Select Medical (SEM) 10-Q 2 May 24 2024 Q1 Quarterly report Financial data

Cover

Cover - shares	3 Months Ended
	Mar. 31, 2024	Apr. 30, 2024
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2024
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, par value $0.001 per share
Trading Symbol	SEM
Security Exchange Name	NYSE
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 Common Stock, Shares Outstanding		130,031,562
Current Fiscal Year End Date	--12-31
Amendment Flag	false
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q1
Entity Central Index Key	0001320414

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets (unaudited) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Current Assets:
Cash and cash equivalents	$ 92,620	$ 84,006
Accounts receivable	1,134,788	940,335
Prepaid income taxes	9,034	22,726
Current portion of interest rate cap contract	42,660	58,962
Other current assets	161,238	151,617
Total Current Assets	1,440,340	1,257,646
Operating lease right-of-use assets	1,176,713	1,188,616
Property and equipment, net	1,024,626	1,023,561
Goodwill	3,517,071	3,513,170
Identifiable intangible assets, net	324,125	329,916
Other assets	375,388	376,722
Total Assets	7,858,263	7,689,631
Current Liabilities:
Overdrafts	28,534	30,274
Current operating lease liabilities	245,617	245,400
Current portion of long-term debt and notes payable	60,184	70,329
Accounts payable	163,551	174,312
Accrued and other liabilities	686,491	728,150
Total Current Liabilities	1,184,377	1,248,465
Non-current operating lease liabilities	1,015,160	1,025,867
Long-term debt, net of current portion	3,758,631	3,587,675
Non-current deferred tax liability	133,987	143,306
Other non-current liabilities	100,175	110,303
Total Liabilities	6,192,330	6,115,616
Commitments and contingencies (Note 14)
Redeemable non-controlling interests	28,290	26,297
Stockholders’ Equity:
Common stock, $0.001 par value, 700,000,000 shares authorized, 128,369,492 and 128,357,832 shares issued and outstanding at 2023 and 2024, respectively	128	128
Capital in excess of par	505,403	493,413
Retained earnings	830,821	751,856
Accumulated other comprehensive income	30,930	42,907
Total Stockholders’ Equity	1,367,282	1,288,304
Non-controlling interests	270,361	259,414
Total Equity	1,637,643	1,547,718
Total Liabilities and Equity	$ 7,858,263	$ 7,689,631

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (unaudited) (Parenthetical) - $ / shares	Mar. 31, 2024	Dec. 31, 2023
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)	128,357,832	128,369,492
Common stock, shares outstanding (in shares)	128,357,832	128,369,492

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations (unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Income Statement [Abstract]
Revenue	$ 1,788,809	$ 1,664,980
Costs and expenses:
Cost of services, exclusive of depreciation and amortization	1,494,610	1,418,819
General and administrative	48,447	42,279
Depreciation and amortization	54,069	52,425
Total costs and expenses	1,597,126	1,513,523
Other operating income	2,284	0
Income from operations	193,967	151,457
Other income and expense:
Equity in earnings of unconsolidated subsidiaries	10,421	8,556
Interest expense	(50,763)	(48,571)
Income before income taxes	153,625	111,442
Income tax expense	36,458	26,185
Net income	117,167	85,257
Less: Net income attributable to non-controlling interests	20,270	14,452
Net income attributable to Select Medical Holdings Corporation	$ 96,897	$ 70,805
Earnings per common share (Note 13):
Basic (in dollars per share)	$ 0.75	$ 0.56
Diluted (in dollars per share)	$ 0.75	$ 0.56

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Comprehensive Income (unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Statement of Comprehensive Income [Abstract]
Net income	$ 117,167	$ 85,257
Other comprehensive loss, net of tax:
Gain (loss) on interest rate cap contract	4,370	(2,696)
Reclassification adjustment for gains included in net income	(16,347)	(13,252)
Net change, net of tax benefit of $5,175, and $3,782	(11,977)	(15,948)
Comprehensive income	105,190	69,309
Less: Comprehensive income attributable to non-controlling interests	20,270	14,452
Comprehensive income attributable to Select Medical Holdings Corporation	$ 84,920	$ 54,857

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Comprehensive Income (unaudited) (Parenthetical) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Statement of Comprehensive Income [Abstract]
Tax benefit (expense) on components of other comprehensive income	$ 3,782	$ 5,175

Condensed Consolidated Statem_4

Condensed Consolidated Statements of Changes in Equity and Income (unaudited) - USD ($) $ in Thousands	Total	Total Stockholders’ Equity	Common Stock	Capital in Excess of Par	Retained Earnings	Accumulated Other Comprehensive Income	Non-controlling Interests
Beginning balance (in shares) at Dec. 31, 2022			127,173,000
Beginning balance at Dec. 31, 2022	$ 1,356,564	$ 1,121,922	$ 127	$ 452,183	$ 581,010	$ 88,602	$ 234,642
Increase (Decrease) in Stockholders' Equity
Net income attributable to Select Medical Holdings Corporation	70,805	70,805			70,805
Net income attributable to non-controlling interests	12,811	0					12,811
Cash dividends declared for common stockholders ($0.125 per share)	(15,897)	(15,897)			(15,897)
Issuance of restricted stock (in shares)			3,000
Issuance of restricted stock	0	0	$ 0	0
Vesting of restricted stock	10,003	10,003		10,003
Issuance of non-controlling interests	2,731	0					2,731
Non-controlling interests acquired in business combination	3,877	0					3,877
Distributions to and purchases of non-controlling interests	(6,069)	0					(6,069)
Redemption value adjustment on non-controlling interests	(436)	(436)			(436)
Other comprehensive loss	(15,948)	(15,948)				(15,948)
Other	0	0		(1)	1
Ending balance (in shares) at Mar. 31, 2023			127,176,000
Ending balance at Mar. 31, 2023	$ 1,418,441	1,170,449	$ 127	462,185	635,483	72,654	247,992
Beginning balance (in shares) at Dec. 31, 2023	128,369,492		128,369,000
Beginning balance at Dec. 31, 2023	$ 1,547,718	1,288,304	$ 128	493,413	751,856	42,907	259,414
Increase (Decrease) in Stockholders' Equity
Net income attributable to Select Medical Holdings Corporation	96,897	96,897			96,897
Net income attributable to non-controlling interests	17,845	0					17,845
Cash dividends declared for common stockholders ($0.125 per share)	(16,045)	(16,045)			(16,045)
Issuance of restricted stock (in shares)			1,000
Issuance of restricted stock	0	0	$ 0	0
Forfeitures of unvested restricted stock (in shares)			(12,000)
Forfeitures of unvested restricted stock	14	14	$ 0	0	14
Vesting of restricted stock	11,596	11,596		11,596
Issuance of non-controlling interests	4,002	0					4,002
Distributions to and purchases of non-controlling interests	(10,506)	394		394			(10,900)
Redemption value adjustment on non-controlling interests	(1,901)	(1,901)			(1,901)
Other comprehensive loss	$ (11,977)	(11,977)				(11,977)
Ending balance (in shares) at Mar. 31, 2024	128,357,832		128,358,000
Ending balance at Mar. 31, 2024	$ 1,637,643	$ 1,367,282	$ 128	$ 505,403	$ 830,821	$ 30,930	$ 270,361

Condensed Consolidated Statem_5

Condensed Consolidated Statements of Changes in Equity and Income (unaudited) (Parenthetical) - $ / shares	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Statement of Stockholders' Equity [Abstract]
Cash dividend declared (in dollars per share)	$ 0.125	$ 0.125

Condensed Consolidated Statem_6

Condensed Consolidated Statements of Cash Flows (unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Operating activities
Net income	$ 117,167	$ 85,257
Adjustments to reconcile net income to net cash provided by (used in) operating activities:
Distributions from unconsolidated subsidiaries	12,374	2,566
Depreciation and amortization	54,069	52,425
Provision for expected credit losses	854	429
Equity in earnings of unconsolidated subsidiaries	(10,421)	(8,556)
(Gain) loss on sale or disposal of assets	44	(7)
Stock compensation expense	11,610	10,181
Amortization of debt discount, premium, and issuance costs	750	565
Deferred income taxes	(6,891)	(2,601)
Changes in operating assets and liabilities, net of effects of business combinations:
Accounts receivable	(195,308)	(55,397)
Other current assets	(9,611)	(11,742)
Other assets	2,363	3,659
Accounts payable	(5,718)	(4,564)
Accrued expenses	(37,971)	(20,775)
Net cash provided by (used in) operating activities	(66,689)	51,440
Investing activities
Business combinations, net of cash acquired	(5,405)	(397)
Purchases of property, equipment, and other assets	(52,517)	(58,885)
Investment in businesses	0	(9,800)
Proceeds from sale of assets and businesses	265	20
Net cash used in investing activities	(57,657)	(69,062)
Financing activities
Borrowings on revolving facilities	495,000	225,000
Payments on revolving facilities	(265,000)	(210,000)
Payments on term loans	(79,085)	0
Borrowings of other debt	17,728	21,448
Principal payments on other debt	(9,061)	(11,170)
Dividends paid to common stockholders	(16,045)	(15,897)
Decrease in overdrafts	(1,740)	(724)
Proceeds from issuance of non-controlling interests	4,002	2,731
Distributions to and purchases of non-controlling interests	(12,839)	(7,969)
Net cash provided by financing activities	132,960	3,419
Net increase (decrease) in cash and cash equivalents	8,614	(14,203)
Cash and cash equivalents at beginning of period	84,006	97,906
Cash and cash equivalents at end of period	92,620	83,703
Supplemental information
Cash paid for interest, excluding amounts received of $17,828 and $22,515 under the interest rate cap contract	88,834	84,531
Cash paid for taxes	$ 604	$ 336

Condensed Consolidated Statem_7

Condensed Consolidated Statements of Cash Flows (unaudited) (Parenthetical) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Statement of Cash Flows [Abstract]
Interest received under interest rate cash flow hedge	$ 22,515	$ 17,828

Basis of Presentation

Basis of Presentation	3 Months Ended
	Mar. 31, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	Basis of Presentation The unaudited condensed 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, Select, and Select’s subsidiaries are collectively referred to as the “Company.” The unaudited condensed consolidated financial statements of the Company as of March 31, 2024, and for the three month periods ended March 31, 2023 and 2024, have been prepared pursuant to the rules and regulations of the Securities and Exchange Commission (the “SEC”) for interim reporting and the accounting principles generally accepted in the United States of America (“GAAP”). Accordingly, certain information and disclosures required by GAAP, which are normally included in the notes to the consolidated financial statements, have been condensed or omitted pursuant to those rules and regulations, although the Company believes the disclosure is adequate to make the information presented not misleading. In the opinion of management, such information contains all adjustments, which are normal and recurring in nature, necessary for a fair statement of the financial position, results of operations and cash flow for such periods. All significant intercompany transactions and balances have been eliminated. The results of operations for the three months ended March 31, 2024, are not necessarily indicative of the results to be expected for the full fiscal year ending December 31, 2024. These unaudited condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto for the year ended December 31, 2023, contained in the Company’s Annual Report on Form 10-K filed with the SEC on February 22, 2024.

Accounting Policies

Accounting Policies	3 Months Ended
	Mar. 31, 2024
Accounting Policies [Abstract]
Accounting Policies	Accounting Policies Recent Accounting Guidance Not Yet Adopted Segment Reporting In November 2023, FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures , which is intended to improve disclosure of segment information so that investors can better understand an entity’s overall performance. The ASU requires entities to quantitatively disclose significant segment expenses that are regularly provided to the chief operating decision maker for each reportable segment, as well as the amount of other segment items for each reportable segment and a description of what the other segment items are comprised. Disclosure of multiple measures of profit or loss will be permitted by the ASU. The ASU is effective for annual reporting periods beginning on or after December 15, 2023, and interim periods with fiscal years beginning after December 15, 2024; however, early adoption is permitted. The ASU is required to be applied retrospectively to all periods presented in the financial statements. The Company is currently reviewing the impact that ASU 2023-07 will have on the disclosures in our consolidated financial statements. Income Taxes In December 2023, FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures, which is intended to improve the transparency and decision usefulness of income tax disclosures. The ASU includes enhanced requirements on the rate reconciliation, including specific categories that must be disclosed, and provides a threshold over which reconciling items must be disclosed. The amendments in the update also require annual disclosure of income taxes paid, disaggregated by federal, state, and foreign taxes, as well as any individual jurisdictions in which income taxes paid is greater than 5% of total income taxes paid. The ASU is effective for annual periods beginning after December 15, 2024; however early adoption is permitted. The ASU can be applied either prospectively or retrospectively. The Company is currently reviewing the impact that ASU 2023-09 will have to the disclosures in our consolidated financial statements. Recently Adopted Accounting Guidance Leases In March 2023, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2023-01, Leases (Topic 842): Common Control Arrangements , which requires companies to amortize leasehold improvements associated with related party leases under common control over the useful life of the leasehold improvement to the common control group. The ASU is effective for annual reporting periods beginning on or after December 15, 2023; however, early adoption is permitted. The ASU can either be applied prospectively or retrospectively. The Company adopted this ASU using the prospective method of transition on January 1, 2024. There was not a material impact on the Company’s consolidated financial statements upon adoption. Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenues, and expenses. Actual results could differ from those estimates.

Credit Risk Concentrations

Credit Risk Concentrations	3 Months Ended
	Mar. 31, 2024
Credit Loss [Abstract]
Credit Risk Concentrations	Credit Risk 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. Because of the diversity in the Company’s non-governmental third-party payor base, as well as their geographic dispersion, accounts receivable due from the Medicare program represent the Company’s only significant concentration of credit risk. Approximately 17% and 20% of the Company’s accounts receivable is due from Medicare at both December 31, 2023, and March 31, 2024, respectively.

Redeemable Non-Controlling Inte

Redeemable Non-Controlling Interests	3 Months Ended
	Mar. 31, 2024
Noncontrolling Interest [Abstract]
Redeemable Non-Controlling Interests	Redeemable Non-Controlling Interests The ownership interests held by outside parties in subsidiaries, which include limited liability companies and limited partnerships, controlled by the Company are classified as 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 redemption values, after the attribution of net income or loss. The changes in redeemable non-controlling interests are as follows: Three Months Ended March 31, 2023 2024 (in thousands) Balance as of January 1 $ 34,043 $ 26,297 Net income attributable to redeemable non-controlling interests 1,641 2,425 Distributions to redeemable non-controlling interests (1,900) (2,333) Redemption value adjustment on redeemable non-controlling interests 436 1,901 Other 179 — Balance as of March 31 $ 34,399 $ 28,290

Variable Interest Entities

Variable Interest Entities	3 Months Ended
	Mar. 31, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Variable Interest Entities	Variable Interest Entities Certain states prohibit the “corporate practice of medicine,” which restricts the Company from owning medical practices which directly employ physicians or therapists and from exercising control over medical decisions by physicians and therapists. In these states, the Company enters into long-term management agreements with medical practices that are owned by licensed physicians or therapists, which, in turn, employ or contract with physicians or therapists who provide professional medical services. The management agreements provide for the Company to direct the transfer of ownership of the medical practices. Based on the provisions of the management agreements, the medical practices are variable interest entities for which the Company is the primary beneficiary. As of December 31, 2023, and March 31, 2024, the total assets of the Company’s variable interest entities were $246.4 million and $263.7 million, respectively, and are principally comprised of accounts receivable. As of December 31, 2023, and March 31, 2024, the total liabilities of the Company’s variable interest entities were $84.3 million and $85.4 million, respectively, and are principally comprised of accounts payable and accrued expenses. These variable interest entities have obligations payable for services received under their management agreements with the Company of $161.8 million and $179.5 million as of December 31, 2023, and March 31, 2024, respectively. These intercompany balances are eliminated in consolidation.

Leases

Leases	3 Months Ended
	Mar. 31, 2024
Leases [Abstract]
Leases	Leases The Company’s total lease cost is as follows: Three Months Ended March 31, 2023 Three Months Ended March 31, 2024 Unrelated Parties Related Parties Total Unrelated Parties Related Parties Total (in thousands) Operating lease cost $ 76,632 $ 1,834 $ 78,466 $ 79,055 $ 1,834 $ 80,889 Finance lease cost: Amortization of right-of-use assets 394 — 394 354 — 354 Interest on lease liabilities 320 — 320 304 — 304 Variable lease cost 15,761 84 15,845 17,076 — 17,076 Sublease income (1,678) — (1,678) (1,760) — (1,760) Total lease cost $ 91,429 $ 1,918 $ 93,347 $ 95,029 $ 1,834 $ 96,863
Leases	Leases The Company’s total lease cost is as follows: Three Months Ended March 31, 2023 Three Months Ended March 31, 2024 Unrelated Parties Related Parties Total Unrelated Parties Related Parties Total (in thousands) Operating lease cost $ 76,632 $ 1,834 $ 78,466 $ 79,055 $ 1,834 $ 80,889 Finance lease cost: Amortization of right-of-use assets 394 — 394 354 — 354 Interest on lease liabilities 320 — 320 304 — 304 Variable lease cost 15,761 84 15,845 17,076 — 17,076 Sublease income (1,678) — (1,678) (1,760) — (1,760) Total lease cost $ 91,429 $ 1,918 $ 93,347 $ 95,029 $ 1,834 $ 96,863

