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Exam Code: FACHE
Exam Name: ACHE Fellow of the American College of Healthcare Executives
Number of Questions: 230 multiple-choice questions (each with 4 answer options). Of these- 200 are scored- and 30 are unscored "trial" questions used for future test development.
Time Allotted: 6 hours total (no breaks specified- but candidates can manage time as needed during the session).
Passing Marks: Not publicly disclosed as a fixed score or percentage by ACHE. The test is scored immediately upon completion- and candidates receive a simple pass/fail result. Historical pass rates vary (e.g.- ~65% average- 72% in 2022)- indicating a scaled threshold based on test difficulty and performance standards.
Exam Format: Computer-based- proctored at Pearson VUE testing centers. Questions are evenly distributed across 10 core knowledge areas (e.g.- leadership- management- governance).

- Healthcare
- Knowledge of healthcare and medical terminology
- Knowledge of healthcare trends
- Knowledge of the levels of healthcare along the continuum of care (e.g.- extended care- acute hospital care- ambulatory care- post-acute care)
- Knowledge of levels of service from a business perspective (e.g.- home health- inpatient- outpatient)
- Knowledge of the types of healthcare organizations (e.g.- non-profit- for-profit- federal- public health)
- Knowledge of ancillary services (e.g.- laboratory and imaging services- therapies)
- Knowledge of support services (e.g.- environment of care- plant operations- materials management- hospitality services)
- Knowledge of the interdependency of integration within and competition among healthcare sectors including partnerships with academic and social care institutions
- Knowledge of clinician roles and qualifying criteria (e.g.- administrative versus clinical)
- Knowledge of evidence-based management practice
- Knowledge of different staff and functional perspectives in healthcare organizations (e.g.- frame of reference- expectations- and responsibilities by discipline and role)
- Knowledge of the patient perspective (e.g.- expectations- concerns- healthcare consumerism) and how it differs from the provider perspective
- Knowledge of the interrelationships among healthcare access- quality- cost- resource allocation- accountability- and the community
- Knowledge of different care delivery models and system access points
- Knowledge of digital health (e.g.- telehealth- telemedicine- telemonitoring)
- Knowledge of population health concepts (e.g.- patient segmentation- risk-based contracting)
- Knowledge of social determinants of health (e.g.- housing- food insecurity)
- Knowledge of preventative medicine concepts (e.g.- community outreach- wellness initiatives- retail health)

- Management and Leadership
- Knowledge of implementation planning (e.g.- operational plan- management plan)
- Knowledge of emergency preparedness (e.g.- contingency planning- emergency response as defined in National Incident Management System (NIMS))
- Knowledge of organizational systems theory and structuring (e.g.- span of control- chain of command- interrelationships of organizational units)
- Knowledge of management functions (e.g.- planning- organizing- directing- controlling- and evaluating)
- Knowledge of leadership and communication styles- and how and in what situations they apply
- Knowledge of team-building techniques (e.g.- communication- use of practical assessment or training tools)
- Knowledge of change management principles
- Knowledge of organizational development resources
- Knowledge of collaborative techniques for engaging and working with clinicians and external stakeholders (e.g.- policymakers- payers- community leaders)
- Knowledge of diversity- equity- inclusion and justice principles and their influence on team and organizational effectiveness
- Knowledge of resource allocation methods (e.g.- for addressing conflicts among departments or staff over scarce resources)
- Knowledge of types of healthcare network structures (e.g.- clinically integrated network- independent practice association) and their impact on local decision-making
- Knowledge of collective bargaining (e.g.- managements rights during union organizing)

- Finance
- Knowledge of financial accounting principles needed to analyze and interpret financial reports (e.g.- which ratios to look at given your current concerns)
- Knowledge of operating budget principles (e.g.- fixed vs. flexible- zero based- variance analysis)
- Knowledge of capital budgeting principles (e.g.- funding sources- long-term implications of capital planning- such as depreciation and value analysis)
- Knowledge of reimbursement methodologies and their ramifications (e.g.- managed care models- national/state programs- value-based- fee-for-service)
- Knowledge of fundamental productivity measures (e.g.- hours per patient day- cost per patient day- units of service per labor hour)
- Knowledge of financial controls (e.g.- internal systems for accounts payable- checks and balances- auditing principles)
- Knowledge of revenue generation (e.g.- service line development- new ways to foster revenue- pricing strategies) and implications for payer mix
- Knowledge of how to prepare and justify a business model (e.g.- make a business case for a new project to gain shareholder support)
- Knowledge of potential impacts and consequences of financial decision-making on operations- healthcare- human resources- and quality of care
- Knowledge of asset management (e.g.- depreciation schedule)
- Knowledge of financing- including funding sources- the process of obtaining credit and bond ratings- and issuing bonds
- Knowledge of philanthropy and foundation work (e.g.- as a source of funding for non-profit organizations or to target for-profit organizations activities)
- Knowledge of supply chain systems- structures- and processes (e.g.- monitoring the effectiveness of supply chain management and strategic decision-making)
- Knowledge of revenue cycle (e.g.- billing- coding- authorizations- collections)

- Human Resources
- Knowledge of human resources laws and regulations (e.g.- labor law- wage and hour- Family and Medical Leave Act (FMLA)- Fair Labor Standards Act (FLSA)- Equal Employment Opportunity Commission (EEOC)- Employee Retirement Income Security Act (ERISA)- workers compensation)
- Knowledge of recruitment and retention approaches and techniques
- Knowledge of staffing methodologies and productivity management (e.g.- acuity-based staffing- flexible staffing- fixed staffing- capability- capacity- and upskilling)
- Knowledge of performance management systems (e.g.- performance-based evaluation- rewards systems- disciplinary policies and procedures)
- Knowledge of employee motivation and development principles and techniques
- Knowledge of employee satisfaction and engagement measurement and improvement techniques
- Knowledge of compensation and benefits practices (e.g.- merit-based- provider contracts)
- Knowledge of employee safety- security- and health issues (e.g.- Occupational Safety and Health Administration (OSHA)- workplace violence- employee burnout)
- Knowledge of conflict resolution and grievance procedures
- Knowledge of potential impacts and consequences of human resources decision-making on operations- finances- healthcare- and quality of care
- Knowledge of selection techniques (e.g.- commonly available assessments and relative benefits)
- Knowledge of labor relations practices and strategies
- Knowledge of job design processes
- Knowledge of succession planning models
- Knowledge of mentorship and coaching practices

- Laws and Regulations
- Knowledge of laws relating to confidentiality (e.g.- privacy act- Freedom of Information Act (FOIA)- release of information)
- Knowledge of healthcare compliance laws and regulations (e.g.- antitrust- conflict of interest- Emergency Medical Treatment and Active Labor Act (EMTALA)- Stark- No Surprises Act)
- Knowledge of Medicare- Medicaid- and other third-party payment regulations
- Knowledge of inspection and accrediting standards- regulations- and organizations (e.g.- Occupational Safety and Health Administration (OSHA)- Food and Drug Administration (FDA)- Nuclear Regulatory Commission (NRC)- Centers for Disease Control and Prevention (CDC)- state and federal accreditation/licensure)
- Knowledge of patients rights laws and regulations (e.g.- informed consent- Health Insurance Portability and Accountability Act (HIPAA)- advance directives- involuntary commitments)
- Knowledge of the different requirements for non-profit and for-profit healthcare organizations (e.g.- community health needs assessment for non-profit organizations)
- Knowledge of the potential impact of laws and regulations on operational- financial- quality of care- health resources- and human resources decisions
- Knowledge of laws and regulations related to collective bargaining
- Knowledge of legal implications for mergers and acquisitions

- Quality and Performance Improvement
- Knowledge of benchmarking principles and sources of best practices information (e.g.- internal- state- and national standards)
- Knowledge of the principles and methods of medical staff peer review
- Knowledge of risk management principles and programs (e.g.- insurance- education- safety- injury management- patient complaints- patient and staff security)
- Knowledge of managerial performance and process improvement tools and techniques (e.g.- plan-do-study-act (PDSA cycle)- lean processing- Six Sigma)
- Knowledge of clinical performance and process improvement tools and techniques (e.g.- clinical pathways- evidence-based medicine- population health- pay-for-performance)
- Knowledge of quality and performance measurement tools (e.g.- patient satisfaction measurements such as Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)- net promoter scores)
- Knowledge of utilization review/case management systems
- Knowledge of tools for improving patient safety (e.g.- reducing avoidable errors- disclosure of errors)
- Knowledge of how quality impacts operations- staffing- and financing decisions

- Business
- Knowledge of the strategic planning process (e.g.- scenario planning- forecasting- community needs assessment)
- Knowledge of business planning processes- including development- implementation- and assessment (e.g.- adding new services/ending existing services)
- Knowledge of basic business contracts- such as what constitutes a contractual commitment- and legal and financial implications (e.g.- intentional damage to a person or business that causes economic harm)
- Knowledge of the impact of the socioeconomic environment has on the functions of the organization
- Knowledge of marketing principles and tools and how to interpret marketing data (e.g.- market analysis- market research- sales- advertising)
- Knowledge of principles of media relations- advertising- social media- and community relations
- Knowledge of the techniques involved in negotiating contracts or services (e.g.- compromise- persuasion) and relevant factors (e.g.- utilization review- models)
- Knowledge of potential impacts and consequences of business decision-making on operations- healthcare- human resources- community- and quality of care

- Healthcare Technology and Information Management
- Knowledge of the role and function of information technology in business operations (e.g.- business intelligence systems)
- Knowledge of technology trends and clinical applications in a healthcare organization
- Knowledge of technology policies and regulations (e.g.- complying with Health Insurance Portability and Accountability Act (HIPAA) security requirements- complying with Health Information Technology for Economic and Clinical Health (HITECH) Act- promoting interoperability)
- Knowledge of health informatics needed for operational decisions (e.g.- data and equipment interoperability standards support)
- Knowledge of potential impacts and consequences of healthcare IT decision-making on staff and processes in finance- operations- healthcare- and quality of care
- Knowledge of information systems continuity (e.g.- disaster planning- recovery- backup- security- sabotage- natural disasters)
- Knowledge of factors that influence selection- acquisition- and maintenance of IT systems (e.g.- upgrades and conversions- technology lifecycles)
- Knowledge of healthcare analytics and clinical informatics applications

- Professionalism and Ethics
- Knowledge of professional code of ethical behavior for ACHE
- Knowledge of patients' rights and responsibilities (e.g.- informed consent- withdrawal of care- advance directives)
- Knowledge of ethics committees roles- structure- and functions
- Knowledge of cultural and spiritual diversity of patients and staff as they relate to healthcare needs
- Knowledge of conflict-of-interest issues and solutions as defined by laws- organizational bylaws- policies and procedures
- Knowledge of the consequences of unethical actions
- Knowledge of ethical implications of human-subject research
- Knowledge of other professional norms and standards of behaviors as defined by professions (e.g.- American Hospital Association (AHA) standards/guidelines- Physicians Oaths- and other professional pledges)
- Knowledge of creating an ethical culture in an organization
- Knowledge of ACHEs Statement on Diversity

- Governance and Organizational Structure
- Knowledge of governance theory (e.g.- mission and values- relationships with board of directors- roles of governing board and management)
- Knowledge of governance structure (e.g.- bylaws- articles of incorporation) and operations (e.g.- board member selection- education- orientation- and assessment)
- Knowledge of medical staff structure and its relationship to governing bodies and facility operations (e.g.- credentialing- privileging- and disciplinary process)
- Knowledge of the governing boards role (e.g.- ultimate accountability- conflict of interest issues- fiduciary responsibility)
- Knowledge of public policy matters and legislative and advocacy processes