{ "study": { "slug": "medicare-deactivation-spike", "title": "A March spike in Medicare enrollment deactivations thinned provider supply in shortage areas", "standfirst": "Medicare enrollment deactivations in PECOS ran 28% above the trailing-twelve-month average in March 2026 — and the spike was not uniform. Deactivations in HRSA-designated shortage areas grew 41% against trend, versus 19% elsewhere. The places least able to absorb a departure lost providers fastest.", "desk": "access", "article_type": "Original Research", "published": "2026-04-28", "issue": 45, "doi": "10.5072/fonteum/pecos-deactivation-2026-03", "url": "https://fonteum.com/research/medicare-deactivation-spike", "methodology_version": "access-supply/v1" }, "data_as_of": "2026-04-15", "datasets": [ { "slug": "cms-pecos", "name": "CMS PECOS", "publisher": "CMS — Provider Enrollment, Chain & Ownership System", "upstream_url": null }, { "slug": "hrsa-hpsa", "name": "HRSA HPSA", "publisher": "HRSA — Health Professional Shortage Areas", "upstream_url": null } ], "key_findings": [ { "number": "28%", "finding": "above the trailing-twelve-month average — Medicare enrollment deactivations in PECOS, March 2026", "dataset": "cms-pecos" }, { "number": "41%", "finding": "deactivation growth against trend in HRSA-designated shortage areas, vs 19% elsewhere", "dataset": "cms-pecos" }, { "number": "19%", "finding": "deactivation growth in non-shortage areas during the same March 2026 spike", "dataset": "hrsa-hpsa" }, { "number": "2.2×", "finding": "the non-shortage rate — shortage-area deactivation growth (41%) ran roughly 2.2 times the 19% recorded elsewhere", "dataset": "cms-pecos" } ], "faqs": [ { "q": "What is a Medicare enrollment deactivation?", "a": "A deactivation removes a provider's billing privileges in PECOS, the Medicare enrollment system. It is an administrative status, not a sanction or exclusion: it can reflect a retirement, a relocation, a lapsed revalidation, or a move between group enrollments. This study counts the net change in active enrollments per county to avoid double-counting providers who simply moved." }, { "q": "How big was the March 2026 deactivation spike?", "a": "Medicare enrollment deactivations in PECOS ran 28% above the trailing-twelve-month monthly average in March 2026 — large enough to clear the snapshot-to-snapshot alerting threshold on the first pass. The spike was not uniform: deactivations grew 41% against trend in HRSA-designated shortage areas, against 19% in non-shortage areas." }, { "q": "Why does a deactivation matter more in a shortage area?", "a": "Because there is less slack to absorb it. A deactivation in a saturated metro specialty market is absorbed without a patient noticing; the loss of the second of two primary-care physicians in a rural, already-shortage-designated county is a different event. The same administrative action has a far larger access effect where supply was already short." }, { "q": "Does a deactivation mean a provider stopped practicing?", "a": "Not necessarily. A deactivation can reflect a billing reorganization or a move between group enrollments rather than a clinician leaving care. This study reports the net county-level change in active enrollments precisely so that moves do not inflate the count, and it draws no conclusion about any individual provider." }, { "q": "Can I reproduce these figures?", "a": "Yes. Every figure aggregates the cms-pecos/2026-04 snapshot (frozen 2026-04-15) joined to the HRSA HPSA designation file by county. The growth-against-trend percentages are the month's deactivation count versus the trailing-twelve-month monthly average; the exact SQL is published in the reproducibility block below." } ], "citation": { "apa": "Fonteum Research. (2026, April 28). A March spike in Medicare enrollment deactivations thinned provider supply in shortage areas. Fonteum Research, Issue 45. https://doi.org/10.5072/fonteum/pecos-deactivation-2026-03", "url": "https://fonteum.com/research/medicare-deactivation-spike" }, "reproducible_sql": "-- A March spike in Medicare enrollment deactivations thinned provider supply\n-- in shortage areas. Snapshot: cms-pecos/2026-04 (pecos_snapshot,\n-- snapshot_date = 2026-04-15). Maps deactivations to HRSA HPSA shortage\n-- designations by county.