Pediatrix Medical (MD) 10-Q 2 May 19 2019 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2019	Apr. 26, 2019
Document and Entity Information [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	Q1
Trading Symbol	MD
Entity Registrant Name	MEDNAX, INC.
Entity Central Index Key	0000893949
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Emerging Growth Company	false
Entity Small Business	false
Entity Common Stock, Shares Outstanding		86,537,633

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets (Unaudited) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Current assets:
Cash and cash equivalents	$ 26,476	$ 25,491
Restricted cash	20,000	20,000
Short-term investments	86,223	21,923
Accounts receivable, net	522,638	506,723
Prepaid expenses	12,862	17,123
Other current assets	16,680	17,166
Assets held for sale	372,537	51,551
Total current assets	1,057,416	659,977
Investments	0	69,699
Property and equipment, net	89,037	90,434
Goodwill	4,065,506	4,061,439
Intangible assets, net	300,662	313,165
Operating lease right-of-use assets	90,983	0
Other assets	102,653	103,134
Assets held for sale	0	639,633
Total assets	5,706,257	5,937,481
Current liabilities:
Accounts payable and accrued expenses	312,957	448,567
Current portion of finance lease liabilities	240	253
Current portion of operating lease liabilities	24,726	0
Income taxes payable	44,971	30,598
Liabilities held for sale	32,289	23,344
Total current liabilities	415,183	502,762
Line of credit	392,000	739,500
Long-term debt and finance lease liabilities, net	1,727,482	1,234,781
Long-term operating lease liabilities	71,162	0
Long-term professional liabilities	208,564	209,060
Deferred income taxes	90,473	95,581
Other liabilities	21,581	31,828
Liabilities held for sale	0	36,085
Total liabilities	2,926,445	2,849,597
Commitments and contingencies
Shareholders' equity:
Preferred stock; $.01 par value; 1,000 shares authorized; none issued	0	0
Common stock; $.01 par value; 200,000 shares authorized; 86,387 and 87,820 shares issued and outstanding, respectively	864	878
Additional paid-in capital	977,872	992,647
Accumulated other comprehensive loss	(194)	0
Retained earnings	1,801,270	2,094,359
Total shareholders' equity	2,779,812	3,087,884
Total liabilities and shareholders' equity	$ 5,706,257	$ 5,937,481

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Unaudited) (Parenthetical) - $ / shares	Mar. 31, 2019	Dec. 31, 2018
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	86,387,000	87,820,000
Common stock, shares outstanding	86,387,000	87,820,000

Condensed Consolidated Statemen

Condensed Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Income Statement [Abstract]
Net revenue	$ 851,183	$ 852,628
Operating expenses:
Practice salaries and benefits	621,539	603,955
Practice supplies and other operating expenses	25,791	27,403
General and administrative expenses	101,821	101,693
Depreciation and amortization	20,033	19,914
Transformational and restructuring related expenses	3,544	0
Total operating expenses	772,728	752,965
Income from operations	78,455	99,663
Investment and other income	1,647	1,474
Interest expense	(30,723)	(19,935)
Equity in earnings of unconsolidated affiliates	1,236	1,525
Total non-operating expenses	(27,840)	(16,936)
Income from continuing operations before income taxes	50,615	82,727
Income tax provision	(8,962)	(22,720)
Income from continuing operations	41,653	60,007
(Loss) income from discontinued operations, net of tax	(284,525)	3,421
Net (loss) income	$ (242,872)	$ 63,428
Income from continuing operations:
Basic	$ 0.48	$ 0.65
Diluted	0.48	0.64
(Loss) income from discontinued operations:
Basic	(3.31)	0.04
Diluted	(3.29)	0.04
Net (loss) income:
Basic	(2.82)	0.68
Diluted	$ (2.81)	$ 0.68
Weighted average common shares:
Basic	86,073	92,859
Diluted	86,545	93,505

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Equity - USD ($) shares in Thousands, $ in Thousands	Total	Common Stock [Member]	Additional Paid-in Capital [Member]	Accumulated Other Comprehensive Loss [Member]	Retained Earnings [Member]
Balance at Dec. 31, 2017	$ 3,066,454	$ 937	$ 1,017,328		$ 2,048,189
Balance, Shares at Dec. 31, 2017		93,721
Net income (loss)	63,428				63,428
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan	4,027	$ 1	4,026
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan, shares		97
Issuance of restricted stock		$ 6	(6)
Issuance of restricted stock, shares		588
Forfeitures of restricted stock, shares		(13)
Stock swaps	(296)		(296)
Stock swaps,shares		(5)
Stock-based compensation expense	9,875		9,875
Balance at Mar. 31, 2018	3,143,488	$ 944	1,030,927		2,111,617
Balance, Shares at Mar. 31, 2018		94,388
Balance at Dec. 31, 2017	3,066,454	$ 937	1,017,328		2,048,189
Balance, Shares at Dec. 31, 2017		93,721
Repurchased common stock	(250,000)
Balance at Dec. 31, 2018	3,087,884	$ 878	992,647		2,094,359
Balance, Shares at Dec. 31, 2018		87,820
Net income (loss)	(242,872)				(242,872)
Unrealized holding loss on investments, net of tax	(194)			$ (194)
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan	3,542	$ 1	3,541
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan, shares		140
Issuance of restricted stock		$ 10	(10)
Issuance of restricted stock, shares		978
Forfeitures of restricted stock, shares		(6)
Stock swaps	(666)		(666)
Stock swaps,shares		(20)
Stock-based compensation expense	11,100		11,100
Repurchased common stock	(78,982)	$ (25)	(28,740)		(50,217)
Repurchased common stock, shares		(2,525)
Balance at Mar. 31, 2019	$ 2,779,812	$ 864	$ 977,872	$ (194)	$ 1,801,270
Balance, Shares at Mar. 31, 2019		86,387

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Cash flows from operating activities:
Net (loss) income	$ (242,872)	$ 63,428
Loss (income) from discontinued operations	284,525	(3,421)
Adjustments to reconcile net income to net cash from operating activities:
Depreciation and amortization	20,033	19,914
Amortization of premiums, discounts and issuance costs	1,520	1,089
Stock-based compensation expense	10,989	9,686
Deferred income taxes	(5,108)	(399)
Other	2,767	(1,216)
Changes in assets and liabilities:
Accounts receivable	(15,915)	(38,444)
Prepaid expenses and other current assets	4,790	634
Other long-term assets	9,580	(486)
Accounts payable and accrued expenses	(132,559)	(129,185)
Income taxes payable	14,373	(38,785)
Payments of contingent consideration liabilities	(42)	(65)
Long-term professional liabilities	(496)	(643)
Other liabilities	(11,993)	1,016
Net cash used in operating activities – continuing operations	(60,408)	(116,877)
Net cash provided by operating activities - discontinued operations	3,591	3,243
Net cash used in operating activities	(56,817)	(113,634)
Cash flows from investing activities:
Acquisition payments, net of cash acquired	(4,250)	(21,975)
Purchases of investments	0	(14,039)
Proceeds from maturities or sales of investments	4,800	3,500
Purchases of property and equipment	(5,821)	(8,463)
Proceeds from sale of controlling interest in assets	0	22,764
Net cash used in investing activities – continuing operations	(5,271)	(18,213)
Net cash used in investing activities - discontinued operations	(3,420)	(3,963)
Net cash used in investing activities	(8,691)	(22,176)
Cash flows from financing activities:
Borrowings on credit agreement	518,500	506,000
Payments on credit agreement	(866,000)	(392,500)
Proceeds from issuance of senior notes	500,000
Payments for financing costs	(8,380)
Payments of contingent consideration liabilities	(1,308)	(367)
Payments on finance lease obligations	(42)	(308)
Proceeds from issuance of common stock	2,876	3,731
Repurchases of common stock	(78,982)
Net cash provided from financing activities – continuing operations	66,664	116,556
Net cash provided from financing activities - discontinued operations	0	(7)
Net cash provided from financing activities	66,664	116,549
Net increase (decrease) in cash and cash equivalents	1,156	(19,261)
Cash, cash equivalents and restricted cash at beginning of period	56,745	80,200
Less cash and cash equivalents of discontinued operations at end of period	(11,425)	(13,116)
Cash, cash equivalents and restricted cash of continuing operations at end of period	$ 46,476	$ 47,823

Basis of Presentation and New A

Basis of Presentation and New Accounting Pronouncements	3 Months Ended
	Mar. 31, 2019
Accounting Policies [Abstract]
Basis of Presentation and New Accounting Pronouncements	1. Basis of Presentation and New Accounting Pronouncements: The accompanying unaudited Condensed Consolidated Financial Statements of the Company and the notes thereto presented in this Form 10-Q have been prepared in accordance with the rules and regulations of the Securities and Exchange Commission (“SEC”) applicable to interim financial statements, and do not include all disclosures required by accounting principles generally accepted in the United States of America (“GAAP”) for complete financial statements. In the opinion of management, these financial statements include all adjustments, consisting only of normal recurring adjustments, necessary for a fair statement of the results of interim periods. The financial statements include all the accounts of MEDNAX, Inc. and its consolidated subsidiaries (collectively, “MDX”) together with the accounts of MDX’s affiliated business corporations or professional associations, professional corporations, limited liability companies and partnerships (the “affiliated professional contractors”). Certain subsidiaries of MDX have contractual management arrangements with its affiliated professional contractors, which are separate legal entities that provide physician services in certain states and Puerto Rico. The terms “MEDNAX” and the “Company” refer collectively to MEDNAX, Inc., its subsidiaries and the affiliated professional contractors. The Company is a party to a joint venture in which it owns a 37.5% economic interest and a second 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. The consolidated results of operations for the interim periods presented are not necessarily indicative of the results to be experienced for the entire fiscal year. In addition, the accompanying unaudited Condensed Consolidated Financial Statements and the notes thereto should be read in conjunction with the Consolidated Financial Statements and the notes thereto included in the Company’s most recent Annual Report on Form 10-K (the “Form 10-K”). 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 on its core physician services business. The Company determined that the criterion to classify the management services service line as assets held for sale within the Company’s Consolidated Balance Sheets effective March 31, 2019 were met, and accordingly, the assets and liabilities of that service line were classified as current assets and liabilities held for sale at March 31, 2019. In addition, in accordance with accounting guidance for discontinued operations, the expected divestiture of the management services service line was deemed to represent a fundamental strategic shift that will have a major effect on the Company’s operations, and accordingly, the operating results of the service line were reported as discontinued operations in the Company’s Consolidated Statements of Income for the three months ended March 31, 2019. Reclassifications have been made to certain prior period financial statements and footnote disclosures to reflect the impact of discontinued operations. See note 6 for more information. Recently Adopted Accounting Pronouncements In February 2016, the accounting guidance related to leases was issued that 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. The adoption of this guidance had a material impact on the Company’s 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. See note 8 for more information.

Cash Equivalents and Investment

Cash Equivalents and Investments	3 Months Ended
	Mar. 31, 2019
Investments, Debt and Equity Securities [Abstract]
Cash Equivalents and Investments	2. Cash Equivalents and Investments: As of March 31, 2019 and December 31, 2018, the Company’s cash equivalents consisted entirely of money market funds totaling $2.5 million and $0.5 million, respectively. Investments consisted of municipal debt securities, federal home loan securities and certificates of deposit. During the three months ended March 31, 2019, the Company changed its accounting policy for and the classification of its investments from held-to-maturity to available for sale. Although there is no stated expectation that the investments will be sold within one year, the investments are available for use, if needed, and accordingly are classified as short-term. Such investments are carried at fair value with any unrealized gains and losses reported as a component of other accumulated comprehensive income or loss. Prior to January 1, 2019, the Company classified its investments as held-to-maturity and carried such investments at amortized cost. Investments with remaining maturities of less than one year were classified as short-term and investments classified as long-term had maturities of one year to five years. Investments held at March 31, 2019 and December 31, 2018 are summarized as follows (in thousands): March 31, 2019 December 31, 2018 Short-Term Long-Term Short-Term Long-Term Municipal debt securities $ 45,111 $ — $ 18,473 $ 30,841 Federal home loan securities 35,234 — 2,000 34,393 Certificates of deposit 5,878 — 1,450 4,465 $ 86,223 $ — $ 21,923 $ 69,699

Fair Value Measurements

Fair Value Measurements	3 Months Ended
	Mar. 31, 2019
Fair Value Disclosures [Abstract]
Fair Value Disclosures	3. Fair Value Measurements: The accounting guidance establishes a fair value hierarchy that prioritizes valuation inputs into three levels based on the extent to which inputs used in measuring fair value are observable in the market. Each fair value measurement is reported in one of three levels: Level 1 – inputs are based upon unadjusted quoted prices for identical instruments traded in active markets. Level 2 – inputs are based upon quoted prices for similar instruments in active markets, quoted prices for identical or similar instruments in markets that are not active, and model-based valuation techniques for which all significant assumptions are observable in the market or can be corroborated by observable market data for substantially the full term of the assets or liabilities. Level 3 – inputs are generally unobservable and typically reflect management’s estimates of assumptions that market participants would use in pricing the asset or liability. The fair values are therefore determined using model-based techniques that include option pricing models, discounted cash flow models, and similar techniques. The following table presents information about the Company’s financial instruments that are accounted for at fair value on a recurring basis at March 31, 2019 and December 31, 2018 (in thousands): Fair Value Fair Value March 31, December 31, Assets: Money market funds Level 1 $ 2,454 $ 481 Short-term investments Level 2 86,223 — Company-owned life insurance Level 2 11,787 10,464 Liabilities: Contingent consideration Level 3 15,069 20,039 (1) Investments were measured at carrying value as of December 31, 2018. See table below. The following table presents information about the Company’s financial instruments that are not carried at fair value at March 31, 2019 and December 31, 2018 (in thousands): March 31, 2019 December 31, 2018 Carrying Fair Value Carrying Fair Value Assets: Short-term investments $ — (2) $ $ — (2) 21,923 21,858 Long-term investments $ — (2) $ — (2) 69,699 69,090 Liabilities: 2023 Notes 750,000 759,375 750,000 736,725 2027 Notes 1,000,000 1,010,000 500,000 482,500 (2) Investments were measured at fair value as of March 31, 2019. See table above. The carrying amounts of cash equivalents, accounts receivable and accounts payable and accrued expenses approximate fair value due to the short maturities of the respective instruments. The carrying value of the line of credit approximates fair value. If the Company’s line of credit was measured at fair value, it would be categorized as Level 2 in the fair value hierarchy.

Accounts Receivable and Net Rev

Accounts Receivable and Net Revenue	3 Months Ended
	Mar. 31, 2019
Text Block [Abstract]
Accounts Receivable and Net Revenue	4. Accounts Receivable and Net Revenue: Accounts receivable, net consists of the following (in thousands): March 31, 2019 December 31, 2018 Gross accounts receivable $ 1,966,918 $ 1,993,395 Allowance for contractual adjustments and uncollectibles (1,444,280 ) (1,486,672 ) $ 522,638 $ 506,723 Patient service revenue is recognized at the time services are provided by the Company’s affiliated physicians. The Company’s performance obligations related to the delivery of services to patients are satisfied at the time of service. Accordingly, there are no performance obligations that are unsatisfied or partially unsatisfied at the end of the reporting period with respect to patient service revenue. Almost all of the Company’s patient service revenue is reimbursed by government-sponsored healthcare programs (“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. The following table summarizes the Company’s net revenue by category (in thousands): Three Months Ended March 31, 2019 2018 Net patient service revenue $ 749,585 $ 756,374 Hospital contract administrative fees 94,721 91,239 Other revenue 6,877 5,015 $ 851,183 $ 852,628 The approximate percentage of net patient service revenue by type of payor was as follows: Three Months Ended March 31, 2019 2018 Contracted managed care 69 % 70 % Government 24 25 Other third-parties 5 4 Private-pay patients 2 1 100 % 100 %

Business Acquisitions

Business Acquisitions	3 Months Ended
	Mar. 31, 2019
Business Combinations [Abstract]
Business Acquisitions	5. Business Acquisitions: During the three months ended March 31, 2019, the Company completed the acquisition of one neonatology physician group practice for $4.3 million. This acquisition expanded the Company’s national network of physician practices. In connection with this acquisition, the Company recorded goodwill of $4.1 million and other intangible assets consisting primarily of physician and hospital agreements of $0.2 million. The Company expects that the goodwill recorded during the three months ended March 31, 2019 will be deductible for tax purposes. In addition, the Company paid $1.4 million for contingent consideration in connection with a prior period acquisition. The Company also recorded a decrease of $4.0 million related to the change in fair value of a contingent consideration agreement for which the probability of the achievement of certain performance measures was updated during the three months ended March 31, 2019. This change in fair value of contingent consideration was recorded within operating expenses.

Assets Held for Sale and Discon

Assets Held for Sale and Discontinued Operations	3 Months Ended
	Mar. 31, 2019
Discontinued Operations and Disposal Groups [Abstract]
Disposal Groups, Including Discontinued Operations, Disclosure	6. Assets Held for Sale and Discontinued Operations: On November 1, 2018, the Company announced the initiation of a process to potentially divest of its management services service line to allow the Company to focus on its core physician services business. The Company determined that the criterion to classify the management services service line as assets held for sale within the Company’s Consolidated Balance Sheets effective March 31, 2019 were met. Accordingly, the assets and liabilities of that service line were classified as current assets and liabilities held for sale at March 31, 2019 as the Company expects to divest of the management services organization within the next twelve months, although there is no assurance that any such divestiture will occur. The classification to assets held for sale impacted the net book value of the assets and liabilities expected to be transferred upon sale. The estimated fair value of the management services service line was determined based on a range of market multiples and other assumptions along with estimated broker, accounting, legal and other costs to sell. The Company deemed the carrying amount of other assets within the service line, specifically accounts receivable and property and equipment, to represent fair value and therefore recorded a non-cash charge of $285.0 million against goodwill, which represented the difference between the estimated fair value of the management services service line and the carrying amount of the net assets held for sale. Recognition of the charge against goodwill resulted in a tax benefit which generated an additional $36.6 million deferred tax asset that increased the fair value of the service line. An incremental non-cash charge is then required to reduce the service line to its previously determined fair value. Accordingly, the Company recorded the incremental non-cash charge of $36.6 million for a total non-cash charge of $321.6 million, reducing the goodwill balance of the management services service line to zero. Upon completion of a divestiture, the Company could record an additional gain or loss on disposal at the time final net proceeds are determined. In addition, in accordance with accounting guidance for discontinued operations, the expected divestiture of the management services service line was deemed to represent a fundamental strategic shift that will have a major effect on the Company’s operations, and accordingly, the operating results of the service line were reported as discontinued operations in the Company’s Consolidated Statements of Income for the three months ended March 31, 2019 with prior periods recast to conform with the current period presentation. The following table is a reconciliation of the major classes of assets and liabilities classified as assets and liabilities held for sale in the accompanying Consolidated Balance Sheets representing the management services service line as of March 31, 2019 and December 31, 2018 (in thousands): March 31, 2019 December 31, 2018 Assets Cash and cash equivalents $ 11,425 $ 11,254 Accounts receivable, net 39,619 38,118 Prepaid expenses and other assets 2,741 2,505 Property and equipment, net 43,440 42,603 Operating lease right-of-use asset 4,843 — Goodwill — 321,556 Intangible assets, net 270,469 275,148 $ 372,537 $ 691,184 Liabilities Accounts payable, accrued expenses and other liabilities $ 23,896 $ 23,770 Operating lease liabilities 7,231 — Deferred income taxes 1,163 35,659 $ 32,290 $ 59,429 The following table summarizes the results of discontinued operations for the three months ended March 31, 2019 and 2018 (in thousands): Three Months Ended March 31, 2019 2018 Net revenue $ 51,222 $ 56,089 Operating expenses: Cost of service salaries and benefits 25,928 27,876 Cost of service supplies and other operating expenses 5,567 5,969 General and administrative expenses 11,023 11,226 Depreciation and amortization 7,262 6,249 Transaction costs 1,100 — Loss on classification as held for sale 321,556 — Total operating expenses 372,436 51,320 (Loss) income from operations (321,214 ) 4,769 Non-operating expenses, net (16 ) (9 ) (Loss) income before income taxes (321,230 ) 4,760 Income tax benefit (provision) 36,705 (1,339 ) Net (loss) income $ (284,525 ) $ 3,421

Accounts Payable and Accrued Ex

Accounts Payable and Accrued Expenses	3 Months Ended
	Mar. 31, 2019
Payables and Accruals [Abstract]
Accounts Payable and Accrued Expenses	7. Accounts Payable and Accrued Expenses: Accounts payable and accrued expenses consist of the following (in thousands): March 31, 2019 December 31, 2018 Accounts payable $ 32,149 $ 31,059 Accrued salaries and bonuses 105,565 242,888 Accrued payroll taxes and benefits 52,385 78,415 Accrued professional liabilities 41,198 34,931 Accrued contingent consideration 15,069 18,760 Accrued interest 26,516 9,477 Other accrued expenses 40,075 33,037 $ 312,957 $ 448,567 The net decrease in accrued salaries and bonuses of $137.3 million, from December 31, 2018 to March 31, 2019, is primarily due to the payment of performance-based incentive compensation, principally to the Company’s affiliated physicians, partially offset by performance-based incentive compensation accrued during the three months ended March 31, 2019. A majority of the Company’s payments for performance-based incentive compensation is paid annually during the first quarter.

Leases

Leases	3 Months Ended
	Mar. 31, 2019
Leases [Abstract]
Leases of Lessee Disclosure	8. Leases: Effective January 1, 2019, the Company adopted the new accounting guidance using the modified retrospective method of applying the new guidance at the adoption date. The Company elected practical expedients permitted under the transition provisions, which allowed the Company to carryforward historical assessments of whether contracts are or contain leases and lease classification. Beginning with January 1, 2019, the Company’s financial position is presented under the new guidance, while the prior period financial statements were not adjusted and continue to be reported in accordance with the previous guidance. The Company primarily leases property under operating leases and has one material equipment operating lease for an aircraft. The Company’s property leases are primarily for its regional, medical and business offices, storage space and temporary housing for medical staff. For leases with terms greater than 12 months, the Company records the related asset and obligation at the present value of the lease payment using a discount rate that reflects the Company’s estimated incremental borrowing rate. Certain of the Company’s leases include rental escalation clauses and renewal options that are factored into the determination of lease payments when appropriate. Operating leases for office equipment are not material, and therefore are excluded from the Company’s Consolidated Balance Sheet. Finance leases are not material but will continue to be reported on the Company’s Consolidated Balance Sheets with the right-of-use assets included in property and equipment, net, and the liabilities included in current portion of long-term debt and finance lease obligations. The table below presents the operating lease-related right-of-use assets and related liabilities recorded on the Company’s balance sheet and the weighted average remaining lease term and discount rate as of March 31, 2019 (dollars in thousands): March 31, 2019 Assets: Operating lease right-of-use assets $ 90,983 Liabilities: Current portion of operating lease liabilities 24,726 Long-term portion of operating lease liabilities 71,162 Other Information: Weighted-average remaining lease term 4.9 years Weighted average discount rate 5.1 % The table below presents certain information related to the lease costs for operating leases during the three months ended March 31, 2019 (in thousands): March 31, 2019 Operating lease costs $ 7,643 Variable lease costs 722 Other operating lease costs 1,633 Total operating lease costs $ 9,998 The table below presents supplemental cash flow information related to operating leases during the three months ended March 31, 2019 (in thousands): March 31, 2019 Operating cash flows for operating leases $ 10,648 The table below reconciles the undiscounted cash flows for each of the first five years and total of the remaining years to the operating lease liabilities recorded on the balance sheet as of March 31, 2019 (in thousands): March 31, 2019 2019 (excluding the three months ended March 31, 2019) $ 19,417 2020 24,418 2021 20,331 2022 15,731 2023 11,694 Thereafter 14,636 Total minimum lease payments 106,227 Less: Amount of payments representing interest (10,339 ) Present value of future minimum lease payments 95,888 Less: Current obligations (24,726 ) Long-term portion of operating leases $ 71,162

Common and Common Equivalent Sh

Common and Common Equivalent Shares	3 Months Ended
	Mar. 31, 2019
Earnings Per Share [Abstract]
Common and Common Equivalent Shares	9. Common and Common Equivalent Shares: Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the period. Diluted net income per common share is calculated by dividing net income by the weighted average number of common and potential common shares outstanding during the period. Potential common shares consist of outstanding restricted stock, deferred stock and stock options and is calculated using the treasury stock method. The calculation of shares used in the basic and diluted net income per common share calculation for the three months ended March 31, 2019 and 2018 is as follows (in thousands): Three Months Ended March 31, 2019 2018 Weighted average number of common shares outstanding 86,073 92,859 Weighted average number of dilutive common share equivalents 472 646 Weighted average number of common and common equivalent shares outstanding 86,545 93,505 Antidilutive securities not included in the diluted net income per common share calculation 504 1

Stock Incentive Plans and Stock

Stock Incentive Plans and Stock Purchase Plans	3 Months Ended
	Mar. 31, 2019
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock Incentive Plans and Stock Purchase Plans	10. Stock Incentive Plans and Stock Purchase Plans: The Company’s Amended and Restated 2008 Incentive Compensation Plan, as amended (the “Amended and Restated 2008 Incentive Plan”) provides for grants of stock options, stock appreciation rights, restricted stock, deferred stock, and other stock-related awards and performance awards that may be settled in cash, stock or other property. Under the Amended and Restated 2008 Incentive Plan, options to purchase shares of common stock may be granted at a price not less than the fair market value of the shares on the date of grant. The options must be exercised within 10 years from the date of grant and generally become exercisable on a pro rata basis over a three-year period from the date of grant. The Company issues new shares of its common stock upon exercise of its stock options. Restricted stock awards generally vest over periods of three years upon the fulfillment of specified service-based conditions and in certain instances performance-based conditions. Deferred stock awards generally vest upon the satisfaction of specified performance-based conditions and service-based conditions. The Company recognizes compensation expense related to its restricted stock and deferred stock awards ratably over the corresponding vesting periods. During the three months ended March 31, 2019, the Company granted 977,745 shares of restricted stock to its employees and non-employee directors under the Amended and Restated 2008 Incentive Plan. At March 31, 2019, the Company had 53,779 shares available for future grants and awards under its Amended and Restated 2008 Incentive Plan. On March 20, 2019, the Company’s Board of Directors amended and restated the Amended and Restated 2008 Incentive Plan, subject to shareholder approval, to, among other things, increase the number of shares of the Company’s common stock available for issuance under the Amended and Restated 2008 Incentive Plan by 8,275,000 shares. Under the Company’s 1996 Non-Qualified Employee Stock Purchase Plan, as amended (the “ESPP”), employees are permitted to purchase the Company’s common stock at 85% of market value on January 1st, April 1st, July 1st and October 1st of each year. Under the Company’s 2015 Non-Qualified Stock Purchase Plan (the “SPP”), certain eligible non-employee service providers are permitted to purchase the Company’s common stock at 90% of market value on January 1st, April 1st, July 1st and October 1st of each year. Each of the ESPP and the SPP provide for the issuance of an aggregate of 2.6 million shares of the Company’s common stock less the number of shares of common stock purchased under the other plan. The Company recognizes stock-based compensation expense for the discount received by participating employees and non-employee service providers. During the three months ended March 31, 2019, 99,866 shares in aggregate were issued under the ESPP and SPP. At March 31, 2019, the Company had approximately 1.5 million shares in aggregate reserved for issuance under the ESPP and SPP. During the three months ended March 31, 2019 and 2018, the Company recognized stock-based compensation expense of $11.0 million and $9.7 million, respectively.

Common Stock Repurchase Program

Common Stock Repurchase Programs	3 Months Ended
	Mar. 31, 2019
Text Block [Abstract]
Common Stock Repurchase Programs	11. Common Stock Repurchase Programs: In July 2013, the Company’s Board of Directors authorized the repurchase of shares of the Company’s common stock up to an amount sufficient to offset the dilutive impact from the issuance of shares under the Company’s equity compensation programs. The share repurchase program allows the Company to make open market purchases from time-to-time based on general economic and market conditions and trading restrictions. The repurchase program also allows for the repurchase of shares of the Company’s common stock to offset the dilutive impact from the issuance of shares, if any, related to the Company’s acquisition program. No shares were purchased under this program during the three months ended March 31, 2019. 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, of which $250.0 million remained available for repurchase as of December 31, 2018. Under this program, during the three months ended March 31, 2019, the Company repurchased 2.5 million shares of its common stock for $78.6 million. The Company also withheld 19,331 shares to satisfy minimum statutory withholding obligations of $0.6 million in connection with the vesting of restricted stock during the quarter. The Company intends to utilize various methods to effect any future share repurchases, including, among others, open market purchases and accelerated share repurchase programs. The amount and timing of repurchases will depend upon several factors, including general economic and market conditions and trading restrictions.

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2019
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	12. 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 o perations, cash flows and the trading price of its securities. The Company has not included an accrual for these matters as of March 31, 2019 in its Condensed Consolidated Financial Statements, as the variables affecting any potential eventual liability depend on the currently unknown facts and circumstances that arise out of, and are specific to, any particular future audit, inquiry and investigation and cannot be reasonably estimated at this time. In the ordinary course of business, the Company becomes involved in pending and threatened legal actions and proceedings, most of which involve claims of medical malpractice related to medical services provided by the Company’s affiliated physicians. The Company’s contracts with hospitals generally require the Company to indemnify them and their affiliates for losses resulting from the negligence of the Company’s affiliated physicians. The Company may also become subject to other lawsuits which could involve large claims and significant costs. The Company believes, based upon a review of pending actions and proceedings, that the outcome of such legal actions and proceedings will not have a material adverse effect on its business, financial condition, results of operations, cash flows and the trading price of its securities. The outcome of such actions and proceedings, however, cannot be predicted with certainty and an unfavorable resolution of one or more of them could have a material adverse effect on the Company’s business, financial condition, results of operations, cash flows and the trading price of its securities. Although the Company currently maintains liability insurance coverage intended to cover professional liability and certain other claims, the Company cannot assure that its insurance coverage will be adequate to cover liabilities arising out of claims asserted against it in the future where the outcomes of such claims are unfavorable. With respect to professional liability risk, the Company generally self-insures a portion of this risk through its wholly owned captive insurance subsidiary. Liabilities in excess of the Company’s insurance coverage, including coverage for professional liability and certain other claims, could have a material adverse effect on the Company’s business, financial condition, results of operations, cash flows and the trading price of its securities.

Basis of Presentation and New_2

Basis of Presentation and New Accounting Pronouncements (Policies)	3 Months Ended
	Mar. 31, 2019
Accounting Policies [Abstract]
Recently Adopted Accounting Pronouncements	Recently Adopted Accounting Pronouncements In February 2016, the accounting guidance related to leases was issued that 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. The adoption of this guidance had a material impact on the Company’s 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. See note 8 for more information.

Cash Equivalents and Investme_2

Cash Equivalents and Investments (Tables)	3 Months Ended
	Mar. 31, 2019
Investments, Debt and Equity Securities [Abstract]
Schedule of Investments	March 31, 2019 December 31, 2018 Short-Term Long-Term Short-Term Long-Term Municipal debt securities $ 45,111 $ — $ 18,473 $ 30,841 Federal home loan securities 35,234 — 2,000 34,393 Certificates of deposit 5,878 — 1,450 4,465 $ 86,223 $ — $ 21,923 $ 69,699

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	3 Months Ended
	Mar. 31, 2019
Fair Value Disclosures [Abstract]
Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis	The following table presents information about the Company’s financial instruments that are accounted for at fair value on a recurring basis at March 31, 2019 and December 31, 2018 (in thousands): Fair Value Fair Value March 31, December 31, Assets: Money market funds Level 1 $ 2,454 $ 481 Short-term investments Level 2 86,223 — Company-owned life insurance Level 2 11,787 10,464 Liabilities: Contingent consideration Level 3 15,069 20,039 (1) Investments were measured at carrying value as of December 31, 2018. See table below.
Financial Instruments Measured At Carrying Amount	The following table presents information about the Company’s financial instruments that are not carried at fair value at March 31, 2019 and December 31, 2018 (in thousands): March 31, 2019 December 31, 2018 Carrying Fair Value Carrying Fair Value Assets: Short-term investments $ — (2) $ $ — (2) 21,923 21,858 Long-term investments $ — (2) $ — (2) 69,699 69,090 Liabilities: 2023 Notes 750,000 759,375 750,000 736,725 2027 Notes 1,000,000 1,010,000 500,000 482,500 (2) Investments were measured at fair value as of March 31, 2019. See table above.

Accounts Receivable and Net R_2

Accounts Receivable and Net Revenue (Tables)	3 Months Ended
	Mar. 31, 2019
Text Block [Abstract]
Schedule of Accounts Receivable, Net	Accounts receivable, net consists of the following (in thousands): March 31, 2019 December 31, 2018 Gross accounts receivable $ 1,966,918 $ 1,993,395 Allowance for contractual adjustments and uncollectibles (1,444,280 ) (1,486,672 ) $ 522,638 $ 506,723
Schedule of Net Revenue	The following table summarizes the Company’s net revenue by category (in thousands): Three Months Ended March 31, 2019 2018 Net patient service revenue $ 749,585 $ 756,374 Hospital contract administrative fees 94,721 91,239 Other revenue 6,877 5,015 $ 851,183 $ 852,628
Schedule of Percentage of Net Revenue	The approximate percentage of net patient service revenue by type of payor was as follows: Three Months Ended March 31, 2019 2018 Contracted managed care 69 % 70 % Government 24 25 Other third-parties 5 4 Private-pay patients 2 1 100 % 100 %

Assets Held for Sale and Disc_2

Assets Held for Sale and Discontinued Operations (Tables)	3 Months Ended
	Mar. 31, 2019
Discontinued Operations and Disposal Groups [Abstract]
Disposal Groups, Including Discontinued Operations	The following table is a reconciliation of the major classes of assets and liabilities classified as assets and liabilities held for sale in the accompanying Consolidated Balance Sheets representing the management services service line as of March 31, 2019 and December 31, 2018 (in thousands): March 31, 2019 December 31, 2018 Assets Cash and cash equivalents $ 11,425 $ 11,254 Accounts receivable, net 39,619 38,118 Prepaid expenses and other assets 2,741 2,505 Property and equipment, net 43,440 42,603 Operating lease right-of-use asset 4,843 — Goodwill — 321,556 Intangible assets, net 270,469 275,148 $ 372,537 $ 691,184 Liabilities Accounts payable, accrued expenses and other liabilities $ 23,896 $ 23,770 Operating lease liabilities 7,231 — Deferred income taxes 1,163 35,659 $ 32,290 $ 59,429 The following table summarizes the results of discontinued operations for the three months ended March 31, 2019 and 2018 (in thousands): Three Months Ended March 31, 2019 2018 Net revenue $ 51,222 $ 56,089 Operating expenses: Cost of service salaries and benefits 25,928 27,876 Cost of service supplies and other operating expenses 5,567 5,969 General and administrative expenses 11,023 11,226 Depreciation and amortization 7,262 6,249 Transaction costs 1,100 — Loss on classification as held for sale 321,556 — Total operating expenses 372,436 51,320 (Loss) income from operations (321,214 ) 4,769 Non-operating expenses, net (16 ) (9 ) (Loss) income before income taxes (321,230 ) 4,760 Income tax benefit (provision) 36,705 (1,339 ) Net (loss) income $ (284,525 ) $ 3,421

Accounts Payable and Accrued _2

Accounts Payable and Accrued Expenses (Tables)	3 Months Ended
	Mar. 31, 2019
Payables and Accruals [Abstract]
Schedule of Accounts Payable and Accrued Expenses	Accounts payable and accrued expenses consist of the following (in thousands): March 31, 2019 December 31, 2018 Accounts payable $ 32,149 $ 31,059 Accrued salaries and bonuses 105,565 242,888 Accrued payroll taxes and benefits 52,385 78,415 Accrued professional liabilities 41,198 34,931 Accrued contingent consideration 15,069 18,760 Accrued interest 26,516 9,477 Other accrued expenses 40,075 33,037 $ 312,957 $ 448,567

Leases (Tables)

Leases (Tables)	3 Months Ended
	Mar. 31, 2019
Leases [Abstract]
Operating Lease Related Assets And Liabilities And Other Related Information	The table below presents the operating lease-related right-of-use assets and related liabilities recorded on the Company’s balance sheet and the weighted average remaining lease term and discount rate as of March 31, 2019 (dollars in thousands): March 31, 2019 Assets: Operating lease right-of-use assets $ 90,983 Liabilities: Current portion of operating lease liabilities 24,726 Long-term portion of operating lease liabilities 71,162 Other Information: Weighted-average remaining lease term 4.9 years Weighted average discount rate 5.1 %
Lease, Cost	The table below presents certain information related to the lease costs for operating leases during the three months ended March 31, 2019 (in thousands): March 31, 2019 Operating lease costs $ 7,643 Variable lease costs 722 Other operating lease costs 1,633 Total operating lease costs $ 9,998
Operating Leases Cash Flow Related Information	The table below presents supplemental cash flow information related to operating leases during the three months ended March 31, 2019 (in thousands): March 31, 2019 Operating cash flows for operating leases $ 10,648
Lessee, Operating Lease, Liability, Maturity	The table below reconciles the undiscounted cash flows for each of the first five years and total of the remaining years to the operating lease liabilities recorded on the balance sheet as of March 31, 2019 (in thousands): March 31, 2019 2019 (excluding the three months ended March 31, 2019) $ 19,417 2020 24,418 2021 20,331 2022 15,731 2023 11,694 Thereafter 14,636 Total minimum lease payments 106,227 Less: Amount of payments representing interest (10,339 ) Present value of future minimum lease payments 95,888 Less: Current obligations (24,726 ) Long-term portion of operating leases $ 71,162

Common and Common Equivalent _2

Common and Common Equivalent Shares (Tables)	3 Months Ended
	Mar. 31, 2019
Earnings Per Share [Abstract]
Schedule of Calculation of Shares Used in Basic and Diluted Net Income Per Share	Three Months Ended March 31, 2019 2018 Weighted average number of common shares outstanding 86,073 92,859 Weighted average number of dilutive common share equivalents 472 646 Weighted average number of common and common equivalent shares outstanding 86,545 93,505 Antidilutive securities not included in the diluted net income per common share calculation 504 1

Basis of Presentation and New_3

Basis of Presentation and New Accounting Pronouncements - Additional Information (Detail)	Mar. 31, 2019	Dec. 31, 2018
Unnamed Corporate Joint Venture [Member]
Basis Of Presentation [Line Items]
Equity method ownership percentage in joint venture	37.50%	49.00%

Cash Equivalents and Investme_3

Cash Equivalents and Investments - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Dec. 31, 2018
Maximum [Member]
Cash Equivalents And Investments [Line Items]
Long Term Investments Maturity Period	5 years
Short Term Investment Maturity Period	1 year
Minimum [Member]
Cash Equivalents And Investments [Line Items]
Long Term Investments Maturity Period	1 year
Cash Equivalents [Member]
Cash Equivalents And Investments [Line Items]
Cash equivalents	$ 2.5	$ 0.5

Cash Equivalents and Investme_4

Cash Equivalents and Investments - Schedule of Investments (Detail) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Available-for-sale [Line Items]
Short-Term	$ 86,223	$ 21,923
Long-Term		69,699
Municipal Debt Securities [Member]
Available-for-sale [Line Items]
Short-Term	45,111	18,473
Long-Term		30,841
Federal Home Loan Securities [Member]
Available-for-sale [Line Items]
Short-Term	35,234	2,000
Long-Term		34,393
Certificates of Deposit [Member]
Available-for-sale [Line Items]
Short-Term	5,878	1,450
Long-Term		$ 4,465

Fair Value Measurements - Sched

Fair Value Measurements - Schedule of fair value on a recurring basis (Details) - Fair Value, Measurements, Recurring [Member] - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Fair Value, Inputs, Level 1 [Member]
Assets:
Money market funds	$ 2,454	$ 481
Fair Value, Inputs, Level 2 [Member]
Assets:
Short-term investments	86,223	0	[1]
Company-owned life insurance	11,787	10,464
Fair Value, Inputs, Level 3 [Member]
Liabilities:
Contingent consideration	$ 15,069	$ 20,039
[1]	Investments were measured at carrying value as of December 31, 2018. See table below.

Fair Value Measurements - Sch_2

Fair Value Measurements - Schedule of financial instruments that are not carried at fair value (Details) - USD ($) $ in Thousands	Mar. 31, 2019		Dec. 31, 2018
Assets:
Carrying Amount, Short-term investments	$ 0	[1]	$ 21,923
Carrying Amount, Long-term Investments	0	[1]	69,699
Assets:
Fair Value, Short-term investments	0	[1]	21,858
Fair Value, Long-term investments	0	[1]	69,090
2023 Notes [Member]
Liabilities:
Notes Payable	750,000		750,000
Liabilities:
Notes Payable Fair Value Disclosure	759,375		736,725
2027 Notes [Member]
Liabilities:
Notes Payable	1,000,000		500,000
Liabilities:
Notes Payable Fair Value Disclosure	$ 1,010,000		$ 482,500
[1]	Investments were measured at fair value as of March 31, 2019. See table above.

Accounts Receivable and Net R_3

Accounts Receivable and Net Revenue - Schedule of Accounts Receivable, Net (Detail) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Receivables [Abstract]
Gross accounts receivable	$ 1,966,918	$ 1,993,395
Allowance for contractual adjustments and uncollectibles	(1,444,280)	(1,486,672)
Accounts receivable, net	$ 522,638	$ 506,723

Accounts Receivable and Net R_4

Accounts Receivable and Net Revenue - Schedule of Net Revenue (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Disaggregation of Revenue [Abstract]
Net revenue	$ 851,183	$ 852,628
Net patient service revenue
Disaggregation of Revenue [Abstract]
Net revenue	749,585	756,374
Hospital contract administrative fees
Disaggregation of Revenue [Abstract]
Net revenue	94,721	91,239
Other revenue [Member]
Disaggregation of Revenue [Abstract]
Net revenue	$ 6,877	$ 5,015

Accounts Receivable and Net R_5

Accounts Receivable and Net Revenue - Schedule of Net Patient Service Revenue by Type of Payor (Detail)	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	100.00%	100.00%
Contracted Managed Care [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	69.00%	70.00%
Government [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	24.00%	25.00%
Other Third-Parties [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	5.00%	4.00%
Private-Pay Patients [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	2.00%	1.00%

Business Acquisitions - Additio

Business Acquisitions - Additional Information (Detail) $ in Millions	3 Months Ended
	Mar. 31, 2019USD ($)Number
Business Acquisition [Line Items]
Total business acquisition consideration	$ 4.3
Contingent consideration payments related to prior-period acquisitions	$ 1.4
Number Of Neonatology Practices Acquired | Number	1
Physician Group [Member]
Business Acquisition [Line Items]
Goodwill	$ 4.1
Other intangible assets	0.2
Change in the fair value of a contingent consideration	$ 4

Assets Held for Sale and Disc_3

Assets Held for Sale and Discontinued Operations - Schedule of Management Services Service Line (Detail) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Assets
Cash and cash equivalents	$ 11,425	$ 11,254
Accounts receivable, net	39,619	38,118
Prepaid expenses and other assets	2,741	2,505
Property and equipment, net	43,440	42,603
Operating lease right-of-use asset	4,843
Goodwill	0	321,556
Intangible assets, net	270,469	275,148
Total Assets	372,537	691,184
Liabilities
Accounts payable, accrued expenses and other liabilities	23,896	23,770
Operating lease liabilities	7,231
Deferred income taxes	1,163	35,659
Total Liabilities	$ 32,290	$ 59,429

Assets Held for Sale and Disc_4

Assets Held for Sale and Discontinued Operations - Schedule of Discontinued Operations (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Discontinued Operations and Disposal Groups [Abstract]
Net revenue	$ 51,222	$ 56,089
Operating expenses:
Cost of service salaries and benefits	25,928	27,876
Cost of service supplies and other operating expenses	5,567	5,969
General and administrative expenses	11,023	11,226
Depreciation and amortization	7,262	6,249
Transaction costs	1,100
Loss on classification as held for sale	321,556
Total operating expenses	372,436	51,320
(Loss) income from operations	(321,214)	4,769
Non-operating expenses, net	(16)	(9)
(Loss) income from operations	(321,230)	4,760
Income tax benefit (provision)	36,705	(1,339)
Net (loss) income	$ (284,525)	$ 3,421

Assets Held for Sale and Disc_5

Assets Held for Sale and Discontinued Operations - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended	12 Months Ended
	Mar. 31, 2019	Dec. 31, 2018
Discontinued Operations and Disposal Groups [Abstract]
Incremental Non-Cash Charge	$ 36.6
Asset Impairment Charges	285	$ 321.6
Deferred Tax Assets, Goodwill and Intangible Assets	$ 36.6

Accounts Payable and Accrued _3

Accounts Payable and Accrued Expenses - Schedule of Accounts Payable and Accrued Expenses (Detail) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Payables and Accruals [Abstract]
Accounts payable	$ 32,149	$ 31,059
Accrued salaries and bonuses	105,565	242,888
Accrued payroll taxes and benefits	52,385	78,415
Accrued professional liabilities	41,198	34,931
Accrued contingent consideration	15,069	18,760
Accrued interest	26,516	9,477
Other accrued expenses	40,075	33,037
Accounts payable and accrued expenses, total	$ 312,957	$ 448,567

Accounts Payable and Accrued _4

Accounts Payable and Accrued Expenses - Additional Information (Detail) $ in Millions	3 Months Ended
	Mar. 31, 2019USD ($)
Net decrease in accrued salaries and bonuses	$ 137.3

Leases - Schedule of operating

Leases - Schedule of operating lease-related right-of-use assets and related liabilities recorded on the Company's balance sheet and the weighted average remaining lease term and discount rate (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Assets:
Operating lease right-of-use assets	$ 90,983	$ 0
Liabilities:
Current portion of operating lease liabilities	24,726	0
Long-term portion of operating lease liabilities	$ 71,162	$ 0
Other Information:
Weighted-average remaining lease term	4 years 10 months 24 days
Weighted average discount rate	5.10%

Leases - Schedule of lease cost

Leases - Schedule of lease costs for operating leases (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)
Operating lease costs	$ 7,643
Variable lease costs	722
Other operating lease costs	1,633
Total operating lease costs	$ 9,998

Leases - Schedule of supplement

Leases - Schedule of supplemental cash flow information related to operating leases (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)
Operating cash flows for operating leases	$ 10,648

Leases - Schedule of operatin_2

Leases - Schedule of operating lease liabilities (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
2019 (excluding the three months ended March 31, 2019)	$ 19,417
2020	24,418
2021	20,331
2022	15,731
2023	11,694
Thereafter	14,636
Total minimum lease payments	106,227
Less: Amount of payments representing interest	(10,339)
Present value of future minimum lease payments	95,888
Less: Current obligations	(24,726)	$ 0
Long-term portion of operating leases	$ 71,162	$ 0

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
	Mar. 31, 2019	Mar. 31, 2018
Earnings Per Share [Abstract]
Weighted average number of common shares outstanding	86,073	92,859
Weighted average number of dilutive common share equivalents	472	646
Weighted average number of common and common equivalent shares outstanding	86,545	93,505
Antidilutive securities not included in the diluted net income per common share calculation	504	1

Stock Incentive Plans and Sto_2

Stock Incentive Plans and Stock Purchase Plans - Additional Information (Detail) - USD ($) $ in Millions	1 Months Ended	3 Months Ended
	Mar. 20, 2019	Mar. 31, 2019	Mar. 31, 2018	Dec. 31, 2018
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		$ 11	$ 9.7
Stock Option [Member] | Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period of options, maximum years		10 years
Restricted Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period		3 years
1996 Non-Qualified Employee Stock Purchase Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of market value of common stock at which employees are permitted to purchase		85.00%
2015 Non-Qualified Stock Purchase Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of market value of common stock at which employees are permitted to purchase		90.00%
Amended and Restated 2008 Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares available for future grants and awards under Stock Incentive Plans		53,779
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period		977,745
Share-based Compensation Arrangement by Share-based Payment Award, Number of Additional Shares Authorized	8,275,000
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		99,866
Common stock, reserved for issuance		1,500,000

Common Stock Repurchase Progr_2

Common Stock Repurchase Programs - Additional Information (Detail) - USD ($) $ in Thousands	1 Months Ended	3 Months Ended	12 Months Ended
	Apr. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Aug. 31, 2018
Common Stock [Line Items]
Common stock authorized for repurchase				$ 500,000
Common stock repurchased		$ 78,982	$ 250,000
Subsequent Event [Member]
Common Stock [Line Items]
Stock repurchased and retired during period, shares	817,950
Stock repurchased and retired during period, value	$ 21,400
Common Stock [Member]
Common Stock [Line Items]
Common stock repurchased		$ 25
Repurchased common stock, shares		2,525,000
Restricted Stock [Member]
Common Stock [Line Items]
Number of shares withheld to satisfy minimum statutory tax withholding obligations		19,331
Amount withheld to satisfy minimum statutory tax withholding obligations		$ 600