Extra attention to Medicare's sickest patients saves money in the long run

Steven Borders of Obetz has lost most of his sight and left leg to complications from diabetes. But despite the despair that sometimes closes in on the tattoo artist who spends most of his time in bed — "I feel like I'm at my life's end," he said through tears last week — he still has goals at age 63: "I would like to go to church and speak to youths and let them know there is a God." A doctor, a nurse practitioner and others providing a more hands-on approach to health care are working to improve those odds. For some of their sickest, costliest patients enrolled in Medicare, they receive incentives to ensure smooth transitions from hospital to home and to head off medical errors and duplication of services.