SCOPE Summit 2026: How Payment Practices and Operational Burden Are Changing Site Behavior

In a video interview with Applied Clinical Trials at the 2026 SCOPE Summit, Holly Leslie, Vice President of Services at Ledger Run, explained that while site selectivity is not yet universal, momentum is clearly building—particularly among larger, more sophisticated sites. Leslie outlined how payment practices, including holdbacks, inconsistent remuneration, and the operational burden created by AI-driven data queries, are becoming key decision factors for sites. She warned that unless sponsors apply the same rigor to payment performance that they do to patient recruitment, sites will increasingly leverage their power to shift work toward sponsors that offer transparency, consistency, and fair compensation.

Editor's note: This transcript is a lightly edited rendering of the original audio/video content. It may contain errors, informal language, or omissions as spoken in the original recording.

ACT: What trends and challenges around payment experience are you seeing in the industry right now?

Leslie: From a trends perspective, it’s the erosion of the standard. We always charged a holdback, a certain percentage of what the sites are getting paid, and sites are being very intolerant of that right now. People are having to look at other ways of dealing with that. What was recommended in the discussion was to cap the holdback or get rid of it for sites you consistently do business with and know will deliver.

Another issue is the inclusion of AI. AI coming into studies is doubling and tripling the number of queries a site has to go through, and not all of those queries are worth a site’s time. Every time you add a query, you’re taking site personnel away from subjects, which is where you want them. Some smaller sites don’t have the staff for that. If you’re not adding additional resources through financial remuneration, you’re increasing burden.

One sponsor in the room said they actually provide someone to help smaller sites answer queries. But if AI is generating the query, is a human really evaluating whether it’s an important data point, a nice-to-have, or a need-to-have? Without that human analysis, you’re putting additional burden on the site. We talk all the time about sites needing less burden, but in reality, we’re consistently adding to it through things we think are enhancements, but to a site, they’re not.

ACT: Will this trend of sites becoming more selective continue? If so, why?

Leslie: Absolutely. Sites are starting to see how much power they have. They can choose between sponsors who do things right and sponsors who don’t. If you consistently have payment issues with a site, that site is eventually going to stop doing business with you and take their patients to a different sponsor. There’s no shortage of trials in most therapeutic areas.

Sites work for multiple sponsors at any given time, and that selection between pain point and satisfaction is going to drive a huge part of this trend. What I challenged the room with was that until sponsors look at payment metrics with the same due diligence they apply to patient recruitment, this problem won’t be solved. We focus so much on getting patients in, but we don’t ensure sites are paid properly, on time, and transparently for the work they’re doing. Until that changes, sites will continue to take their business elsewhere.