We adopted Topic 842 effective January 1, 2019. We applied Topic 842 to all leases as of January 1, 2019. We 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 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.

Three of our hospital facilities are held under operating leases with Universal Health Realty Income Trust with two hospital terms expiring in 2021 and the third expiring in 2026 (see Note 2 for additional disclosure). We are also the lessee of the real property of certain facilities.

The components of lease expense for the three month periods ended March 31, 2020 and 2019 are as follows (in thousands):

	Three months ended March 31,
	2020		2019

Operating lease cost	$	18,115	$	18,079
Variable and short term lease cost (a)		10,178		8,046
Total lease cost	$	28,293	$	26,125

Finance lease cost:
Amortization of right-of-use-assets	$	496	$	481
Interest on lease liabilities		456		484
Total finance lease cost	$	952	$	965

Supplemental cash flow information related to leases for the three month periods ended March 31, 2020 and 2019 are as follows (in thousands):

	Three months ended March 31,
	2020		2019

Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	28,227	$	25,884
Operating cash flows from finance leases	$	489	$	575
Financing cash flows from finance leases	$	628	$	433

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	29,112	$	355,981

Included in the $356 million of right-of-use assets obtained in exchange for operating lease obligations is $6 million 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, 2020 and December 31, 2019 are as follows (in thousands):

	March 31,			December 31,
	2020			2019

Operating Leases
Right of use assets-operating leases	$	341,264		$	326,518

Operating lease liabilities	$	57,772		$	56,442
Operating lease liabilities noncurrent		284,008			270,076
Total operating lease liabilities	$	341,780		$	326,518

Finance Leases
Property and equipment	$	40,206		$	38,582
Accumulated depreciation		(27,107	)		(26,610	)
Property and equipment, net	$	13,099		$	11,972

Current maturities of long-term debt	$	2,021		$	1,650
Long-term debt		17,138			16,359
Total finance lease liabilities	$	19,159		$	18,009

Weighted Average remaining lease term, years
Operating leases		9.6			9.7
Finance leases		6.5			6.9

Weighted Average discount rate
Operating leases		4.6	%		4.7	%
Finance leases		9.5	%		9.8	%

Future maturities of lease liabilities as of March 31, 2020 are as follows (in thousands):

	Operating Leases			Finance Leases
Year ending December 31,
2020 (remaining 9 months)	$	54,063		$	2,792
2021		66,353			3,604
2022		55,163			3,905
2023		50,128			4,000
2024		43,412			4,099
Later years		173,341			8,380
Total lease payments		442,460			26,780
less imputed interest		(100,680	)		(7,621	)
Total	$	341,780		$	19,159