‘Twas the day before Christmas, and all through the clinic,
My patients were fuming, and I was a cynic.
My routine was stung by Affordable Care.
I’d hoped the ridiculous rules would be fair.
In precerting drugs, how the auditors hovered.
Prescriptions for sugar pills only were covered.
The managed care mischief and benefits cap,
That sounded so good, was merely a trap.
Then out in the foyer arose such a clatter,
A patient’s co-pay was the crux of the matter.
Away to the window I flew like a flash,
Shut down the computer and asked him for cash.
He wasn’t abreast of the new plan in place,
That had cut off his nose in spite of his face.
When what to my wondering eyes did appear,
But a government man, just a tiny bit weird.
He showed me a warrant so lively and quick,
That I prayed to the Lord, “This must be a trick.”
More than just illegal, this wasn’t a game.
And he whistled and shouted transgressions by name.
“You downcode! You miscode! You don’t even fix ‘em!
You’re sloppy! You’re stupid! More crooked than Nixon!
I will file my report! From on top you will fall!
Now cash you’ll pay! Cash you’ll pay! Cash you’ll pay! All!”
As dry heaves, that before a wild emesis fly,
When I met this obstacle, thought I would die.
So onto his ribcage, my fingers they flew,
Which gave him no joy. He ain’t ticklish too.
And then in a twinkling, he wanted the proof,
And documentation for each little goof.
So I drew in my head what I thought would astound,
But this audit’s ridiculous claims did abound.
He addressed all inferred, and he read what was put,
In our policy manual, which was thick as a foot.
A bundle of charges he wanted paid back,
‘Cause this was an audit, and he was a RAC.*
His knee, now it bucked! It’s simple, so very.
It started to hemorrhage and looked downright scary.
It no-mattered at all was he friend or a foe,
For the loss of his blood made his suffering show.
His stump of a leg I held tight, no conceding.
My hands they encircled his thigh to stop bleeding.
He’d had a bad cut, from his leg to his belly.
His bandage was only petroleum jelly.
I asked why he’d only done something to soothe.
“ ‘Cause that’s all,” he said, “that my plan would approve.”
An i.v. for fluids and lowering his head,
Soon gave him to know he had nothing to dread.
He spoke not a word, nor called me a jerk.
Physicians just do this. It’s just how we work.
Then thinking about his life saved, I suppose,
Giving a nod, from the stretcher he rose.
He then took his report, his scathing epistle,
And into the trash, threw it down like a missile.
And I heard him exclaim, as he drove out of sight,
“Don’t ever give up. We need you in the fight.”
Adapted by James Patrick Murphy from the poem “A Visit from St. Nicholas,” a.k.a. “‘Twas the Night Before Christmas” by Clement Clarke Moore
*RAC stands for Recovery Audit Contractor