Frequently Asked Questions
Concierge Geriatric & Psychiatric Care in Manhattan
1. What is Metro Medical Direct?
Metro Medical Direct is a private concierge medical and psychiatric house-call practice serving older adults in Manhattan, New York City. The practice provides in-home and telehealth care for seniors with complex medical conditions, dementia, cognitive decline, and mental health concerns.
Unlike traditional clinic-based practices, Metro Medical Direct offers extended visits, direct access to the clinician, and active coordination with assisted living facilities, home health aides, hospitals, and specialists.
This service is designed for medically and psychiatrically complex elders who require more time, oversight, and integration than a typical primary care office can provide.
2. How is Metro Medical Direct different from a regular primary care or geriatric practice in NYC?
Most primary care and geriatric practices in New York City are high-volume and structured around short 10–15 minute office visits.
Metro Medical Direct is a low-volume concierge geriatric care model. It provides:
- Longer in-home visits
- Direct access to the clinician
- Combined primary care and psychiatric expertise
- Active coordination with assisted living staff and specialists
- Proactive crisis prevention rather than reactive urgent visits
The goal is medical stability, reduced hospitalizations, and structured oversight for seniors living in Manhattan.
3. Is Dr. Raymond Zakhari a physician?
No. Dr. Raymond Zakhari, NP is not a physician. He is a triple board-certified nurse practitioner in adult health, family practice, and psychiatric–mental health with a Doctor of Nursing Practice (DNP) degree.
He is licensed in New York State to diagnose, prescribe, and manage complex medical and psychiatric conditions. His training integrates internal medicine, geriatrics-style care, and psychiatry, with a focus on whole-person assessment, functional status, and caregiver impact.
4. Who is the ideal patient for this concierge geriatric practice in Manhattan?
The ideal patient is an older adult living in Manhattan who has multiple medical conditions and cognitive or psychiatric concerns and is experiencing repeated crises.
Common situations include:
- A senior in assisted living who is frequently sent to the emergency room for falls, confusion, shortness of breath, or agitation.
- A parent with early or moderate dementia who is on multiple medications and showing behavioral changes.
- A medically fragile elder living in a private NYC apartment with home health aides whose care has become too complex for a standard office-based physician to manage safely.
This practice is specifically designed for complex elder care in Manhattan.
5. Who usually contacts Metro Medical Direct?
Most inquiries come from:
- Adult children (often living out of town)
- Geriatric care managers in NYC
- Elder law attorneys and trustees
- Assisted living administrators
- Private fiduciaries
In many cases, professional advisors recommend a concierge house-call doctor when an elder’s medical and psychiatric needs are no longer well-coordinated.
6. Do you replace my parent's existing primary care doctor?
In many cases, yes.
Metro Medical Direct often becomes the primary medical and psychiatric point of contact for the elder. Some specialists (cardiology, neurology, etc.) may remain involved for focused conditions, but Dr. Zakhari provides centralized oversight, medication management, and coordination across all providers.
This reduces fragmented care and conflicting recommendations.
7. Do you perform capacity evaluations in Manhattan?
Yes.
As part of both the comprehensive evaluation and ongoing membership, Dr. Zakhari performs structured, decision-specific capacity evaluations when clinically appropriate.
These may include assessment of capacity to:
- Consent to medical treatment
- Manage personal or financial affairs
- Appoint a health care proxy or power of attorney
- Amend estate planning documents
- Participate in guardianship-related decisions
Capacity assessments are task-specific and time-specific. Documentation addresses understanding, appreciation, reasoning, and ability to communicate a choice.
While Metro Medical Direct does not provide contested forensic expert testimony without separate agreement, clinical capacity documentation is often helpful in estate planning and guardianship contexts in Manhattan.
8. What is included in the $6,000 comprehensive evaluation?
The $6,000 comprehensive evaluation is a three-visit in-depth assessment process:
Visit 1 – Extended in-home medical and psychiatric evaluation: Review of diagnoses, medications, hospitalizations, cognitive status, mood, behavior, safety, and functional status.
Visit 2 – Focused follow-up and advanced review: Additional targeted assessment and pharmacogenomic testing when appropriate to support safer prescribing.
Visit 3 – Clinical summary and strategy conference: Structured meeting with adult children, care managers, or attorneys where findings are explained clearly and a detailed plan is provided.
This evaluation stands alone and does not require enrollment in membership. Laboratory testing and imaging are billed separately by outside vendors.
9. How much does concierge membership cost?
Concierge membership is $24,000 per year. Payment options include annual, semi-annual, or quarterly arrangements.
Membership includes:
- Ongoing house-call and telehealth visits
- Direct clinician access within defined boundaries
- Medication management and psychiatric care
- Care coordination with hospitals and assisted living facilities
- Family and fiduciary conferences
- Ongoing documentation and proactive crisis prevention
This is a limited-panel practice focused on high-touch geriatric and psychiatric care in Manhattan.
10. Do you accept Medicare or private insurance?
No.
Metro Medical Direct is a direct-pay concierge medical practice and does not bill Medicare or private insurance.
Families, trusts, or responsible parties pay fees directly. Upon request, documentation or a superbill may be provided for your records. Any reimbursement is handled directly between you and your insurer.
11. Do you provide 24/7 emergency services?
No.
Metro Medical Direct is not an emergency response service and does not replace 911.
Established patients receive responsive access for urgent questions within defined hours. However, if an elder is in immediate danger, you must call 911 or go to the nearest emergency room.
After hospitalization or emergency care, Dr. Zakhari can help interpret events and adjust the long-term care plan.
12. Where do you provide concierge house calls?
Metro Medical Direct provides concierge medical and psychiatric house calls for older adults living throughout Manhattan, New York City.
Primary service areas include: Upper East Side, Carnegie Hill, Lenox Hill, Yorkville, Upper West Side, Lincoln Square, Midtown East, Midtown West, Sutton Place, Turtle Bay, Central Park South, Columbus Circle, Tribeca, Hudson Yards, Flatiron District, Gramercy Park, Chelsea, SoHo, NoLIta, Greenwich Village, West Village, Battery Park City, and Financial District.
House calls are focused exclusively within Manhattan to allow for timely in-person response and consistent oversight. Telehealth services may supplement in-person visits and may be available elsewhere in New York State for established patients, subject to licensing and clinical appropriateness.
13. How do we get started?
The first step is a brief introductory call to determine whether your parent’s situation is appropriate for concierge geriatric and psychiatric care in Manhattan.
If appropriate, the next step is scheduling the $6,000 comprehensive evaluation.
After the evaluation, you and Dr. Raymond Zakhari, NP decide together whether ongoing membership at $24,000 per year is the right fit.
This service is not appropriate for emergencies or walk-in visits.
Still have questions?
Ready to Have a Conversation?
The first step is a brief introductory call. You describe the situation; I’ll tell you directly whether this practice is an appropriate fit.
Not for emergencies. If you believe your parent is in immediate danger, call 911 or go to the nearest emergency room.