Monday, April 8, 2013

BEWARE of Investing in Hospitals: for CEO’s and CFO’s of Private Equity Firms.

                      The attached Crain's article speaks to the serious cash crunch facing hospitals: CFO’s lament at Healthcare Financial Management Association meeting. As an advocate for financial healthcare, I am disturbed by these voices. 

                Private equity firms should BEWARE of investing in hospitals! Before one single dollar is transferred, investors should first learn where the holes are in 99% of hospital financial statements. Unpaid accounts that should be written off, are kept on the books for years at a time as “projected income”  instead of being listed as projected LOSSES. There are reasons for this: 
                 Particularly with respect to No Fault and Workers Comp receivables,  (notoriously difficult and arduous to collect) unpaid claims are presented to CFO’s as part of a “BUCKET by CARRIER” of money “still outstanding.” Claims reports typically emphasize the most egregious payors, INSTEAD of detailing the seriousness of the individual outstanding claims by each individual dollar amount, corresponding to its date of service and date of payment (or non payment). 
                          CFO’s are not aware of the inaccuracies inherent within the “bucket” practice of course, because they focus on bottom lines: income vs expenses. Traditionally, No Fault and Workers Comp have represented a small part of the asset picture. However, with decreasing Medicare/Medicaid and Commercial Insurance payments besieging Hospital profitability on all fronts, this potential asset or loss should be examined through a much finer lens. 
                            Some hospital finance executives speak of their ability to “drill down” on outstanding aged receivables; but the reality is that 99% of hospitals do NOT have adequate systems or personnel needed to provide this detailed reporting to them, should the CFO’s even know to request it. 
                      I would suggest that going forward, CFO’s obtain monthly analyses of the hospital’s revenue performance that will incorporate true and actual No Fault and Workers Compensation collection data. The information should be sorted by dates of service and payment, per individual claim. This is the ONLY true way to determine the profitability of a hospital’s No Fault and Workers Compensation receivables, and to gain a true picture of its collection performance. Typical hospitals are losing over $5 million dollars annually on this potential asset, but sadly, they are not even aware of it. 

               There are companies available which will provide a cost free analysis of a hospital’s data to help CFO’s obtain true and accurate figures. It would serve private equity firms and hospital administrators well, to take advantage of such programs, instead of “doing it the way we always have.”  The bucket approach does not incentivize executives to improve their overall collection performance, and even more important to investors:  it is misleading.

Monday, April 1, 2013

Care Givers vs Care Takers: Why Can't We Get it Right?

There is a huge difference between one who is a caretaker, and one who is a caregiver. Lately, many people are interchanging these words. Educated people such as newscasters, healthcare providers, journalists (and even celebrities such a Oprah Winfrey), are having a hard time using the English language  correctly. 
In addition to the diametrically different connotations of being a “giver” or a “taker”, one must also consider the definitions of caretaker and caregiver: one takes care of the dead – the other takes care of the living.
        For those of us who are caregivers, and for those who are on the receiving end of caregivers’ help, the interchanging of the two words is almost offensive.      
       -- it would be nice if at least in regard to care giving, we could get it right!

Saturday, March 16, 2013

Can Hospital Boards Save Our Hemorrhaging Hospitals? Financial Statements Are Inaccurate!

How Can Hospital Board Members Save Our Hospitals? Financial Statements are inaccurate!

The problem is that Hospital CFO’s are not aware of the problem: In most instances, $5 million dollars in annual losses are buried.
Accounts receivable departments seem to be neglecting to report accurate financial losses for services rendered in No Fault and Workers Compensation cases. 

• The average hospital foregoes collection of approximately $ 5 million EVERY YEAR, 
of No-fault and Workers Compensation reimbursements. 

• Frequently, hospitals even experience a 0% payment rate for many of these services 

Many accounting clerks represent three to five year outstanding insurance covered claims as “pending payment” – when in reality, they are NEVER paid, and/ or drastically underpaid. 

The reason for this is very simple: it takes providers years to get paid, and when they do, they receive a pittance for their services. 

The tragedy is even worse for Hemorrhaging Hospitals: the problem is that Hospital CFO’s are neither aware of the problem nor how to fix it….

