Pediatrix Medical (MD) 10-Q 31 Jul 14 2014 Q2 Quarterly report Financial data

Document_and_Entity_Informatio

Document and Entity Information	6 Months Ended
	Jun. 30, 2014	Jul. 24, 2014
Document And Entity Information [Abstract]	'	'
Document Type	'10-Q	'
Amendment Flag	'false	'
Document Period End Date	30-Jun-14	'
Document Fiscal Year Focus	'2014	'
Document Fiscal Period Focus	'Q2	'
Trading Symbol	'MD	'
Entity Registrant Name	'MEDNAX, INC.	'
Entity Central Index Key	'0000893949	'
Current Fiscal Year End Date	'--12-31	'
Entity Filer Category	'Large Accelerated Filer	'
Entity Common Stock, Shares Outstanding	'	100,242,398

CONDENSED_CONSOLIDATED_BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) (USD $)	Jun. 30, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified
Current assets:	'	'
Cash and cash equivalents	$17,713	$31,137
Short-term investments	7,568	6,457
Accounts receivable, net	327,410	285,397
Prepaid expenses	7,697	6,361
Deferred income taxes	36,434	30,766
Other assets	10,876	8,007
Total current assets	407,698	368,125
Investments	58,076	57,511
Property and equipment, net	60,178	59,911
Goodwill	2,516,253	2,393,731
Other assets, net	132,295	129,438
Total assets	3,174,500	3,008,716
Current liabilities:	'	'
Accounts payable and accrued expenses	241,766	308,754
Current portion of long-term capital lease obligations	103	92
Income taxes payable	20,938	17,946
Total current liabilities	262,807	326,792
Line of credit	178,500	27,000
Long-term capital lease obligations	90	143
Long-term professional liabilities	143,791	139,367
Deferred income taxes	125,406	111,441
Other liabilities	59,129	60,985
Total liabilities	769,723	665,728
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; 100,174 and 101,207 shares issued and outstanding, respectively	1,002	1,012
Additional paid-in capital	884,464	857,953
Retained earnings	1,518,277	1,484,023
Total MEDNAX, Inc. shareholders' equity	2,403,743	2,342,988
Noncontrolling interests	1,034	'
Total equity	2,404,777	2,342,988
Total liabilities and equity	$3,174,500	$3,008,716

CONDENSED_CONSOLIDATED_BALANCE1

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) (Parenthetical) (USD $)	Jun. 30, 2014	Dec. 31, 2013
In Thousands, except Per Share data, unless otherwise specified
Statement Of Financial Position [Abstract]	'	'
Preferred stock, par value	$0.01	$0.01
Preferred stock, shares authorized	1,000	1,000
Preferred stock, issued	0	0
Common stock, par value	$0.01	$0.01
Common stock, shares authorized	200,000	200,000
Common stock, shares issued	100,174	101,207
Common stock, shares outstanding	100,174	101,207

CONDENSED_CONSOLIDATED_STATEME

CONDENSED CONSOLIDATED STATEMENTS OF INCOME (Unaudited) (USD $)	3 Months Ended		6 Months Ended
In Thousands, except Per Share data, unless otherwise specified	Jun. 30, 2014	Jun. 30, 2013	Jun. 30, 2014	Jun. 30, 2013
Income Statement [Abstract]	'	'	'	'
Net patient service revenue	$595,544	$529,180	$1,161,883	$1,031,895
Operating expenses:	'	'	'	'
Practice salaries and benefits	372,216	331,922	744,256	661,123
Practice supplies and other operating expenses	22,466	19,416	43,882	38,916
General and administrative expenses	60,829	54,601	119,243	107,919
Depreciation and amortization	10,361	9,870	20,732	19,014
Total operating expenses	465,872	415,809	928,113	826,972
Income from operations	129,672	113,371	233,770	204,923
Investment and other income	335	396	1,970	798
Interest expense	-2,188	-1,673	-3,559	-2,862
Equity in earnings of unconsolidated affiliate	150	'	150	'
Total non-operating expenses	-1,703	-1,277	-1,439	-2,064
Income before income taxes	127,969	112,094	232,331	202,859
Income tax provision	48,944	42,876	89,646	78,274
Net income	79,025	69,218	142,685	124,585
Less: Net income attributable to noncontrolling interests	-9	'	-9	'
Net income attributable to MEDNAX, Inc.	$79,016	$69,218	$142,676	$124,585
Net income attributable to MEDNAX, Inc.:	'	'	'	'
Basic	$0.80	$0.70	$1.45	$1.26
Diluted	$0.79	$0.68	$1.42	$1.23
Weighted average common shares:	'	'	'	'
Basic	98,411	99,116	98,689	98,868
Diluted	99,866	101,098	100,226	100,942

