Unalaska’s Iliuliuk Family and Health Services provides a wide range of healthcare to the community, from obstetrics and routine primary care, to 24/7 emergency response. But representatives of the island’s primary clinic are worried some of those essential services could be jeopardized if they don’t receive enough funding through the city’s local grants program.
Despite offering emergency services, Unalaska’s clinic is not technically a hospital. It’s an FQHC, which stands for Federally Qualified Health Center. That means the clinic is given federal funds to provide primary care to the community, especially to underserved and low-income patients.
Christy Fassbender, a nurse practitioner at the clinic, said that distinction makes getting the proper funding very tricky.
“We do get some federal funding, but it is specific in what it has to be used for, and it has to be used for primary care,” Fassbender said. “It cannot be used for any emergency services, whether those emergency services are performed during the day, during clinic hours or after hours at night, it can't be used at all.”
Still, that doesn’t stop the clinic from offering emergent services to the community of about 4,500 year-round residents and several thousand seasonal industry workers. They just can’t charge for those as emergency visits. That means they’re consistently running at a financial deficit, according to clinic CEO Dawn Johnson.
“This deficit is growing every time we provide urgent/emergent care services,” Johnson said in an email to KUCB. “In order for IFHS to be able to continue to provide those services, supplemental funding must occur. And potential for emergency care reimbursement must be sought out.”
One way the clinic makes up for that deficit is through city funding. Each year, the City of Unalaska receives grant requests from the clinic and other nonprofit organizations on the island as part of its Community Support Grant Program. Last year, the city granted the clinic $1.1 million. And this year, the clinic requested $800,000.
Johnson said if the request isn’t fully approved, they may be forced to cease providing emergency care.
The clinic’s request is significantly higher than any other organization in the program, coming in at more than twice as much as the next highest request, from Unalaskans Against Sexual Assault and Family Violence, a local nonprofit that operates a shelter and 24/7 crisis line for victims of abuse.
The funding for the grant program comes from three sources: the city’s general fund, a bed tax, which is dedicated to visitor industries and cultural projects, and a tobacco excise tax that is used for public health and eliminating tobacco use.
Last year, the clinic’s request was paid entirely from the tobacco tax, which the city had issued in 2021 and had built up over a few years. But there isn’t enough in that fund to do that again this year, at least not to grant the clinic’s full request. Any extra funding would come from the general fund.
City Manager Bil Homka cautioned council members at the late April city council meeting that in the future, a single organization could end up taking all of the financial resources from the rest of the applicants.
Some city council members voiced concern about continuing to grant such high amounts to the clinic.
Mayor Vince Tutiakoff Sr. said at the meeting he’s in favor of granting full funding to all of the organizations, but he wanted to see more from the clinic.
“Because the amount of money we've put into the clinic — and [it’s] all for good causes — at some point … IFHS needs to come up with some kind of plan to fund themself in the future,” Tutiakoff said.
But Johnson said those plans are in the works.
“IFHS is actively researching and seeking other funding sources whether it be additional grants or additional healthcare services all of which take time to acquire,” she said.
And Fassbender added that the clinic has been working toward building up to hospital code for a couple of years now, “To allow the clinic to move to where they could get a different status, other than the FQHC, to allow for better reimbursement and better services for the community,” Fassbender said.
She said there’s just been a few bumps along the way and it takes time to get to that point.
“We do have solutions, and we are working very hard towards those solutions, but those solutions can take a lot of time,” she said. “And in the interim, obviously we need to have help to provide the services to the community.”
The clinic was awarded about $20 million from the U.S. Department of Treasury to expand its facilities. They started construction on the project last year, in hopes that it could help them secure better funding.
The expanded building would house new emergency, lab, radiology and pharmacy departments, according to Johnson. She said those would be built to hospital-grade standards, which are a key part of getting a separate designation and better reimbursement.
She said they’re not sure what the exact designation of the clinic would be, but they are researching the possibility of a free-standing emergency department or a similar status.
In early April, project management representatives, an engineer and architectural teams visited the island to work on the schematic design. Johnson said they are in the final stages of that part of the design process and expect to put a bid out for contractors in the coming months. After that, they can begin the groundwork.
The project is expected to be finished in December of next year.
Instead of granting or amending the request at their previous city council meeting, council members postponed their decision and suggested forming a committee to meet with clinic officials.
“The delay in the city council’s decision to approve the funding of IFHS for emergency care is disheartening,” Johnson said. “The Community Support Grant is the funding that allows IFHS to continue to provide these services as it bridges the gap between urgent/emergent care given and unattainable reimbursement.”
The Unalaska City Council is expected to vote on the matter at their upcoming meeting on May 13. They are expected to meet for a public work session on Thursday evening.
