USMD 10-Q 16 Nov 15 2015 Q3 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2015	Nov. 10, 2015
Document And Entity Information [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Sep. 30, 2015
Document Fiscal Year Focus	2,015
Document Fiscal Period Focus	Q3
Trading Symbol	USMD
Entity Registrant Name	USMD Holdings, Inc.
Entity Central Index Key	1,507,881
Current Fiscal Year End Date	--12-31
Entity Filer Category	Smaller Reporting Company
Entity Common Stock, Shares Outstanding		11,014,222

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands		Sep. 30, 2015	Dec. 31, 2014
Current assets:
Cash and cash equivalents	[1]	$ 26,471	$ 15,940
Accounts receivable, net of allowance for doubtful accounts of $2,220 and $2,100 at September 30, 2015 and December 31, 2014, respectively	[1]	28,761	24,673
Inventories	[1]	2,310	2,512
Deferred tax assets, net	[1]	6,617	5,873
Prepaid expenses and other current assets	[1]	7,100	4,466
Total current assets	[1]	71,259	53,464
Property and equipment, net	[1]	31,475	20,796
Restricted cash	[1]	6,750
Investments in nonconsolidated affiliates	[1]	60,525	59,780
Goodwill	[1]	97,836	97,836
Intangible assets, net	[1]	14,962	16,613
Other assets	[1]	211	159
Total assets	[1]	283,018	248,648
Current liabilities:
Accounts payable	[2]	10,810	7,708
Accrued payroll	[2]	21,182	13,816
Other accrued liabilities	[2]	19,655	18,373
Other current liabilities	[2]	529	606
Current portion of long-term debt	[2]	1,030	2,040
Current portion of related party long-term debt	[2]	760	746
Current portion of capital lease obligations	[2]	1,439	537
Total current liabilities	[2]	55,405	43,826
Other long-term liabilities	[2]	8,729	1,888
Deferred compensation payable	[2]	4,323	4,491
Long-term debt, less current portion	[2]	34,241	28,264
Related party long-term debt, less current portion	[2]	18,004	3,085
Capital lease obligations, less current portion	[2]	6,736	1,789
Deferred tax liabilities, net	[2]	17,387	20,127
Total liabilities	[2]	$ 144,825	$ 103,470
Commitments and contingencies
USMD Holdings, Inc. stockholders' equity:
Preferred stock, $0.01 par value, 1,000,000 shares authorized; none issued
Common stock, $0.01 par value, 49,000,000 shares authorized; 10,373,125 and 10,181,258 shares issued and outstanding at September 30, 2015 and December 31, 2014, respectively		$ 104	$ 102
Additional paid-in capital		163,204	160,458
Accumulated deficit		(29,061)	(18,750)
Accumulated other comprehensive loss		(2)	(2)
Total USMD Holdings, Inc. stockholders' equity		134,245	141,808
Noncontrolling interests in subsidiaries		3,948	3,370
Total equity		138,193	145,178
Total liabilities and equity		$ 283,018	$ 248,648
[1]	Assets of consolidated variable interest entity ("VIE") included in the consolidated balance sheets above (after elimination of intercompany transactions and balances) consist of: Cash and cash equivalents $ 13,875 $ 10,169 Accounts receivable 1,574 1,150 Prepaid expenses 99 61 Deferred tax asset 3,753 3,850 Total current assets $ 19,301 $ 15,230 The assets of the consolidated VIE can only be used to settle the obligations of the VIE.
[2]	Liabilities of consolidated VIE included in the consolidated balance sheets above (after elimination of intercompany transactions and balances) consist of: Accounts payable $ 3,047 $ 3,517 Other accrued liabilities 12,602 11,506 Total current liabilities $ 15,649 $ 15,023 The liabilities of the consolidated VIE are obligations of the VIE and the creditors have no recourse to USMD Holdings, Inc.

Condensed Consolidated Balance3

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands		Sep. 30, 2015	Dec. 31, 2014
Allowance for doubtful accounts receivable		$ 2,220	$ 2,100
Preferred stock, par value		$ 0.01	$ 0.01
Preferred stock, shares authorized		1,000,000	1,000,000
Preferred stock, issued		0	0
Common stock, par value		$ 0.01	$ 0.01
Common stock, shares authorized		49,000,000	49,000,000
Common stock, shares issued		10,373,125	10,181,258
Common stock, shares outstanding		10,373,125	10,181,258
Cash and cash equivalents	[1]	$ 26,471	$ 15,940
Accounts receivable	[1]	28,761	24,673
Total current assets	[1]	71,259	53,464
Accounts payable	[2]	10,810	7,708
Other accrued liabilities	[2]	19,655	18,373
Total current liabilities	[2]	55,405	43,826
Variable Interest Entity, Primary Beneficiary
Cash and cash equivalents		13,875	10,169
Accounts receivable		1,574	1,150
Prepaid expenses		99	61
Deferred tax asset		3,753	3,850
Total current assets		19,301	15,230
Accounts payable		3,047	3,517
Other accrued liabilities		12,602	11,506
Total current liabilities		$ 15,649	$ 15,023
[1]	Assets of consolidated variable interest entity ("VIE") included in the consolidated balance sheets above (after elimination of intercompany transactions and balances) consist of: Cash and cash equivalents $ 13,875 $ 10,169 Accounts receivable 1,574 1,150 Prepaid expenses 99 61 Deferred tax asset 3,753 3,850 Total current assets $ 19,301 $ 15,230 The assets of the consolidated VIE can only be used to settle the obligations of the VIE.
[2]	Liabilities of consolidated VIE included in the consolidated balance sheets above (after elimination of intercompany transactions and balances) consist of: Accounts payable $ 3,047 $ 3,517 Other accrued liabilities 12,602 11,506 Total current liabilities $ 15,649 $ 15,023 The liabilities of the consolidated VIE are obligations of the VIE and the creditors have no recourse to USMD Holdings, Inc.

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Revenue:
Patient service revenue	$ 50,065	$ 48,907	$ 143,583	$ 139,175
Provision for doubtful accounts related to patient service revenue	(1,161)	(1,013)	(3,499)	(2,276)
Net patient service revenue	48,904	47,894	140,084	136,899
Capitated revenue	24,698	18,500	71,789	47,360
Management and other services revenue	5,284	5,296	15,533	17,409
Lithotripsy revenue	5,881	5,742	16,148	15,930
Net operating revenue	84,767	77,432	243,554	217,598
Operating expenses:
Salaries, wages and employee benefits	42,435	42,637	126,373	123,465
Medical services and supplies expense	28,668	22,517	79,684	58,539
Rent expense	5,184	4,105	13,348	11,780
Provision for doubtful accounts	53	138	(66)	186
Other operating expenses	9,073	7,740	29,128	24,629
Depreciation and amortization	2,519	1,997	6,770	14,173
Total operating expenses	87,932	79,134	255,237	232,772
Loss from operations	(3,165)	(1,702)	(11,683)	(15,174)
Other income (expense):
Interest expense, net	(852)	(706)	(2,345)	(2,099)
Equity in income of nonconsolidated affiliates, net	2,264	2,666	6,777	8,185
Other gain	87		138
Total other income, net	1,499	1,960	4,570	6,086
Income (loss) before income taxes	(1,666)	258	(7,113)	(9,088)
Benefit for income taxes	(952)	(663)	(4,155)	(4,986)
Net income (loss)	(714)	921	(2,958)	(4,102)
Less: net income attributable to noncontrolling interests	(2,827)	(2,667)	(7,353)	(6,980)
Net loss attributable to USMD Holdings, Inc.	$ (3,541)	$ (1,746)	$ (10,311)	$ (11,082)
Loss per share attributable to USMD Holdings, Inc.
Basic	$ (0.34)	$ (0.17)	$ (1)	$ (1.09)
Diluted	$ (0.34)	$ (0.17)	$ (1)	$ (1.09)
Weighted average common shares outstanding
Basic	10,454	10,177	10,353	10,151
Diluted	10,454	10,177	10,353	10,151

Condensed Consolidated Stateme5

Condensed Consolidated Statement of Stockholders' Equity - 9 months ended Sep. 30, 2015 - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Accumulated Other Comprehensive Loss	Accumulated Deficit	Total USMD Holdings Inc.	Noncontrolling Interests in Subsidiaries
Beginning balance at Dec. 31, 2014	$ 145,178	$ 102	$ 160,458	$ (2)	$ (18,750)	$ 141,808	$ 3,370
Beginning balance (in shares) at Dec. 31, 2014	10,181,258	10,181,000
Net income (loss)	$ (2,958)				(10,311)	(10,311)	7,353
Share-based payment expense - stock options	766		766			766
Share-based payment expense - common stock issued	125		125			125
Share-based payment expense - common stock issued (in shares)		15,000
Common stock issued for payment of 2014 accrued compensation	1,857	$ 2	1,855			1,857
Common stock issued for payment of 2014 accrued compensation (in shares)		177,000
Distributions to noncontrolling shareholders	(6,775)						(6,775)
Ending balance at Sep. 30, 2015	$ 138,193	$ 104	$ 163,204	$ (2)	$ (29,061)	$ 134,245	$ 3,948
Ending balance (in shares) at Sep. 30, 2015	10,373,125	10,373,000

Condensed Consolidated Stateme6

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2015		Sep. 30, 2014
Cash flows from operating activities:
Net loss	$ (2,958)		$ (4,102)
Adjustments to reconcile net loss to net cash provided by operating activities:
Provision for doubtful accounts	3,433		2,462
Depreciation and amortization	6,770		14,173
Accretion of debt discount and amortization of debt issuance costs	386		511
(Gain) loss on sale or disposal of assets, net	(18)		230
Gain on sale of ownership interests in nonconsolidated affiliates	(138)
Equity in income of nonconsolidated affiliates, net	(6,777)		(8,185)
Distributions from nonconsolidated affiliates	5,873		11,002
Share-based payment expense	1,934		1,664
Deferred income tax benefit	(3,484)		(7,360)
Change in operating assets and liabilities, net of effects of business combinations:
Accounts receivable	(7,521)		(233)
Inventories	202		(518)
Prepaid expenses and other assets	(1,766)		(774)
Current liabilities	12,546		18,296
Other noncurrent liabilities	733		(41)
Net cash provided by operating activities	9,215		27,125
Cash flows from investing activities:
Cash paid for business combinations, net of cash acquired			(104)
Capital expenditures	(2,920)		(935)
Payments received for the sale of ownership interests in nonconsolidated affiliates	297
Proceeds from sale of property and equipment	18		80
Net cash used in investing activities	(2,605)		(959)
Cash flows from financing activities:
Proceeds from issuance of related party long-term debt	15,457
Proceeds from issuance of long-term debt	4,350
Repayments of borrowings under revolving credit facility			(1,500)
Principal payments on related party long-term debt	(527)		(157)
Payments on long-term debt and capital lease obligations	(1,732)		(8,924)
Payment of debt issuance costs	(102)		(159)
Capital contributions from noncontrolling interests			119
Distributions to noncontrolling interests	(6,775)		(7,013)
Release (restriction) of restricted cash	(6,750)		5,000
Net cash provided by (used in) financing activities	3,921		(12,634)
Net increase in cash and cash equivalents	10,531		13,532
Cash and cash equivalents at beginning of year	15,940	[1]	13,137
Cash and cash equivalents at end of period	26,471	[1]	26,669
Supplemental non-cash investing and financing information:
Property and equipment acquired on account	282		59
Property and equipment acquired through debt or capital lease financing	6,997
Services purchased and financed with debt recorded in other current assets	868
Landlord funded leasehold improvements	1,671
Capitalized construction costs related to build-to-suit financing obligation	3,927
Finance sale of interest in nonconsolidated affiliate with note receivable	159
Cash paid for-
Interest, net of related parties	1,474		1,370
Interest to related parties	291		83
Income tax	1,202		1,915
Cash received for- Income tax refund			11
Accrued Unissued Share-Based Compensation
Supplemental non-cash investing and financing information:
Other significant noncash transaction, value of consideration given	1,043		259
Payment for Liabilities
Supplemental non-cash investing and financing information:
Fair value of common stock issued	$ 1,857		243
Payment for Business Combination
Supplemental non-cash investing and financing information:
Fair value of common stock issued			167
Fair value of assets acquired in business combinations, excluding cash			$ 271
[1]	Assets of consolidated variable interest entity ("VIE") included in the consolidated balance sheets above (after elimination of intercompany transactions and balances) consist of: Cash and cash equivalents $ 13,875 $ 10,169 Accounts receivable 1,574 1,150 Prepaid expenses 99 61 Deferred tax asset 3,753 3,850 Total current assets $ 19,301 $ 15,230 The assets of the consolidated VIE can only be used to settle the obligations of the VIE.

