Significant Accounting Policies Accounts Receivable (Details) (USD $) In Thousands, unless otherwise specified	Mar. 31, 2013	Dec. 31, 2012
Accounts Receivable, Gross, Current	$ 1,082,471	$ 1,126,468
Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	354,326	402,121
Facility Payors [Member]
Accounts Receivable, Gross, Current	556,294	552,793
Private Payors [Member]
Accounts Receivable, Gross, Current	171,851	171,554
0 - 180 Days Past Due [Member]
Accounts Receivable, Gross, Current	705,192	693,031
0 - 180 Days Past Due [Member] | Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	224,747
0 - 180 Days Past Due [Member] | Facility Payors [Member]
Accounts Receivable, Gross, Current	409,412
0 - 180 Days Past Due [Member] | Private Payors [Member]
Accounts Receivable, Gross, Current	71,033
181 Days and Greater Past Due [Member]
Accounts Receivable, Gross, Current	377,279	433,437
181 Days and Greater Past Due [Member] | Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	129,579
181 Days and Greater Past Due [Member] | Facility Payors [Member]
Accounts Receivable, Gross, Current	146,882
181 Days and Greater Past Due [Member] | Private Payors [Member]
Accounts Receivable, Gross, Current	100,818
Trade Accounts Receivable [Member] | Medicare Medicaid and Third Party Payors [Member]
Trade Receivables0 To180 Days Past Due		238,348
Trade Receivables Equal To Greater Than181 Days Past Due		163,773
Trade Accounts Receivable [Member] | Facility Payors [Member]
Trade Receivables0 To180 Days Past Due		383,848
Trade Receivables Equal To Greater Than181 Days Past Due		168,945
Trade Accounts Receivable [Member] | Private Payors [Member]
Trade Receivables0 To180 Days Past Due		70,835
Trade Receivables Equal To Greater Than181 Days Past Due		$ 100,719