Select Medical (SEM) 10-K 20 Feb 20 2019 FY Annual report Financial data

Cover

Cover - USD ($)	12 Months Ended
	Dec. 31, 2019	Feb. 01, 2020	Jun. 28, 2019
Entity Information [Line Items]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2019
Document Transition Report	false
Entity File Number	001-34465
Entity Registrant Name	SELECT MEDICAL HOLDINGS CORP
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	20-1764048
Entity Address, Address Line One	4714 Gettysburg Road
Entity Address, Address Line Two	P.O. Box 2034
Entity Address, City or Town	Mechanicsburg
Entity Address, State or Province	PA
Entity Address, Postal Zip Code	17055
City Area Code	717
Local Phone Number	972-1100
Title of 12(b) Security	Common Stock, $0.001 par value per share
Trading Symbol	SEM
Security Exchange Name	NYSE
Entity Well-known Seasoned Issuer	Yes
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Public Float			$ 1,704,659,609
Entity Common Stock, Shares Outstanding		134,313,112
Documents Incorporated by Reference	Listed hereunder are the documents, any portions of which are incorporated by reference and the Parts of this Form 10-K into which such portions are incorporated: 1. The registrant's definitive proxy statement for use in connection with the 2020 Annual Meeting of Stockholders to be held on or about April 30, 2020 to be filed within 120 days after the registrant’s fiscal year ended December 31, 2019 , portions of which are incorporated by reference into Part III of this Form 10-K. Such definitive proxy statement, except for the parts therein which have been specifically incorporated by reference, should not be deemed “filed” for the purposes of this form 10-K.
Entity Central Index Key	0001320414
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	FY

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Current Assets:
Cash and cash equivalents	$ 335,882	$ 175,178
Accounts receivable	762,677	706,676
Prepaid income taxes	18,585	20,539
Other current assets	95,848	90,131
Total Current Assets	1,212,992	992,524
Operating lease right-of-use assets	1,003,986
Property and equipment, net	998,406	979,810
Goodwill	3,391,955	3,320,726
Identifiable intangible assets, net	409,068	437,693
Other assets	323,881	233,512
Total Assets	7,340,288	5,964,265
Current Liabilities:
Overdrafts	0	25,083
Current operating lease liabilities	207,950
Current portion of long-term debt and notes payable	25,167	43,865
Accounts payable	145,731	146,693
Accrued payroll	183,754	172,386
Accrued vacation	124,111	110,660
Accrued interest	33,853	12,137
Accrued other	191,076	190,691
Income taxes payable	2,638	3,671
Total Current Liabilities	914,280	705,186
Non-current operating lease liabilities	852,897
Long-term debt, net of current portion	3,419,943	3,249,516
Non-current deferred tax liability	148,258	153,895
Other non-current liabilities	101,334	158,940
Total Liabilities	5,436,712	4,267,537
Commitments and contingencies (Note 16)
Redeemable non-controlling interests	974,541	780,488
Stockholders’ Equity:
Common stock, $0.001 par value, 700,000,000 shares authorized, 135,265,864 and 134,328,112 shares issued and outstanding at 2018 and 2019, respectively	134	135
Capital in excess of par	491,038	482,556
Retained earnings	279,800	320,351
Total Stockholders’ Equity	770,972	803,042
Non-controlling interests	158,063	113,198
Total Equity	929,035	916,240
Total Liabilities and Equity	$ 7,340,288	$ 5,964,265

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - $ / shares	Dec. 31, 2019	Dec. 31, 2018
Statement of Financial Position [Abstract]
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	700,000,000	700,000,000
Common stock, shares issued (in shares)	134,328,112	135,265,864
Common stock, shares outstanding (in shares)	134,328,112	135,265,864

Consolidated Statements of Oper

Consolidated Statements of Operations and Comprehensive Income - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Income Statement [Abstract]
Net operating revenues	$ 5,453,922	$ 5,081,258	$ 4,365,245
Costs and expenses:
Cost of services, exclusive of depreciation and amortization	4,641,002	4,341,056	3,735,309
General and administrative	128,463	121,268	114,047
Depreciation and amortization	212,576	201,655	160,011
Total costs and expenses	4,982,041	4,663,979	4,009,367
Income from operations	471,881	417,279	355,878
Other income and expense:
Loss on early retirement of debt	(38,083)	(14,155)	(19,719)
Equity in earnings of unconsolidated subsidiaries	24,989	21,905	21,054
Gain (loss) on sale of businesses	6,532	9,016	(49)
Interest expense	(200,570)	(198,493)	(154,703)
Income before income taxes	264,749	235,552	202,461
Income tax expense (benefit)	63,718	58,610	(18,184)
Net income	201,031	176,942	220,645
Less: Net income attributable to non-controlling interests	52,582	39,102	43,461
Net income attributable to Select Medical Holdings Corporation	$ 148,449	$ 137,840	$ 177,184
Earnings per common share (Note 15):
Basic (in dollars per share)	$ 1.10	$ 1.02	$ 1.33
Diluted (in dollars per share)	$ 1.10	$ 1.02	$ 1.33

Consolidated Statements of Chan

Consolidated Statements of Changes in Equity and Income - USD ($) $ in Thousands	Total	Common Stock	Capital in Excess of Par	Retained Earnings	Total Stockholders’ Equity	Non-controlling Interests
Beginning balance at Dec. 31, 2016	$ 422,159
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income attributable to non-controlling interests	35,639
Distributions to and purchases of non-controlling interests	(5,334)
Redemption adjustment on non-controlling interests	187,506
Other	848
Ending balance at Dec. 31, 2017	640,818
Beginning balance (in shares) at Dec. 31, 2016		132,597,000
Beginning balance at Dec. 31, 2016	905,901	$ 132	$ 443,908	$ 371,685	$ 815,725	$ 90,176
Increase (Decrease) in Stockholders' Equity
Net income attributable to Select Medical Holdings Corporation	177,184			177,184	177,184
Net income attributable to non-controlling interests	7,822				0	7,822
Issuance of restricted stock (in shares)		1,598,000
Issuance of restricted stock	0	$ 2	(2)		0
Forfeitures of unvested restricted stock (in shares)		(27,000)
Forfeitures of unvested restricted stock	0	$ 0	0		0
Vesting of restricted stock	18,291		18,291		18,291
Repurchase of common shares (in shares)		(280,000)
Repurchase of common shares	(4,753)	$ 0	(2,666)	(2,087)	(4,753)
Exercise of stock options (in shares)		227,000
Exercise of stock options	2,017	$ 0	2,017		2,017
Issuance of non-controlling interests	18,280		1,951		1,951	16,329
Distributions to and purchases of non-controlling interests	(5,286)			7	7	(5,293)
Redemption adjustment on non-controlling interests	(187,506)			(187,506)	(187,506)
Other	654			452	452	202
Ending balance (in shares) at Dec. 31, 2017		134,115,000
Ending balance at Dec. 31, 2017	932,604	$ 134	463,499	359,735	823,368	109,236
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income attributable to non-controlling interests	27,775
Issuance of non-controlling interests	163,659
Distributions to and purchases of non-controlling interests	(217,570)
Redemption adjustment on non-controlling interests	164,476
Other	1,330
Ending balance at Dec. 31, 2018	780,488
Increase (Decrease) in Stockholders' Equity
Net income attributable to Select Medical Holdings Corporation	137,840			137,840	137,840
Net income attributable to non-controlling interests	11,327				0	11,327
Issuance of restricted stock (in shares)		1,491,000
Issuance of restricted stock	0	$ 1	(1)		0
Forfeitures of unvested restricted stock (in shares)		(168,000)
Forfeitures of unvested restricted stock	0	$ 0	0		0
Vesting of restricted stock	20,443		20,443		20,443
Repurchase of common shares (in shares)		(357,000)
Repurchase of common shares	(6,837)	$ 0	(3,728)	(3,109)	(6,837)
Exercise of stock options (in shares)		185,000
Exercise of stock options	1,722	$ 0	1,722		1,722
Issuance of non-controlling interests	77,815		1,553	74,341	75,894	1,921
Distributions to and purchases of non-controlling interests	(95,388)		(932)	(83,617)	(84,549)	(10,839)
Redemption adjustment on non-controlling interests	(164,476)			(164,476)	(164,476)
Other	$ 1,190			(363)	(363)	1,553
Ending balance (in shares) at Dec. 31, 2018	135,265,864	135,266,000
Ending balance at Dec. 31, 2018	$ 916,240	$ 135	482,556	320,351	803,042	113,198
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income attributable to non-controlling interests	25,956
Distributions to and purchases of non-controlling interests	(6,205)
Redemption adjustment on non-controlling interests	172,915
Other	1,387
Ending balance at Dec. 31, 2019	974,541
Increase (Decrease) in Stockholders' Equity
Net income attributable to Select Medical Holdings Corporation	148,449			148,449	148,449
Net income attributable to non-controlling interests	26,626				0	26,626
Issuance of restricted stock (in shares)		1,500,000
Issuance of restricted stock	0	$ 2	(2)		0
Forfeitures of unvested restricted stock (in shares)		(43,000)
Forfeitures of unvested restricted stock	0	$ 0	0		0
Vesting of restricted stock	23,382		23,382		23,382
Repurchase of common shares (in shares)		(2,500,000)
Repurchase of common shares	$ (38,531)	$ (3)	(22,565)	(15,963)	(38,531)
Exercise of stock options (in shares)	105,000	105,000
Exercise of stock options	$ 964	$ 0	964		964
Issuance of non-controlling interests	38,121		6,499		6,499	31,622
Distributions to and purchases of non-controlling interests	(14,861)		204		204	(15,065)
Redemption adjustment on non-controlling interests	(172,915)			(172,915)	(172,915)
Other	$ 1,560			(122)	(122)	1,682
Ending balance (in shares) at Dec. 31, 2019	134,328,112	134,328,000
Ending balance at Dec. 31, 2019	$ 929,035	$ 134	$ 491,038	$ 279,800	$ 770,972	$ 158,063

Consolidated Statements of Cash

Consolidated Statements of Cash Flows $ in Thousands	12 Months Ended
	Dec. 31, 2019USD ($)	Dec. 31, 2018USD ($)	Dec. 31, 2017USD ($)
Operating activities
Net income	$ 201,031	$ 176,942	$ 220,645
Adjustments to reconcile net income to net cash provided by operating activities:
Distributions from unconsolidated subsidiaries	20,222	15,721	20,006
Depreciation and amortization	212,576	201,655	160,011
Provision for bad debts	3,038	(103)	1,133
Equity in earnings of unconsolidated subsidiaries	(24,989)	(21,905)	(21,054)
Loss on extinguishment of debt	22,130	2,999	6,527
Gain on sale of assets and businesses	(6,321)	(9,168)	(10,349)
Stock compensation expense	26,451	23,326	19,284
Amortization of debt discount, premium and issuance costs	11,566	13,112	11,130
Deferred income taxes	(7,435)	7,217	(72,324)
Changes in operating assets and liabilities, net of effects of business combinations:
Accounts receivable	(57,991)	54,575	(118,833)
Other current assets	(4,259)	(4,152)	1,597
Other assets	6,122	7,857	(886)
Accounts payable	5,743	(1,778)	3,903
Accrued expenses	37,298	27,896	17,341
Net cash provided by operating activities	445,182	494,194	238,131
Investing activities
Business combinations, net of cash acquired	(93,705)	(523,134)	(27,390)
Purchases of property and equipment	(157,126)	(167,281)	(233,243)
Investment in businesses	(66,090)	(13,482)	(12,682)
Proceeds from sale of assets and businesses	192	6,760	80,350
Net cash used in investing activities	(316,729)	(697,137)	(192,965)
Financing activities
Borrowings on revolving facilities	700,000	595,000	970,000
Payments on revolving facilities	(720,000)	(805,000)	(960,000)
Proceeds from term loans	1,208,106	779,823	1,139,487
Payments on term loans	(1,618,170)	(11,500)	(1,179,442)
Proceeds from 6.250% senior notes	1,244,987	0	0
Payment on 6.375% senior notes	(710,000)	0	0
Revolving facility debt issuance costs	(310)	(1,639)	(4,392)
Borrowings of other debt	24,225	42,218	46,621
Principal payments on other debt	(30,604)	(25,242)	(20,647)
Repurchase of common stock	(38,531)	(6,837)	(4,753)
Proceeds from exercise of stock options	964	1,722	2,017
Decrease in overdrafts	(25,083)	(4,380)	(9,899)
Proceeds from issuance of non-controlling interests	18,447	2,926	9,982
Distributions to and purchases of non-controlling interests	(21,780)	(311,519)	(10,620)
Net cash provided by (used in) financing activities	32,251	255,572	(21,646)
Net increase in cash and cash equivalents	160,704	52,629	23,520
Cash and cash equivalents at beginning of period	175,178	122,549	99,029
Cash and cash equivalents at end of period	335,882	175,178	122,549
Supplemental information:
Cash paid for interest	182,992	193,406	149,156
Cash paid for taxes	70,592	48,153	64,991
Non-cash investing and financing activities:
Liabilities for purchases of property and equipment	28,760	29,134	30,043
Non-cash equity exchange for acquisition of U.S. HealthWorks	$ 0	$ 238,000	$ 0

Consolidated Statements of Ca_2

Consolidated Statements of Cash Flow (Parenthetical) - Senior notes	Dec. 31, 2019
Select 6.250% senior notes
Interest rate of debt	6.25%
Select 6.375% senior notes
Interest rate of debt	6.375%

Organization and Significant Ac

Organization and Significant Accounting Policies	12 Months Ended
	Dec. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Significant Accounting Policies	Organization and Significant Accounting Policies Business Description The consolidated financial statements of Select Medical Holdings Corporation (“Holdings”) include the accounts of its wholly owned subsidiary, Select Medical Corporation (“Select”). Holdings conducts substantially all of its business through Select and its subsidiaries. Holdings and Select and its subsidiaries are collectively referred to as the “Company.” The Company is, based on number of facilities, one of the largest operators of critical illness recovery hospitals, rehabilitation hospitals, outpatient rehabilitation clinics, and occupational health centers in the United States. As of December 31, 2019 , the Company had operations in 47 states and the District of Columbia. As of December 31, 2019 , the Company operated 101 critical illness recovery hospitals, 29 rehabilitation hospitals, and 1,740 outpatient rehabilitation clinics. As of December 31, 2019 , Concentra, a joint venture subsidiary, operated 521 occupational health centers. Concentra also operated 131 onsite clinics at employer worksites and 32 Department of Veterans Affairs CBOCs. The Company is managed through four business segments: the critical illness recovery hospital segment, the rehabilitation hospital segment, the outpatient rehabilitation segment, and the Concentra segment. The Company’s critical illness recovery hospital segment consists of hospitals designed to serve the needs of patients recovering from critical illnesses, often with complex medical needs, and the rehabilitation hospital segment consists of hospitals designed to serve patients that require intensive physical rehabilitation care. Patients are typically admitted to the Company’s critical illness recovery hospitals and rehabilitation hospitals from general acute care hospitals. The Company’s outpatient rehabilitation segment consists of clinics that provide physical, occupational, and speech rehabilitation services. The Company’s Concentra segment consists of occupational health centers that provide workers’ compensation injury care, physical therapy, and consumer health services and onsite clinics located at employer worksites that deliver occupational medicine services. Additionally, the Company’s Concentra segment includes Department of Veterans Affairs community-based outpatient clinics (“CBOCs”) that deliver occupational medicine, physical therapy, veteran’s healthcare, and consumer health services. Use of Estimates The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America (“GAAP”) requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, including disclosure of contingencies, at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Estimates and assumptions are used for, but not limited to: amounts realizable for services performed, estimated useful lives of assets, the valuation of intangible assets, amounts payable for self-insured losses, and the computation of income taxes. Future events and their effects cannot be predicted with certainty; accordingly, the Company’s accounting estimates require the exercise of judgment. The accounting estimates used in the preparation of the financial statements will change as new events occur, as more experience is acquired, as additional information is obtained, and as the Company’s operating environment changes. The Company’s management evaluates and updates assumptions and estimates on an ongoing basis. Actual results could differ from those estimates. Principles of Consolidation The consolidated financial statements include the accounts of Holdings, Select, and the subsidiaries, limited liability companies, and limited partnerships in which the Company has a controlling financial interest. All intercompany balances and transactions are eliminated in consolidation. Non-Controlling Interests The ownership interests held by outside parties in subsidiaries, limited liability companies and limited partnerships controlled by the Company are classified as non-controlling interests. Net income or loss is attributed to the Company’s non-controlling interests. Some of the Company’s non-controlling ownership interests consist of outside parties that have certain redemption rights that, if exercised, require the Company to purchase the parties’ ownership interests. These interests are classified and reported as redeemable non-controlling interests and have been adjusted to their approximate redemption values, after the attribution of net income or loss . The Company’s redeemable non-controlling interests are comprised primarily of the Class A membership interests owned by outside members of Concentra Group Holdings Parent, LLC (“Concentra Group Holdings Parent”), each which have put rights with respect to their interests in Concentra Group Holdings Parent. The redemption value of these membership interests is approximately $750.6 million and $939.9 million as of December 31, 2018 and 2019 , respectively. On January 1, 2020 and February 1, 2020, Select purchased portions of the outstanding membership interests owned by outside members of Concentra Group Holdings Parent. Refer to Note 17 for discussion related to this transaction. Earnings per Share The Company’s capital structure includes common stock and unvested restricted stock awards. To compute earnings per share (“EPS”), the Company applies the two-class method because the Company’s unvested restricted stock awards are participating securities which are entitled to participate equally with the Company’s common stock in undistributed earnings. Application of the Company’s two-class method is as follows: (i) Net income attributable to the Company is reduced by the amount of dividends declared and by the contractual amount of dividends that must be paid for the current period for each class of stock, if any. (ii) The remaining undistributed net income of the Company is then equally allocated to its common stock and unvested restricted stock awards, as if all of the earnings for the period had been distributed. The total net income allocated to each security is determined by adding both distributed and undistributed net income for the period. (iii) The net income allocated to each security is then divided by the weighted average number of outstanding shares for the period to determine the EPS for each security considered in the two-class method. Cash and Cash Equivalents The Company considers all highly liquid investments with a maturity of three months or less when purchased to be cash equivalents. Cash equivalents are stated at cost which approximates fair value. Accounts Receivable Substantially all of the Company’s accounts receivable is related to providing healthcare services to patients. These healthcare services are primarily paid for by federal and state governmental authorities, managed care health plans, commercial insurance companies, and workers’ compensation and employer programs. The Company reports accounts receivable at an amount equal to the consideration the Company expects to receive in exchange for providing healthcare services to its patients, which is estimated using contractual provisions associated with specific payors, historical reimbursement rates, and an analysis of past reimbursement experience to estimate contractual allowances. Amounts that have been deemed to be uncollectible because of circumstances that affect the ability of payors to make payments are written-off as bad debt expense as they occur. Credit Risk and Payor Concentrations Financial instruments that potentially subject the Company to concentrations of credit risk consist primarily of cash balances and accounts receivable. The Company’s excess cash is held with large financial institutions. The Company grants unsecured credit to its patients, most of whom reside in the service area of the Company’s facilities and are insured under third-party payor agreements. Accounts receivable from the Medicare program represents the only significant third-party payor concentration for the Company. The Company does not believe there is significant credit risk associated with this governmental program. Medicare receivables comprise approximately 16% and 15% of the Company’s accounts receivable at December 31, 2018 and 2019 , respectively. The Company’s primary collection risks for its accounts receivable relate to non-governmental payors who insure the Company’s patients and deductibles, co-payments, and self-insured amounts owed by the patient. The Company believes its credit risk with its non-governmental payors is limited due to the diversity in the Company’s non-governmental third-party payor base, as well as their geographic dispersion. Further, deductibles, co-payments, and self-insured amounts owed by the patient are an immaterial portion of the Company’s accounts receivable balance at both December 31, 2018 and 2019 . The Company’s general policy is to verify insurance coverage prior to the date of admission for patients admitted to its critical illness recovery hospitals and rehabilitation hospitals. Within the Company’s outpatient rehabilitation clinics, insurance coverage is verified prior to the patient’s visit. Within the Company’s Concentra centers, insurance coverage is verified or an authorization is received from the patient’s employer prior to the patient’s visit. Net operating revenues generated directly from the Medicare program represented approximately 30% , 27% , and 26% of the Company’s total net operating revenues for the years ended December 31, 2017 , 2018 , and 2019 , respectively. As a provider of services under the Medicare program, the Company is subject to extensive regulations. The inability of any of the Company’s critical illness recovery hospitals, rehabilitation hospitals, or outpatient rehabilitation clinics to comply with Medicare regulations can result in the Company receiving significantly less Medicare payments than the Company currently receives for its services provided to patients. Financial Instruments The Company’s financial instruments consist principally of cash and cash equivalents, accounts receivable, accounts payable, and indebtedness. The carrying amount of cash and cash equivalents, accounts receivable, and accounts payable approximate fair value because of the short-term maturities of these instruments. The principal outstanding, carrying values, and fair values of the Company’s indebtedness are presented in Note 9. Leases The Company evaluates whether a contract is or contains a lease at the inception of the contract. Upon lease commencement, the date on which a lessor makes the underlying asset available to the Company for use, the Company classifies the lease as either an operating or finance lease. Most of the Company’s facility and equipment leases are classified as operating leases. Balance Sheet For both operating and finance leases, the Company recognizes a right-of-use asset and lease liability at lease commencement. A right-of-use asset represents the Company’s right to use an underlying asset for the lease term while the lease liability represents an obligation to make lease payments arising from a lease which are measured on a discounted basis. The Company elected the short-term lease exemption for its equipment leases; accordingly, equipment leases with terms of 12 months or less are not recorded on the consolidated balance sheets. Lease liabilities are measured at the present value of the remaining, fixed lease payments at lease commencement. As most of the Company’s leases do not specify an implicit rate, the Company uses its incremental borrowing rate, which coincides with the lease term at the commencement of a lease, in determining the present value of its remaining lease payments. The Company’s leases may also specify extension or termination clauses. These options are factored into the measurement of the lease liability when it is reasonably certain that the Company will exercise the option. Right-of-use assets are measured at an amount equal to the initial lease liability, plus any prepaid lease payments (less any incentives received, such as reimbursement for leasehold improvements) and initial direct costs, at the lease commencement date. The Company has elected to account for lease and non-lease components, such as common area maintenance, as a single lease component for its facility leases. As a result, the fixed payments that would otherwise be allocated to the non-lease components are accounted for as lease payments and are included in the measurement of the Company’s right-of-use asset and lease liability. Statement of Operations and Comprehensive Income For the Company’s operating leases, rent expense, a component of cost of services and general and administrative expenses on the consolidated statements of operations and comprehensive income, is recognized on a straight-line basis over the lease term. The straight-line rent expense is reflective of the interest expense on the lease liability using the effective interest method and the amortization of the right-of-use asset. The Company may enter into arrangements to sublease portions of its facilities and the Company typically retains the obligation to the lessor under these arrangements. The Company’s subleases are classified as operating leases; accordingly, the Company continues to account for the original leases as it did prior to commencement of the subleases. Sublease income, a component of cost of services on the consolidated statements of operations and comprehensive income, is recognized on a straight-line basis, as a reduction to rent expense, over the term of the sublease. For the Company’s finance leases, interest expense on the lease liability is recognized using the effective interest method. Amortization expense related to the right-of-use asset is recognized on a straight-line basis over the shorter of the estimated useful life of the asset or the lease term. The Company elected the short-term lease exemption for its equipment leases. For these leases, the Company recognizes lease payments on a straight-line basis over the lease term and variable lease payments are expensed as incurred. These expenses are included as components of cost of services on the consolidated statements of operations and comprehensive income. The Company makes payments related to changes in indexes or rates after the lease commencement date. Additionally, the Company makes payments, which are not fixed at lease commencement, for property taxes, insurance, and common area maintenance related to its facility leases. These variable lease payments, which are expensed as incurred, are included as a component of cost of services and general and administrative expenses on the consolidated statements of operations and comprehensive income. Property and Equipment Property and equipment are stated at cost, net of accumulated depreciation. Maintenance and repairs of property and equipment are expensed as incurred. Improvements that increase the estimated useful life of an asset are capitalized. Direct internal and external costs of developing software for internal use, including programming and enhancements, are capitalized and depreciated over the estimated useful lives once the software is placed in service. Capitalized software costs are included within furniture and equipment. Software training costs, maintenance, and repairs are expensed as incurred. Depreciation and amortization are computed using the straight-line method over the estimated useful lives of the assets or the term of the lease, as appropriate. The general range of useful lives is as follows: Land improvements 5 – 25 years Leasehold improvements 1 – 20 years Buildings 40 years Building improvements 5 – 40 years Furniture and equipment 1 – 20 years The Company reviews the realizability of long-lived assets whenever events or circumstances occur which indicate recorded costs may not be recoverable. If it is determined that a long-lived asset or asset group is not recoverable, an impairment charge is recognized based on the excess of the carrying amount of the long-lived asset or asset group over its fair value. Intangible Assets Goodwill and indefinite-lived identifiable intangible assets Goodwill and other indefinite-lived intangible assets are recognized primarily as the result of business combinations. Goodwill is assigned to reporting units based upon the specific nature of the business acquired. When a business combination contains business components related to more than one reporting unit, goodwill is assigned to each reporting unit based upon an allocation determined by the relative fair values of the business acquired. When the Company disposes of a business, the Company allocates a portion of the reporting unit’s goodwill to that business using the relative fair value methodology. Goodwill and other indefinite-lived intangible assets are not amortized, but instead are subject to periodic impairment evaluations. Impairment tests are required to be conducted at least annually or when events or conditions occur that might suggest a possible impairment. These events or conditions include, but are not limited to: a significant adverse change in the business environment, regulatory environment, or legal factors; a current period operating or cash flow loss combined with a history of such losses or a projection of continuing losses; or a sale or disposition of a significant portion of a reporting unit. The occurrence of one of these events or conditions could significantly impact an impairment assessment, necessitating an impairment charge. The Company may first assess qualitatively if it can conclude whether goodwill is more likely than not impaired. If goodwill is more likely than not impaired, the Company is then required to complete a quantitative analysis of whether a reporting unit’s fair value is less than its carrying amount. In evaluating whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount, the Company considers relevant events or circumstances that affect the fair value or carrying amount of a reporting unit. The Company considers both the income and market approach in determining the fair value of its reporting units when performing a quantitative analysis. At December 31, 2019 , the Company’s other indefinite-lived intangible assets consist of trademarks, certificates of need, and accreditations. To determine the fair values of its trademarks, the Company uses a relief from royalty income approach. For the Company’s certificates of need and accreditations, the Company performs qualitative assessments. As part of these assessments, the Company evaluates the current business environment, regulatory environment, legal and other company-specific factors. If it is more likely than not that the fair values are less than the carrying values, the Company performs a quantitative impairment test. The Company’s most recent impairment assessments were completed during the fourth quarter of 2019 utilizing information as of October 1, 2019 . The Company did not identify any instances of impairment with respect to goodwill or other indefinite-lived intangible assets as of October 1, 2019 . Finite-lived identifiable intangible assets At December 31, 2019 , the Company’s finite-lived intangible assets consist of customer relationships and non-compete agreements. Finite-lived intangible assets are amortized based on the pattern in which the economic benefits are consumed or otherwise depleted. If such a pattern cannot be reliably determined, finite-lived intangible assets are amortized on a straight-line basis over their estimated lives. Management believes that the below estimated useful lives are reasonable based on the economic factors applicable to each class of finite-lived intangible asset. Customer relationships 5 – 17 years Non-compete agreements 1 – 15 years The Company reviews the realizability of finite-lived intangible assets whenever events or circumstances occur which indicate recorded amounts may not be recoverable. If the expected undiscounted future cash flows are less than the carrying amount of such assets, the Company recognizes an impairment loss to the extent the carrying amount of the assets exceeds their estimated fair value. Equity Method Investments The Company applies the equity method of accounting for investments in which the Company has the ability to exercise significant influence over the operating and financial policies of the investee, but does not possess a controlling financial interest in the investee. Investments of this nature are recorded at original cost and adjusted periodically to recognize the Company’s proportionate share of the investees’ net income or losses after the date of investment. When net losses from an investment accounted for under the equity method exceed the carrying amount, the investment balance is reduced to zero. The Company resumes accounting for the investment under the equity method if the investee subsequently reports net income and the Company’s share of that net income exceeds the share of the net losses not recognized during the period the equity method was suspended. Investments are written down only when there is clear evidence that a decline in value that is other than temporary has occurred. The Company evaluates its equity method investments for impairment when there is evidence or indicators that a loss in value may be other than temporary. Income Taxes The Company recognizes deferred tax assets and liabilities for the expected future tax consequences of events that have been recognized in the Company’s financial statements. Deferred tax assets and liabilities are determined on the basis of the differences between the book and tax bases of assets and liabilities by using enacted tax rates in effect for the year in which the differences are expected to reverse. The Company also recognizes the future tax benefits from net operating loss carryforwards as deferred tax assets. The effect of a change in tax rates on deferred tax assets and liabilities is recognized in income in the period that includes the enactment date. The Company evaluates the realizability of deferred tax assets and reduces those assets using a valuation allowance if it is more likely than not that some portion or all of the deferred tax asset will not be realized. Among the factors used to assess the likelihood of realization are projections of future taxable income streams, the expected timing of the reversals of existing temporary differences, and the impact of tax planning strategies that could be implemented to avoid the potential loss of future tax benefits. Reserves for uncertain tax positions are established for exposure items related to various federal and state tax matters. Income tax reserves are recorded when an exposure is identified and when, in the opinion of management, it is more likely than not that a tax position will not be sustained and the amount of the liability can be estimated. Insurance Risk Programs Under a number of the Company’s insurance programs, which include the Company’s employee health insurance, workers’ compensation, and professional malpractice liability insurance programs, the Company is liable for a portion of its losses before it can attempt to recover from the applicable insurance carrier. The Company accrues for losses under an occurrence-based approach whereby the Company estimates the losses that will be incurred in a respective accounting period and accrues that estimated liability using actuarial methods. These programs are monitored quarterly and estimates are revised as necessary to take into account additional information. The Company also records insurance proceeds receivable for liabilities which exceed the Company’s deductibles and self-insured retention limits and are recoverable through its insurance policies. Revenue Recognition Patient Services Revenue Patient services revenue is recognized when obligations under the terms of the contract are satisfied; generally, this occurs as the Company provides healthcare services to its patients, as each service provided is distinct and future services rendered are not dependent on previously rendered services. Patient service revenues are recognized at an amount equal to the consideration the Company expects to receive in exchange for providing healthcare services to its patients. These amounts are due from third-party payors, including health insurers and government programs; other payors; and patients. Medicare : Medicare is a federal program that provides medical insurance benefits to persons age 65 and over, some disabled persons, and persons with end stage renal disease. Amounts the Company receives for treatment of patients covered by the Medicare program are generally less than the standard billing rates; accordingly, the Company recognizes revenue based on amounts which are payable by Medicare under prospective payment systems and other payment methods. The expected payment is derived based on the level of clinical services provided. Non-Medicare : The Company is reimbursed for healthcare services provided from various other payor sources which include insurance companies, state Medicaid programs, workers’ compensation programs, health maintenance organizations, preferred provider organizations, other managed care companies and employers, as well as patients. The Company is reimbursed by these payors using a variety of payment methodologies and the amounts the Company receives are generally less than its standard billing rates. In the critical illness recovery hospital and rehabilitation hospital segments, the Company recognizes revenue based on known contractual provisions associated with the specific payor or, where the Company has a relatively homogeneous patient population, the Company will monitor individual payor historical reimbursement rates to derive a per diem rate which is used to determine the amount of revenue to be recognized for services rendered. In the outpatient rehabilitation and Concentra segments, the Company recognizes revenue from payors based on known contractual provisions, negotiated amounts, or usual and customary amounts associated with the specific payor or based on the service provided. The Company performs provision testing, using internally developed systems, whereby the Company monitors historical reimbursement rates and compares them against the associated gross charges for the service provided. The percentage of historical reimbursed claims to gross charges is utilized to determine the amount of revenue to be recognized for services rendered. The Company is subject to potential adjustments to net operating revenues in future periods for administrative matters and other price concessions. These adjustments, which are estimated based on an analysis of historical experience by payor source, are accounted for as a constraint to the amount of revenue recognized by the Company in the period services are rendered. Other Revenues The Company recognizes revenue for services provided to healthcare institutions, principally for providing management and employee leasing services, under contractual arrangements with related parties affiliated with the Company and with other non-affiliated healthcare institutions. Revenue is recognized when the obligations under the terms of the contract are satisfied. Revenues from these services are measured as the amount of consideration the Company expects to receive for those services. Recent Accounting Pronouncements Financial Instruments In June 2016, the FASB issued Accounting Standards Update (“ASU”) 2016-13, Financial Instruments — Credit Losses: Measurement of Credit Losses on Financial Instruments . The current standard delays the recognition of a credit loss on a financial asset until the loss is probable of occurring. The new standard removes the requirement that a credit loss be probable of occurring for it to be recognized and requires entities to use historical experience, current conditions, and reasonable and supportable forecasts to estimate their future expected credit losses. The standard is required to be applied using the modified retrospective approach with a cumulative-effect adjustment to retained earnings, if any, upon adoption. The Company has completed the adoption of the standard as of January 1, 2020. The Company’s primary financial instrument subject to the standard is its accounts receivable derived from contracts with customers. A significant portion of the Company’s accounts receivable is from highly-solvent, creditworthy payors including governmental programs, principally Medicare and Medicaid, and highly-regulated commercial insurers. The Company’s estimate of expected credit losses as of January 1, 2020, using its expected credit loss evaluation processes, resulted in no adjustments to the allowance for credit losses and no cumulative-effect adjustment to retained earnings on the adoption date of the standard. Recently Adopted Accounting Pronouncements Leases The Company adopted Accounting Standards Codification (“ASC”) Topic 842, Leases as of January 1, 2019. The Company used the modified retrospective approach for leases which existed on that date. Prior comparative periods were not adjusted and continue to be reported in accordance with ASC Topic 840, Leases . The Company elected the package of practical expedients, which permitted the Company not to reassess under ASC Topic 842 the Company’s prior conclusions about lease identification, lease classification, and initial direct costs. The Company did not elect the use-of-hindsight or the practical expedient pertaining to land easements; the latter not being applicable to the Company. The adoption of the standard resulted in the recognition of operating lease right-of-use assets of $1,015.0 million and operating lease liabilities of $1,057.0 million at January 1, 2019. The difference between the operating lease right-of-use assets and operating lease liabilities resulted from the reclassification of prepaid rent, deferred rent, unamortized lease incentives, and acquired favorable and unfavorable leasehold interests upon adoption. The Company did not recognize a cumulative-effect adjustment to retained earnings upon adoption.

Acquisitions

Acquisitions	12 Months Ended
	Dec. 31, 2019
Business Combinations [Abstract]
Acquisitions	Acquisitions U.S. HealthWorks Acquisition On February 1, 2018, Concentra acquired all of the issued and outstanding shares of stock of U.S. HealthWorks, Inc. (“U.S. HealthWorks”), an occupational medicine and urgent care provider, from Dignity Health Holding Corporation (“DHHC”). For the years ended December 31, 2017 and 2018, the Company recognized $2.8 million and $2.9 million of U.S. HealthWorks acquisition costs, respectively, which are included in general and administrative expense. Concentra acquired U.S. HealthWorks for $753.6 million . DHHC, a subsidiary of Dignity Health, was issued a 20.0% equity interest in Concentra Group Holdings Parent, which was valued at $238.0 million . The remainder of the purchase price was paid in cash. Select retained a majority voting interest in Concentra Group Holdings Parent following the closing of the transaction. For the U.S. HealthWorks acquisition, the Company allocated the purchase price to tangible and identifiable intangible assets acquired and liabilities assumed based on their estimated fair values in accordance with the provisions of ASC Topic 805, Business Combinations . During the year ended December 31, 2018, the Company finalized the purchase accounting related to this acquisition. The following table reconciles the fair values of identifiable net assets and goodwill to the consideration given for the acquired business (in thousands): Accounts receivable $ 68,934 Other current assets 10,810 Property and equipment 69,712 Identifiable intangible assets 140,406 Other assets 25,435 Goodwill 540,067 Total assets 855,364 Accounts payable and other current liabilities 49,925 Deferred income taxes and other long-term liabilities 51,851 Total liabilities 101,776 Consideration given $ 753,588 The following table outlines the identifiable intangible assets acquired: Fair Value Weighted Average Amortization Period (in thousands) (in years) Customer relationships $ 135,000 15 years Trademark 5,000 1 year Favorable leasehold interests 406 3 years Identifiable intangible assets $ 140,406 The customer relationships and trademarks are amortized on a straight-line basis over their expected useful lives. Favorable leasehold interests, which are now a component of the operating lease right-of-use assets upon adoption of ASC Topic 842, Leases, are amortized to rent expense over the remaining lease terms at the time of acquisition. Goodwill of $540.1 million was recognized for the business combination. The value of goodwill was derived from U.S. HealthWorks’ future earnings potential and its assembled workforce. Goodwill was assigned to the Concentra reporting unit and is not deductible for tax purposes. However, prior to its acquisition, U.S. HealthWorks completed certain acquisitions that resulted in tax deductible goodwill with a value of $83.1 million , which the Company will deduct through 2032. U.S. HealthWorks contributed net operating revenues of $488.8 million for the year ended December 31, 2018, which is reflected in the Company’s consolidated statement of operations and comprehensive income. Due to the integrated nature of the Company’s operations, the Company believes it is not practicable to separately identify earnings of U.S. HealthWorks on a stand-alone basis. Pro Forma Results The following pro forma unaudited results of operations have been prepared assuming the acquisition of U.S. HealthWorks occurred on January 1, 2017. These results are not necessarily indicative of the results of future operations nor of the results that would have occurred had the acquisition been consummated on the aforementioned date. For the Year Ended December 31, 2017 2018 (in thousands, except per share amounts) Net operating revenues $ 4,903,612 $ 5,128,838 Net income attributable to the Company 170,689 140,488 The Company’s pro forma results were adjusted to recognize $2.9 million of U.S. HealthWorks acquisition costs as of January 1, 2017. These acquisition costs were excluded from the pro forma results for the year ended December 31, 2018. Other Acquisitions The Company made acquisitions consisting of critical illness recovery hospital, rehabilitation hospital, outpatient rehabilitation, and Concentra businesses during the year ended December 31, 2019. The consideration given for these acquired businesses consisted principally of $93.7 million of cash and the issuance of $15.1 million of non-controlling interests. The Company allocated the purchase price of these acquired businesses to assets acquired, principally property and equipment, and liabilities assumed based on their estimated fair values in accordance with the provisions of ASC Topic 805, Business Combinations . The Company recognized goodwill of $33.6 million , $14.3 million , $13.0 million , and $16.1 million in our critical illness recovery hospital, rehabilitation hospital, outpatient rehabilitation, and Concentra reporting units, respectively. These acquired businesses are not material individually or collectively.

Variable Interest Entities

Variable Interest Entities	12 Months Ended
	Dec. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Variable Interest Entities	Variable Interest Entities Concentra does not own many of its medical practices, as certain states prohibit the “corporate practice of medicine,” which restricts business corporations from practicing medicine through the direct employment of physicians or from exercising control over medical decisions by physicians. In states which prohibit the corporate practice of medicine, Concentra typically enters into long-term management agreements with professional corporations or associations that are owned by licensed physicians, which, in turn, employ or contract with physicians who provide professional medical services in its occupational health centers. The management agreements have terms that provide for Concentra to conduct, supervise, and manage the day-to-day non-medical operations of the occupational health centers and provide all management and administrative services. Concentra receives a management fee for these services, which is based, in part, on the performance of the professional corporation or association. Additionally, the outstanding voting equity interests of the professional corporations or associations are typically owned by licensed physicians appointed at Concentra’s discretion. Concentra has the ability to direct the transfer of ownership of the professional corporation or association to a new licensed physician at any time. Based on the provisions of these agreements, Concentra has the ability to direct the activities which most significantly impact the performance of these professional corporations and associations and has an obligation to absorb losses or receive benefits which could potentially be significant to the professional corporations and associations. Accordingly, the professional corporations and associations are variable interest entities for which Concentra is the primary beneficiary. As of December 31, 2018 and 2019 , the total assets of Concentra’s variable interest entities were $166.2 million and $178.4 million , respectively, and are principally comprised of accounts receivable. As of December 31, 2018 and 2019 , the total liabilities of Concentra’s variable interest entities were $164.4 million and $176.7 million , respectively, and are principally comprised of accounts payable, accrued expenses, and obligations payable for services received under the aforementioned management agreements.

Leases

Leases	12 Months Ended
	Dec. 31, 2019
Leases [Abstract]
Leases	Leases The Company has operating and finance leases for its facilities and certain equipment. The Company leases its corporate office space from related parties. The Company’s critical illness recovery hospitals and rehabilitation hospitals generally have lease terms of 10 years with two , five year renewal options. These renewal options vary for hospitals which operate as a hospital within a hospital, or “HIH.” The Company’s outpatient rehabilitation clinics generally have lease terms of five years with two , three to five year renewal options. The Company’s Concentra centers generally have lease terms of 10 years with two , five year renewal options. For the year ended December 31, 2019 , the Company’s total lease cost was as follows (in thousands): For the Year Ended December 31, 2019 Unrelated Parties Related Parties Total Operating lease cost $ 271,799 $ 5,498 $ 277,297 Finance lease cost: Amortization of right-of-use assets 258 — 258 Interest on lease liabilities 812 — 812 Short-term lease cost 2,171 — 2,171 Variable lease cost 43,096 553 43,649 Sublease income (9,822 ) — (9,822 ) Total lease cost $ 308,314 $ 6,051 $ 314,365 For the year ended December 31, 2019 , supplemental cash flow information related to leases was as follows (in thousands): Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 274,095 Operating cash flows for finance leases 777 Financing cash flows for finance leases 225 Right-of-use assets obtained in exchange for lease liabilities: Operating leases (1) 1,275,575 Finance leases 9,102 _______________________________________________________________________________ (1) Includes the right-of-use assets obtained in exchange for lease liabilities of $1,057.0 million which were recognized upon adoption of ASC Topic 842 at January 1, 2019. As of December 31, 2019 , supplemental balance sheet information related to leases was as follows (in thousands): Operating Leases Unrelated Parties Related Parties Total Operating lease right-of-use assets $ 971,382 $ 32,604 $ 1,003,986 Current operating lease liabilities $ 202,506 $ 5,444 $ 207,950 Non-current operating lease liabilities 826,049 26,848 852,897 Total operating lease liabilities $ 1,028,555 $ 32,292 $ 1,060,847 Finance Leases Unrelated Parties Related Parties Total Property and equipment, net $ 4,965 $ — $ 4,965 Current portion of long-term debt and notes payable $ 195 $ — $ 195 Long-term debt, net of current portion 13,088 — 13,088 Total finance lease liabilities $ 13,283 $ — $ 13,283 As of December 31, 2019 , the weighted average remaining lease terms and discount rates were as follows: Weighted average remaining lease term (in years): Operating leases 8.0 Finance leases 34.4 Weighted average discount rate: Operating leases 5.9 % Finance leases 7.3 % As of December 31, 2019 , maturities of lease liabilities were approximately as follows (in thousands): Operating Leases Finance Leases Total 2020 $ 263,085 $ 1,182 $ 264,267 2021 227,202 1,193 228,395 2022 187,053 1,203 188,256 2023 143,878 1,214 145,092 2024 110,835 1,225 112,060 Thereafter 483,162 30,404 513,566 Total undiscounted cash flows 1,415,215 36,421 1,451,636 Less: Imputed interest 354,368 23,138 377,506 Total discounted lease liabilities $ 1,060,847 $ 13,283 $ 1,074,130 As of December 31, 2018, the Company’s future minimum lease obligations on long-term, non-cancelable operating leases were approximately as follows (in thousands): 2019 $ 267,846 2020 231,711 2021 193,155 2022 150,155 2023 107,759 Thereafter 484,038 $ 1,434,664 For the years ended December 31, 2017 and 2018 , the Company’s rent expense for facility and equipment operating leases, including cancelable leases, was $267.4 million and $307.8 million , respectively. The Company made payments to related parties for office rent, leasehold improvements, and miscellaneous expenses of $6.2 million and $6.3 million for the years ended December 31, 2017 and 2018 , respectively.
Leases	Leases The Company has operating and finance leases for its facilities and certain equipment. The Company leases its corporate office space from related parties. The Company’s critical illness recovery hospitals and rehabilitation hospitals generally have lease terms of 10 years with two , five year renewal options. These renewal options vary for hospitals which operate as a hospital within a hospital, or “HIH.” The Company’s outpatient rehabilitation clinics generally have lease terms of five years with two , three to five year renewal options. The Company’s Concentra centers generally have lease terms of 10 years with two , five year renewal options. For the year ended December 31, 2019 , the Company’s total lease cost was as follows (in thousands): For the Year Ended December 31, 2019 Unrelated Parties Related Parties Total Operating lease cost $ 271,799 $ 5,498 $ 277,297 Finance lease cost: Amortization of right-of-use assets 258 — 258 Interest on lease liabilities 812 — 812 Short-term lease cost 2,171 — 2,171 Variable lease cost 43,096 553 43,649 Sublease income (9,822 ) — (9,822 ) Total lease cost $ 308,314 $ 6,051 $ 314,365 For the year ended December 31, 2019 , supplemental cash flow information related to leases was as follows (in thousands): Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 274,095 Operating cash flows for finance leases 777 Financing cash flows for finance leases 225 Right-of-use assets obtained in exchange for lease liabilities: Operating leases (1) 1,275,575 Finance leases 9,102 _______________________________________________________________________________ (1) Includes the right-of-use assets obtained in exchange for lease liabilities of $1,057.0 million which were recognized upon adoption of ASC Topic 842 at January 1, 2019. As of December 31, 2019 , supplemental balance sheet information related to leases was as follows (in thousands): Operating Leases Unrelated Parties Related Parties Total Operating lease right-of-use assets $ 971,382 $ 32,604 $ 1,003,986 Current operating lease liabilities $ 202,506 $ 5,444 $ 207,950 Non-current operating lease liabilities 826,049 26,848 852,897 Total operating lease liabilities $ 1,028,555 $ 32,292 $ 1,060,847 Finance Leases Unrelated Parties Related Parties Total Property and equipment, net $ 4,965 $ — $ 4,965 Current portion of long-term debt and notes payable $ 195 $ — $ 195 Long-term debt, net of current portion 13,088 — 13,088 Total finance lease liabilities $ 13,283 $ — $ 13,283 As of December 31, 2019 , the weighted average remaining lease terms and discount rates were as follows: Weighted average remaining lease term (in years): Operating leases 8.0 Finance leases 34.4 Weighted average discount rate: Operating leases 5.9 % Finance leases 7.3 % As of December 31, 2019 , maturities of lease liabilities were approximately as follows (in thousands): Operating Leases Finance Leases Total 2020 $ 263,085 $ 1,182 $ 264,267 2021 227,202 1,193 228,395 2022 187,053 1,203 188,256 2023 143,878 1,214 145,092 2024 110,835 1,225 112,060 Thereafter 483,162 30,404 513,566 Total undiscounted cash flows 1,415,215 36,421 1,451,636 Less: Imputed interest 354,368 23,138 377,506 Total discounted lease liabilities $ 1,060,847 $ 13,283 $ 1,074,130 As of December 31, 2018, the Company’s future minimum lease obligations on long-term, non-cancelable operating leases were approximately as follows (in thousands): 2019 $ 267,846 2020 231,711 2021 193,155 2022 150,155 2023 107,759 Thereafter 484,038 $ 1,434,664 For the years ended December 31, 2017 and 2018 , the Company’s rent expense for facility and equipment operating leases, including cancelable leases, was $267.4 million and $307.8 million , respectively. The Company made payments to related parties for office rent, leasehold improvements, and miscellaneous expenses of $6.2 million and $6.3 million for the years ended December 31, 2017 and 2018 , respectively.

Property and Equipment

Property and Equipment	12 Months Ended
	Dec. 31, 2019
Property, Plant and Equipment [Abstract]
Property and Equipment	Property and Equipment The Company’s property and equipment consists of the following: December 31, 2018 2019 (in thousands) Land $ 87,358 $ 95,549 Leasehold improvements 498,520 543,934 Buildings 481,375 553,701 Furniture and equipment 609,805 670,050 Construction-in-progress 67,333 52,467 Total property and equipment 1,744,391 1,915,701 Accumulated depreciation (764,581 ) (917,295 ) Property and equipment, net $ 979,810 $ 998,406 Depreciation expense was $142.6 million , $171.7 million , and $182.9 million for the years ended December 31, 2017 , 2018 , and 2019 , respectively.

