{ "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": 169, "pageCount": 239, "prevPage": 168, "nextPage": 170, "slideType": "villain_critique", "function": "name_villain", "density": "overcrowded", "nDataPoints": 0, "notes": "Uses expert testimony (KOLs and former executives) to undermine the company's growth narrative.", "elementsJson": [ "headline_text", "paragraph", "bullet_list", "quote_block", "footnote" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-2a2468219173/169", "deckHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173#slide-169", "components": [ { "bbox": null, "kind": "callout", "text": "The PDN opportunity is commercially dead-on-arrival due to referral patterns with PDN patients.", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-3f3d-76db-b345-1bff667be979", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.04, "w": 0.88, "x": 0.06, "y": 0.27 }, "kind": "list", "text": "A KOL and moderate Nevro implanter described the importance of referral patterns and why PDN won't \"move the needle\"", "attrs": null, "subkind": "bullet", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "1d2497d2-45e5-4370-9700-3275265c2848", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.04, "w": 0.88, "x": 0.06, "y": 0.61 }, "kind": "list", "text": "A KOL who tries to implant stimulators for PDN today says their doctors view them as inappropriate candidates and refuse to refer", "attrs": null, "subkind": "bullet", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "285e4bd2-b61f-4433-973a-a23a464bf8f5", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.04, "w": 0.88, "x": 0.06, "y": 0.46 }, "kind": "list", "text": "A former Nevro sales executive states that the company \"has no plan or understanding\" about accessing the PDN market, and that endocrinologists will not hand off these patients", "attrs": null, "subkind": "bullet", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "fcf17ff9-8858-4068-9f98-5c0369b2b754", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.12, "w": 0.88, "x": 0.06, "y": 0.13 }, "kind": "paragraph", "text": "In addition to stimulators already being used today for PDN, skepticism of Nevro's study, a small market of high-risk patients, and high frequency lead placement being incompatible with PDN, the opportunity is commercially dead-on-arrival due to referral patterns with PDN patients. Nevro's former executives and KOL's emphatically repeated that the primary care doctors and endocrinologists who manage PDN patients are gatekeepers who simply will not refer them to doctors who implant stimulators.", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "5e56b1f1-b7e6-4723-9791-18875a7ef517", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.06, "w": 0.83, "x": 0.11, "y": 0.66 }, "kind": "quote", "text": "\"Even if they get FDA approval, the issue is getting referrals. Their doctors do not view PDN patients as ones that you should install a stimulator in.\" - KOL", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "5c9ae414-f364-4e4f-9f42-fd91bb120e95", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.12, "w": 0.83, "x": 0.11, "y": 0.32 }, "kind": "quote", "text": "\"I have trouble getting PDN patients away from vascular surgeons. They hold on to these patients. Those are the ones that would have benefit. The PDN opportunity is not going to move the needle. The thing to realize is that referral patterns are really important. Vascular surgeons hold on to these patients. That's the realty. You don't get the diabetologist referring patient to the pain doctor.\" - KOL", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "84a2c80a-359f-486f-bf54-9a1f21e6fe71", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.08, "w": 0.83, "x": 0.11, "y": 0.51 }, "kind": "quote", "text": "\"The issue is accessing the PDN market. Nevro has no plan or understanding of how to access that market. I spent 12 years in the market. I don't know many endocrinologists that will hand off diabetic patients to pain docs.\" - Former sales executive", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "b5ef7ac9-6830-473d-8450-9f397f8aae05", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "\"I have trouble getting PDN patients away from vascular surgeons. They hold on to these patients. Those are the ones that would have benefit. The PDN opportunity is not going to move the needle. The thing to realize is that referral patterns are really important. Vascular surgeons hold on to these patients. That's the realty. You don't get the diabetologist referring patient to the pain doctor.\" — KOL; \"The issue is accessing the PDN market. Nevro has no plan or understanding of how to access that market. I spent 12 years in the market. I don't know many endocrinologists that will hand off diabetic patients to pain docs.\" — Former sales executive; \"Even if they get FDA approval, the issue is getting referrals. Their doctors do not view PDN patients as ones that you should install a stimulator in.\" — KOL", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-3f3d-76db-b345-1f18c3c962e6", "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": "3a91e4ef-62b3-4f6a-9b10-4d1a23239ab4", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.88, "x": 0.06, "y": 0.09 }, "kind": "title", "text": "11. TAM expansion and growth from painful diabetic neuropathy (PDN) and other new indications are a mirage", "attrs": null, "subkind": "action-title", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "487add7e-9380-4e6b-b321-722ac1c00e33", "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": "56882bb3-0f6d-4b4d-8307-434a03d1a0e6", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }