Significant Accounting Policies Accounts Receivable (Details) (USD $) In Thousands, unless otherwise specified	Mar. 31, 2015	Dec. 31, 2014
Accounts Receivable, Gross, Current	$ 847,035	$ 780,636
Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	257,703	213,310
Facility Payors [Member]
Accounts Receivable, Gross, Current	414,609	396,344
Private Payors [Member]
Accounts Receivable, Gross, Current	174,723	170,982
0 - 180 Days Past Due [Member]
Accounts Receivable, Gross, Current	614,688	551,493
0 - 180 Days Past Due [Member] | Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	221,631	184,492
0 - 180 Days Past Due [Member] | Facility Payors [Member]
Accounts Receivable, Gross, Current	321,127	297,308
0 - 180 Days Past Due [Member] | Private Payors [Member]
Accounts Receivable, Gross, Current	71,930	69,693
181 Days and Greater Past Due [Member]
Accounts Receivable, Gross, Current	232,347	229,143
181 Days and Greater Past Due [Member] | Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	36,072	28,818
181 Days and Greater Past Due [Member] | Facility Payors [Member]
Accounts Receivable, Gross, Current	93,482	99,036
181 Days and Greater Past Due [Member] | Private Payors [Member]
Accounts Receivable, Gross, Current	$ 102,793	$ 101,289