Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2026	Mar. 31, 2025
Cash flows from operating activities:
Net income	$ 29,572	$ 20,737
Adjustments to reconcile net income to net cash from operating activities:
Depreciation and amortization	6,119	5,332
Amortization of premiums, discounts and issuance costs	103	230
Stock-based compensation expense	4,661	3,641
Deferred income taxes	8,342	4,398
Other	(670)	(758)
Changes in assets and liabilities:
Accounts receivable	4,864	17,461
Prepaid expenses and other current assets	34	(1,125)
Other long-term assets	4,744	4,649
Accounts payable and accrued expenses	(181,467)	(159,685)
Income taxes payable	871	2,748
Long-term professional liabilities	(1,112)	(7,590)
Other liabilities	(5,563)	(6,149)
Net cash used in operating activities - continuing operations	(129,502)	(116,111)
Net cash used in operating activities - discontinued operations	(345)	(1,352)
Net cash used in operating activities	(129,847)	(117,463)
Cash flows from investing activities:
Acquisition payments, net of cash acquired	(7,000)	0
Purchases of investments	(7,008)	(7,761)
Proceeds from maturities or sales of investments	7,750	7,300
Purchases of property and equipment	(6,247)	(3,318)
Other	526	(3,685)
Net cash used in investing activities	(11,979)	(7,464)
Cash flows from financing activities:
Payments on term loan	(6,250)	(4,688)
Payments on finance lease obligations	(478)	(339)
Proceeds from issuance of common stock	544	662
Repurchases of common stock	(21,451)	(1,569)
Other	0	(101)
Net cash used in financing activities	(27,635)	(6,035)
Net decrease in cash and cash equivalents	(169,461)	(130,962)
Cash and cash equivalents at beginning of period	375,241	229,940
Cash and cash equivalents at end of period	$ 205,780	$ 98,978