Pediatrix Medical (MD) 10-Q 6 Aug 21 2021 Q2 Quarterly report Financial data

Cover Page

Cover Page - shares	6 Months Ended
	Jun. 30, 2021	Jul. 30, 2021
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Transition Report	false
Amendment Flag	false
Document Period End Date	Jun. 30, 2021
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q2
Entity Registrant Name	Mednax, Inc.
Entity Central Index Key	0000893949
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Common Stock, Shares Outstanding		86,306,731
Title of 12(b) Security	Common Stock, par value $.01 per share
Trading Symbol	MD
Security Exchange Name	NYSE
Entity File Number	001-12111
Entity Incorporation, State or Country Code	FL
Entity Tax Identification Number	26-3667538
Entity Address, Address Line One	1301 Concord Terrace
Entity Address, City or Town	Sunrise
Entity Address, State or Province	FL
Entity Address, Postal Zip Code	33323
City Area Code	954
Local Phone Number	384-0175
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	true

Consolidated Balance Sheets (Un

Consolidated Balance Sheets (Unaudited) - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 338,157	$ 1,123,843
Short-term investments	100,763	104,870
Accounts receivable, net	248,055	241,931
Prepaid expenses	18,896	16,898
Income taxes receivable	29,055	0
Other current assets	17,387	61,806
Total current assets	752,313	1,549,348
Property and equipment, net	68,481	76,191
Goodwill	1,487,105	1,477,968
Intangible assets, net	19,989	26,642
Operating and finance lease right-of-use assets	56,508	55,972
Deferred income tax assets	56,329	54,472
Other assets	114,405	107,355
Total assets	2,555,130	3,347,948
Current liabilities:
Accounts payable and accrued expenses	329,918	423,183
Current portion of finance lease liabilities	2,339	2,219
Current portion of operating lease liabilities	18,848	18,933
Total current liabilities	351,105	444,335
Long-term debt and finance lease liabilities, net	996,643	1,742,586
Long-term operating lease liabilities	39,977	40,970
Long-term professional liabilities	267,319	265,274
Deferred income tax liabilities	48,428	61,746
Other liabilities	42,534	45,320
Total liabilities	1,746,006	2,600,231
Commitments and contingencies
Shareholders' equity:
Preferred stock; $.01 par value; 1,000 shares authorized; none issued	0	0
Common stock; $.01 par value; 200,000 shares authorized; 86337 and 85,593 shares issued and outstanding, respectively	863	856
Additional paid-in capital	1,039,231	1,029,453
Accumulated other comprehensive income	2,513	3,530
Retained deficit	(233,701)	(286,354)
Total Mednax, Inc. shareholders' equity	808,906	747,485
Noncontrolling interest	218	232
Total equity	809,124	747,717
Total liabilities and equity	$ 2,555,130	$ 3,347,948

Consolidated Balance Sheets (_2

Consolidated Balance Sheets (Unaudited) (Parenthetical) - $ / shares	Jun. 30, 2021	Dec. 31, 2020
Statement of Financial Position [Abstract]
Preferred stock, par value	$ 0.01	$ 0.01
Preferred stock, shares authorized	1,000,000	1,000,000
Preferred stock, issued	0	0
Common stock, par value	$ 0.01	$ 0.01
Common stock, shares authorized	200,000,000	200,000,000
Common stock, shares issued	86,337,000	86,337,000
Common stock, shares outstanding	85,593,000	85,593,000

Consolidated Statements of Inco

Consolidated Statements of Income (Unaudited) - USD ($) shares in Thousands, $ in Thousands		3 Months Ended		6 Months Ended
		Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Income Statement [Abstract]
Net revenue		$ 472,959	$ 415,441	$ 919,712	$ 856,686
Operating expenses:
Practice salaries and benefits		317,035	282,985	636,047	599,264
Practice supplies and other operating expenses		24,182	20,173	46,394	44,015
General and administrative expenses		70,968	60,488	137,484	127,930
Gain on sale of building		(7,280)		(7,280)
Depreciation and amortization		8,106	6,751	16,137	13,554
Transformational and restructuring related expenses		9,932	10,479	14,810	26,555
Total operating expenses		422,943	380,876	843,592	811,318
Income from operations		50,016	34,565	76,120	45,368
Investment and other income		4,176	3,576	10,143	2,530
Interest expense		(16,879)	(28,265)	(34,524)	(55,930)
Loss on early extinguishment of debt				(14,532)
Equity in earnings of unconsolidated affiliate		577	305	1,072	799
Total non-operating expenses		(12,126)	(24,384)	(37,841)	(52,601)
Income (loss) from continuing operations before income taxes		37,890	10,181	38,279	(7,233)
Income tax benefit (provision)		(7,363)	(3,097)	(2,408)	(4,182)
Income (loss) from continuing operations		30,527	7,084	35,871	(11,415)
Income (loss) from discontinued operations, net of tax		4,478	(679,520)	16,768	(679,733)
Net income (loss)		35,005	(672,436)	52,639	(691,148)
Net loss attributable to noncontrolling interest		6		14
Net income (loss) attributable to Mednax, Inc.		$ 35,011	$ (672,436)	$ 52,653	$ (691,148)
Income (loss) from continuing operations:
Basic		$ 0.36	$ 0.08	$ 0.42	$ (0.14)
Diluted		0.36	0.08	0.42	(0.14)
Income from discontinued operations:
Basic		0.05	(8.14)	0.20	(8.18)
Diluted		0.05	(8.11)	0.19	(8.18)
Net income (loss) attributable to Mednax, Inc.:
Basic		0.41	(8.06)	0.62	(8.32)
Diluted		$ 0.41	$ (8.03)	$ 0.61	$ (8.32)
Weighted average common shares:
Basic		84,912	83,490	84,660	83,061
Diluted	[1]	85,933	83,744	85,653	83,061
[1]	Due to a loss from continuing operations for the six months ended June 30, 2020, no incremental shares are included because the effect would be antidilutive.

Consolidated Statements of Equi

Consolidated Statements of Equity (Unaudited) - USD ($) $ in Thousands		Total	Common Stock [Member]	Additional Paid-in Capital [Member]	Accumulated Other Comprehensive Income (Loss) [Member]	Retained Deficit [Member]
Balance at Dec. 31, 2019		$ 1,498,996	$ 842	$ 987,942	$ 78	$ 510,134	[1]
Balance, Shares at Dec. 31, 2019			84,248,000
Net income (loss)		(18,712)				(18,712)	[1]
Unrealized holding loss on investments, net of tax		(213)			(213)
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan		1,832	$ 1	1,831
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan, shares			78,000
Issuance of restricted stock			$ 10	(10)
Issuance of restricted stock, shares			968,000
Forfeitures of restricted stock, shares			(19,000)
Stock-based compensation expense		8,035		8,035
Repurchased common stock		(2,542)	$ (1)	(2,541)
Repurchased common stock, shares			(125,000)
Balance at Mar. 31, 2020		1,487,396	$ 852	995,257	(135)	491,422	[1]
Balance, Shares at Mar. 31, 2020			85,150,000
Balance at Dec. 31, 2019		1,498,996	$ 842	987,942	78	510,134	[1]
Balance, Shares at Dec. 31, 2019			84,248,000
Net income (loss)		(691,148)
Balance at Jun. 30, 2020		826,570	$ 855	1,004,786	1,943	181,014	[1]
Balance, Shares at Jun. 30, 2020			85,536,000
Balance at Mar. 31, 2020		1,487,396	$ 852	995,257	(135)	491,422	[1]
Balance, Shares at Mar. 31, 2020			85,150,000
Net income (loss)		(672,436)				(672,436)	[1]
Unrealized holding loss on investments, net of tax		2,078			2,078
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan		2,544	$ 3	2,541
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan, shares			277,000
Issuance of restricted stock			$ 2	(2)
Issuance of restricted stock, shares			200,000
Forfeitures of restricted stock			$ (1)	1
Forfeitures of restricted stock, shares			(57,000)
Stock-based compensation expense		7,489		7,489
Repurchased common stock		(501)	$ (1)	(500)
Repurchased common stock, shares			(34,000)
Balance at Jun. 30, 2020		826,570	$ 855	1,004,786	1,943	181,014	[1]
Balance, Shares at Jun. 30, 2020			85,536,000
Balance at Dec. 31, 2020		747,717	$ 856	1,029,453	3,530	(286,122)	[1]
Balance, Shares at Dec. 31, 2020			85,593,000
Net income (loss)		17,642				17,642	[1]
Net loss attributable to noncontrolling interest	[1]	(8)				(8)
Unrealized holding loss on investments, net of tax		(1,133)			(1,133)
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan		1,042		1,042
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan, shares			52,000
Issuance of restricted stock			$ 7	(7)
Issuance of restricted stock, shares			660,000
Forfeitures of restricted stock, shares			(13,000)
Stock-based compensation expense		3,717		3,717
Repurchased common stock		(1,994)	$ (1)	(1,993)
Repurchased common stock, shares			(82,000)
Balance at Mar. 31, 2021		766,983	$ 862	1,032,212	2,397	(268,488)	[1]
Balance, Shares at Mar. 31, 2021			86,210,000
Balance at Dec. 31, 2020		747,717	$ 856	1,029,453	3,530	(286,122)	[1]
Balance, Shares at Dec. 31, 2020			85,593,000
Net income (loss)		52,653
Net loss attributable to noncontrolling interest		$ (14)
Repurchased common stock, shares		0
Balance at Jun. 30, 2021		$ 809,124	$ 863	1,039,231	2,513	(233,483)	[1]
Balance at Mar. 31, 2021		766,983	$ 862	1,032,212	2,397	(268,488)	[1]
Balance, Shares at Mar. 31, 2021			86,210,000
Net income (loss)		35,011				(35,011)	[1]
Net loss attributable to noncontrolling interest		(6)				(6)	[1]
Unrealized holding loss on investments, net of tax		116			116
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan		1,536	$ 1	1,535
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan, shares			71,000
Issuance of restricted stock			$ 1	(1)
Issuance of restricted stock, shares			69,000
Forfeitures of restricted stock			$ (1)	1
Forfeitures of restricted stock, shares			(5,000)
Stock-based compensation expense		5,735		5,735
Repurchased common stock		(251)	$ 0	(251)
Repurchased common stock, shares			(8,000)
Balance at Jun. 30, 2021		$ 809,124	$ 863	$ 1,039,231	$ 2,513	$ (233,483)	[1]
[1]	Presented within retained earnings on the consolidated balance sheet as the balance is immaterial.

Consolidated Statements of Cash

Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020
Cash flows from operating activities:
Net income (loss)	$ 52,653	$ (691,148)
(Income) loss from discontinued operations	(16,768)	679,733
Adjustments to reconcile net income (loss) to net cash from operating activities:
Depreciation and amortization	16,137	13,554
Amortization of premiums, discounts and issuance costs	1,838	2,785
Loss on early extinguishment of debt	14,532
Stock-based compensation expense	9,452	13,174
Deferred income taxes	(17,033)	37,896
Other	(1,205)	(855)
Gain on sale of building	(7,280)
Changes in assets and liabilities:
Accounts receivable	(26,005)	29,735
Prepaid expenses and other current assets	40,800	(1,913)
Other long-term assets	(1,859)	1,186
Accounts payable and accrued expenses	(54,453)	(114,543)
Income taxes receivable	(28,165)	(70,487)
Long-term professional liabilities	(715)	17,797
Other liabilities	(10,413)	27,585
Net cash used in operating activities – continuing operations	(28,484)	(55,501)
Net cash (used in) provided by operating activities - discontinued operations	(117)	102,052
Net cash (used in) provided by operating activities	(28,601)	46,551
Cash flows from investing activities:
Acquisition payments, net of cash acquired	(7,207)	(75)
Purchases of investments	(8,355)	(32,335)
Proceeds from maturities or sales of investments	10,745	18,135
Purchases of property and equipment	(18,536)	(16,891)
Proceeds from sale of building	24,728	0
Other	0	476
Net cash provided by (used in) investing activities - continuing operations	1,375	(30,690)
Net cash provided by investing activities-discontinued operations	2,350	9,031
Net cash provided by (used in) investing activities	3,725	(21,659)
Cash flows from financing activities:
Borrowings on credit agreement	0	527,500
Payments on credit agreement	0	(527,500)
Redemption of senior notes, including call premium	(759,848)	0
Payments for credit facility amendment	0	(510)
Payments of contingent consideration liabilities	(189)	0
Payments on finance lease obligations	(1,106)	(186)
Proceeds from issuance of common stock	2,578	4,376
Repurchases of common stock	(2,245)	(3,043)
Net cash (used in) provided from financing activities - continuing operations	(760,810)	637
Net cash used in financing activities-discontinued operations	0	(1,248)
Net cash used in financing activities	(760,810)	(611)
Net (decrease) increase in cash and cash equivalents	(785,686)	24,281
Cash and cash equivalents at beginning of period	1,123,843	107,870
Cash and cash equivalents at end of period	$ 338,157	$ 132,151

Basis of Presentation and New A

Basis of Presentation and New Accounting Pronouncements	6 Months Ended
	Jun. 30, 2021
Accounting Policies [Abstract]
Basis of Presentation and New Accounting Pronouncements	1. Basis of Presentation and New Accounting Pronouncements: The accompanying unaudited Consolidated Financial Statements of the Company and the notes thereto presented in this Form 10-Q have been prepared in accordance with the rules and regulations of the Securities and Exchange Commission ("SEC") applicable to interim financial statements, and do not include all disclosures required by accounting principles generally accepted in the United States of America (“GAAP”) for complete financial statements. In the opinion of management, these financial statements include all adjustments, consisting only of normal recurring adjustments, necessary for a fair statement of the results of interim periods. The financial statements include all the accounts of Mednax, Inc. and its consolidated subsidiaries (collectively, “MDX”) together with the accounts of MDX’s affiliated business corporations or professional associations, professional corporations, limited liability companies and partnerships (the “affiliated professional contractors”). Certain subsidiaries of MDX have contractual management arrangements with its affiliated professional contractors, which are separate legal entities that provide physician services in certain states and Puerto Rico. The terms “Mednax” and the “Company” refer collectively to Mednax Inc., its subsidiaries and the affiliated professional contractors. The Compan y is a party to a joint venture in which it owns a 37.5 % economic interest. The Company accounts for this joint venture under the equity method of accounting because the Company exercises significant influence over, but does not control, this entity. The Company is also a party to a joint venture in which it owns a 51 % economic interest and for which it is deemed the primary beneficiary. The equity interest of the outside investor in the equity of this consolidated entity is accounted for and presented as noncontrolling interest on the Company’s Consolidated Balance Sheets. The results from operations attributable to the noncontrolling interest are presented separately on the Company’s Consolidated Statements of Income. The Company divested its anesthesiology services and radiology services medical groups in May 2020 and December 2020, respectively. The operating results of these medical groups are reported as discontinued operations in the Company’s Consolidated Statements of Income for the three months and six months ended June 30, 2020. The consolidated results of operations for the interim periods presented are not necessarily indicative of the results to be experienced for the entire fiscal year. In addition, the accompanying unaudited Consolidated Financial Statements and the notes thereto should be read in conjunction with the Consolidated Financial Statements and the notes thereto included in the Company’s most recent Annual Report on Form 10-K (the “Form 10-K”). New Accounting Pronouncements In December 2019, accounting guidance related to income taxes was issued with the goal of enhancing and simplifying various aspects of the income tax accounting guidance, including requirements related to hybrid tax regimes, deferred taxes on step-up in tax basis of goodwill obtained in a transaction that is not a business combination, separate financial statements of entities not subject to tax, the intraperiod tax allocation exception to the incremental approach, deferred tax liabilities on outside basis differences, and interim-period accounting for enacted changes in tax law and certain year-to-date loss limitations. The guidance became effective for us on January 1, 2021. The adoption of this guidance did not have a material impact on our consolidated financial statements and related disclosures.

Coronavirus Pandemic (COVID-19)

Coronavirus Pandemic (COVID-19)	6 Months Ended
	Jun. 30, 2021
Extraordinary Items [Abstract]
Coronavirus Pandemic (COVID-19)	2. Coronavirus Pandemic (“COVID-19”): COVID-19 has had an impact on the demand for medical services provided by the Company’s affiliated clinicians. Beginning in mid-March 2020, the Company’s affiliated office-based practices, which specialize in maternal-fetal medicine, pediatric cardiology, and numerous pediatric subspecialties, experienced a significant elevation of appointment cancellations compared to historical normal levels. The Company b elieves COVID-19, either directly or indirectly, also had an impact on its neonatology intensive care unit (“NICU”) patient volumes, and there is no assurance that impacts from COVID-19 will not further adversely affect its NICU patient volumes or otherwise adversely affect its NICU and related neonatology business. Further, in late 2020, the Company saw a shift in the mix of patients reimbursed under government-sponsored healthcare programs, but that shift materially reversed during the six months ended June 30, 2021. Overall, the Company’s operating results were significantly impacted by COVID-19 beginning in mid-March 2020, but volumes began to normalize in mid-2020 and substantially recovered throughout 2020 and through June 30, 2021. During 2020, the Company implemented a number of actions to preserve financial flexibility and partially mitigate the significant anticipated impact of COVID-19. These steps included a suspension of most activities related to the Company’s transformational and restructuring programs, limiting these expenditures to those that provide essential support for the Company’s response to COVID-19. In addition, (i) the Company temporarily reduced executive and key management base salaries, including 50 % reductions in salaries for its named executive officers during the second quarter of 2020; (ii) the Board of Directors agreed to forego their annual cash retainer and cash meeting payments, also during the second quarter of 2020; (iii) the Company enacted a combination of salary reductions and furloughs for non-clinical employees; (iv) the Company enacted significant operational and practice-specific expense reduction plans across its clinical operations; and (v) amended and restated its Credit Agreement. Due to the continued uncertainties surrounding the timeline of and impacts from COVID-19, the Company is unable to predict the ultimate impact on its business, financial condition, results of operations and cash flows. The Company, however, believes it will be able to generate sufficient liquidity to satisfy its obligations for the next twelve months. CARES Act In March 2020, the Coronavirus Aid, Relief, and Economic Security Act ("CARES Act") was signed into law. The CARES Act is a relief package intended to assist many aspects of the American economy, including providing up to $ 100 billion in aid to the healthcare industry to reimburse healthcare providers for lost revenue and expenses attributable to COVID-19. The remaining $ 70 billion in aid is intended to focus on providers in areas particularly impacted by COVID-19, rural providers, providers of services with lower shares of Medicare reimbursement or who predominantly serve the Medicaid population, and providers requesting reimbursement for the treatment of uninsured Americans. It is unknown what, if any, portion of the remaining healthcare industry funding of the CARES Act the Company and its affiliated physician practices will qualify for and receive. The Department of Health and Human Services (“HHS”) is administering this program and began disbursing funds in April 2020, of which the Company’s affiliated physician practices within continuing operations received an aggregate of $ 22.0 million during the year ended December 31, 2020 and $ 7.7 million during the six months ended June 30, 2021. The Company has applications pending for certain affiliated physician practices for incremental relief beyond what has been received. In addition, the CARES Act also provided for deferred payment of the employer portion of social security taxes through the end of 2020, and while the Company utilized this deferral option throughout 2020, it repaid the deferred amounts during the second quarter of 2021. Under current tax law, net operating losses can be carried forward indefinitely. The CARES Act enacted rules allowing net operating losses arising in 2020 to be carried back five taxable years. The Company currently expects to generate a net operating loss for the 2020 tax year which it intends to carry back to the 2015 tax year under these provisions to obtain a refund of income tax at the prior 35 % corporate tax rate.

Cash Equivalents and Investment

Cash Equivalents and Investments	6 Months Ended
	Jun. 30, 2021
Investments, Debt and Equity Securities [Abstract]
Cash Equivalents and Investments	3. Cash Equivalents and Investments: As of June 30, 2021 and December 31, 2020 , the Company's cash equivalents consisted entirely of money market funds totaling $ 2.1 million and $ 1.0 million, respectively. Investments consisted of corporate securities, municipal debt securities, federal home loan securities and certificates of deposit. All investments are classified as current. Investments held at June 30, 2021 and December 31, 2020 are summarized as follows (in thousands): June 30, 2021 December 31, 2020 Corporate securities $ 69,897 $ 71,095 Municipal debt securities 15,897 18,707 Federal home loan securities 4,967 8,017 Certificates of deposit 4,717 5,991 U.S. Treasury securities 5,285 1,060 $ 100,763 $ 104,870

Fair Value Measurements

Fair Value Measurements	6 Months Ended
	Jun. 30, 2021
Fair Value Disclosures [Abstract]
Fair Value Disclosures	4. Fair Value Measurements: The accounting guidance establishes a fair value hierarchy that prioritizes valuation inputs into three levels based on the extent to which inputs used in measuring fair value are observable in the market. Each fair value measurement is reported in one of three levels: Level 1 – inputs are based upon unadjusted quoted prices for identical instruments traded in active markets. Level 2 – inputs are based upon quoted prices for similar instruments in active markets, quoted prices for identical or similar instruments in markets that are not active, and model-based valuation techniques for which all significant assumptions are observable in the market or can be corroborated by observable market data for substantially the full term of the assets or liabilities. Level 3 – inputs are generally unobservable and typically reflect management’s estimates of assumptions that market participants would use in pricing the asset or liability. The fair values are therefore determined using model-based techniques that include option pricing models, discounted cash flow models, and similar techniques. The following table presents information about the Company’s financial instruments that are accounted for at fair value on a recurring basis at June 30, 2021 and December 31, 2020 (in thousands): Fair Value Fair Value June 30, 2021 December 31, 2020 Assets: Money market funds Level 1 $ 2,064 $ 1,010 Short-term investments Level 2 100,763 104,870 Mutual Funds Level 1 17,403 15,841 The following table presents information about the Company’s financial instruments that are not carried at fair value at June 30, 2021 and December 31, 2020 (in thousands): June 30, 2021 December 31, 2020 Carrying Fair Carrying Fair Liabilities: 2023 Notes — — 750,000 756,225 2027 Notes 1,000,000 1,057,500 1,000,000 1,070,000 The Company redeemed the full principal balance of its 5.25 % senior unsecured notes due 2023 (the “2023 Notes”) in January 2021. The carrying amounts of cash equivalents, accounts receivable and accounts payable and accrued expenses approximate fair value due to the short maturities of the respective instruments.

Accounts Receivable and Net Rev

Accounts Receivable and Net Revenue	6 Months Ended
	Jun. 30, 2021
Text Block [Abstract]
Accounts Receivable and Net Revenue	5. Accounts Receivable and Net Revenue: Accounts receivable, net consists of the following (in thousands): June 30, 2021 December 31, 2020 Gross accounts receivable $ 1,152,440 $ 1,106,394 Allowance for contractual adjustments and uncollectibles ( 904,385 ) ( 864,463 ) $ 248,055 $ 241,931 Patient service revenue is recognized at the time services are provided by the Company’s affiliated physicians. The Company’s performance obligations related to the delivery of services to patients are satisfied at the time of service. Accordingly, there are no performance obligations that are unsatisfied or partially unsatisfied at the end of the reporting period with respect to patient service revenue. Almost all of the Company’s patient service revenue is reimbursed by government-sponsored healthcare programs (“GHC Programs”) and third-party insurance payors. Payments for services rendered to the Company’s patients are generally less than billed charges. The Company monitors its revenue and receivables from these sources and records an estimated contractual allowance to properly account for the anticipated differences between billed and reimbursed amounts. Accordingly, patient service revenue is presented net of an estimated provision for contractual adjustments and uncollectibles. The Company estimates allowances for contractual adjustments and uncollectibles on accounts receivable based upon historical experience and other factors, including days sales outstanding (“DSO”) for accounts receivable, evaluation of expected adjustments and delinquency rates, past adjustments and collection experience in relation to amounts billed, an aging of accounts receivable, current contract and reimbursement terms, changes in payor mix and other relevant information. Contractual adjustments result from the difference between the physician rates for services performed and the reimbursements by GHC Programs and third-party insurance payors for such services. Collection of patient service revenue the Company expects to receive is normally a function of providing complete and correct billing information to the GHC Programs and third-party insurance payors within the various filing deadlines and typically occurs within 30 to 60 days of billing. Some of the Company’s hospital agreements require hospitals to pay the Company administrative fees. Some agreements provide for fees if the hospital does not generate sufficient patient volume in order to guarantee that the Company receives a specified minimum revenue level. The Company also receives fees from hospitals for administrative services performed by its affiliated physicians providing medical director or other services at the hospital. The following table summarizes the Company’s net revenue by category (in thousands): Three Months Ended Six Months Ended 2021 2020 2021 2020 Net patient service revenue $ 412,950 $ 354,763 $ 794,012 $ 739,199 Hospital contract administrative fees 58,904 52,989 115,970 104,832 Other revenue 1,105 7,689 9,730 12,655 $ 472,959 $ 415,441 $ 919,712 $ 856,686 The approximate percentage of net patient service revenue by type of payor was as follows: Three Months Ended Six Months Ended 2021 2020 2021 2020 Contracted managed care 69 % 69 % 69 % 69 % Government 24 26 25 26 Other third-parties 5 4 5 4 Private-pay patients 2 1 1 1 100 % 100 % 100 % 100 %

Business Combinations and Disco

Business Combinations and Discontinued Operations	6 Months Ended
	Jun. 30, 2021
Business Combination And Discontinued Operations [Abstract]
Business Combination and Discontinued Operations	6 . Business Combinations and Discontinued Operations: Business Combinations During the six months ended June 30, 2021 , the Company completed the acquisition of one pediatric orthopedic practice, one multi-location pediatric urgent care practice and one pediatric cardiology practice for total consideration of $ 12.2 million, of which $ 7.2 million was paid in cash at closing and $ 5.0 million is recorded as current and long-term liabilities. These acquisitions expanded the Company’s national network of physician practices across women’s and children’s services. In connection with these acquisitions, the Company recorded tax deductible goodwill of $ 9.6 million, fixed assets of $ 1.6 million and other intangible assets consisting primarily of physician and hospital agreements of $ 1.0 million. Discontinued Operations – Anesthesiology Services Medical Group The Company divested its anesthesiology services medical group in May 2020. During the six months ended June 30, 2021 , the Company recorded a net decrease to the loss on sale of $ 19.1 million, primarily related to an adjustment to the sales proceeds and book values of net assets sold resulting from a mutual agreement between the buyer and seller reached during the three months ended March 31, 2021 to treat a portion of the divestiture as an asset sale for tax purposes, the disposal of the single anesthesia practice that remained after the divestiture of the anesthesiology medical group in May 2020 and the completion of the valuation for the contingent economic consideration component of the transaction. The net decrease to the loss on sale is reflected as a component of discontinued operations, net of income taxes, in the Company’s Consolidated Statements of Income for the three and six months ended June 30, 2021. The operating results of the anesthesiology services medical group were reported as a component of discontinued operations, net of income taxes, in the Company’s Consolidated Statements of Income for the three and six months ended June 30, 2021 and 2020 as relevant. The Company’s continuing operations financial statements for the six months ended June 30, 2021 reflect the Company’s best estimate of the income tax effects associated with the asset sale change. These estimates include an increase in income tax receivable of $ 24 million, of which $ 9 million is related to loss carryback provisions enacted under the CARES Act, an increase in deferred tax assets of $ 17 million and a reduction to capital loss carryforwards and offsetting valuation allowance of $ 37 million. The Company will adjust these income tax effects as necessary during subsequent periods in 2021 as additional information becomes available. Discontinued Operations – Radiology Services Medical Group The Company divested its radiology services medical group in December 2020. During the six months ended June 30, 2021 , the Company recorded a net increase to the loss on sale of $ 2.3 million, primarily related to the adjustment of certain transaction related accounting. A final working capital true up is pending and is expected to be completed during 2021 and may result in an incremental change to the loss on sale. The operating results of the radiology services medical group were reported as a component of discontinued operations, net of income taxes, in the Company’s Consolidated Statements of Income for the three and six months ended June 30, 2020.

Accounts Payable and Accrued Ex

Accounts Payable and Accrued Expenses	6 Months Ended
	Jun. 30, 2021
Payables and Accruals [Abstract]
Accounts Payable and Accrued Expenses	7. Accounts Payable and Accrued Expenses: Accounts payable and accrued expenses consist of the following (in thousands): June 30, 2021 December 31, 2020 Accounts payable $ 40,658 $ 59,771 Accrued salaries and incentive compensation 129,915 184,849 Accrued payroll taxes and benefits 35,669 43,945 Accrued professional liabilities 36,473 50,607 Accrued interest 29,280 32,721 Other accrued expenses 57,923 51,290 $ 329,918 $ 423,183 The net decrease in accrued salaries and incentive compensation of $ 19.1 million, from December 31, 2020 to June 30, 2021, is primarily due to the payment of performance-based incentive compensation, principally to the Company’s affiliated physicians, partially offset by performance-based incentive compensation accrued during the six months ended June 30, 2021 . A majority of the Company’s payments for performance-based incentive compensation is paid annually during the first quarter.

Common and Common Equivalent Sh

Common and Common Equivalent Shares	6 Months Ended
	Jun. 30, 2021
Earnings Per Share [Abstract]
Common and Common Equivalent Shares	8. Common and Common Equivalent Shares: Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the period. Diluted net income per common share is calculated by dividing net income by the weighted average number of common and potential common shares outstanding during the period. Potential common shares consist of outstanding restricted stock and stock options and is calculated using the treasury stock method. The calculation of shares used in the basic and diluted net income per common share calculation for the three and six months ended June 30, 2021 and 2020 is as follows (in thousands): Three Months Ended Six Months Ended 2021 2020 2021 2020 Weighted average number of common shares outstanding 84,912 83,490 84,660 83,061 Weighted average number of dilutive common share 1,021 254 993 — Weighted average number of common and common 85,933 83,744 85,653 83,061 Antidilutive securities not included in the diluted 13 1,335 15 1,092 (a) Due to a loss from continuing operations for the six months ended June 30, 2020, no incremental shares are included because the effect would be antidilutive.

Stock Incentive Plans and Stock

Stock Incentive Plans and Stock Purchase Plans	6 Months Ended
	Jun. 30, 2021
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock Incentive Plans and Stock Purchase Plans	9. Stock Incentive Plans and Stock Purchase Plans: On May 12, 2021, the Company’s shareholders approved the Company’s Amended and Restated 2008 Incentive Compensation Plan (the “Amended and Restated 2008 Incentive Plan”). The amendments, among other things, increased the number of shares of common stock reserved for delivery under the Amended and Restated 2008 Incentive Plan from 27,775,000 shares to 34,975,000 shares, as well as extended the expiration date to 10 years from the effective date of approval. The Amended and Restated 2008 Incentive Plan provides for grants of stock options, stock appreciation rights, restricted stock, deferred stock, and other stock-related awards and performance awards that may be settled in cash, stock or other property. Under the Amended and Restated 2008 Incentive Plan, options to purchase shares of common stock may be granted at a price not less than the fair market value of the shares on the date of grant. The options must be exercised within 10 years from the date of grant and generally become exercisable on a pro rata basis over a three-year period from the date of grant. The Company issues new shares of its common stock upon exercise of its stock options. Restricted stock awards generally vest over periods of three years upon the fulfillment of specified service-based conditions and in certain instances performance-based conditions. Deferred stock awards generally vest upon the satisfaction of specified performance-based conditions and service-based conditions. The Company recognizes compensation expense related to its restricted stock and deferred stock awards ratably over the corresponding vesting periods. During the six months ended June 30, 2021 , the Company granted 728,290 shares of restricted stock to its employees and non-employee directors under the Amended and Restated 2008 Incentive Plan. At June 30, 2021 , the Company had 3.6 million shares available for future grants and awards under the Amended and Restated 2008 Incentive Plan. On May 12, 2021, the Company’s shareholders approved the Company’s Amended and Restated 1996 Non-Qualified Employee Stock Purchase Plan (the “ESPP”) to increase the number of shares issuable under the ESPP to 9.9 million shares. Under the ESPP, employees are permitted to purchase the Company's common stock at 85 % of market value on January 1st, April 1st, July 1st and October 1st of each year. Under the Company’s 2015 Non-Qualified Stock Purchase Plan (the “SPP”), certain eligible non-employee service providers are permitted to purchase the Company’s common stock at 90 % of market value on January 1st, April 1st, July 1st and October 1st of each year. The Company recognizes stock-based compensation expense for the discount received by participating employees and non-employee service providers. During the six months ended June 30, 2021 , approximately 0.1 million shares were issued under the ESPP. At June 30, 2021 , the Company had approximately 0.4 million shares reserved for issuance under the ESPP. The SPP provides for the issuance of up to 100,000 shares of the Company’s common stock. At June 30, 2021 , the Company had approximately 61,000 shares in the aggregate reserved for issuance under the SPP. No shares have been issued under the SPP in 2021. During the three and six months ended June 30, 2021 and 2020 , the Company recognized stock-based compensation expense of $ 5.8 million and $ 6.4 million, and $ 9.5 million and $ 13.7 million, respectively.

Common Stock Repurchase Program

Common Stock Repurchase Programs	6 Months Ended
	Jun. 30, 2021
Equity [Abstract]
Common Stock Repurchase Programs	10. Common Stock Repurchase Programs: In July 2013, the Company’s Board of Directors authorized the repurchase of shares of the Company’s common stock up to an amount sufficient to offset the dilutive impact from the issuance of shares under the Company’s equity compensation programs. The share repurchase program allows the Company to make open market purchases from time-to-time based on general economic and market conditions and trading restrictions. The repurchase program also allows for the repurchase of shares of the Company’s common stock to offset the dilutive impact from the issuance of shares, if any, related to the Company’s acquisition program. No shares were purchased under this program during the six months ended June 30, 2021. In August 2018, the Company announced that its Board of Directors had authorized the repurchase of up to $ 500.0 million of the Company’s common stock in addition to its existing share repurchase program, of which $ 98.7 million remained available for repurchase as of December 31, 2020. Under this share repurchase program, during the six months ended June 30, 2021 , the Company withheld approximately 0.1 million shares of its common stock to satisfy minimum statutory withholding obligations of $ 2.2 million in connection with the vesting of restricted stock. The Company intends to utilize various methods to effect any future share repurchases, including, among others, open market purchases and accelerated share repurchase programs. The amount and timing of repurchases will depend upon several factors, including general economic and market conditions and trading restrictions.

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2021
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	11. Commitments and Contingencies: The Company expects that audits, inquiries and investigations from government authorities and agencies will occur in the ordinary course of business. Such audits, inquiries and investigations and their ultimate resolutions, individually or in the aggregate, could have a material adverse effect on the Company's business, financial condition, results of operations, cash flows and the trading price of its securities. The Company has not included an accrual for these matters as of June 30, 2021 in its Consolidated Financial Statements, as the variables affecting any potential eventual liability depend on the currently unknown facts and circumstances that arise out of, and are specific to, any particular future audit, inquiry and investigation and cannot be reasonably estimated at this time. In the ordinary course of business, the Company becomes involved in pending and threatened legal actions and proceedings, most of which involve claims of medical malpractice related to medical services provided by the Company's affiliated physicians. The Company's contracts with hospitals generally require the Company to indemnify them and their affiliates for losses resulting from the negligence of the Company's affiliated physicians. The Company may also become subject to other lawsuits which could involve large claims and significant costs. The Company believes, based upon a review of pending actions and proceedings, that the outcome of such legal actions and proceedings will not have a material adverse effect on its business, financial condition, results of operations, cash flows and the trading price of its securities. The outcome of such actions and proceedings, however, cannot be predicted with certainty and an unfavorable resolution of one or more of them could have a material adverse effect on the Company's business, financial condition, results of operations, cash flows and the trading price of its securities. Although the Company currently maintains liability insurance coverage intended to cover professional liability and certain other claims, the Company cannot assure that its insurance coverage will be adequate to cover liabilities arising out of claims asserted against it in the future where the outcomes of such claims are unfavorable. With respect to professional liability risk, the Company generally self-insures a portion of this risk through its wholly owned captive insurance subsidiary. Liabilities in excess of the Company's insurance coverage, including coverage for professional liability and certain other claims, could have a material adverse effect on the Company's business, financial condition, results of operations, cash flows and the trading price of its securities.

Basis of Presentation and New_2

Basis of Presentation and New Accounting Pronouncements (Policies)	6 Months Ended
	Jun. 30, 2021
Accounting Policies [Abstract]
New Accounting Pronouncements	New Accounting Pronouncements In December 2019, accounting guidance related to income taxes was issued with the goal of enhancing and simplifying various aspects of the income tax accounting guidance, including requirements related to hybrid tax regimes, deferred taxes on step-up in tax basis of goodwill obtained in a transaction that is not a business combination, separate financial statements of entities not subject to tax, the intraperiod tax allocation exception to the incremental approach, deferred tax liabilities on outside basis differences, and interim-period accounting for enacted changes in tax law and certain year-to-date loss limitations. The guidance became effective for us on January 1, 2021. The adoption of this guidance did not have a material impact on our consolidated financial statements and related disclosures.

Cash Equivalents and Investme_2

Cash Equivalents and Investments (Tables)	6 Months Ended
	Jun. 30, 2021
Investments, Debt and Equity Securities [Abstract]
Schedule of Investments	Investments held at June 30, 2021 and December 31, 2020 are summarized as follows (in thousands): June 30, 2021 December 31, 2020 Corporate securities $ 69,897 $ 71,095 Municipal debt securities 15,897 18,707 Federal home loan securities 4,967 8,017 Certificates of deposit 4,717 5,991 U.S. Treasury securities 5,285 1,060 $ 100,763 $ 104,870

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	6 Months Ended
	Jun. 30, 2021
Fair Value Disclosures [Abstract]
Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis	The following table presents information about the Company’s financial instruments that are accounted for at fair value on a recurring basis at June 30, 2021 and December 31, 2020 (in thousands): Fair Value Fair Value June 30, 2021 December 31, 2020 Assets: Money market funds Level 1 $ 2,064 $ 1,010 Short-term investments Level 2 100,763 104,870 Mutual Funds Level 1 17,403 15,841
Financial Instruments Measured At Carrying Amount	The following table presents information about the Company’s financial instruments that are not carried at fair value at June 30, 2021 and December 31, 2020 (in thousands): June 30, 2021 December 31, 2020 Carrying Fair Carrying Fair Liabilities: 2023 Notes — — 750,000 756,225 2027 Notes 1,000,000 1,057,500 1,000,000 1,070,000

Accounts Receivable and Net R_2

Accounts Receivable and Net Revenue (Tables)	6 Months Ended
	Jun. 30, 2021
Text Block [Abstract]
Schedule of Accounts Receivable, Net	Accounts receivable, net consists of the following (in thousands): June 30, 2021 December 31, 2020 Gross accounts receivable $ 1,152,440 $ 1,106,394 Allowance for contractual adjustments and uncollectibles ( 904,385 ) ( 864,463 ) $ 248,055 $ 241,931
Schedule of Net Revenue	The following table summarizes the Company’s net revenue by category (in thousands): Three Months Ended Six Months Ended 2021 2020 2021 2020 Net patient service revenue $ 412,950 $ 354,763 $ 794,012 $ 739,199 Hospital contract administrative fees 58,904 52,989 115,970 104,832 Other revenue 1,105 7,689 9,730 12,655 $ 472,959 $ 415,441 $ 919,712 $ 856,686
Schedule of Percentage of Net Revenue	The approximate percentage of net patient service revenue by type of payor was as follows: Three Months Ended Six Months Ended 2021 2020 2021 2020 Contracted managed care 69 % 69 % 69 % 69 % Government 24 26 25 26 Other third-parties 5 4 5 4 Private-pay patients 2 1 1 1 100 % 100 % 100 % 100 %

Accounts Payable and Accrued _2

Accounts Payable and Accrued Expenses (Tables)	6 Months Ended
	Jun. 30, 2021
Payables and Accruals [Abstract]
Schedule of Accounts Payable and Accrued Expenses	Accounts payable and accrued expenses consist of the following (in thousands): June 30, 2021 December 31, 2020 Accounts payable $ 40,658 $ 59,771 Accrued salaries and incentive compensation 129,915 184,849 Accrued payroll taxes and benefits 35,669 43,945 Accrued professional liabilities 36,473 50,607 Accrued interest 29,280 32,721 Other accrued expenses 57,923 51,290 $ 329,918 $ 423,183

Common and Common Equivalent _2

Common and Common Equivalent Shares (Tables)	6 Months Ended
	Jun. 30, 2021
Earnings Per Share [Abstract]
Schedule of Calculation of Shares Used in Basic and Diluted Net Income Per Share	The calculation of shares used in the basic and diluted net income per common share calculation for the three and six months ended June 30, 2021 and 2020 is as follows (in thousands): Three Months Ended Six Months Ended 2021 2020 2021 2020 Weighted average number of common shares outstanding 84,912 83,490 84,660 83,061 Weighted average number of dilutive common share 1,021 254 993 — Weighted average number of common and common 85,933 83,744 85,653 83,061 Antidilutive securities not included in the diluted 13 1,335 15 1,092 (a) Due to a loss from continuing operations for the six months ended June 30, 2020, no incremental shares are included because the effect would be antidilutive.

Basis of Presentation and New_3

Basis of Presentation and New Accounting Pronouncements - Additional Information (Detail)	Jun. 30, 2021
Corporate Joint Venture [Member]
Basis Of Presentation [Line Items]
Equity method ownership percentage in joint venture	51.00%
Unnamed Corporate Joint Venture One [Member]
Basis Of Presentation [Line Items]
Equity method ownership percentage in joint venture	37.50%

Coronavirus Pandemic (COVID-1_2

Coronavirus Pandemic (COVID-19) - Additional Information (Detail) - COVID-19 [Member] - USD ($) $ in Millions	6 Months Ended
	Jun. 30, 2021	Dec. 31, 2020	Mar. 27, 2020
Reimbursement of Lost Revenue			$ 100,000
Proceeds From Contribution In Aid Of Reimbursement of Lost Revenue	$ 7.7	$ 22
2020 Tax Year [Member]
Percentage of refund of income tax at the prior period corporate tax rate	35.00%
Rural Area [Member]
Reimbursement of Lost Revenue			$ 70,000
Executive Officer [Member]
Decrease In Salary | %	50.00%

Cash Equivalents and Investme_3

Cash Equivalents and Investments - Additional Information (Detail) - USD ($) $ in Millions	Jun. 30, 2021	Dec. 31, 2020
Cash Equivalents [Member]
Cash Equivalents And Investments [Line Items]
Cash equivalents	$ 2.1	$ 1

Cash Equivalents and Investme_4

Cash Equivalents and Investments - Schedule of Investments (Detail) - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020
Available-for-sale [Line Items]
Available-for-sale Securities	$ 100,763	$ 104,870
Corporate Securities [Member]
Available-for-sale [Line Items]
Available-for-sale Securities	69,897	71,095
Municipal Debt Securities [Member]
Available-for-sale [Line Items]
Available-for-sale Securities	15,897	18,707
Federal Home Loan Securities [Member]
Available-for-sale [Line Items]
Available-for-sale Securities	4,967	8,017
Certificates of Deposit [Member]
Available-for-sale [Line Items]
Available-for-sale Securities	4,717	5,991
U.S. Treasury securities [Member]
Available-for-sale [Line Items]
Available-for-sale Securities	$ 5,285	$ 1,060

Fair Value Measurements - Sched

Fair Value Measurements - Schedule of fair value on a recurring basis (Details) - Fair Value, Measurements, Recurring [Member] - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020
Fair Value, Inputs, Level 1 [Member]
Assets:
Money market funds	$ 2,064	$ 1,010
Mutual funds	17,403	15,841
Fair Value, Inputs, Level 2 [Member]
Assets:
Short-term investments	$ 100,763	$ 104,870

Fair Value Measurements - Sch_2

Fair Value Measurements - Schedule of financial instruments that are not carried at fair value (Details) - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020
2023 Notes [Member]
Liabilities:
Notes Payable	$ 0	$ 750,000
Liabilities:
Notes Payable Fair Value Disclosure	0	756,225
2027 Notes [Member]
Liabilities:
Notes Payable	1,000,000	1,000,000
Liabilities:
Notes Payable Fair Value Disclosure	$ 1,057,500	$ 1,070,000

Fair Value Measurements - Addit

Fair Value Measurements - Additional Information (Detail)	Jan. 31, 2021
Five Point Two Five Percentage Senior Notes Due Two Thousand Twenty Three [Member] | GAAP Senior Notes [Member]
Fair Value Disclosures [Line Items]
Debt instrument, interest rate, effective percentage	5.25%

