Unalaska’s clinic expansion arrived in September, by barge — in nine pieces.
The nearly finished expansion will feature six emergency beds, two trauma rooms, a new radiology suite and a room designated for people in behavioral health crises. It will also have a pediatric room, a medication room, a nurses’ station and a new lobby.
Dawn Johnson is the clinic’s CEO. She said the new facilities should be ready for use after they get connected to utilities and the new CT and X-ray machines arrive, which she expects to come by the end of the year.
“The goal is for us to be able to work out of that space pretty quickly after it's tied in,” Johnson said.
But she said the expansion won’t solve one of the clinic’s biggest challenges: getting reimbursed for emergency care.
Federal and state regulations limit reimbursement options
In 2023, Iliuliuk Family and Health Services received a $20 million federal grant to expand and renovate its 30-year-old facility. The clinic provides around-the-clock care to the island community of about 4,500 residents, a population that grows during the fishing season. But it’s designated as a federally qualified health center.
Johnson says that designation creates a unique funding challenge because it supports primary care services, but it does not provide emergency care reimbursement.
“Right now, we can bill for the services that we provide, but our payers are only going to pay us what we're designated as, so they're not going to pay us that emergency reimbursement that we should get, but can't,” Johnson said.
Former clinic management hoped that expanding the facility to meet hospital-level standards would qualify it for a change in designation and reimbursement. But Chief Operating Officer Christy Fassbender said the expansion alone won’t make that possible.
“There were a lot of hopes built on the fact that we could turn this into a rural emergency hospital or freestanding ER, however, that's not possible for the state of Alaska,” she said.
Fassbender said state regulations and federal requirements determine how the clinic can operate and bill for emergency care. She said Alaska doesn’t have an upgrade pathway for the clinic to make the transition, and changes would need to happen on a legislative level.
Clinic looks to future partnerships and funding
Johnson said other federally qualified health centers in Alaska are facing similar challenges, including in Skagway and South Naknek.
“We are one of three FQHC clinics in the state of Alaska that operate the way we do,” Johnson said. “There are two others that also are FQHCs but have to do emergency care in their towns, and they don't get reimbursed either.”
Iliuliuk Family and Health Services is looking to partner with the others to address the issues through the state Legislature.
In the meantime, the City of Unalaska’s Community Support grant program continues to help the clinic cover emergency care costs. The city contributed $800,000 each of the last two years, but city council members have expressed concern about continuing to fund the clinic at that level.
Meanwhile, Johnson said the expansion was designed to accommodate a future change in the clinic’s designation.
“The way the building is being built sets us up for future paths that may open up to us,” she said.
The clinic is planning a grand opening in the new year and hopes the community will come out to see the expanded space.
