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

TL;DR

Urgent care visits among older adults in the U.S. more than doubled from 2012 to 2019, with slower growth in rural and disadvantaged areas.

Contribution

The study reveals significant growth in urgent care use by older adults and highlights disparities in access based on age, location, and socioeconomic factors.

Findings

Urgent care visits among older adults increased from 47.7 to 117.2 per 1000 from 2012 to 2019.

Rural and disadvantaged communities saw slower growth in urgent care utilization compared to urban areas.

Advanced practice practitioners managed over half of urgent care visits by 2019.

Abstract

How has urgent care (UC) utilization changed among older adults, and to what degree has utilization varied by patient and community characteristics?

In this cross-sectional study, UC visits among older adults more than doubled from 2012 to 2019, with the slowest growth among beneficiaries aged 85 years or older, eligible for Medicaid, and residing in rural and disadvantaged communities. There was a marked increase in UC visits to advanced practice practitioners (APPs), who managed more than half of visits in 2019.

This study suggests that older adults have increasingly used UC for acute, unscheduled care, although access appears to be limited for vulnerable populations.

Urgent care (UC) centers have proliferated rapidly, yet research on how utilization has changed among older adults is limited.

To examine UC utilization among older adults and assess whether utilization rates varied by beneficiary sociodemographic and community characteristics.

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.

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.

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.

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.

This cross-sectional study examines urgent care utilization among adults aged 65 years or older and assesses whether utilization rates varied by beneficiary sociodemographic and community characteristics.

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