Intangible Assets

Intangible Assets	12 Months Ended
	Dec. 31, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets	Intangible Assets Goodwill The following table shows changes in the carrying amounts of goodwill by reporting unit for the years ended December 31, 2018 and 2019 : Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Rehabilitation Concentra Total (in thousands) Balance as of January 1, 2018 $ 1,045,220 $ 415,528 $ 647,522 $ 674,542 $ 2,782,812 Acquired — 1,118 4,309 537,424 542,851 Measurement period adjustment — — — 4,472 4,472 Sold — — (9,409 ) — (9,409 ) Balance as of December 31, 2018 1,045,220 416,646 642,422 1,216,438 3,320,726 Acquired 33,149 14,254 12,970 18,299 78,672 Measurement period adjustment 435 — — (2,249 ) (1,814 ) Sold — — (5,629 ) — (5,629 ) Balance as of December 31, 2019 $ 1,078,804 $ 430,900 $ 649,763 $ 1,232,488 $ 3,391,955 Identifiable Intangible Assets The following table provides the gross carrying amounts, accumulated amortization, and net carrying amounts for the Company’s identifiable intangible assets: December 31, 2018 2019 Gross Carrying Amount Accumulated Amortization Net Carrying Amount Gross Carrying Amount Accumulated Amortization Net Carrying Amount (in thousands) Indefinite-lived intangible assets: Trademarks $ 166,698 $ — $ 166,698 $ 166,698 $ — $ 166,698 Certificates of need 19,174 — 19,174 17,157 — 17,157 Accreditations 1,857 — 1,857 1,874 — 1,874 Finite-lived intangible assets: Trademarks 5,000 (4,583 ) 417 5,000 (5,000 ) — Customer relationships 280,710 (61,900 ) 218,810 287,373 (87,346 ) 200,027 Favorable leasehold interests (1) 13,553 (6,064 ) 7,489 — — — Non-compete agreements 29,400 (6,152 ) 23,248 32,114 (8,802 ) 23,312 Total identifiable intangible assets $ 516,392 $ (78,699 ) $ 437,693 $ 510,216 $ (101,148 ) $ 409,068 _______________________________________________________________________________ (1) Favorable leasehold interests are a component of the operating lease right-of-use assets upon adoption of ASC Topic 842, Leases . The Company’s accreditations and trademarks have renewal terms and the costs to renew these intangible assets are expensed as incurred. At December 31, 2019 , the accreditations and trademarks have a weighted average time until next renewal of 1.5 years and 7.2 years , respectively. The Company’s finite-lived intangible assets amortize over their estimated useful lives. Amortization expense was $17.4 million , $29.9 million , and $29.6 million for the years ended December 31, 2017 , 2018 , and 2019 , respectively. Estimated amortization expense of the Company’s finite-lived intangible assets for each of the five succeeding years is as follows: 2020 2021 2022 2023 2024 (in thousands) Amortization expense $ 26,943 $ 26,624 $ 26,295 $ 26,019 $ 18,057

Equity Method Investments

Equity Method Investments	12 Months Ended
	Dec. 31, 2019
Equity Method Investments and Joint Ventures [Abstract]
Equity Method Investments	Equity Method Investments The Company’s equity method investments consist principally of minority ownership interests in rehabilitation businesses. Equity method investments of $146.9 million and $230.7 million are presented as part of other assets on the consolidated balance sheets as of December 31, 2018 and 2019 , respectively. At December 31, 2019 , these businesses consist primarily of the following ownership interests: BIR JV, LLP 49.0 % OHRH, LLC 49.0 % GlobalRehab—Scottsdale, LLC 49.0 % Rehabilitation Institute of Denton, LLC 50.0 % ES Rehabilitation, LLC 49.0 % Coastal Virginia Rehabilitation, LLC 49.0 % BHSM Rehabilitation, LLC 49.0 % Vibra Hospital of San Diego, LLC 39.0 % The Company provides contracted services, principally employee leasing services, and charges management fees to related parties affiliated through its equity method investments. Net operating revenues generated from contracted services provided and management fees charged to related parties affiliated through the Company’s equity method investments were $178.1 million , $216.9 million , and $308.2 million for the years ended December 31, 2017 , 2018 , and 2019 , respectively. The Company had receivables from related parties affiliated through its equity method investments of $8.7 million and $11.5 million , which are included as part of other current assets and other assets on the consolidated balance sheet, respectively, as of December 31, 2018. The Company has related party receivables of $5.7 million and $28.7 million which are included as part of other current assets and other assets on the consolidated balance sheet, respectively, as of December 31, 2019. The Company had liabilities to related parties affiliated through the Company’s equity method investments of $15.1 million and $31.2 million , which are included as part of accrued other on the consolidated balance sheets, as of December 31, 2018 and 2019, respectively. Summarized combined financial information of the entities in which the Company has a minority ownership interest is as follows: December 31, 2018 2019 (in thousands) Current assets $ 125,435 $ 178,674 Non-current assets 118,270 317,332 Total assets $ 243,705 $ 496,006 Current liabilities $ 43,792 $ 107,400 Non-current liabilities 16,338 127,976 Equity 183,575 260,630 Total liabilities and equity $ 243,705 $ 496,006 For the Year Ended December 31, 2017 2018 2019 (in thousands) Revenues $ 336,349 $ 393,034 $ 536,464 Cost of services and other operating expenses 289,224 342,603 476,182 Net income 45,648 48,535 58,519

Insurance Risk Programs

Insurance Risk Programs	12 Months Ended
	Dec. 31, 2019
Insurance [Abstract]
Insurance Risk Programs	Insurance Risk Programs Under a number of the Company’s insurance programs, which include the Company’s employee health insurance, workers’ compensation, and professional malpractice liability insurance programs, the Company is liable for a portion of its losses before it can attempt to recover from the applicable insurance carrier. The Company accrues for losses under an occurrence-based approach whereby the Company estimates the losses that will be incurred in a respective accounting period and accrues that estimated liability using actuarial methods. At December 31, 2018 and 2019 , provisions for losses for professional liability risks retained by the Company have been discounted at 3% . The Company recorded a liability of $175.2 million and $157.1 million related to these programs at December 31, 2018 and 2019 , respectively. If the Company did not discount the provisions for losses for professional liability risks, the aggregate liability for all of the insurance risk programs would be approximately $180.7 million and $162.0 million at December 31, 2018 and 2019 , respectively. At December 31, 2018 and 2019 , the Company recorded insurance proceeds receivable of $32.4 million and $15.5 million , respectively, for liabilities which exceeded its deductibles and self-insured retention limits and are recoverable through its insurance policies.

Long-Term Debt and Notes Payabl

Long-Term Debt and Notes Payable	12 Months Ended
	Dec. 31, 2019
Debt Disclosure [Abstract]
Long-Term Debt and Notes Payable	Long-Term Debt and Notes Payable For purposes of this indebtedness footnote, references to Select exclude Concentra Inc. because the Concentra-JPM credit facilities are non-recourse to Holdings and Select. As of December 31, 2019 , the Company’s long-term debt and notes payable were as follows (in thousands): Principal Outstanding Unamortized Premium (Discount) Unamortized Carrying Value Fair Value Select 6.250% senior notes $ 1,225,000 $ 39,988 $ (19,944 ) $ 1,245,044 $ 1,322,020 Select credit facilities: Select term loan 2,143,280 (10,411 ) (11,348 ) 2,121,521 2,145,959 Other debt, including finance leases 78,941 — (396 ) 78,545 78,545 Total debt $ 3,447,221 $ 29,577 $ (31,688 ) $ 3,445,110 $ 3,546,524 Principal maturities of the Company’s long-term debt and notes payable are approximately as follows (in thousands): 2020 2021 2022 2023 2024 Thereafter Total Select 6.250% senior notes $ — $ — $ — $ — $ — $ 1,225,000 $ 1,225,000 Select credit facilities: Select term loan 11,150 11,150 11,150 11,150 11,150 2,087,530 2,143,280 Other debt, including finance leases 14,017 7,255 18,715 3,364 23,550 12,040 78,941 Total debt $ 25,167 $ 18,405 $ 29,865 $ 14,514 $ 34,700 $ 3,324,570 $ 3,447,221 As of December 31, 2018 , the Company’s long-term debt and notes payable were as follows (in thousands): Principal Outstanding Unamortized Premium (Discount) Unamortized Issuance Costs Carrying Value Fair Value Select 6.375% senior notes $ 710,000 $ 550 $ (4,642 ) $ 705,908 $ 706,450 Select credit facilities: Select revolving facility 20,000 — — 20,000 18,400 Select term loan 1,129,875 (9,690 ) (9,321 ) 1,110,864 1,076,206 Concentra-JPM credit facilities: Concentra term loans 1,414,175 (2,765 ) (18,648 ) 1,392,762 1,357,802 Other debt, including finance leases 64,331 — (484 ) 63,847 63,847 Total debt $ 3,338,381 $ (11,905 ) $ (33,095 ) $ 3,293,381 $ 3,222,705 Select Credit Facilities On March 6, 2017, Select entered into a senior secured credit agreement (the “Select credit agreement”) that provided for $1.6 billion in senior secured credit facilities comprised of a $1.15 billion term loan (the “Select term loan”) and a $450.0 million revolving credit facility (the “Select revolving facility” and, together with the Select term loan, the “Select credit facilities”), including a $75.0 million sublimit for the issuance of standby letters of credit. On August 1, 2019, Select entered into Amendment No. 3 to the Select credit agreement. Among other things, Amendment No. 3 (i) provided for an additional $500.0 million in term loans that, along with the existing term loans, have a maturity date of March 6, 2025, (ii) extended the maturity date of the Select revolving facility from March 6, 2022 to March 6, 2024, and (iii) increased the total net leverage ratio permitted under the provisions of the Select revolving facility. On December 10, 2019, Select entered into Amendment No. 4 to the Select credit agreement. Among other things, Amendment No. 4 provided for an additional $615.0 million in term loans that, along with the existing term loans, have a maturity date of March 6, 2025. The interest rate on the Select term loan is equal to the Adjusted LIBO Rate (as defined in the Select credit agreement) plus a percentage ranging from 2.25% to 2.50% , or the Alternate Base Rate (as defined in the Select credit agreement) plus a percentage ranging from 1.25% to 1.50% , in each case subject to a specified leverage ratio. The interest rate on the loans outstanding under the Select revolving facility is equal to the Adjusted LIBO Rate plus a percentage ranging from 2.25% to 2.50% , or the Alternate Base Rate plus a percentage ranging from 1.25% to 1.50% , in each case subject to a specified leverage ratio. The Select revolving facility requires Select to maintain a leverage ratio, as specified in the Select credit agreement, not to exceed 7.00 to 1.00 . As of December 31, 2019 , Select’s leverage ratio was 4.31 to 1.00 . Borrowings under the Select credit facilities are guaranteed by Holdings and substantially all of Select’s current domestic subsidiaries, other than certain non-guarantor subsidiaries including Concentra and its subsidiaries, and will be guaranteed by substantially all of Select’s future domestic subsidiaries. Borrowings under the Select credit facilities are secured by substantially all of Select’s existing and future property and assets and by a pledge of Select’s capital stock, the capital stock of Select’s domestic subsidiaries, other than certain non-guarantor subsidiaries including Concentra and its subsidiaries, and up to 65% of the capital stock of Select’s foreign subsidiaries held directly by Select or a domestic subsidiary. At December 31, 2019 , Select had $411.7 million of availability under the Select revolving facility after giving effect to $38.3 million of outstanding letters of credit. The Select revolving facility is due March 6, 2024. As of December 31, 2019 , the applicable interest rate for the Select term loan was the Adjusted LIBO Rate plus 2.50% or the Alternate Base Rate plus 1.50% . The applicable interest rate for the Select revolving facility was the Adjusted LIBO Rate plus 2.50% or the Alternate Base Rate plus 1.50% . Prepayment of Borrowings Select will be required to prepay borrowings under the Select credit facilities with (i) the net cash proceeds received from non-ordinary course asset sales or other dispositions, or as a result of a casualty or condemnation, subject to reinvestment provisions and other customary carveouts and, to the extent required, the payment of certain indebtedness secured by liens having priority over the debt under the Select credit facilities or subject to a first lien intercreditor agreement, (ii) the net cash proceeds received from the issuance of debt obligations other than certain permitted debt obligations, and (iii) a percentage of excess cash flow (as defined in the Select credit agreement) based on Select’s leverage ratio, as specified in the Select credit agreement. For the year ended December 31, 2019 , the Select credit agreement will require a prepayment of borrowings of 25% of excess cash flow. This will result in a prepayment of approximately $40.0 million . The Company expects to have the borrowing capacity and intends to use borrowings under the Select revolving facility, which has a maturity date of March 6, 2024, to make all or a portion of the required prepayment during the quarter ended March 31, 2020; accordingly, the prepayment is reflected in long-term debt, net of current portion on the consolidated balance sheet as of December 31, 2019 . Upon prepayment, Select will not be required to make the quarterly amortization payments on the Select term loan, as specified in the Select credit agreement, until September 30, 2023. For the year ended December 31, 2018 , the Select credit agreement required a prepayment of borrowings of approximately $98.8 million as a result of excess cash flow. The prepayment was made in February 2019. The Company was no t required to make a prepayment of borrowings as a result of excess cash flow for the year ended December 31, 2017 . Select 6.250% Senior Notes On August 1, 2019, Select issued and sold $550.0 million aggregate principal amount of 6.250% senior notes due August 15, 2026. Select used a portion of the net proceeds of the 6.250% senior notes, together with a portion of the proceeds from the incremental term loan borrowings under the Select credit facilities received on August 1, 2019 (as described above), in part to (i) redeem in full the $710.0 million aggregate principal amount of the 6.375% senior notes at the redemption price of 100.0% of the principal amount plus accrued and unpaid interest on August 30, 2019, (ii) repay in full the outstanding borrowings under the Select revolving facility, and (iii) pay related fees and expenses associated with the financing. On December 10, 2019, Select issued and sold $675.0 million aggregate principal amount of 6.250% senior notes, due August 15, 2026, as additional notes under the indenture pursuant to which it previously issued $550.0 million aggregate principal amount of senior notes. The additional senior notes were issued at 106.00% of the aggregate principal amount. Interest on the senior notes accrues at the rate of 6.250% per annum and is payable semi-annually in arrears on February 15 and August 15 of each year, commencing on February 15, 2020. The senior notes are Select’s senior unsecured obligations which are subordinated to all of Select’s existing and future secured indebtedness, including the Select credit facilities. The senior notes rank equally in right of payment with all of Select’s other existing and future senior unsecured indebtedness and senior in right of payment to all of Select’s existing and future subordinated indebtedness. The senior notes are unconditionally guaranteed on a joint and several basis by each of Select’s direct or indirect existing and future domestic restricted subsidiaries, other than certain non-guarantor subsidiaries, including Concentra and its subsidiaries. Prior to August 15, 2022, Select may redeem some or all of the senior notes by paying a “make-whole” premium. On or after August 15, 2022, Select may redeem some or all of the senior notes at specified redemption prices. In addition, prior to August 15, 2022, Select may redeem up to 40% of the principal amount of the senior notes with the net proceeds of certain equity offerings at a price of 106.250% plus accrued and unpaid interest, if any. Select is obligated to offer to repurchase the senior notes at a price of 101% of their principal amount plus accrued and unpaid interest, if any, as a result of certain change of control events. These restrictions and prohibitions are subject to certain qualifications and exceptions. Concentra-JPM Credit Facilities On June 1, 2015, Concentra Inc. entered into a first lien credit agreement (the “Concentra-JPM first lien credit agreement”) that provided for first lien term loans (the “Concentra-JPM first lien term loan”) and a revolving credit facility (the “Concentra-JPM revolving facility” and, together with the Concentra-JPM first lien term loan, the “Concentra-JPM credit facilities”). On April 8, 2019, Concentra Inc. entered into Amendment No. 5 to the Concentra-JPM first lien credit agreement. Among other things, Amendment No. 5 (i) extended the maturity date of the Concentra-JPM revolving facility from June 1, 2020 to June 1, 2021 and (ii) increased the aggregate commitments available under the Concentra-JPM revolving facility from $75.0 million to $100.0 million . On September 20, 2019, Concentra Inc. entered into Amendment No. 6 to the Concentra-JPM first lien credit agreement. Among other things, Amendment No. 6 (i) provided for an additional $100.0 million in term loans that, along with the existing first lien term loans, had a maturity date of June 1, 2022 and (ii) extended the maturity date of the Concentra-JPM revolving facility from June 1, 2021 to March 1, 2022. Concentra Inc. used the incremental borrowings under the Concentra-JPM first lien credit agreement to prepay in full the $240.0 million term loan outstanding under Concentra Inc. ’s then-outstanding second lien credit agreement, plus a prepayment premium equal to 1.00% of the principal amount prepaid, on September 20, 2019. On December 10, 2019, Concentra Inc. repaid in full the $1,240.3 million Concentra-JPM first lien term loan outstanding under the Concentra-JPM first lien credit agreement. Concentra Inc. continues to have availability of up to $100.0 million under the Concentra-JPM revolving facility, which matures March 1, 2022. The interest rate on the loans outstanding under the Concentra-JPM revolving facility is equal to the Adjusted LIBO Rate (as defined in the Concentra-JPM first lien credit agreement) plus a percentage ranging from 2.25% to 2.50% , or the Alternate Base Rate (as defined in the Concentra-JPM first lien credit agreement) plus a percentage ranging from 1.25% to 1.50% , in each case subject to a first lien net leverage ratio, as specified in the Concentra-JPM first lien credit agreement. The Concentra-JPM first lien credit agreement requires Concentra Inc. to maintain a leverage ratio, as specified in the Concentra-JPM first lien credit agreement, of 5.75 to 1.00 which is tested quarterly, but only if Revolving Exposure (as defined in the Concentra-JPM first lien credit agreement) exceeds 30% of Revolving Commitments (as defined in the Concentra-JPM first lien credit agreement) on such day. The borrowings under the Concentra-JPM first lien credit agreement are guaranteed, on a first lien basis by Concentra Holdings, Inc., Concentra Inc., and certain domestic subsidiaries of Concentra Inc. (subject, in each case, to permitted liens). These borrowings will also be guaranteed by certain of Concentra Inc.’s future domestic subsidiaries. The borrowings are secured by substantially all of Concentra Inc.’s and its domestic subsidiaries’ existing and future property and assets and by a pledge of Concentra Inc.’s capital stock, the capital stock of certain of Concentra Inc.’s domestic subsidiaries and up to 65% of the voting capital stock and 100% of the non-voting capital stock of Concentra Inc.’s foreign subsidiaries, if any. At December 31, 2019 , Concentra Inc. had $85.7 million of availability under the Concentra-JPM revolving facility after giving effect to $14.3 million of outstanding letters of credit. At December 31, 2019 , the applicable interest rate for the Concentra-JPM revolving facility was the Adjusted LIBO Rate plus 2.50% or the Alternate Base Rate plus 1.50% . The Concentra-JPM revolving facility matures on March 1, 2022. Prepayment of Borrowings For the year ended December 31, 2018 , the Concentra-JPM first lien credit agreement required a prepayment of borrowings of $33.9 million as a result of excess cash flow. The prepayment was made in February 2019. Concentra Inc. was no t required to make a prepayment of borrowings as a result of excess cash flow from the year ended December 31, 2017 . Fair Value The Company considers the inputs in the valuation process to be Level 2 in the fair value hierarchy for its senior notes and the Select and Concentra-JPM credit facilities. Level 2 in the fair value hierarchy is defined as inputs that are observable for the asset or liability, either directly or indirectly, which includes quoted prices for identical assets or liabilities in markets that are not active. The fair values of the Select and Concentra-JPM credit facilities were based on quoted market prices for this debt in the syndicated loan market. The fair value of the senior notes was based on quoted market prices. The carrying amount of other debt, principally short-term notes payable, approximates fair value. Loss on Early Retirement of Debt During the year ended December 31, 2017, the Company refinanced the Select credit facilities which resulted in a loss on early retirement of debt of $19.7 million . The loss on early retirement of debt consisted of $6.5 million of debt extinguishment losses and $13.2 million of debt modification losses. During the year ended December 31, 2018, the Company refinanced the Select and Concentra-JPM credit facilities which resulted in losses on early retirement of debt of $14.2 million . The losses on early retirement of debt consisted of $3.0 million of debt extinguishment losses and $11.2 million of debt modification losses. During the year ended December 31, 2019, the Company refinanced its senior notes and the Select and Concentra-JPM credit facilities which resulted in losses on early retirement of debt of $38.1 million . The losses on early retirement of debt consisted of $22.1 million of debt extinguishment losses and $16.0 million of debt modification losses.

Stock Repurchase Program

Stock Repurchase Program	12 Months Ended
	Dec. 31, 2019
Equity [Abstract]
Stock Repurchase Program	Holdings’ board of directors has authorized a common stock repurchase program to repurchase up to $500.0 million worth of shares of its common stock. The program has been extended until December 31, 2020, and will remain in effect until then, unless further extended or earlier terminated by the board of directors. Stock repurchases under this program may be made in the open market or through privately negotiated transactions, and at times and in such amounts as Holdings deems appropriate. Holdings is funding this program with cash on hand and borrowings under the Select revolving facility. Holdings did no t repurchase shares under the common stock repurchase program during the years ended December 31, 2017 and 2018 . During the year ended December 31, 2019, Holdings repurchased 2,165,221 shares at a cost of approximately $33.2 million . The common stock repurchase program has available capacity of $152.1 million as of December 31, 2019 .

Segment Information

Segment Information	12 Months Ended
	Dec. 31, 2019
Segment Reporting [Abstract]
Segment Information	Segment Information The Company identifies its segments according to how the chief operating decision maker evaluates financial performance and allocates resources. The Company’s reportable segments consist of the critical illness recovery hospital segment, rehabilitation hospital segment, outpatient rehabilitation segment, and Concentra segment. Other activities include the Company’s corporate shared services, certain investments, and employee leasing services provided to related parties affiliated through the Company’s equity method investments. The accounting policies of the segments are the same as those described in the summary of significant accounting policies. The Company evaluates performance of the segments based on Adjusted EBITDA. For the years ended December 31, 2017 , 2018 , and 2019 , Adjusted EBITDA is defined as earnings excluding interest, income taxes, depreciation and amortization, gain (loss) on early retirement of debt, stock compensation expense, acquisition costs associated with U.S. HealthWorks, gain (loss) on sale of businesses, and equity in earnings (losses) of unconsolidated subsidiaries. The Company has provided additional information regarding its reportable segments, such as total assets, which contributes to the understanding of the Company and provides useful information to the users of the consolidated financial statements. The following tables summarize selected financial data for the Company’s reportable segments. For the Year Ended December 31, 2017 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Rehabilitation Concentra Other Total (in thousands) Net operating revenues (1) $ 1,725,022 $ 509,108 $ 960,902 $ 1,013,224 $ 156,989 $ 4,365,245 Adjusted EBITDA 252,679 90,041 132,533 157,561 (94,822 ) 537,992 Total assets 1,848,783 868,517 954,661 1,340,919 114,286 5,127,166 Capital expenditures 49,720 96,477 27,721 28,912 30,413 233,243 For the Year Ended December 31, 2018 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Rehabilitation Concentra (2) Other Total (in thousands) Net operating revenues (1) $ 1,753,584 $ 583,745 $ 995,794 $ 1,557,673 $ 190,462 $ 5,081,258 Adjusted EBITDA 243,015 108,927 142,005 251,977 (100,769 ) 645,155 Total assets 1,771,605 894,192 1,002,819 2,178,868 116,781 5,964,265 Capital expenditures 40,855 42,389 30,553 42,205 11,279 167,281 For the Year Ended December 31, 2019 Critical Illness Recovery Hospitals Rehabilitation Hospitals Outpatient Rehabilitation Concentra Other Total (in thousands) Net operating revenues $ 1,836,518 $ 670,971 $ 1,046,011 $ 1,628,817 $ 271,605 $ 5,453,922 Adjusted EBITDA 254,868 135,857 151,831 276,482 (108,130 ) 710,908 Total assets 2,099,833 1,127,028 1,289,190 2,372,187 452,050 7,340,288 Capital expenditures 45,573 27,216 33,628 44,101 6,608 157,126 A reconciliation of Adjusted EBITDA to income before income taxes is as follows: For the Year Ended December 31, 2017 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Rehabilitation Concentra Other Total (in thousands) Adjusted EBITDA $ 252,679 $ 90,041 $ 132,533 $ 157,561 $ (94,822 ) Depreciation and amortization (45,743 ) (20,176 ) (24,607 ) (61,945 ) (7,540 ) Stock compensation expense — — — (993 ) (18,291 ) U.S. HealthWorks acquisition costs — — — (2,819 ) — Income (loss) from operations $ 206,936 $ 69,865 $ 107,926 $ 91,804 $ (120,653 ) $ 355,878 Loss on early retirement of debt (19,719 ) Equity in earnings of unconsolidated subsidiaries 21,054 Loss on sale of businesses (49 ) Interest expense (154,703 ) Income before income taxes $ 202,461 For the Year Ended December 31, 2018 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Rehabilitation Concentra (2) Other Total (in thousands) Adjusted EBITDA $ 243,015 $ 108,927 $ 142,005 $ 251,977 $ (100,769 ) Depreciation and amortization (45,797 ) (24,101 ) (27,195 ) (95,521 ) (9,041 ) Stock compensation expense — — — (2,883 ) (20,443 ) U.S. HealthWorks acquisition costs — — — (2,895 ) — Income (loss) from operations $ 197,218 $ 84,826 $ 114,810 $ 150,678 $ (130,253 ) $ 417,279 Loss on early retirement of debt (14,155 ) Equity in earnings of unconsolidated subsidiaries 21,905 Gain on sale of businesses 9,016 Interest expense (198,493 ) Income before income taxes $ 235,552 For the Year Ended December 31, 2019 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Rehabilitation Concentra Other Total (in thousands) Adjusted EBITDA $ 254,868 $ 135,857 $ 151,831 $ 276,482 $ (108,130 ) Depreciation and amortization (50,763 ) (27,322 ) (28,301 ) (96,807 ) (9,383 ) Stock compensation expense — — — (3,069 ) (23,382 ) Income (loss) from operations $ 204,105 $ 108,535 $ 123,530 $ 176,606 $ (140,895 ) $ 471,881 Loss on early retirement of debt (38,083 ) Equity in earnings of unconsolidated subsidiaries 24,989 Gain on sale of businesses 6,532 Interest expense (200,570 ) Income before income taxes $ 264,749 _______________________________________________________________________________ (1) Prior to 2019, the financial results of employee leasing services provided to related parties affiliated through the Company’s equity method investments were included with the Company’s reportable segments. These results are now reported as part of the Company’s other activities. For the years ended December 31, 2017 and 2018, net operating revenues were conformed to reflect the current presentation. (2) The Concentra segment includes the operating results of U.S. HealthWorks beginning February 1, 2018.

