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  "documentTitle": "Nevro Corp. (NVRO)",
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      "text": "The executive described the resulting patient support burden as a driver of Nevro's broken business model.",
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      "text": "A former Nevro executive, who oversaw a key function, elaborated on the programming difficulties unique to high frequency and explained how the lack of paresthesia undermined the company's value proposition and backfired.",
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      "text": "High frequency comes with challenges. The patient doesn't get feedback from paresthesia... They just crank the device up and have more pain.",
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      "text": "Nevro put together a brand new patient support and programming team... For one algorithm, you'd spend a week and a half just on that algorithm... If they didn't get correct pain coverage, they'd have to bring the patient back in for reprogramming.",
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      "text": "\"High frequency comes with challenges. The patient doesn't get feedback from paresthesia. They either feel pain or don't. That's where the challenge comes in for Nevro. There's a whole psychological issue with paresthesia that plays into it. The patients are dependent on opioids. The device could be working, but patients say it's not working, and then the patients want opioids. Patients have to be in a mindset to be patient to be cooperative. If they had a low frequency device, they're used to making programming changes on the fly, which you can't with high frequency. Some patients are compliant. A good number are not. They just crank the device up and have more pain.\" — Former Nevro executive; \"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.\" — Former Nevro executive",
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      "text": "5. High frequency is Nevro's fatal flaw and dooms any turnaround",
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