Owens & Minor (OMI) 10-Q 4 Nov 24 2024 Q3 Quarterly report Financial data

Cover Page

Cover Page - shares	9 Months Ended
	Sep. 30, 2024	Oct. 28, 2024
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2024
Document Transition Report	false
Entity File Number	1-9810
Entity Registrant Name	Owens & Minor, Inc.
Entity Incorporation, State or Country Code	VA
Entity Tax Identification Number	54-1701843
Entity Address, Address Line One	9120 Lockwood Boulevard
Entity Address, City or Town	Mechanicsville
Entity Address, State or Province	VA
Entity Address, Postal Zip Code	23116
City Area Code	804
Local Phone Number	723-7000
Title of 12(b) Security	Common Stock, $2 par value per share
Trading Symbol	OMI
Security Exchange Name	NYSE
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Smaller reporting company	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		77,108,972
Entity Central Index Key	0000075252
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q3
Amendment Flag	false

Consolidated Statements of Oper

Consolidated Statements of Operations - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Income Statement [Abstract]
Net revenue	$ 2,721,125	$ 2,591,742	$ 8,004,810	$ 7,677,817
Cost of goods sold	2,161,419	2,053,244	6,365,421	6,122,579
Gross profit	559,706	538,498	1,639,389	1,555,238
Distribution, selling and administrative expenses	469,798	452,583	1,416,724	1,356,334
Acquisition-related charges and intangible amortization	21,097	30,217	61,395	74,609
Exit and realignment charges, net	28,880	30,180	85,530	74,817
Other operating expense, net	15,727	1,677	21,542	4,991
Operating income	24,204	23,841	54,198	44,487
Interest expense, net	36,554	38,127	108,108	121,053
Other expense (income), net	1,438	(3,302)	3,796	(843)
Loss before income taxes	(13,788)	(10,984)	(57,706)	(75,723)
Income tax (benefit) provision	(1,018)	(4,558)	8,864	(16,638)
Net loss	$ (12,770)	$ (6,426)	$ (66,570)	$ (59,085)
Net loss per common share
Basic (in dollars per share)	$ (0.17)	$ (0.08)	$ (0.87)	$ (0.78)
Diluted (in dollars per share)	$ (0.17)	$ (0.08)	$ (0.87)	$ (0.78)

Consolidated Statements of Comp

Consolidated Statements of Comprehensive Income (Loss) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Statement of Comprehensive Income [Abstract]
Net loss	$ (12,770)	$ (6,426)	$ (66,570)	$ (59,085)
Other comprehensive income (loss), net of tax:
Currency translation adjustments	25,966	(9,891)	7,398	(9,940)
Change in unrecognized net periodic pension costs	265	152	699	141
Change in gains and losses on derivative instruments	(4,905)	777	(3,697)	699
Total other comprehensive income (loss), net of tax	21,326	(8,962)	4,400	(9,100)
Comprehensive income (loss)	$ 8,556	$ (15,388)	$ (62,170)	$ (68,185)

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Current assets
Cash and cash equivalents	$ 45,454	$ 243,037
Accounts receivable, net of allowances of $5,515 and $7,861	661,664	598,257
Merchandise inventories	1,242,453	1,110,606
Other current assets	166,967	150,890
Total current assets	2,116,538	2,102,790
Property and equipment, net of accumulated depreciation and amortization of $570,033 and $546,397	498,746	543,972
Operating lease assets	357,264	296,533
Goodwill	1,642,196	1,638,846
Intangible assets, net	313,284	361,835
Other assets, net	153,254	149,346
Total assets	5,081,282	5,093,322
Current liabilities
Accounts payable	1,338,021	1,171,882
Accrued payroll and related liabilities	100,002	116,398
Current portion of long-term debt	42,626	206,904
Other current liabilities	453,517	396,701
Total current liabilities	1,934,166	1,891,885
Long-term debt, excluding current portion	1,842,348	1,890,598
Operating lease liabilities, excluding current portion	288,043	222,429
Deferred income taxes, net	25,650	41,652
Other liabilities	116,483	122,592
Total liabilities	4,206,690	4,169,156
Commitments and contingencies
Equity
Common stock, par value $2 per share; authorized - 200,000 shares; issued and outstanding - 77,062 shares and 76,546 shares as of September 30, 2024 and December 31, 2023	154,123	153,092
Paid-in capital	445,749	434,185
Retained earnings	302,138	368,707
Accumulated other comprehensive loss	(27,418)	(31,818)
Total equity	874,592	924,166
Total liabilities and equity	$ 5,081,282	$ 5,093,322

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($) shares in Thousands, $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Allowances for losses on accounts receivable	$ 5,515	$ 7,861
Accumulated depreciation and amortization	$ 570,033	$ 546,397
Common stock, par value (in dollar per share)	$ 2	$ 2
Common stock, authorized (shares)	200,000	200,000
Common stock, issued (shares)	77,062	76,546
Commons stock, outstanding (shares)	77,062	76,546

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Operating activities:
Net loss	$ (66,570)	$ (59,085)
Adjustments to reconcile net loss to cash provided by operating activities:
Depreciation and amortization	199,588	216,640
Share-based compensation expense	19,281	17,417
Benefit for losses on accounts receivable	(1,538)	(487)
Loss (gain) on extinguishment of debt	311	(4,379)
Deferred income tax benefit	(15,119)	(16,315)
Changes in operating lease right-of-use assets and lease liabilities	7,156	(1,517)
Gain from sales and dispositions of property and equipment	(37,682)	(26,462)
Changes in operating assets and liabilities:
Accounts receivable	(59,349)	77,197
Merchandise inventories	(132,433)	247,057
Accounts payable	164,261	46,338
Net change in other assets and liabilities	4,719	122,867
Other, net	7,869	9,674
Cash provided by operating activities	90,494	628,945
Investing activities:
Additions to property and equipment	(148,031)	(140,478)
Additions to computer software	(8,695)	(11,089)
Proceeds from sales of property and equipment	84,759	53,645
Other, net	7,738	(418)
Cash used for investing activities	(64,229)	(98,340)
Financing activities:
Borrowings under amended Receivables Financing Agreement	1,286,400	476,000
Repayments under amended Receivables Financing Agreement	(1,286,400)	(572,000)
Repayments of debt	(211,447)	(270,189)
Other, net	(13,060)	74
Cash used for financing activities	(224,507)	(366,115)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	408	(515)
Net (decrease) increase in cash, cash equivalents and restricted cash	(197,834)	163,975
Cash, cash equivalents and restricted cash at beginning of period	272,924	86,185
Cash, cash equivalents and restricted cash at end of period	75,090	250,160
Supplemental disclosure of cash flow information:
Income taxes paid (received), net	7,610	(6,798)
Interest paid	104,278	101,079
Noncash investing activity:
Unpaid purchases of property and equipment and computer software at end of period	$ 75,176	$ 60,870

Consolidated Statements of Chan

Consolidated Statements of Changes in Equity - USD ($) shares in Thousands, $ in Thousands	Common Stock	Paid-In Capital	Retained Earnings	Accumulated Other Comprehensive Loss	Total
Beginning balance (in shares) at Dec. 31, 2022	76,279
Beginning balance at Dec. 31, 2022	$ 152,557	$ 418,894	$ 410,008	$ (35,855)	$ 945,604
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss			(24,418)		(24,418)
Other comprehensive income (loss)				1,594	1,594
Share-based compensation expense, exercises and other (in shares)	(83)
Share-based compensation expense, exercises and other	$ (166)	1,786			1,620
Ending balance (in shares) at Mar. 31, 2023	76,196
Ending balance at Mar. 31, 2023	$ 152,391	420,680	385,590	(34,261)	924,400
Beginning balance (in shares) at Dec. 31, 2022	76,279
Beginning balance at Dec. 31, 2022	$ 152,557	418,894	410,008	(35,855)	945,604
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss					(59,085)
Other comprehensive income (loss)				(9,100)	(9,100)
Ending balance (in shares) at Sep. 30, 2023	76,499
Ending balance at Sep. 30, 2023	$ 152,997	427,895	350,923	(44,955)	886,860
Beginning balance (in shares) at Mar. 31, 2023	76,196
Beginning balance at Mar. 31, 2023	$ 152,391	420,680	385,590	(34,261)	924,400
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss			(28,241)		(28,241)
Other comprehensive income (loss)				(1,732)	(1,732)
Share-based compensation expense, exercises and other (in shares)	244
Share-based compensation expense, exercises and other	$ 489	1,313			1,802
Ending balance (in shares) at Jun. 30, 2023	76,440
Ending balance at Jun. 30, 2023	$ 152,880	421,993	357,349	(35,993)	896,229
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss			(6,426)		(6,426)
Other comprehensive income (loss)				(8,962)	(8,962)
Share-based compensation expense, exercises and other (in shares)	59
Share-based compensation expense, exercises and other	$ 117	5,902			6,019
Ending balance (in shares) at Sep. 30, 2023	76,499
Ending balance at Sep. 30, 2023	$ 152,997	427,895	350,923	(44,955)	$ 886,860
Beginning balance (in shares) at Dec. 31, 2023	76,546				76,546
Beginning balance at Dec. 31, 2023	$ 153,092	434,185	368,707	(31,818)	$ 924,166
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss			(21,886)		(21,886)
Other comprehensive income (loss)				(11,619)	(11,619)
Share-based compensation expense, exercises and other (in shares)	(97)
Share-based compensation expense, exercises and other	$ (195)	4,402			4,207
Ending balance (in shares) at Mar. 31, 2024	76,449
Ending balance at Mar. 31, 2024	$ 152,897	438,587	346,821	(43,437)	$ 894,868
Beginning balance (in shares) at Dec. 31, 2023	76,546				76,546
Beginning balance at Dec. 31, 2023	$ 153,092	434,185	368,707	(31,818)	$ 924,166
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss					(66,570)
Other comprehensive income (loss)				4,400	$ 4,400
Ending balance (in shares) at Sep. 30, 2024	77,062				77,062
Ending balance at Sep. 30, 2024	$ 154,123	445,749	302,138	(27,418)	$ 874,592
Beginning balance (in shares) at Mar. 31, 2024	76,449
Beginning balance at Mar. 31, 2024	$ 152,897	438,587	346,821	(43,437)	894,868
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss			(31,913)		(31,913)
Other comprehensive income (loss)				(5,307)	(5,307)
Share-based compensation expense, exercises and other (in shares)	599
Share-based compensation expense, exercises and other	$ 1,199	1,855			3,054
Ending balance (in shares) at Jun. 30, 2024	77,048
Ending balance at Jun. 30, 2024	$ 154,096	440,442	314,908	(48,744)	860,702
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss			(12,770)		(12,770)
Other comprehensive income (loss)				21,326	21,326
Share-based compensation expense, exercises and other (in shares)	14
Share-based compensation expense, exercises and other	$ 27	5,307			$ 5,334
Ending balance (in shares) at Sep. 30, 2024	77,062				77,062
Ending balance at Sep. 30, 2024	$ 154,123	$ 445,749	$ 302,138	$ (27,418)	$ 874,592

Consolidated Statements of Ch_2

Consolidated Statements of Changes in Equity (Parenthetical) - $ / shares	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Dec. 31, 2023	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023
Statement of Stockholders' Equity [Abstract]
Common stock, par value (in dollar per share)	$ 2	$ 2	$ 2	$ 2	$ 2	$ 2	$ 2

Summary of Significant Accounti

Summary of Significant Accounting Policies	9 Months Ended
	Sep. 30, 2024
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	Note 1—Summary of Significant Accounting Policies Basis of Presentation The accompanying unaudited consolidated financial statements include the accounts of Owens & Minor, Inc. and the subsidiaries it controls (we, us, or our) and contain all adjustments necessary to conform with U.S. generally accepted accounting principles (GAAP). All significant intercompany accounts and transactions have been eliminated. The results of operations for interim periods are not necessarily indicative of the results expected for the full year. We report our business under two segments: Products & Healthcare Services and Patient Direct. The Products & Healthcare Services segment includes our Medical Distribution division, which includes our U.S. distribution business, along with our outsourced logistics and value-added services businesses, and our Global Products division which manufactures and sources medical surgical products through our production and kitting operations. The Patient Direct segment includes our home healthcare divisions (Byram and Apria). Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation. Use of Estimates The preparation of consolidated financial statements in conformity with GAAP requires us to make assumptions and estimates that affect reported amounts and related disclosures. Actual results may differ from these estimates. Cash, Cash Equivalents and Restricted Cash Cash, cash equivalents and restricted cash includes cash and marketable securities with an original maturity or maturity at acquisition of three months or less. Cash, cash equivalents and restricted cash are stated at cost. Nearly all of our cash, cash equivalents and restricted cash are held in cash depository accounts in major banks in North America, Europe, and Asia. Cash that is held by a major bank and has restrictions on its availability to us is classified as restricted cash. Restricted cash as of September 30, 2024 and December 31, 2023 includes cash held in an escrow account as required by the Centers for Medicare & Medicaid Services in conjunction with the Bundled Payments for Care Improvement initiatives related to wind-down costs of Fusion5, as well as $13.2 million and $13.5 million of cash deposits received subject to limitations on use until remitted to a third-party financial institution (the Purchaser), pursuant to the Master Receivables Purchase Agreement (RPA). The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying consolidated balance sheets that sum to the total of those same amounts presented in the accompanying consolidated statements of cash flows. ​ ​ ​ ​ ​ ​ ​ ​ ​ September 30, 2024 December 31, 2023 Cash and cash equivalents ​ $ 45,454 ​ $ 243,037 Restricted cash included in Other current assets ​ 13,230 ​ 29,887 Restricted cash included in Other assets, net ​ ​ 16,406 ​ ​ — Total cash, cash equivalents, and restricted cash ​ $ 75,090 ​ $ 272,924 ​ Rental Revenue Within our Patient Direct segment, revenues are recognized under fee-for-service arrangements for equipment we rent to patients and sales of equipment, supplies and other items we sell to patients. Revenue that is generated from equipment that we rent to patients is primarily recognized over the noncancelable rental period, typically one month, and commences on delivery of the equipment to the patients. Revenues are recorded at amounts estimated to be received under reimbursement arrangements with third-party payors, including private insurers, prepaid health plans, Medicare, Medicaid and patients. Rental revenue, less estimated adjustments, is recognized as earned on a straight-line basis over the noncancelable lease term. Net revenue related to equipment that we rent to patients was $148 million and $158 million for the three months ended September 30, 2024 and 2023 and $442 million and $458 million for the nine months ended September 30, 2024 and 2023. Sales of Accounts Receivable On March 14, 2023, we entered into the RPA, pursuant to which accounts receivable with an aggregate outstanding amount not to exceed $200 million are sold, on a limited-recourse basis, to the Purchaser in exchange for cash. As of September 30, 2024 and December 31, 2023, there were a total of $121 million and $124 million of uncollected accounts receivable, that were accounted for as sales and removed from our consolidated balance sheets. Under the RPA, we provide certain servicing and collection actions on behalf of the Purchaser; however, we do not maintain any beneficial interest in the accounts receivable sold. Proceeds from the sale of accounts receivable are recorded as an increase to cash and cash equivalents and a reduction to accounts receivable, net of allowances, in the consolidated balance sheets. Cash received from the sale of accounts receivable, net of payments made to the Purchaser, is reflected as cash provided by operating activities in the consolidated statements of cash flows. Total accounts receivable sold under the RPA were $542 million and $1.6 billion for the three and nine months ended September 30, 2024. During the three and nine months ended September 30, 2024, we received net cash proceeds of $538 million and $1.6 billion from the sale of accounts receivable under the RPA and collected $550 million and $1.6 billion of the sold accounts receivable. Total accounts receivable sold under the RPA were $482 million and $894 million for the three and nine months ended September 30, 2023. During the three and nine months ended September 30, 2023, we received net cash proceeds of $478 million and $888 million from the sale of accounts receivable under the RPA and collected $508 million and $805 million of the sold accounts receivable. The losses on sale of accounts receivable, inclusive of professional fees incurred to establish the agreement, recorded in other operating expense, net in the consolidated statements of operations were $3.6 million and $3.5 million for the three months ended September 30, 2024 and 2023 and $10.8 million and $7.1 million for the nine months ended September 30, 2024 and 2023. The RPA is separate and distinct from the accounts receivable securitization program (the Receivables Financing Agreement). Acquisition-Related Charges Acquisition-related charges, included in the ‘acquisition-related charges and intangible amortization’ line item of our consolidated statements of operations, consist primarily of one-time costs related to acquisitions, including transaction costs necessary to consummate acquisitions, which consist of investment banking advisory fees and legal fees, director and officer tail insurance expense, severance and retention bonuses, and professional fees. Acquisition-related charges also include transition expenses and costs to integrate personnel, systems and processes. For the three and nine months ended September 30, 2024, we incurred $6.5 million and $10.2 million of acquisition-related costs related to the expected acquisition of Rotech Healthcare Holdings Inc. (Rotech), which consisted primarily of legal and professional fees. For the three and nine months ended September 30, 2023, we incurred $9.4 million and $11.9 million of acquisition-related costs, consisting of costs primarily related to the acquisition of Apria, Inc. (Apria). ​

Fair Value

Fair Value	9 Months Ended
	Sep. 30, 2024
Fair Value Disclosures [Abstract]
Fair Value	Note 2—Fair Value Fair value is determined based on assumptions that a market participant would use in pricing an asset or liability. The assumptions used are in accordance with a three-tier hierarchy, defined by GAAP, that draws a distinction between market participant assumptions based on (i) observable inputs such as quoted prices in active markets (Level 1), (ii) inputs other than quoted prices in active markets that are observable either directly or indirectly (Level 2) and (iii) unobservable inputs that require the use of present value and other valuation techniques in the determination of fair value (Level 3). The carrying amounts of cash and cash equivalents, restricted cash, accounts receivable, accounts payable, and accrued payroll and related liabilities reported in the consolidated balance sheets approximate fair value due to the short-term nature of these instruments. The fair value of debt is estimated based on quoted market prices or dealer quotes for the identical liability when traded as an asset in an active market (Level 1) or, if quoted market prices or dealer quotes are not available, on the borrowing rates currently available for loans with similar terms, credit ratings, and average remaining maturities (Level 2). See Note 5 for the fair value of debt. The fair value of our derivative contracts is determined based on the present value of expected future cash flows considering the risks involved, including non-performance risk, and using discount rates appropriate for the respective maturities. Observable Level 2 inputs are used to determine the present value of expected future cash flows. See Note 7 for the fair value of derivatives. Our acquisitions may include contingent consideration as part of the purchase price. The fair value of contingent consideration is estimated as of the acquisition date and at the end of each subsequent reporting period based on the present value of the contingent payments to be made using a weighted probability of possible payments (Level 3). Subsequent changes in fair value are recorded as adjustments to acquisition-related charges and intangible amortization within the consolidated statements of operations. ​

Goodwill and Intangible Assets

Goodwill and Intangible Assets	9 Months Ended
	Sep. 30, 2024
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets	Note 3—Goodwill and Intangible Assets The following table summarizes the goodwill balances by segment and the changes in the carrying amount of goodwill at September 30, 2024: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Products & ​ ​ ​ ​ ​ ​ ​ Healthcare ​ ​ ​ ​ ​ Patient Direct ​ Services ​ Consolidated Carrying amount of goodwill, December 31, 2023 ​ $ 1,535,252 ​ $ 103,594 ​ $ 1,638,846 Currency translation adjustments ​ — ​ 3,350 ​ 3,350 Carrying amount of goodwill, September 30, 2024 ​ $ 1,535,252 ​ $ 106,944 ​ $ 1,642,196 ​ Intangible assets subject to amortization, which exclude indefinite-lived intangible assets at September 30, 2024 and December 31, 2023 were as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ September 30, 2024 ​ December 31, 2023 ​ Customer ​ ​ Other Customer ​ ​ Other ​ ​ Relationships ​ Tradenames ​ Intangibles ​ Relationships ​ Tradenames ​ Intangibles Gross intangible assets ​ $ 332,811 ​ $ 202,000 ​ $ 73,055 ​ $ 433,750 ​ $ 202,000 ​ $ 73,958 Accumulated amortization ​ (163,350) ​ (84,324) ​ (48,908) ​ (236,791) ​ (69,655) ​ (41,427) Net intangible assets ​ $ 169,461 ​ $ 117,676 ​ $ 24,147 ​ $ 196,959 ​ $ 132,345 ​ $ 32,531 Weighted average useful life ​ 14 years ​ 10 years ​ 6 years ​ 13 years ​ 10 years ​ 6 years ​ At September 30, 2024 and December 31, 2023, $218 million and $250 million in net intangible assets were held in the Patient Direct segment and $96 million and $112 million were held in the Products & Healthcare Services segment. Amortization expense for intangible assets was $14.6 million and $20.8 million for the three months ended September 30, 2024 and 2023 and $51.2 million and $62.7 million for the nine months ended September 30, 2024 and 2023. As of September 30, 2024, based on the current carrying value of intangible assets subject to amortization, estimated amortization expense were as follows: ​ ​ ​ ​ ​ Year ​ ​ 2024 (remainder) ​ $ 13,680 2025 ​ 54,716 2026 ​ 50,364 2027 ​ 42,015 2028 ​ 32,117 Thereafter ​ ​ 118,392 Total future amortization ​ $ 311,284 ​

Exit and Realignment Costs

Exit and Realignment Costs	9 Months Ended
	Sep. 30, 2024
Restructuring and Related Activities [Abstract]
Exit and Realignment Costs	Note 4—Exit and Realignment Costs We incur exit and realignment and other charges associated with optimizing our operations which includes the consolidation of certain facilities, information technology (IT) strategic initiatives and other strategic actions. These charges also include costs associated with our Operating Model Realignment Program, which include professional fees, severance and other costs to streamline functions and processes. These amounts are excluded from our segments’ operating income. During the three months ended September 30, 2024 and 2023, exit and realignment charges, net of $28.9 million and $30.2 million included $27.1 million and $27.8 million in charges under our Operating Model Realignment Program and IT strategic initiatives. During the nine months ended September 30, 2024 and 2023, exit and realignment charges, net included $90.2 million and $70.6 million in charges under our Operating Model Realignment Program and IT strategic initiatives. Exit and realignment charges, net for the nine months ended September 30, 2024 also included a gain of $7.4 million associated with the sale of our corporate headquarters. During the nine months ended September 30, 2024 and 2023, exit and realignment charges, net were $85.5 million and $74.8 million. We may incur material future costs relating to certain exit and realignment actions, which remain underway and we are not able to reasonably estimate. ​ The following table summarizes the activity related to exit and realignment cost accruals, which are classified as other current liabilities in our consolidated balance sheets, through September 30, 2024 and 2023: ​ ​ ​ ​ ​ ​ Total Accrued exit and realignment costs, December 31, 2023 ​ $ 20,047 Provision for exit and realignment activities: ​ Severance ​ 184 Professional fees ​ 25,625 IT strategic initiatives - related costs ​ ​ 1,241 Other ​ 1,252 Cash payments ​ (11,728) Accrued exit and realignment costs, March 31, 2024 ​ 36,621 Provision for exit and realignment activities: ​ Severance ​ (205) Professional fees ​ 19,182 IT strategic initiatives - related costs ​ ​ 4,809 Other ​ 3,606 Cash payments ​ (33,908) Accrued exit and realignment costs, June 30, 2024 ​ ​ 30,105 Provision for exit and realignment activities: ​ ​ ​ Severance ​ ​ 1,770 Professional fees ​ ​ 15,013 IT strategic initiatives - related costs ​ ​ 4,476 Vendor contract and lease termination costs ​ ​ 2,728 Other ​ ​ 3,481 Cash payments ​ ​ (28,450) Accrued exit and realignment costs, September 30, 2024 ​ $ 29,123 ​ ​ ​ ​ Accrued exit and realignment costs, December 31, 2022 ​ $ 969 Provision for exit and realignment activities: ​ Severance ​ 4,127 Professional fees ​ ​ 9,012 IT strategic initiatives - related costs ​ ​ 123 Vendor contract and lease termination costs ​ ​ 1,824 Other ​ 588 Cash payments ​ (5,546) Accrued exit and realignment costs, March 31, 2023 ​ 11,097 Provision for exit and realignment activities: ​ Severance ​ 505 Professional fees ​ 22,953 IT strategic initiatives - related costs ​ ​ 3,374 Vendor contract and lease termination costs ​ ​ 1,707 Other ​ 424 Cash payments ​ (20,196) Accrued exit and realignment costs, June 30, 2023 ​ ​ 19,864 Provision for exit and realignment activities: ​ Severance ​ 2,361 Professional fees ​ ​ 16,800 IT strategic initiatives - related costs ​ ​ 3,256 Vendor contract and lease termination costs ​ ​ 4,300 Other ​ 2,164 Cash payments ​ ​ (26,311) Accrued exit and realignment costs, September 30, 2023 ​ $ 22,434 ​ ​ In addition to the exit and realignment accruals in the preceding table and the $7.4 million gain associated with the sale of our corporate headquarters, we also incurred $1.4 million and $9.8 million of costs that were expensed as incurred for the three and nine months ended September 30, 2024, which were primarily related to accelerated depreciation of certain assets held in our Products & Healthcare Services segment. We incurred $1.3 million of costs that were expensed as incurred for the three and nine months ended September 30, 2023, which primarily related to charges associated with a lease termination.

Debt

Debt	9 Months Ended
	Sep. 30, 2024
Debt Disclosure [Abstract]
Debt	Note 5—Debt Debt, net of unamortized deferred financing costs, consists of the following: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ September 30, 2024 December 31, 2023 ​ Carrying Estimated Carrying Estimated ​ ​ Amount ​ Fair Value ​ Amount ​ Fair Value 4.375% Senior Notes, due December 2024 ​ $ — ​ $ — ​ $ 171,232 ​ $ 168,754 Term Loan A ​ 353,511 ​ 356,606 ​ 387,591 ​ 390,668 4.500% Senior Notes, due March 2029 ​ 473,701 ​ 433,857 ​ 472,869 ​ 422,647 Term Loan B ​ 500,716 ​ 513,141 ​ 503,212 ​ 518,293 6.625% Senior Notes, due April 2030 ​ 541,848 ​ 536,314 ​ 540,445 ​ 529,472 Finance leases and other ​ 15,198 ​ 15,198 ​ 22,153 ​ 22,153 Total debt ​ 1,884,974 ​ 1,855,116 ​ 2,097,502 ​ 2,051,987 Less current maturities ​ (42,626) ​ (42,626) ​ (206,904) ​ (206,904) Long-term debt ​ $ 1,842,348 ​ $ 1,812,490 ​ $ 1,890,598 ​ $ 1,845,083 ​ On September 16, 2024 (the Redemption Date), we redeemed all of our outstanding 4.375% senior notes due in December 2024 (the 2024 Notes), which had an outstanding aggregate principal balance amount of $171.3 million, pursuant to the terms of the indenture governing the 2024 Notes, at a redemption price equal to 100% of the principal amount of the 2024 Notes, plus accrued and unpaid interest to, but excluding, the Redemption Date. As of the Redemption Date, the 2024 Notes were no longer deemed outstanding and interest on the 2024 Notes ceased to accrue. On March 29, 2022, we entered into a Security Agreement Supplement pursuant to which the Security and Pledge Agreement (the Security Agreement), dated March 10, 2021 was supplemented to grant collateral on behalf of the holders of the 2024 Notes, and the parties secured under the credit agreements including first priority liens and security interests in (a) all present and future shares of capital stock owned by the Grantors (as defined in the Security Agreement) in the Grantors’ present and future subsidiaries, subject to certain customary exceptions, and (b) all present and future personal property and assets of the Grantors, subject to certain exceptions. The Receivables Financing Agreement has a maximum borrowing capacity of $450 million. The interest rate under the Receivables Financing Agreement is based on a spread over a benchmark SOFR rate (as described in the Fourth Amendment to the Receivables Financing Agreement, as further amended by the Fifth Amendment to the Receivables Financing Agreement). Under the Receivables Financing Agreement, certain of our accounts receivable balances are sold to our wholly owned special purpose entity, O&M Funding LLC (O&M Funding). The Receivables Financing Agreement was amended on October 18, 2024, as described in Note 14 – Subsequent Events. We had no borrowings at September 30, 2024 and December 31, 2023 under our Receivables Financing Agreement. At September 30, 2024 and December 31, 2023, we had maximum revolving borrowing capacity of $450 million under our Receivables Financing Agreement. On March 29, 2022, we entered into a term loan credit agreement with an administrative agent and collateral agent and a syndicate of financial institutions, as lenders (the Credit Agreement) that provides for two credit facilities (i) a $500 million Term Loan A facility (the Term Loan A), and (ii) a $600 million Term Loan B facility (the Term Loan B). The interest rate on the Term Loan A is based on the sum of either Term SOFR or the Base Rate and an Applicable Rate which varies depending on the current Debt Ratings or Total Leverage Ratio, determined as to whichever shall result in more favorable pricing to the Borrowers (each as defined in the Credit Agreement). The interest rate on the Term Loan B is based on either the Term SOFR or the Base Rate plus an Applicable Rate. The Term Loan A will mature in March 2027 and the Term Loan B will mature in March 2029. In addition to our scheduled principal payment of $6.3 million on the Term Loan A, we made an unscheduled principal payment of $20.0 million on the Term Loan A during the months ended September 30, 2024. On March 10, 2021, we issued $500 million of 4.500% senior unsecured notes due in March 2029 (the 2029 Unsecured Notes), with interest payable semi-annually. The 2029 Unsecured Notes were sold at 100% of the principal amount with an effective yield of 4.500%. We may redeem all or part of the 2029 Unsecured Notes at the applicable redemption prices described in the Indenture dated March 10, 2021 (the Indenture), plus accrued and unpaid interest, if any, to, but not including, the redemption date. On March 29, 2022, we issued $600 million of 6.625% senior unsecured notes due in April 2030 (the 2030 Unsecured Notes), with interest payable semi-annually. The 2030 Unsecured Notes were sold at 100% of the principal amount with an effective yield of 6.625%. We may redeem all or part of the 2030 Unsecured Notes, prior to April 1, 2025, at a price equal to 100% of the principal amount of the 2030 Unsecured Notes to be redeemed, plus accrued and unpaid interest, if any, to, but excluding, the redemption date, plus a “make-whole” premium, as described in the Indenture dated March 29, 2022 (the New Indenture). From and after April 1, 2025, we may redeem all or part of the 2030 Unsecured Notes at the applicable redemption prices described in the New Indenture, plus accrued and unpaid interest, if any, to, but excluding, the redemption date. We may also redeem up to 40% of the aggregate principal amount of the 2030 Unsecured Notes at any time prior to April 1, 2025, at a redemption price equal to 106.625% with an amount equal to or less than the net cash proceeds from certain equity offerings, plus accrued and unpaid interest, if any, to, but excluding, the redemption date. The 2029 Unsecured Notes and the 2030 Unsecured Notes are subordinated to any of our secured indebtedness, including indebtedness under our credit agreements. We have a revolving credit agreement with an administrative agent and collateral agent and a syndicate of financial institutions, as lenders (the Revolving Credit Agreement) with a maximum borrowing capacity of $450 million. The interest rate under our Revolving Credit Agreement is based on the Adjusted Term SOFR Rate (as defined in the Revolving Credit Agreement). The Revolving Credit Agreement matures in March 2027. At September 30, 2024 and December 31, 2023, our Revolving Credit Agreement was undrawn, and we had letters of credit, which reduce Revolving Credit Agreement availability, totaling $31.5 million and $27.4 million, leaving $419 million and $423 million available for borrowing at the end of each period. We also had letters of credit and bank guarantees which support certain leased facilities as well as other normal business activities in the U.S. and Europe that were issued outside of the Revolving Credit Agreement for $3.0 million as of September 30, 2024 and December 31, 2023. The Revolving Credit Agreement, the Credit Agreement, the Receivables Financing Agreement, the 2029 Unsecured Notes, and the 2030 Unsecured Notes contain cross-default provisions which could result in the acceleration of payments due in the event of default of any of the related agreements. The terms of the applicable credit agreements also require us to maintain ratios for leverage and interest coverage, including on a pro forma basis in the event of an acquisition or divestiture. We were in compliance with our debt covenants at September 30, 2024. ​ As of September 30, 2024, scheduled future principal payments of debt, excluding finance leases and other, were as follows: ​ ​ ​ ​ ​ Year ​ ​ 2024 (remainder) ​ $ 7,750 2025 ​ 40,375 2026 ​ 43,500 2027 ​ 285,375 2028 ​ 6,000 2029 ​ 965,654 2030 ​ 552,189 ​ Current maturities at September 30, 2024 include $31.3 million in principal payments on our Term Loan A, $6.0 million in principal payments on our Term Loan B, and $5.4 million in current portion of finance leases and other.

