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Consolidated Statements of Cash Flows - USD ($)
 12 Months Ended
Dec. 31, 2019
Dec. 31, 2018
Dec. 31, 2017
Cash flows from operating activities:      
Net income $ 445,800,000 $ 375,400,000 $ 350,200,000
Loss (income) from discontinued operations, net of tax 600,000 (1,100,000) 400,000
Adjustments to reconcile net income to net cash provided by operating activities—      
Provision for government, class action, and related settlements 0 52,000,000.0 0
Depreciation and amortization 218,700,000 199,700,000 183,800,000
Amortization of debt-related items 4,500,000 4,000,000.0 8,700,000
Loss on early extinguishment of debt 7,700,000 0 10,700,000
Equity in net income of nonconsolidated affiliates (6,700,000) (8,700,000) (8,000,000.0)
Distributions from nonconsolidated affiliates 6,600,000 8,300,000 8,600,000
Stock-based compensation 114,400,000 85,900,000 47,700,000
Deferred tax expense (benefit) 40,000,000.0 (9,100,000) 60,800,000
Gain on consolidation of Yuma Rehabilitation Hospital (19,200,000) 0 0
Other, net 7,400,000 9,200,000 3,400,000
Changes in assets and liabilities, net of acquisitions —      
Accounts receivable (22,900,000) 7,000,000.0 (31,500,000)
Prepaid expenses and other assets (35,400,000) 11,500,000 (12,600,000)
Accounts payable (6,100,000) 6,600,000 7,500,000
Accrued payroll 13,200,000 14,800,000 24,400,000
Other liabilities (128,900,000) 6,100,000 4,800,000
Net cash (used in) provided by operating activities of discontinued operations (4,400,000) 800,000 (600,000)
Total adjustments 188,900,000 388,100,000 307,700,000
Net cash provided by operating activities 635,300,000 762,400,000 658,300,000
Cash flows from investing activities:      
Acquisition of businesses, net of cash acquired (231,500,000) (143,900,000) (38,800,000)
Purchases of property and equipment (372,400,000) (254,500,000) (225,800,000)
Additions to capitalized software costs (13,000,000.0) (16,000,000.0) (19,200,000)
Purchases of intangible assets (18,700,000) (5,700,000) (3,700,000)
Proceeds from sale of restricted investments 17,600,000 11,600,000 4,200,000
Purchases of restricted investments (32,900,000) (13,300,000) (8,500,000)
Other, net (6,500,000) (2,700,000) 8,800,000
Net cash used in investing activities (657,400,000) (424,500,000) (283,000,000.0)
Cash flows from financing activities:      
Proceeds from bond issuance 1,000,000,000.0 0 0
Principal payments on debt, including pre-payments (519,500,000) (20,600,000) (129,900,000)
Borrowings on revolving credit facility 635,000,000.0 325,000,000.0 273,300,000
Payments on revolving credit facility (620,000,000.0) (390,000,000.0) (330,300,000)
Principal payments under finance lease obligations (19,500,000) (17,900,000) (15,300,000)
Debt amendment and issuance costs (21,500,000) (100,000) (4,100,000)
Repurchases of common stock, including fees and expenses (45,900,000) 0 (38,100,000)
Dividends paid on common stock (108,700,000) (100,800,000) (91,500,000)
Purchase of equity interests in consolidated affiliates (162,900,000) (65,100,000) 0
Proceeds from exercising stock warrants 0 0 26,600,000
Distributions paid to noncontrolling interests of consolidated affiliates (79,800,000) (75,400,000) (51,900,000)
Taxes paid on behalf of employees for shares withheld (16,600,000) (8,300,000) (19,800,000)
Contributions from consolidated affiliates 15,900,000 12,600,000 20,800,000
Other, net (8,300,000) 19,400,000 300,000
Net cash provided by (used in) financing activities 48,200,000 (321,200,000) (359,900,000)
Increase in cash, cash equivalents, and restricted cash 26,100,000 16,700,000 15,400,000
Cash, cash equivalents, restricted cash and restricted cash equivalents at beginning of period 133,500,000 116,800,000 101,400,000
Cash, cash equivalents, restricted cash and restricted cash equivalents at end of period 159,600,000 133,500,000 116,800,000
Reconciliation of Cash, Cash Equivalents, and Restricted Cash      
Cash and cash equivalents at beginning of period 69,200,000 54,400,000 40,500,000
Restricted cash at beginning of period 59,000,000.0 62,400,000 60,900,000
Restricted cash included in other long-term assets at beginning of period 5,300,000 0 0
Cash, cash equivalents, restricted cash and restricted cash equivalents at beginning of period 133,500,000 116,800,000 101,400,000
Cash and cash equivalents at end of period 94,800,000 69,200,000 54,400,000
Restricted cash at end of period 57,400,000 59,000,000.0 62,400,000
Restricted cash included in other long-term assets at end of period 7,400,000 5,300,000 0
Cash, cash equivalents, restricted cash and restricted cash equivalents at end of period 159,600,000 133,500,000 116,800,000
Supplemental cash flow information:      
Interest (155,700,000) (149,600,000) (150,500,000)
Income tax refunds 100,000 600,000 1,900,000
Income tax payments (104,200,000) (115,400,000) (96,400,000)
Supplemental schedule of noncash financing activities:      
Conversion of convertible debt $ 0 $ 0 $ 319,400,000