On Call with Argus Radiology

If you listen to Dr. Jamey Wright tell the story of the company he started, you’ll find his words are as simple and sparse as the walls in his office.

The pace in his voice doesn’t quicken. He doesn’t ramble on or allow for too much decoration in his speech. In an unassuming and humble way, he describes the effort and values that have made Argus Radiology successful.

“It wasn’t anything magical,” Wright says. “We have worked very hard and diligently at doing good work and putting patient care first.”

This patient care isn’t something you can drive to the office at the corner of Stadium Boulevard and Old Highway 63 to experience firsthand. As much fun as movies and television have portraying doctors in emergency rooms slapping films from X-rays or CT scans or MRIs on light boxes, the real deal is less cinematic and much more remote.

Radiology has been transitioning to digital since the late 1990s. It began with radiologists working on-call hours from home at nights via a hodgepodge of dial-up and T1 lines. Then after 2001, as high-speed Internet became more accessible, entire businesses were created to provide offsite services to radiology groups, hospitals, clinics and imaging centers. This leveraging of state-of-the-art technology to provide interpretation services is known as teleradiology. It bridges a gap between supply of experts and demand for diagnostic services, especially for understaffed and rural facilities and even for larger facilities at nights and on weekends. Teleradiology is considered to be the grandfather of telemedicine.

Argus is exclusively a provider of telemedicine services, covering 50 facilities in eight states, including Columbia Radiology Ltd., Medical Imaging Associates (Mexico) and Capital Region Medical Center (Jefferson City) in mid-Missouri. The Argus staff of 10 radiologists and three cardiologists, who work from home in California, Florida, Illinois, Missouri, North Carolina and Texas, averages about 8,500 cases per month.

In terms of scale, Argus is a small player in the world of teleradiology. Virtual Radiologic, one of the largest companies, peaks at more than 24,000 images a day. But Wright isn’t intent on reaching that level. Instead, as has been the design since Argus’ genesis, he wants to provide a personal and productive alternative, and when he describes a client switching from one of the giants to Argus, it’s then that his speech starts to break from its conservation of emotion to allow for a bit more drama.

“I get a great deal of satisfaction whenever we do transition a customer from the big guys,” Wright says. “We’re kind of the underdog with our own little underdog story.”

The nonmagic beginnings

Wright’s experimentation with teleradiology began in 2004. A year removed from opening Advanced Radiology (at the time called Boone Imaging Center) with two other radiologists in Columbia Radiology Ltd., he did some independent contracting work primarily on weekends. Soon this expanded to some evenings. Eventually, in 2006, Wright made an arrangement with Columbia Radiology Ltd. to allow for more teleradiology practice at nights. By 2007, he transitioned full time to teleradiology.

“I loved the pure practice of medicine,” Wright says. “You’d work a 10-hour shift and see a lot of interesting cases, help a lot of patients and not have a lot of administrative burden.”

But by 2009, Wright sensed a growing gap. Teleradiology companies were merging, often into large entities, and they had businesspersons, not radiologists, on top. He felt like radiologists in these companies were treated as hired guns, tools for achieving financial windfalls instead of respected specialists. He also wanted to see patient care lifted as an even higher priority rather than sacrificed for the sake of profit.

The discontent was enough for him to start Argus. Sure, there was financial potential, but it was more what was missing than what was to be gained that stirred his desire. It was an ideological pursuit.

“If you want to make sure it’s done right, sometimes you have to do it yourself,” Wright says.

As always with a startup business, the founder must willingly, even relentlessly, do all the jobs, those that stretch the will and body as much as personal investment capital. For Wright this meant splitting more than 16 hours a day as the primary reading radiologist with countless administrative responsibilities. Fortunately, his home office had plenty of space. He modified a lawn equipment storage room in his basement into a reading room with multiple workstations. His office on the main floor was used for credentialing and clerical work. Often the dining room table was overtaken with paperwork and checks needing attention. He had multiple phone and fax lines in addition to duplicate Internet provider lines so as to ensure his service wouldn’t lapse.

Those early days were probably easiest on his car, which was driven less than 100 miles a month.

