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  "documentTitle": "Nevro Corp. (NVRO)",
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  "authorName": "Kir Kahlon",
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      "text": "Washington state terminated coverage after a lengthy 2018 evidence review by 11 clinicians, slamming stimulators as unsafe with sky-high complication rates of 42-60%, and concluding that they fail to provide pain relief or reduce the need for pain medication like opioids.",
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      "text": "The committee agreed that safety was a significant factor: the number of trial reported complications ranged from 8 to 100%. Device related complication requiring revision ranged from 25% to 38% of patients in short term and 42% to 60% in up to 5 years (not including 54% of patients undergoing pulse generator replacements due to battery life).",
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      "text": "Given the serious limitations of the studies, the committee agreed that, at best, weak evidence exists that SCS may provide temporary improvement of pain in some patients, but there is no evidence of mid or long term pain improvement.",
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      "text": "The committee found that evidence overall on important patient outcomes was limited. For all outcomes, there is no evidence of longer term improvement, particularly important when there are significant risks (including 1/3 revision and high removal rate) and the device is intended for permanent implant.",
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      "text": "Interviews with KOL's, ex-employees, and competitors indicate that the reimbursement environment for spinal cord stimulators is becoming increasingly difficult as insurers crack down. Both government and commercial payors increasingly view stimulators as ineffective and lacking in evidence and high-quality studies; expensive with no ROI; and as driving additional costs given their widespread adverse effects. A key part of the Nevro bull case is based on misguided notions of market growth, which our research indicates faces substantial headwinds as reimbursement rapidly deteriorates. Washington state terminated coverage after a lengthy 2018 evidence review by 11 clinicians, slamming stimulators as unsafe with sky-high complication rates of 42-60%, and concluding that they fail to provide pain relief or reduce the need for pain medication like opioids.",
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      "text": "16. The SCS market growth story fueled by Wall Street is false and undermined by escalating payor backlash",
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      "text": "Scorpion Capital | Nevro (NYSE: NVRO)",
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