Consolidated Statements of Cash Flows (USD $)
In Thousands, unless otherwise specified |
12 Months Ended | ||
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Dec. 31, 2014
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Dec. 31, 2013
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Dec. 31, 2012
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Cash flows from operating activities: | |||
Net income | $ 317,203us-gaap_ProfitLoss | $ 280,517us-gaap_ProfitLoss | $ 240,907us-gaap_ProfitLoss |
Adjustments to reconcile net income to net cash provided from operating activities: | |||
Depreciation and amortization | 45,990us-gaap_DepreciationDepletionAndAmortization | 39,966us-gaap_DepreciationDepletionAndAmortization | 30,816us-gaap_DepreciationDepletionAndAmortization |
Net change in fair value of contingent consideration liabilities | (417)us-gaap_BusinessCombinationContingentConsiderationArrangementsChangeInAmountOfContingentConsiderationLiability1 | 3,656us-gaap_BusinessCombinationContingentConsiderationArrangementsChangeInAmountOfContingentConsiderationLiability1 | 995us-gaap_BusinessCombinationContingentConsiderationArrangementsChangeInAmountOfContingentConsiderationLiability1 |
Stock-based compensation expense | 31,719us-gaap_ShareBasedCompensation | 31,288us-gaap_ShareBasedCompensation | 28,437us-gaap_ShareBasedCompensation |
Equity in earnings of unconsolidated affiliate | (1,780)us-gaap_IncomeLossFromEquityMethodInvestments | ||
Deferred income taxes | 2,559us-gaap_DeferredIncomeTaxExpenseBenefit | 15,920us-gaap_DeferredIncomeTaxExpenseBenefit | 21,344us-gaap_DeferredIncomeTaxExpenseBenefit |
Changes in assets and liabilities: | |||
Accounts receivable | (57,018)us-gaap_IncreaseDecreaseInAccountsReceivable | (37,331)us-gaap_IncreaseDecreaseInAccountsReceivable | (17,678)us-gaap_IncreaseDecreaseInAccountsReceivable |
Prepaid expenses and other assets | 1,506us-gaap_IncreaseDecreaseInPrepaidDeferredExpenseAndOtherAssets | 212us-gaap_IncreaseDecreaseInPrepaidDeferredExpenseAndOtherAssets | (244)us-gaap_IncreaseDecreaseInPrepaidDeferredExpenseAndOtherAssets |
Other assets | 2,137us-gaap_IncreaseDecreaseInOtherOperatingAssets | (3,541)us-gaap_IncreaseDecreaseInOtherOperatingAssets | 1,153us-gaap_IncreaseDecreaseInOtherOperatingAssets |
Accounts payable and accrued expenses | 66,039us-gaap_IncreaseDecreaseInAccountsPayableAndAccruedLiabilities | 49,239us-gaap_IncreaseDecreaseInAccountsPayableAndAccruedLiabilities | 16,953us-gaap_IncreaseDecreaseInAccountsPayableAndAccruedLiabilities |
Income taxes payable | 6,998us-gaap_IncreaseDecreaseInAccruedIncomeTaxesPayable | 5,772us-gaap_IncreaseDecreaseInAccruedIncomeTaxesPayable | (7,343)us-gaap_IncreaseDecreaseInAccruedIncomeTaxesPayable |
Payments of contingent consideration liabilities | (4,071)md_PaymentOfContingentConsiderationLiabilityOperating | (1,308)md_PaymentOfContingentConsiderationLiabilityOperating | (786)md_PaymentOfContingentConsiderationLiabilityOperating |
Long-term professional liabilities | 9,284us-gaap_MalpracticeLossContingencyPeriodIncreaseDecrease | 19,797us-gaap_MalpracticeLossContingencyPeriodIncreaseDecrease | 9,941us-gaap_MalpracticeLossContingencyPeriodIncreaseDecrease |
Other liabilities | 2,492us-gaap_IncreaseDecreaseInOtherOperatingLiabilities | 1,211us-gaap_IncreaseDecreaseInOtherOperatingLiabilities | 411us-gaap_IncreaseDecreaseInOtherOperatingLiabilities |
Net cash provided from operating activities | 422,641us-gaap_NetCashProvidedByUsedInOperatingActivitiesContinuingOperations | 405,398us-gaap_NetCashProvidedByUsedInOperatingActivitiesContinuingOperations | 324,906us-gaap_NetCashProvidedByUsedInOperatingActivitiesContinuingOperations |
Cash flows from investing activities: | |||
Acquisition payments, net of cash acquired | (479,394)us-gaap_PaymentsToAcquireBusinessesNetOfCashAcquired | (238,045)us-gaap_PaymentsToAcquireBusinessesNetOfCashAcquired | (441,006)us-gaap_PaymentsToAcquireBusinessesNetOfCashAcquired |
Purchases of investments | (26,884)us-gaap_PaymentsToAcquireInvestments | (20,802)us-gaap_PaymentsToAcquireInvestments | (33,120)us-gaap_PaymentsToAcquireInvestments |
Proceeds from sales or maturities of investments | 20,735us-gaap_ProceedsFromSaleMaturityAndCollectionsOfInvestments | 11,011us-gaap_ProceedsFromSaleMaturityAndCollectionsOfInvestments | 28,073us-gaap_ProceedsFromSaleMaturityAndCollectionsOfInvestments |
Purchases of property and equipment | (18,061)us-gaap_PaymentsToAcquireOtherPropertyPlantAndEquipment | (15,654)us-gaap_PaymentsToAcquireOtherPropertyPlantAndEquipment | (14,495)us-gaap_PaymentsToAcquireOtherPropertyPlantAndEquipment |
Net cash used in investing activities | (503,604)us-gaap_NetCashProvidedByUsedInInvestingActivitiesContinuingOperations | (263,490)us-gaap_NetCashProvidedByUsedInInvestingActivitiesContinuingOperations | (460,548)us-gaap_NetCashProvidedByUsedInInvestingActivitiesContinuingOperations |
Cash flows from financing activities: | |||
Borrowings on credit facility | 1,754,500us-gaap_ProceedsFromLinesOfCredit | 911,500us-gaap_ProceedsFromLinesOfCredit | 517,500us-gaap_ProceedsFromLinesOfCredit |
Payments on credit facility | (1,213,500)us-gaap_RepaymentsOfLinesOfCredit | (1,028,500)us-gaap_RepaymentsOfLinesOfCredit | (402,500)us-gaap_RepaymentsOfLinesOfCredit |
Payments for credit facility financing costs | (4,281)us-gaap_PaymentsOfFinancingCosts | (2,397)us-gaap_PaymentsOfFinancingCosts | |
Payments of contingent consideration liabilities | (11,740)md_PaymentOfContingentConsiderationLiabilityFinancing | (10,365)md_PaymentOfContingentConsiderationLiabilityFinancing | (9,445)md_PaymentOfContingentConsiderationLiabilityFinancing |
Payments on capital lease obligations | (159)us-gaap_RepaymentsOfLongTermCapitalLeaseObligations | (99)us-gaap_RepaymentsOfLongTermCapitalLeaseObligations | (136)us-gaap_RepaymentsOfLongTermCapitalLeaseObligations |
Excess tax benefit from exercises of stock options and vesting of restricted and deferred stock | 17,462us-gaap_ExcessTaxBenefitFromShareBasedCompensationFinancingActivities | 18,579us-gaap_ExcessTaxBenefitFromShareBasedCompensationFinancingActivities | 6,494us-gaap_ExcessTaxBenefitFromShareBasedCompensationFinancingActivities |
Proceeds from issuance of common stock | 42,876us-gaap_ProceedsFromIssuanceOfCommonStock | 28,697us-gaap_ProceedsFromIssuanceOfCommonStock | 28,810us-gaap_ProceedsFromIssuanceOfCommonStock |
Contribution from noncontrolling interests | 1,025us-gaap_ProceedsFromMinorityShareholders | ||
Repurchases of common stock | (488,429)us-gaap_PaymentsForRepurchaseOfCommonStock | (51,863)us-gaap_PaymentsForRepurchaseOfCommonStock | |
Net cash provided from (used in) financing activities | 97,754us-gaap_NetCashProvidedByUsedInFinancingActivitiesContinuingOperations | (132,051)us-gaap_NetCashProvidedByUsedInFinancingActivitiesContinuingOperations | 138,326us-gaap_NetCashProvidedByUsedInFinancingActivitiesContinuingOperations |
Net increase in cash and cash equivalents | 16,791us-gaap_CashAndCashEquivalentsPeriodIncreaseDecrease | 9,857us-gaap_CashAndCashEquivalentsPeriodIncreaseDecrease | 2,684us-gaap_CashAndCashEquivalentsPeriodIncreaseDecrease |
Cash and cash equivalents at beginning of year | 31,137us-gaap_CashAndCashEquivalentsAtCarryingValue | 21,280us-gaap_CashAndCashEquivalentsAtCarryingValue | 18,596us-gaap_CashAndCashEquivalentsAtCarryingValue |
Cash and cash equivalents at end of year | 47,928us-gaap_CashAndCashEquivalentsAtCarryingValue | 31,137us-gaap_CashAndCashEquivalentsAtCarryingValue | 21,280us-gaap_CashAndCashEquivalentsAtCarryingValue |
Supplemental disclosure of cash flow information: | |||
Interest | 7,323us-gaap_InterestPaidNet | 3,312us-gaap_InterestPaidNet | 2,044us-gaap_InterestPaidNet |
Income taxes | 161,841us-gaap_IncomeTaxesPaidNet | 126,411us-gaap_IncomeTaxesPaidNet | 129,636us-gaap_IncomeTaxesPaidNet |
Non-cash financing activities: | |||
Equipment financed through capital leases | $ 1,244us-gaap_CapitalLeaseObligationsIncurred |
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Payment of contingent consideration liability financing. No definition available.
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- Definition
Payment of contingent consideration liability operating. No definition available.
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- Definition
Amount of increase (decrease) in the value of a contingent consideration liability, including, but not limited to, differences arising upon settlement. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
The increase during the period in capital lease obligations due to entering into new capital leases. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
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. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
Amount of increase (decrease) in cash and cash equivalents. Cash and cash equivalents are the 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. Includes effect from exchange rate changes. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
Amount of deferred income tax expense (benefit) pertaining to income (loss) from continuing operations. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
The aggregate expense recognized in the current period that allocates the cost of tangible assets, intangible assets, or depleting assets to periods that benefit from use of the assets. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
Amount of cash inflow from realized tax benefit related to deductible compensation cost reported on the entity's tax return for equity instruments in excess of the compensation cost for those instruments recognized for financial reporting purposes. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
This item represents the entity's proportionate share for the period of the net income (loss) of its investee (such as unconsolidated subsidiaries and joint ventures) to which the equity method of accounting is applied. This item includes income or expense related to stock-based compensation based on the investor's grant of stock to employees of an equity method investee. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
The amount of cash paid during the current period to foreign, federal, state, and local authorities as taxes on income, net of any cash received during the current period as refunds for the overpayment of taxes. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
The increase (decrease) during the reporting period in the amounts payable to vendors for goods and services received and the amount of obligations and expenses incurred but not paid. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
The increase (decrease) during the reporting period in amount due within one year (or one business cycle) from customers for the credit sale of goods and services. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
The increase (decrease) during the period in the amount due for taxes based on the reporting entity's earnings or attributable to the entity's income earning process (business presence) within a given jurisdiction. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
The increase (decrease) during the reporting period in other assets used in operating activities not separately disclosed in the statement of cash flows. May include changes in other current assets, other noncurrent assets, or a combination of other current and noncurrent assets. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
The increase (decrease) during the reporting period in other liabilities used in operating activities not separately disclosed in the statement of cash flows. May include changes in other current liabilities, other noncurrent liabilities, or a combination of other current and noncurrent liabilities. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
The increase (decrease) during the reporting period in the value of prepaid expenses and other assets not separately disclosed in the statement of cash flows, for example, deferred expenses, intangible assets, or income taxes. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
The amount of cash paid for interest during the period net of cash paid for interest that is capitalized. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
The increase (decrease) in the accrued liability for malpractice claims during an accounting period. No definition available.
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- Definition
Amount of cash inflow (outflow) of financing activities, excluding discontinued operations. Financing activity cash flows include obtaining resources from owners and providing them with a return on, and a return of, their investment; borrowing money and repaying amounts borrowed, or settling the obligation; and obtaining and paying for other resources obtained from creditors on long-term credit. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
Amount of cash inflow (outflow) of investing activities, excluding discontinued operations. Investing activity cash flows include making and collecting loans and acquiring and disposing of debt or equity instruments and property, plant, and equipment and other productive assets. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
Amount of cash inflow (outflow) from operating activities, excluding discontinued operations. Operating activity cash flows include transactions, adjustments, and changes in value not defined as investing or financing activities. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
The cash outflow to reacquire common stock during the period. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
The cash outflow for loan and debt issuance costs. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
The cash outflow associated with the acquisition of a business, net of the cash acquired from the purchase. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
The cash outflow associated with the purchase of all investments (debt, security, other) during the period. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
The cash outflow for acquisition of or capital improvements of property, plant and equipment, used to produce goods or deliver services, and not otherwise defined in the taxonomy. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
The cash inflow from the additional capital contribution to the entity. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
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. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
Amount of cash inflow from a noncontrolling interest. Includes, but is not limited to, purchase of additional shares or other increase in noncontrolling interest ownership. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
The cash inflow associated with the sale, maturity and collection of all investments such as debt, security and so forth during the period. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
The consolidated profit or loss for the period, net of income taxes, including the portion attributable to the noncontrolling interest. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
Amount of cash outflow for payment of an obligation from a lender, including but not limited to, letter of credit, standby letter of credit and revolving credit arrangements. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
The cash outflow for the obligation for a lease meeting the criteria for capitalization (with maturities exceeding one year or beyond the operating cycle of the entity, if longer). Reference 1: http://www.xbrl.org/2003/role/presentationRef
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- Definition
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. Reference 1: http://www.xbrl.org/2003/role/presentationRef
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