Paying Subjects Site/CRO/Sponsor Relationships

Participants Can Relate to Sites: Prolonged Payment Causes Financial Hardships

By Kristina Lopienski
July 31, 2017

Investigator turnover; subject dropouts. Site-centricity; patient-centricity.

Similar concepts, different stakeholders.

While many in the clinical research industry strive to ease the burden for both site and participant involvement in clinical trials, there are a few areas where we’re missing the mark. Whether you have sites or patients in mind, one of biggest issues is the financial burden of slow payments.

In a world where rent is due monthly, credit card cycles are 30 days, and employees are paid bi-weekly, timely reimbursements to sites and participants should be a no-brainer. However, this is the exception rather than the rule.

There is often a ripple effect when sponsors and CROs pay sites slowly, causing many sites to make late payments of their own. This can even trickle down to patients. In fact, 75% of sites report that reimbursement timelines have an impact on their ability to pay stipends and reimbursements to patients.1

Unsurprisingly, late payments to both sites and participants have serious consequences for all clinical research stakeholders.

The pitfalls of delaying payment to sites and participants

Retention decreases

Maintaining positive cash flow is a huge challenge for many sites, with 66% reporting they have less than three months of operating cash on hand.2 In addition to study-related payments, sites have to pay rent, utilities and more. These expenses almost always use the standard invoice timeframe of Net 30. Terms from sponsors that cause payment to be received greater than 30 days can be a threat to site sustainability. This is a leading cause of turnover among clinical investigators.

[Related article: Encouraging Timely Payment from Sponsors: What Can Sites Do?]

Similarly, postponing payment to subjects can prevent them from completing a study if they are relying on that money to travel to and from the visit. Because there are often out-of-pocket expenses related to a trial, delayed payments can cause subjects to temporarily go into debt. That’s why the timing of payments may be just as important to sustaining participation as the money itself.

Engagement suffers
Site payments often arrive even later than the agreed upon payment terms. In reality, quarterly payments can take four and a half to six months to reach sites after the work is performed.2 With no repercussions for the sponsor’s lateness, sites may feel less motivated to put extra effort into that study and may even choose to refrain from working with companies that don’t treat them fairly.

Similar to site satisfaction, the timeliness of payment for subjects affects patient satisfaction. When there’s uncertainty or misaligned expectations around when they will be paid, patients can understandably become frustrated. This broken trust can lead to anger and disengagement, with even a lack of commitment to the site and/or study.

[Related article: Timing Is Everything: Why You Need to Reimburse Subjects Promptly]

Accelerating payments to sites

The majority of sites prefer to work with sponsors and CROs that pay on time and accurately.1 Not only does this help build trust and happier sites, but when sites don’t have to spend their time chasing missing or late payments and worrying about cash flow, they can spend more time recruiting and caring for patients.

Forte and Nimblify partnered with MAGI to perform analyses on the current state of site payments in terms of average payment timelines and trends, and to recognize sponsors that pay sites promptly in a bi-annual awards ceremony. We are expanding the MAGI Award for Excellence in Site Payments project and opening up participation to all US-based sites that use a CTMS.

By aggregating data from as many sites as possible, we will gain a clear picture of how long it takes sponsors to reimburse sites. By recognizing the sponsors that pay sites promptly, we hope to encourage others to do the same and ultimately drive down the average time it takes.

Interested sites can sign the MOU and then contribute standardized data points. All sites will remain anonymous in the results and presentation.

Speeding up payments and reimbursements to participants

Certain forms of payment are quicker to issue than others. For example, some participants have to wait weeks or months to receive a check in the mail. Instead, offering a payment method that allows participants to walk away with money “in hand” can improve dropout rates and provide instant gratification.

Payment systems help automate stipends, allowing coordinators to click ‘Pay’ as soon as a visit is completed, without having to wait for accounting to review them later. Similarly, finance teams can dramatically accelerate travel reimbursements with a streamlined request process. Check out Nimblify Payments and discover a better way to pay.

Check out Nimblify Participant Payments

Related articles:


  1. Site Solutions Summit Survey of Investigative Sites in the US: 2013
  2. Society for Clinical Research Sites (SCRS), Site Payment (White Paper), October 2016

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