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Held for Sale and Discontinued Operations Additional Information (Details)
$ in Thousands
3 Months Ended 6 Months Ended
Jun. 19, 2019
USD ($)
Dec. 05, 2017
Jun. 30, 2019
USD ($)
Jun. 30, 2018
USD ($)
Jun. 30, 2019
USD ($)
Jun. 18, 2019
USD ($)
clinic
Jun. 30, 2018
USD ($)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]              
Proceeds from Divestiture of Businesses $ 4,465,476            
Proceeds from Divestiture of Businesses, Net of Cash Divested $ 3,824,509            
Payments to Acquire Businesses, Gross         $ 65,970   $ 89,465
Series of Individually Immaterial Business Acquisitions              
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]              
Payments to Acquire Businesses, Gross         63,945    
DMG held for sale | Series of Individually Immaterial Business Acquisitions              
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]              
Number of businesses acquired | clinic           2  
Payments to Acquire Businesses, Gross           $ 2,025  
Business Combination, Consideration Transferred, Other           $ 212  
Discontinued Operations, Held-for-sale | DMG held for sale              
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]              
Business acquisition, Effective date of acquisition Jun. 19, 2019            
Purchase and Sale Agreement, Aggregate purchase price $ 4,340,000            
Business Acquisition, Date of Acquisition Agreement   Dec. 05, 2017          
Loss on sale of discontinued operations before taxes     $ (23,022) $ 0 $ (23,022)   $ 0