Guarantor (Cash Flow Statements) (Details) (USD $) In Thousands, unless otherwise specified	12 Months Ended
	Dec. 31, 2013	Dec. 31, 2012	Dec. 31, 2011
Cash flows from operating activities:
Net cash flows provided by operating activities	$ 332,824	$ 295,652	$ 243,423
Cash flows from investing activities:
Acquisition of interests in surgery centers and related transactions	(73,594)	(277,388)	(239,223)
Acquisition of property and equipment	(28,856)	(28,864)	(22,170)
Proceeds from sale of interests in surgery centers	3,553	7,309	7,026
Other	159	0	0
Net cash flows used in investing activities	(98,738)	(298,943)	(254,367)
Cash flows from financing activities:
Proceeds from long-term borrowings	162,204	565,566	288,869
Repayment on long-term borrowings	(202,083)	(394,164)	(129,107)
Distributions to noncontrolling interests	(184,149)	(162,941)	(138,724)
Net cash flows provided by (used in) financing activities	(229,644)	8,971	17,515
Net increase (decrease) in cash and cash equivalents	4,442	5,680	6,571
Cash and cash equivalents, beginning of year	46,398	40,718	34,147
Cash and cash equivalents, end of year	50,840	46,398	40,718
Consolidation, Eliminations [Member]
Cash flows from operating activities:
Net cash flows provided by operating activities	(347,648)	(182,851)	(151,558)
Cash flows from investing activities:
Acquisition of interests in surgery centers and related transactions	694	92,830	88,803
Acquisition of property and equipment	0	0	0
Proceeds from sale of interests in surgery centers	0	0	0
Other	0
Net cash flows used in investing activities	694	92,830	88,803
Cash flows from financing activities:
Proceeds from long-term borrowings	0	0	0
Repayment on long-term borrowings	0	0	0
Distributions to noncontrolling interests	347,648	182,851	151,558
Capital contributions		(90,029)	(84,597)
Changes in intercompany balances with affiliates, net	0	0	0
Other financing activities, net	(694)	(2,801)	(4,206)
Net cash flows provided by (used in) financing activities	346,954	90,021	62,755
Net increase (decrease) in cash and cash equivalents	0	0	0
Cash and cash equivalents, beginning of year	0	0	0
Cash and cash equivalents, end of year	0	0	0
Parent Company [Member]
Cash flows from operating activities:
Net cash flows provided by operating activities	45,127	(83,605)	(67,911)
Cash flows from investing activities:
Acquisition of interests in surgery centers and related transactions	0	(90,029)	(84,597)
Acquisition of property and equipment	(3,693)	(3,681)	(2,858)
Proceeds from sale of interests in surgery centers	0	0	0
Other	0
Net cash flows used in investing activities	(3,693)	(93,710)	(87,455)
Cash flows from financing activities:
Proceeds from long-term borrowings	152,700	560,000	281,100
Repayment on long-term borrowings	(188,081)	(381,220)	(118,100)
Distributions to noncontrolling interests	0	0	0
Capital contributions		0	0
Changes in intercompany balances with affiliates, net	88	(2,666)	(178)
Other financing activities, net	(6,690)	(70)	(3,609)
Net cash flows provided by (used in) financing activities	(41,983)	176,044	159,213
Net increase (decrease) in cash and cash equivalents	(549)	(1,271)	3,847
Cash and cash equivalents, beginning of year	7,259	8,530	4,683
Cash and cash equivalents, end of year	6,710	7,259	8,530
Guarantor Subsidiaries [Member]
Cash flows from operating activities:
Net cash flows provided by operating activities	208,773	182,851	151,558
Cash flows from investing activities:
Acquisition of interests in surgery centers and related transactions	(74,288)	(280,189)	(243,429)
Acquisition of property and equipment	0	0	0
Proceeds from sale of interests in surgery centers	3,553	7,309	7,274
Other	159
Net cash flows used in investing activities	(70,576)	(272,880)	(236,155)
Cash flows from financing activities:
Proceeds from long-term borrowings	0	0	0
Repayment on long-term borrowings	0	0	0
Distributions to noncontrolling interests	(138,875)	0	0
Capital contributions		90,029	84,597
Changes in intercompany balances with affiliates, net	0	0	0
Other financing activities, net	678	0	0
Net cash flows provided by (used in) financing activities	(138,197)	90,029	84,597
Net increase (decrease) in cash and cash equivalents	0	0	0
Cash and cash equivalents, beginning of year	0	0	0
Cash and cash equivalents, end of year	0	0	0
Non-Guarantor Subsidiaries [Member]
Cash flows from operating activities:
Net cash flows provided by operating activities	426,572	379,257	311,334
Cash flows from investing activities:
Acquisition of interests in surgery centers and related transactions	0	0	0
Acquisition of property and equipment	(25,163)	(25,183)	(19,312)
Proceeds from sale of interests in surgery centers	0	0	(248)
Other	0
Net cash flows used in investing activities	(25,163)	(25,183)	(19,560)
Cash flows from financing activities:
Proceeds from long-term borrowings	9,504	5,566	7,769
Repayment on long-term borrowings	(14,002)	(12,944)	(11,007)
Distributions to noncontrolling interests	(392,922)	(345,792)	(290,282)
Capital contributions		0	0
Changes in intercompany balances with affiliates, net	(88)	2,666	178
Other financing activities, net	1,090	3,381	4,292
Net cash flows provided by (used in) financing activities	(396,418)	(347,123)	(289,050)
Net increase (decrease) in cash and cash equivalents	4,991	6,951	2,724
Cash and cash equivalents, beginning of year	39,139	32,188	29,464
Cash and cash equivalents, end of year	44,130	39,139	32,188
Consolidated Entities [Member]
Cash flows from financing activities:
Other financing activities, net	$ (5,616)	$ 510	$ (3,523)