LA MED. NEWS: Louisiana Firm, “Cypress” Courts Concierge Physicians


May 28, 2013 – A few years ago, Dr. R. Michael Murray, an internal medicine practitioner in Birmingham, Ala., was about ready to throw in the towel.

He had a successful practice, with a patient count somewhere between 4,000 and 5,000 people. But he was worn down from seeing 20 to 30 patients a day and putting in 12-hour days, five days a week. Sunday evenings found him still tired and dreading the beginning of the week.

“In my mid- to late 50s, I just started hitting a wall,” Murray said. “I loved what I did, but I just couldn’t keep up the pace.”

The strain took a toll on Murray. His wife said he looked like he was dying. Some of his patients grew alarmed at his appearance.

Murray began casting about for an alternative way to practice. He looked at concierge medicine but wanted something a little different from the management models he’d seen.

Eventually, he came up with a blended practice mode. He limited his practice to 400-plus patients. He added a nutritionist, who also acts as a wellness coach, to his practice. His patients stopped asking him if he was ill.

About the same time, Denham Springs businessman Richard Doughty, a friend of Murray’s and co-founder and co-owner of a $40 million healthcare management firm, began talking to Murray about his business model. Doughty took the practice, benchmarked it, and in 2012 launched Cypress Management Group. Doughty is the company’s chief executive officer, and Murray is Cypress’s medical director.

Doughty said Cypress offers doctors two key differences compared to other concierge management groups: a lower-cost fee structure and a practice model tailored to the needs of the physician and his patients.

Typically, the management firms get one-third of the membership fees patients pay to be part of a concierge practice, Doughty said. Most concierge management contracts are for five years, and the fee structure is in place for the life of the contract.

But most of the hardest work is done over the first 18 months of moving the practice to the concierge model, Doughty said.

“After that, if the concierge company has done a good job, to maintain that ongoing presence and practice there won’t be nearly as much heavy lifting over the course of that contract,” Doughty said.

Cypress’s fees decrease each year, in proportion to the amount of effort and energy required to maintain the practice, Doughty said.

“The difference for physicians, generally, will be several hundred thousand dollars over a five-year contract,” Doughty said.

Doughty co-founded and co-owned Champion Management LLC, which owned and operated outpatient imaging centers in the Southeast through joint ventures with more than 150 physicians.

Those partnerships, Doughty said, gave him a clear understanding of the challenges, and the financial realities, that physicians face.

“That’s why our fee structure is different,” Doughty said.

Doughty said Cypress also offers physicians a choice when it comes to practice models.

If the physician wants a straight concierge practice, Cypress can arrange that. If the doctor wants to maintain his or her current patient population, Cypress can arrange a blended model. The physician sees only the patients that opt to join the concierge practice and oversees the mid-levels, the nurse practitioners or physician’s assistants, who manage the non-concierge patients. That way the patients remain in the practice. Cypress can also set up a block-time model so that the physician dedicates a certain portion of the day to concierge patients and the rest of the time to traditional patients.

Doughty said Cypress will work with six practices this year, but he expects growth will accelerate next year.

He doesn’t want the company to grow too fast too soon, he said. But Cypress has already begun scheduling clients for 2014.

Doughty said he doesn’t think concierge medicine is worsening the shortage of primary care physicians.

The current healthcare delivery system is broken, with physicians rewarded for quantity not quality, Doughty said. The continued cuts in reimbursements for physician services are putting more and more pressure on doctors to see more patients or to offset the cuts with ancillary services.

The increase in regulations and compliance issues, the additional time and resources required to deal with insurance issues, billing and collections are pushing many physicians to sell their practices or retire, Doughty said. Physicians don’t have the desire or the ability to see more patients next year than they did this year.

Concierge medicine keeps doctors in practice for years beyond what they might have otherwise, Doughty said.

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