Revenue from Contracts with Cus

Revenue from Contracts with Customers	12 Months Ended
	Dec. 31, 2019
Revenue from Contract with Customer [Abstract]
Revenue from Contracts with Customers	Revenue from Contracts with Customers The following tables disaggregate the Company’s net operating revenues: For the Year Ended December 31, 2017 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Rehabilitation Concentra Other Total (in thousands) Patient service revenues: Medicare $ 903,503 $ 259,221 $ 148,403 $ 2,128 $ — $ 1,313,255 Non-Medicare 810,723 207,196 739,531 1,002,787 — 2,760,237 Total patient services revenues 1,714,226 466,417 887,934 1,004,915 — 4,073,492 Other revenues 10,796 42,691 72,968 8,309 156,989 291,753 Total net operating revenues $ 1,725,022 $ 509,108 $ 960,902 $ 1,013,224 $ 156,989 $ 4,365,245 For the Year Ended December 31, 2018 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Rehabilitation Concentra Other Total (in thousands) Patient service revenues: Medicare $ 893,429 $ 293,913 $ 161,054 $ 2,168 $ — $ 1,350,564 Non-Medicare 847,447 254,215 762,247 1,545,852 — 3,409,761 Total patient services revenues 1,740,876 548,128 923,301 1,548,020 — 4,760,325 Other revenues 12,708 35,617 72,493 9,653 190,462 320,933 Total net operating revenues $ 1,753,584 $ 583,745 $ 995,794 $ 1,557,673 $ 190,462 $ 5,081,258 For the Year Ended December 31, 2019 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Rehabilitation Concentra Other Total (in thousands) Patient service revenues: Medicare $ 907,963 $ 332,514 $ 171,690 $ 1,965 $ — $ 1,414,132 Non-Medicare 916,650 300,113 794,288 1,615,529 — 3,626,580 Total patient services revenues 1,824,613 632,627 965,978 1,617,494 — 5,040,712 Other revenues 11,905 38,344 80,033 11,323 271,605 413,210 Total net operating revenues $ 1,836,518 $ 670,971 $ 1,046,011 $ 1,628,817 $ 271,605 $ 5,453,922

Stock-based Compensation

Stock-based Compensation	12 Months Ended
	Dec. 31, 2019
Share-based Payment Arrangement [Abstract]
Stock-based Compensation	Stock-based Compensation Holdings’ equity incentive plan provides for the issuance of stock options and restricted stock awards. The equity plan allows for the issuance of 7,735,628 awards, as adjusted for forfeited restricted stock and stock options awards through December 31, 2019 . As of December 31, 2019 , Holdings has capacity to issue 1,727,405 restricted stock and stock option awards under the equity plan. The equity plan allows for authorized but previously unissued shares or shares previously issued and outstanding and reacquired by Holdings to satisfy these awards. The Company measures the compensation costs of stock-based compensation arrangements based on the grant-date fair value and recognizes the costs over the period during which employees are required to provide services. Restricted stock awards are valued by using the closing market price of its stock on the date of grant. These restricted stock awards generally vest over three to four years . Stock options are valued using the Black-Scholes option-pricing model. Forfeitures are recognized as they occur. Transactions related to restricted stock awards are as follows: Shares Weighted Average Grant Date Fair Value (share amounts in thousands) Unvested balance, January 1, 2019 4,450 $ 15.68 Granted 1,500 16.60 Vested (1,300 ) 11.97 Forfeited (43 ) 16.09 Unvested balance, December 31, 2019 4,607 $ 17.03 For the years ended December 31, 2017 , 2018 , and 2019 , the weighted average grant date fair values of restricted stock awards granted were $15.84 , $19.72 , and $16.60 , respectively. For the years ended December 31, 2017 , 2018 , and 2019 , the fair values of restricted stock awards vested were $17.1 million , $19.1 million , and $15.6 million , respectively. As of December 31, 2019 , the Company did not have any stock options outstanding or exercisable. There were no options granted or canceled during the year ended December 31, 2019 . During the year ended December 31, 2019 , 105,000 options were exercised, which had a weighted average exercise price of $9.18 . For the years ended December 31, 2017 , 2018 , and 2019 , the intrinsic values of options exercised were $1.6 million , $1.8 million , and $0.7 million , respectively. Stock compensation expense recognized by the Company was as follows: For the Year Ended December 31, 2017 2018 2019 (in thousands) Stock compensation expense: Included in general and administrative $ 15,706 $ 17,604 $ 20,334 Included in cost of services 3,578 5,722 6,117 Total $ 19,284 $ 23,326 $ 26,451 Stock compensation expense based on current stock-based awards for each of the next five years is estimated to be as follows: 2020 2021 2022 2023 2024 (in thousands) Stock compensation expense $ 24,381 $ 16,031 $ 8,117 $ 1,267 $ 19

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes The components of the Company’s income tax expense for the years ended December 31, 2017 , 2018 , and 2019 were as follows: For the Year Ended December 31, 2017 2018 2019 (in thousands) Current income tax expense: Federal $ 45,809 $ 36,072 $ 55,822 State and local 8,331 15,321 15,331 Total current income tax expense 54,140 51,393 71,153 Deferred income tax expense (benefit) (72,324 ) 7,217 (7,435 ) Total income tax expense (benefit) $ (18,184 ) $ 58,610 $ 63,718 Reconciliations of the statutory federal income tax rate to the effective income tax rate are as follows: For the Year Ended December 31, 2017 2018 2019 Federal income tax at statutory rate 35.0 % 21.0 % 21.0 % State and local income taxes, less federal income tax benefit 3.7 5.0 4.2 Permanent differences 1.7 2.1 1.7 Valuation allowance (7.3 ) 0.5 0.5 Uncertain tax positions (0.6 ) (0.8 ) (0.1 ) Non-controlling interest 0.5 (2.1 ) (2.9 ) Stock-based compensation (1.3 ) (2.2 ) (0.7 ) Deferred income taxes - state income tax rate adjustment (2.8 ) 0.4 0.8 Deferred income taxes - tax legislation rate adjustment (37.5 ) — — Other (0.4 ) 1.0 (0.4 ) Effective income tax rate (9.0 )% 24.9 % 24.1 % The Company’s deferred tax assets and liabilities are as follows: December 31, 2018 2019 (in thousands) Deferred tax assets Allowance for doubtful accounts $ 10,313 $ 13,097 Compensation and benefit-related accruals 51,900 55,300 Professional malpractice liability insurance 13,644 13,753 Deferred revenue 209 274 Federal and state net operating loss and state tax credit carryforwards 40,163 38,933 Interest limitation carryforward 4,675 4,943 Stock awards 5,695 6,251 Equity investments 2,055 2,914 Operating lease liabilities — 267,513 Other 3,271 2,344 Deferred tax assets $ 131,925 $ 405,322 Valuation allowance (17,893 ) (18,461 ) Deferred tax assets, net of valuation allowance $ 114,032 $ 386,861 Deferred tax liabilities Deferred income $ (13,891 ) $ (9,190 ) Investment in unconsolidated affiliates (5,653 ) (7,498 ) Depreciation and amortization (217,950 ) (225,079 ) Deferred financing costs (8,324 ) (6,250 ) Operating lease right-of-use assets — (263,818 ) Other (3,488 ) (3,546 ) Deferred tax liabilities $ (249,306 ) $ (515,381 ) Deferred tax liabilities, net of deferred tax assets $ (135,274 ) $ (128,520 ) The Company’s deferred tax assets and liabilities are included in the consolidated balance sheet captions as follows: December 31, 2018 2019 (in thousands) Other assets $ 18,621 $ 19,738 Non-current deferred tax liability (153,895 ) (148,258 ) $ (135,274 ) $ (128,520 ) As of December 31, 2018 and 2019 , the Company’s valuation allowance is primarily attributable to the uncertainty regarding the realization of state net operating losses and other net deferred tax assets of loss entities. The state net deferred tax assets have a full valuation allowance recorded for entities that have a cumulative history of pre-tax losses (current year in addition to the two prior years). For the year ended December 31, 2018, the Company recorded a net valuation allowance increase of $4.9 million . This increase was comprised of a $3.9 million valuation allowance recognized on net operating losses acquired and recorded as part of U.S. HealthWorks’ opening balance sheet, and a $1.0 million valuation allowance recognized as a result of a net change in state net operating losses for the year ended December 31, 2018. For the year ended December 31, 2019, the Company recorded a net valuation allowance increase of $0.6 million which was the result of a net change in state net operating losses. The changes in the Company’s valuation allowance were recognized as a result of management’s reassessment of the amount of its deferred tax assets that are more likely than not to be realized. At December 31, 2018 and 2019 , the Company’s net deferred tax liabilities of approximately $135.3 million and $128.5 million , respectively, consist of items which have been recognized for tax reporting purposes, but which will increase tax on returns to be filed in the future. The Company has performed an assessment of positive and negative evidence regarding the realization of the net deferred tax assets. This assessment included a review of legal entities with three years of cumulative losses, estimates of projected future taxable income, the effects on future taxable income resulting from the reversal of existing deferred tax liabilities in future periods, and the impact of tax planning strategies that management would and could implement in order to keep deferred tax assets from expiring unused. Although realization is not assured, based on the Company’s assessment, it has concluded that it is more likely than not that such assets, net of the determined valuation allowance, will be realized. The total state net operating losses are approximately $719.6 million . State net operating loss carryforwards expire and are subject to valuation allowances as follows: State Net Operating Losses Gross Valuation Allowance (in thousands) 2020 $ 17,297 $ 14,100 2021 11,772 8,806 2022 39,319 33,790 2023 20,743 15,367 Thereafter through 2038 630,506 413,916

Earnings per Share

Earnings per Share	12 Months Ended
	Dec. 31, 2019
Earnings Per Share [Abstract]
Earnings per Share	Earnings per Share The following table sets forth the net income attributable to the Company, its common shares outstanding, and its participating securities outstanding. There were no dividends declared or contractual dividends paid for the years ended December 31, 2017 , 2018 , and 2019 . Basic EPS Diluted EPS For the Year Ended December 31, For the Year Ended December 31, 2017 2018 2019 2017 2018 2019 (in thousands) Net income $ 220,645 $ 176,942 $ 201,031 $ 220,645 $ 176,942 $ 201,031 Less: net income attributable to non-controlling interests 43,461 39,102 52,582 43,461 39,102 52,582 Net income attributable to the Company 177,184 137,840 148,449 177,184 137,840 148,449 Less: net income attributable to participating securities 5,758 4,551 4,995 5,751 4,548 4,994 Net income attributable to common shares $ 171,426 $ 133,289 $ 143,454 $ 171,433 $ 133,292 $ 143,455 The following tables set forth the computation of EPS under the two-class method: For the Year Ended December 31, 2017 Net Income Allocation Shares (1) Basic EPS Net Income Allocation Shares (1) Diluted EPS (in thousands, except for per share amounts) Common shares $ 171,426 128,955 $ 1.33 $ 171,433 129,126 $ 1.33 Participating securities 5,758 4,332 1.33 5,751 4,332 1.33 Total Company $ 177,184 $ 177,184 For the Year Ended December 31, 2018 Net Income Allocation Shares (1) Basic EPS Net Income Allocation Shares (1) Diluted EPS (in thousands, except for per share amounts) Common shares $ 133,289 130,172 $ 1.02 $ 133,292 130,256 $ 1.02 Participating securities 4,551 4,444 1.02 4,548 4,444 1.02 Total Company $ 137,840 $ 137,840 For the Year Ended December 31, 2019 Net Income Allocation Shares (1) Basic EPS Net Income Allocation Shares (1) Diluted EPS (in thousands, except for per share amounts) Common shares $ 143,454 130,248 $ 1.10 $ 143,455 130,276 $ 1.10 Participating securities 4,995 4,535 $ 1.10 4,994 4,535 $ 1.10 Total Company $ 148,449 $ 148,449 _______________________________________________________________________________ (1) Represents the weighted average share count outstanding during the period.

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
	Dec. 31, 2019
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies Construction Commitments At December 31, 2019 , the Company had outstanding commitments under construction contracts related to new construction, improvements, and renovations totaling approximately $16.2 million . Litigation The Company is a party to various legal actions, proceedings, and claims (some of which are not insured), and regulatory and other governmental audits and investigations in the ordinary course of its business. The Company cannot predict the ultimate outcome of pending litigation, proceedings, and regulatory and other governmental audits and investigations. These matters could potentially subject the Company to sanctions, damages, recoupments, fines, and other penalties. The Department of Justice, Centers for Medicare & Medicaid Services (“CMS”), or other federal and state enforcement and regulatory agencies may conduct additional investigations related to the Company’s businesses in the future that may, either individually or in the aggregate, have a material adverse effect on the Company’s business, financial position, results of operations, and liquidity. To address claims arising out of the Company’s operations, the Company maintains professional malpractice liability insurance and general liability insurance coverages through a number of different programs that are dependent upon such factors as the state where the Company is operating and whether the operations are wholly owned or are operated through a joint venture. For the Company’s wholly owned operations, the Company currently maintains insurance coverages under a combination of policies with a total annual aggregate limit of up to $40.0 million . The Company’s insurance for the professional liability coverage is written on a “claims-made” basis, and its commercial general liability coverage is maintained on an “occurrence” basis. These coverages apply after a self-insured retention limit is exceeded. For the Company’s joint venture operations, the Company has numerous programs that are designed to respond to the risks of the specific joint venture. The annual aggregate limit under these programs ranges from $6.0 million to $20.0 million . The policies are generally written on a “claims-made” basis. Each of these programs has either a deductible or self-insured retention limit. The Company reviews its insurance program annually and may make adjustments to the amount of insurance coverage and self-insured retentions in future years. The Company also maintains umbrella liability insurance covering claims which, due to their nature or amount, are not covered by or not fully covered by the Company’s other insurance policies. These insurance policies also do not generally cover punitive damages and are subject to various deductibles and policy limits. Significant legal actions, as well as the cost and possible lack of available insurance, could subject the Company to substantial uninsured liabilities. In the Company’s opinion, the outcome of these actions, individually or in the aggregate, will not have a material adverse effect on its financial position, results of operations, or cash flows. Healthcare providers are subject to lawsuits under the qui tam provisions of the federal False Claims Act. Qui tam lawsuits typically remain under seal (hence, usually unknown to the defendant) for some time while the government decides whether or not to intervene on behalf of a private qui tam plaintiff (known as a relator) and take the lead in the litigation. These lawsuits can involve significant monetary damages and penalties and award bounties to private plaintiffs who successfully bring the suits. The Company is and has been a defendant in these cases in the past, and may be named as a defendant in similar cases from time to time in the future. Wilmington Litigation. On January 19, 2017, the United States District Court for the District of Delaware unsealed a qui tam Complaint in United States of America and State of Delaware ex rel. Theresa Kelly v. Select Specialty Hospital-Wilmington, Inc. (“SSH‑Wilmington”), Select Specialty Hospitals, Inc., Select Employment Services, Inc., Select Medical Corporation, and Crystal Cheek, No. 16‑347‑LPS. The Complaint was initially filed under seal in May 2016 by a former chief nursing officer at SSH‑Wilmington and was unsealed after the United States filed a Notice of Election to Decline Intervention in January 2017. The corporate defendants were served in March 2017. In the complaint, the plaintiff‑relator alleges that the Select defendants and an individual defendant, who is a former health information manager at SSH‑Wilmington, violated the False Claims Act and the Delaware False Claims and Reporting Act based on allegedly falsifying medical practitioner signatures on medical records and failing to properly examine the credentials of medical practitioners at SSH‑Wilmington. In response to the Select defendants’ motion to dismiss the Complaint, in May 2017 the plaintiff-relator filed an Amended Complaint asserting the same causes of action. The Select defendants filed a Motion to Dismiss the Amended Complaint based on numerous grounds, including that the Amended Complaint did not plead any alleged fraud with sufficient particularity, failed to plead that the alleged fraud was material to the government’s payment decision, failed to plead sufficient facts to establish that the Select defendants knowingly submitted false claims or records, and failed to allege any reverse false claim. In March 2018, the District Court dismissed the plaintiff‑relator’s claims related to the alleged failure to properly examine medical practitioners’ credentials, her reverse false claims allegations, and her claim that defendants violated the Delaware False Claims and Reporting Act. It denied the defendants’ motion to dismiss claims that the allegedly falsified medical practitioner signatures violated the False Claims Act. Separately, the District Court dismissed the individual defendant due to plaintiff-relator’s failure to timely serve the amended complaint upon her. In March 2017, the plaintiff-relator initiated a second action by filing a Complaint in the Superior Court of the State of Delaware in Theresa Kelly v. Select Medical Corporation, Select Employment Services, Inc., and SSH‑Wilmington, C.A. No. N17C-03-293 CLS. The Delaware Complaint alleges that the defendants retaliated against her in violation of the Delaware Whistleblowers’ Protection Act for reporting the same alleged violations that are the subject of the federal Amended Complaint. The defendants filed a motion to dismiss, or alternatively to stay, the Delaware Complaint based on the pending federal Amended Complaint and the failure to allege facts to support a violation of the Delaware Whistleblowers’ Protection Act. In January 2018, the Court stayed the Delaware Complaint pending the outcome of the federal case. The Company intends to vigorously defend these actions, but at this time the Company is unable to predict the timing and outcome of this matter. Contract Therapy Subpoena. On May 18, 2017, the Company received a subpoena from the U.S. Attorney’s Office for the District of New Jersey seeking various documents principally relating to the Company’s contract therapy division, which contracted to furnish rehabilitation therapy services to residents of skilled nursing facilities (“SNFs”) and other providers. The Company operated its contract therapy division through a subsidiary until March 31, 2016, when the Company sold the stock of the subsidiary. The subpoena seeks documents that appear to be aimed at assessing whether therapy services were furnished and billed in compliance with Medicare SNF billing requirements, including whether therapy services were coded at inappropriate levels and whether excessive or unnecessary therapy was furnished to justify coding at higher paying levels. The Company does not know whether the subpoena has been issued in connection with a qui tam lawsuit or in connection with possible civil, criminal or administrative proceedings by the government. The Company has produced documents in response to the subpoena and intends to fully cooperate with this investigation. At this time, the Company is unable to predict the timing and outcome of this matter.

Subsequent Events

Subsequent Events	12 Months Ended
	Dec. 31, 2019
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events On January 1, 2020, Select, Welsh, Carson, Anderson & Stowe XII, L.P. (“WCAS”), and DHHC entered into an agreement pursuant to which Select acquired approximately 17.2% of the outstanding membership interests of Concentra Group Holdings Parent on a fully diluted basis from WCAS, DHHC, and other equity holders of Concentra Group Holdings Parent for approximately $338.4 million . On February 1, 2020, Select, WCAS and DHHC entered into an agreement pursuant to which Select acquired an additional 1.4% of the outstanding membership interests of Concentra Group Holdings Parent on a fully diluted basis from WCAS, DHHC, and other equity holders for approximately $27.8 million . These purchases were in lieu of, and considered to be, the exercise of the first put right provided to certain equity holders under the terms of the Amended and Restated Limited Liability Company Agreement of Concentra Group Holdings Parent, dated as of February 1, 2018. Following these purchases, Select owns approximately 66.6% of the outstanding membership interests of Concentra Group Holdings Parent on a fully diluted basis and approximately 68.8% of the outstanding Class A membership interests of Concentra Group Holdings Parent.

Selected Quarterly Financial Da

Selected Quarterly Financial Data (Unaudited)	12 Months Ended
	Dec. 31, 2019
Quarterly Financial Information Disclosure [Abstract]
Selected Quarterly Financial Data (Unaudited)	Selected Quarterly Financial Data (Unaudited) The tables below sets forth selected unaudited financial data for each quarter of the last two years. First Quarter Second Quarter Third Quarter Fourth Quarter (in thousands, except per share amounts) For the year ended December 31, 2018 Net operating revenues $ 1,252,964 $ 1,296,210 $ 1,267,401 $ 1,264,683 Cost of services, exclusive of depreciation and amortization 1,065,813 1,094,731 1,087,062 1,093,450 Depreciation and amortization 46,771 51,724 50,527 52,633 Income from operations 108,598 120,561 99,837 88,283 Net income 43,982 60,559 42,679 29,722 Net income attributable to Select Medical Holdings Corporation 33,739 46,511 32,917 24,673 Earnings per common share: (1) Basic $ 0.25 $ 0.35 $ 0.24 $ 0.18 Diluted $ 0.25 $ 0.35 $ 0.24 $ 0.18 First Quarter Second Quarter Third Quarter Fourth Quarter (in thousands, except per share amounts) For the year ended December 31, 2019 Net operating revenues $ 1,324,631 $ 1,361,364 $ 1,393,343 $ 1,374,584 Cost of services, exclusive of depreciation and amortization 1,132,092 1,150,150 1,183,111 1,175,649 Depreciation and amortization 52,138 54,993 52,941 52,504 Income from operations 111,724 124,882 122,906 112,369 Net income 53,344 59,986 44,030 43,671 Net income attributable to Select Medical Holdings Corporation 40,834 44,816 30,732 32,067 Earnings per common share: (1) Basic $ 0.30 $ 0.33 $ 0.23 $ 0.24 Diluted $ 0.30 $ 0.33 $ 0.23 $ 0.24 _______________________________________________________________________________ (1) Due to rounding, the summation of quarterly earnings per common share balances may not equal year to date equivalents.

Schedule II - Valuation and Qua

Schedule II - Valuation and Qualifying Accounts	12 Months Ended
	Dec. 31, 2019
SEC Schedule, 12-09, Valuation and Qualifying Accounts [Abstract]
Schedule II - Valuation and Qualifying Accounts	Select Medical Holdings Corporation Select Medical Corporation Schedule II—Valuation and Qualifying Accounts Balance at Beginning of Year Charged to Cost and Expenses Acquisitions (1) Deductions Balance at End of Year (in thousands) Income Tax Valuation Allowance Year ended December 31, 2019 $ 17,893 $ 568 $ — $ — $ 18,461 Year ended December 31, 2018 $ 12,986 $ 1,032 $ 3,875 $ — $ 17,893 Year ended December 31, 2017 $ 26,421 $ (13,435 ) $ — $ — $ 12,986 _______________________________________________________________________________ (1)

Organization and Significant _2

Organization and Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Use of Estimates	Use of Estimates The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America (“GAAP”) requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, including disclosure of contingencies, at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Estimates and assumptions are used for, but not limited to: amounts realizable for services performed, estimated useful lives of assets, the valuation of intangible assets, amounts payable for self-insured losses, and the computation of income taxes. Future events and their effects cannot be predicted with certainty; accordingly, the Company’s accounting estimates require the exercise of judgment. The accounting estimates used in the preparation of the financial statements will change as new events occur, as more experience is acquired, as additional information is obtained, and as the Company’s operating environment changes. The Company’s management evaluates and updates assumptions and estimates on an ongoing basis. Actual results could differ from those estimates.
Principles of Consolidation	Principles of Consolidation The consolidated financial statements include the accounts of Holdings, Select, and the subsidiaries, limited liability companies, and limited partnerships in which the Company has a controlling financial interest. All intercompany balances and transactions are eliminated in consolidation.
Non-Controlling Interests	Non-Controlling Interests The ownership interests held by outside parties in subsidiaries, limited liability companies and limited partnerships controlled by the Company are classified as non-controlling interests. Net income or loss is attributed to the Company’s non-controlling interests. Some of the Company’s non-controlling ownership interests consist of outside parties that have certain redemption rights that, if exercised, require the Company to purchase the parties’ ownership interests. These interests are classified and reported as redeemable non-controlling interests and have been adjusted to their approximate redemption values, after the attribution of net income or loss . The Company’s redeemable non-controlling interests are comprised primarily of the Class A membership interests owned by outside members of Concentra Group Holdings Parent, LLC (“Concentra Group Holdings Parent”), each which have put rights with respect to their interests in Concentra Group Holdings Parent. The redemption value of these membership interests is approximately $750.6 million and $939.9 million as of December 31, 2018 and 2019
Earnings per Share	Earnings per Share The Company’s capital structure includes common stock and unvested restricted stock awards. To compute earnings per share (“EPS”), the Company applies the two-class method because the Company’s unvested restricted stock awards are participating securities which are entitled to participate equally with the Company’s common stock in undistributed earnings. Application of the Company’s two-class method is as follows: (i) Net income attributable to the Company is reduced by the amount of dividends declared and by the contractual amount of dividends that must be paid for the current period for each class of stock, if any. (ii) The remaining undistributed net income of the Company is then equally allocated to its common stock and unvested restricted stock awards, as if all of the earnings for the period had been distributed. The total net income allocated to each security is determined by adding both distributed and undistributed net income for the period. (iii)
Cash and Cash Equivalents	Cash and Cash Equivalents The Company considers all highly liquid investments with a maturity of three months or less when purchased to be cash equivalents. Cash equivalents are stated at cost which approximates fair value.
Accounts Receivable	Accounts Receivable Substantially all of the Company’s accounts receivable is related to providing healthcare services to patients. These healthcare services are primarily paid for by federal and state governmental authorities, managed care health plans, commercial insurance companies, and workers’ compensation and employer programs. The Company reports accounts receivable at an amount equal to the consideration the Company expects to receive in exchange for providing healthcare services to its patients, which is estimated using contractual provisions associated with specific payors, historical reimbursement rates, and an analysis of past reimbursement experience to estimate contractual allowances. Amounts that have been deemed to be uncollectible because of circumstances that affect the ability of payors to make payments are written-off as bad debt expense as they occur.
Credit Risk and Payor Concentrations	Credit Risk and Payor Concentrations Financial instruments that potentially subject the Company to concentrations of credit risk consist primarily of cash balances and accounts receivable. The Company’s excess cash is held with large financial institutions. The Company grants unsecured credit to its patients, most of whom reside in the service area of the Company’s facilities and are insured under third-party payor agreements. Accounts receivable from the Medicare program represents the only significant third-party payor concentration for the Company. The Company does not believe there is significant credit risk associated with this governmental program. Medicare receivables comprise approximately 16% and 15% of the Company’s accounts receivable at December 31, 2018 and 2019 , respectively. The Company’s primary collection risks for its accounts receivable relate to non-governmental payors who insure the Company’s patients and deductibles, co-payments, and self-insured amounts owed by the patient. The Company believes its credit risk with its non-governmental payors is limited due to the diversity in the Company’s non-governmental third-party payor base, as well as their geographic dispersion. Further, deductibles, co-payments, and self-insured amounts owed by the patient are an immaterial portion of the Company’s accounts receivable balance at both December 31, 2018 and 2019 . The Company’s general policy is to verify insurance coverage prior to the date of admission for patients admitted to its critical illness recovery hospitals and rehabilitation hospitals. Within the Company’s outpatient rehabilitation clinics, insurance coverage is verified prior to the patient’s visit. Within the Company’s Concentra centers, insurance coverage is verified or an authorization is received from the patient’s employer prior to the patient’s visit. Net operating revenues generated directly from the Medicare program represented approximately 30% , 27% , and 26% of the Company’s total net operating revenues for the years ended December 31, 2017 , 2018 , and 2019 , respectively. As a provider of services under the Medicare program, the Company is subject to extensive regulations. The inability of any of the Company’s critical illness recovery hospitals, rehabilitation hospitals, or outpatient rehabilitation clinics to comply with Medicare regulations can result in the Company receiving significantly less Medicare payments than the Company currently receives for its services provided to patients.
Financial Instruments	Financial Instruments
Leases	Leases The Company evaluates whether a contract is or contains a lease at the inception of the contract. Upon lease commencement, the date on which a lessor makes the underlying asset available to the Company for use, the Company classifies the lease as either an operating or finance lease. Most of the Company’s facility and equipment leases are classified as operating leases. Balance Sheet For both operating and finance leases, the Company recognizes a right-of-use asset and lease liability at lease commencement. A right-of-use asset represents the Company’s right to use an underlying asset for the lease term while the lease liability represents an obligation to make lease payments arising from a lease which are measured on a discounted basis. The Company elected the short-term lease exemption for its equipment leases; accordingly, equipment leases with terms of 12 months or less are not recorded on the consolidated balance sheets. Lease liabilities are measured at the present value of the remaining, fixed lease payments at lease commencement. As most of the Company’s leases do not specify an implicit rate, the Company uses its incremental borrowing rate, which coincides with the lease term at the commencement of a lease, in determining the present value of its remaining lease payments. The Company’s leases may also specify extension or termination clauses. These options are factored into the measurement of the lease liability when it is reasonably certain that the Company will exercise the option. Right-of-use assets are measured at an amount equal to the initial lease liability, plus any prepaid lease payments (less any incentives received, such as reimbursement for leasehold improvements) and initial direct costs, at the lease commencement date. The Company has elected to account for lease and non-lease components, such as common area maintenance, as a single lease component for its facility leases. As a result, the fixed payments that would otherwise be allocated to the non-lease components are accounted for as lease payments and are included in the measurement of the Company’s right-of-use asset and lease liability. Statement of Operations and Comprehensive Income For the Company’s operating leases, rent expense, a component of cost of services and general and administrative expenses on the consolidated statements of operations and comprehensive income, is recognized on a straight-line basis over the lease term. The straight-line rent expense is reflective of the interest expense on the lease liability using the effective interest method and the amortization of the right-of-use asset. The Company may enter into arrangements to sublease portions of its facilities and the Company typically retains the obligation to the lessor under these arrangements. The Company’s subleases are classified as operating leases; accordingly, the Company continues to account for the original leases as it did prior to commencement of the subleases. Sublease income, a component of cost of services on the consolidated statements of operations and comprehensive income, is recognized on a straight-line basis, as a reduction to rent expense, over the term of the sublease. For the Company’s finance leases, interest expense on the lease liability is recognized using the effective interest method. Amortization expense related to the right-of-use asset is recognized on a straight-line basis over the shorter of the estimated useful life of the asset or the lease term. The Company elected the short-term lease exemption for its equipment leases. For these leases, the Company recognizes lease payments on a straight-line basis over the lease term and variable lease payments are expensed as incurred. These expenses are included as components of cost of services on the consolidated statements of operations and comprehensive income.
Property and Equipment	Property and Equipment Property and equipment are stated at cost, net of accumulated depreciation. Maintenance and repairs of property and equipment are expensed as incurred. Improvements that increase the estimated useful life of an asset are capitalized. Direct internal and external costs of developing software for internal use, including programming and enhancements, are capitalized and depreciated over the estimated useful lives once the software is placed in service. Capitalized software costs are included within furniture and equipment. Software training costs, maintenance, and repairs are expensed as incurred. Depreciation and amortization are computed using the straight-line method over the estimated useful lives of the assets or the term of the lease, as appropriate. The general range of useful lives is as follows: Land improvements 5 – 25 years Leasehold improvements 1 – 20 years Buildings 40 years Building improvements 5 – 40 years Furniture and equipment 1 – 20 years The Company reviews the realizability of long-lived assets whenever events or circumstances occur which indicate recorded costs may not be recoverable. If it is determined that a long-lived asset or asset group is not recoverable, an impairment charge is recognized based on the excess of the carrying amount of the long-lived asset or asset group over its fair value.
Intangible Assets	Intangible Assets Goodwill and indefinite-lived identifiable intangible assets Goodwill and other indefinite-lived intangible assets are recognized primarily as the result of business combinations. Goodwill is assigned to reporting units based upon the specific nature of the business acquired. When a business combination contains business components related to more than one reporting unit, goodwill is assigned to each reporting unit based upon an allocation determined by the relative fair values of the business acquired. When the Company disposes of a business, the Company allocates a portion of the reporting unit’s goodwill to that business using the relative fair value methodology. Goodwill and other indefinite-lived intangible assets are not amortized, but instead are subject to periodic impairment evaluations. Impairment tests are required to be conducted at least annually or when events or conditions occur that might suggest a possible impairment. These events or conditions include, but are not limited to: a significant adverse change in the business environment, regulatory environment, or legal factors; a current period operating or cash flow loss combined with a history of such losses or a projection of continuing losses; or a sale or disposition of a significant portion of a reporting unit. The occurrence of one of these events or conditions could significantly impact an impairment assessment, necessitating an impairment charge. The Company may first assess qualitatively if it can conclude whether goodwill is more likely than not impaired. If goodwill is more likely than not impaired, the Company is then required to complete a quantitative analysis of whether a reporting unit’s fair value is less than its carrying amount. In evaluating whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount, the Company considers relevant events or circumstances that affect the fair value or carrying amount of a reporting unit. The Company considers both the income and market approach in determining the fair value of its reporting units when performing a quantitative analysis. At December 31, 2019 , the Company’s other indefinite-lived intangible assets consist of trademarks, certificates of need, and accreditations. To determine the fair values of its trademarks, the Company uses a relief from royalty income approach. For the Company’s certificates of need and accreditations, the Company performs qualitative assessments. As part of these assessments, the Company evaluates the current business environment, regulatory environment, legal and other company-specific factors. If it is more likely than not that the fair values are less than the carrying values, the Company performs a quantitative impairment test. The Company’s most recent impairment assessments were completed during the fourth quarter of 2019 utilizing information as of October 1, 2019 . The Company did not identify any instances of impairment with respect to goodwill or other indefinite-lived intangible assets as of October 1, 2019 . Finite-lived identifiable intangible assets At December 31, 2019 , the Company’s finite-lived intangible assets consist of customer relationships and non-compete agreements. Finite-lived intangible assets are amortized based on the pattern in which the economic benefits are consumed or otherwise depleted. If such a pattern cannot be reliably determined, finite-lived intangible assets are amortized on a straight-line basis over their estimated lives. Management believes that the below estimated useful lives are reasonable based on the economic factors applicable to each class of finite-lived intangible asset. Customer relationships 5 – 17 years Non-compete agreements 1 – 15 years The Company reviews the realizability of finite-lived intangible assets whenever events or circumstances occur which indicate recorded amounts may not be recoverable. If the expected undiscounted future cash flows are less than the carrying amount of such assets, the Company recognizes an impairment loss to the extent the carrying amount of the assets exceeds their estimated fair value.
Equity Method Investments	Equity Method Investments The Company applies the equity method of accounting for investments in which the Company has the ability to exercise significant influence over the operating and financial policies of the investee, but does not possess a controlling financial interest in the investee. Investments of this nature are recorded at original cost and adjusted periodically to recognize the Company’s proportionate share of the investees’ net income or losses after the date of investment. When net losses from an investment accounted for under the equity method exceed the carrying amount, the investment balance is reduced to zero. The Company resumes accounting for the investment under the equity method if the investee subsequently reports net income and the Company’s share of that net income exceeds the share of the net losses not recognized during the period the equity method was suspended. Investments are written down only when there is clear evidence that a decline in value that is other than temporary has occurred. The Company evaluates its equity method investments for impairment when there is evidence or indicators that a loss in value may be other than temporary.
Income Taxes	Income Taxes The Company recognizes deferred tax assets and liabilities for the expected future tax consequences of events that have been recognized in the Company’s financial statements. Deferred tax assets and liabilities are determined on the basis of the differences between the book and tax bases of assets and liabilities by using enacted tax rates in effect for the year in which the differences are expected to reverse. The Company also recognizes the future tax benefits from net operating loss carryforwards as deferred tax assets. The effect of a change in tax rates on deferred tax assets and liabilities is recognized in income in the period that includes the enactment date. The Company evaluates the realizability of deferred tax assets and reduces those assets using a valuation allowance if it is more likely than not that some portion or all of the deferred tax asset will not be realized. Among the factors used to assess the likelihood of realization are projections of future taxable income streams, the expected timing of the reversals of existing temporary differences, and the impact of tax planning strategies that could be implemented to avoid the potential loss of future tax benefits. Reserves for uncertain tax positions are established for exposure items related to various federal and state tax matters. Income tax reserves are recorded when an exposure is identified and when, in the opinion of management, it is more likely than not that a tax position will not be sustained and the amount of the liability can be estimated.
Insurance Risk Programs	Insurance Risk Programs
Revenue Recognition	Revenue Recognition Patient Services Revenue Patient services revenue is recognized when obligations under the terms of the contract are satisfied; generally, this occurs as the Company provides healthcare services to its patients, as each service provided is distinct and future services rendered are not dependent on previously rendered services. Patient service revenues are recognized at an amount equal to the consideration the Company expects to receive in exchange for providing healthcare services to its patients. These amounts are due from third-party payors, including health insurers and government programs; other payors; and patients. Medicare : Medicare is a federal program that provides medical insurance benefits to persons age 65 and over, some disabled persons, and persons with end stage renal disease. Amounts the Company receives for treatment of patients covered by the Medicare program are generally less than the standard billing rates; accordingly, the Company recognizes revenue based on amounts which are payable by Medicare under prospective payment systems and other payment methods. The expected payment is derived based on the level of clinical services provided. Non-Medicare : The Company is reimbursed for healthcare services provided from various other payor sources which include insurance companies, state Medicaid programs, workers’ compensation programs, health maintenance organizations, preferred provider organizations, other managed care companies and employers, as well as patients. The Company is reimbursed by these payors using a variety of payment methodologies and the amounts the Company receives are generally less than its standard billing rates. In the critical illness recovery hospital and rehabilitation hospital segments, the Company recognizes revenue based on known contractual provisions associated with the specific payor or, where the Company has a relatively homogeneous patient population, the Company will monitor individual payor historical reimbursement rates to derive a per diem rate which is used to determine the amount of revenue to be recognized for services rendered. In the outpatient rehabilitation and Concentra segments, the Company recognizes revenue from payors based on known contractual provisions, negotiated amounts, or usual and customary amounts associated with the specific payor or based on the service provided. The Company performs provision testing, using internally developed systems, whereby the Company monitors historical reimbursement rates and compares them against the associated gross charges for the service provided. The percentage of historical reimbursed claims to gross charges is utilized to determine the amount of revenue to be recognized for services rendered. The Company is subject to potential adjustments to net operating revenues in future periods for administrative matters and other price concessions. These adjustments, which are estimated based on an analysis of historical experience by payor source, are accounted for as a constraint to the amount of revenue recognized by the Company in the period services are rendered. Other Revenues
Recent and Recently Adopted Accounting Pronouncements	Recent Accounting Pronouncements Financial Instruments In June 2016, the FASB issued Accounting Standards Update (“ASU”) 2016-13, Financial Instruments — Credit Losses: Measurement of Credit Losses on Financial Instruments . The current standard delays the recognition of a credit loss on a financial asset until the loss is probable of occurring. The new standard removes the requirement that a credit loss be probable of occurring for it to be recognized and requires entities to use historical experience, current conditions, and reasonable and supportable forecasts to estimate their future expected credit losses. The standard is required to be applied using the modified retrospective approach with a cumulative-effect adjustment to retained earnings, if any, upon adoption. The Company has completed the adoption of the standard as of January 1, 2020. The Company’s primary financial instrument subject to the standard is its accounts receivable derived from contracts with customers. A significant portion of the Company’s accounts receivable is from highly-solvent, creditworthy payors including governmental programs, principally Medicare and Medicaid, and highly-regulated commercial insurers. The Company’s estimate of expected credit losses as of January 1, 2020, using its expected credit loss evaluation processes, resulted in no adjustments to the allowance for credit losses and no cumulative-effect adjustment to retained earnings on the adoption date of the standard. Recently Adopted Accounting Pronouncements Leases The Company adopted Accounting Standards Codification (“ASC”) Topic 842, Leases as of January 1, 2019. The Company used the modified retrospective approach for leases which existed on that date. Prior comparative periods were not adjusted and continue to be reported in accordance with ASC Topic 840, Leases . The Company elected the package of practical expedients, which permitted the Company not to reassess under ASC Topic 842 the Company’s prior conclusions about lease identification, lease classification, and initial direct costs. The Company did not elect the use-of-hindsight or the practical expedient pertaining to land easements; the latter not being applicable to the Company. The adoption of the standard resulted in the recognition of operating lease right-of-use assets of $1,015.0 million and operating lease liabilities of $1,057.0 million at January 1, 2019. The difference between the operating lease right-of-use assets and operating lease liabilities resulted from the reclassification of prepaid rent, deferred rent, unamortized lease incentives, and acquired favorable and unfavorable leasehold interests upon adoption. The Company did not recognize a cumulative-effect adjustment to retained earnings upon adoption.
Variable Interest Entities	Variable Interest Entities Concentra does not own many of its medical practices, as certain states prohibit the “corporate practice of medicine,” which restricts business corporations from practicing medicine through the direct employment of physicians or from exercising control over medical decisions by physicians. In states which prohibit the corporate practice of medicine, Concentra typically enters into long-term management agreements with professional corporations or associations that are owned by licensed physicians, which, in turn, employ or contract with physicians who provide professional medical services in its occupational health centers. The management agreements have terms that provide for Concentra to conduct, supervise, and manage the day-to-day non-medical operations of the occupational health centers and provide all management and administrative services. Concentra receives a management fee for these services, which is based, in part, on the performance of the professional corporation or association. Additionally, the outstanding voting equity interests of the professional corporations or associations are typically owned by licensed physicians appointed at Concentra’s discretion. Concentra has the ability to direct the transfer of ownership of the professional corporation or association to a new licensed physician at any time. Based on the provisions of these agreements, Concentra has the ability to direct the activities which most significantly impact the performance of these professional corporations and associations and has an obligation to absorb losses or receive benefits which could potentially be significant to the professional corporations and associations. Accordingly, the professional corporations and associations are variable interest entities for which Concentra is the primary beneficiary.

Organization and Significant _3

Organization and Significant Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Schedule of property and equipment useful lives	The general range of useful lives is as follows: Land improvements 5 – 25 years Leasehold improvements 1 – 20 years Buildings 40 years Building improvements 5 – 40 years Furniture and equipment 1 – 20 years
Schedule of finite-lived intangible asset useful lives	Management believes that the below estimated useful lives are reasonable based on the economic factors applicable to each class of finite-lived intangible asset. Customer relationships 5 – 17 years Non-compete agreements 1 – 15 years

Acquisitions (Tables)

Acquisitions (Tables)	12 Months Ended
	Dec. 31, 2019
Business Combinations [Abstract]
Schedule of the reconciliation of the fair values of identifiable net assets and goodwill to the consideration given for the acquired business	The following table reconciles the fair values of identifiable net assets and goodwill to the consideration given for the acquired business (in thousands): Accounts receivable $ 68,934 Other current assets 10,810 Property and equipment 69,712 Identifiable intangible assets 140,406 Other assets 25,435 Goodwill 540,067 Total assets 855,364 Accounts payable and other current liabilities 49,925 Deferred income taxes and other long-term liabilities 51,851 Total liabilities 101,776 Consideration given $ 753,588
Schedule of identifiable intangible assets acquired	The following table outlines the identifiable intangible assets acquired: Fair Value Weighted Average Amortization Period (in thousands) (in years) Customer relationships $ 135,000 15 years Trademark 5,000 1 year Favorable leasehold interests 406 3 years Identifiable intangible assets $ 140,406
Schedule of pro forma unaudited results of operations	The following pro forma unaudited results of operations have been prepared assuming the acquisition of U.S. HealthWorks occurred on January 1, 2017. These results are not necessarily indicative of the results of future operations nor of the results that would have occurred had the acquisition been consummated on the aforementioned date. For the Year Ended December 31, 2017 2018 (in thousands, except per share amounts) Net operating revenues $ 4,903,612 $ 5,128,838 Net income attributable to the Company 170,689 140,488

Leases (Tables)

Leases (Tables)	12 Months Ended
	Dec. 31, 2019
Leases [Abstract]
Schedule of Lease Cost	As of December 31, 2019 , the weighted average remaining lease terms and discount rates were as follows: Weighted average remaining lease term (in years): Operating leases 8.0 Finance leases 34.4 Weighted average discount rate: Operating leases 5.9 % Finance leases 7.3 % For the year ended December 31, 2019 , the Company’s total lease cost was as follows (in thousands): For the Year Ended December 31, 2019 Unrelated Parties Related Parties Total Operating lease cost $ 271,799 $ 5,498 $ 277,297 Finance lease cost: Amortization of right-of-use assets 258 — 258 Interest on lease liabilities 812 — 812 Short-term lease cost 2,171 — 2,171 Variable lease cost 43,096 553 43,649 Sublease income (9,822 ) — (9,822 ) Total lease cost $ 308,314 $ 6,051 $ 314,365
Supplemental Cash Flow Information	For the year ended December 31, 2019 , supplemental cash flow information related to leases was as follows (in thousands): Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 274,095 Operating cash flows for finance leases 777 Financing cash flows for finance leases 225 Right-of-use assets obtained in exchange for lease liabilities: Operating leases (1) 1,275,575 Finance leases 9,102 _______________________________________________________________________________ (1) Includes the right-of-use assets obtained in exchange for lease liabilities of $1,057.0 million which were recognized upon adoption of ASC Topic 842 at January 1, 2019.
Supplemental Balance Sheet Information	As of December 31, 2019 , supplemental balance sheet information related to leases was as follows (in thousands): Operating Leases Unrelated Parties Related Parties Total Operating lease right-of-use assets $ 971,382 $ 32,604 $ 1,003,986 Current operating lease liabilities $ 202,506 $ 5,444 $ 207,950 Non-current operating lease liabilities 826,049 26,848 852,897 Total operating lease liabilities $ 1,028,555 $ 32,292 $ 1,060,847 Finance Leases Unrelated Parties Related Parties Total Property and equipment, net $ 4,965 $ — $ 4,965 Current portion of long-term debt and notes payable $ 195 $ — $ 195 Long-term debt, net of current portion 13,088 — 13,088 Total finance lease liabilities $ 13,283 $ — $ 13,283
Maturities of Finance Lease Liabilities	As of December 31, 2019 , maturities of lease liabilities were approximately as follows (in thousands): Operating Leases Finance Leases Total 2020 $ 263,085 $ 1,182 $ 264,267 2021 227,202 1,193 228,395 2022 187,053 1,203 188,256 2023 143,878 1,214 145,092 2024 110,835 1,225 112,060 Thereafter 483,162 30,404 513,566 Total undiscounted cash flows 1,415,215 36,421 1,451,636 Less: Imputed interest 354,368 23,138 377,506 Total discounted lease liabilities $ 1,060,847 $ 13,283 $ 1,074,130
Maturities of Operating Lease Liabilities	As of December 31, 2019 , maturities of lease liabilities were approximately as follows (in thousands): Operating Leases Finance Leases Total 2020 $ 263,085 $ 1,182 $ 264,267 2021 227,202 1,193 228,395 2022 187,053 1,203 188,256 2023 143,878 1,214 145,092 2024 110,835 1,225 112,060 Thereafter 483,162 30,404 513,566 Total undiscounted cash flows 1,415,215 36,421 1,451,636 Less: Imputed interest 354,368 23,138 377,506 Total discounted lease liabilities $ 1,060,847 $ 13,283 $ 1,074,130
Maturities of Operating Lease Liabilities	As of December 31, 2018, the Company’s future minimum lease obligations on long-term, non-cancelable operating leases were approximately as follows (in thousands): 2019 $ 267,846 2020 231,711 2021 193,155 2022 150,155 2023 107,759 Thereafter 484,038 $ 1,434,664

Property and Equipment (Tables)

Property and Equipment (Tables)	12 Months Ended
	Dec. 31, 2019
Property, Plant and Equipment [Abstract]
Schedule of components of property and equipment	The Company’s property and equipment consists of the following: December 31, 2018 2019 (in thousands) Land $ 87,358 $ 95,549 Leasehold improvements 498,520 543,934 Buildings 481,375 553,701 Furniture and equipment 609,805 670,050 Construction-in-progress 67,333 52,467 Total property and equipment 1,744,391 1,915,701 Accumulated depreciation (764,581 ) (917,295 ) Property and equipment, net $ 979,810 $ 998,406

Intangible Assets (Tables)

Intangible Assets (Tables)	12 Months Ended
	Dec. 31, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of carrying amount of goodwill	The following table shows changes in the carrying amounts of goodwill by reporting unit for the years ended December 31, 2018 and 2019 : Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Rehabilitation Concentra Total (in thousands) Balance as of January 1, 2018 $ 1,045,220 $ 415,528 $ 647,522 $ 674,542 $ 2,782,812 Acquired — 1,118 4,309 537,424 542,851 Measurement period adjustment — — — 4,472 4,472 Sold — — (9,409 ) — (9,409 ) Balance as of December 31, 2018 1,045,220 416,646 642,422 1,216,438 3,320,726 Acquired 33,149 14,254 12,970 18,299 78,672 Measurement period adjustment 435 — — (2,249 ) (1,814 ) Sold — — (5,629 ) — (5,629 ) Balance as of December 31, 2019 $ 1,078,804 $ 430,900 $ 649,763 $ 1,232,488 $ 3,391,955
Schedule of gross carrying amounts and accumulative amortization for identifiable intangible assets	The following table provides the gross carrying amounts, accumulated amortization, and net carrying amounts for the Company’s identifiable intangible assets: December 31, 2018 2019 Gross Carrying Amount Accumulated Amortization Net Carrying Amount Gross Carrying Amount Accumulated Amortization Net Carrying Amount (in thousands) Indefinite-lived intangible assets: Trademarks $ 166,698 $ — $ 166,698 $ 166,698 $ — $ 166,698 Certificates of need 19,174 — 19,174 17,157 — 17,157 Accreditations 1,857 — 1,857 1,874 — 1,874 Finite-lived intangible assets: Trademarks 5,000 (4,583 ) 417 5,000 (5,000 ) — Customer relationships 280,710 (61,900 ) 218,810 287,373 (87,346 ) 200,027 Favorable leasehold interests (1) 13,553 (6,064 ) 7,489 — — — Non-compete agreements 29,400 (6,152 ) 23,248 32,114 (8,802 ) 23,312 Total identifiable intangible assets $ 516,392 $ (78,699 ) $ 437,693 $ 510,216 $ (101,148 ) $ 409,068 _______________________________________________________________________________ (1) Favorable leasehold interests are a component of the operating lease right-of-use assets upon adoption of ASC Topic 842, Leases .
Schedule of future estimated amortization expense	Estimated amortization expense of the Company’s finite-lived intangible assets for each of the five succeeding years is as follows: 2020 2021 2022 2023 2024 (in thousands) Amortization expense $ 26,943 $ 26,624 $ 26,295 $ 26,019 $ 18,057

