Document and Entity Information
Document and Entity Information - USD ($) | 12 Months Ended | ||
Dec. 31, 2018 | Feb. 07, 2019 | Jun. 30, 2018 | |
Document And Entity Information [Abstract] | |||
Document Type | 10-K | ||
Amendment Flag | false | ||
Document Period End Date | Dec. 31, 2018 | ||
Document Fiscal Year Focus | 2,018 | ||
Document Fiscal Period Focus | FY | ||
Trading Symbol | MD | ||
Entity Registrant Name | MEDNAX, INC. | ||
Entity Central Index Key | 893,949 | ||
Current Fiscal Year End Date | --12-31 | ||
Entity Well-known Seasoned Issuer | Yes | ||
Entity Current Reporting Status | Yes | ||
Entity Voluntary Filers | No | ||
Entity Filer Category | Large Accelerated Filer | ||
Entity Emerging Company | false | ||
Entity Ex Transition Period | false | ||
Entity Shell Company | false | ||
Entity Small Business | false | ||
Entity Common Stock, Shares Outstanding | 87,920,463 | ||
Entity Public Float | $ 3,943,237,534 |
Consolidated Balance Sheets
Consolidated Balance Sheets - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Current assets: | ||
Cash and cash equivalents | $ 36,745 | $ 60,200 |
Restricted cash | 20,000 | |
Short-term investments | 21,923 | 10,292 |
Accounts receivable, net | 542,272 | 503,999 |
Prepaid expenses | 18,763 | 15,584 |
Other current assets | 17,706 | 37,160 |
Total current assets | 657,409 | 627,235 |
Restricted cash | 20,000 | |
Investments | 69,699 | 80,682 |
Property and equipment, net | 133,037 | 123,536 |
Goodwill | 4,382,995 | 4,283,963 |
Intangible assets, net | 588,312 | 639,928 |
Other assets | 103,459 | 91,934 |
Total assets | 5,934,911 | 5,867,278 |
Current liabilities: | ||
Accounts payable and accrued expenses | 469,342 | 438,017 |
Current portion of long-term debt and capital lease obligations | 253 | 1,401 |
Income taxes payable | 30,598 | 92,007 |
Total current liabilities | 500,193 | 531,425 |
Line of credit | 739,500 | 1,110,500 |
Long-term debt and capital lease obligations, net | 1,234,780 | 740,923 |
Long-term professional liabilities | 209,060 | 212,274 |
Deferred income taxes | 131,240 | 147,797 |
Other liabilities | 32,254 | 57,905 |
Total liabilities | 2,847,027 | 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; 87,820 and 93,721 shares issued and outstanding, respectively | 878 | 937 |
Additional paid-in capital | 992,647 | 1,017,328 |
Retained earnings | 2,094,359 | 2,048,189 |
Total shareholders' equity | 3,087,884 | 3,066,454 |
Total liabilities and shareholders' equity | $ 5,934,911 | $ 5,867,278 |
Consolidated Balance Sheets (Pa
Consolidated Balance Sheets (Parenthetical) - $ / shares | Dec. 31, 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 | 87,820,000 | 93,721,000 |
Common stock, shares outstanding | 87,820,000 | 93,721,000 |
Consolidated Statements of Inco
Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands | 3 Months Ended | 12 Months Ended | |||||||||
Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Income Statement [Abstract] | |||||||||||
Net revenue | $ 932,696 | $ 896,652 | $ 915,918 | $ 901,857 | $ 910,820 | $ 868,951 | $ 842,944 | $ 835,597 | $ 3,647,123 | $ 3,458,312 | $ 3,183,159 |
Operating expenses: | |||||||||||
Practice salaries and benefits | 657,061 | 625,717 | 620,980 | 631,830 | 617,455 | 586,476 | 561,418 | 572,385 | 2,535,588 | 2,337,734 | 2,031,220 |
Practice supplies and other operating expenses | 29,381 | 30,159 | 31,833 | 30,655 | 32,353 | 29,497 | 30,872 | 27,796 | 122,028 | 120,518 | 118,416 |
General and administrative expenses | 112,789 | 102,905 | 107,908 | 108,776 | 108,895 | 101,430 | 103,015 | 103,765 | 432,378 | 417,105 | 372,572 |
Depreciation and amortization | 29,891 | 28,709 | 26,518 | 26,163 | 26,414 | 25,116 | 25,735 | 25,614 | 111,281 | 102,879 | 89,264 |
Total operating expenses | 829,122 | 787,490 | 787,239 | 797,424 | 785,117 | 742,519 | 721,040 | 729,560 | 3,201,275 | 2,978,236 | 2,611,472 |
Income from operations | 103,574 | 109,162 | 128,679 | 104,433 | 125,703 | 126,432 | 121,904 | 106,037 | 445,848 | 480,076 | 571,687 |
Investment and other income | 967 | 1,302 | 1,202 | 1,464 | 2,777 | 235 | 365 | 576 | 4,935 | 3,953 | 2,019 |
Interest expense | (25,448) | (21,782) | (21,604) | (19,935) | (19,844) | (18,428) | (18,535) | (17,752) | (88,769) | (74,559) | (63,092) |
Equity in earnings of unconsolidated affiliates | 2,277 | 1,766 | 1,257 | 1,525 | (294) | (240) | 689 | 797 | 6,825 | 952 | 3,185 |
Total non-operating expenses | (22,204) | (18,714) | (19,145) | (16,946) | (17,361) | (18,433) | (17,481) | (16,379) | (77,009) | (69,654) | (57,888) |
Income before income taxes | 81,370 | 90,448 | 109,534 | 87,487 | 108,342 | 107,999 | 104,423 | 89,658 | 368,839 | 410,422 | 513,799 |
Income tax provision | (21,156) | (24,873) | (30,122) | (24,059) | 27,761 | (42,119) | (40,725) | (34,967) | (100,210) | (90,050) | (189,203) |
Net income | 0 | 0 | 0 | 0 | 268,629 | 320,372 | 324,596 | ||||
Net loss attributable to noncontrolling interests | 0 | 0 | 0 | 0 | 318 | ||||||
Net income attributable to MEDNAX, Inc. | $ 60,214 | $ 65,575 | $ 79,412 | $ 63,428 | $ 136,103 | $ 65,880 | $ 63,698 | $ 54,691 | $ 268,629 | $ 320,372 | $ 324,914 |
Net income attributable to MEDNAX, Inc.: | |||||||||||
Earnings per share, Basic | $ 0.69 | $ 0.72 | $ 0.85 | $ 0.68 | $ 1.47 | $ 0.71 | $ 0.69 | $ 0.59 | $ 2.95 | $ 3.47 | $ 3.52 |
Earnings per share, Diluted | $ 0.68 | $ 0.72 | $ 0.85 | $ 0.68 | $ 1.46 | $ 0.71 | $ 0.69 | $ 0.59 | $ 2.93 | $ 3.45 | $ 3.49 |
Weighted average common shares: | |||||||||||
Basic | 87,810 | 90,984 | 92,987 | 92,859 | 92,756 | 92,589 | 92,181 | 92,360 | 91,104 | 92,431 | 92,422 |
Diluted | 88,258 | 91,359 | 93,529 | 93,505 | 93,159 | 92,881 | 92,812 | 93,143 | 91,606 | 92,958 | 93,109 |
Consolidated Statements of Equi
Consolidated Statements of Equity - USD ($) shares in Thousands | Total | Common Stock [Member] | Additional Paid-in Capital [Member] | Retained Earnings [Member] | Noncontrolling Interests [Member] |
Balance at Dec. 31, 2015 | $ 2,437,846,000 | $ 937,000 | $ 926,235,000 | $ 1,510,356,000 | $ 318,000 |
Balance, Shares at Dec. 31, 2015 | 93,739 | ||||
Net income (loss) | 324,596,000 | 324,914,000 | $ (318,000) | ||
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan | 22,022,000 | $ 5,000 | 22,017,000 | ||
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan, shares | 473 | ||||
Issuance of restricted stock | $ 5,000 | (5,000) | |||
Issuance of restricted stock, shares | 505 | ||||
Stock-based compensation expense | 34,000,000 | 34,000,000 | |||
Forfeitures of restricted stock | $ (1,000) | 1,000 | |||
Forfeitures of restricted stock, shares | 53 | ||||
Repurchased common stock | (61,828,000) | $ (9,000) | (12,075,000) | (49,744,000) | |
Repurchased common stock, shares | (946) | ||||
Excess tax benefit related to employee stock incentive plans | 4,131,000 | 4,131,000 | |||
Balance at Dec. 31, 2016 | 2,760,767,000 | $ 937,000 | 974,304,000 | 1,785,526,000 | |
Balance, Shares at Dec. 31, 2016 | 93,718 | ||||
Net income (loss) | 320,372,000 | 320,372,000 | |||
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan | 23,276,000 | $ 5,000 | 23,271,000 | ||
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan, shares | 528 | ||||
Issuance of restricted stock | $ 5,000 | (5,000) | |||
Issuance of restricted stock, shares | 536 | ||||
Issuance of restricted stock for acquisition consideration | 2,658,000 | $ 1,000 | 2,657,000 | ||
Issuance of restricted stock for acquisition consideration, shares | 69 | ||||
Stock-based compensation expense | 29,573,000 | 29,573,000 | |||
Forfeitures of restricted stock | $ (1,000) | 1,000 | |||
Forfeitures of restricted stock, shares | 92 | ||||
Repurchased common stock | (70,192,000) | $ (10,000) | (12,473,000) | (57,709,000) | |
Repurchased common stock, shares | (1,038) | ||||
Balance at Dec. 31, 2017 | 3,066,454,000 | $ 937,000 | 1,017,328,000 | 2,048,189,000 | |
Balance, Shares at Dec. 31, 2017 | 93,721 | ||||
Net income (loss) | 268,629,000 | 268,629,000 | |||
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan | 18,919,000 | $ 5,000 | 18,914,000 | ||
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan, shares | 495 | ||||
Issuance of restricted stock | $ 8,000 | (8,000) | |||
Issuance of restricted stock, shares | 770 | ||||
Stock-based compensation expense | 38,703,000 | 38,703,000 | |||
Stock swaps | (2,661,000) | $ (1,000) | (2,660,000) | ||
Stock swaps,shares | (56) | ||||
Forfeitures of restricted stock | $ (1,000) | 1,000 | |||
Forfeitures of restricted stock, shares | (69) | ||||
Repurchased common stock | (302,160,000) | $ (70,000) | (79,631,000) | (222,459,000) | |
Repurchased common stock, shares | (7,041) | ||||
Excess tax benefit related to employee stock incentive plans | 0 | ||||
Balance at Dec. 31, 2018 | $ 3,087,884,000 | $ 878,000 | $ 992,647,000 | $ 2,094,359,000 | |
Balance, Shares at Dec. 31, 2018 | 87,820 |
Consolidated Statements of Cash
Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Cash flows from operating activities: | |||
Net income | $ 268,629 | $ 320,372 | $ 324,596 |
Adjustments to reconcile net income to net cash provided from operating activities: | |||
Depreciation and amortization | 111,281 | 102,879 | 89,264 |
Amortization of premiums, discounts and issuance costs | 4,572 | 5,514 | 4,816 |
Stock-based compensation expense | 38,703 | 29,573 | 34,000 |
Deferred income taxes | (24,149) | (60,073) | 18,149 |
Other | (10,903) | (3,783) | 212 |
Changes in assets and liabilities: | |||
Accounts receivable | (36,598) | 7,803 | (34,000) |
Prepaid expenses and other current assets | (5,472) | (2,792) | (783) |
Other long-term assets | (395) | (2,709) | 10,035 |
Accounts payable and accrued expenses | 15,390 | 24,551 | 11,617 |
Income taxes payable | (61,256) | 73,050 | (2,234) |
Payments of contingent consideration liabilities | (1,093) | (750) | (1,037) |
Long-term professional liabilities | (4,490) | 18,478 | (3,452) |
Other liabilities | (4,294) | (735) | (7,405) |
Net cash provided from operating activities | 289,925 | 511,378 | 443,778 |
Cash flows from investing activities: | |||
Acquisition payments, net of cash acquired | (114,491) | (531,696) | (762,302) |
Purchases of investments | (15,884) | (27,723) | (60,976) |
Proceeds from maturities of investments | 13,710 | 25,410 | 41,325 |
Purchases of property and equipment | (48,868) | (49,309) | (39,264) |
Proceeds from sale of controlling interest in assets | 22,764 | ||
Other | 6,705 | ||
Net cash used in investing activities | (142,769) | (576,613) | (821,217) |
Cash flows from financing activities: | |||
Borrowings on credit agreement | 1,723,500 | 2,846,000 | 1,940,000 |
Payments on credit agreement | (2,094,500) | (2,699,000) | (1,510,000) |
Proceeds from issuance of senior notes | 500,000 | ||
Payments for financing costs | (7,090) | (3,525) | |
Payments of contingent consideration liabilities | (5,263) | (5,449) | (10,740) |
Payments on capital lease obligations | (1,356) | (2,267) | (2,130) |
Excess tax benefit from exercises of stock options and vesting of restricted stock | 4,241 | ||
Proceeds from issuance of common stock | 16,258 | 23,276 | 22,022 |
Contribution from noncontrolling interests | 894 | ||
Repurchases of common stock | (302,160) | (70,192) | (61,828) |
Net cash (used in) provided from financing activities | (170,611) | 89,737 | 381,565 |
Net (decrease) increase in cash and cash equivalents | (23,455) | 24,502 | 4,126 |
Cash, cash equivalents and restricted cash at beginning of year | 80,200 | 55,698 | 51,572 |
Cash, cash equivalents and restricted cash at end of year | 56,745 | 80,200 | 55,698 |
Supplemental disclosure of cash flow information: | |||
Interest | 82,540 | 73,837 | 60,453 |
Income taxes | 185,416 | 75,427 | 175,962 |
Non-cash investing and financing activities: | |||
Value of common stock issued for acquisitions | 2,657 | ||
Equipment financed through capital leases | 684 | 1,619 | |
Property and equipment included in accounts payable | $ 2,927 | $ 2,700 | $ 2,673 |
General
General | 12 Months Ended |
Dec. 31, 2018 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
General | 1. General: The principal business activity of MEDNAX, Inc. (“MEDNAX” or the “Company”) and its subsidiaries is to provide neonatal, anesthesia, radiology and teleradiology, maternal-fetal and other pediatric subspecialty physician services. The Company has contracts with affiliated business corporations or professional associations, limited liability companies and partnerships (“affiliated professional contractors”), which are separate legal entities that provide physician services in certain states and Puerto Rico. The Company and its affiliated professional contractors also have contracts with hospitals and other healthcare facilities to provide physician services, which include (i) fee-for-service In addition to its national physician network, the Company also provides services nationwide to healthcare providers, including its own, through complementary businesses including a management services organization specializing in full-service revenue cycle management and a consulting services company. |
Summary of Significant Accounti
Summary of Significant Accounting Policies | 12 Months Ended |
Dec. 31, 2018 | |
Accounting Policies [Abstract] | |
Summary of Significant Accounting Policies | 2. Summary of Significant Accounting Policies: Principles of Presentation The consolidated financial statements include all the accounts of the Company and its subsidiaries combined with the accounts of the affiliated professional contractors with which the Company currently has specific management arrangements. The Company’s agreements with affiliated professional contractors provide that the term of the arrangements are in most cases permanent, subject only to termination by the Company, except in the case of gross negligence, fraud or bankruptcy of the Company. The Company has the right to receive income, both as ongoing fees and as proceeds from the sale of its interest in the Company’s affiliated professional contractors, in an amount that fluctuates based on the performance of the affiliated professional contractors and the change in the fair value of the Company’s interest in the affiliated professional contractors. The Company has exclusive responsibility for the provision of all non-medical day-to-day 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. 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 the Company’s 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. 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 became 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 has accumulated all of the necessary information required to properly account for leases under the new guidance. The Company has implemented a cloud-based software application, inclusive of a lease administration module and an accounting module. The Company is in the process of finalizing workflows, business processes and internal controls surrounding the new lease accounting process in order to meet the reporting and disclosure requirements. Accounting Estimates and Assumptions The preparation of financial statements in conformity with accounting principles generally accepted in the United States (“GAAP”) requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the reporting periods. Significant estimates and assumptions are involved in the calculation of the Company’s allowance for contractual adjustments and uncollectibles on accounts receivable, liabilities for self-insured amounts and claims incurred but not reported related to the Company’s professional liability risks and the fair value of goodwill. Actual results could differ from those estimates. Segment Reporting The results of the Company’s operations are aggregated into a single reportable segment for purposes of presenting financial information in accordance with the accounting guidance for segment reporting. The following table summarizes the Company’s net revenue by service line (in percentages): Years Ended December 31, 2018 2017 2016 Neonatology and other pediatric subspecialties 36 % 37 % 39 % Anesthesiology 35 % 38 % 39 % Radiology 12 % 8 % 6 % Maternal-fetal medicine 8 % 8 % 8 % Management services 6 % 6 % 5 % Pediatric cardiology 3 % 3 % 3 % 100 % 100 % 100 % Revenue Recognition Patient service revenue is recognized at the time services are provided by the Company’s affiliated physicians. The Company’s performance obligations related to the delivery of services to patients are satisfied at the time of service. Accordingly, there are no performance obligations that are unsatisfied or partially unsatisfied at the end of the reporting period with respect to patient service revenue. Almost all of the Company’s patient service revenue is reimbursed by GHC Programs and third-party insurance payors. Payments for services rendered to the Company’s patients are generally less than billed charges. The Company monitors its revenue and receivables from these sources and records an estimated contractual allowance to properly account for the anticipated differences between billed and reimbursed amounts. Accordingly, patient service revenue is presented net of an estimated provision for contractual adjustments and uncollectibles. The Company estimates allowances for contractual adjustments and uncollectibles on accounts receivable based upon historical experience and other factors, including days sales outstanding (“DSO”) for accounts receivable, evaluation of expected adjustments and delinquency rates, past adjustments and collection experience in relation to amounts billed, an aging of accounts receivable, current contract and reimbursement terms, changes in payor mix and other relevant information. Contractual adjustments result from the difference between the physician rates for services performed and the reimbursements by GHC Programs and third-party insurance payors for such services. Collection of patient service revenue the Company expects to receive is normally a function of providing complete and correct billing information to the GHC Programs and third-party insurance payors within the various filing deadlines and typically occurs within 30 to 60 days of billing. Some of the Company’s hospital agreements require hospitals to pay the Company administrative fees. Some agreements provide for fees if the hospital does not generate sufficient patient volume in order to guarantee that the Company receives a specified minimum revenue level. The Company also receives fees from hospitals for administrative services performed by its affiliated physicians providing medical director or other services at the hospital. 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. Accounts receivable are primarily amounts due under fee-for-service Cash and Cash Equivalents Cash equivalents are defined as all highly liquid financial instruments with maturities of 90 days or less from the date of purchase. The Company’s cash equivalents typically consist of demand deposits, amounts on deposit in money market accounts, and funds invested in overnight repurchase agreements. Cash equivalent balances may, at certain times, exceed federally insured limits. Certain cash equivalents carried by the Company are subject to the fair value provisions of the accounting guidance for fair value measurements. See “Fair Value Measurements” below. Restricted Cash Restricted cash consists of funds in escrow related to a potential future payment for contingent consideration for an acquisition completed in 2017. Investments 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 five 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 securities. Property and Equipment Property and equipment are recorded at original purchase cost. Depreciation of property and equipment is computed using the straight-line method over the estimated useful lives of the underlying assets. Estimated useful lives are generally 30 years for buildings; three to seven years for medical equipment, computer equipment, software and furniture; and the lesser of the useful life or the remaining lease term for leasehold improvements and capital leases. Upon sale or retirement of property and equipment, the related cost and accumulated depreciation are eliminated from the respective accounts and any resulting gain or loss is included in earnings. Business Acquisitions The Company accounts for all business acquisitions at fair value and expenses acquisition costs as they are incurred. Any identifiable assets acquired and liabilities assumed are recognized and measured at their respective fair values on the acquisition date. If information about facts and circumstances existing as of the acquisition date is incomplete at the end of the reporting period in which a business acquisition occurs, the Company will report provisional amounts for the items for which the accounting is incomplete. The measurement period ends once the Company receives sufficient information to finalize the fair values; however, the period will not exceed one year from the acquisition date. Any adjustments to provisional amounts that are identified during the measurement period are recognized in the reporting period in which the adjustment amounts are determined. In connection with certain acquisitions, the Company enters into agreements to pay additional amounts in cash or common stock based on the achievement of certain performance measures for up to five years ending after the acquisition dates. The Company measures this contingent consideration at fair value at the acquisition date and records such contingent consideration as a liability or equity on the Company’s Consolidated Balance Sheets on the acquisition date. The fair value of each contingent consideration liability is remeasured at each reporting period with any change in fair value recognized as income or expense within operations in the Company’s Consolidated Statements of Income. See Note 6 for more information on the Company’s business acquisitions. Goodwill and Other Intangible Assets The Company records acquired assets and assumed liabilities at their respective fair values under the acquisition method of accounting. Goodwill represents the excess of purchase price over the fair value of the net assets acquired. Intangible assets with finite lives, principally physician and hospital agreements, customer relationships, patented technology and trade names, are recognized apart from goodwill at the time of acquisition based on the contractual-legal and separability criteria established in the accounting guidance. Intangible assets with finite lives are amortized on either an accelerated basis based on the annual undiscounted economic cash flows associated with the particular intangible asset or on a straight-line basis over their estimated useful lives. Intangible assets with finite lives are amortized over periods of one to 20 years. Goodwill is tested for impairment at a reporting unit level on at least an annual basis in accordance with the subsequent measurement provisions of the accounting guidance for goodwill. The Company defines a reporting unit based upon its management structure for services provided in specific regions of the United States. The Company early adopted new accounting guidance in 2017 that requires only a single-step quantitative test with any goodwill impairment measured as the amount by which a reporting unit’s carrying value exceeds its fair value. The Company uses income and market-based valuation approaches to determine the fair value of its reporting units. These approaches focus on discounted cash flows and market multiples based on the Company’s market capitalization to derive the fair value of a reporting unit. The Company also considers the economic outlook for the healthcare services industry and various other factors during the testing process, including hospital and physician contract changes, local market developments, changes in third-party payor payments, and other publicly available information. The Company completed annual impairment tests in the third quarter of each of 2018, 2017 and 2016 and determined that goodwill was not impaired in any of the three years. Long-Lived Assets The Company is required to evaluate long-lived assets, including intangible assets subject to amortization, whenever events or changes in circumstances indicate that the carrying value of the assets may not be fully recoverable. The recoverability of such assets is measured by a comparison of the carrying value of the assets to the future undiscounted cash flows before interest charges to be generated by the assets. If long-lived assets are impaired, the impairment to be recognized is measured as the excess of the carrying value over the fair value. Long-lived assets held for disposal are reported at the lower of the carrying value or fair value less disposal costs. The Company does not believe there are any indicators that would require an adjustment to such assets or their estimated periods of recovery at December 31, 2018 pursuant to current accounting standards. Common Stock Repurchases The Company repurchases shares of its common stock as authorized from time to time by its Board of Directors. The Company treats repurchased shares of its common stock as retired as any repurchased shares become authorized but unissued shares. The reacquisition cost of repurchased shares is recorded as a reduction in the respective components of shareholders’ equity. Professional Liability Coverage The Company maintains professional liability insurance policies with third-party insurers generally on a claims-made basis, subject to deductibles or self-insured retention, exclusions and other restrictions. The Company’s self-insured retention under its professional liability insurance program is maintained primarily through a wholly owned captive insurance subsidiary. The Company records an estimate of liabilities for self-insured amounts and claims incurred but not reported based on an actuarial valuation using historical loss information, claim emergence patterns and various actuarial assumptions. Liabilities for claims incurred but not reported are not discounted. Income Taxes The Company records deferred income taxes using the liability method, whereby deferred tax assets and liabilities are determined based on the difference between the financial statement and tax bases of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. If it is more likely than not that all or a portion of deferred tax assets will not be realized, a valuation allowance is provided against such deferred tax assets. In making such determination, the Company considers all available positive and negative evidence, including future reversals of existing taxable temporary differences, projected future taxable income, tax-planning The accounting guidance for uncertain tax positions prescribes a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The guidance also requires policy disclosures regarding penalties and interest and extensive disclosures regarding increases and decreases in uncertain tax positions as a result of tax positions taken in a current or prior period, settlements with taxing authorities and any lapse of an applicable statute of limitations. Additional qualitative discussion is required for any tax position that may result in a significant increase or decrease in uncertain tax positions within a 12-month Stock Incentive Plans The Company grants stock-based awards consisting primarily of restricted stock to key employees under its Amended and Restated 2008 Incentive Compensation Plan, as amended. The Company measures the cost of employee services received in exchange for stock-based awards based on grant-date fair value and allocates the resulting compensation expense over the corresponding requisite service period using the graded vesting attribution method. The Company also performs analyses to estimate forfeitures of stock-based awards on an annual basis and adjusts the estimates as necessary based on the number of awards that ultimately vest. Net Income Per Common Share Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the period. Diluted net income per common share is calculated by dividing net income by the weighted average number of common and potential common shares outstanding during the period. Potential common shares consist of outstanding restricted stock, deferred stock and stock options and is calculated using the treasury stock method. On January 1, 2017, the Company adopted new accounting guidance that no longer permits the Company to include the assumed excess tax benefits related to the potential exercise or vesting of its stock-based awards in the treasury stock method computation. 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 December 31, 2018 and 2017, the Company’s money market funds had a fair value of $0.5 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 December 31, 2018 and 2017, the Company’s cash surrender value of life insurance had a fair value of $10.5 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 December 31, 2018 and 2017, the Company’s contingent consideration liabilities had a fair value of $20.0 million and $30.5 million, respectively. See Note 6 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, variable rate long-term debt 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. See Note 10 for information regarding the fair value of the Company’s 5.25% senior unsecured notes due 2023 (the “2023 Notes”) and 6.25% senior unsecured notes due 2027 (the “2027 Notes”). |
Investments
Investments | 12 Months Ended |
Dec. 31, 2018 | |
Investments, Debt and Equity Securities [Abstract] | |
Investments | 3. Investments: Investments held are summarized as follows (in thousands): December 31, 2018 December 31, 2017 Short-Term Long-Term Short-Term Long-Term Municipal debt securities $ 18,473 $ 30,841 $ 8,312 $ 46,195 Federal home loan securities 2,000 34,393 1,000 30,322 Certificates of deposit 1,450 4,465 980 4,165 $ 21,923 $ 69,699 $ 10,292 $ 80,682 Contractual maturities of long-term investments are summarized as follows (in thousands): December 31, 2018 2017 Due after one year through five years $ 69,699 $ 78,561 Due after five years through six years — 2,121 $ 69,699 $ 80,682 |
Accounts Receivable and Net Rev
Accounts Receivable and Net Revenue | 12 Months Ended |
Dec. 31, 2018 | |
Text Block [Abstract] | |
Accounts Receivable and Net Revenue | 4. Accounts Receivable and Net Revenue: Accounts receivable, net consists of the following (in thousands): December 31, 2018 2017 Gross accounts receivable $ 2,031,341 $ 1,790,034 Allowance for contractual adjustments and uncollectibles (1,489,069 ) (1,286,035 ) $ 542,272 $ 503,999 Net revenue consists of the following (in thousands): Years Ended December 31, 2018 2017 2016 Net patient service revenue $ 3,067,784 $ 2,915,648 $ 2,760,192 Hospital contract administrative fees 363,369 315,778 271,886 Management services and other 215,970 226,886 151,081 $ 3,647,123 $ 3,458,312 $ 3,183,159 The following is a summary of our payor mix, expressed as a percentage of net revenue, exclusive of administrative fees and revenue related to management services and other, for the periods indicated: Years Ended December 31, 2018 2017 2016 Contracted managed care 70 % 70 % 70 % Government 24 % 25 % 23 % Other third-parties 4 % 4 % 6 % Private-pay 2 % 1 % 1 % 100 % 100 % 100 % Accounts receivable of $542.3 million and $504.0 million at December 31, 2018 and 2017, respectively, consist primarily of amounts due from GHC Programs and third-party insurance payors for services provided by the Company’s affiliated physicians. Net revenue of $3.6 billion, $3.5 billion and $3.2 billion for the years ended December 31, 2018, 2017 and 2016, respectively, consists primarily of gross billed charges for services provided by the Company’s affiliated physicians less an estimated allowance for contractual adjustments and uncollectibles to properly account for the anticipated differences between gross billed charge amounts and expected reimbursement amounts. The Company’s contractual adjustments and uncollectibles as a percentage of gross patient service revenue vary slightly each year depending on several factors, including improved managed care contracting, changes in reimbursement from state Medicaid programs and other GHC Programs, shifts in the percentage of patient services being reimbursed under GHC Programs and annual price increases. The Company’s annual price increases typically increase contractual adjustments as a percentage of gross patient service revenue. This increase is primarily due to Medicaid, Medicare and other GHC Programs that generally provide for reimbursements on a fee-schedule 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. |
Property and Equipment
Property and Equipment | 12 Months Ended |
Dec. 31, 2018 | |
Property, Plant and Equipment [Abstract] | |
Property and Equipment | 5. Property and Equipment: Property and equipment consists of the following (in thousands): December 31, 2018 2017 Building $ 33,189 $ 33,024 Land 6,683 6,683 Equipment and other 300,981 253,453 340,853 293,160 Accumulated depreciation (207,816 ) (169,624 ) $ 133,037 $ 123,536 At December 31, 2018 and 2017, property and equipment includes medical and other equipment held under capital leases of $4.8 million and $6.1 million, and related accumulated depreciation of $4.0 million and $4.6 million, respectively. The Company recorded depreciation expense of $38.5 million, $33.9 million and $29.0 million for the years ended December 31, 2018, 2017 and 2016, respectively. |
Business Acquisitions
Business Acquisitions | 12 Months Ended |
Dec. 31, 2018 | |
Business Combinations [Abstract] | |
Business Acquisitions | 6. Business Acquisitions: During the year ended December 31, 2018, the Company completed nine physician group practice acquisitions, including five radiology practices, two neonatology practices and two other pediatric subspecialty practices. The acquisition-date fair value of the total consideration for the nine acquisitions was $111.8 million, net of cash acquired. In connection with these acquisitions, the Company recorded goodwill of $95.0 million, other intangible assets consisting primarily of physician and hospital agreements of $17.2 million, current assets of $1.7 million and other liabilities of $2.1 million. These acquisitions expanded the Company’s national network of physician practices. The Company expects to improve the results of physician practices through improved managed care contracting, improved collections and identification of growth initiatives, as well as operating and cost savings based on the significant infrastructure it has developed. With respect to the Company’s acquisition of radiology physician practices, the Company believes that it brings a unique value proposition to radiology physician groups, in that the Company can provide practice management support and a technology platform enabling radiology to be practiced at a national level, as well as teleradiology capabilities that can enhance a physician group’s efficiency, provide subspecialty access and help them to grow strategically and remain competitive while meeting the demands of their hospital partners, third-party payors and regulatory bodies. In addition, the Company believes that radiology physician group practice physicians can complement the staffing needs for its teleradiology services business during certain times, such as nights and weekends, when such physicians are not providing services at their practices. During the year ended December 31, 2018, in connection with certain prior-period acquisitions, the Company paid $6.4 million for contingent consideration and $1.2 million for purchase consideration that had been held back pending satisfaction of certain conditions. Of these amounts, all except for the accretion recorded during 2018 were accrued as of December 31, 2017. In addition, the Company recorded a decrease of $5.3 million related to the change in the fair value of a contingent consideration agreement for which the probability of the achievement of certain performance measures was updated. This change in fair value of contingent consideration was recorded within operating expenses. In connection with certain prior-period acquisitions, the Company also recorded a net increase in goodwill of $4.0 million composed of a decrease in current assets of $1.2 million, a decrease in noncurrent assets of $1.5 million and a decrease in liabilities of $0.2 million for measurement-period adjustments resulting from the finalization of acquisition accounting as well as additional cash consideration of $1.5 million related to a working capital true up. 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. On November 1, 2018, the Company announced the initiation of a process to potentially divest the Company’s management services service line to allow the Company to focus the organization on its core physician services business. There can be no assurance that this process will result in a transaction, and the Company may decide to retain all or part of the management services service line. The Company had expected that the management services service line could be classified as assets and liabilities held for sale within the Company’s Consolidated Balance Sheets and that historical operating results of the service line could be reported as discontinued operations in the Company’s Consolidated Statements of Income for the year ended December 31, 2018; however, the criteria for such classification was not met at December 31, 2018. The management services service line continues to be classified as held and used as of December 31, 2018. During the year ended December 31, 2017, the Company completed 10 physician group practice acquisitions, including four radiology practices, two maternal-fetal medicine practices, one neonatology practice, one pediatric multi-specialty practice and two other pediatric subspecialty practices. On March 31, 2017, the Company sold its 75% economic interest in a joint venture that was previously consolidated. The deconsolidation and removal of 100% of the carrying value of the joint venture’s net assets resulted in a gain on sale that was not material. |
Goodwill and Intangible Assets
Goodwill and Intangible Assets | 12 Months Ended |
Dec. 31, 2018 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Goodwill and Intangible Assets | 7. Goodwill and Intangible Assets: Goodwill was $4.4 billion and $4.3 billion at December 31, 2018 and 2017, respectively. The change in the carrying amount of goodwill of $99.0 million during the year ended December 31, 2018 is primarily related to the Company’s 2018 acquisitions. The Company expects that $63.0 million of the goodwill recorded during the year ended December 31, 2018 will be deductible for tax purposes. 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 December 31, 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. Intangible assets, net, consist of the following (in thousands): December 31, 2018 Gross Accumulated Net Physician and hospital agreements $ 376,871 $ (223,589) $ 153,282 Customer relationships 443,300 (71,870 ) 371,430 Trade names 43,156 (4,630 ) 38,526 Patented and other technology 47,561 (22,487 ) 25,074 $ 910,888 $ (322,576) $ 588,312 December 31, 2017 Gross Accumulated Net Physician and hospital agreements $ 381,635 $ (203,915) $ 177,720 Customer relationships 443,300 (48,837 ) 394,463 Trade names 43,156 (2,933 ) 40,223 Patented and other technology 38,590 (11,068 ) 27,522 $ 906,681 $ (266,753) $ 639,928 During the year ended December 31, 2018, the Company recorded intangible assets related to acquisitions totaling $17.2 million, consisting primarily of physician and hospital agreements. The weighted-average amortization period for these physician and hospital agreements is approximately nine years. Amortization expense for intangible assets was $72.8 million, $68.9 million and $60.3 million for the years ended December 31, 2018, 2017 and 2016, respectively. Amortization expense for existing intangible assets for the next five years is expected to be as follows (in thousands): 2019 $ 66,532 2020 59,969 2021 53,771 2022 46,249 2023 40,448 |
Accounts Payable and Accrued Ex
Accounts Payable and Accrued Expenses | 12 Months Ended |
Dec. 31, 2018 | |
Payables and Accruals [Abstract] | |
Accounts Payable and Accrued Expenses | 8. Accounts Payable and Accrued Expenses: Accounts payable and accrued expenses consist of the following (in thousands): December 31, 2018 2017 Accounts payable $ 31,059 $ 34,632 Accrued salaries and bonuses 249,834 225,429 Accrued payroll taxes and benefits 80,369 75,672 Accrued professional liabilities 34,931 37,912 Accrued contingent consideration 18,760 6,259 Accrued interest 9,477 4,495 Other accrued expenses 44,912 53,618 $ 469,342 $ 438,017 |
Accrued Professional Liabilitie
Accrued Professional Liabilities | 12 Months Ended |
Dec. 31, 2018 | |
Health Care Organizations [Abstract] | |
Accrued Professional Liabilities | 9. Accrued Professional Liabilities: At December 31, 2018 and 2017, the Company’s total accrued professional liabilities of $244.0 million and $250.2 million, respectively, included incurred but not reported loss reserves of $139.1 million and $138.5 million, respectively, and loss reserves for reported claims of $104.9 million and $111.7 million, respectively. Of the total liability, $34.9 million is classified as a current liability within accounts payable and accrued expenses in the Consolidated Balance Sheet. In addition, there is a corresponding insurance receivable of $16.7 million recorded as a component of other assets for certain professional liability claims that are covered by third-party insurance policies. The activity related to the Company’s total accrued professional liability for the years ended December 31, 2018, 2017 and 2016 is as follows (in thousands): Years Ended December 31, 2018 2017 2016 Balance at beginning of year $ 250,187 $ 202,052 $ 202,527 Assumed liabilities through acquisition 1,276 20,716 — Provision (adjustment) for losses related to: Current year 34,483 41,291 38,129 Prior years 10,299 9,983 (25,428 ) Total provision for losses 44,782 51,274 12,701 Claim payments related to: Current year (555 ) (712 ) (766 ) Prior years (51,699 ) (23,143 ) (12,410 ) Total payments (52,254 ) (23,855 ) (13,176 ) Balance at end of year $ 243,991 $ 250,187 $ 202,052 The net decrease in the Company’s total accrued professional liability for the year ended December 31, 2018 was primarily related to an increase in claims payments made in the current year, partially offset by overall unfavorable trends in the Company’s claims experience that impacted its provision for losses. The net increase in the Company’s total accrued professional liability for the year ended December 31, 2017 was primarily related to overall unfavorable trends in the Company’s claims experience that impacted its provision for losses and growth in the program from acquisitions. |
Line of Credit, Long-Term Debt
Line of Credit, Long-Term Debt and Capital Lease Obligations | 12 Months Ended |
Dec. 31, 2018 | |
Debt Disclosure [Abstract] | |
Line of Credit, Long-Term Debt and Capital Lease Obligations | 10. Line of Credit, Long-Term Debt and Capital Lease Obligations: The Company’s Credit Agreement provides for a $2.0 billion unsecured revolving credit facility and includes a $37.5 million sub-facility The Credit Agreement contains customary covenants and restrictions, including covenants that require the Company to maintain a minimum interest charge ratio, not to exceed a specified consolidated leverage ratio and to comply with laws, and restrictions on the ability of the Company to pay dividends and make certain other distributions, as specified therein. Failure to comply with these covenants would constitute an event of default under the Credit Agreement, notwithstanding the ability of the Company to meet its debt service obligations. The Credit Agreement also includes various customary remedies for the lenders following an event of default, including the acceleration of repayment of outstanding amounts under the Credit Agreement. In December 2015, the Company completed a private offering of $750.0 million aggregate principal amount of 2023 Notes. In November 2018, the Company completed a private offering of $500.0 million aggregate principal amount of 2027 Notes. The Company’s obligations under the 2023 Notes and the 2027 Notes are guaranteed on an unsecured senior basis by the same subsidiaries and affiliated professional contractors that guarantee the Credit Agreement. Interest on the 2023 Notes accrues at the rate of 5.25% per annum and is payable semi-annually in arrears on June 1 and December 1. Interest on the 2027 Notes accrues at the rate of 6.25% per annum and is payable semi-annually in arrears on January 15 and July 15, with the initial interest payment due on January 15, 2019. As of December 31, 2018, the Company may redeem all or a portion of the 2023 Notes, at the redemption prices of 102.625% in 2019, 101.313% in 2020 and 100% in 2021 and thereafter, plus accrued and unpaid interest to the redemption date. At any time prior to January 15, 2022, the Company may redeem all or a portion of the 2027 Notes at a redemption price equal to 100% of the principal amount of the notes being redeemed plus an applicable redemption premium and accrued and unpaid interest to the redemption date. In addition, at any time prior to January 15, 2022, the Company may redeem up to 35% of the aggregate principal amount of the 2027 Notes at a redemption price of 106.250% of the principal amount thereof, plus accrued and unpaid interest, if any, to the redemption date, using proceeds from one or more equity offerings. On or after January 15, 2022, the Company may redeem all or a portion of the 2027 Notes, at the redemption prices of 104.688% in 2022, 103.125% in 2023, 101.563% in 2024 and 100% in 2025 and thereafter, plus accrued and unpaid interest to the redemption date. The indenture under which the 2023 Notes and the 2027 Notes are issued, among other things, limits our ability to (1) incur liens and (2) enter into sale and lease-back transactions, and also limits our ability to merge or dispose of all or substantially all of our assets, in all cases, subject to a number of customary exceptions. Although we are not required to make mandatory redemption or sinking fund payments with respect to the 2023 Notes or the 2027 Notes, upon the occurrence of a change in control of MEDNAX, we may be required to repurchase the 2023 Notes or the 2027 Notes at a purchase price equal to 101% of the aggregate principal amount of the 2023 Notes and the 2027 Notes repurchased plus accrued and unpaid interest. The carrying value of the Company’s long-term debt was $2.0 billion and $1.8 billion at December 31, 2018 and 2017, respectively, and consisted of the following (in thousands): December 31, 2018 Principal Unamortized Total Senior Notes $ 1,250,000 $ (15,408 ) $ 1,234,592 Revolving line of credit 739,500 (4,274 ) 735,226 Total $ 1,989,500 $ (19,682 ) $ 1,969,818 December 31, 2017 Principal Unamortized Total Senior Notes $ 750,000 $ (9,503 ) $ 740,497 Revolving line of credit 1,110,500 (4,864 ) 1,105,636 Total $ 1,860,500 $ (14,367 ) $ 1,846,133 The Company presents issuance costs related to long-term debt liabilities, other than revolving credit arrangements, as a direct deduction from the carrying value of that long-term debt. The Company has outstanding letters of credit which reduced the amount available under the Credit Agreement by $0.2 million at December 31, 2018. At December 31, 2018, the Company had an available balance on its Credit Agreement of $1.3 billion. The carrying values of the Company’s variable rate revolving line of credit approximates fair value due to the short-term nature of the interest rates. The estimated fair value of the Company’s 2023 Notes and 2027 Notes were estimated using trading prices as of December 31, 2018 and 2017, respectively, as Level 2 inputs to estimate fair value and are summarized as follows (in thousands): December 31, 2018 2017 2023 Notes $ 736,725 $ 763,125 2027 Notes 482,500 — The Company’s capital lease obligations consist of the following (in thousands): December 31, 2018 2017 Capital lease obligations $ 441 $ 1,826 Less: Current portion (253 ) (1,401 ) Long-term portion $ 188 $ 425 The amounts due under the terms of the Company’s capital lease obligations at December 31, 2018 are as follows: 2019 $ 253 2020 114 2021 74 |
Income Taxes
Income Taxes | 12 Months Ended |
Dec. 31, 2018 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | 11. Income Taxes: The components of the income tax provision (benefit) are as follows (in thousands): December 31, 2018 2017 2016 Federal: Current $ 97,754 $ 130,053 $ 166,758 Deferred (20,176 ) (63,038 ) 15,596 77,578 67,015 182,354 State: Current 26,605 20,070 4,296 Deferred (3,973 ) 2,965 2,553 22,632 23,035 6,849 Total $ 100,210 $ 90,050 $ 189,203 The Company files its tax return on a consolidated basis with its subsidiaries, and its affiliated professional contractors file tax returns on an individual basis. Beginning on January 1, 2018, the Company’s statutory tax rate was reduced from 35.0% to 21.0% as a result of legislation enacted under the Tax Cuts and Jobs Act of 2017 (“TCJA”). The effective tax rate was 27.2%, 21.9% and 36.8% for the years ended December 31, 2018, 2017 and 2016, respectively. During the three months ended December 31, 2017, the Company recorded a $70.0 million income tax benefit related to the reduction of its net deferred tax liability resulting from the reduction in the corporate tax rate under the TCJA. 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 effective income tax rate was favorably impacted by $10.6 million. The differences between the effective rate and the United States federal income tax statutory rate are as follows: December 31, 2018 2017 2016 Tax at statutory rate 21.00 % 35.00 % 35.00 % State income tax, net of federal benefit 4.80 3.33 2.94 Non-deductible 0.44 0.49 0.43 Change in accrual estimates relating to uncertain tax positions 0.05 0.02 (2.11 ) Change in valuation allowance — — 0.48 Other, net 1.20 0.16 0.06 Change in tax law (0.32 ) (17.06 ) — Income tax provision 27.17 % 21.94 % 36.80 % All of the Company’s deferred tax assets and liabilities are classified as long-term. The significant components of deferred income tax assets and liabilities are as follows (in thousands): December 31, 2018 2017 Allowance for uncollectible accounts $ 194,876 $ 80,056 Reserves and accruals 59,270 45,454 Stock-based compensation 9,201 7,975 Net operating loss carryforward 25,226 28,569 Property and equipment 26 685 Other 1,197 970 Deferred tax assets before valuation allowance 289,796 163,709 Less: Valuation allowance (2,628 ) (2,615 ) Deferred tax assets, net of valuation allowance 287,168 161,094 Gross deferred tax liabilities: Amortization (286,552 ) (258,618 ) Accounting method changes (109,418 ) (4,150 ) Accrual to cash adjustment (39 ) (31,290 ) Other (489 ) — Total deferred tax liabilities (396,498 ) (294,058 ) Net deferred tax liability $ (109,330 ) $ (132,964 ) The Company’s net deferred tax liability decreased by $23.6 million during 2018. During 2018, certain of the Company’s affiliated professional contractors elected to change their method of accounting from cash basis to accrual basis for income tax purposes. During the year ended December 31, 2018, the increases in allowance for uncollectible accounts of $114.8 million and accounting method changes of $105.3 million as well as the decrease in accrual to cash adjustment of $31.3 million primarily relate to these accounting method changes. Beginning January 1, 2017, excess tax benefits or deficiencies associated with the exercise of stock options, the vesting of restricted and deferred stock and the purchase of shares under the Company’s non-qualified paid-in-capital. paid-in-capital The Company has net operating loss carryforwards for federal and state tax purposes totaling $101.9 million, $116.0 million and $130.0 million at December 31, 2018, 2017 and 2016, respectively. With respect to the December 31, 2018 balance, approximately $74.3 million expires at various times from 2019 through 2038, and $27.6 million does not expire. As of December 31, 2018, 2017 and 2016, the Company’s liability for uncertain tax positions, excluding accrued interest and penalties, was $11.2 million, $11.0 million and $9.5 million, respectively. As of December 31, 2018, the Company had $10.9 million of uncertain tax positions that, if recognized, would favorably impact its effective tax rate. The following table summarizes the activity related to the Company’s liability for uncertain tax positions for the years ended December 31, 2018, 2017 and 2016 (in thousands): Years Ended December 31, 2018 2017 2016 Balance at beginning of year $ 10,972 $ 9,469 $ 18,447 Increases related to prior year tax positions 385 2,284 301 Decreases related to prior year tax positions — (143 ) (3,927 ) Increases related to current year tax positions 2,900 1,430 2,258 Settlements — — (5,644 ) Decreases related to lapse of statutes of limitation (3,072 ) (2,068 ) (1,966 ) Balance at end of year $ 11,185 $ 10,972 $ 9,469 During the years ended December 31, 2018 and 2017, the Company increased its liability for uncertain tax positions by a total of $0.2 million and $1.5 million, respectively, primarily related to additional taxes on current and prior year positions, partially offset by the expiration of statutes of limitation. In addition, the Company anticipates that its liability for uncertain tax positions will increase by $0.2 million over the next 12 months. The Company includes interest and penalties related to income tax liabilities in income tax expense. The income tax benefit recognized by the Company for interest and penalties during the year ended December 31, 2018 was nominal. The Company recognized income tax benefits of $0.2 million and $7.9 million related to interest and penalties during the years ended December 31, 2017 and 2016, respectively. At December 31, 2018 and 2017, the Company’s accrued liability for interest and penalties related to income tax liabilities totaled $1.1 million and $1.2 million, respectively. The Company is currently subject to U.S. Federal and various state income tax examinations for the tax years 2014 through 2017. |
Common and Common Equivalent Sh
Common and Common Equivalent Shares | 12 Months Ended |
Dec. 31, 2018 | |
Earnings Per Share [Abstract] | |
Common and Common Equivalent Shares | 12. Common and Common Equivalent Shares: The calculation of shares used in the basic and diluted net income per share calculation for the years ended December 31, 2018, 2017 and 2016 is as follows (in thousands): Years Ended December 31, 2018 2017 2016 Weighted average number of common shares outstanding 91,104 92,431 92,422 Weighted average number of dilutive common share equivalents 502 527 687 Weighted average number of common and common equivalent shares outstanding 91,606 92,958 93,109 Antidilutive securities not included in the diluted net income per common share calculation 214 107 2 |
Stock Incentive Plans and Stock
Stock Incentive Plans and Stock Purchase Plans | 12 Months Ended |
Dec. 31, 2018 | |
Disclosure of Compensation Related Costs, Share-based Payments [Abstract] | |
Stock Incentive Plans and Stock Purchase Plans | 13. 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 or service-based conditions. The Company recognizes compensation expense related to its restricted stock and deferred stock awards ratably over the corresponding vesting periods. At December 31, 2018, the Company had 2.0 million shares available for future grants and awards under its Amended and Restated 2008 Incentive Plan. Under the Company’s 1996 Non-Qualified Non-Qualified non-employee Each of the ESPP and the SPP provide for the issuance of an of aggregate 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 The Company recognized $38.7 million, $29.6 million and $34.0 million of stock-based compensation expense related to its stock incentive plans, the ESPP and the SPP during the years ended December 31, 2018, 2017 and 2016, respectively. The activity related to the Company’s restricted stock and deferred stock awards and the corresponding weighted average grant-date fair values for the year ended December 31, 2018 are as follows: Number of Shares Weighted Non-vested 1,041,034 $ 60.21 Awarded 770,480 $ 51.99 Forfeited (69,293 ) $ 56.65 Vested (431,368 ) $ 63.57 Non-vested 1,310,853 $ 54.46 The aggregate fair value of the restricted and deferred stock that vested during the years ended December 31, 2018, 2017 and 2016 was $27.4 million, $29.3 million and $29.8 million, respectively. The weighted average grant-date fair value of restricted and deferred stock awards that were granted during the years ended December 31, 2018, 2017 and 2016 was $51.99, $54.22 and $67.90, respectively. At December 31, 2018, the total stock-based compensation cost related to non-vested The Company did not grant any stock options in 2018, 2017, or 2016, and all stock-based compensation cost related to stock options has been recognized. The activity and certain other information related to the Company’s outstanding stock option awards for the year ended December 31, 2018 are as follows: Number of Stock Options Weighted Average Exercise Price Weighted (in years) Aggregate Value (in Outstanding at January 1, 2018 246,342 $ 27.51 Exercised (133,366 ) $ 27.38 $ 2.8 Outstanding and exercisable at December 31, 2018 112,976 $ 27.65 1.3 $ 0.7 The aggregate intrinsic value of stock options exercised during the years ended December 31, 2018, 2017 and 2016 was $2.8 million, $5.5 million and $6.8 million, respectively. There were no excess tax benefits recognized in additional paid-in paid-in |
Common Stock Repurchase Program
Common Stock Repurchase Programs | 12 Months Ended |
Dec. 31, 2018 | |
Text Block [Abstract] | |
Common Stock Repurchase Programs | 14. Common Stock Repurchase Programs: In July 2013, the Company’s Board of Directors authorized the repurchase of shares of the Company’s common stock up to an amount sufficient to offset the dilutive impact from the issuance of shares under the Company’s equity compensation programs. The share repurchase program allows the Company to make open market purchases from time-to-time In August 2018, the Company announced that its Board of Directors had authorized the repurchase of up to $500.0 million of the Company’s common stock in addition to its existing share repurchase program. As part of this repurchase program, on August 31, 2018, the Company entered into an uncollared accelerated share repurchase (“ASR”) agreement with an investment bank. Under the ASR agreement, the Company agreed to purchase $250.0 million of its common stock in total. On September 4, 2018, the Company paid a total of $250.0 million to the investment bank, which in turn delivered to the Company approximately 4.2 million shares of the Company’s common stock in total based on the market price of a share of Company common stock on August 31, 2018. The payment was recorded as a reduction to the respective components of shareholders’ equity. The ASR agreement was funded by borrowings under the Company’s Credit Agreement discussed in Note 10. Final settlement of the ASR occurred in December 2018 with the delivery to the Company of approximately 1.7 million additional shares of common stock. The final number of shares of common stock that the Company received was based upon the average daily volume weighted-average price of the Company’s common stock during the term of the ASR agreement, less a negotiated discount. Under the share repurchase programs described above, the Company repurchased approximately 7.0 million shares of its common stock for approximately $302.2 million during the year ended December 31, 2018, inclusive of 54,909 shares withheld to satisfy minimum statutory withholding obligations of $2.5 million in connection with the vesting of restricted stock and exercises of stock options during the second quarter of 2018. During the year ended December 31, 2017, the Company repurchased 1.0 million shares of its common stock for $70.2 million, inclusive of 38,257 shares withheld to satisfy minimum statutory withholding obligations of $2.1 million in connection with the vesting of restricted stock. The Company intends to utilize various methods to effect any future share repurchases, including, among others, open market purchases and accelerated share repurchase programs. The amount and timing of repurchases will depend upon several factors, including general economic and market conditions and trading restrictions. |
Retirement Plans
Retirement Plans | 12 Months Ended |
Dec. 31, 2018 | |
Retirement Benefits [Abstract] | |
Retirement Plans | 15. Retirement Plans: The Company maintains six qualified contributory savings plans as allowed under Section 401(k) of the Internal Revenue Code and Section 1165(e) of the Puerto Rico Income Tax Act of 1954 (the “401(k) Plans”). The 401(k) Plans permit participant contributions and allow elective and, in certain situations, non-elective |
Commitments and Contingencies
Commitments and Contingencies | 12 Months Ended |
Dec. 31, 2018 | |
Commitments and Contingencies Disclosure [Abstract] | |
Commitments and Contingencies | 16. Commitments and Contingencies: The Company expects that audits, inquiries and investigations from government authorities and agencies will occur in the ordinary course of business. Such audits, inquiries and investigations and their ultimate resolutions, individually or in the aggregate, could have a material adverse effect on the Company’s business, financial condition, results of operations, cash flows and the trading price of its securities. The Company has not included an accrual for these matters as of December 31, 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. The Company leases space for its regional, medical and business offices, storage space and temporary housing of medical staff. The Company also leases an aircraft. Rent expense for the years ended December 31, 2018, 2017 and 2016 was $42.9 million, $42.6 million and $38.0 million, respectively. Future minimum lease payments under non-cancelable 2019 $ 30,824 2020 22,038 2021 17,946 2022 12,708 2023 9,440 Thereafter 10,522 $ 103,478 |
Selected Quarterly Financial In
Selected Quarterly Financial Information | 12 Months Ended |
Dec. 31, 2018 | |
Quarterly Financial Information Disclosure [Abstract] | |
Selected Quarterly Financial Information | 17. Selected Quarterly Financial Information (Unaudited): The following tables set forth a summary of the Company’s selected quarterly financial information for each of the four quarters ended December 31, 2018 and 2017 (in thousands, except for per share data): 2018 Quarters First Second Third Fourth Net revenue $ 901,857 $ 915,918 $ 896,652 $ 932,696 Operating expenses: Practice salaries and benefits 631,830 620,980 625,717 657,061 Practice supplies and other operating expenses 30,655 31,833 30,159 29,381 General and administrative expenses 108,776 107,908 102,905 112,789 Depreciation and amortization 26,163 26,518 28,709 29,891 Total operating expenses 797,424 787,239 787,490 829,122 Income from operations 104,433 128,679 109,162 103,574 Investment and other income 1,464 1,202 1,302 967 Interest expense (19,935 ) (21,604 ) (21,782 ) (25,448 ) Equity in earnings of unconsolidated affiliates 1,525 1,257 1,766 2,277 Total non-operating (16,946 ) (19,145 ) (18,714 ) (22,204 ) Income before income taxes 87,487 109,534 90,448 81,370 Income tax provision (24,059 ) (30,122 ) (24,873 ) (21,156 ) Net income $ 63,428 $ 79,412 $ 65,575 $ 60,214 Per common and common equivalent share data (1): Net income: Basic $ 0.68 $ 0.85 $ 0.72 $ 0.69 Diluted $ 0.68 $ 0.85 $ 0.72 $ 0.68 Weighted average common shares: Basic 92,859 92,987 90,984 87,810 Diluted 93,505 93,529 91,359 88,258 (1) Basic and diluted per share amounts are computed for each of the periods presented. Accordingly, the sum of the quarterly per share amounts may not agree with the full year amount. 2017 Quarters First Second Third Fourth Net revenue $ 835,597 $ 842,944 $ 868,951 $ 910,820 Operating expenses: Practice salaries and benefits 572,385 561,418 586,476 617,455 Practice supplies and other operating expenses 27,796 30,872 29,497 32,353 General and administrative expenses 103,765 103,015 101,430 108,895 Depreciation and amortization 25,614 25,735 25,116 26,414 Total operating expenses 729,560 721,040 742,519 785,117 Income from operations 106,037 121,904 126,432 125,703 Investment and other income 576 365 235 2,777 Interest expense (17,752 ) (18,535 ) (18,428 ) (19,844 ) Equity (loss) in earnings of unconsolidated affiliate 797 689 (240 ) (294 ) Total non-operating (16,379 ) (17,481 ) (18,433 ) (17,361 ) Income before income taxes 89,658 104,423 107,999 108,342 Income tax (provision) benefit (34,967 ) (40,725 ) (42,119 ) 27,761 Net income $ 54,691 $ 63,698 $ 65,880 $ 136,103 Per common and common equivalent share data (2): Net income: Basic $ 0.59 $ 0.69 $ 0.71 $ 1.47 Diluted $ 0.59 $ 0.69 $ 0.71 $ 1.46 Weighted average common shares: Basic 92,360 92,181 92,589 92,756 Diluted 93,143 92,812 92,881 93,159 (2) Basic and diluted per share amounts are computed for each of the periods presented. Accordingly, the sum of the quarterly per share amounts may not agree with the full year amount. |
Summary of Significant Accoun_2
Summary of Significant Accounting Policies (Policies) | 12 Months Ended |
Dec. 31, 2018 | |
Accounting Policies [Abstract] | |
Principles of Presentation | Principles of Presentation The consolidated financial statements include all the accounts of the Company and its subsidiaries combined with the accounts of the affiliated professional contractors with which the Company currently has specific management arrangements. The Company’s agreements with affiliated professional contractors provide that the term of the arrangements are in most cases permanent, subject only to termination by the Company, except in the case of gross negligence, fraud or bankruptcy of the Company. The Company has the right to receive income, both as ongoing fees and as proceeds from the sale of its interest in the Company’s affiliated professional contractors, in an amount that fluctuates based on the performance of the affiliated professional contractors and the change in the fair value of the Company’s interest in the affiliated professional contractors. The Company has exclusive responsibility for the provision of all non-medical day-to-day 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. |
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 the Company’s 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. |
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 became 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 has accumulated all of the necessary information required to properly account for leases under the new guidance. The Company has implemented a cloud-based software application, inclusive of a lease administration module and an accounting module. The Company is in the process of finalizing workflows, business processes and internal controls surrounding the new lease accounting process in order to meet the reporting and disclosure requirements. |
Accounting Estimates and Assumptions | Accounting Estimates and Assumptions The preparation of financial statements in conformity with accounting principles generally accepted in the United States (“GAAP”) requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the reporting periods. Significant estimates and assumptions are involved in the calculation of the Company’s allowance for contractual adjustments and uncollectibles on accounts receivable, liabilities for self-insured amounts and claims incurred but not reported related to the Company’s professional liability risks and the fair value of goodwill. Actual results could differ from those estimates. |
Segment Reporting | Segment Reporting The results of the Company’s operations are aggregated into a single reportable segment for purposes of presenting financial information in accordance with the accounting guidance for segment reporting. The following table summarizes the Company’s net revenue by service line (in percentages): Years Ended December 31, 2018 2017 2016 Neonatology and other pediatric subspecialties 36 % 37 % 39 % Anesthesiology 35 % 38 % 39 % Radiology 12 % 8 % 6 % Maternal-fetal medicine 8 % 8 % 8 % Management services 6 % 6 % 5 % Pediatric cardiology 3 % 3 % 3 % 100 % 100 % 100 % |
Revenue Recognition | Revenue Recognition Patient service revenue is recognized at the time services are provided by the Company’s affiliated physicians. The Company’s performance obligations related to the delivery of services to patients are satisfied at the time of service. Accordingly, there are no performance obligations that are unsatisfied or partially unsatisfied at the end of the reporting period with respect to patient service revenue. Almost all of the Company’s patient service revenue is reimbursed by GHC Programs and third-party insurance payors. Payments for services rendered to the Company’s patients are generally less than billed charges. The Company monitors its revenue and receivables from these sources and records an estimated contractual allowance to properly account for the anticipated differences between billed and reimbursed amounts. Accordingly, patient service revenue is presented net of an estimated provision for contractual adjustments and uncollectibles. The Company estimates allowances for contractual adjustments and uncollectibles on accounts receivable based upon historical experience and other factors, including days sales outstanding (“DSO”) for accounts receivable, evaluation of expected adjustments and delinquency rates, past adjustments and collection experience in relation to amounts billed, an aging of accounts receivable, current contract and reimbursement terms, changes in payor mix and other relevant information. Contractual adjustments result from the difference between the physician rates for services performed and the reimbursements by GHC Programs and third-party insurance payors for such services. Collection of patient service revenue the Company expects to receive is normally a function of providing complete and correct billing information to the GHC Programs and third-party insurance payors within the various filing deadlines and typically occurs within 30 to 60 days of billing. Some of the Company’s hospital agreements require hospitals to pay the Company administrative fees. Some agreements provide for fees if the hospital does not generate sufficient patient volume in order to guarantee that the Company receives a specified minimum revenue level. The Company also receives fees from hospitals for administrative services performed by its affiliated physicians providing medical director or other services at the hospital. 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. Accounts receivable are primarily amounts due under fee-for-service |
Cash and Cash Equivalents | Cash and Cash Equivalents Cash equivalents are defined as all highly liquid financial instruments with maturities of 90 days or less from the date of purchase. The Company’s cash equivalents typically consist of demand deposits, amounts on deposit in money market accounts, and funds invested in overnight repurchase agreements. Cash equivalent balances may, at certain times, exceed federally insured limits. Certain cash equivalents carried by the Company are subject to the fair value provisions of the accounting guidance for fair value measurements. See “Fair Value Measurements” below. |
Restricted Cash | Restricted Cash Restricted cash consists of funds in escrow related to a potential future payment for contingent consideration for an acquisition completed in 2017. |
Investments | Investments 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 five 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 securities. |
Property and Equipment | Property and Equipment Property and equipment are recorded at original purchase cost. Depreciation of property and equipment is computed using the straight-line method over the estimated useful lives of the underlying assets. Estimated useful lives are generally 30 years for buildings; three to seven years for medical equipment, computer equipment, software and furniture; and the lesser of the useful life or the remaining lease term for leasehold improvements and capital leases. Upon sale or retirement of property and equipment, the related cost and accumulated depreciation are eliminated from the respective accounts and any resulting gain or loss is included in earnings. |
Business Acquisitions | Business Acquisitions The Company accounts for all business acquisitions at fair value and expenses acquisition costs as they are incurred. Any identifiable assets acquired and liabilities assumed are recognized and measured at their respective fair values on the acquisition date. If information about facts and circumstances existing as of the acquisition date is incomplete at the end of the reporting period in which a business acquisition occurs, the Company will report provisional amounts for the items for which the accounting is incomplete. The measurement period ends once the Company receives sufficient information to finalize the fair values; however, the period will not exceed one year from the acquisition date. Any adjustments to provisional amounts that are identified during the measurement period are recognized in the reporting period in which the adjustment amounts are determined. In connection with certain acquisitions, the Company enters into agreements to pay additional amounts in cash or common stock based on the achievement of certain performance measures for up to five years ending after the acquisition dates. The Company measures this contingent consideration at fair value at the acquisition date and records such contingent consideration as a liability or equity on the Company’s Consolidated Balance Sheets on the acquisition date. The fair value of each contingent consideration liability is remeasured at each reporting period with any change in fair value recognized as income or expense within operations in the Company’s Consolidated Statements of Income. See Note 6 for more information on the Company’s business acquisitions. |
Goodwill and Other Intangible Assets | Goodwill and Other Intangible Assets The Company records acquired assets and assumed liabilities at their respective fair values under the acquisition method of accounting. Goodwill represents the excess of purchase price over the fair value of the net assets acquired. Intangible assets with finite lives, principally physician and hospital agreements, customer relationships, patented technology and trade names, are recognized apart from goodwill at the time of acquisition based on the contractual-legal and separability criteria established in the accounting guidance. Intangible assets with finite lives are amortized on either an accelerated basis based on the annual undiscounted economic cash flows associated with the particular intangible asset or on a straight-line basis over their estimated useful lives. Intangible assets with finite lives are amortized over periods of one to 20 years. Goodwill is tested for impairment at a reporting unit level on at least an annual basis in accordance with the subsequent measurement provisions of the accounting guidance for goodwill. The Company defines a reporting unit based upon its management structure for services provided in specific regions of the United States. The Company early adopted new accounting guidance in 2017 that requires only a single-step quantitative test with any goodwill impairment measured as the amount by which a reporting unit’s carrying value exceeds its fair value. The Company uses income and market-based valuation approaches to determine the fair value of its reporting units. These approaches focus on discounted cash flows and market multiples based on the Company’s market capitalization to derive the fair value of a reporting unit. The Company also considers the economic outlook for the healthcare services industry and various other factors during the testing process, including hospital and physician contract changes, local market developments, changes in third-party payor payments, and other publicly available information. The Company completed annual impairment tests in the third quarter of each of 2018, 2017 and 2016 and determined that goodwill was not impaired in any of the three years. |
Long-Lived Assets | Long-Lived Assets The Company is required to evaluate long-lived assets, including intangible assets subject to amortization, whenever events or changes in circumstances indicate that the carrying value of the assets may not be fully recoverable. The recoverability of such assets is measured by a comparison of the carrying value of the assets to the future undiscounted cash flows before interest charges to be generated by the assets. If long-lived assets are impaired, the impairment to be recognized is measured as the excess of the carrying value over the fair value. Long-lived assets held for disposal are reported at the lower of the carrying value or fair value less disposal costs. The Company does not believe there are any indicators that would require an adjustment to such assets or their estimated periods of recovery at December 31, 2018 pursuant to current accounting standards. |
Common Stock Repurchases | Common Stock Repurchases The Company repurchases shares of its common stock as authorized from time to time by its Board of Directors. The Company treats repurchased shares of its common stock as retired as any repurchased shares become authorized but unissued shares. The reacquisition cost of repurchased shares is recorded as a reduction in the respective components of shareholders’ equity. |
Professional Liability Coverage | Professional Liability Coverage The Company maintains professional liability insurance policies with third-party insurers generally on a claims-made basis, subject to deductibles or self-insured retention, exclusions and other restrictions. The Company’s self-insured retention under its professional liability insurance program is maintained primarily through a wholly owned captive insurance subsidiary. The Company records an estimate of liabilities for self-insured amounts and claims incurred but not reported based on an actuarial valuation using historical loss information, claim emergence patterns and various actuarial assumptions. Liabilities for claims incurred but not reported are not discounted. |
Income Taxes | Income Taxes The Company records deferred income taxes using the liability method, whereby deferred tax assets and liabilities are determined based on the difference between the financial statement and tax bases of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. If it is more likely than not that all or a portion of deferred tax assets will not be realized, a valuation allowance is provided against such deferred tax assets. In making such determination, the Company considers all available positive and negative evidence, including future reversals of existing taxable temporary differences, projected future taxable income, tax-planning The accounting guidance for uncertain tax positions prescribes a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The guidance also requires policy disclosures regarding penalties and interest and extensive disclosures regarding increases and decreases in uncertain tax positions as a result of tax positions taken in a current or prior period, settlements with taxing authorities and any lapse of an applicable statute of limitations. Additional qualitative discussion is required for any tax position that may result in a significant increase or decrease in uncertain tax positions within a 12-month |
Stock Incentive Plans | Stock Incentive Plans The Company grants stock-based awards consisting primarily of restricted stock to key employees under its Amended and Restated 2008 Incentive Compensation Plan, as amended. The Company measures the cost of employee services received in exchange for stock-based awards based on grant-date fair value and allocates the resulting compensation expense over the corresponding requisite service period using the graded vesting attribution method. The Company also performs analyses to estimate forfeitures of stock-based awards on an annual basis and adjusts the estimates as necessary based on the number of awards that ultimately vest. |
Net Income Per Common Share | Net Income Per Common Share Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the period. Diluted net income per common share is calculated by dividing net income by the weighted average number of common and potential common shares outstanding during the period. Potential common shares consist of outstanding restricted stock, deferred stock and stock options and is calculated using the treasury stock method. On January 1, 2017, the Company adopted new accounting guidance that no longer permits the Company to include the assumed excess tax benefits related to the potential exercise or vesting of its stock-based awards in the treasury stock method computation. |
Fair Value Measurements | 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 December 31, 2018 and 2017, the Company’s money market funds had a fair value of $0.5 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 December 31, 2018 and 2017, the Company’s cash surrender value of life insurance had a fair value of $10.5 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 December 31, 2018 and 2017, the Company’s contingent consideration liabilities had a fair value of $20.0 million and $30.5 million, respectively. See Note 6 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, variable rate long-term debt 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. See Note 10 for information regarding the fair value of the Company’s 5.25% senior unsecured notes due 2023 (the “2023 Notes”) and 6.25% senior unsecured notes due 2027 (the “2027 Notes”). |
Summary of Significant Accoun_3
Summary of Significant Accounting Policies (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Accounting Policies [Abstract] | |
Schedule of Net Revenue by Service Line | The following table summarizes the Company’s net revenue by service line (in percentages): Years Ended December 31, 2018 2017 2016 Neonatology and other pediatric subspecialties 36 % 37 % 39 % Anesthesiology 35 % 38 % 39 % Radiology 12 % 8 % 6 % Maternal-fetal medicine 8 % 8 % 8 % Management services 6 % 6 % 5 % Pediatric cardiology 3 % 3 % 3 % 100 % 100 % 100 % |
Investments (Tables)
Investments (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Investments, Debt and Equity Securities [Abstract] | |
Schedule of Investments | Investments held are summarized as follows (in thousands): December 31, 2018 December 31, 2017 Short-Term Long-Term Short-Term Long-Term Municipal debt securities $ 18,473 $ 30,841 $ 8,312 $ 46,195 Federal home loan securities 2,000 34,393 1,000 30,322 Certificates of deposit 1,450 4,465 980 4,165 $ 21,923 $ 69,699 $ 10,292 $ 80,682 |
Schedule of Contractual Maturities of Long-Term Investments | Contractual maturities of long-term investments are summarized as follows (in thousands): December 31, 2018 2017 Due after one year through five years $ 69,699 $ 78,561 Due after five years through six years — 2,121 $ 69,699 $ 80,682 |
Accounts Receivable and Net R_2
Accounts Receivable and Net Revenue (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Text Block [Abstract] | |
Schedule of Accounts Receivable, Net | Accounts receivable, net consists of the following (in thousands): December 31, 2018 2017 Gross accounts receivable $ 2,031,341 $ 1,790,034 Allowance for contractual adjustments and uncollectibles (1,489,069 ) (1,286,035 ) $ 542,272 $ 503,999 |
Schedule of Net Revenue | Net revenue consists of the following (in thousands): Years Ended December 31, 2018 2017 2016 Net patient service revenue $ 3,067,784 $ 2,915,648 $ 2,760,192 Hospital contract administrative fees 363,369 315,778 271,886 Management services and other 215,970 226,886 151,081 $ 3,647,123 $ 3,458,312 $ 3,183,159 |
Schedule of Percentage of Net Revenue | The following is a summary of our payor mix, expressed as a percentage of net revenue, exclusive of administrative fees and revenue related to management services and other, for the periods indicated: Years Ended December 31, 2018 2017 2016 Contracted managed care 70 % 70 % 70 % Government 24 % 25 % 23 % Other third-parties 4 % 4 % 6 % Private-pay 2 % 1 % 1 % 100 % 100 % 100 % |
Property and Equipment (Tables)
Property and Equipment (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Property, Plant and Equipment [Abstract] | |
Schedule of Property and Equipment | Property and equipment consists of the following (in thousands): December 31, 2018 2017 Building $ 33,189 $ 33,024 Land 6,683 6,683 Equipment and other 300,981 253,453 340,853 293,160 Accumulated depreciation (207,816 ) (169,624 ) $ 133,037 $ 123,536 |
Goodwill and Intangible Assets
Goodwill and Intangible Assets (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Summary of Intangible Assets, Net | Intangible assets, net, consist of the following (in thousands): December 31, 2018 Gross Accumulated Net Physician and hospital agreements $ 376,871 $ (223,589) $ 153,282 Customer relationships 443,300 (71,870 ) 371,430 Trade names 43,156 (4,630 ) 38,526 Patented and other technology 47,561 (22,487 ) 25,074 $ 910,888 $ (322,576) $ 588,312 December 31, 2017 Gross Accumulated Net Physician and hospital agreements $ 381,635 $ (203,915) $ 177,720 Customer relationships 443,300 (48,837 ) 394,463 Trade names 43,156 (2,933 ) 40,223 Patented and other technology 38,590 (11,068 ) 27,522 $ 906,681 $ (266,753) $ 639,928 |
Amortization Expenses for Existing Intangible Assets for the Next Five Years | Amortization expense for existing intangible assets for the next five years is expected to be as follows (in thousands): 2019 $ 66,532 2020 59,969 2021 53,771 2022 46,249 2023 40,448 |
Accounts Payable and Accrued _2
Accounts Payable and Accrued Expenses (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Payables and Accruals [Abstract] | |
Schedule of Accounts Payable and Accrued Expenses | Accounts payable and accrued expenses consist of the following (in thousands): December 31, 2018 2017 Accounts payable $ 31,059 $ 34,632 Accrued salaries and bonuses 249,834 225,429 Accrued payroll taxes and benefits 80,369 75,672 Accrued professional liabilities 34,931 37,912 Accrued contingent consideration 18,760 6,259 Accrued interest 9,477 4,495 Other accrued expenses 44,912 53,618 $ 469,342 $ 438,017 |
Accrued Professional Liabilit_2
Accrued Professional Liabilities (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Health Care Organizations [Abstract] | |
Schedule of Accrued Professional Liability | The activity related to the Company’s total accrued professional liability for the years ended December 31, 2018, 2017 and 2016 is as follows (in thousands): Years Ended December 31, 2018 2017 2016 Balance at beginning of year $ 250,187 $ 202,052 $ 202,527 Assumed liabilities through acquisition 1,276 20,716 — Provision (adjustment) for losses related to: Current year 34,483 41,291 38,129 Prior years 10,299 9,983 (25,428 ) Total provision for losses 44,782 51,274 12,701 Claim payments related to: Current year (555 ) (712 ) (766 ) Prior years (51,699 ) (23,143 ) (12,410 ) Total payments (52,254 ) (23,855 ) (13,176 ) Balance at end of year $ 243,991 $ 250,187 $ 202,052 |
Line of Credit, Long-Term Deb_2
Line of Credit, Long-Term Debt and Capital Lease Obligations (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Debt Disclosure [Abstract] | |
Schedule of Long-Term Debt | The carrying value of the Company’s long-term debt was $2.0 billion and $1.8 billion at December 31, 2018 and 2017, respectively, and consisted of the following (in thousands): December 31, 2018 Principal Unamortized Total Senior Notes $ 1,250,000 $ (15,408 ) $ 1,234,592 Revolving line of credit 739,500 (4,274 ) 735,226 Total $ 1,989,500 $ (19,682 ) $ 1,969,818 December 31, 2017 Principal Unamortized Total Senior Notes $ 750,000 $ (9,503 ) $ 740,497 Revolving line of credit 1,110,500 (4,864 ) 1,105,636 Total $ 1,860,500 $ (14,367 ) $ 1,846,133 |
Summary of Estimated Fair Value of Notes | The estimated fair value of the Company’s 2023 Notes and 2027 Notes were estimated using trading prices as of December 31, 2018 and 2017, respectively, as Level 2 inputs to estimate fair value and are summarized as follows (in thousands): December 31, 2018 2017 2023 Notes $ 736,725 $ 763,125 2027 Notes 482,500 — |
Schedule of Capital Lease Obligations | The Company’s capital lease obligations consist of the following (in thousands): December 31, 2018 2017 Capital lease obligations $ 441 $ 1,826 Less: Current portion (253 ) (1,401 ) Long-term portion $ 188 $ 425 |
Schedule of Amounts Due Under Terms of Capital Lease Obligations | The amounts due under the terms of the Company’s capital lease obligations at December 31, 2018 are as follows: 2019 $ 253 2020 114 2021 74 |
Income Taxes (Tables)
Income Taxes (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Income Tax Disclosure [Abstract] | |
Summary of Components of Income Tax Provision | The components of the income tax provision (benefit) are as follows (in thousands): December 31, 2018 2017 2016 Federal: Current $ 97,754 $ 130,053 $ 166,758 Deferred (20,176 ) (63,038 ) 15,596 77,578 67,015 182,354 State: Current 26,605 20,070 4,296 Deferred (3,973 ) 2,965 2,553 22,632 23,035 6,849 Total $ 100,210 $ 90,050 $ 189,203 |
Schedule of Differences Between Effective Rate and United States Federal Income Tax Statutory Rate | The differences between the effective rate and the United States federal income tax statutory rate are as follows: December 31, 2018 2017 2016 Tax at statutory rate 21.00 % 35.00 % 35.00 % State income tax, net of federal benefit 4.80 3.33 2.94 Non-deductible 0.44 0.49 0.43 Change in accrual estimates relating to uncertain tax positions 0.05 0.02 (2.11 ) Change in valuation allowance — — 0.48 Other, net 1.20 0.16 0.06 Change in tax law (0.32 ) (17.06 ) — Income tax provision 27.17 % 21.94 % 36.80 % |
Significant Components of Deferred Income Tax Assets and Liabilities | All of the Company’s deferred tax assets and liabilities are classified as long-term. The significant components of deferred income tax assets and liabilities are as follows (in thousands): December 31, 2018 2017 Allowance for uncollectible accounts $ 194,876 $ 80,056 Reserves and accruals 59,270 45,454 Stock-based compensation 9,201 7,975 Net operating loss carryforward 25,226 28,569 Property and equipment 26 685 Other 1,197 970 Deferred tax assets before valuation allowance 289,796 163,709 Less: Valuation allowance (2,628 ) (2,615 ) Deferred tax assets, net of valuation allowance 287,168 161,094 Gross deferred tax liabilities: Amortization (286,552 ) (258,618 ) Accounting method changes (109,418 ) (4,150 ) Accrual to cash adjustment (39 ) (31,290 ) Other (489 ) — Total deferred tax liabilities (396,498 ) (294,058 ) Net deferred tax liability $ (109,330 ) $ (132,964 ) |
Schedule of Activity Related to Gross Unrecognized Tax Benefits | The following table summarizes the activity related to the Company’s liability for uncertain tax positions for the years ended December 31, 2018, 2017 and 2016 (in thousands): Years Ended December 31, 2018 2017 2016 Balance at beginning of year $ 10,972 $ 9,469 $ 18,447 Increases related to prior year tax positions 385 2,284 301 Decreases related to prior year tax positions — (143 ) (3,927 ) Increases related to current year tax positions 2,900 1,430 2,258 Settlements — — (5,644 ) Decreases related to lapse of statutes of limitation (3,072 ) (2,068 ) (1,966 ) Balance at end of year $ 11,185 $ 10,972 $ 9,469 |
Common and Common Equivalent _2
Common and Common Equivalent Shares (Tables) | 12 Months Ended |
Dec. 31, 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 share calculation for the years ended December 31, 2018, 2017 and 2016 is as follows (in thousands): Years Ended December 31, 2018 2017 2016 Weighted average number of common shares outstanding 91,104 92,431 92,422 Weighted average number of dilutive common share equivalents 502 527 687 Weighted average number of common and common equivalent shares outstanding 91,606 92,958 93,109 Antidilutive securities not included in the diluted net income per common share calculation 214 107 2 |
Stock Incentive Plans and Sto_2
Stock Incentive Plans and Stock Purchase Plans (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Disclosure of Compensation Related Costs, Share-based Payments [Abstract] | |
Schedule of Restricted Stock and Deferred Stock Awards | The activity related to the Company’s restricted stock and deferred stock awards and the corresponding weighted average grant-date fair values for the year ended December 31, 2018 are as follows: Number of Shares Weighted Non-vested 1,041,034 $ 60.21 Awarded 770,480 $ 51.99 Forfeited (69,293 ) $ 56.65 Vested (431,368 ) $ 63.57 Non-vested 1,310,853 $ 54.46 |
Schedule of Activity and Certain Other Information Related to Stock Option Awards | The activity and certain other information related to the Company’s outstanding stock option awards for the year ended December 31, 2018 are as follows: Number of Stock Options Weighted Average Exercise Price Weighted (in years) Aggregate Value (in Outstanding at January 1, 2018 246,342 $ 27.51 Exercised (133,366 ) $ 27.38 $ 2.8 Outstanding and exercisable at December 31, 2018 112,976 $ 27.65 1.3 $ 0.7 |
Commitments and Contingencies (
Commitments and Contingencies (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Commitments and Contingencies Disclosure [Abstract] | |
Schedule of Future Minimum Lease Payments under Non-Cancelable Operating Leases | Future minimum lease payments under non-cancelable 2019 $ 30,824 2020 22,038 2021 17,946 2022 12,708 2023 9,440 Thereafter 10,522 $ 103,478 |
Selected Quarterly Financial _2
Selected Quarterly Financial Information (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Quarterly Financial Information Disclosure [Abstract] | |
Summary of Company's Selected Quarterly Financial Information | The following tables set forth a summary of the Company’s selected quarterly financial information for each of the four quarters ended December 31, 2018 and 2017 (in thousands, except for per share data): 2018 Quarters First Second Third Fourth Net revenue $ 901,857 $ 915,918 $ 896,652 $ 932,696 Operating expenses: Practice salaries and benefits 631,830 620,980 625,717 657,061 Practice supplies and other operating expenses 30,655 31,833 30,159 29,381 General and administrative expenses 108,776 107,908 102,905 112,789 Depreciation and amortization 26,163 26,518 28,709 29,891 Total operating expenses 797,424 787,239 787,490 829,122 Income from operations 104,433 128,679 109,162 103,574 Investment and other income 1,464 1,202 1,302 967 Interest expense (19,935 ) (21,604 ) (21,782 ) (25,448 ) Equity in earnings of unconsolidated affiliates 1,525 1,257 1,766 2,277 Total non-operating (16,946 ) (19,145 ) (18,714 ) (22,204 ) Income before income taxes 87,487 109,534 90,448 81,370 Income tax provision (24,059 ) (30,122 ) (24,873 ) (21,156 ) Net income $ 63,428 $ 79,412 $ 65,575 $ 60,214 Per common and common equivalent share data (1): Net income: Basic $ 0.68 $ 0.85 $ 0.72 $ 0.69 Diluted $ 0.68 $ 0.85 $ 0.72 $ 0.68 Weighted average common shares: Basic 92,859 92,987 90,984 87,810 Diluted 93,505 93,529 91,359 88,258 (1) Basic and diluted per share amounts are computed for each of the periods presented. Accordingly, the sum of the quarterly per share amounts may not agree with the full year amount. 2017 Quarters First Second Third Fourth Net revenue $ 835,597 $ 842,944 $ 868,951 $ 910,820 Operating expenses: Practice salaries and benefits 572,385 561,418 586,476 617,455 Practice supplies and other operating expenses 27,796 30,872 29,497 32,353 General and administrative expenses 103,765 103,015 101,430 108,895 Depreciation and amortization 25,614 25,735 25,116 26,414 Total operating expenses 729,560 721,040 742,519 785,117 Income from operations 106,037 121,904 126,432 125,703 Investment and other income 576 365 235 2,777 Interest expense (17,752 ) (18,535 ) (18,428 ) (19,844 ) Equity (loss) in earnings of unconsolidated affiliate 797 689 (240 ) (294 ) Total non-operating (16,379 ) (17,481 ) (18,433 ) (17,361 ) Income before income taxes 89,658 104,423 107,999 108,342 Income tax (provision) benefit (34,967 ) (40,725 ) (42,119 ) 27,761 Net income $ 54,691 $ 63,698 $ 65,880 $ 136,103 Per common and common equivalent share data (2): Net income: Basic $ 0.59 $ 0.69 $ 0.71 $ 1.47 Diluted $ 0.59 $ 0.69 $ 0.71 $ 1.46 Weighted average common shares: Basic 92,360 92,181 92,589 92,756 Diluted 93,143 92,812 92,881 93,159 (2) Basic and diluted per share amounts are computed for each of the periods presented. Accordingly, the sum of the quarterly per share amounts may not agree with the full year amount. |
Summary of Significant Accoun_4
Summary of Significant Accounting Policies - Additional Information (Detail) - USD ($) $ in Millions | 12 Months Ended | ||||
Dec. 31, 2018 | Dec. 31, 2017 | Nov. 30, 2018 | Jan. 31, 2018 | Dec. 31, 2015 | |
Summary Of Significant Accounting Policies [Line Items] | |||||
Equity method ownership percentage in joint venture | 49.00% | ||||
Cash and cash equivalents maturity description | 90 | ||||
Additional amounts to be paid in cash or common stock based on achievement of performance measures within period, maximum years | 5 years | ||||
Money market funds fair value | $ 0.5 | $ 9.2 | |||
Cash surrender fair value of life insurance | 10.5 | 15.6 | |||
Contingent consideration liabilities related to acquisitions | $ 20 | $ 30.5 | |||
5.25% Senior Unsecured Notes Due 2023 [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Debt instrument interest rate | 5.25% | 5.25% | |||
6.25% Senior Unsecured Notes Due 2027 [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Debt instrument interest rate | 6.25% | 6.25% | |||
Unnamed Corporate Joint Venture [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Equity method ownership percentage in joint venture | 37.50% | 49.00% | |||
Government Contracts Concentration Risk [Member] | Accounts Receivable [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Percentage of net accounts receivable | 19.00% | 17.00% | |||
Buildings [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Property and equipment estimated useful lives, years | 30 years | ||||
Maximum [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Long-term investments maturity period, in years | 5 years | ||||
Short-Term investments maturity period, in years | 1 year | ||||
Intangible assets finite lives | 20 years | ||||
Maximum [Member] | Medical Equipment [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Property and equipment estimated useful lives, years | 7 years | ||||
Maximum [Member] | Computer Equipment [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Property and equipment estimated useful lives, years | 7 years | ||||
Maximum [Member] | Software and Software Development Costs [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Property and equipment estimated useful lives, years | 7 years | ||||
Maximum [Member] | Furniture [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Property and equipment estimated useful lives, years | 7 years | ||||
Minimum [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Long-term investments maturity period, in years | 1 year | ||||
Intangible assets finite lives | 1 year | ||||
Minimum [Member] | Medical Equipment [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Property and equipment estimated useful lives, years | 3 years | ||||
Minimum [Member] | Computer Equipment [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Property and equipment estimated useful lives, years | 3 years | ||||
Minimum [Member] | Software and Software Development Costs [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Property and equipment estimated useful lives, years | 3 years | ||||
Minimum [Member] | Furniture [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Property and equipment estimated useful lives, years | 3 years |
Summary of Significant Accoun_5
Summary of Significant Accounting Policies - Schedule of Net Revenue by Service Line (Detail) - Product Concentration Risk [Member] - Sales Revenue, Services, Net [Member] | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Segment Reporting Information [Line Items] | |||
Net revenue in percentage | 100.00% | 100.00% | 100.00% |
Neonatology and Other Pediatric Subspecialties [Member] | |||
Segment Reporting Information [Line Items] | |||
Net revenue in percentage | 36.00% | 37.00% | 39.00% |
Anesthesiology [Member] | |||
Segment Reporting Information [Line Items] | |||
Net revenue in percentage | 35.00% | 38.00% | 39.00% |
Radiology And Teleradiology [Member] | |||
Segment Reporting Information [Line Items] | |||
Net revenue in percentage | 12.00% | 8.00% | 6.00% |
Maternal-Fetal Medicine [Member] | |||
Segment Reporting Information [Line Items] | |||
Net revenue in percentage | 8.00% | 8.00% | 8.00% |
Management Services [Member] | |||
Segment Reporting Information [Line Items] | |||
Net revenue in percentage | 6.00% | 6.00% | 5.00% |
Pediatric Cardiology [Member] | |||
Segment Reporting Information [Line Items] | |||
Net revenue in percentage | 3.00% | 3.00% | 3.00% |
Investments - Schedule of Inves
Investments - Schedule of Investments (Detail) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Schedule of Held-to-maturity Securities [Line Items] | ||
Short-Term | $ 21,923 | $ 10,292 |
Long-Term | 69,699 | 80,682 |
Municipal Debt Securities [Member] | ||
Schedule of Held-to-maturity Securities [Line Items] | ||
Short-Term | 18,473 | 8,312 |
Long-Term | 30,841 | 46,195 |
Federal Home Loan Securities [Member] | ||
Schedule of Held-to-maturity Securities [Line Items] | ||
Short-Term | 2,000 | 1,000 |
Long-Term | 34,393 | 30,322 |
Certificates of Deposit [Member] | ||
Schedule of Held-to-maturity Securities [Line Items] | ||
Short-Term | 1,450 | 980 |
Long-Term | $ 4,465 | $ 4,165 |
Investments - Schedule of Contr
Investments - Schedule of Contractual Maturities of Long-Term Investments (Detail) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Investments, Debt and Equity Securities [Abstract] | ||
Due after one year through five years | $ 69,699 | $ 78,561 |
Due after five years through six years | 2,121 | |
Total | $ 69,699 | $ 80,682 |
Accounts Receivable and Net R_3
Accounts Receivable and Net Revenue - Schedule of Accounts Receivable, Net (Detail) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Receivables [Abstract] | ||
Gross accounts receivable | $ 2,031,341 | $ 1,790,034 |
Allowance for contractual adjustments and uncollectibles | (1,489,069) | (1,286,035) |
Accounts receivable, net | $ 542,272 | $ 503,999 |
Accounts Receivable and Net R_4
Accounts Receivable and Net Revenue - Schedule of Net Revenue (Detail) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended | |||||||||
Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Disaggregation of Revenue [Abstract] | |||||||||||
Net revenue | $ 932,696 | $ 896,652 | $ 915,918 | $ 901,857 | $ 910,820 | $ 868,951 | $ 842,944 | $ 835,597 | $ 3,647,123 | $ 3,458,312 | $ 3,183,159 |
Net patient service revenue | |||||||||||
Disaggregation of Revenue [Abstract] | |||||||||||
Net revenue | 3,067,784 | 2,915,648 | 2,760,192 | ||||||||
Hospital contract administrative fees | |||||||||||
Disaggregation of Revenue [Abstract] | |||||||||||
Net revenue | 363,369 | 315,778 | 271,886 | ||||||||
Management Services [Member] | |||||||||||
Disaggregation of Revenue [Abstract] | |||||||||||
Net revenue | $ 215,970 | $ 226,886 | $ 151,081 |
Accounts Receivable and Net R_5
Accounts Receivable and Net Revenue - Schedule of Net Patient Service Revenue by Type of Payor (Detail) | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | |||
Percentage of net patient service revenue | 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% | 70.00% | 70.00% |
Government [Member] | |||
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | |||
Percentage of net patient service revenue | 24.00% | 25.00% | 23.00% |
Other Third-Parties [Member] | |||
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | |||
Percentage of net patient service revenue | 4.00% | 4.00% | 6.00% |
Private-Pay Patients [Member] | |||
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | |||
Percentage of net patient service revenue | 2.00% | 1.00% | 1.00% |
Accounts Receivable and Net R_6
Accounts Receivable and Net Revenue - Additional Information (Detail) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended | |||||||||
Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Receivables [Abstract] | |||||||||||
Accounts receivable, net | $ 542,272 | $ 503,999 | $ 542,272 | $ 503,999 | |||||||
Net revenue | $ 932,696 | $ 896,652 | $ 915,918 | $ 901,857 | $ 910,820 | $ 868,951 | $ 842,944 | $ 835,597 | $ 3,647,123 | $ 3,458,312 | $ 3,183,159 |
Property Plant and Equipment -
Property Plant and Equipment - Schedule of Property and Equipment (Detail) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Property, Plant and Equipment [Abstract] | ||
Building | $ 33,189 | $ 33,024 |
Land | 6,683 | 6,683 |
Equipment and other | 300,981 | 253,453 |
Property and equipment, gross | 340,853 | 293,160 |
Accumulated depreciation | (207,816) | (169,624) |
Property and equipment, net | $ 133,037 | $ 123,536 |
Property and Equipment - Additi
Property and Equipment - Additional Information (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Property, Plant and Equipment [Line Items] | |||
Medical and other equipment held under capital leases | $ 340,853 | $ 293,160 | |
Accumulated depreciation of property and equipment held under capital leases | 207,816 | 169,624 | |
Recorded depreciation expense | 38,500 | 33,900 | $ 29,000 |
Medical and Other Equipment Held under Capital Lease [Member] | |||
Property, Plant and Equipment [Line Items] | |||
Medical and other equipment held under capital leases | 4,800 | 6,100 | |
Accumulated depreciation of property and equipment held under capital leases | $ 4,000 | $ 4,600 |
Business Acquisitions - Additio
Business Acquisitions - Additional Information (Detail) $ in Millions | Mar. 31, 2017 | Dec. 31, 2018USD ($)Company | Dec. 31, 2017Company |
Business Acquisition [Line Items] | |||
Number of physician group practices acquired | Company | 9 | 10 | |
Number of neonatology practices acquired | Company | 2 | 1 | |
Number of other pediatric subspecialty practices acquired | Company | 2 | 2 | |
Number of radiology practices acquired | Company | 5 | 4 | |
Total business acquisition consideration | $ 111.8 | ||
Contingent consideration payments related to prior-period acquisitions | 6.4 | ||
Purchase consideration payments related to prior-period acquisitions | 1.2 | ||
Change in the fair value of a contingent consideration | (5.3) | ||
Assets held for sale | $ 46 | ||
Sale of equity method investments | 49.00% | ||
Number of maternal-fetal medicine practices acquired | Company | 2 | ||
Number of pediatric multi-specialty practice acquired | Company | 1 | ||
Sale of minority interest percentage | 75.00% | ||
Deconsolidation percentage | 100.00% | ||
Physician Group [Member] | |||
Business Acquisition [Line Items] | |||
Goodwill | $ 95 | ||
Other intangible assets | 17.2 | ||
Decrease in current assets | 1.7 | ||
Other liabilities | 2.1 | ||
Prior-Period Acquisitions [Member] | |||
Business Acquisition [Line Items] | |||
Decrease in current assets | 1.2 | ||
Decrease in noncurrent assets | 1.5 | ||
Decrease in noncurrent liabilities | 0.2 | ||
Net increase in goodwill resulting from finalization of tax acquisition accounting | 4 | ||
Additional cash consideration related to a working capital true up | $ 1.5 |
Goodwill and Intangible Asset_2
Goodwill and Intangible Assets - Additional Information (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Goodwill And Other Intangible Assets [Line Items] | |||
Goodwill | $ 4,382,995 | $ 4,283,963 | |
Change in goodwill carrying amount | 99,000 | ||
Goodwill deductible for tax purpose | 63,000 | ||
Intangible assets related to acquisitions | 17,200 | ||
Amortization expense for intangible assets | $ 72,800 | $ 68,900 | $ 60,300 |
Physician And Hospital Agreements [Member] | |||
Goodwill And Other Intangible Assets [Line Items] | |||
Weighted average amortization period | 9 years | ||
Management Services Reporting Unit [Member] | |||
Goodwill And Other Intangible Assets [Line Items] | |||
Goodwill | $ 321,600 |
Goodwill and Intangible Asset_3
Goodwill and Intangible Assets - Summary of Intangible Assets, Net (Detail) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Finite-Lived Intangible Assets [Line Items] | ||
Gross Carrying Value | $ 910,888 | $ 906,681 |
Accumulated Amortization | (322,576) | (266,753) |
Net Carrying Value | 588,312 | 639,928 |
Physician And Hospital Agreements [Member] | ||
Finite-Lived Intangible Assets [Line Items] | ||
Gross Carrying Value | 376,871 | 381,635 |
Accumulated Amortization | (223,589) | (203,915) |
Net Carrying Value | 153,282 | 177,720 |
Customer Relationships [Member] | ||
Finite-Lived Intangible Assets [Line Items] | ||
Gross Carrying Value | 443,300 | 443,300 |
Accumulated Amortization | (71,870) | (48,837) |
Net Carrying Value | 371,430 | 394,463 |
Trade Names [Member] | ||
Finite-Lived Intangible Assets [Line Items] | ||
Gross Carrying Value | 43,156 | 43,156 |
Accumulated Amortization | (4,630) | (2,933) |
Net Carrying Value | 38,526 | 40,223 |
Patented and Other Technology [Member] | ||
Finite-Lived Intangible Assets [Line Items] | ||
Gross Carrying Value | 47,561 | 38,590 |
Accumulated Amortization | (22,487) | (11,068) |
Net Carrying Value | $ 25,074 | $ 27,522 |
Goodwill and Intangible Asset_4
Goodwill and Intangible Assets - Amortization Expenses for Existing Intangible Assets for the Next Five Years (Detail) $ in Thousands | Dec. 31, 2018USD ($) |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Amortization expense for existing other intangible assets, 2019 | $ 66,532 |
Amortization expense for existing other intangible assets, 2020 | 59,969 |
Amortization expense for existing other intangible assets, 2021 | 53,771 |
Amortization expense for existing other intangible assets, 2022 | 46,249 |
Amortization expense for existing other intangible assets, 2023 | $ 40,448 |
Accounts Payable and Accrued _3
Accounts Payable and Accrued Expenses - Schedule of Accounts Payable and Accrued Expenses (Detail) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Payables and Accruals [Abstract] | ||
Accounts payable | $ 31,059 | $ 34,632 |
Accrued salaries and bonuses | 249,834 | 225,429 |
Accrued payroll taxes and benefits | 80,369 | 75,672 |
Accrued professional liabilities | 34,931 | 37,912 |
Accrued contingent consideration | 18,760 | 6,259 |
Accrued interest | 9,477 | 4,495 |
Other accrued expenses | 44,912 | 53,618 |
Accounts payable and accrued expenses, total | $ 469,342 | $ 438,017 |
Accrued Professional Liabilit_3
Accrued Professional Liabilities - Additional Information (Detail) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 |
Payables and Accruals [Abstract] | ||||
Total accrued professional liability | $ 243,991 | $ 250,187 | $ 202,052 | $ 202,527 |
Accrued professional liability incurred but loss reserves not reported for claims | 139,100 | 138,500 | ||
Accrued professional liability incurred and loss reserves reported for claims | 104,900 | 111,700 | ||
Accrued professional liabilities | 34,931 | $ 37,912 | ||
Insurance receivables | $ 16,700 |
Accrued Professional Liabilit_4
Accrued Professional Liabilities - Schedule of Accrued Professional Liability (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Payables and Accruals [Abstract] | |||
Balance at beginning of year | $ 250,187 | $ 202,052 | $ 202,527 |
Assumed liabilities through acquisition | 1,276 | 20,716 | |
Provision (adjustment) for losses related to Current year | 34,483 | 41,291 | 38,129 |
Provision (adjustment) for losses related to Prior years | 10,299 | 9,983 | (25,428) |
Total provision for losses | 44,782 | 51,274 | 12,701 |
Claim payments related to Current year | (555) | (712) | (766) |
Claim payments related to Prior years | (51,699) | (23,143) | (12,410) |
Total payments | (52,254) | (23,855) | (13,176) |
Balance at end of year | $ 243,991 | $ 250,187 | $ 202,052 |
Line of Credit, Long-Term Deb_3
Line of Credit, Long-Term Debt and Capital Lease Obligations - Additional Information (Detail) - USD ($) | 12 Months Ended | |||
Dec. 31, 2018 | Nov. 30, 2018 | Dec. 31, 2017 | Dec. 31, 2015 | |
Debt Instrument [Line Items] | ||||
Line of Credit facility, maturity date | Oct. 31, 2022 | |||
Long term debt | $ 1,969,818,000 | $ 1,846,133,000 | ||
Letters of credit outstanding amount | 200,000 | |||
Line of Credit facility, available balance | $ 1,300,000,000 | |||
Minimum [Member] | ||||
Debt Instrument [Line Items] | ||||
Commitment fee percentage | 0.15% | |||
Maximum [Member] | ||||
Debt Instrument [Line Items] | ||||
Commitment fee percentage | 0.30% | |||
Alternate Base Rate [Member] | Federal Funds Rate [Member] | ||||
Debt Instrument [Line Items] | ||||
Debt instrument, interest rate | Federal Funds Rate plus 1/2 of 1.00% | |||
Alternate Base Rate [Member] | LIBOR [Member] | ||||
Debt Instrument [Line Items] | ||||
Debt instrument, interest rate | LIBOR for an interest period of one month plus 1.00% | |||
Debt instrument, variable interest rate | 1.00% | |||
Applicable Margin Rate [Member] | LIBOR [Member] | Minimum [Member] | ||||
Debt Instrument [Line Items] | ||||
Debt instrument, variable interest rate | 0.125% | |||
Applicable Margin Rate [Member] | LIBOR [Member] | Maximum [Member] | ||||
Debt Instrument [Line Items] | ||||
Debt instrument, variable interest rate | 0.75% | |||
Unsecured Revolving Credit Facility [Member] | ||||
Debt Instrument [Line Items] | ||||
Line of Credit facility, borrowing capacity | $ 2,000,000,000 | |||
Letters of Credit [Member] | ||||
Debt Instrument [Line Items] | ||||
Line of Credit facility, borrowing capacity | $ 37,500,000 | |||
5.25% Senior Unsecured Notes Due 2023 [Member] | ||||
Debt Instrument [Line Items] | ||||
Aggregate principal amount of debt | $ 750,000,000 | |||
Debt instrument interest rate | 5.25% | 5.25% | ||
Debt instrument maturity date description | Payable semi-annually in arrears on June 1 and December 1 | |||
Debt instrument, maturity year | 2,023 | |||
Long term debt | $ 1,234,592,000 | $ 740,497,000 | ||
5.25% Senior Unsecured Notes Due 2023 [Member] | Change In Control [Member] | ||||
Debt Instrument [Line Items] | ||||
Redemption percentage of principal amount | 101.00% | |||
5.25% Senior Unsecured Notes Due 2023 [Member] | Redemption in 2019 [Member] | ||||
Debt Instrument [Line Items] | ||||
Redemption percentage of principal amount | 102.625% | |||
5.25% Senior Unsecured Notes Due 2023 [Member] | Redemption in 2020 [Member] | ||||
Debt Instrument [Line Items] | ||||
Redemption percentage of principal amount | 101.313% | |||
5.25% Senior Unsecured Notes Due 2023 [Member] | Redemption in 2021 and Thereafter [Member] | ||||
Debt Instrument [Line Items] | ||||
Redemption percentage of principal amount | 100.00% | |||
6.25% Senior Unsecured Notes Due 2027 [Member] | ||||
Debt Instrument [Line Items] | ||||
Aggregate principal amount of debt | $ 500,000,000 | |||
Debt instrument interest rate | 6.25% | 6.25% | ||
Debt instrument maturity date description | Payable semi-annually in arrears on January 15 and July 15 | |||
Debt instrument, maturity year | 2,027 | |||
6.25% Senior Unsecured Notes Due 2027 [Member] | Change In Control [Member] | ||||
Debt Instrument [Line Items] | ||||
Redemption percentage of principal amount | 101.00% | |||
6.25% Senior Unsecured Notes Due 2027 [Member] | Redemption Before 2022 [Member] | ||||
Debt Instrument [Line Items] | ||||
Redemption percentage of principal amount | 100.00% | |||
6.25% Senior Unsecured Notes Due 2027 [Member] | Redemption Before 2022 [Member] | Redeem up to 35% of Aggregate Principal Amount [Member] | ||||
Debt Instrument [Line Items] | ||||
Redemption percentage of principal amount | 35.00% | |||
Redemption price percentage of aggregate principal amount redeemed | 106.25% | |||
6.25% Senior Unsecured Notes Due 2027 [Member] | Redemption in 2022 [Member] | ||||
Debt Instrument [Line Items] | ||||
Redemption percentage of principal amount | 104.688% | |||
6.25% Senior Unsecured Notes Due 2027 [Member] | Redemption in 2023 [Member] | ||||
Debt Instrument [Line Items] | ||||
Redemption percentage of principal amount | 103.125% | |||
6.25% Senior Unsecured Notes Due 2027 [Member] | Redemption in 2024 [Member] | ||||
Debt Instrument [Line Items] | ||||
Redemption percentage of principal amount | 101.563% | |||
6.25% Senior Unsecured Notes Due 2027 [Member] | Redemption in 2025 and Thereafter [Member] | ||||
Debt Instrument [Line Items] | ||||
Redemption percentage of principal amount | 100.00% |
Line of Credit, Long-Term Deb_4
Line of Credit, Long-Term Debt and Capital Lease Obligations - Schedule of Long-Term Debt (Detail) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Debt Instrument [Line Items] | ||
Debt instrument principal amount | $ 1,989,500 | $ 1,860,500 |
Unamortized debt issuance cost | (19,682) | (14,367) |
Long term debt | 1,969,818 | 1,846,133 |
5.25% Senior Unsecured Notes Due 2023 [Member] | ||
Debt Instrument [Line Items] | ||
Debt instrument principal amount | 1,250,000 | 750,000 |
Unamortized debt issuance cost | (15,408) | (9,503) |
Long term debt | 1,234,592 | 740,497 |
Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Debt instrument principal amount | 739,500 | 1,110,500 |
Unamortized debt issuance cost | (4,274) | (4,864) |
Long term debt | $ 735,226 | $ 1,105,636 |
Line of Credit, Long-Term Deb_5
Line of Credit, Long-Term Debt and Capital Lease Obligations - Summary of Estimated Fair Value of Notes (Detail) - Level 2 [Member] - Estimate of Fair Value Measurement [Member] - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
5.25% Senior Unsecured Notes Due 2023 [Member] | ||
Debt Instrument Fair Value [Line Items] | ||
Estimated fair value | $ 736,725 | $ 763,125 |
6.25% Senior Unsecured Notes Due 2027 [Member] | ||
Debt Instrument Fair Value [Line Items] | ||
Estimated fair value | $ 482,500 |
Line of Credit, Long-Term Deb_6
Line of Credit, Long-Term Debt and Capital Lease Obligations - Schedule of Capital Lease Obligations (Detail) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Debt Disclosure [Abstract] | ||
Capital lease obligations | $ 441 | $ 1,826 |
Less: Current portion | (253) | (1,401) |
Long-term portion | $ 188 | $ 425 |
Line of Credit, Long-Term Deb_7
Line of Credit, Long-Term Debt and Capital Lease Obligations - Schedule of Amounts Due Under Terms of Capital Lease Obligations (Detail) $ in Thousands | Dec. 31, 2018USD ($) |
Debt Disclosure [Abstract] | |
2,019 | $ 253 |
2,020 | 114 |
2,021 | $ 74 |
Income Taxes - Summary of Compo
Income Taxes - Summary of Components of Income Tax Provision (Detail) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended | |||||||||
Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Income Tax Disclosure [Abstract] | |||||||||||
Federal, Current | $ 97,754 | $ 130,053 | $ 166,758 | ||||||||
Federal, Deferred | (20,176) | (63,038) | 15,596 | ||||||||
Federal income tax provision, Total | 77,578 | 67,015 | 182,354 | ||||||||
State, Current | 26,605 | 20,070 | 4,296 | ||||||||
State, Deferred | (3,973) | 2,965 | 2,553 | ||||||||
State income tax provision, Total | 22,632 | 23,035 | 6,849 | ||||||||
Income tax provision, Total | $ 21,156 | $ 24,873 | $ 30,122 | $ 24,059 | $ (27,761) | $ 42,119 | $ 40,725 | $ 34,967 | $ 100,210 | $ 90,050 | $ 189,203 |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended | ||||||||||||
Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2019 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | Sep. 30, 2016 | Dec. 31, 2015 | |
Income Tax [Line Items] | ||||||||||||||
Tax at statutory rate | 21.00% | 35.00% | 35.00% | |||||||||||
Effective tax rate | 27.17% | 21.94% | 36.80% | |||||||||||
Income tax benefit resulting from the reduction of deferred tax liabilities | $ (70,000) | |||||||||||||
Effective income tax rate favorable impact of change in uncertain tax positions | $ 10,600 | |||||||||||||
Increase (decrease) in net deferred tax liability | $ (23,600) | |||||||||||||
Increase in allowance for uncollectible accounts | 114,800 | |||||||||||||
Accounting method changes | $ 109,418 | 4,150 | 109,418 | $ 4,150 | ||||||||||
Decrease in accrual to cash adjustment | 31,300 | |||||||||||||
Adjustment to additional paid-in capital for excess tax benefits related to stock-based awards | $ 4,200 | |||||||||||||
Income tax expense for excess tax deficiencies | 1,400 | 200 | ||||||||||||
Net operating loss carryforwards for federal and state tax | 101,900 | 116,000 | 101,900 | 116,000 | 130,000 | |||||||||
Operating loss carryforwards subject to expiration | 74,300 | 74,300 | ||||||||||||
Operating loss carryforwards not subject to expiration | 27,600 | 27,600 | ||||||||||||
Uncertain tax position liability | 11,185 | 10,972 | 11,185 | 10,972 | 9,469 | $ 18,447 | ||||||||
Unrecognized tax benefits that would impact effective tax rate | 10,900 | 10,900 | ||||||||||||
Increase (decrease) in uncertain tax position | 200 | 1,500 | ||||||||||||
Income tax expense (benefit) | 21,156 | $ 24,873 | $ 30,122 | $ 24,059 | (27,761) | $ 42,119 | $ 40,725 | $ 34,967 | 100,210 | 90,050 | 189,203 | |||
Company's accrued liability for interest and penalties related to income tax liabilities | 1,100 | $ 1,200 | $ 1,100 | 1,200 | ||||||||||
Interest and Penalties [Member] | ||||||||||||||
Income Tax [Line Items] | ||||||||||||||
Income tax expense (benefit) | $ 200 | $ 7,900 | ||||||||||||
Earliest Tax Year [Member] | ||||||||||||||
Income Tax [Line Items] | ||||||||||||||
Federal and state income tax examinations | 2,014 | |||||||||||||
Latest Tax Year [Member] | ||||||||||||||
Income Tax [Line Items] | ||||||||||||||
Federal and state income tax examinations | 2,017 | |||||||||||||
Internal Revenue Code Section 481 [Member] | ||||||||||||||
Income Tax [Line Items] | ||||||||||||||
Accounting method changes | $ 105,300 | $ 105,300 | ||||||||||||
Scenario, Forecast [Member] | ||||||||||||||
Income Tax [Line Items] | ||||||||||||||
Increase (decrease) in uncertain tax position | $ 200 | |||||||||||||
Minimum [Member] | ||||||||||||||
Income Tax [Line Items] | ||||||||||||||
Expiration period of operating loss carryforwards | 2,019 | |||||||||||||
Maximum [Member] | ||||||||||||||
Income Tax [Line Items] | ||||||||||||||
Expiration period of operating loss carryforwards | 2,038 |
Income Taxes - Schedule of Diff
Income Taxes - Schedule of Differences Between Effective Rate and United States Federal Income Tax Statutory Rate (Detail) | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Income Tax Disclosure [Abstract] | |||
Tax at statutory rate | 21.00% | 35.00% | 35.00% |
State income tax, net of federal benefit | 4.80% | 3.33% | 2.94% |
Non-deductible expenses | 0.44% | 0.49% | 0.43% |
Change in accrual estimates relating to uncertain tax positions | 0.05% | 0.02% | (2.11%) |
Change in valuation allowance | 0.48% | ||
Other, net | 1.20% | 0.16% | 0.06% |
Change in tax law | (0.32%) | (17.06%) | |
Income tax provision | 27.17% | 21.94% | 36.80% |
Income Taxes - Significant Comp
Income Taxes - Significant Components of Deferred Income Tax Assets and Liabilities (Detail) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Income Tax Disclosure [Abstract] | ||
Allowance for uncollectible accounts | $ 194,876 | $ 80,056 |
Reserves and accruals | 59,270 | 45,454 |
Stock-based compensation | 9,201 | 7,975 |
Net operating loss carryforward | 25,226 | 28,569 |
Property and equipment | 26 | 685 |
Other | 1,197 | 970 |
Deferred tax assets before valuation allowance | 289,796 | 163,709 |
Less: Valuation allowance | (2,628) | (2,615) |
Deferred tax assets, net of valuation allowance | 287,168 | 161,094 |
Gross deferred tax liabilities: | ||
Amortization | (286,552) | (258,618) |
Accounting method changes | (109,418) | (4,150) |
Accrual to cash adjustment | (39) | (31,290) |
Other | (489) | |
Total deferred tax liabilities | (396,498) | (294,058) |
Net deferred tax liability | $ (109,330) | $ (132,964) |
Income Taxes - Schedule of Acti
Income Taxes - Schedule of Activity Related to Gross Unrecognized Tax Benefits (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Income Tax Disclosure [Abstract] | |||
Balance at beginning of year | $ 10,972 | $ 9,469 | $ 18,447 |
Increases related to prior year tax positions | 385 | 2,284 | 301 |
Decreases related to prior year tax positions | (143) | (3,927) | |
Increases related to current year tax positions | 2,900 | 1,430 | 2,258 |
Settlements | (5,644) | ||
Decreases related to lapse of statutes of limitation | (3,072) | (2,068) | (1,966) |
Balance at end of year | $ 11,185 | $ 10,972 | $ 9,469 |
Common and Common Equivalent _3
Common and Common Equivalent Shares - Schedule of Calculation of Shares Used in Basic and Diluted Net Income Per Share (Detail) - shares shares in Thousands | 3 Months Ended | 12 Months Ended | |||||||||
Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Earnings Per Share [Abstract] | |||||||||||
Weighted average number of common shares outstanding | 87,810 | 90,984 | 92,987 | 92,859 | 92,756 | 92,589 | 92,181 | 92,360 | 91,104 | 92,431 | 92,422 |
Weighted average number of dilutive common share equivalents | 502 | 527 | 687 | ||||||||
Weighted average number of common and common equivalent shares outstanding | 88,258 | 91,359 | 93,529 | 93,505 | 93,159 | 92,881 | 92,812 | 93,143 | 91,606 | 92,958 | 93,109 |
Antidilutive securities not included in the diluted net income per common share calculation | 214 | 107 | 2 |
Stock Incentive Plans and Sto_3
Stock Incentive Plans and Stock Purchase Plans - Additional Information (Detail) - USD ($) | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Common stock, aggregate shares authorized | 200,000,000 | 200,000,000 | |
Stock-based compensation expense | $ 38,700,000 | $ 29,600,000 | $ 34,000,000 |
Aggregate fair value of restricted and deferred stocks vested | $ 27,400,000 | $ 29,300,000 | $ 29,800,000 |
Weighted average grant-date fair value of restricted and deferred stock awards granted | $ 51.99 | $ 54.22 | $ 67.90 |
Aggregate intrinsic value of stock options exercised | $ 2,800,000 | $ 5,500,000 | $ 6,800,000 |
Excess tax benefit related to employee stock incentive plans | 0 | 4,131,000 | |
Cash proceeds received from the exercise of stock options | $ 3,700,000 | $ 4,800,000 | $ 4,700,000 |
Stock Option [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Award vesting period | 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] | |||
Award vesting period | 3 years | ||
Restricted and Deferred Stock Units [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Unrecognized compensation expense related to non-vested restricted stock, weighted-average period in years | 1 year 4 months 24 days | ||
Unrecognized compensation expense related to non-vested restricted shares | $ 30,800,000 | ||
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] | Stock Option [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Shares available for future grants and awards under Stock Incentive Plans | 2,000,000 | ||
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] | |||
Common stock, aggregate shares authorized | 2,600,000 | ||
Aggregate number Shares issued under Stock Purchase Plans | 400,000 | ||
Common stock, reserved for issuance | 1,600,000 |
Stock Incentive Plans and Sto_4
Stock Incentive Plans and Stock Purchase Plans - Schedule of Restricted Stock and Deferred Stock Awards (Detail) - $ / shares | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Disclosure of Compensation Related Costs, Share-based Payments [Abstract] | |||
Number of Shares, Non-vested shares at January 1, 2018 | 1,041,034 | ||
Number of Shares, Awarded | 770,480 | ||
Number of Shares, Forfeited | (69,293) | ||
Number of Shares, Vested | (431,368) | ||
Number of Shares, Non-vested shares at December 31, 2018 | 1,310,853 | 1,041,034 | |
Weighted Average Fair Value, Non-vested shares at January 1, 2018 | $ 60.21 | ||
Weighted Average Fair Value, Awarded | 51.99 | $ 54.22 | $ 67.90 |
Weighted Average Fair Value, Forfeited | 56.65 | ||
Weighted Average Fair Value, Vested | 63.57 | ||
Weighted Average Fair Value, Non-vested shares at December 31, 2018 | $ 54.46 | $ 60.21 |
Stock Incentive Plans and Sto_5
Stock Incentive Plans and Stock Purchase Plans - Schedule of Activity and Certain Other Information Related to Stock Option Awards (Detail) - USD ($) $ / shares in Units, $ in Millions | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Disclosure of Compensation Related Costs, Share-based Payments [Abstract] | |||
Number of Shares, Outstanding at January 1, 2018 | 246,342 | ||
Number of Shares, Exercised | (133,366) | ||
Number of Shares, Outstanding at December 31, 2018 | 112,976 | 246,342 | |
Number of Shares, Exercisable at December 31, 2017 | 112,976 | ||
Weighted Average Exercise Price, Outstanding at January 1, 2018 | $ 27.51 | ||
Weighted Average Exercise Price, Exercised | 27.38 | ||
Weighted Average Exercise Price, Outstanding at December 31, 2018 | 27.65 | $ 27.51 | |
Weighted Average Exercise Price, Exercisable at December 31, 2018 | $ 27.65 | ||
Weighted Average Remaining Contractual Term (in years), Outstanding at December 31, 2018 | 1 year 3 months 18 days | ||
Weighted Average Remaining Contractual Term (in years), Exercisable at December 31, 2018 | 1 year 3 months 18 days | ||
Aggregate Intrinsic Value, Exercised | $ 2.8 | $ 5.5 | $ 6.8 |
Aggregate Intrinsic Value, Outstanding at December 31, 2018 | 0.7 | ||
Aggregate Intrinsic Value, Exercisable at December 31, 2018 | $ 0.7 |
Common Stock Repurchase Progr_2
Common Stock Repurchase Programs - Additional Information (Detail) - USD ($) | Sep. 04, 2018 | Dec. 31, 2018 | Jun. 30, 2018 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | Aug. 31, 2018 |
Common Stock [Line Items] | |||||||
Common stock authorized for repurchase | $ 500,000,000 | ||||||
Common stock repurchased | $ 302,160,000 | $ 70,192,000 | $ 61,828,000 | ||||
Common Stock [Member] | |||||||
Common Stock [Line Items] | |||||||
Common stock repurchased | $ 70,000 | $ 10,000 | $ 9,000 | ||||
Repurchased common stock, shares | 7,041,000 | 1,038,000 | 946,000 | ||||
Restricted Stock [Member] | |||||||
Common Stock [Line Items] | |||||||
Number of shares withheld to satisfy minimum statutory tax withholding obligations | 54,909 | 38,257 | |||||
Amount withheld to satisfy minimum statutory tax withholding obligations | $ 2,500,000 | $ 2,100,000 | |||||
Accelerated Share Repurchase (ASR) Agreements [Member] | |||||||
Common Stock [Line Items] | |||||||
Common stock purchase | $ 250,000,000 | ||||||
Common stock repurchased | $ 250,000,000 | ||||||
Repurchased common stock, shares | 4,200,000 | 1,700,000 |
Retirement Plans - Additional I
Retirement Plans - Additional Information (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Retirement Benefits [Abstract] | |||
Expense of retirement plans related to the 401(k) Plans | $ 55.8 | $ 50.7 | $ 45.2 |
Commitments and Contingencies -
Commitments and Contingencies - Additional Information (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Commitments and Contingencies Disclosure [Abstract] | |||
Rent expense | $ 42.9 | $ 42.6 | $ 38 |
Commitments and Contingencies_2
Commitments and Contingencies - Schedule of Future Minimum Lease Payments under Non-Cancelable Operating Leases (Detail) $ in Thousands | Dec. 31, 2018USD ($) |
Commitments and Contingencies Disclosure [Abstract] | |
2,019 | $ 30,824 |
2,020 | 22,038 |
2,021 | 17,946 |
2,022 | 12,708 |
2,023 | 9,440 |
Thereafter | 10,522 |
Total | $ 103,478 |
Selected Quarterly Financial _3
Selected Quarterly Financial Information - Summary of Company's Selected Quarterly Financial Information (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands | 3 Months Ended | 12 Months Ended | |||||||||
Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Quarterly Financial Information Disclosure [Abstract] | |||||||||||
Net revenue | $ 932,696 | $ 896,652 | $ 915,918 | $ 901,857 | $ 910,820 | $ 868,951 | $ 842,944 | $ 835,597 | $ 3,647,123 | $ 3,458,312 | $ 3,183,159 |
Practice salaries and benefits | 657,061 | 625,717 | 620,980 | 631,830 | 617,455 | 586,476 | 561,418 | 572,385 | 2,535,588 | 2,337,734 | 2,031,220 |
Practice supplies and other operating expenses | 29,381 | 30,159 | 31,833 | 30,655 | 32,353 | 29,497 | 30,872 | 27,796 | 122,028 | 120,518 | 118,416 |
General and administrative expenses | 112,789 | 102,905 | 107,908 | 108,776 | 108,895 | 101,430 | 103,015 | 103,765 | 432,378 | 417,105 | 372,572 |
Depreciation and amortization | 29,891 | 28,709 | 26,518 | 26,163 | 26,414 | 25,116 | 25,735 | 25,614 | 111,281 | 102,879 | 89,264 |
Total operating expenses | 829,122 | 787,490 | 787,239 | 797,424 | 785,117 | 742,519 | 721,040 | 729,560 | 3,201,275 | 2,978,236 | 2,611,472 |
Income from operations | 103,574 | 109,162 | 128,679 | 104,433 | 125,703 | 126,432 | 121,904 | 106,037 | 445,848 | 480,076 | 571,687 |
Investment and other income | 967 | 1,302 | 1,202 | 1,464 | 2,777 | 235 | 365 | 576 | 4,935 | 3,953 | 2,019 |
Interest expense | (25,448) | (21,782) | (21,604) | (19,935) | (19,844) | (18,428) | (18,535) | (17,752) | (88,769) | (74,559) | (63,092) |
Equity (loss) in earnings of unconsolidated affiliate | 2,277 | 1,766 | 1,257 | 1,525 | (294) | (240) | 689 | 797 | 6,825 | 952 | 3,185 |
Total non-operating expenses | (22,204) | (18,714) | (19,145) | (16,946) | (17,361) | (18,433) | (17,481) | (16,379) | (77,009) | (69,654) | (57,888) |
Income before income taxes | 81,370 | 90,448 | 109,534 | 87,487 | 108,342 | 107,999 | 104,423 | 89,658 | 368,839 | 410,422 | 513,799 |
Income tax (provision) benefit | (21,156) | (24,873) | (30,122) | (24,059) | 27,761 | (42,119) | (40,725) | (34,967) | (100,210) | (90,050) | (189,203) |
Net income | 0 | 0 | 0 | 0 | 268,629 | 320,372 | 324,596 | ||||
Net loss attributable to noncontrolling interests | 0 | 0 | 0 | 0 | 318 | ||||||
Net income attributable to MEDNAX, Inc. | $ 60,214 | $ 65,575 | $ 79,412 | $ 63,428 | $ 136,103 | $ 65,880 | $ 63,698 | $ 54,691 | $ 268,629 | $ 320,372 | $ 324,914 |
Earnings per share, Basic | $ 0.69 | $ 0.72 | $ 0.85 | $ 0.68 | $ 1.47 | $ 0.71 | $ 0.69 | $ 0.59 | $ 2.95 | $ 3.47 | $ 3.52 |
Earnings per share, Diluted | $ 0.68 | $ 0.72 | $ 0.85 | $ 0.68 | $ 1.46 | $ 0.71 | $ 0.69 | $ 0.59 | $ 2.93 | $ 3.45 | $ 3.49 |
Weighted average shares, Basic | 87,810 | 90,984 | 92,987 | 92,859 | 92,756 | 92,589 | 92,181 | 92,360 | 91,104 | 92,431 | 92,422 |
Weighted average shares, Diluted | 88,258 | 91,359 | 93,529 | 93,505 | 93,159 | 92,881 | 92,812 | 93,143 | 91,606 | 92,958 | 93,109 |