Condensed Consolidated Statements of Cash Flows (USD $) In Thousands, unless otherwise specified	3 Months Ended
	Mar. 31, 2014	Mar. 31, 2013
Cash Flows from Operating Activities:
Net income	$ 151,852	$ 129,935
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	93,359	79,923
Stock-based compensation expense	7,152	7,111
Gains on sales of assets and businesses, net of losses	(10,134)	(2,092)
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	(95,633)	(81,859)
Accrued interest	11,063	11,497
Accrued and deferred income taxes	65,321	59,624
Other working capital accounts	(34,999)	(39,785)
Other assets and deferred charges	9,982	6,662
Other	(3,833)	1,604
Accrued insurance expense, net of commercial premiums paid	21,302	22,962
Payments made in settlement of self-insurance claims	(20,793)	(17,085)
Net cash provided by operating activities	194,639	178,497
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(92,387)	(95,919)
Proceeds received from sale of assets and businesses	11,450	6,657
Acquisition of property and businesses	(3,301)	0
Costs incurred for purchase and implementation of electronic health records application	(6,504)	(16,412)
Net cash provided by (used in) investing activities	(90,742)	(105,674)
Cash Flows from Financing Activities:
Reduction of long-term debt	(109,054)	(69,926)
Additional borrowings	11,900	9,500
Repurchase of common shares	(13,993)	(14,027)
Dividends paid	(4,933)	(4,870)
Issuance of common stock	1,445	1,232
Excess income tax benefits related to stock-based compensation	11,750	9,266
Profit distributions to noncontrolling interests	(1,989)	(10,074)
Net cash (used in) provided by financing activities	(104,874)	(78,899)
Decrease in cash and cash equivalents	(977)	(6,076)
Cash and cash equivalents, beginning of period	17,238	23,471
Cash and cash equivalents, end of period	16,261	17,395
Supplemental Disclosures of Cash Flow Information:
Interest paid	18,893	22,982
Income taxes paid, net of refunds	$ 6,764	$ 4,908