Ophthalmology Funds Flow Hub

UCSD Department of Ophthalmology — Compensation Redesign Committee Resource

✅ Meeting 2 Complete
⚠️ Meeting 3 Upcoming — Dates TBD
🏛️ Krista Fakoory (CFO's Office) — Lead Presenter
📌 2 Open Comp Committee Seats — Apply Now
📊 Key Numbers at a Glance
🚀
wRVU Productivity
88–92nd
Percentile nationally (confirmed by admin)
💰
Total Compensation
55th
Percentile — 35-point gap to productivity
📉
Our Comp / wRVU
$52.84
Blended CARE rate — lowest surgical dept
📈
MGMA Median
$70.54
Ophthalmology comp/wRVU — the benchmark they claim to use
🕳️
Gap vs. ENT Parity
$3.2M
Additional annual CARE payment if paid at ENT rate
🕳️
Gap vs. Surgery Parity
$5.8M
Additional annual CARE payment if paid at Gen Surgery rate
💉
Tepezza Margin (lost)
$3M+
Annual strategic transfer disappearing under new structure
🏥
340B Annual Savings
$393M
UCSD Health total — retina injections major contributor
💊
Retina Drug Margin
$12–36M
Est. annual 340B margin from retina injections — $0 flows to us
🔪
OR Facility Fee Margin
~$3M
Est. annual HOPD facility fee margin from oculoplastic OR cases — $0 flows to us
🔥 Hot Issues Board Click any card to expand
Raise at Meeting 3
Slide 15 Was Never Shown
The cross-department comp/wRVU table — showing Ophthalmology at $56/wRVU, lowest of any surgical department — was distributed in the deck but never presented. Demand it be formally addressed at Meeting 3. This is not an oversight; it is the most damaging slide for the administration's position.
Slide 15 • High Priority
Tepezza $3M Transfer Disappears
Krista Fakoory confirmed on record that a $3M+ annual "strategic support transfer" from Tepezza/infusion margin has been flowing to the department. Under the new structure, this stops. The stated $2.5M CARE payment pickup is therefore a net negative. Demand a full before-and-after accounting before any rate is approved.
Transcript admission • Critical
Request Comp Committee Seat
Dr. King confirmed 2 open seats on the system-wide Clinical Compensation Committee. Nominations go via Council of Chairs or BOG. Ophthalmology must have a representative on this committee — it sets the rules that govern our rates permanently. Submit a nomination immediately.
Action Item • Urgent
Researched & Ready
Blended Rate for Oculoplastics
UCSD's own CARE Payment policy allows a blended rate when a specialty "spans more than 1 MGMA rate area." Oculoplastic surgery spans ophthalmology AND plastic/reconstructive surgery. Same CPT codes, same wRVUs, but plastic surgeons earn $79-96/wRVU vs our $62.93. Formally invoke the blended rate provision in writing before Meeting 3.
Policy-based argument • Strong
15% Gap Rule — Apply Our Percentile
Fakoory explicitly stated UCSD targets paying at the 50th percentile comp/wRVU for departments producing at the 60th-80th percentile — a deliberate 15% gap. Our department produces at the 88-92nd percentile. By UCSD's own standard, we should be paid at the 75th-78th percentile comp/wRVU — approximately $67-75/wRVU — not the 50th.
Admin's own statement • Strong
Kane Recruitment Argument Fails for Oculoplastics
Dr. Kane defended different rates for same CPT codes by saying it's about specialty recruitment cost. By his own logic: there are only ~250 ASOPRS-certified oculoplastic surgeons in the US (extreme scarcity), and the MGMA 90th percentile for oculoplastic comp/wRVU is $95.27. His argument demands a higher rate for us, not a lower one.
Transcript • Kane's own words
MGMA 2021-23 Is Stale — Demand 2024
Fakoory confirmed on record that the benchmark data lags 1.5 years. The MGMA 2024 ophthalmology median wRVU is 8.4% higher than 2021-23 data. CPSC 2024 shows oculoplastic norms 35% higher. Demand all rate scenarios be recalculated using current 2024 data before any rates are finalized.
Data-based • Confirmed by admin
R² = 0.006 — Pay Is Random
The scatter plot shown in Meeting 2 shows R² = 0.0059 using AAMC/CPSC benchmarks — meaning productivity explains less than 1% of compensation variation. Fakoory acknowledged "the R-naught is a little bit weak." This proves the current system pays based on negotiation history, not output. The redesign must correct this.
Shown on slide • Admin acknowledged
Retina 340B Margin Is Invisible
Each Vabysmo/Eylea intravitreal injection generates $900-1,100 in institutional 340B drug margin on top of the physician fee. Retina performs ~40,000 injections annually. Estimated institutional drug margin: $12-36M/year. Retina's CARE payment: $3M/year. The physician fee is 4-6% of total encounter revenue. This must be factored into rate-setting.
UCSD 340B data • Quantified
On the Record
88-92nd Percentile Confirmed
Fakoory stated in Meeting 2: "Within the 88th to 92nd percentile of productivity in the country." This is no longer our claim — it is the administration's own statement on the record. Cite the transcript in every subsequent argument.
Transcript • Meeting 2
15% Gap Is Deliberate Policy
Fakoory: "We're really targeting them to get paid somewhere around the 50th productivity... it's usually about a 15% differential between productivity and compensation." This is explicitly stated policy, not an accident or oversight.
Transcript • Meeting 2
ccFTE Only Affects Perception
Kane stated: "All it does is affect our perception of your productivity." An efficient surgeon seeing 90 patients in a day vs 15 patients per session generates the same CARE payment — but the 90-patient surgeon looks less productive in the model. Our efficiency is penalizing our benchmarking.
Transcript • Kane • Meeting 2
📅 Meeting Log

Meeting 1 — Funds Flow Introduction Complete

Introduction to the funds flow redesign process. Overview of the work group structure, timeline, and scope. Faculty introduced to CARE payment concept.

Meeting 2 — Benchmark Review Complete

Presented by Krista Fakoory (Chief of Staff to CFO). Covered MGMA benchmarks, productivity data, compensation percentiles, and FY27 CARE payment projections. Slide 15 (cross-department comp/wRVU) was never shown.

✅ 88-92nd %tile confirmed ✅ 15% gap policy stated 🔴 Slide 15 skipped 🔴 Tepezza transfer ending disclosed R² weakness acknowledged 2 comp committee seats open

Meeting 3 — Rate Scenarios Upcoming

Expected to present CARE payment rate modeling scenarios. This is the most critical meeting — rates proposed here will form the basis of final implementation. Pre-meeting written submissions should be sent before this meeting.

Watch: Will Slide 15 be shown? Watch: Blended rate scenarios? Watch: Cash-pay inclusion?

Implementation — July 1, 2027 Target Date

CARE payment rates go live. Note: department chair transition also on July 1. No final rates should be locked without incoming chair review.

📖 Finance 101 — For Surgeons
🔢 What is a wRVU? ▼
A work RVU (Relative Value Unit) is a number CMS assigns to every medical procedure to measure how much work it takes. A simple office visit = ~1.5 wRVUs. A complex orbital surgery = 10+ wRVUs. wRVUs are specialty-neutral — the same CPT code generates the same wRVU whether an ophthalmologist or a plastic surgeon performs it.
💡 Example: A blepharoplasty (CPT 15821) generates the same wRVU whether performed by oculoplastics or plastic surgery. But under UCSD's rate structure, the plastic surgeon earns more per wRVU for that identical procedure.
📊 What is MGMA and why does it matter? ▼
MGMA (Medical Group Management Association) surveys 250,000+ physicians annually and publishes compensation and productivity data by specialty. UCSD uses MGMA to set CARE payment rates — specifically, the 50th percentile (median) comp/wRVU for each specialty becomes the target rate. If MGMA says the median ophthalmologist earns $70.54/wRVU, UCSD pays based on that number.
⚠️ Problem: UCSD uses 2021-2022-2023 data to set FY26 rates. This lags the market by 1.5 years. The 2024 MGMA data is already out and shows higher rates — but it isn't being used.
💵 What is a CARE Payment? ▼
The CARE Payment is UCSD Health's way of paying faculty for their clinical work. For every wRVU you generate, UCSD pays you a set dollar amount (the CARE rate). Our blended rate is $52.84/wRVU. If you generate 10,000 wRVUs in a year, your clinical pay from CARE is $528,400. The CARE payment is just one piece of total compensation — you may also receive research salary, teaching stipends, VA pay, etc.
💡 The CARE rate is where this entire fight is focused. Raise the rate per wRVU and everyone's clinical pay goes up proportionally — without anyone needing to work harder.
⏱️ What is ccFTE — and the trap inside it? ▼
ccFTE (Clinical Care FTE) measures how much of your time is designated as clinical. 1.0 ccFTE = 36 clinical hours/week (9 sessions × 4 hours). Our average is 0.4 ccFTE — meaning faculty spend ~40% of their time on billable clinical work, and the rest on research, teaching, and administration.
⚠️ The Trap: ccFTE is time-based, not output-based. A surgeon seeing 90 patients in one efficient clinic session has the same ccFTE as one seeing 15 patients across multiple sessions. Our efficiency makes us look like we work less than we do — which drags down our benchmark percentile. Critically: cosmetic and cash-pay procedures don't count in ccFTE at all.
🎯 The 15% Gap: UCSD policy explained ▼
UCSD deliberately targets paying physicians at the 50th percentile comp/wRVU even when those physicians produce at the 70th-80th percentile for wRVU volume. The 15% differential is acknowledged institutional policy — the extra value generated above the median is recirculated into overhead, academic support, and administration. For a department at the 90th percentile of productivity, this policy means the gap is far larger than 15%.
💡 By UCSD's own standard, a 90th-percentile producer should be paid at the 75th-78th percentile comp/wRVU — approximately $67-75/wRVU. We are paid at $52.84. That is not a 15% gap; it is a 35%+ gap.
🏦 340B and Facility Fees: The Invisible Money ▼
UCSD is a 340B covered entity (Disproportionate Share Hospital, 26% DSH). This allows UCSD to purchase drugs at deeply discounted prices (40-50% below market) while still billing Medicare at the full ASP+6% rate. The difference is pure institutional profit. For anti-VEGF injections like Vabysmo or Eylea, UCSD earns $800-1,100 in drug margin per injection — on top of the physician fee. Additionally, every OR case generates a hospital facility fee (separate from the physician fee) that goes entirely to UCSD Health.
⚠️ None of this appears in any productivity metric or compensation analysis. Retina generates an estimated $12-36M in annual drug margin from injections. Their CARE payment is $3M. The physician fee is approximately 4-6% of total encounter revenue.
🔀 What is a Blended Rate? ▼
UCSD's own policy allows a blended rate when a specialty "spans more than 1 MGMA rate area." Instead of using just the ophthalmology benchmark, a blended rate would combine ophthalmology AND plastic/reconstructive surgery benchmarks — weighted by procedure mix. Oculoplastic surgeons perform the same CPT codes as plastic surgeons, so a blended rate would increase their comp/wRVU closer to the plastic surgery benchmark (~$79-96/wRVU).
💡 The blended rate provision is in UCSD's own written policy. We are entitled to request it. It doesn't require a new policy — it requires invoking an existing one.
⚡ Our Strongest Arguments
1

