Pediatrix Medical (MD) 10-K 20 Feb 24 2023 FY Annual report Financial data

Cover Page

Cover Page - USD ($)	12 Months Ended
	Dec. 31, 2023	Feb. 15, 2024	Jun. 30, 2023
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Transition Report	false
Amendment Flag	false
Document Period End Date	Dec. 31, 2023
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	FY
Entity Registrant Name	Pediatrix Medical Group, Inc.
Entity Central Index Key	0000893949
Current Fiscal Year End Date	--12-31
Entity Well-known Seasoned Issuer	Yes
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Common Stock, Shares Outstanding		84,122,979
Entity Voluntary Filers	No
Title of 12(b) Security	Common Stock, par value $.01 per share
Trading Symbol	MD
Security Exchange Name	NYSE
Securities Act 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
Document Financial Statement Error Correction [Flag]	false
Entity Shell Company	false
Entity Public Float			$ 1,176,563,587
ICFR Auditor Attestation Flag	true
Documents Incorporated by Reference [Text Block]	The registrant’s definitive proxy statement to be filed with the Securities and Exchange Commission pursuant to Regulation 14A, with respect to the 2024 Annual Meeting of Shareholders is incorporated by reference in Part III of this Form 10-K to the extent stated herein. Except with respect to information specifically incorporated by reference in the Form 10-K, each document incorporated by reference herein is deemed not to be filed as part hereof.
Auditor Name	PricewaterhouseCoopers LLP
Auditor Location	Miami, Florida
Auditor Firm ID	238

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($)	Dec. 31, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 73,258,000	$ 9,824,000
Short-term investments	104,485,000	93,239,000
Accounts receivable, net	272,313,000	296,787,000
Prepaid expenses	13,525,000	14,878,000
Income Taxes Receivable	7,565,000	0
Other current assets	12,308,000	13,261,000
Total current assets	483,454,000	427,989,000
Property and equipment, net	75,639,000	73,290,000
Goodwill	1,384,166,000	1,532,092,000
Intangible assets, net	21,240,000	18,491,000
Operating and finance lease right-of-use assets	70,294,000	66,924,000
Deferred income tax assets	102,852,000	105,925,000
Other assets	82,165,000	123,176,000
Total assets	2,219,810,000	2,347,887,000
Current liabilities:
Accounts payable and accrued expenses	350,798,000	374,225,000
Current portion of debt and finance lease liabilities, net	14,913,000	14,898,000
Current portion of operating lease liabilities	21,076,000	21,589,000
Income taxes payable	2,159,000	16,271,000
Total current liabilities	388,946,000	426,983,000
Line of credit	0	4,000,000
Long-term debt and finance lease liabilities, net	618,421,000	632,381,000
Long-term operating lease liabilities	47,238,000	44,213,000
Long-term professional liabilities	251,284,000	275,629,000
Deferred income tax liabilities	34,308,000	33,638,000
Other liabilities	30,552,000	39,411,000
Total liabilities	1,370,749,000	1,456,255,000
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; 00,000 and 82,947 shares issued and outstanding, respectively	840,000	829,000
Additional paid-in capital	999,906,000	983,601,000
Accumulated other comprehensive income (loss)	2,214,000	(3,735,000)
Retained deficit	149,471,000	(89,063,000)
Total shareholders' equity	849,061,000	891,632,000
Total liabilities and shareholders' equity	$ 2,219,810,000	$ 2,347,887,000

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - $ / shares	Dec. 31, 2023	Dec. 31, 2022
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	84,018,023	82,947,132
Common stock, shares outstanding	84,018,023	82,947,132

Consolidated Statements Of Inco

Consolidated Statements Of Income And Comprehensive Income - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Statement [Abstract]
Net revenue	$ 1,994,640	$ 1,972,021	$ 1,911,191
Operating expenses:
Practice salaries and benefits	1,448,275	1,383,319	1,297,477
Practice supplies and other operating expenses	124,800	121,669	100,472
General and administrative expenses	227,542	231,397	263,357
Gain on sale of building	0	0	(7,280)
Depreciation and amortization	36,171	35,636	32,147
Transformational and restructuring related expenses	2,219	27,312	22,100
Goodwill, Impairment Loss	148,312	0	0
Total operating expenses	1,987,319	1,799,333	1,708,273
Income from operations	7,321	172,688	202,918
Investment and other income	4,338	3,671	13,652
Interest expense	(42,075)	(39,695)	(68,722)
Impairment loss	(20,000)	0	0
Loss on early extinguishment of debt	0	(57,016)	(14,532)
Equity in earnings of unconsolidated affiliates	2,057	1,722	1,912
Total non-operating expenses	(55,680)	(91,318)	(67,690)
(Loss) income from continuing operations before income taxes	(48,359)	81,370	135,228
Income tax provision	(12,049)	(18,806)	(27,241)
(Loss) income from continuing operations	(60,408)	62,564	107,987
Income from discontinued operations, net of tax	0	3,767	22,950
Net (loss) income	(60,408)	66,331	130,937
Net loss attributable to noncontrolling interests	0	4	27	[1]
Net (loss) income attributable to Pediatrix Medical Group, Inc.	(60,408)	66,335	130,964
Unrealized holding gain (loss) on investments, net of tax of $527, $1,694 and $742	1,521	(5,051)	(2,213)
Total comprehensive (loss) income attributable to Pediatrix Medical Group, Inc.	$ (58,887)	$ 61,284	$ 128,751
(Loss) income from continuing operations:
Basic	$ 0.73	$ 0.75	$ 1.27
Diluted	0.73	0.74	1.26
Income from discontinued operations:
Basic	0	0.04	0.27
Diluted	0	0.05	0.27
Net (loss) income attributable to Pediatrix Medical Group, Inc.:
Basic	0.73	0.79	1.54
Diluted	$ 0.73	$ 0.79	$ 1.53
Weighted average common shares:
Basic	82,201	83,467	84,832
Diluted	82,201	84,121	85,828
[1] Presented within retained (deficit) earnings as the balance is immaterial.

Condensed Consolidated Statemen

Condensed Consolidated Statements of Income (Parenthetical) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Statement [Abstract]
Net of Tax	$ 527	$ 1,694	$ 742

Consolidated Statements of Equi

Consolidated Statements of Equity - USD ($)		Total	Common Stock [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]
Balance at Dec. 31, 2020		$ 747,717,000	$ 856,000	$ 1,029,453,000	$ (282,592,000)
Balance, Shares at Dec. 31, 2020			85,593,000
Net Income (Loss)		130,964,000			130,964,000
Net loss attributable to noncontrolling interest	[1]	(27,000)			(27,000)
Unrealized holding loss on investments, net of tax	[1]	(2,213,000)			(2,213,000)
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan		6,852,000	$ 3,000	6,849,000
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan, shares			321,000
Issuance of restricted stock			736,000
Issuance of restricted stock Value			$ 7,000	(7,000)
Stock-based compensation expense		18,118,000		18,118,000
Forfeitures of restricted stock			$ 0	0
Forfeitures of restricted stock, shares			(55,000)
Repurchased common stock		(4,719,000)	$ (2,000)	(4,717,000)
Repurchased common stock, shares			(172,000)
Balance at Dec. 31, 2021		896,692,000	$ 864,000	1,049,696,000	(153,868,000)
Balance, Shares at Dec. 31, 2021			86,423,000
Net Income (Loss)		66,335,000			66,335,000
Net loss attributable to noncontrolling interest		(4,000)
Dissolution of and net loss attributable to noncontrolling interest	[1]	(206,000)		8,000	(214,000)
Unrealized holding loss on investments, net of tax	[1]	(5,051,000)			(5,051,000)
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan		5,396,000	$ 3,000	5,393,000
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan, shares			287,000
Issuance of restricted stock			841,000
Issuance of restricted stock Value			$ 8,000	(8,000)
Stock-based compensation expense		16,977,000		16,977,000
Forfeitures of restricted stock			$ 1,000	(1,000)
Forfeitures of restricted stock, shares			(60,000)
Repurchased common stock		(88,511,000)	$ (45,000)	(88,466,000)
Repurchased common stock, shares			(4,544,000)
Balance at Dec. 31, 2022		891,632,000	$ 829,000	983,601,000	(92,798,000)
Balance, Shares at Dec. 31, 2022			82,947,000
Net Income (Loss)		(60,408,000)			(60,408,000)
Net loss attributable to noncontrolling interest		0
Unrealized holding loss on investments, net of tax	[1]	1,521,000			1,521,000
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan		4,912,000	$ 4,000	4,908,000
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan, shares			407,000
Issuance of restricted stock			964,000
Issuance of restricted stock Value			$ 10,000	(10,000)
Stock-based compensation expense		12,323,000		12,323,000
Forfeitures of restricted stock			$ 2,000	2,000
Forfeitures of restricted stock, shares			(239,000)
Repurchased common stock		$ (919,000)	$ (1,000)	(918,000)
Repurchased common stock, shares		0	(61,000)
Balance at Dec. 31, 2023		$ 849,061,000	$ 840,000	$ 999,906,000	$ (151,685,000)
Balance, Shares at Dec. 31, 2023			84,018,000
[1] Presented within retained (deficit) earnings as the balance is immaterial.

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Cash flows from operating activities:
Net Income (Loss)	$ (60,408)	$ 66,335	$ 130,964
Income from discontinued operations	0	(3,767)	(22,950)
Adjustments to reconcile net income to net cash provided from operating activities:
Depreciation and amortization	36,171	35,636	32,147
Amortization of premiums, discounts and issuance costs	1,239	1,765	4,335
Goodwill impairment	168,312	0	0
Loss on early extinguishment of debt	0	57,016	14,532
Stock-based compensation expense	12,323	16,127	18,968
Deferred income taxes	3,239	(22,771)	(31,239)
Gain on sale of building	0	0	(7,280)
Other	(3,167)	144	(2,350)
Changes in assets and liabilities:
Accounts receivable	26,276	(5,543)	(72,731)
Prepaid expenses and other current assets	514	15,928	41,530
Other long-term assets	22,851	17,196	9,799
Accounts payable and accrued expenses	(11,921)	420	21,326
Income taxes (payable) receivable	(21,677)	18,225	(2,285)
Long-term professional liabilities	837	5,600	1,523
Other liabilities	(28,508)	(19,999)	(22,529)
Net cash provided by operating activities - continuing operations	146,081	182,312	113,760
Net cash used in operating activities - discontinued operations	(8,756)	(15,371)	(37,023)
Net cash provided by operating activities	137,325	166,941	76,737
Cash flows from investing activities:
Acquisition payments, net of cash acquired	(6,667)	(28,167)	(29,930)
Purchases of investments	(31,893)	(17,346)	(15,052)
Proceeds from maturities or sales of investments	22,905	16,889	16,496
Purchases of property and equipment	(33,328)	(29,708)	(32,249)
Proceeds from Sale of Buildings	0	0	24,728
Strategic investments	0	0	(20,000)
Other	807	1,378	584
Net cash used in investing activities - continuing operations	(48,176)	(56,954)	(55,423)
Net cash provided by investing activities - discontinued operations	0	0	2,350
Net cash used in investing activities	(48,176)	(56,954)	(53,073)
Cash flows from financing activities:
Borrowings on credit agreement	470,000	830,000	0
Payments on credit agreement	(474,000)	(826,000)	0
Redemption of senior notes, including call premium	0	(1,046,880)	(759,848)
Proceeds from issuance of senior notes and term loan	0	650,000	0
Payments on term loan	(12,500)	(9,375)	0
Payments for credit facility amendment and financing costs	0	(8,621)	0
Payments of contingent consideration liabilities	(1,817)	0	(189)
Payments on finance lease obligations	(2,618)	(2,916)	(2,809)
Proceeds from Issuance of Common Stock	4,912	5,396	6,853
Repurchases of common stock	(919)	(88,511)	(4,719)
Other	(8,773)	9,353	596
Net cash used in financing activities - continuing operations	(25,715)	(487,554)	(760,116)
Net cash used in financing activities - discontinued operations	0	0	0
Net Cash Provided by (Used in) Financing Activities, Total	(25,715)	(487,554)	(760,116)
Net increase (decrease) in cash and cash equivalents	63,434	(377,567)	(736,452)
Cash, cash equivalents at beginning of year	9,824	387,391	1,123,843
Cash and cash equivalents at end of year	73,258	9,824	387,391
Supplemental disclosure of cash flow information:
Interest	42,278	116,235	86,537
Income taxes	30,835	26,908	54,728
Non-cash investing and financing activities:
Equipment financed through finance leases	132	282	6,762
Property and equipment included in accounts payable	$ 2,874	$ 2,589	$ 2,300

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Pay vs Performance Disclosure
Net Income (Loss)	$ (60,408)	$ 66,335	$ 130,964

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended
	Dec. 31, 2023
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

General

General	12 Months Ended
	Dec. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
General	1. General: On July 1, 2022, effective after the close of the market, the Company changed its corporate name from “Mednax, Inc.” to “Pediatrix Medical Group, Inc.” signifying the Company's return to its core focus in caring for women, babies and children. The Company’s common stock continues to trade on the New York Stock Exchange under the ticker symbol “MD.” The principal business activity of Pediatrix Medical Group, Inc. (“Pediatrix” or the “Company”) and its subsidiaries is to provide neonatal, maternal-fetal and other pediatric subspecialty physician services. The Company has contracts with affiliated business corporations or professional associations, limited liability companies and partnerships (“affiliated professional contractors”), which are separate legal entities that provide physician services in certain states and Puerto Rico. The Company ceased providing services in Puerto Rico effective December 31, 2022. The Company and its affiliated professional contractors also have contracts with hospitals and other healthcare facilities to provide physician services, which include (i) fee-for-service contracts, whereby hospitals and other customers agree, in exchange for the Company’s services, to authorize the Company and its healthcare professionals to bill and collect the charges for medical services rendered by the Company’s affiliated healthcare professionals, and (ii) administrative fee contracts, whereby the Company is assured a minimum revenue level.

Coronavirus Pandemic ("COVID")-

Coronavirus Pandemic ("COVID")-19 and the CARES Act	12 Months Ended
	Dec. 31, 2023
Extraordinary Items [Abstract]
Coronavirus Pandemic ("COVID-19")	3. Coronavirus Pandemic (“COVID-19”) and the CARES Act: COVID-19 had an impact on the demand for medical services provided by the Company’s affiliated clinicians during the first half of 2020. 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 with no material impacts from COVID-19 or its variants since that time. Due to the continued uncertainties surrounding the timeline of and impacts from COVID-19 and with multiple variant strains still circulating, the Company is unable to predict the ultimate impact on its business, financial condition, results of operations, cash flows and the trading price of its securities at this time. The Company, however, believes it will be able to generate sufficient liquidity to satisfy its obligations for the next twelve months. 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 aid to the healthcare industry to reimburse healthcare providers for lost revenue and expenses attributable to COVID-19. The Department of Health and Human Services (“HHS”) administered this program and began disbursing funds in April 2020, of which the Company’s affiliated physician practices within continuing operations received an aggregate of $ 13.3 million and $ 26.1 million during the years ended December 31, 2022 and 2021, respectively. 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 all of the deferred amounts as of December 31, 2022.

Summary of Significant Accounti

Summary of Significant Accounting Policies	12 Months Ended
	Dec. 31, 2023
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	2. Summary of Significant Accounting Policies: Principles of Presentation The consolidated financial statements include all the accounts of the Company and its subsidiaries combined with the accounts of the affiliated professional contractors with which the Company currently has specific management arrangements. The Company’s agreements with affiliated professional contractors provide that the term of the arrangements are in most cases permanent, subject only to termination by the Company, except in the case of gross negligence, fraud or bankruptcy of the Company. The Company has the right to receive income, both as ongoing fees and as proceeds from the sale of its interest in the Company’s affiliated professional contractors, in an amount that fluctuates based on the performance of the affiliated professional contractors and the change in the fair value of the Company’s interest in the affiliated professional contractors. The Company has exclusive responsibility for the provision of all non-medical services required for the day-to-day operation and management of the Company’s affiliated professional contractors and establishes the guidelines for the employment and compensation of the physicians. In addition, the agreements provide that the Company has the right, but not the obligation, to purchase, or to designate a person(s) to purchase, the stock of the Company’s affiliated professional contractors for a nominal amount. Separately, in its sole discretion, the Company has the right to assign its interest in the agreements. Based upon the provisions of these agreements, the Company has determined that the affiliated professional contractors are variable interest entities and that the Company is the primary beneficiary as defined in the accounting guidance for consolidation. All significant intercompany and interaffiliate accounts and transactions have been eliminated. The Company 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 and Comprehensive Income. Accounting Estimates and Assumptions The preparation of financial statements in conformity with accounting principles generally accepted in the United States (“GAAP”) requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the reporting periods. Significant estimates and assumptions are involved in the calculation of the Company's allowance for contractual adjustments and uncollectibles on accounts receivable, liabilities for self-insured amounts and claims incurred but not reported related to the Company’s professional liability risks and the fair value of goodwill. Actual results could differ from those estimates. Segment Reporting The Company has one reportable segment, which is also its single reporting unit, for purposes of presenting financial information in accordance with the accounting guidance for segment reporting. The following table summarizes the Company’s net patient service revenue from continuing operations by service line (in percentages): Years Ended December 31, 2023 2022 2021 Neonatology and other pediatric subspecialties 80 % 79 % 77 % Maternal-fetal medicine 16 % 16 % 18 % Pediatric cardiology 4 % 5 % 5 % 100 % 100 % 100 % Revenue Recognition 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 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. Accounts receivable are primarily amounts due under fee-for-service contracts from third-party payors, such as insurance companies, self-insured employers and patients and GHC Programs geographically dispersed throughout the United States and its territories. Concentration of credit risk relating to accounts receivable is limited by the number, diversity and geographic dispersion of the business units managed by the Company, as well as by the large number of patients and payors, including the various governmental agencies in the states in which the Company provides services. Receivables from GHC Programs made up approximately 20 % and 21 % of net accounts receivable related to continuing operations at December 31, 2023 and 2022 , respectively. Cash and Cash Equivalents Cash equivalents are defined as all highly liquid financial instruments with maturities of 90 days or less from the date of purchase. The Company’s cash equivalents typically consist of demand deposits, amounts on deposit in money market accounts, and funds invested in overnight repurchase agreements. Cash equivalent balances may, at certain times, exceed federally insured limits. Certain cash equivalents carried by the Company are subject to the fair value provisions of the accounting guidance for fair value measurements. See “Fair Value Measurements” below. Investments Investments consist primarily of corporate securities, municipal debt securities, federal home loan securities and certificates of deposit. The Company classifies its investments as available for sale. Although there is no stated expectation that the investments will be sold within one year , the investments are available for use, if needed, and accordingly are classified as short-term. Such investments are carried at fair value with any unrealized gains and losses reported as a component of other accumulated comprehensive income or loss. The Company made an investment in a pediatric primary, urgent care and telehealth company during 2021, and the Company elected to measure such investment using the cost method as it did not have a readily determinable fair value. D uring the fourth quarter of 2023, the Company recorded a $ 20.0 million impairment charge related to this cost-method investment as the value of the investment was deemed to be fully impaired based on significant unfavorable events that took place at the underlying entity in the fourth quarter of 2023. Property and Equipment Property and equipment are recorded at original purchase cost. Depreciation of property and equipment is computed using the straight-line method over the estimated useful lives of the underlying assets. Estimated useful lives are generally 30 years for buildings; three to seven years for medical equipment, computer equipment, software and furniture; and the lesser of the useful life or the remaining lease term for leasehold improvements and finance leases. Upon sale or retirement of property and equipment, the related cost and accumulated depreciation are eliminated from the respective accounts and any resulting gain or loss is included in earnings. Business Acquisitions The Company accounts for all business acquisitions at fair value and expenses acquisition costs as they are incurred. Any identifiable assets acquired and liabilities assumed are recognized and measured at their respective fair values on the acquisition date. If information about facts and circumstances existing as of the acquisition date is incomplete at the end of the reporting period in which a business acquisition occurs, the Company will report provisional amounts for the items for which the accounting is incomplete. The measurement period ends once the Company receives sufficient information to finalize the fair values; however, the period will not exceed one year from the acquisition date. Any adjustments to provisional amounts that are identified during the measurement period are recognized in the reporting period in which the adjustment amounts are determined. In connection with certain acquisitions, the Company enters into agreements to pay additional amounts in cash or common stock based on the achievement of certain performance measures for up to five years ending after the acquisition dates. The Company measures this contingent consideration at fair value at the acquisition date and records such contingent consideration as a liability or equity on the Company’s Consolidated Balance Sheets on the acquisition date. The fair value of each contingent consideration liability is remeasured at each reporting period with any change in fair value recognized as income or expense within operations in the Company’s Consolidated Statements of Income and Comprehensive Income. Goodwill and Other Intangible Assets The Company records acquired assets and assumed liabilities at their respective fair values under the acquisition method of accounting. Goodwill represents the excess of purchase price over the fair value of the net assets acquired. Intangible assets with finite lives, principally physician and hospital agreements, are recognized apart from goodwill at the time of acquisition based on the contractual-legal and separability criteria established in the accounting guidance. Intangible assets with finite lives are amortized on either an accelerated basis based on the annual undiscounted economic cash flows associated with the particular intangible asset or on a straight-line basis over their estimated useful lives. Intangible assets with finite lives are amortized over periods of one to 20 years . Goodwill is tested for impairment at a reporting unit level on at least an annual basis in accordance with the subsequent measurement provisions of the accounting guidance for goodwill. When testing goodwill for impairment, the Company may assess qualitative factors for its reporting units to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount, including goodwill. The Company has a single reporting unit. Alternatively, the Company may bypass this qualitative assessment and perform the quantitative goodwill impairment test. The Company completed annual impairment tests for its continuing operations in the third quarter of each of 2023, 2022 and 2021 and determined that goodwill was not impaired. For 2023, 2022 and 2021, the Company elected to perform the qualitative assessment, focused on various factors including macroeconomic conditions, market trends, specific reporting unit financial performance and other entity specific events, to determine if it was more likely than not that the fair value of its single reporting unit exceeded its carrying value, including goodwill. The Company considered the economic outlook for the healthcare services industry and various other factors during the testing process, including hospital and physician contract changes, local market developments, changes in third-party payor payments, and other publicly available information. The Company experienced a triggering event during the fourth quarter of 2023, resulting in a non-cash goodwill impairment charge of $ 148.3 million. S ee Note 8 – Goodwill and Intangible Assets for more information. Long-Lived Assets The Company is required to evaluate long-lived assets, including intangible assets subject to amortization, whenever events or changes in circumstances indicate that the carrying value of the assets may not be fully recoverable. The recoverability of such assets is measured by a comparison of the carrying value of the assets to the future undiscounted cash flows before interest charges to be generated by the assets. If long-lived assets are impaired, the impairment to be recognized is measured as the excess of the carrying value over the fair value. Long-lived assets held for disposal are reported at the lower of the carrying value or fair value less disposal costs. The Company does not believe there are any indicators that would require an adjustment to such assets or their estimated periods of recovery at December 31, 2023 pursuant to current accounting standards. Common Stock Repurchases The Company repurchases shares of its common stock as authorized from time to time by its Board of Directors. The Company treats repurchased shares of its common stock as retired as any repurchased shares become authorized but unissued shares. The reacquisition cost of repurchased shares is recorded as a reduction in the respective components of shareholders’ equity . Professional Liability Coverage The Company maintains professional liability insurance policies with third-party insurers generally on a claims-made basis, subject to deductibles or self-insured retention, exclusions and other restrictions. The Company’s self-insured retention under its professional liability insurance program is maintained primarily through a wholly owned captive insurance subsidiary. The Company records an estimate of liabilities for self-insured amounts and claims incurred but not reported based on an actuarial valuation using historical loss information, claim emergence patterns and various actuarial assumptions. Liabilities for claims incurred but not reported are not discounted. Income Taxes The Company records deferred income taxes using the liability method, whereby deferred tax assets and liabilities are determined based on the difference between the financial statement and tax bases of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. If it is more likely than not that all or a portion of deferred tax assets will not be realized, a valuation allowance is provided against such deferred tax assets. In making such determination, the Company considers all available positive and negative evidence, including future reversals of existing taxable temporary differences, projected future taxable income, tax-planning strategies, and results of recent operations. The accounting guidance for uncertain tax positions prescribes a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The guidance also requires policy disclosures regarding penalties and interest and extensive disclosures regarding increases and decreases in uncertain tax positions as a result of tax positions taken in a current or prior period, settlements with taxing authorities and any lapse of an applicable statute of limitations. Additional qualitative discussion is required for any tax position that may result in a significant increase or decrease in uncertain tax positions within a 12-month period from the Company's reporting date. Stock Incentive Plans The Company grants stock-based awards consisting primarily of restricted stock to key employees under its Amended and Restated 2008 Incentive Compensation Plan. The Company measures the cost of employee services received in exchange for stock-based awards based on grant-date fair value and allocates the resulting compensation expense over the corresponding requisite service period using the graded vesting attribution method. The Company also performs analyses to estimate forfeitures of stock-based awards on an annual basis and adjusts the estimates as necessary based on the number of awards that ultimately vest. Net Income Per Common Share 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, deferred stock and stock options and is calculated using the treasury stock method. 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 December 31, 2023 and 2022 (in thousands): Fair Value Fair Value Category December 31, December 31, Assets: Money market funds Level 1 $ 2,814 $ 1,415 Short-term investments Level 2 104,485 93,239 Mutual funds Level 1 17,687 14,544 The following table presents information about the Company’s financial instruments that are not carried at fair value at December 31, 2023 and 2022 (in thousands): December 31, 2023 December 31, 2022 Carrying Amount Fair Carrying Amount Fair Liabilities: 2030 Notes 400,000 357,000 400,000 344,000 The Company redeemed the full principal balance of its 6.25 % senior unsecured notes due 2027 (the “2027 Notes”) in February 2022. 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. The carrying value of the line of credit approximates fair value. If the Company’s line of credit was measured at fair value, it would be categorized as Level 2 in the fair value hierarchy.

Investments

Investments	12 Months Ended
	Dec. 31, 2023
Investments, Debt and Equity Securities [Abstract]
Investments	4. Investments: Investments held are summarized as follows (in thousands): December 31, 2023 2022 Corporate securities $ 57,878 $ 61,385 U.S. Treasury securities 22,674 10,205 Municipal debt securities 14,649 14,377 Federal home loan securities 5,670 3,562 Certificates of deposit 3,614 3,710 $ 104,485 $ 93,239

Accounts Receivable and Net Rev

Accounts Receivable and Net Revenue	12 Months Ended
	Dec. 31, 2023
Text Block [Abstract]
Accounts Receivable and Net Revenue	5. Accounts Receivable and Net Revenue: Accounts receivable, net consists of the following (in thousands): December 31, 2023 2022 Gross accounts receivable $ 1,379,213 $ 1,548,492 Allowance for contractual adjustments and ( 1,106,900 ) ( 1,251,705 ) $ 272,313 $ 296,787 Net revenue consists of the following (in thousands): Years Ended December 31, 2023 2022 2021 Net patient service revenue $ 1,716,368 $ 1,688,818 $ 1,641,323 Hospital contract administrative fees 275,677 262,931 240,022 Other revenue 2,595 20,272 29,846 $ 1,994,640 $ 1,972,021 $ 1,911,191 The following is a summary of the Company’s payor mix, expressed as a percentage of net revenue, exclusive of administrative fees and other miscellaneous revenue, for the periods indicated: Years Ended December 31, 2023 2022 2021 Contracted managed care 67 % 66 % 68 % Government 26 % 26 % 25 % Other third-parties 5 % 6 % 5 % Private-pay patients 2 % 2 % 2 % 100 % 100 % 100 % Accounts receivable consist primarily of amounts due from GHC Programs and third-party insurance payors for services provided by the Company’s affiliated physicians. Net revenue consists primarily of gross billed charges for services provided by the Company’s affiliated physicians less an estimated allowance for contractual adjustments and uncollectibles to properly account for the anticipated differences between gross billed charge amounts and expected reimbursement amounts. The Company's contractual adjustments and uncollectibles as a percentage of gross patient service revenue vary slightly each year depending on several factors, including improved managed care contracting, changes in reimbursement from state Medicaid programs and other GHC Programs, shifts in the percentage of patient services being reimbursed under GHC Programs and annual price increases. The Company’s annual price increases typically increase contractual adjustments as a percentage of gross patient service revenue. This increase is primarily due to Medicare, Medicaid and other GHC Programs that generally provide for reimbursements on a fee-schedule basis rather than on a gross charge basis. When the Company bills these programs, like other payors, on a gross-charge basis, it also increases its provision for contractual adjustments and uncollectibles by the amount of any price increase, resulting in a higher contractual adjustment percentage. 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.

Property and Equipment

Property and Equipment	12 Months Ended
	Dec. 31, 2023
Property, Plant and Equipment [Abstract]
Property and Equipment	6. Property and Equipment: Property and equipment consists of the following (in thousands): December 31, 2023 2022 Building $ 8,286 $ 8,286 Land 2,032 2,032 Equipment and other 208,036 235,190 218,354 245,508 Accumulated depreciation ( 142,715 ) ( 172,218 ) $ 75,639 $ 73,290 The Company recorded depreciation expense of $ 28.1 million, $ 26.7 million and $ 21.6 million for the years ended December 31, 2023, 2022 and 2021 , respectively.

Business Combinations

Business Combinations	12 Months Ended
	Dec. 31, 2023
Business Combinations [Abstract]
Business Combinations	7. Business Combinations: During the year ended December 31, 2023, the Company completed the acquisition of one pediatric urology practice for total cash consideration of $ 5.0 million and recorded tax deductible goodwill of $ 0.4 million, other intangible assets consisting primarily of physician and hospital agreements of $ 4.5 million and fixed assets of $ 0.1 million. During the year ended December 31, 2022, the Company completed the acquisition of one multi-location pediatric urgent care practice and one pediatric gastroenterology practice for total consideration of $ 31.3 million, of which $ 26.5 million was paid in cash at closing and $ 4.8 million was recorded as contingent consideration liabilities. In connection with these acquisitions, the Company recorded tax deductible goodwill of $ 26.7 million, other intangible assets consisting primarily of physician and hospital agreements of $ 2.3 million, fixed assets of $ 2.2 million and other non-current assets of $ 0.1 million. These acquisitions expanded the Company’s national network of physician practices across women’s and children’s services.

Goodwill and Intangible Assets

Goodwill and Intangible Assets	12 Months Ended
	Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets	8. Goodwill and Intangible Assets: Goodwill was $ 1.38 billion and $ 1.53 billion at December 31, 2023 and 2022, respectively. Goodwill is tested for impairment on at least an annual basis, in accordance with the subsequent measurement provisions of the accounting guidance for goodwill. Consistent with prior years, the Company performed its annual impairment test in the third quarter of 2023 and determined that goodwill was not impaired. However, during the fourth quarter of 2023, the Company experienced a triggering event, due to a sustained decline in its stock price and a market capitalization below the Company's book equity value. As the Company consists of only one reporting unit, and is publicly traded, management estimates the fair value of its reporting unit utilizing the Company’s market capitalization, multiplying the number of actual shares outstanding on December 31, 2023 by its stock price on December 31, 2023 and applying an additional premium to give effect to the Company’s best estimate of a control premium. With respect to the estimated control premium used in its analysis, the Company believes that it is reasonable to expect that a market participant would pay a premium to obtain a controlling interest in the Company. The Company considered information from the public markets for premiums on acquisitions in its industry and also considered other factors, such as the value that may arise from the ability to take advantage of synergies and other benefits that flow from control over another entity. This assessment resulted in a non-cash impairment charge of $ 125.0 million, representing the amount by whi ch the Company's book value exceeded its implied fair value, based on its market capitalization plus an estimated control premium. Consideration was first given to other individual and group long-lived assets, and no impairment was considered necessary on such assets. Recognition of this non-cash charge against goodwill resulted in a tax benefit which generated an additional deferred tax asset of $ 23.3 million that increased the Company's book value. An incremental non-cash charge was required to reduce the Company's book value to its previously determined fair value. Accordingly, we recorded the incremental non-cash charge of $ 23.3 million for a total non-cash charge of $ 148.3 million. A 1 % change in the control premium used would have impacted the non-cash impairment charge by approximately $ 9.0 million. Intangible assets, net, consist of the following (in thousands): December 31, 2023 Gross Carrying Value Accumulated Amortization Net Carrying Value Physician and hospital agreements $ 105,577 $ ( 88,775 ) $ 16,802 Other technology 8,591 ( 4,153 ) 4,438 $ 114,168 $ ( 92,928 ) $ 21,240 December 31, 2022 Gross Carrying Value Accumulated Amortization Net Carrying Value Physician and hospital agreements $ 101,325 $ ( 85,457 ) $ 15,868 Other technology 8,695 ( 6,072 ) 2,623 $ 110,020 $ ( 91,529 ) $ 18,491 During the year ended December 31, 2023 , the Company recorded intangible assets related to acquisitions totaling $ 4.5 million, consisting primarily of physician and hospital agreements. The weighted-average amortization period for these physician and hospital agreements is approximately 10 years. Amortization expense for intangible assets was $ 5.6 million, $ 6.4 million and $ 8.0 million for the years ended December 31, 2023, 2022 and 2021, respectively. Amortization expense for existing intangible assets for the next five years is expected to be as follows (in thousands): 2024 $ 5,751 2025 3,815 2026 2,928 2027 1,621 2028 1,394

Discontinued Operations

Discontinued Operations	12 Months Ended
	Dec. 31, 2023
Discontinued Operations and Disposal Groups [Abstract]
Discontinued Operations	9. Discontinued Operations: The Company divested its anesthesiology services and radiology services medical groups in May 2020 and December 2020, respectively. During the year ended December 31, 2022, the Company recorded a net decrease to the losses on sale of $ 3.8 million, primarily for certain transaction related true ups. The net changes to the losses on sale are reflected as a component of discontinued operations, net of income taxes, in the Company’s Consolidated Statements of Income and Comprehensive Income for the year ended December 31, 2022.

Accounts Payable and Accrued Ex

Accounts Payable and Accrued Expenses	12 Months Ended
	Dec. 31, 2023
Payables and Accruals [Abstract]
Accounts Payable and Accrued Expenses	10. Accounts Payable and Accrued Expenses: Accounts payable and accrued expenses consist of the following (in thousands): December 31, 2023 2022 Accounts payable $ 34,588 $ 31,857 Accrued salaries and incentive compensation 193,112 197,831 Accrued payroll taxes and benefits 36,545 34,983 Accrued professional liabilities 32,039 32,232 Accrued interest 8,262 8,921 Other accrued expenses 46,252 68,401 $ 350,798 $ 374,225

Operating Leases

Operating Leases	12 Months Ended
	Dec. 31, 2023
Leases [Abstract]
Operating Leases	11. Operating Leases: The Company primarily leases property under operating leases and had one material equipment operating lease for an aircraft that expired in January 2022. The Company’s property leases are primarily for its regional, medical and business offices, storage space and temporary housing for medical staff. For leases with terms greater than 12 months, the Company records the related asset and obligation at the present value of the lease payment using a discount rate that reflects the Company’s estimated incremental borrowing rate. Certain of the Company’s leases include rental escalation clauses and renewal options that are factored into the determination of lease payments when appropriate. Operating leases for office equipment are not material, and therefore are excluded from the Company’s Consolidated Balance Sheet. The table below presents the operating lease-related right-of-use assets and related liabilities recorded on the Company’s balance sheet and the weighted average remaining lease term and discount rate as of December 31, 2023 and 2022 (dollars in thousands): December 31, 2023 2022 Assets: Operating lease right-of-use assets $ 61,693 $ 55,796 Liabilities: Current portion of operating lease liabilities 21,076 21,589 Long-term portion of operating lease liabilities 47,238 44,213 Other Information: Weighted-average remaining lease term 4.6 years 3.9 years Weighted average discount rate 5.5 % 4.6 % The table below presents certain information related to the lease costs for operating leases during the years ended December 31, 2023 and 2022 (in thousands): December 31, 2023 2022 Operating lease costs $ 23,200 $ 22,293 Variable lease costs 5,854 6,640 Other operating lease costs 3,613 4,218 Total operating lease costs $ 32,667 $ 33,151 The table below presents supplemental cash flow information related to operating leases during the years ended December 31, 2023 and 2022 (in thousands): December 31, 2023 December 31, 2022 Operating cash flows for operating leases $ 35,747 $ 37,549 The table below reconciles the undiscounted cash flows for each of the first five years and total of the remaining years to the operating lease liabilities recorded on the balance sheet as of December 31, 2023 (in thousands): December 31, 2023 2024 $ 22,141 2025 17,421 2026 12,436 2027 8,906 2028 5,501 Thereafter 10,142 Total minimum lease payments 76,547 Less: Amount of payments representing interest ( 8,233 ) Present value of future minimum lease payments 68,314 Less: Current obligations ( 21,076 ) Long-term portion of operating leases $ 47,238

Accrued Professional Liabilitie

Accrued Professional Liabilities	12 Months Ended
	Dec. 31, 2023
Health Care Organizations [Abstract]
Accrued Professional Liabilities	12. Accrued Professional Liabilities: At December 31, 2023 and 2022, the Company’s total accrued professional liabilities of $ 283.3 million and $ 307.9 million, respectively, included incurred but not reported loss reserves of $ 178.1 million and $ 215.5 million, respectively, and loss reserves for reported claims of $ 105.2 million and $ 92.4 million, respectively. Of the total liability at December 31, 2023 , $ 32.0 million is classified as a current liability within accounts payable and accrued expenses in the Consolidated Balance Sheet. In addition, there is a corresponding insurance receivable of $ 33.2 million recorded as a component of other assets for certain professional liability claims that are covered by third-party insurance policies. These reserves include the accrued professional liabilities for the Company’s continuing operations as reflected in the table below as well as certain retained professional liabilities related to the Company’s former anesthesiology and radiology medical groups that were divested in 2020. The activity related to the Company’s accrued professional liability for continuing operations, excluding the retained professional liabilities related to the Company’s former anesthesiology and radiology medical groups, for the years ended December 31, 2023, 2022, and 2021 is as follows (in thousands): Years Ended December 31, 2023 2022 2021 Balance at beginning of year $ 199,561 $ 190,127 $ 174,803 Liabilities recognized, offset by insurance ( 5,510 ) ( 2,692 ) ( 2,299 ) Provision (adjustment) for losses related to: Current year 55,144 53,180 56,016 Prior years ( 7,551 ) ( 4,056 ) ( 14,231 ) Total provision for losses 47,593 49,124 41,785 Claim payments related to: Current year ( 97 ) ( 73 ) ( 59 ) Prior years ( 38,951 ) ( 36,925 ) ( 24,103 ) Total payments ( 39,048 ) ( 36,998 ) ( 24,162 ) Balance at end of year $ 202,596 $ 199,561 $ 190,127 The net increases in the Company’s total accrued professional liability for the years ended December 31, 2023 and 2022 were primarily related to certain changes in the Company’s claims experience that impacted its provision for losses.

Line of Credit, Long-Term Debt

Line of Credit, Long-Term Debt and Finance Lease Obligations	12 Months Ended
	Dec. 31, 2023
Debt Disclosure [Abstract]
Line of Credit, Long-Term Debt and Finance Lease Obligations	13. Line of Credit, Long-Term Debt and Finance Lease Obligations: On February 11, 2022, the Company issued $ 400.0 million of 5.375 % unsecured senior notes due 2030 (the “2030 Notes”). The Company used the net proceeds from the issuance of the 2030 Notes, together with $ 100.0 million drawn under the Revolving Credit Line (as defined below), $ 250.0 million of Term A Loan (as defined below) and approximately $ 308.0 million of cash on hand, to redeem (the “Redemption”) the 2027 Notes, which had an outstanding principal balance of $ 1.0 billion, and to pay costs, fees and expenses associated with the Redemption and the Credit Agreement Amendment (as defined below). Interest on the 2030 Notes accrues at the rate of 5.375 % per annum, or $ 21.5 million, and is payable semi-annually in arrears on February 15 and August 15, beginning on August 15, 2022 . The Company's obligations under the 2030 Notes are guaranteed on an unsecured senior basis by the same subsidiaries and affiliated professional contractors that guarantee the Amended Credit Agreement (as defined below). The indenture under which the 2030 Notes are issued, among other things, limits the Company's ability to (1) incur liens and (2) enter into sale and lease-back transactions, and also limits the Company's ability to merge or dispose of all or substantially all of its assets, in all cases, subject to a number of customary exceptions . Although the Company is not required to make mandatory redemption or sinking fund payments with respect to the 2030 Notes, upon the occurrence of a change in control, the Company may be required to repurchase the 2030 Notes at a purchase price equal to 101 % of the aggregate principal amount of the 2030 Notes repurchased plus accrued and unpaid interest. Also in connection with the Redemption, the Company amended its credit agreement (the “Credit Agreement”, and such amendment, the "Credit Agreement Amendment"), concurrently with the issuance of the 2030 Notes. The Credit Agreement Amendment, among other things, (i) refinanced the prior unsecured revolving credit facility with a $ 450 million unsecured revolving credit facility, including a $ 37.5 million sub-facility for the issuance of letters of credit (the “Revolving Credit Line”), and a new $ 250 million term A loan facility (“Term A Loan”) and (ii) removed JPMorgan Chase Bank, N.A., as the administrative agent under the Credit Agreement and appointed Bank of America, N.A. as the administrative agent for the lenders. The Credit Agreement, as amended by the Credit Agreement Amendment (the “Amended Credit Agreement”) matures on February 11, 2027 and is guaranteed on an unsecured basis by substantially all of the Company's subsidiaries and affiliated professional contractors. At the Company's option, borrowings under the Amended Credit Agreement bear interest at (i) the Alternate Base Rate (defined as the highest of (a) the prime rate as announced by Bank of America, N.A., (b) the Federal Funds Rate plus 0.50% and (c) Term Secured Overnight Financing Rate ("SOFR") for an interest period of one month plus 1.00% with a 1.00% floor) plus an applicable margin rate of 0.50% for the first two fiscal quarters after the date of the Credit Agreement Amendment, and thereafter at an applicable margin rate ranging from 0.125% to 0.750% based on the Company's consolidated net leverage ratio or (ii) Term SOFR rate (calculated as the Secured Overnight Financing Rate published on the applicable Reuters screen page plus a spread adjustment of 0.10%, 0.15% or 0.25% depending on if the Company selects a one-month, three-month or six-month interest period, respectively, for the applicable loan with a 0% floor), plus an applicable margin rate of 1.50% for the first two full fiscal quarters after the date of the Credit Agreement Amendment, and thereafter at an applicable margin rate ranging from 1.125% to 1.750% based on the Company's consolidated net leverage ratio. The Amended Credit Agreement also provides for other customary fees and charges, including an unused commitment fee with respect to the Revolving Credit Line ranging from 0.150% to 0.200% of the unused lending commitments under the Revolving Credit Line , based on the Company's consolidated net leverage ratio. The Amended Credit Agreement contains customary covenants and restrictions, including covenants that require the Company to maintain a minimum interest coverage ratio, a maximum consolidated total consolidated net leverage ratio and to comply with laws, and restrictions on the ability to pay dividends, incur indebtedness or liens and make certain other distributions subject to baskets and exceptions, in each case, as specified therein. Failure to comply with these covenants would constitute an event of default under the Amended Credit Agreement, notwithstanding the ability of the Company to meet its debt service obligations. The Amended Credit Agreement includes various customary remedies for the lenders following an event of default, including the acceleration of repayment of outstanding amounts under the Amended Credit Agreement. In addition, the Company may increase the principal amount of the Revolving Credit Line or incur additional term loans under the Amended Credit Agreement in an aggregate principal amount such that on a pro forma basis after giving effect to such increase or additional term loans, the Company would be in compliance with the financial covenants, subject to the satisfaction of specified conditions and additional caps in the event that the Amended Credit Agreement is secured. The carrying value of the Company’s long-term debt was $ 622.2 million and $ 637.2 million at December 31, 2023 and 2022, respectively, and consisted of the following (in thousands): December 31, 2023 Principal Unamortized Debt Issuance Costs Total Senior notes $ 400,000 $ ( 4,354 ) $ 395,646 Revolving line of credit — ( 1,006 ) ( 1,006 ) Term A loan 228,125 ( 559 ) 227,566 Total $ 628,125 $ ( 5,919 ) $ 622,206 December 31, 2022 Principal Unamortized Debt Issuance Costs Total Senior notes $ 400,000 $ ( 5,069 ) $ 394,931 Revolving line of credit 4,000 ( 1,489 ) 2,511 Term A loan 240,625 ( 827 ) 239,798 Total $ 644,625 $ ( 7,385 ) $ 637,240 The Company presents issuance costs related to long-term debt liabilities, other than revolving credit and term loan arrangements, as a direct deduction from the carrying value of that long-term debt. The Company had no outstanding letters of credit at December 31, 2023. At December 31, 2023, the Company had an available balance on its Amended Credit Agreement of $ 450.0 million. The carrying values of the Company’s variable rate revolving line of credit and term A loan approximate fair value due to the short-term nature of the interest rates. The estimated fair value of the Company’s 2030 Notes was estimated using trading prices as of December 31, 2023 and 2022, respectively, as Level 2 inputs to estimate fair value for relevant periods and are summarized as follows (in thousands): December 31, 2023 2022 2030 Notes 357,000 344,000 The Company redeemed the full principal balance of its 2027 Notes in February 2022 . The Company’s finance lease obligations, primarily related to equipment used in its newborn hearing screen program, consist of the following (in thousands): December 31, 2023 2022 Finance lease obligations $ 9,241 $ 11,128 Less: Current portion ( 2,413 ) ( 2,398 ) Long-term portion $ 6,828 $ 8,730

