AMN Healthcare Services (AMN) 10-Q 3 May 19 2019 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2019	May 01, 2019
Document and Entity Information [Abstract]
Entity Registrant Name	AMN HEALTHCARE SERVICES INC
Entity Central Index Key	0001142750
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Document Type	10-Q
Document Period End Date	Mar. 31, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	Q1
Amendment Flag	false
Entity Common Stock, Shares Outstanding (excluding treasury shares)		46,619,697

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Current assets:
Cash and cash equivalents	$ 19,116	$ 13,856
Accounts receivable, net of allowances of $11,716 and $10,560 at March 31, 2019 and December 31, 2018, respectively	365,231	365,871
Accounts receivable, subcontractor	55,607	50,143
Prepaid expenses	17,724	12,409
Other current assets	31,209	39,887
Total current assets	488,887	482,166
Restricted cash, cash equivalents and investments	61,279	59,331
Fixed assets, net of accumulated depreciation of $119,489 and $114,413 at March 31, 2019 and December 31, 2018, respectively	93,625	90,419
Operating lease right-of-use assets	97,055
Other assets	105,590	96,152
Goodwill	464,923	438,506
Intangible assets, net of accumulated amortization of $121,575 and $114,924 at March 31, 2019 and December 31, 2018, respectively	326,466	326,147
Total assets	1,637,825	1,492,721
Current liabilities:
Accounts payable and accrued expenses	153,566	149,603
Accrued compensation and benefits	135,792	135,059
Current portion of operating lease liabilities	12,341
Deferred revenue	11,459	12,365
Other current liabilities	20,112	10,243
Total current liabilities	333,270	307,270
Revolving credit facility	150,000	120,000
Notes payable, less unamortized fees	320,798	320,607
Deferred income taxes, net	20,079	27,326
Operating lease liabilities	99,946
Other long-term liabilities	63,746	78,528
Total liabilities	987,839	853,731
Commitments and contingencies
Stockholders’ equity:
Preferred stock, $0.01 par value; 10,000 shares authorized; none issued and outstanding at March 31, 2019 and December 31, 2018	0	0
Common stock, $0.01 par value; 200,000 shares authorized; 49,122 issued and 46,578 outstanding at March 31, 2019 and 48,809 issued and 46,643 outstanding at December 31, 2018	491	488
Additional paid-in capital	447,632	452,730
Treasury stock, at cost (2,544 and 2,166 shares at March 31, 2019 and December 31, 2018, respectively)	(118,368)	(100,438)
Retained earnings	320,181	286,059
Accumulated other comprehensive income	50	151
Total stockholders’ equity	649,986	638,990
Total liabilities and stockholders’ equity	$ 1,637,825	$ 1,492,721

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Statement of Financial Position [Abstract]
Accounts receivable, allowance	$ 11,716	$ 10,560
Accumulated depreciation - fixed assets	119,489	114,413
Accumulated amortization	$ 121,575	$ 114,924
Preferred stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock, shares authorized (in shares)	10,000,000	10,000,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	200,000,000	200,000,000
Common stock, shares issued (in shares)	49,122,000	48,809,000
Common stock, shares outstanding (in shares)	46,578,000	46,643,000
Treasury stock (in shares)	2,544,000	2,166,000

Condensed Consolidated Statemen

Condensed Consolidated Statements of Comprehensive Income - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Statement of Comprehensive Income [Abstract]
Revenue	$ 532,441	$ 522,489
Cost of revenue	355,682	354,665
Gross profit	176,759	167,824
Operating expenses:
Selling, general and administrative	119,997	104,737
Depreciation and amortization	11,710	7,886
Total operating expenses	131,707	112,623
Income from operations	45,052	55,201
Interest expense, net, and other	5,673	5,335
Income before income taxes	39,379	49,866
Income tax expense	5,257	7,185
Net income	34,122	42,681
Other comprehensive loss:
Foreign currency translation and other	(101)	(19)
Other comprehensive loss	(101)	(19)
Comprehensive income	$ 34,021	$ 42,662
Net income per common share:
Basic (in dollars per share)	$ 0.73	$ 0.89
Diluted (in dollars per share)	$ 0.71	$ 0.87
Weighted average common shares outstanding:
Basic (shares)	46,784	47,733
Diluted (shares)	47,772	49,116

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Stockholders' Equity - USD ($) shares in Thousands, $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Treasury Stock	Retained Earnings (Accumulated Deficit)	Accumulated Other Comprehensive Income (Loss)
Beginning balance (in shares) at Dec. 31, 2017		48,411		930
Beginning balance at Dec. 31, 2017	$ 562,527	$ 484	$ 453,351	$ (33,425)	$ 142,229	$ (112)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity awards vested and exercised, net of shares withheld for payroll taxes (in shares)		349
Equity awards vested and exercised, net of shares withheld for payroll taxes	(10,926)	$ 4	(10,930)
Share-based compensation	2,864		2,864
Comprehensive income	42,662				42,681	(19)
Ending balance (in shares) at Mar. 31, 2018		48,760		930
Ending balance at Mar. 31, 2018	599,216	$ 488	445,285	$ (33,425)	186,999	(131)
Beginning balance (in shares) at Dec. 31, 2018		48,809		2,166
Beginning balance at Dec. 31, 2018	638,990	$ 488	452,730	$ (100,438)	286,059	151
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Repurchase of common stock into treasury (in shares)				(378)
Repurchase of common stock into treasury	(17,930)			$ (17,930)
Equity awards vested and exercised, net of shares withheld for payroll taxes (in shares)		313
Equity awards vested and exercised, net of shares withheld for payroll taxes	(10,281)	$ 3	(10,284)
Share-based compensation	5,186		5,186
Comprehensive income	34,021				34,122	(101)
Ending balance (in shares) at Mar. 31, 2019		49,122		2,544
Ending balance at Mar. 31, 2019	$ 649,986	$ 491	$ 447,632	$ (118,368)	$ 320,181	$ 50

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Cash flows from operating activities:
Net income	$ 34,122	$ 42,681
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	11,710	7,886
Non-cash interest expense and other	543	600
Write-off of fees on the prior credit facilities	0	574
Change in fair value of contingent consideration	(700)	0
Increase in allowances for doubtful accounts and sales credits	2,608	2,257
Provision for deferred income taxes	(9,036)	(5,113)
Share-based compensation	5,186	2,864
Loss on disposal or sale of fixed assets	4	5
Amortization of discount on investments	(120)	(15)
Non-cash lease expense	(92)
Changes in assets and liabilities, net of effects from acquisitions:
Accounts receivable	(1,500)	9,154
Accounts receivable, subcontractor	(5,465)	1,985
Income taxes receivable	799	9,881
Prepaid expenses	(5,387)	(2,375)
Other current assets	(1,783)	2,825
Other assets	(6,202)	(89)
Accounts payable and accrued expenses	2,949	(7,816)
Accrued compensation and benefits	330	(4,007)
Other liabilities	9,630	(1,498)
Deferred revenue	(1,418)	(52)
Restricted investments balance	36	(12)
Net cash provided by operating activities	36,214	59,735
Cash flows from investing activities:
Purchase and development of fixed assets	(7,388)	(5,703)
Purchase of investments	(7,362)	(2,086)
Proceeds from maturity of investments	11,700	2,900
Payments to fund deferred compensation plan	(3,583)	(4,724)
Cash paid for acquisitions, net of cash received	(29,525)	0
Cash paid for other intangibles	(90)	0
Net cash used in investing activities	(36,248)	(9,613)
Cash flows from financing activities:
Proceeds from revolving credit facility	30,000	0
Repurchase of common stock	(17,930)	0
Payment of financing costs	0	(2,331)
Earn-out payments for prior acquisitions	0	(1,713)
Cash paid for shares withheld for taxes	(10,280)	(10,926)
Net cash provided by (used in) financing activities	1,790	(14,970)
Effect of exchange rate changes on cash	(101)	(19)
Net increase in cash, cash equivalents and restricted cash	1,655	35,133
Cash, cash equivalents and restricted cash at the beginning of period	84,324	98,894
Cash, cash equivalents and restricted cash at the end of period	85,979	134,027
Supplemental disclosures of cash flow information:
Cash paid for amounts included in the measurement of operating lease liabilities	4,338
Cash paid for interest (net of $102 and $104 capitalized for the three months ended March 31, 2019 and 2018, respectively)	1,524	201
Cash paid for income taxes	4,192	2,731
Acquisitions:
Fair value of tangible assets acquired in acquisitions, net of cash received	1,041	0
Goodwill	26,494	0
Intangible assets	6,880	0
Liabilities assumed	(3,390)	0
Earn-out liabilities	(1,500)	0
Supplemental disclosures of non-cash investing and financing activities:
Purchase of fixed assets recorded in accounts payable and accrued expenses	$ 2,566	$ 2,860

Condensed Consolidated Statem_4

Condensed Consolidated Statements of Cash Flows (Parenthetical) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Statement of Cash Flows [Abstract]
Interest capitalized	$ 102	$ 104

Basis of Presentation

Basis of Presentation	3 Months Ended
	Mar. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
BASIS OF PRESENTATION	BASIS OF PRESENTATION The condensed consolidated balance sheets and related condensed consolidated statements of comprehensive income and cash flows contained in this Quarterly Report on Form 10-Q (this “Quarterly Report”), which are unaudited, include the accounts of AMN Healthcare Services, Inc. and its wholly-owned subsidiaries (collectively, the “Company”). All significant intercompany balances and transactions have been eliminated in consolidation. In the opinion of management, all entries necessary for a fair presentation of such unaudited condensed consolidated financial statements have been included. These entries consisted of all normal recurring items. The results of operations for the interim period are not necessarily indicative of the results to be expected for any other interim period or for the entire fiscal year or for any future period. The unaudited condensed consolidated financial statements do not include all information and notes necessary for a complete presentation of financial position, results of operations and cash flows in conformity with accounting principles generally accepted in the United States (“U.S. GAAP”). Please refer to the Company’s audited consolidated financial statements and the related notes for the fiscal year ended December 31, 2018 , contained in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2018 , filed with the Securities and Exchange Commission on February 21, 2019 (“ 2018 Annual Report”). The preparation of financial statements in conformity with U.S. GAAP requires management to make a number of estimates and assumptions relating to the reporting of assets and liabilities and the disclosure of contingent assets and liabilities at the dates of the financial statements and the reported amounts of revenue and expenses during the reporting periods. On an ongoing basis, the Company evaluates its estimates, including those related to asset impairments, accruals for self-insurance, compensation and related benefits, accounts receivable, contingencies and litigation, earn-out liabilities, and income taxes. Actual results could differ from those estimates under different assumptions or conditions. Recently Adopted Accounting Pronouncements In February 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standard Update (“ASU”) 2016-02, “Leases.” This standard requires organizations that lease assets to recognize the assets and liabilities created by those leases. The standard also will require disclosures to help investors and other financial statement users better understand the amount, timing, and uncertainty of cash flows arising from leases. A modified retrospective transition approach is required, applying the standard to all leases existing at the date of initial application. In addition, the FASB has also issued several amendments to the standard, which clarify certain aspects of the guidance, including an optional transition method for adoption of this standard, which allows organizations to initially apply the new requirements at the effective date, recognize a cumulative effect adjustment to the opening balance of retained earnings, and continue to apply the legacy guidance in Accounting Standards Codification (“ASC”) 840, Leases, including its disclosure requirements, in the comparative periods presented. The new standard provides a number of optional practical expedients in transition. The Company elected the ‘package of practical expedients’, which permits organizations not to reassess under the new standard prior conclusions about lease identification, lease classification and initial direct costs. The Company did not elect to use the hindsight practical expedient to determine the lease term or evaluate impairment for existing leases. The Company adopted ASU 2016-02 effective January 1, 2019 , using the optional transition method described above. The Company recognized the cumulative effect of adopting this guidance as an adjustment as of the effective date, primarily related to the recognition of lease liabilities of $114,807 and corresponding right-of-use assets of $99,525 for existing operating leases. The Company also derecognized existing deferred rent liabilities of $15,302 . These adjustments had no effect on opening retained earnings and prior periods were not retrospectively adjusted and continue to be reported in accordance with ASC 840. The new standard also provides practical expedients for an organization’s ongoing accounting. The Company elected the short-term lease recognition exemption and the practical expedient to not separate lease and non-lease components for all leases that qualify. The Company does not expect the adoption of this standard to impact its results of operations. There was no other material impact to the Company’s condensed consolidated financial statements as a result of adopting this updated standard. Cash, cash equivalents and restricted cash The Company considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. Cash and cash equivalents include currency on hand, deposits with financial institutions and highly liquid investments. Restricted cash and cash equivalents primarily represent cash and money market funds on deposit with financial institutions and investments represents commercial paper that serves as collateral for the Company’s outstanding letters of credit and captive insurance subsidiary claim payments. See Note (6), “New Credit Agreement” and Note (7), “Fair Value Measurement” for additional information. The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying condensed consolidated balance sheets and related notes to the amounts presented in the accompanying condensed consolidated statements of cash flows. March 31, 2019 December 31, 2018 Cash and cash equivalents $ 19,116 $ 13,856 Restricted cash and cash equivalents (included in other current assets) 16,522 26,329 Restricted cash, cash equivalents and investments 61,279 59,331 Total cash, cash equivalents and restricted cash and investments 96,917 99,516 Less restricted investments (10,938 ) (15,192 ) Total cash, cash equivalents and restricted cash $ 85,979 $ 84,324

Acquisitions

Acquisitions	3 Months Ended
	Mar. 31, 2019
Business Combinations [Abstract]
ACQUISITIONS	ACQUISITIONS As set forth below, the Company completed three acquisitions from January 1, 2018 through March 31, 2019 . The Company accounted for each acquisition using the acquisition method of accounting. Accordingly, it recorded the tangible and intangible assets acquired and liabilities assumed at their estimated fair values as of the applicable date of acquisition. Since the applicable date of acquisition, the Company has revised the allocation of the purchase price to the tangible and intangible assets acquired and liabilities assumed based on analysis of information that has been made available through March 31, 2019 . The allocation will continue to be updated through the measurement period, if necessary. For each acquisition, the Company did not incur any material acquisition-related costs. Silversheet Acquisition On January 30, 2019, the Company completed its acquisition of Silversheet, Inc. (“Silversheet”) which provides innovative software and services to reduce the complexities and challenges of the credentialing process for clinicians and healthcare organizations. The initial purchase price of $31,676 included (1) $30,176 cash consideration paid upon acquisition, funded primarily through borrowings under the Company’s $400,000 secured revolving credit facility (the “Senior Credit Facility”), provided for under a credit agreement (the “New Credit Agreement”), dated as of February 9, 2018, by and among the Company and several lenders, and (2) a contingent earn-out payment of up to $25,000 with an estimated fair value of $1,500 as of the acquisition date. The contingent earn-out payment is based on (A) up to $6,000 based on the operating results of Silversheet for the twelve months ending December 31, 2019, and (B) up to $19,000 based on the operating results of Silversheet for the twelve months ending December 31, 2020. The results of Silversheet have been included in the Company’s other workforce solutions segment since the date of acquisition. The New Credit Agreement is more fully described in Note (6), “New Credit Agreement.” The preliminary allocation of the $31,676 purchase price consisted of (1) $1,692 of fair value of tangible assets acquired, which included $651 cash received, (2) $3,390 of liabilities assumed, (3) $6,880 of identified intangible assets, and (4) $26,494 of goodwill, none of which is deductible for tax purposes. The fair value of intangible assets primarily includes $5,300 of developed technology and $1,500 of trademarks with a weighted average useful life of approximately eight years. MedPartners Acquisition On April 9, 2018, the Company completed its acquisition of MedPartners HIM (“MedPartners”), which provides case management, clinical documentation improvement, medical coding and registry services to hospitals and physician medical groups nationwide. The initial purchase price of $200,711 included (1) $196,533 cash consideration paid upon acquisition, funded primarily through borrowings under the Senior Credit Facility, and (2) a contingent earn-out payment of up to $20,000 with an estimated fair value of $4,400 as of the acquisition date. The contingent earn-out payment is based on (A) up to $10,000 based on the operating results of MedPartners for the twelve months ending December 31, 2018, which resulted in no earn-out payment, and (B) up to $10,000 based on the operating results of MedPartners for the six months ending June 30, 2019. The results of MedPartners have been included in the Company’s other workforce solutions segment since the date of acquisition. During the third quarter of 2018, $222 was returned to the Company for the final working capital settlement. The preliminary allocation of the $200,711 purchase price consisted of (1) $28,510 of fair value of tangible assets acquired, which included $8,403 cash received, (2) $11,848 of liabilities assumed, (3) $103,000 of identified intangible assets, and (4) $81,049 of goodwill, all of which is deductible for tax purposes. The intangible assets acquired have a weighted average useful life of approximately sixteen years. The following table summarizes the fair value and useful life of each intangible asset acquired: Fair Value Useful Life (in years) Identifiable intangible assets Tradenames and Trademarks $ 46,000 20 Customer Relationships 57,000 12 $ 103,000 Phillips DiPisa and Leaders For Today Acquisition On April 6, 2018, the Company completed its acquisition of two related entities, Phillips DiPisa and Leaders For Today (“PDA and LFT”), which offer a range of leadership staffing and permanent placement solutions for the healthcare industry. The initial purchase price of $35,503 included (1) $30,268 cash consideration paid upon acquisition, funded through cash on hand, and (2) a contingent earn-out payment of up to $7,000 with an estimated fair value of $5,700 as of the acquisition date. The contingent earn-out payment is based on the operating results of PDA and LFT for the twelve months ending December 31, 2018, which resulted in the full earn-out payment made in April 2019. The results of PDA and LFT have been included in the Company’s other workforce solutions segment since the date of acquisition. During the third quarter of 2018, $465 was returned to the Company for the final working capital settlement. The preliminary allocation of the $35,503 purchase price consisted of (1) $4,373 of fair value of tangible assets acquired, which included $351 cash received, (2) $4,764 of liabilities assumed, (3) $19,110 of identified intangible assets, and (4) $16,784 of goodwill, all of which is deductible for tax purposes. The fair value of intangible assets includes $5,400 of trademarks, $8,000 of customer relationships and $5,710 of staffing databases with a weighted average useful life of approximately twelve years.

Revenue Recognition

Revenue Recognition	3 Months Ended
	Mar. 31, 2019
Revenue Recognition and Deferred Revenue [Abstract]
Revenue Recognition	REVENUE RECOGNITION Revenue primarily consists of fees earned from the temporary and permanent placement of healthcare professionals and executives as well as from the Company’s SaaS-based technology, including its vendor management systems and its scheduling software. Revenue is recognized when control of these services is transferred to the customers, in an amount that reflects the consideration the Company expects to be entitled to in exchange for those services. Revenue from temporary staffing services is recognized as the services are rendered by clinical and non-clinical healthcare professionals. Under the Company’s managed services program arrangements, the Company manages all or a part of a customer’s supplemental workforce needs utilizing its own network of healthcare professionals along with those of third-party subcontractors. Revenue and the related direct costs under MSP arrangements are recorded in accordance with the accounting guidance on reporting revenue gross as a principal versus net as an agent. When the Company uses subcontractors and acts as an agent, revenue is recorded net of the related subcontractor’s expense. Revenue from executive search, physician permanent placement, and recruitment process outsourcing services is recognized as the services are rendered. The Company’s SaaS-based revenue is recognized ratably over the applicable arrangement’s service period. The Company’s customers are primarily billed as services are rendered. Any fees billed in advance of being earned are recorded as deferred revenue. During the three months ended March 31, 2019 , the amount recognized as revenue that was previously deferred was not material. The Company has elected to apply the following practical expedients and optional exemptions related to contract costs and revenue recognition: • Recognize incremental costs of obtaining a contract with amortization periods of one year or less as expense when incurred. These costs are recorded within selling, general and administrative expenses. • Recognize revenue in the amount of consideration to which the Company has a right to invoice the customer if that amount corresponds directly with the value to the customer of the Company’s services completed to date. • Exemptions from disclosing the value of unsatisfied performance obligations for (i) contracts with an original expected length of one year or less, (ii) contracts for which revenue is recognized in the amount of consideration to which the Company has a right to invoice for services performed and (iii) contracts for which variable consideration is allocated entirely to a wholly unsatisfied performance obligation or to a wholly unsatisfied promise to transfer a distinct service that forms part of a single performance obligation. See Note (5), “Segment Information” for additional information.

Net Income Per Common Share

Net Income Per Common Share	3 Months Ended
	Mar. 31, 2019
Earnings Per Share [Abstract]
NET INCOME PER COMMON SHARE	NET INCOME PER COMMON SHARE Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the reporting period. The following table sets forth the computation of basic and diluted net income per common share for the three and three months ended March 31, 2019 and 2018 , respectively: Three Months Ended March 31, 2019 2018 Net income $ 34,122 $ 42,681 Net income per common share - basic $ 0.73 $ 0.89 Net income per common share - diluted $ 0.71 $ 0.87 Weighted average common shares outstanding - basic 46,784 47,733 Plus dilutive effect of potential common shares 988 1,383 Weighted average common shares outstanding - diluted 47,772 49,116 Share-based awards to purchase 66 and 9 shares of common stock were not included in the above calculation of diluted net income per common share for the three months ended March 31, 2019 and 2018, respectively, because the effect of these instruments was anti-dilutive.

Segment Information

Segment Information	3 Months Ended
	Mar. 31, 2019
Segment Reporting [Abstract]
SEGMENT INFORMATION	SEGMENT INFORMATION The Company has three reportable segments: nurse and allied solutions, locum tenens solutions, and other workforce solutions. The Company’s chief operating decision maker relies on internal management reporting processes that provide revenue and operating income by reportable segment for making financial decisions and allocating resources. Segment operating income represents income before income taxes plus depreciation, amortization of intangible assets, share-based compensation, interest expense, net, and other, and unallocated corporate overhead. The Company’s management does not evaluate, manage or measure performance of segments using asset information; accordingly, asset information by segment is not prepared or disclosed. The following table provides a reconciliation of revenue and operating income by reportable segment to consolidated results and was derived from each segment’s internal financial information as used for corporate management purposes: Three Months Ended March 31, 2019 2018 Revenue Nurse and allied solutions $ 337,029 $ 338,179 Locum tenens solutions 80,490 103,117 Other workforce solutions 114,922 81,193 $ 532,441 $ 522,489 Segment operating income Nurse and allied solutions $ 47,922 $ 51,805 Locum tenens solutions 5,701 9,958 Other workforce solutions 26,188 19,851 79,811 81,614 Unallocated corporate overhead 17,863 15,663 Depreciation and amortization 11,710 7,886 Share-based compensation 5,186 2,864 Interest expense, net, and other 5,673 5,335 Income before income taxes $ 39,379 $ 49,866 The Company offers a comprehensive managed services program, in which the Company manages all or a portion of a client’s contingent staffing needs. This service includes both the placement of the Company’s own healthcare professionals and the utilization of other staffing agencies to fulfill the client’s staffing needs. See additional information in Note (3), “Revenue Recognition.” For the three months ended March 31, 2019 and 2018 , revenue under the Company’s managed services program arrangements comprised approximately 67% and 63% for nurse and allied solutions revenue, 24% and 14% for locum tenens solutions revenue and 7% and 9% for other workforce solutions revenue, respectively. The following table summarizes the activity related to the carrying value of goodwill by reportable segment: Nurse and Allied Solutions Locum Tenens Solutions Other Workforce Solutions Total Balance, January 1, 2019 $ 103,107 $ 19,743 $ 315,656 $ 438,506 Goodwill adjustment for MedPartners acquisition — — (64 ) (64 ) Goodwill adjustment for PDA and LFT acquisition — — (13 ) (13 ) Goodwill from Silversheet acquisition — — 26,494 26,494 Balance, March 31, 2019 $ 103,107 $ 19,743 $ 342,073 $ 464,923 Accumulated impairment loss as of December 31, 2018 and March 31, 2019 $ 154,444 $ 53,940 $ 6,555 $ 214,939

New Credit Agreement

New Credit Agreement	3 Months Ended
	Mar. 31, 2019
Debt Disclosure [Abstract]
New Credit Agreement	NEW CREDIT AGREEMENT On February 9, 2018, the Company entered into the New Credit Agreement with several lenders to provide for the $400,000 Senior Credit Facility to replace its then-existing credit facilities. The Senior Credit Facility includes a $50,000 sublimit for the issuance of letters of credit and a $50,000 sublimit for swingline loans. The obligations of the Company under the New Credit Agreement and the Senior Credit Facility are secured by substantially all of the assets of the Company. Borrowings under the Senior Credit Facility bear interest at floating rates, at the Company’s option, based upon either LIBOR plus a spread of 1.00% to 2.00% or a base rate plus a spread of 0.00% to 1.00% . The applicable spread is determined quarterly based upon the Company’s consolidated net leverage ratio. The Senior Credit Facility is available for working capital, capital expenditures, permitted acquisitions and general corporate purposes. The maturity date of the Senior Credit Facility is February 9, 2023. In connection with obtaining the New Credit Agreement, the Company incurred $2,331 in fees paid to lenders and other third parties, which were capitalized and are amortized to interest expense over the term of the New Credit Facility. In addition, the Company wrote off $574 of unamortized financing fees during 2018 relating to the prior credit facilities.

Fair Value Measurement

Fair Value Measurement	3 Months Ended
	Mar. 31, 2019
Fair Value Disclosures [Abstract]
FAIR VALUE MEASUREMENT	FAIR VALUE MEASUREMENT The Company’s valuation techniques and inputs used to measure fair value and the definition of the three levels (Level 1, Level 2, and Level 3) of the fair value hierarchy are disclosed in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note 3—Fair Value Measurement” of the 2018 Annual Report. The Company has not changed the valuation techniques or inputs it uses for its fair value measurement during the three months ended March 31, 2019 . Assets and Liabilities Measured on a Recurring Basis The Company’s restricted cash equivalents that serve as collateral for the Company’s outstanding letters of credit typically consist of money market funds that are measured at fair value based on quoted prices, which are Level 1 inputs. The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company primarily consist of commercial paper that is measured at observable market prices for identical securities that are traded in less active markets, which are Level 2 inputs. Of the $61,786 commercial paper issued and outstanding as of March 31, 2019 , $10,938 had original maturities greater than three months, which were considered available-for-sale securities. As of December 31, 2018 , the Company had $63,243 commercial paper issued and outstanding, of which $15,192 had original maturities greater than three months and were considered available-for-sale securities. The Company’s contingent consideration liabilities are measured at fair value using a probability-weighted discounted cash flow analysis or a simulation-based methodology for the acquired companies, which are Level 3 inputs. The Company recognizes changes to the fair value of its contingent consideration liabilities in selling, general and administrative expenses in the condensed consolidated statements of comprehensive income. The following tables present information about the above-referenced assets and liabilities and indicate the fair value hierarchy of the valuation techniques utilized to determine such fair value: Fair Value Measurements as of March 31, 2019 Total Quoted Prices in Active Markets for Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Money market funds $ 2,473 $ 2,473 $ — $ — Commercial paper 61,786 — 61,786 — Acquisition contingent consideration liabilities (8,500 ) — — (8,500 ) Fair Value Measurements as of December 31, 2018 Total Quoted Prices in Active Markets for Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Money market funds $ 2,461 $ 2,461 $ — $ — Commercial paper 63,243 — 63,243 — Acquisition contingent consideration liabilities (7,700 ) — — (7,700 ) Level 3 Information The following tables set forth a reconciliation of changes in the fair value of contingent consideration liabilities classified as Level 3 in the fair value hierarchy: Three Months Ended March 31, 2019 2018 Balance as of January 1, $ (7,700 ) $ (2,070 ) Settlement of HSG contingent consideration liability for year ended December 31, 2016 — 70 Settlement of HSG contingent consideration liability for year ended December 31, 2017 — 2,000 Change in fair value of contingent consideration liability from Medpartners acquisition 700 — Contingent consideration liability from Silversheet acquisition on January 30, 2019 (1,500 ) — Balance as of March 31, $ (8,500 ) $ — Assets Measured on a Non-Recurring Basis The Company applies fair value techniques on a non-recurring basis associated with valuing potential impairment losses related to its goodwill, indefinite-lived intangible assets, long-lived assets, and equity investments. The Company evaluates goodwill and indefinite-lived intangible assets annually for impairment and whenever circumstances occur indicating that goodwill might be impaired. The Company determines the fair value of its reporting units based on a combination of inputs, including the market capitalization of the Company, as well as Level 3 inputs such as discounted cash flows, which are not observable from the market, directly or indirectly. The Company determines the fair value of its indefinite-lived intangible assets using the income approach (relief-from-royalty method) based on Level 3 inputs. The Company’s equity investment represents an investment in a non-controlled corporation without a readily determinable market value. The Company has elected to measure the investment at cost minus impairment, if any, plus or minus changes resulting from observable price changes. The fair value is determined by using quoted prices for identical or similar investments of the same issuer, which are Level 2 inputs. The Company recognizes changes to the fair value of its equity investment in interest expense, net, and other in the condensed consolidated statements of comprehensive income. The balance of the equity investment classified as Level 2 in the fair value hierarchy was $15,449 as of both March 31, 2019 and December 31, 2018 . There were no changes to the fair value of the equity investment recognized during the three months ended March 31, 2019 . There were no triggering events identified, no indication of impairment of the Company’s goodwill, indefinite-lived intangible assets, long-lived assets, or equity investments, and no impairment charges recorded during the three months ended March 31, 2019 and 2018 . Fair Value of Financial Instruments The Company is required to disclose the fair value of financial instruments for which it is practicable to estimate the value, even though these instruments are not recognized at fair value in the consolidated balance sheets. As of March 31, 2019 , the Company’s senior notes have a carrying amount of $325,000 and an estimated fair value of $320,531 . As of December 31, 2018 , the senior notes had a carrying amount of $325,000 and an estimated fair value of $310,375 . Quoted market prices in active markets for identical liabilities based inputs (Level 1) were used to estimate fair value. The senior notes were issued in October 2016 and have a fixed rate of 5.125% . See additional information in “Item 8. Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (7), Notes Payable and Credit Agreement” of our 2018 Annual Report. The fair value of the Company’s long-term self-insurance accruals cannot be estimated as the Company cannot reasonably determine the timing of future payments.

Leases

Leases	3 Months Ended
	Mar. 31, 2019
Leases [Abstract]
LEASES	LEASES The Company leases certain office facilities, data centers, and equipment under various operating leases. Leases with an initial term of 12 months or less (primarily related to housing arrangements for healthcare professionals on assignment) are not recorded on the balance sheet; the Company recognizes lease expense for these leases on a straight-line basis over the lease term. Most leases include one or more options to renew, with renewal terms that can extend the lease term up to 10 years. Certain leases also include options to terminate the leases within 3 years. The components of lease expense were as follows: Three Months Ended March 31, 2019 Lease Cost Operating lease cost $ 4,536 Short-term lease cost 5,922 Variable and other lease cost 717 Net lease cost $ 11,175 The maturity of lease liabilities as of March 31, 2019 were as follows: Operating Leases Years ending December 31, 2019 (excluding the three months ended March 31, 2019) $ 13,091 2020 17,698 2021 18,183 2022 18,057 2023 17,795 Thereafter 50,318 Total lease payments $ 135,142 Less imputed interest (22,855 ) Present value of lease liabilities $ 112,287 Supplemental cash flow information related to leases was as follows: Three Months Ended March 31, 2019 Cash paid for amounts included in the measurement of operating lease liabilities (operating cash flows) $ 4,338 Operating lease right-of-use assets obtained in exchange for lease obligations $ — Weighted average remaining lease term 7 years Weighted average discount rate 4.8 % Future minimum lease payments under noncancelable operating leases (with initial or remaining lease terms in excess of one year) as of December 31, 2018 were as follows: Operating Leases Years ending December 31, 2019 $ 18,218 2020 18,149 2021 18,349 2022 18,144 2023 17,990 Thereafter 50,436 Total minimum lease payments $ 141,286 Rent expense under operating leases (with initial lease terms in excess of one year ) was $21,402 for the year ended December 31, 2018 .

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2019
Income Tax Disclosure [Abstract]
INCOME TAXES	INCOME TAXES The Company is subject to taxation in the U.S. and various states and foreign jurisdictions. With few exceptions, as of March 31, 2019 , the Company is no longer subject to state, local or foreign examinations by tax authorities for tax years before 2009 and the Company is no longer subject to U.S. federal income or payroll tax examinations for tax years before 2015. The IRS conducted, completed, and settled audits of the Company’s 2011-2012 and 2013 tax years related to income and employment tax issues for the Company’s treatment of certain non-taxable per diem allowances and travel benefits in November 2017 and May 2018, respectively. The Company believes its reserve for unrecognized tax benefits and contingent tax issues is adequate with respect to all open years. Notwithstanding the foregoing, the Company could adjust its provision for income taxes and contingent tax liability based on future developments.

Commitments and Contingencies_

Commitments and Contingencies: Legal Proceedings	3 Months Ended
	Mar. 31, 2019
Commitments and Contingencies Disclosure [Abstract]
COMMITMENTS AND CONTINGENCIES: LEGAL PROCEEDINGS	COMMITMENTS AND CONTINGENCIES: LEGAL PROCEEDINGS From time to time, the Company is involved in various lawsuits, claims, investigations, and proceedings that arise in the ordinary course of business. These matters typically relate to professional liability, tax, compensation, contract, competitor disputes and employee-related matters and include individual and class action lawsuits, as well as inquiries and investigations by governmental agencies regarding the Company’s employment and compensation practices. Additionally, some of the Company’s clients may also become subject to claims, governmental inquiries and investigations, and legal actions relating to services provided by the Company’s healthcare professionals. Depending upon the particular facts and circumstances, the Company may also be subject to indemnification obligations under its contracts with such clients relating to these matters. The Company records a liability when management believes an adverse outcome from a loss contingency is both probable and the amount, or a range, can be reasonably estimated. Significant judgment is required to determine both probability of loss and the estimated amount. The Company reviews its loss contingencies at least quarterly and adjusts its accruals and/or disclosures to reflect the impact of negotiations, settlements, rulings, advice of legal counsel, or other new information, as deemed necessary. The most significant matters for which the Company has established loss contingencies are class actions related to wage and hour claims under California and Federal law. Specifically, among other claims in these lawsuits, it is alleged that employees were not afforded required breaks or compensated for all time worked, employees’ wage statements are not sufficiently clear, and certain expense reimbursements should be included in the regular rate of pay for purposes of calculating overtime rates. The Company believes that its wage and hour practices conform with law in all material respects, but litigation is always subject to inherent uncertainty. As a result, the Company entered into settlement agreements relating to claims in two wage and hour class actions during September and October 2018. The settlement agreements are subject to court approval, which is considered probable. The Company recorded increases to its accruals established in connection with these matters amounting to $12,140 during the third quarter of 2018. With regard to outstanding loss contingencies as of March 31, 2019 , which are included in accounts payable and accrued expenses in the condensed consolidated balance sheet, the Company believes that such matters will not, either individually or in the aggregate, have a material adverse effect on its business, consolidated financial position, results of operations, or cash flows.

