Cardiologist details the many health disparities he encounters in rural Mississippi

Transportation issues in rural areas often leads to missed appointments

"Transportation is a big issue," Fakorede explained. "There's not a public transportation service line for most of these patients in such a rural area. There's not a Lyft or Uber service. These patients have to take another family worker out of work. So if I am the main caretaker of a family and I'm making $32,000 a year and I'm being asked to take my grandmother to see Dr. Fakorede an hour and a half away, what does that look like in terms of my day off of work to not only get her screened, but then I have to take another day to get her checked out or have a procedure done?" 

In a rural poor population, taking a day off to drive a family member to see a doctor could impact keeping the lights on or being able to pay a water bill or car payment. 

"Sometimes these family members have to figure out means to pay other family members to take that time off just for them to meet their visits," he explained.

Even if patients are on Medicaid and can get access to Medicaid transport, this also carries a set of problems. There can often be gaps a a couple hours between transports from one appointment to the next. 

"If you miss your next appointment like a dialysis or if you are on a transplant list and you miss that assessment, you are deemed a noncompliant patient," Fakorede said.

Financial literacy is a major problem for accessing care

Financial barriers also play a pivotal role in healthcare access. Fakorede shared insights into his clinic's approach, where patients' insurance status does not determine their access to care. This approach stands in stark contrast to the experiences of many patients in for-profit hospitals, where inability to pay copays or navigate insurance complexities can result in denial of essential services. 

There is often an assumption that poor and rural residents usually do not have insurance. Despite his practice being located in the center of one of the worst areas with health disparities in the country according to the Centers for Medicare and Medicaid Services (CMS) and the American College of Cardiology (ACC), Fakorede said most of his patients actually do have some form of insurance. 

"I am fortunate to have my outpatient-based lab where as the CEO and sole administrator, your insurance status doesn't play a role in terms of if I do your procedure or not. That is just something that I have personally taken into consideration after watching patients go through for-profit hospitals where they were denied access because they couldn't pay $60 copay. That was actually the No. 1 incentive for me to build my outpatient based lab," he explained.

He also invested in hiring multiple full-time employees to educate patients about their insurance coverage and financial options, and to work on insurance issues such as constant prior authorizations. 

As part of his community outreach, he has started a financial literacy education campaign. 

"Our community engagement is not just what happens in the community; it's investing full-time employees and nurses and intake coordinators to spend time with each patient, to educate them, inform them so that they can make better decisions next time so they can know what they can afford and not afford in terms of their care. And that's not done in a lot of places."

In many hospitals and outpatient facilities, patients get bills in the mail after receiving care and do not understand what they are being charged for, Fakorede explained. They often do not understand why many things are not covered by insurance and feel as if it is a bait-and-switch scheme.

He said this is often why patients do not do regular checkups or seek care early on when they have issues. Instead, they show up in his office when things are already very bad, with gangrenous toes and feet from critical limb ischemia (CLI) due to rampant peripheral artery disease (PAD) in the area.

"That's where the mistrust actually starts happening, because what is the incentive for me to go back once I see this dark spot on my toe? There's no incentive," he said. "They will watch it until literally the toes almost fall off and then they'll seek care. So that's something that we have to address."

Read related interviews with Fakorede here:

Cardiologist moves to Mississippi to fight back against PAD and limit amputations

Health disparities are causing serious harm, leading to 400 amputations per day