Our System of CARE Scorecard, shown in Figure 1, provides important benchmarks for metrics across the care continuum. Drawing on the latest rolling four quarters of Vizient Clinical Data Base data as well as Vizient Operational Data Base and AAMC–Vizient Clinical Practice Solutions Center® data, the scorecard highlights key trends in throughput, access, quality performance, and cost efficiency. Additionally, Sg2 Impact of Change® national forecasts provide forward-looking insights to help health systems anticipate demand and plan for growth. To support meaningful comparisons and peer benchmarking, specific scorecards and trends for academic medical centers and community hospitals (based on Vizient hospital cohort*) are shown on pages 4-15.
Trends across all hospitals
- Patient access shapes utilization patterns. Wait times for new patients remain elevated across all top-volume specialties. With overall E&M visits projected to grow at 17% over the next decade, expanded access strategies and alternative care models across the System of CARE are essential.
- ED volumes continue to rise, driven by emergent visits. Emergent visits are growing faster than urgent visits, while ED length of stay has declined significantly. This suggests improved throughput, though shifts in patient mix may also be contributing.
- Observation ALOS declined modestly, but volume is projected to grow by 12% over the next decade, indicating future pressure on short-stay capacity.
- Inpatient volumes grew 3% over the past four quarters, with an increasing share of admissions coming through the ED, reinforcing its role as the front door of the hospital. Although inpatient ALOS and occupancy rates continue to decline, persistent wait times for new-patient E&M visits suggest ongoing access barriers, highlighting the need to better understand the types of patients being admitted.
- Quality performance is mixed, with mortality rates continuing to improve and readmissions continuing to rise. Meanwhile, increasing direct costs per case and per day are adding pressure to maintain quality while protecting hospital margins. Although inpatient ALOS declined slightly, cost per stay and per day increased, suggesting rising care intensity and cost pressures despite shorter hospital stays.
- Post-acute discharges are trending upward. Planning strategies should include close collaboration with post-acute providers to ensure adequate capacity, particularly as demand increasingly originates outside the traditional inpatient discharge process and substantial growth is projected in the coming years.
AMC vs. community hospital comparisons
- ED volume is rising across both hospital cohorts, with faster growth at AMCs. Emergent visits are increasing faster than urgent visits in both settings and now represent 68% of total ED volume at AMCs compared to 67% at community hospitals, reflecting rising patient acuity.
- ED ALOS remains higher at AMCs (4.0 hours) than community hospitals (2.4 hours). Community hospitals discharge more ED patients than AMCs (79% vs. 71%), indicating more treat-and-release and transfer volumes in nonacademic settings.
- Observation and inpatient ALOS have declined slightly for both AMCs and community hospitals. Observation ALOS remains slightly higher at AMCs (34.3 hours) compared to community hospitals (33.5 hours). Inpatient ALOS also remains higher at AMCs (5.8 days vs 4.6 days), reflecting greater patient acuity and case complexity.
- Inpatient growth has been consistent between AMCs and community hospitals, about 3% year over year. However, a greater share of inpatient discharges originates from the ED in community hospitals (78%) compared to AMCs (66%), underscoring the ED as the primary entry point for community hospitals.
- General acute care occupancy remains high across both cohorts. However, AMCs operate at consistently higher ICU occupancy rates than community hospitals, amplifying capacity constraints as patient acuity rises at AMCs.
- AMCs have higher mortality rates and readmission rates compared to community hospitals. Although mortality rates declined substantially for both cohorts, readmissions persistently increased.
- Cost pressures continue across both hospital cohorts; however, costs per stay and per day are rising faster at AMCs than at community hospitals. AMC costs remain substantially higher, with about 74% more per stay and nearly 37% more per day, which likely reflects greater case complexity and resource intensity.
- Post-acute discharge patterns are similar across AMCs and community hospitals. As inpatient acuity and demand rise, stronger post-acute partnerships are essential to better align capacity with growing ED and inpatient volumes.
Contributor
To speak with one of our experts about performance improvements or System of CARE strategy, email membercenter@sg2.com.
