Flaum focuses on building new infrastructure for regional eye care

When David DiLoreto, MD, PhD, became chair of the Flaum Eye Institute, it was with a bold five-year plan to expand access to eye care for people throughout the region, regardless of socioeconomic boundaries. This included adding specialties never before seen in Rochester and augmenting current specialties—fueled by the recruitment of more than two dozen faculty. Despite the many challenges posed by pandemic-related shutdowns, FEI became a magnet for talented clinicians. What might have taken a decade to accomplish occurred mostly during a 24-month span.

This included adding ocular oncology, ocular genetics, pediatric retina, low vision, urgent eye care, and the Finger Lakes’ most comprehensive uveitis service. In addition, existing programs in cornea, glaucoma, pediatrics, neuro-ophthalmology, optometry, and oculofacial plastics were beefed up to handle increasing demand for services by patients and through referrals from UR Medicine and external health care providers.

An undertaking as massive as this involved hiring of dozens of staff to support recently recruited faculty. It also required re-imagining current clinical facilities and building or acquiring new space. A recently opened comprehensive eye care practice in Geneseo completes the first phase of this plan. It puts the Eye Institute on pace to complete more than 130,000 patient visits in the 2023 calendar year, making it one of the larger academic-based clinical programs in the country.

Supporting much of DiLoreto’s vision during the expansion has been the job of FEI Administrator Joseph Gabriel. He is an adept project manager with a human touch when it comes to coordinating the activities of more than 300 FEI employees. Throughout the expansion, Gabriel directed a talented team responsible for everything from onboarding new associates to overseeing the design of optical shops.

“He’s my right hand,” DiLoreto said. “Joe has been instrumental to the growth of this organization. He has an uncanny ability to maintain calm during the most intense times. I can’t imagine we would have made it this far without his steady hand.”

The first project was the acquisition of Batavia Ophthalmology in June 2022. With it came staff, patients, and owner/cataract surgeon Eric Wu, MD. Incorporating a thriving solo practice with 10,000-plus annual patient visits was nothing new for FEI—it had previously acquired other practices. But this came with a wrinkle. Wu’s offices were located in a building owned by a competing regional health provider; so was the ambulatory surgery center where Wu performed cataract procedures. Wu and his staff would have to be physically moved and a new surgical space would need to be found that was convenient to patients in the region.

“We were lucky to find a piece of real estate that was already set up for medical care,” Gabriel said. “It was formerly occupied by a UR Medicine primary care group that was moving to a new multi-specialty building. It fit the bill perfectly.”

Gabriel was also able to move Wu’s surgeries to Strong West ambulatory surgery center. Just 30 minutes away from Batavia, it maintained convenience for patients and upgraded operating equipment. What most impressed Gabriel about the project was Wu’s attitude toward his staff.

“Normally we begin these transactions with a discreet practice evaluation and then we make an offer,” Gabriel said. “Dr. Wu wouldn’t even enter into this conversation until he knew that all his staff would be taken care of. I really admired this loyalty. I think it’s what makes him such a good addition to the team.”

Simultaneously, Gabriel and UR Medicine were working on FEI’s most ambitious project since it added an entire new floor to what was formerly the Wilmot Cancer Center building at Strong Memorial Hospital: a newly designed and built facility in Webster, New York. The project combined two existing offices from previous practice acquisitions into a nearly 10,000 square-foot, state-of-the-art facility.

Originally planned to open in 2021, the project faced numerous delays related to the pandemic, construction labor shortages, and supply chain issues. Opened in October 2022, the office allowed FEI hospital-based specialties to stretch their practices outside of the main campus. These include retina, oculofacial plastics, and pediatrics, located in a families’ only suite that is named for FEI philanthropist Joanne Lobozzo. In total, 14 providers see patients there.

“It is really an eye opener for efficiency,” Gabriel said. “When you have an empty shell to work with, you can make the space fit workflows instead of conforming people to the space. It is our first Article 28 offsite location, which is New York State’s highest certification standard for healthcare facilities.”

