Consolidated Statements Of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015
Cash flows from operating activities:
Net earnings	$ 283,403	$ 257,781
Adjustments to reconcile net earnings to net cash flows provided by operating activities:
Depreciation and amortization	90,711	70,536
Amortization of deferred loan costs	6,419	6,238
Provision for uncollectibles	359,290	212,546
Net gain on disposals and deconsolidations	(6,739)	(5,854)
Share-based compensation	21,243	11,319
Excess tax benefit from share-based compensation	(3,910)	(3,779)
Deferred income taxes	34,605	7,309
Equity in earnings of unconsolidated affiliates	(18,375)	(11,575)
Net change in fair value of contingent consideration	(2,598)	8,338
Increases (decreases) in cash and cash equivalents, net of acquisitions and dispositions:
Accounts receivable	(387,733)	(232,465)
Supplies inventory	(699)	(533)
Prepaid and other current assets	(16,118)	36,479
Accounts payable	(5,617)	2,316
Accrued expenses and other liabilities	(14,423)	64,760
Other, net	11,631	3,786
Net cash flows provided by operating activities	351,090	427,202
Cash flows from investing activities:
Acquisitions and related expenses	(351,736)	(233,490)
Acquisition of property and equipment	(64,007)	(47,006)
Increase in cash due to consolidation of previously unconsolidated affiliates	31,412	0
Purchases of marketable securities	(498)	(1,743)
Maturities of marketable securities	2,987	4,233
Other, net	(6,488)	(3,974)
Net cash flows used in investing activities	(388,330)	(281,980)
Cash flows from financing activities:
Proceeds from long-term borrowings and revolving credit facility	430,006	10,197
Repayment on long-term borrowings and revolving credit facility	(214,268)	(15,737)
Distributions to noncontrolling interests	(172,075)	(158,144)
Proceeds from issuance of common stock upon exercise of stock options	450	2,356
Repurchase of common stock	(6,145)	(3,684)
Other, net	(1,330)	(867)
Net cash flows provided by (used in) financing activities	36,638	(165,879)
Net decrease in cash and cash equivalents	(602)	(20,657)
Cash and cash equivalents, beginning of period	106,660	208,079
Cash and cash equivalents, end of period	106,058	187,422
Supplemental cash flow information:
Interest payments	101,524	96,418
Income tax paid, net of refunds	$ 53,360	$ 28,429