Pediatrix Medical (MD) 10-Q 27 Oct 16 2016 Q3 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2016	Oct. 21, 2016
Document And Entity Information [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Sep. 30, 2016
Document Fiscal Year Focus	2,016
Document Fiscal Period Focus	Q3
Trading Symbol	MD
Entity Registrant Name	MEDNAX, INC.
Entity Central Index Key	893,949
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Common Stock, Shares Outstanding		93,637,203

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets (Unaudited) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Current assets:
Cash and cash equivalents	$ 52,805	$ 51,572
Short-term investments	10,489	8,853
Accounts receivable, net	486,957	444,737
Prepaid expenses	13,248	9,639
Other current assets	11,958	12,968
Total current assets	575,457	527,769
Investments	79,146	63,288
Property and equipment, net	98,495	83,634
Goodwill	3,828,807	3,366,150
Intangible assets, net	671,742	424,219
Other assets	90,217	82,154
Total assets	5,343,864	4,547,214
Current liabilities:
Accounts payable and accrued expenses	363,291	395,807
Current portion of long-term debt and capital lease obligations	19,621	11,883
Income taxes payable	30,121	21,081
Total current liabilities	413,033	428,771
Line of credit	864,000	343,500
Long-term debt and capital lease obligations	905,181	919,320
Long-term professional liabilities	179,985	176,532
Deferred income taxes	267,833	188,956
Other liabilities	46,495	52,289
Total liabilities	2,676,527	2,109,368
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; 93,572 and 93,739 shares issued and outstanding, respectively	936	937
Additional paid-in capital	958,953	926,235
Retained earnings	1,707,448	1,510,356
Total MEDNAX, Inc. shareholders' equity	2,667,337	2,437,528
Noncontrolling interests		318
Total equity	2,667,337	2,437,846
Total liabilities and equity	$ 5,343,864	$ 4,547,214

Condensed Consolidated Balance3

Condensed Consolidated Balance Sheets (Unaudited) (Parenthetical) - $ / shares	Sep. 30, 2016	Dec. 31, 2015
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	93,572,000	93,739,000
Common stock, shares outstanding	93,572,000	93,739,000

Condensed Consolidated Statemen

Condensed Consolidated Statements of Income (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Income Statement [Abstract]
Net revenue	$ 828,006	$ 722,273	$ 2,352,389	$ 2,038,256
Operating expenses:
Practice salaries and benefits	521,832	450,033	1,498,268	1,292,431
Practice supplies and other operating expenses	31,641	24,007	85,679	72,316
General and administrative expenses	93,457	80,185	275,523	220,522
Depreciation and amortization	24,185	16,918	64,010	46,079
Total operating expenses	671,115	571,143	1,923,480	1,631,348
Income from operations	156,891	151,130	428,909	406,908
Investment income and other income	221	567	1,249	1,093
Interest expense	(17,215)	(6,201)	(46,736)	(14,617)
Equity in earnings of unconsolidated affiliate	796	784	2,379	2,350
Total non-operating expenses	(16,198)	(4,850)	(43,108)	(11,174)
Income before income taxes	140,693	146,280	385,801	395,734
Income tax provision	44,272	55,640	139,284	152,457
Net income	96,421	90,640	246,517	243,277
Net loss attributable to noncontrolling interests	88	141	318	341
Net income attributable to MEDNAX, Inc.	$ 96,509	$ 90,781	$ 246,835	$ 243,618
Net income attributable to MEDNAX, Inc.:
Earnings per share, Basic	$ 1.04	$ 0.98	$ 2.67	$ 2.61
Earnings per share, Diluted	$ 1.04	$ 0.97	$ 2.65	$ 2.59
Weighted average common shares:
Basic	92,604	92,949	92,336	93,195
Diluted	93,146	93,646	93,045	94,123

Condensed Consolidated Stateme5

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015
Cash flows from operating activities:
Net income	$ 246,517	$ 243,277
Adjustments to reconcile net income to net cash provided from operating activities:
Depreciation and amortization	64,010	46,079
Amortization of premiums, discounts and issuance costs	4,077	1,236
Net change in fair value of contingent consideration liabilities	592	(16)
Stock-based compensation expense	25,889	23,960
Equity in earnings of unconsolidated affiliate	(2,379)	(2,350)
Distribution of earnings from unconsolidated affiliate	2,625	2,062
Deferred income taxes	16,276	2,870
Changes in assets and liabilities:
Accounts receivable	(24,812)	(17,623)
Prepaid expenses and other current assets	(1,121)	(4,480)
Other long-term assets	10,279	5,744
Accounts payable and accrued expenses	(32,628)	(52,734)
Income taxes payable	8,930	15,954
Payments of contingent consideration liabilities	(735)	(1,045)
Long-term professional liabilities	3,453	2,814
Other liabilities	(8,143)	(1,183)
Net cash provided from operating activities	312,830	264,565
Cash flows from investing activities:
Acquisition payments, net of cash acquired	(724,861)	(806,304)
Purchases of investments	(50,868)	(20,382)
Proceeds from maturities of investments	32,240	23,208
Purchases of property and equipment	(28,420)	(19,908)
Net cash used in investing activities	(771,909)	(823,386)
Cash flows from financing activities:
Borrowings on credit agreement	1,661,000	1,846,500
Payments on credit agreement	(1,148,000)	(1,056,500)
Payments for credit facility amendment		(1,227)
Payments of contingent consideration liabilities	(8,282)	(9,040)
Payments on capital lease obligations	(1,601)	(1,063)
Excess tax benefit from vesting of restricted stock and exercises from stock options	3,424	11,467
Proceeds from issuance of common stock	15,599	16,722
Repurchases of common stock	(61,828)	(235,051)
Net cash provided from financing activities	460,312	571,808
Net increase in cash and cash equivalents	1,233	12,987
Cash and cash equivalents at beginning of period	51,572	47,928
Cash and cash equivalents at end of period	$ 52,805	$ 60,915

Basis of Presentation and New A

Basis of Presentation and New Accounting Pronouncements	9 Months Ended
	Sep. 30, 2016
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”). Recently Adopted Accounting Pronouncements In September 2015, the accounting guidance related to business combinations was amended to require that adjustments to provisional amounts that are identified during the measurement period be recognized in the reporting period in which the adjustment amounts are determined rather than being retrospectively recognized as of the acquisition date. Such amounts will be required to either be presented separately on the face of the income statement or within a footnote disclosure stating what the impacts on prior period financial statements would have been had such amounts been recognized as of the acquisition date. This guidance became effective for the Company on January 1, 2016. The adoption of this guidance did not have an impact on the Company’s 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. This guidance became effective for the Company on January 1, 2016. The adoption of this guidance did not have an impact on the Company’s Consolidated Financial Statements. New Accounting Pronouncements In August 2016, the accounting guidance related to the statement of cash flows was amended with the intent of reducing diversity in practice as to the classification of certain transactions in the statement of cash flows. This guidance will become effective for the Company on January 1, 2018, with early adoption permitted. The Company does not believe the adoption of this guidance will have a material impact on its Consolidated Financial Statements. In March 2016, the accounting guidance related to various aspects of share-based payment transactions was amended, including income tax consequences, classification of awards as either equity or liabilities, and classification on the statement of cash flows. Under the new guidance, income tax benefits and deficiencies are to be recognized as income tax expense or benefit in the income statement and the tax effects of exercised or vested awards should be treated as discrete items in the reporting period in which they occur. An entity should also recognize excess tax benefits regardless of whether the benefit reduces taxes payable in the current period. Excess tax benefits should be classified along with other income tax cash flows as an operating activity. With regard to forfeitures, the entity may make an entity-wide accounting policy election to either estimate the number of awards that are expected to vest or account for forfeitures when they occur. This guidance will become effective for the Company on January 1, 2017, with early adoption permitted. The Company expects that the adoption of this guidance will have an impact on its Consolidated Financial Statements, however, the impact will be dependent upon future prices of the Company’s common stock and stock-based compensation exercise and vesting activity and therefore cannot be determined. In February 2016, accounting guidance related to leases was issued that will require an entity to recognize leased assets and the rights and obligations created by those leased assets on the balance sheet and to disclose key information about the entity’s leasing arrangements. This guidance will become effective for the Company on January 1, 2019, with early adoption permitted. The Company is currently evaluating the impact that the adoption of this guidance will have on its Consolidated Financial Statements and its evaluation is expected to continue into 2017. 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. The new guidance will become effective for the Company on January 1, 2018, with early adoption permitted on January 1, 2017. The Company does not believe the adoption of this guidance will have a material impact on its Consolidated Financial Statements and expects to complete its evaluation by December 31, 2016.

Cash Equivalents and Investment

Cash Equivalents and Investments	9 Months Ended
	Sep. 30, 2016
Investments, Debt and Equity Securities [Abstract]
Cash Equivalents and Investments	2. Cash Equivalents and Investments: As of September 30, 2016 and December 31, 2015, the Company’s cash equivalents consisted entirely of money market funds totaling $8.1 million and $13.9 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 September 30, 2016 and December 31, 2015 are summarized as follows (in thousands): September 30, 2016 December 31, 2015 Short-Term Long-Term Short-Term Long-Term Municipal debt securities $ 9,999 $ 47,948 $ 8,608 $ 34,858 Federal home loan securities — 26,748 — 26,715 Certificates of deposit 490 4,450 245 1,715 $ 10,489 $ 79,146 $ 8,853 $ 63,288 Contractual maturities of long-term investments are summarized as follows (in thousands): September 30, December 31, Due after one year through five years $ 70,867 $ 60,383 Due after five years through seven years 8,279 2,905 $ 79,146 $ 63,288

Fair Value Measurements

Fair Value Measurements	9 Months Ended
	Sep. 30, 2016
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 September 30, 2016 and December 31, 2015, the Company’s money market funds had a carrying amount of $8.1 million and $13.9 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 September 30, 2016 and December 31, 2015, the Company’s cash surrender value of life insurance had a carrying amount of $15.5 million and $14.5 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 September 30, 2016 and December 31, 2015, the Company’s contingent consideration liabilities had a fair value of $19.9 million and $24.9 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 investments, 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	9 Months Ended
	Sep. 30, 2016
Receivables [Abstract]
Accounts Receivable	4. Accounts Receivable: Accounts receivable, net consists of the following (in thousands): September 30, December 31, Gross accounts receivable $ 1,659,304 $ 1,574,038 Allowance for contractual adjustments and uncollectibles (1,172,347 ) (1,129,301 ) $ 486,957 $ 444,737

Business Acquisitions

Business Acquisitions	9 Months Ended
	Sep. 30, 2016
Business Combinations [Abstract]
Business Acquisitions	5. Business Acquisitions: During the nine months ended September 30, 2016, the Company completed the acquisition of 12 physician group practices, including seven anesthesiology practices, two other pediatric subspecialty practices, one neonatology practice, one maternal-fetal medicine practice and one pediatric cardiology practice. In addition, the Company acquired a third-party receivables company and a patient engagement software company. The total consideration for the 14 acquisitions was $722.2 million, net of $15.0 million of cash acquired. Approximately $718.7 million was paid in cash, and $3.5 million was recorded as a contingent consideration liability. The 12 physician practice acquisitions expand the Company’s national network of physician practices. The Company expects to improve the results of these physician practices through improved managed care contracting, improved collections, identification of growth initiatives, as well as, operating and cost savings based on the significant infrastructure it has developed. The acquisitions of the third-party receivables company and patient engagement software company were additions to the Company’s existing revenue cycle management services company and are expected to further enhance the Company’s service offerings for its hospital and health system partners. The Company’s preliminary allocation of purchase price for the 14 acquisitions is as follows (in thousands): Third-Party Other Total Current assets $ 18,689 $ 200 $ 18,889 Property and equipment 5,807 83 5,890 Other noncurrent assets 115 643 758 Goodwill 201,796 271,837 473,633 Other intangible assets 221,870 68,724 290,594 Current liabilities (5,863 ) (333 ) (6,196 ) Deferred income tax liabilities – long-term (41,934 ) (18,602 ) (60,536 ) Other long-term liabilities (829 ) — (829 ) $ 399,651 $ 322,552 $ 722,203 Other intangible assets consist primarily of customer relationships, technology, physician and hospital agreements and trade names. The Company recorded provisional estimates for certain intangible assets acquired during the three months ended September 30, 2016, and one of the acquisitions completed during the three months ended September 30, 2016 is subject to a working capital adjustment. The final valuation and working capital adjustment will be completed within the measurement period, and management does not believe the additional adjustments will be material. The Company expects that $151.1 million of the goodwill recorded during the nine months ended September 30, 2016 will be deductible for tax purposes. The contingent consideration of $3.5 million recorded during the nine months ended September 30, 2016 is related to an agreement to pay an additional cash amount based on the achievement of certain performance measures for up to five years after the acquisition date. The accrued contingent consideration was recorded as a liability at acquisition-date fair value using the income approach with assumed discount rates ranging from 4.5% to 5.3% over the applicable terms and an assumed payment probability of 100% over the applicable years. The range of the undiscounted amount the Company could pay under the contingent consideration agreement is between $0 and $4.1 million. In addition, during the nine months ended September 30, 2016, the Company paid $9.0 million for contingent consideration related to certain prior-period acquisitions, of which all but the accretion recorded during 2016 was accrued as of December 31, 2015. In connection with certain prior-period acquisitions, the Company also made additional cash payments of $6.2 million, recorded an increase in deferred tax assets of $19.9 million, a decrease in current assets of $0.2 million, an increase in deferred tax liabilities of $2.5 million and a net decrease of $11.0 million in goodwill for measurement-period adjustments resulting from the finalization of certain income tax acquisition accounting. The results of operations of the acquisitions completed during the nine months ended September 30, 2016 and 2015 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 2016 and 2015, including adjustments for pro forma amortization and interest expense, as if the transactions had occurred on January 1, 2015 and January 1, 2014, respectively (in thousands, except per share data): Nine Months Ended September 30, 2016 2015 Pro forma net revenue $ 2,492,022 $ 2,442,735 Pro forma net income (1) $ 251,873 $ 257,331 Pro forma net income per common share (2) Basic $ 2.73 $ 2.76 Diluted $ 2.71 $ 2.73 Weighted average common shares (2) Basic 92,336 93,195 Diluted 93,045 94,123 (1) The effective tax rate used to calculate pro forma net income for the nine months ended September 30, 2016 of 38.8% excludes the income tax benefit related to the settlement of a tax matter. (2) 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 Ex

Accounts Payable and Accrued Expenses	9 Months Ended
	Sep. 30, 2016
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): September 30, December 31, Accounts payable $ 23,346 $ 21,969 Accrued salaries and bonuses 184,450 233,499 Accrued payroll taxes and benefits 64,938 58,979 Accrued professional liabilities 26,988 25,995 Accrued contingent consideration 7,086 13,565 Accrued uncertain tax positions — 7,000 Accrued interest 14,884 2,655 Other accrued expenses 41,599 32,145 $ 363,291 $ 395,807 The net decrease in accrued salaries and bonuses of $49.0 million, from December 31, 2015 to September 30, 2016, 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 nine months ended September 30, 2016. A majority of the Company’s payments for performance-based incentive compensation is paid annually during the first quarter.

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2016
Income Tax Disclosure [Abstract]
Income Taxes	7. Income Taxes: During the three months ended September 30, 2016, the Company settled a certain tax matter with a taxing authority. In connection with this settlement, the Company’s liability for uncertain tax positions decreased by $17.6 million, of which $10.6 million favorably impacted the Company’s effective income tax rate. As of September 30, 2016, the Company’s liability for uncertain tax positions, including accrued interest and penalties, was $11.4 million.

Common and Common Equivalent Sh

Common and Common Equivalent Shares	9 Months Ended
	Sep. 30, 2016
Earnings Per Share [Abstract]
Common and Common Equivalent Shares	8. Common and Common Equivalent Shares: Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the period. Diluted net income per common share is calculated by dividing net income by the weighted average number of common and potential common shares outstanding during the period. Potential common shares consist of outstanding restricted and deferred stock and stock options and is 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 nine months ended September 30, 2016 and 2015 is as follows (in thousands): Three Months September 30, Nine Months Ended September 30, 2016 2015 2016 2015 Weighted average number of common shares outstanding 92,604 92,949 92,336 93,195 Weighted average number of dilutive common share equivalents 542 697 709 928 Weighted average number of common and common equivalent shares outstanding 93,146 93,646 93,045 94,123 Antidilutive securities not included in the diluted net income per common share calculation — — 2 —

Stock Incentive Plans and Stock

Stock Incentive Plans and Stock Purchase Plans	9 Months Ended
	Sep. 30, 2016
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock Incentive Plans and Stock Purchase Plans	9. Stock Incentive Plans and Stock Purchase Plans: 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. The Company recognizes compensation expense related to its restricted stock awards ratably over the corresponding vesting periods. During the nine months ended September 30, 2016, the Company granted 501,325 shares of restricted stock to its employees and non-employee directors under the Amended and Restated 2008 Incentive Plan. At September 30, 2016, the Company had approximately 4.5 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 “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, beginning upon the SPP’s effective date of January 1, 2016. Each of the ESPP and the SPP provide for the issuance of an aggregate of 2.5 million shares of the Company’s common stock less the number of shares of common stock purchased under the other plan. In accordance with the provisions of the accounting guidance for stock-based compensation, the Company recognizes stock-based compensation expense for the discount received by participating employees and non-employee service providers. During the nine months ended September 30, 2016, 226,798 shares were issued under the ESPP and SPP. At September 30, 2016, the Company had approximately 2.4 million shares in aggregate reserved for issuance under the ESPP and SPP. During the three and nine months ended September 30, 2016 and 2015, the Company recognized approximately $8.7 million and $25.9 million, and $8.2 million and $24.0 million, respectively, of stock-based compensation expense. The net excess tax benefit recognized in additional paid-in capital related primarily to restricted stock and stock options for the nine months ended September 30, 2016 was approximately $3.3 million.

Common Stock Repurchase Program

Common Stock Repurchase Program	9 Months Ended
	Sep. 30, 2016
Text Block [Abstract]
Common Stock Repurchase Program	10. Common Stock Repurchase Program: 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. During the nine months ended September 30, 2016, the Company repurchased approximately 0.9 million shares of its common stock for approximately $61.8 million, inclusive of 46,490 shares withheld to satisfy minimum stock withholding obligations of $3.2 million in connection with the vesting of restricted stock during the three months ended June 30, 2016. These stock repurchases completed the repurchases under the program with respect to issuances of shares under the Company’s equity compensation programs during 2016. The Company intends to utilize various methods to effect any future share repurchases, including, among others, open market purchases and accelerated share repurchase programs. The amount and timing of repurchases will depend upon several factors, including general economic and market conditions and trading restrictions.

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2016
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	11. Commitments and Contingencies: The Company expects that audits, inquiries and investigations from government authorities and agencies will occur in the ordinary course of business. Such audits, inquiries and investigations and their ultimate resolutions, individually or in the aggregate, could have a material adverse effect on the Company’s business, financial condition, results of operations, cash flows and the trading price of its common stock. The Company has not included an accrual for these matters as of September 30, 2016 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, results of operations, cash flows and the trading price of its securities. The outcome of such actions and proceedings, however, cannot be predicted with certainty and an unfavorable resolution of one or more of them could have a material adverse effect on the Company’s business, financial condition, results of operations, cash flows and the trading price of its securities. Although the Company currently maintains liability insurance coverage intended to cover professional liability and certain other claims, the Company cannot assure that its insurance coverage will be adequate to cover liabilities arising out of claims asserted against it in the future where the outcomes of such claims are unfavorable. With respect to professional liability risk, the Company generally self-insures a portion of this risk through its wholly owned captive insurance subsidiary. Liabilities in excess of the Company’s insurance coverage, including coverage for professional liability and certain other claims, could have a material adverse effect on the Company’s business, financial condition, results of operations, cash flows and the trading price of its securities.

Basis of Presentation and New17

Basis of Presentation and New Accounting Pronouncements (Policies)	9 Months Ended
	Sep. 30, 2016
Accounting Policies [Abstract]
Recently Adopted Accounting Pronouncements	Recently Adopted Accounting Pronouncements In September 2015, the accounting guidance related to business combinations was amended to require that adjustments to provisional amounts that are identified during the measurement period be recognized in the reporting period in which the adjustment amounts are determined rather than being retrospectively recognized as of the acquisition date. Such amounts will be required to either be presented separately on the face of the income statement or within a footnote disclosure stating what the impacts on prior period financial statements would have been had such amounts been recognized as of the acquisition date. This guidance became effective for the Company on January 1, 2016. The adoption of this guidance did not have an impact on the Company’s 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. This guidance became effective for the Company on January 1, 2016. The adoption of this guidance did not have an impact on the Company’s Consolidated Financial Statements.
New Accounting Pronouncements	New Accounting Pronouncements In August 2016, the accounting guidance related to the statement of cash flows was amended with the intent of reducing diversity in practice as to the classification of certain transactions in the statement of cash flows. This guidance will become effective for the Company on January 1, 2018, with early adoption permitted. The Company does not believe the adoption of this guidance will have a material impact on its Consolidated Financial Statements. In March 2016, the accounting guidance related to various aspects of share-based payment transactions was amended, including income tax consequences, classification of awards as either equity or liabilities, and classification on the statement of cash flows. Under the new guidance, income tax benefits and deficiencies are to be recognized as income tax expense or benefit in the income statement and the tax effects of exercised or vested awards should be treated as discrete items in the reporting period in which they occur. An entity should also recognize excess tax benefits regardless of whether the benefit reduces taxes payable in the current period. Excess tax benefits should be classified along with other income tax cash flows as an operating activity. With regard to forfeitures, the entity may make an entity-wide accounting policy election to either estimate the number of awards that are expected to vest or account for forfeitures when they occur. This guidance will become effective for the Company on January 1, 2017, with early adoption permitted. The Company expects that the adoption of this guidance will have an impact on its Consolidated Financial Statements, however, the impact will be dependent upon future prices of the Company’s common stock and stock-based compensation exercise and vesting activity and therefore cannot be determined. In February 2016, accounting guidance related to leases was issued that will require an entity to recognize leased assets and the rights and obligations created by those leased assets on the balance sheet and to disclose key information about the entity’s leasing arrangements. This guidance will become effective for the Company on January 1, 2019, with early adoption permitted. The Company is currently evaluating the impact that the adoption of this guidance will have on its Consolidated Financial Statements and its evaluation is expected to continue into 2017. 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. The new guidance will become effective for the Company on January 1, 2018, with early adoption permitted on January 1, 2017. The Company does not believe the adoption of this guidance will have a material impact on its Consolidated Financial Statements and expects to complete its evaluation by December 31, 2016.

Cash Equivalents and Investme18

Cash Equivalents and Investments (Tables)	9 Months Ended
	Sep. 30, 2016
Investments, Debt and Equity Securities [Abstract]
Schedule of Investments	Investments held at September 30, 2016 and December 31, 2015 are summarized as follows (in thousands): September 30, 2016 December 31, 2015 Short-Term Long-Term Short-Term Long-Term Municipal debt securities $ 9,999 $ 47,948 $ 8,608 $ 34,858 Federal home loan securities — 26,748 — 26,715 Certificates of deposit 490 4,450 245 1,715 $ 10,489 $ 79,146 $ 8,853 $ 63,288
Schedule of Contractual Maturities of Long-Term Investments	Contractual maturities of long-term investments are summarized as follows (in thousands): September 30, December 31, Due after one year through five years $ 70,867 $ 60,383 Due after five years through seven years 8,279 2,905 $ 79,146 $ 63,288

Accounts Receivable (Tables)

Accounts Receivable (Tables)	9 Months Ended
	Sep. 30, 2016
Receivables [Abstract]
Schedule of Accounts Receivable, Net	Accounts receivable, net consists of the following (in thousands): September 30, December 31, Gross accounts receivable $ 1,659,304 $ 1,574,038 Allowance for contractual adjustments and uncollectibles (1,172,347 ) (1,129,301 ) $ 486,957 $ 444,737

Business Acquisitions (Tables)

Business Acquisitions (Tables)	9 Months Ended
	Sep. 30, 2016
Business Combinations [Abstract]
Summary of Company's Preliminary Allocation of Purchase Price	The Company’s preliminary allocation of purchase price for the 14 acquisitions is as follows (in thousands): Third-Party Other Total Current assets $ 18,689 $ 200 $ 18,889 Property and equipment 5,807 83 5,890 Other noncurrent assets 115 643 758 Goodwill 201,796 271,837 473,633 Other intangible assets 221,870 68,724 290,594 Current liabilities (5,863 ) (333 ) (6,196 ) Deferred income tax liabilities – long-term (41,934 ) (18,602 ) (60,536 ) Other long-term liabilities (829 ) — (829 ) $ 399,651 $ 322,552 $ 722,203
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 2016 and 2015, including adjustments for pro forma amortization and interest expense, as if the transactions had occurred on January 1, 2015 and January 1, 2014, respectively (in thousands, except per share data): Nine Months Ended September 30, 2016 2015 Pro forma net revenue $ 2,492,022 $ 2,442,735 Pro forma net income (1) $ 251,873 $ 257,331 Pro forma net income per common share (2) Basic $ 2.73 $ 2.76 Diluted $ 2.71 $ 2.73 Weighted average common shares (2) Basic 92,336 93,195 Diluted 93,045 94,123 (1) The effective tax rate used to calculate pro forma net income for the nine months ended September 30, 2016 of 38.8% excludes the income tax benefit related to the settlement of a tax matter. (2) 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 21

Accounts Payable and Accrued Expenses (Tables)	9 Months Ended
	Sep. 30, 2016
Payables and Accruals [Abstract]
Schedule of Accounts Payable and Accrued Expenses	Accounts payable and accrued expenses consist of the following (in thousands): September 30, December 31, Accounts payable $ 23,346 $ 21,969 Accrued salaries and bonuses 184,450 233,499 Accrued payroll taxes and benefits 64,938 58,979 Accrued professional liabilities 26,988 25,995 Accrued contingent consideration 7,086 13,565 Accrued uncertain tax positions — 7,000 Accrued interest 14,884 2,655 Other accrued expenses 41,599 32,145 $ 363,291 $ 395,807

Common and Common Equivalent 22

Common and Common Equivalent Shares (Tables)	9 Months Ended
	Sep. 30, 2016
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 nine months ended September 30, 2016 and 2015 is as follows (in thousands): Three Months September 30, Nine Months Ended September 30, 2016 2015 2016 2015 Weighted average number of common shares outstanding 92,604 92,949 92,336 93,195 Weighted average number of dilutive common share equivalents 542 697 709 928 Weighted average number of common and common equivalent shares outstanding 93,146 93,646 93,045 94,123 Antidilutive securities not included in the diluted net income per common share calculation — — 2 —

Basis of Presentation and New23

Basis of Presentation and New Accounting Pronouncements - Additional Information (Detail)	Sep. 30, 2016
Variable Interest Entity, Primary Beneficiary [Member]
Basis Of Presentation [Line Items]
Consolidation method ownership percentage in joint venture	75.00%
Unnamed Corporate Joint Venture [Member]
Basis Of Presentation [Line Items]
Equity method ownership percentage in joint venture	37.50%

Cash Equivalents and Investme24

Cash Equivalents and Investments - Additional Information (Detail) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2016	Dec. 31, 2015
Cash Equivalents And Investments [Line Items]
Cash equivalents	$ 8.1	$ 13.9
Cash Equivalents [Member]
Cash Equivalents And Investments [Line Items]
Cash equivalents	$ 8.1	$ 13.9
Maximum [Member]
Cash Equivalents And Investments [Line Items]
Long-term investments maturity period, in years	7 years
Short-Term investments maturity period, in years	1 year
Minimum [Member]
Cash Equivalents And Investments [Line Items]
Long-term investments maturity period, in years	1 year

Cash Equivalents and Investme25

Cash Equivalents and Investments - Schedule of Investments (Detail) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Schedule of Held-to-maturity Securities [Line Items]
Short-Term	$ 10,489	$ 8,853
Long-Term	79,146	63,288
Municipal Debt Securities [Member]
Schedule of Held-to-maturity Securities [Line Items]
Short-Term	9,999	8,608
Long-Term	47,948	34,858
Federal Home Loan Securities [Member]
Schedule of Held-to-maturity Securities [Line Items]
Long-Term	26,748	26,715
Certificates of Deposit [Member]
Schedule of Held-to-maturity Securities [Line Items]
Short-Term	490	245
Long-Term	$ 4,450	$ 1,715

Cash Equivalents and Investme26

Cash Equivalents and Investments - Schedule of Contractual Maturities of Long-Term Investments (Detail) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Investments, Debt and Equity Securities [Abstract]
Due after one year through five years	$ 70,867	$ 60,383
Due after five years through seven years	8,279	2,905
Total	$ 79,146	$ 63,288

Fair Value Measurements - Addit

Fair Value Measurements - Additional Information (Detail) - USD ($) $ in Millions	Sep. 30, 2016	Dec. 31, 2015
Fair Value Disclosures [Abstract]
Money market funds carrying amount	$ 8.1	$ 13.9
Carrying amount of cash surrender value of life insurance	15.5	14.5
Contingent consideration liabilities related to acquisitions	$ 19.9	$ 24.9

Accounts Receivable - Schedule

Accounts Receivable - Schedule of Accounts Receivable, Net (Detail) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Receivables [Abstract]
Gross accounts receivable	$ 1,659,304	$ 1,574,038
Allowance for contractual adjustments and uncollectibles	(1,172,347)	(1,129,301)
Accounts receivable, net	$ 486,957	$ 444,737

Business Acquisitions - Additio

Business Acquisitions - Additional Information (Detail) $ in Millions	9 Months Ended
	Sep. 30, 2016USD ($)Company
Business Acquisition [Line Items]
Number of physician group practices acquired | Company	12
Number of anesthesiology practices acquired | Company	7
Number of other pediatric subspecialty practices acquired | Company	2
Number of neonatology practices acquired | Company	1
Business acquisition number of entities acquired | Company	14
Total business acquisition consideration, net of cash acquired	$ 722.2
Cash acquired from acquisition	15
Cash payments to acquire businesses	718.7
Contingent consideration liability	$ 3.5
Number of maternal-fetal medicine practices acquired | Company	1
Number of pediatric cardiology practices acquired | Company	1
Number of third-party receivables companies acquired | Company	1
Number of patient engagement software company acquired | Company	1
Goodwill deductible for tax purpose	$ 151.1
Additional cash payment for prior-period acquisitions	9
Prior-Period Acquisitions [Member]
Business Acquisition [Line Items]
Additional cash payment for prior-period acquisitions	6.2
Increase in deferred tax assets	19.9
Decrease to goodwill resulting from finalization of tax acquisition accounting	(11)
Decrease in current assets	0.2
Increase in deferred tax liabilities	$ 2.5
Contingent Consideration [Member]
Business Acquisition [Line Items]
Time period for achievement of certain performance measures for payment of contingent consideration, years	5 years
Assumed payment probability of contingent consideration payment	100.00%
Range of the undiscounted amount under contingent consideration agreement, low	$ 0
Range of the undiscounted amount under contingent consideration agreement, high	$ 4.1
Minimum [Member] | Contingent Consideration [Member]
Business Acquisition [Line Items]
Assumed discount rates for acquisition-date fair value	4.50%
Maximum [Member] | Contingent Consideration [Member]
Business Acquisition [Line Items]
Assumed discount rates for acquisition-date fair value	5.30%

Business Acquisitions - Summary

Business Acquisitions - Summary of Company's Preliminary Allocation of Purchase Price (Detail) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Business Acquisition [Line Items]
Goodwill	$ 3,828,807	$ 3,366,150
Third Party Receivables Acquisition [Member]
Business Acquisition [Line Items]
Current assets	18,689
Property and equipment	5,807
Other noncurrent assets	115
Goodwill	201,796
Other intangible assets	221,870
Current liabilities	(5,863)
Deferred income tax liabilities - long-term	(41,934)
Other long-term liabilities	(829)
Total assets and liabilities	399,651
Other Acquisition [Member]
Business Acquisition [Line Items]
Current assets	200
Property and equipment	83
Other noncurrent assets	643
Goodwill	271,837
Other intangible assets	68,724
Current liabilities	(333)
Deferred income tax liabilities - long-term	(18,602)
Total assets and liabilities	322,552
Third Party Receivables and Other Acquisition [Member]
Business Acquisition [Line Items]
Current assets	18,889
Property and equipment	5,890
Other noncurrent assets	758
Goodwill	473,633
Other intangible assets	290,594
Current liabilities	(6,196)
Deferred income tax liabilities - long-term	(60,536)
Other long-term liabilities	(829)
Total assets and liabilities	$ 722,203

Business Acquisitions - Schedul

Business Acquisitions - Schedule of Pro Forma Information Combines Consolidated Results of Company and Business Acquisitions (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015
Business Combinations [Abstract]
Pro forma net revenue	$ 2,492,022	$ 2,442,735
Pro forma net income	$ 251,873	$ 257,331
Pro forma net income per common share, Basic	$ 2.73	$ 2.76
Pro forma net income per common share, Diluted	$ 2.71	$ 2.73
Weighted average common shares, Basic	92,336	93,195
Weighted average common shares, Diluted	93,045	94,123

Business Acquisitions - Sched32

Business Acquisitions - Schedule of Pro Forma Information Combines Consolidated Results of Company and Business Acquisitions (Parenthetical) (Detail)	9 Months Ended
	Sep. 30, 2016
Business Combinations [Abstract]
Effective income tax rate	38.80%

Accounts Payable and Accrued 33

Accounts Payable and Accrued Expenses - Schedule of Accounts Payable and Accrued Expenses (Detail) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Payables and Accruals [Abstract]
Accounts payable	$ 23,346	$ 21,969
Accrued salaries and bonuses	184,450	233,499
Accrued payroll taxes and benefits	64,938	58,979
Accrued professional liabilities	26,988	25,995
Accrued contingent consideration	7,086	13,565
Accrued uncertain tax positions		7,000
Accrued interest	14,884	2,655
Other accrued expenses	41,599	32,145
Accounts payable and accrued expenses, total	$ 363,291	$ 395,807

Accounts Payable and Accrued 34

Accounts Payable and Accrued Expenses - Additional Information (Detail) $ in Millions	9 Months Ended
	Sep. 30, 2016USD ($)
Payables and Accruals [Abstract]
Net decrease in accrued salaries and bonuses	$ 49

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail) $ in Millions	3 Months Ended
	Sep. 30, 2016USD ($)
Income Tax Disclosure [Abstract]
Company's total liability for uncertain tax positions	$ 11.4
Decrease in uncertain tax position	17.6
Effective income tax rate favorable impact of change in uncertain tax positions	$ 10.6

Common and Common Equivalent 36

Common and Common Equivalent Shares - Schedule of Calculation of Shares Used in Basic and Diluted Net Income Per Share (Detail) - shares shares in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Earnings Per Share [Abstract]
Weighted average number of common shares outstanding	92,604	92,949	92,336	93,195
Weighted average number of dilutive common share equivalents	542	697	709	928
Weighted average number of common and common equivalent shares outstanding	93,146	93,646	93,045	94,123
Antidilutive securities not included in the diluted net income per common share calculation			2

Stock Incentive Plans and Sto37

Stock Incentive Plans and Stock Purchase Plans - Additional Information (Detail) - USD ($) $ in Millions	Nov. 03, 2015	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares available for future grants and awards under Stock Incentive Plans		4,500,000		4,500,000
Stock-based compensation expense related to its stock incentive plans and ESPP		$ 8.7	$ 8.2	$ 25.9	$ 24
Excess tax benefit related to employee stock incentive plans				$ 3.3
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
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%
2015 Non-Qualified Stock Purchase Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of market value of common stock at which employees are permitted to purchase	90.00%
Amended and Restated 2008 Plan [Member] | Employee And Non Employee Director [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Restricted stock granted to employees and non-employees				501,325
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]
Shares issued under Stock Purchase Plan				226,798
Common stock, aggregate shares authorized		2,500,000		2,500,000
Shares reserved for issuance		2,400,000		2,400,000

Common Stock Repurchase Progr38

Common Stock Repurchase Program - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended	9 Months Ended
	Jun. 30, 2016	Sep. 30, 2016
Common Stock [Line Items]
Common stock repurchased		900,000
Common stock repurchased		$ 61.8
Restricted Stock [Member]
Common Stock [Line Items]
Number of shares withheld to satisfy minimum statutory tax withholding obligations	46,490
Amount withheld to satisfy minimum statutory tax withholding obligations	$ 3.2