Equity Method Investments (Tabl

Equity Method Investments (Tables)	12 Months Ended
	Dec. 31, 2019
Equity Method Investments and Joint Ventures [Abstract]
Schedule of equity method investments	At December 31, 2019 , these businesses consist primarily of the following ownership interests: BIR JV, LLP 49.0 % OHRH, LLC 49.0 % GlobalRehab—Scottsdale, LLC 49.0 % Rehabilitation Institute of Denton, LLC 50.0 % ES Rehabilitation, LLC 49.0 % Coastal Virginia Rehabilitation, LLC 49.0 % BHSM Rehabilitation, LLC 49.0 % Vibra Hospital of San Diego, LLC 39.0 % Summarized combined financial information of the entities in which the Company has a minority ownership interest is as follows: December 31, 2018 2019 (in thousands) Current assets $ 125,435 $ 178,674 Non-current assets 118,270 317,332 Total assets $ 243,705 $ 496,006 Current liabilities $ 43,792 $ 107,400 Non-current liabilities 16,338 127,976 Equity 183,575 260,630 Total liabilities and equity $ 243,705 $ 496,006 For the Year Ended December 31, 2017 2018 2019 (in thousands) Revenues $ 336,349 $ 393,034 $ 536,464 Cost of services and other operating expenses 289,224 342,603 476,182 Net income 45,648 48,535 58,519

Long-Term Debt and Notes Paya_2

Long-Term Debt and Notes Payable (Tables)	12 Months Ended
	Dec. 31, 2019
Debt Disclosure [Abstract]
Schedule of long-term debt and notes payable	As of December 31, 2018 , the Company’s long-term debt and notes payable were as follows (in thousands): Principal Outstanding Unamortized Premium (Discount) Unamortized Issuance Costs Carrying Value Fair Value Select 6.375% senior notes $ 710,000 $ 550 $ (4,642 ) $ 705,908 $ 706,450 Select credit facilities: Select revolving facility 20,000 — — 20,000 18,400 Select term loan 1,129,875 (9,690 ) (9,321 ) 1,110,864 1,076,206 Concentra-JPM credit facilities: Concentra term loans 1,414,175 (2,765 ) (18,648 ) 1,392,762 1,357,802 Other debt, including finance leases 64,331 — (484 ) 63,847 63,847 Total debt $ 3,338,381 $ (11,905 ) $ (33,095 ) $ 3,293,381 $ 3,222,705 As of December 31, 2019 , the Company’s long-term debt and notes payable were as follows (in thousands): Principal Outstanding Unamortized Premium (Discount) Unamortized Carrying Value Fair Value Select 6.250% senior notes $ 1,225,000 $ 39,988 $ (19,944 ) $ 1,245,044 $ 1,322,020 Select credit facilities: Select term loan 2,143,280 (10,411 ) (11,348 ) 2,121,521 2,145,959 Other debt, including finance leases 78,941 — (396 ) 78,545 78,545 Total debt $ 3,447,221 $ 29,577 $ (31,688 ) $ 3,445,110 $ 3,546,524
Schedule of principal maturities of long-term debt and notes payable	Principal maturities of the Company’s long-term debt and notes payable are approximately as follows (in thousands): 2020 2021 2022 2023 2024 Thereafter Total Select 6.250% senior notes $ — $ — $ — $ — $ — $ 1,225,000 $ 1,225,000 Select credit facilities: Select term loan 11,150 11,150 11,150 11,150 11,150 2,087,530 2,143,280 Other debt, including finance leases 14,017 7,255 18,715 3,364 23,550 12,040 78,941 Total debt $ 25,167 $ 18,405 $ 29,865 $ 14,514 $ 34,700 $ 3,324,570 $ 3,447,221

Segment Information (Tables)

Segment Information (Tables)	12 Months Ended
	Dec. 31, 2019
Segment Reporting [Abstract]
Schedule of selected financial data	The following tables summarize selected financial data for the Company’s reportable segments. For the Year Ended December 31, 2017 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Rehabilitation Concentra Other Total (in thousands) Net operating revenues (1) $ 1,725,022 $ 509,108 $ 960,902 $ 1,013,224 $ 156,989 $ 4,365,245 Adjusted EBITDA 252,679 90,041 132,533 157,561 (94,822 ) 537,992 Total assets 1,848,783 868,517 954,661 1,340,919 114,286 5,127,166 Capital expenditures 49,720 96,477 27,721 28,912 30,413 233,243 For the Year Ended December 31, 2018 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Rehabilitation Concentra (2) Other Total (in thousands) Net operating revenues (1) $ 1,753,584 $ 583,745 $ 995,794 $ 1,557,673 $ 190,462 $ 5,081,258 Adjusted EBITDA 243,015 108,927 142,005 251,977 (100,769 ) 645,155 Total assets 1,771,605 894,192 1,002,819 2,178,868 116,781 5,964,265 Capital expenditures 40,855 42,389 30,553 42,205 11,279 167,281 For the Year Ended December 31, 2019 Critical Illness Recovery Hospitals Rehabilitation Hospitals Outpatient Rehabilitation Concentra Other Total (in thousands) Net operating revenues $ 1,836,518 $ 670,971 $ 1,046,011 $ 1,628,817 $ 271,605 $ 5,453,922 Adjusted EBITDA 254,868 135,857 151,831 276,482 (108,130 ) 710,908 Total assets 2,099,833 1,127,028 1,289,190 2,372,187 452,050 7,340,288 Capital expenditures 45,573 27,216 33,628 44,101 6,608 157,126
Schedule of reconciliation of Adjusted EBITDA to income before income taxes	A reconciliation of Adjusted EBITDA to income before income taxes is as follows: For the Year Ended December 31, 2017 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Rehabilitation Concentra Other Total (in thousands) Adjusted EBITDA $ 252,679 $ 90,041 $ 132,533 $ 157,561 $ (94,822 ) Depreciation and amortization (45,743 ) (20,176 ) (24,607 ) (61,945 ) (7,540 ) Stock compensation expense — — — (993 ) (18,291 ) U.S. HealthWorks acquisition costs — — — (2,819 ) — Income (loss) from operations $ 206,936 $ 69,865 $ 107,926 $ 91,804 $ (120,653 ) $ 355,878 Loss on early retirement of debt (19,719 ) Equity in earnings of unconsolidated subsidiaries 21,054 Loss on sale of businesses (49 ) Interest expense (154,703 ) Income before income taxes $ 202,461 For the Year Ended December 31, 2018 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Rehabilitation Concentra (2) Other Total (in thousands) Adjusted EBITDA $ 243,015 $ 108,927 $ 142,005 $ 251,977 $ (100,769 ) Depreciation and amortization (45,797 ) (24,101 ) (27,195 ) (95,521 ) (9,041 ) Stock compensation expense — — — (2,883 ) (20,443 ) U.S. HealthWorks acquisition costs — — — (2,895 ) — Income (loss) from operations $ 197,218 $ 84,826 $ 114,810 $ 150,678 $ (130,253 ) $ 417,279 Loss on early retirement of debt (14,155 ) Equity in earnings of unconsolidated subsidiaries 21,905 Gain on sale of businesses 9,016 Interest expense (198,493 ) Income before income taxes $ 235,552 For the Year Ended December 31, 2019 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Rehabilitation Concentra Other Total (in thousands) Adjusted EBITDA $ 254,868 $ 135,857 $ 151,831 $ 276,482 $ (108,130 ) Depreciation and amortization (50,763 ) (27,322 ) (28,301 ) (96,807 ) (9,383 ) Stock compensation expense — — — (3,069 ) (23,382 ) Income (loss) from operations $ 204,105 $ 108,535 $ 123,530 $ 176,606 $ (140,895 ) $ 471,881 Loss on early retirement of debt (38,083 ) Equity in earnings of unconsolidated subsidiaries 24,989 Gain on sale of businesses 6,532 Interest expense (200,570 ) Income before income taxes $ 264,749 _______________________________________________________________________________ (1) Prior to 2019, the financial results of employee leasing services provided to related parties affiliated through the Company’s equity method investments were included with the Company’s reportable segments. These results are now reported as part of the Company’s other activities. For the years ended December 31, 2017 and 2018, net operating revenues were conformed to reflect the current presentation. (2) The Concentra segment includes the operating results of U.S. HealthWorks beginning February 1, 2018.

Revenue from Contracts with C_2

Revenue from Contracts with Customers (Tables)	12 Months Ended
	Dec. 31, 2019
Revenue from Contract with Customer [Abstract]
Schedule of disaggregation of net operating revenues	The following tables disaggregate the Company’s net operating revenues: For the Year Ended December 31, 2017 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Rehabilitation Concentra Other Total (in thousands) Patient service revenues: Medicare $ 903,503 $ 259,221 $ 148,403 $ 2,128 $ — $ 1,313,255 Non-Medicare 810,723 207,196 739,531 1,002,787 — 2,760,237 Total patient services revenues 1,714,226 466,417 887,934 1,004,915 — 4,073,492 Other revenues 10,796 42,691 72,968 8,309 156,989 291,753 Total net operating revenues $ 1,725,022 $ 509,108 $ 960,902 $ 1,013,224 $ 156,989 $ 4,365,245 For the Year Ended December 31, 2018 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Rehabilitation Concentra Other Total (in thousands) Patient service revenues: Medicare $ 893,429 $ 293,913 $ 161,054 $ 2,168 $ — $ 1,350,564 Non-Medicare 847,447 254,215 762,247 1,545,852 — 3,409,761 Total patient services revenues 1,740,876 548,128 923,301 1,548,020 — 4,760,325 Other revenues 12,708 35,617 72,493 9,653 190,462 320,933 Total net operating revenues $ 1,753,584 $ 583,745 $ 995,794 $ 1,557,673 $ 190,462 $ 5,081,258 For the Year Ended December 31, 2019 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Rehabilitation Concentra Other Total (in thousands) Patient service revenues: Medicare $ 907,963 $ 332,514 $ 171,690 $ 1,965 $ — $ 1,414,132 Non-Medicare 916,650 300,113 794,288 1,615,529 — 3,626,580 Total patient services revenues 1,824,613 632,627 965,978 1,617,494 — 5,040,712 Other revenues 11,905 38,344 80,033 11,323 271,605 413,210 Total net operating revenues $ 1,836,518 $ 670,971 $ 1,046,011 $ 1,628,817 $ 271,605 $ 5,453,922

Stock-based Compensation (Table

Stock-based Compensation (Tables)	12 Months Ended
	Dec. 31, 2019
Share-based Payment Arrangement [Abstract]
Schedule of restricted stock awards	Transactions related to restricted stock awards are as follows: Shares Weighted Average Grant Date Fair Value (share amounts in thousands) Unvested balance, January 1, 2019 4,450 $ 15.68 Granted 1,500 16.60 Vested (1,300 ) 11.97 Forfeited (43 ) 16.09 Unvested balance, December 31, 2019 4,607 $ 17.03
Schedule of stock compensation expense recognized	Stock compensation expense recognized by the Company was as follows: For the Year Ended December 31, 2017 2018 2019 (in thousands) Stock compensation expense: Included in general and administrative $ 15,706 $ 17,604 $ 20,334 Included in cost of services 3,578 5,722 6,117 Total $ 19,284 $ 23,326 $ 26,451
Schedule of stock compensation expense based on current stock-based awards for each of the next five years	Stock compensation expense based on current stock-based awards for each of the next five years is estimated to be as follows: 2020 2021 2022 2023 2024 (in thousands) Stock compensation expense $ 24,381 $ 16,031 $ 8,117 $ 1,267 $ 19

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Schedule of the components of income tax expense	The components of the Company’s income tax expense for the years ended December 31, 2017 , 2018 , and 2019 were as follows: For the Year Ended December 31, 2017 2018 2019 (in thousands) Current income tax expense: Federal $ 45,809 $ 36,072 $ 55,822 State and local 8,331 15,321 15,331 Total current income tax expense 54,140 51,393 71,153 Deferred income tax expense (benefit) (72,324 ) 7,217 (7,435 ) Total income tax expense (benefit) $ (18,184 ) $ 58,610 $ 63,718
Schedule of reconciliations of the statutory federal income tax rate to the effective income tax rate	Reconciliations of the statutory federal income tax rate to the effective income tax rate are as follows: For the Year Ended December 31, 2017 2018 2019 Federal income tax at statutory rate 35.0 % 21.0 % 21.0 % State and local income taxes, less federal income tax benefit 3.7 5.0 4.2 Permanent differences 1.7 2.1 1.7 Valuation allowance (7.3 ) 0.5 0.5 Uncertain tax positions (0.6 ) (0.8 ) (0.1 ) Non-controlling interest 0.5 (2.1 ) (2.9 ) Stock-based compensation (1.3 ) (2.2 ) (0.7 ) Deferred income taxes - state income tax rate adjustment (2.8 ) 0.4 0.8 Deferred income taxes - tax legislation rate adjustment (37.5 ) — — Other (0.4 ) 1.0 (0.4 ) Effective income tax rate (9.0 )% 24.9 % 24.1 %
Schedule of deferred tax assets and liabilities	The Company’s deferred tax assets and liabilities are as follows: December 31, 2018 2019 (in thousands) Deferred tax assets Allowance for doubtful accounts $ 10,313 $ 13,097 Compensation and benefit-related accruals 51,900 55,300 Professional malpractice liability insurance 13,644 13,753 Deferred revenue 209 274 Federal and state net operating loss and state tax credit carryforwards 40,163 38,933 Interest limitation carryforward 4,675 4,943 Stock awards 5,695 6,251 Equity investments 2,055 2,914 Operating lease liabilities — 267,513 Other 3,271 2,344 Deferred tax assets $ 131,925 $ 405,322 Valuation allowance (17,893 ) (18,461 ) Deferred tax assets, net of valuation allowance $ 114,032 $ 386,861 Deferred tax liabilities Deferred income $ (13,891 ) $ (9,190 ) Investment in unconsolidated affiliates (5,653 ) (7,498 ) Depreciation and amortization (217,950 ) (225,079 ) Deferred financing costs (8,324 ) (6,250 ) Operating lease right-of-use assets — (263,818 ) Other (3,488 ) (3,546 ) Deferred tax liabilities $ (249,306 ) $ (515,381 ) Deferred tax liabilities, net of deferred tax assets $ (135,274 ) $ (128,520 ) The Company’s deferred tax assets and liabilities are included in the consolidated balance sheet captions as follows: December 31, 2018 2019 (in thousands) Other assets $ 18,621 $ 19,738 Non-current deferred tax liability (153,895 ) (148,258 ) $ (135,274 ) $ (128,520 )
Schedule of state net operating loss carryforwards	The total state net operating losses are approximately $719.6 million . State net operating loss carryforwards expire and are subject to valuation allowances as follows: State Net Operating Losses Gross Valuation Allowance (in thousands) 2020 $ 17,297 $ 14,100 2021 11,772 8,806 2022 39,319 33,790 2023 20,743 15,367 Thereafter through 2038 630,506 413,916

Earnings per Share (Tables)

Earnings per Share (Tables)	12 Months Ended
	Dec. 31, 2019
Earnings Per Share [Abstract]
Schedule of computation of basic and diluted earnings per share	The following table sets forth the net income attributable to the Company, its common shares outstanding, and its participating securities outstanding. There were no dividends declared or contractual dividends paid for the years ended December 31, 2017 , 2018 , and 2019 . Basic EPS Diluted EPS For the Year Ended December 31, For the Year Ended December 31, 2017 2018 2019 2017 2018 2019 (in thousands) Net income $ 220,645 $ 176,942 $ 201,031 $ 220,645 $ 176,942 $ 201,031 Less: net income attributable to non-controlling interests 43,461 39,102 52,582 43,461 39,102 52,582 Net income attributable to the Company 177,184 137,840 148,449 177,184 137,840 148,449 Less: net income attributable to participating securities 5,758 4,551 4,995 5,751 4,548 4,994 Net income attributable to common shares $ 171,426 $ 133,289 $ 143,454 $ 171,433 $ 133,292 $ 143,455 The following tables set forth the computation of EPS under the two-class method: For the Year Ended December 31, 2017 Net Income Allocation Shares (1) Basic EPS Net Income Allocation Shares (1) Diluted EPS (in thousands, except for per share amounts) Common shares $ 171,426 128,955 $ 1.33 $ 171,433 129,126 $ 1.33 Participating securities 5,758 4,332 1.33 5,751 4,332 1.33 Total Company $ 177,184 $ 177,184 For the Year Ended December 31, 2018 Net Income Allocation Shares (1) Basic EPS Net Income Allocation Shares (1) Diluted EPS (in thousands, except for per share amounts) Common shares $ 133,289 130,172 $ 1.02 $ 133,292 130,256 $ 1.02 Participating securities 4,551 4,444 1.02 4,548 4,444 1.02 Total Company $ 137,840 $ 137,840 For the Year Ended December 31, 2019 Net Income Allocation Shares (1) Basic EPS Net Income Allocation Shares (1) Diluted EPS (in thousands, except for per share amounts) Common shares $ 143,454 130,248 $ 1.10 $ 143,455 130,276 $ 1.10 Participating securities 4,995 4,535 $ 1.10 4,994 4,535 $ 1.10 Total Company $ 148,449 $ 148,449 _______________________________________________________________________________ (1) Represents the weighted average share count outstanding during the period.

Selected Quarterly Financial _2

Selected Quarterly Financial Data (Unaudited) (Tables)	12 Months Ended
	Dec. 31, 2019
Quarterly Financial Information Disclosure [Abstract]
Schedule of unaudited selected quarterly financial data	The tables below sets forth selected unaudited financial data for each quarter of the last two years. First Quarter Second Quarter Third Quarter Fourth Quarter (in thousands, except per share amounts) For the year ended December 31, 2018 Net operating revenues $ 1,252,964 $ 1,296,210 $ 1,267,401 $ 1,264,683 Cost of services, exclusive of depreciation and amortization 1,065,813 1,094,731 1,087,062 1,093,450 Depreciation and amortization 46,771 51,724 50,527 52,633 Income from operations 108,598 120,561 99,837 88,283 Net income 43,982 60,559 42,679 29,722 Net income attributable to Select Medical Holdings Corporation 33,739 46,511 32,917 24,673 Earnings per common share: (1) Basic $ 0.25 $ 0.35 $ 0.24 $ 0.18 Diluted $ 0.25 $ 0.35 $ 0.24 $ 0.18 First Quarter Second Quarter Third Quarter Fourth Quarter (in thousands, except per share amounts) For the year ended December 31, 2019 Net operating revenues $ 1,324,631 $ 1,361,364 $ 1,393,343 $ 1,374,584 Cost of services, exclusive of depreciation and amortization 1,132,092 1,150,150 1,183,111 1,175,649 Depreciation and amortization 52,138 54,993 52,941 52,504 Income from operations 111,724 124,882 122,906 112,369 Net income 53,344 59,986 44,030 43,671 Net income attributable to Select Medical Holdings Corporation 40,834 44,816 30,732 32,067 Earnings per common share: (1) Basic $ 0.30 $ 0.33 $ 0.23 $ 0.24 Diluted $ 0.30 $ 0.33 $ 0.23 $ 0.24 _______________________________________________________________________________ (1) Due to rounding, the summation of quarterly earnings per common share balances may not equal year to date equivalents.

Organization and Significant _4

Organization and Significant Accounting Policies - Business Description (Details)	12 Months Ended
	Dec. 31, 2019business_segmenthospitalstate
Segment information
Number of states in which the entity had operations | state	47
Number of business segments | business_segment	4
Critical illness recovery hospital
Segment information
Number of facilities operated by the entity	101
Rehabilitation hospital
Segment information
Number of facilities operated by the entity	29
Outpatient Rehabilitation
Segment information
Number of outpatient rehabilitation clinics operated by entity	1,740
Concentra
Segment information
Number of occupational health centers operated by entity	521
Number of onsite clinics	131
Number of department of veterans affairs community-based outpatient clinics	32

Organization and Significant _5

Organization and Significant Accounting Policies - Non-Controlling Interests (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Redeemable Noncontrolling Interest [Line Items]
Redeemable non-controlling interests	$ 974,541	$ 780,488	$ 640,818	$ 422,159
Outside Members of Concentra Group Holdings Parent, LLC
Redeemable Noncontrolling Interest [Line Items]
Redeemable non-controlling interests	$ 939,900	$ 750,600

Organization and Significant _6

Organization and Significant Accounting Policies - Credit Risk and Payor Concentrations (Details) - Third-party payor risk	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Accounts receivable
Percentage of concentration risk	15.00%	16.00%
Net operating revenues
Percentage of concentration risk	26.00%	27.00%	30.00%

Organization and Significant _7

Organization and Significant Accounting Policies - Property and Equipment (Details)	12 Months Ended
	Dec. 31, 2019
Land improvements | Minimum
Property and equipment
Estimated useful lives	5 years
Land improvements | Maximum
Property and equipment
Estimated useful lives	25 years
Leasehold improvements | Minimum
Property and equipment
Estimated useful lives	1 year
Leasehold improvements | Maximum
Property and equipment
Estimated useful lives	20 years
Buildings
Property and equipment
Estimated useful lives	40 years
Building improvements | Minimum
Property and equipment
Estimated useful lives	5 years
Building improvements | Maximum
Property and equipment
Estimated useful lives	40 years
Furniture and equipment | Minimum
Property and equipment
Estimated useful lives	1 year
Furniture and equipment | Maximum
Property and equipment
Estimated useful lives	20 years

Organization and Significant _8

Organization and Significant Accounting Policies - Intangible Assets (Details)	12 Months Ended
	Dec. 31, 2019
Customer relationships | Minimum
Intangible Assets and Liabilities
Useful life of intangible assets	5 years
Customer relationships | Maximum
Intangible Assets and Liabilities
Useful life of intangible assets	17 years
Non-compete agreements | Minimum
Intangible Assets and Liabilities
Useful life of intangible assets	1 year
Non-compete agreements | Maximum
Intangible Assets and Liabilities
Useful life of intangible assets	15 years

Organization and Significant _9

Organization and Significant Accounting Policies - Recently Adopted Accounting Pronouncements (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Jan. 01, 2019
Recently Adopted Accounting Pronouncements
Operating lease right-of-use assets	$ 1,003,986
Total discounted lease liabilities	$ 1,060,847
Accounting Standards Update 2016-02
Recently Adopted Accounting Pronouncements
Operating lease right-of-use assets		$ 1,015,000
Total discounted lease liabilities		$ 1,057,000

Acquisitions - U.S. HealthWorks

Acquisitions - U.S. HealthWorks Acquisition (Details) - USD ($) $ in Thousands	Feb. 01, 2018	Dec. 31, 2018	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2019
Business Acquisition [Line Items]
Non-cash equity exchange for acquisition of U.S. HealthWorks		$ 238,000	$ 238,000	$ 0	$ 0
Consideration given for identifiable net assets and goodwill acquired to the net cash paid
Goodwill		3,320,726	3,320,726	2,782,812	$ 3,391,955
U.S HealthWorks
Business Acquisition [Line Items]
Acquisition costs			$ 2,900	$ 2,800
Consideration transferred	$ 753,600
Consideration given for identifiable net assets and goodwill acquired to the net cash paid
Accounts receivable	68,934
Other current assets	10,810
Property and equipment	69,712
Identifiable intangible assets	140,406
Other assets	25,435
Goodwill	540,067
Total assets	855,364
Accounts payable and other current liabilities	49,925
Deferred income taxes and other long-term liabilities	51,851
Total liabilities	101,776
Consideration given	753,588
Value of goodwill deductible for tax purposes	$ 83,100
Net revenues of acquiree		$ 488,800
Concentra Group Holdings Parent | U.S HealthWorks
Business Acquisition [Line Items]
Equity interest issued (percent)	20.00%
Non-cash equity exchange for acquisition of U.S. HealthWorks	$ 238,000
Customer relationships | U.S HealthWorks
Consideration given for identifiable net assets and goodwill acquired to the net cash paid
Identifiable intangible assets	$ 135,000
Weighted Average Amortization Period	15 years
Trademarks | U.S HealthWorks
Consideration given for identifiable net assets and goodwill acquired to the net cash paid
Identifiable intangible assets	$ 5,000
Weighted Average Amortization Period	1 year
Favorable leasehold interests | U.S HealthWorks
Consideration given for identifiable net assets and goodwill acquired to the net cash paid
Identifiable intangible assets	$ 406
Weighted Average Amortization Period	3 years

Acquisitions - Proforma Results

Acquisitions - Proforma Results (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Pro forma results of operations
Net operating revenues	$ 5,128,838	$ 4,903,612
Net income attributable to the Company	140,488	170,689
U.S HealthWorks
Pro forma results of operations
Acquisition costs	2,900	$ 2,800
Pro Forma | U.S HealthWorks
Pro forma results of operations
Acquisition costs	$ 2,900

