Consolidated Statements of Cash Flows (USD $) In Thousands, unless otherwise specified	12 Months Ended
	Dec. 31, 2012	Dec. 31, 2011	Dec. 31, 2010
Cash flows from operating activities:
Net loss	$ (8,517)	$ (6,198)	$ (20,577)
Adjustments to reconcile net loss to net cash (used in) provided by operating activities:
Depreciation	4,736	5,703	9,408
Provision for loss on doubtful accounts	914	746	1,061
Loss (gain) on investments	68	(42)	(943)
Gain on sale of property and equipment	(239)	(618)	(1,962)
Impairment charges	617	104	1,694
Deferred income taxes			393
Stock-based compensation	2,060	1,676	1,272
Insurance reserves	(604)	(191)	(1,748)
Changes in operating assets and liabilities:
Patient accounts receivable	(1,610)	(1,128)	1,975
Other accounts receivable	1,522	(397)	(106)
Prepaid income taxes	45	432	11,563
Prepaid expenses and other	748	352	1,548
Accounts payable	(57)	(7)	1,643
Deferred revenue, net of professional fees	(2,264)	(3,938)	(5,536)
Accrued liabilities and other	(2,507)	5	1,673
Net cash (used in) provided by operations	(5,088)	(3,501)	1,358
Cash flows from investing activities:
Purchases of property and equipment	(1,160)	(1,509)	(878)
Proceeds from sale of assets	305	1,400	2,829
Purchases of investment securities	(39,656)	(166,968)	(404,339)
Proceeds from sale of investment securities	62,883	173,430	401,714
Other, net			(35)
Net cash provided by (used in) investing activities	22,372	6,353	(709)
Cash flows from financing activities:
Principal payments of capital lease obligations and loan	(4,004)	(3,280)	(5,859)
Shares repurchased for treasury stock	(357)	(288)	(193)
Proceeds from exercise of stock options	57	24	13
Net cash used in financing activities	(4,304)	(3,544)	(6,039)
Net effect of exchange rate changes on cash and cash equivalents	105	(90)	211
Increase (decrease) in cash and cash equivalents	13,085	(782)	(5,179)
Cash and cash equivalents at beginning of year	18,568	19,350	24,529
Cash and cash equivalents at end of year	31,653	18,568	19,350
Cash paid or received during the year for:
Interest paid	84	529	620
Income taxes refunded	79	499	12,086
Income taxes paid	$ 64	$ 64	$ 125