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, Vizient 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.
Figure 1. System of CARE Scorecard
New patient access by select specialty
Emergency department utilization
Observation services utilization
Post-acute care: IP disposition by location
Key takeaways
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.
*Using the
Vizient hospital cohort list, the AMC cohort is defined as comprehensive AMCs and large, specialized complex care medical center hospitals. The community hospital cohort is defined as complex care medical centers, community hospitals, small community hospitals and critical access hospitals. 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 March 2026. 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 Vizient 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; Vizient Strategy Analytics, 2026.