Accounts Receivable and Net R_3

Accounts Receivable and Net Revenue - Schedule of Accounts Receivable, Net (Detail) - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020
Receivables [Abstract]
Gross accounts receivable	$ 1,152,440	$ 1,106,394
Allowance for contractual adjustments and uncollectibles	(904,385)	(864,463)
Accounts receivable, net	$ 248,055	$ 241,931

Accounts Receivable and Net R_4

Accounts Receivable and Net Revenue - Schedule of Net Revenue (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Disaggregation of Revenue [Abstract]
Net revenue	$ 472,959	$ 415,441	$ 919,712	$ 856,686
Net patient service revenue [Member]
Disaggregation of Revenue [Abstract]
Net revenue	412,950	354,763	794,012	739,199
Hospital contract administrative fees [Member]
Disaggregation of Revenue [Abstract]
Net revenue	58,904	52,989	115,970	104,832
Other revenue [Member]
Disaggregation of Revenue [Abstract]
Net revenue	$ 1,105	$ 7,689	$ 9,730	$ 12,655

Accounts Receivable and Net R_5

Accounts Receivable and Net Revenue - Schedule of Net Patient Service Revenue by Type of Payor (Detail)	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	100.00%	100.00%	100.00%	100.00%
Contracted Managed Care [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	69.00%	69.00%	69.00%	69.00%
Government [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	24.00%	26.00%	25.00%	26.00%
Other Third-Parties [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	5.00%	4.00%	5.00%	4.00%
Private-Pay Patients [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	2.00%	1.00%	1.00%	1.00%

Business Combinations and Dis_2

Business Combinations and Discontinued Operations - Additional information (Detail) $ in Thousands	6 Months Ended
	Jun. 30, 2021USD ($)Number	Jun. 30, 2020USD ($)
Increase in income tax receivable	$ 28,165	$ 70,487
Pediatric Orthopedic Practice And Multi Location Pediatric Urgent Care Practice [Member]
Number of other pediatric orthopedic practice acquired | Number	1
Number of other multi location pediatric urgent care practice acquired | Number	1
Business acquisition total consideration	$ 12,200
Business acquisition consideration paid in cash	7,200
Business combination consideration identifiable as current and long term liabilities	5,000
Goodwill	9,600
Other intangible assets	1,000
Fixed assets	1,600
North American Partners In Anesthesia [Member]
Increase decrease in valuation allowance deferred tax assets	37,000
Increase in income tax receivable	24,000
Tax adjustments, sttlements and unusual provisions	9,000
Increase in deferred tax assets	17,000
Anesthesiology Services Medical Group [Member]
Incremental loss on sale, net	19,100
Radiology Services Medical Group [Member]
Incremental loss on sale, net	$ 2,300

Accounts Payable and Accrued _3

Accounts Payable and Accrued Expenses - Schedule of Accounts Payable and Accrued Expenses (Detail) - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020
Payables and Accruals [Abstract]
Accounts payable	$ 40,658	$ 59,771
Accrued salaries and incentive compensation	129,915	184,849
Accrued payroll taxes and benefits	35,669	43,945
Accrued professional liabilities	36,473	50,607
Accrued interest	29,280	32,721
Other accrued expenses	57,923	51,290
Accounts payable and accrued expenses, total	$ 329,918	$ 423,183

Accounts Payable and Accrued _4

Accounts Payable and Accrued Expenses - Additional Information (Detail) $ in Millions	6 Months Ended
	Jun. 30, 2021USD ($)
Net decrease in accrued salaries and bonuses	$ 19.1

Common and Common Equivalent _3

Common and Common Equivalent Shares - Schedule of Calculation of Shares Used in Basic and Diluted Net Income Per Share (Detail) - shares shares in Thousands		3 Months Ended		6 Months Ended
		Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Earnings Per Share [Abstract]
Weighted average number of common shares outstanding		84,912	83,490	84,660	83,061
Weighted average number of dilutive common share equivalents		1,021	254	993	0
Weighted average number of common and common equivalent shares outstanding	[1]	85,933	83,744	85,653	83,061
Antidilutive securities not included in the diluted net income per common share calculation		13	1,335	15	1,092
[1]	Due to a loss from continuing operations for the six months ended June 30, 2020, no incremental shares are included because the effect would be antidilutive.

Stock Incentive Plans and Sto_2

Stock Incentive Plans and Stock Purchase Plans - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020	May 12, 2021	May 11, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock, aggregate shares authorized	200,000,000		200,000,000				200,000,000
Aggregate number Shares issued under Stock Purchase Plans			0
Stock-based compensation expense	$ 5.8	$ 9.5	$ 6.4	$ 13.7
Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock, reserved for issuance	100,000		100,000
Stock Option [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			3 years
Stock Option [Member] | Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period of options, maximum years			10 years
Restricted Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			3 years
1996 Non-Qualified Employee Stock Purchase Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares common stock reserved					9,900,000
Percentage of market value of common stock at which employees are permitted to purchase			85.00%
2015 Non-Qualified Stock Purchase Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of market value of common stock at which employees are permitted to purchase			90.00%
Amended and Restated 2008 Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares common stock reserved					34,975,000	27,775,000
Amended and Restated 2008 Plan [Member] | Stock Option [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares available for future grants and awards under Stock Incentive Plans	3,600,000		3,600,000
Amended and Restated 2008 Plan [Member] | Restricted Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period			728,290
1996 Non-Qualified Employee Stock Purchase Plan and 2015 Non-Qualified Stock Purchase Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Aggregate number Shares issued under Stock Purchase Plans			100,000
Common stock, reserved for issuance	400,000		400,000
1996 Non-Qualified Employee Stock Purchase Plan and 2015 Non-Qualified Stock Purchase Plan [Member] | Stock Option [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock, reserved for issuance	61,000		61,000

Common Stock Repurchase Progr_2

Common Stock Repurchase Programs - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended				6 Months Ended
	Jun. 30, 2021	Mar. 31, 2021	Jun. 30, 2020	Mar. 31, 2020	Jun. 30, 2021	Dec. 31, 2020	Aug. 31, 2018
Common Stock [Line Items]
Stock repurchased during period, shares					0
Common stock authorized for repurchase							$ 500
Company's Common stock remained available for repurchase						$ 98.7
Common Stock [Member]
Common Stock [Line Items]
Stock repurchased during period, shares	8,000	82,000	34,000	125,000
Restricted Stock [Member]
Common Stock [Line Items]
Number of shares withheld to satisfy minimum statutory tax withholding obligations					100,000
Amount withheld to satisfy minimum statutory tax withholding obligations					$ 2.2