Leases - Lease Costs (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Leases [Abstract]
Facility operating expense	$ 4,532		$ 13,761
Facility lease expense	67,253	$ 70,392	203,610	$ 232,752
Operating lease expense	71,785		217,371
Operating lease expense adjustment	4,814		13,626
Changes in operating lease assets and liabilities for lessor capital expenditure reimbursements	(11,043)		(12,043)
Operating cash flows from operating leases	65,556		218,954
Non-cash recognition of right-of-use assets obtained in exchange for new operating lease obligations	22,375		26,356
Depreciation and amortization	11,675		35,030
Interest expense: financing lease obligations	16,567	$ 20,896	49,959	$ 66,216
Financing lease expense	28,242		84,989
Operating cash flows from financing leases	16,567		49,959
Financing cash flows from financing leases	5,549		16,502
Total cash flows from financing leases	$ 22,116		$ 66,461