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General - Concentration of Business (Details) - USD ($)
$ in Thousands
3 Months Ended
Mar. 31, 2016
Mar. 31, 2015
Concentration of Business    
Net revenue $ 1,117,022 $ 980,968
Minimum    
Concentration of Business    
Term of Contract 1 year  
Term of renewed contract 1 year  
Notice period for termination of contract 60 days  
Maximum    
Concentration of Business    
Term of Contract 3 years  
Term of renewed contract 2 years  
Notice period for termination of contract 180 days  
Pennsylvania Counties    
Concentration of Business    
Net revenue $ 110,000 $ 91,600