Collecting payments has long been an issue for clinical sites, especially those without the financial resources to withstand payment terms of 90 to 120 days. At the SCRS (Society for Clinical Research Sites) Global Site Solutions summit last fall, I even heard some site personnel state they will pay less attention to studies where the sponsor or CRO does not make payments in a timely manner. That should not be a surprise. We know that 40 percent of sites have cited slow payments as a primary operating concern. And last year, 66 percent of sites globally reported having less than three months’ worth of operating cash on-hand. Now it seems that financial stress at sites may even be negatively impacting the success of clinical trials.
SCRS, in partnership with payment solutions provider Greenphire, has produced a white paper looking at problems related to site payments and patient reimbursements. The global survey focused on financial operation processes at sites for handling study payments and patient reimbursements, as well as how payment processes and systems impact financial stability.
The survey found sites expected to be treated as a valued business partner by sponsors and CROs and require four key improvements from payers:
But the survey found slow payments do not just impact sites. Payment processes affect patient payments in multiple ways, and these interactions directly impact patients as well.
Technology Plays An Important Role
Accounting tasks account for a considerable amount of resources for sites. Many use paper or spreadsheet software to manage accounts receivable, and sometimes the personnel performing the accounting tasks also perform patient care functions. At many sites, patient stipends and reimbursement are also performed by those same individuals, along with the tax reporting requirements in many regions. Unfortunately, that means time spent on finances results in time spent away from patients. Those financial tasks include creating invoices, tracking payments, and reconciling payments once they arrive.
For that reason, sites reported they place a high value on improvements in accounting processes as well as information that makes their accounting tasks easier. Previous surveys have found sites especially value timely electronic payment within 30 days, and that delays create financial hardship. But this is the first survey to report that delayed payments are a burden not just in the U.S., but around the world.
To dig a little deeper into why payment processes and optimization have such a profound impact on sites, respondents were asked about their accounting practices. The survey found only 35 percent of respondents use accounting software such as a clinical trial management system (CTMS) to manage accounts receivable. Around 60 percent are still using paper or spreadsheet applications, and 5 percent do not track accounts receivable at all. Half of the sites responding noted they generate invoices by hand. Sites outside the U.S. are twice as likely to use a paper accounts receivable system and are three times as likely to have no account receivables system at all.
The process is not any cleaner when it comes to patient stipends and reimbursements. Paper checks or cash were reported as the most used method of reimbursement. While debit cards offer greater efficiencies, many respondents expressed doubts as to whether respondents would be receptive to them. Tax information is another burden. Sixty-one percent of sites noted they were required to provide information to tax authorities or patients relating to patient reimbursements, yet only 52 percent stated they have a system that is “somewhat” or “extremely” effective in generating the required information.
SCRS notes it is in everyone’s best interest to have site personnel focused on patients. When those resources are allocated to accounting functions, time is taken away from more critical tasks such as patient identification, recruitment, retention, and care. Still, 48 percent of individuals involved in accounting were found to have duties that include seeing patients. Therefore, accounting tasks could serve to diminish patient contact and impact trial success.
Not surprisingly, more than 60 percent of respondents indicated a preference for electronic payment and 83 percent preferring payment terms of 30 days or less. Timely payments are also critical to timely payment of stipends to patients, something sites place a great deal of importance on. When asked about the importance of providing patients with their stipend or reimbursement immediately after a visit, 77 percent of sites ranked it as “very important” or “extremely important.” Furthermore, seventy-five percent of sites noted reimbursement timelines have an impact on their ability to pay stipends and reimbursements to patients. Delayed payments, therefore, create a cascade of negative effects on sites and their studies.
Are You A Sponsor Of Choice?
Today, more sponsors seem to want to be a “sponsor of choice” to site and CRO partners. But if they truly want to be valued by sites, taking care of the payment issue would be a good first step. Survey respondents noted they use payment timeliness as a factor in determining which sponsors and CROs to accept studies from. Occasionally, sites will even make the decision to stop work on a study when they have not been paid, again creating a negative impact on studies.
How can sponsors and CROs help? Aside from speeding up payments and using electronic payment methods, 72 percent of sites would like access to their financial information in the electronic systems of their payers, noting that ability would be “valuable” or “very valuable.” The information they would most like to access is the amount currently due, expected date of payment, payment details, and a record of what has been paid.
While SCRS notes it is heartening that some sponsors have committed to making monthly payments to sites, it continues to encourage sponsors and CROs to treat sites as true business partners and pay for services received in standard business time, that is, within a month of receipt. Meeting the goals of monthly electronic payments, access to their financial information, and a reduction in manual invoicing is expected to improve site sustainability around the world. SCRS also notes the barriers to implementing these improvements are significantly lower than they once were, and remaining barriers must be removed to improve accounting efficiencies for all sites.
The study collected responses from 760 site personnel between December 20, 2016 and February 7, 2017. Approximately 75 percent of respondents were located in the U.S. and most had been involved in clinical research for more than 10 years. Three-quarters of respondents were part of a hospital or clinical practice, while the remaining 25 percent worked at a freestanding clinical research site or academic medical center.
For more information on the site payments white paper, click here.