Condensed Consolidated Statements of Cash Flows (USD $) In Thousands, unless otherwise specified	3 Months Ended
	Mar. 31, 2012	Mar. 31, 2011
Cash Flows from Operating Activities:
Net income	$ 142,570	$ 129,987
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	73,820	71,526
Stock based compensation expense	5,486	3,954
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	(146,670)	(103,919)
Accrued interest	13,280	12,875
Accrued and deferred income taxes	75,471	68,994
Other working capital accounts	(48,074)	(27,056)
Other assets and deferred charges	7,120	6,777
Other	(2,082)	11,208
Accrued insurance expense, net of commercial premiums paid	24,581	23,744
Payments made in settlement of self-insurance claims	(18,279)	(14,913)
Net cash provided by operating activities	127,223	183,177
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(92,563)	(56,558)
Proceeds received from sale of assets and businesses	53,461	991
Costs incurred for purchase and implementation of electronic health records application	(14,501)	(8,145)
Return of deposit on terminated purchase agreement	6,500	0
Net cash used in investing activities	(47,103)	(63,712)
Cash Flows from Financing Activities:
Reduction of long-term debt	(70,942)	(136,403)
Additional borrowings	0	73,500
Financing costs	0	(23,140)
Repurchase of common shares	(2,017)	(3,170)
Dividends paid	(4,832)	(4,876)
Issuance of common stock	1,016	1,251
Profit distributions to noncontrolling interests	(2,575)	(4,025)
Net cash used in financing activities	(79,350)	(96,863)
Increase in cash and cash equivalents	770	22,602
Cash and cash equivalents, beginning of period	41,229	29,474
Cash and cash equivalents, end of period	41,999	52,076
Supplemental Disclosures of Cash Flow Information:
Interest paid	25,945	37,130
Income taxes paid, net of refunds	$ 3,419	$ 4,527