System of CARE scorecard: Q2 2024 to Q1 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 2024 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 for peer benchmarking, detailed trends are also shown by Vizient hospital cohort. The academic medical center (AMC) cohort is defined as comprehensive AMC and large, specialized complex care medical center hospital. The community hospital cohort is defined as complex care medical center, community hospital, small community hospital and critical access hospital.
Note: Analysis for new patient access and average occupancy includes all age groups. All other analysis excludes 0-17 age group. Evaluation and management (E&M) visits are defined as visits—evaluation and management, established patient visits—in person, established patient visits— virtual, new patient visits—in person, new patient visits—virtual. Sg2 CARE Grouper definitions are used to define emergent and urgent visits. 30-day readmission rates include all causes for readmission. 0% indicates the forecast is flat (less than ±1%). ALOS = average length of stay; CARE = Clinical Alignment and Resource Effectiveness; ED = emergency department; IP = inpatient; OP = outpatient; PAC = post-acute care; SNF = skilled nursing facility. Sources: Data from AAMC-Vizient Clinical Practice Solutions Center, Vizient Clinical Data Base, and Vizient Operational Data Base, used with permission of Vizient, Inc. All rights reserved. Accessed July 2025. Impact of Change®, 2025; HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 2021. Agency for Healthcare Research and Quality, Rockville, MD; Proprietary Sg2 All-Payer Claims Data Set, 2023; The following 2023 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas Pop-Facts®, 2025; Sg2 Analysis, 2025.
Trends across all hospitals (Q1 2022 to Q1 2025)
- Patient access remains a challenge. New patients are not seen within 10 days for over half of the top-volume specialties—all projected to grow over the next decade—which highlights the need to expand access and enhance patient experience.
- ED throughput is improving, with a shorter average length of stay and a stable admission rate at 22%, while emergent visits now make up a growing share of ED volume.
- Observation ALOS has declined in recent quarters, but volume is projected to grow by 12% over the next decade, indicating future pressure on shortstay capacity.
- Inpatient ALOS has remained steady and 65% of admissions originate from the ED. Persistently high occupancy across units continues to constrain flexibility for new or elective cases.
- Quality performance is improving, while costs are increasing. Data show rising direct costs per case and per day along with changes in mortality rates (slight decrease) and 30-day readmission rates (slight increase).
- The percentage of IP discharges to post-acute care have held steady, yet 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 (4.7 hours) than community hospitals (3.5 hours). Community hospitals also discharge more ED patients than AMCs (~80% vs ~75%), indicating more treatand-release volumes in non-academic settings.
- Observation ALOS is similar across AMCs and community hospitals (33.7 vs. 32.6 hours), with modest recent declines. Inpatient ALOS remains higher at AMCs than community hospitals (6.1 vs 4.8 days), reflecting greater acuity, though ALOS for both has plateaued.
- 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.
- Cost increases are more pronounced at AMCs (10%–16%) than community hospitals (6%–16%), potentially due to higher 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
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Trends: academic medical centers
Including comprehensive academic medical center and large, specialized complex care medical center hospital cohorts
- 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 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, inpatient discharge or post-acute, 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
- 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 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, inpatient discharge or post-acute, 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?