Trends: Academic medical centers
Including comprehensive academic medical center and large, specialized complex care medical center hospital cohorts*
Figure 2 shows the AMC System of CARE Scorecard, which provides important benchmarks for metrics across the care continuum. Drawing on the latest rolling four quarters of data in the Vizient Clinical Data Base as well as the Vizient Operational Data Base, the scorecard highlights key trends in throughput, access, quality performance, and cost efficiency. To support meaningful comparisons and peer benchmarking, detailed trends are provided on pages 4-9.
- Is a decline in ED ALOS at your hospital a sign of improved efficiency or does it result from a shift in patient mix?
- As ED length of stay declines, is your capacity keeping pace with rising volumes? Are those volumes marked by a shift in patient acuity?
- What local and national factors are driving the shift toward higher-acuity ED visits? How can systems manage this trend as overall volumes rise?
- Is there still opportunity to reduce low-acuity ED visits by expanding access to alternative care settings?
- What factors are contributing to declines in observation and inpatient length of stay: changes in utilization patterns, operational improvements, or greater access to post-acute care?
- If these trends continue, what are the strategic implications for capacity and future growth?
- Is the ED increasingly serving as the default entry point for inpatient care due to access barriers elsewhere in the system? How does that influence inpatient capacity planning?
- How are hospitals adapting to a growing proportion of inpatient volumes from the ED?
- What strategies are being deployed by your hospital to optimize bed utilization across inpatient unit types?
- How should hospitals rebalance inpatient capacity when unscheduled ED admissions begin to displace planned or elective care?
- What is driving the divergence between the declining mortality rate and rising readmission rate?
- What does this pattern signal about performance across inpatient care, care transitions, and post-acute coordination?
- What is driving the growing number of discharges to post-acute care, and what does it signal about inpatient acuity, quality, and discharge practices?
- How can community hospital leaders strengthen post-acute partnerships as patient volumes grow and throughput pressures increase?
Trends: Community hospitals
Including complex care medical center, community hospital, small community hospital, and critical access hospital cohorts*
Figure 13 shows the Community Hospital System of CARE Scorecard, which provides important benchmarks for metrics across the care continuum. Drawing on the latest rolling four quarters of data in the Vizient Clinical Data Base as well as the Vizient Operational Data Base, the scorecard highlights key trends in throughput, access, quality performance, and cost efficiency. To support meaningful comparisons and peer benchmarking, detailed trends are provided on pages 10-15.
- Is a decline in ED ALOS at your hospital a sign of improved efficiency or does it result from a shift in patient mix?
- As ED length of stay declines, is your capacity keeping pace with rising volumes? Are those volumes marked by a shift in patient acuity?
- What local factors are contributing to faster growth in emergent ED visits compared with urgent visits?
- How can community hospitals expand access strategies to reduce reliance on the ED as the primary front door to care?
- What is contributing to stable ED admission rates despite rising emergent volume?
- What plans should be made for discharge workflows and downstream capacity as this pattern continues?
- To what extent are length-of-stay trends driven by local payer dynamics, utilization trends, or operational improvements?
- How do case mix and patient acuity influence ALOS trends? Does newly available capacity create opportunity to meet new demand or strategically grow services?
- Is the ED increasingly serving as the default entry point for inpatient care due to access barriers elsewhere in the system? How does that influence inpatient capacity planning?
- How are hospitals adapting to a growing proportion of inpatient volumes from the ED?
- What strategies are being deployed at your hospital to optimize bed utilization across inpatient unit types?
- How should community hospital leaders think about bed mix, staffing, and flex capacity to support future growth?
- What is driving the divergence between the declining mortality rate and rising readmission rate?
- What does this pattern signal about performance across inpatient care, care transitions, and post-acute coordination?
- What is contributing most to rising direct cost per stay and per day: inflation, acuity, or operational inefficiency?
- What are the implications for staffing, standardization, throughput, and site of care?
- What is driving the growing number of discharges to post-acute care, and what does it signal about inpatient acuity, quality, and discharge practices?
- How can AMCs strengthen post-acute partnerships as patient volumes grow and throughput pressures increase?