So I made 3 trips yesterday to a ALS patient who was becoming more and more anxious as she became more and more short of breath. Mind you respiratory therapy visits are non reibursed and provided as part of the service we offer. Had she capped (which will happen in 6 months) she would have been sent to the ER admitted, intubated and sent to ICU. So which plan is more cost effective?? Keeping her home or capping her and causing an addmission.