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Held for Sale and Discontinued Operations Additional Information (Details) $ in Thousands |  | 3 Months Ended | 9 Months Ended | 12 Months Ended
--- | --- | --- | --- | ---
Jun. 01, 2018 USD ($) | Sep. 30, 2018 USD ($) | Sep. 30, 2017 USD ($) | Sep. 30, 2018 USD ($) clinic | Sep. 30, 2017 USD ($) | Dec. 31, 2017 USD ($)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Payments to Acquire Businesses, Gross |  |  |  | $ 113,526 | $ 726,538 |
Goodwill impairment charges |  | $ 0 | $ 0 | 3,106 | 34,696 | $ 36,196
Series of Individually Immaterial Business Acquisitions [Member] |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Payments to Acquire Businesses, Gross |  |  |  | $ 110,671 |  |
DMG held for sale | Series of Individually Immaterial Business Acquisitions [Member] |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Number of businesses acquired | clinic |  |  |  | 3 |  |
Payments to Acquire Businesses, Gross |  |  |  | $ 2,854 |  |
Business Combination, Consideration Transferred, Other |  |  |  | 275 |  |
Discontinued Operations, Held-for-sale | DMG held for sale |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Valuation Charge To Record Valuation Allowance And Related Tax Expense for Disposal Group |  | 216,147 |  |  |  |
Valuation Adjustment on Disposal Group |  | 98,201 | 0 | 98,201 | 0 |
Tax Expense Related To Valuation Adjustment for Disposal Group |  | 117,946 |  |  |  |
Goodwill impairment charges |  | $ 0 | $ 601,040 | $ 0 | $ 651,659 |
Tandigm Health |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Sale of Stock, Percentage of Ownership before Transaction | 19.00% |  |  |  |  |
Gain (Loss) on Disposition of Business, Net of Tax | $ 18,636 |  |  |  |  |

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