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  "documentTitle": "Nevro Corp. (NVRO)",
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  "authorName": "Kir Kahlon",
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  "notes": "Uses direct quotes from former employees to build a case of unethical business practices.",
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      "text": "The wild west dynamic is far from a bug: it is a feature specifically engineered, in our opinion, to promote over-utilization and the abuses that KOL’s describe.",
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      "text": "A former Nevro executive stated that trial leads are basically given away",
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      "text": "A former Nevro district manager explained that low-cost leads enable doctors to make almost $10,000 on a trial, creating a powerful motivation to implant patients who are questionable candidates",
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      "text": "Former executives and reps revealed a key lever by which Nevro fans these flames. On top of aggressively incentivizing reps to convert patients from trial to permanent implant, doctors are given free or low-cost trial leads, creating a powerful financial motivation to jam patients into trial stimulators. The wild west dynamic is far from a bug: it is a feature specifically engineered, in our opinion, to promote over-utilization and the abuses that KOL’s describe.",
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      "text": "A lot of doctors own a surgical center and Medicare reimbursement at ASC’s for doing a trial is $4686 per lead, and how much are the companies selling the leads to the surgical centers for? Say $500. So, you do two leads, you can buy it for a thousand, now you've gotten back 100% of $4686 times two or let's just say $9000, but since it's Medicare, Medicare pays 80% of that, and then hopefully they have a co-insurance, and the co-insurance picks up the 20% that the Medicare does not. So, now I'm an ASC owner, and I'm a doctor. What do I do when I see questionable patients and injection pays $30?",
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      "text": "Trial leads are often given to a facility for like $100, sometimes even less. They're trying to incent physicians to do trial leads. The idea from a company's perspective is that if we get the trial we're going to sell a stimulator for $25,000. There are those sorts of things that are happening. Centers negotiate very low prices on the actual trial leads themselves. They're just trying to maximize their margin and some physicians leverage the number of trials they do to get the lowest price, so if they don't get $100 from Boston Scientific they will go to Nevro or Medtronic might give them free trial leads.",
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      "text": "\"Trial leads are often given to a facility for like $100, sometimes even less. They're trying to incent physicians to do trial leads. The idea from a company's perspective is that if we get the trial we're going to sell a stimulator for $25,000.\" — Former Nevro executive; \"A lot of doctors own a surgical center and Medicare reimbursement at ASC's for doing a trial is $4686 per lead... so, now I'm an ASC owner, and I'm a doctor. What do I do when I see questionable patients and injection pays $30?\" — Former Nevro district manager",
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      "text": "Source: Consultation calls with experts",
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      "text": "Over-utilization, unnecessary implants, and patient exploitation are key drivers of Nevro’s sales",
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      "text": "Scorpion Capital | Nevro (NYSE: NVRO)",
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