U.S. Rep. Bruce Braley was in the spotlight recently, praising Iowa for providing high-quality health care while controlling costs. He is concerned about geographic inequality in Medicare reimbursement. Iowa ranks low in Medicare beneficiary spending and ranks high on 22 quality indicators. As a result, he has introduced the Medicare Payment Improvement Act, which would move reimbursement from “fee for services” to a value index based on quality outcomes, not quantity of services.

Other changes to hospital reimbursement are already in place that reward high quality of care and penalize poor outcomes. In 2008, the Centers for Medicaid and Medicare Services (CMS) implemented a policy on “never events” – harmful events that should never occur in a hospital. This policy prohibits billing of additional costs to patients who developed conditions that were not present at the time of hospital admission but were present at discharge. Examples include pressure ulcers (also known as bed sores), injuries from falls and infections.

So, with the national changes in reimbursement practices, how can Iowa hospitals continue to be role models for delivering high-quality care?

Essentially, the emphasis on good outcomes drives accountability for hospitalized patients primarily from providers – physicians and nurse practitioners – to the entire hospital team. I believe nurses are the point guards of this team, providing professional care around the clock with an eye on the overall status of the patients.

Nursing assessment is the key to expert clinical practice. Nurses need to know how to access databases, learn about and implement research findings, take accountability for evaluation and improvement of point-of-care outcomes, advocate for patients, leverage human, environmental and material resources, and initiate safety and prevention protocols.

One of the key safety and prevention protocols initiated by nurses is prevention of pressure ulcers. According to the Agency for Healthcare Research and Quality, the average pressure ulcer-related stay extends hospitalization 13-14 days and costs between $16,755 and $20,430. So from a purely economic view, hospitals want to prevent their occurrence.

I would go further, however, and argue that patients who suffer pressure ulcers have a dramatic decrease in quality of life, with many months of painful treatments to heal the wound. It can affect all aspects of a person’s daily living. Hospitals have an ethical obligation to keep ulcers from occurring.

As point guards for the integration of care, nurses will need to assume widespread leadership roles within hospital organizations. Hospitals need to reward nurses both monetarily and through recognition of their expertise.

The next time you or a loved one need to be hospitalized, pay attention to the nursing care you receive. Your health depends on it.

Jean Logan is vice chair of the Board of Trustees at Broadlawns Medical Center and professor of nursing at Grand View University.