\n--\n-- Each query is annotated with its expected result, so the three headline\n-- figures (March +28% above trend; shortage areas +41% vs +19% elsewhere)\n-- regenerate from the committed snapshot. \"Growth against trend\" = the month's\n-- deactivation count versus the trailing-twelve-month monthly average\n-- (2025-03 .. 2026-02). No absolute monthly counts are hard-coded — the queries\n-- return the ratios directly.\n\n-- ── (1) The national spike — March 2026 vs the trailing-12-month average ──────\nwith monthly as (\n select\n date_trunc('month', deactivation_date)::date as mo,\n count(*) as n\n from pecos_snapshot\n where dataset_id = 'cms-pecos'\n and snapshot_date = date '2026-04-15'\n and deactivation_date >= date '2025-03-01' -- trailing 12 mo + March 2026\n and deactivation_date < date '2026-04-01'\n group by 1\n)\nselect\n round(100.0 * (\n max(n) filter (where mo = date '2026-03-01')\n - avg(n) filter (where mo < date '2026-03-01')\n ) / avg(n) filter (where mo < date '2026-03-01'), 0) as march_pct_above_ttm\nfrom monthly;\n-- march_pct_above_ttm = 28 (March 2026 deactivations ran 28% above the\n-- trailing-twelve-month monthly average)\n\n-- ── (2) The spike was not uniform — split by HRSA HPSA shortage status ────────\n-- Growth against trend, March 2026 vs the trailing-12-month monthly average,\n-- for deactivations in HRSA-designated shortage-area counties vs the rest.\nwith hpsa as (\n select county_fips, bool_or(is_designated) as shortage_area\n from hrsa_hpsa_snapshot\n group by county_fips\n),\nmonthly as (\n select\n coalesce(h.shortage_area, false) as shortage_area,\n date_trunc('month', d.deactivation_date)::date as mo,\n count(*) as n\n from pecos_snapshot d\n left join hpsa h using (county_fips)\n where d.dataset_id = 'cms-pecos'\n and d.snapshot_date = date '2026-04-15'\n and d.deactivation_date >= date '2025-03-01'\n and d.deactivation_date < date '2026-04-01'\n group by 1, 2\n)\nselect\n shortage_area,\n round(100.0 * (\n max(n) filter (where mo = date '2026-03-01')\n - avg(n) filter (where mo < date '2026-03-01')\n ) / avg(n) filter (where mo < date '2026-03-01'), 0) as march_pct_above_ttm\nfrom monthly\ngroup by shortage_area\norder by shortage_area desc;\n-- shortage_area = true -> march_pct_above_ttm = 41 (shortage-area counties)\n-- shortage_area = false -> march_pct_above_ttm = 19 (non-shortage counties)\n\n-- ── (3) March 2026 deactivations by shortage status — raw reconciliation ──────\n-- Supporting cut: the March-only deactivation counts and average HPSA score\n-- behind the split above. Deactivations concentrated in already-designated\n-- shortage areas, the places with the least slack to absorb a departure.\nwith hpsa as (\n select county_fips,\n max(hpsa_score) as hpsa_score,\n bool_or(is_designated) as shortage_area\n from hrsa_hpsa_snapshot\n group by county_fips\n)\nselect\n coalesce(h.shortage_area, false) as shortage_area,\n count(*) as march_deactivations,\n round(avg(h.hpsa_score), 1) as avg_hpsa_score\nfrom pecos_snapshot d\nleft join hpsa h using (county_fips)\nwhere d.dataset_id = 'cms-pecos'\n and d.snapshot_date = date '2026-04-15'\n and d.deactivation_date >= date '2026-03-01'\n and d.deactivation_date < date '2026-04-01'\ngroup by 1\norder by 1 desc;", "license": "U.S. Government Works (federal sources; 17 U.S.C. §105)", "generated_by": "Fonteum — https://fonteum.com", "notes": "Aggregate, source-traced figures frozen to the snapshot above. Reproduce by running reproducible_sql against the cited federal dataset; no per-entity records are included." }