Clair A. Francomano, MD in Baltimore: Clinical Geneticist Specializing in Hereditary Connective Tissue Disorders

Clair A. Francomano is a clinical geneticist based at Johns Hopkins Hospital in Baltimore whose practice focuses on diagnosis and management of hereditary connective tissue disorders, most notably Ehlers-Danlos syndrome (EDS) and related conditions. She maintains both inpatient consultation capacity and an outpatient genetics clinic, positioning her as one of Baltimore's specialized resources for complex genetic diagnoses that often go misdiagnosed for years.

What the Practice Actually Is

Francomano operates a genetics consultation service within Johns Hopkins' Department of Genetic Medicine, where she evaluates patients with suspected or confirmed hereditary connective tissue conditions. Unlike general genetics practices that cover a broad spectrum of genetic disorders (cystic fibrosis, hemophilia, chromosomal conditions), her clinic narrows deep into connective tissue pathology. This specificity matters because EDS and related disorders present across multiple medical systems—rheumatology, orthopedics, dermatology, gastroenterology—and often accumulate misdiagnoses before reaching a geneticist. Francomano's reputation in this space draws referrals from across the Mid-Atlantic and nationally.

Services and Diagnostic Scope

The practice conducts comprehensive genetic evaluation for hereditary connective tissue disorders. Initial visits typically involve detailed family history, physical examination focusing on skin extensibility, joint hypermobility, and structural features relevant to connective tissue phenotype, and often genetic testing (DNA sequencing or specific mutation analysis). Johns Hopkins' genetics laboratory, located on the same campus, can complete most testing in-house, reducing turnaround time compared to sending samples to commercial laboratories.

Cost varies significantly depending on insurance and testing complexity. Johns Hopkins Hospital operates under a tiered revenue model; uninsured patients often qualify for financial assistance, and those with insurance typically pay in-network rates ranging from $200 to $500 for an initial genetics consultation copay or coinsurance, with genetic testing costs between $500 and $3,000 depending on the panel ordered (verify current pricing and insurance coverage before scheduling, as genetics testing pricing changes frequently).

The clinic accepts most major insurances, though prior authorization is sometimes required for genetic testing. Out-of-pocket costs for uninsured patients depend on Hopkins' financial assistance application; contact the clinic directly for current income-based thresholds.

How It Compares to Other Baltimore-Area Genetics Resources

Baltimore's clinical genetics landscape includes general genetics practices at University of Maryland Medical Center and Sinai Hospital, both offering broader genetic services. Those practices handle prenatal diagnosis, cancer genetics, metabolic disorders, and general diagnostic genetics. Francomano's differentiator is depth rather than breadth: she is not a screening geneticist but a subspecialist whose expertise in connective tissue disorders makes her the appropriate referral for patients in whom EDS or similar conditions are suspected or need confirmation after a diagnostic odyssey. For a patient with a family history of cystic fibrosis or suspected hereditary breast and ovarian cancer, a general geneticist at UMD or Sinai may be faster and closer. For a patient with hypermobile joints, skin findings, and a decade of unresolved symptoms, Francomano's specialization shortens the diagnostic path.

Who This Practice Serves and Does Not Serve

The practice suits patients with known or suspected hereditary connective tissue disorders seeking definitive diagnosis, genetic counseling, and management planning. It also suits clinicians (rheumatologists, orthopedic surgeons, cardiologists) who need specialist confirmation of complex cases. The practice does not serve patients seeking carrier screening for common genetic conditions, prenatal genetic counseling, or genetic testing for cancer risk. It is not an entry point for someone with a family history of a genetic condition but no personal symptoms or findings; that patient should start with a general geneticist.

What the First Visit Involves

A new patient receives a genetics consultation appointment, usually 45 minutes to an hour. Arrive early for check-in at Johns Hopkins Hospital; the Department of Genetic Medicine's office location requires navigation within the hospital's medical campus. Bring any previous genetic tests, imaging studies, medical records from other specialists, and a complete family pedigree if possible (three generations is ideal). Francomano will examine relevant features, discuss genetic basis of the suspected condition, explain testing options, and outline next steps. If genetic testing is ordered, results typically return within 2 to 4 weeks, followed by a results visit to review findings and implications.

Hours, Location, and Logistics

The practice operates at Johns Hopkins Hospital's East Baltimore medical campus, within the offices of the Department of Genetic Medicine. Hours are weekday mornings and early afternoons; specific scheduling availability varies by month. Parking at Johns Hopkins includes both hourly surface lots (around $3 to $5 per hour) and validated parking for outpatient appointments (confirm eligibility when scheduling). Public transit via MTA light rail and bus service connects to Johns Hopkins, though the East Baltimore campus sits adjacent to several neighborhoods with limited walkability; a car or rideshare is practical.

Francomano's subspecialty depth and Johns Hopkins' infrastructure position her clinic as Baltimore's most focused resource for patients whose unresolved connective tissue symptoms point toward a genetic diagnosis.