Significant Accounting Policies Accounts Receivable (Details) (USD $) In Thousands, unless otherwise specified	Jun. 30, 2012	Dec. 31, 2011
Accounts Receivable, Gross, Current	$ 1,219,320	$ 1,290,027
Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	443,094	457,085
Facility Payors [Member]
Accounts Receivable, Gross, Current	577,586	591,928
Private Payors [Member]
Accounts Receivable, Gross, Current	198,640	241,014
0 - 180 Days Past Due [Member]
Accounts Receivable, Gross, Current	726,868	731,225
0 - 180 Days Past Due [Member] | Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	261,913	257,782
0 - 180 Days Past Due [Member] | Facility Payors [Member]
Accounts Receivable, Gross, Current	393,128	387,509
0 - 180 Days Past Due [Member] | Private Payors [Member]
Accounts Receivable, Gross, Current	71,827	85,934
181 Days and Greater Past Due [Member]
Accounts Receivable, Gross, Current	492,452	558,802
181 Days and Greater Past Due [Member] | Medicare Medicaid and Third Party Payors [Member]
Accounts Receivable, Gross, Current	181,181	199,303
181 Days and Greater Past Due [Member] | Facility Payors [Member]
Accounts Receivable, Gross, Current	184,458	204,419
181 Days and Greater Past Due [Member] | Private Payors [Member]
Accounts Receivable, Gross, Current	$ 126,813	$ 155,080