Financial Incentives Research Articles

Incorporation of Calcimimetics into ESRD Bundle: Changes in Etelcalcetide Utilization and PTH Control Following End of TDAPA Designation

Introduction: Calcimimetics, including intravenous etelcalcetide and oral cinacalcet, are often prescribed to hemodialysis patients to prevent complications of elevated parathyroid hormone (PTH) levels. In January 2021, US dialysis reimbursement policy switched from the transitional drug add-on payment adjustment (TDAPA) to an increased bundled payment, with $10.09 per session added for all hemodialysis patients to cover the expense for calcimimetics, whether or not patients are administered etelcalcetide. We leveraged this natural experiment to investigate the impact of this policy change. Methods: This analysis included 713 US in-center hemodialysis patients enrolled in the United States Dialysis Outcomes and Practice Patterns Study (US-DOPPS) who discontinued etelcalcetide during the TDAPA transition period (December 2020 – April 2021). Within a self-matched longitudinal design, within-patient changes in mean PTH, calcium, and phosphorus were assessed in the six months pre- vs. post- etelcalcetide discontinuation, using linear regression adjusted for potential confounders. Results: Etelcalcetide use in US-DOPPS decreased 58%, from 12% to 5% from July 2020 to July 2021; 73% of etelcalcetide discontinuers switched to cinacalcet within six months. Comparing the six months pre- vs. post- etelcalcetide discontinuation, mean PTH levels increased by 107 (95% CI: 80, 133) pg/mL, and the prevalence of PTH >600 pg/mL increased by 15% (95% CI: 11%, 19%), from 28% to 43% overall, and increased from 26% to 49% among Black patients. Mean serum calcium and phosphorus levels increased by 0.42 and 0.16 mg/dL, respectively. Conclusion: Etelcalcetide use decreased substantially after TDAPA ended in January 2021, with most patients switching to cinacalcet. The subsequent increase in PTH levels was swift and sustained, and especially pronounced among Black patients, raising concerns about disparities and potential downstream impact on clinical outcomes. Despite the spirit of the policy change, the flat per-treatment increased payment may have inadvertently created a financial incentive to restrict patient access to a more effective therapy, and potentially stifle drug innovation.

Renewable energy technology diffusion model: Evaluation of financial incentives in the electricity market of ecuador

This paper develops a simulation model using the System Dynamics paradigm to evaluate the effect of applying financial incentives on the diffusion of non-conventional renewable energy technologies in the Ecuadorian electricity market. The barriers to the diffusion of renewable energies are studied, the diffusion models are characterised, and the model is built with market variables and financial indicators integrated into its base structure. The Ecuadorian electricity market is described as a case study focusing on the incentive scheme. Based on investment, generation, and indirect incentives, this scheme plays a crucial role in promoting renewable energy technologies. Different long-term diffusion scenarios are simulated and compared with each other and with the baseline scenario to obtain diffusion rates and financial information for five renewable generation technologies: non-conventional hydro, wind, solar photovoltaic, biomass, and geothermal. The results of the simulations show that the combination of incentives leads to high diffusion rates, reassuring the audience about the potential impact of the proposed model. However, the feed-in tariff and tradable green certificate incentives are the most effective in promoting the use of renewable energy. For the Ecuadorian electricity market, the results show that wind and biomass technologies would be the most profitable, as opposed to geothermal energy, whose diffusion will not be feasible within the simulated period.

Barriers of adopting sustainable soil management practices for organic and conventional farming systems

There is a general consensus among stakeholders about the benefits of sustainable soil management practices for soil health, yet their implementation lags behind expectations. The aim of this paper is to analyse factors supporting or hindering the implementation of sustainable soil management practices in conventional and organic farming systems. This is achieved using a Logit model, based on penalized maximum likelihood estimation on survey data by 76 farmers from 10 federal states in Germany. Affected factors were categorized in two main groups: agricultural soil management practices, and barriers to their implementation. The measures for soil improving agricultural management included (I) structural landscape elements, (II) organic fertilization, (III) diversified crop rotation, (IV) permanent soil cover (V) conservation tillage, (VI) reduced weight pressure, and (VII) optimized timing of wheeling. Results show differences in preferences between conventional and organic farmers for key sustainable soil management practices, including conservation tillage, optimized wheeling timing, reduced weight pressure, and diversified crop rotation. Economic constraints decrease crop rotation diversification in conventional systems by 14%. Conservation tillage raises the chance of a farm being conventional by 16%, while optimizing wheeling timing reduces it by 60%, highlighting soil compaction concerns among organic farmers. Marginal effects confirm that economic factors, not knowledge, are the main barriers to sustainable soil management. Inconsistent policies, lack of support, and insufficient financial incentives from government institutions can hinder the willingness of farmers to adopt these practices, further exacerbating the barriers to adoption.

