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Long-term debt (Detail) - USD ($) $ in Thousands |  |  |  | 3 Months Ended | 9 Months Ended |
--- | --- | --- | --- | --- | --- | ---
Aug. 13, 2024 | Aug. 07, 2024 | May 09, 2024 | Sep. 30, 2024 | Jun. 30, 2024 | Sep. 30, 2024 | Dec. 31, 2023
Debt Instrument [Line Items] |  |  |  |  |  |  |
Total debt principal outstanding |  |  |  | $ 9,623,754 |  | $ 9,623,754 | $ 8,445,980
Discount Premium And Deferred Financing Costs |  |  |  | (67,168) |  | (67,168) | (54,347)
Carrying amount of long-term debt, net of unamortized discounts |  |  |  | 9,556,586 |  | 9,556,586 | 8,391,633
Less current portion |  |  |  | (296,255) |  | (296,255) | (123,299)
Total long-term debt |  |  |  | $ 9,260,331 |  | $ 9,260,331 | 8,268,334
Debt interest rate during period |  |  |  | 5.69% |  | 4.84% |
Long-term debt, weighted average interest rate, at point in time |  |  |  | 5.71% |  | 5.71% |
Revolving line of credit |  |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |  |
Secured Debt |  |  |  | $ 0 |  | $ 0 | 0
Revolving line of credit, fair value of amount outstanding |  |  |  | 0 |  | $ 0 |
Debt Instrument, Maturity Date |  |  |  |  |  | Apr. 28, 2028 |
SOFR | Revolving line of credit |  |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |  |
Debt Instrument, Description of Variable Rate Basis |  |  |  |  |  | Base + 1.75% |
4.625% Senior Notes |  |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |  |
Senior Notes |  |  |  | 2,750,000 |  | $ 2,750,000 | 2,750,000
Debt Instrument, Fair Value Disclosure |  |  |  | 2,622,813 |  | $ 2,622,813 |
Debt interest rate during period |  |  |  |  |  | 4.625% |
Debt Instrument, Maturity Date |  |  |  |  |  | Jun. 01, 2030 |
3.75% Senior Notes |  |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |  |
Senior Notes |  |  |  | 1,500,000 |  | $ 1,500,000 | 1,500,000
Debt Instrument, Fair Value Disclosure |  |  |  | 1,350,000 |  | $ 1,350,000 |
Debt interest rate during period |  |  |  |  |  | 3.75% |
Debt Instrument, Maturity Date |  |  |  |  |  | Feb. 15, 2031 |
6.875% Senior Notes |  |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |  |
Senior Notes | $ 1,000,000 |  |  | 1,000,000 |  | $ 1,000,000 |
Debt Instrument, Fair Value Disclosure |  |  |  | $ 1,035,000 |  | $ 1,035,000 |
Debt interest rate during period | 6.875% |  |  | 6.875% |  |  |
Debt Instrument, Payment Terms | The 6.875% Senior Notes pay interest on March 1 and September 1 of each year beginning March 1, 2025 and mature on September 1, 2032 |  |  |  |  |  |
Debt Instrument, Date of First Required Payment | Mar. 01, 2025 |  |  |  |  |  |
Debt Instrument, Maturity Date |  |  |  |  |  | Sep. 01, 2032 |
Debt Instrument, Redemption, Description | The Company may redeem up to 40% of the aggregate principal amount of the 6.875% Senior Notes at any time prior to September 1, 2027 |  |  |  |  |  |
Debt Instrument, Redemption Price, Percentage Any time Prior to September 1, 2027 | 106.875% |  |  |  |  |  |
Debt Instrument, Redemption Price, Percentage On or After September 1, 2027 | 101.00% |  |  |  |  |  |
Debt Instrument related fees, discounts, and other professional expenses | $ 11,187 |  |  |  |  |  |
Acquisition obligations and other notes payable |  |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |  |
Acquisition obligations and other notes payable |  |  |  | $ 87,945 |  | $ 87,945 | 102,328
Long-term debt, weighted average interest rate, at point in time |  |  |  | 6.55% |  | 6.55% |
Acquisition obligations and other notes payable, fair value |  |  |  | $ 87,945 |  | $ 87,945 |
Debt instrument, maturity date, description |  |  |  |  |  | 2024-2036 |
Financing lease obligations |  |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |  |
Financing lease obligations |  |  |  | $ 236,722 |  | $ 236,722 | 255,491
Finance lease, weighted average discount rate, percent |  |  |  | 4.62% |  | 4.62% |
Debt instrument, maturity date, description |  |  |  |  |  | 2025-2040 |
Change Healthcare Temporary Funding Assistance |  |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |  |
Debt interest rate during period |  |  |  |  |  | 0.00% |
CHC Temporary Funding Assistance |  |  |  | $ 119,814 |  | $ 119,814 |
CHC Temporary Funding Assistance, Fair Value |  |  |  | $ 119,814 |  | 119,814 |
CHC Repayment Terms |  |  |  | within 45 business days of notice |  |  |
Term Loan A-1 |  |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |  |
Secured Debt |  |  |  | $ 2,289,022 |  | 2,289,022 | 1,234,375
Debt Instrument, Fair Value Disclosure |  |  |  | 2,277,577 |  | 2,277,577 |
Debt Instrument, Periodic Payment, Principal |  |  |  |  |  | $ 45,353 |
