Tackling Research Site Payment Delays

Michelle Hartmann, Director and Owner of South Broward Research, speaks with David Unger, Director of Operational Excellence and Site Payment Lead at Merck, about tackling clinical research site payment delays. David shares how Merck identified and addressed key challenges in their payment processes, leading to more timely payments and improved site satisfaction. Hear how Merck implemented various strategies including system upgrades, process simplifications, and better communication with sites. Learn how your organization can strive for continuous improvement and collaboration to enhance site payment efficiency.

Transcript

Michelle Hartman: 0:00

Hello and welcome to SCRS Talks. I'm Michelle Hartman, director and owner of South Broward Research and member of the SCRS Payment Initiative. SCRS Talks is a place where industry leaders can discuss pressing industry concerns and solutions. The payment initiative is focused on issues impacting clinical research sites and trial participants and has three work streams dedicated to site payment frequencies, hold back payments, and taxation of trial participant stipends. Today I'm joined by David Unger, site payment lead on Merck's Global Site Budgets and Payments team. David has generously offered to share some insight into Merck's initiatives to address research site payment delays. David, would you mind starting off with a little bit about yourself for our listeners?

David Unger: 0:49

Sure. I'm Dave Unger. I'm the Director of Operational Excellence and the Site Payment Lead here at Merck within our Global Site Budgets and Payments team. I'm actually located in New Jersey, work out of our Raleigh headquarters. I've been at Merck actually for 21 years now. I've had multiple finance positions, supporting clinical operations, and in 2016 actually transitioned into clinical operations where I was one of the site budget TA leads, and then shortly after that took over heading up the payments team. So I oversee a team of payment coordinators, and they're obviously responsible for making all the payments to sites and then working to resolve any issues. Probably since I started, our primary focus has really been on continuous improvement. So basically looking at our process, looking at our systems and just kind of identifying different ways that we could decrease our payment cycle times and then increase the volume of payments were able to make.

Michelle Hartman: 1:54

That is a mouthful. So thank you for sharing that. Well, how did Merck identify the problems associated with site payments and issues that the sites were having?

David Unger: 2:03

Yeah, so kind of a couple of different approaches. Internally, when I first had started, I conducted an assessment on our current process to see what issues our teams were seeing. So I collected feedback from our study teams, our budget negotiators, and actually our payment coordinators- just kind of understand, from their perspectives, what were the issues? What were they seeing? And externally from the sites, we had conducted a large survey that was sent out to them and had a couple of budget and payment questions as well. So I kind of use that information from there. It was looking at the different bottlenecks within our process. So what was taking the most time? Was there a lack of clarity? Was it certain line items that caused most of the issues? Was there a disconnect in terminology in the budget? So things that we could kind of simplify and make those clear. Another thing was the requirements piece in terms of supporting documentation, and then another feedback loop was from our senior management. So, whenever they would go visit countries, 1 of the things that they always came back with was, 1 of the major pain points within a lot of countries was the site payment process. So it's kind of where we got our information from.

Michelle Hartman: 3:20

Well, you really did reach out to lots of different layers and lots of different people that have an impact on what's happening there in terms of with the sites and as well as within the company. So it's kind of like a very holistic kind of process that you had. But so from, all of that feedback that you gathered, what changes did Merck implement to improve the processes to address some of those issues that you identified?

