Start: Tell Us About Your Practice

• Briefly describe your practice—specialty, facility type, and how many neuromodulation implants you perform annually.
• Which neuromodulation therapies do you routinely implant or manage? Options: Spinal Cord Stimulation (SCS), Dorsal Root Ganglion (DRG) Stimulation, Peripheral Nerve Stimulation (PNS), Deep Brain Stimulation (DBS), Responsive Neurostimulation (RNS), None / I refer out
• Who typically owns patient selection and eligibility at your center? Options: Pain physician, Functional neurosurgeon, Neurologist, Multidisciplinary committee, Clinic manager, Other
• How would you describe your center’s appetite for adopting new stimulation technologies or waveforms? Options: Very early adopter, Cautious early adopter, Wait-and-see, Conservative / rarely change
• What patient characteristics most commonly make you consider device therapy? (give examples or thresholds)

What’s Actually Blocking Patients From Getting Better?

• What prevents patients who look like good candidates from reaching a successful implant and meaningful, sustained relief?
• How often do logistical issues—OR time, scheduling, or device availability—delay or derail treatment? Options: Almost always, Often, Sometimes, Rarely
• How often do insurance or prior authorization problems force you to change therapy or abandon a plan? Options: Almost always, Often, Sometimes, Rarely
• Which non-clinical factors most commonly stop a patient from converting from trial to implant? Options: Prior authorization denial, Patient inability to recharge, Lack of caregiver support, Scheduling/OR delays, Cost concerns, Other
• When those barriers happen, how does it affect the team and the patient emotionally and operationally?

Who Really Decides — And Who’s Silent?

• If the purchase and clinical decision were a team sport, who’s carrying the ball—and whose voice is missing when it matters most?
• Which stakeholders are usually involved in the final device decision at your center? Options: Implanting physician, Neurosurgeon, Hospital procurement, Clinical engineering/biomed, Administrators/finance, Patient/caregiver, Payer representative, Referring physician
• Which of those stakeholders most often tips the decision and why?
• What timeline and internal checkpoints (committees, approvals) must be satisfied before an implant is scheduled?
• Are there informal influencers—nurses, CRNAs, patient advocates—who change the outcome after the formal decision is made? Options: Yes, often, Sometimes, Rarely, No

When Trials Fail: Tell Us the Real Story

• When a trial doesn’t convert, what usually happened that nobody fixed in time?
• What are the top reasons trials fail at your center? Options: Insufficient programming optimization, Lead migration or technical issue, Inadequate patient selection, Patient couldn’t manage recharge, Infection or complication, Payer withdrew coverage, Side effects or intolerability
• How quickly do you escalate to vendor field clinical engineering when programming is complex during a trial? Options: Immediately (same day), Within 48 hours, Within a week, Rarely involve vendor
• Which objective metrics do you require to convert a trial to implant (be specific—% pain reduction, functional measure names, opioid reduction thresholds)?
• Tell us about one trial that failed and what you wish had been done differently—logistics, programming, patient prep, or vendor support.

What Outcome Would Make You Proud?

• If you had to present one patient that proves the value of your neuromodulation program, what would that case look like?
• Which outcome measures matter most to you and your team when judging success? Options: NRS pain reduction, Oswestry Disability Index (ODI), EQ-5D / QoL, Opioid dose reduction, Trial-to-implant conversion rate, Seizure frequency reduction, Tremor amplitude reduction, Patient satisfaction
• What conversion rate and explant/failure rate would you consider acceptable from a new device in your center (select a range)? Options: Conversion ≥ 80% / Explant ≤ 5%, Conversion 60–79% / Explant 6–10%, Conversion 40–59% / Explant 11–20%, Conversion <40% / Explant >20%
• How important is battery longevity versus recharge burden for your patient population? Options: Battery longevity is primary, Recharge burden matters more, Both equally important, Depends on patient profile
• Describe the lifestyle trade-offs your ideal patient is willing to accept to achieve sustained benefit (travel, recharge, device visibility, MRI constraints).