Description of Business, Basis

Description of Business, Basis of Presentation and Recently Issued Accounting Pronouncements	9 Months Ended
	Sep. 30, 2015
Accounting Policies [Abstract]
Description of Business, Basis of Presentation and Recently Issued Accounting Pronouncements	Note 1 – Description of Business, Basis of Presentation and Recently Issued Accounting Pronouncements Description of Business: USMD Holdings, Inc. (“USMD” or the “Company”) is an innovative, early-stage physician-led integrated health system. An integrated health system is considered early-stage when it has not yet established all the components necessary to be considered a fully integrated health system. Through its subsidiaries and affiliates, the Company provides healthcare services to patients and management and operational services to hospitals and other healthcare service providers. The Company provides healthcare services to patients in physician clinics, hospitals and other healthcare facilities, including cancer treatment centers and anatomical pathology and clinical laboratories. A wholly owned subsidiary of the Company is the sole member of a Texas Certified Non-Profit Health Organization that owns and operates a multi-specialty physician group practice (“USMD Physician Services”) in the Dallas-Fort Worth, Texas metropolitan area. Through other wholly owned subsidiaries, the Company provides management and operational services to two general acute care hospitals in the Dallas-Fort Worth, Texas metropolitan area and provides management and/or operational services to three cancer treatment centers in three states and 21 lithotripsy service providers (i.e., kidney stone treatment) primarily located in the South-Central United States. Of these managed entities, the Company has minority ownership interests in the two hospitals, one cancer treatment center and 19 lithotripsy service providers. The Company consolidates the operations of 17 lithotripsy service providers into its financial statements. In addition, the Company wholly owns and operates two clinical laboratories, one anatomical pathology laboratory, one cancer treatment center and two lithotripsy service providers in the Dallas-Fort Worth, Texas metropolitan area. Basis of Presentation: The unaudited condensed consolidated financial statements of the Company have been prepared in conformity with accounting principles generally accepted in the United States (“GAAP”) for interim financial statements and pursuant to the rules and regulations of the Securities and Exchange Commission (the “SEC”) for interim reporting. Certain information and note disclosures normally included in annual financial statements prepared in accordance with GAAP have been condensed or omitted pursuant to those rules and regulations, although the Company believes that the disclosures made are adequate to make the information in this report not misleading. These condensed consolidated financial statements reflect all adjustments that, in the opinion of the Company’s management, are necessary for fair presentation of the condensed consolidated financial statements. The December 31, 2014 condensed consolidated balance sheet data was derived from audited financial statements but does not include all disclosures required by GAAP. The operating results for the interim periods are not necessarily indicative of results for the full fiscal year. These condensed consolidated financial statements should be read in conjunction with the Company’s Annual Report on Form 10-K for the year ended December 31, 2014 filed with the SEC on April 15, 2015. The condensed consolidated financial statements include the accounts of the Company, entities controlled by the Company through its direct or indirect ownership of a majority interest and any other entities in which the Company has a controlling financial interest. The Company consolidates VIEs where the Company is the primary beneficiary. The primary beneficiary of a VIE is the party that has both the power to direct the activities that most significantly impact the VIE’s economic performance and the obligation to absorb losses or the right to receive benefits that could potentially be significant to the VIE. The Company consolidates entities in which it or its wholly owned subsidiary is the general partner or managing member and the limited partners or members, respectively, do not have sufficient rights to overcome the presumption of the Company’s control. The Company eliminates all significant intercompany accounts and transactions in consolidation. The Company uses the equity method to account for investments in entities it or its wholly owned subsidiaries do not control, but over which it or its wholly owned subsidiaries have the ability to exercise significant influence. The Company does not consolidate equity method investments, but rather measures them at their initial cost and subsequently adjusts their carrying values through income for the Company’s respective share of earnings or losses during the period. Recently Issued Accounting Pronouncements In April 2015 the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2015-03, “Interest – Imputation of Interest (Subtopic 835-30) – Simplifying the Presentation of Debt Issuance Costs” (“ASU 2015-03”). ASU 2015-03 requires that debt issuance costs related to a recognized debt liability be presented in the balance sheet as a direct deduction from the carrying amount of that debt liability, consistent with debt discounts. Prior to adoption of this amendment, debt issuance costs are required to be presented in the balance sheet as a deferred charge (an asset). ASU 2015-03 is effective for financial statements issued for fiscal years beginning after December 15, 2015, and interim periods within those fiscal years. Early adoption is permitted. The provisions of ASU 2015-03 must be applied on a retrospective basis. Management is evaluating the impact that adoption of ASU 2015-03 will have on the Company’s consolidated financial statements. In May 2014 the FASB issued ASU No. 2014-09, “Revenue from Contracts with Customers” (“ASU-2014-09”). ASU 2014-09 requires revenue recognition to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. ASU 2014-09 provides a single principles-based, five-step model to be applied to all contracts with customers. The five steps are to identify the contract(s) with the customer, identify the performance obligations in the contact, determine the transaction price, allocate the transaction price to the performance obligations in the contract and recognize revenue when each performance obligation is satisfied. The provisions of ASU 2014-09 may be applied either retrospectively to each prior reporting period presented or retrospectively with the cumulative effect of the update recognized at the date of the initial application along with additional disclosures. On August 14, 2015, the FASB issued ASU No. 2015-14, which defers the effective date of ASU 2014-09 by one year and permits early adoption on a limited basis. As a result of the deferral, ASU 2014-09 will be effective for the Company beginning January 1, 2018. Early adoption is permitted beginning January 1, 2017. Management is evaluating the impact that adoption of ASU 2014-09 will have on the Company’s consolidated financial statements.

Variable Interest Entity

Variable Interest Entity	9 Months Ended
	Sep. 30, 2015
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Variable Interest Entity	Note 2 – Variable Interest Entity In April 2013, the Company became an equal co-member of a Texas non-profit corporation that has been approved by the Texas Medical Board as a Certified Non-Profit Health Organization (“WNI-DFW”). WNI-DFW has a contractual arrangement to manage patient care by providing or arranging for the provision of all the necessary healthcare services for a health plan’s given Medicare Advantage patient population in the North Texas area served by WNI-DFW. Pursuant to the arrangement, WNI-DFW receives a fixed fee per patient under what is typically known as a “risk contract.” Risk contracting refers to a population health management model in which an entity receives from the third party payer a fixed payment per member per month for a defined patient population, and the entity is then responsible for arranging and/or providing all of the healthcare services required by that patient population. The entity accomplishes this by managing patient care and by contracting with healthcare providers to provide needed healthcare services for the patient population. In such a model, the contracting entity is then responsible for incurring or paying for the cost of healthcare services required by that patient population. The entity generates a net surplus if the cost of all healthcare services provided to the patient population is less than the payments received from the third party payer, and it generates a net deficit if the cost of such services is higher than the payments received. On June 1, 2013, WNI-DFW commenced operations. The Company evaluated whether it has a variable interest in WNI-DFW, whether WNI-DFW is a VIE and whether the Company has a controlling financial interest in WNI-DFW. The Company concluded that it has variable interests in WNI-DFW on the basis of its capital contribution to WNI-DFW and because WNI-DFW has entered into a Primary Care Physician Agreement (“PCP Agreement”) with USMD Physician Services. WNI-DFW’s equity at risk, as defined by GAAP, is considered to be insufficient to finance its activities without additional support, and, therefore, WNI-DFW is considered a VIE. In order to determine whether the Company has a controlling financial interest in the VIE and, thus, is the VIE’s primary beneficiary, the Company considered whether it has i) the power to direct the activities of WNI-DFW that most significantly impact its economic performance and ii) the obligation to absorb losses of WNI-DFW that could potentially be significant to it or the right to receive benefits from WNI-DFW that could potentially be significant to it. The Company concluded that the members, the board of directors and the executive management team of WNI-DFW are structured in a way that neither member nor its designee has the individual power to direct the activities of WNI-DFW that most significantly impact its economic performance. Management considered whether the various service and support agreements between WNI-DFW and its members (or their affiliates) provide either variable interest party with this power and concluded that the PCP Agreement between USMD Physician Services and WNI-DFW does provide the power to USMD Physician Services to direct such activities. Under the PCP Agreement, USMD Physician Services is responsible for providing many services related to the growth of the patient population WNI-DFW will manage, the management of that population’s healthcare needs, and the provision of required healthcare services to those patients. The Company has concluded that the success or failure of USMD Physician Services in conducting these activities will most significantly impact the economic performance of WNI-DFW. In addition, the Company’s variable interests in WNI-DFW obligate the Company to absorb deficits and provide it with the right to receive benefits that could potentially be significant to WNI-DFW. As a result of this analysis, the Company concluded that it is the primary beneficiary of WNI-DFW and therefore consolidates the balance sheets, results of operations and cash flows of WNI-DFW. The Company performs a qualitative assessment of WNI-DFW on an ongoing basis to determine if it continues to be the primary beneficiary. The following table summarizes the carrying amounts of the assets and liabilities of WNI-DFW included in the Company’s consolidated balance sheets (after elimination of intercompany transactions and balances) (in thousands): September 30, December 31, Current assets: Cash and cash equivalents $ 13,875 $ 10,169 Accounts receivable 1,574 1,150 Prepaid expenses 99 61 Deferred tax asset 3,753 3,850 Total current assets $ 19,301 $ 15,230 Current liabilities: Accounts payable $ 3,047 $ 3,517 Other accrued liabilities 12,602 11,506 Total current liabilities $ 15,649 $ 15,023 The assets of WNI-DFW can only be used to settle obligations of WNI-DFW. The creditors of WNI-DFW have no recourse to the general credit of the Company. Upon notification from WNI-DFW, the Company is contractually obligated to fund certain cash requirements of WNI-DFW. For the three and nine months ended September 30, 2015, WNI-DFW contributed capitated revenue of $24.7 million and $71.8 million, respectively, and income before provision for income taxes of $2.0 million and $8.0 million (after elimination of intercompany transactions), respectively. For the three and nine months ended September 30, 2014, WNI-DFW contributed capitated revenue of $18.5 million and $47.4 million, respectively, and income before provision for income taxes of $1.7 million and $5.2 million, respectively (after elimination of intercompany transactions). Estimated Medical Claims Liability In connection with the operations of WNI-DFW, the Company makes estimates related to incurred but not reported (“IBNR”) medical claims of WNI-DFW. The patient population to which WNI-DFW provides health services has limited medical claims activity from which claims-based actuarial judgments can be made. In addition, the full population is relatively small for precise actuarial determinations. Therefore, in addition to calculating IBNR claims using an actuarial estimate based on historical medical claims activity, management includes an adjustment factor based on broader patient populations deemed to be similar in risk profile to the WNI-DFW managed patient population. If actual results are not consistent with the Company’s estimate, the Company may be exposed to variances in medical services and supplies expense that may be material. At September 30, 2015 and December 31, 2014, the Company has recorded IBNR claims payable of $12.6 million and $11.4 million, respectively, which is included in other accrued liabilities.

Investments in Nonconsolidated

Investments in Nonconsolidated Affiliates	9 Months Ended
	Sep. 30, 2015
Equity Method Investments and Joint Ventures [Abstract]
Investments in Nonconsolidated Affiliates	Note 3 – Investments in Nonconsolidated Affiliates The net carrying values and ownership percentages of nonconsolidated affiliates accounted for under the equity method are as follows (dollars in thousands): September 30, 2015 December 31, 2014 Carrying Ownership Carrying Ownership USMD Hospital at Arlington, L.P. $ 50,409 46.40% $ 49,518 46.40% USMD Hospital at Fort Worth, L.P. 9,989 30.88% 9,956 30.88% Other 127 3%-34% 306 4%-34% $ 60,525 $ 59,780 At September 30, 2015, USMD Hospital at Arlington, L.P. (“USMD Arlington”) and USMD Hospital at Fort Worth, L.P. (“USMD Fort Worth”) were significant equity investees, as that term is defined by SEC Regulation S-X Rule 8-03(b)(3). Financial information for USMD Arlington and USMD Forth Worth is as follows (in thousands): Three Months Ended Nine Months Ended 2015 2014 2015 2014 USMD Arlington: Revenue $ 24,953 $ 24,159 $ 71,376 $ 67,711 Income from operations $ 5,281 $ 5,212 $ 15,537 $ 15,009 Net income $ 4,327 $ 4,916 $ 13,536 $ 13,232 USMD Fort Worth: Revenue $ 6,255 $ 10,873 $ 17,761 $ 29,417 Income from operations $ 732 $ 3,064 $ 1,524 $ 7,449 Net income $ 588 $ 2,861 $ 1,092 $ 6,871

Patient Service Revenue

Patient Service Revenue	9 Months Ended
	Sep. 30, 2015
Health Care Organizations [Abstract]
Patient Service Revenue	Note 4 – Patient Service Revenue The Company’s patient service revenue by payer is summarized in the table that follows (dollars in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2015 2014 2015 2014 Amount Ratio of Net Amount Ratio of Net Amount Ratio of Net Amount Ratio of Net Medicare $ 15,361 31.4 % $ 14,498 30.3 % $ 44,811 32.0 % $ 41,166 30.1 % Medicaid 76 0.2 350 0.7 522 0.4 1,084 0.8 Managed care and commercial payers 33,385 68.3 33,185 69.3 95,331 68.1 94,274 68.9 Self-pay 1,243 2.5 874 1.8 2,919 2.1 2,651 1.9 Patient service revenue before provision for doubtful accounts 50,065 102.4 48,907 102.1 143,583 102.5 139,175 101.7 Patient service revenue provision for doubtful accounts (1,161 ) (2.4 ) (1,013 ) (2.1 ) (3,499 ) (2.5 ) (2,276 ) (1.7 ) Net patient service revenue $ 48,904 100.0 % $ 47,894 100.0 % $ 140,084 100.0 % $ 136,899 100.0 % Allowance for Doubtful Accounts The allowance for doubtful accounts is based on management’s assessment of the collectibility of patient and customer accounts. The Company regularly reviews this allowance by considering factors such as historical experience, credit quality, the age of the accounts receivable balances and current economic conditions that may affect a patient’s or customer’s ability to pay. Uncollectible accounts are written off once collection efforts are exhausted. At September 30, 2015 and December 31, 2014, the allowance for doubtful accounts was 7.2% and 7.8%, respectively, of accounts receivable. A summary of the Company’s accounts receivable allowance for doubtful accounts activity is as follows (in thousands): Balance at Provision Revenue Provision Write-offs, net of Balance at 2015 $ 2,100 3,499 (66 ) (3,313 ) $ 2,220

Intangible Assets

Intangible Assets	9 Months Ended
	Sep. 30, 2015
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets	Note 5 – Intangible Assets The components of amortizable intangible assets consist of the following (in thousands): September 30, 2015 December 31, 2014 Gross Accumulated Net Gross Accumulated Net Management agreements $ 5,246 $ (883 ) $ 4,363 $ 5,246 $ (738 ) $ 4,508 Trade names 11,168 (9,239 ) 1,929 11,168 (8,845 ) 2,323 Customer relationships 767 (767 ) — 767 (596 ) 171 Noncompete agreements 12,547 (3,877 ) 8,670 12,547 (2,936 ) 9,611 $ 29,728 $ (14,766 ) $ 14,962 $ 29,728 $ (13,115 ) $ 16,613 For the three and nine months ended September 30, 2015, aggregate amortization expense of intangible assets totaled $0.5 million and $1.7 million, respectively. For the three and nine months ended September 30, 2014, aggregate amortization expense of intangible assets totaled $0.6 million and $9.9 million, respectively, including an $8.4 million impairment loss. Total estimated amortization expense for the Company’s intangible assets through the end of 2015 and during the four succeeding years is as follows (in thousands): October through December 2015 $ 493 2016 $ 1,974 2017 $ 1,972 2018 $ 1,972 2019 $ 1,665

Other Accrued Liabilities

Other Accrued Liabilities	9 Months Ended
	Sep. 30, 2015
Payables and Accruals [Abstract]
Other Accrued Liabilities	Note 6 – Other Accrued Liabilities Other accrued liabilities consist of the following (in thousands): September 30, December 31, Accrued payables $ 2,798 $ 3,246 Accrued bonus 2,383 2,000 Other accrued liabilities 1,379 1,078 IBNR claims payable 12,589 11,379 Income taxes payable 506 670 $ 19,655 $ 18,373

Long-Term Debt and Capital Leas

Long-Term Debt and Capital Lease Obligations	9 Months Ended
	Sep. 30, 2015
Debt Disclosure [Abstract]
Long-Term Debt and Capital Lease Obligations	Note 7 – Long-Term Debt and Capital Lease Obligations Long-term debt and capital lease obligations consist of the following (in thousands): September 30, December 31, USMD Holdings, Inc.: Credit Agreement: Term Loan $ 6,750 $ 7,500 Revolving line of credit — — Convertible subordinated notes due 2019, net of unamortized discount of $2,516 and $2,978 at September 30, 2015 and December 31, 2014, respectively 21,826 21,364 Convertible subordinated notes due 2020 (including $700 related party notes) 5,050 — Subordinated related party notes payable 3,304 3,831 USMD Arlington related party advance, net of unamortized discount of $240 at September 30, 2015 14,760 — Other loans payable 984 212 Capital lease obligations 7,253 1,032 59,927 33,939 Consolidated lithotripsy entities: Notes payable 1,361 1,228 Capital lease obligations 922 1,294 2,283 2,522 Total long-term debt and capital lease obligations 62,210 36,461 Less: current portion (3,229 ) (3,323 ) Long-term debt and capital lease obligations, less current portion $ 58,981 $ 33,138 USMD Arlington Related Party Advance On September 18, 2015, the Company and the other partners of USMD Arlington amended the partnership agreement of USMD Arlington to allow for a one-time special distribution from USMD Arlington to the Company. USMD Arlington financed the special distribution with the proceeds of new debt issued by USMD Arlington in the original principal amount of $15,000,000, which USMD Arlington borrowed specifically for the purpose of funding the special distribution. The Company received proceeds from the special distribution of $14.8 million, net of lender fees. The Company has determined that the special distribution is, in substance, a debt arrangement (the “Advance”). The Advance accrues interest that is payable to USMD Arlington at the 30-Day London Interbank Offered Rate plus a margin of 2.85% (3.04% at September 30, 2015). In addition, the Company is required to pay the limited partners of USMD Arlington a pre-determined quarterly financing fee equal to 3.22% per annum of the scheduled outstanding balance at the end of each month. To the extent available, principal and interest payments due on the Advance will be withheld monthly from future USMD Arlington distributions otherwise due to the Company. If distributions to the Company withheld by USMD Arlington for any three month period ending in February, May, August or November during the debt term are less than principal and interest payments due for that three month period, the Company will make payments in amounts equal to the difference between amounts withheld from distributions and amounts due for that three month period. Subject to the preceding terms, principal payments of $312,500 are due monthly beginning December 31, 2016 and the debt matures November 28, 2020. If the Company fails to make payments due under the terms of the Advance, the Company’s ownership interest in USMD Arlington may be reduced and the ownership interest of the limited partners of USMD Arlington may be proportionally increased. In connection with the Advance, the Company incurred debt issuance costs of $43,000, which will be amortized through the maturity date using the effective interest method. Amendments to Credit Agreement On August 11, 2015 and September 18, 2015, respectively, the Company entered into Amendment No. 9 to Credit Agreement (“Amendment No. 9”) and Amendment No. 10 to Credit Agreement (“Amendment No. 10”) (collectively, the “Amendments”) with Southwest Bank, as administrative agent for the lenders (“Administrative Agent”), to amend that certain Credit Agreement dated August 31, 2012 (as previously amended, the “Credit Agreement”). Amendment No. 9 to Credit Agreement was effective June 30, 2015. Amendment No. 9 restructures the Company’s $6.75 million term loan facility (the “Term Loan”) and modifies certain financial covenants, among other provisions. Amendment No. 10 approves the Advance and modifies certain definitions, as needed, to reflect the Advance or to include or exclude the debt and debt services associated with such loan from the definitions relating to fixed charges, and the senior leverage ratio. The Amendments require the Company to fully cash collateralize the $6.75 million Term Loan, which is presented as restricted cash on the Company’s consolidated balance sheet. The cash held as collateral is held in a segregated account with the Administrative Agent. The account is governed by a deposit account control agreement executed in connection with Amendment No. 9 and bears interest at a rate of 0.55% per annum. The Company does not have the right to withdraw funds from such account without the prior written consent of the Administrative Agent. The Company may, however, prepay the Term Loan at any time, in whole or in part, with the cash held in the segregated account. Once the Term Loan was fully cash collateralized, the Company was no longer required to make scheduled principal payments on the Term Loan and the outstanding principal balance of the Term Loan will be due and payable at maturity. The Term Loan bears interest at a rate of 1.80% per annum. Amendment No. 10 requires the Company to meet a senior leverage ratio of no greater than 1.00:1.00 in order to borrow funds under the revolving credit facility and to pay down the borrowings under the revolving credit facility in the event its senior leverage ratio exceeds 1.00:1.00. Beginning on September 30, 2016, Amendment No. 9 requires the Company to maintain a fixed charge coverage ratio of at least 1.25:1.00. Both covenants are calculated on a rolling four quarter basis. However, not more than once during any period of four consecutive fiscal quarters, the Company is permitted to maintain compliance with its financial covenants if the fixed charge coverage ratio is at least 1.00:1.00 and the senior leverage ratio is no greater than 1.25:1.00. Under the Credit Agreement as revised by the Amendments, if the Term Loan is fully cash collateralized and there are no borrowings under the revolving credit facility, the fixed charge coverage ratio will not be tested in any fiscal quarter ending on or after September 30, 2016, and the senior leverage ratio will not be tested in any fiscal quarter ending on or after September 30, 2015. Convertible Subordinated Notes Due 2020 On April 29, 2015, the Company issued convertible subordinated notes in the aggregate principal amount of $1.55 million (the “2020-11 Convertible Notes”) to private investors. The 2020-11 Convertible Notes mature on November 1, 2020 and bear interest at a fixed rate of 7.25% per annum. Interest will be paid monthly, in cash or in shares of common stock as the Company elects, on the last day of each month commencing on May 31, 2015. Principal is due in full at maturity. The Company may prepay the 2020-11 Convertible Notes, in whole or in part, at any time after April 29, 2016 without penalty. Each noteholder will have the right at any time after April 29, 2016, prior to the payment in full of the 2020-11 Convertible Note, to convert all or any part of the unpaid principal balance of the 2020-11 Convertible Note into shares of common stock of the Company at the rate of one share of common stock for each $10.61 of principal. The conversion rate will be appropriately adjusted for stock splits, mergers or other fundamental corporate transactions. The conversion option has no cash settlement provisions. The 2020-11 Convertible Notes are convertible into 146,086 common shares of the Company at a conversion price of $10.61 per share. Three members of the Company’s Board of Directors hold 2020-11 Convertible Notes totaling $0.7 million. Effective March 13, 2015, the Company issued convertible subordinated notes in the aggregate principal amount of $3.5 million (the “2020-09 Convertible Notes”) to private investors. The 2020-09 Convertible Notes mature on September 1, 2020 and bear interest at a fixed rate of 7.75% per annum. Interest payments are due and payable on the last day of each month and may be paid in cash or in shares of common stock of the Company, as the Company elects. Principal is due in full upon maturity. The Company may prepay the 2020-09 Convertible Notes, in whole or in part, at any time after March 13, 2016 without penalty. Each noteholder has the right at any time after March 13, 2016, prior to the payment in full of the 2020-09 Convertible Note, to convert all or any part of the unpaid principal balance of the 2020-09 Convertible Note into shares of common stock of the Company at the rate of one share of common stock for each $11.10 of principal. The conversion price will be appropriately adjusted for stock splits, mergers or other fundamental corporate transactions. The conversion option has no cash settlement provisions. The 2020-09 Convertible Notes are convertible into 315,315 common shares of the Company at a conversion price of $11.10 per share. The indebtedness represented by the convertible subordinated notes due in 2020 is expressly subordinate to all senior indebtedness of the Company currently outstanding or incurred in the future, which includes indebtedness in connection with its Credit Agreement. The Company evaluated the conversion options embedded in the convertible subordinated notes due in 2020 and concluded that the options do not meet the criteria for bifurcation and separate accounting as a derivative as they are indexed to the Company’s own stock and, if freestanding, would be classified in stockholders’ equity. Specifically, the variables affecting any adjustment to the conversion price would be inputs to the fair value of a fixed-for-fixed option on equity shares, or are otherwise designed to maintain the economic position of both parties before and after the event that precipitates an adjustment of the conversion price (i.e. merger). Other Loans Payable Effective August 31, 2015, the Company entered into an arrangement to finance $0.5 million of its annual directors and officers insurance policy. The loan bears interest at a fixed rate of 3.53% and principal and interest payments are due monthly in eleven equal installments of $45,000 beginning September 30, 2015 until maturity in July 2016. In connection with the master lease arrangement described below, the Company financed $0.3 million of training and implementation services purchased from the equipment vendor. The financing arrangements were effective August 4, 2015 and have terms of 66, 55 and 44 months. Beginning March 2016, the financing arrangement requires aggregate minimum monthly payments of $7,000, which will reduce beginning in 2019 as the shorter term arrangements are paid off. The financing arrangements bear interest at fixed rates with a weighted average of 5.0%. From inception to the first payment date, interest charges will be added to the loan balance. In 2014, concurrent with a capital lease of medical equipment for the USMD Arlington Independent Diagnostic Testing Facility (“IDTF”), the Company financed $157,000 of training and implementation services purchased from the equipment vendor. In July 2015, concurrent with additions to the capital lease, $52,000 of additional services was added to the loan. The financing arrangement requires 25 quarterly principal and interest payments of $11,000 beginning September 30, 2015. The financing arrangements bear interest at fixed rates with a weighted average of 6.4%. From inception to the first payment date, interest charges were added to the loan balance. Capital Lease Obligations In connection with establishment of an IDTF at USMD Arlington, the Company entered into a master leasing arrangement with the financing subsidiary of an equipment vendor. Under this arrangement, the Company has entered into twelve leases for medical systems totaling $5.4 million. The leases have terms of 66, 55 and 44 months. Beginning at the lease commencement date, the 66 month leases require minimum monthly payments of $63,000, the 55 month lease requires minimum monthly payments of $8,000 and the 44 month leases require minimum monthly payments of $53,000. Effective with delivery and acceptance, the equipment leases commenced in August 2015. In July 2015, the Company entered into a capital lease to finance the acquisition of electronic health record software licenses totaling $1.0 million. The lease required an initial payment of $80,000 on July 7, 2015 followed by 35 monthly payments of $25,000 beginning August 7, 2015. In 2014, in connection with establishment of the USMD Arlington IDTF, the Company entered into a capital lease to finance the purchase of medical equipment totaling $0.6 million. In July 2015, the Company added $0.1 million of equipment to the capital lease. Payments are variable subject to a defined per-use minimum. The lease requires 25 minimum quarterly payments of $35,000 beginning September 30, 2015. From lease inception to the first payment date, interest was added to the capital lease balance. Consolidated Lithotripsy Entities – Notes Payable In May 2015, one of the Company’s consolidated lithotripsy partnerships acquired equipment totaling $0.5 million and executed a note payable to finance the full amount of the purchased equipment. The note bears interest at a fixed rate of 2.95% and principal and interest payments are due monthly in 60 equal installments of $8,513 until maturity in May 2020. The note is secured by the financed equipment. Long-Term Debt Maturities Maturities of the Company’s long-term debt at September 30, 2015, excluding unamortized debt discounts, are as follows (in thousands): October through December 2015 $ 445 2016 8,446 2017 5,766 2018 4,830 2019 28,342 Thereafter 8,962 Total $ 56,791

Fair Value of Financial Instrum

Fair Value of Financial Instruments	9 Months Ended
	Sep. 30, 2015
Fair Value Disclosures [Abstract]
Fair Value of Financial Instruments	Note 8 – Fair Value of Financial Instruments Financial instruments consist mainly of cash and cash equivalents, accounts receivable, accounts payable, short-term borrowings and long-term debt. The carrying value of financial instruments with a short-term or variable-rate nature approximate fair value and are not presented in the table below. The carrying value and estimated fair value of the Company’s financial instruments that do not approximate fair value are set forth in the table below (in thousands): September 30, 2015 December 31, 2014 Carrying Fair Value Carrying Fair Value Term Loan $ 6,750 $ 6,750 $ 7,500 $ 7,500 Convertible subordinated notes due 2019 $ 21,826 $ 17,510 $ 21,364 $ 19,857 Convertible subordinated notes due 2020 $ 5,050 $ 4,218 $ — $ — Subordinated related party notes payable $ 3,304 $ 3,208 $ 3,831 $ 3,689 Consolidated lithotripsy entity notes payable $ 1,361 $ 1,360 $ 1,228 $ 1,228 Other loans payable $ 538 $ 537 $ 212 $ 213 At September 30, 2015 and December 31, 2014, the carrying value of the Company’s Term Loan approximates fair value due to recent amendment of the debt at September 30, 2015 and recent issuance of the debt at December 30, 2014. No events have occurred subsequent to issuance and amendment of the Term Loan to substantially impact the estimated borrowing rate applicable to the Term Loan. The Company estimates the fair value of the convertible subordinated notes as the sum of the independently estimated fair values of the debt host instrument and embedded conversion option (Level 3 fair value measurement). The Company calculates the present value of future principal and interest payments of the debt host using estimated borrowing rates for similar subordinated debt or debt for which the Company could use to retire the existing debt. The recently issued convertible subordinated notes due 2020 have effective interest rates that are higher than the effective interest rates of the convertible subordinated notes due 2019. Consequently, beginning with the June 30, 2015 disclosure of fair value of the convertible subordinated notes due 2019, the estimated borrowing rate used in the calculation of fair value was increased commensurate with the borrowing rate of the convertible subordinated notes due 2020. The fair value of the embedded conversion option is valued using a Black-Scholes option pricing model. Quoted market prices are not available for the convertible subordinated notes. The Company estimates the fair value of its subordinated related party notes using discounted cash flows based primarily on borrowing rates currently available to it for similar debt or debt for which the Company could use the proceeds to retire existing debt (Level 3 fair value measurement). The Company’s consolidated lithotripsy entities enter into term notes for equipment; borrowing rates are based on individual entity creditworthiness. The Company estimates current borrowing rates for the lithotripsy entity notes payable and its other loans payable by adjusting the discount factor of the obligations at the balance sheet date by the variance in borrowing rates between the issuance dates and balance sheet date (Level 2 fair value measurement). If the creditworthiness of an individual lithotripsy entity has significantly changed from the debt issuance date, management estimates the applicable borrowing rate based on the current facts and circumstances. Quoted market prices are not available for the Company’s long-term debt.

Share-Based Payment

Share-Based Payment	9 Months Ended
	Sep. 30, 2015
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Share-Based Payment	Note 9 – Share-Based Payment Pursuant to the USMD Holdings, Inc. 2010 Equity Compensation Plan, as amended (the “Equity Compensation Plan”), the Company may grant equity awards to employees, nonemployee directors and nonemployee service providers in the form of stock options, restricted stock and stock appreciation rights. The terms of the Equity Compensation Plan provide for the reservation of up to 2.5 million shares of common stock for issuance under the Equity Compensation Plan. At September 30, 2015, the Company had 1.2 million shares available for grant under the Equity Compensation Plan. Stock Options On August 6, 2015, the Company granted options to purchase 100,000 shares of the Company’s common stock with a strike price of $8.21 per share. The options were granted pursuant to the Equity Compensation Plan and had a grant date fair value of $3.03 per share. Options for 20,000 shares vested on the grant date and the remaining options will vest at a rate of 20,000 shares per year on January 1 of each calendar year, beginning on January 1, 2016, until fully vested. The options expire on August 6, 2023. Payments in Common Stock For services rendered as members of the Company’s Board of Directors, the Company has elected to compensate directors in common stock of the Company in lieu of cash. Beginning with the second quarter of 2015, grant dates occur on the last day of each quarter for services rendered during that quarter. Previously, shares were granted on the last day of each month. Shares granted are fully vested, non-forfeitable and granted pursuant to the Equity Compensation Plan. For their services as directors during the three and nine months ended September 30, 2015, the Company granted to members of its Board of Directors an aggregate 21,316 and 53,050, respectively, shares of its common stock. The grant date fair value of the shares was $153,000 and $478,000, respectively, which is included in other operating expenses on the Company’s statement of operations. On February 20, 2015, in payment of Board of Directors’ compensation earned August 1, 2014 through December 31, 2014, the Company issued to members of the Company’s Board of Directors 30,724 previously granted shares of its common stock with an aggregate grant date fair value of $273,000. On July 9, 2015, in payment of certain 2014 bonuses due to physicians and compensation deferred by certain physicians in the first quarter of 2015, the Company granted and issued 26,764 shares of its common stock to those physicians. The shares had a grant date fair value of $225,000 and were issued pursuant to the Company’s Equity Compensation Plan. On April 28, 2015 in payment of a portion compensation deferred by certain physicians in the fourth quarter of 2014, the Company granted and issued 78,368 shares of its common stock to those physicians. The shares had a grant date fair value of $785,000 and were issued pursuant to the Company’s Equity Compensation Plan. Pursuant to the Company’s Equity Compensation Plan, on March 4, 2015, in payment of certain compensation accrued at December 31, 2014, the Company granted 40,311 shares of its common stock to certain executives and members of senior management. The shares had a grant date fair value of $549,000 and were issued on March 6, 2015. On March 5, 2015, in payment of salaries deferred in 2014 under the Company’s Salary Deferral Plan, the Company issued 15,700 shares of its common stock to certain executives and members of senior management. The shares had a grant date fair value of $150,000 and were issued pursuant to the Company’s Equity Compensation Plan. For the three and nine months ended September 30, 2015, pursuant to the Company’s Salary Deferral Plan, the Company granted 32,093 and 63,504, respectively, shares of its common stock. The grant date fair value of the shares was $229,000 and $527,000, respectively, which is included in salaries, wages and employee benefits on the Company’s statement of operations. The shares were granted in payment of salary amounts deferred during the first and second quarters of 2015. A consultant to the Company has agreed to be partially compensated in common stock for services rendered. Grant dates occur on the last day of each month and shares granted are fully vested and non-forfeitable. Pursuant to the Equity Compensation Plan, during the nine months ended September 30, 2015, the Company granted to the consultant 4,129 shares of common stock with a grant date fair value of $38,000.

Earnings (loss) per Share

Earnings (loss) per Share	9 Months Ended
	Sep. 30, 2015
Earnings Per Share [Abstract]
Earnings (loss) per Share	Note 10 – Earnings (loss) per Share Basic earnings (loss) per share is computed by dividing net income (loss) attributable to the Company’s stockholders by the weighted-average number of common shares outstanding during the period, including fully vested common shares that have been granted, but not yet issued. Diluted earnings (loss) per share is based on the weighted-average number of common shares outstanding plus the number of additional shares that would have been outstanding had the potentially dilutive common shares been issued. Securities that are potentially dilutive to common shares include outstanding stock options and the convertible subordinated notes. Potential common shares are excluded from the computation of diluted earnings per common share when the effect would be antidilutive. Dilutive potential common shares related to stock options are calculated in accordance with the treasury stock method, which assumes that proceeds from the exercise of stock options are used to purchase common shares at the average market price during the period. Proceeds from the exercise of stock options include the amount the employee must pay for exercising stock options, the amount of compensation cost for future services that the Company has not yet recognized and the amount of tax benefits that would be recorded in additional paid-in capital when the award becomes deductible. The number of shares remaining represents the potentially dilutive effect of the securities. Stock options are only dilutive to the extent that the average market price of common stock during the period exceeds the exercise price of the options. Dilutive common shares related to the convertible subordinated notes are calculated in accordance with the if-converted method. Under the if-converted method, if dilutive, net income (loss) attributable to the Company’s stockholders is adjusted to add back the amount of after-tax interest charges recognized in the period, including any deemed interest from a beneficial conversion feature, and the convertible subordinated notes are assumed to have been converted with the resulting common shares added to weighted average shares outstanding. These securities are only dilutive to the extent that the after-tax interest charges per common share exceed basic earnings per share. The following table presents a reconciliation of the numerators and denominators of basic and diluted earnings (loss) per share and the computation of basic and diluted earnings (loss) per share (in thousands, except per share data): Three Months Ended Nine Months Ended 2015 2014 2015 2014 Numerator: Net loss attributable to USMD Holdings, Inc. - basic $ (3,541 ) $ (1,746 ) $ (10,311 ) $ (11,082 ) Effect of potentially dilutive securities: Interest on convertible notes, net of tax — — — — Net loss attributable to USMD Holdings, Inc. - diluted $ (3,541 ) $ (1,746 ) $ (10,311 ) $ (11,082 ) Denominator: Weighted-average common shares outstanding 10,454 10,177 10,353 10,151 Effect of potentially dilutive securities: Stock options — — — — Convertible subordinated notes due 2019 — — — — Convertible subordinated notes due 2020 — — — — Weighted-average common shares outstanding assuming dilution 10,454 10,177 10,353 10,151 Loss per share attributable to USMD Holdings, Inc.: Basic $ (0.34 ) $ (0.17 ) $ (1.00 ) $ (1.09 ) Diluted $ (0.34 ) $ (0.17 ) $ (1.00 ) $ (1.09 ) The following table presents the potential shares excluded from the diluted earnings (loss) per share calculation because the effect of including theses potential shares would be antidilutive (in thousands): Three Months Ended Nine Months Ended 2015 2014 2015 2014 Stock options 966 802 966 802 Convertible subordinated notes due 2019 1,042 1,042 1,042 1,042 Convertible subordinated notes due 2020 461 — 461 — 2,469 1,844 2,469 1,844

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2015
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Note 11 – Commitments and Contingencies Financial Guarantees As of September 30, 2015, the Company had issued guarantees to third parties of the indebtedness and other obligations of certain of its current and one former nonconsolidated investees. Should the investees fail to pay the obligations due, the Company could be required to make payments totaling an aggregate of $24.9 million. The guarantees provide for recourse against the investee; however, generally, if the Company was required to perform under the guarantees, recovery of any amount from investees would be unlikely. Included in the guarantee amount above is the Company’s guarantee of 46.4% of the obligations of USMD Arlington that were incurred to finance the Advance to the Company. If the Company was required to perform under that guarantee or record a liability for that guarantee, its obligations under the Advance would likely decrease by an equal amount. The remaining terms of these guarantees range from 15 to 152 months. The Company records a liability for performance under financial guarantees when, upon review of available financial information of the nonconsolidated affiliate and in consideration of pertinent factors, management determines that it is probable it will have to perform under the respective guarantee and the liability is reasonably estimable. The Company has not recorded a liability for these guarantees, as it believes it is not probable that it will have to perform under these agreements. Purchase Commitments In connection with arrangements to lease equipment for the new IDTF at USMD Arlington, the Company entered into service and maintenance agreements for the equipment. Future minimum payments due under these service agreements are as follows: October through December 2015 $ 52 2016 966 2017 846 2018 845 2019 846 Thereafter 819 Total $ 4,374 Gain Contingency - Sale of Interest in Equity Method Investee Effective January 31, 2015, a subsidiary of the Company sold for $1.6 million its interest in a cancer treatment center that it accounted for under the equity method of accounting. The investment had a carrying value of $159,000. The interest was sold to the other owner of the cancer treatment center. The buyer issued a promissory note to the Company for the $1.6 million sale price; however, the Company concluded that only $159,000 of the note was reasonably assured of collection and recorded a note receivable in that amount. Upon collection of the $159,000 note receivable, the Company began recognizing gain on the sale as additional payments are received. For the nine months ended September 30, 2015, the Company had recognized an aggregate gain on the sale of $138,000, which is recorded in other gain on the Company’s consolidated statement of operations. The Company had provided management services to the cancer treatment center under a long term contract and the contract was terminated with the sale of its interest. Litigation The Company is from time to time subject to litigation and related claims and arbitration matters arising in the ordinary course of business, including claims relating to contracts and financial obligations, partnership or joint venture entity disputes and, with respect to USMD Physician Services, claims arising from the provision of professional medical services to patients. In some cases, plaintiffs may seek damages, including punitive damages that may not be covered by insurance. In other cases, claims may not be covered by insurance at all. The Company maintains professional and general liability insurance through commercial insurance carriers for claims and in amounts that the Company believes to be sufficient for its operations, although, potentially, some claims may exceed the scope and amount of coverage in effect. The Company expenses as incurred legal costs associated with litigation or other loss contingencies. The Company accrues for a contingent loss when it is both probable that a liability has been incurred and the amount of the loss can be reasonably estimated. Significant judgment is required in both the determination of the probability of a loss and the determination as to whether a loss is reasonably estimable. These determinations are updated at least quarterly and are adjusted to reflect the effects of negotiations, settlements, rulings, advice of legal counsel and technical experts and other information and events pertaining to a particular matter. To the extent there is a reasonable possibility that probable losses could exceed amounts already accrued, if any, and the additional loss or range of loss is estimable, management discloses the additional loss or range of loss. For matters where the Company has evaluated that a loss is not probable, but is reasonably possible, the Company will disclose an estimate of the possible loss or range of loss or make a statement that such an estimate cannot be made. Certain subsidiaries of the Company in the ordinary course of business are party to various medical negligence lawsuits and wrongful termination lawsuits. In addition, subsidiaries of the Company have received notices of potential medical loss claims. For lawsuits and claims where the Company can reasonably estimate a range of loss, the Company estimates a reasonably possible range of loss of $0.2 million to $1.2 million. In the remaining lawsuits and the potential claims, the parties are in the early stages of discovery and/or the plaintiffs have not made specific demands for damages. Due to these circumstances, the Company is unable to estimate a reasonably possible range of loss related to these lawsuits and claims. The Company is insured against the claims described above and believes based on the facts known to date that any damage award related to such claims would be recoverable from its insurer. The Company is subject to various additional claims and legal proceedings that have arisen in the ordinary course of its business activities. Management believes that any liability that may ultimately result from the resolution of these matters will not have a material adverse effect on the financial condition, results of operations or cash flows of the Company. Financial Advisory Commitment The Company has in place with an investment banking firm a financial advisory services agreement, as amended, (“FAS Agreement”). Under the FAS Agreement, the Company may be obligated to compensate the firm in cash for certain financial transactions, depending on the transaction type and size, in amounts generally equal to the greater of a minimum $1.0 million to $3.0 million, a percentage of the potential transaction value, or a fee to be determined in the future based on prevailing market rates for the services provided, subject to the review and restrictions imposed by the Financial Industry Regulatory Authority as further defined in the FAS Agreement. If the Company enters into a qualifying financial transaction during a one year to thirty month period subsequent to termination of the FAS Agreement, depending on the transaction type and size, the investment banking firm may be entitled to compensation under the terms of the FAS Agreement. The FAS Agreement remains in effect until terminated by either party. As of September 30, 2015, the Company has not closed any transaction for which compensation is due to the investment banking firm. Build-to-Suit Lease For build-to-suit lease arrangements, the Company evaluates lease terms to assess whether, for accounting purposes, it should be the owner of the construction project. Under build-to-suit lease arrangements, to the extent the Company is involved in the construction of structural improvements or takes construction risk prior to commencement of a lease, the Company establishes assets and liabilities for the estimated construction costs of the shell facility. Improvements to the facility during the construction project are capitalized, and, to the extent funded by a tenant improvement allowance, the facility financing obligation is increased. Upon occupancy of facilities under build-to-suit leases, the Company assesses whether these arrangements qualify for sales recognition under the sale-leaseback accounting guidance. If the Company continues to be the deemed owner for accounting purposes, the facilities are accounted for as financing obligations. Payments the Company makes under leases in which we are considered the owner of the facility are allocated to land rental expense, based on the relative values of the land and building at the commencement of construction, reductions of the facility financing obligation and interest expense recognized on the outstanding obligation. To the extent gross future payments do not equal the recorded liability, the liability is settled upon return of the facility to the lessor. Any difference between the book value of the assets and remaining facility obligation are recorded in other income (expense), net. For existing arrangements, the differences are expected to be immaterial. The Company has entered into an arrangement to lease the majority of medical office building space in a shell facility that was under construction at the date of lease inception. In addition to its normal tenant improvements, the Company is required to install the heating, ventilation and cooling equipment and systems for its leased portion of the building. The Company is also at risk for any construction cost overruns associated with these specific structural and tenant improvements. As a result, the Company concluded that for accounting purposes, it is the deemed owner of the building during the construction period. As of September 30, 2015, the landlord has incurred $3.9 million of construction costs, which the Company has recorded as construction in progress, with a corresponding build-to-suit construction financing obligation, which is recorded as a component of other long-term liabilities. The Company will continue to increase the asset and corresponding financing obligation as additional building costs are incurred by the landlord during the construction period. In addition, the amounts that the Company pays or incurs for normal tenant improvements and structural improvements are also being recorded to the construction-in-progress asset and financing obligation. Under the lease, after a five month rent abatement, the Company is required to pay an initial base rent of $36,000 per month, increasing 3% per year, as well as all its share of building operating expenses. The lease term expires March 31, 2026 and the Company has an option to extend the lease term for two consecutive terms of five years each. Operating Lease Commitments As part of its current initiatives, the Company has begun consolidating certain physician clinics into newly leased, larger clinic locations that more effectively centralize and align physicians and ancillary services. In connection with this initiative, the Company has entered into new leases and renewed existing leases of medical office building space. Generally, the Company enters into leases for existing medical office building space or for space in a completed building shell and then constructs normal tenant improvements to meet its needs, subject to landlord approval. The leases provide for tenant improvement allowances to fund the design and construction of the tenant improvements. The Company records improvements to the leased space as leasehold improvements, including the improvements funded by the landlord. Tenant improvement allowances funded by the landlord are also recorded to deferred rent and amortized as a reduction to rent expense over the term of the lease beginning at the asset in-service date. For the nine months ended September 30, 2015, the Company has recorded non-cash tenant improvement allowances of $1.7 million. Future minimum rental commitments under non-cancelable operating leases are as follows (in thousands): October through December 2015 $ 3,433 2016 13,285 2017 11,554 2018 10,650 2019 9,768 Thereafter 46,328 Total $ 95,018

Related Party Transactions

Related Party Transactions	9 Months Ended
	Sep. 30, 2015
Related Party Transactions [Abstract]
Related Party Transactions	Note 12 – Related Party Transactions The Company provides management, clinical and support services to various nonconsolidated affiliates in which it has limited partnership or ownership interests. Management and other services revenue and accounts receivable from these entities are as follows (in thousands): Management and Other Services Revenue Three Months Ended September 30, Nine Months Ended September 30, 2015 2014 2015 2014 USMD Arlington $ 2,772 $ 2,689 $ 8,163 $ 7,855 USMD Fort Worth 840 847 2,469 2,987 Other equity method investees 325 406 1,063 1,398 $ 3,937 $ 3,942 $ 11,695 $ 12,240 Accounts Receivable September 30, December 31, USMD Arlington $ 719 $ 472 USMD Fort Worth 342 300 Other equity method investees 146 230 $ 1,207 $ 1,002 One consolidated lithotripsy entity provides lithotripsy services to USMD Arlington and USMD Fort Worth. For the three months ended September 30, 2015 and 2014, the Company recognized lithotripsy revenues from USMD Arlington and USMD Fort Worth totaling $0.6 million and $0.5 million, respectively. For the nine months ended September 30, 2015 and 2014, the Company recognized lithotripsy revenues from USMD Arlington and USMD Fort Worth totaling $1.5 million and $1.6 million, respectively. At September 30, 2015 and December 31, 2014, the consolidated lithotripsy entity has accounts receivable from USMD Arlington and USMD Fort Worth of $0.3 million and $0.1 million, respectively. The Company leases medical office building space from USMD Arlington for certain of its physicians, its Arlington-based cancer treatment center and its IDTF. For the three months ended September 30, 2015 and 2014, the Company recognized rent expense related to USMD Arlington totaling $0.7 million and $0.5 million, respectively. For the nine months ended September 30, 2015 and 2014, the Company recognized rent expense related to USMD Arlington totaling $1.3 million and $1.4 million, respectively.

Subsequent Events

Subsequent Events	9 Months Ended
	Sep. 30, 2015
Subsequent Events [Abstract]
Subsequent Events	Note 13 – Subsequent Events Business Combination Effective October 1, 2015, the Company acquired certain assets of a five-physician general surgery practice and the physicians became employees of the Company. As consideration for the acquired practice, the Company paid $57,000 in cash and agreed to issue to the former owners of the acquired practice the number of shares of the Company’s common stock equal to $200,000 divided by the closing price of the stock on the date of issuance of the common stock. The physicians entered into employment agreements with the Company and these agreements include covenants not to compete. Share-Based Payment On October 6, 2015, in payment of certain 2014 bonuses due to physicians and compensation deferred by certain physicians in the first and second quarters of 2015, the Company granted and issued 609,363 shares of its common stock to those physicians. The shares had a grant date fair value of $5.5 million and were issued pursuant to the Company’s Equity Compensation Plan. On October 6, 2015, in payment of Board of Directors’ compensation earned January 1, 2015 through June 30, 2015, the Company issued to members of the Company’s Board of Directors 31,734 previously granted shares of its common stock with an aggregate grant date fair value of $325,000. Amendment to Credit Agreement On November 13, 2015, the Company entered into Amendment No. 11 to Credit Agreement (the “Amendment”) with Southwest Bank, as administrative agent for the lenders, to amend, effective September 30, 2015, that certain Credit Agreement dated August 31, 2012 (as previously amended, the “Credit Agreement”). The Amendment increases the maximum amount of capital expenditures allowed under the Credit Agreement in 2015 from $6.0 million to $15.0 million.

Description of Business, Basi20

Description of Business, Basis of Presentation and Recently Issued Accounting Pronouncements (Policies)	9 Months Ended
	Sep. 30, 2015
Accounting Policies [Abstract]
Description of Business	Description of Business: USMD Holdings, Inc. (“USMD” or the “Company”) is an innovative, early-stage physician-led integrated health system. An integrated health system is considered early-stage when it has not yet established all the components necessary to be considered a fully integrated health system. Through its subsidiaries and affiliates, the Company provides healthcare services to patients and management and operational services to hospitals and other healthcare service providers. The Company provides healthcare services to patients in physician clinics, hospitals and other healthcare facilities, including cancer treatment centers and anatomical pathology and clinical laboratories. A wholly owned subsidiary of the Company is the sole member of a Texas Certified Non-Profit Health Organization that owns and operates a multi-specialty physician group practice (“USMD Physician Services”) in the Dallas-Fort Worth, Texas metropolitan area. Through other wholly owned subsidiaries, the Company provides management and operational services to two general acute care hospitals in the Dallas-Fort Worth, Texas metropolitan area and provides management and/or operational services to three cancer treatment centers in three states and 21 lithotripsy service providers (i.e., kidney stone treatment) primarily located in the South-Central United States. Of these managed entities, the Company has minority ownership interests in the two hospitals, one cancer treatment center and 19 lithotripsy service providers. The Company consolidates the operations of 17 lithotripsy service providers into its financial statements. In addition, the Company wholly owns and operates two clinical laboratories, one anatomical pathology laboratory, one cancer treatment center and two lithotripsy service providers in the Dallas-Fort Worth, Texas metropolitan area.
Basis of Presentation	Basis of Presentation: The unaudited condensed consolidated financial statements of the Company have been prepared in conformity with accounting principles generally accepted in the United States (“GAAP”) for interim financial statements and pursuant to the rules and regulations of the Securities and Exchange Commission (the “SEC”) for interim reporting. Certain information and note disclosures normally included in annual financial statements prepared in accordance with GAAP have been condensed or omitted pursuant to those rules and regulations, although the Company believes that the disclosures made are adequate to make the information in this report not misleading. These condensed consolidated financial statements reflect all adjustments that, in the opinion of the Company’s management, are necessary for fair presentation of the condensed consolidated financial statements. The December 31, 2014 condensed consolidated balance sheet data was derived from audited financial statements but does not include all disclosures required by GAAP. The operating results for the interim periods are not necessarily indicative of results for the full fiscal year. These condensed consolidated financial statements should be read in conjunction with the Company’s Annual Report on Form 10-K for the year ended December 31, 2014 filed with the SEC on April 15, 2015. The condensed consolidated financial statements include the accounts of the Company, entities controlled by the Company through its direct or indirect ownership of a majority interest and any other entities in which the Company has a controlling financial interest. The Company consolidates VIEs where the Company is the primary beneficiary. The primary beneficiary of a VIE is the party that has both the power to direct the activities that most significantly impact the VIE’s economic performance and the obligation to absorb losses or the right to receive benefits that could potentially be significant to the VIE. The Company consolidates entities in which it or its wholly owned subsidiary is the general partner or managing member and the limited partners or members, respectively, do not have sufficient rights to overcome the presumption of the Company’s control. The Company eliminates all significant intercompany accounts and transactions in consolidation. The Company uses the equity method to account for investments in entities it or its wholly owned subsidiaries do not control, but over which it or its wholly owned subsidiaries have the ability to exercise significant influence. The Company does not consolidate equity method investments, but rather measures them at their initial cost and subsequently adjusts their carrying values through income for the Company’s respective share of earnings or losses during the period.
Recently Issued Accounting Pronouncements	Recently Issued Accounting Pronouncements In April 2015 the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2015-03, “Interest – Imputation of Interest (Subtopic 835-30) – Simplifying the Presentation of Debt Issuance Costs” (“ASU 2015-03”). ASU 2015-03 requires that debt issuance costs related to a recognized debt liability be presented in the balance sheet as a direct deduction from the carrying amount of that debt liability, consistent with debt discounts. Prior to adoption of this amendment, debt issuance costs are required to be presented in the balance sheet as a deferred charge (an asset). ASU 2015-03 is effective for financial statements issued for fiscal years beginning after December 15, 2015, and interim periods within those fiscal years. Early adoption is permitted. The provisions of ASU 2015-03 must be applied on a retrospective basis. Management is evaluating the impact that adoption of ASU 2015-03 will have on the Company’s consolidated financial statements. In May 2014 the FASB issued ASU No. 2014-09, “Revenue from Contracts with Customers” (“ASU-2014-09”). ASU 2014-09 requires revenue recognition to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. ASU 2014-09 provides a single principles-based, five-step model to be applied to all contracts with customers. The five steps are to identify the contract(s) with the customer, identify the performance obligations in the contact, determine the transaction price, allocate the transaction price to the performance obligations in the contract and recognize revenue when each performance obligation is satisfied. The provisions of ASU 2014-09 may be applied either retrospectively to each prior reporting period presented or retrospectively with the cumulative effect of the update recognized at the date of the initial application along with additional disclosures. On August 14, 2015, the FASB issued ASU No. 2015-14, which defers the effective date of ASU 2014-09 by one year and permits early adoption on a limited basis. As a result of the deferral, ASU 2014-09 will be effective for the Company beginning January 1, 2018. Early adoption is permitted beginning January 1, 2017. Management is evaluating the impact that adoption of ASU 2014-09 will have on the Company’s consolidated financial statements.

Variable Interest Entity (Table

Variable Interest Entity (Tables)	9 Months Ended
	Sep. 30, 2015
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Carrying Amounts of Assets and Liabilities of WNI-DFW	The following table summarizes the carrying amounts of the assets and liabilities of WNI-DFW included in the Company’s consolidated balance sheets (after elimination of intercompany transactions and balances) (in thousands): September 30, December 31, Current assets: Cash and cash equivalents $ 13,875 $ 10,169 Accounts receivable 1,574 1,150 Prepaid expenses 99 61 Deferred tax asset 3,753 3,850 Total current assets $ 19,301 $ 15,230 Current liabilities: Accounts payable $ 3,047 $ 3,517 Other accrued liabilities 12,602 11,506 Total current liabilities $ 15,649 $ 15,023

Investments in Nonconsolidate22

Investments in Nonconsolidated Affiliates (Tables)	9 Months Ended
	Sep. 30, 2015
Financial Information of Nonconsolidated Affiliates Accounted for Under Equity Method	The net carrying values and ownership percentages of nonconsolidated affiliates accounted for under the equity method are as follows (dollars in thousands): September 30, 2015 December 31, 2014 Carrying Ownership Carrying Ownership USMD Hospital at Arlington, L.P. $ 50,409 46.40% $ 49,518 46.40% USMD Hospital at Fort Worth, L.P. 9,989 30.88% 9,956 30.88% Other 127 3%-34% 306 4%-34% $ 60,525 $ 59,780
USMD Arlington and USMD Fort Worth
Financial Information of Nonconsolidated Affiliates Accounted for Under Equity Method	Financial information for USMD Arlington and USMD Forth Worth is as follows (in thousands): Three Months Ended Nine Months Ended 2015 2014 2015 2014 USMD Arlington: Revenue $ 24,953 $ 24,159 $ 71,376 $ 67,711 Income from operations $ 5,281 $ 5,212 $ 15,537 $ 15,009 Net income $ 4,327 $ 4,916 $ 13,536 $ 13,232 USMD Fort Worth: Revenue $ 6,255 $ 10,873 $ 17,761 $ 29,417 Income from operations $ 732 $ 3,064 $ 1,524 $ 7,449 Net income $ 588 $ 2,861 $ 1,092 $ 6,871

Patient Service Revenue (Tables

Patient Service Revenue (Tables)	9 Months Ended
	Sep. 30, 2015
Health Care Organizations [Abstract]
Patient Service Revenue	The Company’s patient service revenue by payer is summarized in the table that follows (dollars in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2015 2014 2015 2014 Amount Ratio of Net Amount Ratio of Net Amount Ratio of Net Amount Ratio of Net Medicare $ 15,361 31.4 % $ 14,498 30.3 % $ 44,811 32.0 % $ 41,166 30.1 % Medicaid 76 0.2 350 0.7 522 0.4 1,084 0.8 Managed care and commercial payers 33,385 68.3 33,185 69.3 95,331 68.1 94,274 68.9 Self-pay 1,243 2.5 874 1.8 2,919 2.1 2,651 1.9 Patient service revenue before provision for doubtful accounts 50,065 102.4 48,907 102.1 143,583 102.5 139,175 101.7 Patient service revenue provision for doubtful accounts (1,161 ) (2.4 ) (1,013 ) (2.1 ) (3,499 ) (2.5 ) (2,276 ) (1.7 ) Net patient service revenue $ 48,904 100.0 % $ 47,894 100.0 % $ 140,084 100.0 % $ 136,899 100.0 %
Summary of Accounts Receivable Allowance	A summary of the Company’s accounts receivable allowance for doubtful accounts activity is as follows (in thousands): Balance at Provision Revenue Provision Write-offs, net of Balance at 2015 $ 2,100 3,499 (66 ) (3,313 ) $ 2,220

Intangible Assets (Tables)

Intangible Assets (Tables)	9 Months Ended
	Sep. 30, 2015
Goodwill and Intangible Assets Disclosure [Abstract]
Components of Amortizable Intangible Assets	The components of amortizable intangible assets consist of the following (in thousands): September 30, 2015 December 31, 2014 Gross Accumulated Net Gross Accumulated Net Management agreements $ 5,246 $ (883 ) $ 4,363 $ 5,246 $ (738 ) $ 4,508 Trade names 11,168 (9,239 ) 1,929 11,168 (8,845 ) 2,323 Customer relationships 767 (767 ) — 767 (596 ) 171 Noncompete agreements 12,547 (3,877 ) 8,670 12,547 (2,936 ) 9,611 $ 29,728 $ (14,766 ) $ 14,962 $ 29,728 $ (13,115 ) $ 16,613
Estimated Amortization Expense for Intangible Assets through End of 2015 and During Succeeding Four Years	Total estimated amortization expense for the Company’s intangible assets through the end of 2015 and during the four succeeding years is as follows (in thousands): October through December 2015 $ 493 2016 $ 1,974 2017 $ 1,972 2018 $ 1,972 2019 $ 1,665

Other Accrued Liabilities (Tabl

Other Accrued Liabilities (Tables)	9 Months Ended
	Sep. 30, 2015
Payables and Accruals [Abstract]
Summary of Other Accrued Liabilities	Other accrued liabilities consist of the following (in thousands): September 30, December 31, Accrued payables $ 2,798 $ 3,246 Accrued bonus 2,383 2,000 Other accrued liabilities 1,379 1,078 IBNR claims payable 12,589 11,379 Income taxes payable 506 670 $ 19,655 $ 18,373

Long-Term Debt and Capital Le26

Long-Term Debt and Capital Lease Obligations (Tables)	9 Months Ended
	Sep. 30, 2015
Debt Disclosure [Abstract]
Long-Term Debt and Capital Lease Obligations	Long-term debt and capital lease obligations consist of the following (in thousands): September 30, December 31, USMD Holdings, Inc.: Credit Agreement: Term Loan $ 6,750 $ 7,500 Revolving line of credit — — Convertible subordinated notes due 2019, net of unamortized discount of $2,516 and $2,978 at September 30, 2015 and December 31, 2014, respectively 21,826 21,364 Convertible subordinated notes due 2020 (including $700 related party notes) 5,050 — Subordinated related party notes payable 3,304 3,831 USMD Arlington related party advance, net of unamortized discount of $240 at September 30, 2015 14,760 — Other loans payable 984 212 Capital lease obligations 7,253 1,032 59,927 33,939 Consolidated lithotripsy entities: Notes payable 1,361 1,228 Capital lease obligations 922 1,294 2,283 2,522 Total long-term debt and capital lease obligations 62,210 36,461 Less: current portion (3,229 ) (3,323 ) Long-term debt and capital lease obligations, less current portion $ 58,981 $ 33,138
Maturities of Long-Term Debt	Maturities of the Company’s long-term debt at September 30, 2015, excluding unamortized debt discounts, are as follows (in thousands): October through December 2015 $ 445 2016 8,446 2017 5,766 2018 4,830 2019 28,342 Thereafter 8,962 Total $ 56,791

Fair Value of Financial Instr27

Fair Value of Financial Instruments (Tables)	9 Months Ended
	Sep. 30, 2015
Fair Value Disclosures [Abstract]
Carrying Value and Estimated Fair Value of Financial Instruments	The carrying value and estimated fair value of the Company’s financial instruments that do not approximate fair value are set forth in the table below (in thousands): September 30, 2015 December 31, 2014 Carrying Fair Value Carrying Fair Value Term Loan $ 6,750 $ 6,750 $ 7,500 $ 7,500 Convertible subordinated notes due 2019 $ 21,826 $ 17,510 $ 21,364 $ 19,857 Convertible subordinated notes due 2020 $ 5,050 $ 4,218 $ — $ — Subordinated related party notes payable $ 3,304 $ 3,208 $ 3,831 $ 3,689 Consolidated lithotripsy entity notes payable $ 1,361 $ 1,360 $ 1,228 $ 1,228 Other loans payable $ 538 $ 537 $ 212 $ 213

Earnings (loss) per Share (Tabl

Earnings (loss) per Share (Tables)	9 Months Ended
	Sep. 30, 2015
Earnings Per Share [Abstract]
Reconciliation of Numerators and Denominators of Basic and Diluted Earnings (Loss) Per Share and Computation of Basic and Diluted Earnings (Loss) Per Share	The following table presents a reconciliation of the numerators and denominators of basic and diluted earnings (loss) per share and the computation of basic and diluted earnings (loss) per share (in thousands, except per share data): Three Months Ended Nine Months Ended 2015 2014 2015 2014 Numerator: Net loss attributable to USMD Holdings, Inc. - basic $ (3,541 ) $ (1,746 ) $ (10,311 ) $ (11,082 ) Effect of potentially dilutive securities: Interest on convertible notes, net of tax — — — — Net loss attributable to USMD Holdings, Inc. - diluted $ (3,541 ) $ (1,746 ) $ (10,311 ) $ (11,082 ) Denominator: Weighted-average common shares outstanding 10,454 10,177 10,353 10,151 Effect of potentially dilutive securities: Stock options — — — — Convertible subordinated notes due 2019 — — — — Convertible subordinated notes due 2020 — — — — Weighted-average common shares outstanding assuming dilution 10,454 10,177 10,353 10,151 Loss per share attributable to USMD Holdings, Inc.: Basic $ (0.34 ) $ (0.17 ) $ (1.00 ) $ (1.09 ) Diluted $ (0.34 ) $ (0.17 ) $ (1.00 ) $ (1.09 )
Potential Shares Excluded from Diluted Earnings (Loss) per share Calculation	The following table presents the potential shares excluded from the diluted earnings (loss) per share calculation because the effect of including theses potential shares would be antidilutive (in thousands): Three Months Ended Nine Months Ended 2015 2014 2015 2014 Stock options 966 802 966 802 Convertible subordinated notes due 2019 1,042 1,042 1,042 1,042 Convertible subordinated notes due 2020 461 — 461 — 2,469 1,844 2,469 1,844

Commitments and Contingencies (

Commitments and Contingencies (Tables)	9 Months Ended
	Sep. 30, 2015
Commitments and Contingencies Disclosure [Abstract]
Future Minimum Payments Under Service Agreements	Future minimum payments due under these service agreements are as follows: October through December 2015 $ 52 2016 966 2017 846 2018 845 2019 846 Thereafter 819 Total $ 4,374
Schedule of Future Minimum Lease Commitments under Operating Leases	Future minimum rental commitments under non-cancelable operating leases are as follows (in thousands): October through December 2015 $ 3,433 2016 13,285 2017 11,554 2018 10,650 2019 9,768 Thereafter 46,328 Total $ 95,018

Related Party Transactions (Tab

Related Party Transactions (Tables)	9 Months Ended
	Sep. 30, 2015
Related Party Transactions [Abstract]
Management and Other Services Revenue and Accounts Receivable	Management and other services revenue and accounts receivable from these entities are as follows (in thousands): Management and Other Services Revenue Three Months Ended September 30, Nine Months Ended September 30, 2015 2014 2015 2014 USMD Arlington $ 2,772 $ 2,689 $ 8,163 $ 7,855 USMD Fort Worth 840 847 2,469 2,987 Other equity method investees 325 406 1,063 1,398 $ 3,937 $ 3,942 $ 11,695 $ 12,240 Accounts Receivable September 30, December 31, USMD Arlington $ 719 $ 472 USMD Fort Worth 342 300 Other equity method investees 146 230 $ 1,207 $ 1,002

Description of Business, Basi31

Description of Business, Basis of Presentation and Recently Issued Accounting Pronouncements - Additional Information (Detail)	9 Months Ended
	Sep. 30, 2015TreatmentCenterLabHospitalState
Accounting Policies [Abstract]
Providing management and operational services to number of general acute care hospitals | Hospital	2
Number of cancer treatment center	3
Number of states for cancer treatment | State	3
Number of lithotripsy service providers	21
Numbers of managed hospitals in which the Company has ownership interests | Hospital	2
Number of cancer treatment centers in which Company has ownership interests	1
Number of managed lithotripsy service centers in which Company has ownership interests	19
Number of managed lithotripsy service centers in which company consolidates into its financial statement	17
Number of wholly owned and operated clinical labs | Lab	2
Numbers of wholly owned and operated anatomical pathology laboratories	1
Number of wholly owned and operated cancer treatment centers	1
Number of wholly owned and operated lithotripsy service centers	2

Carrying Amounts of Assets and

Carrying Amounts of Assets and Liabilities of WNI-DFW (Detail) - USD ($) $ in Thousands		Sep. 30, 2015		Dec. 31, 2014		Sep. 30, 2014	Dec. 31, 2013
Current assets:
Cash and cash equivalents		$ 26,471	[1]	$ 15,940	[1]	$ 26,669	$ 13,137
Accounts receivable	[1]	28,761		24,673
Total current assets	[1]	71,259		53,464
Current liabilities:
Accounts payable	[2]	10,810		7,708
Other accrued liabilities		1,379		1,078
Total current liabilities	[2]	55,405		43,826
Variable Interest Entity, Primary Beneficiary
Current assets:
Cash and cash equivalents		13,875		10,169
Accounts receivable		1,574		1,150
Prepaid expenses		99		61
Deferred tax asset		3,753		3,850
Total current assets		19,301		15,230
Current liabilities:
Accounts payable		3,047		3,517
Other accrued liabilities		12,602		11,506
Total current liabilities		$ 15,649		$ 15,023
[1]	Assets of consolidated variable interest entity ("VIE") included in the consolidated balance sheets above (after elimination of intercompany transactions and balances) consist of: Cash and cash equivalents $ 13,875 $ 10,169 Accounts receivable 1,574 1,150 Prepaid expenses 99 61 Deferred tax asset 3,753 3,850 Total current assets $ 19,301 $ 15,230 The assets of the consolidated VIE can only be used to settle the obligations of the VIE.
[2]	Liabilities of consolidated VIE included in the consolidated balance sheets above (after elimination of intercompany transactions and balances) consist of: Accounts payable $ 3,047 $ 3,517 Other accrued liabilities 12,602 11,506 Total current liabilities $ 15,649 $ 15,023 The liabilities of the consolidated VIE are obligations of the VIE and the creditors have no recourse to USMD Holdings, Inc.