Retirement Plans

Retirement Plans	9 Months Ended
	Sep. 30, 2024
Retirement Benefits [Abstract]
Retirement Plans	Note 6—Retirement Plans We have a frozen noncontributory, unfunded retirement plan for certain retirees in the U.S. (U.S. Retirement Plan). As of September 30, 2024 and December 31, 2023, the accumulated benefit obligation of the U.S. Retirement Plan was $32.9 million and $34.1 million. Certain of our foreign subsidiaries also have defined benefit pension plans covering substantially all of their respective teammates. The components of net periodic benefit cost for the three and nine months ended September 30, 2024 and 2023 were as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ Nine Months Ended ​ ​ September 30, ​ September 30, ​ 2024 2023 2024 2023 Service cost ​ $ 446 ​ $ 429 ​ $ 1,362 ​ $ 1,316 Interest cost ​ ​ 635 ​ ​ 705 ​ ​ 1,925 ​ ​ 2,128 Recognized net actuarial loss ​ 79 ​ 124 ​ 241 ​ 370 Net periodic benefit cost ​ $ 1,160 ​ $ 1,258 ​ $ 3,528 ​ $ 3,814 ​

Derivatives

Derivatives	9 Months Ended
	Sep. 30, 2024
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Derivatives	Note 7—Derivatives We are directly and indirectly affected by changes in foreign currency, which may adversely impact our financial performance and are referred to as “market risks.” When deemed appropriate, we use derivatives as a risk management tool to mitigate the potential impact of certain market risks. We do not enter into derivative financial instruments for trading purposes. We enter into foreign currency contracts to manage our foreign exchange exposure related to certain balance sheet items that do not meet the requirements for hedge accounting. These derivative instruments are adjusted to fair value at the end of each period through earnings. The gain or loss recorded on these instruments is substantially offset by the remeasurement adjustment on the foreign currency denominated asset or liability. We pay interest on our Credit Agreement which fluctuates based on changes in our benchmark interest rates. In order to mitigate the risk of increases in benchmark rates on our term loans, we entered into an interest rate swap agreement whereby we agree to exchange with the counterparty, at specified intervals, the difference between fixed and variable amounts calculated by reference to the notional amount. The interest rate swaps were designated as cash flow hedges. Cash flows related to the interest rate swap agreement are included in interest expense, net. We determine the fair value of our foreign currency derivatives and interest rate swaps based on observable market-based inputs or unobservable inputs that are corroborated by market data. We do not view the fair value of our derivatives in isolation, but rather in relation to the fair values or cash flows of the underlying exposure. All derivatives are carried at fair value in our consolidated balance sheets. We consider the risk of counterparty default to be minimal. We report cash flows from our hedging instruments in the same cash flow statement category as the hedged items. The following table summarizes the terms and fair value of our outstanding derivative financial instruments as of September 30, 2024: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Notional ​ Derivative Assets Derivative Liabilities ​ Amount Maturity Date Classification Fair Value Classification Fair Value Cash flow hedges ​ ​ ​ ​ ​ ​ Interest rate swaps ​ $ 300,000 ​ March 2027 Other assets, net ​ $ 3,451 ​ Other liabilities ​ $ — ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Economic (non-designated) hedges ​ ​ ​ ​ ​ Foreign currency contracts ​ $ 33,350 ​ October 2024 Other current assets ​ $ 106 ​ Other current liabilities ​ $ 8 ​ The following table summarizes the terms and fair value of our outstanding derivative financial instruments as of December 31, 2023: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Notional ​ Derivative Assets Derivative Liabilities ​ Amount Maturity Date Classification Fair Value Classification Fair Value Cash flow hedges ​ ​ ​ ​ ​ ​ ​ ​ ​ Interest rate swaps ​ $ 350,000 ​ March 2027 ​ Other assets, net ​ $ 8,447 ​ Other liabilities ​ $ — ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Economic (non-designated) hedges ​ ​ ​ ​ ​ Foreign currency contracts ​ $ 78,436 ​ January 2024 Other current assets ​ $ 1,043 ​ Other current liabilities ​ $ — ​ The notional amount of the interest rate swaps represents the amount in effect at the end of the period. Based on contractual terms, the notional amount will decrease in increments of $50 million on the last business day of March of each year until the maturity date. The following table summarizes the effect of cash flow hedge accounting on our consolidated statements of operations for the three and nine months ended September 30, 2024: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total Amount of Expense ​ ​ ​ Amount of (Loss) Gain ​ ​ ​ Line Items Presented in the ​ Amount of Gain Reclassified ​ ​ Recognized in Other ​ Location of Gain ​ Consolidated Statement of ​ from Accumulated Other ​ ​ Comprehensive Income ​ Reclassified from ​ Operations in Which the ​ Comprehensive Loss into ​ (Loss) Accumulated Other Effects are Recorded Net Loss ​ ​ Three months ended ​ Nine months ended ​ Comprehensive Loss ​ Three months ended ​ Nine months ended ​ Three months ended ​ Nine months ended ​ ​ September 30, 2024 ​ September 30, 2024 ​ into Income ​ September 30, 2024 ​ September 30, 2024 ​ September 30, 2024 ​ September 30, 2024 Interest rate swaps ​ $ (4,872) ​ $ 1,283 Interest expense, net ​ $ 36,554 ​ $ 108,108 ​ $ 1,757 ​ $ 6,280 The amount of ineffectiveness associated with these contracts was immaterial for the periods presented. ​ The following table summarizes the effect of cash flow hedge accounting on our consolidated statements of operations for the three and nine months ended September 30, 2023: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total Amount of Expense ​ ​ ​ Amount of Gain ​ ​ ​ Line Items Presented in the ​ Amount of Gain Reclassified ​ ​ Recognized in Other ​ Location of Gain ​ Consolidated Statement of ​ from Accumulated Other ​ Comprehensive Income ​ Reclassified from ​ Operations in Which the ​ Comprehensive Loss into ​ ​ (Loss) Accumulated Other Effects are Recorded Net Loss ​ ​ Three months ended ​ Nine months ended ​ Comprehensive Loss ​ Three months ended ​ Nine months ended ​ Three months ended ​ Nine months ended ​ ​ September 30, 2023 ​ September 30, 2023 ​ into Income ​ September 30, 2023 ​ September 30, 2023 ​ September 30, 2023 ​ September 30, 2023 Interest rate swaps ​ $ 3,621 ​ $ 8,026 Interest expense, net ​ $ 38,127 ​ $ 121,053 ​ $ 2,569 ​ $ 7,080 ​ The amount of ineffectiveness associated with these contracts was immaterial for the periods presented. For the three and nine months ended September 30, 2024, we recognized a gain of $4.2 million and a loss of $1.0 million associated with our economic (non-designated) foreign currency contracts. For the three and nine months ended September 30, 2023, we recognized losses of $2.4 million and $3.3 million associated with our economic (non-designated) foreign currency contracts. We recorded the change in fair value of derivative instruments and the remeasurement adjustment of the foreign currency denominated asset or liability in other operating expense, net for our foreign exchange contracts.

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2024
Income Tax Disclosure [Abstract]
Income Taxes	Note 8—Income Taxes The effective tax rate was 7.4% and (15.4)% for the three and nine months ended September 30, 2024, compared to 41.5% and 22.0% in the same periods of 2023. The change in these rates for the three month periods resulted primarily from changes in results of operations in the jurisdictions in which we operate and the incremental tax benefit recorded for foreign derived intangible income in the third quarter of 2023. The change in these rates for the nine month periods resulted primarily from remeasurement of our uncertain tax positions, as described below, as well as the factors described for the three month periods. ​ On August 26, 2020, we received a Notice of Proposed Adjustment (NOPA) from the IRS regarding our 2015 and 2016 consolidated income tax returns. On June 30, 2021, we received a NOPA from the IRS regarding our 2017 and 2018 consolidated income tax returns. Within the NOPAs, the IRS has asserted that our taxable income for the aforementioned years should be higher based on their assessment of the appropriate amount of taxable income that we should report in the United States in connection with our sourcing of products by our foreign subsidiaries for sale in the United States by our domestic subsidiaries. The transfer pricing methodology was consistently applied for all years subject to the NOPAs and 2019 into 2022, but is no longer employed. ​ During the three months ended June 30, 2024, the IRS and the relevant foreign taxing authority mutually agreed to proposed adjustments to our 2015 through 2018 consolidated tax returns. This was communicated to us in late June 2024. As a result, we remeasured the uncertain tax position for the 2015 through 2018 tax years, as well as the affected 2019 through 2022 tax years, to the amount expected to be paid upon a final agreement with the IRS. This matter does not impact our 2023, 2024 or future tax years. The total change in estimate, net of an income tax benefit from the foreign taxing authority, is $17.9 million, or $(0.23) impact per basic and diluted common share, including $4.7 million of interest, for the nine months ended September 30, 2024 and is reflected within the income tax provision on our consolidated statements of operations. The total change in estimate reflects an increase in the liability for unrecognized tax benefits of $19.7 million recorded within other current liabilities, partially offset by a $1.9 million increase in the receivable from the foreign taxing authority recorded within other current assets, on our consolidated balance sheet at September 30, 2024. The balance sheet classification and amount owed may be subject to change depending on the timing of a final agreement with the IRS. Excluding the impact of $0.7 million of interest, there has been no change in estimate for the three months ended September 30, 2024. ​ The liability for unrecognized tax benefits was $38.2 million at September 30, 2024 and $22.7 million at December 31, 2023. Unrecognized tax benefits of $35.5 million and $20.0 million at September 30, 2024 and December 31, 2023 would impact our effective tax rate if recognized. ​ We regularly assess the likelihood of adverse outcomes resulting from examinations such as this to determine the adequacy of our tax reserves. We believe that we have adequately reserved for this matter and that the final adjudication of this matter will not have a material impact on our consolidated financial position, results of operations or cash flows beyond the amounts described herein.

Net Loss per Common Share

Net Loss per Common Share	9 Months Ended
	Sep. 30, 2024
Earnings Per Share [Abstract]
Net Loss per Common Share	Note 9—Net Loss per Common Share The following summarizes the calculation of net loss per common share attributable to common shareholders for the three and nine months ended September 30, 2024 and 2023: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ Nine Months Ended ​ ​ September 30, ​ September 30, (in thousands, except per share data) 2024 2023 2024 2023 Net loss ​ $ (12,770) ​ $ (6,426) ​ $ (66,570) ​ $ (59,085) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted average shares outstanding - basic ​ 77,090 ​ 76,203 ​ 76,657 ​ 75,691 Dilutive shares ​ — ​ — ​ — ​ — Weighted average shares outstanding - diluted ​ 77,090 ​ 76,203 ​ 76,657 ​ 75,691 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Net loss per common share ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Basic ​ $ (0.17) ​ $ (0.08) ​ $ (0.87) ​ $ (0.78) Diluted ​ $ (0.17) ​ $ (0.08) ​ $ (0.87) ​ $ (0.78) ​ Share-based awards of approximately 1.4 million and 1.5 million shares for the three and nine months ended September 30, 2024 and approximately 1.5 million and 1.6 million shares for the three and nine months ended September 30, 2023 were excluded from the calculation of net loss per diluted common share as the effect would be anti-dilutive.

Accumulated Other Comprehensive

Accumulated Other Comprehensive (Loss) Income	9 Months Ended
	Sep. 30, 2024
Equity [Abstract]
Accumulated Other Comprehensive (Loss) Income	Note 10—Accumulated Other Comprehensive (Loss) Income The following table shows the changes in accumulated other comprehensive (loss) income by component for the three and nine months ended September 30, 2024 and 2023: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Currency ​ ​ ​ ​ ​ ​ Retirement ​ Translation ​ ​ ​ ​ ​ ​ ​ ​ Plans ​ Adjustments ​ Derivatives ​ Total Accumulated other comprehensive (loss) income, June 30, 2024 ​ $ (4,681) ​ $ (51,522) ​ $ 7,459 ​ $ (48,744) Other comprehensive income (loss) before reclassifications ​ 275 ​ 25,966 ​ (4,872) ​ 21,369 Income tax ​ (68) ​ — ​ 1,267 ​ 1,199 Other comprehensive income (loss) before reclassifications, net of tax ​ 207 ​ 25,966 ​ (3,605) ​ 22,568 Amounts reclassified from accumulated other comprehensive income (loss) ​ 79 ​ — ​ (1,757) ​ (1,678) Income tax ​ (21) ​ — ​ 457 ​ 436 Amounts reclassified from accumulated other comprehensive income (loss), net of tax ​ 58 ​ — ​ (1,300) ​ (1,242) Other comprehensive income (loss) ​ 265 ​ 25,966 ​ (4,905) ​ 21,326 Accumulated other comprehensive (loss) income, September 30, 2024 ​ $ (4,416) ​ $ (25,556) ​ $ 2,554 ​ $ (27,418) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Currency ​ ​ ​ ​ ​ ​ Retirement ​ Translation ​ ​ ​ ​ ​ ​ ​ ​ Plans ​ Adjustments ​ Derivatives ​ Total Accumulated other comprehensive (loss) income, June 30, 2023 ​ $ (7,212) ​ $ (40,144) ​ $ 11,363 ​ $ (35,993) Other comprehensive (loss) income before reclassifications ​ — ​ (9,891) ​ 3,621 ​ (6,270) Income tax ​ — ​ — ​ (941) ​ (941) Other comprehensive (loss) income before reclassifications, net of tax ​ — ​ (9,891) ​ 2,680 ​ (7,211) Amounts reclassified from accumulated other comprehensive income (loss) ​ 124 ​ — ​ (2,569) ​ (2,445) Income tax ​ 28 ​ — ​ 666 ​ 694 Amounts reclassified from accumulated other comprehensive income (loss), net of tax ​ 152 ​ — ​ (1,903) ​ (1,751) Other comprehensive income (loss) ​ 152 ​ (9,891) ​ 777 ​ (8,962) Accumulated other comprehensive (loss) income, September 30, 2023 ​ $ (7,060) ​ $ (50,035) ​ $ 12,140 ​ $ (44,955) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Currency ​ ​ ​ ​ ​ ​ Retirement ​ Translation ​ ​ ​ ​ ​ ​ ​ ​ Plans ​ Adjustments ​ Derivatives ​ Total Accumulated other comprehensive (loss) income, December 31, 2023 ​ $ (5,115) ​ $ (32,954) ​ $ 6,251 ​ $ (31,818) Other comprehensive income before reclassifications ​ 694 ​ 7,398 ​ 1,283 ​ 9,375 Income tax ​ (173) ​ — ​ (334) ​ (507) Other comprehensive income before reclassifications, net of tax ​ 521 ​ 7,398 ​ 949 ​ 8,868 Amounts reclassified from accumulated other comprehensive income (loss) ​ 241 ​ — ​ (6,280) ​ (6,039) Income tax ​ (63) ​ — ​ 1,634 ​ 1,571 Amounts reclassified from accumulated other comprehensive income (loss), net of tax ​ 178 ​ — ​ (4,646) ​ (4,468) Other comprehensive income (loss) ​ 699 ​ 7,398 ​ (3,697) ​ 4,400 Accumulated other comprehensive (loss) income, September 30, 2024 ​ $ (4,416) ​ $ (25,556) ​ $ 2,554 ​ $ (27,418) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Currency ​ ​ ​ ​ ​ ​ Retirement ​ Translation ​ ​ ​ ​ ​ ​ ​ ​ Plans ​ Adjustments ​ Derivatives ​ Total Accumulated other comprehensive (loss) income, December 31, 2022 ​ $ (7,201) ​ $ (40,095) ​ $ 11,441 ​ $ (35,855) Other comprehensive (loss) income before reclassifications ​ — ​ (9,940) ​ 8,026 ​ (1,914) Income tax ​ — ​ — ​ (2,086) ​ (2,086) Other comprehensive (loss) income before reclassifications, net of tax ​ — ​ (9,940) ​ 5,940 ​ (4,000) Amounts reclassified from accumulated other comprehensive income (loss) ​ 370 ​ — ​ (7,080) ​ (6,710) Income tax ​ (229) ​ — ​ 1,839 ​ 1,610 Amounts reclassified from accumulated other comprehensive income (loss), net of tax ​ 141 ​ — ​ (5,241) ​ (5,100) Other comprehensive income (loss) ​ 141 ​ (9,940) ​ 699 ​ (9,100) Accumulated other comprehensive (loss) income, September 30, 2023 ​ $ (7,060) ​ $ (50,035) ​ $ 12,140 ​ $ (44,955) ​ We include amounts reclassified out of accumulated other comprehensive (loss) income related to defined benefit pension plans as a component of net periodic pension cost recorded in Other expense, net.

Segment Information

Segment Information	9 Months Ended
	Sep. 30, 2024
Segment Reporting [Abstract]
Segment Information	Note 11—Segment Information We periodically evaluate our application of accounting guidance for reportable segments and disclose information about reportable segments based on the way management organizes the enterprise for making operating decisions and assessing performance. We report our business under two segments: Products & Healthcare Services and Patient Direct. The Products & Healthcare Services segment includes our Medical Distribution division, which includes our U.S. distribution business, along with our outsourced logistics and value-added services businesses, and our Global Products division which manufactures and sources medical surgical products through our production and kitting operations. The Patient Direct segment includes our home healthcare divisions (Byram and Apria). We evaluate the performance of our segments based on their operating income excluding acquisition-related charges and intangible amortization and exit and realignment charges, net, along with other adjustments, that, as a result of their nature, would not be expected to occur as part of our normal business operations on a regular basis. Segment assets exclude inter-segment account balances as we believe their inclusion would be misleading and not meaningful. The following tables present financial information by segment: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ Nine Months Ended ​ ​ September 30, ​ September 30, ​ 2024 2023 2024 2023 Net revenue: ​ ​ ​ ​ Products & Healthcare Services ​ $ 2,034,279 ​ $ 1,943,467 ​ $ 6,019,721 ​ $ 5,789,679 Patient Direct ​ 686,846 ​ 648,275 ​ 1,985,089 ​ 1,888,138 Consolidated net revenue ​ $ 2,721,125 ​ $ 2,591,742 ​ $ 8,004,810 ​ $ 7,677,817 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Operating income: ​ ​ ​ ​ Products & Healthcare Services ​ $ 4,233 ​ $ 19,803 ​ $ 27,187 ​ $ 24,564 Patient Direct ​ 79,932 ​ 64,435 ​ 190,598 ​ 169,349 Acquisition-related charges and intangible amortization ​ (21,097) ​ (30,217) ​ (61,395) ​ (74,609) Exit and realignment charges, net ​ ​ (28,880) ​ ​ (30,180) ​ ​ (85,530) ​ ​ (74,817) Litigation and related charges (1) ​ (9,984) ​ — ​ (16,662) ​ — Consolidated operating income ​ $ 24,204 ​ $ 23,841 ​ $ 54,198 ​ $ 44,487 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Depreciation and amortization: ​ ​ ​ ​ Products & Healthcare Services ​ $ 18,382 ​ $ 20,021 ​ $ 60,832 ​ $ 57,360 Patient Direct ​ 43,232 ​ 53,631 ​ 138,756 ​ 159,280 Consolidated depreciation and amortization ​ $ 61,614 ​ $ 73,652 ​ $ 199,588 ​ $ 216,640 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Share-based compensation: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Products & Healthcare Services ​ $ 4,141 ​ $ 2,917 ​ $ 13,696 ​ $ 10,649 Patient Direct ​ ​ 1,198 ​ ​ 1,699 ​ ​ 4,131 ​ ​ 5,113 Other (2) ​ ​ 341 ​ ​ 1,126 ​ ​ 1,454 ​ ​ 1,655 Consolidated share-based compensation ​ $ 5,680 ​ $ 5,742 ​ $ 19,281 ​ $ 17,417 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Capital expenditures: ​ ​ ​ ​ Products & Healthcare Services ​ $ 17,763 ​ $ 5,023 ​ $ 29,130 ​ $ 17,957 Patient Direct ​ 43,755 ​ 45,565 ​ 127,596 ​ 133,610 Consolidated capital expenditures ​ $ 61,518 ​ $ 50,588 ​ $ 156,726 ​ $ 151,567 ​ (1) Litigation and related charges includes settlement costs and related fees of legal matters within our Apria division, which do not occur in the ordinary course of our business, are non-recurring/infrequent and are inherently unpredictable in timing and amount. These charges are reported within Other operating expense, net in our Statements of Operations for the three and nine months ended September 30, 2024. ​ (2) Other share-based compensation expense is captured within Exit and realignment charges, net or Acquisition-related charges for the three and nine months ended September 30, 2024 and 2023. ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ September 30, 2024 ​ December 31, 2023 Total assets: ​ ​ Products & Healthcare Services ​ $ 2,519,690 ​ $ 2,359,825 Patient Direct ​ ​ 2,516,138 ​ ​ 2,490,460 Segment assets ​ ​ 5,035,828 ​ ​ 4,850,285 Cash and cash equivalents ​ 45,454 ​ 243,037 Consolidated total assets ​ $ 5,081,282 ​ $ 5,093,322 ​ Non-cash last-in, first-out (LIFO) charges (credits) to merchandise inventories valued at the lower of cost or market, with the approximate cost determined by the LIFO method for distribution inventories in the U.S. within our Products & Healthcare Services segment, were $6.7 million and $(3.7) million for the three months ended September 30, 2024 and 2023, and $11.0 million and $(3.3) million for the nine months ended September 30, 2024 and 2023. The net book value of patient service equipment sales and dispositions within the Patient Direct segment, net of the gain for returned equipment to Philips Respironics for previously recalled equipment, were $7.9 million and $10.0 million for the three months ended September 30, 2024 and 2023 and $22.7 million and $27.2 million for the nine months ended September 30, 2024 and 2023. ​ The following table presents net revenue by geographic area, which were attributed based on the location from which we ship products or provide services: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ Nine Months Ended ​ ​ September 30, ​ September 30, ​ ​ 2024 2023 2024 2023 Net revenue: ​ ​ ​ ​ United States ​ $ 2,661,469 ​ $ 2,518,952 ​ $ 7,821,088 ​ $ 7,470,424 International ​ 59,656 ​ 72,790 ​ 183,722 ​ 207,393 Consolidated net revenue ​ $ 2,721,125 ​ $ 2,591,742 ​ $ 8,004,810 ​ $ 7,677,817 ​

Recent Accounting Pronouncement

Recent Accounting Pronouncements	9 Months Ended
	Sep. 30, 2024
Accounting Policies [Abstract]
Recent Accounting Pronouncements	Note 12—Recent Accounting Pronouncements In November 2023, the Financial Accounting Standards Board (FASB) issued Accounting Standards Update (ASU) 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures, which will require disclosure of additional detailed information about a reportable segment’s expenses, including significant segment expenses regularly provided to the Chief Operating Decision Maker (CODM), the title and position of the CODM, and how the CODM uses the reported measure(s) of a segment’s profit or loss. This ASU is effective for us in annual periods beginning after December 15, 2023 and interim periods within annual years beginning after December 15, 2024. The amendments in this ASU must be applied on a retrospective basis to all prior periods presented in the financial statements and early adoption is permitted. We expect this ASU to only impact our disclosures with no impacts to our results of operations, financial condition and cash flows. In December 2023, the FASB Issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures, which will require additional annual income tax disclosures, including disclosure of reconciling items by jurisdiction and nature to the extent those items exceed a specified threshold. In addition, this ASU will require disclosure of income taxes paid, net of refunds received disaggregated by federal, state, and foreign and by jurisdiction if the amount is more than 5% of total income tax payments, net of refunds received. The amendments in this ASU are effective for us in annual periods beginning after December 15, 2024. The amendments in this ASU are required to be applied on a prospective basis and retrospective adoption is permitted. We expect this ASU to only impact our disclosures with no impacts to our results of operations, financial condition and cash flows

Commitments, Contingent Liabili

Commitments, Contingent Liabilities, and Legal Proceedings	9 Months Ended
	Sep. 30, 2024
Commitments and Contingencies Disclosure [Abstract]
Commitments, Contingent Liabilities, and Legal Proceedings	Note 13—Commitments, Contingent Liabilities, and Legal Proceedings Commitments include $48.4 million of legally binding lease payments for the Morgantown, West Virginia center of excellence for medical supplies and logistics lease signed, but not yet commenced. Refer to our Annual Report on Form 10-K for the year ended December 31, 2023 for disclosure of other material contractual obligations. We are party to various legal claims that are ordinary and incidental to our business, including ones related to commercial disputes, employment, workers’ compensation, product liability, regulatory and other matters. We maintain insurance coverage for employment, product liability, workers’ compensation and other personal injury litigation matters, subject to policy limits, applicable deductibles and insurer solvency. We establish reserves from time to time based upon periodic assessment of the potential outcomes of pending matters. Based on current knowledge and the advice of counsel, we believe that the accrual as of September 30, 2024 for currently pending matters considered probable of loss, which is not material, is sufficient. In addition, we believe that other currently pending matters are not reasonably possible to result in a material loss, as payment of the amounts claimed is remote, the claims are immaterial, individually and in the aggregate, or the claims are expected to be adequately covered by insurance, subject to policy limits, applicable deductibles, exclusions and insurer solvency. On July 22, 2024, we entered into an Agreement and Plan of Merger to acquire Rotech for $1.36 billion in cash. Given anticipated tax benefits of approximately $40 million from the transaction, the net purchase price is approximately $1.32 billion. Rotech is a national leader in providing home medical equipment in the US. The definitive agreement contains certain termination rights for the Company and Rotech. In the event that we terminate the contract, we will be required to pay Rotech a termination fee of $70.0 million. The transaction is subject to customary closing conditions, including expiration or termination of the applicable waiting period under the Hart Scott Rodino Act, and is expected to close in the first half of 2025. We have fully committed financing in place and expect to use a combination of cash and incremental borrowings to fund the purchase price.

Subsequent Events

Subsequent Events	9 Months Ended
	Sep. 30, 2024
Subsequent Events [Abstract]
Subsequent Events	Note 14 - Subsequent Events On October 18, 2024, O&M Funding and Owens & Minor Medical, LLC., each a wholly-owned subsidiary of the Company, entered into a Receivables Purchase Agreement (the Receivables Sale Program) with persons from time to time party hereto, as Purchasers, PNC Bank, National Association, as Administrative Agent, and PNC Capital Markets LLC, as Structuring Agent, pursuant to which accounts receivable with an aggregate outstanding amount not to exceed $450 million are sold, on a limited-recourse basis, to the Purchasers in exchange for cash. The Receivables Sale Program amends and restates in its entirety, the Receivables Financing Agreement, dated as of February 19, 2020. Transactions under this agreement will be accounted for as sales in accordance with ASC 860, Transfers and Servicing, with the sold receivables removed from our consolidated balance sheets. Under the Receivables Sale Program, we provide certain servicing and collection actions on behalf of the Purchasers; however, we do not maintain a ny beneficial interest in the accounts receivable sold.

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2024	Sep. 30, 2023
Pay vs Performance Disclosure
Net Income (Loss)	$ (12,770)	$ (31,913)	$ (21,886)	$ (6,426)	$ (28,241)	$ (24,418)	$ (66,570)	$ (59,085)

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended
	Sep. 30, 2024
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2024
Accounting Policies [Abstract]
Basis of Presentation and Consolidation	Basis of Presentation The accompanying unaudited consolidated financial statements include the accounts of Owens & Minor, Inc. and the subsidiaries it controls (we, us, or our) and contain all adjustments necessary to conform with U.S. generally accepted accounting principles (GAAP). All significant intercompany accounts and transactions have been eliminated. The results of operations for interim periods are not necessarily indicative of the results expected for the full year. We report our business under two segments: Products & Healthcare Services and Patient Direct. The Products & Healthcare Services segment includes our Medical Distribution division, which includes our U.S. distribution business, along with our outsourced logistics and value-added services businesses, and our Global Products division which manufactures and sources medical surgical products through our production and kitting operations. The Patient Direct segment includes our home healthcare divisions (Byram and Apria).
Reclassifications	Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation.
Use of Estimates	Use of Estimates The preparation of consolidated financial statements in conformity with GAAP requires us to make assumptions and estimates that affect reported amounts and related disclosures. Actual results may differ from these estimates.
Cash, Cash Equivalents and Restricted Cash	Cash, Cash Equivalents and Restricted Cash Cash, cash equivalents and restricted cash includes cash and marketable securities with an original maturity or maturity at acquisition of three months or less. Cash, cash equivalents and restricted cash are stated at cost. Nearly all of our cash, cash equivalents and restricted cash are held in cash depository accounts in major banks in North America, Europe, and Asia. Cash that is held by a major bank and has restrictions on its availability to us is classified as restricted cash. Restricted cash as of September 30, 2024 and December 31, 2023 includes cash held in an escrow account as required by the Centers for Medicare & Medicaid Services in conjunction with the Bundled Payments for Care Improvement initiatives related to wind-down costs of Fusion5, as well as $13.2 million and $13.5 million of cash deposits received subject to limitations on use until remitted to a third-party financial institution (the Purchaser), pursuant to the Master Receivables Purchase Agreement (RPA). The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying consolidated balance sheets that sum to the total of those same amounts presented in the accompanying consolidated statements of cash flows. ​ ​ ​ ​ ​ ​ ​ ​ ​ September 30, 2024 December 31, 2023 Cash and cash equivalents ​ $ 45,454 ​ $ 243,037 Restricted cash included in Other current assets ​ 13,230 ​ 29,887 Restricted cash included in Other assets, net ​ ​ 16,406 ​ ​ — Total cash, cash equivalents, and restricted cash ​ $ 75,090 ​ $ 272,924
Rental Revenue	Rental Revenue Within our Patient Direct segment, revenues are recognized under fee-for-service arrangements for equipment we rent to patients and sales of equipment, supplies and other items we sell to patients. Revenue that is generated from equipment that we rent to patients is primarily recognized over the noncancelable rental period, typically one month, and commences on delivery of the equipment to the patients. Revenues are recorded at amounts estimated to be received under reimbursement arrangements with third-party payors, including private insurers, prepaid health plans, Medicare, Medicaid and patients. Rental revenue, less estimated adjustments, is recognized as earned on a straight-line basis over the noncancelable lease term. Net revenue related to equipment that we rent to patients was $148 million and $158 million for the three months ended September 30, 2024 and 2023 and $442 million and $458 million for the nine months ended September 30, 2024 and 2023.
Sales of Accounts Receivable	Sales of Accounts Receivable On March 14, 2023, we entered into the RPA, pursuant to which accounts receivable with an aggregate outstanding amount not to exceed $200 million are sold, on a limited-recourse basis, to the Purchaser in exchange for cash. As of September 30, 2024 and December 31, 2023, there were a total of $121 million and $124 million of uncollected accounts receivable, that were accounted for as sales and removed from our consolidated balance sheets. Under the RPA, we provide certain servicing and collection actions on behalf of the Purchaser; however, we do not maintain any beneficial interest in the accounts receivable sold. Proceeds from the sale of accounts receivable are recorded as an increase to cash and cash equivalents and a reduction to accounts receivable, net of allowances, in the consolidated balance sheets. Cash received from the sale of accounts receivable, net of payments made to the Purchaser, is reflected as cash provided by operating activities in the consolidated statements of cash flows. Total accounts receivable sold under the RPA were $542 million and $1.6 billion for the three and nine months ended September 30, 2024. During the three and nine months ended September 30, 2024, we received net cash proceeds of $538 million and $1.6 billion from the sale of accounts receivable under the RPA and collected $550 million and $1.6 billion of the sold accounts receivable. Total accounts receivable sold under the RPA were $482 million and $894 million for the three and nine months ended September 30, 2023. During the three and nine months ended September 30, 2023, we received net cash proceeds of $478 million and $888 million from the sale of accounts receivable under the RPA and collected $508 million and $805 million of the sold accounts receivable. The losses on sale of accounts receivable, inclusive of professional fees incurred to establish the agreement, recorded in other operating expense, net in the consolidated statements of operations were $3.6 million and $3.5 million for the three months ended September 30, 2024 and 2023 and $10.8 million and $7.1 million for the nine months ended September 30, 2024 and 2023. The RPA is separate and distinct from the accounts receivable securitization program (the Receivables Financing Agreement).
Acquisition-Related Charges	Acquisition-Related Charges Acquisition-related charges, included in the ‘acquisition-related charges and intangible amortization’ line item of our consolidated statements of operations, consist primarily of one-time costs related to acquisitions, including transaction costs necessary to consummate acquisitions, which consist of investment banking advisory fees and legal fees, director and officer tail insurance expense, severance and retention bonuses, and professional fees. Acquisition-related charges also include transition expenses and costs to integrate personnel, systems and processes. For the three and nine months ended September 30, 2024, we incurred $6.5 million and $10.2 million of acquisition-related costs related to the expected acquisition of Rotech Healthcare Holdings Inc. (Rotech), which consisted primarily of legal and professional fees. For the three and nine months ended September 30, 2023, we incurred $9.4 million and $11.9 million of acquisition-related costs, consisting of costs primarily related to the acquisition of Apria, Inc. (Apria).
Fair Value Measurements	Fair value is determined based on assumptions that a market participant would use in pricing an asset or liability. The assumptions used are in accordance with a three-tier hierarchy, defined by GAAP, that draws a distinction between market participant assumptions based on (i) observable inputs such as quoted prices in active markets (Level 1), (ii) inputs other than quoted prices in active markets that are observable either directly or indirectly (Level 2) and (iii) unobservable inputs that require the use of present value and other valuation techniques in the determination of fair value (Level 3). The carrying amounts of cash and cash equivalents, restricted cash, accounts receivable, accounts payable, and accrued payroll and related liabilities reported in the consolidated balance sheets approximate fair value due to the short-term nature of these instruments. The fair value of debt is estimated based on quoted market prices or dealer quotes for the identical liability when traded as an asset in an active market (Level 1) or, if quoted market prices or dealer quotes are not available, on the borrowing rates currently available for loans with similar terms, credit ratings, and average remaining maturities (Level 2). See Note 5 for the fair value of debt. The fair value of our derivative contracts is determined based on the present value of expected future cash flows considering the risks involved, including non-performance risk, and using discount rates appropriate for the respective maturities. Observable Level 2 inputs are used to determine the present value of expected future cash flows. See Note 7 for the fair value of derivatives. Our acquisitions may include contingent consideration as part of the purchase price. The fair value of contingent consideration is estimated as of the acquisition date and at the end of each subsequent reporting period based on the present value of the contingent payments to be made using a weighted probability of possible payments (Level 3). Subsequent changes in fair value are recorded as adjustments to acquisition-related charges and intangible amortization within the consolidated statements of operations. ​
Segment Information	We periodically evaluate our application of accounting guidance for reportable segments and disclose information about reportable segments based on the way management organizes the enterprise for making operating decisions and assessing performance. We report our business under two segments: Products & Healthcare Services and Patient Direct. The Products & Healthcare Services segment includes our Medical Distribution division, which includes our U.S. distribution business, along with our outsourced logistics and value-added services businesses, and our Global Products division which manufactures and sources medical surgical products through our production and kitting operations. The Patient Direct segment includes our home healthcare divisions (Byram and Apria).
Recent Accounting Pronouncements	In November 2023, the Financial Accounting Standards Board (FASB) issued Accounting Standards Update (ASU) 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures, which will require disclosure of additional detailed information about a reportable segment’s expenses, including significant segment expenses regularly provided to the Chief Operating Decision Maker (CODM), the title and position of the CODM, and how the CODM uses the reported measure(s) of a segment’s profit or loss. This ASU is effective for us in annual periods beginning after December 15, 2023 and interim periods within annual years beginning after December 15, 2024. The amendments in this ASU must be applied on a retrospective basis to all prior periods presented in the financial statements and early adoption is permitted. We expect this ASU to only impact our disclosures with no impacts to our results of operations, financial condition and cash flows. In December 2023, the FASB Issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures, which will require additional annual income tax disclosures, including disclosure of reconciling items by jurisdiction and nature to the extent those items exceed a specified threshold. In addition, this ASU will require disclosure of income taxes paid, net of refunds received disaggregated by federal, state, and foreign and by jurisdiction if the amount is more than 5% of total income tax payments, net of refunds received. The amendments in this ASU are effective for us in annual periods beginning after December 15, 2024. The amendments in this ASU are required to be applied on a prospective basis and retrospective adoption is permitted. We expect this ASU to only impact our disclosures with no impacts to our results of operations, financial condition and cash flows

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	9 Months Ended
	Sep. 30, 2024
Accounting Policies [Abstract]
Schedule of Cash and Cash Equivalents	The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying consolidated balance sheets that sum to the total of those same amounts presented in the accompanying consolidated statements of cash flows. ​ ​ ​ ​ ​ ​ ​ ​ ​ September 30, 2024 December 31, 2023 Cash and cash equivalents ​ $ 45,454 ​ $ 243,037 Restricted cash included in Other current assets ​ 13,230 ​ 29,887 Restricted cash included in Other assets, net ​ ​ 16,406 ​ ​ — Total cash, cash equivalents, and restricted cash ​ $ 75,090 ​ $ 272,924
Schedule restricted on cash and cash equivalents	The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying consolidated balance sheets that sum to the total of those same amounts presented in the accompanying consolidated statements of cash flows. ​ ​ ​ ​ ​ ​ ​ ​ ​ September 30, 2024 December 31, 2023 Cash and cash equivalents ​ $ 45,454 ​ $ 243,037 Restricted cash included in Other current assets ​ 13,230 ​ 29,887 Restricted cash included in Other assets, net ​ ​ 16,406 ​ ​ — Total cash, cash equivalents, and restricted cash ​ $ 75,090 ​ $ 272,924

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)	9 Months Ended
	Sep. 30, 2024
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Goodwill	The following table summarizes the goodwill balances by segment and the changes in the carrying amount of goodwill at September 30, 2024: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Products & ​ ​ ​ ​ ​ ​ ​ Healthcare ​ ​ ​ ​ ​ Patient Direct ​ Services ​ Consolidated Carrying amount of goodwill, December 31, 2023 ​ $ 1,535,252 ​ $ 103,594 ​ $ 1,638,846 Currency translation adjustments ​ — ​ 3,350 ​ 3,350 Carrying amount of goodwill, September 30, 2024 ​ $ 1,535,252 ​ $ 106,944 ​ $ 1,642,196
Intangible Assets	Intangible assets subject to amortization, which exclude indefinite-lived intangible assets at September 30, 2024 and December 31, 2023 were as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ September 30, 2024 ​ December 31, 2023 ​ Customer ​ ​ Other Customer ​ ​ Other ​ ​ Relationships ​ Tradenames ​ Intangibles ​ Relationships ​ Tradenames ​ Intangibles Gross intangible assets ​ $ 332,811 ​ $ 202,000 ​ $ 73,055 ​ $ 433,750 ​ $ 202,000 ​ $ 73,958 Accumulated amortization ​ (163,350) ​ (84,324) ​ (48,908) ​ (236,791) ​ (69,655) ​ (41,427) Net intangible assets ​ $ 169,461 ​ $ 117,676 ​ $ 24,147 ​ $ 196,959 ​ $ 132,345 ​ $ 32,531 Weighted average useful life ​ 14 years ​ 10 years ​ 6 years ​ 13 years ​ 10 years ​ 6 years
Schedule of estimated amortization expense	As of September 30, 2024, based on the current carrying value of intangible assets subject to amortization, estimated amortization expense were as follows: ​ ​ ​ ​ ​ Year ​ ​ 2024 (remainder) ​ $ 13,680 2025 ​ 54,716 2026 ​ 50,364 2027 ​ 42,015 2028 ​ 32,117 Thereafter ​ ​ 118,392 Total future amortization ​ $ 311,284 ​

Exit and Realignment Costs (Tab

Exit and Realignment Costs (Tables)	9 Months Ended
	Sep. 30, 2024
Restructuring and Related Activities [Abstract]
Schedule of Exit and Realignment Cost Accrual Activity	​ The following table summarizes the activity related to exit and realignment cost accruals, which are classified as other current liabilities in our consolidated balance sheets, through September 30, 2024 and 2023: ​ ​ ​ ​ ​ ​ Total Accrued exit and realignment costs, December 31, 2023 ​ $ 20,047 Provision for exit and realignment activities: ​ Severance ​ 184 Professional fees ​ 25,625 IT strategic initiatives - related costs ​ ​ 1,241 Other ​ 1,252 Cash payments ​ (11,728) Accrued exit and realignment costs, March 31, 2024 ​ 36,621 Provision for exit and realignment activities: ​ Severance ​ (205) Professional fees ​ 19,182 IT strategic initiatives - related costs ​ ​ 4,809 Other ​ 3,606 Cash payments ​ (33,908) Accrued exit and realignment costs, June 30, 2024 ​ ​ 30,105 Provision for exit and realignment activities: ​ ​ ​ Severance ​ ​ 1,770 Professional fees ​ ​ 15,013 IT strategic initiatives - related costs ​ ​ 4,476 Vendor contract and lease termination costs ​ ​ 2,728 Other ​ ​ 3,481 Cash payments ​ ​ (28,450) Accrued exit and realignment costs, September 30, 2024 ​ $ 29,123 ​ ​ ​ ​ Accrued exit and realignment costs, December 31, 2022 ​ $ 969 Provision for exit and realignment activities: ​ Severance ​ 4,127 Professional fees ​ ​ 9,012 IT strategic initiatives - related costs ​ ​ 123 Vendor contract and lease termination costs ​ ​ 1,824 Other ​ 588 Cash payments ​ (5,546) Accrued exit and realignment costs, March 31, 2023 ​ 11,097 Provision for exit and realignment activities: ​ Severance ​ 505 Professional fees ​ 22,953 IT strategic initiatives - related costs ​ ​ 3,374 Vendor contract and lease termination costs ​ ​ 1,707 Other ​ 424 Cash payments ​ (20,196) Accrued exit and realignment costs, June 30, 2023 ​ ​ 19,864 Provision for exit and realignment activities: ​ Severance ​ 2,361 Professional fees ​ ​ 16,800 IT strategic initiatives - related costs ​ ​ 3,256 Vendor contract and lease termination costs ​ ​ 4,300 Other ​ 2,164 Cash payments ​ ​ (26,311) Accrued exit and realignment costs, September 30, 2023 ​ $ 22,434

Debt (Tables)

Debt (Tables)	9 Months Ended
	Sep. 30, 2024
Debt Disclosure [Abstract]
Schedule of Debt	Debt, net of unamortized deferred financing costs, consists of the following: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ September 30, 2024 December 31, 2023 ​ Carrying Estimated Carrying Estimated ​ ​ Amount ​ Fair Value ​ Amount ​ Fair Value 4.375% Senior Notes, due December 2024 ​ $ — ​ $ — ​ $ 171,232 ​ $ 168,754 Term Loan A ​ 353,511 ​ 356,606 ​ 387,591 ​ 390,668 4.500% Senior Notes, due March 2029 ​ 473,701 ​ 433,857 ​ 472,869 ​ 422,647 Term Loan B ​ 500,716 ​ 513,141 ​ 503,212 ​ 518,293 6.625% Senior Notes, due April 2030 ​ 541,848 ​ 536,314 ​ 540,445 ​ 529,472 Finance leases and other ​ 15,198 ​ 15,198 ​ 22,153 ​ 22,153 Total debt ​ 1,884,974 ​ 1,855,116 ​ 2,097,502 ​ 2,051,987 Less current maturities ​ (42,626) ​ (42,626) ​ (206,904) ​ (206,904) Long-term debt ​ $ 1,842,348 ​ $ 1,812,490 ​ $ 1,890,598 ​ $ 1,845,083
Schedule of Maturities of Long-Term Debt	​ As of September 30, 2024, scheduled future principal payments of debt, excluding finance leases and other, were as follows: ​ ​ ​ ​ ​ Year ​ ​ 2024 (remainder) ​ $ 7,750 2025 ​ 40,375 2026 ​ 43,500 2027 ​ 285,375 2028 ​ 6,000 2029 ​ 965,654 2030 ​ 552,189

Retirement Plans (Tables)

Retirement Plans (Tables)	9 Months Ended
	Sep. 30, 2024
Retirement Benefits [Abstract]
Schedule of Components of Net Periodic Benefit Cost	The components of net periodic benefit cost for the three and nine months ended September 30, 2024 and 2023 were as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ Nine Months Ended ​ ​ September 30, ​ September 30, ​ 2024 2023 2024 2023 Service cost ​ $ 446 ​ $ 429 ​ $ 1,362 ​ $ 1,316 Interest cost ​ ​ 635 ​ ​ 705 ​ ​ 1,925 ​ ​ 2,128 Recognized net actuarial loss ​ 79 ​ 124 ​ 241 ​ 370 Net periodic benefit cost ​ $ 1,160 ​ $ 1,258 ​ $ 3,528 ​ $ 3,814 ​

Derivatives (Tables)

Derivatives (Tables)	9 Months Ended
	Sep. 30, 2024
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Schedule of Derivative Instruments	The following table summarizes the terms and fair value of our outstanding derivative financial instruments as of September 30, 2024: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Notional ​ Derivative Assets Derivative Liabilities ​ Amount Maturity Date Classification Fair Value Classification Fair Value Cash flow hedges ​ ​ ​ ​ ​ ​ Interest rate swaps ​ $ 300,000 ​ March 2027 Other assets, net ​ $ 3,451 ​ Other liabilities ​ $ — ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Economic (non-designated) hedges ​ ​ ​ ​ ​ Foreign currency contracts ​ $ 33,350 ​ October 2024 Other current assets ​ $ 106 ​ Other current liabilities ​ $ 8 ​ The following table summarizes the terms and fair value of our outstanding derivative financial instruments as of December 31, 2023: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Notional ​ Derivative Assets Derivative Liabilities ​ Amount Maturity Date Classification Fair Value Classification Fair Value Cash flow hedges ​ ​ ​ ​ ​ ​ ​ ​ ​ Interest rate swaps ​ $ 350,000 ​ March 2027 ​ Other assets, net ​ $ 8,447 ​ Other liabilities ​ $ — ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Economic (non-designated) hedges ​ ​ ​ ​ ​ Foreign currency contracts ​ $ 78,436 ​ January 2024 Other current assets ​ $ 1,043 ​ Other current liabilities ​ $ —
Schedule of Cash Flow Hedges Included in Accumulated Other Comprehensive Income (Loss)	The following table summarizes the effect of cash flow hedge accounting on our consolidated statements of operations for the three and nine months ended September 30, 2024: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total Amount of Expense ​ ​ ​ Amount of (Loss) Gain ​ ​ ​ Line Items Presented in the ​ Amount of Gain Reclassified ​ ​ Recognized in Other ​ Location of Gain ​ Consolidated Statement of ​ from Accumulated Other ​ ​ Comprehensive Income ​ Reclassified from ​ Operations in Which the ​ Comprehensive Loss into ​ (Loss) Accumulated Other Effects are Recorded Net Loss ​ ​ Three months ended ​ Nine months ended ​ Comprehensive Loss ​ Three months ended ​ Nine months ended ​ Three months ended ​ Nine months ended ​ ​ September 30, 2024 ​ September 30, 2024 ​ into Income ​ September 30, 2024 ​ September 30, 2024 ​ September 30, 2024 ​ September 30, 2024 Interest rate swaps ​ $ (4,872) ​ $ 1,283 Interest expense, net ​ $ 36,554 ​ $ 108,108 ​ $ 1,757 ​ $ 6,280 The amount of ineffectiveness associated with these contracts was immaterial for the periods presented. ​ The following table summarizes the effect of cash flow hedge accounting on our consolidated statements of operations for the three and nine months ended September 30, 2023: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total Amount of Expense ​ ​ ​ Amount of Gain ​ ​ ​ Line Items Presented in the ​ Amount of Gain Reclassified ​ ​ Recognized in Other ​ Location of Gain ​ Consolidated Statement of ​ from Accumulated Other ​ Comprehensive Income ​ Reclassified from ​ Operations in Which the ​ Comprehensive Loss into ​ ​ (Loss) Accumulated Other Effects are Recorded Net Loss ​ ​ Three months ended ​ Nine months ended ​ Comprehensive Loss ​ Three months ended ​ Nine months ended ​ Three months ended ​ Nine months ended ​ ​ September 30, 2023 ​ September 30, 2023 ​ into Income ​ September 30, 2023 ​ September 30, 2023 ​ September 30, 2023 ​ September 30, 2023 Interest rate swaps ​ $ 3,621 ​ $ 8,026 Interest expense, net ​ $ 38,127 ​ $ 121,053 ​ $ 2,569 ​ $ 7,080

Net Loss per Common Share (Tabl

Net Loss per Common Share (Tables)	9 Months Ended
	Sep. 30, 2024
Earnings Per Share [Abstract]
Summary of Calculation of Net Loss Per Common Share	The following summarizes the calculation of net loss per common share attributable to common shareholders for the three and nine months ended September 30, 2024 and 2023: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ Nine Months Ended ​ ​ September 30, ​ September 30, (in thousands, except per share data) 2024 2023 2024 2023 Net loss ​ $ (12,770) ​ $ (6,426) ​ $ (66,570) ​ $ (59,085) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted average shares outstanding - basic ​ 77,090 ​ 76,203 ​ 76,657 ​ 75,691 Dilutive shares ​ — ​ — ​ — ​ — Weighted average shares outstanding - diluted ​ 77,090 ​ 76,203 ​ 76,657 ​ 75,691 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Net loss per common share ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Basic ​ $ (0.17) ​ $ (0.08) ​ $ (0.87) ​ $ (0.78) Diluted ​ $ (0.17) ​ $ (0.08) ​ $ (0.87) ​ $ (0.78)

Accumulated Other Comprehensi_2

Accumulated Other Comprehensive (Loss) Income (Tables)	9 Months Ended
	Sep. 30, 2024
Equity [Abstract]
Schedule of Accumulated Other Comprehensive (Loss) Income	The following table shows the changes in accumulated other comprehensive (loss) income by component for the three and nine months ended September 30, 2024 and 2023: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Currency ​ ​ ​ ​ ​ ​ Retirement ​ Translation ​ ​ ​ ​ ​ ​ ​ ​ Plans ​ Adjustments ​ Derivatives ​ Total Accumulated other comprehensive (loss) income, June 30, 2024 ​ $ (4,681) ​ $ (51,522) ​ $ 7,459 ​ $ (48,744) Other comprehensive income (loss) before reclassifications ​ 275 ​ 25,966 ​ (4,872) ​ 21,369 Income tax ​ (68) ​ — ​ 1,267 ​ 1,199 Other comprehensive income (loss) before reclassifications, net of tax ​ 207 ​ 25,966 ​ (3,605) ​ 22,568 Amounts reclassified from accumulated other comprehensive income (loss) ​ 79 ​ — ​ (1,757) ​ (1,678) Income tax ​ (21) ​ — ​ 457 ​ 436 Amounts reclassified from accumulated other comprehensive income (loss), net of tax ​ 58 ​ — ​ (1,300) ​ (1,242) Other comprehensive income (loss) ​ 265 ​ 25,966 ​ (4,905) ​ 21,326 Accumulated other comprehensive (loss) income, September 30, 2024 ​ $ (4,416) ​ $ (25,556) ​ $ 2,554 ​ $ (27,418) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Currency ​ ​ ​ ​ ​ ​ Retirement ​ Translation ​ ​ ​ ​ ​ ​ ​ ​ Plans ​ Adjustments ​ Derivatives ​ Total Accumulated other comprehensive (loss) income, June 30, 2023 ​ $ (7,212) ​ $ (40,144) ​ $ 11,363 ​ $ (35,993) Other comprehensive (loss) income before reclassifications ​ — ​ (9,891) ​ 3,621 ​ (6,270) Income tax ​ — ​ — ​ (941) ​ (941) Other comprehensive (loss) income before reclassifications, net of tax ​ — ​ (9,891) ​ 2,680 ​ (7,211) Amounts reclassified from accumulated other comprehensive income (loss) ​ 124 ​ — ​ (2,569) ​ (2,445) Income tax ​ 28 ​ — ​ 666 ​ 694 Amounts reclassified from accumulated other comprehensive income (loss), net of tax ​ 152 ​ — ​ (1,903) ​ (1,751) Other comprehensive income (loss) ​ 152 ​ (9,891) ​ 777 ​ (8,962) Accumulated other comprehensive (loss) income, September 30, 2023 ​ $ (7,060) ​ $ (50,035) ​ $ 12,140 ​ $ (44,955) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Currency ​ ​ ​ ​ ​ ​ Retirement ​ Translation ​ ​ ​ ​ ​ ​ ​ ​ Plans ​ Adjustments ​ Derivatives ​ Total Accumulated other comprehensive (loss) income, December 31, 2023 ​ $ (5,115) ​ $ (32,954) ​ $ 6,251 ​ $ (31,818) Other comprehensive income before reclassifications ​ 694 ​ 7,398 ​ 1,283 ​ 9,375 Income tax ​ (173) ​ — ​ (334) ​ (507) Other comprehensive income before reclassifications, net of tax ​ 521 ​ 7,398 ​ 949 ​ 8,868 Amounts reclassified from accumulated other comprehensive income (loss) ​ 241 ​ — ​ (6,280) ​ (6,039) Income tax ​ (63) ​ — ​ 1,634 ​ 1,571 Amounts reclassified from accumulated other comprehensive income (loss), net of tax ​ 178 ​ — ​ (4,646) ​ (4,468) Other comprehensive income (loss) ​ 699 ​ 7,398 ​ (3,697) ​ 4,400 Accumulated other comprehensive (loss) income, September 30, 2024 ​ $ (4,416) ​ $ (25,556) ​ $ 2,554 ​ $ (27,418) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Currency ​ ​ ​ ​ ​ ​ Retirement ​ Translation ​ ​ ​ ​ ​ ​ ​ ​ Plans ​ Adjustments ​ Derivatives ​ Total Accumulated other comprehensive (loss) income, December 31, 2022 ​ $ (7,201) ​ $ (40,095) ​ $ 11,441 ​ $ (35,855) Other comprehensive (loss) income before reclassifications ​ — ​ (9,940) ​ 8,026 ​ (1,914) Income tax ​ — ​ — ​ (2,086) ​ (2,086) Other comprehensive (loss) income before reclassifications, net of tax ​ — ​ (9,940) ​ 5,940 ​ (4,000) Amounts reclassified from accumulated other comprehensive income (loss) ​ 370 ​ — ​ (7,080) ​ (6,710) Income tax ​ (229) ​ — ​ 1,839 ​ 1,610 Amounts reclassified from accumulated other comprehensive income (loss), net of tax ​ 141 ​ — ​ (5,241) ​ (5,100) Other comprehensive income (loss) ​ 141 ​ (9,940) ​ 699 ​ (9,100) Accumulated other comprehensive (loss) income, September 30, 2023 ​ $ (7,060) ​ $ (50,035) ​ $ 12,140 ​ $ (44,955)

Segment Information (Tables)