Where Tech or Support Has Let You Down

• What has a vendor done—or failed to do—that led you to lose confidence in their technology or team?
• Which vendor behaviors undermine your trust most? Options: Delayed field support, Inconsistent device availability, Limited programming flexibility, Poor clinician training, Slow software updates, Opaque clinical evidence
• On a 1–5 scale, how responsive are your current field clinical reps when you need urgent programming help? Options: 1 - Not responsive, 2 - Below average, 3 - Average, 4 - Good, 5 - Exceptional
• When you need urgent remote programming or troubleshooting, what typically happens and how does it feel for you and the patient?
• Which training formats have been the most effective for your team? Options: Hands-on OR proctoring, Simulation lab, Virtual live training, On-demand videos, Peer-to-peer mentorship

Payers, Prior Auth, and the Hidden Delays

• What’s the single payer-related obstacle that costs your patients the most time, hope, or clinical momentum?
• How predictable is prior authorization approval for neuromodulation at your center? Options: Very predictable, Somewhat predictable, Unpredictable, We frequently get denials
• Which payer objections do you see most frequently? Options: Insufficient documentation, Trial-to-implant coverage limits, Device type restrictions (rechargeable vs non), Medical necessity challenges, Coverage only after conservative therapy
• How much added time do prior auth processes add to a patient’s treatment timeline on average? Options: <1 week, 1–3 weeks, 1–2 months, >2 months
• What documentation or clinical evidence do payers request that you find most burdensome? Options: Operative notes, Pain diaries, Functional outcome measures, Prior conservative therapy records, Specialist consult notes
• Have you used third-party prior authorization support or a reimbursement concierge—did it change approval speed or outcomes? Options: Yes, significantly improved, Yes, modest improvement, No change, We have not used

The Operating Room — Where Plans Meet Reality

• What usually breaks down between the plan on paper and the OR table during implantation?
• Which OR constraints cause the most friction for implant procedures? Options: Limited OR time, Inadequate imaging availability, Staffing gaps, Anesthesia scheduling, Sterile processing delays, Lead/device not available
• How often are procedures delayed or rescheduled due to OR or equipment issues? Options: Very frequently, Often, Occasionally, Rarely
• Who owns coordination of device inventory, programming hardware, and field rep presence before the OR start? Options: Clinic coordinator, OR manager, Field clinical rep, Implanting physician, Clinical engineering/biomed
• What would make OR procedures smoother from your perspective—logistics, staffing, device provisioning, or training?

If We Did Our Job Perfectly, What Next?

• Imagine every trial converted on schedule and patients maintained meaningful benefit—what would change for your practice in the next 12 months?
• How would sustained success change referral patterns, OR utilization, or your clinic’s capacity planning?
• Which vendor-provided services would matter most to sustain that success? Options: Dedicated field clinical engineer, Reliable device inventory, Remote programming platform, Reimbursement concierge, Structured clinician training, Patient education/coaching
• Would you be open to a time-limited pilot that measures trial-to-implant conversion and patient outcomes side-by-side with your current approach? Options: Yes — interested, Maybe — need more info, No — not interested
• If yes, what specific success criteria and timeline would you require to commit (metrics, sample size, review cadence)?

Getting Comfortable Together

• Tell us about your practice setting and team—where do you treat neuromodulation patients? Options: Academic medical center, Community hospital, Ambulatory surgical center (ASC), Private practice, Specialty clinic, Other
• Roughly how many neuromodulation trials and permanent implants do you perform per year? Options: 0–10, 11–30, 31–75, 76–150, 150+
• Which specialties are involved in patient selection and implantation at your site? Options: Pain medicine, Functional neurosurgery, Neurology, Anesthesiology, Physical medicine & rehab, Other
• How is responsibility split between clinic and OR for trial setup, programming, and follow-up?
• Who on your team usually owns communication with device field clinical engineers and reps? Options: Physician, Advanced practice provider (APP), Nurse coordinator, Clinic manager, Hospital clinical engineering, Other

Who Actually Decides—and Who’s Silent?