David Unger: 3:46

So one of the first things that we had heard, especially internally was it was our systems. There was a lot of duplicative effort. There was a lack of good integration. Systems weren't talking to each other. But, obviously that's a huge investment in time, cost, people. So we couldn't really wait for just new systems. It was part of our strategic plan to do that, but we really figured focusing on process was something that we could do immediately. So we implemented, I think at first it was a lot of simple, simple changes, like uh you know, clear assignment of roles and responsibilities. So who on the team was doing what and when? Which roles were playing, doing reviews and approvals? Also, we had defined and measured our performance metrics. So looking at our cycle times for the different deliverables and then established targets for those so we'd have something to compare ourselves against and to try and shoot for to beat. One of the most important things I think that we did was the budget and payment alignment meeting. So because we're part global site budgets and payments, we're part of like the same team. So, it was really easy to kind of work together looking at different things within the budget. So, looking at the different wording, what was it within the contract and, what was required for supporting documentation as well. And to really just trying to simplify that. Things that we came up with to make a, a huge really a huge impact, would be like budget buckets, so we weren't reliant on quantities anymore. So we would have like an individual budget line item, but not the quantity for it. And the total would be on a total line. So, if we're talking about imaging or something like that, you would have the chest scan, the cost for a chest scan. You'd have the abdomen, CT, the cost for that, but there wouldn't be 10 of each. It would be, just a total number for all of the imaging. And this way, any mix would work. And as long as it wasn't over that amount, we wouldn't have to be amending the budget all the time. So, it really cut back on the number of amendments. Another thing that we implemented was the withholding. We had heard a lot of feedback about, withholding and why we're doing it. We'd always done just a fixed amount. So we weren't doing like a percentage and it wasn't really a substantial amount. It was just a couple of thousand dollars, I think. But, we eliminated that as part of our process, and then with our new system, we're able to automate our visit payments. So basically going from like 30 days where we would go through and make payments on visits. Now we're able to automate it and do it twice per month. Our startup payments, so we drove that basically off the executed contract or you know, sometimes site ready milestones as well. And I think from making all of these changes, we're able to really drive continuous decreases in our cycle times. One other piece of it would be, better communication with sites. So we, also provided FAQs for invoicing requirements, anything that we could do to make the process easier, easier or simpler so sites could get paid quicker. That's kind of what we focused on. So anything that would help and we could kind of gauge like, hey, was this working? We would go back to sites and just kind of get feedback providing them with a, you know, submission guidelines for invoices and stuff like that. And just really see like, hey, we're taking some shots in the dark here. Is this helpful at all? Is it getting to the right people kind of stuff.

Michelle Hartman: 7:15

As a site, I can tell you it's greatly appreciated. Taking a look at this and the simplifying and I find it so interesting that you had said like the budget and the payments that that's aligned within your company because it seems a lot of times the budgets can be completely separate from payments. So you've negotiated this great budget, but now as a site trying to get the payment from that budget that you've negotiated becomes a hurdle sometimes. So it's interesting how you have that alignment within your company. And, I like the FAQ also for invoicing, because many times, creating this budget, and you have the all of these invoicables, and then you try to do it, and they keep getting kicked back, kicked back, kicked back. So that is so interesting. And you were speaking a little bit about how changing your payment terms affected the sites. What other feedback are you receiving and how are you continuing to monitor your outcomes?

David Unger: 8:08

We were lucky here, I guess. We won the Eagle award twice, which was a great thing. I mean, obviously it's not just payments, but, I think payments Definitely play a role, especially in a site satisfaction. But, our aim was always to pay based on work performed, right, and eliminate any of the obstacles. So we could just pay pay sites quicker. We don't hold invoices or we don't hold our payments for 30 days or 60 days or 90 days. As invoices come in, we process them as soon as we can. So, we have readily turn them around within a couple of days and it has to go through the whole financial flow process, but we're not holding things back. And I think that sites can really count on Merck to pay timely. I'm not going to say that there aren't or haven't ever been issues, that it's always smooth sailing, but we do aim to resolve anything that does Surface rather quickly. We have a huge portfolio of studies that we pay. So we really try to standardize things and rely on automation wherever we can. So. When it comes to monitoring our outcomes, we're looking at our performance metrics on a monthly and then quarterly basis and using this information to look at any issues that surface and any areas of potential improvement. We also get feedback from sites. So while our budget negotiators are out there talking to sites, a lot of information comes back from them. So we meet with them regularly to talk through some things and then on the payments team as well, they identify different challenges that they have. And then, we kind of focus on this information and bring this up at our budget and payment alignment meetings.

Michelle Hartman: 9:47

That's wonderful. Again, just it's so appreciated and I'm glad you are getting the feedback and that you're hearing how, how it is affecting the sites because it is a positive. I would think it's well, at least, again from a site, my site perspective, right? It because we, we deal with so many different sponsors and different CROs and it's not all aligning that way. Changes are coming, but it's not always easy. So could you walk us through your timelines for making decisions to change and maybe implementation and adoption of the changes?

