{ "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": 173, "pageCount": 239, "prevPage": 172, "nextPage": 174, "slideType": "expose_contradiction", "function": "expose_contradiction", "density": "overcrowded", "nDataPoints": 1, "notes": "Uses expert testimonials to debunk company growth narrative.", "elementsJson": [ "headline_text", "paragraph", "quote_block" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-2a2468219173/173", "deckHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173#slide-173", "components": [ { "bbox": null, "kind": "callout", "text": "The notion that insurers would allow such an aggressive first line treatment is preposterous.", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-3f3d-76db-b345-509c85563621", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.35, "w": 0.9, "x": 0.05, "y": 0.13 }, "kind": "paragraph", "text": "In addition to PDN, Nevro has begun to dangle a second indication expansion as part of its turnaround plan: non-surgical refractory back pain (NSRBP), for which it will present 3 month data in January. Stimulators are generally only reimbursable after a patient has already exhausted other options like back surgery. In plain English, NSRBP – also called “virgin back” or “first line back” - means implanting a $25,000 stimulator right away - without prior authorization - when a patient walks in with back pain. The notion that insurers would allow such an aggressive first line treatment is preposterous. We commend the Street for their morsel of accuracy in at least indirectly trashing the opportunity, e.g., a 10/22/20 report by Guggenheim – otherwise frothing with a $190 TP – which stated that 30% of Nevro’s sales are already for NSRBP (after prior auth); that the indication is already on-label; and that reimbursement is the obstacle. Not surprisingly, one KOL after another – including Nevro loyalists – ripped the NSRBP “indication expansion” as a delusion and outside the standard of care.", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "5a348352-bc1a-4e2f-9d7e-17d72632d560", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.12, "w": 0.9, "x": 0.05, "y": 0.8 }, "kind": "quote", "text": "“Insurers are making it even harder. Getting approval for stimulators is the hardest it has been. In some local code determinations, they’re making doctors send the patient to a neurosurgeon who writes a letter stating the patient is not a candidate. In an age like this, stimulators for first-line back....there’s no way that’s going to happen. You can’t go right to a $50,000 treatment. I mean, that’s way outside of the standard care.” – KOL and high volume implanter", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "09190109-9523-4543-bce9-b7d2da075a7b", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.1, "w": 0.9, "x": 0.05, "y": 0.51 }, "kind": "quote", "text": "“Spinal cord stimulation as a first-line treatment is, no...it’s absolutely not a realistic opportunity.. The insurance companies will never cover that. If Nevro’s saying they’ll make stimulators the first line of treatment when a back pain patient comes in, I have never heard of that.” – KOL and high volume implanter", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "7190b27a-ff46-4102-831f-322a37247950", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.15, "w": 0.9, "x": 0.05, "y": 0.63 }, "kind": "quote", "text": "“As far as stimulators being used for first-line back, this is question that’s been asked for 15-25 years. Whenever a company comes out and says, we are using it for back pain, it causes problems. Back pain is a huge diagnosis category. The industry has gotten in trouble by claiming it works better for back pain than another device. Upfront back pain is so multi-factorial. I don’t see that market being appropriate for spinal cord stimulation. There are a lot of psychological issues as well, so I don’t see non-surgical back as a big market for them or any company.” – KOL and Nevro user", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "a65158d6-c1eb-4875-b61b-017ee190fd04", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "Spinal cord stimulation as a first-line treatment is, no...it’s absolutely not a realistic opportunity.. The insurance companies will never cover that. If Nevro’s saying they’ll make stimulators the first line of treatment when a back pain patient comes in, I have never heard of that. — KOL and high volume implanter; As far as stimulators being used for first-line back, this is question that’s been asked for 15-25 years... I don’t see that market being appropriate for spinal cord stimulation. There are a lot of psychological issues as well, so I don’t see non-surgical back as a big market for them or any company. — KOL and Nevro user; Insurers are making it even harder. Getting approval for stimulators is the hardest it has been... stimulators for first-line back....there’s no way that’s going to happen. You can’t go right to a $50,000 treatment. I mean, that’s way outside of the standard care. — KOL and high volume implanter", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-3f3d-76db-b345-54a166452eb9", "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": "635e01f5-9c6c-4093-8e26-6f952b10c94f", "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": "35f472f2-bf8d-4681-a95d-f14640b84402", "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": "77b4a48a-a81b-4ed9-be31-1e43e1013c02", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }