{ "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": 236, "pageCount": 239, "prevPage": 235, "nextPage": 237, "slideType": "expose_contradiction", "function": "expose_contradiction", "density": "overcrowded", "nDataPoints": 0, "notes": "Uses a quote from a former executive to support the claim of unauthorized medical practice.", "elementsJson": [ "headline_text", "paragraph", "quote_block", "footnote" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-2a2468219173/236", "deckHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173#slide-236", "components": [ { "bbox": null, "kind": "callout", "text": "We particularly note the role of reps and the central team in managing side effects such as “over-stimulation” - given the complex and multi-factorial nature of pain management, we question how reps are making clinical diagnoses of “over-stimulation” and determining its cause and treatment.", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-3f3d-76db-b34c-2e8a2afb8fbf", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.25, "w": 0.88, "x": 0.06, "y": 0.14 }, "kind": "paragraph", "text": "A former Nevro executive described the role of the central patient support and programming team – and that of reps generally – in a manner we believe to be identical to the practice of medicine: having “a list of patients they were in charge of”; “high patient contact”; using trial and error to direct the correct dosage of stimulation. Determining dosage goes to the heart of practicing medicine. He stated that this central team was unique to Nevro’s business model and driven by the programming-intensive nature of high frequency. We particularly note the role of reps and the central team in managing side effects such as “over-stimulation” – given the complex and multi-factorial nature of pain management, we question how reps are making clinical diagnoses of “over-stimulation” and determining its cause and treatment.", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "191ef7b7-cf3f-41a4-bce5-9c85fd623071", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.18, "w": 0.88, "x": 0.06, "y": 0.73 }, "kind": "quote", "text": "“Nevro had high patient contact. They had to develop a structure to support patients because high frequency stimulation didn’t result in immediate feedback to the patient. With low frequencies, the patient gets immediate feedback. With HF, there’s no paresthesia and feedback. You have to change the program, then wait 24 to 48 hours. Overstimulation exceeds the patient’s problem threshold. The patient then says I’m in worse pain now than before the surgery. We’d need to turn off the device for 24 to 48 hours and shut the patient down to wash the stimulation out of their system.” – Former Nevro executive", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "bef05883-44fa-4e99-ac57-f095bfbf946f", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.3, "w": 0.88, "x": 0.06, "y": 0.41 }, "kind": "quote", "text": "“Nevro put together a brand new patient support and programming team. It’s role was to work with patients, call the patient on a daily basis, and advise the patient to turn the stimulator on or off. It was a big organization. They would have a list of patients they were in charge of. They would call them daily during the trial, right after, after the procedure, to make sure the stim is set correctly. No other neuromodulation company had that. It was unique to HF10. A lot of times the patient had to be patient. We’d lower or increase the stimulation. We’d start at a low frequency, would wait 24 to 48 hours, would increase it by 1, then wait, then increase it again. For one algorithm, you’d spend a week and a half just on that algorithm. The reps would ask on the phone if you’re getting pain coverage, take notes, then add 3 milliamps. They’d have to go through this over the next 3 to 4 weeks to get correct coverage. If they didn’t get correct pain coverage, they’d have to bring the patient back in for reprogramming to see which programs work or don’t work.”", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "f21eb780-2b5d-4004-bbb2-26e92e40302e", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "“Nevro put together a brand new patient support and programming team. It’s role was to work with patients, call the patient on a daily basis, and advise the patient to turn the stimulator on or off. They would have a list of patients they were in charge of. They would call them daily during the trial, right after, after the procedure, to make sure the stim is set correctly. No other neuromodulation company had that. It was unique to HF10. A lot of times the patient had to be patient. We’d lower or increase the stimulation. We’d start at a low frequency, would wait 24 to 48 hours, would increase it by 1, then wait, then increase it again. For one algorithm, you’d spend a week and a half just on that algorithm. The reps would ask on the phone if you’re getting pain coverage, take notes, then add 3 milliamps. They’d have to go through this over the next 3 to 4 weeks to get correct coverage. If they didn’t get correct coverage, they’d have to bring the patient back in for reprogramming to see which programs work or don’t work.” — Former Nevro executive", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-3f3d-76db-b34c-302a79b4eacb", "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": "921524c7-51fb-45b3-9678-7278b1a0991a", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.88, "x": 0.06, "y": 0.09 }, "kind": "title", "text": "19. Nevro's business model is predicated on employees engaging in the unauthorized practice of medicine", "attrs": null, "subkind": "action-title", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "b407030e-2b72-4c91-83ae-0ec5807022a6", "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": "3d4d1d92-2af4-46ac-8cae-c2df682c5f63", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }