Deferred tax assets (liabilities) (Detail) - USD ($)	Dec. 31, 2018	Dec. 31, 2017
Deferred tax assets (liabilities):
State taxes	$ 1,886,010	$ 1,001,754
Stock options	1,660,664	1,784,524
Accrued payroll and related costs	238,633	185,130
Accrued hospital pool deficit	168,413	282,913
Allowance for bad debts	1,124,917	0
Investment in other entities	884,922	(1,437,061)
Net operating loss carryforward	6,414,256	7,069,776
Property and equipment	(1,286,087)	(1,286,452)
Acquired intangible assets	(24,084,892)	(28,626,943)
Risk Pool Receivable	(2,434,573)	0
Other	(792,781)	(504,307)
Net deferred tax liabilities before valuation allowance	(16,220,518)	(21,530,666)
Valuation Allowance	(3,395,417)	(3,385,932)
Net deferred tax liabilities	$ (19,615,935)	$ (24,916,598)