Pediatrix Medical (MD) 10-Q 30 Apr 15 2015 Q1 Quarterly report Financial data

Document_and_Entity_Informatio

Document and Entity Information	3 Months Ended
	Mar. 31, 2015	Apr. 24, 2015
Document And Entity Information [Abstract]
Document Type	10-Q
Amendment Flag	FALSE
Document Period End Date	31-Mar-15
Document Fiscal Year Focus	2015
Document Fiscal Period Focus	Q1
Trading Symbol	MD
Entity Registrant Name	MEDNAX, INC.
Entity Central Index Key	893949
Current Fiscal Year End Date	-19
Entity Filer Category	Large Accelerated Filer
Entity Common Stock, Shares Outstanding		93,529,121

Condensed_Consolidated_Balance

Condensed Consolidated Balance Sheets (Unaudited) (USD $)	Mar. 31, 2015	Dec. 31, 2014
In Thousands, unless otherwise specified
Current assets:
Cash and cash equivalents	$50,219	$47,928
Short-term investments	6,769	6,035
Accounts receivable, net	360,874	352,191
Prepaid expenses	4,474	7,036
Deferred income taxes	47,157	45,961
Other assets	8,464	7,901
Total current assets	477,957	467,052
Investments	63,802	64,082
Property and equipment, net	67,274	66,048
Goodwill	2,813,673	2,776,188
Other assets, net	223,608	235,425
Total assets	3,646,314	3,608,795
Current liabilities:
Accounts payable and accrued expenses	212,290	380,658
Current portion of long-term debt and capital lease obligations	10,435	10,465
Income taxes payable	44,702	25,150
Total current liabilities	267,427	416,273
Line of credit	698,500	368,000
Long-term debt and capital lease obligations	188,226	190,855
Long-term professional liabilities	153,596	148,651
Deferred income taxes	163,036	160,487
Other liabilities	61,467	58,963
Total liabilities	1,532,252	1,343,229
Commitments and contingencies
Shareholders' equity:
Preferred stock; $.01 par value; 1,000 shares authorized; none issued
Common stock; $.01 par value; 200,000 shares authorized; 93,448 and 96,030 shares issued and outstanding, respectively	934	960
Additional paid-in capital	875,411	886,877
Retained earnings	1,236,888	1,376,782
Total MEDNAX, Inc. shareholders' equity	2,113,233	2,264,619
Noncontrolling interests	829	947
Total equity	2,114,062	2,265,566
Total liabilities and equity	$3,646,314	$3,608,795

Condensed_Consolidated_Balance1

Condensed Consolidated Balance Sheets (Unaudited) (Parenthetical) (USD $)	Mar. 31, 2015	Dec. 31, 2014
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	93,448,000	96,030,000
Common stock, shares outstanding	93,448,000	96,030,000

Condensed_Consolidated_Stateme

Condensed Consolidated Statements of Income (Unaudited) (USD $)	3 Months Ended
In Thousands, except Per Share data, unless otherwise specified	Mar. 31, 2015	Mar. 31, 2014
Income Statement [Abstract]
Net revenue	$639,395	$566,338
Operating expenses:
Practice salaries and benefits	419,595	372,040
Practice supplies and other operating expenses	23,431	21,417
General and administrative expenses	67,936	58,414
Depreciation and amortization	13,612	10,370
Total operating expenses	524,574	462,241
Income from operations	114,821	104,097
Investment income	142	1,635
Interest expense	-3,267	-1,371
Equity in earnings of unconsolidated affiliate	821
Total non-operating (expenses) income	-2,304	264
Income before income taxes	112,517	104,361
Income tax provision	43,928	40,701
Net income	68,589	63,660
Net loss attributable to noncontrolling interests	118
Net income attributable to MEDNAX, Inc.	$68,707	$63,660
Net income attributable to MEDNAX, Inc.:
Earnings per share, Basic	$0.73	$0.64
Earnings per share, Diluted	$0.72	$0.63
Weighted average common shares:
Basic	94,231	99,076
Diluted	95,325	100,696

