How to run an anesthesia RFP: a hospital’s guide

An anesthesia RFP is one of the few moments when the hospital sets the terms. Run well, it produces bids you can compare, obligations you can enforce and a contract you can manage. Run in a hurry, it produces proposals that answer different questions and a coverage gap you cannot afford.

The money involved justifies the care. Much of what is written about an anesthesia services RFP is for the groups that respond. This guide is for the hospital that issues one.

Decide whether an RFP is the right tool

An RFP is not the only way to fix an anesthesia arrangement. Often it is not the first.

If the problems are specific and fixable, try renegotiating. Put the metrics in writing and give the group a defined period to meet them. Kaufman describes a common approach: give the group "a few months" to correct a breach, to avoid the disruption of replacing it.¹

An RFP makes more sense when:

• Coverage gaps or service problems persist after a cure period.
• You cannot test the group's subsidy request with the data it provides.
• You are adding sites or services the current arrangement was not built for.
• The contract is ending and the board expects a market test.

Weigh the cost, too. An RFP can unsettle the clinicians you rely on today, including those you may want to keep. Make the decision deliberately, and write down why.

Build the team and gather your own data first

Kaufman advises treating hospital-based physician services as a service line, with "an experienced executive team" accountable for performance.¹ For an RFP, that means a small, named team: an executive sponsor, finance, perioperative leadership, nursing, a physician leader and counsel. Include clinical voices. Hilo Medical Center's 2020 RFP named an evaluation committee of one member from the anesthesia division and two from executive management.²

Then gather your data, before you write the RFP. Bidders price what you show them. If you show them little, they price the risk.

At minimum, pull:

• Case volume by site and hour. Every anesthetizing location, by day of week and time block.
• Payer mix. By case volume, and by site if it differs.
• The current coverage grid. Staffed rooms and hours, call arrangements, obstetric coverage.
• The current subsidy. What you pay, how it is calculated and what it has bought.

Public RFPs show what this looks like. Hilo's included a data questionnaire covering payer mix by case volume, case volume by type, patients' ASA physical status, rooms staffed by time block and on-call arrangements.²

Write requirements that bidders can price

Clear requirements make proposals comparable. Vague ones let each bidder answer a different question. There is no single anesthesia RFP template, but the strongest documents cover the same ground.

Coverage by location and hour

List every location and the hours you expect it staffed, including nights, weekends and holidays. Look past the main OR. In one national anesthesia registry, the share of cases performed outside the operating room rose from 28.3% in 2010 to 35.9% in 2014.³ Endoscopy, the cath lab, interventional radiology and labor and delivery belong on the grid.

Care-team model

State your expectations, then ask each bidder to propose a model by location. Anesthesiologists, CRNAs and anesthesiologist assistants can work in different combinations. Medicare pays for an anesthesiologist's medical direction of up to four concurrent cases.⁴ Federal hospital rules also allow a state to request an exemption from physician supervision of CRNAs.⁵ Ask for options, not a single answer. Natividad Medical Center's 2023 RFP asked for staffing options, "including Physician and CRNA combinations."⁶

Quality and service metrics

Name a short list the group can influence. Hilo's RFP listed on-time first-case starts, day-of-surgery cancellations, selected MIPS measures and specific adverse events.² Say how each will be measured and reported.

Reporting and data rights

Require regular reports on coverage, staffing, billing and collections, with the right to audit. Natividad asked for estimated collections by payer and three years of billing and collections history.⁶

Cost proposal

Give every bidder the same format: direct costs, indirect costs, expected revenue and the resulting subsidy. Natividad and Hilo both asked for this breakdown.⁶²

Transition obligations

Require coverage to stay whole from day one. Hilo said it expected the contractor to keep the current service "intact and operational during any transitional periods."²

Set a realistic timeline and scoring grid

Plan for these phases:

1. Preparation: data, requirements, scoring grid and approvals.
2. Release, with a pre-proposal meeting or site visit.
3. Written questions and published answers.
4. Proposals due.
5. Evaluation, clarifications and presentations.
6. Best and final offers, if needed.
7. Award, contract and credentialing.
8. Transition and go-live.

Public schedules show how the pieces fit. Hilo issued its RFP on January 28, 2020, took proposals on April 17, planned an award around May 8 and set a contract start of August 6.² Work backward from the date your current agreement ends, and leave room for credentialing.

Name one point of contact. Natividad warned that unauthorized contact with county staff "may be considered undue pressure and cause for disqualification."⁶ Tell your medical staff the rules as well.