Acquisitions - Other Acquisitio

Acquisitions - Other Acquisitions (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Business Acquisition [Line Items]
Goodwill	$ 3,391,955	$ 3,320,726	$ 2,782,812
Critical Illness Recovery Hospital Reporting Unit
Business Acquisition [Line Items]
Goodwill	33,600
Rehabilitation Hospital Reporting Unit
Business Acquisition [Line Items]
Goodwill	14,300
Outpatient Rehabilitation Reporting Unit
Business Acquisition [Line Items]
Goodwill	13,000
Concentra Reporting Unit
Business Acquisition [Line Items]
Goodwill	16,100
Other Acquisitions
Business Acquisition [Line Items]
Cash paid to acquire businesses	93,700
Issuance of non-controlling interests	$ 15,100

Variable Interest Entities (Det

Variable Interest Entities (Details) - USD ($) $ in Millions	Dec. 31, 2019	Dec. 31, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Variable interest entity, assets	$ 178.4	$ 166.2
Variable interest entity, liabilities	$ 176.7	$ 164.4

Leases - Narrative (Details)

Leases - Narrative (Details) $ in Millions	12 Months Ended
	Dec. 31, 2019renewal_option	Dec. 31, 2018USD ($)	Dec. 31, 2017USD ($)
Lessee, Lease, Description [Line Items]
Total rent expense for facility and equipment operating leases | $		$ 307.8	$ 267.4
Critical Illness Recovery Hospital
Lessee, Lease, Description [Line Items]
Lease term	10 years
Number of renewal options	2
Lease renewal term	5 years
Rehabilitation Hospital
Lessee, Lease, Description [Line Items]
Lease term	10 years
Number of renewal options	2
Lease renewal term	5 years
Outpatient Rehabilitation
Lessee, Lease, Description [Line Items]
Lease term	5 years
Number of renewal options	2
Concentra
Lessee, Lease, Description [Line Items]
Lease term	10 years
Number of renewal options	2
Lease renewal term	5 years
Affiliated Entity
Lessee, Lease, Description [Line Items]
Payments for office rent, leasehold improvements and miscellaneous expenses | $		$ 6.3	$ 6.2
Minimum | Outpatient Rehabilitation
Lessee, Lease, Description [Line Items]
Lease renewal term	3 years
Maximum | Outpatient Rehabilitation
Lessee, Lease, Description [Line Items]
Lease renewal term	5 years

Leases - Schedule of Lease Cost

Leases - Schedule of Lease Cost (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2019USD ($)
Lessee, Lease, Description [Line Items]
Operating lease cost	$ 277,297
Finance lease cost:
Amortization of right-of-use assets	258
Interest on lease liabilities	812
Short-term lease cost	2,171
Variable lease cost	43,649
Sublease income	(9,822)
Total lease cost	314,365
Unrelated Parties
Lessee, Lease, Description [Line Items]
Operating lease cost	271,799
Finance lease cost:
Amortization of right-of-use assets	258
Interest on lease liabilities	812
Short-term lease cost	2,171
Variable lease cost	43,096
Sublease income	(9,822)
Total lease cost	308,314
Related Parties
Lessee, Lease, Description [Line Items]
Operating lease cost	5,498
Finance lease cost:
Amortization of right-of-use assets	0
Interest on lease liabilities	0
Short-term lease cost	0
Variable lease cost	553
Sublease income	0
Total lease cost	$ 6,051

Leases - Supplemental Cash Flow

Leases - Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands	Jan. 01, 2019	Dec. 31, 2019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows for operating leases		$ 274,095
Operating cash flows for finance leases		777
Financing cash flows for finance leases		225
Right-of-use assets obtained in exchange for lease liabilities:
Operating leases		1,275,575
Finance leases		$ 9,102
Accounting Standards Update 2016-02
Right-of-use assets obtained in exchange for lease liabilities:
Operating leases	$ 1,057,000

Leases - Supplemental Balance S

Leases - Supplemental Balance Sheet Information (Details) $ in Thousands	Dec. 31, 2019USD ($)
Operating Leases
Operating lease right-of-use assets	$ 1,003,986
Current operating lease liabilities	207,950
Non-current operating lease liabilities	852,897
Total operating lease liabilities	1,060,847
Finance Leases
Property and equipment, net	4,965
Current portion of long-term debt and notes payable	195
Long-term debt, net of current portion	13,088
Total finance lease liabilities	13,283
Unrelated Parties
Operating Leases
Operating lease right-of-use assets	971,382
Current operating lease liabilities	202,506
Non-current operating lease liabilities	826,049
Total operating lease liabilities	1,028,555
Finance Leases
Property and equipment, net	4,965
Current portion of long-term debt and notes payable	195
Long-term debt, net of current portion	13,088
Total finance lease liabilities	13,283
Related Parties
Operating Leases
Operating lease right-of-use assets	32,604
Current operating lease liabilities	5,444
Non-current operating lease liabilities	26,848
Total operating lease liabilities	32,292
Finance Leases
Property and equipment, net	0
Current portion of long-term debt and notes payable	0
Long-term debt, net of current portion	0
Total finance lease liabilities	$ 0

Leases - Weighted Average Lease

Leases - Weighted Average Lease Terms and Discount Rates (Details)	Dec. 31, 2019
Weighted average remaining lease term (in years):
Operating leases	8 years
Finance leases	34 years 4 months 24 days
Weighted average discount rate:
Operating leases	5.90%
Finance leases	7.30%

Leases - Maturities of Operatin

Leases - Maturities of Operating and Finance Lease Liabilities (Details) $ in Thousands	Dec. 31, 2019USD ($)
Operating Leases
2020	$ 263,085
2021	227,202
2022	187,053
2023	143,878
2024	110,835
Thereafter	483,162
Total undiscounted cash flows	1,415,215
Less: Imputed interest	354,368
Total discounted lease liabilities	1,060,847
Finance Leases
2020	1,182
2021	1,193
2022	1,203
2023	1,214
2024	1,225
Thereafter	30,404
Total undiscounted cash flows	36,421
Less: Imputed interest	23,138
Total discounted lease liabilities	13,283
Total
2020	264,267
2021	228,395
2022	188,256
2023	145,092
2024	112,060
Thereafter	513,566
Total undiscounted cash flows	1,451,636
Less: Imputed interest	377,506
Total discounted lease liabilities	$ 1,074,130

Leases - Future Minimum Lease O

Leases - Future Minimum Lease Obligations (Details) $ in Thousands	Dec. 31, 2018USD ($)
Leases [Abstract]
2019	$ 267,846
2020	231,711
2021	193,155
2022	150,155
2023	107,759
Thereafter	484,038
Total	$ 1,434,664

Property and Equipment (Details

Property and Equipment (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Property and equipment
Total property and equipment	$ 1,915,701	$ 1,744,391
Accumulated depreciation	(917,295)	(764,581)
Property and equipment, net	998,406	979,810
Depreciation expense	182,900	171,700	$ 142,600
Land
Property and equipment
Total property and equipment	95,549	87,358
Leasehold improvements
Property and equipment
Total property and equipment	543,934	498,520
Buildings
Property and equipment
Total property and equipment	553,701	481,375
Furniture and equipment
Property and equipment
Total property and equipment	670,050	609,805
Construction-in-progress
Property and equipment
Total property and equipment	$ 52,467	$ 67,333

Intangible Assets - Carrying Am

Intangible Assets - Carrying Amount of Goodwill (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Goodwill
Balance at the beginning of the year	$ 3,320,726	$ 2,782,812
Acquired	78,672	542,851
Measurement period adjustment	(1,814)	4,472
Sold	(5,629)	(9,409)
Balance at the end of the year	3,391,955	3,320,726
Critical Illness Recovery Hospital
Goodwill
Balance at the beginning of the year	1,045,220	1,045,220
Acquired	33,149	0
Measurement period adjustment	435	0
Sold	0	0
Balance at the end of the year	1,078,804	1,045,220
Rehabilitation Hospital
Goodwill
Balance at the beginning of the year	416,646	415,528
Acquired	14,254	1,118
Measurement period adjustment	0	0
Sold	0	0
Balance at the end of the year	430,900	416,646
Outpatient Rehabilitation
Goodwill
Balance at the beginning of the year	642,422	647,522
Acquired	12,970	4,309
Measurement period adjustment	0	0
Sold	(5,629)	(9,409)
Balance at the end of the year	649,763	642,422
Concentra
Goodwill
Balance at the beginning of the year	1,216,438	674,542
Acquired	18,299	537,424
Measurement period adjustment	(2,249)	4,472
Sold	0	0
Balance at the end of the year	$ 1,232,488	$ 1,216,438

Intangible Assets - Carrying Va

Intangible Assets - Carrying Value and Amortization of Identifiable Intangible Assets and Liabilities (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Finite Lived And Indefinite Lived Intangible Assets By Major Class [Line Items]
Total identifiable intangible assets, Accumulated Amortization	$ (101,148)	$ (78,699)
Total identifiable intangible assets, Gross Carrying Amount	510,216	516,392
Total identifiable intangible assets, Net Carrying Amount	409,068	437,693
Amortized intangible assets:
Amortization expense	29,600	29,900	$ 17,400
Estimated amortization expense
2020	26,943
2021	26,624
2022	26,295
2023	26,019
2024	18,057
Trademarks
Finite Lived And Indefinite Lived Intangible Assets By Major Class [Line Items]
Finite-lived intangible assets, Gross Carrying Amount	5,000	5,000
Total identifiable intangible assets, Accumulated Amortization	(5,000)	(4,583)
Finite-lived intangible assets, Net Carrying Amount	0	417
Customer relationships
Finite Lived And Indefinite Lived Intangible Assets By Major Class [Line Items]
Finite-lived intangible assets, Gross Carrying Amount	287,373	280,710
Total identifiable intangible assets, Accumulated Amortization	(87,346)	(61,900)
Finite-lived intangible assets, Net Carrying Amount	200,027	218,810
Favorable leasehold interests
Finite Lived And Indefinite Lived Intangible Assets By Major Class [Line Items]
Finite-lived intangible assets, Gross Carrying Amount	0	13,553
Total identifiable intangible assets, Accumulated Amortization	0	(6,064)
Finite-lived intangible assets, Net Carrying Amount	0	7,489
Non-compete agreements
Finite Lived And Indefinite Lived Intangible Assets By Major Class [Line Items]
Finite-lived intangible assets, Gross Carrying Amount	32,114	29,400
Total identifiable intangible assets, Accumulated Amortization	(8,802)	(6,152)
Finite-lived intangible assets, Net Carrying Amount	23,312	23,248
Trademarks
Finite Lived And Indefinite Lived Intangible Assets By Major Class [Line Items]
Indefinite-lived intangible assets	$ 166,698	166,698
Amortized intangible assets:
Weighted average time until next renewal	7 years 2 months 12 days
Certificates of need
Finite Lived And Indefinite Lived Intangible Assets By Major Class [Line Items]
Indefinite-lived intangible assets	$ 17,157	19,174
Accreditations
Finite Lived And Indefinite Lived Intangible Assets By Major Class [Line Items]
Indefinite-lived intangible assets	$ 1,874	$ 1,857
Amortized intangible assets:
Weighted average time until next renewal	1 year 6 months

Equity Method Investments (Deta

Equity Method Investments (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Schedule of Equity Method Investments [Line Items]
Net operating revenues from contracted services and management fees to related parties	$ 308.2	$ 216.9	$ 178.1
Due to Related Parties, Current	$ 31.2	15.1
BIR JV, LLP
Schedule of Equity Method Investments [Line Items]
Percentage of ownership	49.00%
OHRH, LLC
Schedule of Equity Method Investments [Line Items]
Percentage of ownership	49.00%
GlobalRehab—Scottsdale, LLC
Schedule of Equity Method Investments [Line Items]
Percentage of ownership	49.00%
Rehabilitation Institute of Denton, LLC
Schedule of Equity Method Investments [Line Items]
Percentage of ownership	50.00%
ES Rehabilitation, LLC
Schedule of Equity Method Investments [Line Items]
Percentage of ownership	49.00%
Coastal Virginia Rehabilitation, LLC
Schedule of Equity Method Investments [Line Items]
Percentage of ownership	49.00%
BHSM Rehabilitation, LLC
Schedule of Equity Method Investments [Line Items]
Percentage of ownership	49.00%
Vibra Hospital of San Diego, LLC
Schedule of Equity Method Investments [Line Items]
Percentage of ownership	39.00%
Other non current assets
Schedule of Equity Method Investments [Line Items]
Equity method investments	$ 230.7	146.9
Other current assets
Schedule of Equity Method Investments [Line Items]
Accounts receivable, related parties	5.7	8.7
Other assets
Schedule of Equity Method Investments [Line Items]
Accounts receivable, related parties	$ 28.7	$ 11.5

Equity Method Investments - Sum

Equity Method Investments - Summarized Combined Financial Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Equity Method Investments and Joint Ventures [Abstract]
Current assets	$ 178,674	$ 125,435
Non-current assets	317,332	118,270
Total assets	496,006	243,705
Current liabilities	107,400	43,792
Non-current liabilities	127,976	16,338
Equity	260,630	183,575
Total liabilities and equity	496,006	243,705
Revenues	536,464	393,034	$ 336,349
Cost of services and other operating expenses	476,182	342,603	289,224
Net income	$ 58,519	$ 48,535	$ 45,648

Insurance Risk Programs (Detail

Insurance Risk Programs (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Insurance [Abstract]
Discount rate for provisions for losses for professional liability (as a percent)	3.00%	3.00%
Liability recorded after discounting	$ 157.1	$ 175.2
Value of aggregate liability, if the entity did not discount the provisions for losses	162	180.7
Insurance proceeds receivable	$ 15.5	$ 32.4

Long-Term Debt and Notes Paya_3

Long-Term Debt and Notes Payable - Components of Long-Term Debt and Notes Payable (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Aug. 01, 2019	Dec. 31, 2018
Long-term debt and notes payable
Principal Outstanding	$ 3,447,221		$ 3,338,381
Unamortized Premium (Discount)	29,577		(11,905)
Unamortized Issuance Costs	(31,688)		(33,095)
Carrying Value	3,445,110		3,293,381
Fair Value	$ 3,546,524		3,222,705
Senior notes | Select 6.250% senior notes
Long-term debt and notes payable
Interest rate of debt	6.25%
Senior notes | Select 6.375% senior notes
Long-term debt and notes payable
Interest rate of debt	6.375%
Other
Long-term debt and notes payable
Principal Outstanding	$ 78,941		64,331
Unamortized Premium (Discount)	0		0
Unamortized Issuance Costs	(396)		(484)
Carrying Value	78,545		63,847
Fair Value	$ 78,545		$ 63,847
Select Medical Corporation | Senior notes | Select 6.250% senior notes
Long-term debt and notes payable
Interest rate of debt	6.25%	6.25%
Principal Outstanding	$ 1,225,000
Unamortized Premium (Discount)	39,988
Unamortized Issuance Costs	(19,944)
Carrying Value	1,245,044
Fair Value	1,322,020
Select Medical Corporation | Senior notes | Select 6.375% senior notes
Long-term debt and notes payable
Interest rate of debt		6.375%	6.375%
Principal Outstanding			$ 710,000
Unamortized Premium (Discount)			550
Unamortized Issuance Costs			(4,642)
Carrying Value			705,908
Fair Value			706,450
Select Medical Corporation | Revolving facility | Credit facility
Long-term debt and notes payable
Principal Outstanding			20,000
Unamortized Premium (Discount)			0
Unamortized Issuance Costs			0
Carrying Value			20,000
Fair Value			18,400
Select Medical Corporation | Term loan | Credit facility
Long-term debt and notes payable
Principal Outstanding	2,143,280		1,129,875
Unamortized Premium (Discount)	(10,411)		(9,690)
Unamortized Issuance Costs	(11,348)		(9,321)
Carrying Value	2,121,521		1,110,864
Fair Value	$ 2,145,959		1,076,206
Concentra Inc. | Term loan | Credit facility
Long-term debt and notes payable
Principal Outstanding			1,414,175
Unamortized Premium (Discount)			(2,765)
Unamortized Issuance Costs			(18,648)
Carrying Value			1,392,762
Fair Value			$ 1,357,802

Long-Term Debt and Notes Paya_4

Long-Term Debt and Notes Payable - Principal Maturities of Long-Term Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Long-term debt and notes payable
2020	$ 25,167
2021	18,405
2022	29,865
2023	14,514
2024	34,700
Thereafter	3,324,570
Total	3,447,221	$ 3,338,381
Other
Long-term debt and notes payable
2020	14,017
2021	7,255
2022	18,715
2023	3,364
2024	23,550
Thereafter	12,040
Total	78,941	64,331
Select Medical Corporation | Senior notes | Select 6.250% senior notes
Long-term debt and notes payable
2020	0
2021	0
2022	0
2023	0
2024	0
Thereafter	1,225,000
Total	1,225,000
Select Medical Corporation | Credit facility | Term loan
Long-term debt and notes payable
2020	11,150
2021	11,150
2022	11,150
2023	11,150
2024	11,150
Thereafter	2,087,530
Total	$ 2,143,280	1,129,875
Concentra Inc. | Credit facility | Term loan
Long-term debt and notes payable
Total		$ 1,414,175

Long-Term Debt and Notes Paya_5

Long-Term Debt and Notes Payable - Select Credit Facilities (Details) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Dec. 10, 2019	Aug. 01, 2019	Mar. 06, 2017
Long-term debt and notes payable
Payments on term loans	$ 1,618,170,000	$ 11,500,000	$ 1,179,442,000
Credit facility | 2017 Select Credit Facilities | Select Medical Corporation
Long-term debt and notes payable
Current borrowing capacity						$ 1,600,000,000
Aggregate principal amount				$ 615,000,000	$ 500,000,000	1,150,000,000
Percentage of capital stock of foreign subsidiaries	65.00%
Prepayment of borrowings of excess cash flow (percentage)	25.00%
Payments on term loans	$ 40,000,000	$ 98,800,000	$ 0
Credit facility | 2017 Select Credit Facilities | Select Medical Corporation | Adjusted LIBO
Long-term debt and notes payable
Interest rate margin (as a percent)	2.50%
Credit facility | 2017 Select Credit Facilities | Select Medical Corporation | Adjusted LIBO | Minimum
Long-term debt and notes payable
Interest rate margin (as a percent)	2.25%
Credit facility | 2017 Select Credit Facilities | Select Medical Corporation | Adjusted LIBO | Maximum
Long-term debt and notes payable
Interest rate margin (as a percent)	2.50%
Credit facility | 2017 Select Credit Facilities | Select Medical Corporation | Alternate Base Rate
Long-term debt and notes payable
Interest rate margin (as a percent)	1.50%
Credit facility | 2017 Select Credit Facilities | Select Medical Corporation | Alternate Base Rate | Minimum
Long-term debt and notes payable
Interest rate margin (as a percent)	1.25%
Credit facility | 2017 Select Credit Facilities | Select Medical Corporation | Alternate Base Rate | Maximum
Long-term debt and notes payable
Interest rate margin (as a percent)	1.50%
Credit facility | 2017 Select Credit Facilities | Select Medical Corporation | Revolving facility
Long-term debt and notes payable
Current borrowing capacity						450,000,000
Leverage ratio	4.31
Remaining borrowing capacity	$ 411,700,000
Credit facility | 2017 Select Credit Facilities | Select Medical Corporation | Revolving facility | Maximum | Leverage ratio less than 7.0 to 1.00
Long-term debt and notes payable
Leverage ratio	7
Credit facility | 2017 Select Credit Facilities | Select Medical Corporation | Revolving facility | Adjusted LIBO
Long-term debt and notes payable
Interest rate margin (as a percent)	2.50%
Credit facility | 2017 Select Credit Facilities | Select Medical Corporation | Revolving facility | Adjusted LIBO | Minimum
Long-term debt and notes payable
Interest rate margin (as a percent)	2.25%
Credit facility | 2017 Select Credit Facilities | Select Medical Corporation | Revolving facility | Adjusted LIBO | Maximum
Long-term debt and notes payable
Interest rate margin (as a percent)	2.50%
Credit facility | 2017 Select Credit Facilities | Select Medical Corporation | Revolving facility | Alternate Base Rate
Long-term debt and notes payable
Interest rate margin (as a percent)	1.50%
Credit facility | 2017 Select Credit Facilities | Select Medical Corporation | Revolving facility | Alternate Base Rate | Minimum
Long-term debt and notes payable
Interest rate margin (as a percent)	1.25%
Credit facility | 2017 Select Credit Facilities | Select Medical Corporation | Revolving facility | Alternate Base Rate | Maximum
Long-term debt and notes payable
Interest rate margin (as a percent)	1.50%
Credit facility | 2017 Select Credit Facilities | Select Medical Corporation | Letter of credit
Long-term debt and notes payable
Current borrowing capacity						$ 75,000,000
Outstanding letters of credit	$ 38,300,000

Long-Term Debt and Notes Paya_6

Long-Term Debt and Notes Payable - Select 6.250% Senior Notes (Details) - USD ($)	Dec. 10, 2019	Aug. 01, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Debt Instrument [Line Items]
Repayment of senior notes			$ 710,000,000	$ 0	$ 0
Senior notes | Select 6.250% senior notes
Debt Instrument [Line Items]
Interest rate of debt			6.25%
Senior notes | Select 6.375% senior notes
Debt Instrument [Line Items]
Interest rate of debt			6.375%
Select Medical Corporation | Senior notes | Select 6.250% senior notes
Debt Instrument [Line Items]
Interest rate of debt		6.25%	6.25%
Aggregate principal amount	$ 675,000,000	$ 550,000,000
Redemption price (percentage)			106.25%
Premium received upon issuance (percentage)	106.00%
Principal amount of senior notes redeemable with proceeds of equity offerings (percentage)			40.00%
Redemption price, change of control			101.00%
Select Medical Corporation | Senior notes | Select 6.375% senior notes
Debt Instrument [Line Items]
Interest rate of debt		6.375%		6.375%
Repayment of senior notes		$ 710,000,000
Redemption price (percentage)		100.00%

Long-Term Debt and Notes Paya_7

Long-Term Debt and Notes Payable - Concentra-JPM Credit Facilities (Details) - USD ($)	Dec. 10, 2019	Sep. 20, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Aug. 01, 2019	Apr. 08, 2019	Mar. 06, 2017
Debt Instrument [Line Items]
Payments on term loans			$ 1,618,170,000	$ 11,500,000	$ 1,179,442,000
Concentra Inc. | Credit facility
Debt Instrument [Line Items]
Payments on term loans	$ 1,240,300,000
Concentra Inc. | Credit facility | First Lien Credit Agreement
Debt Instrument [Line Items]
Payments on term loans				33,900,000	0
Concentra Inc. | Credit facility | First Lien Credit Agreement Maturing June 1, 2020
Debt Instrument [Line Items]
Maximum borrowing capacity							$ 75,000,000
Concentra Inc. | Credit facility | First Lien Credit Agreement Maturing June 1, 2021
Debt Instrument [Line Items]
Maximum borrowing capacity	100,000,000						$ 100,000,000
Concentra Inc. | Credit facility | First Lien Credit Agreement Maturing June 1, 2022
Debt Instrument [Line Items]
Aggregate principal amount		$ 100,000,000
Concentra Inc. | Credit facility | Second Lien Term Loan Due June 1, 2023
Debt Instrument [Line Items]
Maximum borrowing capacity		$ 240,000,000
Concentra Inc. | Credit facility | Concentra credit facilities
Debt Instrument [Line Items]
Voting capital stock of domestic subsidiaries pledged as collateral (as a percent)			65.00%
Non-voting capital stock of foreign subsidiaries pledged as collateral (as a percent)			100.00%
Concentra Inc. | Revolving facility | Credit facility
Debt Instrument [Line Items]
Remaining borrowing capacity			$ 85,700,000
Concentra Inc. | Revolving facility | Credit facility | Adjusted LIBO
Debt Instrument [Line Items]
Interest rate margin (as a percent)			2.50%
Concentra Inc. | Revolving facility | Credit facility | Alternate Base Rate
Debt Instrument [Line Items]
Interest rate margin (as a percent)			1.50%
Concentra Inc. | Revolving facility | Credit facility | First Lien Credit Agreement | Adjusted LIBO | Minimum
Debt Instrument [Line Items]
Interest rate margin (as a percent)			2.25%
Concentra Inc. | Revolving facility | Credit facility | First Lien Credit Agreement | Adjusted LIBO | Maximum
Debt Instrument [Line Items]
Interest rate margin (as a percent)			2.50%
Concentra Inc. | Revolving facility | Credit facility | First Lien Credit Agreement | Alternate Base Rate | Minimum
Debt Instrument [Line Items]
Interest rate margin (as a percent)			1.25%
Concentra Inc. | Revolving facility | Credit facility | First Lien Credit Agreement | Alternate Base Rate | Maximum
Debt Instrument [Line Items]
Interest rate margin (as a percent)			1.50%
Concentra Inc. | Revolving facility | Leverage ratio equal to 5.75 to 1.00 | Credit facility | First Lien Credit Agreement
Debt Instrument [Line Items]
Leverage ratio			5.75
Percentage of revolving exposure to revolving commitments that needs to be exceeded for the leverage ratio to apply			30.00%
Concentra Inc. | Letter of credit | Credit facility
Debt Instrument [Line Items]
Outstanding letters of credit			$ 14,300,000
Concentra Inc. | On or prior to February 1, 2020 | Credit facility | Second Lien Term Loan Due June 1, 2023
Debt Instrument [Line Items]
Prepayment premium (as a percent)		1.00%
Select Medical Corporation | Credit facility | 2017 Select Credit Facilities
Debt Instrument [Line Items]
Aggregate principal amount	$ 615,000,000					$ 500,000,000		$ 1,150,000,000
Payments on term loans			$ 40,000,000	$ 98,800,000	$ 0
Select Medical Corporation | Credit facility | 2017 Select Credit Facilities | Adjusted LIBO
Debt Instrument [Line Items]
Interest rate margin (as a percent)			2.50%
Select Medical Corporation | Credit facility | 2017 Select Credit Facilities | Adjusted LIBO | Minimum
Debt Instrument [Line Items]
Interest rate margin (as a percent)			2.25%
Select Medical Corporation | Credit facility | 2017 Select Credit Facilities | Adjusted LIBO | Maximum
Debt Instrument [Line Items]
Interest rate margin (as a percent)			2.50%
Select Medical Corporation | Credit facility | 2017 Select Credit Facilities | Alternate Base Rate
Debt Instrument [Line Items]
Interest rate margin (as a percent)			1.50%
Select Medical Corporation | Credit facility | 2017 Select Credit Facilities | Alternate Base Rate | Minimum
Debt Instrument [Line Items]
Interest rate margin (as a percent)			1.25%
Select Medical Corporation | Credit facility | 2017 Select Credit Facilities | Alternate Base Rate | Maximum
Debt Instrument [Line Items]
Interest rate margin (as a percent)			1.50%
Select Medical Corporation | Revolving facility | Credit facility | 2017 Select Credit Facilities
Debt Instrument [Line Items]
Leverage ratio			4.31
Remaining borrowing capacity			$ 411,700,000
Select Medical Corporation | Revolving facility | Credit facility | 2017 Select Credit Facilities | Adjusted LIBO
Debt Instrument [Line Items]
Interest rate margin (as a percent)			2.50%
Select Medical Corporation | Revolving facility | Credit facility | 2017 Select Credit Facilities | Adjusted LIBO | Minimum
Debt Instrument [Line Items]
Interest rate margin (as a percent)			2.25%
Select Medical Corporation | Revolving facility | Credit facility | 2017 Select Credit Facilities | Adjusted LIBO | Maximum
Debt Instrument [Line Items]
Interest rate margin (as a percent)			2.50%
Select Medical Corporation | Revolving facility | Credit facility | 2017 Select Credit Facilities | Alternate Base Rate
Debt Instrument [Line Items]
Interest rate margin (as a percent)			1.50%
Select Medical Corporation | Revolving facility | Credit facility | 2017 Select Credit Facilities | Alternate Base Rate | Minimum
Debt Instrument [Line Items]
Interest rate margin (as a percent)			1.25%
Select Medical Corporation | Revolving facility | Credit facility | 2017 Select Credit Facilities | Alternate Base Rate | Maximum
Debt Instrument [Line Items]
Interest rate margin (as a percent)			1.50%
Select Medical Corporation | Letter of credit | Credit facility | 2017 Select Credit Facilities
Debt Instrument [Line Items]
Outstanding letters of credit			$ 38,300,000