If anything buoyed Wright in the first year, it was the knowledge he was building something with his values at the forefront.

Ultimately, these values allowed Wright to gain momentum, securing clients from around the country, many who were friends from medical school or colleagues he had worked with through the years.

“That was my impetus behind starting Argus in a nutshell,” Wright says, “to have a service that I could be proud off and be able to offer it to my best and longest friends and be assured that we would serve them well.”

An extension of leadership

In 2010, Argus expanded to a team of four radiologists covering 20 facilities across five states. It was the company’s first year turning a profit. It was also the year Dr. Michael Khoury joined the team as a reading radiologist, exchanging his scrubs for the comfort of board shorts and T-shirts.

Khoury’s home base is in San Diego, but he has offices with the necessary equipment in a spare bedroom at his in-law’s house in Oceanside, California, and in his childhood bedroom at his parents’ home in Wichita, Kansas.

Khoury says he likes the culture he’s found at Argus. He isn’t worked for more than eight to 10 hours a night or more than seven consecutive days. He is made directly accessible to the clients he serves, and most know him by name. Sometimes when he calls to discuss a case over the phone, the emergency room physician will want to stretch out the conversation to chat about Khoury and his family. He says it feels a lot like the hospitals he first started working at in the Midwest. It’s more human than corporate.

“Dr. Wright understands what’s expected of radiologists,” Khoury says. “He does a good job of taking care of us. And that, in turn, allows us to take care of our clients and patients.”

When Todd Moritz, who was hired in 2012 as director of new business development, looks at the radiologists employed by Argus, he sees extensions of Wright. They are driven and single minded, as well as honorable and responsible. The results reflect the effort. Argus likes to boast that it has never lost a client because of dissatisfaction.

“One of first things I did was survey our clients because I heard all these positive things about Argus,” Moritz says. “And any sales rep knows when they get deeper into any company, what they generally find is, ‘Oh, they didn’t tell me about that coming in.’ But as I got deeper into Argus and started getting the results from some anonymous surveys, I found people really did love this company.”

Moritz says the business’s obsessive focus made the difference. The Argus team would work harder, quicker and be more accurate in the end. In the business of teleradiology, efficiency and accuracy matter most of all. Argus averages a 14.7-minute turnaround and has a 0.13 percent discrepancy rate.

Capital Region Medical Center, which has used outside teleradiology providers to read emergent images on night shifts since 2007, began working with Argus in May 2011 after switching from a larger company out of Minnesota. The relationship with Argus eases the overnight workload on Capital Region’s four radiologists.

“We have a good service in our backyard,” says Kristy Trent, the manager of medical imaging. “It’s definitely a much more personal service. I like that we can pick up the phone and call Dr. Wright, the president of the company. We couldn’t do that with the previous company. They are very responsive to our needs.”

With satisfied customers comes loyalty.

“In a very competitive market, their loyalty says we remain their best option,” Wright says. “They trust us with their patients, their livelihood and their reputation. When I hear testimonial statements such as, ‘We have switched teleradiology vendors several times, but we finally made our last switch,’ then I know we are doing it right.”

When the magic happens

Quick turnarounds aren’t always a matter of life and death, but in early hours of a mid-December morning, from his garage in San Diego, Khoury knew it could be. After an initial two-second scan of an image on his screen, he saw something that set his heart pounding. This person’s belly was filled with blood. Rather than making notes, which he might do in non-life-threatening cases, he picked up the phone and called the hospital. He told the emergency room physician that his patient had rupture of an aortic aneurysm, which could easily lead to a cardiac event. They needed to act. A life depended on it.

“Almost everything we do is stat,” Wright says. “Every night we’re seeing cases that we are impacting significantly by getting an expert option in 15 to 20 minutes.”

This impact is why Wright will never just manage operations at Argus. He still spends about 50 percent of his time processing images. The one thing radiology has always been to him is a chance to provide personal care. It’s why you may even find him filling in for a friend at the Audrain Medical Center in Mexico, Missouri, from time to time.

“I enjoy taking care of patients,” Wright says. “I like this mix. A little bit of all three makes me happy.”