Land use change and ecosystem service tradeoffs on California agricultural land

Abstract Introduction 
The need to transition to sustainable agricultural practices while maintaining high food yield and strengthening resilience to climate change cannot be overstated. California farmers have received incentive funding from federal and state agencies to use land management practices that are less impactful to the land and in line with California’s sustainability goals. However, there are no regional monitoring measures to determine whether farming is becoming more sustainable. 

Methods 
In this study, we used land cover change analysis and ecosystem services modeling to understand how farming practices influence environmental benefits on California farmland from 2010 to 2020. We analyzed the tradeoffs between soil erosion control, soil carbon storage, and production of California’s top agricultural commodities, and we compared these changes to changes in land cover in five agricultural regions statewide. 

Results and Conclusion 
We found that the trade-offs in ecosystem services and food production differ depending on the regional context, and that major expansion in almond production and land use changes have had different impacts throughout California. Statewide, soil organic carbon storage increased, soil erosion control increased slightly, and food production boomed for most commodities. Incentive programs that influence farming practices may need to operate at a regional level rather than a statewide level to achieve sustainable outcomes specific to each region.

OPTIMIZING ENERGY EFFICIENCY: A COMPREHENSIVE ANALYSIS OF BUILDING DESIGN PARAMETERS

This study explores the critical role of financial incentives, energy performance certifications, government policies, and advanced technologies in driving the adoption of energy-efficient building practices. Financial incentives, such as tax credits, rebates, and grants, are shown to significantly reduce the upfront costs associated with energy-efficient technologies, making these innovations more accessible to developers and building owners. The research highlights the effectiveness of energy performance certifications, like LEED and Energy Star, in enhancing the market value and energy performance of buildings by providing a structured framework for evaluating sustainability. Government policies and building codes, including the International Energy Conservation Code (IECC) and ASHRAE standards, are identified as key drivers of energy efficiency, compelling developers to meet stringent performance standards. Additionally, the integration of renewable energy technologies, such as solar panels and geothermal heat pumps, alongside smart building automation systems, plays a vital role in reducing energy consumption and improving operational efficiency. However, regional disparities in the availability of financial incentives and enforcement of policies present challenges to widespread adoption. The study concludes that expanding financial support, strengthening policy enforcement, and increasing public and industry awareness of the long-term financial and environmental benefits of energy-efficient buildings are essential for accelerating the transition to sustainable building practices. By addressing these challenges, the construction industry can make significant strides toward reducing energy consumption, lowering greenhouse gas emissions, and achieving global sustainability goals.

Driving industrial symbiosis: Evaluating policy intervention effects on waste heat utilization in local district heating networks

This study aims to quantitatively assess the required policy support level to ensure economic viability for all stakeholders in the context of using industrial waste heat as source of local district heating (DH). Additionally, the research explores the potential of industrial symbiosis to support district-level energy transition in the context of Positive Energy Districts and Smart Cities. The proposed approach combines energy modelling tools, namely the Multi Energy System Simulator (MESS) model and financial concepts (i.e. Cash Flow Analysis, Net Present Value Evaluation) typical of industry’s project evaluation. It is then tested in the area of Bolzano, Italy. The study examines various policy scenarios, including financial incentives and the involvement of district heating operators (DHOs). Initial findings indicate that district heating offers significant cost advantages (up to –23%) over electrified systems. However, industries face challenges meeting standard payback periods without policy intervention in the context of projects using waste heat as a source of DH. A combined scenario involving DHOs handling connection costs with a 60% incentive and industries receiving a 15% Feed-In Premium shows promising results in achieving economic feasibility. The results underscore the critical role of policy support in overcoming barriers. Consequently, it is possible to strengthen cooperation between industries and districts fostering local energy transition. Nonetheless, the achievement of positive energy balance requires a stronger presence of RES particularly on the electricity side. The study highlights the broader implications for similar projects in other regions and the essential role of policy interventions in facilitating such industrial symbiosis.

Public spending and sustainable economic development

Purpose Despite the increase in public spending by Sub-Saharan African (SSA) Governments in a bid to foster the growth of human capital and sustainable development, they continue to experience a very slow rate of progress. This study aims to investigate the impacts of public spending on sustainable economic development in SSA. Design/methodology/approach The study adopts the system generalized method of moments to account for cross-sectional dependence and endogeneity for 38 SSA countries from 1996 to 2019. Findings The findings indicate that public spending inhibits sustainable economic development while human capital enhances sustainable economic development in SSA. Furthermore, the study equally reveals that the development-inhibiting role of public spending is modulated through human capital and governance quality. Public spending interacts with human capital and governance quality to produce negative net effects and positive synergy effects, respectively. Originality/value Based on these findings, the study suggests that governments in SSA countries should discourage heavy dependence on public spending. Policies that provide a framework for financial incentives in the domain of health and education should be encouraged to increase investment in human capital.

Evolutionary game theoretical approach for reducing carbon emissions in a complex supply chain organization

PurposeOur research explores the intricate behavior of low-carbon supply chain organizations in an ever-evolving landscape, emphasizing the profound implications of government-mandated low-carbon policies and the growing low-carbon market. Central to our exploration is applying a combined game theory model, merging Evolutionary Game Theory (EGT) with the Shapley Value Cooperative Game Theory Approach (SVCGTA).Design/methodology/approachWe establish a two-tier supply chain featuring retailers and manufacturers within this novel framework. We leverage an integrated approach, combining strategic Evolutionary Game Theory and Cooperative Game Theory, to conduct an in-depth analysis of four distinct low-carbon strategy combinations for retailers and manufacturers.FindingsThe implications of our findings transcend theoretical boundaries and resonate with a trinity of economic, environmental and societal interests. Our research goes beyond theoretical constructs to consider real-world impacts, including the influence of changes in government low-carbon policies, the dynamics of consumer sensitivities and the strategic calibration of retailer carbon financing incentives and subsidies on the identified ESS. Notably, our work highlights that governments can effectively incentivize organizations to reduce carbon emissions by adopting a more flexible approach, such as regulating carbon prices, rather than imposing rigid carbon caps.Originality/valueOur comprehensive analysis reveals the emergence of an Evolutionary Stability Strategy (ESS) that evolves in sync with the phases of low-carbon technology development. During the initial stages, our research suggests that manufacturers or retailers adopt low-carbon behavior as the optimal approach.

Role of Financial and Non-financial Incentives on Employee’s Performance: A Study on the Banking and Insurance Sectors of Nepal

As the banking and insurance are service sector industries, the competence and dedication of the employees of these sectors significantly influence customer satisfaction and organizational success. Therefore, the performance of employees stands as a crucial factor determining the success of banks and insurance companies. This research aims to explore the impact of financial and non-financial incentives on the performance of employees working in the Nepalese banking and insurance sectors. A structured questionnaire was employed to collect the data for the study from 400 sample employees of these sectors by using a non-probability sampling method. For the analysis of data, tools such as Cronbach’s Alpha analysis and Regression analysis was carried out to assess the relationship among the variables. In addition, to analyze the findings of ordinal variables, Ordinal Logistic Regression Model was used. The study found a positive correlation between financial incentives (bonuses and fringe benefits) and employee performance. By the value of Ordinal Logistic Regression, factors like age, experience, and job security did not indicate a significant impact on employee performance. In contrast to that, factors like age, experience, and job security did not indicate a significant impact on employee’s performance. The findings of the study also challenge the theoretical assumption that higher pay directly leads to improved performance, suggesting that high pay expectations might lead to performance pressure and reduced employee performance. Similarly, while working conditions were not significant, emphasizing upgrades solely based on this factor may not be justified in the banking and insurance sectors based on this research. Recommendations include the necessity for managers or HR professionals to strike a balance between financial and non-financial incentives to optimize employee performance and thereby enhance company productivity.

Financial hedging incentive contracts in global supply chains: A distributionally robust approach

AbstractThis paper developed a global supply chain with a supplier and a retailer in different countries. When exchange rate and demand risks are concentrated in retailer, a distributionally robust approach is used to formulate an optimized robust ordering strategy. Furthermore, the effect of financial hedging incentive contracts on the robust decisions and the profits of the global supply chain is explored. Our findings show that the correlation between exchange rate and demand does not affect the robust decisions of retailer. The effectiveness of financial hedging incentive contracts depends on the trade‐off between transaction costs of financial hedging and the degree of supplier incentives and the growth rate of order quantity.

Adapting Green Building Practices and Smart Technology in Developing Countries

This paper reviews the integration of green building practices and smart technologies in developing countries, focusing on the challenges and opportunities these regions face. While developed nations have advanced significantly in sustainability through green building certifications and smart systems, developing countries encounter barriers such as financial constraints, limited technical expertise, and insufficient policy frameworks. This research employs a systematic literature review to examine case studies from Africa, Southeast Asia, and Latin America, exploring how these regions can adapt sustainable practices to their unique socio-economic and environmental conditions. The findings reveal that despite significant challenges, green building and smart technologies offer long-term benefits, including improved energy efficiency, reduced operational costs, and enhanced quality of life. Successful adaptations, such as using locally sourced materials and implementing low-cost smart systems, demonstrate the feasibility of sustainable development even in regions with limited resources. Case studies from Nigeria, South Africa, and Kenya showcase promising examples where sustainable construction has been successfully integrated. This paper contributes to the existing body of knowledge by providing an in-depth analysis of the factors enabling or hindering the adoption of green building and smart technologies in developing nations. The research concludes that stronger governmental support, enhanced technical training, and broader awareness campaigns are essential to overcoming these barriers. Key recommendations include implementing financial incentives for developers, scaling successful green building projects, and fostering public-private partnerships to promote innovation. Additionally, the study calls for policy reforms that align with international sustainability goals while considering local challenges. In conclusion, the integration of green building practices and smart technologies presents a viable solution for sustainable urbanization in developing countries, offering a path toward environmental and economic resilience.

Impact of financial incentives introduced during the COVID-19 pandemic on nursing staff: a mixed-method protocol

IntroductionThe COVID-19 pandemic has had a major impact on nursing staff, resulting in alarming turnover rates. As part of the Quebec (Canada) government’s response to the pandemic, nurses have been...

Adding nudge-based reminders to financial incentives for promoting antibody testing and vaccination to prevent the spread of rubella

We study the effects of combining financial incentives with nudges to promote antibody testing and vaccination to prevent the spread of rubella. In 2019, the Japanese government began providing vouchers for free antibody testing and vaccination to men aged 40–57 years. Vouchers were automatically mailed to 40–46-year-old men in 2019. While those aged 47–57 received vouchers after April 2020, they could obtain vouchers for undertaking antibody testing and being vaccinated in 2019 by applying. Focusing on this policy distinction, we conducted a online field experiment with Japanese 40–57-year-old men in February and March 2020. We randomly sent nudge-based text message reminders recommending antibody testing and vaccination and tracked self-reported behavior until March of 2020. One nudge-based reminder with an altruistic message on fetal harm through infection from men to pregnant women significantly promoted antibody testing among those who had already received vouchers as a financial incentive. This message could also encourage vaccinations among those who had already received vouchers. By contrast, nudge-based reminders had no promoting effect for those who must apply for vouchers.

Which factors influence the decision of hospitals to provide procedures on an outpatient basis? –Mixed-methods evidence from Germany

Shifting care from the resource-intensive inpatient setting to the more economically efficient outpatient sector is being promoted internationally by policymakers. Financial incentives are a major focus of such efforts because low levels of hospital outpatient care are attributed to differences in payment for inpatient and outpatient services. In Germany, however, there is significant variation in the extent to which hospitals provide outpatient care despite a uniform payment system. Therefore, other factors must be influencing German hospitals’ strategic decisions whether to offer outpatient care. While most research has focused on specific procedures or lacks empirical support, our study provides a comprehensive analysis of the factors beyond financial incentives that influence the provision of hospital outpatient services in Germany. We employed a mixed-methods approach, first contacting health care experts with in-depth knowledge of the hospital outpatient landscape to identify possible influencing factors and then conducting a comprehensive quantitative analysis of all German hospitals. Our findings suggest that policymakers seeking to promote hospital outpatient care should consider a broad range of factors. We found that a hospital's service mix, size, procedure volume, and emergency care infrastructure significantly affected the proportion of outpatient services it offered. Strategic hospital planning emphasizing specialization and adherence to minimum volume standards might therefore be a valuable policy tool. Our analysis also highlights the importance of demographic and socioeconomic factors, such as the regional share of single-person households, suggesting that a comprehensive policy framework should account for broader population characteristics and not just elements directly related to hospital care.

