Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014
Cash flows from operating activities:
Consolidated net loss	$ (17,292)	$ (52,447)
Adjustments to reconcile net (loss) income to net cash provided by operating activities:
Depreciation	57,413	64,120
Asset impairment charges	2,339	2,025
Intangible asset impairment charge		34,900
Amortization of intangibles, deferred financing costs and bond premium	9,664	10,359
Provision for doubtful accounts	208	658
Provision for inventory obsolescence	299	(27)
Non-cash share-based compensation expense	1,902	801
Gain on sales and disposals of equipment	(3,547)	(1,791)
Deferred income taxes	697	(13,545)
Changes in operating assets and liabilities:
Accounts receivable	(2,533)	1,667
Inventories	(405)	(253)
Other operating assets	542	(2,137)
Accounts payable	595	221
Other operating liabilities	(6,636)	(9,274)
Net cash provided by operating activities	43,246	35,277
Cash flows from investing activities:
Medical equipment purchases	(38,771)	(44,563)
Property and office equipment purchases	(3,148)	(3,610)
Proceeds from disposition of property and equipment	10,799	6,996
Acquisition	(2,600)
Purchases of noncontrolling interests		(46)
Net cash used in investing activities	(33,720)	(41,223)
Cash flows from financing activities:
Proceeds under senior secured credit facility	104,952	123,400
Payments under senior secured credit facility	(108,900)	(107,200)
Payments of principal under capital lease obligations	(5,756)	(5,199)
Distributions to noncontrolling interests	(360)	(436)
Contributions from new members to limited liability companies	70
Dividend and equity distribution payments	(39)	(73)
Change in book overdrafts	507	(4,546)
Net cash (used in) provided by financing activities	(9,526)	5,946
Supplemental cash flow information:
Interest paid	51,432	51,528
Income taxes paid	728	318
Non-cash activities:
Medical equipment purchases included in accounts payable (at end of period)	10,906	10,973
Capital lease additions	$ 7,108	$ 1,038