CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018
Cash Flows from Operating Activities:
Net income	$ 65,613	$ 60,861
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	8,074	6,718
Non-cash compensation	12,153	7,811
401(k) employer match	4,686	4,894
Amortization and impairment of operating lease right of use assets	17,495	0
(Gain) loss on disposal of property and equipment	(2)	650
Deferred income taxes	5,875	9,145
Equity in earnings from equity method investments	(4,932)	(4,836)
Amortization of deferred debt issuance costs/debt discount	433	355
Write off of deferred debt issuance cost	0	38
Return on equity investment	842	2,204
Changes in operating assets and liabilities, net of impact of acquisitions:
Patient accounts receivable	(24,165)	3,604
Other current assets	(8,343)	(11,680)
Other assets	(56)	688
Accounts payable	(9,475)	3,623
Accrued expenses	29,262	4,548
Other long-term obligations	(181)	2,347
Operating lease liabilities	(16,200)	0
Operating lease right of use assets	(1,754)	0
Net cash provided by operating activities	79,325	90,970
Cash Flows from Investing Activities:
Proceeds from sale of deferred compensation plan assets	213	471
Proceeds from the sale of property and equipment	146	11
Investments in equity method investees	(210)	0
Purchases of property and equipment	(2,693)	(1,611)
Acquisitions of businesses, net of cash acquired	(345,414)	(4,074)
Net cash used in investing activities	(347,958)	(5,203)
Cash Flows from Financing Activities:
Proceeds from issuance of stock upon exercise of stock options	1,343	2,609
Proceeds from issuance of stock to employee stock purchase plan	1,534	1,157
Shares withheld upon stock vesting	(4,490)	(2,832)
Noncontrolling interest distribution	(457)	(350)
Proceeds from borrowings under term loan	175,000	0
Proceeds from borrowings under revolving line of credit	184,500	127,500
Repayments of borrowings under revolving line of credit	(92,000)	0
Principal payments of long-term obligations	(2,277)	(90,475)
Debt issuance costs	(847)	(2,433)
Purchase of company stock	0	(181,402)
Net cash provided by (used in) financing activities	262,306	(146,226)
Net decrease in cash and cash equivalents	(6,327)	(60,459)
Cash and cash equivalents at beginning of period	20,229	86,363
Cash and cash equivalents at end of period	13,902	25,904
Supplemental Disclosures of Cash Flow Information:
Cash paid for interest	4,187	2,080
Cash paid for income taxes, net of refunds received	$ 7,849	$ 6,149