Sustainable Development and Renewable Energy Policies in the European Union: Transformations and Impacts

The development of renewable energies in the EU is essential for sustainable development and energy security, having a significant impact on labor markets. Strategies and policies target the EU's objectives and commitments, financial incentives, regulations, innovations, research, in line with labor market opportunities. Reconversion of the workforce and transition to renewable energies are needed, as well as reskilling from traditional industries to green energy sectors. and reducing dependence on fossil energy sources contributes to energy security in the EU. Our proposals emphasize the importance of renewable energies in the reduction of greenhouse gas emissions and the preservation of the environment, with a particular emphasis on the promotion of sustainable development. Ensuring energy security and sustainable development strategies necessitates multilateral cooperation in the development of renewable energies. To analyze the theme, we propose theoretical and practical approaches, correlating sustainable development theory, labor market theory and public policy theory, with practical applications in renewable energy sector strategies and policies and impact on labor markets. Keywords: renewable energies, labor markets, sustainable development, financial incentives, multilateral security

International comparison of hospitalizations and emergency department visits related to mental health conditions across high-income countries before and during the COVID-19 pandemic.

To explore variation in rates of acute care utilization for mental health conditions, including hospitalizations and emergency department (ED) visits, across high-income countries before and during the COVID-19 pandemic. Administrative patient-level data between 2017 and 2020 of eight high-income countries: Canada, England, Finland, France, New Zealand, Spain, Switzerland, and the United States (US). Multi-country retrospective observational study using a federated data approach that evaluated age-sex standardized rates of hospitalizations and ED visits for mental health conditions. There was significant variation in rates of acute mental health care utilization across countries. Among the subset of four countries with both hospitalization and ED data, the US had the highest pre-COVID-19 combined average annual acute care rate of 1613 episodes/100,000 people (95% CI: 1428, 1797). Finland had the lowest rate of 776 (686, 866). When examining hospitalization rates only, France had the highest rate of inpatient hospitalizations of 988/100,000 (95% CI 858, 1118) while Spain had the lowest at 87/100,000 (95% CI 76, 99). For ED rates for mental health conditions, the US had the highest rate of 958/100,000 (95% CI 861, 1055) while France had the lowest rate with 241/100,000 (95% CI 216, 265). Notable shifts coinciding with the onset of the COVID-19 pandemic were observed including a substitution of care setting in the US from ED to inpatient care, and overall declines in acute care utilization in Canada and France. The study underscores the importance of understanding and addressing variation in acute care utilization for mental health conditions, including the differential effect of COVID-19, across different health care systems. Further research is needed to elucidate the extent to which factors such as workforce capacity, access barriers, financial incentives, COVID-19 preparedness, and community-based care may contribute to these variations. Approximately one billion people globally live with a mental health condition, with significant consequences for individuals and societies. Rates of mental health diagnoses vary across high-income countries, with substantial differences in access to effective care. The COVID-19 pandemic has exacerbated mental health challenges globally, with varying impacts across countries. This study provides a comprehensive international comparison of hospitalization and emergency department visit rates for mental health conditions across eight high-income countries. It highlights significant variations in acute care utilization patterns, particularly in countries that are more likely to care for people with mental health conditions in emergency departments rather than inpatient facilities The study identifies temporal and cross-country differences in acute care management of mental health conditions coinciding with the onset of the COVID-19 pandemic.

Conceptualising constructive resistance as a thriving strategy for men in nursing.

Nursing has improved over the centuries from the physician's handmaiden to a recognised profession. Yet, the image of a nurse is often associated with notions of caring and nurturing- attributes considered feminine. Indeed, cultural, and societal biases exist that can deter men from entering the nursing profession where their sense of masculinity is questioned. Several studies have highlighted the existence of gender-based stereotypes, stigma, rejection, loneliness and discrimination which impact the retention of men in the nursing profession. Despite the established evidence regarding negative experiences, it appears limited attention has been paid to the men who decide to stay in nursing: how do they thrive in a profession wherein biases are evident within and in the wider societal context? Undoubtedly, several factors such as job security and financial incentives may contribute to men remaining in nursing. Beyond these, we borrow the notion of 'constructive resistance' to underscore that though the biases may be apparent, male nurses are able to construct alternatives that accommodate the image of a man in the nursing profession. Strategies such as developing the image as a 'super nurse' can create opportunities for male nurses to be preferred by other healthcare providers as well as female nurses. Thus, although resistance may usually appear as a negative phenomenon, constructive resistance represents hidden advantages which offers an opportunity to retain male nurses. These need to be highlighted and explored more as they can offer deeper insight into strategies that can be employed to improve retention and representation of men in nursing particularly at a time when the impact of nursing shortage remains a global issue.

