Pediatrix Medical (MD) 10-Q 1 Aug 19 2019 Q2 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	6 Months Ended
	Jun. 30, 2019	Jul. 26, 2019
Document and Entity Information [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Transition Report	false
Amendment Flag	false
Document Period End Date	Jun. 30, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	Q2
Entity Registrant Name	MEDNAX, INC.
Entity Central Index Key	0000893949
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Common Stock, Shares Outstanding		84,212,571
Title of 12(b) Security	Common Stock
Trading Symbol	MD
Security Exchange Name	NYSE
Entity File Number	001-12111
Entity Incorporation, State or Country Code	FL
Entity Tax Identification Number	26-3667538
Entity Address, Address Line One	1301 Concord Terrace
Entity Address, City or Town	Sunrise
Entity Address, State or Province	FL
Entity Address, Postal Zip Code	33323
City Area Code	954
Local Phone Number	384-0175
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets (Unaudited) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Current assets:
Cash and cash equivalents	$ 24,482	$ 25,491
Restricted cash	15,760	20,000
Short-term investments	82,835	21,923
Accounts receivable, net	504,190	506,723
Prepaid expenses	14,816	17,123
Other current assets	17,678	17,166
Assets held for sale	325,759	51,551
Total current assets	985,520	659,977
Investments	0	69,699
Property and equipment, net	92,720	90,434
Goodwill	4,069,564	4,061,439
Intangible assets, net	286,101	313,165
Operating lease right-of-use assets	89,857	0
Other assets	115,049	103,134
Assets held for sale	0	639,633
Total assets	5,638,811	5,937,481
Current liabilities:
Accounts payable and accrued expenses	386,408	448,567
Current portion of finance lease liabilities	206	253
Current portion of operating lease liabilities	24,494	0
Income taxes payable	1,656	30,598
Liabilities held for sale	28,282	23,344
Total current liabilities	441,046	502,762
Line of credit	351,500	739,500
Long-term debt and finance lease liabilities, net	1,728,418	1,234,781
Long-term operating lease liabilities	70,531	0
Long-term professional liabilities	215,213	209,060
Deferred income taxes	84,629	95,581
Other liabilities	22,447	31,828
Liabilities held for sale	0	36,085
Total liabilities	2,913,784	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; 84,096 and 87,820 shares issued and outstanding, respectively	841	878
Additional paid-in capital	967,429	992,647
Accumulated other comprehensive income	38	0
Retained earnings	1,756,719	2,094,359
Total shareholders' equity	2,725,027	3,087,884
Total liabilities and shareholders' equity	$ 5,638,811	$ 5,937,481

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Unaudited) (Parenthetical) - $ / shares	Jun. 30, 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	84,096,000	87,820,000
Common stock, shares outstanding	84,096,000	87,820,000

Condensed Consolidated Statemen

Condensed Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Income Statement [Abstract]
Net revenue	$ 868,309	$ 864,987	$ 1,719,492	$ 1,717,615
Operating expenses:
Practice salaries and benefits	608,962	593,047	1,230,501	1,197,004
Practice supplies and other operating expenses	28,016	28,329	53,807	55,730
General and administrative expenses	103,540	100,938	205,361	202,631
Depreciation and amortization	19,809	20,280	39,842	40,195
Transformational and restructuring related expenses	27,482	0	31,026	0
Total operating expenses	787,809	742,594	1,560,537	1,495,560
Income from operations	80,500	122,393	158,955	222,055
Investment and other income	1,222	1,225	2,869	2,699
Interest expense	(31,080)	(21,618)	(61,803)	(41,553)
Equity in earnings of unconsolidated affiliates	1,990	1,257	3,226	2,782
Total non-operating expenses	(27,868)	(19,136)	(55,708)	(36,072)
Income from continuing operations before income taxes	52,632	103,257	103,247	185,983
Income tax provision	(17,116)	(28,482)	(26,078)	(51,202)
Income from continuing operations	35,516	74,775	77,169	134,781
(Loss) income from discontinued operations, net of tax	(43,761)	4,637	(328,286)	8,059
Net (loss) income	$ (8,245)	$ 79,412	$ (251,117)	$ 142,840
Income from continuing operations:
Basic	$ 0.43	$ 0.80	$ 0.91	$ 1.45
Diluted	0.42	0.80	0.91	1.44
(Loss) income from discontinued operations:
Basic	(0.53)	0.05	(3.88)	0.09
Diluted	(0.52)	0.05	(3.86)	0.09
Net (loss) income:
Basic	(0.10)	0.85	(2.97)	1.54
Diluted	$ (0.10)	$ 0.85	$ (2.95)	$ 1.53
Weighted average common shares:
Basic	83,234	92,987	84,623	92,922
Diluted	83,689	93,529	85,087	93,516

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) Income [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
Net income (loss)	142,840
Balance at Jun. 30, 2018	3,186,922	$ 934	1,032,573		2,153,415
Balance, Shares at Jun. 30, 2018		93,374
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
Balance at Mar. 31, 2018	3,143,488	$ 944	1,030,927		2,111,617
Balance, Shares at Mar. 31, 2018		94,388
Net income (loss)	79,412				79,412
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan	8,023	$ 2	8,021
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan, shares		214
Issuance of restricted stock, shares		9
Forfeitures of restricted stock, shares		(32)
Stock swaps	(2,365)		(2,365)
Stock swaps, shares		(50)
Stock-based compensation expense	10,524		10,524
Repurchased common stock	(52,160)	$ (12)	(14,534)		(37,614)
Repurchased common stock, shares		(1,155)
Balance at Jun. 30, 2018	3,186,922	$ 934	1,032,573		2,153,415
Balance, Shares at Jun. 30, 2018		93,374
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 gain (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
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)	(251,117)
Repurchased common stock	(144,500)
Repurchased common stock, shares		(5,000)
Balance at Jun. 30, 2019	2,725,027	$ 841	967,429	38	1,756,719
Balance, Shares at Jun. 30, 2019		84,096
Balance at Mar. 31, 2019	2,779,812	$ 864	977,872	(194)	1,801,270
Balance, Shares at Mar. 31, 2019		86,387
Net income (loss)	(8,245)				(8,245)
Unrealized holding gain (loss) on investments, net of tax	232			232
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan	3,675	$ 2	3,673
Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan, shares		155
Issuance of restricted stock		$ 1	(1)
Issuance of restricted stock, shares		123
Forfeitures of restricted stock		$ (1)	1
Forfeitures of restricted stock, shares		(61)
Stock swaps		$ 0
Stock-based compensation expense	15,080		15,080
Repurchased common stock	(65,527)	$ (25)	(29,196)		(36,306)
Repurchased common stock, shares		(2,508)
Balance at Jun. 30, 2019	$ 2,725,027	$ 841	$ 967,429	$ 38	$ 1,756,719
Balance, Shares at Jun. 30, 2019		84,096

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018
Cash flows from operating activities:
Net (loss) income	$ (251,117)	$ 142,840
Loss (income) from discontinued operations	328,286	(8,059)
Adjustments to reconcile net income to net cash from operating activities:
Depreciation and amortization	39,842	40,195
Amortization of premiums, discounts and issuance costs	2,934	2,212
Stock-based compensation expense	20,950	20,012
Deferred income taxes	(10,953)	(21,946)
Other	13,150	(2,148)
Changes in assets and liabilities:
Accounts receivable	2,533	(28,235)
Prepaid expenses and other current assets	805	(1,775)
Other long-term assets	14,036	(283)
Accounts payable and accrued expenses	(57,105)	(80,667)
Income taxes payable	(28,942)	(39,909)
Payments of contingent consideration liabilities	(418)	(65)
Long-term professional liabilities	(3,474)	(5,863)
Other liabilities	(15,605)	(1,079)
Net cash provided by operating activities – continuing operations	54,922	15,230
Net cash provided by operating activities - discontinued operations	7,913	6,374
Net cash provided by operating activities	62,835	21,604
Cash flows from investing activities:
Acquisition payments, net of cash acquired	(11,450)	(25,575)
Purchases of investments	0	(15,884)
Proceeds from maturities or sales of investments	8,180	5,995
Purchases of property and equipment	(16,480)	(18,296)
Proceeds from sale of controlling interest in assets	0	22,764
Net cash used in investing activities – continuing operations	(19,750)	(30,996)
Net cash used in investing activities - discontinued operations	(7,553)	(7,978)
Net cash used in investing activities	(27,303)	(38,974)
Cash flows from financing activities:
Borrowings on credit agreement	898,500	821,500
Payments on credit agreement	(1,286,500)	(782,500)
Proceeds from issuance of senior notes	500,000	0
Payments for financing costs	(9,194)	0
Payments of contingent consideration liabilities	(5,171)	(367)
Payments on finance lease obligations	(98)	(623)
Proceeds from issuance of common stock	6,551	9,389
Repurchases of common stock	(144,509)	(52,160)
Net cash used in financing activities – continuing operations	(40,421)	(4,761)
Net cash used in financing activities - discontinued operations	0	(13)
Net cash used in financing activities	(40,421)	(4,774)
Net decrease in cash and cash equivalents	(4,889)	(22,144)
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	(11,614)	(12,226)
Cash, cash equivalents and restricted cash of continuing operations at end of period	$ 40,242	$ 45,830

Basis of Presentation and New A

Basis of Presentation and New Accounting Pronouncements	6 Months Ended
	Jun. 30, 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 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 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 and continue to meet the criteria at June 30, 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 and six months ended June 30, 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	6 Months Ended
	Jun. 30, 2019
Investments, Debt and Equity Securities [Abstract]
Cash Equivalents and Investments	2. Cash Equivalents and Investments: As of June 30, 2019 and December 31, 2018, the Company’s cash equivalents consisted entirely of money market funds totaling $0.4 million and $0.5 million, respectively. Investments consisted of municipal debt securities, federal home loan securities and certificates of deposit. During the six months ended June 30, 2019, the Company changed the classification of its investments from held-to-maturity one year Prior to January 1, 2019, the Company classified its investments as held-to-maturity Investments held at June 30, 2019 and December 31, 2018 are summarized as follows (in thousands): June 30, 2019 December 31, 2018 Short-Term Long-Term Short-Term Long-Term Municipal debt securities $ 43,272 $ — $ 18,473 $ 30,841 Federal home loan securities 34,397 — 2,000 34,393 Certificates of deposit 5,166 — 1,450 4,465 $ 82,835 $ — $ 21,923 $ 69,699

Fair Value Measurements

Fair Value Measurements	6 Months Ended
	Jun. 30, 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 June 30, 2019 and December 31, 2018 (in thousands): Fair Value Fair Value June 30, 2019 December 31, Assets: Money market funds Level 1 $ 398 $ 481 Short-term investments Level 2 82,835 — (1) Company-owned life insurance Level 2 12,185 10,464 Liabilities: Contingent consideration Level 3 8,299 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 June 30, 2019 and December 31, 2018 (in thousands): June 30, 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 750,000 738,975 750,000 736,725 2027 Notes 1,000,000 983,700 500,000 482,500 (2) Investments were measured at fair value as of June 30, 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	6 Months Ended
	Jun. 30, 2019
Text Block [Abstract]
Accounts Receivable and Net Revenue	4. Accounts Receivable and Net Revenue: Accounts receivable, net consists of the following (in thousands): June 30, 2019 December 31, 2018 Gross accounts receivable $ 1,916,850 $ 1,993,395 Allowance for contractual adjustments and uncollectibles (1,412,660 ) (1,486,672 ) $ 504,190 $ 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 June 30, Six Months Ended June 30, 2019 2018 2019 2018 Net patient service revenue $ 765,525 $ 763,667 $ 1,515,110 $ 1,520,040 Hospital contract administrative fees 96,741 95,534 191,462 186,773 Other revenue 6,043 5,786 12,920 10,802 $ 868,309 $ 864,987 $ 1,719,492 $ 1,717,615 The approximate percentage of net patient service revenue by type of payor was as follows: Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Contracted managed care 70 % 70 % 70 % 70 % Government 24 25 24 25 Other third-parties 4 4 5 4 Private-pay 2 1 1 1 100 % 100 % 100 % 100 %

Business Acquisitions

Business Acquisitions	6 Months Ended
	Jun. 30, 2019
Business Combinations [Abstract]
Business Acquisitions	5. Business Acquisitions: During the six months ended June 30, 2019, the Company completed the acquisition of one neonatology physician practice and two $11.5 million. These acquisitions expanded the Company’s national network of physician practices. In connection with these acquisitions, the Company recorded goodwill of $8.1 million and other intangible assets consisting primarily of physician and hospital agreements of $3.4 million. The Company expects that the goodwill recorded during the six months ended June 30, 2019 will be deductible for tax purposes. In addition, the Company paid $5.6 million for contingent consideration in connection with prior period acquisitions. The Company also recorded a decrease of $6.6 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 six months ended June 30, 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	6 Months Ended
	Jun. 30, 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 were met at March 31, 2019 and continue to be met at June 30, 2019. Accordingly, the assets and liabilities of that service line were classified as current assets and liabilities held for sale at June 30, 2019 as the Company expects to divest of the management services organization within twelve months of March 31, 2019, although there is no assurance that any such divestiture will occur. 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 and six months ended June 30, 2019 with prior periods recast to conform with the current period presentation. 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 initially determined at March 31, 2019 based on an estimated market value 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 during the first quarter of 2019 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 non-cash 36.6 non-cash 50.0 16.4 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 June 30, 2019 and December 31, 2018 (in thousands): June 30, 2019 December 31, 2018 Assets Cash and cash equivalents $ 11,614 $ 11,254 Accounts receivable, net 39,787 38,118 Prepaid expenses and other assets 2,310 2,505 Property and equipment, net 47,573 42,603 Deferred income taxes 15,569 Operating lease right-of-use 4,883 — Goodwill — 321,556 Intangible assets, net 204,023 275,148 $ 325,759 $ 691,184 Liabilities Accounts payable, accrued expenses and other liabilities $ 21,390 $ 23,770 Lease liabilities 6,892 — Deferred income taxes — 35,659 $ 28,282 $ 59,429 The following table summarizes the results of discontinued operations for the three and six months ended June 30, 2019 and 2018 (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Net revenue $ 53,141 $ 58,242 $ 104,363 $ 114,331 Operating expenses: Cost of service salaries and benefits 26,667 27,930 52,595 55,806 Cost of service supplies and other operating expenses 6,370 6,225 11,937 12,194 General and administrative expenses 11,421 11,562 22,444 22,788 Depreciation and amortization — 6,237 7,262 12,486 Transaction costs 300 — 1,400 — Loss on classification as held for sale 66,446 — 388,002 — Total operating expenses 111,204 51,954 483,640 103,274 (Loss) income from operations (58,063 ) 6,288 (379,277 ) 11,057 Non-operating expenses, net (17 ) (11 ) (33 ) (19 ) (Loss) income before income taxes (58,080 ) 6,277 (379,310 ) 11,038 Income tax benefit (provision) 14,319 (1,640 ) 51,024 (2,979 ) Net (loss) income $ (43,761 ) $ 4,637 $ (328,286 ) $ 8,059

Accounts Payable and Accrued Ex

Accounts Payable and Accrued Expenses	6 Months Ended
	Jun. 30, 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): June 30, 2019 December 31, 2018 Accounts payable $ 32,386 $ 31,059 Accrued salaries and bonuses 151,982 242,888 Accrued payroll taxes and benefits 64,197 78,415 Accrued professional liabilities 44,837 34,931 Accrued contingent consideration 8,299 18,760 Accrued interest 34,183 9,477 Other accrued expenses 50,524 33,037 $ 386,408 $ 448,567 The net decrease in accrued salaries and bonuses of $90.9 million, from December 31, 2018 to June 30, 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 six months ended June 30, 2019. A majority of the Company’s payments for performance-based incentive compensation is paid annually during the first quarter.

Leases

Leases	6 Months Ended
	Jun. 30, 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 The table below presents the operating lease-related right-of-use June 30, 2019 Assets: Operating lease right-of-use $ 89,857 Liabilities: Current portion of operating lease liabilities 24,494 Long-term portion of operating lease liabilities 70,531 Other Information: Weighted-average remaining lease term 4.7 years Weighted average discount rate 5.0 % The table below presents certain information related to the lease costs for operating leases during the three and six months ended June 30, 2019 (in thousands): Three Months Ended Six Months Ended Operating lease costs $ 7,428 $ 15,071 Variable lease costs 1,069 1,791 Other operating lease costs 1,325 2,958 Total operating lease costs $ 9,822 $ 19,820 The table below presents supplemental cash flow information related to operating leases during the six months ended June 30, 2019 (in thousands): June 30, 2019 Operating cash flows for operating leases $ 20,528 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 June 30, 2019 (in thousands): June 30, 2019 2019 (excluding the six months ended June 30, 2019) $ 11,821 2020 26,064 2021 22,013 2022 17,170 2023 12,626 Thereafter 15,383 Total minimum lease payments 105,077 Less: Amount of payments representing interest (10,052 ) Present value of future minimum lease payments 95,025 Less: Current obligations (24,494 ) Long-term portion of operating leases $ 70,531

Common and Common Equivalent Sh

Common and Common Equivalent Shares	6 Months Ended
	Jun. 30, 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 and six months ended June 30, 2019 and 2018 is as follows (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Weighted average number of common shares outstanding 83,234 92,987 84,623 92,922 Weighted average number of dilutive common share equivalents 455 542 464 594 Weighted average number of common and common equivalent shares outstanding 83,689 93,529 85,087 93,516 Antidilutive securities not included in the diluted net income per common share calculation 923 392 713 197

