February 24, 2022

Advocate in Action: Dr. Silva Outlines Advocacy Success Strategies


Image of Dr. Silva

Getting a bill introduced at the state legislative level and having it enacted is not an easy feat, but Dr. Ezequiel “Zeke” Silva III, MD, FACR, FSIR, FBRMA, RCC, was instrumental in doing that in 2021 in Texas. Representing both the Texas Radiological Society and the Texas Medical Association, Dr. Silva led the charge in advocating for House Bill (H.B.) 3459, which established a continuous prior authorization exemption for physicians who earn a 90% approval rate on prior authorization requests for a given service over a period of six months.

Known as the “gold card” legislation, this bill passed in September 2021, and Dr. Silva is now focused on its implementation. While every state legislature is different, there are a few key strategies that Dr. Silva learned that could be beneficial in other states when thinking about introducing legislation:

  • Identify a pressing and relevant issue to both patients and physicians.
  • Gather reliable data. Data was important in Dr. Silva’s experience with H.B. 3459 to demonstrate the negative consequences of prior authorization and helped strengthen the necessity of the bill.
  • Build coalitions with other medical specialties, medical organizations and impacted individuals. This is essential when speaking to legislators and their staff and testifying at legislative committee hearings.
  • If possible, find a physician legislator to be the primary sponsor. Rep. Greg Bonnen, MD, a neurosurgeon and medical professor, was the prime sponsor of H.B. 3459.
  • Know the Process — Become familiar with how the legislation, if enacted, will be implemented. In this case, H.B. 3459 is being implemented by the Texas Department of Insurance.

Dr. Silva believes the Texas legislation could serve as a model for other states. To that end, he recently testified before the Mississippi Senate Insurance Committee in support of similar state legislation.

Dr. Silva resides in San Antonio, Texas where he is a member of the board of directors for the South Texas Radiology Group, medical director of Radiology at the Methodist Texan Hospital, and an adjunct professor at UT Health-Long School of Medicine, San Antonio. He is the immediate past Chair of the ACR Commission on Economics.

The reason he brings so much energy to advocacy is that many people, even those in other medical specialties, do not fully understand the important role of a radiologist. Not only do radiologists offer a unique perspective on healthcare issues, but their work also directly impacts other physicians. With H.B. 3459, having a radiologist like Dr. Silva speak about the burdens of prior authorization was particularly impactful to legislators.

Dr. Silva is a graduate of the University of Texas at Austin. He completed medical school and residency at Baylor College of Medicine before pursuing a fellowship in vascular and interventional radiology at Massachusetts General Hospital.

The American College of Radiology® (ACR®) supports advocacy efforts at the state and federal levels.

For more information about the legislation or if you want to highlight you or your colleague’s advocacy activities, please contact Dillon Harp, ACR Senior State Government Relations Specialist.