CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2016	Dec. 31, 2015	Dec. 31, 2014
Operating activities
Income from continuing operations	$ 45,942	$ 41,650	$ 28,752
Adjustments to reconcile net income to net cash provided by (used in) operating activities:
Depreciation and Amortization Expense	12,160	11,955	9,571
Provision for bad debts	14,790	19,243	15,780
Stock-based compensation expense	4,872	4,225	4,094
Deferred income taxes	7,402	1,518	2,402
Loss on disposal of assets	1,199	710	47
Impairment of intangibles and other		1,280	3,603
Changes in operating assets and liabilities, net of acquisitions:
Receivables	(28,873)	(27,951)	(16,372)
Prepaid expenses and other assets	1,034	(3,793)	191
Prepaid income taxes	1,641	441	911
Accounts payable and accrued expenses	9,182	10,526	(10,460)
Income tax payable	84
Net amounts due to/from governmental entities	(1,961)	130	138
Net cash provided by operating activities	67,472	59,934	38,657
Investing activities
Cash paid for acquisitions, primarily goodwill and intangible assets	(23,156)	(70,572)	(73,933)
Purchases of property, building and equipment	(16,009)	(13,283)	(8,105)
Advanced payments on acquisitions	(11,488)
Other	273
Net cash (used in) investing activities	(50,380)	(83,855)	(82,038)
Financing activities
Proceeds from line of credit	38,000	83,000	75,000
Payments on line of credit	(49,000)	(45,000)	(37,000)
Excess tax benefits from vesting of stock awards	1,303	914	124
Proceeds from employee stock purchase plan	912	782	782
Payments on debt	(238)	(233)	(202)
Noncontrolling interest distributions	(9,413)	(8,324)	(6,843)
Payments of deferred financing fees			(852)
Purchase of additional controlling interest		(275)	(359)
Sale of noncontrolling interest	356		193
Withholding taxes paid on stock-based compensation	(1,996)	(1,479)	(945)
Proceeds from exercise of stock options	109	144
Net cash (used in) provided by financing activities	(19,967)	29,529	29,898
Change in cash	(2,875)	5,608	(13,483)
Cash at beginning of period	6,139	531	14,014
Cash at end of period	3,264	6,139	531
Supplemental disclosures of cash flow information
Interest paid	3,123	1,870	2,461
Income taxes paid	$ 11,533	$ 20,361	$ 11,781