Trends in Urgent Care Utilization Among Medicare Beneficiaries From 2012 to 2019.

Importance: Urgent care (UC) centers have proliferated rapidly, yet research on how utilization has changed among older adults is limited. Objectives: To examine UC utilization among older adults and assess whether utilization rates varied by beneficiary sociodemographic and community characteristics. Design, Setting, and Participants: This cross-sectional study used data from a 20% national sample of fee-for-service Medicare beneficiaries aged 65 years or older using UC centers from January 1, 2012, to December 31, 2019. Statistical analysis was performed from May 1, 2021, to November 24, 2025. Main Outcome and Measures: Among Medicare beneficiaries aged 65 years or older, unadjusted UC visits were calculated by year from 2012 to 2019 overall and stratified by demographic characteristics, frailty, community rurality, Social Deprivation Index (SDI), and physician supply. Adjusted incidence rate ratios (IRRs) were calculated for UC visits in 2018 and 2019 using negative binomial models. Trends in the distribution of UC visits among the most frequent clinician specialty categories (primary care, emergency medicine, and advanced practice practitioners [APPs]) were examined using linear models. Results: There were 3 516 816 UC visits among 9 514 946 beneficiaries (mean [SD] age across visits, 75.2 [7.5] years; 63.4% women). UC visits increased from 47.7 to 117.2 per 1000 from 2012 to 2019 (9.0 [95% CI, 9.0-9.1] visits per 1000 per year). The growth in UC utilization was slowest for beneficiaries aged 85 years or older (4.0 [95% CI, 3.8-4.1] visits per 1000 per year), Medicaid-eligible beneficiaries (4.0 [95% CI, 3.9-4.2] visits per 1000 per year), those residing in communities that were rural (5.0 [95% CI, 4.8-5.2] visits per 1000 per year), thow who were disadvantaged (6.8 [95% CI, 6.0-7.6] visits per 1000 per year), and those with fewer physicians (7.2 [95% CI, 5.5-8.8] visits per 1000 per year). In 2018 and 2019, beneficiaries residing in rural communities had 45% lower adjusted UC utilization compared with urban communities (IRR, 0.55 [95% CI, 0.54-0.55]) and those residing in zip codes in the SDI fourth quartile had 23% lower adjusted UC utilization (IRR, 0.77 [95% CI, 0.77-0.78]) compared with those in the most advantaged quartile. The percentage of beneficiaries managed by APPs increased from 21.0% in 2012 to 50.8% in 2019. Conclusions and Relevance: In this cross-sectional analysis, UC utilization increased markedly among older adults, with a disproportionate concentration in urban, less-disadvantaged communities. The distribution of clinician training and specialty also changed, with APPs delivering care for more than half of UC visits among older adults in 2019. These findings highlight the evolving patterns of acute care delivery for this growing population and the need for additional evidence on how these trends are associated with patient-centered outcomes and the efficiency of care.