Balance Sheet Details

Balance Sheet Details	3 Months Ended
	Mar. 31, 2019
Balance Sheet Related Disclosures [Abstract]
BALANCE SHEET DETAILS	BALANCE SHEET DETAILS The consolidated balance sheets detail is as follows as of March 31, 2019 and December 31, 2018 : March 31, 2019 December 31, 2018 Other current assets: Restricted cash and cash equivalents $ 16,522 $ 26,329 Income tax receivable — 799 Other 14,687 12,759 Other current assets $ 31,209 $ 39,887 Fixed assets: Furniture and equipment $ 36,313 $ 34,211 Software 168,030 162,006 Leasehold improvements 8,771 8,615 213,114 204,832 Accumulated depreciation (119,489 ) (114,413 ) Fixed assets, net $ 93,625 $ 90,419 Other assets: Life insurance cash surrender value $ 64,500 $ 55,028 Other 41,090 41,124 Other assets $ 105,590 $ 96,152 Accounts payable and accrued expenses: Trade accounts payable $ 23,203 $ 31,537 Subcontractor payable 55,575 50,892 Accrued expenses 37,831 30,236 Loss contingencies 24,578 24,549 Professional liability reserve 7,961 8,633 Other 4,418 3,756 Accounts payable and accrued expenses $ 153,566 $ 149,603 Accrued compensation and benefits: Accrued payroll $ 39,933 $ 42,571 Accrued bonuses 13,546 18,021 Accrued travel expense 2,684 3,417 Health insurance reserve 3,582 3,559 Workers compensation reserve 8,378 7,817 Deferred compensation 65,820 55,720 Other 1,849 3,954 Accrued compensation and benefits $ 135,792 $ 135,059 Other current liabilities: Acquisition related liabilities $ 7,668 $ 7,918 Other 12,444 2,325 Other current liabilities $ 20,112 $ 10,243 Other long-term liabilities: Workers compensation reserve $ 18,953 $ 19,454 Professional liability reserve 38,058 38,324 Deferred rent — 15,012 Unrecognized tax benefits 4,916 4,862 Deferred revenue 769 865 Other 1,050 11 Other long-term liabilities $ 63,746 $ 78,528

Subsequent Events

Subsequent Events	3 Months Ended
	Mar. 31, 2019
Subsequent Events [Abstract]
SUBSEQUENT EVENTS	SUBSEQUENT EVENTS On April 29, 2019, the Company entered into an agreement to acquire Advanced Medical Personnel Services, Inc. (“Advanced”) for $200,000 in cash and tiered contingent consideration of up to $20,000 . Advanced is a national healthcare staffing company that specializes in placing therapists and nurses across multiple settings, including hospitals, schools, clinics, skilled nursing facilities, and home health. The closing of the acquisition is contingent upon satisfaction of certain conditions and, upon consummation, Advanced will become a wholly owned subsidiary of the Company.

Basis of Presentation (Policies

Basis of Presentation (Policies)	3 Months Ended
	Mar. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Use of Estimates	The preparation of financial statements in conformity with U.S. GAAP requires management to make a number of estimates and assumptions relating to the reporting of assets and liabilities and the disclosure of contingent assets and liabilities at the dates of the financial statements and the reported amounts of revenue and expenses during the reporting periods. On an ongoing basis, the Company evaluates its estimates, including those related to asset impairments, accruals for self-insurance, compensation and related benefits, accounts receivable, contingencies and litigation, earn-out liabilities, and income taxes. Actual results could differ from those estimates under different assumptions or conditions.
Recently Adopted Accounting Pronouncements	Recently Adopted Accounting Pronouncements In February 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standard Update (“ASU”) 2016-02, “Leases.” This standard requires organizations that lease assets to recognize the assets and liabilities created by those leases. The standard also will require disclosures to help investors and other financial statement users better understand the amount, timing, and uncertainty of cash flows arising from leases. A modified retrospective transition approach is required, applying the standard to all leases existing at the date of initial application. In addition, the FASB has also issued several amendments to the standard, which clarify certain aspects of the guidance, including an optional transition method for adoption of this standard, which allows organizations to initially apply the new requirements at the effective date, recognize a cumulative effect adjustment to the opening balance of retained earnings, and continue to apply the legacy guidance in Accounting Standards Codification (“ASC”) 840, Leases, including its disclosure requirements, in the comparative periods presented. The new standard provides a number of optional practical expedients in transition. The Company elected the ‘package of practical expedients’, which permits organizations not to reassess under the new standard prior conclusions about lease identification, lease classification and initial direct costs. The Company did not elect to use the hindsight practical expedient to determine the lease term or evaluate impairment for existing leases. The Company adopted ASU 2016-02 effective January 1, 2019 , using the optional transition method described above. The Company recognized the cumulative effect of adopting this guidance as an adjustment as of the effective date, primarily related to the recognition of lease liabilities of $114,807 and corresponding right-of-use assets of $99,525 for existing operating leases. The Company also derecognized existing deferred rent liabilities of $15,302 . These adjustments had no effect on opening retained earnings and prior periods were not retrospectively adjusted and continue to be reported in accordance with ASC 840. The new standard also provides practical expedients for an organization’s ongoing accounting. The Company elected the short-term lease recognition exemption and the practical expedient to not separate lease and non-lease components for all leases that qualify. The Company does not expect the adoption of this standard to impact its results of operations. There was no other material impact to the Company’s condensed consolidated financial statements as a result of adopting this updated standard. Cash, cash equivalents and restricted cash The Company considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. Cash and cash equivalents include currency on hand, deposits with financial institutions and highly liquid investments. Restricted cash and cash equivalents primarily represent cash and money market funds on deposit with financial institutions and investments represents commercial paper that serves as collateral for the Company’s outstanding letters of credit and captive insurance subsidiary claim payments. See Note (6), “New Credit Agreement” and Note (7), “Fair Value Measurement” for additional information. The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying condensed consolidated balance sheets and related notes to the amounts presented in the accompanying condensed consolidated statements of cash flows. March 31, 2019 December 31, 2018 Cash and cash equivalents $ 19,116 $ 13,856 Restricted cash and cash equivalents (included in other current assets) 16,522 26,329 Restricted cash, cash equivalents and investments 61,279 59,331 Total cash, cash equivalents and restricted cash and investments 96,917 99,516 Less restricted investments (10,938 ) (15,192 ) Total cash, cash equivalents and restricted cash $ 85,979 $ 84,324
Revenue Recognition	Revenue primarily consists of fees earned from the temporary and permanent placement of healthcare professionals and executives as well as from the Company’s SaaS-based technology, including its vendor management systems and its scheduling software. Revenue is recognized when control of these services is transferred to the customers, in an amount that reflects the consideration the Company expects to be entitled to in exchange for those services. Revenue from temporary staffing services is recognized as the services are rendered by clinical and non-clinical healthcare professionals. Under the Company’s managed services program arrangements, the Company manages all or a part of a customer’s supplemental workforce needs utilizing its own network of healthcare professionals along with those of third-party subcontractors. Revenue and the related direct costs under MSP arrangements are recorded in accordance with the accounting guidance on reporting revenue gross as a principal versus net as an agent. When the Company uses subcontractors and acts as an agent, revenue is recorded net of the related subcontractor’s expense. Revenue from executive search, physician permanent placement, and recruitment process outsourcing services is recognized as the services are rendered. The Company’s SaaS-based revenue is recognized ratably over the applicable arrangement’s service period. The Company’s customers are primarily billed as services are rendered. Any fees billed in advance of being earned are recorded as deferred revenue. During the three months ended March 31, 2019 , the amount recognized as revenue that was previously deferred was not material. The Company has elected to apply the following practical expedients and optional exemptions related to contract costs and revenue recognition: • Recognize incremental costs of obtaining a contract with amortization periods of one year or less as expense when incurred. These costs are recorded within selling, general and administrative expenses. • Recognize revenue in the amount of consideration to which the Company has a right to invoice the customer if that amount corresponds directly with the value to the customer of the Company’s services completed to date. • Exemptions from disclosing the value of unsatisfied performance obligations for (i) contracts with an original expected length of one year or less, (ii) contracts for which revenue is recognized in the amount of consideration to which the Company has a right to invoice for services performed and (iii) contracts for which variable consideration is allocated entirely to a wholly unsatisfied performance obligation or to a wholly unsatisfied promise to transfer a distinct service that forms part of a single performance obligation.
Net Income per Common Share	Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the reporting period.
Segment Information	The Company’s chief operating decision maker relies on internal management reporting processes that provide revenue and operating income by reportable segment for making financial decisions and allocating resources. Segment operating income represents income before income taxes plus depreciation, amortization of intangible assets, share-based compensation, interest expense, net, and other, and unallocated corporate overhead. The Company’s management does not evaluate, manage or measure performance of segments using asset information; accordingly, asset information by segment is not prepared or disclosed.
Fair Value of Financial Instruments	Fair Value of Financial Instruments The Company is required to disclose the fair value of financial instruments for which it is practicable to estimate the value, even though these instruments are not recognized at fair value in the consolidated balance sheets. As of March 31, 2019 , the Company’s senior notes have a carrying amount of $325,000 and an estimated fair value of $320,531 . As of December 31, 2018 , the senior notes had a carrying amount of $325,000 and an estimated fair value of $310,375 . Quoted market prices in active markets for identical liabilities based inputs (Level 1) were used to estimate fair value. The senior notes were issued in October 2016 and have a fixed rate of 5.125% . See additional information in “Item 8. Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (7), Notes Payable and Credit Agreement” of our 2018 Annual Report. The fair value of the Company’s long-term self-insurance accruals cannot be estimated as the Company cannot reasonably determine the timing of future payments. Assets Measured on a Non-Recurring Basis The Company applies fair value techniques on a non-recurring basis associated with valuing potential impairment losses related to its goodwill, indefinite-lived intangible assets, long-lived assets, and equity investments. The Company evaluates goodwill and indefinite-lived intangible assets annually for impairment and whenever circumstances occur indicating that goodwill might be impaired. The Company determines the fair value of its reporting units based on a combination of inputs, including the market capitalization of the Company, as well as Level 3 inputs such as discounted cash flows, which are not observable from the market, directly or indirectly. The Company determines the fair value of its indefinite-lived intangible assets using the income approach (relief-from-royalty method) based on Level 3 inputs. Assets and Liabilities Measured on a Recurring Basis The Company’s restricted cash equivalents that serve as collateral for the Company’s outstanding letters of credit typically consist of money market funds that are measured at fair value based on quoted prices, which are Level 1 inputs. The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company primarily consist of commercial paper that is measured at observable market prices for identical securities that are traded in less active markets, which are Level 2 inputs. Of the $61,786 commercial paper issued and outstanding as of March 31, 2019 , $10,938 had original maturities greater than three months, which were considered available-for-sale securities. As of December 31, 2018 , the Company had $63,243 commercial paper issued and outstanding, of which $15,192 had original maturities greater than three months and were considered available-for-sale securities.

Basis of Presentation (Tables)

Basis of Presentation (Tables)	3 Months Ended
	Mar. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Schedule of Restricted Cash	The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying condensed consolidated balance sheets and related notes to the amounts presented in the accompanying condensed consolidated statements of cash flows. March 31, 2019 December 31, 2018 Cash and cash equivalents $ 19,116 $ 13,856 Restricted cash and cash equivalents (included in other current assets) 16,522 26,329 Restricted cash, cash equivalents and investments 61,279 59,331 Total cash, cash equivalents and restricted cash and investments 96,917 99,516 Less restricted investments (10,938 ) (15,192 ) Total cash, cash equivalents and restricted cash $ 85,979 $ 84,324
Schedule of Cash and Cash Equivalents	The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying condensed consolidated balance sheets and related notes to the amounts presented in the accompanying condensed consolidated statements of cash flows. March 31, 2019 December 31, 2018 Cash and cash equivalents $ 19,116 $ 13,856 Restricted cash and cash equivalents (included in other current assets) 16,522 26,329 Restricted cash, cash equivalents and investments 61,279 59,331 Total cash, cash equivalents and restricted cash and investments 96,917 99,516 Less restricted investments (10,938 ) (15,192 ) Total cash, cash equivalents and restricted cash $ 85,979 $ 84,324

Acquisition (Tables)

Acquisition (Tables)	3 Months Ended
	Mar. 31, 2019
Business Combinations [Abstract]
Schedule of Intangible Assets Acquired	The following table summarizes the fair value and useful life of each intangible asset acquired: Fair Value Useful Life (in years) Identifiable intangible assets Tradenames and Trademarks $ 46,000 20 Customer Relationships 57,000 12 $ 103,000

Net Income Per Common Share (Ta

Net Income Per Common Share (Tables)	3 Months Ended
	Mar. 31, 2019
Earnings Per Share [Abstract]
Computation of basic and diluted net income per common share	The following table sets forth the computation of basic and diluted net income per common share for the three and three months ended March 31, 2019 and 2018 , respectively: Three Months Ended March 31, 2019 2018 Net income $ 34,122 $ 42,681 Net income per common share - basic $ 0.73 $ 0.89 Net income per common share - diluted $ 0.71 $ 0.87 Weighted average common shares outstanding - basic 46,784 47,733 Plus dilutive effect of potential common shares 988 1,383 Weighted average common shares outstanding - diluted 47,772 49,116

Segment Information (Tables)

Segment Information (Tables)	3 Months Ended
	Mar. 31, 2019
Segment Reporting [Abstract]
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results	The following table provides a reconciliation of revenue and operating income by reportable segment to consolidated results and was derived from each segment’s internal financial information as used for corporate management purposes: Three Months Ended March 31, 2019 2018 Revenue Nurse and allied solutions $ 337,029 $ 338,179 Locum tenens solutions 80,490 103,117 Other workforce solutions 114,922 81,193 $ 532,441 $ 522,489 Segment operating income Nurse and allied solutions $ 47,922 $ 51,805 Locum tenens solutions 5,701 9,958 Other workforce solutions 26,188 19,851 79,811 81,614 Unallocated corporate overhead 17,863 15,663 Depreciation and amortization 11,710 7,886 Share-based compensation 5,186 2,864 Interest expense, net, and other 5,673 5,335 Income before income taxes $ 39,379 $ 49,866
Summary of goodwill by reportable segment	The following table summarizes the activity related to the carrying value of goodwill by reportable segment: Nurse and Allied Solutions Locum Tenens Solutions Other Workforce Solutions Total Balance, January 1, 2019 $ 103,107 $ 19,743 $ 315,656 $ 438,506 Goodwill adjustment for MedPartners acquisition — — (64 ) (64 ) Goodwill adjustment for PDA and LFT acquisition — — (13 ) (13 ) Goodwill from Silversheet acquisition — — 26,494 26,494 Balance, March 31, 2019 $ 103,107 $ 19,743 $ 342,073 $ 464,923 Accumulated impairment loss as of December 31, 2018 and March 31, 2019 $ 154,444 $ 53,940 $ 6,555 $ 214,939

Fair Value Measurement (Tables)

Fair Value Measurement (Tables)	3 Months Ended
	Mar. 31, 2019
Fair Value Disclosures [Abstract]
Schedule of financial assets and liabilities measured at fair value on recurring basis	The following tables present information about the above-referenced assets and liabilities and indicate the fair value hierarchy of the valuation techniques utilized to determine such fair value: Fair Value Measurements as of March 31, 2019 Total Quoted Prices in Active Markets for Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Money market funds $ 2,473 $ 2,473 $ — $ — Commercial paper 61,786 — 61,786 — Acquisition contingent consideration liabilities (8,500 ) — — (8,500 ) Fair Value Measurements as of December 31, 2018 Total Quoted Prices in Active Markets for Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Money market funds $ 2,461 $ 2,461 $ — $ — Commercial paper 63,243 — 63,243 — Acquisition contingent consideration liabilities (7,700 ) — — (7,700 )
Reconciliations of changes in the fair value of contingent consideration liabilities	The following tables set forth a reconciliation of changes in the fair value of contingent consideration liabilities classified as Level 3 in the fair value hierarchy: Three Months Ended March 31, 2019 2018 Balance as of January 1, $ (7,700 ) $ (2,070 ) Settlement of HSG contingent consideration liability for year ended December 31, 2016 — 70 Settlement of HSG contingent consideration liability for year ended December 31, 2017 — 2,000 Change in fair value of contingent consideration liability from Medpartners acquisition 700 — Contingent consideration liability from Silversheet acquisition on January 30, 2019 (1,500 ) — Balance as of March 31, $ (8,500 ) $ —
Reconciliations of equity investments included in net income	The balance of the equity investment classified as Level 2 in the fair value hierarchy was $15,449 as of both March 31, 2019 and December 31, 2018 . There were no changes to the fair value of the equity investment recognized during the three months ended March 31, 2019 .

Leases (Tables)

Leases (Tables)	3 Months Ended
	Mar. 31, 2019
Leases [Abstract]
Maturity of Lease Liabilities	The maturity of lease liabilities as of March 31, 2019 were as follows: Operating Leases Years ending December 31, 2019 (excluding the three months ended March 31, 2019) $ 13,091 2020 17,698 2021 18,183 2022 18,057 2023 17,795 Thereafter 50,318 Total lease payments $ 135,142 Less imputed interest (22,855 ) Present value of lease liabilities $ 112,287
Supplemental Cash Flow Disclosures Related to Leases	Supplemental cash flow information related to leases was as follows: Three Months Ended March 31, 2019 Cash paid for amounts included in the measurement of operating lease liabilities (operating cash flows) $ 4,338 Operating lease right-of-use assets obtained in exchange for lease obligations $ — The components of lease expense were as follows: Three Months Ended March 31, 2019 Lease Cost Operating lease cost $ 4,536 Short-term lease cost 5,922 Variable and other lease cost 717 Net lease cost $ 11,175
Assumptions Used for Operating Leases	Weighted average remaining lease term 7 years Weighted average discount rate 4.8 %
Schedule of Future Minimum Payments for Operating Leases Under ASC 840	Future minimum lease payments under noncancelable operating leases (with initial or remaining lease terms in excess of one year) as of December 31, 2018 were as follows: Operating Leases Years ending December 31, 2019 $ 18,218 2020 18,149 2021 18,349 2022 18,144 2023 17,990 Thereafter 50,436 Total minimum lease payments $ 141,286

Balance Sheet Details (Tables)

