Legislative Republicans and Democrats bristled at excuses Department of Health and Human Services officials gave Tuesday over their failure to create a mandated watchdog program.
“Do you understand how frustrating this is for the members of the General Assembly? Three years now we have required the creation of an office,” Sen. Ralph Hise, R-Mitchell, said during a Joint Legislative Oversight Committee on Health and Human Services meeting.
The 2015 General Assembly passed a law creating the Office of Program Evaluation Reporting and Accountability. Lawmakers were concerned that while DHHS gets the second highest level of state funding after education, the agency provides scant information on cost or outcome measurements. The current $5.2 billion DHHS budget accounts for 23 percent of the state General fund.
The law required the DHHS secretary to appoint a director to oversee OPERA, an independent division that reported directly to the secretary. The director’s position remains open.
While the department issued an update on the OPERA mandate, Hise scoffed at the department’s lack of transparency.
“Once again we get another report that for all practical purposes the department has done nothing,” he said. “It looks to me as if there’s just certain evaluations the department doesn’t want done.”
OPERA’s duties include evaluating DHHS programs, listing all programs and publishing the list on a department website; developing an inventory of all contracts, department data, and records; and conducting announced and unannounced inspections of all DHHS facilities — including interviews with employees.
“A statute is not a suggestion,” said committee co-chairman Rep. Josh Dobson, R-McDowell.
“Nobody wants to be accountable, and numbers and data hold you accountable,” said Sen. Tommy Tucker, R-Union.
Rod Davis, DHHS chief financial officer, said three positions were created, and recruitment was conducted to find a director, but there has been no expenditure of funds, no hiring, and no program evaluations by that office.
He said the DHHS Office of Budget Analysis was performing many of the functions spelled out in the OPERA legislation. That office is independent, and department officials believe it could perform the assigned functions without creating a new office.
DHHS Secretary Mandy Cohen said she has interviewed candidates for the director’s job, but hasn’t found any takers. She said some of the OPERA contracting and evaluation activities have been done, and some independent program evaluations were performed.
Cohen said it would be better to beef up existing programs than create a new office with redundant functions.
“A lot of times we’re doing things over, and over, and over, but the outcomes are not changing because we’re not evaluating and having the accountability,” said Rep. Carla Cunningham, D-Mecklenburg. She said the independent OPERA program is necessary.
In another matter, Christie Burris, director of the state Health Information Exchange Authority, updated lawmakers on the state’s NC HealthConnex program, which will put every North Carolinian’s health records on a centralized database.
The program is designed to store electronic health records in one place, letting providers anywhere in the state offer better care to patients. Now records are stored at individual hospitals, pharmacies, dentist and doctor’s offices, labs, and transportation services.
The data, covering larger patient populations, also could identify sickness and disease trends.
It costs a lot to connect to the system, Burris said. So does the proper technology to use it. The state is exploring whether current computer systems providers now use could be linked to the state system. The state charges nothing to use the system, but Burris said the vendors who operate the program might.
Burris projected 98 percent of the state’s health providers would be connected by the June 1, 2020 deadline. To date about 90 percent of hospitals and 87 percent of county health departments have signed on. Some are reluctant to join, or want to provide only state-related data on Medicaid and State Health Plan patients.
Patients have legitimate concerns about their electronic health records being sent beyond their doctor’s office, and the risk they would be illegally accessed, said Rep. Greg Murphy, R-Pitt. He asked whether patients who don’t have insurance must sign waivers to release their health records.
Burris said North Carolina is an “opt-out state,” which means “every citizen is automatically opted in to the Health Information Exchange until they exercise their right to opt out.” She promised high security safeguard standards for the state and its vendors.
Rep. Nelson Dollar, R-Wake, was concerned whether government agencies would be able to access people’s health records, and Sen. Jeff Tarte, R-Mecklenburg, raised a red flag about the state automatically collecting that information.
“I don’t think most North Carolinians recognize … their most personal clinical and health information is now owned by the state of North Carolina,” Tarte said. “They have the option to opt out, but they never had the option to opt in, and that’s troublesome.”