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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": "The slide uses direct quotes from KOLs and high-volume implanters to build a case for regulatory/legal risk regarding the unauthorized practice of medicine.",
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      "text": "Nevro's business model is predicated on employees engaging in the unauthorized practice of medicine",
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      "text": "A KOL took the rep's characterization of his role even further, and stated that stimulator reps have a “very unique” role versus typical reps because “You have clinic hours” and “You actually have patients.” He stated what reps are “legally, ethically, appropriately” supposed to do versus their actual conduct. A second implanter, one of Nevro's highest volume users, stated that he simply outsources patient care to reps if they still have pain after implant. He stated that reps use x-rays to diagnose the patient and to re-program the device, and that if the rep fails, that a central call center – the “Therapy Optimization Team” – takes over.",
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      "text": "Question: “Isn't that kind of a risk? A rep isn't licensed to practice medicine.”",
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      "text": "Who has more experience programming the device - me or somebody who spends their entire life programming stimulators? Being a stimulator rep is not like being a pharma rep selling Viagra. You have clinic hours. It's a very unique sales position. You actually have patients. You actually come into clinic. I'll walk by a room and go, oh, Mike the rep is in room three and he's programming somebody. Cool, I didn't even know. I can make recommendations to reps but they're really the experts in programming.",
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      "text": "If a patient is not responding or the pain comes back, I have the rep come talk to them. They can check in a rough way whether the leads have moved so in most cases, they get an X-ray of the leads before they come in so they have a better idea of how to program it. If it's just that the therapy has diminished, then Nevro has a special group of clinical specialists that manage those cases remotely and guide the representatives on what to do if they cannot solve the problem themselves. Now, if everything is in place and everything is functioning as expected, but a patient is not getting pain relief, that's when they start trying other programs and they start engaging the Therapy Optimization Team as Nevro calls it.",
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      "text": "Programming is usually done by the rep. I have a programming computer, but the reps do it all day long. Legally, ethically, appropriately, the rep is supposed to meet the patient in my office. The reality is that some of them meet at the patient's house. They're not supposed to do that. They'll go to their house and they'll hook up their programmer and they'll program right there.",
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      "text": "\"Programming is usually done by the rep. I have a programming computer, but the reps do it all day long. Legally, ethically, appropriately, the rep is supposed to meet the patient in my office. The reality is that some of them meet at the patient's house. They're not supposed to do that. They'll go to their house and they'll hook up their programmer and they'll program right there.\" — KOL; \"Who has more experience programming the device - me or somebody who spends their entire life programming stimulators? Being a stimulator rep is not like being a pharma rep selling Viagra. You have clinic hours. It's a very unique sales position. You actually have patients. You actually come into clinic. I'll walk by a room and go, oh, Mike the rep is in room three and he's programming somebody. Cool, I didn't even know. I can make recommendations to reps but they're really the experts in programming.\" — KOL; \"If a patient is not responding or the pain comes back, I have the rep come talk to them. They can check in a rough way whether the leads have moved so in most cases, they get an X-ray of the leads before they come in so they have a better idea of how to program it. If it's just that the therapy has diminished, then Nevro has a special group of clinical specialists that manage those cases remotely and guide the representatives on what to do if they cannot solve the problem themselves. Now, if everything is in place and everything is functioning as expected, but a patient is not getting pain relief, that's when they start trying other programs and they start engaging the Therapy Optimization Team as Nevro calls it.\" — High volume Nevro implanter",
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      "text": "19. Nevro's business model is predicated on employees engaging in the unauthorized practice of medicine",
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      "text": "Scorpion Capital | Nevro (NYSE: NVRO)",
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