Currently submitted to: JMIR Preprints
Date Submitted: Jun 6, 2025
Open Peer Review Period: Jun 6, 2025 - May 22, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Physician-Managed Distribution of Urological Catheters: A Path to Efficiency
ABSTRACT
Background:
The growing trend of integrated healthcare services within physician groups has improved care delivery by enhancing convenience, efficiency, and care coordination. However, it has also raised concerns about financial incentives potentially driving overutilization.
Objective:
We examine the impact of distribution method (traditional third-party referral versus physician-managed via Rx Redefined technology platform) on the quantity of urinary catheters supplied to Medicare patients.
Methods:
We analyzed utilization patterns for urological catheters (HCPCS codes A4351, A4352, and A4353) using 2021 Medicare claims data. We identified 54 urology specialists in core metropolitan areas who were enrolled in the Rx Redefined platform throughout 2021 and compared their utilization patterns with unenrolled urologists in the same regions. For enrolled physicians, who managed approximately 40 percent of their prescriptions through the platform, we also compared utilization between physician-managed and third-party distribution methods.
Results:
For catheter services A4351 and A4352, when distribution was managed by third parties, we found no significant differences in utilization (i.e. units supplied) between enrolled and unenrolled physicians. However, physician-managed distribution through Rx Redefined resulted in significantly lower utilization compared to third-party vendor distribution by non-enrolled physicians (p < 0.001 for both codes). In paired analysis of enrolled physicians, direct management showed significantly lower utilization compared to third-party distribution for A4351 (p = 0.014), but this difference was not significant for A4352 (p = 0.62).
Conclusions:
These findings demonstrate that physician-managed catheter distribution does not lead to increased utilization. In fact, for certain catheter types, physician-managed distribution may result in lower utilization compared to traditional third-party referral methods, suggesting a potential reduction in oversupply and improved efficiency.
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