FL. Died February 10, 2014, age 89. Medical Society County of Kings.

ObiTuArieS

• Working as appropriate with your county medical society, be available to meet with your members of the legisla-ture at least twice a year

• Being responsible for calling or writing letters to mem-bers of the legislature on issues that impact physicians

• Attend training programs in regard to legislative issues• Enlisting other member to support our action plans and

mobilize them to action• Joining and recruiting others to join MSSNYPACPlease join the many other physicians who have signed up

to become a Physician Advocacy Liaison.

Physician Advocacy Liaison(Continued from page 1)

Page 14 • MSSNY’s News of New York • November 2017 November 2017 • MSSNY’s News of New York • Page 15

Annual House of DelegatesMarch 23-25, 2018

Adams Mark Hotel, Buffalo, New York

The Medical Society of the State of New York’s Annual H ouse of Delegates Meeting & Vendor Expo isthe society’s only annual event for hundreds of physician leaders - including medical students, residentsand young physicians. These physician leaders - from Montauk to Buffalo - come together to deliberatelegislative policy, to attend educational seminars, to network with colleagues, and to visit the Vendor Expo.The Expo features carefully vetted vendors that showcase their companies and services, which enhancephysicians’lives as well as their practices.

MSSNY H ouse of Delegate attendees are decision makers. They represent the full spectrum of New York State medicalprofessionals, including all specialties and sub-specialties. These attendees represent the specific interests of group medicalstaffs, small practices, IPAs and single practitioners. County medical societies and specialty societies also participate in thedeliberations, and send members of their executive staffs to seek out and recommend new and improved benefits for theirmembers.

Booth Space is Limited.Call now for more information and rates:

Roseann Raia at: (516) 488-6100, ext. 302, or email: rraia@mssny.org

Medical Society of the State of New York

No other event brings together New York State’s top players in the medical profession!

Reserve Before December 1, 2017 & Receive a 20% Discount

Page 16 • MSSNY’s News of New York • November 2017 November 2017 • MSSNY’s News of New York • Page 17

• Physician’s Practice: Diagnostic Imaging – 09/16/17 3 Reasons to Stay with Your Current EHR Vendor (MSSNY President Dr. Charles Rothberg quoted)

• Middletown Town Herald Record 09/17/17 Letter: Cuomo: Reject pro-posed medical liability law (Letter to the Editor from MSSNY Member Stephanie Zeszutek)

• National Catholic Register – 09/18/17 Assisted Suicide Denied in New York (MSSNY mentioned)

• Albany Times Union – 09/25/17 Letter: Bill too one-sided on medical malpractice (Letter to the Editor from MSSNY President Dr. Charles Rothberg, MD)

• Politico New York Healthcare – 09/27/17 Republicans Concede on Obamacare Repeal (MSSNY President Dr. Charles Rothberg, MD’s statement picked up)

• Monroe County Post – 09/27/17 Monroe County Medical Society joins ABMS (Monore County Medical Society mentioned)

• Newsday – 09/28/17 New York’s aid-in-dying advocates look to 2018 (MSSNY mentioned)

• SILive – 09/30/17 Costly medical mari-juana pushes patients to street sales (MSSNY mentioned)

• Newsday – 10/2/17 NY hospital and phy-sician groups gear up to help Puerto Rico (MSSNY President Dr. Charles Rothberg quoted)

• AP (story appeared in 119 newspapers; see links below) – 10/2/17 NY hospital, doctors prepare medical aid for Puerto Rico North Country Public RadioLake Placid NewsBusiness News WorldQuad-Cities OnlineLompoc RecordThesouthern.comThe Greeneville SunHeraldCourier.comThe Ledger IndependentSports - Times UnionRelationship ScienceMetro NewsNewsbug.InfoHouston ChronicleVancouver SunThe Windsor StarThe Washington TimesMontreal GazetteYahoo! NewsThe Star PhoenixWKTV.comYahoo! New Zealand - NewsRegina Leader-Post

News 10 ABC - WTENWBNG-TVWIVB.comInfoTel NewsThe Bellingham HeraldMiami HeraldThe Kansas City StarThe Charlotte ObserverThe Fresno BeeThe Wichita Eagle and Kansas.comNational PostTri-City HeraldThe Island PacketMerced Sun-StarLexington Herald-LeaderNew Haven RegisterDariennewsonlineSFGateConnecticut PostThe News & ObserverStamfordAdvocate.comTheHourWestport-NewsNewsTimes.com (AP)Greenwich TimeFairfield Citizen OnlineSeattlepi.comNew Canaan NewsTheState.comThe Republic (AP)Bradenton HeraldThe Modesto BeeMyrtleBeachOnline.comThe News TribuneHerald OnlineBelleville News DemocratLedger-EnquirerSun HeraldThe OlympianMacon TelegraphClay Center DispatchHarrisonDaily.comThe Daily Star (AP)Journal Gazette & Times-CourierOlean Times HeraldNapa Valley Register (AP)The World LinkJournal Review OnlineChippewa HeraldThe Southwest Iowa News SourceThe Billings GazetteThe Seattle TimesAuburnpub.comWacotrib.comDaily Journal OnlineThe Times and DemocratPantagraph.comThe Argus-PressFremont TribuneTheCourierExpress.comTucson.com

Lebanon-ExpressRoanoke.comPostStar.comMadison.comMorning TimesFinger Lakes TimesTrib.comFort Bend HeraldThe Journal Times OnlineThe Columbus TelegramWaterloo-Cedar Falls CourierBeatrice Daily SunThe Sentinel - CumberlinkWatertown Daily Times Online (AP)MissoulianMagicvalley.comHerald & ReviewThe EagleAuburnPub.comJournalStar.comLa Crosse Tribune (AP)The Muscatine JournalMTStandard.comThe Bismarck TribuneNewsOKHanford SentinelRavalli RepublicTDN.comElko Daily Free PressAlbany Democrat-HeraldThegardenisland.comAP (Hosted)Winona Daily NewsChron.comSt. Louis Post-Dispatch (AP)Quad-City TimesRapidcityjournal.comBowling Green Daily NewsThe Times of Northwest Indiana

• Fierce Healthcare – 10/03/17 Trump to survey Puerto Rico; HHS will broaden support of healthcare facilities damaged by Hurricane Maria (MSSNY mentioned)

• Buffalo News – 10/08/17 Another Voice: International medical students are good for health care (MSSNY mentioned)

• New York Amsterdam News -10/12/17 Healthy aging: Doable and it beats the alternative (MSSNY President Dr. Charles Rothberg, MD quoted)

• Newsday – 10/12/17 President Trump signs executive order on health care (MSSNY President Dr. Charles Rothberg, MD quoted)

• Politico – 10/13/17 New York Healthcare Digest (MSSNY President Dr. Charles Rothberg, MD quoted)

• True Viral News – 10/13/17 Trump signs order to provide ‘Obamacare relief (MSSNY President Dr. Charles Rothberg, MD quoted)

mSSNY iN The NeWS

Page 16 • MSSNY’s News of New York • November 2017 November 2017 • MSSNY’s News of New York • Page 17

Program Highlights:Free Card For Everyone

No Restrictions on Eligibility

Low Price Guarantee

Discounts Most Medications

Accepted at Over 68,000 Pharmacies

HIPAA Compliant

More New York Residents Have Access to

Prescription Savings

For more information or to order free hard cards visit:

www.newyorkrxcard.comChez Ciccone • fciccone@nyrxcard.com

Phone: 800-931-2297

Free Card

Everyone EligibleSave up to 75%

Free Statewide Prescription

Assistance Program

he Centers for Disease Control reports that Americans

spend more on prescription drugs than people in any other country: some $45 billion in out-of-pocket dollars in the last year alone. With that in mind, the New York Rx Card is reminding physicians that their patients who aren’t insured or who take prescription drugs that aren’t covered by their health insurance plans, can use the New York Rx Card to obtain discounts of up to 75 percent off the retail price for FDA-approved medications.

New York Rx Card has been working closely with Medical Society of the State of New York, as well as numerous clinics and hospitals around the state to distribute free discount prescription cards so that all New York residents will have access to this free program. New York Rx Card was launched to help the uninsured and underinsured residents afford their prescription medications. The program can also be used by people that have health insurance coverage with no prescription benefits, which is common in many health savings accounts (HSA) and high deductible health plans.

Another unique component of the program is their preferred pharmacy option. New York Rx Card has chosen CVS as their preferred pharmacy so that residents who don’t have access to a computer and can’t obtain a hard card, can visit any CVS to have their prescriptions processed through New York Rx Card. Residents can simply reference “New York Rx Card” to have their prescription processed through the program. New York Rx Card is accepted at over 68,000 participating regional and national pharmacies.

New York Rx Card has helped residents save over $143 million since its inception in 2010. You can help by encouraging your patients to print a free New York Rx Card at www.newyorkrxcard.com. New York Rx Card is also available as an app for iPhone and Android. You can search “Free Rx iCard” in the app store. Any physicians who are interested in ordering free cards for their clinic/hospital can email Chez Ciccone, New York Rx Card Program Director at fciccone@nyrxcard.com.

Free Rx iCard New York Rx Card

Statewide Prescription Assistance Program Offers a Prescription to High Healthcare Costs

New York Rx Card Preferred Pharmacy:

Page 18 • MSSNY’s News of New York • November 2017 November 2017 • MSSNY’s News of New York • Page 19

MEdical FaMilY PRacticE FOR SalE – lONg BEach, NY

Established 14 years. Newly renovated. Fully equipped ground floor premises.

3 exam rooms. Must see! Call Carol – 516-238-3422

WaNt tO SEll YOuR MEdical PRacticE? dO YOu havE MEdical OFFicE SPacE tO SEll OR ShaRE?

Clineeds is a new online platform designed to help medical providers sell their practice or buy, sell and share medical office space.

Listing is FREE! No contracts. No commitments. No fees. Sign up today at

http://www.clineeds.com/sign-up

FOR RENt OR ShaRE WOOdBuRY, lONg iSlaNd

Beautiful recently renovated Plastic Surgery office available for part-time share and

AAAA-certified (by end of summer). OR available for rent. Centrally located

on Long Island. Close to expressways.3 exam rooms, 1 procedure room /OR.

Waiting room, break room and personal of-fice. Free WIFI.

Available for full or half-days. Suits Plastic/Cosmetic Surgeons/Derm/

ENT/ObGyn/Podiatry or other Medical MDs. Contact Patricia at info@cosmetichg.com

or 631-318-4008

RivERdalE MEdical OFFicE FOR SalE – PRiME lOcatiON

Co-op with private entrance features 2 exam rooms, lab, office & bathroom.

Must see! Call 718-230-7069.

MEdical diREctOR - aidS iNStitutEMiNiMuM QualiFicatiONS:

Current license and registration to practice medicine in New York State and board

certification AND either a Master’s Degree in Public Health or two years of experience in an HIV program or public health program.

Preferred Qualifications:Master’s Degree in in Public Health. Five

years of experience including clinical service in an HIV program or clinical fellowship

program (infectious diseases/HIV medicine). Experience in quality management/quality improvement. Knowledge of the HIV health

care delivery system in New York State. Experience in/knowledge of the New York

State Ending the Epidemic initiative. Experi-ence in STD prevention and care, drug user health, and/or LGBT health. Experience in health policy development, analysis and

evaluation. Experience with evolving health information technologies.

Experience in health program management and administration.

Responsibilities:The Medical Director, AIDS Institute, plays a significant role in shaping HIV, hepatitis C, and STD care and services, drug user health, and LGBT health care throughout

New York State. Please click the link below for more informa-tion pertaining to this position and to apply: https://careers-healthresearch.icims.com/

jobs/3742/medical-director---aids-institute/job

Affirmative Action/Equal Opportunity Employer/Qualified Individuals with

Disabilities/Qualified Protected Veterans

Classified ads can be accessed at www.mssny.org. Click classifieds.DECEMBER 2017 ISSUE CLOSES NOVEMBER 15 $200 PER AD; $250 WITH PHOTO

PHYSICIANS’ SEARCH SERVICES • ALLIED MEDICAL PLACEMENTS • LOCUM TENENS PRACTICE VALUATION • PRACTICE BROkERAGE • PRACTICE CONSULTING • REAL ESTATE

