COVID-19 has created a serious cash-flow problem for the health care system, particularly in rural areas. Unalaska's only clinic has faced financial issues for a long time, but the coronavirus pandemic has only exacerbated the problem.
Unalaska is the largest community in Alaska without a critical access hospital. The nearest emergency room is almost a thousand miles away.
As a result, Iliuliuk Family and Health Services (IFHS) often operates as the de facto emergency room for Unalaska. But it's certified only as a community health center. Melanee Tiura, CEO of the clinic, said that can be a problem.
"So we are a community health center and we receive federal funding to be able to support our primary care work," said Tiura. "But what that does not entail is 24/7 emergency coverage."
Unalaska's clinic has been facing financial challenges for years. Part of the reason is that it provides such comprehensive medical coverage. It has nurses, doctors, even a lab. There is always someone on call.
"Not every night is a busy night, but we still have to pay for that infrastructure to be in place so that it's available whenever anybody needs it," said Tiura. "And that's been the historical problem financially for this organization."
IFHS's most profitable revenue stream is through primary care visits. But because of coronavirus-related restrictions, those visits have dropped drastically in the past few months. Now, Unalaska's only health care facility — which serves anywhere from ten to fifteen thousand year-round residents and seasonal workers — is in danger of running out of money.
Ironically, the very policies they've implemented to keep the town safe are now threatening the organization's ability to survive.
"Places like Unalaska, we're going to get a peak later than other places. And so we've implemented the right strategies to be able to to reduce the impact in our community, the rapid spread of disease," said Tiura. "But that hurt us very early on."
Tiura has had to turn to other strategies to make up for that lost revenue. IFHS has started scheduling telemedicine calls, though Unalaska struggles with bandwidth and internet access problems. Staff hours have also been reduced.
Recently, the clinic received about $1.1 million in emergency funding, including $500,000 from the City of Unalaska. The clinic also requested an additional $180,000—the same amount as last year—through annual community grant funding. The city awarded $168,000, or 90 percent of the request.
But even given that funding and the cost-cutting measures, Tiura predicts that will only cover the clinic for five or six more months, assuming everything stays relatively stable.
Most Unalaskans have some kind of medical insurance. But many transient workers in the fishing industry do not. Particularly the thousands of seasonal workers in the processing plants.
In the past, plants have sent uninsured patients to the clinic with what Tiura calls "purchase orders," or a promise to pay the fees associated with certain medical issues.
But if there's an outbreak in the plants, like there has been in several meat processors throughout the Lower 48, it's unclear who will cover the uninsured patients.
Tiura said that, so far, the plants have not explicitly committed to covering those potential costs.
"And nor would there really have been, so far, a platform for them to do that," she added. "We expect many of these patients will come over with a purchase order."
According to Tiura, there haven't been any concrete plans for coronavirus-related purchase orders, yet.