CONSOLIDATED STATEMENTS OF CASH FLOWS (USD $) In Thousands, unless otherwise specified	12 Months Ended
	Dec. 31, 2013	Dec. 31, 2012	Dec. 31, 2011
Cash flows from operating activities:
Net income (loss)	$ (8,541)	$ 8,024	$ (157,693)
Adjustments to reconcile net income to net cash provided by operating activities, net of business acquisitions:
Depreciation and amortization	52,791	51,734	49,988
Impairment loss	0	0	183,288
Amortization of deferred loan costs	1,685	2,284	1,894
Amortization of debt discount	3,140	0	0
Share-based employee compensation expense	7,116	6,371	9,246
Deferred income taxes	(5,077)	(1,334)	(3,572)
Excess tax benefits from share-based payment arrangements	(718)	(492)	(433)
Decrease (increase) in accounts receivable, net	19,099	(23,439)	(7,452)
Increase (decrease) in other current assets	(598)	2,984	6,960
Increase (decrease) in accounts payable	9,224	(995)	1,466
Decrease in accrued salaries and benefits	(5,780)	(12,980)	(8,932)
(Decrease) increase in other current liabilities	(1,196)	13,637	2,676
Other	383	(5,096)	(1,144)
Net cash flows provided by operating activities	71,528	40,698	76,292
Cash flows from investing activities:
Acquisition of property and equipment	(41,346)	(48,912)	(49,290)
Business acquisitions, net of cash acquired, and equity investments	(830)	(4,693)	(23,523)
Other	(7,717)	(6,872)	(6,889)
Net cash flows used in investing activities	(49,893)	(60,477)	(79,702)
Cash flows from financing activities:
Proceeds from issuance of long-term debt	352,850	755,550	439,621
Payments of long-term debt	(529,874)	(736,355)	(417,490)
Repurchases of common stock	0	0	(23,690)
Excess tax benefits from share-based payment arrangements	718	492	433
Exercise of stock options	12,748	2,835	4,825
Deferred loan costs	(5,264)	(2,547)	0
Proceeds from cash convertible senior notes	150,000	0	0
Proceeds from convertible note	20,000	0	0
Proceeds from sale of warrants	15,150	0	0
Payments for cash convertible note hedge transactions	(36,750)	0	0
Change in outstanding checks and other	526	582	(709)
Net cash flows (used in) provided by financing activities	(19,896)	20,557	2,990
Effect of exchange rate changes on cash	(914)	117	220
Net increase (decrease) in cash and cash equivalents	825	895	(200)
Cash and cash equivalents, beginning of period	1,759	864	1,064
Cash and cash equivalents, end of period	2,584	1,759	864
Supplemental disclosure of cash flow information:
Cash paid during the period for interest	10,080	12,001	11,106
Cash paid during the period for income taxes	650	2,282	7,874
Noncash Activities:
Issuance of unregistered common stock associated with Navvis acquisition	0	0	3,262
Issuance of unregistered common stock associated with Ascentia acquisition	0	58	0
Issuance of unregistered common stock associated with Ornish partnership	$ 467	$ 0	$ 0