Consolidated Statements Of Cash Flows (USD $) In Thousands, unless otherwise specified	12 Months Ended
	Dec. 31, 2011	Dec. 31, 2010	Dec. 31, 2009
Cash Flows from Operating Activities:
Net (loss) income	$ (382,342)	$ 113,273	$ 136,223
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	39,559	34,589	28,312
Provision for doubtful accounts	13,708	19,214	20,178
Non-cash compensation	8,292	10,634	7,848
401(k) employer match	7,550	22,762	19,083
Loss on disposal of property and equipment	2,440	3,236	822
Deferred income taxes	(121,949)	25,927	21,547
Equity in earnings from equity investments	(1,494)	(3,016)	(2,343)
Amortization of deferred debt issuance costs	1,576	1,576	1,576
Return on equity investment	1,638	1,765	980
Goodwill and other intangibles impairment charge	579,955
Changes in operating assets and liabilities, net of impact of acquisitions:
Patient accounts receivable	(6,526)	(10,494)	5,200
Other current assets	(2,033)	1,981	(14,996)
Other assets	(258)	(2,387)	2,327
Accounts payable	(1,521)	4,606	1,674
Accrued expenses	5,049	(17,813)	16,505
Other long-term obligations	(1,981)	420	2,723
Net cash provided by operating activities	141,663	206,273	247,659
Cash Flows from Investing Activities:
Proceeds from sale of deferred compensation plan assets	985	2,592	956
Proceeds from the sale of property and equipment		49	41
Purchases of deferred compensation plan assets	(545)	(1,089)	(3,107)
Purchases of property and equipment	(44,415)	(63,971)	(36,359)
Purchase of investment	(4,500)	(5,000)
Acquisitions of businesses, net of cash acquired	(132,235)	(3,821)	(53,572)
Acquisitions of reacquired franchise rights		(2,376)	(5,214)
Net cash (used in) investing activities	(180,710)	(73,616)	(97,255)
Cash Flows from Financing Activities:
Outstanding checks in excess of bank balance			(4,548)
Proceeds from issuance of stock upon exercise of stock options and warrants	245	1,501	3,772
Proceeds from issuance of stock to employee stock purchase plan	5,149	6,204	5,342
Tax benefit from stock option exercises	(453)	2,386	1,506
Non-controlling interest distribution	(700)	(304)
Proceeds from revolving line of credit			50,200
Repayments of revolving line of credit			(130,700)
Purchase of company stock		(11,796)
Principal payments of long-term obligations	(37,485)	(44,838)	(44,338)
Net cash (used in) financing activities	(33,244)	(46,847)	(118,766)
Net increase (decrease) in cash and cash equivalents	(72,291)	85,810	31,638
Cash and cash equivalents at beginning of period	120,295	34,485	2,847
Cash and cash equivalents at end of period	48,004	120,295	34,485
Supplemental Disclosures of Cash Flow Information:
Cash paid for interest	7,340	8,339	10,339
Cash paid for income taxes, net of refunds received	11,655	50,765	68,635
Supplemental Disclosures of Non-Cash Financing and Investing Activities:
Notes payable issued for/assumed in acquisitions	1,058	750	9,455
Notes payable issued for software licenses		$ 10,801	$ 1,463