{ "docId": "019dd923-622c-750b-8b9a-40e2965928db", "docSlug": "e5bffbaac707", "documentTitle": "TransMedics (TMDX)", "authorId": "58_Scorpion_Capital", "authorName": "Scorpion Capital", "documentKindSlug": "research-note", "documentKindLabel": "Research note", "sourceTypeSlug": "short_seller", "sourceTypeLabel": "Short seller", "presentationDate": "2025-01-10 00:00:00", "orientation": "landscape", "aspectRatio": 1.3333334, "pageNumber": 166, "pageCount": 342, "prevPage": 165, "nextPage": 167, "slideType": "expose_contradiction", "function": "expose_contradiction", "density": "dense", "nDataPoints": 0, "notes": "The slide uses direct quotes from UCSF hospital administrators to frame the argument that TransMedics usage is being curtailed due to cost and lack of clinical indication.", "elementsJson": [ "paragraph", "quote_block", "footnote" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-40e2965928db/166", "deckHref": "/decks/019dd923-622c-750b-8b9a-40e2965928db", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-40e2965928db.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-40e2965928db#slide-166", "components": [ { "bbox": { "h": 0.18, "w": 0.86, "x": 0.07, "y": 0.52 }, "kind": "callout", "text": "Surgeons using device when it “wasn’t clinically indicated”; administrators have cracked down\n“Our heart transplant group was using it because they might not have a procurement surgeon available to go get a heart, and this could just be a standard heart. It's not like anything that required the device but they would use it out of convenience, which is a very expensive backup plan. We've since remedied that...we were using it even when it wasn’t clinically indicated. For lung transplant, our surgical director is very mindful of cost. [Redacted] will only use it when absolutely necessary.” – UCSF hospital administrator", "attrs": null, "subkind": "primary", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "ab901209-0ef7-4f57-9e33-baf4ba428182", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.18, "w": 0.86, "x": 0.07, "y": 0.72 }, "kind": "callout", "text": "“Using it too liberally” as “surgeons are preferring it” because it’s “more convenient”\nQ: “Why did the surgical director and/or you make the decision to try to move away from TransMedics? Is it primarily cost or is it you don't see much clinical benefit from it?”\nA: “I think the surgeon, Dr. [redacted]. questioned if we’re using it too liberally, like on organs we would have taken otherwise before TransMedics was even available to us, but now the surgeons are preferring it because it might be more convenient. If you have this option at your fingertips...they’re making that call and they’re enjoying it. I think he thinks it’s being used a little bit too liberally, and the cost has been a concern.” - UCSF hospital administrator", "attrs": null, "subkind": "primary", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "b170b39e-8272-4e64-9afd-1d42e4eb7df0", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "callout", "text": "UCSF, a high-volume user who told us they intend to shut down most TransMedics usage in early 2025, clued into the game its surgeons were playing across all three programs - heart, lung, and liver.", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-5373-719d-a97e-46ab2c562757", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.45, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "However, hospitals and transplant administrators are increasingly realizing that surgeons are disingenuous when they say they need “to see liver function improve, lung O2 to improve, or heart function to improve” – and are beginning to severely limit or eliminate TransMedics usage entirely, as we shall cover in more detail. UCSF, a high-volume user who told us they intend to shut down most TransMedics usage in early 2025, clued into the game its surgeons were playing across all three programs - heart, lung, and liver: “its not like anything that required the device but they would use it out of convenience, which is a very expensive backup plan...even when it wasn’t clinically indicated”; “we’ve since remedied that.” The “surgical director is very mindful of coast...and questioned if we’re using it too liberally, like on organs we would have taken otherwise before TransMedics was available...the cost has been a concern.”", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "df6ede99-c74b-4ae6-81c5-e1212ad22147", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "“its not like anything that required the device but they would use it out of convenience, which is a very expensive backup plan...even when it wasn’t clinically indicated”; “we’ve since remedied that.” The “surgical director is very mindful of cost...and questioned if we’re using it too liberally, like on organs we would have taken otherwise before TransMedics was available...the cost has been a concern.” — UCSF hospital administrator", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-5373-719d-a97e-48fefbe13b34", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "subkind": null, "toolName": null, "toolSlug": null, "confidence": null, "componentId": "64345775-7e66-4b2d-9f40-a9618efa228a", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }