{ "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": 238, "pageCount": 239, "prevPage": 237, "nextPage": 239, "slideType": "expose_contradiction", "function": "expose_contradiction", "density": "overcrowded", "nDataPoints": 0, "notes": "Uses direct quotes from former executives to build a case of regulatory and ethical risk.", "elementsJson": [ "headline_text", "paragraph", "quote_block" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-2a2468219173/238", "deckHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173#slide-238", "components": [ { "bbox": null, "kind": "callout", "text": "Nevro's business model is predicated on employees engaging in the unauthorized practice of medicine", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-3f3d-76db-b34b-a2ac232cb5e7", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.22, "w": 0.88, "x": 0.06, "y": 0.13 }, "kind": "paragraph", "text": "Two former Nevro executives elaborated on why “reps engaging in the practice of medicine has always been the concern,” suggesting that the risk is known inside the company. One stated that programming their device is so time intensive that the company’s entire value proposition and business model are predicated on doctors outsourcing patient care to Nevro. A second stated that Nevro’s reps and clinical specialists are “not health care providers in any way, shape, or form” but are “responsible for the care of patients.” He added that patients would be “pretty concerned” if they knew the credentials of these employees. He added that it’s illegal in Europe for reps to program stimulators, and that Nevro’s US model is “weird” and requires “huge overhead.”", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "fb082e9a-5d3b-4f1c-956e-03ba7cf80573", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.09, "w": 0.88, "x": 0.06, "y": 0.62 }, "kind": "quote", "text": "“They’re not health care providers in any way, shape, or form. Some of them are not educated in medicine or science at all, and they’re responsible for the care of patients. You can say that’s definitely not a great thing. If the patients knew what the credentials of some of the caregivers are they would probably be pretty concerned.” – Former Nevro executive #2", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "12550677-8a86-4ee8-8816-91c8bc3036e6", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.15, "w": 0.88, "x": 0.06, "y": 0.37 }, "kind": "quote", "text": "“Reps engaging in the practice of medicine has always been the concern. It’s very time consuming to schedule the patient with a doctor to reprogram them. A majority of the doctors don’t know how stimulators work or how to program them. The rep is in the operating room doing the programming. The doctors are not involved in the programming. They understand at a high level that they’re driving a current through the spine. From a technical standpoint to use the programmer or remote control, not so much.” – Former Nevro executive #1", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "28e2ba35-e81b-4ee1-aa75-5c3785b2a519", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.07, "w": 0.88, "x": 0.06, "y": 0.53 }, "kind": "quote", "text": "“Doctors don’t want to give up office space to have patients to come in. They might have a portfolio of several hundred patients that need reprogramming, who they’d have schedule and reschedule, which would tie up a lot of office space.” – Former Nevro executive #1", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "65bca161-adba-457a-b09d-b608df0b54db", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.12, "w": 0.88, "x": 0.06, "y": 0.73 }, "kind": "quote", "text": "“In Europe because of regulations, reps aren’t allowed to interact with the patient. Programming has to be done by a physician, so healthcare professionals there have learned how to program the patient. In the US having manufacturers on the hook for support is not realistic. It requires a huge overhead to maintain and support a neuromodulation business. It’s a weird model. Whenever you send a rep to program the device, the manufacturer is not getting paid. The rep spends two hours programming.” – Former Nevro executive #2", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "98bdfac4-693a-43ed-b60f-15137af44c2e", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "\"Reps engaging in the practice of medicine has always been the concern. It’s very time consuming to schedule the patient with a doctor to reprogram them. The majority of the doctors don’t know how stimulators work or how to program them. The rep is in the operating room doing the programming. The doctors are not involved in the programming. They understand at a high level that they’re driving a current through the spine. From a technical standpoint to use the programmer or remote control, not so much.\" — Former Nevro executive #1; \"They’re not health care providers in any way, shape, or form. Some of them are not educated in medicine or science at all, and they’re responsible for the care of patients. You can say that’s definitely not a great thing. If the patients knew what the credentials of some of the caregivers are they would probably be pretty concerned.\" — Former Nevro executive #2", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-3f3d-76db-b34b-a5b6acab0150", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.02, "w": 0.15, "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": "7b046c8f-9428-4874-bf90-bf2f804d7730", "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": "6c4de848-c7e2-4dbd-a0c3-9f9cf266bb80", "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": "6be06229-7ae4-4ed4-87f3-67d8580f658d", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [ { "name": "antagonist-introduction", "slug": null, "matchId": "71f09ef7-70ee-4b27-9edb-59dfea340718", "evidence": "Frames the company's business model as inherently unethical/illegal through executive testimony.", "confidence": 0.8 } ], "arcBeats": [], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }