Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Cash flows from operating activities:
Net income (loss)	$ 14,206	$ (21,188)
Income from discontinued operations	0	247
Adjustments to reconcile net income (loss) to net cash from operating activities:
Depreciation and amortization	8,953	8,769
Amortization of premiums, discounts and issuance costs	393	577
Loss on early extinguishment of debt	0	57,016
Stock-based compensation expense	3,009	4,435
Deferred income taxes	2,008	2,389
Other	(391)	(605)
Changes in assets and liabilities:
Accounts receivable	21,345	(20,152)
Prepaid expenses and other current assets	(4,470)	16,212
Other long-term assets	952	863
Accounts payable and accrued expenses	(150,125)	(159,271)
Income taxes payable	5,299	17,216
Long-term professional liabilities	2,378	2,684
Other liabilities	(4,201)	877
Net cash used in operating activities - continuing operations	(100,644)	(89,931)
Net cash used in operating activities - discontinued operations	(273)	(7,551)
Net cash used in operating activities	(100,917)	(97,482)
Cash flows from investing activities:
Acquisition payments, net of cash acquired	(1,667)	(25,667)
Purchases of investments	(9,549)	(1,272)
Proceeds from maturities or sales of investments	6,865	7,712
Purchases of property and equipment	(6,999)	(7,145)
Other	0	99
Net cash used in investing activities	(11,350)	(26,273)
Cash flows from financing activities:
Borrowings on credit agreement	216,000	248,500
Payments on credit agreement	(106,000)	(99,500)
Payments on term loan	(3,125)	0
Redemption of senior notes, including call premium	0	(1,046,880)
Proceeds from senior notes and term loan	0	650,000
Payments for financing costs		(7,924)
Payment on finance lease obligation	(703)	(747)
Proceeds from issuance of common stock	1,095	1,174
Repurchases of common stock	(775)	(1,166)
Other	2,075	86
Net cash used in financing activities	108,567	(256,457)
Net decrease in cash and cash equivalents	(3,700)	(380,212)
Cash and cash equivalents at beginning of period	9,824	387,391
Cash and cash equivalents at end of period	$ 6,124	$ 7,179