Tuesday, January 29, 2013

Hemorrhaging Hospitals and Profitable Providers: A Look at Ethical Negligence

Are ASC’s Ethically Responsible to notify their investors that they leave 60% of No Fault /Workers Comp reimbursement money with the carriers? In many cases, the partners can’t agree to enroll in the Program because one or more of them have “untouchables” (family member attorney or collection firms) whose services would become obsolete with the new business model.  While No Fault/Workers Compensation only represents  7%  of a typical orthopedic practice’s revenue, some partners don’t believe it is “worth it to worry about it.”  I would like to know, is it ethically negligent to leave money with the insurance companies which could otherwise be given to medical research and other charities? In my opinion, this is Toxic Money Waste.    

Wednesday, January 16, 2013

Governor Cuomo and Hemorrhaging Hospitals: Will he decide it's "no fault"?

Hemorrhaging Hospitals forgo millions annually because they are not adept at collecting No Fault and Workers Compensation claim reimbursements.  The MRT (Medicaid Redesign Team) is looking for ways to help heal New York Hemorrhaging Hospitals and to assure their viability in the years to come. Will the MRT hold  Hemorrhaging Hospitals accountable to accepting new and more profitable programs? Or, will we remain with Toxic Revenue Waste Matter  the way it has  always been because of institutional bureaucratic mentality and the need to keep the status quo: "We always did it this way."

Wednesday, January 2, 2013

Hemorrhaging Hospitals and Mental Health Claims by Angela Hart

In this recent New York Times article, the issue of mental health claims is addressed. Here is yet another area in which Hemorrhaging Hospitals need to appeal claims on a regular basis. One New York hospital lost $50,000 because they hadn't filed an emergency admittance health insurance claim on the Monday following the Friday night that the patient had been treated. .

Tuesday, December 4, 2012

Another New York Hospital Hemorrhages to Death!

 Another New York Hospital Hemorrhages to Death!
Is it time for providers to TOTALLY outsource billing, collecting and appealing?

A Brooklyn hospital, Interfaith Medical Center, has just filed for Chapter 11 bankruptcy. Apparently, the hospital's cash expenses exceed its receipts by two million dollars.The hospital is claiming that they require twenty million from the State to continue operating; actually needing a bailout in order to pay its vendors and meet payroll.

I wholeheartedly  sympathize with the people on the receiving end of such proposed funds. However, as a Providers Advocate who is much too keenly aware of the dismal financial future facing so many providers who continue to resist change,  I am APPALLED at the concept of bailing out ANY institution that does not agree to be held accountable to doing just that: Changing the quantity and quality of the payments due them through health insurance appeals as well as no-fault, workers compensation, and  personal injury claims.

I believe that it is time for providers to let go of the battle so that they can win the war-- before they lose the war. Get out of the claim business and focus on making people well because that is what they do best.

Inasmuch as the average hospital annually leaves approximately 5 million dollars of no fault and workers compensation claims uncollected (average surgical centers actually never even collect on 60% of their No fault and workers comp claims) regrettably I must concur with Kenneth Raske, president and C.E.O. of the Greater New York Hospital Association: “ may turn out that profound problems with the ways health care is paid for... will make it virtually impossible for all but a small number of the city’s hospitals to stay afloat”  because the hospitals are just NOT getting paid enough for these potentially lucrative services.

In addition, hospitals are losing many more millions of dollars annually because they do not have the staff to consistently and effectively appeal adverse determinations for health care payments from insurance carriers.

Utilization Managers do not have enough resources to deal with myriad claim denials for numerous hospital departments. Bill collection agencies focus on collecting money from the patients  (many of whom are too sick  to appeal their claims)  instead of focusing on the insurance companies who have the means to pay appealed claims.

Hospitals should out-source this end of the business so that every single substantial service they provide by every single department in the hospital,
can be handled in the most profitable way. The time has come.

Monday, August 27, 2012

Tuesday, July 17, 2012

Hemorrhaging Hospitals: Open Letter to Kenneth Raske

“Hemorrhaging  Hospitals Toxic Money Waste Syndrome”
-- Was St. Vincent’s an accident waiting to happen?

An Open Letter to Kenneth Raske, President and C.E.O. of the Greater New York Hospital Association

In the Oct 25, 2010 New Yorker “News and Features” column entitled “St. Vincent’s Is the Lehman Brothers of Hospitals”,  Kenneth Raske,  president and C.E.O. of the Greater New York Hospital Association, was quoted as saying  “Its demise was only the beginning. An alarming number of New York’s major medical institutions are teetering on the financial edge.  Indeed, it may turn out that profound problems with the ways health care is paid for, combined with the inherent disadvantages of doing business in New York, will make it virtually impossible for all but a small number of the city’s hospitals to stay afloat.”  Mr. Raske affirms, “We’ve got a lot of hospitals in trouble”.