Variable Interest Entity - Addi

Variable Interest Entity - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014	Dec. 31, 2014
Variable Interest Entity [Line Items]
Capitated revenue	$ 24,698	$ 18,500	$ 71,789	$ 47,360
Income before provision for income taxes	(1,666)	258	(7,113)	(9,088)
Accrued medical claims IBNR	12,600		12,600		$ 11,400
Variable Interest Entity, Primary Beneficiary
Variable Interest Entity [Line Items]
Capitated revenue	24,700	18,500	71,800	47,400
Income before provision for income taxes	$ 2,000	$ 1,700	$ 8,000	$ 5,200

Net Carrying Values and Ownersh

Net Carrying Values and Ownership Percentages of Nonconsolidated Affiliates Accounted for Under Equity Method (Detail) - USD ($) $ in Thousands		Sep. 30, 2015	Dec. 31, 2014
Schedule of Equity Method Investments [Line Items]
Equity method investments	[1]	$ 60,525	$ 59,780
USMD Hospital at Arlington, L.P.
Schedule of Equity Method Investments [Line Items]
Equity method investments		$ 50,409	$ 49,518
Percentage of wholly owned subsidiary		46.40%	46.40%
USMD Hospital at Fort Worth, L.P.
Schedule of Equity Method Investments [Line Items]
Equity method investments		$ 9,989	$ 9,956
Percentage of wholly owned subsidiary		30.88%	30.88%
Other
Schedule of Equity Method Investments [Line Items]
Equity method investments		$ 127	$ 306
Other | Minimum
Schedule of Equity Method Investments [Line Items]
Percentage of wholly owned subsidiary		3.00%	4.00%
Other | Maximum
Schedule of Equity Method Investments [Line Items]
Percentage of wholly owned subsidiary		34.00%	34.00%
[1]	Assets of consolidated variable interest entity ("VIE") included in the consolidated balance sheets above (after elimination of intercompany transactions and balances) consist of: Cash and cash equivalents $ 13,875 $ 10,169 Accounts receivable 1,574 1,150 Prepaid expenses 99 61 Deferred tax asset 3,753 3,850 Total current assets $ 19,301 $ 15,230 The assets of the consolidated VIE can only be used to settle the obligations of the VIE.

Summarized Financial Informatio

Summarized Financial Information for Individually Significant Equity Method Investees (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
USMD Hospital at Arlington, L.P.
Schedule of Equity Method Investments [Line Items]
Revenue	$ 24,953	$ 24,159	$ 71,376	$ 67,711
Income from operations	5,281	5,212	15,537	15,009
Net income	4,327	4,916	13,536	13,232
USMD Hospital at Fort Worth, L.P.
Schedule of Equity Method Investments [Line Items]
Revenue	6,255	10,873	17,761	29,417
Income from operations	732	3,064	1,524	7,449
Net income	$ 588	$ 2,861	$ 1,092	$ 6,871

Patient Service Revenue (Detail

Patient Service Revenue (Detail) - USD ($) $ in Thousands	Sep. 30, 2015	Dec. 31, 2014	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Health care organization patient service revenue one			$ 50,065	$ 48,907	$ 143,583	$ 139,175
Patient service revenue provision for doubtful accounts, Amount			(1,161)	(1,013)	(3,499)	(2,276)
Net patient service revenue, Amount			$ 48,904	$ 47,894	$ 140,084	$ 136,899
Health care organization patient service revenue percentage			102.40%	102.10%	102.50%	101.70%
Patient service revenue provision for doubtful accounts, percentage	(7.20%)	(7.80%)	(2.40%)	(2.10%)	(2.50%)	(1.70%)
Net patient service revenue, Percentage			100.00%	100.00%	100.00%	100.00%
Medicare
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Health care organization patient service revenue one			$ 15,361	$ 14,498	$ 44,811	$ 41,166
Health care organization patient service revenue percentage			31.40%	30.30%	32.00%	30.10%
Medicaid
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Health care organization patient service revenue one			$ 76	$ 350	$ 522	$ 1,084
Health care organization patient service revenue percentage			0.20%	0.70%	0.40%	0.80%
Managed care and commercial payers
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Health care organization patient service revenue one			$ 33,385	$ 33,185	$ 95,331	$ 94,274
Health care organization patient service revenue percentage			68.30%	69.30%	68.10%	68.90%
Self-pay
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Health care organization patient service revenue one			$ 1,243	$ 874	$ 2,919	$ 2,651
Health care organization patient service revenue percentage			2.50%	1.80%	2.10%	1.90%

Patient Service Revenue - Addit

Patient Service Revenue - Additional Information (Detail)	Sep. 30, 2015	Dec. 31, 2014	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Health Care Organizations [Abstract]
Allowance for doubtful accounts as a percentage of accounts receivable	7.20%	7.80%	2.40%	2.10%	2.50%	1.70%

Summary of Accounts Receivable

Summary of Accounts Receivable Allowance (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Health Care Organizations [Abstract]
Beginning balance			$ 2,100
Provision for Doubtful Accounts Related to Patient Service Revenue	$ 1,161	$ 1,013	3,499	$ 2,276
Provision for Doubtful Accounts	53	$ 138	(66)	$ 186
Write-offs, net of Recoveries			(3,313)
Ending balance	$ 2,220		$ 2,220

Components of Amortizable Intan

Components of Amortizable Intangible Assets (Detail) - USD ($) $ in Thousands	Sep. 30, 2015	Dec. 31, 2014
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 29,728	$ 29,728
Accumulated Amortization	(14,766)	(13,115)
Net Carrying Amount	14,962	16,613
Management agreement
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	5,246	5,246
Accumulated Amortization	(883)	(738)
Net Carrying Amount	4,363	4,508
Trade names
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	11,168	11,168
Accumulated Amortization	(9,239)	(8,845)
Net Carrying Amount	1,929	2,323
Customer relationships
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	767	767
Accumulated Amortization	(767)	(596)
Net Carrying Amount		171
Noncompete agreements
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	12,547	12,547
Accumulated Amortization	(3,877)	(2,936)
Net Carrying Amount	$ 8,670	$ 9,611

Intangible Assets - Additional

Intangible Assets - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization of intangible assets	$ 0.5	$ 0.6	$ 1.7	$ 9.9
Impairment loss		$ 8.4		$ 8.4

Estimated Amortization Expense

Estimated Amortization Expense for Intangible Assets through End of 2015 and During Succeeding Four Years (Detail) $ in Thousands	Sep. 30, 2015USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
October through December 2015	$ 493
2,016	1,974
2,017	1,972
2,018	1,972
2,019	$ 1,665

Summary of Other Accrued Liabil

Summary of Other Accrued Liabilities (Detail) - USD ($) $ in Thousands		Sep. 30, 2015	Dec. 31, 2014
Other Accrued Liabilities
Accrued payables		$ 2,798	$ 3,246
Accrued bonus		2,383	2,000
Other accrued liabilities		1,379	1,078
IBNR claims payable		12,589	11,379
Income taxes payable		506	670
Other accrued liabilities	[1]	$ 19,655	$ 18,373
[1]	Liabilities of consolidated VIE included in the consolidated balance sheets above (after elimination of intercompany transactions and balances) consist of: Accounts payable $ 3,047 $ 3,517 Other accrued liabilities 12,602 11,506 Total current liabilities $ 15,649 $ 15,023 The liabilities of the consolidated VIE are obligations of the VIE and the creditors have no recourse to USMD Holdings, Inc.

Long-Term Debt and Capital Le43

Long-Term Debt and Capital Lease Obligations (Detail) - USD ($) $ in Thousands	Sep. 30, 2015	Dec. 31, 2014
Schedule of Long-term Debt Instruments
Total long-term debt and capital lease obligations	$ 62,210	$ 36,461
Less: current portion	(3,229)	(3,323)
Long-term debt and capital lease obligations, less current portion	58,981	33,138
Total long-term debt and capital lease obligations	62,210	36,461
USMD Holdings
Schedule of Long-term Debt Instruments
Term Loan	6,750	7,500
Other loans payable	984	212
Revolving line of credit	0	0
Capital lease obligations	7,253	1,032
Subordinated related party notes payable	3,304	3,831
Total long-term debt and capital lease obligations	59,927	33,939
Total long-term debt and capital lease obligations	59,927	33,939
USMD Holdings | USMD Hospital at Arlington, L.P.
Schedule of Long-term Debt Instruments
Related party advance	14,760
USMD Holdings | Convertible Subordinated Notes Due 2019
Schedule of Long-term Debt Instruments
Convertible subordinated notes	21,826	21,364
USMD Holdings | Convertible Subordinated Notes Due 2020
Schedule of Long-term Debt Instruments
Convertible subordinated notes	5,050
Subordinated related party notes payable	700
Lithotripsy Entity
Schedule of Long-term Debt Instruments
Notes payable	1,361	1,228
Capital lease obligations	922	1,294
Total long-term debt and capital lease obligations	2,283	2,522
Total long-term debt and capital lease obligations	$ 2,283	$ 2,522

Long-Term Debt and Capital Le44

Long-Term Debt and Capital Lease Obligations (Parenthetical) (Detail) - USMD Holdings - USD ($) $ in Thousands	Sep. 30, 2015	Dec. 31, 2014
Debt Instrument [Line Items]
Notes payable to related party	$ 3,304	$ 3,831
Convertible Subordinated Notes Due 2019
Debt Instrument [Line Items]
Unamortized discount	2,516	$ 2,978
Convertible Subordinated Notes Due 2020
Debt Instrument [Line Items]
Notes payable to related party	700
USMD Hospital at Arlington, L.P.
Debt Instrument [Line Items]
Unamortized discount	$ 240

Long-Term Debt and Capital Le45

Long-Term Debt and Capital Lease Obligations - Additional Information - USMD Arlington Related Party Advance (Detail) - USD ($)	Sep. 18, 2015	Sep. 30, 2015
Debt Instrument [Line Items]
Proceeds from the Advance		$ 4,350,000
USMD Hospital at Arlington, L.P.
Debt Instrument [Line Items]
Principal amount	$ 15,000,000
Proceeds from the Advance	$ 14,800,000
Debt instrument fixed rate		3.04%
Principal payments		$ 312,500
Principal payments beginning date		Dec. 31, 2016
Debt maturity date		Nov. 28, 2020
Debt issuance costs		$ 43,000
USMD Hospital at Arlington, L.P. | Libor Rate
Debt Instrument [Line Items]
Debt instrument variable rate term, description		30-Day London Interbank Offered Rate plus a margin of 2.85% (3.04% at September 30, 2015).
Debt instrument variable rate term		30 days
Debt instrument variable rate		2.85%
Limited Partners of USMD Arlington
Debt Instrument [Line Items]
Quarterly financing fee percentage		3.22%

Long-Term Debt and Capital Le46

Long-Term Debt and Capital Lease Obligations - Additional Information - Amendments to Credit Agreement (Detail) - USD ($) $ in Thousands	Aug. 11, 2015	Sep. 18, 2015
Minimum
Debt Instrument [Line Items]
Debt instrument senior leverage ratio		100.00%
Maximum
Debt Instrument [Line Items]
Debt instrument senior leverage ratio		100.00%
Term Loan
Debt Instrument [Line Items]
Aggregate principal amount	$ 6,750
Cash collateral for borrowed securities	$ 6,750
Interest rate on cash held as collateral	0.55%
Loan interest at collateralized	1.80%
Four Scheduled Quarterly | Minimum
Debt Instrument [Line Items]
Debt instrument fixed charge coverage ratio		125.00%
Four Scheduled Quarterly | Maximum
Debt Instrument [Line Items]
Debt instrument senior leverage ratio		100.00%
Quarterly | Minimum
Debt Instrument [Line Items]
Debt instrument fixed charge coverage ratio		100.00%
Quarterly | Maximum
Debt Instrument [Line Items]
Debt instrument senior leverage ratio		125.00%

Long-Term Debt and Capital Le47

Long-Term Debt and Capital Lease Obligations - Additional Information - Convertible Subordinated Notes Due 2020 (Detail) $ / shares in Units, $ in Thousands	9 Months Ended
	Sep. 30, 2015USD ($)shares$ / shares	Apr. 29, 2015USD ($)	Mar. 13, 2015USD ($)
Debt Instrument [Line Items]
Debt instrument, Carrying value	$ 56,791
2020-11 Convertible Notes
Debt Instrument [Line Items]
Debt instrument face amount		$ 1,550
Debt instrument fixed interest rate		7.25%
Debt instrument maturity date	Nov. 1, 2020
Conversion price of common stock, per share | $ / shares	$ 10.61
Debt instrument, convertible, number of shares | shares	146,086
2020-11 Convertible Notes | Three Members of Board of Directors
Debt Instrument [Line Items]
Debt instrument, Carrying value	$ 700
2020-09 Convertible Notes
Debt Instrument [Line Items]
Debt instrument face amount			$ 3,500
Debt instrument fixed interest rate			7.75%
Debt instrument maturity date	Sep. 1, 2020
Conversion price of common stock, per share | $ / shares	$ 11.10
Debt instrument, convertible, number of shares | shares	315,315

Long-Term Debt and Capital Le48

Long-Term Debt and Capital Lease Obligations - Additional Information - Other Loans Payable (Detail) - USD ($)	1 Months Ended		9 Months Ended	12 Months Ended
	Aug. 31, 2015	Jul. 31, 2015	Sep. 30, 2015	Dec. 31, 2014
Debt Instrument [Line Items]
Services purchased and financed with debt recorded in other current assets			$ 868,000
Other Loans Payable, Financed Directors and Officers
Debt Instrument [Line Items]
Services purchased and financed with debt recorded in other current assets	$ 500,000
Fixed interest rate	3.53%
Principal and interest payments	$ 45,000
Debt instrument, frequency of periodic payment			Eleven equal installments
Debt instrument maturity period	2016-07
Other Loans Payable, Financed Training
Debt Instrument [Line Items]
Services purchased and financed with debt recorded in other current assets			$ 300,000
Principal and interest payments			$ 7,000
Debt instrument, frequency of periodic payment			Financing arrangements were effective August 4, 2015 and have terms of 66, 55 and 44 months.
Debt instrument, weighted average interest rate			5.00%
Other Loans Payable, Financed Training | USMD Hospital at Arlington, L.P.
Debt Instrument [Line Items]
Services purchased and financed with debt recorded in other current assets		$ 52,000		$ 157,000
Principal and interest payments			$ 11,000
Debt instrument, frequency of periodic payment			25 quarterly principal and interest payments
Debt instrument, weighted average interest rate			6.40%

