Cleveland Concierge Physicians - Dr. Richard Tomm MD and Dr. Todd Locke MD

Concierge Care Comes to Cleveland
By Kathryn J. Siranosian, MS

Twenty-four-hour access to your doctor, even on weekends. Appointments routinely scheduled to last 45 minutes, or more. Diagnostic testing and medical specialists, all on-site. House calls. For many primary care patients, this list of services probably sounds just too good to be true. Maybe back in the days of Marcus Welby it was considered the norm, but today’s physicians don’t make house calls, do they?

Yes, some do. In fact, that list only partially describes the type of exceptionally personal service provided to patients by internists Richard Tomm, MD, and Todd Locke, MD, the physicians at CustomCare MD, a retainer-fee primary care practice located at University Suburban Health Center in South Euclid.

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" approach.

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."

According to Dr. Locke, this type of frustration is typical among physicians. Over the past few decades, managed care has become synonymous with decreased reimbursements, he explained. In response to the resulting increased economic pressure, physicians try to squeeze in more patients.

"For doctors, there’s frustration. For patients, the impact is that they feel they’re getting less and less face time with their doctor," said Dr. Locke, who is familiar with both sides of that coin. He worked for 20 years as a primary care physician in a managed care practice, followed by seven years as an insurance company executive.

"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 care."

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 selected specialists;

• expert travel consultation, including immunizations for foreign travel;

• Medicare and private insurer coverage for routine medical services, like office visits, labs, surgery, radiology and hospitalizations.

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 that, too."

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 and smoothly.

"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 trip."

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 care.

"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 patients."

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.