Trouble? This is an understatement. It is a little known fact that most New York hospitals are losing hundreds of millions of dollars annually because they do not regularly appeal concurrent or retrospective adverse determinations for health care service payments from insurance carriers. However, in New York State alone, HMO providers and patients win over 47% of internally appealed claims and 40% of externally appealed claims!  

Inasmuch as only 5,543 internal and 542 external claims were appealed in 2010 (according to New York Consumer Guide to Health Insurers) it is hard to imagine that St. Vincent’s appealed very many claims on a regular basis --if at all. Thus, my theory remains valid that toxic money waste was a feasible culprit in our city’s loss of a very important institution.

With success rates of way over 40%, why aren't  ALL hospitals and other providers implementing the resources available to them?

While many provisions of Health Care Reform regulate insurance companies’ dealings, surprisingly, waste practices by hospitals have gone unaddressed thus far. We are not talking about toxic medical waste here. No, instead we are addressing Toxic Money Waste:  un-appealed, unclaimed money for covered claims! Sounds like a tongue twister, but this is no funny riddle. Toxic money waste is real, and it is happening all across America, and in a New York hospital near you. This unhealthy medical practice has devastating far-reaching effects on Americans in areas such as personal bankruptcies, hospital closings, job losses, government spending, and increased medical care expense to patients.

Simply put, the fewer and lower the payments that hospitals receive from insurance companies, the worse off we all are.

Many healthcare reforms mean more money for hospitals  -- but New York hospitals are not using resources to go and get it. Is it hubris on their part?  When I contacted a well known Upper East Side hospital that had only recently begun participating in networks other than Empire Blue, the C.F.O. rudely announced that his hospital was “quite capable of doing their job”  

Funny, I thought the hospital’s job was to make people well  -- not to be insurance experts. I wanted to remind him of that proverb which speaks to pride coming before a fall. I wanted to beg him to reconsider taking a better look at the systems his hospital does NOT have in place because most Utilization Managers need to stay more “medically minded” than financially aggressive, and sadly they do not have enough resources to deal with concurrent claim denials  --  let alone retrospective ones. I wanted to tell him that his billing clerks  do not have the time, means or sophistication to take the initiatives required for dealing with C.E.O.’s of insurance companies and Sate Insurance  Commissioners.  I wanted to tell him that bill collection agencies focus on collecting money from the patients  (many of whom are too sick  to appeal their claims)  instead of focusing on the insurance companies who have the means to pay appealed claims. I wanted to tell him that consultants work on a contingency basis so that there is no risk or up front expense to the providers.  I wanted to tell him all this, but he hung up the telephone rather abruptly after he told me that he "had ripped up not only mine, but all the letters he receives which offer to help him on a contingency basis."

If hospitals administrators would please think outside the proverbial box, they will  increase revenue by millions of dollars and possibly head off this disaster before it is too late. 

Mr. Raske is correct:  
 "profound problems with the ways health care is paid for... will make it virtually impossible for all but a small number of the city’s hospitals to stay afloat.” 

In light of ever-increasing costs to providers in malpractice insurance and lower reimbursement levels, it is unconscionable that hospitals do not take full advantage of their rights to submit first and second level appeals as well as External Review appeals and complaints.

And so my personal appeal, and I mean this with the utmost respect, is that Hospital administrators would stop complaining about insurance company reimbursements, and begin complaining to them and to the State, without delay. Unless providers make use of healthcare benefit reforms right now, health reform may be too little, too late, for all of us.

These are extenuating circumstances. Please: step up the plate and stop the hemorrhaging!

There is no need to blame this hemorrhaging on "disadvantages of doing business in New York"  -- we are the greatest city in the world and we love our great hospitals! We want to keep them here -- and financially healthy.  

Physician Heal Thyself

(blog in progress)

Appeals and Grievances: Who's not appealing and why aren't they grieving?

Consumer Guide to Insurers: But who's doing the guiding?

(blog in progress)

Toxic Money Waste: A serious epidemic

(blog in progress)

Wednesday, September 7, 2011

A thoughtful response to the Ellen Willis article posted by Ken Levine

A thoughtful response to the Ellen Willis piece that Ken recently posted.
I read the entire article, with much interest.  While some of it was above my comprehension level due to the geo-political nature of it all, as well as the historical context within which it was written,  there are some parts I would like to speak to, because of the religious biblical implications -- and or, their relevance with respect to the present political and,  oxymoronic  pro Islamic  anti-religious world view.

About me: I am a Messianic Gentile, and I am wholeheartedly an anti-anti Zionist as well. The reason for my strong support of  Israel and Zionism, is due to the strong relationship I have with the Hebrew God, who revealed Himself to us by taking the form of a Jewish Rabbi more than two thousand years ago. His Spirit now lives inside of me, and the understanding of my Jewish Spiritual heritage delights my own spirit in abounding love of both the State of Israel as well as the Jewish people.

While some of my comments will be pithy  (especially the first few) you will find more lengthy replies later in my responses. Please forgive the poor formatting and citations, and lack of footnotes etc., I just do not have energy or time to deal with that right now.
The  points  which I would like to speak to,  are addressed chronologically as derived from Ms. Willis's article, as follows:

1.  "Anti-Zionism in the present political context entails an unprecedented demand  for an   existing state....what else would displaced Jews have done after 1945....knock en mass on the doors of unreceptive European countries and a reluctant  US? ...  anti-Jewish genocide cannot be laid to rest...but remains a possibility implicit in the deep  structure of Christian and Islamic cultures."

I  sincerely wish Ms. Willis were alive today to witness the repentant hearts of many (not all) TRUE Christians -- those who call themselves Christian not because they were born into Gentile homes... and not because they went through a formal educational religious conversion process... --  But rather, because they have had a personal, spiritual experience with the living Jewish Messiah. Thank G-d, the Christian culture has evolved. Patrick Cameron, the Haitian black gentleman I interviewed on my TV show, is just one beautiful example. Towards the end of our interview, he provides the viewer with an excellent teaching on the Hebrew translation of "In the Beginning."

2.  " Anti-Semitism remains the wild card of world politics and the lightening rod  of political crisis,   however constantly it is downplayed or denied. They say that the raising of anti- Semitism in the Palestine  debate--  is used to stifle criticism of Israel.  However, the  reverse is true: accusations of blind loyalty to Israel, intolerance of debate, and exaggeration of Jewish  vulnerability at the expense of "real" (italics mine) Palestine victims, are routinely used to stifle  discussion of how anti-Semitism influences the Israeli-Palestinian conflict or the world's reaction to it."

Very well put Ms. Willis. This is because we are living in a time when "what is good will be called evil, and what is evil will be called good " ("Woe to those who call evil good, and good evil; who put darkness for light, and light for darkness;" (Isaiah 5:20).

3. "My anti-anti-Zionism does not imply support for... efforts  to destroy the Palestinians'  physical, political, and social infrastructure while expanding Jewish settlements in occupied territory, or the disastrous  policy of permitting such settlements in the first place."

Ms. Willis may have been familiar with the following Jewish scripture:
"However, in the cities of the nations the Lord your God is giving you as an inheritance, do not leave alive anything that breathes.  Completely destroy them—the Hittites, Amorites, Canaanites, Perizzites, Hivites and Jebusites—as the Lord your God has commanded you.  Otherwise, they will teach you to follow all the detestable things they do in worshiping their gods, and you will sin against the Lord your God (DEUTERONOMY. 20 ).

 " But Manasseh did not drive out the people of Beth Shan or Taanach or Dor or Ibleam or Megiddo and their surrounding settlements, for the Canaanites were determined to live in that land.  When Israel became strong, they pressed the Canaanites into forced labor but never drove them out completely. Nor did Ephraim drive out the Canaanites living in Gezer, but the Canaanites continued to live there among them. Neither did Zebulun drive out the Canaanites living in Kitron or Nahalol, so these Canaanites lived among them, but Zebulun did subject them to forced labor.  Nor did Asher drive out those living in Akko or Sidon or Ahlab or Akzib or Helbah or Aphek or Rehob.  The Asherites lived among the Canaanite inhabitants of the land because they did not drive them out. Neither did Naphtali drive out those living in Beth Shemesh or Beth Anath.." (JUDGES 1:27-33).

 ‘But if you do not drive out the inhabitants of the land, those you allow to remain will become barbs in your eyes and thorns in your sides. They will give you trouble in the land where you will live (Numbers 33:55).


