Top billing

Top billing

Operating a surgery center is as hard as operating

on a patient, doctors are realizing. That's when

they call on Caryl Serbin and Judith English.

Entrepreneurial doctors in recent years have shunned hospitals and opened up their own surgery centers.

But now many of them are discovering that it's just as difficult to run a business as it is to operate on a patient. That's where Caryl Serbin and Judith English come in.

The two Fort Myers business partners own and manage Surgery Consultants of America and Serbin Surgery Center Billing. What started out as a small billing company has turned into a high-growth business with 52 employees who help physicians and hospitals with everything they need to operate a surgery center successfully - from facility design to computer systems, billing, software, gaining accreditation and Medicare certification and negotiating insurance contracts. Together, their two companies have 17 management and billing contracts in 10 states.

One of the latest deals is a partnership agreement with Dallas-based Cambridge Healthcare Development Corp., a 21-year-old health care real estate firm that develops, owns and manages facilities for physicians, hospitals and large health systems. Serbin and English estimate that partnership will spur 20% annual growth in their business (they declined to cite revenues or other financial data).

The major benefit of working with a firm such as Cambridge is that large health-care systems and hospitals have figured out that they must create joint ventures with physicians to keep them from becoming competitors. Cambridge has experience helping these large systems plan, finance, build and manage new facilities over long periods. It owns 17 facilities totaling 1.3 million square feet and has another 1.6 million square feet in development in six states.

Serbin and English fit nicely into Cambridge because they can offer management and billing to Cambridge's current and future clients.

At the same time, there's plenty of opportunity for Serbin and English outside of Cambridge's client list. There are about 5,000 surgery centers in the United States, and only about 10% of the 4,000 centers owned and operated by small to mid-size physician groups outsource their work, English estimates.

As medical reimbursements from the government and managed-care insurance companies shrink and get more complicated, doctors are finding the billing and management of surgery centers more daunting. Cash flow can become particularly worrisome when claims are rejected for administrative reasons, a common occurrence.

Early on, Serbin and English realized that hospitals would need to build ambulatory surgery centers as well, because they were losing business to entrepreneurial physicians who had built their own. Hospitals have started to do that, and that has become a good source of revenues because hospitals prefer to outsource billing in those centers, Serbin says.

Serbin Surgery Center Billing has been growing at a 10% to 15% annual pace, with billing representing 60% of the combined companies' revenues. "The billing piece is always going to grow faster," Serbin says.

To generate sales, Serbin has become a fixture on the medical-billing lecture circuit, giving speeches about the latest changes in that industry. She spends hours preparing presentations that have substance. "It's our best advertisement," she says.

Serbin and English grew their two companies without borrowing. They went into business in 1999 after spending years working for hospitals in management and billing. "We lived and breathed this business," Serbin recalls. "We were so intense about it."

Although they had no clients when they started, they knew they could make a business out of what they had practiced for years. Still, looking back, they concede that if they knew what they know now about starting a business, they probably wouldn't have done it.

Says Serbin: "It was rewarding to succeed."

-Jean Gruss