In the world of clinical research, ensuring the financial sustainability of clinical trial sites is a critical challenge—one that directly affects study success. Recently, I had the opportunity to be a guest on the SCRS Talks podcast, where I shared my thoughts on how payment practices impact site sustainability and what steps the industry can take to improve these processes.
The Reality of Payment Delays
One of the biggest challenges sites face is delayed payments. Many clinical trial sites report accounts receivables that are more than 90 days past due, meaning that from the date of service, they may wait up to 180 days to receive compensation. This delay puts significant financial strain on sites, often impacting their ability to cover operational costs, including staff salaries.
With nearly 20 years of experience in the clinical research industry, I have primarily worked for CROs. I later transitioned to a site network owned by a CRO, where I served as the director of project management and was exposed to many of the challenges that sites face. Many of them feel that they are essentially self-funding clinical trials instead of receiving the necessary financial support to conduct them. This imbalance in cash flow can lead to financial instability, putting the sites at risk of becoming non-operational and hindering their ability to continue their research.
Addressing Payment Inefficiencies
A key to addressing these challenges is reevaluating how and how often sites are being paid. Many sponsors and CROs remain committed to quarterly payment terms. This may work for some sites but for others, this arrangement puts them at great risk. Alternative options to consider include structured study advances or monthly payment terms, both of which can alleviate much of the financial strain faced by sites.
Another crucial step is simplifying the payment process. Payment workflows have become increasingly complex due to audit requirements, varying global processes and regulatory concerns. Quite frequently, especially at smaller research sites, staff who are responsible for seeing patients are also responsible for managing invoicing and/or payment reconciliation. It’s just not sustainable. As such, the more sponsors and CROs can help to simplify and provide clarity across the invoicing and payment processes, the better off sites will be, resulting in improved sponsor-site relationships and increased study efficiency.
Overcoming Contract and Middleman Challenges
Contract language also plays a crucial role in payment efficiency. Many sites experience payment delays due to rigid contractual requirements that demand amendments for minor reimbursements, such as dry ice or transportation costs. Introducing more flexible contract terms that allow for reasonable variances without requiring extensive approvals could significantly reduce administrative bottlenecks.
Additionally, many sites are unaware that the entity processing their payments is often a middleman, such as a CRO, which may also be waiting on payments from sponsors. Addressing this issue by shortening payment terms at each level of the process could greatly improve site cash flow.
The Role of Technology in Site Payment Optimization
Advancements in technology offer a promising path forward. Payment solutions like Greenphire’s Site Payments tool, which integrates with electronic data capture (EDC) systems, coupled with the system’s ability to actually generate invoices, can automate the entire payment process, eliminating the back-and-forth hindrances often required for invoicing, payment execution and reconciliation. Ultimately, this reduces errors and administrative burden while ensuring that sites are paid accurately and, on a site-preferred basis, allowing for financial stability. Greenphire’s Site Payments Tool also offers a site portal that gives sites real-time visibility into when payments are made and what they are for – down to the procedure, visit and invoiceable level.
Food for Thought for Sponsors, CROs, and Sites
To enhance site sustainability and improve payment efficiency, here are some thoughts to keep in mind:
- For Sites: Understand contract payment triggers, leverage and advocate for available technology, and establish clear escalation points for delayed payments.
- For Sponsors and CROs: Evaluate and invest in technology to streamline and connect critical workflows, prioritize frequent and timely payments, and ensure contract terms are flexible enough to support site sustainability.
- For the Industry as a Whole: Reevaluate traditional complex financial processes, think about industry challenges from the lense of each stakeholder, and embrace innovation to reduce administrative burden.
As clinical trials continue to evolve, addressing site payment inefficiencies must remain a top priority. Sites should not have to choose between financial stability and providing quality care to patients. By embracing streamlined processes, leveraging technology, and fostering transparency, the industry can create a more sustainable and efficient payment ecosystem.
Want to learn more about improving site payments?
- Tune in to the full SCRS Talks podcast for a deeper dive into these critical industry challenges and solutions
- Learn more about our site payments platform
- Connect with an expert to discuss your trial needs
