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Revenue Recognition Revenue Recognition (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended |
--- | --- | --- | ---
Sep. 30, 2018 | Sep. 30, 2017 | Sep. 30, 2018 | Sep. 30, 2017 | Dec. 31, 2017
Revenue, Initial Application Period Cumulative Effect Transition [Line Items] |  |  |  |  |
Allowance for Doubtful Accounts Receivable | $ 71,108 |  | $ 71,108 |  | $ 218,399
Provision for uncollectible accounts | 11,977 | $ 119,321 | 35,838 | $ 335,979 |
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 | $ 1,246 |  | 77,473 |  |
Change in Accounting Principle Topic 606, Effect of Adoption, Quantification |  |  | $ 36,000 |  |
Medicare |  |  |  |  |
Revenue, Initial Application Period Cumulative Effect Transition [Line Items] |  |  |  |  |
Percent of revenue paid by a payor | 80.00% |  |  |  |

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