Segment Information (Tables)	9 Months Ended
	Sep. 30, 2024
Segment Reporting [Abstract]
Schedule of Financial Information by Segment	The following tables present financial information by segment: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ Nine Months Ended ​ ​ September 30, ​ September 30, ​ 2024 2023 2024 2023 Net revenue: ​ ​ ​ ​ Products & Healthcare Services ​ $ 2,034,279 ​ $ 1,943,467 ​ $ 6,019,721 ​ $ 5,789,679 Patient Direct ​ 686,846 ​ 648,275 ​ 1,985,089 ​ 1,888,138 Consolidated net revenue ​ $ 2,721,125 ​ $ 2,591,742 ​ $ 8,004,810 ​ $ 7,677,817 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Operating income: ​ ​ ​ ​ Products & Healthcare Services ​ $ 4,233 ​ $ 19,803 ​ $ 27,187 ​ $ 24,564 Patient Direct ​ 79,932 ​ 64,435 ​ 190,598 ​ 169,349 Acquisition-related charges and intangible amortization ​ (21,097) ​ (30,217) ​ (61,395) ​ (74,609) Exit and realignment charges, net ​ ​ (28,880) ​ ​ (30,180) ​ ​ (85,530) ​ ​ (74,817) Litigation and related charges (1) ​ (9,984) ​ — ​ (16,662) ​ — Consolidated operating income ​ $ 24,204 ​ $ 23,841 ​ $ 54,198 ​ $ 44,487 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Depreciation and amortization: ​ ​ ​ ​ Products & Healthcare Services ​ $ 18,382 ​ $ 20,021 ​ $ 60,832 ​ $ 57,360 Patient Direct ​ 43,232 ​ 53,631 ​ 138,756 ​ 159,280 Consolidated depreciation and amortization ​ $ 61,614 ​ $ 73,652 ​ $ 199,588 ​ $ 216,640 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Share-based compensation: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Products & Healthcare Services ​ $ 4,141 ​ $ 2,917 ​ $ 13,696 ​ $ 10,649 Patient Direct ​ ​ 1,198 ​ ​ 1,699 ​ ​ 4,131 ​ ​ 5,113 Other (2) ​ ​ 341 ​ ​ 1,126 ​ ​ 1,454 ​ ​ 1,655 Consolidated share-based compensation ​ $ 5,680 ​ $ 5,742 ​ $ 19,281 ​ $ 17,417 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Capital expenditures: ​ ​ ​ ​ Products & Healthcare Services ​ $ 17,763 ​ $ 5,023 ​ $ 29,130 ​ $ 17,957 Patient Direct ​ 43,755 ​ 45,565 ​ 127,596 ​ 133,610 Consolidated capital expenditures ​ $ 61,518 ​ $ 50,588 ​ $ 156,726 ​ $ 151,567 ​ (1) Litigation and related charges includes settlement costs and related fees of legal matters within our Apria division, which do not occur in the ordinary course of our business, are non-recurring/infrequent and are inherently unpredictable in timing and amount. These charges are reported within Other operating expense, net in our Statements of Operations for the three and nine months ended September 30, 2024. ​ (2) Other share-based compensation expense is captured within Exit and realignment charges, net or Acquisition-related charges for the three and nine months ended September 30, 2024 and 2023.
Schedule of Consolidated Total Assets	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ September 30, 2024 ​ December 31, 2023 Total assets: ​ ​ Products & Healthcare Services ​ $ 2,519,690 ​ $ 2,359,825 Patient Direct ​ ​ 2,516,138 ​ ​ 2,490,460 Segment assets ​ ​ 5,035,828 ​ ​ 4,850,285 Cash and cash equivalents ​ 45,454 ​ 243,037 Consolidated total assets ​ $ 5,081,282 ​ $ 5,093,322
Schedule of Financial Information by Geographic Area	The following table presents net revenue by geographic area, which were attributed based on the location from which we ship products or provide services: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ Nine Months Ended ​ ​ September 30, ​ September 30, ​ ​ 2024 2023 2024 2023 Net revenue: ​ ​ ​ ​ United States ​ $ 2,661,469 ​ $ 2,518,952 ​ $ 7,821,088 ​ $ 7,470,424 International ​ 59,656 ​ 72,790 ​ 183,722 ​ 207,393 Consolidated net revenue ​ $ 2,721,125 ​ $ 2,591,742 ​ $ 8,004,810 ​ $ 7,677,817 ​

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Additional Information (Details) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) segment	Sep. 30, 2023 USD ($)	Dec. 31, 2023 USD ($)	Mar. 14, 2023 USD ($)
Summary Of Significant Accounting Policies [Line Items]
Number of operating segments | segment			2
Rotech Healthcare Holdings Inc
Summary Of Significant Accounting Policies [Line Items]
Acquisition-related charges	$ 6.5		$ 10.2
Apria Inc
Summary Of Significant Accounting Policies [Line Items]
Acquisition-related charges		$ 9.4		$ 11.9
Rental Equipment
Summary Of Significant Accounting Policies [Line Items]
Revenue related to equipment	148	158	442	458
Master Receivables Purchase Agreement
Summary Of Significant Accounting Policies [Line Items]
Restricted cash	13.2		13.2		$ 13.5
Uncollected accounts receivable	121		121		$ 124
Net cash proceeds	542	482	1,600	894
Cash proceeds from sale of accounts receivable	538	478	1,600	888
Cash proceeds from collection of accounts receivable	550	508	1,600	805
Master Receivables Purchase Agreement | Other Operating Income (Expense)
Summary Of Significant Accounting Policies [Line Items]
Losses on sale of accounts receivable	$ (3.6)	$ (3.5)	$ (10.8)	$ (7.1)
Master Receivables Purchase Agreement | Maximum
Summary Of Significant Accounting Policies [Line Items]
Uncollected accounts receivable						$ 200

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Reconciliation of Cash and Cash Equivalents (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023	Sep. 30, 2023	Dec. 31, 2022
Accounting Policies [Abstract]
Cash and cash equivalents	$ 45,454	$ 243,037
Restricted cash included in Other current assets	13,230	29,887
Restricted cash included in Other assets, net	16,406	0
Total cash, cash equivalents, and restricted cash	$ 75,090	$ 272,924	$ 250,160	$ 86,185

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Acquired Finite-Lived Intangible Assets [Line Items]
Intangible assets, net	$ 313,284		$ 313,284		$ 361,835
Intangible amortization	14,600	$ 20,800	51,200	$ 62,700
Patient Direct
Acquired Finite-Lived Intangible Assets [Line Items]
Intangible assets, net	218,000		218,000		250,000
Products & Healthcare Services
Acquired Finite-Lived Intangible Assets [Line Items]
Intangible assets, net	$ 96,000		$ 96,000		$ 112,000

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets - Goodwill Roll Forward (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2024 USD ($)
Goodwill [Roll Forward]
Goodwill, beginning balance	$ 1,638,846
Currency translation adjustments	3,350
Goodwill, ending balance	1,642,196
Patient Direct
Goodwill [Roll Forward]
Goodwill, beginning balance	1,535,252
Goodwill, ending balance	1,535,252
Products & Healthcare Services
Goodwill [Roll Forward]
Goodwill, beginning balance	103,594
Currency translation adjustments	3,350
Goodwill, ending balance	$ 106,944

Goodwill and Intangible Asset_4

Goodwill and Intangible Assets - Intangible Assets (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Finite-Lived Intangible Assets [Line Items]
Net intangible assets	$ 313,284	$ 361,835
Customer Relationships
Finite-Lived Intangible Assets [Line Items]
Gross intangible assets	332,811	433,750
Accumulated amortization	(163,350)	(236,791)
Net intangible assets	$ 169,461	$ 196,959
Weighted average useful life	14 years	13 years
Tradenames
Finite-Lived Intangible Assets [Line Items]
Gross intangible assets	$ 202,000	$ 202,000
Accumulated amortization	(84,324)	(69,655)
Net intangible assets	$ 117,676	$ 132,345
Weighted average useful life	10 years	10 years
Other Intangibles
Finite-Lived Intangible Assets [Line Items]
Gross intangible assets	$ 73,055	$ 73,958
Accumulated amortization	(48,908)	(41,427)
Net intangible assets	$ 24,147	$ 32,531
Weighted average useful life	6 years	6 years

Goodwill and Intangible Asset_5

Goodwill and Intangible Assets - Estimated future amortization expense (Details) $ in Thousands	Sep. 30, 2024 USD ($)
Estimated future amortization expense
2024 (remainder)	$ 13,680
2025	54,716
2026	50,364
2027	42,015
2028	32,117
Thereafter	118,392
Total future amortization	$ 311,284

Exit and Realignment Costs - Na

Exit and Realignment Costs - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Restructuring Cost and Reserve [Line Items]
Exit and realignment charges, net	$ 28,880	$ 30,180	$ 85,530	$ 74,817
Gain of associated with the sale			$ 7,400
Restructuring Incurred Cost Statement Of Income Or Comprehensive Income Extensible Enumeration Not Disclosed Flag	costs that were expensed as incurred		costs that were expensed as incurred
Products & Healthcare Services
Restructuring Cost and Reserve [Line Items]
Incurred expensed costs	$ 1,400		$ 9,800
Lease Termination
Restructuring Cost and Reserve [Line Items]
Incurred expensed costs		1,300		1,300
Operating Model Realignment Program and IT strategic initiatives
Restructuring Cost and Reserve [Line Items]
Expenses changes	$ 27,100	$ 27,800	$ 90,200	$ 70,600

Exit and Realignment Costs - Ac

Exit and Realignment Costs - Accrual for Exit and Realignment Costs (Details) - USD ($) $ in Thousands	3 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023
Restructuring Reserve [Roll Forward]
Accrued exit and realignment charges, beginning balance	$ 30,105	$ 36,621	$ 20,047	$ 19,864	$ 11,097	$ 969
Cash payments	(28,450)	(33,908)	(11,728)	(26,311)	(20,196)	(5,546)
Accrued exit and realignment charges, ending balance	29,123	30,105	36,621	22,434	19,864	11,097
Severance
Restructuring Reserve [Roll Forward]
Restructuring charges	1,770	(205)	184	2,361	505	4,127
Professional fees
Restructuring Reserve [Roll Forward]
Restructuring charges	15,013	19,182	25,625	16,800	22,953	9,012
IT strategic initiatives - related costs
Restructuring Reserve [Roll Forward]
Restructuring charges	4,476	4,809	1,241	3,256	3,374	123
Vendor contract and lease termination costs
Restructuring Reserve [Roll Forward]
Restructuring charges	2,728			4,300	1,707	1,824
Other
Restructuring Reserve [Roll Forward]
Restructuring charges	$ 3,481	$ 3,606	$ 1,252	$ 2,164	$ 424	$ 588

Debt - Schedule of Debt (Detail

Debt - Schedule of Debt (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Sep. 16, 2024	Dec. 31, 2023	Mar. 29, 2022	Mar. 10, 2021
Debt Instrument [Line Items]
Long-term debt	$ 1,842,348		$ 1,890,598
Senior Notes | 4.375% Senior Notes, due December 2024
Debt Instrument [Line Items]
Interest rate of debt	4.375%	4.375%	4.375%
Senior Notes | 4.500% Senior Notes, due March 2029
Debt Instrument [Line Items]
Interest rate of debt	4.50%		4.50%		4.50%
Senior Notes | 6.625% Senior Notes, due April 2030
Debt Instrument [Line Items]
Interest rate of debt	6.625%		6.625%	6.625%
Carrying Amount
Debt Instrument [Line Items]
Total debt	$ 1,884,974		$ 2,097,502
Less current maturities	(42,626)		(206,904)
Long-term debt	1,842,348		1,890,598
Carrying Amount | Finance leases and other
Debt Instrument [Line Items]
Finance leases and other	15,198		22,153
Carrying Amount | Senior Notes | 4.375% Senior Notes, due December 2024
Debt Instrument [Line Items]
Long-term debt	0		171,232
Carrying Amount | Senior Notes | 4.500% Senior Notes, due March 2029
Debt Instrument [Line Items]
Long-term debt	473,701		472,869
Carrying Amount | Senior Notes | 6.625% Senior Notes, due April 2030
Debt Instrument [Line Items]
Long-term debt	541,848		540,445
Carrying Amount | Secured Debt | Term Loan A
Debt Instrument [Line Items]
Long-term debt	353,511		387,591
Carrying Amount | Secured Debt | Term Loan B
Debt Instrument [Line Items]
Long-term debt	500,716		503,212
Estimated Fair Value
Debt Instrument [Line Items]
Total debt	1,855,116		2,051,987
Less current maturities	(42,626)		(206,904)
Long-term debt	1,812,490		1,845,083
Estimated Fair Value | Finance leases and other
Debt Instrument [Line Items]
Finance leases and other	15,198		22,153
Estimated Fair Value | Senior Notes | 4.375% Senior Notes, due December 2024
Debt Instrument [Line Items]
Long-term debt	0		168,754
Estimated Fair Value | Senior Notes | 4.500% Senior Notes, due March 2029
Debt Instrument [Line Items]
Long-term debt	433,857		422,647
Estimated Fair Value | Senior Notes | 6.625% Senior Notes, due April 2030
Debt Instrument [Line Items]
Long-term debt	536,314		529,472
Estimated Fair Value | Secured Debt | Term Loan A
Debt Instrument [Line Items]
Long-term debt	356,606		390,668
Estimated Fair Value | Secured Debt | Term Loan B
Debt Instrument [Line Items]
Long-term debt	$ 513,141		$ 518,293

Debt - Narrative (Details)

Debt - Narrative (Details) $ in Thousands				3 Months Ended	9 Months Ended
	Sep. 16, 2024 USD ($)	Mar. 29, 2022 USD ($) item	Mar. 10, 2021 USD ($)	Sep. 30, 2024 USD ($)	Sep. 30, 2024 USD ($)	Dec. 31, 2023 USD ($)
Debt Instrument [Line Items]
Number of credit facilities | item		2
Due in 2024				$ 7,750	$ 7,750
Principal payments				42,626	42,626	$ 206,904
Revolving Credit Agreement
Debt Instrument [Line Items]
Maximum borrowing capacity				450,000	450,000
Letter of Credit
Debt Instrument [Line Items]
Letters of credit outstanding, amount				3,000	3,000	3,000
Line of Credit
Debt Instrument [Line Items]
Line of credit facility, remaining borrowing capacity				419,000	419,000	423,000
Line of Credit | Letter of Credit
Debt Instrument [Line Items]
Letters of credit outstanding, amount				$ 31,500	$ 31,500	$ 27,400
4.375% Senior Notes, due December 2024 | Senior Notes
Debt Instrument [Line Items]
Face amount	$ 171,300
Interest rate of debt	4.375%			4.375%	4.375%	4.375%
Senior notes redemption price, percentage	100%
Receivables Financing Agreement
Debt Instrument [Line Items]
Current borrowing capacity		$ 450,000
Receivables Financing Agreement | Line of Credit
Debt Instrument [Line Items]
Line of credit facility, remaining borrowing capacity				$ 450,000	$ 450,000	$ 450,000
Term Loan A
Debt Instrument [Line Items]
Face amount		500,000
Principal payments				31,300	31,300
Scheduled principal payment				6,300
Unscheduled principal payment				20,000
Term Loan B
Debt Instrument [Line Items]
Face amount		600,000
Principal payments				$ 6,000	$ 6,000
4.500% Senior Notes, due March 2029 | Senior Notes
Debt Instrument [Line Items]
Face amount			$ 500,000
Interest rate of debt			4.50%	4.50%	4.50%	4.50%
Debt issued, percent of par			100%
Effective yield percentage			4.50%
6.625% Senior Notes, due April 2030 | Senior Notes
Debt Instrument [Line Items]
Face amount		$ 600,000
Interest rate of debt		6.625%		6.625%	6.625%	6.625%
Debt issued, percent of par		100%
Effective yield percentage		6.625%
Senior notes redemption price, percentage					100%
6.625% Senior Notes, due April 2030 | Senior Notes | Debt Instrument, Redemption, Period One
Debt Instrument [Line Items]
Senior notes redemption price, percentage					106.625%
Redemption price, percentage of principal amount redeemed					40%
Finance leases and other
Debt Instrument [Line Items]
Principal payments				$ 5,400	$ 5,400

