{ "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": 233, "pageCount": 239, "prevPage": 232, "nextPage": 234, "slideType": "expose_contradiction", "function": "expose_contradiction", "density": "overcrowded", "nDataPoints": 1, "notes": "Uses direct quotes from high-volume implanters to substantiate claims of systemic abuse in specific US regions.", "elementsJson": [ "headline_text", "paragraph", "quote_block", "footnote" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-2a2468219173/233", "deckHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173#slide-233", "components": [ { "bbox": null, "kind": "callout", "text": "18, Over-utilization, unnecessary implants, and patient exploitation are key drivers of Nevro’s sales", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-3f3d-76db-b34b-71869e6f94fb", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.25, "w": 0.88, "x": 0.06, "y": 0.13 }, "kind": "paragraph", "text": "One of Nevro’s highest volume implanters elaborated on pain practices threatening to cut off monthly opioid refills to pressure patients into stimulators, and estimated that a stunning 30% or more of implanters in his region – one of the largest metro’s in Florida – are bad actors. He stated that main source for stimulator patients are pain clinics that also traffic in opioids, which doctors use to “bait” patients into stimulators. He noted that as the state cracked down on opioid abuse, stimulator volumes declined. Another of Nevro’s highest volume implanters, in New York, described New Jersey, Texas, Florida, and Louisiana as notable pockets of abuse, and stated that companies like Nevro are happy to engage with “those docs if they see some legitimacy of usage.”", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "69f24f9c-8a85-41a9-979d-1865d378f2fb", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.25, "w": 0.88, "x": 0.06, "y": 0.41 }, "kind": "quote", "text": "The number of stimulator patients declined because in Florida, unfortunately, there are a lot of bad actors and there were a lot of people on pain medication that shouldn’t have been and a lot of the patients that funneled into stimulators were those. Their bait is to offer medication, and once patients were engaged with these drugs, they would do whatever was financially appropriate for themselves, so those are the bad actors. When a patient is on opioids, they have to come in monthly which gives the doctor the chance to convince them to do anything or otherwise their opioids will get discontinued. We saw that occur for years. That’s really bad. Yeah, it is a complicated situation. If we’re talking about my region [large metro redacted] I would say that at least 30% of the doctors implanting stimulators are bad actors.", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "06e1302d-2726-494a-9bdd-00cf0237c2e7", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.22, "w": 0.88, "x": 0.06, "y": 0.68 }, "kind": "quote", "text": "New Jersey is probably a pocket of abuse. They have a high rate of usage in the workers comp and Medicare population and then you see it a lot in Texas and Florida and Louisiana. They’re doing a high rate of trials, a high rate of implants. They have surgery centers and have a very high rate of usage of any interventional therapy, stim included. You do a lot of injections, then you do your stim and then you continue your injection and then maybe revise the stim or you swap it out or put something else and that kind of stuff. Stimulator companies are happy to engage with those docs if they see some legitimacy of usage.", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "598e0a92-c1f2-4255-ac7d-6dc8ccaa3118", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "The number of stimulator patients declined because in Florida, unfortunately, there are a lot of bad actors and there were a lot of people on pain medication that shouldn't have been and a lot of the patients that funneled into stimulators were those. Their bait is to offer medication, and once patients were engaged with these drugs, they would do whatever was financially appropriate for themselves, so those are the bad actors. When a patient is on opioids, they have to come in monthly which gives the doctor the chance to convince them to do anything or otherwise their opioids will get discontinued. We saw that occur for years. That’s really bad. Yeah, it is a complicated situation. If we’re talking about my region [large metro redacted] I would say that at least 30% of the doctors implanting stimulators are bad actors. — High volume Nevro implanter in Florida; New Jersey is probably a pocket of abuse. They have a high rate of usage in the workers comp and Medicare population and then you see it a lot in Texas and Florida and Louisiana. They’re doing a high rate of trials, a high rate of implants. They have surgery centers and have a very high rate of usage of any interventional therapy, stim included. You do a lot of injections, then you do your stim and then you continue your injection and then maybe revise the stim or you swap it out or put something else and that kind of stuff. Stimulator companies are happy to engage with those docs if they see some legitimacy of usage. — High volume Nevro implanter in New York", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-3f3d-76db-b34b-760195e8100b", "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": "27c1e7c3-8f1e-490d-af39-beab93006953", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.88, "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": "fae217dc-3474-4845-a38d-4028708ac31b", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.35, "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": "8ff2a3f3-1e69-4926-95ec-3a6518c846ae", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [ { "name": "fraud-exposure", "slug": null, "matchId": "01f61783-abf7-434e-b85e-81afc89c9697", "evidence": "The slide uses expert testimony to expose alleged unethical and fraudulent business practices.", "confidence": 0.9 } ], "arcBeats": [], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }