Society for Clinical Research Sites landscape survey found that 80% of sites had six or fewer months of operating cash on hand. Site payments are often on terms of up to 90 days from receipt of a correct invoice, sometimes with holdbacks that stretch the wait further (Applied Clinical Trials).
That makes payment timing more than a site's problem. A survey by the Clinical Trials Transformation Initiative found that nearly 40% of sites reported stopping participation in clinical trials because of payment delays (ACRP). When experienced sites leave, sponsors lose capacity, start-up gets slower and enrolment suffers.
How the wait builds up
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Stage
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What happens
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Typical delay source
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Work done
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Site completes the visit and pays its staff
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Site funds the work up front
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Data entered
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Visit data reaches EDC
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Entry backlog
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Visit confirmed
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Sponsor or CRO confirms the visit is payable
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Manual confirmation
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Invoice
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Invoice raised or generated
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Errors cause rejection and resubmission
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Payment terms
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Clock runs from a correct invoice
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Terms of up to 90 days
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Holdback
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A share is retained until close-out
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Release delayed after close-out
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1. Sites fund the work first
Sites pay staff, buy supplies and run procedures before they are paid. With short cash reserves, every week of delay is a week the site is lending money to the study.
2. Payment frequency matters as much as payment terms
According to the 2024 SCRS landscape survey, 72% of sites prefer monthly payment schedules, but only about 38% are able to negotiate them (Bourne Partners summary of SCRS data). Quarterly payments on top of long terms leave sites waiting months for routine visits.
3. Incorrect invoices restart the clock
When terms run from a correct invoice, every rejected invoice adds a full cycle. Invoices generated from visit data the sponsor already holds remove most of the errors that cause rejection.
4. Holdbacks need a release plan
Holdbacks protect sponsors until close-out, but they are often released long after the site has finished its work. Tracking holdbacks per site, with a release trigger, keeps the end of the study from becoming a payment dispute.
5. Sites need to see their own status
Without visibility, site finance teams email the study team to ask what has been paid. A portal that shows earned, invoiced and paid amounts per visit removes those requests and builds trust.
What sponsors can change
- Offer monthly payments as the default
- Generate payable amounts from completed visit data
- Reduce invoice rejections by invoicing from the same data
- Track holdbacks per site with a defined release trigger
- Give sites a view of earned, invoiced and paid amounts
- Monitor invoices ageing past agreed terms
What this means by role
- Clinical operations directors: payment speed affects which experienced sites take your next study.
- Study finance leads: fewer rejected invoices and fewer status requests.
- CTMs and clinical operations managers: fewer escalations from sites about missing payments.
- Site directors and site finance teams: predictable cash flow makes it possible to take on more studies.
How Cloudbyz CTFM approaches this
Cloudbyz CTFM, built natively on Salesforce with Cloudbyz CTMS and EDC, is designed so that completed subject visits generate invoices against the site budget, holdbacks are applied as the contract defines, and sites and sponsors can see status through portals. Payment schedules depend on how each site's terms are configured.
The Financial Navigator, an Agentforce agent, flags invoices ageing past 90 days and surfaces the gap between what sites have been paid and what the sponsor has received. The Invoice Reconciliation Agent is designed to check site invoices against the system proforma and route exceptions to a person, so correct invoices are not held up behind problem ones.
See site payments in CTFM
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