Long-Term Debt and Notes Payabl

Long-Term Debt and Notes Payable	3 Months Ended
	Mar. 31, 2024
Debt Disclosure [Abstract]
Long-Term Debt and Notes Payable	Long-Term Debt and Notes Payable As of March 31, 2024, the Company’s long-term debt and notes payable are as follows: Principal Unamortized Premium (Discount) Unamortized Carrying Value Fair Value (in thousands) 6.250% senior notes $ 1,225,000 $ 14,041 $ (7,186) $ 1,231,855 $ 1,226,531 Credit facilities: Revolving facility 510,000 — — 510,000 506,175 Term loan 2,013,400 (11,088) (2,973) 1,999,339 2,015,917 Other debt, including finance leases 77,667 — (46) 77,621 77,621 Total debt $ 3,826,067 $ 2,953 $ (10,205) $ 3,818,815 $ 3,826,244 Principal maturities of the Company’s long-term debt and notes payable are approximately as follows: 2024 2025 2026 2027 2028 Thereafter Total (in thousands) 6.250% senior notes $ — $ — $ 1,225,000 $ — $ — $ — $ 1,225,000 Credit facilities: Revolving facility — — — 510,000 — — 510,000 Term loan — — — 2,013,400 — — 2,013,400 Other debt, including finance leases 58,155 3,151 2,461 1,941 1,620 10,339 77,667 Total debt $ 58,155 $ 3,151 $ 1,227,461 $ 2,525,341 $ 1,620 $ 10,339 $ 3,826,067 As of December 31, 2023, the Company’s long-term debt and notes payable are as follows: Principal Unamortized Premium (Discount) Unamortized Carrying Value Fair Value (in thousands) 6.250% senior notes $ 1,225,000 $ 15,533 $ (7,937) $ 1,232,596 $ 1,228,063 Credit facilities: Revolving facility 280,000 — — 280,000 278,600 Term loan 2,092,485 (12,040) (3,229) 2,077,216 2,092,485 Other debt, including finance leases 68,255 — (63) 68,192 68,192 Total debt $ 3,665,740 $ 3,493 $ (11,229) $ 3,658,004 $ 3,667,340

Accrued and other liabilities

Accrued and other liabilities	3 Months Ended
	Mar. 31, 2024
Payables and Accruals [Abstract]
Accrued and other liabilities	Accrued and other liabilities The following table sets forth the components of accrued and other liabilities on the Condensed Consolidated Balance Sheets: December 31, 2023 March 31, 2024 Accrued payroll $ 238,768 $ 184,801 Accrued vacation 157,748 164,113 Accrued interest 32,472 14,438 Accrued other 297,663 292,587 Income taxes payable 1,499 30,552 Accrued and other liabilities $ 728,150 $ 686,491

Interest Rate Cap

Interest Rate Cap	3 Months Ended
	Mar. 31, 2024
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Interest Rate Cap	Interest Rate Cap The Company is subject to market risk exposure arising from changes in interest rates on its term loan, which bears interest at a rate which is indexed to one-month Term SOFR. The Company’s objective in using an interest rate derivative is to mitigate its exposure to increases in interest rates. The interest rate cap limits the Company’s exposure to increases in the variable rate index to 1.0% on $2.0 billion of principal outstanding under the term loan, as the interest rate cap provides for payments from the counterparty when interest rates rise above 1.0%. The interest rate cap has a $2.0 billion notional amount and is effective through September 30, 2024. The Company will pay a monthly premium for the interest rate cap over the term of the agreement. The annual premium is equal to 0.0916% of the notional amount, or approximately $1.8 million. The interest rate cap has been designated as a cash flow hedge and is highly effective at offsetting the changes in cash outflows when the variable rate index exceeds 1.0%. Changes in the fair value of the interest rate cap, net of tax, are recognized in other comprehensive income and are reclassified out of accumulated other comprehensive income and into interest expense when the hedged interest obligations affect earnings. The following table outlines the changes in accumulated other comprehensive income (loss), net of tax, during the periods presented: Three Months Ended March 31, 2023 2024 (in thousands) Balance as of January 1 $ 88,602 $ 42,907 Gain (loss) on interest rate cap cash flow hedge (2,696) 4,370 Amounts reclassified from accumulated other comprehensive income (13,252) (16,347) Balance as of March 31 $ 72,654 $ 30,930 The effects on net income of amounts reclassified from accumulated other comprehensive income are as follows: Three Months Ended March 31, Statement of Operations 2023 2024 (in thousands) Gains included in interest expense $ 17,552 $ 21,509 Income tax expense (4,300) (5,162) Amounts reclassified from accumulated other comprehensive income $ 13,252 $ 16,347 The Company expects that approximately $40.7 million of estimated pre-tax gains will be reclassified from accumulated other comprehensive income into interest expense through the expiration of the interest rate cap on September 30, 2024.

Fair Value of Financial Instrum

Fair Value of Financial Instruments	3 Months Ended
	Mar. 31, 2024
Fair Value Disclosures [Abstract]
Fair Value of Financial Instruments	Fair Value of Financial Instruments Financial instruments which are measured at fair value, or for which a fair value is disclosed, are classified in the fair value hierarchy, as outlined below, on the basis of the observability of the inputs used in the fair value measurement: • Level 1 – inputs are based upon quoted prices for identical instruments in active markets. • Level 2 – inputs are based upon quoted prices for similar instruments in active markets, quoted prices for identical or similar instruments in markets that are not active, and model-based valuation techniques for which all significant inputs are observable in the market or can be corroborated by observable market data. • Level 3 – inputs are generally unobservable and typically reflect management’s estimates of assumptions that market participants would use in pricing the instrument. The Company’s interest rate cap contract is recorded at its fair value in the condensed consolidated balance sheets on a recurring basis. The fair value of the interest rate cap contract is based upon a model-derived valuation using observable market inputs, such as interest rates and interest rate volatility, and the strike price. Financial Instrument Balance Sheet Classification Level December 31, 2023 March 31, 2024 Asset: (in thousands) Interest rate cap contract, current portion Current portion of interest rate cap contract Level 2 $ 58,962 $ 42,660 The Company does not measure its indebtedness at fair value in its condensed consolidated balance sheets. The fair value of the credit facilities is based on quoted market prices for this debt in the syndicated loan market. The fair value of the senior notes is based on quoted market prices. The carrying value of the Company’s other debt, as disclosed in Note 7 – Long-Term Debt and Notes Payable, approximates fair value. December 31, 2023 March 31, 2024 Financial Instrument Level Carrying Value Fair Value Carrying Value Fair Value (in thousands) 6.250% senior notes Level 2 $ 1,232,596 $ 1,228,063 $ 1,231,855 $ 1,226,531 Credit facilities: Revolving facility Level 2 280,000 278,600 510,000 506,175 Term loan Level 2 2,077,216 2,092,485 1,999,339 2,015,917

Segment Information

Segment Information	3 Months Ended
	Mar. 31, 2024
Segment Reporting [Abstract]
Segment Information	Segment Information 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 with non-consolidating subsidiaries. The Company evaluates the performance of its segments based on Adjusted EBITDA. Adjusted EBITDA is defined as earnings excluding interest, income taxes, depreciation and amortization, gain (loss) on early retirement of debt, stock compensation expense, transaction costs associated with the Concentra separation, 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. Three Months Ended March 31, 2023 2024 (in thousands) Revenue: Critical illness recovery hospital $ 593,926 $ 655,880 Rehabilitation hospital 231,462 265,700 Outpatient rehabilitation 295,903 303,158 Concentra 456,298 467,598 Other 87,391 96,473 Total Company $ 1,664,980 $ 1,788,809 Adjusted EBITDA: Critical illness recovery hospital $ 76,773 $ 115,940 Rehabilitation hospital 47,216 61,400 Outpatient rehabilitation 30,199 24,928 Concentra 93,748 96,142 Other (33,873) (36,493) Total Company $ 214,063 $ 261,917 Total assets: Critical illness recovery hospital $ 2,507,265 $ 2,608,979 Rehabilitation hospital 1,203,069 1,233,828 Outpatient rehabilitation 1,397,823 1,423,740 Concentra 2,300,632 2,362,848 Other 290,947 228,868 Total Company $ 7,699,736 $ 7,858,263 Purchases of property, equipment, and other assets: Critical illness recovery hospital $ 23,658 $ 15,941 Rehabilitation hospital 8,582 7,101 Outpatient rehabilitation 9,932 9,500 Concentra 14,400 17,231 Other 2,313 2,744 Total Company $ 58,885 $ 52,517 A reconciliation of Adjusted EBITDA to income before income taxes is as follows: Three Months Ended March 31, 2023 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Concentra Other Total (in thousands) Adjusted EBITDA $ 76,773 $ 47,216 $ 30,199 $ 93,748 $ (33,873) Depreciation and amortization (16,637) (6,888) (8,457) (18,310) (2,133) Stock compensation expense — — — (178) (10,003) Income (loss) from operations $ 60,136 $ 40,328 $ 21,742 $ 75,260 $ (46,009) $ 151,457 Equity in earnings of unconsolidated subsidiaries 8,556 Interest expense (48,571) Income before income taxes $ 111,442 Three Months Ended March 31, 2024 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Concentra Other Total (in thousands) Adjusted EBITDA $ 115,940 $ 61,400 $ 24,928 $ 96,142 $ (36,493) Depreciation and amortization (17,157) (7,135) (9,181) (18,485) (2,111) Stock compensation expense — — — (166) (11,444) Concentra separation transaction costs (1) — — — (1,993) (278) Income (loss) from operations $ 98,783 $ 54,265 $ 15,747 $ 75,498 $ (50,326) $ 193,967 Equity in earnings of unconsolidated subsidiaries 10,421 Interest expense (50,763) Income before income taxes $ 153,625 _______________________________________________________________________________

Revenue from Contracts with Cus

Revenue from Contracts with Customers	3 Months Ended
	Mar. 31, 2024
Revenue from Contract with Customer [Abstract]
Revenue from Contracts with Customers	Revenue from Contracts with Customers The following tables disaggregate the Company’s revenue for the three months ended March 31, 2023 and 2024: Three Months Ended March 31, 2023 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Concentra Other Total (in thousands) Patient service revenue: Medicare $ 229,383 $ 110,055 $ 45,801 $ 243 $ — $ 385,482 Non-Medicare 363,305 109,925 231,985 454,598 — 1,159,813 Total patient services revenues 592,688 219,980 277,786 454,841 — 1,545,295 Other revenue 1,238 11,482 18,117 1,457 87,391 119,685 Total revenue $ 593,926 $ 231,462 $ 295,903 $ 456,298 $ 87,391 $ 1,664,980 Three Months Ended March 31, 2024 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Concentra Other Total (in thousands) Patient service revenue: Medicare $ 226,261 $ 126,386 $ 45,841 $ 266 $ — $ 398,754 Non-Medicare 428,666 126,577 239,613 465,601 — 1,260,457 Total patient services revenues 654,927 252,963 285,454 465,867 — 1,659,211 Other revenue 953 12,737 17,704 1,731 96,473 129,598 Total revenue $ 655,880 $ 265,700 $ 303,158 $ 467,598 $ 96,473 $ 1,788,809

Earnings per Share

Earnings per Share	3 Months Ended
	Mar. 31, 2024
Earnings Per Share [Abstract]
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. There were no contractual dividends paid for the three months ended March 31, 2023 and 2024. (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. The following table sets forth the net income attributable to the Company, its common shares outstanding, and its participating securities outstanding. Basic and Diluted EPS Three Months Ended March 31, 2023 2024 (in thousands) Net income $ 85,257 $ 117,167 Less: net income attributable to non-controlling interests 14,452 20,270 Net income attributable to the Company 70,805 96,897 Less: Distributed and undistributed income attributable to participating securities 2,573 3,398 Distributed and undistributed income attributable to common shares $ 68,232 $ 93,499 The following tables set forth the computation of EPS under the two-class method: Three Months Ended March 31, 2023 2024 Net Income Allocation Shares (1) Basic and Diluted EPS Net Income Allocation Shares (1) Basic and Diluted EPS (in thousands, except for per share amounts) Common shares $ 68,232 122,553 $ 0.56 $ 93,499 123,859 $ 0.75 Participating securities 2,573 4,622 $ 0.56 3,398 4,501 $ 0.75 Total Company $ 70,805 $ 96,897 _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ (1) Represents the weighted average share count outstanding during the period.

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2024
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies 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 hospital and outpatient clinic operations, the Company currently maintains insurance coverages under a combination of policies with a total annual aggregate limit of up to $37.0 million for professional malpractice liability insurance and $40.0 million for general liability insurance. For the Company’s Concentra center operations, the Company currently maintains insurance coverages under a combination of policies with a total annual aggregate limit of up to $29.0 million for professional malpractice liability insurance and $29.0 million for general liability insurance. 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 designed a separate insurance program that responds to the risks of specific joint ventures. Most of the Company’s joint ventures are insured under a master program with an annual aggregate limit of up to $80.0 million, subject to a sublimit aggregate ranging from $23.0 million to $33.0 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 also maintains additional types of liability insurance covering claims which, due to their nature or amount, are not covered by or not fully covered by the applicable professional malpractice and general liability insurance policies, including workers compensation, property and casualty, directors and officers, cyber liability insurance, and employment practices liability insurance coverages. Our insurance policies generally are silent with respect to punitive damages so coverage is available to the extent insurable under the law of any applicable jurisdiction, and are subject to various deductibles and policy limits. The Company reviews its insurance program annually and may make adjustments to the amount of insurance coverage and self-insured retentions in future years. Significant legal actions, as well as the cost and possible lack of available insurance, could subject the Company to substantial uninsured liabilities. 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. Oklahoma City Investigation. On August 24, 2020, the Company and Select Specialty Hospital – Oklahoma City, Inc. (“SSH–Oklahoma City”) received civil investigative demands (“CIDs”) from the U.S. Attorney’s Office for the Western District of Oklahoma seeking responses to interrogatories and the production of various documents principally relating to the documentation, billing and reviews of medical services furnished to patients at SSH-Oklahoma City. The Company understands that the investigation arose from a qui tam lawsuit alleging billing fraud related to charges for respiratory therapy services at SSH–Oklahoma City and Select Specialty Hospital – Wichita, Inc. The Company has produced documents in response to the CIDs and is fully cooperating with this investigation. At this time, the Company is unable to predict the timing and outcome of this matter. Physical Therapy Billing. On October 7, 2021, the Company received a letter from a Trial Attorney at the U.S. Department of Justice, Civil Division, Commercial Litigation Branch, Fraud Section (“DOJ”) stating that the DOJ, in conjunction with the U.S. Department of Health and Human Services (“HHS”), is investigating the Company in connection with potential violations of the False Claims Act, 31 U.S.C. § 3729, et seq . The letter specified that the investigation relates to the Company’s billing for physical therapy services, and indicated that the DOJ would be requesting certain records from the Company. In October and December 2021, the DOJ requested, and the Company furnished, records relating to six of the Company’s outpatient therapy clinics in Florida. In 2022 and 2023, the DOJ requested certain data relating to all of the Company’s outpatient therapy clinics nationwide, and sought information about the Company’s ability to produce additional data relating to the physical therapy services furnished by the Company’s outpatient therapy clinics and Concentra. The Company has produced data and other documents requested by the DOJ and is fully cooperating on this investigation. At this time, the Company is unable to predict the timing and outcome of this matter. California Department of Insurance Investigation . On February 5, 2024, Concentra received a subpoena from the California Department of Insurance relating to an investigation under the California Insurance Frauds Prevention Act (“IFPA”), Cal. Ins. Code § 1871.7 et seq ., which allows a whistleblower to file a false claims lawsuit based on the submission of false or fraudulent claims to insurance companies. The subpoena seeks documentation relating mainly to Concentra’s billing and coding for physical therapy claims submitted to commercial insurers and workers compensation carriers located or doing business in California. The Company has produced data and other documents requested by the California Department of Insurance and is fully cooperating on this investigation. At this time, the Company is unable to predict the timing and outcome of this matter. Perry Johnson & Associates, Inc. Data Breach . On November 10, 2023, Perry Johnson & Associates, Inc., a third-party vendor of health information technology solutions that provides medical transcription services (“PJ&A”), notified Concentra Health Services, Inc. (“Concentra”) that certain information related to particular Concentra patients was potentially affected by a cybersecurity event. In February 2024, Concentra sent notices to almost four million patients who may have been impacted by the data breach. During the first quarter of 2024, Concentra became aware of six putative class action lawsuits files against PJ&A and Concentra related to the data breach. The first was filed in the U.S. District Court for the Eastern District of Michigan on February 19, 2024 by Elliot Curry, individually and on behalf of all others similarly situated. Plaintiff alleged, among other things, that he became the victim of identity theft as a result of the PJ&A data breach and that Concentra had lax data security policies. The second was filed in the U.S. District Court for the Eastern District of New York on February 21, 2024 by Tiffany Williams and Jo Joaquim, individually and on behalf of all others similarly situated. Plaintiffs alleged, among other things, that they face an immediate and heightened risk of identity theft as a result of the data breach and that the defendants failed to take measures to properly safeguard their private information. The third was filed in the U.S. District Court for the Eastern District of Missouri on February 26, 2024 by Stephen Tate, a.k.a. Steven Tate, individually and on behalf of all others similarly situated. Plaintiff alleged, among other things, that he faces a heightened and imminent risk of identity theft as a result of the data breach and that the defendants failed to take measures to properly safeguard his private information. The fourth was filed in the U.S. District Court for the Eastern District of Michigan on February 26, 2024 by Eric Franczak, individually and on behalf of all others similarly situated. Plaintiff alleged, among other things, that he faces a substantially increased risk of fraud and identity theft as a result of the data breach and that the defendants failed to take measures to properly safeguard his private information. The fifth was filed in the U.S. District Court for the Eastern District of Michigan on March 6, 2024 by Lazema Johnson, individually and on behalf of all others similarly situated. Plaintiff alleged, among other things, that she faces a substantially increased risk of fraud and identity theft as a result of the data breach and that the defendants failed to take measures to properly safeguard her private information. The sixth was filed in the Superior Court of California, County of Los Angeles, on April 8, 2024 by Robert Valencia, individually and on behalf of all others similarly situated. Plaintiff alleged, among other things, that he faces a substantially increased risk of fraud and identity theft as a result of the data breach and that the defendants failed to take measures to properly safeguard his private information. The Company is working with its cybersecurity risk insurance policy carrier and does not believe that the data breach or the lawsuits will have a material impact on its operations or financial performance. However, at this time, the Company is unable to predict the timing and outcome of these matters.

Subsequent Events

Subsequent Events	3 Months Ended
	Mar. 31, 2024
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events On May 1, 2024, the Company’s Board of Directors declared a cash dividend of $0.125 per share. The dividend will be payable on or about May 30, 2024, to stockholders of record as of the close of business on May 16, 2024.

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Pay vs Performance Disclosure
Net income attributable to Select Medical Holdings Corporation	$ 96,897	$ 70,805

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended
	Mar. 31, 2024
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Accounting Policies (Policies)

Accounting Policies (Policies)	3 Months Ended
	Mar. 31, 2024
Accounting Policies [Abstract]
Recent Accounting Guidance Not Yet Adopted and Recently Adopted Accounting Guidance	Recent Accounting Guidance Not Yet Adopted Segment Reporting In November 2023, FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures , which is intended to improve disclosure of segment information so that investors can better understand an entity’s overall performance. The ASU requires entities to quantitatively disclose significant segment expenses that are regularly provided to the chief operating decision maker for each reportable segment, as well as the amount of other segment items for each reportable segment and a description of what the other segment items are comprised. Disclosure of multiple measures of profit or loss will be permitted by the ASU. The ASU is effective for annual reporting periods beginning on or after December 15, 2023, and interim periods with fiscal years beginning after December 15, 2024; however, early adoption is permitted. The ASU is required to be applied retrospectively to all periods presented in the financial statements. The Company is currently reviewing the impact that ASU 2023-07 will have on the disclosures in our consolidated financial statements. Income Taxes In December 2023, FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures, which is intended to improve the transparency and decision usefulness of income tax disclosures. The ASU includes enhanced requirements on the rate reconciliation, including specific categories that must be disclosed, and provides a threshold over which reconciling items must be disclosed. The amendments in the update also require annual disclosure of income taxes paid, disaggregated by federal, state, and foreign taxes, as well as any individual jurisdictions in which income taxes paid is greater than 5% of total income taxes paid. The ASU is effective for annual periods beginning after December 15, 2024; however early adoption is permitted. The ASU can be applied either prospectively or retrospectively. The Company is currently reviewing the impact that ASU 2023-09 will have to the disclosures in our consolidated financial statements. Recently Adopted Accounting Guidance Leases In March 2023, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2023-01, Leases (Topic 842): Common Control Arrangements , which requires companies to amortize leasehold improvements associated with related party leases under common control over the useful life of the leasehold improvement to the common control group. The ASU is effective for annual reporting periods beginning on or after December 15, 2023; however, early adoption is permitted. The ASU can either be applied prospectively or retrospectively. The Company adopted this ASU using the prospective method of transition on January 1, 2024. There was not a material impact on the Company’s consolidated financial statements upon adoption.
Use of Estimates	Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenues, and expenses. Actual results could differ from those estimates.
Credit Risk Concentrations	Credit Risk 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.
Redeemable Non-Controlling Interests	Redeemable Non-Controlling Interests The ownership interests held by outside parties in subsidiaries, which include limited liability companies and limited partnerships, controlled by the Company are classified as 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 redemption values, after the attribution of net income or loss.
Variable Interest Entities	Variable Interest Entities Certain states prohibit the “corporate practice of medicine,” which restricts the Company from owning medical practices which directly employ physicians or therapists and from exercising control over medical decisions by physicians and therapists. In these states, the Company enters into long-term management agreements with medical practices that are owned by licensed physicians or therapists, which, in turn, employ or contract with physicians or therapists who provide professional medical services. The management agreements provide for the Company to direct the transfer of ownership of the medical practices. Based on the provisions of the management agreements, the medical practices are variable interest entities for which the Company is the primary beneficiary.

Redeemable Non-Controlling In_2

Redeemable Non-Controlling Interests (Tables)	3 Months Ended
	Mar. 31, 2024
Noncontrolling Interest [Abstract]
Schedule of redeemable non-controlling interests	The changes in redeemable non-controlling interests are as follows: Three Months Ended March 31, 2023 2024 (in thousands) Balance as of January 1 $ 34,043 $ 26,297 Net income attributable to redeemable non-controlling interests 1,641 2,425 Distributions to redeemable non-controlling interests (1,900) (2,333) Redemption value adjustment on redeemable non-controlling interests 436 1,901 Other 179 — Balance as of March 31 $ 34,399 $ 28,290

Leases (Tables)

Leases (Tables)	3 Months Ended
	Mar. 31, 2024
Leases [Abstract]
Schedule of lease cost	The Company’s total lease cost is as follows: Three Months Ended March 31, 2023 Three Months Ended March 31, 2024 Unrelated Parties Related Parties Total Unrelated Parties Related Parties Total (in thousands) Operating lease cost $ 76,632 $ 1,834 $ 78,466 $ 79,055 $ 1,834 $ 80,889 Finance lease cost: Amortization of right-of-use assets 394 — 394 354 — 354 Interest on lease liabilities 320 — 320 304 — 304 Variable lease cost 15,761 84 15,845 17,076 — 17,076 Sublease income (1,678) — (1,678) (1,760) — (1,760) Total lease cost $ 91,429 $ 1,918 $ 93,347 $ 95,029 $ 1,834 $ 96,863

Long-Term Debt and Notes Paya_2

Long-Term Debt and Notes Payable (Tables)	3 Months Ended
	Mar. 31, 2024
Debt Disclosure [Abstract]
Schedule of long-term debt and notes payable	As of March 31, 2024, the Company’s long-term debt and notes payable are as follows: Principal Unamortized Premium (Discount) Unamortized Carrying Value Fair Value (in thousands) 6.250% senior notes $ 1,225,000 $ 14,041 $ (7,186) $ 1,231,855 $ 1,226,531 Credit facilities: Revolving facility 510,000 — — 510,000 506,175 Term loan 2,013,400 (11,088) (2,973) 1,999,339 2,015,917 Other debt, including finance leases 77,667 — (46) 77,621 77,621 Total debt $ 3,826,067 $ 2,953 $ (10,205) $ 3,818,815 $ 3,826,244 As of December 31, 2023, the Company’s long-term debt and notes payable are as follows: Principal Unamortized Premium (Discount) Unamortized Carrying Value Fair Value (in thousands) 6.250% senior notes $ 1,225,000 $ 15,533 $ (7,937) $ 1,232,596 $ 1,228,063 Credit facilities: Revolving facility 280,000 — — 280,000 278,600 Term loan 2,092,485 (12,040) (3,229) 2,077,216 2,092,485 Other debt, including finance leases 68,255 — (63) 68,192 68,192 Total debt $ 3,665,740 $ 3,493 $ (11,229) $ 3,658,004 $ 3,667,340
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: 2024 2025 2026 2027 2028 Thereafter Total (in thousands) 6.250% senior notes $ — $ — $ 1,225,000 $ — $ — $ — $ 1,225,000 Credit facilities: Revolving facility — — — 510,000 — — 510,000 Term loan — — — 2,013,400 — — 2,013,400 Other debt, including finance leases 58,155 3,151 2,461 1,941 1,620 10,339 77,667 Total debt $ 58,155 $ 3,151 $ 1,227,461 $ 2,525,341 $ 1,620 $ 10,339 $ 3,826,067

Accrued and other liabilities (

Accrued and other liabilities (Tables)	3 Months Ended
	Mar. 31, 2024
Payables and Accruals [Abstract]
Components of accrued and other liabilities	The following table sets forth the components of accrued and other liabilities on the Condensed Consolidated Balance Sheets: December 31, 2023 March 31, 2024 Accrued payroll $ 238,768 $ 184,801 Accrued vacation 157,748 164,113 Accrued interest 32,472 14,438 Accrued other 297,663 292,587 Income taxes payable 1,499 30,552 Accrued and other liabilities $ 728,150 $ 686,491

