Note 3 - Net Patient Revenues (Details Textual) - USD ($)	Mar. 31, 2019	Dec. 31, 2018
Accounts Receivable, Allowance for Credit Loss, Ending Balance	$ 5,169,000	$ 4,610,000
Medicare and Medicaid [Member]
Accounts Receivable, Allowance for Credit Loss, Ending Balance	$ 16,293,000	$ 16,108,000