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Note 2 - Revenue Recognition 1 (Details Textual) - USD ($)
$ in Thousands
3 Months Ended 9 Months Ended
Sep. 30, 2018
Jun. 30, 2018
Sep. 30, 2017
Sep. 30, 2018
Sep. 30, 2017
Mar. 31, 2018
Selling, General and Administrative Expense, Total $ 16,879   $ 17,108 $ 49,398 $ 52,331  
Annual Cap of Rural Health Care Support   $ 571,000       $ 400,000
Percentage of Refund Available   100.00%       84.40%
Contract with Customer, Asset, Cumulative Catch-up Adjustment to Revenue, Change in Estimate of Transaction Price   $ 2,082        
Revenue, Remaining Performance Obligation, Amount 104,022     104,022    
Contract with Customer, Provision for Uncollectible Accounts Receivable       2,371    
Accounting Standards Update 2014-09 [Member]            
Selling, General and Administrative Expense, Total $ 676     $ 772