Balance Sheet Details (Tables)	3 Months Ended
	Mar. 31, 2019
Balance Sheet Related Disclosures [Abstract]
Schedule of Supplemental Balance Sheet Disclosures	The consolidated balance sheets detail is as follows as of March 31, 2019 and December 31, 2018 : March 31, 2019 December 31, 2018 Other current assets: Restricted cash and cash equivalents $ 16,522 $ 26,329 Income tax receivable — 799 Other 14,687 12,759 Other current assets $ 31,209 $ 39,887 Fixed assets: Furniture and equipment $ 36,313 $ 34,211 Software 168,030 162,006 Leasehold improvements 8,771 8,615 213,114 204,832 Accumulated depreciation (119,489 ) (114,413 ) Fixed assets, net $ 93,625 $ 90,419 Other assets: Life insurance cash surrender value $ 64,500 $ 55,028 Other 41,090 41,124 Other assets $ 105,590 $ 96,152 Accounts payable and accrued expenses: Trade accounts payable $ 23,203 $ 31,537 Subcontractor payable 55,575 50,892 Accrued expenses 37,831 30,236 Loss contingencies 24,578 24,549 Professional liability reserve 7,961 8,633 Other 4,418 3,756 Accounts payable and accrued expenses $ 153,566 $ 149,603 Accrued compensation and benefits: Accrued payroll $ 39,933 $ 42,571 Accrued bonuses 13,546 18,021 Accrued travel expense 2,684 3,417 Health insurance reserve 3,582 3,559 Workers compensation reserve 8,378 7,817 Deferred compensation 65,820 55,720 Other 1,849 3,954 Accrued compensation and benefits $ 135,792 $ 135,059 Other current liabilities: Acquisition related liabilities $ 7,668 $ 7,918 Other 12,444 2,325 Other current liabilities $ 20,112 $ 10,243 Other long-term liabilities: Workers compensation reserve $ 18,953 $ 19,454 Professional liability reserve 38,058 38,324 Deferred rent — 15,012 Unrecognized tax benefits 4,916 4,862 Deferred revenue 769 865 Other 1,050 11 Other long-term liabilities $ 63,746 $ 78,528

Basis of Presentation Basis of

Basis of Presentation Basis of Presentation - Recently Adopted Accounting Pronouncements (Details) - USD ($) $ in Thousands	Jan. 01, 2019	Mar. 31, 2019	Dec. 31, 2018	Mar. 31, 2018	Dec. 31, 2017
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Operating lease right-of-use assets		$ 97,055
Present value of lease liabilities		112,287
Cash and cash equivalents		19,116	$ 13,856
Restricted cash and cash equivalents (included in other current assets)		16,522	26,329
Restricted cash, cash equivalents and investments		61,279	59,331
Total cash, cash equivalents and restricted cash and investments		96,917	99,516
Less restricted investments		(10,938)	(15,192)
Cash, cash equivalents and restricted cash at the end of period		$ 85,979	$ 84,324	$ 134,027	$ 98,894
Accounting Standards Update 2016-02
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Operating lease right-of-use assets	$ 99,525
Present value of lease liabilities	(114,807)
Derecognition of existing deferred rent liabilities	$ 15,302

Acquisitions (Details)

Acquisitions (Details)	Jan. 30, 2019USD ($)	Apr. 09, 2018USD ($)	Apr. 06, 2018USD ($)	Mar. 31, 2019USD ($)aquisition	Sep. 30, 2018USD ($)	Dec. 31, 2018USD ($)	Feb. 09, 2018USD ($)
Business Acquisition [Line Items]
Number of acquisitions | aquisition				3
Goodwill				$ 464,923,000		$ 438,506,000
Silversheet
Business Acquisition [Line Items]
Initial purchase price	$ 31,676,000
Cash consideration	30,176,000
Tiered contingent earn-out payment	25,000,000
Estimated fair value of contingent earn-out payment	1,500,000
Tangible assets acquired, including cash received	1,692,000
Cash received	651,000
Liabilities assumed	3,390,000
Intangible assets acquired	6,880,000
Goodwill	$ 26,494,000
Intangible assets, weighted-average useful life (in years)	8 years
Silversheet | Based on operating results for the twelve months ending December 31, 2019
Business Acquisition [Line Items]
Tiered contingent earn-out payment	$ 6,000,000
Silversheet | Based on operating results for the twelve months ending December 31, 2020
Business Acquisition [Line Items]
Tiered contingent earn-out payment	19,000,000
Silversheet | Developed Technology
Business Acquisition [Line Items]
Intangible assets acquired	5,300,000
Silversheet | Trademarks
Business Acquisition [Line Items]
Intangible assets acquired	$ 1,500,000
MedPartners
Business Acquisition [Line Items]
Initial purchase price		$ 200,711,000
Cash consideration		196,533,000
Tiered contingent earn-out payment		20,000,000
Estimated fair value of contingent earn-out payment		4,400,000
Tangible assets acquired, including cash received		28,510,000
Cash received		8,403,000
Liabilities assumed		11,848,000
Intangible assets acquired		103,000,000
Goodwill		$ 81,049,000
Intangible assets, weighted-average useful life (in years)		16 years
Working capital settlement received					$ 222,000
MedPartners | Based on operating results for the twelve months ending December 31, 2018
Business Acquisition [Line Items]
Tiered contingent earn-out payment		$ 10,000,000
MedPartners | Based on operating results for the six months ended June 30, 2019
Business Acquisition [Line Items]
Tiered contingent earn-out payment		10,000,000
MedPartners | Customer Relationships
Business Acquisition [Line Items]
Intangible assets acquired		$ 57,000,000
PDA and LFT
Business Acquisition [Line Items]
Initial purchase price			$ 35,503,000
Cash consideration			30,268,000
Tiered contingent earn-out payment			7,000,000
Estimated fair value of contingent earn-out payment			5,700,000
Tangible assets acquired, including cash received			4,373,000
Cash received			351,000
Liabilities assumed			4,764,000
Intangible assets acquired			19,110,000
Goodwill			$ 16,784,000
Intangible assets, weighted-average useful life (in years)			12 years
Working capital settlement received					$ 465,000
PDA and LFT | Trademarks
Business Acquisition [Line Items]
Intangible assets acquired			$ 5,400,000
PDA and LFT | Customer Relationships
Business Acquisition [Line Items]
Intangible assets acquired			8,000,000
PDA and LFT | Staffing Databases
Business Acquisition [Line Items]
Intangible assets acquired			$ 5,710,000
Revolving Credit Facility | Line of Credit
Business Acquisition [Line Items]
Maximum borrowing capacity							$ 400,000,000

Acquisitions - Schedule of Inta

Acquisitions - Schedule of Intangible Assets Acquired (Details) - MedPartners $ in Thousands	Apr. 09, 2018USD ($)
Acquired Finite-Lived Intangible Assets [Line Items]
Intangible assets acquired	$ 103,000
Tradenames and Trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Intangible assets acquired	$ 46,000
Useful Life	20 years
Customer Relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Intangible assets acquired	$ 57,000
Useful Life	12 years

Net Income Per Common Share - N

Net Income Per Common Share - Narrative (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Computation of basic and diluted net income per common share
Net income	$ 34,122	$ 42,681
Net income per common share - basic (in dollars per share)	$ 0.73	$ 0.89
Net income per common share - diluted (in dollars per share)	$ 0.71	$ 0.87
Weighted average common shares outstanding - basic (in shares)	46,784	47,733
Plus dilutive effect of potential common shares (in shares)	988	1,383
Weighted average common shares outstanding - diluted (in shares)	47,772	49,116
Common stock excluded from calculation of EPS (in shares)	66	9

Segment Information - Narrative

Segment Information - Narrative (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)segment	Mar. 31, 2018USD ($)
Segment Reporting, Revenue Reconciling Item [Line Items]
Number of reportable segments | segment	3
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Revenue	$ 532,441	$ 522,489
Segment operating income	45,052	55,201
Depreciation and amortization	11,710	7,886
Share-based compensation	5,186	2,864
Interest expense, net, and other	5,673	5,335
Income before income taxes	39,379	49,866
Operating segments
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Revenue	532,441	522,489
Segment operating income	79,811	81,614
Operating segments | Nurse and Allied Solutions
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Revenue	337,029	338,179
Segment operating income	47,922	51,805
Operating segments | Locum Tenens Solutions
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Revenue	80,490	103,117
Segment operating income	5,701	9,958
Operating segments | Other Workforce Solutions
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Revenue	114,922	81,193
Segment operating income	26,188	19,851
Unallocated corporate overhead
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Unallocated corporate overhead	$ 17,863	$ 15,663
Product concentration risk | Sales revenue, net | Managed Services Program Arrangements | Nurse and Allied Solutions
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Revenue from contract with customer, percent	67.00%	63.00%
Product concentration risk | Sales revenue, net | Managed Services Program Arrangements | Locum Tenens Solutions
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Revenue from contract with customer, percent	24.00%	14.00%
Product concentration risk | Sales revenue, net | Managed Services Program Arrangements | Other Workforce Solutions
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Revenue from contract with customer, percent	7.00%	9.00%