• If you had to name the single biggest non-clinical barrier to getting a patient from consult to implant, what would it be?
• List the decision-makers who influence whether a patient proceeds (clinical, administrative, procurement, payer, family). Who tends to push back?
• Which stakeholder most commonly dictates timeline pressure: clinical team, hospital admin, payer, or patient/family? Options: Clinical team, Hospital administration, Payer, Patient / family, Research protocols
• Have disagreements between stakeholders ever led to delayed or cancelled implants? Tell us about one recent example and how it felt to the team.
• Who at your site signs off on acceptance criteria after implant (e.g., physician, multidisciplinary panel, quality department)? Options: Lead physician, Multidisciplinary team, Clinic manager, Hospital quality/safety, Other

Which Patients Do You Reach For — And Which Do You Keep Waiting?

• Are there patient profiles you instinctively offer trials to—and profiles you won’t? What’s driving those instincts?
• What objective criteria do you use to select trial candidates (diagnosis codes, prior treatments, pain scores, diagnostic imaging, psychological screening)? Options: Chronic pain >6 months, Failed conservative therapy, Opioid reduction goal, Specific diagnosis (FBSS, CRPS, etc.), Psychological clearance, Other
• Which comorbidities or social factors most often push you away from recommending a trial (substance use, cognitive impairment, lack of support, mobility limitations)? Options: Substance use disorder, Active severe psychiatric illness, Cognitive impairment, Lack of caregiver/support, Unstable medical comorbidities, Other
• Walk us through a recent borderline patient you debated—what tipped the decision and how long did that debate take?
• Where do your referrals most commonly come from (self-referral, PCP, surgical colleagues, pain networks)? Options: Self-referral, Primary care, Orthopedics, Neurosurgery, Neurology, Other specialists

From Trial to Implant: Where Does It Break Down?

• What if most trial failures are not clinical but logistical—how often does a non-clinical issue stop a good candidate from converting? Options: Almost always, Often, Sometimes, Rarely, Never
• What is your typical trial-to-implant conversion rate, and how stable has that number been over the past 12 months? Options: <30%, 30–50%, 51–70%, 71–90%, >90%
• For trials that don’t convert, what are the top three reasons (e.g., inadequate pain relief, device intolerance, scheduling/insurance, patient withdrew)? Options: Inadequate pain relief, Intolerance/side effects, Device-related complications, Insurance/prior auth issues, Patient preference/withdrawal, Other
• Describe the touchpoints you use during a trial to monitor progress (phone check-ins, clinic visits, remote programming)—which tend to be most predictive of success? Options: Phone calls, In-clinic programming visits, Remote programming/telehealth, Patient-reported outcome surveys, Wearable/actigraphy data, Other
• When a trial looks promising clinically but fails administratively (e.g., prior auth lapse, scheduling delay), what usually prevents remediation?

The OR and Clinic Rhythm: What Slows You Down?

• If you could eliminate one recurring OR or clinic bottleneck immediately, what would free up the most capacity?
• What are your typical constraints around OR time and availability for implants (block scheduling, on-call windows, ASC access)? Options: Dedicated block time, Shared block time, On-call/emergency slots, ASC scheduling only, Variable/unpredictable
• Which pieces of equipment or supplies most often cause last-minute cancellations or delays (programmers, lead sets, sterile trays, batteries)? Options: Programmer availability, Lead/lead extensions, Sterile implant trays, Batteries/power modules, Imaging/navigation tools, Other
• How reliable is credentialing and privileging for your implanting clinicians and field engineers—have gaps ever caused cancellations? Options: Very reliable, Mostly reliable, Occasionally problematic, Frequently problematic
• What typical OR staffing mix do you need for a smooth implant (scrub tech, neurophysiology tech, anesthesia type), and which role is most often missing or overbooked?

Prior Auths and Payers: The Hidden Surgery

• What if prior authorizations are the single biggest adversary to a timely implant—how often do they change the clinical plan? Options: Very often, Often, Sometimes, Rarely, Never
• Which payers do you treat most frequently, and which are the hardest to get approval from? Options: Medicare, Medicaid, Commercial A, Commercial B, Self-pay, Other
• What percentage of authorizations are approved on first submission, and how long does the average approval take? Options: <25%, 25–50%, 51–75%, 76–90%, >90%
• When authorizations are denied, what are the most common reasons (medical necessity, missing documentation, coding errors, payer policy)? Options: Medical necessity, Incomplete documentation, Coding/billing errors, Payer policy exclusions, Prior surgery history, Other
• Who manages appeals and prior auth follow-up at your site, and how much clinical time does that consume weekly? Options: Physician, APP/Nurse, Dedicated prior auth coordinator, Third-party service, Other

Patient Experience & Lifestyle: Recharge Burden, Expectations, and Regret

• How often do lifestyle concerns (recharging, MRI limitations, body image) drive patients to decline a particular device option? Options: Very often, Often, Sometimes, Rarely, Never
• Which device features trigger the most patient questions or hesitation (recharge frequency, longevity, size, MRI-conditionality, remote control)? Options: Recharge frequency, Battery longevity, Device size/visibility, MRI-conditional restrictions, Remote programming requirements, Other
• Describe how you counsel patients on rechargeable vs non-rechargeable options—what trade-offs do patients find hardest to accept?
• Have you had patients request explant or conversion due to recharge burden or lifestyle mismatch? Tell us what led to that decision.
• What tools, educational materials, or demos have helped patients feel confident about the device lifestyle? Which have failed?

Programming, Support, and Field Team Dynamics

• What if timely programming support is the difference between sustained benefit and explant—how quickly do you need field or remote support during a trial or early post-op? Options: Immediate (same day), Within 24 hours, 48–72 hours, Within a week, Longer
• How satisfied are you with the clinical expertise and availability of field clinical engineers during trials and implants? Options: Very satisfied, Satisfied, Neutral, Dissatisfied, Very dissatisfied
• Which programming challenges most commonly require escalation to engineering or manufacturer clinical specialists (complex waveforms, lead migration, patient-specific anatomy)? Options: Complex waveform optimization, Lead migration issues, Unexpected side effects, Anatomical programming limitations, Device-software issues, Other
• Do you use remote programming or tele-stimulation for follow-up? If yes, how often and for which scenarios? Options: Not used, Used occasionally, Used routinely for early follow-up, Used for long-term optimization
• When a programming issue persists, what internal escalation path do you follow and how long before you involve the manufacturer?

Data, Metrics, and Acceptance: How Do You Know It's Working?

• If we measured one thing that would convince your team a therapy is successful, what would that metric be (pain score reduction, opioid reduction, function, quality of life)? Options: Pain score reduction, Opioid dose reduction, Improved function/ADLs, Patient satisfaction/QoL, Reduction in healthcare utilization, Other
• What standardized outcome measures do you collect during trial and after implant (NRS, ODI, PROMIS, PDQ, seizure frequency)? Options: NRS/VAS, ODI, PROMIS, PDQ, Seizure logs, Other
• What are your formal acceptance criteria post-implant (minimum % pain reduction, functional improvement, or trial signal), and who signs off?
• How do you document and track explants, conversions, and long-term device performance across patients? Options: EMR problem list, Registry/database, Spreadsheets, Manufacturer tracking, We don't track systematically
• What frequency of follow-up visits or remote checks do you find ideal in the first 6 months to catch issues before they lead to explant? Options: Weekly, Bi-weekly, Monthly, Every 3 months, On-demand

What Would Happen If You Changed This Process?

• Imagine the trial-to-implant pathway worked seamlessly—what would that free you to do clinically and operationally?
• What single operational change (scheduling, staffing, payer strategy, device selection) do you believe would lift your conversion rate the most?
• How much organizational appetite is there for testing a new workflow or device-support model right now? Options: High — ready to pilot, Moderate — open with caveats, Low — need convincing, None — not a priority
• If we propose a pilot that targets one bottleneck you named, who would need to be involved and who would champion it at your site?
• What concerns would you have about trying a different approach, and what would you need to see to feel safe moving forward?

Quick Check — Where Are We Right Now?