FOR HELP, INFORMATION OR TO PLACE YOUR AD, CALL CHRISTINA SOUTHARD 516-488-6100 x355 • FAx 516-488-2188

clASSiFieD ADverTiSiNg

offICe sPaCe for LEASE/RENT

PraCtICe for sale

HELP WANTED

buSiNeSS ShOWcASe

Over 35 years of experience representing physicians, nurses and other licensed health care providers in: •OPMCInvestigations,InterviewsandHearings; •OPDInvestigations,InterviewsandHearings; •SubstanceAbuseissues; •MedicalRecordKeeping; •SexualMisconductInvestigations; •ClaimsbyHMOsandMedicare/MedicaidforReim-

bursement; •ResolvingCriminalConvictionswithOPMCand

OPD.Experienced, Reliable, Efficient and Discreet.

315 West 106th Street, Suite 1ANew York, New York 10025212-244-9090/ 646-678-0608pwalker@peltzwalker.com

PAUL E. WALKER, ESQ.ATTORNEY AT LAW

Page 18 • MSSNY’s News of New York • November 2017 November 2017 • MSSNY’s News of New York • Page 19

SecOND: meASure iT – NO meASuremeNT, NO imPrOvemeNT

There are a few validated measurement tools that are available. The key is to make sure that the measurement is systematic, periodic and easy to administer. A system-atic approach to measurement (and later, improvement) is not only a sign of rigor but also of commitment. It can include forming a committee or designating a champion or a “wellbeing officer” who would be in charge of measurement and implementation of the interventions and subsequent reporting.

Periodic measurement is necessary to evaluate for improve-ment (or worsening) of burnout. There are no strict guidelines about the frequency of measurement but yearly or biennial measurement is acceptable. The measure needs to be anony-mous with respect to identifiers traceable to the individual physician in order to be accurate and honest. Online versions of the tools involve a third party that ensures anonymity of the source but makes available aggregate data to institution administrators.

Administrators must keep in mind that, getting physicians to reveal what the stressors are, must overcome the culture of medicine that includes a culture of endurance, silence and complaining/whining, and it begins with physicians in training (8). Yet, identifying the organizational problems is the critical step to ease these burdens as well as improve safety.

Ease of administration of the measure is an important

factor to consider. The longer the survey the less likely to obtain complete answers or a high response rate. Format is also another factor. In a small unit, it might be easier to use a paper format, but in larger institutions an online survey might be easier to administer.

In sum, measurement is an essential step that can guide leaders to the direction of change and to the effectiveness of interventions.ThirD: iDeNTiFY YOur burNOuT PheNOTYPe

Depending on the setting in which physicians practice, the phenotype of burnout might be different. For example, in a busy office practice, administrative burdens might be the main culprit. In a unit where practice focuses on chronic disease management or palliative care, dealing with com-passion fatigue might be the main issue. The predominant burnout drivers can differ by units, and will present clues to interventions. One way to identify the main issues that are problematic in the workplace is to simply ask the staff “What matters?” as discussed in the IHI white paper, “Finding Joy at Work.” (9)

FOurTh: STArT WiTh lOW-hANgiNg FruiTSome interventions may be easy to implement, gain favor

among physicians and help “break the ice.” For example, carving out time for practitioners to catch up with adminis-trative duties without asking them to make up for that time can go a long way. Additional interventions may include a mingle dinner for staff to “vent” and get to know each other better, a peer support or second-victim program, or a retreat

MSSNY’s Stress and Burnout Task Force(Continued from page 8)

Responsibility  Matrix

Action Comment Action Comment

Acknowledge    Change

New  issues,  understand  their  impact,  understand how  to  adapt Validate  Suffering Empathy,  validate  feelings,  recognize  

impact;  you  will  navigate  with  them  as  partners

Own  Safety  and    Quality

Acknowledge  variability  of  care  and  its  impact  on  outcomes,  improve  care  delivery

Communicate Keep  physicians  informed  and  the  “why”  behind  decisions.  Is  two  way  street:  In  addition  to  sharing  information  are  you  listening  to  what  they  say?

Promote    Accountability  and    Peer  Mentoring

Must  hold  each  other  accountable,  and  be  proactive  to  advance  this  responsibility

Help  PhysiciansUnderstand  the  Business

Help  educate  our  physician partners  so  they  better  understand  the  things  we  do.

Stop  Bad  Behavior Have  to  stop  yelling,  bullying,  lack  of  follow-­‐up,  not  responding  or  outright  verbal  or  physical abuse.

Be  Inclusive If  you  want  physician  support  for  keydecisions,  include  them  in  the  real  decision  making.

Practice  Humility Respect  the  knowledge  and  skills  of  our  non  clinical  colleagues.   Recognize  the  Need  

for  SymbiosisRecognize  the  need  for  tandem  roles  of  physicians and  administrators  for  quality  of  care  and  maintaining  health  of  the  business

Lead  By  Example Physicians  are  looked  up  to  for  guidance  and  advice  and  people  closely  follow  their  actions.

Beware  of  Trigger  Issues

Before  executing  something  new,  understand  the  mood  of  your  physicians  and  the  effect  the  change  will  have  relative  to  other  recent  changes  and  ensure  appropriate  consultation  and  communication.

Physician  Responsibility Administrator  Responsibility

Adapted from Merlino J. August 19, 2015: www.beckershospitalreview.com

Figure 3 - responsibility matrix (Continued on page 20)

Page 20 • MSSNY’s News of New York • November 2017 November 2017 • MSSNY’s News of New York • Page 21

for emotional and cognitive rejuvenation. Regardless of the cost or complexity of the intervention, it should be targeted and well-implemented.FiFTh: SuPPOrT AND DevelOP YOur leADerS

Strong leadership is undoubtedly one of the essential ele-ments of reducing burnout in the workplace (10). Characteristics of effective leaders include good listening skills, accountability, a sense of fairness and being supportive. Leaders who share the core values of physicians and staff increase engagement throughout the organization, which helps reduce feelings of helplessness that come from loss of control (10), and “leaders who engage their teams meaningfully create work environ-ments more likely to engender a sense of well-being and less likely to engender burnout.” (11).

For additional strategies, please consult the article by Shanafelt and associates on executive leadership and physi-cian wellbeing (7).

Linzer and associates (12) proposed several realistic solu-tions from their Healthy Work Place Study, including workflow redesign and improvement in communication. Improving workflows reduced burnout 6-fold, targeted quality improve-

ment projects addressing clinician concerns reduced burnout 5-fold, and improving communication between team mem-bers improved professional satisfaction 3-fold. (13) Specific interventions include use of medical assistants for data entry, pairing of medical assistants (MAs) and physicians, providing adequate time for MAs to perform tasks previously done by physicians, improved teamwork, and routine clinical meet-ings to discuss important topics and surveying physicians for their “wish list” issues. Other potential organizational steps include promotion of part-time careers and job-sharing, pro-tected time for meaningful personal activities, maintenance of manageable primary care panel sizes, hiring physician floats to cover predictable life events and allocation of ade-quate resources to primary care clinics. (14)

More recently, Shanafelt and associates (15) outlined the business case for investing in physician well-being by analyzing costs associated with burnout. These include phy-sician turnover, lost revenue due to decreased productivity and organizational threats posed by lower quality of care, decreased patient satisfaction and reduced patient safety. It is estimated that the organizational cost to replace a single physician is between $500,000 and $1,000,000 when con-

MSSNY’s Stress and Burnout Task Force(Continued from page 19)

Figure 4 (Continued on page 21)

Page 20 • MSSNY’s News of New York • November 2017 November 2017 • MSSNY’s News of New York • Page 21

sidering costs of recruitment and lost revenue. Studies have also shown that loss of a physician causes increased burnout for colleagues and other members of the care team.

It’s important for organizations to understand the fac-tors that drive burnout and to realize that they can make substantive changes in many of these drivers, and often at relatively little cost. Nonetheless, even low-cost interventions can be challenging because change is always difficult. This dynamic highlights the importance of change management and the capacity to lead an organization through change. See Figure 3 for a responsibility matrix that addresses physician responsibilities and administrator responsibilities in improv-ing physician/administrator relationships. The business case to reduce burnout, when coupled with the moral and ethical imperatives, creates an even more compelling argument for organizations to act.

