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, 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 (AMCs) and community hospitals (based on Vizient hospital cohort*) are shown on pages 4-15.
Figure 1. System of CARE Scorecard
Figure 1. System of CARE Scorecard (continued)
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. 30-day readmission rates include all causes for readmission. 0% indicates the forecast is flat (less than ±1%). ALOS = average length of stay; AMC = academic medical center; CARE = Clinical Alignment and Resource Effectiveness; ED = emergency department; IP = inpatient; LOS = length of stay; OP = outpatient; PAC = post-acute care; SNF = skilled nursing facility; YoY = year-over-year. Sources: Data from AAMCVizient Clinical Practice Solutions Center, Vizient Clinical Data Base, and Vizient Operational Data Base, used with permission of Vizient, Inc. All rights reserved. Accessed August 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
- 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.
*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 August 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.
