CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Cash Flows from Operating Activities:
Net income	$ 31,573	$ 27,320
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	2,895	3,593
Non-cash compensation	6,615	4,044
401(k) employer match	2,379	2,567
Amortization and impairment of operating lease right of use assets	8,345	0
(Gain) loss on disposal of property and equipment	(4)	563
Deferred income taxes	3,269	2,945
Equity in earnings from equity method investments	(1,216)	(1,860)
Amortization of deferred debt issuance costs/debt discount	213	178
Return on equity investment	725	625
Changes in operating assets and liabilities, net of impact of acquisitions:
Patient accounts receivable	(22,333)	8,260
Other current assets	(10,635)	(6,982)
Other assets	(338)	46
Accounts payable	(11,140)	(1,523)
Accrued expenses	18,838	(1,807)
Other long-term obligations	(144)	2,348
Operating lease liabilities	(8,139)	0
Operating lease right of use assets	(844)	0
Net cash provided by operating activities	20,059	40,317
Cash Flows from Investing Activities:
Proceeds from sale of deferred compensation plan assets	208	462
Proceeds from the sale of property and equipment	65	5
Investments in equity method investees	(120)	0
Purchases of property and equipment	(1,198)	(1,462)
Acquisitions of businesses, net of cash acquired	(327,867)	(2,250)
Net cash used in investing activities	(328,912)	(3,245)
Cash Flows from Financing Activities:
Proceeds from issuance of stock upon exercise of stock options	356	125
Proceeds from issuance of stock to employee stock purchase plan	782	597
Shares withheld upon stock vesting	(2,688)	(1,305)
Noncontrolling interest distribution	(366)	(28)
Proceeds from borrowings under term loan	175,000	0
Proceeds from borrowings under revolving line of credit	161,500	0
Repayments of borrowings under revolving line of credit	(34,000)	0
Principal payments of long-term obligations	(559)	(2,819)
Debt issuance costs	(847)	0
Net cash provided by (used in) financing activities	299,178	(3,430)
Net (decrease) increase in cash and cash equivalents	(9,675)	33,642
Cash and cash equivalents at beginning of period	20,229	86,363
Cash and cash equivalents at end of period	10,554	120,005
Supplemental Disclosures of Cash Flow Information:
Cash paid for interest	725	1,065
Cash paid for income taxes, net of refunds received	$ 404	$ 2,813