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  "documentTitle": "Nevro Corp. (NVRO)",
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  "authorName": "Kir Kahlon",
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  "presentationDate": "2021-01-07 00:00:00",
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  "notes": "Includes a direct testimonial from a high-volume implanter to support the thesis.",
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      "text": "As states crack down on opioids, the stimulator market gets hammered as well.",
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      "text": "We note a key, misunderstood dynamic regarding the market growth narrative pushed by Nevro and Wall Street. Nevro is portrayed as a beneficiary of the opioid crisis, with stimulators pitched as a savior. Over the past five years, the opioid crisis has been the primary explanation used to lend legitimacy to fabricated double-digit growth rates. Our research indicates that Nevro is in fact a beneficiary of the opioid epidemic, not because it’s a safer alternative, but because opioids are the “bait” – to quote a Nevro implanter - that drive stimulator volumes at the same sketchy pain clinics. As opioid users flooded clinics, doctors had more patients to push stimulators onto, by threatening to withhold monthly refills, among other pressure tactics. In states like Florida that have cracked down on pain doctors, stimulator volumes have collapsed. One of Nevro’s highest volume implanters, in Florida, explained how an opioid crackdown has led to his stimulator volumes dropping by half. As states crack down on opioids, the stimulator market gets hammered as well.",
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      "text": "The number of stimulator patients entering clinics declined in Florida. Unfortunately, there are a lot of bad actors and a lot of people on pain medication who shouldn’t have been and a lot of the patients that funneled into stimulators were those. There are doctors here in Florida, which I don’t consider part of my colleagues or community, but you see these things happening. Their bait is to offer everything, including the pain medication, so once the patients were engaged with these drugs, they would do whatever was financially appropriate, for themselves or for the practice, so those are the bad doctors, the bad actors.” – One of Nevro’s highest volume implanters",
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      "text": "“I’ve implanted a hundred stimulators in some years but last year it dropped to 50 or 60. The rules for pain clinics in opiate management in Florida changed. Although I had been a low-opiate prescriber, a large number of the patients that came into the practice were already on pain medication or looking to get started or continuing on them. I never wanted to dedicate myself to that or contribute to the opiate crisis. Regardless, I think that the end result of us being more stringent with patients that we allowed to enter the practice was a decrease in the overall numbers of stimulator implants. I want to be careful with what I say. The motivation for patients to come in to see the right doctor to manage their pain was sometimes the wrong motivation. They just wanted to continue their pain medications or the status quo. But within those huge number of patients, we could find the appropriate candidates for this type of therapy.”",
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      "text": "“I’ve implanted a hundred stimulators in some years but last year it dropped to 50 or 60. The rules for pain clinics in opiate management in Florida changed... Regardless, I think that the end result of us being more stringent with patients that we allowed to enter the practice was a decrease in the overall numbers of stimulator implants.” — One of Nevro’s highest volume implanters",
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      "text": "Source: Consultation calls with experts",
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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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