{ "docId": "019dd923-622c-750b-8b9a-2a2468219173", "docSlug": "ce565b841c40", "documentTitle": "Nevro Corp. (NVRO)", "authorId": "58_Scorpion_Capital", "authorName": "Kir Kahlon", "documentKindSlug": "activist-deck", "documentKindLabel": "Activist deck", "sourceTypeSlug": "short_seller", "sourceTypeLabel": "Short seller", "presentationDate": "2021-01-07 00:00:00", "orientation": "landscape", "aspectRatio": 1.3333334, "pageNumber": 149, "pageCount": 239, "prevPage": 148, "nextPage": 150, "slideType": "villain_critique", "function": "expose_contradiction", "density": "overcrowded", "nDataPoints": 1, "notes": "Uses expert testimony (KOLs) to expose a technical contradiction in the product's value proposition.", "elementsJson": [ "headline_text", "paragraph", "quote_block", "footnote" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-2a2468219173/149", "deckHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173#slide-149", "components": [ { "bbox": null, "kind": "callout", "text": "Toggling a device between high frequency and low frequency – the entire point of Omnia - is clinically unrealistic and reckless.", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-3f3d-76db-b342-b94578551018", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.25, "w": 0.88, "x": 0.06, "y": 0.13 }, "kind": "paragraph", "text": "Toggling a device between high frequency and low frequency – the entire point of Omnia - is clinically unrealistic and reckless. When doctors implant Omnia leads at the vertebrae used for high frequency stimulation, they render it irrelevant and/or dangerous for low-frequency stimulation which requires lead insertion in a different location. Investors should therefore not be surprised at Grossman’s comments that Omnia is still used for high frequency 85-90% of the time. One KOL after another highlighted the lead insertion issue and why it renders Omnia’s high-plus-low-frequency messaging disingenuous and “a lie.” We posed a question and note the reply, which stated that “you’re screwed” if you toggle frequencies. A second KOL provided additional detail to underscore the same concern.", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "24098401-2c8b-4cb2-8215-7b07d9713ff4", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.25, "w": 0.88, "x": 0.06, "y": 0.67 }, "kind": "quote", "text": "Nevro says that you should cover the 9/10 thoracic interspace. That’s their thing. Low-frequency stimulation can be anywhere from T8 to L1. If you want to stimulate the back, you’re probably doing T10. That whole science, the art of neuromodulation, was what Nevro said they mitigated. You don’t have to be a neuromodulator. Historically, when you look at [names redacted, the most prominent KOL’s in the field] we would look for different ways to get pain relief at different locations within the spinal cord versus what we called “plant and pray.” Nevro’s electrodes usually cover the top of T9 and the bottom of T10, which may stimulate a certain anatomic region. If you need foot coverage, that location doesn't have a hope. For below the knee, that array is not going to work. Unfortunately if the HF10 doesn't work, you might not be in the right spot with the leads to do tonic [low frequency stimulation].", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "080c6e11-7d90-488b-b507-20badc6a467c", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.25, "w": 0.88, "x": 0.06, "y": 0.41 }, "kind": "quote", "text": "Q: How do you use other waveforms with Omnia like low frequency, if the leads are still in the same place as for high frequency? You hit the nail on the head. That’s part of the problem. Nevro is so locked in that their leads have to be at one spot. If there's any variation they get lost. Low frequency doesn't necessarily work at just that T9/10 junction. A lot of it works at T8/9. You’re bound by their restrictions. So if you use high frequency first and the leads have to be over the T9/10j unction, you’re screwed if that patient does better with low frequency because that’s not where the leads are implanted.", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "242174e9-d50f-4d65-b093-2fa6a1ac5331", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "“You hit the nail on the head. That’s part of the problem. Nevro is so locked in that their leads have to be at one spot. If there’s any variation they get lost. Low frequency doesn’t necessarily work at just that T9/10 junction. A lot of it works at T8/9. You’re bound by their restrictions. So if you use high frequency first and the leads have to be over the T9/10junction, you’re screwed if that patient does better with low frequency because that’s not where the leads are implanted.” — KOL and high volume implanter", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-3f3d-76db-b342-bf1744bb5b37", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.02, "w": 0.2, "x": 0.06, "y": 0.96 }, "kind": "source-note", "text": "Source: Consultation calls with experts", "attrs": null, "subkind": null, "toolName": null, "toolSlug": null, "confidence": null, "componentId": "802f6c63-55ec-4108-b676-ee5ff69114c3", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.88, "x": 0.06, "y": 0.09 }, "kind": "title", "text": "10. The new Omnia stimulator, the centerpiece of Nevro’s turnaround hopes, is a Hail Mary and colossal flop", "attrs": null, "subkind": "action-title", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "bb7d4dd4-ea3a-4a8c-94ff-793c775019fe", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.35, "x": 0.06, "y": 0.04 }, "kind": "title", "text": "Scorpion Capital | Nevro (NYSE: NVRO)", "attrs": null, "subkind": "headline", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "a2598d86-34ac-4f8a-884f-db163ab6d9db", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [ { "name": "fraud-exposure", "slug": null, "matchId": "c4146ba2-3ff6-4975-8eeb-00f62b8f7802", "evidence": "The slide explicitly frames the company's marketing as 'a lie' and 'disingenuous' based on expert testimony.", "confidence": 0.9 } ], "arcBeats": [ { "to": 150, "from": 51, "beatId": "903c076a-f368-4ca1-844c-277874c1afb2", "arcName": "Overcoming the Monster", "arcSlug": "overcoming-monster", "beatName": "The Victory", "beatSlug": "overcoming-monster-the-victory", "evidence": "The deck presents a conclusion that Nevro's problems are insurmountable", "position": 2, "confidence": 0.8, "parentBeatName": "Turn", "parentBeatSlug": "turn" } ], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }