Significant Accounting Policies Accounts Receivable (Details) (USD $) In Thousands, unless otherwise specified	Jun. 30, 2013	Dec. 31, 2012
Accounts Receivable, Gross, Current	$ 983,212	$ 1,126,468
Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	289,690	402,121
Facility Payors [Member]
Accounts Receivable, Gross, Current	532,468	552,793
Private Payors [Member]
Accounts Receivable, Gross, Current	161,054	171,554
0 - 180 Days Past Due [Member]
Accounts Receivable, Gross, Current	649,339	693,031
0 - 180 Days Past Due [Member] | Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	204,910	238,348
0 - 180 Days Past Due [Member] | Facility Payors [Member]
Accounts Receivable, Gross, Current	372,440	383,848
0 - 180 Days Past Due [Member] | Private Payors [Member]
Accounts Receivable, Gross, Current	71,989	70,835
181 Days and Greater Past Due [Member]
Accounts Receivable, Gross, Current	333,873	433,437
181 Days and Greater Past Due [Member] | Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	84,780	163,773
181 Days and Greater Past Due [Member] | Facility Payors [Member]
Accounts Receivable, Gross, Current	160,028	168,945
181 Days and Greater Past Due [Member] | Private Payors [Member]
Accounts Receivable, Gross, Current	$ 89,065	$ 100,719