The evolution of value-based spine care: Dr. Dwight Tyndall on the key challenges & opportunities


Dwight Tyndall, MD, a spine surgeon with Munster, Ind.-based Spine Care Specialists, has spent his career focused on advancing the spine field with minimally invasive surgery, motion preservation and outpatient procedures.

Here, Dr. Tyndall discusses the biggest challenges for spine surgeons today and where he sees value-based spine care headed.

Question: What are the biggest concerns for your practice today? What keeps you up at night?

Dr. Dwight Tyndall: Decreasing reimbursements, patient access issues and denied approval for procedures are my biggest concerns. It has become more challenging to obtain approval for spinal fusions. As I move my patients to the outpatient setting, which I think is the future, the market hasn't caught up. We have had challenges explaining to insurers why outpatient spine surgery in the ASC is better for patients and their bottom-line. It's a new concept so it's natural they have push back. However, most of the time, we have gotten approval.

Q: Which orthopedic and spine device trends and technologies do you see making the biggest impact long term? What do you think is just a fad?

DT: Robotics and biologics hold great promise long term but will take significant development to become an every day standard of care. If you apply these technologies correctly you can achieve better and more consistent clinical outcomes. With robotics, you can standardize procedures therefore making them more consistent and hence patient care more consistent and predictable. There is a larger upfront cost, but over time and with enough cases the technology should pay for itself.

Robots can help the surgeons by taking the variability out of the procedure, which then will make the surgeon more efficient. There are a lot of surgeons putting in pedicle screws with the robot now, and it is surprising how quickly and consistently that part of the procedure can now become.

In some ways, I think of a robotic system like an MRI, in that MRI facilitated greatly improved patient care with better and more precise imaging.

I think fluoroscopic-guided percutaneous TLIFs is a fad in that we will evolve away from it with better techniques and technology.

Q: How do you ensure you're staying on the cutting-edge of your surgical practice while also being mindful of achieving value-based outcomes for your patients?

DT: I am always investigating new techniques and technology but being objective, cost aware and critical in my thought process before applying those new techniques and technologies.

Q: Where do you see your practice evolving over the next five years?

DT: We will become an integrated musculoskeletal delivery system. I think orthopedics is currently focused on orthopedic surgery. The patient goes to the surgeon for a diagnosis with a surgical procedure and the surgeon fixes it. At the point of seeing an orthopedic surgeon, patients are at the end of the continuum of care; they have gone through nonoperative treatment and now they are visiting the surgeon. However, if we look at the larger picture, any patient with any musculoskeletal complaints should be seen at the surgeon's office since the surgeon will be more involved than just performing surgery. The surgeon will be going from just performing surgery, that is, managing one aspect of care, to become the manager of a disease continuum and hence manager of all aspects of musculoskeletal care.

The surgeon will be part of an integrated musculoskeletal delivery system with other musculoskeletal providers who can provide care even if the patient doesn't need surgery at a particular moment.

Learn more about the big trends in spine at the Becker's 17th Annual Future of Spine + Spine, Orthopedic & Pain Management-Driven ASC Conference in Chicago, June 13-15, 2019. Click here

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