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.
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.
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.
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 recordLowest 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 15Oculoplastics 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-basedThe 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 itThe 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 dataThe cFTE Build-Up Model Penalizes Efficiency — Confirmed from Administration Slides
Administration's own slides confirm average billable cFTE = 0.43 — only consistent with a build-up (zero-up) model. The double-normalization embedded in their methodology (verbatim from slides): productivity is divided by cFTE for benchmarking, while compensation is multiplied by cFTE for target-setting. Applied to a physician generating 10,000 wRVU at 0.45 cFTE: their wRVU normalizes to 22,222 (99th+ percentile) while their comp target is set at $157,500. The gap versus a 1.0 cFTE peer doing identical work: ~$123,200/year in suppressed fixed base. Ophthalmology's high-throughput, efficient care model — which the administration cites as a strength — is being used against us in the benchmarking framework.
💪 Strong — verbatim from Administration slidesHigh wRVU in Ophthalmology = Real Collected Revenue, Not Theoretical Work Units
Ophthalmology's payer mix is predominantly Medicare and commercial insurance with minimal Medicaid and near-zero uncompensated care. In specialties where high volume includes significant unfunded or undercompensated work (EM, hospitalists, primary care), a conservative compensation approach relative to wRVU output may have institutional justification. In ophthalmology, that rationale does not apply. Virtually every wRVU we generate translates directly to collected revenue the health system has already banked. With 216,792 departmental wRVUs budgeted for FY27 — one of the highest-volume service lines at UCSD — this is not a theoretical claim. We are not asking to be compensated for work the institution cannot afford. We are asking to be appropriately rewarded for work the institution has already collected on.
💪 Strong — payer mix + collections dataThe 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📩 Documents available from Dr. Korn. Contact via email or iMessage.