System of CARE Scorecard: Q3 2024 to Q2 2025
Our new 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 (AMCs) and community hospitals (based on Vizient hospital cohort*) are shown on pages 4-15.
Trends across all hospitals
- Patient access remains a challenge. New patients are unable to be seen within 10 days for all the top-volume specialties, with overall evaluation and management (E&M) visits projected to grow at 17% over the next decade, highlighting the need to expand access and enhance patient experience.
- Emergency department (ED) throughput is improving, with a shorter average length of stay (ALOS) and a slight increase in inpatient admission rate at 25%, while emergent visits now make up a growing share of ED volume.
- Observation ALOS has remained stable with slight fluctuation in recent quarters, but volume is projected to grow by 12% over the next decade, indicating future pressure on short-stay capacity.
- Inpatient ALOS experienced a slight decline and 69% of admissions originate from the ED. Persistently high occupancy across units continues to constrain flexibility for new or elective cases.
- Quality performance change is mixed given mortality is decreasing, but readmissions have increased slightly while costs are increasing. Data show rising direct costs per case and per day along with slight changes in mortality rates (decrease) and 30-day readmission rates (slight increase).
- Post-acute discharges have been trending upward, and projected growth is substantial, highlighting a need to reassess post-acute capacity as demand grows.
AMC vs community hospital comparisons
- ED ALOS remains higher at AMCs (4.5 hours) than community hospitals (3.2 hours), despite similar emergent (~66%) vs. urgent profiles (~34%). Community hospitals also discharge more ED patients than AMCs (~79% vs. ~71%), indicating more treat-and-release and transfer volumes in non-academic settings.
- Observation ALOS is similar across AMCs and community hospitals (32.5 vs. 31.8 hours), with recent declines. Inpatient ALOS remains higher at AMCs than community hospitals (5.8 vs. 4.2 days), reflecting greater acuity, though ALOS for both has slightly declined.
- A greater share of inpatient discharges originates from the ED in community hospitals (76%) vs. AMCs (65%), underscoring the ED’s role as the primary entry point for community hospitals.
- Occupancy remains high across both cohorts, with AMCs operating at relatively higher levels across unit types, escalating capacity constraints as demand increases.
- Both AMCs and community hospitals saw doubledigit cost increases per stay and per day. AMC costs remain substantially higher compared to community hospitals, with 70% more per stay and 32% more per day, likely reflecting 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, contact 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 local factors are influencing the steady ED admission rate, despite growth in emergent volumes?
- Do current ED workflows align with the fact that most patients are discharged rather than admitted? Where is there opportunity for improvement?
- 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 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 targeted strategies can move quality metrics from steadiness to meaningful performance improvement?
- Considering local dynamics, at what point in the care continuum—during inpatient discharge or in the post-acute phase—can interventions to reduce readmissions have the greatest impact?
- What are the primary drivers of rising direct cost per case in your market or at your hospital?
- How can health systems redesign care delivery or resource allocation to manage increasing costs?
- Are discharge decisions primarily driven by patient clinical needs or by the availability of post-acute care resources?
- How does your hospital strengthen partnerships across post-acute settings to better align capacity with rising inpatient and ED volume?
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 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 local factors are influencing the steady ED admission rate, despite growth in emergent volumes?
- How can ED workflows be further optimized to support safe, efficient discharges?
- 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?
- Are your current unit configurations aligned with evolving patterns of patient acuity and length of stay?
- What targeted strategies can advance meaningful performance improvement?
- Considering local dynamics, at what point in the care continuum—during inpatient discharge or in the post-acute phase—can interventions to reduce readmissions have the greatest impact?
- What are the primary drivers of rising direct costs per case in your market or at your hospital?
- How can health systems redesign care delivery or resource allocation to manage increasing costs?
- Are discharge decisions primarily driven by patient clinical needs or by the availability of post-acute care resources?
- How does your hospital strengthen partnerships across post-acute settings to better align capacity with rising inpatient and ED volume?