Data on the Edge

System of CARE Scorecard: Q4 2024 to Q3 2025

VizientReport
By Vizient Intelligence
10 min readFeb 5, 2026
Data and analyticsClinical operations and quality
Key points
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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
New patient access by select specialty
Figure 1.1 System of CARE scorecard
Emergency department utilization
Figure 1.2 System of CARE scorecard
Observation services utilization
Figure 1.3 System of CARE scorecard
Inpatient utilization
Figure 1.4 System of CARE scorecard
Post-acute care: IP disposition by location
Figure 1.5 System of CARE scorecard
Key takeaways

Trends across all hospitals

  • Patient access remains a challenge. New patients are unable to be seen within 10 days for all of 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 (IP) 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 68% of admissions originate from the ED. Occupancy rates across units have declined slightly but remain high, continuing to limit flexibility for new or elective cases.
  • Quality performance change is mixed given mortality is decreasing, but readmissions increased slightly while costs are increasing. Data show rising direct costs per case and per day along with a decrease in mortality rates but a slight increase in 30-day readmission rates.
  • Post-acute discharges are trending upward and projected growth is substantial, underscoring the need for a strong post-acute strategy to meet rising demand.

AMC vs. community hospital comparisons

  • ED ALOS remains higher at AMCs (4.5 hours) than community hospitals (3.3 hours), despite similar emergent (~66%) versus urgent profiles (~34%). Community hospitals also discharge more.
  • ED patients than AMCs (~80% vs. ~72%), indicating more treat-and-release and transfer volumes in nonacademic settings.
  • Observation ALOS is similar across AMCs and community hospitals (33.6 vs. 32.9 hours), with recent declines. Inpatient ALOS remains higher at AMCs than community hospitals (5.8 vs. 4.6 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 for general acute care remains high across both cohorts, with AMCs operating at even higher rates in intensive care units, amplifying capacity constraints as demand increases.
  • Cost increases per stay and per day continue for both AMCs and community hospitals. AMC costs remain substantially higher compared to community hospitals, with 71% more per stay and 34% 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 Soluions Center®, Vizient Clinical Data Base and Vizient Operational Data Base, used with permission of Vizient, Inc. All rights reserved. Accessed December 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.
Vizient Strategy Intelligence contributors

Contributor 

To speak with one of our experts about performance improvements or System of CARE strategy, email membercenter@vizientinc.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.

 
Figure 2. System of CARE Scorecard, AMCs
Emergency department utilization, rolling four quarters, Q3 2024–Q3 2025
Figure 2. System of CARE Scorecard, AMCs
Observation services utilization
Figure 2. System of CARE Scorecard, AMCs
 
Figure 3. ED average length of stay*, AMCs, Q4 2022–Q3 2025
Figure 3. ED average length of stay*, AMCs, Q4 2022–Q3 2025
Key questions for consideration
  • 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?
Figure 4. ED volume trends, AMCs, Q4 2022–Q3 2025
Figure 4. ED volume trends, AMCs, Q4 2022–Q3 2025
Key questions for consideration
  • 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?
Figure 5. ED discharge and inpatient admission trends, AMCs, Q4 2022–Q3 2025
Figure 5. ED discharge and inpatient admission trends, AMCs, Q4 2022–Q3 2025
Key questions for consideration
  • 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?
Figure 6. Average length of stay, AMCs, Q4 2022–Q3 2025
Figure 6. Average length of stay, AMCs, Q4 2022–Q3 2025
Key questions for consideration
  • 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?
Figure 7. Inpatient discharge trends, AMCs, Q4 2022–Q3 2025
Figure 7. Inpatient discharge trends, AMCs, Q4 2022–Q3 2025
Key questions for consideration
  • 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?
Figure 8. Inpatient occupancy rate by unit type, AMCs, Q3 2022–Q2 2025
Figure 8. Inpatient occupancy rate by unit type, AMCs, Q3 2022–Q2 2025
Key questions for consideration
  • 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?
Figure 9. 30-day readmission rate*, AMCs, Q4 2022–Q3 2025
Figure 9. 30-day readmission rate*, AMCs, Q4 2022–Q3 2025
Figure 10. Mortality rate, AMCs, Q4 2022–Q3 2025
Figure 10. Mortality rate, AMCs, Q4 2022–Q3 2025
Key questions for consideration
  • 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?
Figure 11. Average direct cost, AMCs, Q4 2022–Q3 2025
Figure 11. Average direct cost, AMCs, Q4 2022–Q3 2025
Key questions for consideration
  • 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?
Figure 12. % of inpatient discharges to post-acute care, AMCs Q4 2022–Q3 2025
Figure 12. % of inpatient discharges to post-acute care, AMCs Q4 2022–Q3 2025
Key questions for consideration
  • 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.

 
Figure 13. System of CARE Scorecard, community hospitals
Emergency department utilization, rolling four quarters, Q3 2024–Q3 2025
Figure 13. System of CARE Scorecard, community hospitals
Observation services utilization
Figure 13. System of CARE Scorecard, community hospitals
Inpatient utilization
Figure 13. System of CARE Scorecard, community hospitals Figure 13. System of CARE Scorecard, community hospitals
Post-acute care: IP disposition by location
Figure 13. System of CARE Scorecard, community hospitals
 
Figure 14. ED average length of stay*, community hospitals, Q4 2022–Q3 2025
Figure 14. ED average length of stay*, community hospitals, Q4 2022–Q3 2025
Key questions for consideration
  • 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?
Figure 15. ED volume trends, community hospitals, Q4 2022–Q3 2025
Figure 15. ED volume trends, community hospitals, Q4 2022–Q3 2025
Key questions for consideration
  • 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?
Figure 16. ED discharge and inpatient admission trends, community hospitals, Q4 2022–Q3 2025
Figure 16. ED discharge and inpatient admission trends, community hospitals, Q4 2022–Q3 2025
Key questions for consideration
  • 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?
Figure 17. Average length of stay, community hospitals, Q4 2022–Q3 2025
Figure 17. Average length of stay, community hospitals, Q4 2022–Q3 2025
Key questions for consideration
  • 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?
Figure 18. Inpatient discharge trends, community hospitals, Q4 2022–Q3 2025
Figure 18. Inpatient discharge trends, community hospitals, Q4 2022–Q3 2025
Key questions for consideration
  • 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?
Figure 19. Inpatient occupancy rate by unit type, community hospitals, Q3 2022–Q2 2025
Figure 19. Inpatient occupancy rate by unit type, community hospitals, Q3 2022–Q2 2025
Key questions for consideration
  • What strategies are being deployed by 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?
Figure 20. 30-day readmission rate*, community hospitals, Q4 2022–Q3 2025
Figure 20. 30-day readmission rate*, community hospitals, Q4 2022–Q3 2025
Figure 21. Mortality rate, community hospitals, Q4 2022–Q3 2025
Figure 21. Mortality rate, community hospitals, Q4 2022–Q3 2025
Key questions for consideration
  • 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?
Figure 22. Average direct cost, community hospitals, Q4 2022–Q3 2025
Figure 22. Average direct cost, community hospitals, Q4 2022–Q3 2025
Key questions for consideration
  • 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?
Figure 23. % of inpatient discharges to post-acute care, community hospitals, Q4 2022–Q3 2025
Figure 23. % of inpatient discharges to post-acute care, community hospitals, Q4 2022–Q3 2025
Key questions for consideration
  • 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?

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Vizient Intelligence is a diverse team of subject matter experts and thought leaders who represent specialties ranging from clinical service lines to enterprise strategy. The team develops strategy-specific content in the form of editorial reports, including the Data on the Edge series, and perspective-based analytics, such as the Impact of Change® forecast.

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