Segment Information - Goodwill

Segment Information - Goodwill (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Dec. 31, 2018
Goodwill [Roll Forward]
Goodwill, beginning balance	$ 438,506
Goodwill, ending balance	464,923
Accumulated impairment loss	214,939	$ 214,939
Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	103,107
Goodwill, ending balance	103,107
Accumulated impairment loss	154,444	154,444
Locum Tenens Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	19,743
Goodwill, ending balance	19,743
Accumulated impairment loss	53,940	53,940
Other Workforce Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	315,656
Goodwill, ending balance	342,073
Accumulated impairment loss	6,555	$ 6,555
MedPartners
Goodwill [Roll Forward]
Goodwill, adjustments	(64)
MedPartners | Other Workforce Solutions
Goodwill [Roll Forward]
Goodwill, adjustments	(64)
PDA and LFT
Goodwill [Roll Forward]
Goodwill, adjustments	(13)
PDA and LFT | Other Workforce Solutions
Goodwill [Roll Forward]
Goodwill, adjustments	(13)
Silversheet
Goodwill [Roll Forward]
Goodwill acquired	26,494
Silversheet | Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill acquired	0
Silversheet | Locum Tenens Solutions
Goodwill [Roll Forward]
Goodwill acquired	0
Silversheet | Other Workforce Solutions
Goodwill [Roll Forward]
Goodwill acquired	$ 26,494

New Credit Agreement - Narrativ

New Credit Agreement - Narrative (Details) - Line of Credit - USD ($)	Feb. 09, 2018	Mar. 31, 2019
Debt Instrument [Line Items]
Fees paid to lenders and other third parties		$ 2,331,000
Unamortized financing fees written off		$ 574,000
Letter of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 50,000,000
Revolving Credit Facility, Swing Line Loan
Debt Instrument [Line Items]
Maximum borrowing capacity	50,000,000
Revolving Credit Facility
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 400,000,000
Revolving Credit Facility | London Interbank Offered Rate (LIBOR) | Minimum
Debt Instrument [Line Items]
Basis spread on variable rate	1.00%
Revolving Credit Facility | London Interbank Offered Rate (LIBOR) | Maximum
Debt Instrument [Line Items]
Basis spread on variable rate	2.00%
Revolving Credit Facility | Base Rate | Minimum
Debt Instrument [Line Items]
Basis spread on variable rate	0.00%
Revolving Credit Facility | Base Rate | Maximum
Debt Instrument [Line Items]
Basis spread on variable rate	1.00%

Fair Value Measurement - Narrat

Fair Value Measurement - Narrative (Details) - USD ($)	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018	Dec. 31, 2018	Oct. 31, 2016
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Impairment charges	$ 0	$ 0
Fair Value, Measurements, Nonrecurring | Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity investment balance	15,449,000		$ 15,449,000
Commercial paper | Fair Value, Measurements, Recurring
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Commercial paper	61,786,000		63,243,000
Commercial paper | Fair Value, Measurements, Recurring | Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Commercial paper	61,786,000		63,243,000
Available-for-sale securities	10,938,000		15,192,000
5.125% Senior Notes due 2024 [Member] | Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying amount of senior notes	325,000,000		325,000,000
Estimated fair value of senior notes	$ 320,531,000		$ 310,375,000
5.125% Senior Notes Due 2024 | Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate				5.125%

Fair Value Measurement - Financ

Fair Value Measurement - Financial Assets and Liabilities (Details) - Fair Value, Measurements, Recurring - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Money market funds
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	$ 2,473	$ 2,461
Money market funds | Quoted Prices in Active Markets for Identical Assets (Level 1)
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	2,473	2,461
Money market funds | Significant Other Observable Inputs (Level 2)
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	0	0
Money market funds | Significant Unobservable Inputs (Level 3)
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	0	0
Commercial paper
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	61,786	63,243
Commercial paper | Quoted Prices in Active Markets for Identical Assets (Level 1)
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	0	0
Commercial paper | Significant Other Observable Inputs (Level 2)
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	61,786	63,243
Commercial paper | Significant Unobservable Inputs (Level 3)
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	0	0
Acquisition contingent consideration liabilities
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	(8,500)	(7,700)
Acquisition contingent consideration liabilities | Quoted Prices in Active Markets for Identical Assets (Level 1)
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	0	0
Acquisition contingent consideration liabilities | Significant Other Observable Inputs (Level 2)
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	0	0
Acquisition contingent consideration liabilities | Significant Unobservable Inputs (Level 3)
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	$ (8,500)	$ (7,700)

Fair Value Measurement - Reconc

Fair Value Measurement - Reconciliation of Changes in Contingent Consideration Liabilities (Details) - Significant Unobservable Inputs (Level 3) - Acquisition contingent consideration liabilities - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ (7,700)	$ (2,070)
Ending balance	(8,500)	0
MedPartners
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Change in fair value of contingent consideration earn-out liability from acquisition	700	0
Silversheet
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Contingent consideration earn-out liability	(1,500)	0
Contingent consideration liability for year ended December 31, 2016 | HSG
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement of earn-out	0	70
Contingent consideration liability for year ended December 31, 2017 | HSG
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement of earn-out	$ 0	$ 2,000

Leases - Narrative (Details)

Leases - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2019	Dec. 31, 2018
Lessee, Lease, Description [Line Items]
Option to extend, term	10 years
Option to terminate, term	3 years
Rent expense		$ 21,402
Minimum
Lessee, Lease, Description [Line Items]
Lease term	1 year

Leases - Components of Lease Ex

Leases - Components of Lease Expense (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)
Leases [Abstract]
Operating lease cost	$ 4,536
Short-term lease cost	5,922
Variable and other lease cost	717
Net lease cost	$ 11,175

Leases - Maturity of Lease Liab

Leases - Maturity of Lease Liabilities (Details) $ in Thousands	Mar. 31, 2019USD ($)
Leases [Abstract]
2019 (excluding the three months ended March 31, 2019)	$ 13,091
2020	17,698
2021	18,183
2022	18,057
2023	17,795
Thereafter	50,318
Total lease payments	135,142
Less imputed interest	(22,855)
Present value of lease liabilities	$ 112,287

Leases - Supplemental Cash Flow

Leases - Supplemental Cash Flow Information Regarding Leases (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)
Leases [Abstract]
Cash paid for amounts included in the measurement of operating lease liabilities (operating cash flows)	$ 4,338
Operating lease right-of-use assets obtained in exchange for lease obligations	$ 0

Leases - Assumptions Used for O

Leases - Assumptions Used for Operating Leases (Details)	Mar. 31, 2019
Leases [Abstract]
Weighted average remaining lease term	7 years
Weighted average discount rate	4.80%

Leases - Minimum Lease Payments

Leases - Minimum Lease Payments Under ASC 840 (Details) $ in Thousands	Dec. 31, 2018USD ($)
Leases [Abstract]
2019	$ 18,218
2020	18,149
2021	18,349
2022	18,144
2023	17,990
Thereafter	50,436
Total minimum lease payments	$ 141,286

Commitments and Contingencies_2

Commitments and Contingencies: Legal Proceedings - Narrative (Details) - Wage and Hour claims - Pending Litigation $ in Thousands	3 Months Ended
	Sep. 30, 2018USD ($)	Oct. 31, 2018claim
Loss Contingencies [Line Items]
Number of class actions related to wage and hour claims | claim		2
Increase to loss contingency accruals | $	$ 12,140

Balance Sheet Details - Narrati

Balance Sheet Details - Narrative (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Other current assets:
Restricted cash and cash equivalents	$ 16,522	$ 26,329
Income tax receivable	0	799
Other	14,687	12,759
Other current assets	31,209	39,887
Fixed assets:
Furniture and equipment	36,313	34,211
Software	168,030	162,006
Leasehold improvements	8,771	8,615
Fixed assets, gross	213,114	204,832
Accumulated depreciation	(119,489)	(114,413)
Fixed assets, net	93,625	90,419
Other assets:
Life insurance cash surrender value	64,500	55,028
Other	41,090	41,124
Other assets	105,590	96,152
Accounts payable and accrued expenses:
Trade accounts payable	23,203	31,537
Subcontractor payable	55,575	50,892
Accrued expenses	37,831	30,236
Loss contingencies	24,578	24,549
Professional liability reserve	7,961	8,633
Other	4,418	3,756
Accounts payable and accrued expenses	153,566	149,603
Accrued compensation and benefits:
Accrued payroll	39,933	42,571
Accrued bonuses	13,546	18,021
Accrued travel expense	2,684	3,417
Health insurance reserve	3,582	3,559
Workers compensation reserve	8,378	7,817
Deferred compensation	65,820	55,720
Other	1,849	3,954
Accrued compensation and benefits	135,792	135,059
Other current liabilities:
Acquisition related liabilities	7,668	7,918
Other	12,444	2,325
Other current liabilities	20,112	10,243
Other long-term liabilities:
Workers compensation reserve	18,953	19,454
Professional liability reserve	38,058	38,324
Deferred rent	0	15,012
Unrecognized tax benefits	4,916	4,862
Deferred revenue	769	865
Other	1,050	11
Other long-term liabilities	$ 63,746	$ 78,528

Subsequent Events - Narrative (

Subsequent Events - Narrative (Details) - Advanced - Subsequent Event	Apr. 29, 2019USD ($)
Subsequent Event [Line Items]
Cash consideration	$ 200,000,000
Tiered contingent earn-out payment	$ 20,000,000

Uncategorized Items - ahs-20190

Label	Element	Value
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ 2,089,000
Retained Earnings [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ 2,089,000