Healthcare Construction Bidding Guide: Hospital & Medical Facility Contracts 2025

Healthcare Construction Market Overview

Healthcare Construction Market

Annual Investment:

$55B+

Healthcare construction

Cost per SF:

$400-800

Hospital construction

Growth Rate:

4-6%

Annual growth

Healthcare construction is one of the most specialized and demanding sectors in the industry. Projects require compliance with complex regulatory frameworks, infection control protocols, and construction in occupied facilities while maintaining patient care. Contractors who develop expertise in this sector can command premium pricing and build long-term relationships with healthcare systems.

Market Drivers

Growth Factors

• Aging population healthcare needs
• Technology and equipment upgrades
• Outpatient facility expansion
• Seismic and code compliance

Project Trends

• Ambulatory surgery centers
• Behavioral health facilities
• Rural hospital improvements
• Emergency department expansion

Healthcare Project Types

Facility Categories

Acute Care Hospitals

New construction, additions, and renovations of inpatient facilities. Most complex regulatory requirements and highest construction costs.

Ambulatory Surgery Centers (ASC)

Outpatient surgical facilities. Growing rapidly as procedures shift from hospitals. Less complex than acute care.

Medical Office Buildings (MOB)

Physician offices, clinics, imaging centers. May require OSHPD-3 or similar approval depending on services.

Specialty Facilities

Dialysis centers, cancer treatment, rehabilitation hospitals, psychiatric facilities. Each has unique requirements.

Common Renovation Projects

Operating room upgrades
Emergency department expansion
Patient room modernization
HVAC system replacement
Medical gas system upgrades

Specialty Systems

Medical gas piping systems
Critical power and generators
Nurse call systems
Radiation shielding
Air handling and HEPA filtration

Regulatory Requirements

California HCAI (Formerly OSHPD)

The California Department of Health Care Access and Information (HCAI) regulates hospital and clinic construction. Understanding HCAI approval is essential for California healthcare work.

Building Categories

• HCAI-1: Acute care hospitals
• HCAI-2: Skilled nursing
• HCAI-3: Clinics
• HCAI-4: Correctional treatment

Process Requirements

• Plan review and approval
• Inspector of Record (IOR)
• Special inspections
• Close-out certification

Joint Commission Standards

Environment of Care requirements
Life Safety Code compliance
Interim Life Safety Measures (ILSM)
Emergency preparedness
Utility system management

CMS/Medicare Requirements

Conditions of Participation
Life Safety Code (NFPA 101)
Healthcare Facilities Code (NFPA 99)
ADA/Accessibility requirements
FGI Guidelines compliance

Infection Control Risk Assessment (ICRA)

ICRA Requirements

Infection Control Risk Assessment is mandatory for construction in healthcare facilities. Contractors must implement barriers and procedures to prevent airborne contamination and protect patients.

Class I

Low Risk

Inspection, minor maintenance. Minimal dust generation.

Class II

Moderate Risk

Small-scale work, short duration. Limited dust barriers required.

Class III

Medium-High Risk

Major work near patient areas. Hard barriers, negative air required.

Class IV

High Risk

Major construction in critical areas. Full containment, HEPA, anteroom.

ICRA Implementation

Physical Requirements

• Dust barriers to deck
• Negative air pressure
• HEPA filtration
• Sealed penetrations
• Dedicated construction exits

Procedural Requirements

• Daily ICRA monitoring logs
• Worker traffic management
• Debris removal protocols
• Clean-up before barrier removal
• Infection control sign-off

Healthcare Bidding Process

Procurement Methods

Public Healthcare Systems

County and public hospitals follow public bidding rules. Lowest responsible bidder, prevailing wage, DBE goals typically apply.

Private Health Systems

Invited competitive bids or negotiated contracts. Prequalification and relationship-building are critical.

Design-Build & CMAR

Complex healthcare projects often use alternative delivery. Qualifications and approach matter as much as price.

Key Bid Components

Qualifications

• Healthcare project experience
• ICRA certifications
• Key personnel qualifications
• References from health systems

Technical Approach

• Phasing and logistics plan
• Infection control approach
• Quality assurance program
• Schedule with milestones

Winning Healthcare Contracts

Success Strategies

Invest in Healthcare Expertise
ICRA training, ASHE certifications, and healthcare-specific experience differentiate your firm.
Build Health System Relationships
Healthcare systems prefer contractors they trust. Excellent performance leads to repeat work.
Understand MEP Complexity
Medical gas, emergency power, and specialized HVAC require experienced trade partners.
Excel at Occupied Facility Work
Demonstrate ability to work safely in active healthcare environments with minimal disruption.

Critical Risk Areas

ICRA violations can shut down projects and harm patients
Utility shutdowns must be carefully coordinated with operations
Fire watch and ILSM documentation is critical
Plan review delays (HCAI) can extend schedules significantly
Equipment coordination with vendors is complex