Significant Accounting Policies Accounts Receivable (Details) (USD $) In Thousands, unless otherwise specified	Sep. 30, 2013	Dec. 31, 2012
Accounts Receivable, Gross, Current	$ 950,193	$ 1,126,468
Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	278,654	402,121
Facility Payors [Member]
Accounts Receivable, Gross, Current	514,231	552,793
Private Payors [Member]
Accounts Receivable, Gross, Current	157,308	171,554
0 - 180 Days Past Due [Member]
Accounts Receivable, Gross, Current	634,750	693,031
0 - 180 Days Past Due [Member] | Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	210,957	238,348
0 - 180 Days Past Due [Member] | Facility Payors [Member]
Accounts Receivable, Gross, Current	351,162	383,848
0 - 180 Days Past Due [Member] | Private Payors [Member]
Accounts Receivable, Gross, Current	72,631	70,835
181 Days and Greater Past Due [Member]
Accounts Receivable, Gross, Current	315,443	433,437
181 Days and Greater Past Due [Member] | Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	67,697	163,773
181 Days and Greater Past Due [Member] | Facility Payors [Member]
Accounts Receivable, Gross, Current	163,069	168,945
181 Days and Greater Past Due [Member] | Private Payors [Member]
Accounts Receivable, Gross, Current	$ 84,677	$ 100,719