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Revenue Recognition Revenue Recognition (Detail) - USD ($)
$ in Thousands
3 Months Ended 6 Months Ended
Jun. 30, 2018
Jun. 30, 2017
Jun. 30, 2018
Jun. 30, 2017
Dec. 31, 2017
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]          
Allowance for Doubtful Accounts Receivable $ 110,962   $ 110,962   $ 218,399
Provision for uncollectible accounts 49,406 $ 109,600 23,861 $ 216,658  
Difference between Revenue Guidance in Effect before and after Topic 606 [Member]          
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]          
Contract with Customer, Performance Obligation Satisfied in Previous Period 8,817   76,227    
Change in Accounting Principle Topic 606, Effect of Adoption, Quantification $ 12,000   $ 36,000    
Medicare          
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]          
Percent of revenue paid by a payor 80.00%