Income Taxes - Significant Components of Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Deferred Tax Assets:
Accrued other and prepaid expenses	$ 2,955	$ 3,494
Allowance for doubtful accounts	624	704
Intangible Assets	7,776	10,725
Net operating loss carryforwards	14,718	17,228
Derivative interest	0	7,940
Accrued professional liability claims	1,709	2,632
Accrued workers’ compensation claims	2,512	3,439
Share-based compensation	734	0
Credit carryforwards	189	1,055
Other	444	584
Gross deferred tax assets	31,661	47,801
Valuation allowance	(1,076)	(46,454)
Deferred tax assets	30,585	1,347
Deferred Tax Liabilities:
Depreciation	(41)	(70)
Indefinite intangibles	(9,964)	(13,971)
Tax on unrepatriated earnings	(466)	(263)
Share-based compensation	0	(197)
Deferred tax liabilities	(10,471)	(14,501)
Net deferred taxes	$ 20,114	$ (13,154)