Raymond Zakhari, RN, holds Siggy Freud, therapy dog
(Photo courtsey of Metro Medical Direct)
Raymond Zakhari, RN, BSN, EdM, MS, ANP-BC, FNP-BC, founded a New York City primary care practice, called Metro Medical Direct, based on the old-fashioned house call. His model of care, however, is by no means behind the times. He blends traditional house calls with high-tech virtual care.
The concept to deliver easy-access, time-efficient, technology-based medicine to patients came to Zakhari after he experienced the inconvenience of being a patient and the convenience of being an online consumer. After his deployment to Iraq in 2006 with the Air National Guard, Zakhari returned to work at a Manhattan nursing home, when his health took a bad turn.
"In order for me to see a doctor, I would have [had] to cancel my own patients’ [appointments] because doctors’ offices are only open 9 to 5 or 8 to 4. To get an appointment, the wait time was six to eight weeks," he said. "I thought there had to be an easier way."
He discovered the easier way while online grocery shopping. He’d shop from home, order food and the food would be at his door within hours. He thought, "Why couldn’t healthcare be similar?" So he started Metro Medical Direct in 2009.
"[I] built a model that is putting the patient at the forefront of their care," Zakhari said.
For most of Zakhari’s patients, the process begins with the patient logging onto MetroMedicalDirect.com and requesting an appointment time. Zakhari receives instant notification of the request and replies with a confirmation or change. If it’s the first appointment or an annual physical, he shows up at the patient’s home, office or hotel at the agreed-upon time. He delivers care, prescribing needed medications and documenting everything on his laptop, iPad or smart phone, using an electronic medical record.
He then can follow up with conversations, answer questions and make follow-up visits, based on patient preferences, by Webcam, email, text, phone or in person.
All Web-based communication is HIPAA compliant because it’s done through a secure patient portal, where patients can access test results, conversations with Zakhari and more when needed. "Basically, the Web-based technology has become my office staff," he said.
If patients want only traditional care using a phone and in-person visits, he accommodates them.
Zakhari, who worked in hospital ICUs and EDs before going into a primary care graduate program, has not yet taken the business full time. He sees his patients with Metro Medical Direct at nights and on weekends, and works as a hospitalist during the day.
Three years into the business, he said he has about 100 patients. "I deliberately keep the panel small. And the reason I do is [when] patients call or text me, I know who they are. I know their story," Zakhari said. "Professional boundaries are maintained, but the idea is that they can pick up the phone or text me or send me a message on their portal about what’s on their mind."
The nurse practitioner said about 60% of his patients are male. And most of the men he treats are working professionals, in their mid-20s to mid-40s. His female patients, he said, tend to be elderly.
"The interesting thing that I’ve discovered is both those demographics tend to avoid going to the doctor for the same reasons: the hassle and time waiting and time spent on the phone," Zakhari said.
He doesn’t conduct traditional patient satisfaction surveys, but said patients tell him they are happy because of the ready access they have to Zakhari — whether by phone or computer — and the time they save not having to go to physicians’ offices.
Sylvia Wood, 31, of Chicago, said Zakhari provided her family’s general healthcare when they lived in New York.
"We continue to interact despite being in different cities because he knows my family’s health history and because we can use virtual technology. I can text him with any question, major or minor, and, if the response warrants a conversation, he’ll call me," Wood said. "We used a Webcam once when my son had an eye infection, and Ray examined him over video. I like the convenience this offers; it seems like the time and effort it takes to get an appointment and get to a doctor’s office for a 2-minute evaluation is the last thing you want to deal with when you’re busy, and you or your child is sick."
The care provided by Metro Medical Direct is fee for service. Zakhari does not take Medicare or private insurance. He plans to make Metro Medical Direct a franchised, turnkey practice model. But he admits the model is not perfect. One hurdle is the logistics of traditional house calls.
"You can’t book a lot of patients in a day because, logistically, you have to travel to them," he said.
For information, visit www.MetroMedicalDirect.com.
The concept to deliver easy-access, time-efficient, technology-based medicine to patients came to Zakhari after he experienced the inconvenience of being a patient and the convenience of being an online consumer. After his deployment to Iraq in 2006 with the Air National Guard, Zakhari returned to work at a Manhattan nursing home, when his health took a bad turn.
"In order for me to see a doctor, I would have [had] to cancel my own patients’ [appointments] because doctors’ offices are only open 9 to 5 or 8 to 4. To get an appointment, the wait time was six to eight weeks," he said. "I thought there had to be an easier way."
He discovered the easier way while online grocery shopping. He’d shop from home, order food and the food would be at his door within hours. He thought, "Why couldn’t healthcare be similar?" So he started Metro Medical Direct in 2009.
"[I] built a model that is putting the patient at the forefront of their care," Zakhari said.
For most of Zakhari’s patients, the process begins with the patient logging onto MetroMedicalDirect.com and requesting an appointment time. Zakhari receives instant notification of the request and replies with a confirmation or change. If it’s the first appointment or an annual physical, he shows up at the patient’s home, office or hotel at the agreed-upon time. He delivers care, prescribing needed medications and documenting everything on his laptop, iPad or smart phone, using an electronic medical record.
He then can follow up with conversations, answer questions and make follow-up visits, based on patient preferences, by Webcam, email, text, phone or in person.
All Web-based communication is HIPAA compliant because it’s done through a secure patient portal, where patients can access test results, conversations with Zakhari and more when needed. "Basically, the Web-based technology has become my office staff," he said.
If patients want only traditional care using a phone and in-person visits, he accommodates them.
Zakhari, who worked in hospital ICUs and EDs before going into a primary care graduate program, has not yet taken the business full time. He sees his patients with Metro Medical Direct at nights and on weekends, and works as a hospitalist during the day.
Three years into the business, he said he has about 100 patients. "I deliberately keep the panel small. And the reason I do is [when] patients call or text me, I know who they are. I know their story," Zakhari said. "Professional boundaries are maintained, but the idea is that they can pick up the phone or text me or send me a message on their portal about what’s on their mind."
The nurse practitioner said about 60% of his patients are male. And most of the men he treats are working professionals, in their mid-20s to mid-40s. His female patients, he said, tend to be elderly.
"The interesting thing that I’ve discovered is both those demographics tend to avoid going to the doctor for the same reasons: the hassle and time waiting and time spent on the phone," Zakhari said.
He doesn’t conduct traditional patient satisfaction surveys, but said patients tell him they are happy because of the ready access they have to Zakhari — whether by phone or computer — and the time they save not having to go to physicians’ offices.
Sylvia Wood, 31, of Chicago, said Zakhari provided her family’s general healthcare when they lived in New York.
"We continue to interact despite being in different cities because he knows my family’s health history and because we can use virtual technology. I can text him with any question, major or minor, and, if the response warrants a conversation, he’ll call me," Wood said. "We used a Webcam once when my son had an eye infection, and Ray examined him over video. I like the convenience this offers; it seems like the time and effort it takes to get an appointment and get to a doctor’s office for a 2-minute evaluation is the last thing you want to deal with when you’re busy, and you or your child is sick."
The care provided by Metro Medical Direct is fee for service. Zakhari does not take Medicare or private insurance. He plans to make Metro Medical Direct a franchised, turnkey practice model. But he admits the model is not perfect. One hurdle is the logistics of traditional house calls.
"You can’t book a lot of patients in a day because, logistically, you have to travel to them," he said.
For information, visit www.MetroMedicalDirect.com.
Lisette Hilton is a freelance writer. Send letters to editorNY@nurse.com or post a comment below.
