CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Cash flows provided by operating activities:
Net income	$ 22,121	$ 8,775
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	26,513	26,906
Provision for doubtful accounts	629	284
Share-based compensation expense	15,565	10,089
Deferred income taxes	2,067	(723)
Amortization of debt discounts and issuance costs	1,564	1,202
Gain on sale and disposal of fixed assets	(729)	(1,200)
Changes in operating assets and liabilities:
Accounts receivable, net	39,531	1,914
Inventories	(3,834)	(6,310)
Other current assets and other assets	(3,115)	(1,769)
Income taxes	(6,814)	2,613
Accounts payable	12,912	(1,751)
Accrued expenses and other current liabilities	6,914	(2,144)
Accrued compensation related costs	2,339	(15,583)
Other liabilities	8,016	(1,736)
Operating lease liabilities, net of amortization of right-of-use assets	1,559	(622)
Changes in operating assets and liabilities:	57,508	(25,388)
Net cash provided by operating activities	125,238	19,945
Cash flows used in investing activities
Acquisitions, net of cash acquired	(16,854)	(31,585)
Purchase of property, plant, and equipment	(19,352)	(20,262)
Purchase of therapeutic program equipment leased to third parties under operating leases	(3,194)	(5,165)
Proceeds from sale of property, plant, and equipment	1,578	2,181
Purchase of company-owned life insurance investment	(250)
Net cash used in investing activities	(38,072)	(54,831)
Cash flows used in financing activities:
Borrowings under revolving credit agreement	79,000
Repayment of borrowings under revolving credit agreement	(79,000)
Repayment of term loan	(3,788)	(3,788)
Payment of employee taxes on share-based compensation	(6,841)	(3,710)
Payment on seller notes	(2,200)	(2,688)
Payment of financing lease obligations	(521)	(344)
Payments under vendor financing arrangements	(550)
Payment of debt issuance costs	(214)
Proceeds from the exercise of options	39	249
Net cash used in financing activities	(14,075)	(10,281)
Increase (decrease) in cash and cash equivalents	73,091	(45,167)
Cash and cash equivalents at beginning of period	74,419	95,114
Cash and cash equivalents at end of period	147,510	49,947
Non-cash financing and investing activities:
Seller notes, deferred payment obligations and additional consideration related to acquisitions	29,420	5,053
Purchase of property, plant, and equipment in accounts payable at period end	4,299	3,492
Purchase of property, plant, and equipment through vendor financing		2,200
Right-of-use assets obtained in exchange for finance lease obligations	$ 1,975	$ 282