Compounding the problem is that between half to one-third of hospitals with more than 50 licensed beds do not have any such agreement with a PSO today. Some that did have discontinued the arrangement.
Many have resisted such relationships because of fears about confidentiality.
The few who do have arrangements with PSOs may be aligned with organizations that aren't on the list. For example, Foster says, many if not most, hospitals work with the Pennsylvania Patient Safety Authority, but it is not on the AHRQ list because it fails to meet certain requirements.
"Some patient safety organizations are very, very effective at helping hospitals with strategies to improve safety. They collect data and analyze it well. But they're not eligible to be designated under the federal system."
Wendy Nickel, of the Society of Hospital Medicine PSO, which received AHRQ approval in 2011, says that while 350 hospitals participate in some or all of its improvement programs, only 50 have signed up for PSO services or programs.
"There hasn't been a great marketing job or promotion about what PSOs are, [or] what protections they provide," she says. "It's no one's fault; it's just that it's been very tough for PSOs to explain who they are and what kind of data protection they offer, describe the legislation and explain why this is important.
"We have some issues coming up in a very time-sensitive manner, and people are either still not aware, or they're starting to scramble around this. We're dealing with a major learning curve."
William Munier, MD, director of AHRQ's Center for Quality Improvement and Patient Safety, acknowledged the issues in an email. He wrote that "some states have state-designated PSOs and private organizations use the term as well." But they are not necessarily qualified under AHRQ's rules.