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, 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 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.
Figure 1. System of CARE scorecard
*For patients discharged home only.
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. Vizient 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 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, 2025.
Key takeaways
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.
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 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, 2025.
