If you have back problems in the Tampa Bay area, odds are that the Comprehensive Spine Institute is on your radar. The outpatient medical office in Clearwater provides a host of services — everything from physical therapy to steroid injections to surgical procedures — in a quest to be a one-stop shop for spinal services.
But the business faced one big challenge: In order to expand, the institute needed outside assistance to hire new employees and offer new services. CSI Ortho’s Dr. Ashraf Ragab was up for the challenge. Ragab, an orthopedic surgeon, wears two hats in his professional life: He’s both a medical professional and a businessman running a busy company.
"I'm a spine surgeon, and I started on my own," says Dr. Ashraf Ragab, CSI’s founder. "In this age, it's very difficult to be on your own in practice. It requires a lot of resources, especially because of things like reimbursements coming down or overhead costs."
Since CSI Ortho opened in 2011, Ragab and his team have been focused on building a comprehensive healthcare center that offers more than just outpatient surgery. Patients seek CSI Ortho for assistance with physical therapy and pain management. CSI Ortho specializes in minimally invasive surgery that Ragab says leads to much less pain in the recovery process. It also serves a huge population in the city: Although Tampa Bay area has a relatively older population than some other metropolitan areas, CSI Ortho’s clients range in all ages and professions. Being able to serve clients of all ages and physical ailments (the office often sees worker’s comp cases of middle-aged men and women, for example) means the business is in a very competitive market.
"In this age, it's very difficult to be on your own in practice. It requires a lot of resources."
"The objective is to serve patients mostly on an outpatient basis," Ragab says. "That helps the patient, and prevents them from going to hospitals. We can give better care to patients by offering care here — that also saves insurance companies and the government a lot of money by doing it on an outpatient basis." It made sense, both from a business and patient-care perspective, to offer all services under the same roof. And in order to help his patients, he needed to find help with financial services so he could afford the services they need.
When Ragab searched for funding to build his office, and then later to build a surgery center, he turned to Synovus. Synovus banker Aaron Sherwood says he was determined to understand Ragab’s needs. The bank offers commercial services such as SBA loans and cash management solutions to business clients. In CSI’s case, the bank helped the growing medical practice with business loans and money management solutions. Using the loans, CSI was able to finance property for a new facility and hire additional surgeons and employees. "I came across this property that now takes up almost a half block in Clearwater," Ragab says. "Synovus was instrumental in my being able to purchase the practice. As we worked together more and more, we were also able to build a surgery center on the same property. We’ve grown tremendously in the last five years."
Outsiders not working in the medical field might not realize that running a medical practice requires serious logistics and planning skills on the business side of things. Ragab faces an ongoing search to recruit physical therapists, a neurosurgeon, and another orthopedic surgeon. This requires paying salaries, acquiring new equipment, and planning for future growth of their offices and physical facilities. And because Ragab’s practice offers a wide variety of services to patients, it must serve a diverse mix of needs — everything from relatively simple practices like prescribing neck or back braces to complicated surgical procedures — and deal with the paperwork of insurance companies. Those kind of logistical demands would make any seasoned businessman sweat. But as CSI Ortho expands their practice and adds both new employees and new service offerings, Ragab and his team know they have some expert help when it comes to scaling up.
"CSI Ortho’s concerns were time-sensitive, and we needed to meet the demands of their schedule because Dr. Ragab’s in surgery several days a week, and consulting with his patients," Sherwood says. "They needed clear agendas going into meetings. We had a good understanding of their craft, and how their operating and flow cycle works. We understood how they get paid, how they will have delays in payment because of the nature of reimbursement — things across the board that are a concern for any bank."
"The first business loan we took was from Synovus," Ragab says. "We evaluated a lot of options such as small business loans versus traditional loans. Synovus was able to guide me through the whole process and situation once we established that they were supportive on the journey — and they still are. I've also compared their offers with other banks, and obviously stuck with them because they offered a lot of things — not just loans, but support that other banks did not."
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