{ "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": 220, "pageCount": 239, "prevPage": 219, "nextPage": 221, "slideType": "villain_critique", "function": "name_villain", "density": "overcrowded", "nDataPoints": 0, "notes": "Uses testimonial-style quotes to frame the company as corrupt and exploitative.", "elementsJson": [ "headline_text", "bullet_list", "paragraph", "quote_block", "footnote" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-2a2468219173/220", "deckHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173#slide-220", "components": [ { "bbox": null, "kind": "callout", "text": "A former Nevro sales rep stated the company is “not on the up and up,” and will “invariably be audited by Medicare,” describing how patients are pressured, manipulated, or lied into implants.", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-3f3e-76f7-b9d6-0099b853d658", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.07, "w": 0.88, "x": 0.06, "y": 0.41 }, "kind": "list", "text": "A former Nevro sales rep stated the company is “not on the up and up,” and will “invariably be audited by Medicare,” describing how patients are pressured, manipulated, or lied into implants.", "attrs": null, "subkind": "bullet", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "22e09c48-6574-4088-b663-44bd9af12223", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.05, "w": 0.88, "x": 0.06, "y": 0.67 }, "kind": "list", "text": "A former high volume Nevro implanter states that clinics are “bamboozling patients” into permanent implants despite a lack of pain relief during the trial and implied Nevro was “corrupt.”", "attrs": null, "subkind": "bullet", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "b7f69fc1-2465-4ccd-ab4c-63bc8f4696ea", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.25, "w": 0.88, "x": 0.06, "y": 0.13 }, "kind": "paragraph", "text": "We find Grossman’s incentivizing of trial implants as troubling, given that former employees and KOL’s describe trials as the gateway for misuse, over-utilization, and patient manipulation. First, doctors push as many patients into trials as possible, whether medically indicated or not, given lucrative reimbursement for trials versus permanent implants. Second, sales reps then manipulate patients during the trial to push them into a permanent implant, given the conversion ratio drives their compensation. A former rep stated that Nevro is abusing the system and his opinion that a Medicare audit is inevitable, with a KOL implying the company is “corrupt” and clinics are “bamboozling patients.”", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "8c91156b-0a41-4750-8aa3-f283e6f3e08a", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.15, "w": 0.83, "x": 0.11, "y": 0.49 }, "kind": "quote", "text": "There were definitely practices at Nevro that pushed patients into implants. They will invariably be audited by Medicare. They’re doing other things that are not on the up and up. In the past I worked with a couple of practices where doctors would tell patients they wouldn’t get medication if they didn’t do a stimulator trial. I had patients show up for a visit and not know they were there for a stimulator trial. In every town there are one to two bad eggs. They’re in it for the wrong reasons.", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "2cd138a7-252f-4e9d-8d98-826c3faf80cc", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.18, "w": 0.83, "x": 0.11, "y": 0.75 }, "kind": "quote", "text": "Clinics are bamboozling patients into implanting the device when, in fact, the device during trial did not provide them adequate pain relief. This caters only to the physician cohort that doesn't really care about outcomes. It's about how many you can implant. And if they have to be explanted, even better. It's another surgery you can charge for. Nevro's also paying probably great honoraria for the Kapural's of the world to publish this kind of bullshit data that hurts us all. They did it with Senza and now they're doing it again with diabetic neuropathy. They're shooting everybody in the foot with their practices. That's the kind of corrupt stuff that we're seeing.", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "90f3c61b-b1af-4ec8-8c07-92a95ea89a02", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "“There were definitely practices at Nevro that pushed patients into implants. They will invariably be audited by Medicare. They’re doing other things that are not on the up and up. In the past I worked with a couple of practices where doctors would tell patients they wouldn’t get medication if they didn’t do a stimulator trial. I had patients show up for a visit and not know they were there for a stimulator trial. In every town there are one to two bad eggs. They’re in it for the wrong reasons.” — Former Nevro sales rep; “Clinics are bamboozling patients into implanting the device when, in fact, the device during trial did not provide them adequate pain relief. This caters only to the physician cohort that doesn't really care about outcomes. It's about how many you can implant. And if they have to be explanted, even better. It's another surgery you can charge for. Nevro's also paying probably great honoraria for the Kapural's of the world to publish this kind of bullshit data that hurts us all. They did it with Senza and now they're doing it again with diabetic neuropathy. They're shooting everybody in the foot with their practices. That's the kind of corrupt stuff that we're seeing.” — KOL and high volume implanter", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-3f3e-76f7-b9d6-0519dec762c1", "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": "13c03a9d-3682-40e7-ac19-987ccc32dfde", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.85, "x": 0.06, "y": 0.09 }, "kind": "title", "text": "Over-utilization, unnecessary implants, and patient exploitation are key drivers of Nevro’s sales", "attrs": null, "subkind": "action-title", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "8ec737c0-000f-44f0-8f91-dfc8813d5fda", "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": "98f82d85-bff2-47eb-a243-3bd778cf27e2", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }