Healthcare
15%of exam
Management and Leadership
13%of exam
Finance
12%of exam
Human Resources
12%of exam
Laws and Regulations
9%of exam
EMTALAHIPAAStark LawFalse Claims Act
Quality and Performance Improvement
9%of exam
Business
8%of exam
Strategic PlanningSWOT AnalysisMarketing MixContract Negotiation
Healthcare Technology and Information Management
8%of exam
EHRInteroperabilityTelehealthDisaster Recovery
Professionalism and Ethics
8%of exam
ACHE Code of EthicsFour PrinciplesConflict of InterestCultural Diversity
Governance and Organizational Structure
6%of exam
Governing BoardMedical Staff BylawsBoard CommitteesCredentialing
Quick Facts
- Exam
- FACHE Board of Governors
- Credential
- ACHE Fellow (FACHE)
- Questions
- 230 (200 scored)
- Time
- 6 hours
- Pass Score
- ~65%
- Format
- MCQ, Pearson VUE
- Level
- Advanced / Executive
- Blueprint
- Aug 1, 2023
Continuum of Care Levels
Primary, Secondary, Tertiary, Quaternary, then Subacute
Primary: first contactSecondary: specialist careTertiary: subspecialty careQuaternary: experimental care
HMO vs PPO
HMO
- PCP gatekeeper required
- Referral needed for specialist
- Lower premiums
PPO
- No referral needed
- Out-of-network allowed
- Higher premiums
Restrictive vs flexible network
Care Delivery Models
- HMO
- Referral-based network, gatekeeper PCP
- PPO
- Flexible network, no referral
- POS
- HMO-PPO hybrid, PCP required
- ACO
- Shared savings, coordinated care
- PCMH
- Team-based primary care model
- IDN
- Single governance, multiple settings
- CIN
- Clinically integrated, separate ownership
Medicare vs Medicaid
Medicare
- Federal, age 65+
- Disability eligible too
Medicaid
- Federal-state, low-income
- Eligibility varies by state
Age/disability vs income
Levels and Continuum of Care
- Primary care
- First contact, prevention focus
- Secondary care
- Specialist care, community hospital
- Tertiary care
- Highly specialized subspecialty care
- Quaternary care
- Rare, experimental advanced care
- Subacute care
- Post-acute skilled nursing rehab
- Hospice
- End-of-life comfort care
- CHNA
- Community health needs assessment
Which Leadership Style Fits
- Team is new, unskilled→Directive style(High structure)
- Team is experienced→Delegating style(Situational leadership)
- Need culture change→Transformational leader(Vision-driven)
- Routine, stable operations→Transactional leader(Reward/punishment)
Leadership Styles
- Transformational
- Inspires vision-driven change
- Transactional
- Reward and punishment based
- Servant
- Puts team needs first
- Situational
- Adapts to team readiness
- Laissez-faire
- Hands-off, high autonomy
Change and Planning Tools
- Kotter's 8 Steps
- Urgency through institutionalized change
- Lewin's Model
- Unfreeze, change, refreeze
- SWOT
- Strengths, weaknesses, opportunities, threats
- Gantt Chart
- Visual project timeline tracking
- Succession Planning
- Prepares internal future leaders
Which Reimbursement Model
- Pay per visit→Fee-for-service(Volume-based)
- Fixed per diagnosis→DRG payment(Inpatient Medicare)
- Fixed per member→Capitation(Risk shifts to provider)
- Physician work value→RVU scale(RBRVS-based)
- One price, episode→Bundled payment(Joint replacement example)
Financial Statements
- Balance Sheet
- Assets, liabilities, net assets
- Income Statement
- Revenue minus total expenses
- Cash Flow Statement
- Tracks cash in and out
- Statement of Net Assets
- Nonprofit equity snapshot
Financial Ratios
- Current Ratio
- Current assets over liabilities
- Days Cash on Hand
- Liquidity cushion in days
- Operating Margin
- Operating income over revenue
- Debt Service Coverage
- Cash available for debt
Reimbursement and Revenue Cycle
- DRG
- Fixed inpatient payment, Medicare
- RVU
- Physician work value unit
- Fee-for-Service
- Pay per service rendered
- Capitation
- Fixed payment per member
- Bundled Payment
- One price per episode
- Revenue Cycle
- Registration through payment collection
HR Laws
- FMLA
- Unpaid, job-protected leave
- ADA
- Requires disability accommodation
- FLSA
- Sets wage and overtime rules
- Title VII
- Bans employment discrimination
- NLRA
- Protects union organizing rights
Staffing and Performance
- Turnover Rate
- Separations divided by headcount
- 360 Review
- Multi-rater performance feedback
- Collective Bargaining
- Union contract negotiation process
- Succession Planning
- Builds internal leadership pipeline
Stark Law vs Anti-Kickback Statute
Stark Law
- Physician self-referral
- Strict liability, no intent
- Civil penalties only
Anti-Kickback Statute
- Referral payment scheme
- Requires criminal intent
- Criminal and civil penalties
Referral vs payment intent
Which Healthcare Law Applies
- ED refuses to screen→EMTALA(Screen, stabilize, transfer)
- Physician self-referral for profit→Stark Law(Strict liability)
- Kickback for referrals→Anti-Kickback Statute(Requires intent)
- False Medicare billing→False Claims Act(Whistleblower qui tam)
- Patient data breach→HIPAA(Privacy and security)
Key Healthcare Laws
- EMTALA
- Screen and stabilize, ED
- HIPAA
- Privacy and security rules
- Stark Law
- Bans physician self-referral
- Anti-Kickback Statute
- Bans referral payment, intent-based
- False Claims Act
- Punishes fraudulent Medicare billing
- ACA
- Coverage expansion, value-based care
- Joint Commission
- Accreditation, grants deemed status
Donabedian Quality Model
Structure leads to Process leads to Outcome
Structure: resources/settingProcess: care deliveredOutcome: patient result
Lean vs Six Sigma
Lean
- Eliminates waste
- Speeds up flow
Six Sigma
- Reduces defects
- Uses DMAIC data
Speed vs precision
Which Quality Tool to Use
- Small rapid test→PDSA cycle(One change at a time)
- Reduce process waste→Lean(Value stream focus)
- Reduce defect variation→Six Sigma(DMAIC method)
- Serious preventable event→Root cause analysis(Find system failure)
- Measure patient experience→HCAHPS survey(Publicly reported)
Quality Frameworks
- Donabedian Model
- Structure, process, outcome
- IHI Triple Aim
- Health, experience, cost
- PDSA Cycle
- Plan, do, study, act
- Lean
- Eliminates process waste
- Six Sigma
- DMAIC reduces process defects
IHI Triple Aim
Better Health, Better Care, Lower Cost
Population healthPatient experiencePer capita cost
Quality Measures
- HCAHPS
- Patient experience survey score
- Never Event
- Serious, preventable reportable error
- Sentinel Event
- Unexpected death or harm
- Root Cause Analysis
- Finds underlying system failure
- Core Measures
- Standardized outcome benchmarks
PDSA Cycle
Plan, Do, Study, Act, repeat
Plan: design testDo: try changeStudy: check dataAct: adopt or adjust
Strategic and Business Planning
- SWOT Analysis
- Internal and external scan
- Environmental Scan
- Market and competitor review
- Business Plan
- Feasibility, market, financial case
- Marketing Mix
- Product, price, place, promotion
- Contract Negotiation
- Aligns terms, risk, value
HIPAA Privacy vs Security Rule
Privacy Rule
- Covers all PHI forms
- Use and disclosure limits
Security Rule
- Covers electronic PHI only
- Technical safeguards required
All PHI vs ePHI only
Health IT and Security
- EHR
- Electronic health record system
- Interoperability
- Systems exchange patient data
- HIPAA Security Rule
- Protects electronic PHI only
- Telehealth
- Remote virtual care delivery
- Disaster Recovery
- Restores systems after outage
- Data Analytics
- Informs operational decision-making
Four Ethics Principles
Autonomy, Beneficence, Nonmaleficence, Justice
Autonomy: patient choiceBeneficence: do goodNonmaleficence: avoid harmJustice: fair access
Ethics Principles
- Autonomy
- Patient self-determination right
- Beneficence
- Acting for patient benefit
- Nonmaleficence
- Avoiding causing patient harm
- Justice
- Fair resource distribution rule
- ACHE Code of Ethics
- Professional conduct standard
- Conflict of Interest
- Disclose competing personal interests
Governance vs Management
Board Governance
- Sets strategy, oversight
- Fiduciary duty
Management
- Executes operations
- Reports to board
Oversight vs execution
Governance Structures
- Governing Board
- Ultimate legal fiduciary authority
- Medical Staff Bylaws
- Rules for physician privileging
- Corporate Bylaws
- Governance rules and procedures
- Board Committee
- Focused oversight subgroup work
- Credentialing
- Verifies provider qualifications, licensure
Common Traps
Stark Law is not Anti-Kickback Statute
Stark = strict liability ≠ AKS = requires intent
HMO is not PPO
HMO needs referrals ≠ PPO allows out-of-network
Medicare is not Medicaid
Medicare = age/disability ≠ Medicaid = income-based
Never Event is not Sentinel Event
Never event = preventable list ≠ Sentinel = any serious harm
Lean is not Six Sigma
Lean = removes waste ≠ Six Sigma = removes defects
Privacy Rule is not Security Rule
Privacy = all PHI forms ≠ Security = electronic PHI only
Governance is not Management
Board sets strategy ≠ Executives run operations
Last Minute
- 1.Weights: Healthcare 15%, Leadership 13%
- 2.Finance and HR both 12%
- 3.Laws and Quality both 9%
- 4.Business, Tech, Ethics each 8%
- 5.Governance is lowest at 6%
- 6.230 questions, 200 scored total
- 7.Six-hour time limit, Pearson VUE
- 8.Passing score is about 65%
- 9.EMTALA requires screen and stabilize
- 10.Stark Law is strict liability
- 11.Anti-Kickback Statute requires intent
- 12.PDSA: Plan, Do, Study, Act
- 13.Triple Aim: health, experience, cost
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