Significant Accounting Policies Accounts Receivable (Details) - USD ($) $ in Thousands	Jun. 30, 2015	Dec. 31, 2014
Accounts Receivable, Gross, Current	$ 838,598	$ 780,636
Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	246,729	213,310
Facility Payors [Member]
Accounts Receivable, Gross, Current	414,471	396,344
Private Payors [Member]
Accounts Receivable, Gross, Current	177,398	170,982
0 - 180 Days Past Due [Member]
Accounts Receivable, Gross, Current	608,905	551,493
0 - 180 Days Past Due [Member] | Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	213,162	184,492
0 - 180 Days Past Due [Member] | Facility Payors [Member]
Accounts Receivable, Gross, Current	321,660	297,308
0 - 180 Days Past Due [Member] | Private Payors [Member]
Accounts Receivable, Gross, Current	74,083	69,693
181 Days and Greater Past Due [Member]
Accounts Receivable, Gross, Current	229,693	229,143
181 Days and Greater Past Due [Member] | Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	33,567	28,818
181 Days and Greater Past Due [Member] | Facility Payors [Member]
Accounts Receivable, Gross, Current	92,811	99,036
181 Days and Greater Past Due [Member] | Private Payors [Member]
Accounts Receivable, Gross, Current	$ 103,315	$ 101,289