Clinical trial sites are leaking money, often without even realizing it. In this episode of Note to File, Denali and Brad sit down with Dr. Daniel Fox of CRPN (Clinical Research Payment Network) to unpack the ugly truth about site finances, brutal IWOs, "free" trial coaches, and why so many sites end up doing work for zero pay.

From unscheduled visits that never get reimbursed to vague CTAs that sponsors happily reinterpret after startup, Daniel breaks down exactly where sites lose money, how to protect yourself, and what real leverage you have, whether you're a small independent site or part of a growing network. The conversation also hits Operation Trialblazer, collapsing trial phases, PE/VC money in research, and how site strategy shifts when your endgame is an exit versus a long-term community mission.

Stick around to the end for Daniel's surprise: a clinical research negotiating board game designed to help sponsors, CROs, and sites see each other's incentives and turn budget pain into something a little more fun.

Episode highlights:
- Why most sites treat finance like a side job and pay for it later
- IWOs, "invoice it or lose it," and contracts that quietly erase your revenue
- The gap between contract negotiators and coordinators doing the actual work
- How specific language in your CTA can save you from post-award "reinterpretation"
- IRB fees, pass-throughs, and central IRBs that don't want to pay sites
- Trial coaches and CTEs: "free" support that eats your time and margins
- Operation Trialblazer and what single, bigger trials mean for sites
- PE and big site networks: chasing EBITDA versus serving patients and sponsors
- When to fail fast on a bad trial instead of grinding it out and wasting money
- Daniel's CRPN negotiating board game and how it brings site finance to life

If you run or support a clinical trial site and have ever asked, "Where did all the money go?" this episode is for you.