Significant Accounting Policies Accounts Receivable (Details) (USD $) In Thousands, unless otherwise specified	Jun. 30, 2014	Dec. 31, 2013
Accounts Receivable, Gross, Current	$ 885,174	$ 898,286
Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	265,158	263,335
Facility Payors [Member]
Accounts Receivable, Gross, Current	457,018	475,195
Private Payors [Member]
Accounts Receivable, Gross, Current	162,998	159,756
0 - 180 Days Past Due [Member]
Accounts Receivable, Gross, Current	617,048	599,643
0 - 180 Days Past Due [Member] | Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	213,869	195,544
0 - 180 Days Past Due [Member] | Facility Payors [Member]
Accounts Receivable, Gross, Current	326,672	328,444
0 - 180 Days Past Due [Member] | Private Payors [Member]
Accounts Receivable, Gross, Current	76,507	75,655
181 Days and Greater Past Due [Member]
Accounts Receivable, Gross, Current	268,126	298,643
181 Days and Greater Past Due [Member] | Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	51,289	67,791
181 Days and Greater Past Due [Member] | Facility Payors [Member]
Accounts Receivable, Gross, Current	130,346	146,751
181 Days and Greater Past Due [Member] | Private Payors [Member]
Accounts Receivable, Gross, Current	$ 86,491	$ 84,101