Give up?  It’s when the sick senior was treated at that same hospital less than 30 days ago for heart attack, heart failure, or pneumonia.  Starting in less than three months, the list of conditions will be expanded to cover COPD (chronic obstructive pulmonary disease) and hip and knee replacements.

And the fines aren’t insignificant.  They began at 1% of Medicare payments in 2013 and went to 2% this year.  Next year they’ll be at 3%.  That’s a lot of money, and it’s being paid by an ever-increasing number of hospitals:  2,217 in fiscal 2012, 2,225 in 2013, and 2,610 in 2014.  To put that last figure in perspective, the universe was only about 3,370 hospitals.  So only 769 — or 23% — escaped without a fine.

What’s the theory of the fines?  Well, it’s both simple and simple-minded:  if the patient has to come back, it must be the hospital’s fault.  It couldn’t possibly, for example, be because the patient didn’t comply with post-discharge instructions, or lives in an unhealthy setting, or was too poor for follow-up care, or couldn’t afford necessary medicine.  No, it had to be the hospital’s fault.  So if the hospitals are punished severely enough, no patient will ever have to be readmitted.

So far, CMS hasn’t seemed to notice the strange coincidence that a big proportion of fines are incurred by hospitals in poor communities.  For example, Modern Healthcare reported Friday that about a quarter of the hospitals with maximum fines for the most recent year are in Kentucky, a state with forty counties classified as having “persistent poverty.”

There’s no truth to the rumor that CMS is considering a plan to improve quality even more by fining hospitals whenever they see the same patient more than once in a lifetime.