Business of Medicine


MACRA - Resources to help you complete the Improvement Activities

July 27, 2017

To get the maximum of 40 points for the Improvement Activity score, large practices (more than 15 clinicians) must complete:

       2 high weighted activities, or

       1 high and 2 medium weighted activities, or

       4 medium weighted activities

To get the maximum of 40 points for the Improvement Activity score, small practices (15 or fewer clinicians) must complete:

      1 high weighted activity, or

      2 medium weighted activies

Suggested medium weighted Patient Safety Improvement Activies

1. Administer AHRQ Survey of Patient Safety Culture for the medical office, hospital, or ambulatory surgery center and submit data

2. Implement a fall screening and assessment program and address modifiable risk factors.  Some examples:

3. Register for and participate in your state’s prescriptions drug monitoring program

4. Use decision support and standardized treatment protocols, such as AHRQ's National Guideline Clearinghouse or U.S. Preventive Services Task Force's Published Recommendations

5. Use tools to assist practices to track specific measures meaningful to their specialty, such as:

  • American College of Surgeons Surgical Risk Calculator

  • Clinical calculators available in MagMutual PolicyOwners’ free subscription to  UpToDate:

    • Clinical indicators for malignant hyperthermia

    • Pulmonary embolism Wells score

    • APACHE II : A severity of disease classification system

    • Atrial fibrillation CHADS(2) score for stoke risk

    • Cardiovascular risk assessment: 10-year ACC/AHA

    • Braden score: Pressure ulcer risk stratification

    • Clinical Opioid Withdrawal Scale (COWS) for Adults and Adolescents

    • ARISCAT (Canet) Preoperative pulmonary risk index

    • Westley Croup Severity Score Blatchford Score for gastrointestinal bleeding

    • CURB-65 Pneumonia Severity Score

    • AUDIT Alcohol consumption screening

    • Depression screening by nine-item Patient Health Questionnaire (PHQ-90)

    • Epworth Sleepiness Scale

    • Opioid Equianalgesic Calculator

6. Implement an antibiotic stewardship program.  For detailed information and the CDC’s checklist for the core elements of outpatient antibiotic stewardship, click here.

Suggested high weighted Patient Safety Improvement Activities

1. Participate in a CAHPS Survey

2. Consult your state’s prescription drug monitoring program prior to issuing controlled substances at least 60% of the time (for the first year) for opioid prescriptions lasting longer than 3 days.  For more information, click on your state’s link, above.


The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.