4.  Israel owes its existence to a world-historical catastrophe. The bloody standoff between Israelis and Palestinians is... a clash of two nationalism's run amok..."

Genesis 25 teaches us differently:
"Isaac prayed to the Lord on behalf of his wife, because she was childless. The Lord answered his prayer, and his wife Rebekah became pregnant. The babies jostled each other within her, and she said, “Why is this happening to me?” So she went to inquire of the Lord. The Lord said to her,
'Two nations are in your womb,
and two peoples from within you will be separated;
one people will be stronger than the other,
and the older will serve the younger.' (Genesis 25:21-2.)

Genesis 16 also teaches us differently:
The angel of the Lord also said to Hagar:
“You are now pregnant
    and you will give birth to a son.
You shall name him Ishmael,
    for the Lord has heard of your misery.
 He will be a wild donkey of a man;
    his hand will be against everyone
    and everyone’s hand against him,
            and he will live in hostility
    toward all his brothers.” (Genesis 16:11-12).

5. A double standard of moral expectations for Israel...suggests that more is at stake here than an ordinary   political dispute-- just as more is at stake in the Israel -Palestine clash than an ordinary border dispute.  If Israel’s conflict with the Palestinians and the Arabs generally cannot be understood without reference to the larger question of relations between Jews and the rest of the world ...I’d argue that no one, Jewish or not,  brought up in a Christian or Islamic-dominated culture can come to this issue without baggage, since the   patriarchal monotheism that governs our ... structure of morality ...was invented by Jews...

I would beg to differ...
'The Lord had said to Abram, “Go from your country, your people and your father’s household to the land I will show you.
 “I will make you into a great nation,
    and I will bless you;
I will make your name great,
    and you will be a blessing.
 I will bless those who bless you,
    and whoever curses you I will curse;
and all peoples on earth
    will be blessed through you.
 So Abram went, as the Lord had told him; and Lot went with him. Abram was seventy-five years old when he set out from Harran. He took his wife Sarai, his nephew Lot, all the possessions they had accumulated and the people they had acquired in Harran, and they set out for the land of Canaan, and they arrived there.
 Abram traveled through the land as far as the site of the great tree of Moreh at Shechem. At that time the Canaanites were in the land. The Lord appeared to Abramand said, “To your offspring I will give this land.” So he built an altar there to the Lord, who had appeared to him.
From there he went on toward the hills east of Bethel and pitched his tent, with Bethel on the west and Ai on the east. There he built an altar to the Lord and called on the name of the Lord.' (GENESIS 12:1-8).

 6. The Jews, in their mythic role as the “chosen people” destined to achieve the redemption of the world through their adherence to God’s law, embody a similar duality: they are avatars of spiritual freedom on the one hand, patriarchal authority .. on the other. In relation to Christianity and Islam, the Jews are the authors of morality but also the stubborn nay-sayers, setting themselves apart, refusing to embrace Jesus or Mohammed as the fulfillment of their quest.

The Prophet Isaiah
 Who has believed our message
    and to whom has the arm of the Lord been revealed?
 He grew up before him like a tender shoot,
    and like a root out of dry ground.
He had no beauty or majesty to attract us to him,
    nothing in his appearance that we should desire him.
 He was despised and rejected by mankind,
    a man of suffering, and familiar with pain.
Like one from whom people hide their faces
    he was despised, and we held him in low esteem. Surely he took up our pain
    and bore our suffering,
yet we considered him punished by God,
    stricken by him, and afflicted.
 But he was pierced for our transgressions,
    he was crushed for our iniquities;
the punishment that brought us peace was on him,
    and by his wounds we are healed.
 We all, like sheep, have gone astray,
    each of us has turned to our own way;
and the Lord has laid on him
    the iniquity of us all.
 He was oppressed and afflicted,
    yet he did not open his mouth;
he was led like a lamb to the slaughter,
    and as a sheep before its shearers is silent,
    so he did not open his mouth.
 By oppression[a] and judgment he was taken away.
    Yet who of his generation protested?
For he was cut off from the land of the living;
    for the transgression of my people he was punished.[b]
 He was assigned a grave with the wicked,
    and with the rich in his death,
though he had done no violence,
    nor was any deceit in his mouth.
 Yet it was the Lord’s will to crush him and cause him to suffer,
    and though the Lord makes his life an offering for sin,
he will see his offspring and prolong his days,
    and the will of the Lord will prosper in his hand.
 After he has suffered,
    he will see the light of life and be satisfied;
by his knowledge[f] my righteous servant will justify many,
    and he will bear their iniquities.
 Therefore I will give him a portion among the great,
    and he will divide the spoils with the strong,
because he poured out his life unto death,
    and was numbered with the transgressors.
For he bore the sin of many,
    and made intercession for the transgressors.

