CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Operating activities
Income from continuing operations	$ 60,386	$ 45,942	$ 41,650
Adjustments to reconcile net income to net cash provided by (used in) operating activities:
Depreciation and Amortization Expense	13,422	12,160	11,955
Provision for bad debts	9,484	14,790	19,243
Stock-based compensation expense	5,964	4,872	4,225
Deferred income taxes	(4,475)	7,402	1,518
Loss on disposal of assets	60	1,199	710
Impairment of intangibles and other	1,511		1,280
Changes in operating assets and liabilities, net of acquisitions:
Receivables	(36,390)	(28,873)	(27,951)
Prepaid expenses and other assets	(26,973)	1,034	(3,793)
Prepaid income taxes	(7,006)	1,641	441
Accounts payable and accrued expenses	19,666	9,182	10,526
Income tax payable	(3,499)	84
Net amounts due to/from governmental entities	176	(1,961)	130
Net cash provided by operating activities	32,326	67,472	59,934
Investing activities
Cash paid for acquisitions, primarily goodwill and intangible assets	(64,598)	(23,156)	(70,572)
Purchases of property, building and equipment	(10,176)	(16,009)	(13,283)
Advanced payments on acquisitions	0	(11,488)
Goodwill related to prior year adjustments	0	273
Net cash (used in) investing activities	(74,774)	(50,380)	(83,855)
Financing activities
Proceeds from line of credit	96,000	38,000	83,000
Payments on line of credit	(39,000)	(49,000)	(45,000)
Excess tax benefits from vesting of stock awards	0	1,303	914
Proceeds from employee stock purchase plan	1,026	912	782
Payments on debt	(260)	(238)	(233)
Noncontrolling interest distributions	(11,382)	(9,413)	(8,324)
Purchase of additional controlling interest	(1,488)	0	(275)
Sale of noncontrolling interest	251	356	0
Withholding taxes paid on stock-based compensation	(3,114)	(1,996)	(1,479)
Proceeds from exercise of stock options	0	109	144
Net cash (used in) provided by financing activities	42,033	(19,967)	29,529
Change in cash	(415)	(2,875)	5,608
Cash at beginning of period	3,264	6,139	531
Cash at end of period	2,849	3,264	6,139
Supplemental disclosures of cash flow information
Interest paid	3,853	3,123	1,870
Income taxes paid	$ 25,199	$ 11,533	$ 20,361