Accrued Professional Liabilities - Components of Reserves (Details) - USD ($) $ in Thousands	Sep. 30, 2015	Dec. 31, 2014
Payables and Accruals [Abstract]
Estimated losses under self-insured programs	$ 29,153	$ 25,337
Incurred but not reported losses	32,931	28,448
Total accrued professional liabilities	62,084	53,785
Less estimated losses payable within one year	12,606	11,983
Total	$ 49,478	$ 41,802