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Revenue Recognition Revenue Recognition (Detail) - USD ($)
$ in Thousands
3 Months Ended 9 Months Ended
Sep. 30, 2018
Sep. 30, 2017
Sep. 30, 2018
Sep. 30, 2017
Dec. 31, 2017
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]          
Allowance for Doubtful Accounts Receivable $ 71,108   $ 71,108   $ 218,399
Provision for uncollectible accounts 11,977 $ 119,321 35,838 $ 335,979  
Difference between Revenue Guidance in Effect before and after Topic 606 [Member]          
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]          
Contract with Customer, Performance Obligation Satisfied in Previous Period $ 1,246   77,473    
Change in Accounting Principle Topic 606, Effect of Adoption, Quantification     $ 36,000    
Medicare          
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]          
Percent of revenue paid by a payor 80.00%