Debt Instrument, Maturity Date |  |  |  |  |  | Apr. 28, 2028 |
Term Loan A-1 | SOFR |  |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |  |
Debt Instrument, Description of Variable Rate Basis |  |  |  |  |  | Base + 1.75% |
Increased Term Loan A-1 |  |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |  |
Proceeds from Issuance of Debt | $ 1,100,000 |  |  |  |  |  |
Debt Instrument, effective date | Aug. 13, 2024 | Aug. 07, 2024 |  |  |  |  |
Changes to Terms of Debt Agreement |  | The Sixth Amendment also incorporated the provisions of the Fifth Amendment to the Credit Agreement, dated as of August 7, 2024, which removed a cap on the amount of incremental term "A" loans the Company can incur under the Credit Agreement. |  |  |  |  |
Debt Instrument, Payment Terms | The Increased Term Loan A-1 requires amortizing quarterly principal payments that began on September 30, 2024 of $29,728 per quarter through June 30, 2027, and $44,591 per quarter from September 30, 2027 through March 31, 2028, with the balance due on April 28, 2028. |  |  |  |  |  |
Debt Instrument, Frequency of Periodic Payment | quarterly |  |  |  |  |  |
Debt Instrument, Date of First Required Payment | Sep. 30, 2024 |  |  |  |  |  |
Debt Instrument, Quarterly Payment Through June 30, 2027 | $ 29,728 |  |  |  |  |  |
Debt Instrument, Quarterly Payment From September 30, 2027 Through March 31, 2028 | $ 44,591 |  |  |  |  |  |
Debt Instrument, Periodic Payment Terms, Balloon Payment to be Paid |  |  |  | 1,828,245 |  | $ 1,828,245 |
Debt Instrument, Maturity Date Range, Start | Sep. 30, 2024 |  |  |  |  |  |
Debt Instrument, Maturity Date Range, End | Apr. 28, 2028 |  |  |  |  |  |
Debt Instrument, Maturity Date | Apr. 28, 2028 |  |  |  |  |  |
Increased Term Loan A-1 | Minimum |  |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |  |
SOFR Plus Interest Rate Margin | 0.00% |  |  |  |  |  |
Increased Term Loan A-1 | SOFR | Minimum |  |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |  |
SOFR Plus Interest Rate Margin | 1.25% |  |  |  |  |  |
Increased Term Loan A-1 | SOFR | Maximum |  |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |  |
SOFR Plus Interest Rate Margin | 2.25% |  |  |  |  |  |
Increased Term Loan A-1 | Adjusted Rate |  |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |  |
SOFR Plus Interest Rate Margin | 0.10% |  |  |  |  |  |
Term Loan B-1 |  |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |  |
Secured Debt |  |  |  | 0 |  | 0 | $ 2,603,786
Debt Instrument, Fair Value Disclosure |  |  |  | 0 |  | 0 |
Debt Instrument, Periodic Payment, Principal |  |  |  |  |  | $ 13,716 |
Debt Instrument, Maturity Date |  |  |  |  |  | Aug. 12, 2026 |
Constructive Financing Cash Outflows |  |  |  |  | $ 722,351 |  |
Prepayment of Term Loan B 1 | $ 949,819 |  |  |  | 728,653 |  |
Extended Term Loan B-1 |  |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |  |
Secured Debt |  |  |  | 1,640,251 |  | $ 1,640,251 |
Debt Instrument, Fair Value Disclosure |  |  |  | $ 1,638,201 |  | $ 1,638,201 |
Debt Instrument, effective date |  |  | May 09, 2024 |  |  |  |
Debt Instrument, Payment Terms |  |  |  |  |  | The Extended Term Loan B-1 requires quarterly principal payments beginning on December 31, 2024 of 0.25% of the aggregate principal amount of the Extended Term Loan B-1 outstanding on the Fourth Amendment Effective Date, with the balance due on May 9, 2031. |
Debt Instrument, Frequency of Periodic Payment |  |  |  |  |  | quarterly |
Debt Instrument, Date of First Required Payment |  |  |  | Dec. 31, 2024 |  |  |
Debt Instrument, Quarterly Payment, % of Aggregate Principal Outstanding |  |  |  | 0.25% |  | 0.25% |
Debt Instrument, Periodic Payment Terms, Balloon Payment to be Paid |  |  |  | $ 1,533,635 |  | $ 1,533,635 |
Debt Instrument, Maturity Date Range, Start |  |  |  | Dec. 31, 2024 |  |  |
Debt Instrument, Maturity Date Range, End |  |  |  |  |  | May 09, 2031 |
Debt Instrument, Maturity Date |  |  |  |  |  | May 09, 2031 |
Constructive Financing Cash Outflows |  |  |  |  | $ 6,302 |  |
Extended Term Loan B-1 | Minimum |  |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |  |
SOFR Plus Interest Rate Margin |  |  |  | 0.00% |  |  |
Extended Term Loan B-1 | SOFR |  |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |  |
Debt Instrument, Description of Variable Rate Basis |  |  |  | SOFR + 2.00% |  |  |
Term Loan A-1 and Revolver | Adjusted Rate |  |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |  |
SOFR Plus Interest Rate Margin |  |  |  |  |  | 0.10% |

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