The Prophet Ellen Willis

7. ...who knows what America will look like a few years from now, what our aims in the Middle East will be, what trade-offs we will make?
In the debates over Zionism and anti-Zionism, the situation of Jews is by no means the only question. But it is a question. Is it possible that Jews could once again be massacred? Given the rise of Islamic fundamentalism, the ubiquity of anti-Semitism in the Arab world, the anti-Jewish subtext in much anti-Zionist polemic along with the denial that any such sentiment exists—and given that in an increasingly murderous world the unthinkable takes place on a daily basis—I have to argue that the possibility cannot be dismissed. If there should be a mass outbreak of anti-Jewish violence it will no doubt focus on Israel, but it will not, in the end, be caused by Israel, and the hatred will not disappear if Israel does.

DISCLAIMER BY ANGELA HART: i HAVE NOT READ mR. aLFRED'S BIO, and I do not know anything about him. however, his biblical analysis, at  first glance, looks correct to me and so i included it herein.  (iSRAEL WILL NEVER DISAPPEAR! G-D HAS PLANS FOR HER.)


We have previously covered Old Testament prophecies concerning the first coming—the incarnation—of Jesus. Now, we will see what the Bible has foretold about the second coming of Jesus.
As we come to this second area, however, we enter a completely different approach than the prophecies concerning Jesus’ first coming, and this is because of Jesus’ own words about it:
But of that day and hour no one knows, not even the angels of heaven, nor the Son, but the Father alone. (Matthew 24:36)
And so when they had come together, they were asking Him, saying, “Lord, is it at this time You are restoring the kingdom to Israel?” He said to them, “It is not for you to know times or epochs which the Father has fixed by His own authority. (Acts 1:6-7)
The importance of the above two passages cannot be overstated. Many of us have seen several attempts to pinpoint when Jesus was supposed to come back based on various current events (i.e., after Israel became a nation on 5/14/48; the Six-Day war from 6/5/67-6/10/67; the assassination of Anwar Sadat on 10/6/81; the expulsion of the Shah of Iran and the installation of an Islamic state in Iran under the Ayatollah Khomeini in 1979; the 40 year generation theory from 1948-1988; Y-2K; the 40 year generation theory from 1967-2007; the terror attack of 9/11/2001; the election of Barack Obama; the election of Mahmoud Ahmadinejad as Iranian President in 2005; and many more).
As we will see, such attempts are not new; they have been going on for at least 2000 years!
At this point, we are going to look first at the Scripture that foretells the Second Coming of Jesus in the Old Testament, then we will look at the Scripture that foretells the Second Coming of Jesus in the New Testament, and then we will look at some attempts throughout history that have tried to pinpoint when Jesus was returning.


One of the most important Old Testament prophecies concerning the return of Christ and the reestablishment of Israel is found in Ezekiel 37-39. In chapter 37, we have an account of the nation of Israel being resurrected, and, without falling into the trap of eisegesis (i.e., reading into the text something that isn’t there), I believe that most any knowledgeable and objectiveindividual, be they a biblical or historical scholar, or any adult who has a solid grasp on Scripture and world history, would have to say that these chapters have and are happening before our very eyes. Below is a very succinct analysis of these chapters:


You can see this in Ezekiel 37:1-4. Here’s what happened in history:

IN THE 1890S

In the late 19th century, a movement called Zionism emerged under the direction of a man named Theodor Herzl, and his unabashed goal was the reestablishment of Israel in Palestine. In 1895, Herzl met with a wealthy Jewish businessman in Paris, Baron Maurice de Hirsch, and suggested to him the vision of the Jews once again having their own nation and flag.
Herzl ...felt that what was needed was a worldwide counsel meeting of those who shared his same Zionist aspirations. He finally settled on Basel, Switzerland:
The congress met at the end of August 1897, attended by about 200 delegates, mostly from central and eastern Europe and Russia along with a few from western Europe and even the United States.... When Herzl’s imposing figure came to the podium, there was tumultuous applause. “We want to lay the foundation stone,” he declared, “for the house which will become the refuge of the Jewish nation. Zionism is the return to Judaism even before the return to the land of Israel.” ...The three-day congress agreed upon a program, henceforth to be known as the Basel Program, declaring that “Zionism aspires to create a publicly guaranteed homeland for the Jewish people in the land of Israel.” It also set up the Zionist Organization with Herzl as president. (Ibid.)


After WWI, the Balfour Declaration, which was a part of the settlement of the War and the dismemberment of the former Ottoman Empire under Turkish control (Turkey was an ally with Germany, and thus, on the losing end), provided for “the establishment in Palestine of a national home for the Jewish people” (Ibid., vol. 1, 832-832).


After WWII, President Harry Truman was a strong proponent for letting the European Jewish refugees move and resettle in Palestine. This was ultimately referred to the United Nations, and the following is the account of what happened:
Thus, for the first time since 63 BC when Israel came under Roman domination by Pompey, in exactly 2,011 years, Israel was once again a nation of its own authority and government. However, during the 1948 War of Jewish Independence, the Jordanians retained control of the Old City, while the modern state of Israel retained control of the modern city of Jerusalem and declared it to be its capital. However, between June 5-10, 1967, during what is called the Six Day War, Israel regained control of the Old City of Jerusalem, and for the first time since 70 AD when Titus sacked and destroyed Jerusalem, the whole of Jerusalem was once again under Jewish control.


Ezekiel 37:15-20 simply talks about the reunification of the Jews around the one element of their nation, Israel, and the fact that they are all Jews, versus one of the ten northern tribes or the two southern tribes.


Ezekiel 37:21-28 has a twofold application: verses 21-22 may be seen to have a modern prototype with the establishment of the Nation of Israel, but they also portend of the future during the millenneal reign of Christ.


Ezekiel 38:1-39:29 describes end-time war and conflicts, but it is not altogether clear just when these battles will occur.


However, in 38:1-6 delineates all of the enemies of Israel who will be joined against her. Furthermore, in Ezekiel 38:8-16, we have the battle plan that is aimed at Israel.


The ultimate victory over Gog is described in 38:17-39:20, and the last portion of this carnage is also described in Revelation 19:17-18, and this passage in Revelation is considered to be associated with the battle of Armageddon.
As stated initially, the exact time of when this battle occurs is not certain. Some think it might occur toward the end of the first half of the Tribulation period while Israel is at peace, but, as has already been stated, the description of the birds and animals eating the flesh of those killed during the battle is clearly a description of the battle of Armageddon that takes place not during the middle of the Tribulation, but rather at the end (Revelation 19:17-21).