Long-Term Debt and Capital Le49

Long-Term Debt and Capital Lease Obligations - Additional Information - Capital Lease Obligations (Detail)	1 Months Ended	9 Months Ended
	Jul. 31, 2015USD ($)Installment	Sep. 30, 2015USD ($)Installment	Dec. 31, 2014USD ($)
Equipment Leased
Debt Instrument [Line Items]
Equipment added to capital lease	$ 100,000		$ 600,000
Medical Systems Leasing Arrangement | Equipment Leased
Debt Instrument [Line Items]
Equipment added to capital lease		$ 5,400,000
Software Licenses | Equipment Leased
Debt Instrument [Line Items]
Equipment added to capital lease	$ 1,000,000
Capital Lease Obligations
Debt Instrument [Line Items]
Lease arrangement, required minimum monthly payment		$ 35,000
Debt instrument, frequency of periodic payment		25 minimum quarterly
Capital Lease Obligations | Medical Systems Leasing Arrangement
Debt Instrument [Line Items]
Number of leases | Installment		12
USMD Arlington IDTF Master leasing arrangement		Beginning at the lease commencement date, the 66 month leases require minimum monthly payments of $63,000, the 55 month lease requires minimum monthly payments of $8,000 and the 44 month leases require minimum monthly payments of $53,000.
Capital Lease Obligations | Medical Systems Leasing Arrangement | Lease Term of 66 Month
Debt Instrument [Line Items]
Lease arrangement, number of installments | Installment		66
Lease arrangement, required minimum monthly payment		$ 63,000
Capital Lease Obligations | Medical Systems Leasing Arrangement | Lease Term of 55 Month
Debt Instrument [Line Items]
Lease arrangement, number of installments | Installment		55
Lease arrangement, required minimum monthly payment		$ 8,000
Capital Lease Obligations | Medical Systems Leasing Arrangement | Lease Term of 44 Month
Debt Instrument [Line Items]
Lease arrangement, number of installments | Installment		44
Lease arrangement, required minimum monthly payment		$ 53,000
Capital Lease Obligations | Software Licenses
Debt Instrument [Line Items]
Lease arrangement, number of installments | Installment	35
Lease arrangement, required minimum monthly payment	$ 25,000
USMD Arlington IDTF Master leasing arrangement		The lease required an initial payment of $80,000 on July 7, 2015 followed by 35 monthly payments of $25,000 beginning August 7, 2015.
Capital Lease initial payment	$ 80,000

Long-Term Debt and Capital Le50

Long-Term Debt and Capital Lease Obligations - Additional Information - Consolidated Lithotripsy Entities - Notes Payable (Detail) - Lithotripsy Partnership [Member] - Notes Payable, Other Payables Financed Equipment [Member]	1 Months Ended	9 Months Ended
	May. 31, 2015USD ($)	Sep. 30, 2015Installment
Debt Instrument [Line Items]
Equipment added to capital lease	$ 500,000
Fixed interest rate		2.95%
Number of payments | Installment		60
Debt instrument, frequency of periodic payment		Principal and interest payments are due monthly in 60 equal installments
Principal and interest payments	$ 8,513
Debt instrument payment terms		Principal and interest payments are due monthly in 60 equal installments of $8,513 until maturity in May 2020.
Debt instrument maturity date		May 13, 2020

Maturities of Long-Term Debt (D

Maturities of Long-Term Debt (Detail) $ in Thousands	Sep. 30, 2015USD ($)
Debt Disclosure [Abstract]
October through December 2015	$ 445
2,016	8,446
2,017	5,766
2,018	4,830
2,019	28,342
Thereafter	8,962
Total	$ 56,791

Carrying Value and Estimated Fa

Carrying Value and Estimated Fair Value of Financial Instruments (Detail) - USD ($) $ in Thousands	Sep. 30, 2015	Dec. 31, 2014
Carrying Value | Term Loan
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Term Loan	$ 6,750	$ 7,500
Carrying Value | Convertible Subordinated Notes Due 2019
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Convertible subordinated notes	21,826	21,364
Carrying Value | Convertible Subordinated Notes Due 2020
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Convertible subordinated notes	5,050
Carrying Value | Subordinated Related Party Notes Payable
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Subordinated related party notes payable	3,304	3,831
Carrying Value | Lithotripsy Entity
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Consolidated lithotripsy entity notes payable	1,361	1,228
Carrying Value | Notes Payable, Other Payables
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Other loans payable	538	212
Fair Value | Term Loan
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Notes payable, fair value	6,750	7,500
Fair Value | Convertible Subordinated Notes Due 2019
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Notes payable, fair value	17,510	19,857
Fair Value | Convertible Subordinated Notes Due 2020
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Notes payable, fair value	4,218
Fair Value | Subordinated Related Party Notes Payable
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Notes payable, fair value	3,208	3,689
Fair Value | Lithotripsy Entity
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Notes payable, fair value	1,360	1,228
Fair Value | Notes Payable, Other Payables
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Notes payable, fair value	$ 537	$ 213

Share-Based Payment - Additiona

Share-Based Payment - Additional Information (Detail) - USD ($)	Aug. 06, 2015	Jul. 09, 2015	Apr. 28, 2015	Mar. 06, 2015	Mar. 05, 2015	Mar. 04, 2015	Feb. 20, 2015	Sep. 30, 2015	Sep. 30, 2015
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation, shares granted		26,764	78,368
Share-based compensation, common stock granted at fair value		$ 225,000	$ 785,000
Share-based compensation, common stock issued		26,764	78,368
Share-based compensation, aggregate grant date fair value									$ 1,857,000
Salary Deferral Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation, shares granted								32,093	63,504
Share-based compensation, common stock granted at fair value					$ 150,000			$ 229,000	$ 527,000
Share-based compensation, common stock issued					15,700
Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options granted	100,000
Shares granted , strike price	$ 8.21
Grant date fair value	$ 3.03
Shares vested on grant date	20,000
Shares vesting per year	20,000
Options Expiration date	Aug. 6, 2023
USMD Holdings | Equity Compensation Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock for issuance								2,500,000	2,500,000
Holdings reserved shares for grant								1,200,000	1,200,000
USMD Holdings | Senior Management | Equity Compensation Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation, shares granted						40,311
Share-based compensation, common stock granted at fair value				$ 549,000
Share-based compensation, common stock issued				40,311
USMD Holdings | Consultant | Equity Compensation Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares granted to consultant in payment of service rendered									4,129
Grant date fair value of shares granted to consultant in payment of service rendered									$ 38,000
USMD Holdings | Board of Directors | Equity Compensation Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation, shares granted								21,316	53,050
Share-based compensation, common stock granted at fair value								$ 153,000	$ 478,000
Share-based compensation, common stock issued							30,724
Share-based compensation, aggregate grant date fair value							$ 273,000

Reconciliation of Numerators an

Reconciliation of Numerators and Denominators of Basic and Diluted Earnings (Loss) Per Share and Computation of Basic and Diluted Earnings (Loss) Per Share (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Numerator:
Net loss attributable to USMD Holdings, Inc. - basic	$ (3,541)	$ (1,746)	$ (10,311)	$ (11,082)
Interest on convertible notes, net of tax	0	0	0	0
Net loss attributable to USMD Holdings, Inc. - diluted	$ (3,541)	$ (1,746)	$ (10,311)	$ (11,082)
Denominator:
Weighted-average common shares outstanding	10,454	10,177	10,353	10,151
Stock options	0	0	0	0
Weighted-average common shares outstanding assuming dilution	10,454	10,177	10,353	10,151
Loss per share attributable to USMD Holdings, Inc.:
Basic	$ (0.34)	$ (0.17)	$ (1)	$ (1.09)
Diluted	$ (0.34)	$ (0.17)	$ (1)	$ (1.09)
Convertible Subordinated Notes Due 2019
Denominator:
Convertible subordinated notes	0	0	0	0
Convertible Subordinated Notes Due 2020
Denominator:
Convertible subordinated notes	0	0	0	0

Potential Shares Excluded from

Potential Shares Excluded from Diluted Earnings (Loss) per share Calculation (Detail) - shares shares in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive Securities Excluded From Computation of Earnings Per Share	2,469	1,844	2,469	1,844
Stock Options
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive Securities Excluded From Computation of Earnings Per Share	966	802	966	802
Convertible Subordinated Notes Due 2019
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive Securities Excluded From Computation of Earnings Per Share	1,042	1,042	1,042	1,042
Convertible Subordinated Notes Due 2020
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive Securities Excluded From Computation of Earnings Per Share	461		461

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Detail)	1 Months Ended	9 Months Ended
	Jan. 31, 2015USD ($)	Sep. 30, 2015USD ($)Leases
Commitments and Contingencies Disclosure [Line Items]
Maximum aggregate payments to pay the obligations due		$ 24,900,000
Remaining terms of guarantees, description		The remaining terms of these guarantees range from 15 to 152 months.
Sale of subsidiary	$ 1,600,000
Equity method investment carrying value	159,000
Notes received from sale of equity method investment, gross	1,600,000
Notes received from sale of equity method investment, net	$ 159,000
Gain recognized on sale of subsidiary		$ 138,000
Landlord funded leasehold improvements		1,671,000
Build To Suit Lease Arrangements [Member]
Commitments and Contingencies Disclosure [Line Items]
Lease, construction costs		3,900,000
Initial base rent monthly payments		$ 36,000
Percentage of increase in rent payments		3.00%
Lease expiration date		Mar. 31, 2026
Number of lease extension options | Leases		2
Term of lease under lease extension option one		5 years
Term of lease under lease extension option two		5 years
USMD Hospital at Arlington, L.P.
Commitments and Contingencies Disclosure [Line Items]
Guarantee obligations percentage		46.40%
Medical Negligence Lawsuits
Commitments and Contingencies Disclosure [Line Items]
Estimate range of loss, minimum		$ 200,000
Estimate range of loss, maximum		$ 1,200,000
Minimum
Commitments and Contingencies Disclosure [Line Items]
Remaining terms of guarantees		15 months
Financial transactions amounts		$ 1,000,000
Maximum
Commitments and Contingencies Disclosure [Line Items]
Remaining terms of guarantees		152 months
Financial transactions amounts		$ 3,000,000

Future Minimum Payments Under S

Future Minimum Payments Under Service Agreements (Detail) $ in Thousands	Sep. 30, 2015USD ($)
Purchase Obligation, Fiscal Year Maturity [Abstract]
Future Minimum Payments October through December 2015	$ 52
Future Minimum Payments 2016	966
Future Minimum Payments 2017	846
Future Minimum Payments 2018	845
Future Minimum Payments 2019	846
Future Minimum Payments Thereafter	819
Future Minimum Payments Total	$ 4,374

Future Minimum Lease Commitment

Future Minimum Lease Commitments Under Operating Leases (Detail) $ in Thousands	Sep. 30, 2015USD ($)
Commitments and Contingencies Disclosure [Abstract]
Minimum Lease Commitments October through December 2015	$ 3,433
Minimum Lease Commitments 2016	13,285
Minimum Lease Commitments 2017	11,554
Minimum Lease Commitments 2018	10,650
Minimum Lease Commitments 2019	9,768
Minimum Lease Commitments Thereafter	46,328
Minimum Lease Commitments Total	$ 95,018

Management and Other Services R

Management and Other Services Revenue and Accounts Receivable (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014	Dec. 31, 2014
Related Party Transaction [Line Items]
Management and Other Services Revenue	$ 3,937	$ 3,942	$ 11,695	$ 12,240
Accounts Receivable	1,207		1,207		$ 1,002
USMD Hospital at Arlington, L.P.
Related Party Transaction [Line Items]
Management and Other Services Revenue	2,772	2,689	8,163	7,855
Accounts Receivable	719		719		472
USMD Hospital at Fort Worth, L.P.
Related Party Transaction [Line Items]
Management and Other Services Revenue	840	847	2,469	2,987
Accounts Receivable	342		342		300
Other
Related Party Transaction [Line Items]
Management and Other Services Revenue	325	$ 406	1,063	$ 1,398
Accounts Receivable	$ 146		$ 146		$ 230

Related Party Transactions - Ad

Related Party Transactions - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014	Dec. 31, 2014
Related Party Transaction [Line Items]
Lithotripsy revenue	$ 5,881	$ 5,742	$ 16,148	$ 15,930
Related party accounts receivable	1,207		1,207		$ 1,002
Rent expense	5,184	4,105	13,348	11,780
USMD Arlington and USMD Fort Worth
Related Party Transaction [Line Items]
Lithotripsy revenue	600	500	1,500	1,600
Related party accounts receivable	300		300		100
USMD Hospital at Arlington, L.P.
Related Party Transaction [Line Items]
Related party accounts receivable	719		719		$ 472
Rent expense	$ 700	$ 500	$ 1,300	$ 1,400

Subsequent Events - Additional

Subsequent Events - Additional Information (Detail)	Nov. 13, 2015USD ($)	Oct. 06, 2015USD ($)shares	Oct. 01, 2015USD ($)Employee	Sep. 18, 2015USD ($)	Jul. 09, 2015USD ($)shares	Apr. 28, 2015USD ($)shares
Subsequent Event [Line Items]
Share-based compensation, common stock issued | shares					26,764	78,368
Share-based compensation, shares granted | shares					26,764	78,368
Share-based compensation, common stock granted at fair value					$ 225,000	$ 785,000
Maximum annual financing of capital expenditures				$ 6,000,000
Subsequent Event
Subsequent Event [Line Items]
Share-based compensation, common stock issued | shares		609,363
Share-based compensation, shares granted | shares		609,363
Share-based compensation, common stock granted at fair value		$ 5,500,000
Maximum annual financing of capital expenditures	$ 15,000,000
Subsequent Event | Board of Directors
Subsequent Event [Line Items]
Share-based compensation, common stock issued | shares		31,734
Share-based compensation, common stock granted at fair value		$ 325,000
Subsequent Event | Physician General Surgery Practice
Subsequent Event [Line Items]
Number of physicians | Employee			5
Cash consideration paid as consideration in business combination			$ 57,000
Business combination consideration, payable in common stock			$ 200,000