CONDENSED_CONSOLIDATED_STATEME1

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) (USD $)	6 Months Ended
In Thousands, unless otherwise specified	Jun. 30, 2014	Jun. 30, 2013
Cash flows from operating activities:	'	'
Net income	$142,685	$124,585
Adjustments to reconcile net income to net cash provided from operating activities:	'	'
Depreciation and amortization	20,732	19,014
Net change in fair value of contingent consideration liabilities	460	706
Stock-based compensation expense	15,849	15,092
Equity in earnings of unconsolidated affiliate	-150	'
Deferred income taxes	7,492	16,210
Changes in assets and liabilities:	'	'
Accounts receivable	-42,013	-21,708
Prepaid expenses and other assets	-3,055	-2,251
Other assets	632	179
Accounts payable and accrued expenses	-64,349	-53,409
Income taxes payable	3,009	-3,924
Payments of contingent consideration liabilities	-3,767	-616
Long-term professional liabilities	4,424	11,962
Other liabilities	2,472	2,392
Net cash provided from operating activities	84,421	108,232
Cash flows from investing activities:	'	'
Acquisition payments, net of cash acquired	-135,497	-116,944
Purchases of investments	-9,726	-14,946
Proceeds from sales or maturities of investments	8,050	2,263
Purchases of property and equipment	-7,753	-9,345
Net cash used in investing activities	-144,926	-138,972
Cash flows from financing activities:	'	'
Borrowings on line of credit	634,000	565,000
Payments on line of credit	-482,500	-555,200
Payments of contingent consideration liabilities	-6,910	-5,094
Payments on capital lease obligations	-42	-53
Excess tax benefit from exercises of stock options	9,816	7,795
Proceeds from issuance of common stock	18,388	10,175
Contribution from noncontrolling interests	1,025	'
Repurchases of common stock	-126,696	'
Net cash provided from financing activities	47,081	22,623
Net decrease in cash and cash equivalents	-13,424	-8,117
Cash and cash equivalents at beginning of period	31,137	21,280
Cash and cash equivalents at end of period	$17,713	$13,163

Basis_of_Presentation_and_New_

Basis of Presentation and New Accounting Pronouncements:	6 Months Ended
	Jun. 30, 2014
Accounting Policies [Abstract]	'
Basis of Presentation and New Accounting Pronouncements:	'
	1	Basis of Presentation and New Accounting Pronouncements:
	The accompanying unaudited Condensed Consolidated Financial Statements of the Company and the notes thereto presented in this Form 10-Q have been prepared in accordance with the rules and regulations of the Securities and Exchange Commission (“SEC”) applicable to interim financial statements, and do not include all disclosures required by accounting principles generally accepted in the United States of America (“GAAP”) for complete financial statements. In the opinion of management, these financial statements include all adjustments, consisting only of normal recurring adjustments, necessary for a fair statement of the results of interim periods. The financial statements include all the accounts of MEDNAX, Inc. and its consolidated subsidiaries (collectively, “MDX”) together with the accounts of MDX’s affiliated professional associations, corporations and partnerships (the “affiliated professional contractors”). MDX has contractual management arrangements with its affiliated professional contractors, which are separate legal entities that provide physician services in certain states and Puerto Rico. The terms “MEDNAX” and the “Company” refer collectively to MEDNAX, Inc., its subsidiaries and the affiliated professional contractors.
	On June 1, 2014, the Company entered into a joint venture in which it owns a 75% economic interest. The Company has a management agreement with the joint venture and, based on the provisions within the agreement, the Company has determined that the joint venture is a variable interest entity for which the Company is the primary beneficiary as defined in the accounting guidance for consolidation. Accordingly, the financial results of the joint venture are fully consolidated into the Company’s operating results. The equity interests of the outside investor in the equity and results of operations of this consolidated entity are accounted for and presented as noncontrolling interests.
	On June 1, 2014, the Company entered into a second 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 consolidated results of operations for the interim periods presented are not necessarily indicative of the results to be experienced for the entire fiscal year. In addition, the accompanying unaudited Condensed Consolidated Financial Statements and the notes thereto should be read in conjunction with the Consolidated Financial Statements and the notes thereto included in the Company’s most recent Annual Report on Form 10-K (the “Form 10-K”).
	Reclassifications have been made to certain prior period financial statements to conform with the current year presentation. Specifically, the Company reclassified $40.7 million of its deferred tax assets as of December 31, 2013 from current deferred income taxes to long-term deferred income taxes. This revision represents the correction of an error in the classification of certain deferred tax assets in our prior period financial statements that the Company has determined to be immaterial.
	All share and per share data set forth herein give effect to the two-for-one split of the Company’s common stock that became effective on December 19, 2013.
	New Accounting Pronouncements
	There were no new accounting pronouncements issued or effective during the six months ended June 30, 2014, that had or are expected to have a material impact on the Company’s Condensed Consolidated Financial Statements.

Cash_Equivalents_and_Investmen

Cash Equivalents and Investments:	6 Months Ended
	Jun. 30, 2014
Investments Debt And Equity Securities [Abstract]	'
Cash Equivalents and Investments:	'
	2	Cash Equivalents and Investments:
	As of June 30, 2014 and December 31, 2013, the Company’s cash equivalents consisted entirely of money market funds with a fair value of $7.2 million and $5.3 million, respectively.
	Investments consist of municipal debt securities, federal home loan securities and certificates of deposit. Investments with remaining maturities of less than one year are classified as short-term investments. Investments classified as long-term have maturities of one year to seven years.
	The Company intends and has the ability to hold its held-to-maturity securities to maturity, and therefore carries such investments at amortized cost in accordance with the provisions of the accounting guidance for investments in debt and equity securities.
	Investments held at June 30, 2014 and December 31, 2013 are summarized as follows (in thousands):
			June 30, 2014				December 31, 2013
			Short-Term		Long-Term		Short-Term		Long-Term
	Municipal debt securities		$	7,075	$	35,580	$	5,492	$	34,495
	Federal home loan securities			—		22,248		—		22,520
	Certificates of deposit			493		248		965		496
			$	7,568	$	58,076	$	6,457	$	57,511

Fair_Value_Measurements

Fair Value Measurements:	6 Months Ended
	Jun. 30, 2014
Fair Value Disclosures [Abstract]	'
Fair Value Measurements:	'
	3	Fair Value Measurements:
	In accordance with the accounting guidance for fair value measurements and disclosures, the Company carries its money market funds included in cash and cash equivalents at fair value. In accordance with the three-tier fair value hierarchy under this guidance, the Company determined the fair value using quoted market prices, a Level 1 input as defined under the accounting guidance for fair value measurements. At June 30, 2014 and December 31, 2013, the Company’s money market funds had a carrying amount of $7.2 million and $5.3 million, respectively.
	The Company also carries the cash surrender value of life insurance related to its deferred compensation arrangements at fair value. The investments underlying the life insurance contracts consist primarily of exchange-traded equity securities and mutual funds with quoted prices in active markets. In accordance with the three-tier fair value hierarchy, the Company determined the fair value using the cash surrender value of the life insurance, a Level 2 input as defined under the accounting guidance for fair value measurements. At June 30, 2014 and December 31, 2013, the Company’s cash surrender value of life insurance had a carrying amount of $17.2 million and $17.1 million, respectively.
	In addition, the Company carries its contingent consideration liabilities related to acquisitions at fair value. In accordance with the three-tier fair value hierarchy, the Company determined the fair value of its contingent consideration liabilities using the income approach with assumed discount rates and payment probabilities. The income approach uses Level 3, or unobservable inputs as defined under the accounting guidance for fair value measurements. At June 30, 2014 and December 31, 2013, the Company’s contingent consideration liabilities had a fair value of $32.9 million and $43.0 million, respectively. See Note 5 for more information regarding the Company’s contingent consideration liabilities recorded and paid during the six months ended June 30, 2014.
	The carrying amounts of cash equivalents, short-term investments, accounts receivable and accounts payable and accrued expenses approximate fair value due to the short maturities of the respective instruments. The carrying values of long-term investments, line of credit and capital lease obligations approximate fair value. If the Company’s line of credit were measured at fair value, it would be categorized as Level 2 in the fair value hierarchy.

Accounts_Receivable

Accounts Receivable:	6 Months Ended
	Jun. 30, 2014
Receivables [Abstract]	'
Accounts Receivable:	'
	4	Accounts Receivable:
	Accounts receivable, net consists of the following (in thousands):
			June 30, 2014			December 31, 2013
	Gross accounts receivable		$	1,149,989		$	997,682
	Allowance for contractual adjustments and uncollectibles			(822,579	)		(712,285	)
			$	327,410		$	285,397

Business_Acquisitions

Business Acquisitions:	6 Months Ended
	Jun. 30, 2014
Business Combinations [Abstract]	'
Business Acquisitions:	'
	5	Business Acquisitions:
	During the six months ended June 30, 2014, the Company completed the acquisition of six physician group practices and a complementary consulting services company for total consideration of $138.6 million, consisting of $135.5 million in cash, $2.4 million in other liabilities and $0.7 million of contingent consideration. In connection with these acquisitions, the Company recorded goodwill of $129.7 million, other intangible assets consisting primarily of physician and hospital agreements of $8.8 million, other assets of $1.2 million and other liabilities of $1.1 million. These acquisitions primarily expanded the Company’s national network of physician practices. The Company expects that $94.9 million of the goodwill recorded during the six months ended June 30, 2014 will be deductible for tax purposes.
	The contingent consideration of $0.7 million recorded during the six months ended June 30, 2014 is related to shares of common stock that will vest and an additional cash amount that will become payable in each case based on the achievement of certain performance measures for up to four years ending after the acquisition date. Approximately $0.7 million of the contingent consideration was recorded as equity with the remaining $41,000 recorded as a liability, both at acquisition-date fair value.
	In addition, during the six months ended June 30, 2014, the Company paid $10.7 million for contingent consideration related to certain prior-period acquisitions, of which all but the accretion recorded during 2014 was accrued for as of December 31, 2013.
	On June 1, 2014, the Company entered into two joint ventures. In connection with the joint venture in which it owns a 75% economic interest, the financial results of the joint venture are fully consolidated into the Company’s operating results and are not material to the Condensed Consolidated Financial Statements. In connection with the joint venture in which the Company owns a 37.5% economic interest, the Company completed a nonmonetary exchange of certain operations with a fair value of $7.7 million as contribution credit in the joint venture. The carrying value of the goodwill transferred of $7.2 million and the fixed assets transferred of $0.5 million approximated the fair value of the contribution to this joint venture, and accordingly no gain or loss was recognized on the transaction. The investment in this joint venture is included in other assets, net as presented in the Company’s Condensed Consolidated Balance Sheet.
	The following unaudited pro forma information combines the consolidated results of operations of the Company on a GAAP basis and the acquisitions completed during 2014 and 2013, including adjustments for pro forma amortization and interest expense, as if the transactions had occurred on January 1, 2013 and January 1, 2012, respectively (in thousands, except for per share data):
			Six Months Ended
			June 30,
			2014		2013
	Net patient service revenue		$	1,180,246	$	1,141,219
	Net income		$	144,404	$	136,067
	Net income per common share (1):
	Basic		$	1.46	$	1.38
	Diluted		$	1.44	$	1.35
	Weighted average shares (1):
	Basic			98,689		98,868
	Diluted			100,226		100,942
	(1)	The comparison of net income per share is affected by the change in the number of weighted average shares outstanding in each period. The basic and diluted weighted average shares outstanding for the six months ended June 30, 2014 were 98.7 million and 100.2 million, respectively, as compared to 98.9 million and 100.9 million, respectively, for the six months ended June 30, 2013.
	The pro forma results do not necessarily represent results which would have occurred if the acquisitions had taken place at the beginning of the periods, nor are they indicative of the results of future combined operations.

Accounts_Payable_and_Accrued_E

Accounts Payable and Accrued Expenses:	6 Months Ended
	Jun. 30, 2014
Payables And Accruals [Abstract]	'
Accounts Payable and Accrued Expenses:	'
	6	Accounts Payable and Accrued Expenses:
	Accounts payable and accrued expenses consist of the following (in thousands):
			June 30,		December 31,
			2014		2013
	Accounts payable		$	25,386	$	18,605
	Accrued salaries and bonuses			118,378		189,439
	Accrued payroll taxes and benefits			42,901		43,403
	Accrued professional liabilities			19,635		19,324
	Accrued contingent consideration			14,545		19,833
	Other accrued expenses			20,921		18,150
			$	241,766	$	308,754
	The net decrease in accrued salaries and bonuses of $71.0 million, from $189.4 million at December 31, 2013 to $118.4 million at June 30, 2014, is primarily due to the payment of performance-based incentive compensation, principally to the Company’s physicians, partially offset by performance-based incentive compensation accrued during the six months ended June 30, 2014. A majority of the Company’s payments for performance-based incentive compensation is paid annually in the first quarter.

Common_and_Common_Equivalent_S

Common and Common Equivalent Shares:	6 Months Ended
	Jun. 30, 2014
Earnings Per Share [Abstract]	'
Common and Common Equivalent Shares:	'
	7	Common and Common Equivalent Shares:
	Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the period. Diluted net income per share is calculated by dividing net income by the weighted average number of common and potential common shares outstanding during the applicable period. Potential common shares consist of outstanding stock options and non-vested restricted and deferred stock calculated using the treasury stock method. Under the treasury stock method, the Company includes the assumed excess tax benefits related to the potential exercise or vesting of its stock-based awards using the difference between the average market price for the applicable period less the option price, if any, and the fair value of the stock-based award on the date of grant multiplied by the applicable tax rate.
	The calculation of shares used in the basic and diluted net income per common share calculation for the three and six months ended June 30, 2014 and 2013 is as follows (in thousands):
			Three Months Ended				Six Months Ended
			June 30,				June 30,
			2014		2013		2014		2013
	Weighted average number of common shares outstanding			98,411		99,116		98,689		98,868
	Weighted average number of dilutive common share equivalents			1,455		1,982		1,537		2,074
	Weighted average number of common and common equivalent shares outstanding			99,866		101,098		100,226		100,942
	Antidilutive securities not included in the dilutive earnings per share calculation			—		138		—		68

Stock_Incentive_Plans_and_Stoc

Stock Incentive Plans and Stock Purchase Plan:	6 Months Ended
	Jun. 30, 2014
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]	'
Stock Incentive Plans and Stock Purchase Plan:	'
	8	Stock Incentive Plans and Stock Purchase Plan:
	The Company’s Amended and Restated 2008 Incentive Compensation Plan, as amended (the “Amended and Restated 2008 Incentive Plan”) provides for grants of stock options, stock appreciation rights, restricted stock, deferred stock, and other stock-related awards and performance awards that may be settled in cash, stock or other property.
	Under the Amended and Restated 2008 Incentive Plan, options to purchase shares of common stock may be granted at a price not less than the fair market value of the shares on the date of grant. The options must be exercised within 10 years from the date of grant and generally become exercisable on a pro rata basis over a three-year period from the date of grant. The Company issues new shares of its common stock upon exercise of its stock options. Restricted stock awards generally vest over periods of three years upon the fulfillment of specified service-based conditions and in certain instances performance-based conditions. Deferred stock awards vest upon the satisfaction of specified performance-based conditions through December 31, 2018. The Company recognizes compensation expense related to its restricted stock and deferred stock awards ratably over the corresponding vesting periods. During the six months ended June 30, 2014, the Company granted 503,336 shares of restricted stock to its employees and 19,917 shares of restricted stock to its non-employee directors under the Amended and Restated 2008 Incentive Plan. At June 30, 2014, the Company had approximately 6.3 million shares available for future grants and awards under the Amended and Restated 2008 Incentive Plan.
	Under the Company’s 1996 Non-Qualified Employee Stock Purchase Plan, as amended (the “Non-Qualified Plan”), 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. In accordance with the provisions of the accounting guidance for stock-based compensation, the Company recognizes stock-based compensation expense for the 15% discount received by participating employees. During the six months ended June 30, 2014, 128,063 shares were issued under the Non-Qualified Plan. At June 30, 2014, the Company had approximately 466,600 shares reserved for issuance under the Non-Qualified Plan.
	During the three and six months ended June 30, 2014 and 2013, the Company recognized approximately $7.7 million and $15.8 million, and $7.8 million and $15.1 million, respectively, of stock-based compensation expense. The net excess tax benefit recognized in additional paid-in capital related to the exercise of stock options for the six months ended June 30, 2014 was approximately $9.8 million.

Common_Stock_Repurchase_Progra

Common Stock Repurchase Programs:	6 Months Ended
	Jun. 30, 2014
Text Block [Abstract]	'
Common Stock Repurchase Programs:	'
	9	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 Stock Incentive Plans and Non-Qualified Plan. 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. During the six months ended June 30, 2014, the Company repurchased approximately 2.2 million shares of its common stock for approximately $126.7 million. The repurchase program was also expanded to allow 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.

Commitments_and_Contingencies

Commitments and Contingencies:	6 Months Ended
	Jun. 30, 2014
Commitments And Contingencies Disclosure [Abstract]	'
Commitments and Contingencies:	'
	10	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 common stock. The Company has not included an accrual for these matters as of June 30, 2014 in its Condensed 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 defense 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 or results of operations. 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 common stock.
	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 common stock.

Cash_Equivalents_and_Investmen1

Cash Equivalents and Investments: (Tables)	6 Months Ended
	Jun. 30, 2014
Investments Debt And Equity Securities [Abstract]	'
Schedule of Investments	'
	Investments held at June 30, 2014 and December 31, 2013 are summarized as follows (in thousands):
		June 30, 2014				December 31, 2013
		Short-Term		Long-Term		Short-Term		Long-Term
	Municipal debt securities	$	7,075	$	35,580	$	5,492	$	34,495
	Federal home loan securities		—		22,248		—		22,520
	Certificates of deposit		493		248		965		496
		$	7,568	$	58,076	$	6,457	$	57,511

Accounts_Receivable_Tables

Accounts Receivable: (Tables)	6 Months Ended
	Jun. 30, 2014
Receivables [Abstract]	'
Schedule of Accounts Receivable, Net	'
	Accounts receivable, net consists of the following (in thousands):
		June 30, 2014			December 31, 2013
	Gross accounts receivable	$	1,149,989		$	997,682
	Allowance for contractual adjustments and uncollectibles		(822,579	)		(712,285	)
		$	327,410		$	285,397

Business_Acquisitions_Tables

Business Acquisitions: (Tables)	6 Months Ended
	Jun. 30, 2014
Business Combinations [Abstract]	'
Schedule of Pro Forma Information Combines Consolidated Results of Company and Business Acquisitions	'
	The following unaudited pro forma information combines the consolidated results of operations of the Company on a GAAP basis and the acquisitions completed during 2014 and 2013, including adjustments for pro forma amortization and interest expense, as if the transactions had occurred on January 1, 2013 and January 1, 2012, respectively (in thousands, except for per share data):
			Six Months Ended
			June 30,
			2014		2013
	Net patient service revenue		$	1,180,246	$	1,141,219
	Net income		$	144,404	$	136,067
	Net income per common share (1):
	Basic		$	1.46	$	1.38
	Diluted		$	1.44	$	1.35
	Weighted average shares (1):
	Basic			98,689		98,868
	Diluted			100,226		100,942
	(1)	The comparison of net income per share is affected by the change in the number of weighted average shares outstanding in each period. The basic and diluted weighted average shares outstanding for the six months ended June 30, 2014 were 98.7 million and 100.2 million, respectively, as compared to 98.9 million and 100.9 million, respectively, for the six months ended June 30, 2013.

Accounts_Payable_and_Accrued_E1

Accounts Payable and Accrued Expenses: (Tables)	6 Months Ended
	Jun. 30, 2014
Payables And Accruals [Abstract]	'
Schedule of Accounts Payable and Accrued Expenses	'
	Accounts payable and accrued expenses consist of the following (in thousands):
		June 30,		December 31,
		2014		2013
	Accounts payable	$	25,386	$	18,605
	Accrued salaries and bonuses		118,378		189,439
	Accrued payroll taxes and benefits		42,901		43,403
	Accrued professional liabilities		19,635		19,324
	Accrued contingent consideration		14,545		19,833
	Other accrued expenses		20,921		18,150
		$	241,766	$	308,754

Common_and_Common_Equivalent_S1

Common and Common Equivalent Shares: (Tables)	6 Months Ended
	Jun. 30, 2014
Earnings Per Share [Abstract]	'
Schedule of Calculation of Shares Used in Basic and Diluted Net Income Per Share	'
	The calculation of shares used in the basic and diluted net income per common share calculation for the three and six months ended June 30, 2014 and 2013 is as follows (in thousands):
		Three Months Ended				Six Months Ended
		June 30,				June 30,
		2014		2013		2014		2013
	Weighted average number of common shares outstanding		98,411		99,116		98,689		98,868
	Weighted average number of dilutive common share equivalents		1,455		1,982		1,537		2,074
	Weighted average number of common and common equivalent shares outstanding		99,866		101,098		100,226		100,942
	Antidilutive securities not included in the dilutive earnings per share calculation		—		138		—		68

Basis_of_Presentation_and_New_1

Basis of Presentation and New Accounting Pronouncements - Additional Information (Detail) (USD $)	6 Months Ended	0 Months Ended
In Millions, unless otherwise specified	Jun. 30, 2014	Dec. 31, 2013	Dec. 31, 2013
		Long Term Deferred Income Taxes [Member]	Deferred Income Taxes [Member]
Basis Of Presentation [Line Items]	'	'	'
Equity ownership percentage in joint venture	37.50%	'	'
Direct ownership percentage in joint venture	75.00%	'	'
Deferred income taxes, reclassification adjustment	'	$40.70	($40.70)
Stock Split	'two-for-one	'	'

Cash_Equivalents_and_Investmen2

Cash Equivalents and Investments - Additional Information (Detail) (USD $)	6 Months Ended
In Millions, unless otherwise specified	Jun. 30, 2014	Jun. 30, 2014	Jun. 30, 2014	Dec. 31, 2013
	Maximum [Member]	Minimum [Member]	Money Market Funds [Member]	Money Market Funds [Member]
Schedule of Investments [Line Items]	'	'	'	'
Money market funds at fair value	'	'	$7.20	$5.30
Long-term investments maturity period, in years	'7 years	'1 year	'	'
Short-Term investments maturity period, in years	'1 year	'	'	'

Cash_Equivalents_and_Investmen3

Cash Equivalents and Investments - Schedule of Investments (Detail) (USD $)	Jun. 30, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified
Schedule of Investments [Line Items]	'	'
Short-Term	$7,568	$6,457
Long-Term	58,076	57,511
Municipal Debt Securities [Member]	'	'
Schedule of Investments [Line Items]	'	'
Short-Term	7,075	5,492
Long-Term	35,580	34,495
Federal Home Loan Securities [Member]	'	'
Schedule of Investments [Line Items]	'	'
Long-Term	22,248	22,520
Certificates of Deposit [Member]	'	'
Schedule of Investments [Line Items]	'	'
Short-Term	493	965
Long-Term	$248	$496

Fair_Value_Measurements_Additi

Fair Value Measurements - Additional Information (Detail) (USD $)	Jun. 30, 2014	Dec. 31, 2013
In Millions, unless otherwise specified
Fair Value Disclosures [Abstract]	'	'
Money market funds carrying amount	$7.20	$5.30
Carrying amount of cash surrender value of life insurance	17.2	17.1
Contingent consideration liabilities related to acquisitions	$32.90	$43

Accounts_Receivable_Schedule_o

Accounts Receivable - Schedule of Accounts Receivable, Net (Detail) (USD $)	Jun. 30, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified
Receivables [Abstract]	'	'
Gross accounts receivable	$1,149,989	$997,682
Allowance for contractual adjustments and uncollectibles	-822,579	-712,285
Accounts receivable, net	$327,410	$285,397

Business_Acquisitions_Addition

Business Acquisitions - Additional Information (Detail) (USD $)	6 Months Ended
	Jun. 30, 2014	Jun. 01, 2014
	Company	JointVenture
Business Combinations [Abstract]	'	'
Number of physician group practices acquired	6	'
Business acquisition, total consideration	$138,600,000	'
Cash consideration	135,500,000	'
Business acquisition, other liabilities	2,400,000	'
Contingent consideration	700,000	'
Goodwill recorded in connection with acquisitions	129,700,000	'
Other intangible assets	8,800,000	'
Other liabilities	1,100,000	'
Other assets	1,200,000	'
Goodwill deductible for tax purposes	94,900,000	'
Business acquisition contingent consideration recorded as equity	700,000	'
Business acquisition contingent consideration recorded as liability	41,000	'
Time period for achievement of certain performance measures for payment of contingent consideration, years	'4 years	'
Contingent consideration payments related to prior-period acquisitions	10,700,000	'
Number of joint ventures	'	2
Fair value, contribution credit	7,700,000	'
Carrying value of goodwill transferred	7,200,000	'
Fixed assets transferred	500,000	'
Gain or loss from the joint venture transaction	$0	'
Joint venture ownership 1, economic interest	75.00%	'
Joint venture ownership 2, economic interest	37.50%	'

Business_Acquisitions_Schedule

Business Acquisitions - Schedule of Pro Forma Information Combines Consolidated Results of Company and Business Acquisitions (Detail) (USD $)	6 Months Ended
In Thousands, except Per Share data, unless otherwise specified	Jun. 30, 2014	Jun. 30, 2013
Business Combinations [Abstract]	'	'
Net patient service revenue	$1,180,246	$1,141,219
Net income	$144,404	$136,067
Net income per share, Basic	$1.46	$1.38
Net income per share, Diluted	$1.44	$1.35
Weighted average shares, Basic	98,689	98,868
Weighted average shares, Diluted	100,226	100,942

Business_Acquisitions_Schedule1

Business Acquisitions - Schedule of Pro Forma Information Combines Consolidated Results of Company and Business Acquisitions (Parenthetical) (Detail)	3 Months Ended		6 Months Ended
In Thousands, unless otherwise specified	Jun. 30, 2014	Jun. 30, 2013	Jun. 30, 2014	Jun. 30, 2013
Business Combinations [Abstract]	'	'	'	'
Basic weighted average shares outstanding	98,411	99,116	98,689	98,868
Diluted weighted average shares outstanding	99,866	101,098	100,226	100,942

Accounts_Payable_and_Accrued_E2

Accounts Payable and Accrued Expenses - Schedule of Accounts Payable and Accrued Expenses (Detail) (USD $)	Jun. 30, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified
Payables And Accruals [Abstract]	'	'
Accounts payable	$25,386	$18,605
Accrued salaries and bonuses	118,378	189,439
Accrued payroll taxes and benefits	42,901	43,403
Accrued professional liabilities	19,635	19,324
Accrued contingent consideration	14,545	19,833
Other accrued expenses	20,921	18,150
Accounts payable and accrued expenses, total	$241,766	$308,754

Accounts_Payable_and_Accrued_E3

Accounts Payable and Accrued Expenses - Additional Information (Detail) (USD $)	6 Months Ended
	Jun. 30, 2014	Dec. 31, 2013
Payables And Accruals [Abstract]	'	'
Net decrease in accrued salaries and bonuses	($71,000,000)	'
Accrued salaries and bonuses	$118,378,000	$189,439,000

Common_and_Common_Equivalent_S2

Common and Common Equivalent Shares - Schedule of Calculation of Shares Used in Basic and Diluted Net Income Per Share (Detail)	3 Months Ended		6 Months Ended
In Thousands, unless otherwise specified	Jun. 30, 2014	Jun. 30, 2013	Jun. 30, 2014	Jun. 30, 2013
Earnings Per Share [Abstract]	'	'	'	'
Weighted average number of common shares outstanding	98,411	99,116	98,689	98,868
Weighted average number of dilutive common share equivalents	1,455	1,982	1,537	2,074
Weighted average number of common and common equivalent shares outstanding	99,866	101,098	100,226	100,942
Antidilutive securities not included in the dilutive earnings per share calculation	'	138	'	68

Stock_Incentive_Plans_and_Stoc1

Stock Incentive Plans and Stock Purchase Plan - Additional Information (Detail) (USD $)	3 Months Ended		6 Months Ended
In Millions, except Share data, unless otherwise specified	Jun. 30, 2014	Jun. 30, 2013	Jun. 30, 2014	Jun. 30, 2013
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]	'	'	'	'
Shares available for future grants and awards under Stock Incentive Plans	6,300,000	'	6,300,000	'
Stock-based compensation expense related to its Stock Incentive Plans and Non-Qualified Plan	$7.70	$7.80	$15.80	$15.10
Net excess tax benefit recognized in additional paid-in capital related to the exercise of stock options	'	'	$9.80	'
Non-employee Directors [Member]	'	'	'	'
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]	'	'	'	'
Restricted stock granted to employees and non-employees	'	'	19,917	'
1996 Non-Qualified Employee 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	'	'	85.00%	'
Percentage of discount received by participating employees	'	'	15.00%	'
Shares reserved for issuance	466,600	'	466,600	'
Shares issued under Non-Qualified Plan	'	'	128,063	'
Stock Option [Member]	'	'	'	'
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]	'	'	'	'
Number of years over which options become exercisable on a pro rata basis	'	'	'3 years	'
Stock Option [Member] | Maximum [Member]	'	'	'	'
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]	'	'	'	'
Vesting period of options, maximum years	'	'	'10 years	'
Restricted Stock [Member]	'	'	'	'
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]	'	'	'	'
Number of years over which options become exercisable on a pro rata basis	'	'	'3 years	'
Restricted Stock [Member] | Employees [Member]	'	'	'	'
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]	'	'	'	'
Restricted stock granted to employees and non-employees	'	'	503,336	'

Common_Stock_Repurchase_Progra1

Common Stock Repurchase Program - Additional Information (Detail) (Common Stock [Member], USD $)	6 Months Ended
In Millions, unless otherwise specified	Jun. 30, 2014
Common Stock [Member]	'
Common Stock [Line Items]	'
Common stock repurchased, shares	2.2
Common stock repurchased, value	$126.70