Publish the scoring grid in the RFP. Common criteria:

• Coverage plan and staffing depth
• Quality program and physician leadership
• Experience and references
• Cost and subsidy
• Transition plan
• Acceptance of key contract terms

Weights vary. Natividad gave cost 20% of the score; Hilo gave it 40%.⁶² We would weight coverage and quality, together, well ahead of price. A low bid that cannot staff your rooms is not a saving. Natividad put it plainly: the award "will not be based on cost alone."⁶

Check references, visit sites and negotiate with finalists

Ask for references who saw the group at work, not only those who signed its contract. Natividad asked for two hospital administrators, two surgical nurse managers and six physicians across surgical specialties.⁶ Call them. Ask about coverage gaps, turnover, leadership and how problems were handled.

Visit a site each finalist serves. Hilo asked bidders for access to two of their sites, including calls with providers and administrators.² Bring a clinician, and watch how the team runs a morning.

Then negotiate with one or two finalists. Test staffing assumptions, subsidy mechanics, volume adjustments, metrics tied to payment and termination terms. Keep the runner-up in play. Natividad's RFP reserved the right to move to the next-ranked bidder if negotiations failed.⁶

Plan the transition before you award

Transitions tend to break at the seams: credentialing, payer enrollment, scheduling and clinicians caught between two contracts.

Start with your current agreement. Check the notice period and any clause that limits hiring the group's clinicians. A sample anesthesia services agreement published by the AANA, for example, bars the facility from soliciting the group's clinicians for twelve months after termination.⁷ If you hope to keep clinicians who know your rooms, find out early whether you can. Hilo asked bidders to make offers to its current anesthesiologists and to leave non-compete clauses out of their agreements.²

Restrictive covenants also have federal attention. In September 2025, the FTC chairman sent warning letters urging healthcare employers and staffing firms to review their noncompete agreements.⁸

Involve counsel early on restrictive covenants, non-solicitation, exclusivity, notice and termination periods, fair market value and any public-records rules that apply to proposals.

Then write a day-by-day plan for the last month of the old contract and the first month of the new one. Give every location on the grid an owner.

A short checklist

• Decide between renegotiation and an RFP, and record why.
• Name the team, including a clinician and counsel.
• Pull case volume by site and hour, payer mix, the coverage grid and the current subsidy.
• Write requirements for coverage, care-team model, metrics, data rights and transition.
• Issue one cost format to every bidder.
• Build the timeline backward from your contract end date.
• Publish the scoring grid.
• Check references and visit sites.
• Negotiate with finalists, and keep the runner-up in play.
• Review restrictive covenants and notice terms with counsel.
• Assign an owner to every location for go-live.

If a renewal is on the table instead, start with our questions before renewing an anesthesia contract. For how we support the process end to end, see anesthesia RFP and transition support.

Sources

1. Nathan Kaufman, "Nathan Kaufman: Hospital-based anesthesia and radiology operate in a broken financial model," HFMA, January 2026. https://www.hfma.org/finance-and-business-strategy/physician-compensation/hospital-based-anesthesia-and-radiology-a-broken-financial-model/ ↩ ↩²

2. Hilo Medical Center, "Request for Proposals RFP #HHSC 20-0317: Anesthesia Management Services for Hilo Medical Center," Hawaii Health Systems Corporation, January 2020. https://www.hbmc.org/wp-content/uploads/2020/01/20-0317-Anesthesia-Request-for-Proposals-issued.pdf ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹

3. Alexander Nagrebetsky, Rodney A. Gabriel, Richard P. Dutton and Richard D. Urman, "Growth of Nonoperating Room Anesthesia Care in the United States: A Contemporary Trends Analysis," Anesthesia & Analgesia, April 2017. https://pubmed.ncbi.nlm.nih.gov/27918331/ ↩

4. U.S. Code of Federal Regulations, "42 CFR § 415.110 – Conditions for payment: Medically directed anesthesia services," via Legal Information Institute, Cornell Law School, current text. https://www.law.cornell.edu/cfr/text/42/415.110 ↩

5. U.S. Code of Federal Regulations, "42 CFR § 482.52 – Condition of participation: Anesthesia services," via Legal Information Institute, Cornell Law School, current text. https://www.law.cornell.edu/cfr/text/42/482.52 ↩

6. Natividad Medical Center, "Request for Proposals RFP# 9600-87 for Anesthesia Services," County of Monterey, August 2023. https://www.natividad.com/wp-content/uploads/2023/08/9600-87-Anesthesia-Services-RFP.pdf ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸

7. American Association of Nurse Anesthesiology, "Anesthesia Services Agreement Sample," AANA Professional Practice Division, October 2015. https://www.aana.com/wp-content/uploads/2023/01/anesthesia-services-agreement.pdf ↩

8. Federal Trade Commission, "FTC Chairman Ferguson Issues Noncompete Warning Letters to Healthcare Employers and Staffing Companies," FTC press release, September 2025. https://www.ftc.gov/news-events/news/press-releases/2025/09/ftc-chairman-ferguson-issues-noncompete-warning-letters-healthcare-employers-staffing-companies ↩