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2023
Income Tax Disclosure [Abstract]
Income Taxes	14. Income Taxes: The components of the income tax provision (benefit) are as follows (in thousands): December 31, 2023 2022 2021 Federal: Current $ 8,040 $ 38,877 $ 41,592 Deferred 1,467 ( 19,679 ) ( 20,373 ) 9,507 19,198 21,219 State: Current 770 2,700 16,888 Deferred 1,772 ( 3,092 ) ( 10,866 ) 2,542 ( 392 ) 6,022 Total $ 12,049 $ 18,806 $ 27,241 The Company files its tax return on a consolidated basis with its subsidiaries, and its affiliated professional contractors file tax returns on an individual basis. The effective tax rate for continuing operations was ( 24.9 )% , 23.1 % and 20.1 % for the years ended December 31, 2023, 2022 and 2021, respectively. The effective tax rate for the year ended December 31, 2023 includes $ 17.8 million of expense related to non-cash impairment charges related to goodwill and a cost-method investment. The effective tax rate for the year ended December 31, 2021 includes a $ 10.8 million benefit related to a change in estimate of an income tax receivable based on loss carryback provisions under the CARES Act which allow 2020 net operating loss to be carried back for refund at prior 35 % federal tax rate. The income tax receivable resulted from a mutual agreement reached with the buyer of our former anesthesiology services medical group to treat a portion of the divestiture as an asset sale for tax purposes. The differences between the effective rate and the United States federal income tax statutory rate are as follows: December 31, 2023 2022 2021 Tax at statutory rate 21.00 % 21.00 % 21.00 % State income tax, net of federal benefit 2.79 1.53 4.72 Non-deductible expenses ( 4.43 ) 1.48 3.42 Equity compensation adjustments ( 3.98 ) 1.35 0.77 Change in accrual estimates relating to 0.67 ( 3.28 ) ( 1.08 ) Change in valuation allowance ( 13.82 ) 1.72 ( 0.26 ) Goodwill impairment ( 26.67 ) ─ ─ Other, net ( 0.48 ) ( 0.69 ) ( 0.46 ) Change in tax law ─ ─ ( 7.97 ) Income tax provision ( 24.92 )% 23.11 % 20.14 % All of the Company’s deferred tax assets and liabilities are classified as long-term. The significant components of deferred income tax assets and liabilities are as follows (in thousands): December 31, 2023 2022 Allowance for uncollectible accounts $ 139,998 $ 152,526 Reserves and accruals 59,218 66,969 Stock-based compensation 3,022 3,694 Operating loss and other carryforwards 34,739 28,773 Capital loss carryforwards 422,809 422,793 Operating lease assets 19,133 19,096 Property and equipment 2,056 2,481 Other 5,520 256 Deferred tax assets before valuation 686,495 696,588 Less: Valuation allowance ( 435,940 ) ( 429,260 ) Deferred tax assets, net of valuation 250,555 267,328 Gross deferred tax liabilities: Amortization ( 162,538 ) ( 176,398 ) Operating lease liabilities ( 17,342 ) ( 16,510 ) Other ( 2,131 ) ( 2,133 ) Total deferred tax liabilities ( 182,011 ) ( 195,041 ) Net deferred tax assets $ 68,544 $ 72,287 The Company’s net deferred tax assets were $ 68.5 million as of December 31, 2023, as compared to $ 72.3 million at December 31, 2022. The decrease in net deferred tax assets of $ 3.8 million during the year ended December 31, 2023 was primarily related to decreases in deferred tax assets for allowance for uncollectible accounts of $ 12.5 million, reserves and accruals of $ 7.8 million and valuation allowance of $ 6.7 million, partially offset by increases in deferred tax assets for operating and other loss carryforwards of $ 5.9 million, other items of of $ 5.2 million and a decrease in deferred tax liabilities for amortization of $ 13.9 million. The increase in valuation allowance of $ 6.7 million primarily related to the effect of the impairment of a cost-method investment included in other. For the years ended December 31, 2023, 2022 and 2021, income tax expense of $ 1.9 million, $ 1.1 million and $ 1.0 million, respectively, was recognized for excess tax deficiencies associated with equity compensation. The Company has $ 1.71 billion of capital loss carryforwards as of December 31, 2023 which were generated from disposal of its former anesthesiology and radiology services medical groups, of which the majority expire in 2025 . As of December 31, 2023, management has determined that it is more likely than not that the tax benefits related to these carryforwards will not be realized and has recorded a full valuation allowance against the related deferred tax assets. Additionally, the Company had net operating loss carryforwards for federal and state tax purposes totaling $ 56.4 million, $ 46.7 million and $ 61.7 million at December 31, 2023, 2022 and 2021, respectively. With respect to the December 31, 2023 balance, $ 18.3 million expires at various times from 2033 through 2042 , and $ 38.1 million does not expire. As of December 31, 2023, 2022 and 2021, the Company’s liability for uncertain tax positions, excluding accrued interest and penalties, was $ 2.4 million, $ 2.8 million and $ 4.9 million, respectively. As of December 31, 2023, the Company had $ 2.4 million of uncertain tax positions that, if recognized, would favorably impact its effective tax rate. The following table summarizes the activity related to the Company’s liability for uncertain tax positions for the years ended December 31, 2023, 2022 and 2021 (in thousands): Years Ended December 31, 2023 2022 2021 Balance at beginning of year $ 2,838 $ 4,928 $ 6,168 Increases related to prior year tax positions 70 379 — Increases related to current year tax 200 800 900 Decreases related to lapse of statutes ( 659 ) ( 3,269 ) ( 2,140 ) Balance at end of year $ 2,449 $ 2,838 $ 4,928 During the year ended December 31, 2023, the Company decreased its liability for uncertain tax positions by $ 0.4 million, primarily related to expiration of statutes of limitation, partially offset by additional taxes on current year and prior year positions. During the year ended December 31, 2022, the Company decreased its liability for uncertain tax positions by $ 2.1 million, primarily related to expiration of statutes of limitation, partially offset by additional taxes on current year positions. In addition, the Company anticipates that its liability for uncertain tax positions will increase by $ 0.8 million over the next 12 months. The Company includes interest and penalties related to income tax liabilities in income tax expense. During the year ended December 31, 2023, 2022 and 2021, the Company included $ 0.2 million, $ 0.3 million and $ 0.4 million, respectively, of interest and penalties in income tax expense. At December 31, 2023 and 2022, the Company's accrued liability for interest and penalties related to income tax liabilities totaled $ 0.3 million and $ 0.2 million, respectively. The Company is currently subject to U.S. Federal and various state income tax examinations for the tax years 2020 through 2022 .

Common and Common Equivalent Sh

Common and Common Equivalent Shares	12 Months Ended
	Dec. 31, 2023
Earnings Per Share [Abstract]
Common and Common Equivalent Shares	15. Common and Common Equivalent Shares: The calculation of shares used in the basic and diluted net income per share calculation for the years ended December 31, 2023, 2022, and 2021 is as follows (in thousands): Years Ended December 31, 2023 2022 2021 Weighted average number of common 82,201 83,467 84,832 Weighted average number of dilutive common — 654 996 Weighted average number of common and common 82,201 84,121 85,828 Antidilutive securities (restricted stock and stock options, as relevant) not included in the diluted net income per common share calculation 1,115 406 11 (a) Due to a loss for the year ended December 31, 2023, 0.4 million incremental shares are not included because the effect would be antidilutive.

Stock Incentive Plans and Stock

Stock Incentive Plans and Stock Purchase Plans	12 Months Ended
	Dec. 31, 2023
Share-Based Payment Arrangement [Abstract]
Stock Incentive Plans and Stock Purchase Plans	16. Stock Incentive Plans and Stock Purchase Plans: The Company's Amended and Restated 2008 Incentive Compensation Plan (the "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 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 year ended December 31, 2023, the Company granted 0.8 million shares of restricted stock to its employees and non-employee directors under the 2008 Incentive Plan. At December 31, 2023, the Company had 9.0 million shares available for future grants and awards under the 2008 Incentive Plan. Under the Company’s Amended and Restated 1996 Non-Qualified Employee Stock Purchase Plan, as amended (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 year ended December 31, 2023, approximately 0.4 million shares were issued under the ESPP. At December 31, 2023 , the Company had approximately 2.1 million shares reserved for issuance under the ESPP. At December 31, 2023, the Company had approximately 61,000 shares reserved for issuance under the SPP. No shares have been issued under the SPP since October 2020. The Company recognized $ 12.3 million, $ 14.4 million and $ 19.0 million of stock-based compensation expense related to its stock incentive plans, the ESPP and the SPP during the years ended December 31, 2023, 2022 and 2021, respectively. This excludes accelerated stock-based compensation expense related to certain position eliminations that is included within transformational and restructuring related expenses. The activity related to the Company's restricted stock awards and the corresponding weighted average grant-date fair values for the year ended December 31, 2023 are as follows: Number of Weighted Non-vested shares at January 1, 2023 1,195,397 $ 23.32 Awarded 820,101 $ 15.25 Forfeited ( 239,653 ) $ 22.61 Vested ( 418,756 ) $ 22.91 Non-vested shares at December 31, 2023 1,357,089 $ 18.69 The aggregate fair value of the restricted stock that vested during the years ended December 31, 2023, 2022 and 2021 was $ 9.6 million, $ 19.1 million and $ 25.1 million, respectively. The weighted average grant-date fair value of restricted stock awards that were granted during the years ended December 31, 2023, 2022 and 2021 was $ 15.25 , $ 22.64 and $ 25.17 , respectively. At December 31, 2023 , the total stock-based compensation cost related to non-vested restricted stock remaining to be recognized as compensation expense over a weighted-average period of 1.4 years was $ 8.7 million. The activity and certain other information related to the Company’s outstanding stock option awards for the year ended December 31, 2023 are as follows: Number of Weighted Weighted Average Aggregate Intrinsic Outstanding at January 1, 2023 887,731 $ 16.91 Expired ( 887,731 ) $ 16.91 Outstanding at December 31, 2023 — — $ — Exercisable at December 31, 2023 — — $ — At December 31, 2023 , there was no remaining unrecognized stock compensation expense for stock options.

Common Stock Repurchase Program

Common Stock Repurchase Programs	12 Months Ended
	Dec. 31, 2023
Equity [Abstract]
Common Stock Repurchase Programs	17. 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 year ended December 31, 2023. 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 $ 4.6 million remained available for repurchase as of December 31, 2023. Under this share repurchase program, during the year ended December 31, 2023, the Company purchased 61,000 shares of its common stock for $ 0.9 million, representing shares withheld to satisfy minimum statutory withholding obligations in connection with the vesting of restricted stock. During the year ended December 31, 202 2, the Company purchased 4.5 million shares of its common stock for $ 88.5 million, of which 0.2 million shares and $ 2.9 million, respectively, were for shares withheld to satisfy minimum statutory withholding obligations 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.

Retirement Plans

Retirement Plans	12 Months Ended
	Dec. 31, 2023
Retirement Benefits [Abstract]
Retirement Plans	18. Retirement Plans: The Company maintained two qualified contributory savings plans as allowed under Section 401(k) of the Internal Revenue Code and Section 1165(e) of the Puerto Rico Income Tax Act of 1954 (the “401(k) Plans”) through December 31, 2022. The Company ceased providing services in Puerto Rico on December 31, 2022, and accordingly, the Puerto Rico 401(k) Plan was no longer maintained beginning on January 1, 2023. The 401(k) Plans permit participant contributions and allow elective and, in certain situations, non-elective Company contributions based on each participant’s contribution or a specified percentage of eligible wages. Participants may defer a percentage of their annual compensation subject to the limits defined in the 401(k) Plans. The Company recorded expense for its continuing operations of $ 24.1 million, $ 22.6 million and $ 21.0 million for the years ended December 31, 2023, 2022 and 2021 , respectively, primarily related to the 401(k) Plans.

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
	Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	19. 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 December 31, 2023 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.

EXHIBITS AND FINANCIAL STATEMEN

EXHIBITS AND FINANCIAL STATEMENT SCHEDULE	12 Months Ended
	Dec. 31, 2023
SEC Schedule, 12-09, Valuation and Qualifying Accounts [Abstract]
Exhibits and Financial Statement Schedule	(a)(1) Financial Statements The information required by this Item is included in Item 8 of Part II of this Form 10-K. (a)(2) Financial Statement Schedule The following financial statement schedule for the years ended December 31, 2023, 2022 and 2021, is included in this Form 10-K as set forth below (in thousands). Pediatrix Medical Group, Inc. Schedule II: Valuatio n and Qualifying Accounts Years Ended December 31, 2023 2022 2021 Allowance for contractual adjustments and uncollectibles: Balance at beginning of year $ 1,251,705 $ 1,091,310 $ 791,842 Amount charged against operating revenue 6,069,245 5,921,519 5,436,786 Accounts receivable contractual adjustments and write-offs ( 6,214,050 ) ( 5,761,124 ) ( 5,137,318 ) Balance at end of year $ 1,106,900 $ 1,251,705 $ 1,091,310 All other schedules have been omitted because they are not applicable, not required or the information is included elsewhere herein. (a)(3) Exhibits See Item 15(b) of this Form 10-K.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2023
Accounting Policies [Abstract]
Principles of Presentation	Principles of Presentation The consolidated financial statements include all the accounts of the Company and its subsidiaries combined with the accounts of the affiliated professional contractors with which the Company currently has specific management arrangements. The Company’s agreements with affiliated professional contractors provide that the term of the arrangements are in most cases permanent, subject only to termination by the Company, except in the case of gross negligence, fraud or bankruptcy of the Company. The Company has the right to receive income, both as ongoing fees and as proceeds from the sale of its interest in the Company’s affiliated professional contractors, in an amount that fluctuates based on the performance of the affiliated professional contractors and the change in the fair value of the Company’s interest in the affiliated professional contractors. The Company has exclusive responsibility for the provision of all non-medical services required for the day-to-day operation and management of the Company’s affiliated professional contractors and establishes the guidelines for the employment and compensation of the physicians. In addition, the agreements provide that the Company has the right, but not the obligation, to purchase, or to designate a person(s) to purchase, the stock of the Company’s affiliated professional contractors for a nominal amount. Separately, in its sole discretion, the Company has the right to assign its interest in the agreements. Based upon the provisions of these agreements, the Company has determined that the affiliated professional contractors are variable interest entities and that the Company is the primary beneficiary as defined in the accounting guidance for consolidation. All significant intercompany and interaffiliate accounts and transactions have been eliminated. The Company 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 and Comprehensive Income.
Accounting Estimates and Assumptions	Accounting Estimates and Assumptions The preparation of financial statements in conformity with accounting principles generally accepted in the United States (“GAAP”) requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the reporting periods. Significant estimates and assumptions are involved in the calculation of the Company's allowance for contractual adjustments and uncollectibles on accounts receivable, liabilities for self-insured amounts and claims incurred but not reported related to the Company’s professional liability risks and the fair value of goodwill. Actual results could differ from those estimates.
Segment Reporting	Segment Reporting The Company has one reportable segment, which is also its single reporting unit, for purposes of presenting financial information in accordance with the accounting guidance for segment reporting. The following table summarizes the Company’s net patient service revenue from continuing operations by service line (in percentages): Years Ended December 31, 2023 2022 2021 Neonatology and other pediatric subspecialties 80 % 79 % 77 % Maternal-fetal medicine 16 % 16 % 18 % Pediatric cardiology 4 % 5 % 5 % 100 % 100 % 100 %
Revenue Recognition	Revenue Recognition 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 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. Accounts receivable are primarily amounts due under fee-for-service contracts from third-party payors, such as insurance companies, self-insured employers and patients and GHC Programs geographically dispersed throughout the United States and its territories. Concentration of credit risk relating to accounts receivable is limited by the number, diversity and geographic dispersion of the business units managed by the Company, as well as by the large number of patients and payors, including the various governmental agencies in the states in which the Company provides services. Receivables from GHC Programs made up approximately 20 % and 21 % of net accounts receivable related to continuing operations at December 31, 2023 and 2022 , respectively.
Cash and Cash Equivalents	Cash and Cash Equivalents Cash equivalents are defined as all highly liquid financial instruments with maturities of 90 days or less from the date of purchase. The Company’s cash equivalents typically consist of demand deposits, amounts on deposit in money market accounts, and funds invested in overnight repurchase agreements. Cash equivalent balances may, at certain times, exceed federally insured limits. Certain cash equivalents carried by the Company are subject to the fair value provisions of the accounting guidance for fair value measurements. See “Fair Value Measurements” below.
Investments	Investments Investments consist primarily of corporate securities, municipal debt securities, federal home loan securities and certificates of deposit. The Company classifies its investments as available for sale. Although there is no stated expectation that the investments will be sold within one year , the investments are available for use, if needed, and accordingly are classified as short-term. Such investments are carried at fair value with any unrealized gains and losses reported as a component of other accumulated comprehensive income or loss. The Company made an investment in a pediatric primary, urgent care and telehealth company during 2021, and the Company elected to measure such investment using the cost method as it did not have a readily determinable fair value. D uring the fourth quarter of 2023, the Company recorded a $ 20.0 million impairment charge related to this cost-method investment as the value of the investment was deemed to be fully impaired based on significant unfavorable events that took place at the underlying entity in the fourth quarter of 2023.
Property and Equipment	Property and Equipment Property and equipment are recorded at original purchase cost. Depreciation of property and equipment is computed using the straight-line method over the estimated useful lives of the underlying assets. Estimated useful lives are generally 30 years for buildings; three to seven years for medical equipment, computer equipment, software and furniture; and the lesser of the useful life or the remaining lease term for leasehold improvements and finance leases. Upon sale or retirement of property and equipment, the related cost and accumulated depreciation are eliminated from the respective accounts and any resulting gain or loss is included in earnings.
Business Acquisitions	Business Acquisitions The Company accounts for all business acquisitions at fair value and expenses acquisition costs as they are incurred. Any identifiable assets acquired and liabilities assumed are recognized and measured at their respective fair values on the acquisition date. If information about facts and circumstances existing as of the acquisition date is incomplete at the end of the reporting period in which a business acquisition occurs, the Company will report provisional amounts for the items for which the accounting is incomplete. The measurement period ends once the Company receives sufficient information to finalize the fair values; however, the period will not exceed one year from the acquisition date. Any adjustments to provisional amounts that are identified during the measurement period are recognized in the reporting period in which the adjustment amounts are determined. In connection with certain acquisitions, the Company enters into agreements to pay additional amounts in cash or common stock based on the achievement of certain performance measures for up to five years ending after the acquisition dates. The Company measures this contingent consideration at fair value at the acquisition date and records such contingent consideration as a liability or equity on the Company’s Consolidated Balance Sheets on the acquisition date. The fair value of each contingent consideration liability is remeasured at each reporting period with any change in fair value recognized as income or expense within operations in the Company’s Consolidated Statements of Income and Comprehensive Income.
Goodwill and Other Intangible Assets	Goodwill and Other Intangible Assets The Company records acquired assets and assumed liabilities at their respective fair values under the acquisition method of accounting. Goodwill represents the excess of purchase price over the fair value of the net assets acquired. Intangible assets with finite lives, principally physician and hospital agreements, are recognized apart from goodwill at the time of acquisition based on the contractual-legal and separability criteria established in the accounting guidance. Intangible assets with finite lives are amortized on either an accelerated basis based on the annual undiscounted economic cash flows associated with the particular intangible asset or on a straight-line basis over their estimated useful lives. Intangible assets with finite lives are amortized over periods of one to 20 years . Goodwill is tested for impairment at a reporting unit level on at least an annual basis in accordance with the subsequent measurement provisions of the accounting guidance for goodwill. When testing goodwill for impairment, the Company may assess qualitative factors for its reporting units to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount, including goodwill. The Company has a single reporting unit. Alternatively, the Company may bypass this qualitative assessment and perform the quantitative goodwill impairment test. The Company completed annual impairment tests for its continuing operations in the third quarter of each of 2023, 2022 and 2021 and determined that goodwill was not impaired. For 2023, 2022 and 2021, the Company elected to perform the qualitative assessment, focused on various factors including macroeconomic conditions, market trends, specific reporting unit financial performance and other entity specific events, to determine if it was more likely than not that the fair value of its single reporting unit exceeded its carrying value, including goodwill. The Company considered the economic outlook for the healthcare services industry and various other factors during the testing process, including hospital and physician contract changes, local market developments, changes in third-party payor payments, and other publicly available information. The Company experienced a triggering event during the fourth quarter of 2023, resulting in a non-cash goodwill impairment charge of $ 148.3 million. S ee Note 8 – Goodwill and Intangible Assets for more information.
Long-Lived Assets	Long-Lived Assets The Company is required to evaluate long-lived assets, including intangible assets subject to amortization, whenever events or changes in circumstances indicate that the carrying value of the assets may not be fully recoverable. The recoverability of such assets is measured by a comparison of the carrying value of the assets to the future undiscounted cash flows before interest charges to be generated by the assets. If long-lived assets are impaired, the impairment to be recognized is measured as the excess of the carrying value over the fair value. Long-lived assets held for disposal are reported at the lower of the carrying value or fair value less disposal costs. The Company does not believe there are any indicators that would require an adjustment to such assets or their estimated periods of recovery at December 31, 2023 pursuant to current accounting standards.
Common Stock Repurchases	Common Stock Repurchases The Company repurchases shares of its common stock as authorized from time to time by its Board of Directors. The Company treats repurchased shares of its common stock as retired as any repurchased shares become authorized but unissued shares. The reacquisition cost of repurchased shares is recorded as a reduction in the respective components of shareholders’ equity
Professional Liability Coverage	Professional Liability Coverage The Company maintains professional liability insurance policies with third-party insurers generally on a claims-made basis, subject to deductibles or self-insured retention, exclusions and other restrictions. The Company’s self-insured retention under its professional liability insurance program is maintained primarily through a wholly owned captive insurance subsidiary. The Company records an estimate of liabilities for self-insured amounts and claims incurred but not reported based on an actuarial valuation using historical loss information, claim emergence patterns and various actuarial assumptions. Liabilities for claims incurred but not reported are not discounted.
Income Taxes	Income Taxes The Company records deferred income taxes using the liability method, whereby deferred tax assets and liabilities are determined based on the difference between the financial statement and tax bases of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. If it is more likely than not that all or a portion of deferred tax assets will not be realized, a valuation allowance is provided against such deferred tax assets. In making such determination, the Company considers all available positive and negative evidence, including future reversals of existing taxable temporary differences, projected future taxable income, tax-planning strategies, and results of recent operations. The accounting guidance for uncertain tax positions prescribes a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The guidance also requires policy disclosures regarding penalties and interest and extensive disclosures regarding increases and decreases in uncertain tax positions as a result of tax positions taken in a current or prior period, settlements with taxing authorities and any lapse of an applicable statute of limitations. Additional qualitative discussion is required for any tax position that may result in a significant increase or decrease in uncertain tax positions within a 12-month period from the Company's reporting date.
Stock Incentive Plans	Stock Incentive Plans The Company grants stock-based awards consisting primarily of restricted stock to key employees under its Amended and Restated 2008 Incentive Compensation Plan. The Company measures the cost of employee services received in exchange for stock-based awards based on grant-date fair value and allocates the resulting compensation expense over the corresponding requisite service period using the graded vesting attribution method. The Company also performs analyses to estimate forfeitures of stock-based awards on an annual basis and adjusts the estimates as necessary based on the number of awards that ultimately vest.
Net Income Per Common Share	Net Income Per Common Share 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, deferred stock and stock options and is calculated using the treasury stock method.
Fair Value Measurements	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 December 31, 2023 and 2022 (in thousands): Fair Value Fair Value Category December 31, December 31, Assets: Money market funds Level 1 $ 2,814 $ 1,415 Short-term investments Level 2 104,485 93,239 Mutual funds Level 1 17,687 14,544 The following table presents information about the Company’s financial instruments that are not carried at fair value at December 31, 2023 and 2022 (in thousands): December 31, 2023 December 31, 2022 Carrying Amount Fair Carrying Amount Fair Liabilities: 2030 Notes 400,000 357,000 400,000 344,000 The Company redeemed the full principal balance of its 6.25 % senior unsecured notes due 2027 (the “2027 Notes”) in February 2022. 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. The carrying value of the line of credit approximates fair value. If the Company’s line of credit was measured at fair value, it would be categorized as Level 2 in the fair value hierarchy.

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2023
Accounting Policies [Abstract]
Schedule of Net Revenue by Service Line	The following table summarizes the Company’s net patient service revenue from continuing operations by service line (in percentages): Years Ended December 31, 2023 2022 2021 Neonatology and other pediatric subspecialties 80 % 79 % 77 % Maternal-fetal medicine 16 % 16 % 18 % Pediatric cardiology 4 % 5 % 5 % 100 % 100 % 100 %
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 December 31, 2023 and 2022 (in thousands): Fair Value Fair Value Category December 31, December 31, Assets: Money market funds Level 1 $ 2,814 $ 1,415 Short-term investments Level 2 104,485 93,239 Mutual funds Level 1 17,687 14,544
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 December 31, 2023 and 2022 (in thousands): December 31, 2023 December 31, 2022 Carrying Amount Fair Carrying Amount Fair Liabilities: 2030 Notes 400,000 357,000 400,000 344,000

Investments (Tables)

Investments (Tables)	12 Months Ended
	Dec. 31, 2023
Investments, Debt and Equity Securities [Abstract]
Schedule of Investments	Investments held are summarized as follows (in thousands): December 31, 2023 2022 Corporate securities $ 57,878 $ 61,385 U.S. Treasury securities 22,674 10,205 Municipal debt securities 14,649 14,377 Federal home loan securities 5,670 3,562 Certificates of deposit 3,614 3,710 $ 104,485 $ 93,239

Accounts Receivable and Net R_2

Accounts Receivable and Net Revenue (Tables)	12 Months Ended
	Dec. 31, 2023
Text Block [Abstract]
Schedule of Accounts Receivable, Net	Accounts receivable, net consists of the following (in thousands): December 31, 2023 2022 Gross accounts receivable $ 1,379,213 $ 1,548,492 Allowance for contractual adjustments and ( 1,106,900 ) ( 1,251,705 ) $ 272,313 $ 296,787
Schedule of Net Revenue	Net revenue consists of the following (in thousands): Years Ended December 31, 2023 2022 2021 Net patient service revenue $ 1,716,368 $ 1,688,818 $ 1,641,323 Hospital contract administrative fees 275,677 262,931 240,022 Other revenue 2,595 20,272 29,846 $ 1,994,640 $ 1,972,021 $ 1,911,191
Schedule of Percentage of Net Revenue	The following is a summary of the Company’s payor mix, expressed as a percentage of net revenue, exclusive of administrative fees and other miscellaneous revenue, for the periods indicated: Years Ended December 31, 2023 2022 2021 Contracted managed care 67 % 66 % 68 % Government 26 % 26 % 25 % Other third-parties 5 % 6 % 5 % Private-pay patients 2 % 2 % 2 % 100 % 100 % 100 %

Property and Equipment (Tables)

Property and Equipment (Tables)	12 Months Ended
	Dec. 31, 2023
Property, Plant and Equipment [Abstract]
Schedule of Property and Equipment	Property and equipment consists of the following (in thousands): December 31, 2023 2022 Building $ 8,286 $ 8,286 Land 2,032 2,032 Equipment and other 208,036 235,190 218,354 245,508 Accumulated depreciation ( 142,715 ) ( 172,218 ) $ 75,639 $ 73,290

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)	12 Months Ended
	Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Summary of Intangible Assets, Net	Intangible assets, net, consist of the following (in thousands): December 31, 2023 Gross Carrying Value Accumulated Amortization Net Carrying Value Physician and hospital agreements $ 105,577 $ ( 88,775 ) $ 16,802 Other technology 8,591 ( 4,153 ) 4,438 $ 114,168 $ ( 92,928 ) $ 21,240 December 31, 2022 Gross Carrying Value Accumulated Amortization Net Carrying Value Physician and hospital agreements $ 101,325 $ ( 85,457 ) $ 15,868 Other technology 8,695 ( 6,072 ) 2,623 $ 110,020 $ ( 91,529 ) $ 18,491
Amortization Expenses for Existing Intangible Assets for the Next Five Years	Amortization expense for existing intangible assets for the next five years is expected to be as follows (in thousands): 2024 $ 5,751 2025 3,815 2026 2,928 2027 1,621 2028 1,394

Accounts Payable and Accrued _2

Accounts Payable and Accrued Expenses (Tables)	12 Months Ended
	Dec. 31, 2023
Payables and Accruals [Abstract]
Schedule of Accounts Payable and Accrued Expenses	Accounts payable and accrued expenses consist of the following (in thousands): December 31, 2023 2022 Accounts payable $ 34,588 $ 31,857 Accrued salaries and incentive compensation 193,112 197,831 Accrued payroll taxes and benefits 36,545 34,983 Accrued professional liabilities 32,039 32,232 Accrued interest 8,262 8,921 Other accrued expenses 46,252 68,401 $ 350,798 $ 374,225

Operating Leases (Tables)

Operating Leases (Tables)	12 Months Ended
	Dec. 31, 2023
Leases [Abstract]
Operating Lease Related Assets And Liabilities And Other Related Information	The table below presents the operating lease-related right-of-use assets and related liabilities recorded on the Company’s balance sheet and the weighted average remaining lease term and discount rate as of December 31, 2023 and 2022 (dollars in thousands): December 31, 2023 2022 Assets: Operating lease right-of-use assets $ 61,693 $ 55,796 Liabilities: Current portion of operating lease liabilities 21,076 21,589 Long-term portion of operating lease liabilities 47,238 44,213 Other Information: Weighted-average remaining lease term 4.6 years 3.9 years Weighted average discount rate 5.5 % 4.6 %
Lease, Cost	The table below presents certain information related to the lease costs for operating leases during the years ended December 31, 2023 and 2022 (in thousands): December 31, 2023 2022 Operating lease costs $ 23,200 $ 22,293 Variable lease costs 5,854 6,640 Other operating lease costs 3,613 4,218 Total operating lease costs $ 32,667 $ 33,151
Operating Leases Cash Flow Related Information	The table below presents supplemental cash flow information related to operating leases during the years ended December 31, 2023 and 2022 (in thousands): December 31, 2023 December 31, 2022 Operating cash flows for operating leases $ 35,747 $ 37,549
Lessee, Operating Lease, Liability, Maturity	The table below reconciles the undiscounted cash flows for each of the first five years and total of the remaining years to the operating lease liabilities recorded on the balance sheet as of December 31, 2023 (in thousands): December 31, 2023 2024 $ 22,141 2025 17,421 2026 12,436 2027 8,906 2028 5,501 Thereafter 10,142 Total minimum lease payments 76,547 Less: Amount of payments representing interest ( 8,233 ) Present value of future minimum lease payments 68,314 Less: Current obligations ( 21,076 ) Long-term portion of operating leases $ 47,238

Accrued Professional Liabilit_2

Accrued Professional Liabilities (Tables)	12 Months Ended
	Dec. 31, 2023
Health Care Organizations [Abstract]
Schedule of Accrued Professional Liability	The activity related to the Company’s accrued professional liability for continuing operations, excluding the retained professional liabilities related to the Company’s former anesthesiology and radiology medical groups, for the years ended December 31, 2023, 2022, and 2021 is as follows (in thousands): Years Ended December 31, 2023 2022 2021 Balance at beginning of year $ 199,561 $ 190,127 $ 174,803 Liabilities recognized, offset by insurance ( 5,510 ) ( 2,692 ) ( 2,299 ) Provision (adjustment) for losses related to: Current year 55,144 53,180 56,016 Prior years ( 7,551 ) ( 4,056 ) ( 14,231 ) Total provision for losses 47,593 49,124 41,785 Claim payments related to: Current year ( 97 ) ( 73 ) ( 59 ) Prior years ( 38,951 ) ( 36,925 ) ( 24,103 ) Total payments ( 39,048 ) ( 36,998 ) ( 24,162 ) Balance at end of year $ 202,596 $ 199,561 $ 190,127

Line of Credit, Long-Term Deb_2

Line of Credit, Long-Term Debt and Finance Lease Obligations (Tables)	12 Months Ended
	Dec. 31, 2023
Debt Disclosure [Abstract]
Schedule of Long-Term Debt	The carrying value of the Company’s long-term debt was $ 622.2 million and $ 637.2 million at December 31, 2023 and 2022, respectively, and consisted of the following (in thousands): December 31, 2023 Principal Unamortized Debt Issuance Costs Total Senior notes $ 400,000 $ ( 4,354 ) $ 395,646 Revolving line of credit — ( 1,006 ) ( 1,006 ) Term A loan 228,125 ( 559 ) 227,566 Total $ 628,125 $ ( 5,919 ) $ 622,206 December 31, 2022 Principal Unamortized Debt Issuance Costs Total Senior notes $ 400,000 $ ( 5,069 ) $ 394,931 Revolving line of credit 4,000 ( 1,489 ) 2,511 Term A loan 240,625 ( 827 ) 239,798 Total $ 644,625 $ ( 7,385 ) $ 637,240
Summary of Estimated Fair Value of Notes	The estimated fair value of the Company’s 2030 Notes was estimated using trading prices as of December 31, 2023 and 2022, respectively, as Level 2 inputs to estimate fair value for relevant periods and are summarized as follows (in thousands): December 31, 2023 2022 2030 Notes 357,000 344,000
Schedule of Financial Lease Obligations	The Company redeemed the full principal balance of its 2027 Notes in February 2022 . The Company’s finance lease obligations, primarily related to equipment used in its newborn hearing screen program, consist of the following (in thousands): December 31, 2023 2022 Finance lease obligations $ 9,241 $ 11,128 Less: Current portion ( 2,413 ) ( 2,398 ) Long-term portion $ 6,828 $ 8,730

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2023
Income Tax Disclosure [Abstract]
Summary of Components of Income Tax Provision	The components of the income tax provision (benefit) are as follows (in thousands): December 31, 2023 2022 2021 Federal: Current $ 8,040 $ 38,877 $ 41,592 Deferred 1,467 ( 19,679 ) ( 20,373 ) 9,507 19,198 21,219 State: Current 770 2,700 16,888 Deferred 1,772 ( 3,092 ) ( 10,866 ) 2,542 ( 392 ) 6,022 Total $ 12,049 $ 18,806 $ 27,241
Schedule of Differences Between Effective Rate and United States Federal Income Tax Statutory Rate	The differences between the effective rate and the United States federal income tax statutory rate are as follows: December 31, 2023 2022 2021 Tax at statutory rate 21.00 % 21.00 % 21.00 % State income tax, net of federal benefit 2.79 1.53 4.72 Non-deductible expenses ( 4.43 ) 1.48 3.42 Equity compensation adjustments ( 3.98 ) 1.35 0.77 Change in accrual estimates relating to 0.67 ( 3.28 ) ( 1.08 ) Change in valuation allowance ( 13.82 ) 1.72 ( 0.26 ) Goodwill impairment ( 26.67 ) ─ ─ Other, net ( 0.48 ) ( 0.69 ) ( 0.46 ) Change in tax law ─ ─ ( 7.97 ) Income tax provision ( 24.92 )% 23.11 % 20.14 %
Significant Components of Deferred Income Tax Assets and Liabilities	All of the Company’s deferred tax assets and liabilities are classified as long-term. The significant components of deferred income tax assets and liabilities are as follows (in thousands): December 31, 2023 2022 Allowance for uncollectible accounts $ 139,998 $ 152,526 Reserves and accruals 59,218 66,969 Stock-based compensation 3,022 3,694 Operating loss and other carryforwards 34,739 28,773 Capital loss carryforwards 422,809 422,793 Operating lease assets 19,133 19,096 Property and equipment 2,056 2,481 Other 5,520 256 Deferred tax assets before valuation 686,495 696,588 Less: Valuation allowance ( 435,940 ) ( 429,260 ) Deferred tax assets, net of valuation 250,555 267,328 Gross deferred tax liabilities: Amortization ( 162,538 ) ( 176,398 ) Operating lease liabilities ( 17,342 ) ( 16,510 ) Other ( 2,131 ) ( 2,133 ) Total deferred tax liabilities ( 182,011 ) ( 195,041 ) Net deferred tax assets $ 68,544 $ 72,287
Schedule of Activity Related to Gross Unrecognized Tax Benefits	The following table summarizes the activity related to the Company’s liability for uncertain tax positions for the years ended December 31, 2023, 2022 and 2021 (in thousands): Years Ended December 31, 2023 2022 2021 Balance at beginning of year $ 2,838 $ 4,928 $ 6,168 Increases related to prior year tax positions 70 379 — Increases related to current year tax 200 800 900 Decreases related to lapse of statutes ( 659 ) ( 3,269 ) ( 2,140 ) Balance at end of year $ 2,449 $ 2,838 $ 4,928

Common and Common Equivalent _2

Common and Common Equivalent Shares (Tables)	12 Months Ended
	Dec. 31, 2023
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 share calculation for the years ended December 31, 2023, 2022, and 2021 is as follows (in thousands): Years Ended December 31, 2023 2022 2021 Weighted average number of common 82,201 83,467 84,832 Weighted average number of dilutive common — 654 996 Weighted average number of common and common 82,201 84,121 85,828 Antidilutive securities (restricted stock and stock options, as relevant) not included in the diluted net income per common share calculation 1,115 406 11 (a) Due to a loss for the year ended December 31, 2023, 0.4 million incremental shares are not included because the effect would be antidilutive.

Stock Incentive Plans and Sto_2

Stock Incentive Plans and Stock Purchase Plans (Tables)	12 Months Ended
	Dec. 31, 2023
Share-Based Payment Arrangement [Abstract]
Schedule of Restricted Stock and Deferred Stock Awards	The activity related to the Company's restricted stock awards and the corresponding weighted average grant-date fair values for the year ended December 31, 2023 are as follows: Number of Weighted Non-vested shares at January 1, 2023 1,195,397 $ 23.32 Awarded 820,101 $ 15.25 Forfeited ( 239,653 ) $ 22.61 Vested ( 418,756 ) $ 22.91 Non-vested shares at December 31, 2023 1,357,089 $ 18.69
Schedule of Activity and Certain Other Information Related to Stock Option Awards	The activity and certain other information related to the Company’s outstanding stock option awards for the year ended December 31, 2023 are as follows: Number of Weighted Weighted Average Aggregate Intrinsic Outstanding at January 1, 2023 887,731 $ 16.91 Expired ( 887,731 ) $ 16.91 Outstanding at December 31, 2023 — — $ — Exercisable at December 31, 2023 — — $ —

Coronavirus Pandemic ("COVID"_2

Coronavirus Pandemic ("COVID")-19 and the CARES Act - Additional Information (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Line of credit remaining borrowing capacity	$ 450,000
Letters of Credit [Member]
Letters of credit	$ 0
COVID-19 [Member]
Proceeds From Contribution In Aid Of Reimbursement of Lost Revenue		$ 13,300	$ 26,100

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Feb. 28, 2022
Summary Of Significant Accounting Policies [Line Items]
Cash and cash equivalents maturity description		90
Asset Impairment Charges	$ 20,000	$ 20,000	$ 0	$ 0
Additional amounts to be paid in cash or common stock based on achievement of performance measures within period, maximum years		5 years
Goodwill, Impairment Loss		$ 148,312	$ 0	$ 0
GAAP Senior Notes [Member] | Six Point Two Five Percentage Senior Notes Due Two Thousand Twenty Seven [Member]
Summary Of Significant Accounting Policies [Line Items]
Debt instrument, interest rate, effective percentage					6.25%
Unnamed Corporate Joint Venture One [Member]
Summary Of Significant Accounting Policies [Line Items]
Equity method ownership percentage in joint venture	37.50%	37.50%
Unnamed Corporate Joint Venture Two [Member]
Summary Of Significant Accounting Policies [Line Items]
Equity method ownership percentage in joint venture	51%	51%
Buildings [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years	30 years	30 years
United States [Member] | Credit Concentration Risk [Member] | Accounts Receivable [Member]
Summary Of Significant Accounting Policies [Line Items]
Percentage of net accounts receivable		20%	21%
Maximum [Member]
Summary Of Significant Accounting Policies [Line Items]
Short-Term investments maturity period, in years		1 year
Intangible assets finite lives	20 years	20 years
Maximum [Member] | Medical Equipment [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years	7 years	7 years
Maximum [Member] | Computer Equipment [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years	7 years	7 years
Maximum [Member] | Software and Software Development Costs [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years	7 years	7 years
Maximum [Member] | Furniture [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years	7 years	7 years
Minimum [Member]
Summary Of Significant Accounting Policies [Line Items]
Intangible assets finite lives	1 year	1 year
Minimum [Member] | Medical Equipment [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years	3 years	3 years
Minimum [Member] | Computer Equipment [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years	3 years	3 years
Minimum [Member] | Software and Software Development Costs [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years	3 years	3 years
Minimum [Member] | Furniture [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years	3 years	3 years

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Schedule of Net Revenue by Service Line (Detail) - Product Concentration Risk [Member] - Sales Revenue, Services, Net [Member]	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Segment Reporting Information [Line Items]
Net revenue in percentage	100%	100%	100%
Neonatology and Other Pediatric Subspecialties [Member]
Segment Reporting Information [Line Items]
Net revenue in percentage	80%	79%	77%
Maternal-Fetal Medicine [Member]
Segment Reporting Information [Line Items]
Net revenue in percentage	16%	16%	18%
Pediatric Cardiology [Member]
Segment Reporting Information [Line Items]
Net revenue in percentage	4%	5%	5%

Summary of Significant Accoun_6

Summary of Significant Accounting Policies - Schedule of fair value on a recurring basis (Detail) - Fair Value, Recurring [Member] - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Fair Value, Inputs, Level 1 [Member]
Assets:
Money market funds	$ 2,814	$ 1,415
Short-term investments	104,485
Mutual funds	$ 17,687	14,544
Fair Value, Inputs, Level 2 [Member]
Assets:
Short-term investments		$ 93,239

Summary of Significant Accoun_7

Summary of Significant Accounting Policies - Schedule of financial instruments that are not carried at fair value (Detail) - 2030 Notes [Member] - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Liabilities:
Notes Payable	$ 400,000	$ 400,000
Liabilities:
Notes Payable Fair Value Disclosure	$ 357,000	$ 344,000

Investments - Schedule of Inves

Investments - Schedule of Investments (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Debt Securities, Held-to-Maturity, Allowance for Credit Loss [Line Items]
Available-for-sale Securities	$ 0	$ 93,239
Corporate Securities [Member]
Debt Securities, Held-to-Maturity, Allowance for Credit Loss [Line Items]
Available-for-sale Securities	57,878	61,385
US Treasury Securities [Member]
Debt Securities, Held-to-Maturity, Allowance for Credit Loss [Line Items]
Available-for-sale Securities	22,674	10,205
Municipal Debt Securities [Member]
Debt Securities, Held-to-Maturity, Allowance for Credit Loss [Line Items]
Available-for-sale Securities	14,649	14,377
Federal Home Loan Securities [Member]
Debt Securities, Held-to-Maturity, Allowance for Credit Loss [Line Items]
Available-for-sale Securities	5,670	3,562
Certificates of Deposit [Member]
Debt Securities, Held-to-Maturity, Allowance for Credit Loss [Line Items]
Available-for-sale Securities	$ 3,614	$ 3,710

Accounts Receivable and Net R_3

Accounts Receivable and Net Revenue - Schedule of Accounts Receivable, Net (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Receivables [Abstract]
Gross accounts receivable	$ 1,379,213	$ 1,548,492
Allowance for contractual adjustments and uncollectibles	(1,106,900)	(1,251,705)
Accounts receivable, net	$ 272,313	$ 296,787

Accounts Receivable and Net R_4

Accounts Receivable and Net Revenue - Schedule of Net Revenue (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Disaggregation of Revenue [Abstract]
Net revenue	$ 1,994,640	$ 1,972,021	$ 1,911,191
Net patient service revenue [Member]
Disaggregation of Revenue [Abstract]
Net revenue	1,716,368	1,688,818	1,641,323
Hospital contract administrative fees [Member]
Disaggregation of Revenue [Abstract]
Net revenue	275,677	262,931	240,022
Other revenue [Member]
Disaggregation of Revenue [Abstract]
Net revenue	$ 2,595	$ 20,272	$ 29,846

Accounts Receivable and Net R_5

Accounts Receivable and Net Revenue - Schedule of Net Patient Service Revenue by Type of Payor (Detail)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	100%	100%	100%
Contracted Managed Care [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	67%	66%	68%
Government [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	26%	26%	25%
Other Third-Parties [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	5%	6%	5%
Private-Pay Patients [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	2%	2%	2%

Property Plant and Equipment -

Property Plant and Equipment - Schedule of Property and Equipment (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Property, Plant and Equipment [Abstract]
Building	$ 8,286	$ 8,286
Land	2,032	2,032
Equipment and other	208,036	235,190
Property and equipment, gross	218,354	245,508
Accumulated depreciation	(142,715)	(172,218)
Property and equipment, net	$ 75,639	$ 73,290

Property and Equipment - Additi

Property and Equipment - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Property, Plant and Equipment [Line Items]
Recorded depreciation expense	$ 28.1	$ 26.7	$ 21.6

Business Combinations - Additio

Business Combinations - Additional Information (Detail) $ in Thousands	12 Months Ended
	Dec. 31, 2023 USD ($) Number	Dec. 31, 2022 USD ($) Number
Business Acquisition [Line Items]
Business Acquisition, Goodwill, Expected Tax Deductible Amount	$ 400	$ 26,700
Other intangible assets	4,500	2,300
Fixed assets	100	2,200
Other non-current assets	82,165	123,176
Pediatric Gastroenterology And Gynecology practice And Multi Location Pediatric Urgent Care Practice [Member]
Business Acquisition [Line Items]
Total business acquisition consideration		$ 31,300
Number of other multi location pediatric urgent care practice acquired | Number		1
One pediatric gastroenterology practice | Number		1
Business acquisition consiideration paid in cash		$ 26,500
Business acquisitions contingent consideration liability		4,800
Pediatric Urology Practice [Member]
Business Acquisition [Line Items]
Total business acquisition consideration	$ 5,000
Number of pediatric urology practice acquired | Number	1
Pediatric Subspecialty Practice [Member]
Business Acquisition [Line Items]
Other non-current assets		$ 100

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Goodwill And Other Intangible Assets [Line Items]
Goodwill	$ 1,384,166	$ 1,384,166	$ 1,532,092
Intangible assets related to acquisitions		4,500
Additional Deferred Tax Assets	23,300	23,300
Non Cash Impairment Charges		148,312	0	$ 0
Good will Impairment Loss excluding Deferred Tax Assets Charge		125,000
Incremental Non Cash Charge		23,300
Change in Non Cash Impairment Charges		9,000
Non-cash charge against goodwill	$ 20,000	20,000	0	0
Goodwill impairment		168,312	0	0
Goodwill, Impairment Loss		$ 148,312	0	0
Change in Rate of Control Premium		1%
Amortization expense for intangible assets		$ 5,600	$ 6,400	$ 8,000
Weighted-average amortization period		10 years

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets - Summary of Intangible Assets, Net (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	$ 114,168	$ 110,020
Accumulated Amortization	(92,928)	(91,529)
Net Carrying Value	21,240	18,491
Physician And Hospital Agreements [Member]
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	105,577	101,325
Accumulated Amortization	(88,775)	(85,457)
Net Carrying Value	16,802	15,868
Other Technology [Member]
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	8,591	8,695
Accumulated Amortization	(4,153)	(6,072)
Net Carrying Value	$ 4,438	$ 2,623

Goodwill and Intangible Asset_4

Goodwill and Intangible Assets - Amortization Expenses for Existing Intangible Assets for the Next Five Years (Detail) $ in Thousands	Dec. 31, 2023 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
2024	$ 5,751
2025	3,815
2026	2,928
2027	1,621
2028	$ 1,394

Discontinued Operations - Addit

Discontinued Operations - Additional Information (Detail) - USD ($)	3 Months Ended	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Non-cash charge against goodwill	$ 20,000,000	$ 20,000,000	$ 0	$ 0
Deferred Tax Assets, Goodwill and Intangible Assets	23,300,000	23,300,000
Valuation Allowance, Deferred Tax Asset, Increase (Decrease), Amount		6,700,000
Income Taxes Receivable	$ 7,565,000	$ 7,565,000	0
Anesthesiology Services Medical Group [Member]
Decrease to the loss on sale, net			$ 3,800,000

Accounts Payable and Accrued _3

Accounts Payable and Accrued Expenses - Schedule of Accounts Payable and Accrued Expenses (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Payables and Accruals [Abstract]
Accounts payable	$ 34,588	$ 31,857
Accrued salaries and incentive compensation	193,112	197,831
Accrued payroll taxes and benefits	36,545	34,983
Accrued professional liabilities	32,039	32,232
Accrued interest	8,262	8,921
Other accrued expenses	46,252	68,401
Accounts payable and accrued expenses, total	$ 350,798	$ 374,225

Operating Leases - Schedule of

Operating Leases - Schedule of operating lease-related right-of-use assets and related liabilities recorded on the Company's balance sheet and the weighted average remaining lease term and discount rate (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Assets:
Operating Lease, Right-of-Use Asset, Statement of Financial Position [Extensible Enumeration]	Operating And Finance Lease Right Of Use Assets	Operating And Finance Lease Right Of Use Assets
Operating lease right-of-use assets	$ 61,693	$ 55,796
Liabilities:
Current portion of operating lease liabilities	$ 21,076	$ 21,589
Finance Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration]	Current portion of operating lease liabilities	Current portion of operating lease liabilities
Long-term portion of operating leases liabilities	$ 47,238	$ 44,213
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration]	Long-term portion of operating leases liabilities	Long-term portion of operating leases liabilities
Other Information:
Weighted-average remaining lease term	4 years 7 months 6 days	3 years 10 months 24 days
Weighted average discount rate	5.50%	4.60%

Operating Leases - Schedule o_2

Operating Leases - Schedule of lease costs for operating leases (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Operating lease costs	$ 23,200	$ 22,293
Variable lease costs	5,854	6,640
Other operating lease costs	3,613	4,218
Total operating lease costs	$ 32,667	$ 33,151

Operating Leases - Schedule o_3

Operating Leases - Schedule of supplemental cash flow information related to operating leases (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Operating cash flows for operating leases	$ 35,747	$ 37,549

Operating Leases - Schedule o_4

Operating Leases - Schedule of operating lease liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
2024	$ 22,141
2025	17,421
2026	12,436
2027	8,906
2028	5,501
Thereafter	10,142
Total minimum lease payments	76,547
Less: Amount of payments representing interest	(8,233)
Present value of future minimum lease payments	68,314
Less: Current obligations	(21,076)	$ (21,589)
Long-term portion of operating leases liabilities	$ 47,238	$ 44,213

Accrued Professional Liabilit_3

Accrued Professional Liabilities - Additional Information (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Payables and Accruals [Abstract]
Total accrued professional liability	$ 283,300	$ 307,900
Accrued professional liabilities	32,039	32,232
Insurance receivables	33,200
Accrued professional liability incurred but loss reserves not reported for claims	178,100	215,500
Accrued professional liability incurred and loss reserves reported for claims	$ 105,200	$ 92,400

Accrued Professional Liabilit_4

Accrued Professional Liabilities - Schedule of Accrued Professional Liability (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Payables and Accruals [Abstract]
Balance at beginning of year	$ 199,561	$ 190,127	$ 174,803
Liabilities recognized, offset by insurance receivable	(5,510)	(2,692)	(2,299)
Provision (adjustment) for losses related to Current year	55,144	53,180	56,016
Provision (adjustment) for losses related to Prior years	(7,551)	(4,056)	(14,231)
Total provision for losses	47,593	49,124	41,785
Claim payments related to Current year	(97)	(73)	(59)
Claim payments related to Prior years	(38,951)	(36,925)	(24,103)
Total payments	(39,048)	(36,998)	(24,162)
Balance at end of year	$ 202,596	$ 199,561	$ 190,127

Line of Credit, Long-Term Deb_3

Line of Credit, Long-Term Debt and Finance Lease Obligations - Additional Information (Detail) - USD ($) $ in Thousands		12 Months Ended
	Feb. 11, 2022	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Debt Instrument [Line Items]
Debt Instrument, Frequency of Periodic Payment		payable semi-annually in arrears on February 15 and August 15, beginning on August 15, 2022
Debt Instrument, Description		Notes are guaranteed on an unsecured senior basis by the same subsidiaries and affiliated professional contractors that guarantee the Amended Credit Agreement (as defined below). The indenture under which the 2030 Notes are issued, among other things, limits the Company's ability to (1) incur liens and (2) enter into sale and lease-back transactions, and also limits the Company's ability to merge or dispose of all or substantially all of its assets, in all cases, subject to a number of customary exceptions
Purchase Price		101%
Borrowings on credit agreement		$ 470,000	$ 830,000	$ 0
Debt instrument interest rate		5.375%
Debt instrument maturity date description			February 2022
Long term debt		$ 622,200	$ 637,200
Line of Credit facility, available balance		450,000
Long-Term Debt
Debt Instrument [Line Items]
Unsecured Long-Term Debt	$ 250,000
Cash	308,000
5.37% Unsecured Senior Notes Due 2030 Member
Debt Instrument [Line Items]
Senior Notes	$ 400,000
Debt instrument interest rate	5.375%
Debt instrument, maturity year	2030
Interest accrued periodically		21,500
Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Proceeds from Issuance of Unsecured Debt	$ 100,000
Borrowings on credit agreement		37,500
Revolving Credit Facility [Member] | Long-Term Debt
Debt Instrument [Line Items]
Unsecured Long-Term Debt		250,000
Revolving Credit Facility [Member] | Credit Agreement [Member]
Debt Instrument [Line Items]
Unsecured Debt		$ 450,000
Interest Rate, description		(i) the Alternate Base Rate (defined as the highest of (a) the prime rate as announced by Bank of America, N.A., (b) the Federal Funds Rate plus 0.50% and (c) Term Secured Overnight Financing Rate ("SOFR") for an interest period of one month plus 1.00% with a 1.00% floor) plus an applicable margin rate of 0.50% for the first two fiscal quarters after the date of the Credit Agreement Amendment, and thereafter at an applicable margin rate ranging from 0.125% to 0.750% based on the Company's consolidated net leverage ratio or (ii) Term SOFR rate (calculated as the Secured Overnight Financing Rate published on the applicable Reuters screen page plus a spread adjustment of 0.10%, 0.15% or 0.25% depending on if the Company selects a one-month, three-month or six-month interest period, respectively, for the applicable loan with a 0% floor), plus an applicable margin rate of 1.50% for the first two full fiscal quarters after the date of the Credit Agreement Amendment, and thereafter at an applicable margin rate ranging from 1.125% to 1.750% based on the Company's consolidated net leverage ratio. The Amended Credit Agreement also provides for other customary fees and charges, including an unused commitment fee with respect to the Revolving Credit Line ranging from 0.150% to 0.200% of the unused lending commitments under the Revolving Credit Line
Letters of Credit [Member]
Debt Instrument [Line Items]
Letters of credit outstanding amount		$ 0
2027 Notes
Debt Instrument [Line Items]
Long term debt	$ 1,000,000

