Significant Accounting Policies Accounts Receivable (Details) (USD $) In Thousands, unless otherwise specified	Mar. 31, 2014	Dec. 31, 2013
Accounts Receivable, Gross, Current	$ 935,981	$ 898,286
Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	283,894	263,335
Facility Payors [Member]
Accounts Receivable, Gross, Current	490,043	475,195
Private Payors [Member]
Accounts Receivable, Gross, Current	162,044	159,756
0 - 180 Days Past Due [Member]
Accounts Receivable, Gross, Current	670,798	599,643
0 - 180 Days Past Due [Member] | Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	234,075	195,544
0 - 180 Days Past Due [Member] | Facility Payors [Member]
Accounts Receivable, Gross, Current	357,955	328,444
0 - 180 Days Past Due [Member] | Private Payors [Member]
Accounts Receivable, Gross, Current	78,768	75,655
181 Days and Greater Past Due [Member]
Accounts Receivable, Gross, Current	265,183	298,643
181 Days and Greater Past Due [Member] | Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	49,819	67,791
181 Days and Greater Past Due [Member] | Facility Payors [Member]
Accounts Receivable, Gross, Current	132,088	146,751
181 Days and Greater Past Due [Member] | Private Payors [Member]
Accounts Receivable, Gross, Current	$ 83,276	$ 84,101