Significant Accounting Policies Accounts Receivable (Details) (USD $) In Thousands, unless otherwise specified	Sep. 30, 2014	Dec. 31, 2013
Accounts Receivable, Gross, Current	$ 845,904	$ 898,286
Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	248,879	263,335
Facility Payors [Member]
Accounts Receivable, Gross, Current	429,059	475,195
Private Payors [Member]
Accounts Receivable, Gross, Current	167,966	159,756
0 - 180 Days Past Due [Member]
Accounts Receivable, Gross, Current	585,016	599,643
0 - 180 Days Past Due [Member] | Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	201,382	195,544
0 - 180 Days Past Due [Member] | Facility Payors [Member]
Accounts Receivable, Gross, Current	306,681	328,444
0 - 180 Days Past Due [Member] | Private Payors [Member]
Accounts Receivable, Gross, Current	76,953	75,655
181 Days and Greater Past Due [Member]
Accounts Receivable, Gross, Current	260,888	298,643
181 Days and Greater Past Due [Member] | Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	47,497	67,791
181 Days and Greater Past Due [Member] | Facility Payors [Member]
Accounts Receivable, Gross, Current	122,378	146,751
181 Days and Greater Past Due [Member] | Private Payors [Member]
Accounts Receivable, Gross, Current	$ 91,013	$ 84,101