Chautauqua Hospice & Palliative Care is joining the Hospice and Palliative Care Association of New York State in asking Gov. Kathy Hochul to sign the Hospice Care Integrity and Oversight Act into law.

The bill (A.565/S.3437) would prohibit the establishment of new for-profit hospice agencies in New York state.

“Hospice care is about compassion, dignity, and mission, not profit,” said Mike Testa, CEO at Chautauqua Hospice & Palliative Care. “We’re asking the Governor to put patients and families first by preventing the growth of for-profit hospice agencies in New York.”

The state Assembly approved the legislation in March after a lengthy floor debate by a 99-50 vote. Assemblyman Andrew Molitor, R-Westfield, voted against the legislation, as did Assemblyman Joe Sempolinski, R-Canisteo. The Senate vote was 47-13 in April with state Sen. George Borrello, R-Sunset Bay, voting against.

A version of the bill passed the state Senate during the 2023-24 session but didn’t pass the Assembly. A version also passed the state Legislature in 2022 but was vetoed. In her 2022 veto message 149, Hochul said she will direct the New York State Master Plan for the Aging “to assess the services offered by for-profit hospices” and “to include a recommendation on their continued need.” That plan was due to be finalized in June 2025 – three months after the Assembly passed A.565.

Assemblywoman Amy Paulin, D-Scarsdale, said during floor debate there are only two for-profit hospice providers in New York state, both of which would be allowed to continue to exist if Hochul signs A.565. They could also expand to other facilities but would not be allowed to increase the number of beds they offer. In the three years since Hochul vetoed the ban on new for-profit hospice providers there have been no for-profit hospice applications submitted to the state Health Department.

“I’m not suggesting that the two that we have now are not doing a good job. I don’t know that one way or the other. I’ve been told that there’s no fraud and there’s no problems by the Governor’s office. So I believe that. And so, therefore, I’m talking about prohibiting new ones from coming in when we know that for-profit, across the country, have been problematic. I don’t want to bring those problematic entities into our state.”

Republicans took issue with potentially limiting the number of new hospice providers in the state at a time when there aren’t enough hospice beds statewide as well as a lack of data available regarding complaints or issues for for-profit hospice providers in New York.

” I understand that we want to allow for New Yorkers to have the highest possible level of care,” said Assemblyman Josh Jensen, R-Rochester. “But when we have for-profit providers in New York who are already providing high levels of care in the hospice and palliative care and we are 50th in the country of hospice and palliative care access, it is misguided to artificially ban providers who may want to come into the state with no evidence that they would be bad actors. The Department of Health does have oversight prerogatives on granting anybody the ability to practice in New York. If we have trust in the Health Department, then we should allow them to fulfill that duty and not discriminate based on whether they’re for-profit or not-for-profit.”

Local hospice advocates are raising concerns about the risks of expanding profit-driven hospice models in the state. Weill Cornell Medicine researchers released a study published by JAMA in November 2024 saying for-profit hospices performed substantially worse than hospices owned by not-for-profit agencies.

The researchers analyzed Consumer Assessment of Health Care Providers and Systems (CAHPS) data from January 2021 through December 2022. CAHPS, the national standard for assessing the quality of patient care, surveyed the caregivers of those who passed away in hospice by telephone and mail. The researchers compared measures for communication, timely care, treating family members with respect, emotional and religious support, help for symptoms, hospice care training, hospice rating and willingness to recommend.

Of the 2,676 hospices included in the final analysis, approximately 25% were owned by private equity and publicly traded companies and 40% were other types of privately owned for-profit hospices. Though only 25% of the hospices surveyed were not-for-profit, they provided the highest-rated quality care including focus on managing pain, comfort, dignity and quality of life.

Hospices acquired by private equity and publicly traded companies between 2007 and 2021 were found to have the lowest performance ratings across all CAHPS measures. They had worse caregiver-reported experiences including hospitalizations of patients and higher rates of live discharges–removing patients from hospice because they no longer meet the criteria for declining health and then re-enrolling them later. This can be distressing for the patients and create unnecessary stress for the family.

Although prior research has revealed poorer user experiences in for-profit compared to not-for-profit hospices, this study found that ownership by private equity or publicly traded companies was an especially problematic category of for-profit hospice.

The paper also noted that the facilities surveyed cared for 87% of all Medicare hospice users. The shift toward for-profit hospices has a profound effect especially on these patients, whose quality of care may suffer from the focus on profit maximization and incentives to generate market returns.

“If you or someone you love has been touched by hospice care, this is a powerful way to give back,” added Testa. “Together, we can make sure hospice in New York remains compassionate, accountable, and focused on people over profits.”