December 23, 2025
At Shannon, we believe strong healthcare systems are built through listening, transparency, and accountability. We value the voices of our patients, employees, and community members and appreciate the time and thought shared during the public COPA meeting held on September 25, 2025.
During the meeting, Shannon provided an overview of the changes and new services implemented since the integration of the South Campus. The meeting was open to anyone within the Shannon service area, and participants were invited to share oral and written comments. Approximately 30 community members attended the forum.
This document responds directly to the concerns raised. A copy of this response will be emailed to all attendees who submitted comments and provided an email address, and it will be publicly available at www.CareforSanAngelo.com.
What is a Certificate of Public Advantage (COPA)?
In 2020, Shannon Health System acquired San Angelo Community Medical Center and Community Medical Associates. This integration allowed our community’s hospitals to combine resources, protect access to care, and reinvest savings into local healthcare services. The integration also preserved more than 400 healthcare jobs and allowed patients to continue seeing many of their established physicians.
We acknowledge community concerns regarding consolidation and the perception of a “monopoly.” It is true that the integration resulted in one primary hospital system in San Angelo. However, the COPA exists specifically to protect the public interest in situations like this by placing the hospital under state oversight and accountability.
The COPA is overseen by the Office of Public Insurance Counsel (OPIC) and requires Shannon to demonstrate that the integration:
- Improves or maintains quality of care
- Expands or preserves access to care
- Keeps cost increases within state-approved limits
Since the COPA became effective, Shannon has:
- Introduced new services, including expanded telemedicine
- Invested significantly in replacing outdated equipment and upgrading facilities on both the Downtown and South campuses
- Added more than 150 physicians and advanced practice professionals
- Opened additional clinic locations to improve access across the region
Shannon is required to submit extensive quarterly and annual reports to OPIC, and any hospital-based pricing changes must be reviewed and approved by the state. Since the COPA’s implementation, Shannon’s rate increases have remained consistent with historical trends prior to the COPA.
Most importantly, the COPA helps ensure that healthcare decisions and dollars remain locally governed, rather than controlled by a national or out-of-state entity unfamiliar with the needs of West Texas.
Tax-Exempt, Nonprofit Status
Shannon is a locally owned, private, nonprofit healthcare system. As required under the Affordable Care Act, Shannon publicly reports its charity care and community benefit through the IRS Form 990, Schedule H.
In fiscal year 2024, Shannon provided:
- $72.1 million in charity care
- $37.2 million in community benefit programs
This represents a significant increase compared to approximately $33 million in total charity care in 2020 across both organizations prior to integration.
Tom Green County does not have a hospital tax. Without Shannon’s nonprofit structure and charitable mission, this level of care for uninsured and underinsured patients would otherwise require taxpayer support. Through the Shannon Trust, additional funding supports facility modernization, technology upgrades, and expanded access to care.
For more than 90 years, Shannon has honored the vision of our benefactor, Margaret Shannon, by providing care regardless of a patient’s ability to pay.
Access to Care & Physician Recruitment/Retention
What we heard:
- Long wait times for appointments, especially specialty care
- Concerns about staff shortages
- Requests for more time with physicians
- Questions about physician schedules and the role of nurse practitioners
What we are doing:
Improving access remains one of our highest priorities. Shannon currently provides access to more than 400 providers across 40 specialties and 30 locations, and we continue to actively recruit physicians and advanced practice professionals.
An internal leadership team reviews access-to-care data monthly, including wait times for new and existing patients by specialty. Based on this data:
- Recruitment priorities are adjusted by specialty
- Staffing models are reviewed and updated
- Virtual health options are expanded in select specialty areas to increase access more quickly
Shannon is also expanding the use of patient navigators, who help patients coordinate appointments, understand treatment options, and move through care more efficiently.
In our Urgent Care centers, the “On My Way” feature allows patients to register remotely, receive real-time updates, and wait elsewhere until it is time to be seen—reducing wait-room congestion and improving the patient experience.
To further support timely access to care, Shannon offers a free “Ask A Nurse” hotline, available 24 hours a day, 7 days a week. Calls are answered by Shannon Registered Nurses who provide trusted clinical guidance and help patients determine the most appropriate next step for their care. This service helps patients make informed decisions, avoid unnecessary emergency visits, and access the right level of care as efficiently as possible—especially during evenings, weekends, or when clinic appointments are not immediately available.
Quality of Care
What we heard:
- Questions about the role of nurse practitioners
- Concerns about emergency services at the South Campus
- Requests for more education focused on nutrition and preventive care
- Concerns regarding staff interactions
Our response:
Shannon has been CIHQ-accredited since 2014, meeting all Medicare Conditions of Participation. We continue to invest heavily in clinical quality, technology, and care coordination.
Advanced practice professionals—such as nurse practitioners—play a critical role in improving access while working in collaboration with physicians. This team-based approach is widely used in high-performing health systems nationwide.
Shannon’s South Campus Emergency Department operates in accordance with state and federal regulations. When patients require a higher level of care, established protocols guide safe and timely transfers.
We also recognize that patient experience—including courtesy and communication—is an essential part of quality. Patient feedback is actively reviewed, and concerns related to staff interactions are addressed through coaching, training, and leadership follow-up.
Patient Safety
Patient safety is foundational to every decision we make. Shannon Medical Center has received an “A” Hospital Safety Grade from The Leapfrog Group, recognizing excellence in preventing medical errors and patient harm.
In addition, Shannon partners with the Mayo Clinic Care Network to review processes and adopt best practices related to discharge planning, primary care models, and provider onboarding—strengthening safety and continuity of care.
Employee Compensation
What we heard:
- Concerns about wages
- Questions about unionization
Our response:
Shannon conducts regular market compensation analyses to ensure wages and benefits are competitive within our region and the healthcare industry. Compensation decisions are based on role, experience, and market benchmarks.
We recognize that supporting our workforce is essential to providing safe, high-quality care, and we continually evaluate opportunities to improve compensation, benefits, and workplace support.
Fair Treatment of Employees and Leaders
Shannon is committed to maintaining a workplace that is respectful, inclusive, and fair. We do not tolerate discrimination or harassment of any kind and take appropriate action when concerns arise.
We are committed to diversity, equity, and inclusion at all levels of the organization and strive to create an environment where all team members feel valued, supported, and empowered to provide excellent care.
Cost of Care
What we heard:
Concerns about pricing and affordability
Concerns about billing and collections
Our response:
We understand the financial stress healthcare costs can create for patients and families. Shannon offers financial assistance programs to qualified patients and works with individuals to explore payment options when needed.
As a nonprofit system, all revenue is reinvested into patient care, workforce support, and access expansion. The COPA provides state oversight to ensure pricing remains within approved limits and serves the public interest.
Does the COPA Prevent Other Healthcare Organizations from Coming to San Angelo?
No. The COPA does not prevent other healthcare providers or organizations from entering San Angelo or Tom Green County. Any organization may establish healthcare services in the region, subject to standard licensing and regulatory requirements.
Transfers to Higher Levels of Care
Patients are transferred to higher levels of care only when clinically necessary. Shannon follows established medical guidelines to ensure each patient receives care in the most appropriate setting.
Through expanded trauma, cardiac, NICU, and AirMed services, Shannon continues to reduce the need for transfers while ensuring patient safety remains the top priority.