90th Percentile Productivity, 50th Percentile Pay

The administration confirmed our department produces at the 88th-92nd percentile nationally. UCSD deliberately pays at the 50th percentile comp/wRVU — creating a 35-40 percentile gap. This is not a rounding error; it is a structural transfer of faculty-generated value to the institution. By UCSD's own 15% gap policy, we should be paid at the 75th-78th percentile comp/wRVU (~$67-75/wRVU).

💪 Strong — confirmed on record
2

Lowest Comp/wRVU of Any Surgical Department

Slide 15 shows Ophthalmology at $56/wRVU — below Primary Care, Emergency Medicine, and every surgical department including Neurosurgery ($96.37), Surgery ($79.40), Ortho ($72.39), ENT ($67.82), and Urology ($64.13). We have the second-highest average wRVU per provider in the institution, behind only Dermatology. High volume, low rate — this requires explicit justification.

💪 Strong — their own Slide 15
3

Oculoplastics Is Plastic Surgery, Not General Ophthalmology

Oculoplastic surgeons perform the same CPT codes as plastic surgeons — blepharoplasty, orbital decompression, eyelid reconstruction. CMS assigns identical wRVUs. UCSD pays oculoplastics $62.93/wRVU and plastic surgery ~$79-96/wRVU for identical procedures. UCSD's own policy allows a blended rate when a specialty spans more than one MGMA rate area — and oculoplastics clearly spans ophthalmology and plastic/reconstructive surgery.

💪 Strong — policy-based
4

The Net Tepezza Transfer Makes the Pickup a Loss

Fakoory disclosed that $3M+ in annual Tepezza/infusion margin has been transferred to the department as a "strategic support transfer" — and this will not continue under the new structure. The stated $2.5M CARE payment pickup is therefore a net negative when the transfer loss is included. A full before-and-after accounting must be presented before any rate is approved.

💪 Strong — admin disclosed it
5

The Benchmark Is Stale by Design

UCSD uses MGMA 2021-2023 data — acknowledged to lag 1.5 years. The MGMA 2024 ophthalmology median wRVU is 8.4% higher. CPSC 2024 (UCSD's own academic benchmark partner) shows oculoplastic norms 35% above the data being used. Rate scenarios must be recalculated using current 2024 data. Using stale data in an inflationary period systematically under-prices physician compensation every year.

📊 Medium-Strong — requires 2024 data
6

The 340B, Facility Fee, and OR Margin Is Not Counted

For every dollar of CARE payment received, UCSD Health collects $5-10 in facility fees and drug margin from the same clinical encounter. Retina alone generates an estimated $12-36M annually in 340B drug margin — none of which flows to the department. Oculoplastic OR cases generate an estimated $3M/year in HOPD facility fee margin — high-volume, low supply cost cases that are highly profitable to the institution. OR facility fee margin is entirely invisible to the CARE payment model. A compensation model that ignores 94-96% of encounter revenue is not a partnership.

📊 Medium — requires UCSD finance data
📁 Document Library
📄
Department Position Paper v5
PDF — Full advocacy document
📄
Oculoplastic Rate Argument
PDF — Blended rate case with slide
📋
Meeting 2 Cheat Sheet v3
PDF — Slide-by-slide probing questions
📊
MGMA Benchmark Data (FY26)
Excel — Licensed MGMA percentile data
📝
Meeting 2 Transcript
DOCX — Full audio transcript
📑
Meeting 2 Slide Deck
PPTX — Admin presentation
📊
TED Drug Comparison
PDF — Anti-VEGF comparison analysis
📄
Funds Flow Meeting 1 Deck
PPTX — Prior meeting slides

📩 Documents available from Dr. Korn. Contact via email or iMessage.

💬 Committee Q&A Board Post questions — Eve analyzes each one
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