Consolidated Statements of Cash Flows (USD $) In Thousands, unless otherwise specified	12 Months Ended
Dec. 31, 2014	Dec. 31, 2013	Dec. 31, 2012
Cash Flows from Operating Activities:
Net income	$ 604,996us-gaap_ProfitLoss	$ 554,023us-gaap_ProfitLoss	$ 489,047us-gaap_ProfitLoss
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	375,624	337,356	308,690
Gains on sales of assets and businesses, net of losses	(7,837)us-gaap_GainLossOnDispositionOfAssets1	(3,114)us-gaap_GainLossOnDispositionOfAssets1	(27,085)us-gaap_GainLossOnDispositionOfAssets1
Stock based compensation expense	31,092us-gaap_ShareBasedCompensation	27,783us-gaap_ShareBasedCompensation	22,518us-gaap_ShareBasedCompensation
Costs related to extinguishment of debt	19,730	0	29,170
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	(105,708)	(49,708)	(71,068)
Accrued interest	4,400	(1,197)	152
Accrued and deferred income taxes	33,920	34,861	(5,666)
Other working capital accounts	73,912	26,234	28,554
Other assets and deferred charges	13,667	8,984	30,976
Other	2,449	23,485	6,367
Accrued insurance expense, net of commercial premiums paid	59,276	(3,821)	62,660
Payments made in settlement of self-insurance claims	(69,645)	(70,645)	(75,084)
Net cash provided by operating activities	1,035,876	884,241	799,231
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(391,150)	(358,493)	(363,192)
Acquisition of property and businesses	(431,386)	(12,636)	(527,847)
Proceeds received from sales of assets and businesses	15,178	37,482	149,311
Costs incurred for purchase and implementation of electronic health records application	(13,488)	(49,811)	(54,362)
Increase in insurance subsidiary investments	(12,000)	0	0
Return of Deposit on terminated purchase agreement	0	0	6,500
Net cash provided by (used in) investing activities	(832,846)	(383,458)	(789,590)
Cash Flows from Financing Activities:
Reduction of long-term debt	(879,129)us-gaap_RepaymentsOfLongTermDebt	(440,224)us-gaap_RepaymentsOfLongTermDebt	(849,647)us-gaap_RepaymentsOfLongTermDebt
Additional borrowings	830,000us-gaap_ProceedsFromLinesOfCredit	15,761us-gaap_ProceedsFromLinesOfCredit	913,500us-gaap_ProceedsFromLinesOfCredit
Financing costs	(14,976)us-gaap_PaymentsOfFinancingCosts	(231)us-gaap_PaymentsOfFinancingCosts	(8,283)us-gaap_PaymentsOfFinancingCosts
Repurchase of common shares	(100,749)	(27,201)	(19,154)
Dividends paid	(29,665)us-gaap_PaymentsOfDividends	(19,621)us-gaap_PaymentsOfDividends	(58,395)us-gaap_PaymentsOfDividends
Issuance of common stock	6,863	5,708	5,435
Excess income tax benefits related to stock based compensation	33,912	20,121	16,040
Profit distributions to noncontrolling interests	(33,680)	(61,329)	(26,895)
Net cash (used in) provided by financing activities	(187,424)	(507,016)	(27,399)
Effect of exchange rate changes on cash and cash equivalents	(775)	0	0
Increase (decrease) in cash and cash equivalents	14,831	(6,233)	(17,758)
Cash and cash equivalents, beginning of period	17,238	23,471	41,229
Cash and cash equivalents, end of period	32,069	17,238	23,471
Supplemental Disclosures of Cash Flow Information:
Interest paid, including early redemption premium and original issue discount write-off in 2014	130,279us-gaap_InterestPaidNet	131,259us-gaap_InterestPaidNet	157,415us-gaap_InterestPaidNet
Income taxes paid, net of refunds	258,612us-gaap_IncomeTaxesPaidNet	259,896us-gaap_IncomeTaxesPaidNet	264,824us-gaap_IncomeTaxesPaidNet
Noncash purchases of property and equipment	$ 35,469	$ 36,212	$ 34,896

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Amount of currency on hand as well as demand deposits with banks or financial institutions. Includes other kinds of accounts that have the general characteristics of demand deposits. Also includes short-term, highly liquid investments that are both readily convertible to known amounts of cash and so near their maturity that they present insignificant risk of changes in value because of changes in interest rates. Excludes cash and cash equivalents within disposal group and discontinued operation.

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The cash outflow for loan and debt issuance costs.

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-Publisher FASB

-Name Accounting Standards Codification

-Glossary Financing Activities

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-Paragraph 15

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The cash outflow associated with the acquisition of a business, net of the cash acquired from the purchase.

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The cash outflow for acquisition of or capital improvements on other tangible or intangible assets not otherwise defined in the taxonomy.

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The cash outflow associated with the acquisition of long-lived, physical assets that are used in the normal conduct of business to produce goods and services and not intended for resale; includes cash outflows to pay for construction of self-constructed assets.

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The cash inflow from the additional capital contribution to the entity.

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Amount of cash inflow from contractual arrangement with the lender, including but not limited to, letter of credit, standby letter of credit and revolving credit arrangements.

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-Article 4

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The cash inflow from the sale of property, plant and equipment (capital expenditures), software, and other intangible assets.

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The consolidated profit or loss for the period, net of income taxes, including the portion attributable to the noncontrolling interest.

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The cash outflow for debt initially having maturity due after one year or beyond the normal operating cycle, if longer.

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The aggregate amount of noncash, equity-based employee remuneration. This may include the value of stock or unit options, amortization of restricted stock or units, and adjustment for officers' compensation. As noncash, this element is an add back when calculating net cash generated by operating activities using the indirect method.

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