• Roughly how many neuromodulation procedures (trial + permanent) did your center perform in the last 6 months? Options: 0, 1-5, 6-15, 16-30, 31+
• How would you describe your current confidence that all items for an upcoming trial/implant can be verified within two business days? Options: Very confident, Somewhat confident, Not confident, We don’t have a process
• What typically takes the longest to confirm before a scheduled case? Options: Device inventory/availability, Prior authorization, OR slot confirmation, Surgeon credentialing, Patient education/consent, Other
• If you had to name one invisible bottleneck that only surfaces on the day of surgery, what is it?
• Which internal team owns day‑of readiness checks at your center? Options: Surgery scheduling/OR coordinator, Clinical engineering/biomed, Nursing manager, Field clinical rep/industry, Multidisciplinary shared ownership, Other

What’s Behind Schedule Slips?

• If we’re honest, which recurring issue most often derails scheduled neuromodulation cases? Options: Device or kit not available, Prior auth denial or delay, Staffing or OR overrun, Missing credentialing, Patient not prepared/late, Other
• How long does a typical slip caused by that issue add to your timeline? Options: Same day cancellation, 1–3 days, 1–2 weeks, 3–6 weeks, Longer than 6 weeks
• Walk me through the last time this happened—what stopped the case from moving forward and how did it feel for your team and the patient?
• When these slips happen, what's the most common workaround your team uses? Options: Reschedule the case, Use alternative device/loaner, Escalate to vendor field team, Proceed without key equipment, Cancel and refer elsewhere, Other
• Who usually owns the communication back to the patient when a scheduled case is delayed or canceled? Options: Scheduling/OR staff, Surgeon or clinic nurse, Field clinical rep, Centralized patient navigator, No one consistently

Who Really Decides — And What Makes Them Hesitate?

• Who holds the final 'go/no‑go' for a trial or permanent implant in your organization—and who actually makes the day‑to‑day decisions? Options: Lead surgeon/neurosurgeon, Pain clinic medical director, Hospital procurement/contracting, Insurance/payer, Multidisciplinary committee, Other
• What specific concerns or metrics cause decision‑makers to pause approval for a case (e.g., evidence level, reimbursement, staffing)?
• How often does procurement/contracting availability drive the implant timeline rather than clinical readiness? Options: Almost always, Often, Sometimes, Rarely, Never
• When decision‑makers ask for more data, what evidence moves them fastest (clinical outcomes, trial conversion rates, cost per implanted patient, patient satisfaction)? Options: Clinical trial data, Local center outcomes, Economic/cost model, Patient testimonials, Device longevity/reliability, Other
• Who should we loop in earlier to reduce approval hesitation, from your perspective?

When Devices Don’t Show Up — Stories and Impact

• Tell us about the most impactful time a device, kit, or trial system wasn’t there as expected—what were the downstream effects?
• How often do you encounter device shortages or missing kits for planned cases? Options: Weekly, Monthly, A few times a year, Rarely, Never
• What are the most common root causes when equipment is unavailable (supply chain, inventory tracking, shipping, internal stock policies)? Options: Supply chain/manufacturer stock, Internal inventory miscount, Shipping delays, Contracting limits, Loaner policy gaps, Other
• When shortages happen, how do you measure the cost—financial, reputational, or clinical—to your program?
• Would standardized pre‑case device checklists or vendor‑managed consignment reduce these incidents for you? Options: Yes — substantially, Yes — somewhat, Maybe, No

What Would a Flawless Launch Free You To Do?

• Imagine your next trial‑to‑implant pathway was flawless—what would that change for your patients, your clinic, and your sense of risk?
• Which measurable outcome would signal success for you after deployment (trial conversion rate, time to optimization, patient satisfaction, revenue neutrality)? Options: Trial conversion rate, Time to optimal programming, Patient-reported outcome improvement, Reduced explant rate, Financial breakeven, Other
• What emotional shift would your team feel if deployments were predictable and on schedule? Options: Relief/less burnout, Renewed clinical confidence, More willingness to adopt new tech, No change, Other
• What’s the one metric you’d like us to help you improve most in the first 6 months post‑deployment? Options: Trial conversion percentage, Time from trial to implant, Patient adherence to recharge, Number of programming visits, Reimbursement approval time, Other
• If we could remove one logistic burden from your team on launch day, what should we take off your plate?

