The American Medical Group Association was born out of the desire for physicians practicing in groups to improve the quality of patient care by sharing best practices, experiences, and strategies with their peers. Over the year, AMGA has become the primary advocate of group practice, promoting multispecialty medical groups and other organized systems of care as the preferred delivery system for coordinated, patient-centered, efficient, quality medical care in America.
Here are some of the highlights of AMGA’s history.
The group practice movement began in earnest in the early part of the 20th century. Many historians believe that the birth of the modern day group practice goes all the way back to the 1800s, when W. W. Mayo opened his first office in Rochester, Minnesota in 1864. The Mayo Clinic served as a catalyst for the formation of a number of other group practices in the Midwest, with six new Midwest groups established between 1900 and 1915 alone. Over the next 10 years, 106 new groups were established in the United States, 33 of them in the Midwest. Because of the Great Depression, group practice growth slowed to a crawl between 1926 and 1932, with only 17 new groups established throughout the country. After 1935, however, the movement took off in earnest, with steady growth up to and beyond World War II.
In most cases the single largest motivating factor for these early group practice pioneers was the desire to practice better medicine. An early 1950s survey conducted by the American Association of Medical Clinics (the original name of the American Medical Group Association) confirms this altruistic motive of early group practice pioneers: improving the quality of care was the most important reason cited for forming a group in the first place.
As group practices sprang up across the nation, it became apparent that some formal mechanism for communicating and sharing ideas across groups was needed. Wallace Yater, M.D., head of the Yater Clinic in Washington, D.C., called together an assembly of physicians from 36 group practices on December 4-5, 1949 for the purpose of organizing a national association of private medical clinics. Representatives from all across the country attended this session at the Library of the Medical Society in Washington, D.C. With the election of a president (Dr. Yater), vice president (Claire Stealy, M.D., of the Rees-Stealy Clinic), secretary-treasurer (Arthur Griep, M.D., of the Welborn Hospital Clinic), and an executive committee (Dean Echols, M.D. of the Ochsner Clinic and Clifford Loos, M.D., of the Ross-Loos Medical Group), this session produced the birth of the modern-day American Medical Group Association. In fact, the 36 groups represented at the meeting, along with others joining the association between 1949 and 1952, were designated charter members of the American Association of Medical Clinics (AAMC).
The Organization’s Founding
The Certificate of Incorporation of AAMC, filed with the Recorder of Deeds of the District of Columbia on May 1, 1950, listed five principle reasons for founding the AAMC:
From the beginning AAMC lived up to these lofty goals. Perhaps the most important service AAMC offered was its annual meeting, first held in Washington, D.C. on December 4, 1950. Conference attendees represented 43 member clinics and three non-member groups. This conference and those that followed each year served as a wonderful vehicle for group practice leaders to share ideas and discuss many of the important issues discussed previously.
But AAMC was more than just a vehicle for getting together once a year. The Association hired staff under the direction of Edwin P. Jordan, M.D., of Charlottesville, Virginia, who was hired to manage the affairs of the organization. Under his direction, AAMC began producing a news bulletin (which later became the Group Practice Journal) that served as another vehicle for members to exchange information and ideas. The bulletin also included summaries of the proceedings of the annual conferences, thus providing a formal record of the important discussions that took place at each year’s session.
In the 1950s, AAMC began conducting studies and surveys on the activities of group practices. For example, one of the first studies evaluated graduate and post-graduate education activities among member clinics. Other studies led to interesting findings with respect to some of the important issues highlighted previously, such as recruitment and retention. For example, a 1956 AAMC survey of 110 physicians who left group practice found that less than one in three of these physicians left because they preferred the financial arrangements or other aspects of solo practice.
Other activities of AAMC at this time included the following:
Finally, AAMC sought to utilize its negotiating "clout" as a representative of multiple group practices as a means of securing goods and services at a discounted rate. Perhaps the best early example of this activity is the AAMC Income Protection Plan that went into effect November 15, 1959. This program initially provided disability protection to 590 physicians in 34 member clinics; by 1961 it served 1,000 members in 55 clinics. AAMC also began offering a life insurance program that by 1961 covered 1,574 lives.
With services such as these it is no wonder that AAMC’s popularity increased rapidly. By 1958, in fact, the membership totaled 122 clinics from around the country.
Early Role of the Association
One of the most important roles that AAMC played in the early days of group practice was to establish strong principles that helped to hold the group together. For example, one of the critical issues that frequently led to a young group’s demise involved the distribution of income. But under the leadership of Dr. Jordan the AAMC, through its meetings and other services, helped to establish fair distribution as a non-negotiable standard of group practice. Members of the association could utilize the AAMC and peer organizations for assistance in coming up with an appropriate distribution schedule. The AAMC also stood firmly for the idea of creating sound ethical principles in the practice of medicine. These "standards" for group practice operation became a glue that held AAMC member organizations together at a time when many non-member groups dissolved.
In late 1968, AAMC began a formal accreditation program for medical groups. This program was transferred to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in the mid-1970s, and later to the Accreditation Association for Ambulatory Health Care (AAAHC). AAMC was also an early champion of technology in medical practice, encouraging the use of computers beginning in the 1960s.
In late 1974 (at the organization’s 25th annual meeting), the American Association of Medical Clinics formally changed its name to the American Group Practice Association (AGPA). The name change reflected growing dissatisfaction with the use of the word clinic, which by the mid-1970s had become an all-purpose term used to define anything from a storefront first aid station to a full-fledged hospital. Many people also had come to denote the term as being synonymous with a rest home, a terminal care facility, a detoxification center, or as a place where free care was provided. In the minds of legislators, the lay public, and even other professionals, however, the term "clinic" seldom connoted the physician groups that made up the members of the association. A second reason for the name change was that the old acronym (AAMC) was often confused with the Association of American Medical Colleges.
Membership grew steadily through the ‘70s and by the end of the decade had reached 367 medical group members and approximately 9,000 physicians providing care to more than 10 million people. Also during that time, GroupPAC was formed for the association. Also, AGPA launched the American Academy of Medical Directors, which later became the American College of Physician executives (ACPE), increased data collection and analysis, launched insurance products and other services, and battled high malpractice insurance premiums that were threatening the survival of many medical groups.
The 1980s and 1990s
Health care experienced rapid change in the 1980s and 1990s, with numerous mergers and acquisitions, the rise of physician management companies, the growth of managed care, new reimbursement policies and regulations, among other challenges. AGPA and later AMGA continued to assist group practices with the critical issues facing them.
In the mid 1980s, AGPA became a specialty society in the American Medical Association (AMA). In the early 1990s, the association formed the Quality Management and Research division and the Outcomes Management Consortia (which later became the Institute for Quality Leadership). Through these initiatives, the organization supported the work of medical groups in benchmarking and improving care delivery. Later in that decade, the AMGA Acclaim Award and other quality awards were established.
In mid-1996, AGPA merged with the Unified Medical Group Association (UMGA) to form the American Medical Group Association (AMGA). The merger was clearly a case where the leaders of two already strong organizations felt they could become even stronger by joining forces, thus expanding opportunities and enhancing the value for all members. The roots of the merger were seeded in the complementary nature of AGPA and UMGA, which shared similar goals but had little duplication of effort. While each organization was a respected force in the health care industry, the combined UMGA/AGPA became far stronger than either association alone could be in providing resources to meet the challenges facing group practices during a time of rapid change.
While both organizations shared the same values and philosophies (e.g., a commitment to quality), each brought unique expertise and resources to the combined entity. AGPA had established itself as leading the emergence of group practice in the United States. With its large, broad-based membership and strong presence in the nation’s capital, AGPA had become an influential voice in the development of group practice in the United States. For its part, UMGA had helped group practices master the techniques of prepaid, capitated care for over 20 years. The combined entity was able to bring the membership expanded services in the areas of capitation management, legislative advocacy, systems integration support, quality management and research, and education and training.
The New Millennium
Today AMGA still champions coordinated, quality care and is recognized as the voice of medical groups and other organized systems of care in America. Some of the more recent initiatives include:
For more about recent AMGA events and initiatives, visit the News section.
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