Debt - Schedule of Future Princ

Debt - Schedule of Future Principal Payments of Debt (Details) $ in Thousands	Sep. 30, 2024 USD ($)
Debt Disclosure [Abstract]
2024 (remainder)	$ 7,750
2025	40,375
2026	43,500
2027	285,375
2028	6,000
2029	965,654
2030	$ 552,189

Retirement Plans - Narrative (D

Retirement Plans - Narrative (Details) - USD ($) $ in Millions	9 Months Ended	12 Months Ended
	Sep. 30, 2024	Dec. 31, 2023
Defined Benefit Plan Disclosure [Line Items]
Defined Benefit Plan, Type [Extensible Enumeration]	us-gaap:PensionPlansDefinedBenefitMember	us-gaap:PensionPlansDefinedBenefitMember
United States
Defined Benefit Plan Disclosure [Line Items]
Accumulated benefit obligation	$ 32.9	$ 34.1

Retirement Plans - Components o

Retirement Plans - Components of Net Periodic Benefit Cost (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Retirement Benefits [Abstract]
Service cost	$ 446	$ 429	$ 1,362	$ 1,316
Interest cost	635	705	1,925	2,128
Recognized net actuarial loss	79	124	241	370
Net periodic benefit cost	$ 1,160	$ 1,258	$ 3,528	$ 3,814

Derivatives - Summary of the te

Derivatives - Summary of the terms and fair value of our outstanding derivative financial instruments (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Economic (non-designated) hedges | Foreign currency contracts
Derivative [Line Items]
Notional Amount	$ 33,350	$ 78,436
Cash flow hedges | Designated as Hedging Instrument | Interest rate swaps
Derivative [Line Items]
Notional Amount	300,000	350,000
Other assets, net | Cash flow hedges | Designated as Hedging Instrument | Interest rate swaps
Derivative [Line Items]
Derivative Asset, Fair Value	3,451	8,447
Other current assets | Economic (non-designated) hedges | Foreign currency contracts
Derivative [Line Items]
Derivative Asset, Fair Value	106	1,043
Other liabilities | Cash flow hedges | Designated as Hedging Instrument | Interest rate swaps
Derivative [Line Items]
Derivative Liabilities, Fair Value	0	0
Other current liabilities | Economic (non-designated) hedges | Foreign currency contracts
Derivative [Line Items]
Derivative Liabilities, Fair Value	$ 8	$ 0

Derivatives - Narrative (Detail

Derivatives - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Designated as Hedging Instrument | Interest rate swaps
Derivative [Line Items]
Notional amount, incremental decreases			$ 50
Economic (non-designated) hedges | Foreign currency contracts
Derivative [Line Items]
Loss on derivative not designed as hedging instrument	$ 4.2	$ 2.4	$ 1	$ 3.3

Derivatives - Summary of the ef

Derivatives - Summary of the effect of cash flow hedge (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Derivative Instruments, Gain (Loss) [Line Items]
Total Amount of Expense Line Items Presented in the Consolidated Statement of Operations in Which the Effects are Recorded	$ (36,554)	$ (38,127)	$ (108,108)	$ (121,053)
Interest rate swaps
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain Recognized in Other Comprehensive Income (Loss)	(4,872)	3,621	1,283	8,026
Interest expense, net | Interest rate swaps | Reclassification out of Accumulated Other Comprehensive Income
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain Reclassified from Accumulated Other Comprehensive Loss into Net Loss	$ 1,757	$ 2,569	$ 6,280	$ 7,080

Income Taxes (Details)

Income Taxes (Details) - USD ($) $ / shares in Units, $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Income Tax Disclosure [Abstract]
Effective tax rate	7.40%	41.50%	(15.40%)	22%
Change in estimate of uncertain tax position			$ 17.9
Impact per basic common share			$ (0.23)
Impact per diluted common share			$ (0.23)
Interest expenses for income tax examination			$ 4.7
Increase in the liability for unrecognized tax benefits	$ 19.7		19.7
Amount receivable from the tax authority for income tax examination	1.9		1.9
Interest on income tax expense	0.7
Liability for unrecognized tax benefits	38.2		38.2		$ 22.7
Unrecognized tax benefits that would impact effective tax rate	$ 35.5		$ 35.5		$ 20

Net Loss per Common Share - Sum

Net Loss per Common Share - Summary of Calculation of Net Loss Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2024	Sep. 30, 2023
Earnings Per Share [Abstract]
Net loss	$ (12,770)	$ (31,913)	$ (21,886)	$ (6,426)	$ (28,241)	$ (24,418)	$ (66,570)	$ (59,085)
Weighted average shares outstanding - basic	77,090			76,203			76,657	75,691
Dilutive shares	0			0			0	0
Weighted average shares outstanding - diluted	77,090			76,203			76,657	75,691
Net loss per common share
Basic (in dollars per share)	$ (0.17)			$ (0.08)			$ (0.87)	$ (0.78)
Diluted (in dollars per share)	$ (0.17)			$ (0.08)			$ (0.87)	$ (0.78)

Net Loss per Common Share - Nar

Net Loss per Common Share - Narrative (Details) - shares shares in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Earnings Per Share [Abstract]
Shares excluded from calculation of net loss Per diluted common share	1.4	1.5	1.5	1.6

Accumulated Other Comprehensi_3

Accumulated Other Comprehensive (Loss) Income - Schedule of Accumulated Other Comprehensive (Loss) Income By Component (Details) - USD ($) $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2024	Sep. 30, 2023
Accumulated Other Comprehensive Income (Loss), Net of Tax [Roll Forward]
Beginning balance	$ 860,702	$ 894,868	$ 924,166	$ 896,229	$ 924,400	$ 945,604	$ 924,166	$ 945,604
Total other comprehensive income (loss), net of tax	21,326	(5,307)	(11,619)	(8,962)	(1,732)	1,594	4,400	(9,100)
Ending balance	874,592	860,702	894,868	886,860	896,229	924,400	874,592	886,860
Retirement Plans
Accumulated Other Comprehensive Income (Loss), Net of Tax [Roll Forward]
Beginning balance	(4,681)		(5,115)	(7,212)		(7,201)	(5,115)	(7,201)
Other comprehensive income (loss) before reclassifications	275			0			694	0
Income tax	(68)			0			(173)	0
Other comprehensive income (loss) before reclassifications, net of tax	207			0			521	0
Amounts reclassified from accumulated other comprehensive income (loss)	79			124			241	370
Income tax	(21)			28			(63)	(229)
Amounts reclassified from accumulated other comprehensive income (loss), net of tax	58			152			178	141
Total other comprehensive income (loss), net of tax	265			152			699	141
Ending balance	(4,416)	(4,681)		(7,060)	(7,212)		(4,416)	(7,060)
Currency Translation Adjustments
Accumulated Other Comprehensive Income (Loss), Net of Tax [Roll Forward]
Beginning balance	(51,522)		(32,954)	(40,144)		(40,095)	(32,954)	(40,095)
Other comprehensive income (loss) before reclassifications	25,966			(9,891)			7,398	(9,940)
Income tax	0			0			0	0
Other comprehensive income (loss) before reclassifications, net of tax	25,966			(9,891)			7,398	(9,940)
Amounts reclassified from accumulated other comprehensive income (loss)	0			0			0	0
Income tax	0			0			0	0
Amounts reclassified from accumulated other comprehensive income (loss), net of tax	0			0			0	0
Total other comprehensive income (loss), net of tax	25,966			(9,891)			7,398	(9,940)
Ending balance	(25,556)	(51,522)		(50,035)	(40,144)		(25,556)	(50,035)
Derivatives
Accumulated Other Comprehensive Income (Loss), Net of Tax [Roll Forward]
Beginning balance	7,459		6,251	11,363		11,441	6,251	11,441
Other comprehensive income (loss) before reclassifications	(4,872)			3,621			1,283	8,026
Income tax	1,267			(941)			(334)	(2,086)
Other comprehensive income (loss) before reclassifications, net of tax	(3,605)			2,680			949	5,940
Amounts reclassified from accumulated other comprehensive income (loss)	(1,757)			(2,569)			(6,280)	(7,080)
Income tax	457			666			1,634	1,839
Amounts reclassified from accumulated other comprehensive income (loss), net of tax	(1,300)			(1,903)			(4,646)	(5,241)
Total other comprehensive income (loss), net of tax	(4,905)			777			(3,697)	699
Ending balance	2,554	7,459		12,140	11,363		2,554	12,140
Total
Accumulated Other Comprehensive Income (Loss), Net of Tax [Roll Forward]
Beginning balance	(48,744)	(43,437)	(31,818)	(35,993)	(34,261)	(35,855)	(31,818)	(35,855)
Other comprehensive income (loss) before reclassifications	21,369			(6,270)			9,375	(1,914)
Income tax	1,199			(941)			(507)	(2,086)
Other comprehensive income (loss) before reclassifications, net of tax	22,568			(7,211)			8,868	(4,000)
Amounts reclassified from accumulated other comprehensive income (loss)	(1,678)			(2,445)			(6,039)	(6,710)
Income tax	436			694			1,571	1,610
Amounts reclassified from accumulated other comprehensive income (loss), net of tax	(1,242)			(1,751)			(4,468)	(5,100)
Total other comprehensive income (loss), net of tax	21,326	(5,307)	(11,619)	(8,962)	(1,732)	1,594	4,400	(9,100)
Ending balance	$ (27,418)	$ (48,744)	$ (43,437)	$ (44,955)	$ (35,993)	$ (34,261)	$ (27,418)	$ (44,955)

Segment Information - Financial

Segment Information - Financial Information by Segment (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024 USD ($) segment	Sep. 30, 2023 USD ($) segment	Sep. 30, 2024 USD ($) segment	Sep. 30, 2023 USD ($) segment
Financial information by segment
Net revenue	$ 2,721,125	$ 2,591,742	$ 8,004,810	$ 7,677,817
Operating income	24,204	23,841	54,198	44,487
Acquisition-related charges and intangible amortization	21,097	30,217	61,395	74,609
Exit and realignment charges, net	(28,880)	(30,180)	(85,530)	(74,817)
Depreciation and amortization	61,614	73,652	199,588	216,640
Share-based compensation	5,680	5,742	19,281	17,417
Capital expenditures	$ 61,518	$ 50,588	$ 156,726	$ 151,567
Number of Reportable Segments | segment	2	2	2	2
Operating Segments
Financial information by segment
Net revenue	$ 2,721,125	$ 2,591,742	$ 8,004,810	$ 7,677,817
Operating Segments | Products & Healthcare Services
Financial information by segment
Net revenue	2,034,279	1,943,467	6,019,721	5,789,679
Operating income	4,233	19,803	27,187	24,564
Depreciation and amortization	18,382	20,021	60,832	57,360
Share-based compensation	4,141	2,917	13,696	10,649
Capital expenditures	17,763	5,023	29,130	17,957
Operating Segments | Patient Direct
Financial information by segment
Net revenue	686,846	648,275	1,985,089	1,888,138
Operating income	79,932	64,435	190,598	169,349
Depreciation and amortization	43,232	53,631	138,756	159,280
Share-based compensation	1,198	1,699	4,131	5,113
Capital expenditures	43,755	45,565	127,596	133,610
Segment Reconciling Items
Financial information by segment
Acquisition-related charges and intangible amortization	(21,097)	(30,217)	(61,395)	(74,609)
Exit and realignment charges, net	(28,880)	(30,180)	(85,530)	(74,817)
Litigation and related charges	(9,984)		(16,662)
Share-based compensation	$ 341	$ 1,126	$ 1,454	$ 1,655

Segment Information - Consolida

Segment Information - Consolidated Total Assets (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Segment Reporting, Asset Reconciling Item [Line Items]
Cash and cash equivalents	$ 45,454	$ 243,037
Assets	5,081,282	5,093,322
Operating Segments
Segment Reporting, Asset Reconciling Item [Line Items]
Assets	5,035,828	4,850,285
Operating Segments | Products & Healthcare Services
Segment Reporting, Asset Reconciling Item [Line Items]
Assets	2,519,690	2,359,825
Operating Segments | Patient Direct
Segment Reporting, Asset Reconciling Item [Line Items]
Assets	$ 2,516,138	$ 2,490,460

Segment Information - Narrative

Segment Information - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Products & Healthcare Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Non-cash adjustments to merchandise inventory	$ 6.7	$ (3.7)	$ 11	$ (3.3)
Patient Direct
Segment Reporting, Revenue Reconciling Item [Line Items]
Net book value of sales and dispositions	$ 7.9	$ 10	$ 22.7	$ 27.2

Segment Information - Financi_2

Segment Information - Financial Information by Geographical Area (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Revenues from External Customers and Long-Lived Assets [Line Items]
Consolidated net revenue	$ 2,721,125	$ 2,591,742	$ 8,004,810	$ 7,677,817
United States
Revenues from External Customers and Long-Lived Assets [Line Items]
Consolidated net revenue	2,661,469	2,518,952	7,821,088	7,470,424
International
Revenues from External Customers and Long-Lived Assets [Line Items]
Consolidated net revenue	$ 59,656	$ 72,790	$ 183,722	$ 207,393

Commitments, Contingent Liabi_2

Commitments, Contingent Liabilities, and Legal Proceedings (Details) - USD ($) $ in Millions	Jul. 22, 2024	Sep. 30, 2024
Other Commitments [Line Items]
Commitments of legally binding lease payments		$ 48.4
Rotech Healthcare Holdings Inc
Other Commitments [Line Items]
Payments to acquire business in cash	$ 1,360
Business combination, anticipated tax benefits	40
Business combination, estimated consideration to be transferred	1,320
Business combination, termination fee	$ 70

Subsequent Events - Narrative (

Subsequent Events - Narrative (Details) $ in Millions	Oct. 18, 2024 USD ($)
Subsequent event
Subsequent Event [Line Items]
Maximum outstanding amount of accounts receivable	$ 450