Interest Rate Cap (Tables)

Interest Rate Cap (Tables)	3 Months Ended
	Mar. 31, 2024
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Schedule of accumulated other comprehensive income (loss)	The following table outlines the changes in accumulated other comprehensive income (loss), net of tax, during the periods presented: Three Months Ended March 31, 2023 2024 (in thousands) Balance as of January 1 $ 88,602 $ 42,907 Gain (loss) on interest rate cap cash flow hedge (2,696) 4,370 Amounts reclassified from accumulated other comprehensive income (13,252) (16,347) Balance as of March 31 $ 72,654 $ 30,930
Schedule of reclassification out of accumulated other comprehensive income	The effects on net income of amounts reclassified from accumulated other comprehensive income are as follows: Three Months Ended March 31, Statement of Operations 2023 2024 (in thousands) Gains included in interest expense $ 17,552 $ 21,509 Income tax expense (4,300) (5,162) Amounts reclassified from accumulated other comprehensive income $ 13,252 $ 16,347

Fair Value of Financial Instr_2

Fair Value of Financial Instruments (Tables)	3 Months Ended
	Mar. 31, 2024
Fair Value Disclosures [Abstract]
Schedule of interest rate cap	Financial Instrument Balance Sheet Classification Level December 31, 2023 March 31, 2024 Asset: (in thousands) Interest rate cap contract, current portion Current portion of interest rate cap contract Level 2 $ 58,962 $ 42,660
Schedule of long-term debt	December 31, 2023 March 31, 2024 Financial Instrument Level Carrying Value Fair Value Carrying Value Fair Value (in thousands) 6.250% senior notes Level 2 $ 1,232,596 $ 1,228,063 $ 1,231,855 $ 1,226,531 Credit facilities: Revolving facility Level 2 280,000 278,600 510,000 506,175 Term loan Level 2 2,077,216 2,092,485 1,999,339 2,015,917

Segment Information (Tables)

Segment Information (Tables)	3 Months Ended
	Mar. 31, 2024
Segment Reporting [Abstract]
Schedule of selected financial data for reportable segments	The following tables summarize selected financial data for the Company’s reportable segments. Three Months Ended March 31, 2023 2024 (in thousands) Revenue: Critical illness recovery hospital $ 593,926 $ 655,880 Rehabilitation hospital 231,462 265,700 Outpatient rehabilitation 295,903 303,158 Concentra 456,298 467,598 Other 87,391 96,473 Total Company $ 1,664,980 $ 1,788,809 Adjusted EBITDA: Critical illness recovery hospital $ 76,773 $ 115,940 Rehabilitation hospital 47,216 61,400 Outpatient rehabilitation 30,199 24,928 Concentra 93,748 96,142 Other (33,873) (36,493) Total Company $ 214,063 $ 261,917 Total assets: Critical illness recovery hospital $ 2,507,265 $ 2,608,979 Rehabilitation hospital 1,203,069 1,233,828 Outpatient rehabilitation 1,397,823 1,423,740 Concentra 2,300,632 2,362,848 Other 290,947 228,868 Total Company $ 7,699,736 $ 7,858,263 Purchases of property, equipment, and other assets: Critical illness recovery hospital $ 23,658 $ 15,941 Rehabilitation hospital 8,582 7,101 Outpatient rehabilitation 9,932 9,500 Concentra 14,400 17,231 Other 2,313 2,744 Total Company $ 58,885 $ 52,517
Schedule of reconciliation of Adjusted EBITDA to income before income taxes	A reconciliation of Adjusted EBITDA to income before income taxes is as follows: Three Months Ended March 31, 2023 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Concentra Other Total (in thousands) Adjusted EBITDA $ 76,773 $ 47,216 $ 30,199 $ 93,748 $ (33,873) Depreciation and amortization (16,637) (6,888) (8,457) (18,310) (2,133) Stock compensation expense — — — (178) (10,003) Income (loss) from operations $ 60,136 $ 40,328 $ 21,742 $ 75,260 $ (46,009) $ 151,457 Equity in earnings of unconsolidated subsidiaries 8,556 Interest expense (48,571) Income before income taxes $ 111,442 Three Months Ended March 31, 2024 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Concentra Other Total (in thousands) Adjusted EBITDA $ 115,940 $ 61,400 $ 24,928 $ 96,142 $ (36,493) Depreciation and amortization (17,157) (7,135) (9,181) (18,485) (2,111) Stock compensation expense — — — (166) (11,444) Concentra separation transaction costs (1) — — — (1,993) (278) Income (loss) from operations $ 98,783 $ 54,265 $ 15,747 $ 75,498 $ (50,326) $ 193,967 Equity in earnings of unconsolidated subsidiaries 10,421 Interest expense (50,763) Income before income taxes $ 153,625 _______________________________________________________________________________

Revenue from Contracts with C_2

Revenue from Contracts with Customers (Tables)	3 Months Ended
	Mar. 31, 2024
Revenue from Contract with Customer [Abstract]
Schedule of disaggregation of revenue	The following tables disaggregate the Company’s revenue for the three months ended March 31, 2023 and 2024: Three Months Ended March 31, 2023 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Concentra Other Total (in thousands) Patient service revenue: Medicare $ 229,383 $ 110,055 $ 45,801 $ 243 $ — $ 385,482 Non-Medicare 363,305 109,925 231,985 454,598 — 1,159,813 Total patient services revenues 592,688 219,980 277,786 454,841 — 1,545,295 Other revenue 1,238 11,482 18,117 1,457 87,391 119,685 Total revenue $ 593,926 $ 231,462 $ 295,903 $ 456,298 $ 87,391 $ 1,664,980 Three Months Ended March 31, 2024 Critical Illness Recovery Hospital Rehabilitation Hospital Outpatient Concentra Other Total (in thousands) Patient service revenue: Medicare $ 226,261 $ 126,386 $ 45,841 $ 266 $ — $ 398,754 Non-Medicare 428,666 126,577 239,613 465,601 — 1,260,457 Total patient services revenues 654,927 252,963 285,454 465,867 — 1,659,211 Other revenue 953 12,737 17,704 1,731 96,473 129,598 Total revenue $ 655,880 $ 265,700 $ 303,158 $ 467,598 $ 96,473 $ 1,788,809

Earnings per Share (Tables)

Earnings per Share (Tables)	3 Months Ended
	Mar. 31, 2024
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. Basic and Diluted EPS Three Months Ended March 31, 2023 2024 (in thousands) Net income $ 85,257 $ 117,167 Less: net income attributable to non-controlling interests 14,452 20,270 Net income attributable to the Company 70,805 96,897 Less: Distributed and undistributed income attributable to participating securities 2,573 3,398 Distributed and undistributed income attributable to common shares $ 68,232 $ 93,499 The following tables set forth the computation of EPS under the two-class method: Three Months Ended March 31, 2023 2024 Net Income Allocation Shares (1) Basic and Diluted EPS Net Income Allocation Shares (1) Basic and Diluted EPS (in thousands, except for per share amounts) Common shares $ 68,232 122,553 $ 0.56 $ 93,499 123,859 $ 0.75 Participating securities 2,573 4,622 $ 0.56 3,398 4,501 $ 0.75 Total Company $ 70,805 $ 96,897 _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ (1) Represents the weighted average share count outstanding during the period.

Credit Risk Concentrations (Det

Credit Risk Concentrations (Details)	3 Months Ended	12 Months Ended
	Mar. 31, 2024	Dec. 31, 2023
Medicare Receivable | Credit Concentration Risk | Accounts Receivable
Concentration Risk [Line Items]
Percentage of concentration risk	20%	17%

Redeemable Non-Controlling In_3

Redeemable Non-Controlling Interests (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Increase (Decrease) in Temporary Equity [Roll Forward]
Balance, beginning	$ 26,297	$ 34,043
Net income attributable to redeemable non-controlling interests	2,425	1,641
Distributions to redeemable non-controlling interests	(2,333)	(1,900)
Redemption value adjustment on redeemable non-controlling interests	1,901	436
Other	0	179
Balance, ending	$ 28,290	$ 34,399

Variable Interest Entities (Det

Variable Interest Entities (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023	Mar. 31, 2023
Variable Interest Entity [Line Items]
Assets	$ 7,858,263	$ 7,689,631	$ 7,699,736
Liabilities	6,192,330	6,115,616
Variable Interest Entity, Primary Beneficiary
Variable Interest Entity [Line Items]
Assets	263,700	246,400
Liabilities	85,400	84,300
Variable Interest Entity, Primary Beneficiary | Related Party
Variable Interest Entity [Line Items]
Obligations payable	$ 179,500	$ 161,800

