Joining Forces, Improving Health: The Center for Neurosciences, Othopaedics & Spine

The Center for Neurosciences, Orthopaedics & Spine (CNOS) has a long history of providers joining forces to improve care in the tri-state region of Iowa, Nebraska, and South Dakota. 

Fourteen Siouxland-area neurologists, neurosurgeons, and orthopaedists - specialists that in some regions may even view each other as competitors - combined their practices in 1998 to form the original clinic in Dakota Dunes, South Dakota. 

In the nearly 24 years since then, the team has expanded to 38 doctors, nine specialties, four clinic locations, 22 outreach sites, and more than 309 employees. Through partnerships with the Dunes Surgical Hospital, Mercy Medical Center and UnityPoint Health–St. Luke's, CNOS providers have contributed to HealthGrades 5-Star ratings in joint replacement, total knee replacement, total hip replacement, hip fracture repair, cervical spine and treatment of stroke.

Now, CNOS has formed yet another strategic alignment, this time with Tri-State Specialists, an independent multi-specialty practice in Sioux City. 

New Faces, New Specialties

Tri-State and CNOS combined forces under the CNOS umbrella in January adding seven new physicians and two new specialties. Former Tri-State orthopaedic surgeon Aaron Althaus, MD, a native of Sioux City, is one of them.

"It was a very complimentary situation," says Dr. Althaus of the merger. "We were able to bring some new things to the group. And they are a strong practice with some advanced expertise and tools like the Mako Robotic System for joint replacement which allows us to offer state-of-the-art care."

Althaus, a native of Sioux City and a graduate of the University of Iowa Carver College of Medicine, completed his fellowship training at the Insall Scott Kelly Institute for Orthopaedics and Sports Medicine at the NYU Hospital for Joint Diseases in New York City. He has both a broad knowledge of orthopaedic injuries and conditions and a deep understanding of the patients he serves.

"We have a strong agricultural base and a largely blue collar workforce that is loyal to the area," says Althaus. "People here want and need high quality orthopaedic care, but they also want to stay here and support their local healthcare facilities. This group and this model allows us to treat people locally with advanced specialty care so they do not have to travel anywhere."

In addition to strengthening and expanding CNOS' orthopaedic offerings, the alignment with Tri-State allows CNOS to expand into two new specialty areas: dermatology and general surgery.

"This coming together means we can meet more of the needs of the community, not only in orthopaedics but also in areas we have not been able to offer before," says neurosurgeon Hendrik Klopper, MD, who has been with CNOS since 2017. "This is good for patients in the area and good for us as an independent organization."

The group plans to add a gastroenterologist this fall. 

Independence and Quality Tracking

Both Althaus and Klopper say the fact that CNOS has remained independent for nearly 24 years, was a big selling point for them. 

"I feel like working for an independent organization gives me the opportunity to treat patients the way I want to treat them," says Dr. Althaus. "At CNOS, I have a lot of control to do what I want to do and to decide how I'm going to approach each individual case."

Like Althaus, Klopper is also a native of the Upper Midwest. Dr. Klopper grew up in Philip, South Dakota and attended the University of South Dakota School of Medicine. He completed his neurosurgical residency at the University of Nebraska Medical Center in Omaha and worked for a larger hospital system in Sioux Falls before coming to CNOS. Klopper says the advantages of independence were especially apparent early in the pandemic.  

"One of the disadvantages in a bigger organization is that there is some bureaucratic inertia and there is not much physician involvement in the day-to-day decisions," he says. "When COVID hit, there was a lot of change from a regulatory standpoint. We were able to make quick decisions about how we were going to implement things and manage this risk, sometimes within a couple of hours."

At the same time, Klopper says he appreciates the organization's commitment to tracking quality measures and continually improving, something he says is less common in independent practices. 

"We are part of a national registry where every patient that has spine surgery is followed," explains Klopper. "We look at outcome measures - patient reported and objective criteria - and compare these to national benchmarks. We work to continue to stay above the national averages for these quality outcome measures. Not a lot of places outside of major medical centers are doing this."

Paving the Way for Future Growth

CNOS has continued to expand its footprint across the region. In need of more space to accommodate the new physicians, the group opened its fourth clinic location in South Sioux City, Nebraska in March. In addition to the main clinic in Dakota Dunes, the group also has clinics at Northside and Sunnybrook in Sioux City.

The providers of CNOS now serve patients in 22 outreach locations from Spencer, Iowa in the north and Onawa in the south, west to Norfolk, Nebraska and as far east as Fort Dodge. 

"We are between two fairly large medical markets and it is our goal to make sure the people in this area have access to the highest quality care, too," says Dr. Althaus. 

Althaus says the newest partnership between CNOS and Tri-State not only helps make this possible in the short term, but also paves the way for continued growth and improvement.

"Having this larger, strong team improves our ability to recruit new well-trained specialists to the area," he says. "We also have established doctors who have been around for 30 years who have phenomenal experience. The combination of the two is invaluable."

CNOS by the Numbers:

Physicians: 38

Employees: 230+

Specialties:

• Orthopaedics

• Sports Medicine

• Neurology

• Neurosurgery

• Rheumatology

• Podiatry

• General Surgery

• Dermatology

• Physical Therapy

• Gastroenterology (September 22)

Clinic Locations: 4

• Dakota Dunes, SD

• Sioux City, IA (2)

• South Sioux City, NE

Outreach locations: 22