Leases - Lease Costs (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Leases [Abstract]
Facility operating expense	$ 1,621	$ 1,634	$ 4,705	$ 10,996
Facility lease expense	41,317	43,226	124,419	131,508
Operating lease expense	42,938	44,860	129,124	142,504
Operating lease expense adjustment	8,714	6,273	25,329	16,263
Changes in operating lease assets and liabilities for lessor capital expenditure reimbursements	(4,367)	(11,551)	(9,224)	(27,057)
Operating net cash outflows from operating leases	47,285	39,582	145,229	131,710
Depreciation and amortization	7,405	7,677	22,678	22,901
Interest expense: financing lease obligations	11,916	11,674	35,968	34,549
Financing lease expense	19,321	19,351	58,646	57,450
Operating cash outflows from financing leases	11,916	11,674	35,968	34,549
Financing cash outflows from financing leases	5,506	5,039	16,606	14,692
Changes in financing lease assets and liabilities for lessor capital expenditure reimbursement	(2,727)	(4,136)	(9,704)	(7,583)
Total net cash outflows from financing leases	$ 14,695	$ 12,577	$ 42,870	$ 41,658