Long-Term Debt and Notes Paya_8

Long-Term Debt and Notes Payable - Loss on Early Retirement of Debt (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Debt Disclosure [Abstract]
Loss on early retirement of debt	$ 38,083	$ 14,155	$ 19,719
Loss on extinguishment of debt	(22,130)	(2,999)	(6,527)
Loss on debt modification	$ 16,000	$ 11,200	$ 13,200

Stock Repurchase Program - Narr

Stock Repurchase Program - Narrative (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Equity, Class of Treasury Stock [Line Items]
Repurchase of common stock	$ 38,531	$ 6,837	$ 4,753
Common Stock Repurchase Program
Equity, Class of Treasury Stock [Line Items]
Maximum amount authorized to be repurchased under the common stock repurchase program	$ 500,000
Repurchase of common stock (in shares)	2,165,221	0	0
Repurchase of common stock	$ 33,200
Repurchase program available capacity	$ 152,100

Segment Information - Selected

Segment Information - Selected Financial Data (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Segment information
Net operating revenues	$ 1,374,584	$ 1,393,343	$ 1,361,364	$ 1,324,631	$ 1,264,683	$ 1,267,401	$ 1,296,210	$ 1,252,964	$ 5,453,922	$ 5,081,258	$ 4,365,245
Adjusted EBITDA									710,908	645,155	537,992
Total assets	7,340,288				5,964,265				7,340,288	5,964,265	5,127,166
Capital expenditures									157,126	167,281	233,243
Corporate, non-Segment
Segment information
Net operating revenues									271,605	190,462	156,989
Adjusted EBITDA									(108,130)	(100,769)	(94,822)
Total assets	452,050				116,781				452,050	116,781	114,286
Capital expenditures									6,608	11,279	30,413
Critical Illness Recovery Hospital | Operating Segments
Segment information
Net operating revenues									1,836,518	1,753,584	1,725,022
Adjusted EBITDA									254,868	243,015	252,679
Total assets	2,099,833				1,771,605				2,099,833	1,771,605	1,848,783
Capital expenditures									45,573	40,855	49,720
Rehabilitation Hospital | Operating Segments
Segment information
Net operating revenues									670,971	583,745	509,108
Adjusted EBITDA									135,857	108,927	90,041
Total assets	1,127,028				894,192				1,127,028	894,192	868,517
Capital expenditures									27,216	42,389	96,477
Outpatient Rehabilitation | Operating Segments
Segment information
Net operating revenues									1,046,011	995,794	960,902
Adjusted EBITDA									151,831	142,005	132,533
Total assets	1,289,190				1,002,819				1,289,190	1,002,819	954,661
Capital expenditures									33,628	30,553	27,721
Concentra | Operating Segments
Segment information
Net operating revenues									1,628,817	1,557,673	1,013,224
Adjusted EBITDA									276,482	251,977	157,561
Total assets	$ 2,372,187				$ 2,178,868				2,372,187	2,178,868	1,340,919
Capital expenditures									$ 44,101	$ 42,205	$ 28,912

Segment Information - Reconcili

Segment Information - Reconciliation of Adjusted EBITDA to Income Before Taxes (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Segment information
Adjusted EBITDA									$ 710,908	$ 645,155	$ 537,992
Depreciation and amortization	$ (52,504)	$ (52,941)	$ (54,993)	$ (52,138)	$ (52,633)	$ (50,527)	$ (51,724)	$ (46,771)	(212,576)	(201,655)	(160,011)
Stock compensation expense									(26,451)	(23,326)	(19,284)
Income from operations	$ 112,369	$ 122,906	$ 124,882	$ 111,724	$ 88,283	$ 99,837	$ 120,561	$ 108,598	471,881	417,279	355,878
Loss on early retirement of debt									(38,083)	(14,155)	(19,719)
Equity in earnings of unconsolidated subsidiaries									24,989	21,905	21,054
Gain (loss) on sale of businesses									6,532	9,016	(49)
Interest expense									(200,570)	(198,493)	(154,703)
Income before income taxes									264,749	235,552	202,461
Operating Segments | Critical Illness Recovery Hospital
Segment information
Adjusted EBITDA									254,868	243,015	252,679
Depreciation and amortization									(50,763)	(45,797)	(45,743)
Stock compensation expense									0	0	0
U.S. HealthWorks acquisition costs										0	0
Income from operations									204,105	197,218	206,936
Operating Segments | Rehabilitation Hospital
Segment information
Adjusted EBITDA									135,857	108,927	90,041
Depreciation and amortization									(27,322)	(24,101)	(20,176)
Stock compensation expense									0	0	0
U.S. HealthWorks acquisition costs										0	0
Income from operations									108,535	84,826	69,865
Operating Segments | Outpatient Rehabilitation
Segment information
Adjusted EBITDA									151,831	142,005	132,533
Depreciation and amortization									(28,301)	(27,195)	(24,607)
Stock compensation expense									0	0	0
U.S. HealthWorks acquisition costs										0	0
Income from operations									123,530	114,810	107,926
Operating Segments | Concentra
Segment information
Adjusted EBITDA									276,482	251,977	157,561
Depreciation and amortization									(96,807)	(95,521)	(61,945)
Stock compensation expense									(3,069)	(2,883)	(993)
U.S. HealthWorks acquisition costs										(2,895)	(2,819)
Income from operations									176,606	150,678	91,804
Corporate, non-Segment
Segment information
Adjusted EBITDA									(108,130)	(100,769)	(94,822)
Depreciation and amortization									(9,383)	(9,041)	(7,540)
Stock compensation expense									(23,382)	(20,443)	(18,291)
U.S. HealthWorks acquisition costs										0	0
Income from operations									$ (140,895)	$ (130,253)	$ (120,653)

Revenue from Contracts with C_3

Revenue from Contracts with Customers (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Disaggregation of Revenue [Line Items]
Total net operating revenues	$ 1,374,584	$ 1,393,343	$ 1,361,364	$ 1,324,631	$ 1,264,683	$ 1,267,401	$ 1,296,210	$ 1,252,964	$ 5,453,922	$ 5,081,258	$ 4,365,245
Medicare
Disaggregation of Revenue [Line Items]
Total net operating revenues									1,414,132	1,350,564	1,313,255
Non-Medicare
Disaggregation of Revenue [Line Items]
Total net operating revenues									3,626,580	3,409,761	2,760,237
Total patient services revenues
Disaggregation of Revenue [Line Items]
Total net operating revenues									5,040,712	4,760,325	4,073,492
Other revenues
Disaggregation of Revenue [Line Items]
Total net operating revenues									413,210	320,933	291,753
Operating Segments | Critical Illness Recovery Hospital
Disaggregation of Revenue [Line Items]
Total net operating revenues									1,836,518	1,753,584	1,725,022
Operating Segments | Critical Illness Recovery Hospital | Medicare
Disaggregation of Revenue [Line Items]
Total net operating revenues									907,963	893,429	903,503
Operating Segments | Critical Illness Recovery Hospital | Non-Medicare
Disaggregation of Revenue [Line Items]
Total net operating revenues									916,650	847,447	810,723
Operating Segments | Critical Illness Recovery Hospital | Total patient services revenues
Disaggregation of Revenue [Line Items]
Total net operating revenues									1,824,613	1,740,876	1,714,226
Operating Segments | Critical Illness Recovery Hospital | Other revenues
Disaggregation of Revenue [Line Items]
Total net operating revenues									11,905	12,708	10,796
Operating Segments | Rehabilitation Hospital
Disaggregation of Revenue [Line Items]
Total net operating revenues									670,971	583,745	509,108
Operating Segments | Rehabilitation Hospital | Medicare
Disaggregation of Revenue [Line Items]
Total net operating revenues									332,514	293,913	259,221
Operating Segments | Rehabilitation Hospital | Non-Medicare
Disaggregation of Revenue [Line Items]
Total net operating revenues									300,113	254,215	207,196
Operating Segments | Rehabilitation Hospital | Total patient services revenues
Disaggregation of Revenue [Line Items]
Total net operating revenues									632,627	548,128	466,417
Operating Segments | Rehabilitation Hospital | Other revenues
Disaggregation of Revenue [Line Items]
Total net operating revenues									38,344	35,617	42,691
Operating Segments | Outpatient Rehabilitation
Disaggregation of Revenue [Line Items]
Total net operating revenues									1,046,011	995,794	960,902
Operating Segments | Outpatient Rehabilitation | Medicare
Disaggregation of Revenue [Line Items]
Total net operating revenues									171,690	161,054	148,403
Operating Segments | Outpatient Rehabilitation | Non-Medicare
Disaggregation of Revenue [Line Items]
Total net operating revenues									794,288	762,247	739,531
Operating Segments | Outpatient Rehabilitation | Total patient services revenues
Disaggregation of Revenue [Line Items]
Total net operating revenues									965,978	923,301	887,934
Operating Segments | Outpatient Rehabilitation | Other revenues
Disaggregation of Revenue [Line Items]
Total net operating revenues									80,033	72,493	72,968
Operating Segments | Concentra
Disaggregation of Revenue [Line Items]
Total net operating revenues									1,628,817	1,557,673	1,013,224
Operating Segments | Concentra | Medicare
Disaggregation of Revenue [Line Items]
Total net operating revenues									1,965	2,168	2,128
Operating Segments | Concentra | Non-Medicare
Disaggregation of Revenue [Line Items]
Total net operating revenues									1,615,529	1,545,852	1,002,787
Operating Segments | Concentra | Total patient services revenues
Disaggregation of Revenue [Line Items]
Total net operating revenues									1,617,494	1,548,020	1,004,915
Operating Segments | Concentra | Other revenues
Disaggregation of Revenue [Line Items]
Total net operating revenues									11,323	9,653	8,309
Corporate, non-Segment
Disaggregation of Revenue [Line Items]
Total net operating revenues									271,605	190,462	156,989
Corporate, non-Segment | Medicare
Disaggregation of Revenue [Line Items]
Total net operating revenues									0	0	0
Corporate, non-Segment | Non-Medicare
Disaggregation of Revenue [Line Items]
Total net operating revenues									0	0	0
Corporate, non-Segment | Total patient services revenues
Disaggregation of Revenue [Line Items]
Total net operating revenues									0	0	0
Corporate, non-Segment | Other revenues
Disaggregation of Revenue [Line Items]
Total net operating revenues									$ 271,605	$ 190,462	$ 156,989

Stock-based Compensation - Narr

Stock-based Compensation - Narrative (Details) - USD ($) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Stock based Compensation
Exercise of stock options (in shares)	105,000
Exercise of stock options, weighted average exercise price (in dollars per share)	$ 9.18
Total intrinsic value of options exercised	$ 0.7	$ 1.8	$ 1.6
Restricted stock awards
Stock based Compensation
Weighted average grant date fair value of granted shares (in dollars per share)	$ 16.60	$ 19.72	$ 15.84
Weighted average grant date fair value of vested shares	$ 15.6	$ 19.1	$ 17.1
2016 equity incentive plan | Restricted stock and stock option
Stock based Compensation
Number of shares authorized (in shares)	7,735,628
Number of shares authorized, remaining (in shares)	1,727,405
Minimum | Restricted stock awards
Stock based Compensation
Award vesting period	3 years
Maximum | Restricted stock awards
Stock based Compensation
Award vesting period	4 years

Stock-based Compensation - Rest

Stock-based Compensation - Restricted Stock Awards (Details) - Restricted stock awards - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Shares
Unvested balance, at beginning of the year (in shares)	4,450
Granted (in shares)	1,500
Vested (in shares)	(1,300)
Forfeited (in shares)	(43)
Unvested balance, at end of the year (in shares)	4,607	4,450
Weighted Average Grant Date Fair Value
Unvested balance, at beginning of the year (in dollars per share)	$ 15.68
Granted (in dollars per share)	16.60	$ 19.72	$ 15.84
Vested (in dollars per share)	11.97
Forfeited (in dollars per share)	16.09
Unvested balance, at end of the year (in dollars per share)	$ 17.03	$ 15.68

Stock-based Compensation - Stoc

Stock-based Compensation - Stock Compensation Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Stock based Compensation
Total	$ 26,451	$ 23,326	$ 19,284
Stock compensation expense for each of the next five years, based on restricted stock awards granted
2020	24,381
2021	16,031
2022	8,117
2023	1,267
2024	19
Included in general and administrative
Stock based Compensation
Total	20,334	17,604	15,706
Included in cost of services
Stock based Compensation
Total	$ 6,117	$ 5,722	$ 3,578

Income Taxes - Tax Expense Comp

Income Taxes - Tax Expense Components and Reconciliation to Federal Statutory Rate (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Current income tax expense:
Federal	$ 55,822	$ 36,072	$ 45,809
State and local	15,331	15,321	8,331
Total current income tax expense	71,153	51,393	54,140
Deferred income tax expense (benefit)	(7,435)	7,217	(72,324)
Total income tax expense (benefit)	$ 63,718	$ 58,610	$ (18,184)
Reconciliation of the statutory federal income tax rate to the effective income tax rate
Federal income tax at statutory rate	21.00%	21.00%	35.00%
State and local income taxes, less federal income tax benefit	4.20%	5.00%	3.70%
Permanent differences	1.70%	2.10%	1.70%
Valuation allowance	0.50%	0.50%	(7.30%)
Uncertain tax positions	(0.10%)	(0.80%)	(0.60%)
Non-controlling interest	(2.90%)	(2.10%)	0.50%
Stock-based compensation	(0.70%)	(2.20%)	(1.30%)
Deferred income taxes - state income tax rate adjustment	0.80%	0.40%	(2.80%)
Deferred income taxes - tax legislation rate adjustment	0.00%	0.00%	(37.50%)
Other	(0.40%)	1.00%	(0.40%)
Effective income tax rate	24.10%	24.90%	(9.00%)

Income Taxes - Narrative (Detai

Income Taxes - Narrative (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Valuation allowance (release) increase	$ 600	$ 4,900
Valuation allowance release, federal net operating losses		3,900
Valuation allowance, change in state net operating losses		1,000
Deferred tax liabilities, net of deferred tax assets	$ 128,520	$ 135,274
Period of review for entities with cumulative losses	3 years
State and Local Jurisdiction
Income Taxes [Line Items]
Net operating losses	$ 719,600

Income Taxes - Deferred Tax Ass

Income Taxes - Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Deferred tax assets
Allowance for doubtful accounts	$ 13,097	$ 10,313
Compensation and benefit-related accruals	55,300	51,900
Professional malpractice liability insurance	13,753	13,644
Deferred revenue	274	209
Federal and state net operating loss and state tax credit carryforwards	38,933	40,163
Interest limitation carryforward	4,943	4,675
Stock awards	6,251	5,695
Equity investments	2,914	2,055
Operating lease liabilities	267,513
Other	2,344	3,271
Deferred tax assets	405,322	131,925
Valuation allowance	(18,461)	(17,893)
Deferred tax assets, net of valuation allowance	386,861	114,032
Deferred tax liabilities
Deferred income	(9,190)	(13,891)
Investment in unconsolidated affiliates	(7,498)	(5,653)
Depreciation and amortization	(225,079)	(217,950)
Deferred financing costs	(6,250)	(8,324)
Operating lease right-of-use assets	(263,818)
Other	(3,546)	(3,488)
Deferred tax liabilities	(515,381)	(249,306)
Deferred tax liabilities, net of deferred tax assets	$ (128,520)	$ (135,274)

Income Taxes - Deferred Tax A_2

Income Taxes - Deferred Tax Assets and Liabilities Included in the Consolidated Balance Sheet (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Other assets	$ 19,738	$ 18,621
Non-current deferred tax liability	(148,258)	(153,895)
Deferred tax liabilities, net of deferred tax assets	$ (128,520)	$ (135,274)

Income Taxes - Expiration of St

Income Taxes - Expiration of State NOL's and Gross Valuation Allowances (Details) - State and Local Jurisdiction $ in Thousands	Dec. 31, 2019USD ($)
State Net Operating Losses
2020	$ 17,297
2021	11,772
2022	39,319
2023	20,743
Thereafter through 2038	630,506
Gross Valuation Allowance
2020	14,100
2021	8,806
2022	33,790
2023	15,367
Thereafter through 2038	$ 413,916

Earnings per Share - Narrative

Earnings per Share - Narrative (Details) - $ / shares	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Earnings Per Share [Abstract]
Dividends declared and contractual dividends paid, basic	$ 0	$ 0	$ 0
Dividends declared and contractual dividends paid, diluted	$ 0	$ 0	$ 0

Earnings per Share - Net Income

Earnings per Share - Net Income Attributable to the Company, Common Shares Outstanding, and Participating Securities Outstanding (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Earnings Per Share [Abstract]
Net income	$ 43,671	$ 44,030	$ 59,986	$ 53,344	$ 29,722	$ 42,679	$ 60,559	$ 43,982	$ 201,031	$ 176,942	$ 220,645
Less: Net income attributable to non-controlling interests									52,582	39,102	43,461
Net income attributable to Select Medical Holdings Corporation	$ 32,067	$ 30,732	$ 44,816	$ 40,834	$ 24,673	$ 32,917	$ 46,511	$ 33,739	148,449	137,840	177,184
Basic EPS
Less: net income attributable to participating securities									4,995	4,551	5,758
Net income attributable to common shares									143,454	133,289	171,426
Diluted EPS
Less: net income attributable to participating securities									4,994	4,548	5,751
Net income allocated to common shares									$ 143,455	$ 133,292	$ 171,433

Earnings per Share - Computatio

Earnings per Share - Computation of EPS Under the Two-Class Method (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Net Income Allocation, Basic
Net income allocated to common shares									$ 143,454	$ 133,289	$ 171,426
Net income allocated to participating securities									4,995	4,551	5,758
Net Income Allocation, Diluted
Net income allocated to common shares									143,455	133,292	171,433
Net income allocated to participating securities									4,994	4,548	5,751
Net income attributable to Select Medical Holdings Corporation	$ 32,067	$ 30,732	$ 44,816	$ 40,834	$ 24,673	$ 32,917	$ 46,511	$ 33,739	$ 148,449	$ 137,840	$ 177,184
Weighted average common shares outstanding, basic (in shares)									130,248	130,172	128,955
Weighted average common shares outstanding, diluted (in shares)									130,276	130,256	129,126
Weighted average participating securities outstanding (in shares)									4,535	4,444	4,332
Basic EPS
Basic EPS (in dollars per share)	$ 0.24	$ 0.23	$ 0.33	$ 0.30	$ 0.18	$ 0.24	$ 0.35	$ 0.25	$ 1.10	$ 1.02	$ 1.33
Diluted EPS
Diluted EPS (in dollars per share)	$ 0.24	$ 0.23	$ 0.33	$ 0.30	$ 0.18	$ 0.24	$ 0.35	$ 0.25	$ 1.10	$ 1.02	$ 1.33

Commitments and Contingencies -

Commitments and Contingencies - Leases and Construction Commitments (Details) $ in Millions	12 Months Ended
	Dec. 31, 2019USD ($)
Construction Commitments
Construction Commitments
Construction contract commitments	$ 16.2

Commitments and Contingencies_2

Commitments and Contingencies - Litigation (Details) - Professional liability claims $ in Millions	12 Months Ended
	Dec. 31, 2019USD ($)
Maximum
Commitments and Contingencies
Total annual aggregate limit of insurance coverage	$ 40
Joint Venture Operations | Minimum
Commitments and Contingencies
Total annual aggregate limit of insurance coverage	6
Joint Venture Operations | Maximum
Commitments and Contingencies
Total annual aggregate limit of insurance coverage	$ 20

Subsequent Events (Details)

Subsequent Events (Details) - Subsequent Event - Concentra Group Holdings Parent - USD ($) $ in Millions	Feb. 01, 2020	Jan. 01, 2020
Subsequent Event [Line Items]
Percentage of membership interests purchased	1.40%	17.20%
Payments for Repurchase of Redeemable Noncontrolling Interest	$ 27.8	$ 338.4
Outstanding membership interest	66.60%
Class A Units
Subsequent Event [Line Items]
Outstanding membership interest	68.80%

Selected Quarterly Financial _3

Selected Quarterly Financial Data (Unaudited) (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Quarterly Financial Information Disclosure [Abstract]
Total net operating revenues	$ 1,374,584	$ 1,393,343	$ 1,361,364	$ 1,324,631	$ 1,264,683	$ 1,267,401	$ 1,296,210	$ 1,252,964	$ 5,453,922	$ 5,081,258	$ 4,365,245
Cost of services, exclusive of depreciation and amortization	1,175,649	1,183,111	1,150,150	1,132,092	1,093,450	1,087,062	1,094,731	1,065,813	4,641,002	4,341,056	3,735,309
Depreciation and amortization	52,504	52,941	54,993	52,138	52,633	50,527	51,724	46,771	212,576	201,655	160,011
Income from operations	112,369	122,906	124,882	111,724	88,283	99,837	120,561	108,598	471,881	417,279	355,878
Net income	43,671	44,030	59,986	53,344	29,722	42,679	60,559	43,982	201,031	176,942	220,645
Net income attributable to Select Medical Holdings Corporation	$ 32,067	$ 30,732	$ 44,816	$ 40,834	$ 24,673	$ 32,917	$ 46,511	$ 33,739	$ 148,449	$ 137,840	$ 177,184
Earnings per common share (Note 15):
Basic (in dollars per share)	$ 0.24	$ 0.23	$ 0.33	$ 0.30	$ 0.18	$ 0.24	$ 0.35	$ 0.25	$ 1.10	$ 1.02	$ 1.33
Diluted (in dollars per share)	$ 0.24	$ 0.23	$ 0.33	$ 0.30	$ 0.18	$ 0.24	$ 0.35	$ 0.25	$ 1.10	$ 1.02	$ 1.33

Schedule II - Valuation and Q_2

Schedule II - Valuation and Qualifying Accounts (Details) - Income Tax Valuation Allowance - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Changes in valuation and qualifying accounts
Balance at Beginning of Year	$ 17,893	$ 12,986	$ 26,421
Charged to Cost and Expenses	568	1,032	(13,435)
Acquisitions	0	3,875	0
Deductions	0	0	0
Balance at End of Year	$ 18,461	$ 17,893	$ 12,986