The Hard Truth About Prior Authorization

• How frequently does prior authorization feel like an avoidable bottleneck rather than a standard administrative step? Options: Almost always, Often, Sometimes, Rarely, Never
• What are the top three reasons payers deny or delay authorization for your neuromodulation patients? Options: Incomplete documentation, Lack of prior conservative therapy, Coding errors, Medical necessity debates, Patient eligibility issues, Other
• Who in your organization handles appeals and tracking of authorizations, and how long does a typical appeal take? Options: Dedicated prior auth team, Clinic nurse/coordinator, Physician signs appeal, Vendor support handles it, No consistent owner
• What prior authorization support would change the game for you—dedicated appeals support, templated clinical documentation, payer escalation, or something else? Options: Dedicated appeals support, Templated documentation, Payer escalation assistance, Real‑time eligibility checks, Other
• Describe an authorization win—what did the team do differently and how could we help replicate that process?

Patient Readiness — More Than Consent

• How confident are you that patients fully understand life with the device they’re signing up for (charging, follow‑ups, MRI limits, lifestyle effects)? Options: Completely confident, Mostly confident, Sometimes confident, Not confident
• Which patient concerns most frequently cause them to reconsider or cancel (recharge burden, infection risk, loss of efficacy, lifestyle impact)? Options: Recharge burden, Surgical risks/infection, Efficacy concerns, MRI/scan restrictions, Impact on daily life/work, Other
• What patient education tools do you currently use before a trial/implant? Options: Printed brochures, Video walk‑throughs, Peer/patient testimonials, In‑clinic demo of device, Online portal/resources, None
• How often do patients fail to adhere to recharge or follow‑up plans after implant, and what are the usual reasons? Options: Very often, Sometimes, Rarely, Never
• What would make your patients feel more prepared and confident the week before surgery?

Coordination & OR Logistics — Where It Breaks

• Which part of OR coordination gets low priority until it becomes a crisis? Options: Implant kit availability, Field clinical rep presence, Anesthesia planning, Sterile processing/turnaround, Surgery length estimation, Other
• Are your surgeons and nursing teams credentialed for all device lines you use, and how often does missing credentialing block a case? Options: All credentialed — never a problem, Mostly credentialed — occasional issue, Frequently an issue, Credentialing gaps exist and block cases
• Do you require a field clinical representative in the room for trials/implants? If yes, how reliably is that requirement met? Options: Yes — reliably present, Yes — sometimes present, No — not required, No — but would find it helpful
• How do you manage sterile trays and implant kit turnover—centralized supply, vendor consignment, or ad hoc? Options: Centralized hospital supply, Vendor consignment/stock, Ad hoc from clinic, Hybrid model
• What OR scheduling friction would you eliminate first if you could wave a wand?

Accepting Responsibility — Who Does What When It Goes Wrong?

• If deployment day stalls, who do people call first—and does that person have the authority to resolve the issue? Options: OR coordinator, Surgeon, Field clinical rep, Clinical engineering/biomed, Vendor operations, Other
• Do you have a documented escalation path and on‑call contacts for vendor/device issues on procedure days? Options: Yes — documented and tested, Yes — documented but untested, Informal verbal process, No formal escalation path
• How would you rate the current responsiveness of vendor field clinical teams when problems arise in the OR? Options: Excellent, Good, Fair, Poor, No experience
• What service level agreement (SLA) would be meaningful to you for day‑of support (response time, onsite arrival window, remote programming availability)? Options: < 30 minutes response, < 1 hour onsite, < 4 hours onsite, Remote programming within 30 minutes, Other
• Who should be included in a shared day‑of escalation contact list for your site (names/roles/phones)?

Action Plan — Clear Steps to Go Live

• What single change would remove the most friction from your next trial or implant launch? Options: Guaranteed device availability, Prior auth handled externally, Dedicated OR block, Onsite vendor CE/rep coverage, Improved patient education, Other
• Which of the following readiness items do you want us to validate for your next scheduled case? Options: Device & kits availability, Prior authorization confirmation, OR slot & staffing, Surgeon credentialing, Patient education completed, Field rep scheduled, Other
• What timeline do you feel is realistic to get to a 'green' readiness state for a single case (from today)? Options: 48 hours, 1 week, 2–4 weeks, 1–2 months, Longer
• Who on your team will make the final sign‑off that everything is ready to proceed (name/role)?
• What would success look like on day +30 after implant—please list 3 measurable or observable outcomes you want us to support you in achieving.

Getting Comfortable — Tell Us About Your Practice

• Briefly describe your clinic or hospital setting and the patient populations you treat with neuromodulation.
• Which procedures do you perform regularly today? Options: Spinal cord stimulation (SCS), Dorsal root ganglion (DRG) stimulation, Peripheral nerve stimulation (PNS), Deep brain stimulation (DBS), Vagus nerve stimulation (VNS), I don't implant but refer
• Roughly how many trials and permanent implants does your team complete per month? Options: 0–2, 3–5, 6–10, 11–20, 20+
• Who typically owns device selection and trial/implant decisions in your institution? Options: Attending physician, Surgical service line lead, Multidisciplinary committee, Administration/procurement, Other
• What matters most to you when choosing a neuromodulation partner—rank or describe top 3 (clinical evidence, programming, battery, field support, payer assistance, MRI, other). Options: Clinical evidence, Programming flexibility, Battery longevity / recharge burden, Field clinical engineering support, Payer/prior authorization assistance, MRI compatibility, Other
• What have been the most positive experiences you’ve had with device vendors during trials or implants?

Why Do We Keep Accepting Suboptimal Trials?

• When a trial fails to convert, what do you most often blame—patient selection, device programming, surgical technique, or follow-up? Why? Options: Patient selection, Device programming, Surgical technique, Inadequate follow-up, Insurance/authorization delays, Other
• How often do you feel a trial's programming was truly optimized before declaring failure? Options: Almost always, Often, Sometimes, Rarely, Never
• Walk me through a recent trial that didn't convert—what happened step by step, and what decisions felt irreversible in hindsight?
• Which signals do you use to decide whether to persist with programming versus stopping the trial? Options: Pain reduction %, Functional improvement, Patient-reported quality of life, Medication reduction, Adverse events/intolerance, Other
• How does a failed trial feel for you and your team—frustrating, wasted resources, erodes confidence with patients, or something else? Options: Frustrating, Resource-intensive, Erodes patient trust, Clinically informative, Other

Where the Workflow Really Breaks Down

• If I asked your OR or clinic staff what the single biggest recurring bottleneck is for trial-to-implant flow, what would they say?
• How consistent is patient selection criteria across referring physicians and surgeons at your center? Options: Very consistent, Mostly consistent, Some variation, Wide variation
• Describe the most common administrative or operational failure — scheduling, device availability, insurance denials, or credentialing — and how long it typically delays care. Options: Scheduling delays, Device availability issues, Insurance denials, Credentialing/privileges, Patient education gaps
• When you encounter delays (e.g., prior auth or device shipping), how do patients react and how often does that change their willingness to proceed? Options: Rarely change mind, Sometimes delay or cancel, Often cancel, Usually transfer care
• Who on your team usually handles programming during trials and early post-implant visits, and what training gaps exist for them? Options: Physician, Fellow/Resident, Nurse practitioner/PA, Field clinical specialist, Other

What Outcomes Would Make You Proud

• If a therapy consistently achieved the outcomes you most want for patients, what would that look like in measurable terms?
• Which three outcome metrics do you track or wish you tracked most closely? Options: Pain score reduction (NRS/VAS), Functional improvement (ODI/6MWT), Medication reduction (opioid dose), Trial-to-implant conversion rate, Explant rate, Patient satisfaction/PROs, Other
• How important is battery/recharge burden to your patients' long-term adherence and satisfaction? Options: Primary concern, Important but not primary, Occasionally raised, Not a major concern
• Tell me about a patient outcome from a neuromodulation case that reinforced your confidence in the therapy—what changed for them, and how did it feel?
• What would you consider an unacceptable trade-off between pain relief and lifestyle impact (e.g., frequency of recharging, programming complexity, MRI limitations)?