Despite the IOM’s 1999 To Err is Human report and its clear message of how organizational/systemic issues cause the majority of errors, most of the efforts, investigation, training and blame have focused on end actors i.e. the clinicians (16). A

similar story has emerged that ‘blaming the victim’ has been the approach in reducing burnout until recently. The majority of stressors affecting physicians are organizational/systemic (6). In quality and safety arenas, as well as burnout reduction programs at hospitals, we have a quality and safety opportu-nity as well as a moral responsibility to look at and improve systemic/organizational contributions to error and burnout.

Beyond the institutional and organizational factors, we have considered in this article, many important drivers of physician burnout and dissatisfaction are external to the organizations in which we work, yet are systemic ills in the healthcare ecosystem. These include laws, rules and regula-tions imposed upon the practice of medicine by state and federal governments as well as public and private payers. Without attempting to address these issues as well, the posi-tive consequences of organizational change will be limited. Organized medicine in general, and MSSNY in particular, have a history of effective advocacy efforts to change public policy, and this will be the subject of the fifth, and final, article of this series.

MSSNY’s Stress and Burnout Task Force(Continued from page 20)

reFereNceS1. Shanafelt TD, et al. “Changes in Burnout

and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014.” Mayo Clinic Proceedings. 90(12): 1600 – 1613.

2. Shanafelt et al. Burnout and satisfaction with work/life balance among US physi-cians relative to the General US Population. Arch Int. Med Vol 172 (18) 1377-1385.

3. Linzer et al. Organizational Climate, Stress and Error in Primary Care: The MEMO Study. Advances in Patient Safety (1): 65-77. 2005.

4. Shanafelt T. et al. Addressing Physician Burnout. The Way Forward. JAMA Mar 7 317 (9):901-902.

5. Privitera MR, Atallah F. Physician Burnout as an Individual and Public Health Issue. Medical Society of the State of New York’s News of New York. Vol 73 (7): 6-7, 16-17.

6. Atallah F, Privitera MR. Physician Burnout - The State of the State. MSSNY Talk Force on Physician Stress and Burnout Survey Findings. Medical Society of the State of New York’s News of New York. Vol 73 (8): 6-8.

7. Shanafelt TD, Noseworthy JH. Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clin Proc. 2017 Jan;92(1):129-146.

8. Privitera MR, Gomez-Ceseare C, Bedient T. Burnout reduction for the Individual Clinician. Medical Society of the State of New York’s News of New York. Vol 73 (9): 6-7, 12-13. 2017.

9. Perlo J. Balik B, et al. IHI Framework for Improving Joy in Work. IHI White Paper. Cambridge Massachusetts. Institution for Healthcare Improvement 2017. Available at ihi.org.

10. Shanafelt TD, Gorringe G, Menaker R, Storz KA, Reeves D, Buskirk SJ, Sloan JA, Swensen SJ. Impact of organizational leadership on physician burnout and satisfaction. Mayo Clin Proc. 2015 Apr;90(4):432-40.

11. Lister ED, Ledbetter TG et al. The Engaged Physician. Mayo Clin Proc. 2015 Apr;90(4): 425-427.

12. Linzer M, Poplau S. Building a Sustainable Primary Care Workforce: Where Do We Go from Here? J Am Board Fam Med. 2017 Mar-Apr;30(2):127-129.

13. Linzer M, Poplau S, Grossman E, Varkey A, Yale S, Williams E, Hicks L, Brown RL, Wallock J, Kohnhorst D, Barbouche M. A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study. J Gen Intern Med. 2015 Aug;30(8):1105-11.

14. Linzer M, Levine R, Meltzer D, Poplau S, Warde C, West CP. 10 bold steps to prevent

burnout in general internal medicine. J Gen Intern Med. 2014 Jan;29(1):18-20.

15. Shanafelt T, Goh J, Sinsky C. The Business Case for Investing in Physician Well-being. JAMA Intern Med. 2017 Sep 25.

16. Kohn, L.T., Corrigan, J., Donaldson, M.S., To err is human: building a safer health sys-tem. 2000, National Academy of Sciences: Washington, D.C.

AuThOrS:Louis Snitkoff, MD, FACP Member of MSSNY Physician Stress and Burnout Task ForceCMO, CapitalCare Medical Group, Albany, NY

Fouad Atallah, MD, FACOGMember of MSSNY Physician Stress and Burnout Task ForceDirector of Patient Safety/OBGYNMaimonides Medical Center, Brooklyn NY

Michael R. Privitera, MDChair, MSSNY Physician Stress and Burnout Task ForceDirector, Medical Faculty and Clinician Wellness ProgramUniversity of Rochester Medical Center

Jeffrey Selzer, MDMember of MSSNY Physician Stress and Burnout Task ForceMedical Director, Committee for Physician Health

adVertIsIng in the News of New York WORkS!Call for rates! 516-488-6100 ext 355

Page 22 • MSSNY’s News of New York • May 2017

May 2017 • MSSNY’s News of New York • Page 23

BUSINESS SHOWCASE

Classified ads can be accessed at www.mssny.org. Click classifieds.

JUNE 2017 ISSUE CLOSES MAY 15 $200 PER AD; $250 WITH PHOTO

PHYSICIANS’ SEARCH SERVICES • ALLIED MEDICAL PLACEMENTS • LOCUM TENENS

PRACTICE VALUATION • PRACTICE BROKERAGE • PRACTICE CONSULTING • REAL ESTATE

FOR HELP, INFORMATION OR TO PLACE YOUR AD, CALL CHRISTINA SOUTHARD 516-488-6100 X355 • FAX 516-488-2188

CLASSIFIED ADVERTISING

Place Your Classified Ad In

News Of New York!

Leasing or Selling Space? Selling your practice

or equipment? All Ads $200; $250 with Photo.

Call 516-488-6100, ext 355

LUXURIOUS MEDICAL OFFICE

SPACE TO SHARE

IN MANHATTAN

Spacious and modern well-

ness office suite off 5th avenue,

near grand central, and all major

subway lines. Newly renovated

space catering to the needs of

various health practitioners and

their clients (vision, chiropractors,

acupuncturists, psychologists,

nutritionists, etc.) 13 foot ceilings

throughout.

Two spacious waiting areas, el-

egantly furnished. Two bathrooms

en suite. Fully equipped kitchen/

pantry area.

Two elevators. Free coffee/tea

station, hot/cold water cooler, free

mail sorting services. Windowed

offices starting from $2,800.

Utilities, cleanings and

high speed internet.

Call: 570-499-5851 / email:

columbuslaservision@gmail.com

HELP WANTED

OFFICE SPACE TO SHARE PAGING PRIMARY CARE MDS WHO LOVE

TECHNOLOGY

98point6 is a Seattle startup who wants your

input. We’re seeking practicing physicians to join

our council and help shape the next generation of

primary care.

If the fusion of health care and technology inspires

you, please apply here.

OPHTHALMOLOGIST PART TIME

Ophthalmologist needed to work at multiple nursing

homes in all 5 boros except Staten Island. Part time

or full-time position available. Generous salary and

incentives.Ttech provided. Opportunity to perform

surgery, but not required. Please email cv to

privacyssw@gmail.com

Page 10 • MSSNY’s News of New York • June 2017

June 2017 • MSSNY’s News of New York • Page 11

IPRO has been awarded a spe-

cial contract from the Centers

for Medicare & Medicaid Services

(CMS) to help physician practices

in New York, Maryland, Virginia

and the District of Columbia pre-

pare for and participate in the new

Quality Payment Program, estab-

lished by the Medicare Access and

CHIP Reauthorization Act of 2015

(MACRA). This technical assis-

tance, authorized and funded

under MACRA, brings direct sup-

port to an estimated thousands

of Merit-based Incentive Payment

System (MIPS) eligible clinicians in

small practices with 15 or fewer cli-

nicians, including small practices in

rural locations, health professional

shortage areas and medically

underserved areas across the

country. The direct technical assis-

tance is available immediately,

free to all MIPS eligible clini-

cians, and will deliver support for

up to a five-year period. “We’re

very pleased to be able to sup-

port CMS in this effort to offer free

technical assistance to thousands

of physicians as they implement

the new value-based Medicare

payment system,” said IPRO Chief

Medical Officer Clare Bradley, MD,

MPH. IPRO will provide customized

technical assistance to MIPS eli-

gible clinicians, which may include,

but is not limited to, the following:

• Conveying the MIPS expecta-

tions and timelines

• Explaining the MIPS feedback

report• Creating a MIPS-score improve-

ment plan

• Evaluating practice readiness for

joining an Advanced Alternative

Payment Model (APM)

• Assessing and optimizing Health

Information Technology

• Supporting change manage-

ment and strategic planning

• Developing and disseminat-

ing education and training

materials

• Enabling peer-to-peer learning

and local partnerships.

For more information regarding

this support service, go to www.

mssny.org for contact information

or to seek assistance.

IPRO Supporting

CMS Payment Program

The BankAmericard Cash Rewards™ credit card

for Medical Society of the State of New York.

Grocery store and gas bonus rewards apply to the first

$1,500 in combined purchases in these categories each

To apply visit: newcardonline.com

Use Priority Code VACN54.

cash back on purchases

everywhere, every time

cash back

at grocery stores

cash back

on gas

1%2%3%

▼ For information about the rates, fees, other costs and benefits associated with the use of this Rewards card, or to apply, go to the website listed above or write to P.O. Box 15020,

Wilmington, DE 19850. The 2% cash back on grocery store purchases and 3% cash back on gas purchases applies to the first $1,500 in combined purchases in these categories each

quarter. After that the base 1% earn rate applies to those purchases.

† You will qualify for $100 bonus cash rewards if you use your new credit card account to make any combination of Purchase transactions totaling at least $500 (exclusive of any fees,

returns and adjustments) that post to your account within 90 days of the account open date. Limit one (1) bonus cash rewards offer per new account. This one-time promotion is

limited to new customers opening an account in response to this offer. Other advertised promotional bonus cash rewards offers can vary from this promotion and may not be

substituted. Allow 8-12 weeks from qualifying for the bonus cash rewards to post to your rewards balance.

By opening and/or using these products from Bank of America, you’ll be providing valuable financial support to Medical Society of the State of New York.

This credit card program is issued and administered by Bank of America, N.A. Visa and Visa Signature are registered trademarks of Visa International Service Association, and are used

by the issuer pursuant to license from Visa U.S.A. Inc. BankAmericard Cash Rewards is a trademark and Bank of America and the Bank of America logo are registered trademarks of

Bank�of�America Corporation.

©2016 Bank of America Corporation

ARPH45XW-05132015

AD-06-15-0544

The cure for the common card

$100cash rewards bonus

after qualifying purchase(s).†

Legislation Advances to Assure Peer Review Prior to

Health Plan Contract Non-Renewal

Legislation (S.3943, Hannon) to assure that a physician has a right to a hearing

before their clinical peers before their participation contract with a health insurance

company can be non-renewed was reported unanimously from the Senate Health

Committee to the Senate floor.

MSSNY supports this legislation. Identical legislation (A.2704, Lavine) recently

passed the Assembly. The purpose of the bill is to address a gap in current law that

prohibits a health insurance company from terminating a physician’s contract with

a health plan without a written explanation of the reasons for the proposed contract

termination and an opportunity for a hearing before clinical peers, but does not

apply those rights to situations where the physician’s contract is not renewed.

There have been instances in the last few years where certain health insurance

companies have dropped significant numbers of physicians from their networks

without providing any recourse to these physicians to challenge these non-renewals.

This legislation would provide important protections to better assure the continuity

of the physician-patient treatment relationship. Physicians can send a letter to their

Senator in support of this legislation here.

Page 2 • MSSNY’s News of New York • June 2017

June 2017 • MSSNY’s News of New York • Page 3

Choosing medical liability insurance is about trust. Knowing that you have the resources, guidance and expertise to support you…today

and tomorrow. So, at a time when others are struggling, MLMIC stands strong, and you can count on this:Commitment to responsible pricing at cost, with a history of providing dividends

Unparalleled claims, risk management and legal servicesThe experience and expertise of the largest malpractice carrier in New York State

Put your trust in MLMIC.Visit MLMIC.com/physicianor call (888) 996-1183 today.* The 20% dividend applies to policyholders insured on May 1, 2017 and who maintain continuous coverage through July 1, 2017 and is based upon the annual rate of premium in e�ect on May 1, 2017.

SAVE 20% when you are insured by May 1st*

MLMIC STANDSBEHIND YOU

Proudly endorsed by more than 60 state, county medical and specialty societies