Leases (Details)

Leases (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Operating lease cost
Unrelated Parties	$ 79,055	$ 76,632
Related Parties	1,834	1,834
Total	80,889	78,466
Amortization of right-of-use assets
Unrelated Parties	354	394
Related Parties	0	0
Total	354	394
Interest on lease liabilities
Unrelated Parties	304	320
Related Parties	0	0
Total	304	320
Variable lease cost
Unrelated Parties	17,076	15,761
Related Parties	0	84
Total	17,076	15,845
Sublease income
Unrelated Parties	(1,760)	(1,678)
Related Parties	0	0
Total	(1,760)	(1,678)
Total lease cost
Unrelated Parties	95,029	91,429
Related Parties	1,834	1,918
Total	$ 96,863	$ 93,347

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	Mar. 31, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
Principal Outstanding	$ 3,826,067	$ 3,665,740
Unamortized Premium (Discount)	2,953	3,493
Unamortized Issuance Costs	(10,205)	(11,229)
Carrying Value	3,818,815	3,658,004
Fair Value	$ 3,826,244	$ 3,667,340
Senior notes | 6.250% senior notes
Debt Instrument [Line Items]
Interest rate of debt (as a percent)	6.25%	6.25%
Principal Outstanding	$ 1,225,000	$ 1,225,000
Unamortized Premium (Discount)	14,041	15,533
Unamortized Issuance Costs	(7,186)	(7,937)
Carrying Value	1,231,855	1,232,596
Fair Value	1,226,531	1,228,063
Term loan
Debt Instrument [Line Items]
Principal Outstanding	2,013,400	2,092,485
Unamortized Premium (Discount)	(11,088)	(12,040)
Unamortized Issuance Costs	(2,973)	(3,229)
Carrying Value	1,999,339	2,077,216
Fair Value	2,015,917	2,092,485
Other debt, including finance leases
Debt Instrument [Line Items]
Principal Outstanding	77,667	68,255
Unamortized Premium (Discount)	0	0
Unamortized Issuance Costs	(46)	(63)
Carrying Value	77,621	68,192
Fair Value	77,621	68,192
Revolving facility | Revolving facility
Debt Instrument [Line Items]
Principal Outstanding	510,000	280,000
Unamortized Premium (Discount)	0	0
Unamortized Issuance Costs	0	0
Carrying Value	510,000	280,000
Fair Value	$ 506,175	$ 278,600

Long-Term Debt and Notes Paya_4

Long-Term Debt and Notes Payable - Principal Maturities Of Long-Term Debt (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
2024	$ 58,155
2025	3,151
2026	1,227,461
2027	2,525,341
2028	1,620
Thereafter	10,339
Total	$ 3,826,067	$ 3,665,740
Senior notes | 6.250% senior notes
Debt Instrument [Line Items]
Interest rate of debt (as a percent)	6.25%	6.25%
2024	$ 0
2025	0
2026	1,225,000
2027	0
2028	0
Thereafter	0
Total	1,225,000	$ 1,225,000
Revolving facility | Revolving facility
Debt Instrument [Line Items]
2024	0
2025	0
2026	0
2027	510,000
2028	0
Thereafter	0
Total	510,000	280,000
Term loan
Debt Instrument [Line Items]
2024	0
2025	0
2026	0
2027	2,013,400
2028	0
Thereafter	0
Total	2,013,400	2,092,485
Other debt, including finance leases
Debt Instrument [Line Items]
2024	58,155
2025	3,151
2026	2,461
2027	1,941
2028	1,620
Thereafter	10,339
Total	$ 77,667	$ 68,255

Accrued and other liabilities_2

Accrued and other liabilities (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Payables and Accruals [Abstract]
Accrued payroll	$ 184,801	$ 238,768
Accrued vacation	164,113	157,748
Accrued interest	14,438	32,472
Accrued other	292,587	297,663
Income taxes payable	30,552	1,499
Accrued and other liabilities	$ 686,491	$ 728,150

Interest Rate Cap - Narrative (

Interest Rate Cap - Narrative (Details) - Interest Rate Cap $ in Millions	3 Months Ended
	Mar. 31, 2024 USD ($)
Derivative [Line Items]
Derivative cap interest rate (as a percent)	1%
Notional amount	$ 2,000
Annual premium (in percent)	0.000916
Annual premium amount	$ 1.8
Estimated pre-tax gain expected to be reclassified through expiration	$ 40.7

Interest Rate Cap - Schedule of

Interest Rate Cap - Schedule of Accumulated Other Comprehensive Income (Loss) (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance	$ 1,547,718	$ 1,356,564
Ending balance	1,637,643	1,418,441
Accumulated Gain (Loss), Net, Cash Flow Hedge, Parent | Interest Rate Cap
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance	42,907	88,602
Gain (loss) on interest rate cap cash flow hedge	4,370	(2,696)
Amounts reclassified from accumulated other comprehensive income	(16,347)	(13,252)
Ending balance	$ 30,930	$ 72,654

Interest Rate Cap - Schedule _2

Interest Rate Cap - Schedule of Reclassification out of Accumulated Other Comprehensive Income (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Reclassification Adjustment out of Accumulated Other Comprehensive Income on Derivatives [Line Items]
Gains included in interest expense	$ (50,763)	$ (48,571)
Income tax expense	(36,458)	(26,185)
Amounts reclassified from accumulated other comprehensive income	96,897	70,805
Reclassification out of Accumulated Other Comprehensive Income | Accumulated Gain (Loss), Net, Cash Flow Hedge, Parent | Interest Rate Cap
Reclassification Adjustment out of Accumulated Other Comprehensive Income on Derivatives [Line Items]
Gains included in interest expense	21,509	17,552
Income tax expense	(5,162)	(4,300)
Amounts reclassified from accumulated other comprehensive income	$ 16,347	$ 13,252

Fair Value of Financial Instr_3

Fair Value of Financial Instruments - Schedule of Interest Rate Cap (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Interest rate cap contract, current portion	$ 42,660	$ 58,962
Interest Rate Cap | Fair Value, Inputs, Level 2 | Fair Value, Recurring
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Interest rate cap contract, current portion	$ 42,660	$ 58,962

Fair Value of Financial Instr_4

Fair Value of Financial Instruments - Schedule of Long-Term Debt (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair Value	$ 3,826,244	$ 3,667,340
Senior notes | 6.250% senior notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate of debt (as a percent)	6.25%	6.25%
Carrying Value	$ 1,231,855	$ 1,232,596
Fair Value	1,226,531	1,228,063
Senior notes | Fair Value, Inputs, Level 2 | 6.250% senior notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Value	1,231,855	1,232,596
Fair Value	1,226,531	1,228,063
Revolving facility | Fair Value, Inputs, Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Value	510,000	280,000
Fair Value	506,175	278,600
Term loan
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Value	1,999,339	2,077,216
Fair Value	2,015,917	2,092,485
Term loan | Fair Value, Inputs, Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Value	1,999,339	2,077,216
Fair Value	$ 2,015,917	$ 2,092,485

Segment Information - Selected

Segment Information - Selected Financial Data (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023
Segment Reporting Information [Line Items]
Revenue	$ 1,788,809	$ 1,664,980
Adjusted EBITDA	261,917	214,063
Total assets	7,858,263	7,699,736	$ 7,689,631
Purchases of property, equipment, and other assets	52,517	58,885
Operating Segments | Critical Illness Recovery Hospital
Segment Reporting Information [Line Items]
Revenue	655,880	593,926
Adjusted EBITDA	115,940	76,773
Total assets	2,608,979	2,507,265
Purchases of property, equipment, and other assets	15,941	23,658
Operating Segments | Rehabilitation Hospital
Segment Reporting Information [Line Items]
Revenue	265,700	231,462
Adjusted EBITDA	61,400	47,216
Total assets	1,233,828	1,203,069
Purchases of property, equipment, and other assets	7,101	8,582
Operating Segments | Outpatient Rehabilitation
Segment Reporting Information [Line Items]
Revenue	303,158	295,903
Adjusted EBITDA	24,928	30,199
Total assets	1,423,740	1,397,823
Purchases of property, equipment, and other assets	9,500	9,932
Operating Segments | Concentra
Segment Reporting Information [Line Items]
Revenue	467,598	456,298
Adjusted EBITDA	96,142	93,748
Total assets	2,362,848	2,300,632
Purchases of property, equipment, and other assets	17,231	14,400
Other
Segment Reporting Information [Line Items]
Revenue	96,473	87,391
Adjusted EBITDA	(36,493)	(33,873)
Total assets	228,868	290,947
Purchases of property, equipment, and other assets	$ 2,744	$ 2,313

Segment Information - Reconcili

Segment Information - Reconciliation of Adjusted EBITDA to Income Before Taxes (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Segment Reporting Information [Line Items]
Adjusted EBITDA	$ 261,917	$ 214,063
Depreciation and amortization	(54,069)	(52,425)
Income from operations	193,967	151,457
Equity in earnings of unconsolidated subsidiaries	10,421	8,556
Interest expense	(50,763)	(48,571)
Income before income taxes	153,625	111,442
Operating Segments | Critical Illness Recovery Hospital
Segment Reporting Information [Line Items]
Adjusted EBITDA	115,940	76,773
Depreciation and amortization	(17,157)	(16,637)
Stock compensation expense	0	0
Concentra separation transaction costs	0
Income from operations	98,783	60,136
Operating Segments | Rehabilitation Hospital
Segment Reporting Information [Line Items]
Adjusted EBITDA	61,400	47,216
Depreciation and amortization	(7,135)	(6,888)
Stock compensation expense	0	0
Concentra separation transaction costs	0
Income from operations	54,265	40,328
Operating Segments | Outpatient Rehabilitation
Segment Reporting Information [Line Items]
Adjusted EBITDA	24,928	30,199
Depreciation and amortization	(9,181)	(8,457)
Stock compensation expense	0	0
Concentra separation transaction costs	0
Income from operations	15,747	21,742
Operating Segments | Concentra
Segment Reporting Information [Line Items]
Adjusted EBITDA	96,142	93,748
Depreciation and amortization	(18,485)	(18,310)
Stock compensation expense	(166)	(178)
Concentra separation transaction costs	(1,993)
Income from operations	75,498	75,260
Other
Segment Reporting Information [Line Items]
Adjusted EBITDA	(36,493)	(33,873)
Depreciation and amortization	(2,111)	(2,133)
Stock compensation expense	(11,444)	(10,003)
Concentra separation transaction costs	(278)
Income from operations	$ (50,326)	$ (46,009)

Revenue from Contracts with C_3

Revenue from Contracts with Customers (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Disaggregation of Revenue [Line Items]
Total revenue	$ 1,788,809	$ 1,664,980
Total patient services revenues
Disaggregation of Revenue [Line Items]
Total revenue	1,659,211	1,545,295
Medicare
Disaggregation of Revenue [Line Items]
Total revenue	398,754	385,482
Non-Medicare
Disaggregation of Revenue [Line Items]
Total revenue	1,260,457	1,159,813
Other revenue
Disaggregation of Revenue [Line Items]
Total revenue	129,598	119,685
Operating Segments | Critical Illness Recovery Hospital
Disaggregation of Revenue [Line Items]
Total revenue	655,880	593,926
Operating Segments | Critical Illness Recovery Hospital | Total patient services revenues
Disaggregation of Revenue [Line Items]
Total revenue	654,927	592,688
Operating Segments | Critical Illness Recovery Hospital | Medicare
Disaggregation of Revenue [Line Items]
Total revenue	226,261	229,383
Operating Segments | Critical Illness Recovery Hospital | Non-Medicare
Disaggregation of Revenue [Line Items]
Total revenue	428,666	363,305
Operating Segments | Critical Illness Recovery Hospital | Other revenue
Disaggregation of Revenue [Line Items]
Total revenue	953	1,238
Operating Segments | Rehabilitation Hospital
Disaggregation of Revenue [Line Items]
Total revenue	265,700	231,462
Operating Segments | Rehabilitation Hospital | Total patient services revenues
Disaggregation of Revenue [Line Items]
Total revenue	252,963	219,980
Operating Segments | Rehabilitation Hospital | Medicare
Disaggregation of Revenue [Line Items]
Total revenue	126,386	110,055
Operating Segments | Rehabilitation Hospital | Non-Medicare
Disaggregation of Revenue [Line Items]
Total revenue	126,577	109,925
Operating Segments | Rehabilitation Hospital | Other revenue
Disaggregation of Revenue [Line Items]
Total revenue	12,737	11,482
Operating Segments | Outpatient Rehabilitation
Disaggregation of Revenue [Line Items]
Total revenue	303,158	295,903
Operating Segments | Outpatient Rehabilitation | Total patient services revenues
Disaggregation of Revenue [Line Items]
Total revenue	285,454	277,786
Operating Segments | Outpatient Rehabilitation | Medicare
Disaggregation of Revenue [Line Items]
Total revenue	45,841	45,801
Operating Segments | Outpatient Rehabilitation | Non-Medicare
Disaggregation of Revenue [Line Items]
Total revenue	239,613	231,985
Operating Segments | Outpatient Rehabilitation | Other revenue
Disaggregation of Revenue [Line Items]
Total revenue	17,704	18,117
Operating Segments | Concentra
Disaggregation of Revenue [Line Items]
Total revenue	467,598	456,298
Operating Segments | Concentra | Total patient services revenues
Disaggregation of Revenue [Line Items]
Total revenue	465,867	454,841
Operating Segments | Concentra | Medicare
Disaggregation of Revenue [Line Items]
Total revenue	266	243
Operating Segments | Concentra | Non-Medicare
Disaggregation of Revenue [Line Items]
Total revenue	465,601	454,598
Operating Segments | Concentra | Other revenue
Disaggregation of Revenue [Line Items]
Total revenue	1,731	1,457
Other
Disaggregation of Revenue [Line Items]
Total revenue	96,473	87,391
Other | Total patient services revenues
Disaggregation of Revenue [Line Items]
Total revenue	0	0
Other | Medicare
Disaggregation of Revenue [Line Items]
Total revenue	0	0
Other | Non-Medicare
Disaggregation of Revenue [Line Items]
Total revenue	0	0
Other | Other revenue
Disaggregation of Revenue [Line Items]
Total revenue	$ 96,473	$ 87,391

Earnings per Share - Narrative

Earnings per Share - Narrative (Details) - USD ($)	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Earnings Per Share [Abstract]
Contractual dividends paid	$ 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
	Mar. 31, 2024	Mar. 31, 2023
Earnings Per Share [Abstract]
Net income	$ 117,167	$ 85,257
Less: Net income attributable to non-controlling interests	20,270	14,452
Net income attributable to Select Medical Holdings Corporation	96,897	70,805
Basic EPS
Less: Distributed and undistributed income attributable to participating securities - Basic EPS	3,398	2,573
Distributed and undistributed income attributable to common shares	93,499	68,232
Diluted EPS
Less: Distributed and undistributed income attributable to participating securities - Diluted EPS	3,398	2,573
Distributed and undistributed income attributable to common shares	$ 93,499	$ 68,232

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
	Mar. 31, 2024	Mar. 31, 2023
Net Income Allocation
Net income allocated to common shares - basic	$ 93,499	$ 68,232
Participating securities - basic	3,398	2,573
Net income allocated to common shares - diluted	93,499	68,232
Participating securities - diluted	3,398	2,573
Net income attributable to Select Medical Holdings Corporation	$ 96,897	$ 70,805
Weighted average common shares outstanding, basic (in shares)	123,859	122,553
Weighted average common shares outstanding, diluted (in shares)	123,859	122,553
Weighted average participating securities outstanding (in shares)	4,501	4,622
Basic EPS
Basic EPS (in dollars per share)	$ 0.75	$ 0.56
Diluted EPS
Diluted EPS (in dollars per share)	$ 0.75	$ 0.56

Commitments and Contingencies (

Commitments and Contingencies (Details) $ in Millions	1 Months Ended	3 Months Ended
	Feb. 29, 2024 class_action_lawsuit patient	Mar. 31, 2024 USD ($)
Commitments and Contingencies
Number of patients | patient	4,000,000
Number of class action lawsuits | class_action_lawsuit	6
Professional liability claims | Critical Illness Recovery Hospitals, Rehabilitation Hospitals And Outpatient Rehabilitiation
Commitments and Contingencies
Total annual aggregate limit of insurance coverage		$ 37
Professional liability claims | Concentra
Commitments and Contingencies
Total annual aggregate limit of insurance coverage		29
Professional liability claims | Joint Venture Operations
Commitments and Contingencies
Total annual aggregate limit of insurance coverage		80
Professional liability claims | Joint Venture Operations | Minimum
Commitments and Contingencies
Total annual aggregate limit of insurance coverage		23
Professional liability claims | Joint Venture Operations | Maximum
Commitments and Contingencies
Total annual aggregate limit of insurance coverage		33
General Liability | Critical Illness Recovery Hospitals, Rehabilitation Hospitals And Outpatient Rehabilitiation
Commitments and Contingencies
Total annual aggregate limit of insurance coverage		40
General Liability | Concentra
Commitments and Contingencies
Total annual aggregate limit of insurance coverage		$ 29

Subsequent Events (Details)

Subsequent Events (Details)	May 01, 2024 $ / shares
Subsequent Event
Subsequent Event [Line Items]
Cash dividend declared (in dollars per share)	$ 0.125