Process improvements related to new patient scheduling.

26 Background: With over 530 physicians across 280 locations, the new patient time to first appointment varied across the state, with results ranging from 1 to 33 average days to schedule. Beginning in January 2021, a new patient scheduling model was developed to improve access to care and the patient experience. A new patient scheduling model was developed. The program was structured to support both on site and remote scheduling. Methods: Provider scheduling cards detailing physician preferences for scheduling, required records and prioritization for the type of diseases seen was implemented. Physicians were required to designate new patient time slots in their clinics tied to new patient volume trends. New patient scheduling workflows and required record guidelines were standardized and revised. Reporting and tracking metrics were created – average days to schedule, average days to appointment, referral fulfillment rate, referral to appointment ratio, true cancellation rate. Physicians were eligible to participate in a yearly bonus if time to first appointment goals were met. Utilized Virtual and in-person APPs provided benign hematology consults to address capacity constraints. Results: New patient true cancellation rates decreased from 9.84% to 5.22% resulting in capture of over 800 patients a month. There was a 56% increase in patient retention with a 138% increase in referral volume. The Practice realized a 69% reduction in average days to schedule from 9 to 3 days. The average time to first appointments improved from 23 to 14 days; a 38% decrease. Conclusions: With increasing numbers of new cancer patients, increasing numbers of cancer survivors and shortages of medical oncologists, it is essential to maintain access to timely cancer care. New models helped improve patient experience and practice retention of new cancer patients, by focusing on administrative staff to implement these programs. APP benign hematology clinics freed up physician time for new cancer patient consults. Physician support was obtained with education, frequent outreach, and financial incentives. 2021 Q1 2021 Q2 2021 Q3 2021 Q4 2022 Q1 2022 Q2 2022 Q3 2022 Q4 2023 Q1 2023 Q2 2023 Q3 2023 Q4 2024 Q1 Referral Volume 44,305 54,379 57,282 57,475 67,890 75,111 79,281 75,843 85,419 91,811 94,286 88,396 100,115 Avg. Days to Scheduled 9.1 6.9 5.4 6.2 5.8 4.9 3.9 4.0 3.7 4.0 3.8 3.6 3.3 Avg. Days to Appointment 22.4 24.3 23.3 22.9 20.9 21.8 20.0 19.2 17.0 17.5 17.1 16.7 14.9

The impact of current pediatric anesthesiology fellows shortfall on freestanding children's hospitals and practices

The pediatric anesthesiology workforce is currently facing a critical shortage, which will have significant consequences for patient care and the healthcare system as a whole. The workforce is aging, and despite increasing numbers of anesthesiology residents, fewer graduates are entering the field of pediatrics. It should also be noted that fewer medical school graduates are entering pediatrics as well. This situation raises concerns about the availability of specialists and the training of future physicians. To address this shortage, a comprehensive strategy is urgently needed, including outreach, mentorship, financial incentives, and policy changes to attract and retain new talent in pediatric anesthesiology. Immediate intervention is necessary to prevent a severe impact on the availability and quality of pediatric anesthesia care.

What the National Coverage Determination for Carotid Artery Stenting Means for the Treatment of Patients with Carotid Artery Disease

ObjectivesIn October 2023, the Centers for Medicare & Medicaid Services (CMS) agreed to revisit its national coverage determination (NCD) for carotid artery stenting (CAS). We provide an overview of the arguments presented in favor and against NCD expansion, and discuss the likely ramifications on patient care and outcomes in the future. MethodsWe completed a narrative review of the arguments presented in favor and against NCD expansion. ResultsArguments presented in favor of the CAS NCD expansion predominantly focused on the outcomes of four large multicenter randomized controlled trials published between 2010 and 2021 that reported similar outcomes for composite endpoints between patients undergoing CAS and carotid endarterectomy. The main arguments against expanding the CAS NCD centered around higher patient stroke risks with CAS, increasing healthcare costs, premature decision-making, and the lack of a validated shared decision-making tool that can be readily applied to carotid revascularization. ConclusionsBy expanding the indications for CAS to asymptomatic and standard-risk patients, they will be exposed to excess and unnecessary risks without any evident benefits, potentially leading to widespread adoption of a procedure driven by financial incentives rather than genuine patient benefits.