Line of Credit, Long-Term Deb_4

Line of Credit, Long-Term Debt and Finance Lease Obligations - Schedule of Long-Term Debt (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Debt instrument principal amount	$ 628,125	$ 644,625
Unamortized debt issuance cost	(5,919)	(7,385)
Long term debt	622,206	637,240
2030 Notes
Debt Instrument [Line Items]
Debt instrument principal amount	400,000	400,000
Unamortized debt issuance cost	(4,354)	(5,069)
Long term debt	395,646	394,931
Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Debt instrument principal amount	0	4,000
Unamortized debt issuance cost	(1,006)	(1,489)
Long term debt	1,006	2,511
Term A loan
Debt Instrument [Line Items]
Debt instrument principal amount	228,125	240,625
Unamortized debt issuance cost	(559)	(827)
Long term debt	$ 227,566	$ 239,798

Line of Credit, Long-Term Deb_5

Line of Credit, Long-Term Debt and Finance Lease Obligations - Summary of Estimated Fair Value of Notes (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
2030 Notes | Level 2 [Member] | Estimate of Fair Value Measurement [Member]
Debt Instrument Fair Value [Line Items]
Estimated fair value	$ 357,000	$ 344,000

Line of Credit, Long-Term Deb_6

Line of Credit, Long-Term Debt and Financial Lease Obligations - Schedule of Financial Lease Obligations (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Debt Disclosure [Abstract]
Finance lease obligations	$ 9,241	$ 11,128
Less: Current portion	$ (2,413)	$ (2,398)
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration]	Operating Lease, Liability, Noncurrent	Operating Lease, Liability, Noncurrent
Long-term portion	$ 6,828	$ 8,730

Income Taxes - Summary of Compo

Income Taxes - Summary of Components of Income Tax Provision (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Federal, Current	$ 8,040	$ 38,877	$ 41,592
Federal, Deferred	1,467	(19,679)	(20,373)
Federal income tax provision, Total	9,507	19,198	21,219
State, Current	770	2,700	16,888
State, Deferred	1,772	(3,092)	(10,866)
State income tax provision, Total	2,542	(392)	6,022
Income tax provision, Total	$ 12,049	$ 18,806	$ 27,241

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Tax [Line Items]
Effective tax rate	(24.92%)	23.11%	20.14%
Impairment charges related to Goodwill	$ 17,800
Increase (decrease) in net deferred tax liability	13,900
Income tax expense for excess tax deficiencies	1,900	$ 1,100	$ 1,000
Net operating loss carryforwards for federal and state tax	$ 56,400	46,700	61,700
Expiration period of operating loss carryforwards	2025
Operating loss carryforwards subject to expiration	$ 18,300
Operating loss carryforwards not subject to expiration	38,100
Uncertain tax position liability	2,449	2,838	4,928	$ 6,168
Unrecognized tax benefits that would impact effective tax rate	2,400
Increase (decrease) in uncertain tax position	800
Company's accrued liability for interest and penalties related to income tax liabilities	300	200
Net deferred tax assets	68,544	72,287
Capital loss carryforwards	1,710,000
Income Tax , Penalties and Interest Expense	$ 200	$ 300	400
Benefit related to a change in estimate of an income tax receivable			$ 10,800
Federal tax rate	21%	21%	21%
Increase in net deferred tax assets	$ 3,800
Increase Decrease In Uncollectible Accounts	12,500
Increase Decrease In Reserves And Accruals	7,800
Increase decrease in valuation allowance	6,700
Increase Decrease In operating and other loss carryforwards	5,900
Increase Decrease In other items	5,200
Valuation Allowance, Deferred Tax Asset, Increase (Decrease), Amount	$ 6,700
Earliest Tax Year [Member]
Income Tax [Line Items]
Federal and state income tax examinations	2020
Latest Tax Year [Member]
Income Tax [Line Items]
Increase (decrease) in uncertain tax position	$ 400	$ 2,100
Federal and state income tax examinations	2022
2020 [Member]
Income Tax [Line Items]
Federal tax rate			35%
Minimum [Member]
Income Tax [Line Items]
Expiration period of operating loss carryforwards	2033
Maximum [Member]
Income Tax [Line Items]
Expiration period of operating loss carryforwards	2042

Income Taxes - Schedule of Diff

Income Taxes - Schedule of Differences Between Effective Rate and United States Federal Income Tax Statutory Rate (Detail)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Tax at statutory rate	21%	21%	21%
State income tax, net of federal benefit	2.79%	1.53%	4.72%
Non-deductible expenses	(4.43%)	1.48%	3.42%
Equity compensation adjustments	(3.98%)	1.35%	0.77%
Change in accrual estimates relating to uncertain tax positions	0.67%	(3.28%)	(1.08%)
Change in valuation allowance	(13.82%)	1.72%	(0.26%)
Goodwill impairment	(26.67%)	0%	0%
Other, net	(0.48%)	(0.69%)	(0.46%)
Change in tax law	0%	0%	(7.97%)
Income tax provision	(24.92%)	23.11%	20.14%

Income Taxes - Significant Comp

Income Taxes - Significant Components of Deferred Income Tax Assets and Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Allowance for uncollectible accounts	$ 139,998	$ 152,526
Reserves and accruals	59,218	66,969
Stock-based compensation	3,022	3,694
Operating loss and other carryforwards	34,739	28,773
Capital loss carryforwards	422,809	422,793
Operating lease assets	19,133	19,096
Property and equipment	2,056	2,481
Other	5,520	256
Deferred tax assets before valuation allowance	686,495	696,588
Less: Valuation allowance	(435,940)	(429,260)
Deferred tax assets, net of valuation allowance	250,555	267,328
Gross deferred tax liabilities:
Amortization	(162,538)	(176,398)
Operating lease liabilities	(17,342)	(16,510)
Other	(2,131)	(2,133)
Total deferred tax liabilities	(182,011)	(195,041)
Net deferred tax assets	$ 68,544	$ 72,287

Income Taxes - Schedule of Acti

Income Taxes - Schedule of Activity Related to Gross Unrecognized Tax Benefits (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Balance at beginning of year	$ 2,838	$ 4,928	$ 6,168
Increases related to prior year tax positions	70	379	0
Increases related to current year tax positions	200	800	900
Decreases related to lapse of statutes of limitation	(659)	(3,269)	(2,140)
Balance at end of year	$ 2,449	$ 2,838	$ 4,928

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		12 Months Ended
		Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Earnings Per Share [Abstract]
Weighted average number of common shares outstanding		82,201	83,467	84,832
Weighted average number of dilutive common share equivalents	[1]	0	654	996
Weighted average number of common and common equivalent shares outstanding		82,201	84,121	85,828
Antidilutive securities (restricted stock and stock options, as relevant) not included in the diluted net income per common share calculation		1,115	406	11
[1] (a) Due to a loss for the year ended December 31, 2023, 0.4 million incremental shares are not included because the effect would be antidilutive.

Common and Common Equivalent _4

Common and Common Equivalent Shares - Schedule of Calculation of Shares Used in Basic and Diluted Net Income Per Share (Parenthetical) (Details) shares in Millions	12 Months Ended
	Dec. 31, 2023 shares
Earnings Per Share [Abstract]
Incremental Shares Not Included Due To Anti dilutive Effect	0.4

Stock Incentive Plans and Sto_3

Stock Incentive Plans and Stock Purchase Plans - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
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	820,101
Common stock, aggregate shares authorized	200,000,000	200,000,000
Stock-based compensation expense	$ 12,300,000	$ 14,400,000	$ 19,000,000
Aggregate fair value of restricted and deferred stocks vested	$ 9,600	$ 19,100,000	$ 25,100,000
Weighted average grant-date fair value of restricted and deferred stock awards granted	$ 15.25	$ 22.64	$ 25.17
Stock Option, Share Based Compensation Cost Not Yet Recognized Period For Recognition	$ 0
Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period	3 years
Aggregate number Shares issued under Stock Purchase Plans	400,000
Employee Stock Option | 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
Restricted and Deferred Stock Units [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation expense related to non-vested restricted stock, weighted-average period in years	1 year 4 months 24 days
Unrecognized compensation expense related to non-vested restricted shares	$ 8,700
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%
Amended and Restated 2008 Plan [Member] | Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares available for future grants and awards under Stock Incentive Plans	9,000
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	800
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]
Percentage of market value of common stock at which employees are permitted to purchase	85%
Aggregate number Shares issued under Stock Purchase Plans	0
Common stock, reserved for issuance	2,100,000
1996 Non-Qualified Employee Stock Purchase Plan and 2015 Non-Qualified Stock Purchase Plan [Member] | Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock, reserved for issuance	61,000

Stock Incentive Plans and Sto_4

Stock Incentive Plans and Stock Purchase Plans - Schedule of Restricted Stock and Deferred Stock Awards (Detail) - $ / shares	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-Based Payment Arrangement [Abstract]
Number of Shares, Non-vested shares at January 1, 2023	1,195,397
Number of Shares, Awarded	820,101
Number of Shares, Forfeited	(239,653)
Number of Shares, Vested	(418,756)
Number of Shares, Non-vested shares at December 31, 2023	1,357,089	1,195,397
Weighted Average Fair Value, Non-vested shares at January 1, 2023	$ 23.32
Weighted Average Fair Value, Awarded	15.25	$ 22.64	$ 25.17
Weighted Average Fair Value, Forfeited	22.61
Weighted Average Fair Value, Vested	22.91
Weighted Average Fair Value, Non-vested shares at December 31, 2023	$ 18.69	$ 23.32

Stock Incentive Plans and Sto_5

Stock Incentive Plans and Stock Purchase Plans - Schedule of Activity and Certain Other Information Related to Stock Option Awards (Detail) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2023 USD ($) $ / shares shares
Share-Based Payment Arrangement [Abstract]
Number of Shares, Outstanding at January 1, 2023	887,731
Number of Stock Options Expired	(887,731)
Number of Shares, Outstanding at December 31, 2023	0
Number of Shares, Exercisable at December 31, 2023	0
Weighted Average Exercise Price, Outstanding at January 1, 2023 | $ / shares	$ 16.91
Weighted Average Exercise Price Awarded | $ / shares	16.91
Weighted Average Exercise Price Exercised | $ / shares	$ 16.91
Aggregate Intrinsic Value, Outstanding at December 31, 2023 | $	$ 0
Aggregate Intrinsic Value, Exercisable at December 31, 2023 | $	$ 0

Common Stock Repurchase Progr_2

Common Stock Repurchase Programs - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Aug. 31, 2018
Common Stock [Line Items]
Common stock authorized for repurchase				$ 500,000,000
Common stock repurchased	$ 919,000	$ 88,511,000	$ 4,719,000
Company's Common stock repurchased				$ 4,600,000
Repurchased common stock, shares	0
Stock Repurchase Program, Number of Shares Authorized to be Repurchased	61,000	4,500,000
Payments for Repurchase of Common Stock	$ 919,000	$ 88,511,000	$ 4,719,000
Restricted Stock [Member]
Common Stock [Line Items]
Common stock repurchased		$ 2,900,000
Repurchased common stock, shares		200,000

Retirement Plans - Additional I

Retirement Plans - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Retirement Benefits [Abstract]
Expense of retirement plans related to the 401(k) Plans	$ 24.1	$ 22.6	$ 21

Subsequent Events Additional In

Subsequent Events Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2023
Line of Credit Facility [Line Items]
Debt instrument interest rate		5.375%
Debt instrument maturity date description	February 2022
Line of credit remaining borrowing capacity		$ 450

Selected Quarterly Financial In

Selected Quarterly Financial Information - Summary of Company's Selected Quarterly Financial Information (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Quarterly Financial Information Disclosure [Abstract]
Net revenue	$ 1,994,640	$ 1,972,021	$ 1,911,191
Practice salaries and benefits	1,448,275	1,383,319	1,297,477
Practice supplies and other operating expenses	124,800	121,669	100,472
General and administrative expenses	227,542	231,397	263,357
Gain on sale of building	0	0	(7,280)
Depreciation and amortization	36,171	35,636	32,147
Transformational and restructuring related expenses	2,219	27,312	22,100
Total operating expenses	1,987,319	1,799,333	1,708,273
Income from operations	7,321	172,688	202,918
Investment and other (expense) income	4,338	3,671	13,652
Interest expense	(42,075)	(39,695)	(68,722)
Loss on early extinguishment of debt	0	(57,016)	(14,532)
Equity in earnings of unconsolidated affiliates	2,057	1,722	1,912
Total non-operating expenses	(55,680)	(91,318)	(67,690)
(Loss) income from continuing operations before income taxes	(48,359)	81,370	135,228
Income tax benefit (provision)	(12,049)	(18,806)	(27,241)
(Loss) income from continuing operations	(60,408)	62,564	107,987
(Loss) income from discontinued operations, net of tax	0	3,767	22,950
Net (loss) income	(60,408)	66,331	130,937
Net (loss) income attributable to Pediatrix Medical Group, Inc.	$ (60,408)	$ 66,335	$ 130,964
Income from continuing operations, Basic	$ 0.73	$ 0.75	$ 1.27
Income from continuing operations, Diluted	0.73	0.74	1.26
Loss from discontinued operations, Basic	0	0.04	0.27
Loss from discontinued operations, Diluted	0	0.05	0.27
Earnings Per Share, Basic	0.73	0.79	1.54
Earnings Per Share, Diluted	$ 0.73	$ 0.79	$ 1.53
Weighted Average Number of Shares Outstanding, Basic	82,201	83,467	84,832
Weighted average shares, Diluted	82,201	84,121	85,828

EXHIBITS AND FINANCIAL STATEM_2

EXHIBITS AND FINANCIAL STATEMENT SCHEDULE - Valuation and Qualifying Accounts (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
SEC Schedule, 12-09, Valuation and Qualifying Accounts [Abstract]
Balance at beginning of year	$ 1,251,705	$ 1,091,310	$ 791,842
Amount charged against operating revenue	6,069,245	5,921,519	5,436,786
Accounts receivable contractual adjustments and write-offs (net of recoveries)	(6,214,050)	(5,761,124)	(5,137,318)
Balance at end of year	$ 1,106,900	$ 1,251,705	$ 1,091,310