Condensed_Consolidated_Stateme1

Condensed Consolidated Statements of Cash Flows (Unaudited) (USD $)	3 Months Ended
In Thousands, unless otherwise specified	Mar. 31, 2015	Mar. 31, 2014
Cash flows from operating activities:
Net income	$68,589	$63,660
Adjustments to reconcile net income to net cash used in operating activities:
Depreciation and amortization	13,612	10,370
Net change in fair value of contingent consideration liabilities	289	346
Stock-based compensation expense	7,836	8,071
Equity in earnings of unconsolidated affiliate	-821
Distribution of earnings from unconsolidated affiliate	2,062
Deferred income taxes	2,023	-387
Changes in assets and liabilities:
Accounts receivable	-8,683	-30,292
Prepaid expenses and other assets	1,999	-1,480
Other assets	705	341
Accounts payable and accrued expenses	-169,622	-131,370
Income taxes payable	19,552	26,076
Payments of contingent consideration liabilities	-34	-2,779
Long-term professional liabilities	4,945	6,419
Other liabilities	3,864	1,203
Net cash used in operating activities	-53,684	-49,822
Cash flows from investing activities:
Acquisition payments, net of cash acquired	-37,724	-69,375
Purchases of investments	-3,719	-3,904
Proceeds from sales or maturities of investments	3,265	3,635
Purchases of property and equipment	-5,388	-4,570
Net cash used in investing activities	-43,566	-74,214
Cash flows from financing activities:
Borrowings on credit facility	634,500	371,500
Payments on credit facility	-306,500	-150,500
Payments of contingent consideration liabilities	-371	-645
Payments on capital lease obligations	-159	-25
Excess tax benefit from exercises of stock options and vesting of restricted stock	1,076	1,935
Proceeds from issuance of common stock	4,596	7,398
Repurchases of common stock	-233,601	-116,989
Net cash provided from financing activities	99,541	112,674
Net increase (decrease) in cash and cash equivalents	2,291	-11,362
Cash and cash equivalents at beginning of period	47,928	31,137
Cash and cash equivalents at end of period	$50,219	$19,775

Basis_of_Presentation_and_New_

Basis of Presentation and New Accounting Pronouncements	3 Months Ended
	Mar. 31, 2015
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 business corporations or professional associations, professional corporations, limited liability companies and partnerships (the “affiliated professional contractors”). Certain subsidiaries of MDX have contractual management arrangements with its affiliated professional contractors, which are separate legal entities that provide physician services in certain states and Puerto Rico. The terms “MEDNAX” and the “Company” refer collectively to MEDNAX, Inc., its subsidiaries and the affiliated professional contractors.
	The Company has 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 terms of 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. The Company has 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”).
	New Accounting Pronouncements
	In March 2015, the accounting guidance related to the presentation of debt issuance costs was amended to require that such costs be presented in the balance sheet as a direct deduction from the carrying amount of the related debt liability. The new guidance is required to be adopted on a retrospective basis as a change in accounting principle and will become effective for the Company on January 1, 2016 with early adoption permitted. The adoption of this guidance will affect financial statement presentation only, and therefore will not have a material impact on the Company’s Condensed Consolidated Financial Statements.
	In February 2015, the accounting guidance related to consolidation was amended to include changes to both the variable and voting interest models used by companies to evaluate whether an entity should be consolidated. The new guidance will become effective for the Company on January 1, 2016, and early adoption is permitted. The adoption of this guidance is not expected to have an impact on the Company’s Condensed Consolidated Financial Statements.
	In May 2014, the accounting guidance related to revenue recognition was amended to outline a single, comprehensive model for accounting for revenue from contracts with customers. While the new guidance supersedes existing revenue recognition guidance, it closely aligns with current GAAP. The new guidance will become effective for the Company on January 1, 2017, and early adoption is not permitted. The Company is currently evaluating the impact, if any, the adoption of this guidance will have on the Company’s Condensed Consolidated Financial Statements.

Cash_Equivalents_and_Investmen

Cash Equivalents and Investments	3 Months Ended
	Mar. 31, 2015
Investments, Debt and Equity Securities [Abstract]
Cash Equivalents and Investments	2	Cash Equivalents and Investments:
	As of March 31, 2015 and December 31, 2014, the Company’s cash equivalents consisted entirely of money market funds with a fair value of $5.3 million and $5.1 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 March 31, 2015 and December 31, 2014 are summarized as follows (in thousands):
			March 31, 2015				December 31, 2014
			Short-Term		Long-Term		Short-Term		Long-Term
	Municipal debt securities		$	6,273	$	35,316	$	5,539	$	35,827
	Federal home loan securities			—		27,261		—		27,030
	Certificates of deposit			496		1,225		496		1,225
			$	6,769	$	63,802	$	6,035	$	64,082
	Contractual maturities of long-term investments are summarized as follows (in thousands):
			March 31, 2015		December 31, 2014
	Due after one year through five years		$	59,552	$	54,959
	Due after five years through seven years			4,250		9,123
			$	63,802	$	64,082

Fair_Value_Measurements

Fair Value Measurements	3 Months Ended
	Mar. 31, 2015
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 March 31, 2015 and December 31, 2014, the Company’s money market funds had a carrying amount of $5.3 million and $5.1 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 March 31, 2015 and December 31, 2014, the Company’s cash surrender value of life insurance had a carrying amount of $16.0 million.
	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 March 31, 2015 and December 31, 2014, the Company’s contingent consideration liabilities had a fair value of $35.2 million and $35.3 million, respectively. See Note 5 for more information regarding the Company’s contingent consideration liabilities.
	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, long-term debt and capital lease obligations approximate fair value. If the Company’s line of credit and long-term debt were measured at fair value, they would be categorized as Level 2 in the fair value hierarchy.

Accounts_Receivable

Accounts Receivable	3 Months Ended
	Mar. 31, 2015
Receivables [Abstract]
Accounts Receivable	4	Accounts Receivable:
	Accounts receivable, net consists of the following (in thousands):
			March 31, 2015			December 31, 2014
	Gross accounts receivable		$	1,251,666		$	1,200,958
	Allowance for contractual adjustments and uncollectibles			(890,792	)		(848,767	)
			$	360,874		$	352,191

Business_Acquisitions

Business Acquisitions	3 Months Ended
	Mar. 31, 2015
Business Combinations [Abstract]
Business Acquisitions	5	Business Acquisitions:
	During the three months ended March 31, 2015, the Company completed the acquisition of three physician group practices for total cash consideration of $37.1 million. In connection with these acquisitions, the Company recorded goodwill of $33.6 million, other intangible assets consisting primarily of physician and hospital agreements of $4.8 million and other liabilities of $1.3 million. These acquisitions expanded the Company’s national network of physician practices.
	In addition, during the three months ended March 31, 2015, the Company paid $0.4 million for contingent consideration related to certain prior-period acquisitions, of which all but the accretion recorded during 2015 was accrued as of December 31, 2014. In connection with prior-period acquisitions, the Company also recorded a net increase of $3.9 million to goodwill composed of a decrease in intangible assets of $5.3 million, a decrease of $2.0 million in other long-term liabilities and $0.6 million in additional cash consideration related to a working capital true-up adjustment. These measurement period adjustments did not have a material impact on the Company’s Condensed Consolidated Financial Statements in any period; therefore, the Company has not retrospectively adjusted such statements. The Company expects that $10.8 million of the goodwill recorded during the three months ended March 31, 2015 will be deductible for tax purposes.
	During the three months ended March 31, 2014, the Company paid $3.4 million for contingent consideration related to certain prior-period acquisitions, of which all but the accretion recorded during 2014 was accrued as of December 31, 2013.
	The results of operations of the practices acquired during the three months ended March 31, 2015 and 2014 have been included in the Company’s Condensed Consolidated Financial Statements from the dates of acquisition. The following unaudited pro forma information combines the consolidated results of operations of the Company on a GAAP basis and the acquisitions completed during 2015 and 2014, including adjustments for pro forma amortization and interest expense, as if the transactions had occurred on January 1, 2014 and January 1, 2013, respectively (in thousands, except per share data):
			Three Months Ended
			March 31,
			2015		2014
	Net revenue		$	643,718	$	632,774
	Net income		$	69,371	$	68,446
	Net income per common share (1):
	Basic		$	0.74	$	0.69
	Diluted		$	0.73	$	0.68
	Weighted average common shares (1):
	Basic			94,231		99,076
	Diluted			95,325		100,696
	(1)	The comparison of net income per common share is affected by the changes in the number of weighted average shares outstanding in each period.
	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 indicated, nor are they indicative of the results of future combined operations.

Accounts_Payable_and_Accrued_E

Accounts Payable and Accrued Expenses	3 Months Ended
	Mar. 31, 2015
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):
			March 31, 2015		December 31, 2014
	Accounts payable		$	22,826	$	32,783
	Accrued salaries and bonuses			80,541		231,390
	Accrued payroll taxes and benefits			40,379		49,858
	Accrued professional liabilities			20,432		19,718
	Accrued contingent consideration			18,264		17,010
	Other accrued expenses			29,848		29,899
			$	212,290	$	380,658
	The net decrease in accrued salaries and bonuses of $150.8 million, from December 31, 2014 to March 31, 2015, 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 three months ended March 31, 2015. 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	3 Months Ended
	Mar. 31, 2015
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 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 and deferred stock and stock options 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 months ended March 31, 2015 and 2014 is as follows (in thousands):
			Three Months Ended
			March 31,
			2015		2014
	Weighted average number of common shares outstanding			94,231		99,076
	Weighted average number of dilutive common share equivalents			1,094		1,620
	Weighted average number of common and common equivalent shares outstanding			95,325		100,696
	Antidilutive securities not included in the diluted net income per common share calculation			—		1

Stock_Incentive_Plans_and_Stoc

Stock Incentive Plans and Stock Purchase Plan	3 Months Ended
	Mar. 31, 2015
Disclosure of Compensation Related Costs, Share-based 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 generally vest upon the satisfaction of specified performance-based conditions or service based conditions. The Company recognizes compensation expense related to its restricted stock and deferred stock awards ratably over the corresponding vesting periods. At March 31, 2015, the Company had approximately 6.3 million shares available for future grants and awards under its Amended and Restated 2008 Incentive Plan.
	Under the Company’s 1996 Non-Qualified Employee Stock Purchase Plan, as amended (the “Stock Purchase 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 three months ended March 31, 2015, 51,138 shares were issued under the Stock Purchase Plan. At March 31, 2015, the Company had approximately 283,400 shares reserved for issuance under the Stock Purchase Plan.
	During the three months ended March 31, 2015 and 2014, the Company recognized approximately $7.8 million and $8.1 million, respectively, of stock-based compensation expense. The net excess tax benefit recognized in additional paid-in capital related primarily to stock options and restricted stock for the three months ended March 31, 2015 was approximately $1.1 million.

Common_Stock_Repurchase_Progra

Common Stock Repurchase Programs	3 Months Ended
	Mar. 31, 2015
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 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 share repurchases were made under this program during the three months ended March 31, 2015. 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.
	In October 2014, the Company announced that its Board of Directors had authorized the repurchase of up to $600.0 million of shares of the Company’s common stock in addition to its existing share repurchase program. This program was completed during the three months ended March 31, 2015, pending final settlement of the accelerated share repurchase program discussed below and an accelerated share repurchase program entered into in December 2014. During the three months ended March 31, 2015, the Company repurchased approximately 2.7 million shares of its common stock for approximately $233.6 million, inclusive of the aggregate value of common stock held back pending final settlement of the March 2015 accelerated share repurchase program.
	On March 12, 2015, the Company entered into a second uncollared accelerated share repurchase (“ASR”) agreement with an investment bank. Under the ASR agreement, the Company agreed to purchase $200.0 million of its common stock in total. On March 16, 2015, the Company paid a total of $200.0 million to an investment bank, which in turn delivered to the Company approximately 2.2 million shares of the Company’s common stock in total based on the market price of a share of Company common stock on March 12, 2015. The payment was recorded as a reduction to the respective components of shareholders’ equity. The final number of shares of common stock that the Company may receive, or may be required to remit, upon settlement under the ASR agreement will be based upon the average daily volume weighted-average price of the Company’s common stock during the term of the ASR agreement, less a negotiated discount. Final settlement of the ASR agreement is expected to occur within nine months of commencement of the program, and may occur earlier at the option of the investment bank. The terms of the ASR agreement are subject to adjustment if the Company were to enter into or announce certain types of transactions that may affect the Company’s common stock. If the Company is obligated to make an adjustment payment to the investment bank under the ASR agreement, the Company may elect to satisfy such obligation in cash or in shares of the Company’s common stock. The ASR agreement was funded by borrowings under the Company’s line of credit.

Commitments_and_Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2015
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 March 31, 2015 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 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 and cash flows.

Basis_of_Presentation_and_New_1

Basis of Presentation and New Accounting Pronouncements (Policies)	3 Months Ended
	Mar. 31, 2015
Accounting Policies [Abstract]
New Accounting Pronouncements	New Accounting Pronouncements
	In March 2015, the accounting guidance related to the presentation of debt issuance costs was amended to require that such costs be presented in the balance sheet as a direct deduction from the carrying amount of the related debt liability. The new guidance is required to be adopted on a retrospective basis as a change in accounting principle and will become effective for the Company on January 1, 2016 with early adoption permitted. The adoption of this guidance will affect financial statement presentation only, and therefore will not have a material impact on the Company’s Condensed Consolidated Financial Statements.
	In February 2015, the accounting guidance related to consolidation was amended to include changes to both the variable and voting interest models used by companies to evaluate whether an entity should be consolidated. The new guidance will become effective for the Company on January 1, 2016, and early adoption is permitted. The adoption of this guidance is not expected to have an impact on the Company’s Condensed Consolidated Financial Statements.
	In May 2014, the accounting guidance related to revenue recognition was amended to outline a single, comprehensive model for accounting for revenue from contracts with customers. While the new guidance supersedes existing revenue recognition guidance, it closely aligns with current GAAP. The new guidance will become effective for the Company on January 1, 2017, and early adoption is not permitted. The Company is currently evaluating the impact, if any, the adoption of this guidance will have on the Company’s Condensed Consolidated Financial Statements.

Cash_Equivalents_and_Investmen1

Cash Equivalents and Investments (Tables)	3 Months Ended
	Mar. 31, 2015
Investments, Debt and Equity Securities [Abstract]
Schedule of Investments	Investments held at March 31, 2015 and December 31, 2014 are summarized as follows (in thousands):
		March 31, 2015				December 31, 2014
		Short-Term		Long-Term		Short-Term		Long-Term
	Municipal debt securities	$	6,273	$	35,316	$	5,539	$	35,827
	Federal home loan securities		—		27,261		—		27,030
	Certificates of deposit		496		1,225		496		1,225
		$	6,769	$	63,802	$	6,035	$	64,082
Schedule of Contractual Maturities of Long-Term Investments	Contractual maturities of long-term investments are summarized as follows (in thousands):
		March 31, 2015		December 31, 2014
	Due after one year through five years	$	59,552	$	54,959
	Due after five years through seven years		4,250		9,123
		$	63,802	$	64,082

Accounts_Receivable_Tables

Accounts Receivable (Tables)	3 Months Ended
	Mar. 31, 2015
Receivables [Abstract]
Schedule of Accounts Receivable, Net	Accounts receivable, net consists of the following (in thousands):
		March 31, 2015			December 31, 2014
	Gross accounts receivable	$	1,251,666		$	1,200,958
	Allowance for contractual adjustments and uncollectibles		(890,792	)		(848,767	)
		$	360,874		$	352,191

Business_Acquisitions_Tables

Business Acquisitions (Tables)	3 Months Ended
	Mar. 31, 2015
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 2015 and 2014, including adjustments for pro forma amortization and interest expense, as if the transactions had occurred on January 1, 2014 and January 1, 2013, respectively (in thousands, except per share data):
			Three Months Ended
			March 31,
			2015		2014
	Net revenue		$	643,718	$	632,774
	Net income		$	69,371	$	68,446
	Net income per common share (1):
	Basic		$	0.74	$	0.69
	Diluted		$	0.73	$	0.68
	Weighted average common shares (1):
	Basic			94,231		99,076
	Diluted			95,325		100,696
	(1)	The comparison of net income per common share is affected by the changes in the number of weighted average shares outstanding in each period.

Accounts_Payable_and_Accrued_E1

Accounts Payable and Accrued Expenses (Tables)	3 Months Ended
	Mar. 31, 2015
Payables and Accruals [Abstract]
Schedule of Accounts Payable and Accrued Expenses	Accounts payable and accrued expenses consist of the following (in thousands):
		March 31, 2015		December 31, 2014
	Accounts payable	$	22,826	$	32,783
	Accrued salaries and bonuses		80,541		231,390
	Accrued payroll taxes and benefits		40,379		49,858
	Accrued professional liabilities		20,432		19,718
	Accrued contingent consideration		18,264		17,010
	Other accrued expenses		29,848		29,899
		$	212,290	$	380,658

Common_and_Common_Equivalent_S1

Common and Common Equivalent Shares (Tables)	3 Months Ended
	Mar. 31, 2015
Earnings Per Share [Abstract]
Schedule of Calculation of Shares Used in Basic and Diluted Net Income Per Common Share	The calculation of shares used in the basic and diluted net income per common share calculation for the three months ended March 31, 2015 and 2014 is as follows (in thousands):
		Three Months Ended
		March 31,
		2015		2014
	Weighted average number of common shares outstanding		94,231		99,076
	Weighted average number of dilutive common share equivalents		1,094		1,620
	Weighted average number of common and common equivalent shares outstanding		95,325		100,696
	Antidilutive securities not included in the diluted net income per common share calculation		—		1

Basis_of_Presentation_and_New_2

Basis of Presentation and New Accounting Pronouncements - Additional Information (Detail)	Mar. 31, 2015
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Equity method ownership percentage in joint venture	37.50%
Direct ownership percentage in joint venture	75.00%

Cash_Equivalents_and_Investmen2

Cash Equivalents and Investments - Additional Information (Detail) (USD $)	3 Months Ended
In Millions, unless otherwise specified	Mar. 31, 2015	Dec. 31, 2014
Cash and Cash Equivalents [Line Items]
Cash equivalents consisted entirely of money market funds with a fair value	5.3	$5.10
Maximum [Member]
Cash and Cash Equivalents [Line Items]
Long-term investments maturity period, in years	7 years
Short-Term investments maturity period, in years	1 year
Minimum [Member]
Cash and Cash Equivalents [Line Items]
Long-term investments maturity period, in years	1 year

Cash_Equivalents_and_Investmen3

Cash Equivalents and Investments - Schedule of Investments (Detail) (USD $)	Mar. 31, 2015	Dec. 31, 2014
In Thousands, unless otherwise specified
Schedule of Held-to-maturity Securities [Line Items]
Short-Term	$6,769	$6,035
Long-Term	63,802	64,082
Municipal Debt Securities [Member]
Schedule of Held-to-maturity Securities [Line Items]
Short-Term	6,273	5,539
Long-Term	35,316	35,827
Federal Home Loan Securities [Member]
Schedule of Held-to-maturity Securities [Line Items]
Long-Term	27,261	27,030
Certificates of Deposit [Member]
Schedule of Held-to-maturity Securities [Line Items]
Short-Term	496	496
Long-Term	$1,225	$1,225

Cash_Equivalents_and_Investmen4

Cash Equivalents and Investments - Schedule of Contractual Maturities of Long-Term Investments (Detail) (USD $)	Mar. 31, 2015	Dec. 31, 2014
In Thousands, unless otherwise specified
Investments, Debt and Equity Securities [Abstract]
Due after one year through five years	$59,552	$54,959
Due after five years through seven years	4,250	9,123
Total	$63,802	$64,082

Fair_Value_Measurements_Additi

Fair Value Measurements - Additional Information (Detail) (USD $)	Mar. 31, 2015	Dec. 31, 2014
In Millions, unless otherwise specified
Fair Value Disclosures [Abstract]
Money market funds carrying amount	$5.30	$5.10
Carrying amount of cash surrender value of life insurance	16	16
Contingent consideration liabilities related to acquisitions	$35.20	$35.30

Accounts_Receivable_Schedule_o

Accounts Receivable - Schedule of Accounts Receivable, Net (Detail) (USD $)	Mar. 31, 2015	Dec. 31, 2014
In Thousands, unless otherwise specified
Receivables [Abstract]
Gross accounts receivable	$1,251,666	$1,200,958
Allowance for contractual adjustments and uncollectibles	-890,792	-848,767
Accounts receivable, net	$360,874	$352,191

Business_Acquisitions_Addition

Business Acquisitions - Additional Information (Detail) (USD $)	3 Months Ended
	Mar. 31, 2015	Mar. 31, 2014	Dec. 31, 2014
	Company
Business Acquisition [Line Items]
Number of physician group practices acquired	3
Business acquisition, total consideration	$37,100,000
Goodwill	2,813,673,000		2,776,188,000
Other intangible assets	4,800,000
Other liabilities	1,300,000
Contingent consideration payments related to prior-period acquisitions	400,000	3,400,000
Goodwill deductible for tax purposes	10,800,000
Three Physician Group Practices Acquisition [Member]
Business Acquisition [Line Items]
Goodwill	33,600,000
Prior-Period Acquisitions [Member]
Business Acquisition [Line Items]
Goodwill	3,900,000
Other intangible assets	5,300,000
Other liabilities	2,000,000
Additional cash consideration related to a working capital	$600,000

Business_Acquisitions_Schedule

Business Acquisitions - Schedule of Pro Forma Information Combines Consolidated Results of Company and Business Acquisitions (Detail) (USD $)	3 Months Ended
In Thousands, except Per Share data, unless otherwise specified	Mar. 31, 2015	Mar. 31, 2014
Business Combinations [Abstract]
Net revenue	$643,718	$632,774
Net income	$69,371	$68,446
Net income per common share, Basic	$0.74	$0.69
Net income per common share, Diluted	$0.73	$0.68
Weighted average common shares, Basic	94,231	99,076
Weighted average common shares, Diluted	95,325	100,696

Accounts_Payable_and_Accrued_E2

Accounts Payable and Accrued Expenses - Schedule of Accounts Payable and Accrued Expenses (Detail) (USD $)	Mar. 31, 2015	Dec. 31, 2014
In Thousands, unless otherwise specified
Payables and Accruals [Abstract]
Accounts payable	$22,826	$32,783
Accrued salaries and bonuses	80,541	231,390
Accrued payroll taxes and benefits	40,379	49,858
Accrued professional liabilities	20,432	19,718
Accrued contingent consideration	18,264	17,010
Other accrued expenses	29,848	29,899
Accounts payable and accrued expenses, total	$212,290	$380,658

Accounts_Payable_and_Accrued_E3

Accounts Payable and Accrued Expenses - Additional Information (Detail) (USD $)	3 Months Ended
In Millions, unless otherwise specified	Mar. 31, 2015
Payables and Accruals [Abstract]
Net decrease in accrued salaries and bonuses	$150.80

Common_and_Common_Equivalent_S2

Common and Common Equivalent Shares - Schedule of Calculation of Shares Used in Basic and Diluted Net Income Per Common Share (Detail)	3 Months Ended
In Thousands, unless otherwise specified	Mar. 31, 2015	Mar. 31, 2014
Earnings Per Share [Abstract]
Weighted average number of common shares outstanding	94,231	99,076
Weighted average number of dilutive common share equivalents	1,094	1,620
Weighted average number of common and common equivalent shares outstanding	95,325	100,696
Antidilutive securities not included in the diluted net income per common share calculation		1

Stock_Incentive_Plans_and_Stoc1

Stock Incentive Plans and Stock Purchase Plan - Additional Information (Detail) (USD $)	3 Months Ended
In Millions, except Share data, unless otherwise specified	Mar. 31, 2015	Mar. 31, 2014
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
Stock-based compensation expense	$7.80	$8.10
Excess tax benefit related to employee stock incentive plans	$1.10
Stock Option [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of years over which stock awards vest or become exercisable	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 stock awards vest or become exercisable	3 years
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	283,400
Shares issued under Stock Purchase Plan	51,138

Common_Stock_Repurchase_Progra1

Common Stock Repurchase Programs - Additional Information (Detail) (USD $)	3 Months Ended		0 Months Ended
Share data in Millions, unless otherwise specified	Mar. 31, 2015	Mar. 31, 2014	Mar. 16, 2015	Mar. 12, 2015	Oct. 31, 2014
Common Stock [Line Items]
Repurchases of common stock	$233,601,000	$116,989,000
Common stock authorized for repurchase					600,000,000
Common stock shares issued	2.7
Common stock paid	233,600,000
Common stock purchase				200,000,000
Accelerated Share Repurchase (ASR) Agreements [Member]
Common Stock [Line Items]
Common stock shares issued			2.2
Common stock paid			200,000,000
Accelerated Share Repurchase Programs and Open Market Purchases [Member]
Common Stock [Line Items]
Repurchases of common stock	$0