Before the paint was dry in Webster, construction was already underway to open another suburban location. This time in the town of Pittsford. Located in an office park at a major crossroads, the office was a complete remodel of an existing space. With a mandate and budget that Gabriel described as “fast” and “affordable,” the results are astonishing.

At nearly 6,000 square feet of patient care space, the new office mirrors many of the finishes and colors of the Webster build. It also includes advanced diagnostics, spacious exam rooms, and beautiful views of a wooded area through floor-to-ceiling windows. Like Webster, the location enables general eye care practitioners and specialists to provide services to patients who formerly had to come to FEI’s main campus. This includes cornea and pediatrics. Opened in November 2022, the facility has attracted new patients to the Eye Institute, serving nearly 1,000 local households to date.

With suburban expansion well in hand, Gabriel and DiLoreto turned their focus “downtown.” Part of FEI’s mission is to provide for those who lack access to equitable care. Much of this population resides in urban Rochester, which has some of the highest poverty rates in the nation.

Through his participation on the board of Goodwill Industries of the Finger Lakes, DiLoreto became aware that the organization had space available at its downtown campus. He and Gabriel toured an empty shell on the third floor of a building. It would require a complete buildout. As they discussed their needs, they discovered that everything they wanted was already in place on the ground floor of the same building. There, Goodwill had a large, but underutilized, office where they performed low-vision exams and vision rehabilitation services. It was the beginning of an incredible collaboration.

The Eye Institute and Goodwill came to an agreement in which FEI would rent the ground floor office and take over low-vision examinations. In addition, FEI would bring in well eye care for adults and children with the idea of using the location to serve Rochester’s urban core. The spot was ideal because it is on two of Rochester’s main bus routes and less than a mile from Rochester Transportation Service’s main terminal. FEI’s Christine Coward, MD, was identified as medical director.

“Sometimes it’s good to be lucky,” Gabriel said. “The University has limited resources to fund expansion, and we had used our share on some of the previous projects. We were able to come into an existing facility and figure out how to make it work as a full-service eye clinic. I really enjoyed the creativity of re-imagining the space. Anyone can blow out a wall and not give thought to what’s already there. Goodwill are fantastic collaborators. They helped us come in under budget and meet our February 2023 opening target.”

The clinic is already fulfilling many of its outreach missions and includes an optical shop that has high-quality eye wear that is affordably priced. A food pantry, supplied by Foodlink, is also on site for patients who may have food security issues.

From the urban, FEI extended to the region, opening the Geneseo clinic in November 2023. It is in a temporary location shared with UR Medicine’s Ear, Nose & Throat division until FEI moves into a multi-specialty building currently under construction. The office is staffed by FEI’s latest faculty recruit, Ruba Muhtaseb, MD, who provides medical eye care, cataract surgery, and eye exams. Soon to follow will be pediatric ophthalmology. Some of the related surgical care will occur locally at the UR Medicine-affiliated Noyes Surgery Center.

“This is our furthest expansion southward to date and represents another step in our plan to provide the highest standard of eye care to the region,” Gabriel said. “The collaboration with ENT allows us to share some key office staff while we grow the practice and eventually move into the new building.”

This 18-month expansion positions FEI to better serve patients closer to where they live. It also gives a growing group of doctors more room to deliver expert care. All totaled, the projects added over 20,000 sq. ft. of clinical space, a net gain of 32 exam rooms, and three additional locations for surgery. And it’s not over. DiLoreto and Gabriel have a green light to further expand the network. This will more closely align FEI with UR Medicine’s growing primary care network to serve as a trusted source for future eye-related referrals.

“It has been busy but rewarding,” Gabriel said. “I think our ability to be flexible has built trust with UR Medicine administration. I can’t begin to thank everyone who helped, from project managers to contractors to the doctors and staff at FEI. It was an incredible and worthwhile lift.”

Zachary Laird | 12/19/2023