12 Signs Your Investigator Site Payments Should Be "Under New Management"

The success of your studies is greatly affected by your relationship with your sites, and confusing -or ineffective- payment processes are bound to reduce site satisfaction. How do you know if your current payment process (whether in-house or external) is hindering the success of your studies? Here are 12 signs that it might be time to consider a change to your current site payment strategy:

1.) You have accumulated more complaints from your sites about delayed, missing, or inaccurate payments than you care to count.

Managing clinical trials is complicated.  It is difficult to master every task, especially without the right tools and expertise.  While 87% of sponsors/CROs agree that payments are one of their critical processes, 56% agree that payments are delayed almost all the time (MCC 2017 Clinical Site Payment Study) – not to mention quarterly payment terms. 

2.) “Payment Issues” appears as a standing agenda item in your weekly team meeting.

While seeing payments as a regular agenda item would seem like progress, this type of attention is not what was intended.

3.) Your CRAs feel more like payment brokers.

CRAs carry a unique role as advocates for the sponsor/CRO as well as the site.  With the prevalence of payment delays and issues, CRAs are forced to mediate payment issues to ensure sites stay motivated and engaged.  In some cases, CRAs are even asked to manage payments themselves—a task requiring expertise they are unlikely to possess.

4.) Your sites feel more like institutional lenders than scientific contributors.

60%+ of sites have less than 3 months operating cash (SCRS 2014-2017).  90% of sites consider monthly payments ‘extremely or very important’ according to the 2017 SCRS White Paper on Budget and Payment Systems – a statistic that drives engagement.  Sponsors rely on site solvency for engagement and contribution toward the development of new medicines. Sponsors need data and sites need cash flow to run their businesses.

5.) You fielded a call from a cautiously optimistic site that received a check from you for $50,000 and they have no idea what is it for – in fact, you don’t either.

While mistakes are inevitable in any process, automated processes with controls in place, robust reporting, and trained experts minimize such occurrences.

6.) As a CRO, you must call the sponsor again to request a rush on funds so you can make payments.

Due to miscalculation, data entry push, or spike in enrollment, your pool of sponsor funds has run dry. This leads to the issues in items 7 and 8 below.

7.) As a CRO, you must tell the sites you are waiting for money from the sponsor.

It doesn’t matter what your payment schedule looks like; if you have no money from your sponsor, you have a problem. To make matters worse, a quarterly schedule means sites will go 4 months or more without payment. Site interest and engagement may start to wane.

8.) As a sponsor, you’ve become exhausted by conversations with your AP explaining how site payments differ from ‘regular’ payments and should not follow the company’s standard net payment terms.

With internal payment processing, sponsors may be able to expedite site payments or ‘trick’ the net payment term counter with backdating.  If you are using a CRO and now need to quickly run an ad-hoc replenishment, you may be calling in all your favors to AP to get them to release the funds – which assumes you have already managed to obtain top management approval for a huge invoice.

9.) You just received a call from your KOL or lead investigator, informing you that they have not received payment in 4 months.

Investigator dissatisfaction with payment terms is widespread. Chances are now high that everyone is behind in receiving payments– which may begin curbing enrollment and site engagement efforts for your study.

10.) Sites are threatening or actively refusing to continue enrollment or data entry until payment issues are resolved.

No sponsor, CRO, or site wants a relationship to be reduced to such drastic terms, but you now have an unfortunate situation where trust has been lost and the site played the only card they felt they had left. Most situations like these are preventable with proactive management and focus on payment processes. One of these ordeals should easily justify an ROI to outsource to an expert.

11.) You can’t decipher how to administer payments against the budget schedule in the contract.

The investigator payment process begins with a well-designed, concise budget as part of a CTA.  An airtight budget schedule is only as good as your organization’s ability to administer payments against it.

12.) You are recruiting sites for your new study and your ‘go-to’ sites are choosing to participate in your competitor’s protocol, which features monthly payment terms and focused payment experts.

Sites place high value on scientific merit of studies, but they also need to a run a business.  If they know cash flow will be a struggle, choosing a safer option makes sense. Paying quickly and accurately is a competitive advantage for both sponsors and CROs.

Maintaining good relationships with your research sites is crucial for the success of your studies. Outsourcing your site payment processes to experts will help foster good site relationships, and will allow you to give payments the attention they deserve as you focus on other complexities of clinical trial management.