Running an Anesthesia Services RFP: A Hospital’s Checklist

The short answer: an anesthesia services RFP is how a hospital tests the market for its anesthesia coverage, usually when the current group cannot cover the schedule, the relationship has ended, or a contract is expiring without a workable renewal. A good one defines the coverage the hospital needs in hours and locations, asks every bidder for the same cost, staffing and collections information, scores proposals on published weights, and leaves several months between the proposal deadline and the start date: between two and a half and eight and a half months in the public RFPs reviewed here. Before issuing one, price the arrangement you already have. An RFP is a poor way to find out what coverage should cost, and an expensive way to find out that the incumbent was a fair deal.

Before you issue it

• Benchmark the current arrangement. Measure the subsidy per location, per hour of coverage and per case against the market, and check the group’s collections (how stipends are measured). If the gap is collections or unused coverage, a new group will not close it.
• Read the current contract’s exit terms. The without-cause notice period (30 to 180 days in the contracts and RFPs reviewed here, sometimes available to only one side), any non-solicitation clause that stops the hospital from hiring the group’s clinicians, and what happens to coverage during the notice period.
• Check who can actually cover the rooms. Non-compete agreements on the incumbent’s clinicians can leave a hospital unable to staff a transition. In 2024 two Trinity Health hospitals sued their national anesthesia group, alleging that non-competes, and a buyout demand of more than $20 million at one of them, made replacing it prohibitively expensive. The group denied the claims; both suits were settled in 2025. Several states now restrict physician non-competes.
• Decide whether the incumbent is invited. If the current group should be in the field, write the RFP so it is tested on the same terms as everyone else.

What to put in the RFP

Public anesthesia RFPs from county and public hospitals, including Natividad Medical Center in California (2023), Nassau University Medical Center in New York (2024 and 2025), Hilo Medical Center in Hawaii (2020) and JPS Health Network in Texas (2020), ask for much the same things.

1. The coverage you need

• A coverage grid: each location, its hours and days, and the posts covered around the clock (in-house anesthesia for trauma, obstetrics, a dedicated emergency room).
• Response times: Natividad required an in-house response for trauma within 15 minutes and backup within 30; Nassau required 30 minutes for trauma and 60 for stat consults, in person or by phone.
• Services beyond the operating room: endoscopy, interventional radiology, MRI, a pre-operative clinic, pain service, teaching.
• Case volume by location, so bidders price the same workload.

2. The staffing plan

• The care team model and ratio by location (what each ratio costs), and named leadership: a medical director or chief.
• Credentials of the clinicians proposed; Nassau asked for a résumé for every anesthesiologist.
• Recruitment and retention plans, and how much of the schedule would depend on locums (what locums cost).

3. Quality and performance

• Metrics the group will report: on-time first-case starts, cancellations, turnover, complications and patient satisfaction.
• Targets that can be written into the contract. Hilo asked for same-day cancellations under 5%.
• Participation in hospital committees and quality programs.

4. The money

• The proposed subsidy and how it is built: a cost breakdown including clinician pay and the group’s margin above cost, as Natividad required.
• Expected collections by payer, billing audit results and billing history; Natividad asked for three years. We would also ask for the group’s commercial conversion factors.
• The payment structure: fixed stipend, collections guarantee or cost-based funding. We would also ask bidders to state caps and annual escalators.
• Audited financial statements, ownership (Nassau asked for anyone with 5% or more), and any history of sanctions, litigation or bankruptcy.

5. Insurance and the contract

• Malpractice coverage, typically $1 million per occurrence and $3 million in total in these RFPs (per clinician in some), with tail coverage if the policy is claims-made, as Natividad, Hilo and JPS required.
• A sample agreement attached to the RFP, so bidders price the terms they will sign. Natividad’s included the hospital’s right to bring in other coverage if the group could not staff the schedule.
• A transition plan: how the bidder would start, and Hilo’s requirement that the winner keep services running through the changeover.
• References, including the people who work with the group every day. Natividad asked for two administrators, two surgical nurse managers and six surgeons or obstetricians.

How to score it

Publish the weights in the RFP. Two public examples:

Cost matters, but a low subsidy bid from a group that cannot staff the grid is the most expensive outcome. Score the staffing plan’s credibility, and compare cost on the same basis: subsidy per hour of coverage and the collections each bidder assumes.

A realistic timeline

After the award, the new group still has to sign the contract, recruit, license and credential its clinicians, and enroll with payers, which takes months. Plan backward from the date the current contract ends, allowing for its notice period, and build in coverage if the start slips.

The legal guardrails

• Fair market value. Whatever the hospital pays must be consistent with fair market value, set in advance, commercially reasonable and not tied to the volume or value of referrals, to fit the exceptions under the physician self-referral law and the anti-kickback safe harbor. An RFP with comparable bids is useful evidence; a negotiated number on its own is not proof of fair market value.
• Exclusivity. Exclusive anesthesia contracts can be lawful: in Jefferson Parish Hospital District No. 2 v. Hyde (1984) the Supreme Court found that one hospital’s exclusive contract was not an illegal tying arrangement. Keep exclusivity and non-solicitation clauses narrowly drawn.
• State law. Non-compete restrictions, corporate practice of medicine rules and, in a growing number of states, notice requirements for health care transactions all vary.

The checklist

1. Benchmark the current arrangement and confirm why an RFP is needed.
2. Read the current contract’s notice, non-solicitation and transition terms.
3. Write the coverage grid, response times and volumes.
4. Set the information every bidder must give: staffing plan, quality metrics, cost build-up, collections by payer, financials and ownership.
5. Attach a sample agreement with the terms you need.
6. Publish the scoring weights and the evaluation committee.
7. Hold a pre-proposal meeting and a site visit.
8. Interview finalists, including the clinicians who would lead the service.
9. Check references with surgeons and nurse managers, not only executives.
10. Leave enough time between award and start for credentialing, and plan for a delayed start.

For groups on the other side of the table, our guide to writing a winning RFP response covers what hospitals look for.

Sources

• Natividad Medical Center, RFP 9600-87, Anesthesia Services (August 2023).
• Nassau University Medical Center, RFP 008-2024 and RFP 004-2025, Anesthesia Services.
• Hilo Medical Center, RFP 20-0317, Anesthesia Services (2020).
• JPS Health Network, Anesthesia Services RFP (2020).
• 42 CFR 411.357(d) and 1001.952(d); Jefferson Parish Hospital District No. 2 v. Hyde, 466 U.S. 2 (1984).
• Trinity Health hospitals’ complaints against North American Partners in Anesthesia: St. Joseph’s Hospital Health Center (N.D.N.Y. 5:24-cv-00276) and Holy Cross Hospital (S.D. Fla. 0:24-cv-60315), February 2024; settlement reported October 2025.