Consolidated Statements of Cash Flows $ in Thousands	12 Months Ended
	Dec. 31, 2018 USD ($)	Dec. 31, 2017 USD ($)	Dec. 31, 2016 USD ($)
OPERATING ACTIVITIES
Net income (loss)	$ 74,183	$ (8,165)	$ (13,808)
Adjustments to reconcile net income (loss) to net cash provided by operating activities:
Depreciation, amortization and other	46,266	30,762	22,796
Stock-based compensation expense	11,709	9,061	7,986
Amortization of debt discount and deferred issuance costs	3,952	6,022	5,891
Change in fair value of acquisition contingencies	1,114	(81)	(485)
Accretion of interest on deferred consideration	10,000	2,608	0
Amortization of inventory step-up to fair value	3,650	10,950	0
Change in deferred tax assets and liabilities	(20,458)	365	(2,603)
Loss (gain) on extinguishment of debt	8,262	0	(421)
Increase (Decrease) in Operating Capital
Accounts receivable	8,236	(42,052)	(6,265)
Inventories	(3,974)	362	859
Prepaid expenses and other current and non-current assets	(12,681)	(9,113)	(489)
Accounts payable	(331)	12,956	4,323
Accrued payroll and related expenses	1,674	7,130	(375)
Other current and non-current liabilities	4,743	6,904	(5,594)
Net cash provided by operating activities	136,345	27,709	11,815
INVESTING ACTIVITIES
Acquisitions of property, equipment and intangibles	(31,689)	(17,510)	(11,909)
Acquisition of other businesses, net of cash acquired	0	(14,451)	(5,061)
Acquisition of Triage and BNP Businesses	0	(399,798)	0
Proceeds from sale of Summers Ridge Property	146,644
Net cash provided by (used for) investing activities	114,955	(431,759)	(16,970)
FINANCING ACTIVITIES
Proceeds from issuance of Term Loan	0	245,000	0
Proceeds from issuance of Revolving Credit Facility	0	10,000	0
Proceeds from issuance of common stock	17,047	25,426	8,575
Payments of debt issuance costs	(513)	(8,682)	0
Payments on lease obligation	(130)	(98)	(540)
Payments on Revolving Credit Facility	(40,000)
Repurchases of common stock	(4,344)	(541)	(20,168)
Repurchases of Convertible Senior Notes	0	0	(4,459)
Payments on acquisition contingent consideration	(6,303)	(497)	(207)
Payments of deferred consideration	(46,000)
Payments of Term Loan	(161,813)
Transaction costs related to debt exchange	(2,002)
Net cash (used for) provided by financing activities	(244,058)	270,608	(16,799)
Effect of exchange rate changes on cash	367	20	(9)
Net increase (decrease) in cash and cash equivalents	7,609	(133,422)	(21,963)
Cash and cash equivalents, beginning of period	36,086	169,508	191,471
Cash and cash equivalents, at end of period	43,695	36,086	169,508
SUPPLEMENTAL DISCLOSURES OF CASH FLOW INFORMATION
Cash paid during the period for interest	7,929	9,137	6,488
Cash paid during the period for income taxes	6,923	1,274	490
NON-CASH INVESTING ACTIVITIES
Purchase of property, equipment and intangibles by incurring current liabilities	1,785	1,446	3,280
NON-CASH FINANCING ACTIVITIES
Decrease of accrued payroll and related expenses upon issuance of common stock	0	903	539
Receivable for stock option exercises	0	0	251
Deferred consideration for acquisition of BNP Business		$ 220,550	$ 0
Extinguishment of Convertible Senior Notes through issuance of stock	200,219
Principal amount of Term Loan exchanged for Revolving Credit Facility	$ 83,187