Stock Incentive Plans and Stock

Stock Incentive Plans and Stock Purchase Plans	6 Months Ended
	Jun. 30, 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: On May 16, 2019, the Company’s shareholders approved the Company’s Amended and Restated 2008 Incentive Compensation Plan (the “Amended and Restated 2008 Incentive Plan”). The amendments, among other things, increased the number of shares of common stock reserved for delivery under the under the Amended and Restated 2008 Incentive Plan from 19,500,000 shares to 27,775,000 shares, as well as extended the expiration date to ten years from the effective date of approval. The Amended and Restated 2008 Incentive Plan provides for grants of stock options, stock appreciation rights, restricted stock, deferred stock, and other stock-related awards and performance awards that may be settled in cash, stock or other property. Under the Amended and Restated 2008 Incentive Plan, options to purchase shares of common stock may be granted at a price not less than the fair market value of the shares on the date of grant. The options must be exercised within 10 years from the date of grant and generally become exercisable on a pro rata basis over a three-year period from the date of grant. The Company issues new shares of its common stock upon exercise of its stock options. Restricted stock awards generally vest over periods of three years upon the fulfillment of specified service-based conditions and in certain instances performance-based conditions. Deferred stock awards generally vest upon the satisfaction of specified performance-based conditions and service-based conditions. The Company recognizes compensation expense related to its restricted stock and deferred stock awards ratably over the corresponding vesting periods. During the six months ended June 30, 2019, the Company granted 1,100,913 shares of restricted stock to its employees and non-employee Under the Company’s 1996 Non-Qualified Non-Qualified non-employee Each of the ESPP and the SPP provide for the issuance of an aggregate of 2.6 million shares of the Company’s common stock less the number of shares of common stock purchased under the other plan. The Company recognizes stock-based compensation expense for the discount received by participating employees and non-employee During the three and six months ended June 30, 2019 and 2018, the Company recognized stock-based compensation expense of $10.0 million and $21.0 million, and $10.3 million and $20.0 million, respectively.

Common Stock Repurchase Program

Common Stock Repurchase Programs	6 Months Ended
	Jun. 30, 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 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 six months ended June 30, 2019, the Company repurchased approximately 5.0 million shares of its common stock for $144.5 million, inclusive of 63,666 shares withheld to satisfy minimum statutory withholding obligations of $1.7 million in connection with the vesting of restricted stock during the six months ended June 30, 2019. 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	6 Months Ended
	Jun. 30, 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 operations, cash flows and the trading price of its securities. The Company has not included an accrual for these matters as of June 30, 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)	6 Months Ended
	Jun. 30, 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)	6 Months Ended
	Jun. 30, 2019
Investments, Debt and Equity Securities [Abstract]
Schedule of Investments	June 30, 2019 December 31, 2018 Short-Term Long-Term Short-Term Long-Term Municipal debt securities $ 43,272 $ — $ 18,473 $ 30,841 Federal home loan securities 34,397 — 2,000 34,393 Certificates of deposit 5,166 — 1,450 4,465 $ 82,835 $ — $ 21,923 $ 69,699

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	6 Months Ended
	Jun. 30, 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 June 30, 2019 and December 31, 2018 (in thousands): Fair Value Fair Value June 30, 2019 December 31, Assets: Money market funds Level 1 $ 398 $ 481 Short-term investments Level 2 82,835 — (1) Company-owned life insurance Level 2 12,185 10,464 Liabilities: Contingent consideration Level 3 8,299 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 June 30, 2019 and December 31, 2018 (in thousands): June 30, 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 750,000 738,975 750,000 736,725 2027 Notes 1,000,000 983,700 500,000 482,500 (2) Investments were measured at fair value as of June 30, 2019. See table above.

Accounts Receivable and Net R_2

Accounts Receivable and Net Revenue (Tables)	6 Months Ended
	Jun. 30, 2019
Text Block [Abstract]
Schedule of Accounts Receivable, Net	Accounts receivable, net consists of the following (in thousands): June 30, 2019 December 31, 2018 Gross accounts receivable $ 1,916,850 $ 1,993,395 Allowance for contractual adjustments and uncollectibles (1,412,660 ) (1,486,672 ) $ 504,190 $ 506,723
Schedule of Net Revenue	The following table summarizes the Company’s net revenue by category (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Net patient service revenue $ 765,525 $ 763,667 $ 1,515,110 $ 1,520,040 Hospital contract administrative fees 96,741 95,534 191,462 186,773 Other revenue 6,043 5,786 12,920 10,802 $ 868,309 $ 864,987 $ 1,719,492 $ 1,717,615
Schedule of Percentage of Net Revenue	The approximate percentage of net patient service revenue by type of payor was as follows: Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Contracted managed care 70 % 70 % 70 % 70 % Government 24 25 24 25 Other third-parties 4 4 5 4 Private-pay 2 1 1 1 100 % 100 % 100 % 100 %

Assets Held for Sale and Disc_2

Assets Held for Sale and Discontinued Operations (Tables)	6 Months Ended
	Jun. 30, 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 June 30, 2019 and December 31, 2018 (in thousands): June 30, 2019 December 31, 2018 Assets Cash and cash equivalents $ 11,614 $ 11,254 Accounts receivable, net 39,787 38,118 Prepaid expenses and other assets 2,310 2,505 Property and equipment, net 47,573 42,603 Deferred income taxes 15,569 Operating lease right-of-use 4,883 — Goodwill — 321,556 Intangible assets, net 204,023 275,148 $ 325,759 $ 691,184 Liabilities Accounts payable, accrued expenses and other liabilities $ 21,390 $ 23,770 Lease liabilities 6,892 — Deferred income taxes — 35,659 $ 28,282 $ 59,429 The following table summarizes the results of discontinued operations for the three and six months ended June 30, 2019 and 2018 (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Net revenue $ 53,141 $ 58,242 $ 104,363 $ 114,331 Operating expenses: Cost of service salaries and benefits 26,667 27,930 52,595 55,806 Cost of service supplies and other operating expenses 6,370 6,225 11,937 12,194 General and administrative expenses 11,421 11,562 22,444 22,788 Depreciation and amortization — 6,237 7,262 12,486 Transaction costs 300 — 1,400 — Loss on classification as held for sale 66,446 — 388,002 — Total operating expenses 111,204 51,954 483,640 103,274 (Loss) income from operations (58,063 ) 6,288 (379,277 ) 11,057 Non-operating expenses, net (17 ) (11 ) (33 ) (19 ) (Loss) income before income taxes (58,080 ) 6,277 (379,310 ) 11,038 Income tax benefit (provision) 14,319 (1,640 ) 51,024 (2,979 ) Net (loss) income $ (43,761 ) $ 4,637 $ (328,286 ) $ 8,059

Accounts Payable and Accrued _2

Accounts Payable and Accrued Expenses (Tables)	6 Months Ended
	Jun. 30, 2019
Payables and Accruals [Abstract]
Schedule of Accounts Payable and Accrued Expenses	Accounts payable and accrued expenses consist of the following (in thousands): June 30, 2019 December 31, 2018 Accounts payable $ 32,386 $ 31,059 Accrued salaries and bonuses 151,982 242,888 Accrued payroll taxes and benefits 64,197 78,415 Accrued professional liabilities 44,837 34,931 Accrued contingent consideration 8,299 18,760 Accrued interest 34,183 9,477 Other accrued expenses 50,524 33,037 $ 386,408 $ 448,567

Leases (Tables)

Leases (Tables)	6 Months Ended
	Jun. 30, 2019
Leases [Abstract]
Operating Lease Related Assets And Liabilities And Other Related Information	The table below presents the operating lease-related right-of-use June 30, 2019 Assets: Operating lease right-of-use $ 89,857 Liabilities: Current portion of operating lease liabilities 24,494 Long-term portion of operating lease liabilities 70,531 Other Information: Weighted-average remaining lease term 4.7 years Weighted average discount rate 5.0 %
Lease, Cost	The table below presents certain information related to the lease costs for operating leases during the three and six months ended June 30, 2019 (in thousands): Three Months Ended Six Months Ended Operating lease costs $ 7,428 $ 15,071 Variable lease costs 1,069 1,791 Other operating lease costs 1,325 2,958 Total operating lease costs $ 9,822 $ 19,820
Operating Leases Cash Flow Related Information	The table below presents supplemental cash flow information related to operating leases during the six months ended June 30, 2019 (in thousands): June 30, 2019 Operating cash flows for operating leases $ 20,528
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 June 30, 2019 (in thousands): June 30, 2019 2019 (excluding the six months ended June 30, 2019) $ 11,821 2020 26,064 2021 22,013 2022 17,170 2023 12,626 Thereafter 15,383 Total minimum lease payments 105,077 Less: Amount of payments representing interest (10,052 ) Present value of future minimum lease payments 95,025 Less: Current obligations (24,494 ) Long-term portion of operating leases $ 70,531

Common and Common Equivalent _2

Common and Common Equivalent Shares (Tables)	6 Months Ended
	Jun. 30, 2019
Earnings Per Share [Abstract]
Schedule of Calculation of Shares Used in Basic and Diluted Net Income Per Share	The calculation of shares used in the basic and diluted net income per common share calculation for the three and six months ended June 30, 2019 and 2018 is as follows (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Weighted average number of common shares outstanding 83,234 92,987 84,623 92,922 Weighted average number of dilutive common share equivalents 455 542 464 594 Weighted average number of common and common equivalent shares outstanding 83,689 93,529 85,087 93,516 Antidilutive securities not included in the diluted net income per common share calculation 923 392 713 197

Basis of Presentation and New_3

Basis of Presentation and New Accounting Pronouncements - Additional Information (Detail)	Jun. 30, 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	6 Months Ended
	Jun. 30, 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	$ 0.4	$ 0.5

Cash Equivalents and Investme_4

Cash Equivalents and Investments - Schedule of Investments (Detail) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Available-for-sale [Line Items]
Short-Term	$ 82,835	$ 21,923
Long-Term		69,699
Municipal Debt Securities [Member]
Available-for-sale [Line Items]
Short-Term	43,272	18,473
Long-Term		30,841
Federal Home Loan Securities [Member]
Available-for-sale [Line Items]
Short-Term	34,397	2,000
Long-Term		34,393
Certificates of Deposit [Member]
Available-for-sale [Line Items]
Short-Term	$ 5,166	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	Jun. 30, 2019	Dec. 31, 2018
Fair Value, Inputs, Level 1 [Member]
Assets:
Money market funds	$ 398	$ 481
Fair Value, Inputs, Level 2 [Member]
Assets:
Short-term investments	82,835
Company-owned life insurance	12,185	10,464
Fair Value, Inputs, Level 3 [Member]
Liabilities:
Contingent consideration	$ 8,299	$ 20,039

Fair Value Measurements - Sch_2

Fair Value Measurements - Schedule of financial instruments that are not carried at fair value (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Assets:
Carrying Amount, Short-term investments		$ 21,923
Carrying Amount, Long-term Investments		69,699
Assets:
Fair Value, Short-term investments		21,858
Fair Value, Long-term investments		69,090
2023 Notes [Member]
Liabilities:
Notes Payable	$ 750,000	750,000
Liabilities:
Notes Payable Fair Value Disclosure	738,975	736,725
2027 Notes [Member]
Liabilities:
Notes Payable	1,000,000	500,000
Liabilities:
Notes Payable Fair Value Disclosure	$ 983,700	$ 482,500

Accounts Receivable and Net R_3

Accounts Receivable and Net Revenue - Schedule of Accounts Receivable, Net (Detail) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Receivables [Abstract]
Gross accounts receivable	$ 1,916,850	$ 1,993,395
Allowance for contractual adjustments and uncollectibles	(1,412,660)	(1,486,672)
Accounts receivable, net	$ 504,190	$ 506,723

Accounts Receivable and Net R_4

Accounts Receivable and Net Revenue - Schedule of Net Revenue (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Disaggregation of Revenue [Abstract]
Net revenue	$ 868,309	$ 864,987	$ 1,719,492	$ 1,717,615
Net patient service revenue
Disaggregation of Revenue [Abstract]
Net revenue	765,525	763,667	1,515,110	1,520,040
Hospital contract administrative fees
Disaggregation of Revenue [Abstract]
Net revenue	96,741	95,534	191,462	186,773
Other revenue [Member]
Disaggregation of Revenue [Abstract]
Net revenue	$ 6,043	$ 5,786	$ 12,920	$ 10,802

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		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	100.00%	100.00%	100.00%	100.00%
Contracted Managed Care [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	70.00%	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%	24.00%	25.00%
Other Third-Parties [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	4.00%	4.00%	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%	1.00%	1.00%

Business Acquisitions - Additio

Business Acquisitions - Additional Information (Detail) $ in Millions	6 Months Ended
	Jun. 30, 2019USD ($)Number
Business Acquisition [Line Items]
Total business acquisition consideration	$ 11.5
Contingent consideration payments related to prior-period acquisitions	$ 5.6
Number Of Neonatology Practices Acquired | Number	1
Number Of Maternal-fetal Medicine Practices Acquired | Number	2
Physician Group [Member]
Business Acquisition [Line Items]
Goodwill	$ 8.1
Other intangible assets	3.4
Change in the fair value of a contingent consideration	$ 6.6

Assets Held for Sale and Disc_3

Assets Held for Sale and Discontinued Operations - Schedule of Management Services Service Line (Detail) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Assets
Cash and cash equivalents	$ 11,614	$ 11,254
Accounts receivable, net	39,787	38,118
Prepaid expenses and other assets	2,310	2,505
Property and equipment, net	47,573	42,603
Deferred income taxes	15,569
Operating lease right-of-use asset	4,883
Goodwill		321,556
Intangible assets, net	204,023	275,148
Total Assets	325,759	691,184
Liabilities
Accounts payable, accrued expenses and other liabilities	21,390	23,770
Lease liabilities	6,892
Deferred income taxes		35,659
Total Liabilities	$ 28,282	$ 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		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Discontinued Operations and Disposal Groups [Abstract]
Net revenue	$ 53,141	$ 58,242	$ 104,363	$ 114,331
Operating expenses:
Cost of service salaries and benefits	26,667	27,930	52,595	55,806
Cost of service supplies and other operating expenses	6,370	6,225	11,937	12,194
General and administrative expenses	11,421	11,562	22,444	22,788
Depreciation and amortization	0	6,237	7,262	12,486
Transaction costs	300	0	1,400	0
Loss on classification as held for sale	66,446	0	388,002	0
Total operating expenses	111,204	51,954	483,640	103,274
(Loss) income from operations	(58,063)	6,288	(379,277)	11,057
Non-operating expenses, net	(17)	(11)	(33)	(19)
(Loss) income before income taxes	(58,080)	6,277	(379,310)	11,038
Income tax benefit (provision)	14,319	(1,640)	51,024	(2,979)
Net (loss) income	$ (43,761)	$ 4,637	$ (328,286)	$ 8,059

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
	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018
Asset Impairment Charges	$ 66.4	$ 285	$ 321.6
Deferred Tax Assets, Goodwill and Intangible Assets	16.4	36.6
Deferred Tax Assets Goodwill [Member]
Asset Impairment Charges	16.4	$ 36.6
Deferred Tax Assets Intangible Assets [Member]
Asset Impairment Charges	$ 50

Accounts Payable and Accrued _3

Accounts Payable and Accrued Expenses - Schedule of Accounts Payable and Accrued Expenses (Detail) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Payables and Accruals [Abstract]
Accounts payable	$ 32,386	$ 31,059
Accrued salaries and bonuses	151,982	242,888
Accrued payroll taxes and benefits	64,197	78,415
Accrued professional liabilities	44,837	34,931
Accrued contingent consideration	8,299	18,760
Accrued interest	34,183	9,477
Other accrued expenses	50,524	33,037
Accounts payable and accrued expenses, total	$ 386,408	$ 448,567

Accounts Payable and Accrued _4

Accounts Payable and Accrued Expenses - Additional Information (Detail) $ in Millions	6 Months Ended
	Jun. 30, 2019USD ($)
Net decrease in accrued salaries and bonuses	$ 90.9

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	Jun. 30, 2019	Dec. 31, 2018
Assets:
Operating lease right-of-use assets	$ 89,857	$ 0
Liabilities:
Current portion of operating lease liabilities	24,494	0
Long-term portion of operating lease liabilities	$ 70,531	$ 0
Other Information:
Weighted-average remaining lease term	4 years 8 months 12 days
Weighted average discount rate	5.00%

Leases - Schedule of lease cost

Leases - Schedule of lease costs for operating leases (Details) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2019
Operating lease costs	$ 7,428	$ 15,071
Variable lease costs	1,069	1,791
Other operating lease costs	1,325	2,958
Total operating lease costs	$ 9,822	$ 19,820

Leases - Schedule of supplement

Leases - Schedule of supplemental cash flow information related to operating leases (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2019USD ($)
Operating cash flows for operating leases	$ 20,528

Leases - Schedule of operatin_2

Leases - Schedule of operating lease liabilities (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
2019 (excluding the six months ended June 30, 2019)	$ 11,821
2020	26,064
2021	22,013
2022	17,170
2023	12,626
Thereafter	15,383
Total minimum lease payments	105,077
Less: Amount of payments representing interest	(10,052)
Present value of future minimum lease payments	95,025
Less: Current obligations	(24,494)	$ 0
Long-term portion of operating leases	$ 70,531	$ 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		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Earnings Per Share [Abstract]
Weighted average number of common shares outstanding	83,234	92,987	84,623	92,922
Weighted average number of dilutive common share equivalents	455	542	464	594
Weighted average number of common and common equivalent shares outstanding	83,689	93,529	85,087	93,516
Antidilutive securities not included in the diluted net income per common share calculation	923	392	713	197

Stock Incentive Plans and Sto_2

Stock Incentive Plans and Stock Purchase Plans - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018	May 16, 2019	May 15, 2019	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				200,000,000
Stock-based compensation expense	$ 10	$ 21	$ 10.3	$ 20
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	8,200,000		8,200,000
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period			1,100,913
Share based compensation authorized shares					27,775,000	19,500,000
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		2,600,000
Aggregate number Shares issued under Stock Purchase Plans			300,000
Common stock, reserved for issuance	1,300,000		1,300,000

Common Stock Repurchase Progr_2

Common Stock Repurchase Programs - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended			6 Months Ended	12 Months Ended
	Jun. 30, 2019	Mar. 31, 2019	Jun. 30, 2018	Jun. 30, 2019	Dec. 31, 2018	Aug. 31, 2018
Common Stock [Line Items]
Common stock authorized for repurchase						$ 500,000
Common stock repurchased	$ 65,527	$ 78,982	$ 52,160	$ 144,500	$ 250,000
Common Stock [Member]
Common Stock [Line Items]
Common stock repurchased	$ 25	$ 25	$ 12
Repurchased common stock, shares	2,508,000	2,525,000	1,155,000	5,000,000
Restricted Stock [Member]
Common Stock [Line Items]
Number of shares withheld to satisfy minimum statutory tax withholding obligations				63,666
Amount withheld to satisfy minimum statutory tax withholding obligations				$ 1,700