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Income Taxes Effective tax rate (Details) - USD ($)
$ in Thousands
3 Months Ended 9 Months Ended
Sep. 30, 2023
Sep. 30, 2022
Sep. 30, 2023
Sep. 30, 2022
Business Acquisition, Contingent Consideration [Line Items]        
Change in fair value of contingent earn-out $ (15,572) $ (4,059) $ (12,256) $ (31,253)
Share-based Payment Arrangement, Expense, Tax Benefit 600 $ 1,500 $ 800 4,100
contingent consideration, tax expense 0     $ 0
Return-to-Provision Tax Benefit $ 7,500      
Effective Income Tax Rate 235.00% 38.00% 70.00% 37.00%
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent     21.00% 21.00%
Share-based Payment Arrangement, Expense, Tax Benefit $ 600 $ 1,500 $ 800 $ 4,100
contingent consideration, tax expense 0     0
Unrecognized Tax Benefits, Reduction Resulting from Lapse of Applicable Statute of Limitations 0   6,000  
SmithsMedical        
Business Acquisition, Contingent Consideration [Line Items]        
Change in fair value of contingent earn-out $ (15,600) $ 4,100 $ 12,300 $ 31,300