Pediatrix Medical (MD) 10-Q 2 Aug 18 2018 Q2 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	6 Months Ended
	Jun. 30, 2018	Jul. 27, 2018
Document And Entity Information [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Jun. 30, 2018
Document Fiscal Year Focus	2,018
Document Fiscal Period Focus	Q2
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		93,466,848

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets (Unaudited) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Current assets:
Cash and cash equivalents	$ 38,056	$ 60,200
Restricted cash	19,000
Short-term investments	9,902	10,292
Accounts receivable, net	527,997	503,999
Prepaid expenses	15,752	15,584
Other current assets	14,223	37,160
Total current assets	624,930	627,235
Restricted cash	1,000	20,000
Investments	90,186	80,682
Property and equipment, net	131,922	123,536
Goodwill	4,304,740	4,283,963
Intangible assets, net	614,226	639,928
Other assets	92,634	91,934
Total assets	5,859,638	5,867,278
Current liabilities:
Accounts payable and accrued expenses	358,255	438,017
Current portion of long-term debt and capital lease obligations	860	1,401
Income taxes payable	52,098	92,007
Total current liabilities	411,213	531,425
Line of credit	1,149,500	1,110,500
Long-term debt and capital lease obligations, net	741,612	740,923
Long-term professional liabilities	207,687	212,274
Deferred income taxes	126,505	147,797
Other liabilities	36,199	57,905
Total liabilities	2,672,716	2,800,824
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; 93,374 and 93,721 shares issued and outstanding, respectively	934	937
Additional paid-in capital	1,032,573	1,017,328
Retained earnings	2,153,415	2,048,189
Total shareholders' equity	3,186,922	3,066,454
Total liabilities and shareholders' equity	$ 5,859,638	$ 5,867,278

Condensed Consolidated Balance3

Condensed Consolidated Balance Sheets (Unaudited) (Parenthetical) - $ / shares	Jun. 30, 2018	Dec. 31, 2017
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	93,374,000	93,721,000
Common stock, shares outstanding	93,374,000	93,721,000

Condensed Consolidated Statemen

Condensed Consolidated Statements of Income (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017
Operating expenses:
Practice salaries and benefits	$ 620,980	$ 561,418	$ 1,252,810	$ 1,133,803
Practice supplies and other operating expenses	31,833	30,872	62,488	58,668
General and administrative expenses	107,908	103,015	216,684	206,780
Depreciation and amortization	26,518	25,735	52,681	51,349
Total operating expenses	787,239	721,040	1,584,663	1,450,600
Income from operations	128,679	121,904	233,112	227,941
Investment and other income	1,202	365	2,666	941
Interest expense	(21,604)	(18,535)	(41,539)	(36,287)
Equity in earnings of unconsolidated affiliates	1,257	689	2,782	1,486
Total non-operating expenses	(19,145)	(17,481)	(36,091)	(33,860)
Income before income taxes	109,534	104,423	197,021	194,081
Income tax provision	(30,122)	(40,725)	(54,181)	(75,692)
Net income	$ 79,412	$ 63,698	$ 142,840	$ 118,389
Net income:
Earnings per share, Basic	$ 0.85	$ 0.69	$ 1.54	$ 1.28
Earnings per share, Diluted	$ 0.85	$ 0.69	$ 1.53	$ 1.27
Weighted average common shares:
Basic	92,987	92,181	92,922	92,270
Diluted	93,529	92,812	93,516	92,977
Health Care
Net revenue	$ 915,918	$ 842,944	$ 1,817,775	$ 1,678,541

Condensed Consolidated Stateme5

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017
Cash flows from operating activities:
Net income	$ 142,840	$ 118,389
Adjustments to reconcile net income to net cash from operating activities:
Depreciation and amortization	52,681	51,349
Amortization of premiums, discounts and issuance costs	2,212	2,740
Stock-based compensation expense	20,399	14,781
Deferred income taxes	(21,211)	18,454
Other	(2,148)	(3,407)
Changes in assets and liabilities:
Accounts receivable	(23,998)	18,361
Prepaid expenses and other current assets	(1,178)	(666)
Other long term assets	(317)	(3,425)
Accounts payable and accrued expenses	(100,442)	(87,862)
Income taxes payable	(39,909)	(15,900)
Payments of contingent consideration liabilities	(65)	(299)
Long-term professional liabilities	(5,863)	1,016
Other liabilities	(1,397)	2,282
Net cash provided from operating activities	21,604	115,813
Cash flows from investing activities:
Acquisition payments, net of cash acquired	(25,575)	(113,746)
Purchases of investments	(15,884)	(15,324)
Proceeds from maturities of investments	5,995	7,290
Purchases of property and equipment	(26,274)	(21,909)
Proceeds from sale of controlling interest in assets	22,764
Other		3,868
Net cash used in investing activities	(38,974)	(139,821)
Cash flows from financing activities:
Borrowings on credit agreement	821,500	821,000
Payments on credit agreement	(782,500)	(754,000)
Payments of contingent consideration liabilities	(367)	(1,961)
Payments on capital lease obligations	(636)	(998)
Proceeds from issuance of common stock	9,389	13,990
Repurchases of common stock	(52,160)	(70,192)
Contribution from noncontrolling interests		894
Net cash (used in) provided from financing activities	(4,774)	8,733
Net decrease in cash and cash equivalents	(22,144)	(15,275)
Cash, cash equivalents and restricted cash at beginning of period	80,200	55,698
Cash, cash equivalents and restricted cash at end of period	$ 58,056	$ 40,423

Basis of Presentation and New A

Basis of Presentation and New Accounting Pronouncements	6 Months Ended
	Jun. 30, 2018
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 The Company is a party to a joint venture in which it owns a 37.5% economic interest. In January 2018, the Company entered into an additional joint venture in which it owns a 49.0% economic interest. The Company accounts for these joint ventures under the equity method of accounting because the Company exercises significant influence over, but does not control, these entities. See Note 5 for more information regarding the January 2018 joint venture. 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 10-K”). Recently Adopted Accounting Pronouncements 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 core principle of the new accounting guidance is to require an entity to recognize as revenue the amount that reflects the consideration to which it expects to be entitled in exchange for goods or services as it transfers control to its customers. The guidance became effective for the Company on January 1, 2018 and was adopted on a full retrospective basis. The primary change for healthcare providers under the new guidance is the requirement to report the allowance for uncollectibles associated with patient responsibility amounts as a reduction in net revenue as opposed to bad debt expense, a component of operating expenses. The Company has historically included the allowance for uncollectibles associated with patient responsibility amounts with its allowance for contractual adjustments as a reduction in net revenue as such amounts are not material. Accordingly, the adoption of this guidance did not have an impact on our Consolidated Financial Statements, other than increased financial statement disclosures. The guidance requires increased disclosures, including qualitative and quantitative disclosures about the nature, amount, timing and uncertainty of revenue and cash flows arising from contracts with customers. See Note 4 for more information. New Accounting Pronouncements In February 2016, the 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 expects that the adoption of this guidance will have a material impact on its Consolidated Balance Sheets and related disclosures, resulting from the recognition of significant right of use assets and related liabilities primarily related to its operating lease arrangements for space in hospitals and certain other facilities for its business and medical offices. The Company has completed the review of its existing lease portfolio and is accumulating all of the necessary information required to properly account for leases under the new guidance. The Company has selected a software application, inclusive of a lease administration module and an accounting module, and has begun the implementation process. The Company is in the process of designing workflows, business processes and internal controls surrounding the lease accounting process in order to meet the reporting and disclosure requirements. The Company’s implementation and continued evaluation of this new guidance and its impacts are expected to continue through the third quarter of 2018.

Cash Equivalents and Investment

Cash Equivalents and Investments	6 Months Ended
	Jun. 30, 2018
Investments, Debt and Equity Securities [Abstract]
Cash Equivalents and Investments	2. Cash Equivalents and Investments: As of June 30, 2018 and December 31, 2017, the Company’s cash equivalents consisted entirely of money market funds totaling $2.4 million and $9.2 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 six years. The Company intends and has the ability to hold its securities to maturity, and therefore carries such investments at amortized cost in accordance with the provisions of the accounting guidance for investments in debt and equity securities. Investments held at June 30, 2018 and December 31, 2017 are summarized as follows (in thousands): June 30, 2018 December 31, 2017 Short-Term Long-Term Short-Term Long-Term Municipal debt securities $ 8,432 $ 48,613 $ 8,312 $ 46,195 Federal home loan securities — 36,393 1,000 30,322 Certificates of deposit 1,470 5,180 980 4,165 $ 9,902 $ 90,186 $ 10,292 $ 80,682 Contractual maturities of long-term investments are summarized as follows (in thousands): June 30, 2018 December 31, 2017 Due after one year through five years $ 89,186 $ 78,561 Due after five years through six years 1,000 2,121 $ 90,186 $ 80,682

Fair Value Measurements

Fair Value Measurements	6 Months Ended
	Jun. 30, 2018
Fair Value Disclosures [Abstract]
Fair Value Measurements	3. Fair Value Measurements: In accordance with the accounting guidance for fair value measurements and disclosures, the Company carries its money market funds included in cash and cash equivalents at fair value. In accordance with the three-tier fair value hierarchy under this guidance, the Company determined the fair value using quoted market prices, a Level 1 input as defined under the accounting guidance for fair value measurements. At June 30, 2018 and December 31, 2017, the Company’s money market funds had a carrying amount of $2.4 million and $9.2 million, respectively. The Company also carries the cash surrender value of life insurance related to its deferred compensation arrangements at fair value. The investments underlying the life insurance contracts consist primarily of exchange-traded equity securities and mutual funds with quoted prices in active markets. In accordance with the three-tier fair value hierarchy, the Company determined the fair value using the cash surrender value of the life insurance, a Level 2 input as defined under the accounting guidance for fair value measurements. At June 30, 2018 and December 31, 2017, the Company’s cash surrender value of life insurance had a carrying amount of $15.7 million and $15.6 million, respectively. In addition, the Company carries its contingent consideration liabilities related to acquisitions at fair value. In accordance with the three-tier fair value hierarchy, the Company determined the fair value of its contingent consideration liabilities using the income approach with assumed discount rates and payment probabilities. The income approach uses Level 3, or unobservable inputs as defined under the accounting guidance for fair value measurements. At June 30, 2018 and December 31, 2017, the Company’s contingent consideration liabilities had a fair value of $30.7 million and $30.5 million, respectively. The carrying amounts of cash equivalents, short-term investments, accounts receivable and accounts payable and accrued expenses approximate fair value due to the short maturities of the respective instruments. The carrying values of long-term investments, line of credit and capital lease obligations approximate fair value. If the Company’s investments were measured at fair value, they would be categorized as Level 2 in the fair value hierarchy. If the Company’s line of credit was measured at fair value, it would be categorized as Level 2 in the fair value hierarchy. The estimated fair value of the Company’s 5.25% senior unsecured notes due 2023 was $735.0 million and $763.1 million, at June 30, 2018 and December 31, 2017, respectively, and was estimated using trading prices on such dates as Level 2 inputs to estimate fair value.

Accounts Receivable and Net Rev

Accounts Receivable and Net Revenue	6 Months Ended
	Jun. 30, 2018
Text Block [Abstract]
Accounts Receivable and Net Revenue	4. Accounts Receivable and Net Revenue: Accounts receivable, net consists of the following (in thousands): June 30, 2018 December 31, 2017 Gross accounts receivable $ 1,918,787 $ 1,790,034 Allowance for contractual adjustments and uncollectibles (1,390,790 ) (1,286,035 ) $ 527,997 $ 503,999 Patient service revenue is recognized at the time services are provided by the Company’s affiliated physicians. The Company’s performance obligations related to the delivery of services to patients are satisfied at the time of service. Accordingly, there are no performance obligations that are unsatisfied or partially unsatisfied at the end of the reporting period with respect to patient service revenue. Almost all of the Company’s patient service revenue is reimbursed by government-sponsored healthcare programs and third-party insurance payors. Payments for services rendered to the Company’s patients are generally less than billed charges. The Company monitors its revenue and receivables from these sources and records an estimated contractual allowance to properly account for the anticipated differences between billed and reimbursed amounts. Accordingly, patient service revenue is presented net of an estimated provision for contractual adjustments and uncollectibles. The Company estimates allowances for contractual adjustments and uncollectibles on accounts receivable based upon historical experience and other factors, including days sales outstanding (“DSO”) for accounts receivable, evaluation of expected adjustments and delinquency rates, past adjustments and collection experience in relation to amounts billed, an aging of accounts receivable, current contract and reimbursement terms, changes in payor mix and other relevant information. Contractual adjustments result from the difference between the physician rates for services performed and the reimbursements by government-sponsored healthcare programs and third-party insurance payors for such services. Collection of patient service revenue the Company expects to receive is normally a function of providing complete and correct billing information to the government-sponsored healthcare programs and third-party insurance payors within the various filing deadlines and typically occurs within 30 to 60 days of billing. Some of the Company’s hospital agreements require hospitals to pay the Company administrative fees. Some agreements provide for fees if the hospital does not generate sufficient patient volume in order to guarantee that the Company receives a specified minimum revenue level. The Company also receives fees from hospitals for administrative services performed by its affiliated physicians providing medical director or other services at the hospital. In addition, the Company generates revenue through its management services organization for services rendered under various coding and billing contracts. Contract terms are specific to each customer and may include a combination of a flat fee for coding of medical charts, a fixed fee per patient visit as well as a percentage of cash collections received by the providers. Revenue for flat and fixed fee arrangements is recognized in the month the coding occurs or the patient visit occurs. Revenue for percentage fees are recognized in the month that cash is collected for customers from payors. The following table summarizes the Company’s net revenue by category (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2018 2017 2018 2017 Net patient service revenue $ 763,667 $ 708,739 $ 1,520,040 $ 1,414,192 Hospital contract administrative fees 95,534 75,604 186,773 147,869 Management services and other 56,717 58,601 110,962 116,480 $ 915,918 $ 842,944 $ 1,817,775 $ 1,678,541 The approximate percentage of net patient service revenue by type of payor was as follows: Three Months Ended June 30, Six Months Ended June 30, 2018 2017 2018 2017 Contracted managed care 70 % 71 % 70 % 71 % Government 25 24 25 24 Other third-parties 4 4 4 4 Private-pay 1 1 1 1 100 % 100 % 100 % 100 %

Business Acquisitions, Joint Ve

Business Acquisitions, Joint Ventures and Goodwill	6 Months Ended
	Jun. 30, 2018
Text Block [Abstract]
Business Acquisitions, Joint Ventures and Goodwill	5. Business Acquisitions, Joint Ventures and Goodwill: During the six months ended June 30, 2018, the Company completed the acquisition of five physician group practices, including two radiology practices, one neonatology practice and two pediatric subspecialty practices. The acquisition-date fair value of the total consideration for the five acquisitions was $24.4 million. These acquisitions expanded the Company’s national network of physician practices. In connection with these acquisitions, the Company recorded goodwill of $15.5 million and other intangible assets consisting primarily of physician and hospital agreements of $8.9 million. In addition, during the six months ended June 30, 2018, in connection with certain prior-period acquisitions, the Company paid $0.4 million for contingent consideration and $1.2 million for purchase consideration that had been held back pending satisfaction of certain conditions. All amounts except for the accretion recorded during 2018 were accrued as of December 31, 2017. In connection with certain prior-period acquisitions, the Company also recorded a decrease in current assets of $1.2 million, a decrease in noncurrent assets of $1.5 million, an increase in current liabilities of $1.4 million and an increase in noncurrent liabilities of $1.2 million, with a corresponding net increase in goodwill of $5.3 million for measurement-period adjustments resulting from the finalization of acquisition accounting. The Company expects that $18.2 million of the goodwill recorded during the six months ended June 30, 2018 will be deductible for tax purposes. In January 2018, the Company completed the sale of a controlling interest and the contribution of remaining assets to a joint venture related to the $46.0 million of assets held for sale at December 31, 2017. The Company accounts for its 49.0% economic interest in the joint venture as an equity method investment. The investment in this joint venture is included in other assets as presented in the Company’s Condensed Consolidated Balance Sheet. The Company’s management services reporting unit has experienced lower operating results than previously forecasted primarily due to a slower rate of new customer bookings and an increase in customer termination activity. The Company continues to believe that the fair value of the reporting unit exceeds the carrying value, and accordingly the goodwill assigned to the management services reporting unit is not impaired Although the Company believes that the current assumptions and estimates used in its goodwill analysis are reasonable, supportable and appropriate, continued efforts to maintain or improve the performance of this business could be impacted by unfavorable or unforeseen changes which could impact the existing assumptions used in the impairment analysis. Various factors could reasonably be expected to unfavorably impact existing assumptions, primarily delays in new customer bookings and the related delay in revenue from new customers, increases in customer termination activity or increases in operating costs. Accordingly, there can be no assurance that the estimates and assumptions made for the purposes of the goodwill impairment analysis will prove to be accurate predictions of future performance. The carrying value of the Company’s management services reporting unit included goodwill of $321.6 million as of June 30, 2018. The Company will continue to closely monitor the performance of the management services reporting unit. If an impairment loss is required in a future period, it could have a material adverse effect on the Company’s business, financial condition, results of operations, cash flows and the trading price of the Company’s securities.

Accounts Payable and Accrued Ex

Accounts Payable and Accrued Expenses	6 Months Ended
	Jun. 30, 2018
Payables and Accruals [Abstract]
Accounts Payable and Accrued Expenses	6. Accounts Payable and Accrued Expenses: Accounts payable and accrued expenses consist of the following (in thousands): June 30, 2018 December 31, 2017 Accounts payable $ 28,377 $ 34,632 Accrued salaries and bonuses 144,911 225,429 Accrued payroll taxes and benefits 71,379 75,672 Accrued professional liabilities 35,253 37,912 Accrued contingent consideration 26,783 6,259 Accrued interest 5,077 4,495 Other accrued expenses 46,475 53,618 $ 358,255 $ 438,017 The net decrease in accrued salaries and bonuses of $80.5 million from December 31, 2017 to June 30, 2018 is primarily due to the payment of performance-based incentive compensation, principally to the Company’s physicians, partially offset by performance-based incentive compensation accrued during the six months ended June 30, 2018. A majority of the Company’s payments for performance-based incentive compensation is paid annually during the first quarter.

Common and Common Equivalent Sh

Common and Common Equivalent Shares	6 Months Ended
	Jun. 30, 2018
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 stock, deferred stock and stock options and is calculated using the treasury stock method. The calculation of shares used in the basic and diluted net income per common share calculation for the three and six months ended June 30, 2018 and 2017 is as follows (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2018 2017 2018 2017 Weighted average number of common shares outstanding 92,987 92,181 92,922 92,270 Weighted average number of dilutive common share equivalents 542 631 594 707 Weighted average number of common and common equivalent shares outstanding 93,529 92,812 93,516 92,977 Antidilutive securities not included in the diluted net income per common share calculation 392 8 197 5

Stock Incentive Plans and Stock

Stock Incentive Plans and Stock Purchase Plans	6 Months Ended
	Jun. 30, 2018
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock Incentive Plans and Stock Purchase Plans	8. 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. Deferred stock awards generally vest upon the satisfaction of specified performance-based conditions and service-based conditions. The Company recognizes compensation expense related to its restricted stock and deferred stock awards ratably over the corresponding vesting periods. During the six months ended June 30, 2018, the Company granted 597,550 shares of restricted stock to its employees and non-employee Under the Company’s 1996 Non-Qualified Non-Qualified non-employee Each of the ESPP and the SPP provide for the issuance of an aggregate of 2.6 million shares of the Company’s common stock less the number of shares of common stock purchased under the other plan. The Company recognizes stock-based compensation expense for the discount received by participating employees and non-employee During the three and six months ended June 30, 2018 and 2017, the Company recognized stock-based compensation expense of $10.5 million and $20.4 million, and $7.3 million and $14.8 million, respectively.

Common Stock Repurchase Program

Common Stock Repurchase Program	6 Months Ended
	Jun. 30, 2018
Text Block [Abstract]
Common Stock Repurchase Program	9. 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

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2018
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 securities. The Company has not included an accrual for these matters as of June 30, 2018 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 New16

Basis of Presentation and New Accounting Pronouncements (Policies)	6 Months Ended
	Jun. 30, 2018
Accounting Policies [Abstract]
Recently Adopted Accounting Pronouncements	Recently Adopted Accounting Pronouncements 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 core principle of the new accounting guidance is to require an entity to recognize as revenue the amount that reflects the consideration to which it expects to be entitled in exchange for goods or services as it transfers control to its customers. The guidance became effective for the Company on January 1, 2018 and was adopted on a full retrospective basis. The primary change for healthcare providers under the new guidance is the requirement to report the allowance for uncollectibles associated with patient responsibility amounts as a reduction in net revenue as opposed to bad debt expense, a component of operating expenses. The Company has historically included the allowance for uncollectibles associated with patient responsibility amounts with its allowance for contractual adjustments as a reduction in net revenue as such amounts are not material. Accordingly, the adoption of this guidance did not have an impact on our Consolidated Financial Statements, other than increased financial statement disclosures. The guidance requires increased disclosures, including qualitative and quantitative disclosures about the nature, amount, timing and uncertainty of revenue and cash flows arising from contracts with customers. See Note 4 for more information.
New Accounting Pronouncements	New Accounting Pronouncements In February 2016, the 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 expects that the adoption of this guidance will have a material impact on its Consolidated Balance Sheets and related disclosures, resulting from the recognition of significant right of use assets and related liabilities primarily related to its operating lease arrangements for space in hospitals and certain other facilities for its business and medical offices. The Company has completed the review of its existing lease portfolio and is accumulating all of the necessary information required to properly account for leases under the new guidance. The Company has selected a software application, inclusive of a lease administration module and an accounting module, and has begun the implementation process. The Company is in the process of designing workflows, business processes and internal controls surrounding the lease accounting process in order to meet the reporting and disclosure requirements. The Company’s implementation and continued evaluation of this new guidance and its impacts are expected to continue through the third quarter of 2018.

Cash Equivalents and Investme17

Cash Equivalents and Investments (Tables)	6 Months Ended
	Jun. 30, 2018
Investments, Debt and Equity Securities [Abstract]
Schedule of Investments	Investments held at June 30, 2018 and December 31, 2017 are summarized as follows (in thousands): June 30, 2018 December 31, 2017 Short-Term Long-Term Short-Term Long-Term Municipal debt securities $ 8,432 $ 48,613 $ 8,312 $ 46,195 Federal home loan securities — 36,393 1,000 30,322 Certificates of deposit 1,470 5,180 980 4,165 $ 9,902 $ 90,186 $ 10,292 $ 80,682
Schedule of Contractual Maturities of Long-Term Investments	Contractual maturities of long-term investments are summarized as follows (in thousands): June 30, 2018 December 31, 2017 Due after one year through five years $ 89,186 $ 78,561 Due after five years through six years 1,000 2,121 $ 90,186 $ 80,682

Accounts Receivable and Net R18

Accounts Receivable and Net Revenue (Tables)	6 Months Ended
	Jun. 30, 2018
Text Block [Abstract]
Schedule of Accounts Receivable, Net	Accounts receivable, net consists of the following (in thousands): June 30, 2018 December 31, 2017 Gross accounts receivable $ 1,918,787 $ 1,790,034 Allowance for contractual adjustments and uncollectibles (1,390,790 ) (1,286,035 ) $ 527,997 $ 503,999
Schedule of Net Revenue	The following table summarizes the Company’s net revenue by category (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2018 2017 2018 2017 Net patient service revenue $ 763,667 $ 708,739 $ 1,520,040 $ 1,414,192 Hospital contract administrative fees 95,534 75,604 186,773 147,869 Management services and other 56,717 58,601 110,962 116,480 $ 915,918 $ 842,944 $ 1,817,775 $ 1,678,541
Schedule of Percentage of Net Patient Service Revenue	The approximate percentage of net patient service revenue by type of payor was as follows: Three Months Ended June 30, Six Months Ended June 30, 2018 2017 2018 2017 Contracted managed care 70 % 71 % 70 % 71 % Government 25 24 25 24 Other third-parties 4 4 4 4 Private-pay 1 1 1 1 100 % 100 % 100 % 100 %

Accounts Payable and Accrued 19

Accounts Payable and Accrued Expenses (Tables)	6 Months Ended
	Jun. 30, 2018
Payables and Accruals [Abstract]
Schedule of Accounts Payable and Accrued Expenses	Accounts payable and accrued expenses consist of the following (in thousands): June 30, 2018 December 31, 2017 Accounts payable $ 28,377 $ 34,632 Accrued salaries and bonuses 144,911 225,429 Accrued payroll taxes and benefits 71,379 75,672 Accrued professional liabilities 35,253 37,912 Accrued contingent consideration 26,783 6,259 Accrued interest 5,077 4,495 Other accrued expenses 46,475 53,618 $ 358,255 $ 438,017

Common and Common Equivalent 20

Common and Common Equivalent Shares (Tables)	6 Months Ended
	Jun. 30, 2018
Earnings Per Share [Abstract]
Schedule of Calculation of Shares Used in Basic and Diluted Net Income Per Share	The calculation of shares used in the basic and diluted net income per common share calculation for the three and six months ended June 30, 2018 and 2017 is as follows (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2018 2017 2018 2017 Weighted average number of common shares outstanding 92,987 92,181 92,922 92,270 Weighted average number of dilutive common share equivalents 542 631 594 707 Weighted average number of common and common equivalent shares outstanding 93,529 92,812 93,516 92,977 Antidilutive securities not included in the diluted net income per common share calculation 392 8 197 5

Basis of Presentation and New21

Basis of Presentation and New Accounting Pronouncements - Additional Information (Detail)	Jun. 30, 2018	Jan. 31, 2018
Basis Of Presentation [Line Items]
Equity method ownership percentage in joint venture	49.00%
Unnamed Corporate Joint Venture [Member]
Basis Of Presentation [Line Items]
Equity method ownership percentage in joint venture	37.50%	49.00%

Cash Equivalents and Investme22

Cash Equivalents and Investments - Additional Information (Detail) - USD ($) $ in Millions	6 Months Ended
	Jun. 30, 2018	Dec. 31, 2017
Cash Equivalents And Investments [Line Items]
Cash equivalents	$ 2.4	$ 9.2
Cash Equivalents [Member]
Cash Equivalents And Investments [Line Items]
Cash equivalents	$ 2.4	$ 9.2
Maximum [Member]
Cash Equivalents And Investments [Line Items]
Long-term investments maturity period, in years	6 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 Investme23

Cash Equivalents and Investments - Schedule of Investments (Detail) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Schedule of Held-to-maturity Securities [Line Items]
Short-Term	$ 9,902	$ 10,292
Long-Term	90,186	80,682
Municipal Debt Securities [Member]
Schedule of Held-to-maturity Securities [Line Items]
Short-Term	8,432	8,312
Long-Term	48,613	46,195
Federal Home Loan Securities [Member]
Schedule of Held-to-maturity Securities [Line Items]
Short-Term		1,000
Long-Term	36,393	30,322
Certificates of Deposit [Member]
Schedule of Held-to-maturity Securities [Line Items]
Short-Term	1,470	980
Long-Term	$ 5,180	$ 4,165

Cash Equivalents and Investme24

Cash Equivalents and Investments - Schedule of Contractual Maturities of Long-Term Investments (Detail) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Investments, Debt and Equity Securities [Abstract]
Due after one year through five years	$ 89,186	$ 78,561
Due after five years through [six] years	1,000	2,121
Total	$ 90,186	$ 80,682

Fair Value Measurements - Addit

Fair Value Measurements - Additional Information (Detail) - USD ($) $ in Millions	Jun. 30, 2018	Dec. 31, 2017
Fair Value Measurements Disclosure [Line Items]
Money market funds carrying amount	$ 2.4	$ 9.2
Carrying amount of cash surrender value of life insurance	15.7	15.6
Contingent consideration liabilities related to acquisitions	30.7	30.5
5.25% Senior Unsecured Notes Due 2023 [Member]
Fair Value Measurements Disclosure [Line Items]
Estimated fair value of notes	$ 735	$ 763.1
Debt instrument interest rate	5.25%

Accounts Receivable and Net R26

Accounts Receivable and Net Revenue - Schedule of Accounts Receivable, Net (Detail) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Receivables [Abstract]
Gross accounts receivable	$ 1,918,787	$ 1,790,034
Allowance for contractual adjustments and uncollectibles	(1,390,790)	(1,286,035)
Accounts receivable, net	$ 527,997	$ 503,999

Accounts Receivable and Net R27

Accounts Receivable and Net Revenue - Schedule of Net Revenue (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017
Net patient service revenue
Disaggregation of Revenue [Abstract]
Net revenue	$ 763,667	$ 708,739	$ 1,520,040	$ 1,414,192
Hospital contract administrative fees
Disaggregation of Revenue [Abstract]
Net revenue	95,534	75,604	186,773	147,869
Management services and other
Disaggregation of Revenue [Abstract]
Net revenue	56,717	58,601	110,962	116,480
Health Care
Disaggregation of Revenue [Abstract]
Net revenue	$ 915,918	$ 842,944	$ 1,817,775	$ 1,678,541

Accounts Receivable and Net R28

Accounts Receivable and Net Revenue - Schedule of Net Patient Service Revenue by Type of Payor (Detail)	3 Months Ended		6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	100.00%	100.00%	100.00%	100.00%
Contracted Managed Care [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	70.00%	71.00%	70.00%	71.00%
Government [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	25.00%	24.00%	25.00%	24.00%
Other Third-Parties [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	4.00%	4.00%	4.00%	4.00%
Private-Pay Patients [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	1.00%	1.00%	1.00%	1.00%

Business Acquisitions, Joint 29

Business Acquisitions, Joint Ventures and Goodwill - Additional Information (Detail) $ in Thousands	6 Months Ended
	Jun. 30, 2018USD ($)Company	Dec. 31, 2017USD ($)
Business Acquisition [Line Items]
Number of physician group practices acquired | Company	5
Number of neonatology practices acquired | Company	1
Number of other pediatric subspecialty practices acquired | Company	2
Number of radiology practices acquired | Company	2
Total business acquisition consideration	$ 24,400
Goodwill	4,304,740	$ 4,283,963
Contingent consideration payments related to prior-period acquisitions	400
Purchase consideration payments related to prior-period acquisitions	1,200
Assets held for sale	$ 46,000
Sale of equity method investments	49.00%
Management Services Reporting Unit [Member]
Business Acquisition [Line Items]
Goodwill	$ 321,600
Physician Group [Member]
Business Acquisition [Line Items]
Goodwill	15,500
Other intangible assets	8,900
Prior-Period Acquisitions [Member]
Business Acquisition [Line Items]
Decrease in current assets	1,200
Decrease in noncurrent assets	1,500
Decrease in current liabilities	1,400
Increase in noncurrent liabilities	1,200
Net increase in goodwill resulting from finalization of tax acquisition accounting	5,300
Goodwill deductible for tax purposes	$ 18,200

Accounts Payable and Accrued 30

Accounts Payable and Accrued Expenses - Schedule of Accounts Payable and Accrued Expenses (Detail) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Payables and Accruals [Abstract]
Accounts payable	$ 28,377	$ 34,632
Accrued salaries and bonuses	144,911	225,429
Accrued payroll taxes and benefits	71,379	75,672
Accrued professional liabilities	35,253	37,912
Accrued contingent consideration	26,783	6,259
Accrued interest	5,077	4,495
Other accrued expenses	46,475	53,618
Accounts payable and accrued expenses, total	$ 358,255	$ 438,017

Accounts Payable and Accrued 31

Accounts Payable and Accrued Expenses - Additional Information (Detail) $ in Millions	6 Months Ended
	Jun. 30, 2018USD ($)
Payables and Accruals [Abstract]
Net decrease in accrued salaries and bonuses	$ 80.5

Common and Common Equivalent 32

Common and Common Equivalent Shares - Schedule of Calculation of Shares Used in Basic and Diluted Net Income Per Share (Detail) - shares shares in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017
Earnings Per Share [Abstract]
Weighted average number of common shares outstanding	92,987	92,181	92,922	92,270
Weighted average number of dilutive common share equivalents	542	631	594	707
Weighted average number of common and common equivalent shares outstanding	93,529	92,812	93,516	92,977
Antidilutive securities not included in the diluted net income per common share calculation	392	8	197	5

Stock Incentive Plans and Sto33

Stock Incentive Plans and Stock Purchase Plans - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017	Dec. 31, 2017
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock, aggregate shares authorized	200,000,000		200,000,000		200,000,000
Stock-based compensation expense	$ 10.5	$ 7.3	$ 20.4	$ 14.8
Stock Option [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			10 years
Stock Option [Member] | Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period of options, maximum years			10 years
Restricted Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			3 years
1996 Non-Qualified Employee Stock Purchase Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of market value of common stock at which employees are permitted to purchase			85.00%
2015 Non-Qualified Stock Purchase Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of market value of common stock at which employees are permitted to purchase			90.00%
Amended and Restated 2008 Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares available for future grants and awards under Stock Incentive Plans	2,300,000		2,300,000
Restricted stock granted			597,550
1996 Non-Qualified Employee Stock Purchase Plan and 2015 Non-Qualified Stock Purchase Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Aggregate number Shares issued under Stock Purchase Plans			182,888
Common stock, aggregate shares authorized	2,600,000		2,600,000
Common stock, reserved for issuance	1,800,000		1,800,000

Common Stock Repurchase Progr34

Common Stock Repurchase Program - Additional Information (Detail) $ in Millions	6 Months Ended
	Jun. 30, 2018USD ($)shares
Common Stock [Line Items]
Common stock repurchased | $	$ 52.2
Common Stock [Member]
Common Stock [Line Items]
Repurchased common stock, shares | shares	1,200,000
Restricted Stock [Member]
Common Stock [Line Items]
Number of shares withheld to satisfy minimum statutory tax withholding obligations | shares	54,909
Amount withheld to satisfy minimum statutory tax withholding obligations | $	$ 2.5