Goodwill (Details) (USD $)	12 Months Ended				12 Months Ended
	Dec. 31, 2012	Dec. 31, 2011	Dec. 31, 2010	Dec. 31, 2009 HealthHonors [Member]	Dec. 31, 2011 Navvis & Company [Member]	Dec. 31, 2012 Ascentia [Member]
Goodwill [Roll Forward]
Balance, beginning of period	$ 335,392,000	$ 496,265,000	$ 496,446,000
HealthHonors purchase price adjustment			(181,000)
Navvis purchase		21,527,000
Impairment loss		(182,400,000)
Ascentia purchase	3,303,000
Balance, end of period	338,695,000	335,392,000	496,265,000
Business Acquisition [Line Items]
Cash payment for the acquisition				14,500,000	23,700,000	5,500,000
Acquisition date fair value of earn-out arrangement				3,000,000
Unregistered shares of common stock issued (in shares)					432,902	14,409
Value of common stock issued					$ 3,300,000	$ 100,000