David Unger: 10:21

Sure. So, the decision to make changes, I guess, started basically when I first took over leading a team just based on the feedback I had received. I knew that systems was not going to be something that we could do overnight. And, In order to change really relied on the team. So we have a really strong team here with a lot of creative, innovative ideas and, talking with the payments team, understanding the different challenges that they had so, the focus was really on process. And it was really something we did immediately. It was just kind of assessing the situation, looking at different levers that we could change and then making those changes. Again, keeping that close alignment with the budget team, just ensure everybody was kind of on the same page. But some changes that were completely internal, we did like instantly. As long as they were within compliance and audit requirements, we're fine. That was 1 of the big things that I had pushed was this for my team to just be like, okay, if we're doing something and you don't think we should be doing it and it's serving no purpose, then how do we, kind of eliminate that? And that's how we just worked through our entire process. I think that one of the lessons learned was that we couldn't make all the changes at once So what was really successful, I think, is just making small, incremental changes on a continuous basis. I think that was really helpful because we had tried a couple of times to roll out about five different things at once. And it kind of became a soup sandwich or something, because it's across too many different groups and too many different teams. And there was just too much change. So we, just kind of focused on one or two small changes, implement those, get those working and then just continuously doing that. And we're really able to tribe down our cycle times. And obstacles on the system side, Obviously, it's a much longer process. Just developing the business cases and having the senior management support and then just obviously doing all the due diligence on the system capabilities and what's out there.

Michelle Hartman: 12:15

Yeah, and I guess you have obstacles come as you go, like you said it. I think taking it step by step. It's like anytime you're trying to make change, you're trying to improve different systems, you have to break it down and go piece by piece. And it seems like that's been successful for you all.

David Unger: 12:32

Yeah. It's not a simple task. There's a lot of, of integrations, especially in a global company. And not everybody has the capabilities to do it.

Michelle Hartman: 12:41

What message would you like to share with the industry so that other sponsors or CROs may adopt some of these best practices? Share a little bit of your secret sauce.

David Unger: 12:51

Yeah, I think that, you know, I think we all just need to be creative and work together to find different solutions. We're both trying to achieve the same thing. You guys are trying to get paid quicker. And, on the sponsor side, we're trying to pay quickly as we can for the work performed. And, sometimes, looking for these different solutions, what works for 1 company might not work for everyone. It only takes really a little bit of effort to make these improvements, especially when there are small adjustments. And they really compound over time. That's that's what we've seen. We've just kind of built upon, 1 success. We'd implement something and then, a couple of months later, implementing something else. And it really just kind of compounded and drove down our cycle times quite a bit. Also just kind of challenging the way that we think. So looking at our current process, we would look at it through like a different lens from the site side, not just from our side. So, we would talk to different Sites and get their feedback. We had a lot of people who previously worked at sites and get their input as well. Again, just that alignment between the budget and payment team I feel like it's so important because if it's disconnected, it really just slows things down. Previously, when I 1st started in the group, it was just the budget side. And then, that's when the payments team came in not too long after, and that's when I took lead that, but just that coming together of both groups was really, I think, just really caused a lot of momentum and success And when it comes to systems, it is an enormous undertaking with a huge commitment, both financially and with resources and time and, you really have to have senior management support, or, it will go nowhere. So, until there's a, you know, there's no clinical Venmo payment system out there yet, but I think that we can always continue to focus on the process until there is.

Michelle Hartman: 14:41

Right. I like what you say here, like, in terms of messages, just step by step, you can start small, you don't have to make the whole change at the same time. Yeah, systems, you have to tackle that, but you know that you can definitely make a change by just Doing one thing at a time and compound, using your word there. And I love the challenge the way we think. If we keep doing what we've been doing, we're going to continue to do it. But it's knowing that there's something that you can change, that you've made the change and it hasn't been that long since this change has been happening and you can see concrete evidence of what what you're doing. As you said, Eagle Award for the last 2 years and it does make a difference. I think for sites from a site mindset is when they're looking at sponsors to work with, how they pay is really a big part of the decision making.

David Unger: 15:29

Totally understand. And, it's something that we've been focusing on now for a number of years and, just kind of trying to continue to improve it.

Michelle Hartman: 15:36

Right. Well, David, I thank you again for joining us today and sharing your insight. And for everyone listening, we invite you to learn more about the SCRS payment initiative at myscrs. org. That's m y s c r s dot org. You can find resources for both sites and industry partners to understand the impact of delayed payments on sites, as well as opportunities to support these important programs. Really, we thank you for listening and until next time.