Leases - Lease Costs (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Leases [Abstract]
Facility operating expense	$ 1,523	$ 4,842
Facility lease expense	41,564	44,418
Operating lease expense	43,087	49,260
Operating lease expense adjustment	8,307	4,664
Changes in operating lease assets and liabilities for lessor capital expenditure reimbursements	(1,490)	(7,563)
Operating net cash outflows from operating leases	49,904	46,361
Depreciation and amortization	7,665	7,630
Interest expense: financing lease obligations	12,058	11,383
Financing lease expense	19,723	19,013
Operating cash outflows from financing leases	12,058	11,383
Financing cash outflows from financing leases	5,490	4,789
Changes in financing lease assets and liabilities for lessor capital expenditure reimbursement	(3,207)	(1,389)
Total net cash outflows from financing leases	$ 14,341	$ 14,783