CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018
Cash Flows from Operating Activities:
Net income	$ 99,938	$ 92,409
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	12,440	9,882
Non-cash compensation	18,451	12,653
401(k) employer match	7,545	6,934
Amortization and impairment of operating lease right of use assets	27,014	0
Loss on disposal of property and equipment	6	738
Deferred income taxes	17,798	14,916
Equity in earnings from equity method investments	(4,120)	(6,461)
Amortization of deferred debt issuance costs/debt discount	653	596
Return on equity investment	3,727	4,373
Changes in operating assets and liabilities, net of impact of acquisitions:
Patient accounts receivable	(39,469)	6,166
Other current assets	(10,194)	(32)
Other assets	202	726
Accounts payable	(8,145)	(670)
Accrued expenses	27,903	14,758
Other long-term obligations	(231)	2,462
Operating lease liabilities	(24,116)	0
Operating lease right of use assets	(2,622)	0
Net cash provided by operating activities	126,780	159,450
Cash Flows from Investing Activities:
Proceeds from sale of deferred compensation plan assets	287	563
Proceeds from the sale of property and equipment	158	51
Investments in equity method investees	(210)	(3,477)
Purchases of property and equipment	(6,337)	(5,684)
Acquisitions of businesses, net of cash acquired	(345,460)	(4,074)
Net cash used in investing activities	(351,562)	(12,621)
Cash Flows from Financing Activities:
Proceeds from issuance of stock upon exercise of stock options	3,388	2,749
Proceeds from issuance of stock to employee stock purchase plan	2,384	1,787
Shares withheld upon stock vesting	(9,385)	(5,421)
Noncontrolling interest distribution	(910)	(530)
Proceeds from borrowings under term loan	175,000	0
Proceeds from borrowings under revolving line of credit	192,500	127,500
Repayments of borrowings under revolving line of credit	(133,000)	(70,000)
Principal payments of long-term obligations	(3,820)	(91,071)
Debt issuance costs	(847)	(2,433)
Purchase of company stock	0	(181,402)
Repurchase of noncontrolling interest	0	(361)
Net cash provided by (used in) financing activities	225,310	(219,182)
Net increase (decrease) in cash and cash equivalents	528	(72,353)
Cash and cash equivalents at beginning of period	20,229	86,363
Cash and cash equivalents at end of period	20,757	14,010
Supplemental Disclosures of Cash Flow Information:
Cash paid for interest	7,756	2,989
Cash paid for income taxes, net of refunds received	$ 17,656	$ 11,017