{ "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": 170, "pageCount": 239, "prevPage": 169, "nextPage": 171, "slideType": "expose_contradiction", "function": "expose_contradiction", "density": "overcrowded", "nDataPoints": 0, "notes": "The slide uses a 'quote-sandwich' structure to validate the thesis headline.", "elementsJson": [ "headline_text", "paragraph", "quote_block", "footnote" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-2a2468219173/170", "deckHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173#slide-170", "components": [ { "bbox": null, "kind": "callout", "text": "One of Nevro’s highest volume implanters – a consultant and speaker for the company – threw cold water on the PDN opportunity.", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-3f3d-76db-b345-e1685d7d78d7", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.25, "w": 0.9, "x": 0.05, "y": 0.13 }, "kind": "paragraph", "text": "One of Nevro’s highest volume implanters – a consultant and speaker for the company – threw cold water on the PDN opportunity. He questioned Nevro’s TAM claims and explained how referral patterns make it unrealistic to get PDN patients. He described his personal attempts to market stimulators for PDN and why they failed: the only place to find these patients is in Medicare/Medicaid clinics with a low-income population, where PDN patients have extensive comorbidities like infections, amputation risk, and other issues that preclude them as viable stimulator candidates. A former Nevro executive added that primary care doctors have “a huge amount of skepticism” about stimulators and that “a genuine financial disincentive” prevents them from referring their PDN patients.", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "86c87b92-035e-4659-953e-e0ed54e21b94", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.15, "w": 0.9, "x": 0.05, "y": 0.77 }, "kind": "quote", "text": "“The issue that everyone going into PDN has are the primary care physicians responsible for the patient group. They are not interventional pain physicians. It's convincing that primary care doctor to refer that patient off to another physician to manage that condition. There’s a huge amount of skepticism from the actual physicians managing these PDN patients. There is a genuine financial disincentive for them to send a patient to another person to manage something that they feel they can manage themselves.” – Former Nevro executive", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "2b6441e3-f121-425f-94b1-9aca6cf90fbd", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.35, "w": 0.9, "x": 0.05, "y": 0.41 }, "kind": "quote", "text": "“Nevro throws around this number of 2 million diabetics a year, but not all of those are painful diabetics seeking out treatment beyond other therapies. Gabapentin and Lyrica are failures. They don't really do much. The problem is the referral patterns aren't quite there yet. One, it takes the insurance coding and approval and two, finding these patients, because these patients do not exist in typical pain practices, the ones that treat back and leg pain all day. These practices don't necessarily see PDN. I decided that I was going to start marketing SCS for PDN treatment and ultimately endocrinologists don't have PDN patients, neurologists don't have them. The sick population Medicare, Medicaid practices have them. So you go into Harlem, you go into the Bronx or any hospital that has a sort of Medicaid clinic, they have them. But then the challenge is, they have cardiac disease that keeps them on blood thinners or they have recurrent infections or they are likely to amputate and so it just becomes challenging as to what are we going to do with those patients.” – KOL and one of Nevro’s highest volume implanters", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "37f94513-0fc8-40ec-956f-fa8f65a8af67", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "“Nevro throws around this number of 2 million diabetics a year, but not all of those are painful diabetics seeking out treatment beyond other therapies... The sick population Medicare, Medicaid practices have them. So you go into Harlem, you go into the Bronx or any hospital that has a sort of Medicaid clinic, they have them. But then the challenge is, they have cardiac disease that keeps them on blood thinners or they have recurrent infections or they are likely to amputate and so it just becomes challenging as to what are we going to do with those patients.” — KOL and one of Nevro’s highest volume implanters; “The issue that everyone going into PDN has are the primary care physicians responsible for the patient group. They are not interventional pain physicians. It's convincing that primary care doctor to refer that patient off to another physician to manage that condition. There's a huge amount of skepticism from the actual physicians managing these PDN patients. There is a genuine financial disincentive for them to send a patient to another person to manage something that they feel they can manage themselves.” — Former Nevro executive", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-3f3d-76db-b345-e71533991294", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.02, "w": 0.2, "x": 0.05, "y": 0.96 }, "kind": "source-note", "text": "Source: Consultation calls with experts", "attrs": null, "subkind": null, "toolName": null, "toolSlug": null, "confidence": null, "componentId": "c18e0c51-7149-4f71-81c5-0ca29a6d1bb3", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.9, "x": 0.05, "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": "4018422c-09f0-427d-8fe1-31db3adfd798", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.4, "x": 0.05, "y": 0.04 }, "kind": "title", "text": "Scorpion Capital | Nevro (NYSE: NVRO)", "attrs": null, "subkind": "headline", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "aab633ac-aead-4e5a-a30d-ff3d22effb8b", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [ { "name": "antagonist-introduction", "slug": null, "matchId": "1a15ceef-1fcc-4be8-a61d-7301dcfaf4cb", "evidence": "The slide frames Nevro's management claims as a 'mirage' and uses expert testimony to discredit them.", "confidence": 0.8 } ], "arcBeats": [], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }