With surgery and wound healing as core components of hospital care, there are multiple quality measures and value-based care programs relevant to safe, effective, and clinically efficient pressure injury prevention and wound healing, In addition, the upcoming launch of the Transforming Episode Accountability Model (TEAM) in 2026 will put even greater financial pressure on hospitals to optimize healing and recovery from surgery. This presents a prime opportunity to focus on a powerful, underutilized strategy: nutrition care. Proper nutrition plays a vital role in pressure injury prevention and wound healing, recovery, and ultimately overall hospital performance in quality and value-based care programs. 

Malnutrition: A Key Contributor to Wound Healing Challenges 

For nutrition professionals, the link between malnutrition and impaired wound healing is well known—but it warrants emphasizing in the context of hospital quality measures and interdisciplinary care. Inadequate intake of protein, zinc, vitamins C, E, B12, and other critical nutrients compromises collagen synthesis, immune response, and tissue regeneration (Breslow et al., 1993; Stechmiller, 2010; Arensberg et al., 2024). The clinical consequences are significant and measurable, contributing to: 

• Higher incidence of pressure injuries and compromised skin integrity, which is already a concern when patients are immobilized during hospitalization and spend extended periods of time in the same position post-surgery 
• Poor postoperative healing, including higher risk of wound dehiscence 
• Greater risk of infection and  
• Risk of prolonged length of stay (Guo & Dipietro, 2010; Arensberg et al., 2024) 

Nutrition’s Impact on Hospital Quality Performance 

While the malnutrition care score (MCS) is the only measure exclusively focused on nutrition in the hospital setting, there are multiple other measures and programs in the hospital quality space that are closely tied to nutrition care. Hospital-acquired wounds such as pressure injuries (stage 3+ and unstageable) and postoperative wound dehiscence are key components of the Patient Safety and Adverse Events Composite (PSI 90), a CMS quality measure used to assess preventable complications. PSI 90 is directly tied to the Hospital-Acquired Condition (HAC) Reduction Program, which penalizes hospitals in the bottom quartile of performance with a 1% reduction in their Medicare reimbursement. 

As a well-established risk factor for skin breakdown, impaired healing, and infection, malnutrition directly contributes to the occurrence of 3 out of the 10 PSI 90 events (Pressure Ulcer Rate, In-Hospital Fall with Hip Fracture Rate, and Postoperative Wound Dehiscence Rate). There is also a new voluntary acute care Hospital Harm-Pressure Injury (HH-PI) quality measure focused on incentivizing hospital best practices. Different from the PSI 90, the HH-PI is aimed at reducing new hospital acquired pressure injuries (Shepps 2024). 

By integrating nutrition-focused protocols (e.g., timely screening, targeted nutrition interventions, and care team coordination), hospitals can: 

• Lower the incidence of pressure injuries and surgical wound complications  
• Improve PSI 90 composite scores 
• Reduce the risk of financial penalties under the HAC Reduction Program 

For example, a study by Tappenden et al. (2013) showed that standardized nutrition care pathways led to significant reductions in hospital-acquired pressure injuries and LOS—key factors in PSI 90 outcomes. This is an ideal application of the MCS as a tool for quality improvement outside of simply reporting the measure for regulatory purposes. By applying the steps in the measure components to the surgical and at-risk populations, hospitals can work on increasing adherence to the protocols and track the impact on associated clinical outcomes. In addition, practice tools such as the multidisciplinary Standardized Pressure Injury Prevention Protocol Checklist (SPIPP-Adult) 2.0 (Pittman et al., 2023) validated by the National Pressure Injury Advisory Panel can be beneficial in standardizing protocols. 

What is TEAM, and Why Nutrition Matters 

The Transforming Episode Accountability Model (TEAM) is a mandatory bundled payment model from the Centers for Medicare & Medicaid Services (CMS), scheduled to begin in January 2026. It will apply to hospitals in selected regions and cover common surgical procedures including lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedure.

TEAM will hold hospitals financially accountable for cost and quality across the entire 30-day episode of care, including post-acute outcomes. Hospitals will face financial rewards or penalties based on their performance relative to benchmarks. In this context, nutrition is a high-impact strategy to drive success in TEAM. Malnourished patients are more likely to experience readmissions, complications, and extended recovery—factors that increase episode cost and harm quality performance. Embedding nutrition assessment and intervention into the care pathway can help reduce avoidable complications, shorten recovery time, and align care with TEAM’s value-based objectives. 

Leveraging the MCS to Drive Wound Improvement 

Nutrition care is not only clinically essential—it’s increasingly strategic for success under value-based models like TEAM and the HAC Reduction Program. For hospitals already implementing the MCS, the next step is ensuring that its components are tightly integrated with wound prevention and management protocols. Since the MCS is now publicly reported under the Hospital Inpatient Quality Reporting (IQR) Program, there is added urgency to optimize each domain—not just for compliance, but to meaningfully impact patient safety indicators tied to reimbursement. To directly influence wound-related outcomes, hospitals should evaluate how well they’re performing in each step of the nutrition care process: 

• Screening: Ensure high-risk populations—such as post-surgical, ICU, and immobile patients—are prioritized for rapid nutrition screening within the first 24 hours. These groups are also at highest risk for pressure injuries and wound dehiscence. 
• Assessment: Streamline pathways for clinical nutrition assessment when wounds are present or suspected. Utilize validated tools that account for wound burden when determining malnutrition severity. 
• Diagnosis: Ensure alignment between malnutrition and wound documentation to strengthen coding accuracy and support risk adjustment. Collaboration between nutrition, wound care, physicians, and clinical documentation improvement (CDI) teams is essential. 
• Care Planning: Embed wound-specific nutrition interventions (such as specialized supplements containing arginine, glutamine, beta-hydroxy-beta-methylbutyrate (HMB), protein, and micronutriens) into the nutrition care plan, especially for patients with existing stage 2+ pressure injuries or non-healing surgical wounds.  

Facilities that optimize the MCS process could more than improve quality scores—they could reduce PSI 90 indicator rates, enhance interdisciplinary care coordination, minimize penalties under the HAC Reduction Program, and optimize financial returns if participating in TEAM. 

Conclusion 

Nutrition care is a proven, high-impact strategy for improving wound prevention, accelerating surgical healing, and enhancing hospital quality scores. Through tools like the MCS and a structured nutrition care process, hospitals can strengthen performance in PSI 90, meet HAC Reduction goals, and prepare for future requirements like the TEAM payment model. 

Now is the time to act—invest in nutrition, prevent wounds, and share your story to help shape the future of quality hospital care. 

Share Your Success Story with CMS 

As CMS prepares the FY2026 Inpatient Prospective Payment System (IPPS) final rule, public comments are a key opportunity to highlight successful strategies. MQii will be submitting this public comment letter to CMS and would welcome those interested in signing on to the MQii public comment to email us at malnutritionquality@avalerehealth.com. 

Additionally, if your facility has implemented the MCS or used nutrition care to improve patient outcomes, we encourage you to submit a comment to CMS using this public comment letter template and tailoring it to your unique experiences. Public comments can be submitted here. Sharing your experience helps reinforce the value of nutrition in national policy conversations.