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General (Details 12) - USD ($)
$ in Thousands
9 Months Ended
Sep. 30, 2015
Dec. 31, 2014
Redeemable Non-Controlling Interest disclosures    
Redeemable non-controlling interest $ 8,246 $ 5,957
Alpha Care Holdings Inc.    
Redeemable Non-Controlling Interest disclosures    
Percentage of ownership held by reporting entity 82.00%  
Percentage of remaining shares which the entity may be required to purchase in the event of exercise of put options by other shareholders 50.00%  
Redeemable non-controlling interest $ 8,200 $ 5,900
Increase (Reduction) in carrying value as a result of operating income (losses) $ 2,300