Choices That Shape Patient Lives

• Do you default to rechargeable or non-rechargeable devices, and why might you deviate from that default? Options: Rechargeable (default), Non-rechargeable (default), Case-by-case
• How do you decide whether MRI-conditional features are required up-front versus deferred as a consideration? Options: Always require MRI-conditional, Assess per patient, Rarely required, Unsure
• Describe a time a device feature (waveform, contact count, remote programming) directly changed a patient’s outcome—what was the feature and result?
• How involved would you like the field clinical team to be during programming and follow-up—hands-off, on-call, co-programming in-clinic, or embedded on site? Options: Hands-off, On-call support, Co-programming in-clinic, Embedded/onsite
• What concerns do you have about patient self-management (recharging, remote adjustments), and how do you currently educate or monitor them?

The Hidden Barriers — Prior Auth, Scheduling, & Supply

• Why do prior authorizations and payer interactions still feel like a gating factor in your practice? Options: Documentation burden, Clinical criteria mismatch, Delays in approval, Frequent denials, Other
• How long does the average prior authorization take from submission to approval for neuromodulation in your center? Options: <1 week, 1–2 weeks, 2–4 weeks, >4 weeks, Varies widely
• When a case is denied, what are the most common reasons given by payers and how do you appeal?
• How often do device shortages, backorders, or delivery timing force you to reschedule or change device choice? Options: Never, Rarely, Occasionally, Often
• If a vendor offered managed prior authorization support or inventory guarantees, what value would that create for your team and patients?

If We Could Prove Value Today

• Imagine a vendor could guarantee a measurable improvement—what single metric would most convince you to change your device choice or process? Options: Higher trial-to-implant conversion, Lower explant rate, Longer battery life, Faster time-to-treatment, Better patient-reported outcomes
• What evidence or proof points do you require—randomized data, real-world registries, single-center results, or peer testimonials? Options: Randomized controlled trials, Real-world registry data, Single-center outcomes, Peer-to-peer testimonials, Economic/ROI analyses, Other
• If we proposed a 90-day proof pilot in your center to validate improved programming workflows, what would success look like operationally and clinically?
• What logistical or political obstacles within your institution would make running a pilot difficult, and how long would it take to clear them? Options: Contracting, IRB/ethics, Scheduling/OR access, Procurement, None
• How would you want outcomes from a pilot reported back—format, cadence, and which stakeholders need to see it? Options: Executive summary, Detailed clinical report, Dashboard with KPIs, Quarterly presentation, Other

Commitments, Measures, and Red Lines

• What are the non-negotiables for you when agreeing to a commercial partnership (warranty, training, service SLAs, supply guarantees, clear escalation path)? Options: Warranty/repair policy, Comprehensive training, Service-level agreements (SLAs), Inventory/supply guarantees, Escalation path for clinical issues, Other
• Which post-implant support activities do you expect from a vendor and at what frequency (remote programming, on-site visits, scheduled check-ins)? Options: Remote programming/on-call, On-site clinical specialist visits, Scheduled follow-ups at 2/6/12 weeks, Patient education refreshers, Ad-hoc troubleshooting
• What would constitute an unacceptable clinical outcome or safety signal that would prompt you to pause implants or re-evaluate the program? Options: High explant rate, Unexpected adverse device events, Significant infection cluster, Rapid battery failures, High rate of non-conversion
• Realistically, what timeline would you expect from pilot agreement to measurable clinical readouts that inform a long-term decision? Options: 30 days, 60–90 days, 3–6 months, 6–12 months
• Who else needs to be involved or convinced internally for us to move forward—names, roles, and what would win them over?