Significant Accounting Policies Accounts Receivable (Details) (USD $) In Thousands, unless otherwise specified	Sep. 30, 2012	Dec. 31, 2011
Accounts Receivable, Gross, Current	$ 1,199,573	$ 1,290,027
Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	439,524	457,085
Facility Payors [Member]
Accounts Receivable, Gross, Current	571,730	591,928
Private Payors [Member]
Accounts Receivable, Gross, Current	188,319	241,014
0 - 180 Days Past Due [Member]
Accounts Receivable, Gross, Current	705,174	731,225
0 - 180 Days Past Due [Member] | Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	248,195	257,782
0 - 180 Days Past Due [Member] | Facility Payors [Member]
Accounts Receivable, Gross, Current	386,445	387,509
0 - 180 Days Past Due [Member] | Private Payors [Member]
Accounts Receivable, Gross, Current	70,534	85,934
181 Days and Greater Past Due [Member]
Accounts Receivable, Gross, Current	494,399	558,802
181 Days and Greater Past Due [Member] | Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	191,329	199,303
181 Days and Greater Past Due [Member] | Facility Payors [Member]
Accounts Receivable, Gross, Current	185,285	204,419
181 Days and Greater Past Due [Member] | Private Payors [Member]
Accounts Receivable, Gross, Current	$ 117,785	$ 155,080