Have M.D., Will Travel

At a time when the health-care system seems to be getting ever bigger and more complex, Dr. Richard Ochrym is moving in the opposite direction. After nine-and-a-half years as a family doctor in a group practice and six years with a solo practice (both in Amenia), and dealing with increasing costs and decreasing reimbursements, Ochrym found himself thinking, there has got to be a better way.

He thinks, now, he has found it: house calls.

Ochrym, who has lived in Salisbury for 15 years, shut down his private practice and now sees patients in their homes, places of business or at hotels. He will respond to a call within 24 hours, any time of day or night, even on the weekends. He can perform physicals, treat acute illnesses, draw blood, remove growths and suture the site in the comfort of his patient’s home.

Ochrym’s house calls typically last at least an hour, compared to the 15 or 20 minutes he was able to spend with a patient in his previous practice.

"The last house visit I made was down in Dover Plains," he said. "We just sat at the dining room table and I did my intake. I left an hour and 15 minutes later. He invited me to stay for lunch — he was going to make me grilled cheese, but I have to watch my cholesterol."

Ochrym has been running his health-care experiment for more than a month now. He said that business has been slow, as with any new project, but he expects that once people get used to the idea of house calls, things will pick up.

"It was difficult to close the practice," he said. "It’s like family after a while. We welcomed everybody to follow us, but what we’re doing right now isn’t for everyone."

Mary Ochrym, Ochrym’s wife and office manager, has complete faith that her husband will win over the Northwest Corner as he did western Dutchess County.

"He was so well known in Amenia," she said. "We never had to advertise. The place was hopping. But the reimbursements kept going down and the denials — when we wouldn’t get paid — were getting more frequent."

Ochrym said that his colleagues have been skeptical of his venture. Ten years ago, he said, doctors were banding together to deal with HMOs.

"It’s a numbers game. As reimbursements go down, you recoup by adding patients."

Ochrym said he felt rushed in his practice and would often not get home until 10 p.m. or later. In his solo practice, he had 2,500 patients in his computers and saw 15 to 20 people a day.

"I can’t work like that," he said. "I need to walk away knowing that I did the best that I could do."

Ochrym said he felt Salisbury was a logical choice to set up his home visit business because it is a "physician-underserved area."

"When people try to get appointments with their primary care physician, they might have to wait a week," he said. "When you’re acutely ill, what’s your next option? The emergency room, which means a high co-pay and a long wait."

One of the effects of the "rushed climate" is that patients would come to him from a specialist and not know what the specialist found. He said they were often confused about their treatment and options.

To address this problem, Ochrym now spends as long as he needs to with his patients, in their homes, explaining what he has done and the treatment he recommends. He said he even counted out three weeks’ worth of pills for one patient who had trouble keeping track of all his medications.

After the visit, Ochrym spends an hour and a half completing a detailed medical report, which he then mails to the patient. He writes down any directions he has given the patient to be sure there is no confusion. He keeps all records electronically. And he encourages patients to call him if they have questions.

"Don’t be afraid. I’m not going to charge every time you call," he said.

Ochrym’s rates vary based on the complexity of the case and the distance he has to travel to treat a patient. A sore throat in Salisbury runs about $75, while a complete physical in Wingdale would be $125 to $150. Ochrym does not deal with insurance companies directly and collects payment (cash or check) at the time of the house call. However, he will provide patients with a receipt and the necessary information to file for reimbursement with an insurance provider. He said that most preferred provider organizations should cover his visits, but that Medicare will not. He encourages potential patients to check with their insurance companies before calling.

While he can provide a number of medical services in a patient’s home, there are some things his malpractice insurance won’t allow him to do.

For example, he cannot deliver babies at home. Ochrym is affiliated with Sharon Hospital and able to refer patients to specialists if they need care he cannot provide.

Ochrym sees himself filling a niche for people who have difficulty getting to a doctor’s office, such as the elderly and those who aren’t able to take time off work. He said that he is available to check in on older patients on a regular basis to help relieve the family of some of the burden of caring for the infirm. He also said that by seeing patients in their homes, he can make recommendations to make the home safer. For example, he recommended that a patient who used a walker remove the throw rugs that were scattered throughout her home to reduce the danger of falling.

While he expects to have a number of regular patients, he also said that he wants to be available on an "as needed" basis for the community as a whole. He said he is willing to come out in snow storms and to see patients with acute problems who can’t get in to see their primary doctor.

At this point, Ochrym seems relaxed and happy in his new practice. He said he enjoys the "Norman Rockwell quality" of being a small-town doctor. His daughter even bought him an old-fashioned medical bag that he takes on calls with him.

"It’s a small town. If you don’t keep your nose clean, it’ll kill you," he said. "I hope that when I leave, my patients will say, ‘That was the best hundred bucks we’ve spent.’ I’m really relying on word of mouth."