{ "docId": "019dd923-622c-750b-8b99-b43d907adb44", "docSlug": "3c210b1fcba7", "documentTitle": "Tempus AI, Inc. (TEM)", "authorId": "54_Spruce_Point_Capital", "authorName": "Spruce Point Capital Management", "documentKindSlug": "activist-deck", "documentKindLabel": "Activist deck", "sourceTypeSlug": "short_seller", "sourceTypeLabel": "Short seller", "presentationDate": "2025-05-28 00:00:00", "orientation": "landscape", "aspectRatio": 1.3333334, "pageNumber": 64, "pageCount": 76, "prevPage": 63, "nextPage": 65, "slideType": "expose_contradiction", "function": "expose_contradiction", "density": "balanced", "nDataPoints": 0, "notes": "The slide uses a yellow callout box to frame the argument against the company's policy.", "elementsJson": [ "headline_text", "paragraph", "footnote" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b99-b43d907adb44/64", "deckHref": "/decks/019dd923-622c-750b-8b99-b43d907adb44", "deckJsonHref": "/decks/019dd923-622c-750b-8b99-b43d907adb44.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b99-b43d907adb44#slide-64", "components": [ { "bbox": { "h": 0.7, "w": 0.9, "x": 0.05, "y": 0.16 }, "kind": "callout", "text": "Ambry Genetics highlights that doing DNA and RNA testing together at the same time (concurrent testing) improves the detection of disease-causing variants and reduces uncertain results compared to DNA-only testing. They argue this approach is especially helpful for complex cases, underrepresented populations, or when fast, comprehensive answers are needed. But why does Ambry only offer RNA testing as a concurrent option with DNA testing, instead of allowing RNA to be used as a reflex test when it’s actually needed? Reflex RNA testing—where RNA is only analyzed if DNA results are unclear—has been shown to be more cost-effective and resource-efficient for many patients, especially those with well-understood genetic backgrounds or when DNA findings are already definitive. In these straightforward cases, we believe adding RNA testing for everyone increases costs and lab work without providing new useful information. Ambry’s justification for mandating concurrent testing is based on concerns that some rare variants might be missed with a reflex approach and that many patients never return for follow-up RNA testing if it’s not done upfront. However, this “one-size-fits-all” policy ignores the fact that most patients don’t need both tests at the same time, and it doesn’t align with what many clinicians and insurers prefer—balancing thoroughness with cost control. Other labs and clinical guidelines often support reflex RNA testing for routine cases and reserve concurrent testing for more complex or high-risk situations. So, the question remains: why won’t Ambry allow for reflex RNA testing when it could save money and resources without sacrificing quality of care? Shouldn’t the choice of testing strategy be based on each patient’s needs, rather than a blanket policy that may not be necessary for everyone?", "attrs": null, "subkind": "primary", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "728bd936-71f0-4d65-a001-a7b7a3188a92", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "callout", "text": "Shouldn't the choice of testing strategy be based on each patient's needs, rather than a blanket policy that may not be necessary for everyone?", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd952-fb91-749f-a6b2-86fc6c0ccfb9", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.02, "w": 0.15, "x": 0.05, "y": 0.97 }, "kind": "source-note", "text": "Source: Ambry Requisition Form", "attrs": null, "subkind": null, "toolName": null, "toolSlug": null, "confidence": null, "componentId": "d2f982e5-91a7-441b-afd4-6f5ee21e29d1", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.12, "w": 0.65, "x": 0.31, "y": 0.03 }, "kind": "title", "text": "Concurrent Testing Benefits: Do Ambry's Findings Hold Up To Independent Scrutiny?", "attrs": null, "subkind": "headline", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "1e1210c6-60fe-4668-9b9e-59082403076a", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [ { "name": "ceo-quote-contradiction", "slug": null, "matchId": "7675cd3f-d410-4d3a-a071-149ccf91671c", "evidence": "The slide contrasts the company's stated benefits of concurrent testing against the clinical and economic reality of reflex testing.", "confidence": 0.85 } ], "arcBeats": [ { "to": 69, "from": 12, "beatId": "019de87d-e40d-7574-b4dc-522b102a6735", "arcName": "The Consultant's Gambit", "arcSlug": "consultants-gambit", "beatName": "Evidence & Proof", "beatSlug": null, "evidence": "Five evidence sections: insiders, AI hype, partnerships, accounting, billing.", "position": 4, "confidence": 78, "parentBeatName": null, "parentBeatSlug": null }, { "to": 69, "from": 12, "beatId": "019de87d-e501-7638-91f7-175bec763c5d", "arcName": "The Mountain", "arcSlug": "mountain", "beatName": "Rising Action", "beatSlug": null, "evidence": "Mounting evidence across insiders, AI, partnerships, accounting, billing.", "position": 2, "confidence": 55, "parentBeatName": null, "parentBeatSlug": null } ], "loops": [ { "to": 66, "from": 57, "name": "Benchmark Gap", "slug": "39-benchmark-gap", "bestFor": "Performance improvement, competitive analysis, target setting", "matchId": "019de87d-e6ef-77cf-9281-b1f3dc9c1d8c", "evidence": "Ambry 78% CAGR vs Myriad -3%, Invitae 24%, Caris 28% — explicit peer-gap chart with CAGR boxes.", "position": 7, "objective": "Show Ambry as outlier vs peers on CPT 81479 billing", "structure": "Our Performance -> Industry Average -> Best-in-Class -> The Gap = The Opportunity", "confidence": 87, "description": "Compare performance against best-in-class to quantify the opportunity" } ], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }