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Patient-Centered Communication and Diagnostic Testing

¹ Department of Family Medicine, University of Rochester Medical Center, Rochester, NY
² Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
³ Rochester Center to Improve Communication in Health Care, Rochester, NY
⁴ Department of Family and Community Medicine, and Center for Health Services Research in Primary Care, University of California, Davis, Sacramento Campus, Sacramento, Calif
⁵ Department of Community and Preventive Medicine, University of Rochester, Rochester, NY

CORRESPONDING AUTHOR: Ronald M. Epstein, MD, 1381 South Avenue, Rochester, NY 14620, Ronald_Epstein{at}urmc.rochester.edu

PURPOSE Although patient-centered communication is associated with improved health and patient trust, information about the impact of patient-centered communication on health care costs is limited. We studied the relationship between patient-centered communication and diagnostic testing expenditures.

METHODS We undertook an observational cross-sectional study using covert standardized patient visits to study physician interaction style and its relationship to diagnostic testing costs. Participants were 100 primary care physicians in the Rochester, NY, area participating in a large managed care organization (MCO). Audio recordings of 2 standardized patient encounters for each physician were rated using the Measure of Patient-Centered Communication (MPCC). Standardized diagnostic testing and other expenditures, adjusted for patient demographics and case-mix, were derived from the MCO claims database. Analyses were adjusted for demographics and standardized patient detection.

RESULTS Compared with other physicians, those who had MPCC scores in the lowest tercile had greater standardized diagnostic testing expenditures (11.0% higher, 95% confidence interval [CI], 4.5%–17.8%) and greater total standardized expenditures (3.5% higher, 95% CI, 1.0%–6.1%). Whereas lower MPCC scores were associated with shorter visits, adjustment for visit length and standardized patient detection did not affect the relationship with expenditures. Total (testing, ambulatory and hospital care) expenditures were also greater for physicians who had lower MPCC scores, an effect primarily associated with the effect on testing expenditures.

CONCLUSIONS Patient-centered communication is associated with fewer diagnostic testing expenditures but also with increased visit length. Because costs and visit length may affect physicians’ and health systems’ willingness to endorse and practice a patient-centered approach, these results should be confirmed in future randomized trials.

Key Words: Communication • health care economics • health care delivery • physician-patient relations • standardized patients • diagnostic tests, routine • health expenditures • evaluation studies

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