{ "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": 171, "pageCount": 239, "prevPage": 170, "nextPage": 172, "slideType": "expose_contradiction", "function": "expose_contradiction", "density": "overcrowded", "nDataPoints": 0, "notes": "Uses expert testimony to contradict company growth narratives.", "elementsJson": [ "headline_text", "paragraph", "quote_block", "footnote" ], "metadataConfidence": 0.95, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-2a2468219173/171", "deckHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173#slide-171", "components": [ { "bbox": null, "kind": "callout", "text": "The other aspect is how much do these PDN patients really want to have an implant?", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-3f3d-76db-b345-cb7fdc3e94d9", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.25, "w": 0.88, "x": 0.06, "y": 0.13 }, "kind": "paragraph", "text": "The Nevro consultant/speaker and KOL who failed in his attempts to broaden his practice to PDN patients mentioned two other barriers to commercialization. First, PDN patients do not want implants, and because they’re not recurring monthly patients like those on opioids, pain practices don’t have the opportunity to “constantly bombard” them with a stimulator sell (we detail patients being pressured into stimulators in a later section). Second, he reinforced the point made by other doctors that Medicare already covers stimulations for PDN today, and that PDN is therefore not a new market for Nevro. Because the PDN population is almost all Medicare/Medicaid, the patients are not an attractive commercial pay opportunity: they’re typically unable to work and therefore lack employer healthcare, which is essentially the definition of commercial insurance. He added that Nevro may not even get label exclusivity from commercial insurers if approved for PDN, as Medicare covers any stimulator for it today. meaning that any commercial payors would cover all stimulators not just Nevro’s.", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "3b70e07b-4cb1-4d34-b6a2-c6ca62399f3b", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.25, "w": 0.88, "x": 0.06, "y": 0.58 }, "kind": "quote", "text": "For PDN it will have to be determined how they do in terms of negotiating with the payers. Are they going to get a label exclusivity on it? Because yes, you can code it today as neuropathic pain of the leg. The commercial payers are not interested in engaging with diabetic neuropathy right now. The trouble is that the diabetic population that has significant enough pain tends to be the Medicare, Medicaid population. You can use any device for Medicare. With the bulk of the population being Medicare, doctors can use the device for PDN today. And commercial-insured patients don't mean much, because commercial insurance usually means an employed person that generally is not the one that's usually a severe diabetic.", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "794e768e-2578-491c-b779-c143e861d859", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.15, "w": 0.88, "x": 0.06, "y": 0.41 }, "kind": "quote", "text": "The other aspect is how much do these PDN patients really want to have an implant? The back and leg pain patients are constantly getting bombarded with the idea of simulation. Here it's like a one-time consult, maybe a referral from a from a primary care doc and then the patient says \"Well that's not really what I expected to hear\" and they walk out. The back and leg patient keeps coming back to you and you can keep talking about stim as an option.", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "e3ba35c6-f8fd-488c-8014-fea301bdf435", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "“The other aspect is how much do these PDN patients really want to have an implant? The back and leg pain patients are constantly getting bombarded with the idea of simulation. Here it's like a one-time consult, maybe a referral from a from a primary care doc and then the patient says \"Well that's not really what I expected to hear\" and they walk out. The back and leg patient keeps coming back to you and you can keep talking about stim as an option.” “For PDN it will have to be determined how they do in terms of negotiating with the payers. Are they going to get a label exclusivity on it? Because yes, you can code it today as neuropathic pain of the leg. The commercial payers are not interested in engaging with diabetic neuropathy right now. The trouble is that the diabetic population that has significant enough pain tends to be the Medicare, Medicaid population. You can use any device for Medicare. With the bulk of the population being Medicare, doctors can use the device for PDN today. And commercial-insured patients don't mean much, because commercial insurance usually means an employed person that generally is not the one that's usually a severe diabetic.” — KOL and one of Nevro’s highest volume implanters", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-3f3d-76db-b345-cd623e7515b0", "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": "223f0966-f5bf-4fd4-aeae-cd8632dadc7b", "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": "c9060a34-015a-47fb-989d-6bf5278a4d10", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.4, "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": "9fb90d5c-2e95-4fee-ae90-d5aed8c003b8", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [ { "name": "fraud-exposure", "slug": null, "matchId": "a4a08ea7-6c25-48af-9dc1-b8aa5686090f", "evidence": "Contradicting company TAM claims with expert testimony", "confidence": 0.8 } ], "arcBeats": [], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }