Teri Kuffel, JD

Championing O&P

Teri Kuffel, JD, combines her legal background with her business acumen to advocate on behalf of the profession

This month, O&P Almanac debuts a new column focusing on individuals who go above and beyond to advocate on behalf of the O&P profession. Here, you will get to know colleagues and O&P stakeholders who champion issues of importance to O&P practitioners, business owners, and patients, and who foster relationships with decision-makers to ensure equitable access for individuals with limb loss and limb impairment.

TERI KUFFEL, JD, EMBRACED O&P advocacy to unite her two professional interests—law and her family business. Kuffel is vice president of Arise Orthotics & Prosthetics Inc. in Spring Lake Park, Minnesota, which she founded with her husband, Charles Kuffel, MSM, CPO, LPO, FAAOP, but she began her career as an attorney and worked at a law firm for several years after graduation. Then she switched focus, using her legal skills to help her brother build an O&P practice in

Teri Kuffel, JD, brought patient Nick Nelson (seated in wheelchair) to the first AOPA Policy Forum she attended in 2011. Also pictured are Charles Kuffel, MSM, CPO, LPO, FAAOP, Rep. Erik Paulsen, Nick’s mom, and two of Kuffel’s children. Arizona before moving to Minnesota to open Arise O&P. Since Arise launched in 2007, Kuffel has overseen the contract, human resources, and organizational management of the facility, and has become extremely involved in advocating on behalf of both O&P patients and the profession itself.

“My interest in advocacy grew out of an organic need to do more than just run an O&P business,” says Kuffel, who is president-elect of AOPA and a long-time board member. “It’s an incredible field, so I felt an incredible desire to help.” She now dedicates part of her time to studying O&P policy issues and honing her skills at effectively communicating with legislators. “No one asked me to be an advocate,” she says, “but I felt compelled to do so.”

Policy Forum Pro

Kuffel began advocating for the profession on a national front more than 10 years ago, when she attended her first AOPA Policy Forum in 2011. Since then, she hasn’t missed the annual event, where O&P stakeholders from across the nation convene in Washington, D.C., to attend legislative-focused educational sessions, then meet with their members of Congress to encourage them to support O&P-friendly bills.

Kuffel (far right) brought a large contingent of clinicians and patients from Minnesota to the 2015 patient rally at HHS headquarters.

In 2011, Kuffel and her team “were the only ones who brought patients” to the Policy Forum, she recalls. “We brought 11-year-old Nick Nelson and his mom, Greta, to D.C. to meet with Minnesota legislators. It was an amazing trip.” Kuffel and the Nelsons had face time with almost all the Minnesota senators and representatives. That first Policy Forum experience inspired Kuffel to “tell Nick’s story, and to tell more stories to be effective in this environment.”

Kuffel encouraged other O&P professionals to invite patients to advocacy events, and the number of Policy Forum attendees who are accompanied by limb loss patients on their legislative visits has grown. Now, “I couldn’t imagine walking into meetings without patients,” says Kuffel. “Their stories are incredibly impactful, and they tell them like no one else can.”

In recent years, she has brought Aaron Holm and Rob Rieckenberg on her trips to Washington. Both men are individuals with limb loss who are involved in the amputee advocacy group Wiggle Your Toes—an organization where Kuffel also holds a board member position. “Aaron and Rob have been on this journey with me,” she says. “They’re part of the ‘Minnesota Dream Team,’ and we’re usually the largest group from any state” at events such as the Policy Forum. She suggests that advocacy teams from other states consider including at least one policy person, one practitioner, and one patient in each legislative visit, for maximum impact. More often than not, Kuffel’s husband, Charlie, accompanies her on these visits to lend his extensive clinical expertise to the discussions.

Kuffel has taken on more important roles at the annual Policy Forum in recent years, frequently educating others how best to conduct one-on-one meetings with legislators. (See “Advocating for Patients During the Policy Forum—and Beyond” in the May 2021 O&P Almanac.) After last year’s event was virtual, due to the COVID-19 pandemic, she is looking forward to traveling to Capitol Hill for the in-person 2022 AOPA Policy Forum and encouraging senators and representatives to support the Medicare O&P PatientCentered Care Act, S 2556 and HR 1990.

Up for a Challenge

One of the most difficult-yet-rewarding advocacy initiatives Kuffel has been involved in was working with AOPA in 2015 when the four DME MACs published a draft Local Coverage Determination (LCD) and Policy Article governing Medicare coverage of lower-limb prostheses. The policy would have dramatically and adversely impacted care for U.S. amputees, effectively reverting to the standard of care and limb technology of the 1970s.

AOPA responded immediately, mobilizing members, allies, and advisers to work on multiple strategies, with the goal of requesting that the draft policy be rescinded. AOPA spearheaded an initiative that generated more than 5,000 comments from patients, practitioners, and other interested parties, which were included in the official record for LCD rulemaking. The association also submitted 43 pages of comments regarding the draft policy; conducted a data analysis demonstrating that the data used by CMS contractors to support their proposed policy was based on outdated information; and published a series of print and television advertising campaigns, as well as a series of patient vignettes communicating the personal impact of the proposed LCD on patient care.

On Aug. 26, 2015, AOPA arranged for five speakers at the DME MAC public meeting in Linthicum, Maryland, then organized a patient rally at U.S. Department of Health and Human Services headquarters. Kuffel brought several clinicians and patients from Minnesota and played a key role in these meetings.

At the rally’s conclusion, representatives from AOPA, the O&P Alliance, and the Amputee Coalition met with high-ranking CMS officials who said they would work with the regional contactors’ medical directors. CMS later announced that it would not finalize the draft LCD, and that the LCD would not be implemented in anything close to its original form. CMS subsequently convened a multidisciplinary workgroup to develop a consensus statement that informs Medicare policy by reviewing the available clinical evidence that defines best practices in the care of beneficiaries who require lower-limb prostheses.

The decision to halt the progress of the proposed LCD was a clear win for AOPA and the profession. “It was an empowering experience to walk and stand with so many in our industry,” Kuffel says, “to advocate for policy to support reasonable access to care and devices for those with limb loss and limb impairment.”

Additional Involvement

In addition to her work with AOPA, Kuffel takes part in other initiatives to advance care for O&P patients and support the work of prosthetists and orthotists. She has attended every Amputee Coalition Hill Day for the past five years. “The goal of these efforts is to advocate for and

Kuffel with Aaron Holm, Sen. John McCain, and Rob Rieckenberg

with the population we serve to provide education that results in access to care and devices for these individuals, our patients, friends, family members.”

Kuffel also works closely on state-specific programs and has forged relationships with both private payors and the administrators of Minnesota’s Medicaid program. She has “helped facilitate small and large groups in submitting policy drafts and fee schedule requests, which have resulted in changes to both private payor medical policy and fee schedules concerning O&P claims,” she says. Kuffel frequently unites clinicians, patients, and clinical research experts to help effect change—most notably with Minnesota Medicaid and BCBS of Minnesota.

For the past 10 years, Kuffel has been on the Board of the Minnesota Society of Orthotists, Prosthetists, & Pedorthists, which has been active in prompting two new laws. The Minnesota State Orthotist, Prosthetist, and Pedorthist Licensure Act, passed in 2016, mandates that only licensed, qualified O&P professionals engage in O&P care in the state. The second law, passed in 2020, expands the scope of prescribers of O&P in Minnesota to match those individuals who are approved to do so, per CMS. “Together with representatives from the limb loss and impairment community of Minnesota, we effectively drafted bills and became grassroots advocates and hobby-lobbyists to bring the bills to our legislators in offices and committee hearings, and ultimately to the governor for signature into law,” says Kuffel.

She also plays a role in educating the next generation of O&P advocates in her position as an associate professor at Concordia University St. Paul. “I talk to my students about advocating for and with” limb loss patients, “and I encourage them to take that next step now. Don’t wait to be asked—do what you can.”

Planning for an Impactful Future

Kuffel will continue her advocacy journey over the next year, by attending the Policy Forum and by supporting “any and all policy initiatives put forth by the leadership in our extended O&P community,” she says. “It is truly what I am called to do—to help bridge the gap between patients and legislators to help restore, maintain, and provide access to care.”

She encourages other O&P professionals to consider serving in a similar capacity. “The basic needs of our patients know no political agenda and cross both party lines,” Kuffel adds. “We need to motivate practitioners to help their patients beyond the exam room. This journey is great, and the numbers of those who serve are too few.”

Kuffel also encourages others to engage in local and state-level efforts. “It is just as important to get to know administrators in state Medicaid programs because they have the power to control the O&P care for a population in arguably the greatest need,” she explains.

“If there’s a flame flickering in your belly that is telling you to help, then help,” Kuffel says. “Don’t wait to be asked, do the asking. Take the first step and start the journey to help others. Be an advocate. Help educate. Be purposeful in your actions to help provide access to care and devices.”