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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": "Uses testimonials from former executives and KOLs to support the thesis of financial abuse.",
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      "text": "Over-utilization, unnecessary implants, and patient exploitation are key drivers of Nevro's sales",
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      "text": "Nevro’s stimulators are mostly implanted at doctor-owned ambulatory surgery centers (ASC’s) which greatly magnifies the incentivize to push and overutilize trials and stimulators versus hospitals.",
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      "text": "A former Nevro executive stated that doctors make far money for a trial than a permanent implant, leading them to proliferate trial volumes.",
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      "text": "KOL’s and former executives outlined the distorted financial incentives that lead to abuse around trials. Trials are extremely lucrative, while permanent implants may lose money. Doctors therefore push patients into trials with no intention of doing a permanent implant. The problem is exacerbated by doctor-owned ASC’s which drive the vast majority of stimulator volume.",
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      "text": "Pain doctors don’t make a lot of money implanting stimulators. They make more money trialing. You can make thousands of dollars trialing a procedure. In the past you used to be paid per electrode, so Boston Scientific created a 16 electrode lead and the government figured out what was happening and then they reimbursed by lead not electrode. You can make $5,000 to $8,000 for a trial and a couple of hundred to a couple of thousand for implantation. It’s not very lucrative to implant. It’s always been that way.",
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      "text": "I'd say the majority of stim is done in ASC's, in the pain world. If you own your own ASC you're more likely to push stim therapy and stim trials and implants on your patients. If you are a hospital employee, you're likely to not care as much and your utilization is going to be far less for a given hundred patients.",
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      "text": "Pain doctors don't make a lot of money implanting stimulators. They make more money trialing. You can make thousands of dollars trialing a procedure. In the past you used to be paid per electrode, so Boston Scientific created a 16 electrode lead and the government figured out what was happening and then they reimbursed by lead not electrode. You can make $5,000 to $8,000 for a trial and a couple of hundred to a couple of thousand for implantation. It's not very lucrative to implant. It's always been that way. — Former Nevro executive; I'd say the majority of stim is done in ASC's, in the pain world. If you own your own ASC you're more likely to push stim therapy and stim trials and implants on your patients. If you are a hospital employee, you're likely to not care as much and your utilization is going to be far less for a given hundred patients. — One of Nevro's highest volume KOL's",
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      "text": "Source: Consultation calls with experts",
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      "text": "Scorpion Capital | Nevro (NYSE: NVRO)",
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