By Erik Yorke 

November 5, 2025 

Bridging Financial and Operational Gaps in Clinical Trials 

For all the technological advances in clinical research, one issue remains stubbornly unresolved: timely, transparent payments to sites. At the latest SCOPE 365 ClinEco Connect, industry peers came together to examine why, after decades of discussion, site payment challenges persist, and what practical steps could finally close the gap. 

Moderated by Carrie Lewis, Executive Director of Clinical Program Optimization at Endo, the session spotlighted how the lack of standardization, communication, and flexibility in payment practices continues to strain relationships between sponsors, CROs, and sites. The discussion was candid, collaborative, and focused squarely on action. 

The Payment Problem That Won’t Go Away 

Participants described a familiar story: delays caused by multi-step invoicing, conflicting instructions between sponsors and CROs, and missing remittance information that forces sites into endless manual tracking. The result? Frustration, cash flow challenges, and eroding trust. 

As one attendee put it, “You can’t expect sites to keep working without pay. (We must) respect their need to run a business.” 

The group agreed that trust and transparency are as important as timeliness. Sites want visibility into what was paid, when, and why. They want real-time reconciliation portals and detailed remittance reports. Above all, they want to feel like equal partners rather than the last link in the financial chain. 

From Negotiation to Partnership 

A central theme was the need to treat budgeting and contracting as two-way conversations. Sites were urged to advocate strongly during budget discussions, documenting advertising, staffing, and administrative needs rather than underbidding to secure participation. 

At the same time, sponsors and CROs were encouraged to show flexibility when study conditions change. “Renegotiation shouldn’t be a failure, it’s good business when assumptions change,” said one participant. 

Endo’s Carrie Lewis shared examples of how open dialogue, sometimes even simple email renegotiations, has helped maintain momentum and prevent site burnout. Sponsors, she noted, can demonstrate leadership by making transparency an expectation and empowering CROs to act within clear parameters. 

Practical Fixes and Proven Models 

The conversation turned tactical as participants shared solutions that have worked in their own organizations. Automation emerged as a key enabler, with systems that connect EDC verification directly to payment triggers. However, attendees emphasized that automation must include site-facing transparency, not just back-end efficiency. 

Other success factors included: 

• Pre-funding study budgets to prevent downstream payment lags.
• Collaborative escalation paths so sites can reach sponsors directly when issues arise.
• Flexible amendment processes that allow updates mid-study without excessive red tape.
• Advocacy through accountability, with sites politely pausing work when payments stall to prompt resolution. 

Each of these approaches, attendees agreed, represents a small but meaningful step toward rebuilding trust across the research ecosystem. 

Data, Dialogue, and Doing Better 

Ultimately, the discussion underscored that payment performance is a reflection of partnership health. Continuous feedback into fair-market-value (FMV) tools and internal benchmarks helps align budgets with reality. But equally important is the willingness to communicate openly—before, during, and after contract execution. 

As Lewis concluded, “If we can’t get a payment out the door, I can’t ask a site to keep screening. We have to respect each other’s business realities. Because without our sites, we have no trials.” 

This discussion was part of the SCOPE 365 ClinEco Connect series, a continuing program of open, peer-driven conversations designed to accelerate learning and collaboration across the clinical research ecosystem. 

To explore upcoming sessions or review past summaries, visit clineco.io/meetups.