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 income	$ 489,047	$ 448,870	$ 275,795
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	308,690	295,861	223,997
Gains on sales of assets and businesses, net of losses	(27,085)	(452)	(1,993)
Stock based compensation expense	22,518	18,225	16,799
Costs related to extinguishment of debt	29,170	0	0
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	(71,068)	(134,838)	22,726
Accrued interest	152	(3,577)	8,408
Accrued and deferred income taxes	10,374	85,792	132
Other working capital accounts	28,554	(28,382)	(26,437)
Other assets and deferred charges	30,976	37,160	11,539
Other	6,367	(1,387)	812
Accrued insurance expense, net of commercial premiums paid	62,660	83,612	19,739
Payments made in settlement of self-insurance claims	(75,084)	(82,633)	(50,173)
Net cash provided by operating activities	815,271	718,251	501,344
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(363,192)	(285,682)	(239,274)
Acquisition of property and businesses	(527,847)	(29,466)	(1,958,298)
Proceeds received from sales of assets and businesses	149,311	67,592	21,460
Costs incurred for purchase and implementation of electronic health records application	(54,362)	(38,249)	(17,971)
Return of deposit on terminated purchase agreement	6,500	0	0
Net cash provided by (used in) investing activities	(789,590)	(285,805)	(2,194,083)
Cash Flows from Financing Activities:
Reduction of long-term debt	(849,647)	(381,517)	(1,392,086)
Additional borrowings	913,500	98,100	3,266,146
Financing costs	(8,283)	(23,608)	(101,815)
Repurchase of common shares	(19,154)	(60,482)	(11,528)
Dividends paid	(58,395)	(19,466)	(19,422)
Issuance of common stock	5,435	4,779	3,594
Profit distributions to noncontrolling interests	(26,895)	(38,497)	(32,456)
Proceeds from sale of noncontrolling interests in majority owned business	0	0	600
Net cash (used in) provided by financing activities	(43,439)	(420,691)	1,713,033
(Decrease) increase in cash and cash equivalents	(17,758)	11,755	20,294
Cash and cash equivalents, beginning of period	41,229	29,474	9,180
Cash and cash equivalents, end of period	23,471	41,229	29,474
Supplemental Disclosures of Cash Flow Information:
Interest paid	157,415	176,328	76,900
Income taxes paid, net of refunds	$ 264,824	$ 163,029	$ 152,088