CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Cash Flows from Operating Activities:
Net income	$ 176,156	$ 139,604
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	21,763	19,955
Non-cash compensation	17,860	19,758
Amortization and impairment of operating lease right of use assets	30,181	29,149
Gain on disposal of property and equipment	(64)	(77)
(Gain) loss on equity method investments	(31,092)	2,980
Write-off of other comprehensive income	0	(15)
Deferred income taxes	34,729	(2,762)
Equity in earnings from equity method investments	(3,932)	(2,399)
Amortization of deferred debt issuance costs/debt discount	669	653
Return on equity method investments	4,268	3,919
Changes in operating assets and liabilities, net of impact of acquisitions:
Patient accounts receivable	(17,638)	6,486
Other current assets	(6,219)	(28,217)
Other assets	(938)	(91)
Accounts payable	(1,192)	(1,627)
Accrued expenses	(9,363)	25,594
Other long-term obligations	(1,785)	38,481
Operating lease liabilities	(27,372)	(25,576)
Operating lease right of use assets	(2,304)	(2,775)
Net cash provided by operating activities	183,727	223,040
Cash Flows from Investing Activities:
Proceeds from sale of deferred compensation plan assets	126	94
Proceeds from sale of property and equipment	140	80
Purchases of property and equipment	(5,187)	(2,995)
Investments in technology assets	(147)	0
Investments in equity method investees	0	(875)
Proceeds from sale of equity method investment	0	17,876
Acquisitions of businesses, net of cash acquired	(264,872)	(299,723)
Net cash used in investing activities	(269,940)	(285,543)
Cash Flows from Financing Activities:
Proceeds from issuance of stock upon exercise of stock options	1,706	6,070
Proceeds from issuance of stock to employee stock purchase plan	3,022	2,600
Shares withheld to pay taxes on non-cash compensation	(16,694)	(54,172)
Noncontrolling interest distribution	(1,253)	(672)
Proceeds from borrowings under term loan	290,312	0
Proceeds from borrowings under revolving line of credit	500,700	432,000
Repayments of borrowings under revolving line of credit	(551,700)	(357,000)
Principal payments of long-term obligations	(5,893)	(7,360)
Debt issuance costs	(2,792)	0
Purchase of company stock	(84,879)	0
Provider relief fund advance	(1,465)	60,000
Net cash provided by financing activities	131,064	81,466
Net increase in cash, cash equivalents and restricted cash	44,851	18,963
Cash, cash equivalents and restricted cash at beginning of period	83,357	96,490
Cash, cash equivalents and restricted cash at end of period	128,208	115,453
Supplemental Disclosures of Cash Flow Information:
Cash paid for interest	3,479	4,902
Cash paid for income taxes, net of refunds received	25,482	30,290
Cash paid for operating lease liabilities	29,676	28,351
Cash paid for finance lease liabilities	1,509	1,483
Supplemental Disclosures of Non-Cash Activity:
Right of use assets obtained in exchange for operating lease liabilities	34,881	29,876
Right of use assets obtained in exchange for finance lease liabilities	814	822
Reductions to right of use assets resulting from reductions to operating lease liabilities	$ 1,183	$ 767