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v2.4.1.9

Supplemental Condensed Consolidating Statements of Cash flows (Detail) (USD $) In Thousands, unless otherwise specified | 3 Months Ended
--- | ---
Mar. 31, 2015 | Mar. 31, 2014
Condensed Financial Statements, Captions [Line Items] |  |
Net cash provided by operating activities | $ 271,275 us-gaap_NetCashProvidedByUsedInOperatingActivities | $ 194,639 us-gaap_NetCashProvidedByUsedInOperatingActivities
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (89,276)us-gaap_PaymentsToAcquirePropertyPlantAndEquipment | (92,387)us-gaap_PaymentsToAcquirePropertyPlantAndEquipment
Proceeds received from sale of assets and businesses | 0 us-gaap_ProceedsFromSaleOfProductiveAssets | 11,450 us-gaap_ProceedsFromSaleOfProductiveAssets
Acquisition of property and businesses | (34,500)us-gaap_PaymentsToAcquireBusinessesNetOfCashAcquired | (3,301)us-gaap_PaymentsToAcquireBusinessesNetOfCashAcquired
Costs incurred for purchase and implementation of electronic health records application | 0 us-gaap_PaymentsToAcquireOtherProductiveAssets | (6,504)us-gaap_PaymentsToAcquireOtherProductiveAssets
Net cash used in investing activities | (123,776)us-gaap_NetCashProvidedByUsedInInvestingActivities | (90,742)us-gaap_NetCashProvidedByUsedInInvestingActivities
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (158,871)us-gaap_RepaymentsOfLongTermDebt | (109,054)us-gaap_RepaymentsOfLongTermDebt
Additional borrowings | 20,800 us-gaap_ProceedsFromLinesOfCredit | 11,900 us-gaap_ProceedsFromLinesOfCredit
Repurchase of common shares | (28,767)us-gaap_PaymentsForRepurchaseOfCommonStock | (13,993)us-gaap_PaymentsForRepurchaseOfCommonStock
Dividends paid | (9,899)us-gaap_PaymentsOfDividends | (4,933)us-gaap_PaymentsOfDividends
Issuance of common stock | 1,768 us-gaap_ProceedsFromIssuanceOfCommonStock | 1,445 us-gaap_ProceedsFromIssuanceOfCommonStock
Excess income tax benefits related to stock-based compensation | 20,807 us-gaap_ExcessTaxBenefitFromShareBasedCompensationFinancingActivities | 11,750 us-gaap_ExcessTaxBenefitFromShareBasedCompensationFinancingActivities
Profit distributions to noncontrolling interests | (2,413)us-gaap_PaymentsOfDividendsMinorityInterest | (1,989)us-gaap_PaymentsOfDividendsMinorityInterest
Proceeds received from sale/leaseback of real property | 12,551 us-gaap_SaleLeasebackTransactionGrossProceedsFinancingActivities | 0 us-gaap_SaleLeasebackTransactionGrossProceedsFinancingActivities
Changes in intercompany balances with affiliates, net | 0 us-gaap_ProceedsFromPaymentsForOtherFinancingActivities | 0 us-gaap_ProceedsFromPaymentsForOtherFinancingActivities
Net cash (used in) provided by financing activities | (144,024)us-gaap_NetCashProvidedByUsedInFinancingActivities | (104,874)us-gaap_NetCashProvidedByUsedInFinancingActivities
Effect of exchange rate changes on cash and cash equivalents | (466)us-gaap_EffectOfExchangeRateOnCashAndCashEquivalents | 0 us-gaap_EffectOfExchangeRateOnCashAndCashEquivalents
Decrease in cash and cash equivalents | 3,009 us-gaap_CashAndCashEquivalentsPeriodIncreaseDecrease | (977)us-gaap_CashAndCashEquivalentsPeriodIncreaseDecrease
Cash and cash equivalents, beginning of period | 32,069 us-gaap_CashAndCashEquivalentsAtCarryingValue | 17,238 us-gaap_CashAndCashEquivalentsAtCarryingValue
Cash and cash equivalents, end of period | 35,078 us-gaap_CashAndCashEquivalentsAtCarryingValue | 16,261 us-gaap_CashAndCashEquivalentsAtCarryingValue
Consolidating Adjustments |  |
Condensed Financial Statements, Captions [Line Items] |  |
Net cash provided by operating activities | 0 us-gaap_NetCashProvidedByUsedInOperatingActivities / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember | 0 us-gaap_NetCashProvidedByUsedInOperatingActivities / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | 0 us-gaap_PaymentsToAcquirePropertyPlantAndEquipment / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember | 0 us-gaap_PaymentsToAcquirePropertyPlantAndEquipment / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember
Proceeds received from sale of assets and businesses |  | 0 us-gaap_ProceedsFromSaleOfProductiveAssets / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember
Acquisition of property and businesses | 0 us-gaap_PaymentsToAcquireBusinessesNetOfCashAcquired / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember |
Costs incurred for purchase and implementation of electronic health records application |  | 0 us-gaap_PaymentsToAcquireOtherProductiveAssets / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember
Net cash used in investing activities | 0 us-gaap_NetCashProvidedByUsedInInvestingActivities / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember | 0 us-gaap_NetCashProvidedByUsedInInvestingActivities / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | 0 us-gaap_RepaymentsOfLongTermDebt / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember | 0 us-gaap_RepaymentsOfLongTermDebt / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember
Additional borrowings | 0 us-gaap_ProceedsFromLinesOfCredit / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember | 0 us-gaap_ProceedsFromLinesOfCredit / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember
Repurchase of common shares | 0 us-gaap_PaymentsForRepurchaseOfCommonStock / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember | 0 us-gaap_PaymentsForRepurchaseOfCommonStock / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember
Dividends paid | 0 us-gaap_PaymentsOfDividends / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember | 0 us-gaap_PaymentsOfDividends / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember
Issuance of common stock | 0 us-gaap_ProceedsFromIssuanceOfCommonStock / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember | 0 us-gaap_ProceedsFromIssuanceOfCommonStock / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember
Excess income tax benefits related to stock-based compensation | 0 us-gaap_ExcessTaxBenefitFromShareBasedCompensationFinancingActivities / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember | 0 us-gaap_ExcessTaxBenefitFromShareBasedCompensationFinancingActivities / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember
Profit distributions to noncontrolling interests | 0 us-gaap_PaymentsOfDividendsMinorityInterest / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember | 0 us-gaap_PaymentsOfDividendsMinorityInterest / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember
Proceeds received from sale/leaseback of real property | 0 us-gaap_SaleLeasebackTransactionGrossProceedsFinancingActivities / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember |
Changes in intercompany balances with affiliates, net | 0 us-gaap_ProceedsFromPaymentsForOtherFinancingActivities / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember | 0 us-gaap_ProceedsFromPaymentsForOtherFinancingActivities / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember
Net cash (used in) provided by financing activities | 0 us-gaap_NetCashProvidedByUsedInFinancingActivities / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember | 0 us-gaap_NetCashProvidedByUsedInFinancingActivities / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember
Effect of exchange rate changes on cash and cash equivalents | 0 us-gaap_EffectOfExchangeRateOnCashAndCashEquivalents / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember |
Decrease in cash and cash equivalents | 0 us-gaap_CashAndCashEquivalentsPeriodIncreaseDecrease / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember | 0 us-gaap_CashAndCashEquivalentsPeriodIncreaseDecrease / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember
Cash and cash equivalents, beginning of period | 0 us-gaap_CashAndCashEquivalentsAtCarryingValue / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember | 0 us-gaap_CashAndCashEquivalentsAtCarryingValue / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember
Cash and cash equivalents, end of period | 0 us-gaap_CashAndCashEquivalentsAtCarryingValue / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember | 0 us-gaap_CashAndCashEquivalentsAtCarryingValue / us-gaap_ConsolidationItemsAxis = us-gaap_ConsolidationEliminationsMember
Parent |  |
Condensed Financial Statements, Captions [Line Items] |  |
Net cash provided by operating activities | 62,343 us-gaap_NetCashProvidedByUsedInOperatingActivities / dei_LegalEntityAxis = us-gaap_ParentCompanyMember | 70,888 us-gaap_NetCashProvidedByUsedInOperatingActivities / dei_LegalEntityAxis = us-gaap_ParentCompanyMember
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | 0 us-gaap_PaymentsToAcquirePropertyPlantAndEquipment / dei_LegalEntityAxis = us-gaap_ParentCompanyMember | 0 us-gaap_PaymentsToAcquirePropertyPlantAndEquipment / dei_LegalEntityAxis = us-gaap_ParentCompanyMember
Proceeds received from sale of assets and businesses |  | 0 us-gaap_ProceedsFromSaleOfProductiveAssets / dei_LegalEntityAxis = us-gaap_ParentCompanyMember
Acquisition of property and businesses | 0 us-gaap_PaymentsToAcquireBusinessesNetOfCashAcquired / dei_LegalEntityAxis = us-gaap_ParentCompanyMember | 0 us-gaap_PaymentsToAcquireBusinessesNetOfCashAcquired / dei_LegalEntityAxis = us-gaap_ParentCompanyMember
Costs incurred for purchase and implementation of electronic health records application |  | 0 us-gaap_PaymentsToAcquireOtherProductiveAssets / dei_LegalEntityAxis = us-gaap_ParentCompanyMember
Net cash used in investing activities | 0 us-gaap_NetCashProvidedByUsedInInvestingActivities / dei_LegalEntityAxis = us-gaap_ParentCompanyMember | 0 us-gaap_NetCashProvidedByUsedInInvestingActivities / dei_LegalEntityAxis = us-gaap_ParentCompanyMember
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (156,097)us-gaap_RepaymentsOfLongTermDebt / dei_LegalEntityAxis = us-gaap_ParentCompanyMember | (97,975)us-gaap_RepaymentsOfLongTermDebt / dei_LegalEntityAxis = us-gaap_ParentCompanyMember
Additional borrowings | 20,800 us-gaap_ProceedsFromLinesOfCredit / dei_LegalEntityAxis = us-gaap_ParentCompanyMember | 11,900 us-gaap_ProceedsFromLinesOfCredit / dei_LegalEntityAxis = us-gaap_ParentCompanyMember
Repurchase of common shares | (28,767)us-gaap_PaymentsForRepurchaseOfCommonStock / dei_LegalEntityAxis = us-gaap_ParentCompanyMember | (13,993)us-gaap_PaymentsForRepurchaseOfCommonStock / dei_LegalEntityAxis = us-gaap_ParentCompanyMember
Dividends paid | (9,899)us-gaap_PaymentsOfDividends / dei_LegalEntityAxis = us-gaap_ParentCompanyMember | (4,933)us-gaap_PaymentsOfDividends / dei_LegalEntityAxis = us-gaap_ParentCompanyMember
Issuance of common stock | 1,768 us-gaap_ProceedsFromIssuanceOfCommonStock / dei_LegalEntityAxis = us-gaap_ParentCompanyMember | 1,445 us-gaap_ProceedsFromIssuanceOfCommonStock / dei_LegalEntityAxis = us-gaap_ParentCompanyMember
Excess income tax benefits related to stock-based compensation | 20,807 us-gaap_ExcessTaxBenefitFromShareBasedCompensationFinancingActivities / dei_LegalEntityAxis = us-gaap_ParentCompanyMember | 11,750 us-gaap_ExcessTaxBenefitFromShareBasedCompensationFinancingActivities / dei_LegalEntityAxis = us-gaap_ParentCompanyMember
Profit distributions to noncontrolling interests | 0 us-gaap_PaymentsOfDividendsMinorityInterest / dei_LegalEntityAxis = us-gaap_ParentCompanyMember | 0 us-gaap_PaymentsOfDividendsMinorityInterest / dei_LegalEntityAxis = us-gaap_ParentCompanyMember
Proceeds received from sale/leaseback of real property | 0 us-gaap_SaleLeasebackTransactionGrossProceedsFinancingActivities / dei_LegalEntityAxis = us-gaap_ParentCompanyMember |
Changes in intercompany balances with affiliates, net | 89,045 us-gaap_ProceedsFromPaymentsForOtherFinancingActivities / dei_LegalEntityAxis = us-gaap_ParentCompanyMember | 20,918 us-gaap_ProceedsFromPaymentsForOtherFinancingActivities / dei_LegalEntityAxis = us-gaap_ParentCompanyMember
Net cash (used in) provided by financing activities | (62,343)us-gaap_NetCashProvidedByUsedInFinancingActivities / dei_LegalEntityAxis = us-gaap_ParentCompanyMember | (70,888)us-gaap_NetCashProvidedByUsedInFinancingActivities / dei_LegalEntityAxis = us-gaap_ParentCompanyMember
Effect of exchange rate changes on cash and cash equivalents | 0 us-gaap_EffectOfExchangeRateOnCashAndCashEquivalents / dei_LegalEntityAxis = us-gaap_ParentCompanyMember |
Decrease in cash and cash equivalents | 0 us-gaap_CashAndCashEquivalentsPeriodIncreaseDecrease / dei_LegalEntityAxis = us-gaap_ParentCompanyMember | 0 us-gaap_CashAndCashEquivalentsPeriodIncreaseDecrease / dei_LegalEntityAxis = us-gaap_ParentCompanyMember
Cash and cash equivalents, beginning of period | 0 us-gaap_CashAndCashEquivalentsAtCarryingValue / dei_LegalEntityAxis = us-gaap_ParentCompanyMember | 0 us-gaap_CashAndCashEquivalentsAtCarryingValue / dei_LegalEntityAxis = us-gaap_ParentCompanyMember
Cash and cash equivalents, end of period | 0 us-gaap_CashAndCashEquivalentsAtCarryingValue / dei_LegalEntityAxis = us-gaap_ParentCompanyMember | 0 us-gaap_CashAndCashEquivalentsAtCarryingValue / dei_LegalEntityAxis = us-gaap_ParentCompanyMember
Guarantors |  |
Condensed Financial Statements, Captions [Line Items] |  |
Net cash provided by operating activities | 124,046 us-gaap_NetCashProvidedByUsedInOperatingActivities / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember | 51,661 us-gaap_NetCashProvidedByUsedInOperatingActivities / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (59,217)us-gaap_PaymentsToAcquirePropertyPlantAndEquipment / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember | (70,385)us-gaap_PaymentsToAcquirePropertyPlantAndEquipment / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember
Proceeds received from sale of assets and businesses |  | 11,450 us-gaap_ProceedsFromSaleOfProductiveAssets / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember
Acquisition of property and businesses | (22,513)us-gaap_PaymentsToAcquireBusinessesNetOfCashAcquired / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember | 0 us-gaap_PaymentsToAcquireBusinessesNetOfCashAcquired / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember
Costs incurred for purchase and implementation of electronic health records application |  | (6,504)us-gaap_PaymentsToAcquireOtherProductiveAssets / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember
Net cash used in investing activities | (81,730)us-gaap_NetCashProvidedByUsedInInvestingActivities / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember | (65,439)us-gaap_NetCashProvidedByUsedInInvestingActivities / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (2,561)us-gaap_RepaymentsOfLongTermDebt / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember | (228)us-gaap_RepaymentsOfLongTermDebt / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember
Additional borrowings | 0 us-gaap_ProceedsFromLinesOfCredit / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember | 0 us-gaap_ProceedsFromLinesOfCredit / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember
Repurchase of common shares | 0 us-gaap_PaymentsForRepurchaseOfCommonStock / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember | 0 us-gaap_PaymentsForRepurchaseOfCommonStock / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember
Dividends paid | 0 us-gaap_PaymentsOfDividends / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember | 0 us-gaap_PaymentsOfDividends / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember
Issuance of common stock | 0 us-gaap_ProceedsFromIssuanceOfCommonStock / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember | 0 us-gaap_ProceedsFromIssuanceOfCommonStock / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember
Excess income tax benefits related to stock-based compensation | 0 us-gaap_ExcessTaxBenefitFromShareBasedCompensationFinancingActivities / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember | 0 us-gaap_ExcessTaxBenefitFromShareBasedCompensationFinancingActivities / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember
Profit distributions to noncontrolling interests | 0 us-gaap_PaymentsOfDividendsMinorityInterest / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember | 0 us-gaap_PaymentsOfDividendsMinorityInterest / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember
Proceeds received from sale/leaseback of real property | 0 us-gaap_SaleLeasebackTransactionGrossProceedsFinancingActivities / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember |
Changes in intercompany balances with affiliates, net | (45,555)us-gaap_ProceedsFromPaymentsForOtherFinancingActivities / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember | 13,735 us-gaap_ProceedsFromPaymentsForOtherFinancingActivities / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember
Net cash (used in) provided by financing activities | (48,116)us-gaap_NetCashProvidedByUsedInFinancingActivities / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember | 13,507 us-gaap_NetCashProvidedByUsedInFinancingActivities / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember
Effect of exchange rate changes on cash and cash equivalents | (466)us-gaap_EffectOfExchangeRateOnCashAndCashEquivalents / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember |
Decrease in cash and cash equivalents | (6,266)us-gaap_CashAndCashEquivalentsPeriodIncreaseDecrease / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember | (271)us-gaap_CashAndCashEquivalentsPeriodIncreaseDecrease / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember
Cash and cash equivalents, beginning of period | 21,784 us-gaap_CashAndCashEquivalentsAtCarryingValue / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember | 7,990 us-gaap_CashAndCashEquivalentsAtCarryingValue / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember
Cash and cash equivalents, end of period | 15,518 us-gaap_CashAndCashEquivalentsAtCarryingValue / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember | 7,719 us-gaap_CashAndCashEquivalentsAtCarryingValue / dei_LegalEntityAxis = us-gaap_GuarantorSubsidiariesMember
Non Guarantors |  |
Condensed Financial Statements, Captions [Line Items] |  |
Net cash provided by operating activities | 84,886 us-gaap_NetCashProvidedByUsedInOperatingActivities / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember | 72,090 us-gaap_NetCashProvidedByUsedInOperatingActivities / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (30,059)us-gaap_PaymentsToAcquirePropertyPlantAndEquipment / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember | (22,002)us-gaap_PaymentsToAcquirePropertyPlantAndEquipment / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember
Proceeds received from sale of assets and businesses |  | 0 us-gaap_ProceedsFromSaleOfProductiveAssets / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember
Acquisition of property and businesses | (11,987)us-gaap_PaymentsToAcquireBusinessesNetOfCashAcquired / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember | (3,301)us-gaap_PaymentsToAcquireBusinessesNetOfCashAcquired / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember
Costs incurred for purchase and implementation of electronic health records application |  | 0 us-gaap_PaymentsToAcquireOtherProductiveAssets / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember
Net cash used in investing activities | (42,046)us-gaap_NetCashProvidedByUsedInInvestingActivities / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember | (25,303)us-gaap_NetCashProvidedByUsedInInvestingActivities / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (213)us-gaap_RepaymentsOfLongTermDebt / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember | (10,851)us-gaap_RepaymentsOfLongTermDebt / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember
Additional borrowings | 0 us-gaap_ProceedsFromLinesOfCredit / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember | 0 us-gaap_ProceedsFromLinesOfCredit / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember
Repurchase of common shares | 0 us-gaap_PaymentsForRepurchaseOfCommonStock / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember | 0 us-gaap_PaymentsForRepurchaseOfCommonStock / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember
Dividends paid | 0 us-gaap_PaymentsOfDividends / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember | 0 us-gaap_PaymentsOfDividends / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember
Issuance of common stock | 0 us-gaap_ProceedsFromIssuanceOfCommonStock / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember | 0 us-gaap_ProceedsFromIssuanceOfCommonStock / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember
Excess income tax benefits related to stock-based compensation | 0 us-gaap_ExcessTaxBenefitFromShareBasedCompensationFinancingActivities / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember | 0 us-gaap_ExcessTaxBenefitFromShareBasedCompensationFinancingActivities / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember
Profit distributions to noncontrolling interests | (2,413)us-gaap_PaymentsOfDividendsMinorityInterest / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember | (1,989)us-gaap_PaymentsOfDividendsMinorityInterest / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember
Proceeds received from sale/leaseback of real property | 12,551 us-gaap_SaleLeasebackTransactionGrossProceedsFinancingActivities / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember |
Changes in intercompany balances with affiliates, net | (43,490)us-gaap_ProceedsFromPaymentsForOtherFinancingActivities / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember | (34,653)us-gaap_ProceedsFromPaymentsForOtherFinancingActivities / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember
Net cash (used in) provided by financing activities | (33,565)us-gaap_NetCashProvidedByUsedInFinancingActivities / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember | (47,493)us-gaap_NetCashProvidedByUsedInFinancingActivities / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember
Effect of exchange rate changes on cash and cash equivalents | 0 us-gaap_EffectOfExchangeRateOnCashAndCashEquivalents / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember |
Decrease in cash and cash equivalents | 9,275 us-gaap_CashAndCashEquivalentsPeriodIncreaseDecrease / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember | (706)us-gaap_CashAndCashEquivalentsPeriodIncreaseDecrease / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember
Cash and cash equivalents, beginning of period | 10,285 us-gaap_CashAndCashEquivalentsAtCarryingValue / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember | 9,248 us-gaap_CashAndCashEquivalentsAtCarryingValue / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember
Cash and cash equivalents, end of period | $ 19,560 us-gaap_CashAndCashEquivalentsAtCarryingValue / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember | $ 8,542 us-gaap_CashAndCashEquivalentsAtCarryingValue / dei_LegalEntityAxis = us-gaap_NonGuarantorSubsidiariesMember

X
- Definition Amount of currency on hand as well as demand deposits with banks or financial institutions. Includes other kinds of accounts that have the general characteristics of demand deposits. Also includes short-term, highly liquid investments that are both readily convertible to known amounts of cash and so near their maturity that they present insignificant risk of changes in value because of changes in interest rates. Excludes cash and cash equivalents within disposal group and discontinued operation. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Cash -URI http://asc.fasb.org/extlink&oid=6506951 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Cash Equivalents -URI http://asc.fasb.org/extlink&oid=6507016 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher SEC -Name Regulation S-X (SX) -Number 210 -Section 02 -Paragraph 1 -Article 5 Reference 4: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 210 -SubTopic 10 -Section S99 -Paragraph 1 -Subparagraph (SX 210.5-02.1) -URI http://asc.fasb.org/extlink&oid=6877327&loc=d3e13212-122682 Reference 5: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 210 -SubTopic 10 -Section 45 -Paragraph 1 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=28358313&loc=d3e6676-107765 Reference 6: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 4 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3044-108585 + Details
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- Definition Amount of increase (decrease) in cash and cash equivalents. Cash and cash equivalents are the amount of currency on hand as well as demand deposits with banks or financial institutions. Includes other kinds of accounts that have the general characteristics of demand deposits. Also includes short-term, highly liquid investments that are both readily convertible to known amounts of cash and so near their maturity that they present insignificant risk of changes in value because of changes in interest rates. Includes effect from exchange rate changes. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3521-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 830 -SubTopic 230 -Section 45 -Paragraph 1 -URI http://asc.fasb.org/extlink&oid=6450594&loc=d3e33268-110906 + Details
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- Definition Amount of increase (decrease) from the effect of exchange rate changes on cash and cash equivalent balances held in foreign currencies. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 830 -SubTopic 230 -Section 45 -Paragraph 1 -URI http://asc.fasb.org/extlink&oid=6450594&loc=d3e33268-110906 + Details
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- Definition Amount of cash inflow from realized tax benefit related to deductible compensation cost reported on the entity's tax return for equity instruments in excess of the compensation cost for those instruments recognized for financial reporting purposes. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 718 -SubTopic 20 -Section 55 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=32706628&loc=d3e11374-113907 + Details
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- Definition Amount of cash inflow (outflow) from financing activities, including discontinued operations. Financing activity cash flows include obtaining resources from owners and providing them with a return on, and a return of, their investment; borrowing money and repaying amounts borrowed, or settling the obligation; and obtaining and paying for other resources obtained from creditors on long-term credit. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3521-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 26 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3574-108585 + Details
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- Definition Amount of cash inflow (outflow) from investing activities, including discontinued operations. Investing activity cash flows include making and collecting loans and acquiring and disposing of debt or equity instruments and property, plant, and equipment and other productive assets. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3521-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 26 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3574-108585 + Details
