In February 2016, the FASB issued ASU 2016-02 (Topic 842) "Leases." Topic 842 supersedes the lease requirements in Accounting Standards Codification Topic 840, "Leases." Under Topic 842, lessees are required to recognize assets and liabilities on the balance sheet for most leases and provide enhanced disclosures. Leases will be classified as either finance or operating.

We adopted Topic 842 effective January 1, 2019. We applied Topic 842 to all leases as of January 1, 2019 with comparative periods continuing to be reported under Topic 840. We have elected the practical expedient package to not reassess at adoption (i) expired or existing contracts for whether they are or contain a lease, (ii) the lease classification of any existing leases or (iii) initial indirect costs for existing leases. We have also elected the policy exemption that allows lessees to choose to not separate lease and non-lease components by class of underlying asset and are applying this expedient to all relevant asset classes.

We determine if an arrangement is or contains a lease at inception of the contract. Our right-of-use assets represent our right to use the underlying assets for the lease term and our lease liabilities represent our obligation to make lease payments arising from the leases. Right-of-use assets and lease liabilities are recognized at commencement date based on the present value of lease payments over the lease term. We use the implicit rate noted within the contract. If not readily available, we use our estimated incremental borrowing rate, which is derived using a collateralized borrowing rate for the same currency and term as the associated lease. A right-of-use asset and lease liability is not recognized for leases with an initial term of 12 months or less and we recognize lease expense for these leases on a straight-line basis over the lease term within lease and rental expense.

Our operating leases are primarily for real estate, including certain acute care facilities, off-campus outpatient facilities, medical office buildings, and corporate and other administrative offices. Our real estate lease agreements typically have initial terms of five to 10 years. These real estate leases may include one or more options to renew, with renewals that can extend the lease term from five to 10 years. The exercise of lease renewal options is at our sole discretion. When determining the lease term, we included options to extend or terminate the lease when it is reasonably certain that we will exercise that option.

The components of lease expense for the three month period ended March 31, 2019 are as follows (in thousands):

	Three months ended March 31,
	2019

Operating lease cost	$	18,079
Variable and short term lease cost (a)		8,046
Total lease cost	$	26,125

Finance lease cost:
Amortization of right-of-use-assets	$	481
Interest on lease liabilities		484
Total finance lease cost	$	965

(a)

Includes equipment, month-to-month and leases with a maturity of less than 12 months.

Supplemental cash flow information related to leases for the three month period ended March 31, 2019 are as follows (in thousands):

	Three months ended March 31,
	2019

Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	25,884
Operating cash flows from finance leases	$	575
Financing cash flows from finance leases	$	433

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	355,981
Finance leases	0

Included in the $356 million of right-of-use assets obtained in exchange for operating lease obligations is $6 million of new operating leases entered into during the three month period ended March 31, 2019.

Supplemental balance sheet information related to leases as of March 31, 2019 are as follows (in thousands):

	March 31,
	2019

Operating Leases
Right of use assets-operating leases	$	342,032

Operating lease liabilities	$	56,136
Operating lease liabilities noncurrent		286,101
Total operating lease liabilities	$	342,237

Finance Leases
Property and equipment	$	23,250
Accumulated depreciation		(9,882	)
Property and equipment, net	$	13,368

Current maturities of long-term debt	$	1,737
Long-term debt		17,612
Total finance lease liabilities	$	19,349

Weighted Average remaining lease term, years
Operating leases		10.4
Finance leases		7.8

Weighted Average discount rate
Operating leases		4.7	%
Finance leases		10.5	%

	Operating Leases			Finance Leases
Year ending December 31,
2019 (remaining 9 months)	$	52,447		$	2,842
2020		62,920			3,375
2021		55,817			3,257
2022		45,404			3,559
2023		41,277			3,654
Later years		183,572			12,096
Total lease payments		441,437			28,783
less imputed interest		(99,200	)		(9,434	)
Total	$	342,237		$	19,349

Future minimum rental payments under lease commitments with a term of more than one year as of December 31, 2018, prior to our adoption of ASU 2016-02 are as follows (amounts in thousands):

Year	Capital Leases			Operating Leases
2019	$	3,996		$	72,353
2020		3,345			59,492
2021		3,227			48,891
2022		3,508			35,233
2023		3,624			28,839
Later years		12,070			123,039
Total minimum rental	$	29,770		$	367,847
Less: Amount representing interest		(9,829	)
Present value of minimum rental commitments		19,941
Less: Current portion of capital lease obligations		(2,128	)
Long-term portion of capital lease obligations	$	17,813