Although relatively new to the Cleveland
area, the retainer-fee practice model debuted in the U.S. in
1996. Since then, hundreds of practices nation-wide have adopted
this "concierge" or "membership-style"
How does it work? Essentially, CustomCare MD
patients pay an annual fee in exchange for primary medical care
that’s both highly personal and responsive. Members still rely
on their employer-sponsored health insurance or Medicare to
cover routine services, diagnostics, and hospitalizations, and
they still assume responsibility for any deductibles and
co-payments. But, with the annual fees to help offset practice
expenses, Dr. Tomm and Dr. Locke don’t need to manage a horde
of patients. While a typical primary care practice handles a
case load of thousands, by contrast, CustomCare MD services only
hundreds. Consequently, with fewer patients overall, there’s
more time available for each one.
"What we’ve done is change the way we
practice so that we can have more time to spend with our
patients," said Dr. Tomm, who launched CustomCare MD in
2005. Previously, Dr. Tomm worked for seven years in a
traditional managed care practice.
"During that time, I saw a large
increase in the number of people I was seeing on a day-to-day
basis," he recalled. "My schedule was so packed with
appointments that I couldn’t fit in people who needed to be
seen same-day, and I couldn’t spend as much time with patients
as I wanted. It got to the point where I was really frustrated.
There just weren’t enough hours in the day."
"I’ve seen how managed care has caused certain
problems with the practice of medicine, and now I’ve gone 180 degrees in the
other direction," he said. "At CustomCare MD I can spend much more
time with each patient. Patients seem pleasantly surprised that I have enough
time to address all of their questions and concerns. Professionally, this
model creates the right environment for providing the highest quality medical
As a retainer-fee practice, CustomCare MD can offer
patients specific advantages, including:
• 24/7 access to a seasoned internist;
• a detailed baseline medical evaluation that focuses on
prevention, nutrition, exercise and personal habits and lifestyle;
• house calls;
• unhurried office visits;
• guaranteed same-day appointments;
• easy access to medical and surgical specialties, lab,
radiology, MRI, outpatient surgery, nutrition services and physical therapy,
all under one roof at the University Suburban Health Center location;
• personal coordination of all specialty care with
• expert travel consultation, including immunizations for
• Medicare and private insurer coverage for routine
medical services, like office visits, labs, surgery, radiology and
Patients notice a difference from the moment they
walk in the door — the waiting room has seating for only four
people. Since CustomCare MD doesn’t double-book appointments, there’s
usually no wait time. In fact, most of the time, the waiting room
(dubbed "the no-waiting room") is empty, because patients
are ushered into exam rooms as soon as they arrive.
"At first, that’s a big adjustment for
people, because they’re used to having to wait," Dr. Tomm said.
"We make it a point to honor appointment times, and same-day
appointments are guaranteed for urgent and emergent cases."
An office visit at CustomCare MD is also
significantly different from the typical 15-minute appointment that’s
now the standard of care in most medical practices. Routine office
visits at CustomCare MD are typically 45 minutes and physical
examinations are scheduled for 90 minutes, at least.
"With these longer office visits, we are able
to have discussions with our patients about nutrition, exercise, and
their health management," Dr. Tomm explained. "In other
practices, there just isn’t the time for those sorts of
conversations. I think we are serving our patients better because we
can do more with education and preventative medicine."
Communication like this is a fundamental component of the
concierge care practice model, and patients are overwhelmingly positive about
this personal, customized approach. In particular, patients who are managing
chronic conditions, or those who are disabled or frail, can benefit
tremendously from longer in-depth office visits.
"If a disabled patient needs more time in the office,
or even a house call, we can accommodate that," Dr. Tomm said.
"Also, many patients with complicated medical histories really need a
quarterback to help them coordinate their care … we’re here to help with
In addition to these comprehensive consultations, it’s
not unusual for Dr. Tomm and Dr. Locke to accompany their patients to a
specialist’s office, insuring that a diagnosis or treatment proceeds quickly
"We introduce our patients to the specialists’ staff
and help get the ball rolling," Dr. Tomm said. "That can mean a
quicker diagnosis and, ultimately, a better outcome."
Comprehensive office visits at CustomCare MD are also a
boon for patients who travel internationally. Dr. Tomm has advanced training
in travel medicine, and the practice is a resource for the latest Center for
Disease Control (CDC) alerts, warnings and health precautions. Plus, vaccines
for a wide
variety of diseases — including typhoid, shingles,
meningitis, hepatitis A, hepatitis B, tetanus/diphtheria, and yellow fever —
are available at the office.
Ultimately, CustomCare MD is distinguished by this
exceptional level of physician expertise and availability — in the exam
room, on a house call or even over the phone. Take for example, a 78-year-old
CustomCare patient who was in a remote part of Brazil, fishing the Amazon
River, when a fainting spell hit. After passing out three times in a row, the
man knew he needed help. The nearest doctor, however, was 48 hours away by
boat. A charter plane could make it into the area, but not for three or four
days, weather permitting. After considering his options, the man decided to do
what he was used to doing when he had a medical concern. He called Dr. Locke.
"He used a satellite phone to call me," said Dr.
Locke. "I was able to alter his medication by phone and solve his
problem. By careful daily monitoring by satellite phone, we kept his blood
pressure under control, and so he was able to enjoy the remainder of his
Admittedly, this was an unusual situation — not one that
the physicians at CustomCare MD deal with on a routine basis. But it’s a
good example of how they go the extra mile to serve their patients.
"People are often surprised when they hear my voice
answering the phone on the weekend," Dr. Locke said. "But, after
all, we are the on-call docs."
24/7 access means that CustomCare MD doctors are only a
phone call away. If an emergency arises, patients know they can reach their
personal physician — the one who knows their medical history and can quickly
grasp their current status.
"We know our patients, so in an emergency we’re able
to start working with them right away," said Dr. Locke. "We can
determine if they need to go to the emergency room, or if it’s just an ‘I’ll
meet you at the office on Saturday morning’ type of situation."
Office visits on Saturday morning? Yes. CustomCare MD
proves that this level of service and commitment can exist, even in today’s
era of managed care. In fact, Dr. Tomm and Dr. Locke believe that they’re at
the forefront of a new trend, one that is focused on restoring the traditional
role of the doctor-patient relationship, the foundation of patient-centered
"I went to medical school so I could practice medicine
like this," Dr. Locke concludes. "This is the way we were trained.
This is primary care medicine that is satisfying to me, and satisfying to my
Marcus Welby would probably like it, too.
For more information about CustomCare MD, call Dr. Todd
Locke at 216-381-1520 or Dr. Richard Tomm at 216-382-8000, or visit their
website at www.CustomCareMD.com.