However, in Ezekiel 39:21-29, at the end of this battle, the defeated nations will observe God’s judgment against them; Israel will forever know the Lord their God who brought them back from exile; and God will pour out His Spirit on Israel:
21 And I shall set My glory among the nations; and all the nations will see My judgment which I have executed, and My hand which I have laid on them. 22 “And the house of Israel will know that I am the LORD their God from that day onward. 23 “And the nations will know that the house of Israel went into exile for their iniquity because they acted treacherously against Me, and I hid My face from them; so I gave them into the hand of their adversaries, and all of them fell by the sword. 24 “According to their uncleanness and according to their transgressions I dealt with them, and I hid My face from them.”‘” 25 Therefore thus says the Lord God, “Now I shall restore the fortunes of Jacob, and have mercy on the whole house of Israel; and I shall be jealous for My holy name. 26 “And they shall forget their disgrace and all their treachery which they perpetrated against Me, when they live securely on their own land with no one to make them afraid. 27 “When I bring them back from the peoples and gather them from the lands of their enemies, then I shall be sanctified through them in the sight of the many nations. 28 “Then they will know that I am the LORD their God because I made them go into exile among the nations, and then gathered them again to their own land; and I will leave none of them there any longer. 29 “And I will not hide My face from them any longer, for I shall have poured out My Spirit on the house of Israel,” declares the Lord God. (Ezekiel 39:21-29)
This being the case, we also see in Revelation that John also saw a vision wherein Gog and Magog would fight at the end of the millenniam inRevelation 20:7-9:
7 And when the thousand years are completed, Satan will be released from his prison, 8 and will come out to deceive the nations which are in the four corners of the earth, Gog and Magog, to gather them together for the war; the number of them is like the sand of the seashore. 9 And they came up on the broad plain of the earth and surrounded the camp of the saints and the beloved city, and fire came down from heaven and devoured them. (Revelation 20:7-9)
This, therefore, is an example of true biblical prophecy, but also of our inability to fully understand how it is all going to play out. Thus, as we look at all of the above, the following scenarios are the possible considerations: (1) an initial battle just before the middle of the Tribulation; (2) a continuing struggle leading up to the battle of Armageddon; (3) two battles with Gog and Magog, with one being during the Tribulation (either at the middle or end), and the other at the end of the Millennium.
There is one more Old Testament prophecy for us to look at. Daniel 9:20-27:
20 Now while I was speaking and praying, and confessing my sin and the sin of my people Israel, and presenting my supplication before the LORD my God in behalf of the holy mountain of my God, 21 while I was still speaking in prayer, then the man Gabriel, whom I had seen in the vision previously, came to me in my extreme weariness about the time of the evening offering. 22 And he gave me instruction and talked with me, and said, “O Daniel, I have now come forth to give you insight with understanding. 23 “At the beginning of your supplications the command was issued, and I have come to tell you, for you are highly esteemed; so give heed to the message and gain understanding of the vision. 24 “Seventy weeks have been decreed for your people and your holy city, to finish the transgression, to make an end of sin, to make atonement for iniquity, to bring in everlasting righteousness, to seal up vision and prophecy, and to anoint the most holy place. 25 “So you are to know and discern that from the issuing of a decree to restore and rebuild Jerusalem until Messiah the Prince there will be seven weeks and sixty-two weeks; it will be built again, with plaza and moat, even in times of distress. 26 “Then after the sixty-two weeks the Messiah will be cut off and have nothing, and the people of the prince who is to come will destroy the city and the sanctuary. And its end will come with a flood; even to the end there will be war; desolations are determined. 27 “And he will make a firm covenant with the many for one week, but in the middle of the week he will put a stop to sacrifice and grain offering; and on the wing of abominations will come one who makes desolate, even until a complete destruction, one that is decreed, is poured out on the one who makes desolate.” (Daniel 9:20-27)
As you can see, this passage has much to do with the first coming of Jesus, and it is actually only verse 27 that has to do with the Second Coming of Christ. That verse is of extreme importance with regard to the events during the Tribulation period that will usher in Jesus’ return. However, the “seventy weeks” spoken of in verse 24 are controversial from the point of view of its historical context, versus a prophetic oversight that would transcend the historical perspective of Daniel’s time period.
From the prophetical perspective, there is a debate as to whether Daniel is really a prophecy, or rather a historical “retelling” of what occurred. The reason for that question is the specificity with which the book of Daniel lays out the prophetic future in such detail from Daniel’s time frame in the early 6th century BC up to and through the death of Antiochus Epiphanes in 164 BC, which is covered in chapter 11. Thus, the question arises as to whether or not this is prophecy or history because of the disbelief of some who say that NO PROPHECY could ever be that specifically correct, and the reason for their saying that is that they have a very limited view of God and His supernatural power and ability to give such a prophecy to a man, if they even believe in prophecy at all. Therefore, what is at issue for many scholars, teachers, and pastors is whether or not such specific prophecy could possibly be ascribed to God, and if they do not believe it can, then they see this as simply a “historical retelling” of events that occurred, and consequently, they view Daniel as having been written sometime in the late 2nd to perhaps the early 1st century BC.
However, setting aside the critical analysis for the sake of brevity, we are going to look at the Book of Daniel as an authentic, accurate, and divinely inspired account of the historic events that occurred in the life of Daniel from 605 BC to 538 BC, and of future, prophetic and authenticated historical events that would occur up through the death of Antiochus Epiphanes in 164 BC, and then to the birth, life, death, and resurrection of Christ in the first half of the 1st century BC, and finally, to the final seven year “tribulation” period, wherein we will see the Antichrist come and fulfillII Thessalonians 2:1-10 and Revelation 11 & 13. Therefore, with regard to verse 27, what we see being described is the peace treaty that the Antichrist will make with the Jews at the beginning of the Tribulation, but then in the middle of the Tribulation, he will break it off and seek to kill all of the Jews (see Revelation 11:1-14 and 2 Thessalonians 2:1-12).
Thus, the above New Testament passages are a fulfillment of Daniel 9:27regarding the Antichrist and his ultimate end at the Second Coming of Jesus described in II Thessalonians 2:8: “And then the lawless one will be revealed whom the Lord will slay with the breath of His mouth and bring to an end by the appearance of His coming.”