CONSOLIDATED STATEMENTS OF CASH FLOWS (USD $) In Thousands, unless otherwise specified	12 Months Ended
	Dec. 31, 2012	Dec. 31, 2011	Dec. 31, 2010
Cash flows from operating activities:
Net income (loss)	$ 8,024	$ (157,693)	$ 47,330
Adjustments to reconcile net income to net cash provided by operating activities, net of business acquisitions:
Depreciation and amortization	51,734	49,988	52,756
Gain on sale of investment	0	0	(1,163)
Impairment loss	0	183,288	0
Amortization of deferred loan costs	2,284	1,894	1,827
Share-based employee compensation expense	6,371	9,246	11,450
Excess tax benefits from share-based payment arrangements	(492)	(433)	(1,067)
(Increase) decrease in accounts receivable, net	(23,439)	(7,452)	12,207
Decrease (increase) in other current assets	2,984	6,960	(159)
(Decrease) increase in accounts payable	(995)	1,466	(2,256)
Decrease in accrued salaries and benefits	(12,980)	(8,932)	(19,715)
Increase (decrease) in other current liabilities	13,637	2,676	(45,206)
Deferred income taxes	(1,334)	(3,572)	16,682
Other	(5,096)	(1,144)	201
Net cash flows provided by operating activities	40,698	76,292	72,887
Cash flows from investing activities:
Acquisition of property and equipment	(48,912)	(49,290)	(44,431)
Sale of investment	0	0	1,163
Business acquisitions, net of cash acquired, and equity investments	(4,693)	(23,523)	0
Other	(6,872)	(6,889)	(5,581)
Net cash flows used in investing activities	(60,477)	(79,702)	(48,849)
Cash flows from financing activities:
Proceeds from issuance of long-term debt	755,550	439,621	656,997
Deferred loan costs	(2,547)	0	(3,219)
Repurchases of common stock	0	(23,690)	(4,494)
Excess tax benefits from share-based payment arrangements	492	433	1,067
Exercise of stock options	2,835	4,825	1,133
Payments of long-term debt	(736,355)	(417,490)	(673,188)
Change in outstanding checks and other	582	(709)	(3,717)
Net cash flows provided by (used in) financing activities	20,557	2,990	(25,421)
Effect of exchange rate changes on cash	117	220	91
Net increase (decrease) in cash and cash equivalents	895	(200)	(1,292)
Cash and cash equivalents, beginning of period	864	1,064	2,356
Cash and cash equivalents, end of period	1,759	864	1,064
Supplemental disclosure of cash flow information:
Cash paid during the period for interest	12,001	11,106	12,137
Cash paid during the period for income taxes	2,282	7,874	13,231
Noncash Activities:
Assets acquired through capital lease obligations	0	0	8,435
Issuance of unregistered common stock associated with Navvis acquisition	0	3,262	0
Issuance of unregistered common stock associated with Ascentia acquisition	$ 58	$ 0	$ 0