For journalists, researchers, and data users.

Lede

Skin-cancer incidence has been rising for two decades while the dermatologist supply has barely kept pace — and the gap is not evenly distributed. With melanoma now the fifth most common cancer in U.S. adults, where you live increasingly determines whether a suspicious mole gets seen by a board-certified dermatologist within weeks or months.

Data point

Fonteum Research counts NPI-1 records flagged with dermatology taxonomy (CMS NPPES) at the state level and normalizes against the U.S. Census Bureau's most recent state population estimate. The state-by-state distribution sits in the published CSV at /research/data/dermatology-access-density-2026.csv. Multiple states have HRSA Health Professional Shortage Area exposure overlapping their lowest-density quartile.

So what

Where a person's ZIP code falls inside a low-density state has direct downstream effects: longer wait times for routine screenings, more travel for biopsies, and higher rates of patients defaulting to non-specialist care. For a healthcare reporter, this is the rare access story that travels — every state has a different answer.

Tension

The counterintuitive angle: density does not always track urbanization. Several mid-density Sun Belt states show worse per-capita supply than parts of Appalachia once HRSA shortage exposure is layered in. The simple urban-vs-rural framing breaks.

Suggested external experts (independent of Fonteum)

• American Academy of Dermatology workforce policy staff
• HRSA Bureau of Health Workforce (HPSA program lead)
• A state medical-board chair (e.g. CA Medical Board, FL DOH)
• Health-services researcher who studies physician-distribution literature

Lede

Home-health spending is one of the fastest-growing segments of Medicare, projected to keep climbing as the boomer cohort ages in place. Yet star ratings — the only public-facing CMS quality signal a family can act on — are heavily concentrated in some states and missing in others.

Data point

Fonteum's snapshot of the CMS Care Compare Home Health Care Agencies dataset (6jpm-sxkc) builds state-level aggregates: mean Quality-of-Patient-Care star rating, count of rated vs unrated agencies, and ownership mix (For Profit vs Non Profit vs Government). The full state aggregate sits at /research/data/home-health-quality-by-state-2026.csv.

So what

A family choosing a home-health agency for a parent should be looking at the star rating. In states where 30%+ of agencies are unrated, that decision happens with no public quality signal — and the for-profit/non-profit ownership mix shifts materially across state lines, which has been associated with outcome variation in the academic literature.

Tension

The home-health industry has lobbied to reduce CMS rating frequency on grounds that small samples produce noisy stars. The data shows that rating gaps cluster geographically — and the states with the thinnest rating coverage are also the states with the highest for-profit market share. Whether that is causation or correlation is an open question.

Suggested external experts (independent of Fonteum)

• MedPAC home-health analyst
• CMS Care Compare program lead
• A state long-term-care ombudsman
• A health-economist on CMS quality-rating methodology

Lede

Nursing-home quality variation between U.S. states is wider than most readers assume. CMS publishes overall star ratings for every certified facility, and when those are aggregated to the state level, the spread between best and worst quartile states is dramatic — large enough that an aging parent's options are heavily shaped by which side of a state line they live on.

Data point

Fonteum's CMS Care Compare Provider Data snapshot calculates state-level mean overall star rating, component sub-rating distributions, ownership mix, and rated vs unrated counts. The state-by-state breakdown is at /research/data/nursing-home-quality-by-state-2026.csv. Several states cluster well below the national-average star rating; several others cluster above.

So what

Aging-in-place is a cliché until a fall, a stroke, or a dementia diagnosis forces a placement decision. At that point the star rating is the only standardized public signal. State-level variation is the headline a national reporter can localize anywhere.

Tension

The contested element: ownership-mix correlation with rating. The for-profit chain consolidation of the past decade has been associated with rating shifts that critics characterize as deterioration and operators characterize as measurement-methodology change. Both interpretations have proponents inside CMS; the data alone does not settle it.

Suggested external experts (independent of Fonteum)

• MedPAC long-term-care analyst
• AARP Public Policy Institute long-term-care researcher
• A state Department of Health surveyor
• A health-services academic on nursing-home ownership trends

Lede

Most provider directories you've encountered as a consumer are either (a) backfilled from Google Business Profile with no source citation or (b) a paid lead-gen list dressed up as a directory. A small but growing category — academic-grade provider graphs — does the opposite: every field on a profile is anchored to a federal or state public-record source, and the source citation is rendered visibly to the reader.

Data point

Fonteum's provenance graph stamps four pieces of metadata on every published field: the originating source (e.g. CMS NPPES, CMS Care Compare), the last-checked ISO date, a §95 confidence tier, and the public/restricted display permission. Those four show up on every profile via the ProvenanceCard component, with the same contract documented at /data-provenance and /data-platform/schema.

So what

The methodology story is the better business story than the directory itself. Local-services data has been a wild west for two decades; the question of who is allowed to sell what about whom — and how — is moving back into regulatory focus (FTC click-to-cancel, CMS provider-directory accuracy, state UPL enforcement). A reporter can use Fonteum as a worked example of the alternative pattern.

Tension

The doctrine has tradeoffs. Source-cited is not the same as pre-vetted, and a buyer who wants a quality stamp will not find one. Several state-board datasets are restricted from redistribution and will never appear in this graph. Whether 'public record cited, never overclaimed' is a defensible long-term posture — or an unstable middle ground — is a real disagreement inside the industry.

Suggested external experts (independent of Fonteum)

• FTC Bureau of Consumer Protection (provider-directory enforcement)
• ONC HHS interoperability lead
• A health-data-portability academic (e.g. Mark Savage, Jodi Daniel)
• A state attorney-general consumer-protection desk