Word: duking
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...knows doctors cannot base every decision on the evidence since there is never enough. But he believes medical scientists can do a lot more to codify what works best. "We're in an era where we can no longer afford to guess whether things are beneficial," says Califf. And Duke officials believe his DCRI, which coordinates a worldwide network of clinical investigators, will make Duke a leader in evidence-based medicine, driving down costs at the medical center without harming health while bringing in millions of dollars in funding from pharmaceutical firms...
...medical center. DCRI is currently coordinating 12 international studies, involving more than 1,500 clinical investigators in 35 countries. With net revenues this year projected to top $55 million (up from $30 million in '96), DCRI has the potential of becoming the largest single profit center at Duke...
...second floor of the Duke Clinic, Dr. Ralph Snyderman is making rounds. That would be nothing special if he didn't run the place. Snyderman is chancellor of Duke University Medical Center, so for him to be looking in on patients is a bit like Bill Gates debugging code on a Windows program. Still, it's something he does one month every year, usually in June, like most other doctors at Duke. Right now he's checking on the progress of James McAllister, 73, who has a spinal tumor. McAllister is doing well enough to leave a high-cost intensive...
That's how Snyderman has to think. As Duke's CEO, he's both doctor and businessman. More than that, he's the chief visionary behind Duke's risky refashioning of itself as a health "system," one he's gambling will prove profitable enough to subsidize Duke's money-losing missions in teaching and research. Once, Medicare payments and privately insured patients paid for everything, no questions asked. Now HMOs question everything. The Balanced Budget Act, passed by Congress last year, will mean big cuts in Medicare payments, which, when added to the pervasive weight of managed care, threaten...
...hard start to his plan has the hospital cutting $30 million annually from its $654 million costs for at least three years. It gets more controversial after that. His real gamble is to push Duke into a range of new businesses--all aimed at creating something like a health-care shopping mall, with everything from its own HMO to primary-care clinics, retirement communities and hospice care, for a good part of the surrounding population...