Consolidated Statements Of Cash Flows (USD $) In Thousands, unless otherwise specified	9 Months Ended
	Sep. 30, 2013	Sep. 30, 2012
Cash flows from operating activities:
Net earnings (loss)	$ 190,376	$ 164,249
Adjustments to reconcile net earnings to net cash flows provided by operating activities:
Depreciation and amortization	24,651	22,345
Net (gain) loss on sale of long-lived assets	84	599
Gain (loss) on deconsolidation	(2,237)	0
Share-based compensation	6,070	5,119
Excess tax benefit from share-based compensation	(1,890)	(1,268)
Deferred income taxes	29,835	18,617
Equity in earnings of unconsolidated affiliates, net	(2,193)	(1,103)
Increase (decrease) in cash and cash equivalents, net of effects of acquisitions and dispositions, due to changes in:
Accounts receivable, net	(1,439)	4,831
Supplies inventory	(338)	343
Prepaid and other current assets	(1,001)	(325)
Accounts payable	(2,823)	(2,775)
Accrued expenses and other liabilities	6,820	3,510
Other, net	3,018	1,970
Net cash flows provided by operating activities	248,933	216,112
Cash flows from investing activities:
Acquisition of interests in surgery centers and related transactions	(59,455)	(16,097)
Acquisition of property and equipment	(20,711)	(20,800)
Proceeds from sale of interests in surgery centers	151	0
Other	107	0
Net cash flows used in investing activities	(79,908)	(36,897)
Cash flows from financing activities:
Proceeds from long-term borrowings	129,435	50,211
Repayment on long-term borrowings	(151,676)	(111,139)
Distributions to noncontrolling interests	(137,081)	(123,066)
Proceeds from issuance of common stock upon exercise of stock options	23,289	11,928
Repurchase of common stock	(35,481)	(13,101)
Capital contributions and ownership transactions by noncontrolling interests	961	1,409
Excess tax benefit from share-based compensation	1,890	1,268
Financing cost incurred	(1,257)	(1,761)
Net cash flows provided by (used in) financing activities	(169,920)	(184,251)
Net increase (decrease) in cash and cash equivalents	(895)	(5,036)
Cash and cash equivalents, beginning of period	46,398	40,718
Cash and cash equivalents, end of period	$ 45,503	$ 35,682