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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 exam 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 exam 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 exam 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 exam 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 exams 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 exam 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 exam)
- Knowledge of business planning processes, including development, implementation, and exam (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 exam)
- 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