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- Definition Amount of cash inflow (outflow) from operating activities, including discontinued operations. Operating activity cash flows include transactions, adjustments, and changes in value not defined as investing or financing activities. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 28 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3602-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3521-108585 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 25 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3536-108585 + Details
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- Definition The cash outflow to reacquire common stock during the period. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Financing Activities -URI http://asc.fasb.org/extlink&oid=6513228 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3291-108585 + Details
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- Definition Cash outflow in the form of capital distributions and dividends to common shareholders, preferred shareholders and noncontrolling interests. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Financing Activities -URI http://asc.fasb.org/extlink&oid=6513228 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3291-108585 + Details
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- Definition Amount of cash outflow in the form of ordinary dividends provided by the non-wholly owned subsidiary to noncontrolling interests. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Financing Activities -URI http://asc.fasb.org/extlink&oid=6513228 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3291-108585 + Details
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- Definition The cash outflow associated with the acquisition of a business, net of the cash acquired from the purchase. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Investing Activities -URI http://asc.fasb.org/extlink&oid=6516133 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 13 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3213-108585 + Details
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- Definition The cash outflow for acquisition of or capital improvements on other tangible or intangible assets not otherwise defined in the taxonomy. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Investing Activities -URI http://asc.fasb.org/extlink&oid=6516133 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 13 -Subparagraph (c) -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3213-108585 + Details
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- Definition The cash outflow associated with the acquisition of long-lived, physical assets that are used in the normal conduct of business to produce goods and services and not intended for resale; includes cash outflows to pay for construction of self-constructed assets. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Investing Activities -URI http://asc.fasb.org/extlink&oid=6516133 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 13 -Subparagraph (c) -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3213-108585 + Details
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- Definition The cash inflow from the additional capital contribution to the entity. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Financing Activities -URI http://asc.fasb.org/extlink&oid=6513228 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 14 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3255-108585 + Details
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- Definition Amount of cash inflow from contractual arrangement with the lender, including but not limited to, letter of credit, standby letter of credit and revolving credit arrangements. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 235 -SubTopic 10 -Section S99 -Paragraph 1 -Subparagraph (SX 210.4-08.(f)) -URI http://asc.fasb.org/extlink&oid=26873400&loc=d3e23780-122690 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher SEC -Name Regulation S-X (SX) -Number 210 -Section 08 -Paragraph f -Article 4 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Financing Activities -URI http://asc.fasb.org/extlink&oid=6513228 Reference 4: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 14 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3255-108585 + Details
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