edical doctors are highly educated, incredibly busy people working in what are often chaotic environments. They are in this line of work because they want to help others, not because they love business. Yet, for them to follow their calling, their practices must be profitable.

With assistance from receptionists and office managers, physicians can focus primarily on treating patients, knowing their gatekeepers will take care of day-to-day operations. But maintaining a profitable practice is challenging.

The costs seem always on the rise. These include leases or mortgages; medical supplies; equipment; malpractice insurance and payroll. On the revenue side are two critical inputs: what insurance companies pay (to those accepting insurance) and what patients pay.

Insurance companies determine how treatments and procedures are priced. And coding or submission errors can delay payments by weeks.

Collecting from patients can be even more tedious: There are so many from whom to collect. Also, a significant number may not pay at the time of service and may not respond to invoices thereafter. For health-care professionals, this often spells cash-flow problems.

The CDHC landscape

To help control health-care costs, the U.S. government has instituted consumer-directed health care (CDHC). CDHC makes use of high-deductible health-care plans whereby individuals and families are responsible for 100% of all their medical expenses until they exceed their plans' deductibles (typically $1,200 for singles, $2,500 for families).

Participants in CDHC can establish tax-exempt, individual health savings accounts (HSAs) from which they may withdraw funds when they need health-care-related services or products.

For health-care professionals, CDHC means fewer co-pays, with insurance companies paying the bulk of the bills. For patients moving to consumer-directed plans, the amount for which they are responsible increases dramatically. Why? Because until patients exceed their deductibles, the burden of payment is exclusively on them.

As patients become responsible for larger portions of their bills, it becomes important - even critical - that practices offer them as many payment options as possible, particularly if doctors expect full payment at the time of service. If a practice can't collect from a patient, there is no recourse.

Remember, insurance companies are out of the picture until the annual deductible is surpassed. And in many cases, it will never be reached.

To improve cash flow, practices must maximize the likelihood of receiving full payment at the time of service. They will increase their odds if they accept credit cards, many of which are now tied to patients' HSAs.

Your role is to convince doctors it's in their best financial interests to accept all major credit cards. The good news is that it really is. And taking the appropriate steps will help you sell successfully to this market.

Step 1: Get in (twice)

Some professionals go the formal route with an actual sales appointment, while others simply walk in, announce themselves, sit and wait patiently. Both are effective in that you ultimately get a few minutes of face time with the office manager.

This is the person you generally have to impress before getting to see the doctor. Meeting the manager will, therefore, be the first of at least two visits.

Step 2: Sell the value to the office manager

The key to selling to the office manager is to make your pitch in 30 seconds.

Be sure to hit the right note, which is that you are selling cost savings to the practice, and choice and convenience to the practice's patients. This, of course, comes at a price: the discount rate plus fees.

Supplement your pitch with a few carefully selected marketing pieces. Emphasize key selling points since the office manager has to sell his or her boss on your services (without your presence) before you can come back. Well versed in numbers, most physicians are moved by the following value scenarios:

• Faster payment and improved cash flow: Additional payment options increase the likelihood of patients paying larger bills in full and at the time of service. This lowers a practice's accounts receivable and its exposure to bad debt.

• Reduced billing costs: When patients pay in full before leaving the office, there's no need to send invoices or engage collection services. While the costs of accepting cards vary considerably by brand, they are certainly lower when compared with the cost of billing and collections.

Step 3: Sell the value to the doctor

Once the office manager presells the doctor, you will then have the doctor's attention for two to five minutes. As the physician makes 99% of the financial decisions for the office, it will most likely be just the two of you. At this brief meeting you should be prepared to illustrate the cost savings just described.

Step 4: Show the doc the money

Given all their other expenses, the discount rates charged by credit card companies weigh heavily on doctors' minds: While they may not know which cards they accept, they know it's costing them.

To provide comfort, create a simple model that compares the typical cost of processing a credit card to a practice's cost of invoicing, billing, collections and write-offs, per patient.

You can cite some of this data from industry research, while some information might have to come from the doctor's records. Qualitative claims should also complement your sale.

For example, doctors will be able to offer patients a choice in payment methods and honor the new HSA and flexible spending account cards that many patients will receive from their employers, etc. But, your numeric value proposition will be most persuasive.

Practice makes opportunity

Anyone who has successfully sold to doctors knows these sales require time and patience. Here are some best practices to help you make that final close:

• To identify doctors, leverage the Yellow Pages, your company's health-care network list, your family and friends, and local and regional medical and dental associations and conferences.
• Schedule appointments with practices during lunch, and bring the staff a snack or meal. Or schedule appointments with office managers during the last 10 minutes of the lunch break.
• Speak honestly about the financial realities facing doctors.
• Present yourself as a problem solver with solutions that will help the practice make more money.

With approximately one-third of all office-based doctors currently not accepting plastic (that's more than 220,000 prospects), this is a very big opportunity. By leveraging this information, sales professionals can truly become consultants, positioned as key partners to doctors' practices.

Isn't it time you paid a visit to a doctor? With double-digit growth rates in this field, it's likely to be a most enjoyable trip.

Elizabeth Langwith is a Vice President of Strategy and Business Development at American Express Co. One of her responsibilities includes growing credit card acceptance and usage in the health-care industry. E-mail her at elizabeth.langwith@aexp.com