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Constructive Financing Cash Inflow

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Percentage points added to the reference rate to compute the variable rate on the debt instrument.

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Amount, before unamortized (discount) premium and debt issuance costs, of long-term debt. Includes, but is not limited to, notes payable, bonds payable, commercial loans, mortgage loans, convertible debt, subordinated debt and other types of debt.

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Fair value portion of debt instrument payable, including, but not limited to, notes payable and loans payable.

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Amount of the fee that accompanies borrowing money under the debt instrument.

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Description of the frequency of periodic payments (monthly, quarterly, annual).

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Net increase or decrease in the carrying amount of the debt instrument for the period.

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The average effective interest rate during the reporting period.

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Latest date the outstanding debt instruments are required to be repaid, in YYYY-MM-DD format.

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Description of the payment terms of the debt instrument (for example, whether periodic payments include principal and frequency of payments) and discussion about any contingencies associated with the payment.

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Amount of the required periodic payments applied to principal.

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Amount of payment greater than the preceding installment payments to be paid at final maturity date of debt.

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Description of debt redemption features under terms of the debt agreement.

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Long-Term Debt - Schedule of Long-Term Debt (Details) - USD ($) $ in Thousands				3 Months Ended		12 Months Ended
	Aug. 13, 2024	Aug. 07, 2024	May 09, 2024	Sep. 30, 2024	Jun. 30, 2024	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022	Feb. 13, 2025
Long-term debt disclosure
Long-term debt, weighted average interest rate, at point in time						5.68%
Financing lease obligations						$ 216,401
Long-term debt totals:
Total debt principal outstanding						9,511,106	$ 8,445,980
Discount, premium and deferred financing costs						(64,336)	(54,347)
Carrying amount of long-term debt, net of unamortized discounts, premiums and deferred financing costs						9,446,770	8,391,633
Less current portion						(270,867)	(123,299)
Total long-term debt						9,175,903	8,268,334
Debt Instrument, footnotes to the table
Debt prepayment, extinguishment and modification costs				$ 10,081	$ 9,732	$ 19,813	7,962	$ 0
Debt, Weighted Average Interest Rate						5.07%
Senior Notes 4.625% due 2030
Senior Notes:
Senior Notes						$ 2,750,000	2,750,000
Long-term debt disclosure
Debt Instrument, Maturity Date						Jun. 01, 2030
Debt, interest rate at a point in time.						4.625%
Debt Instrument, Fair Value Disclosure						$ 2,533,438
Senior Notes 3.75% due 2031
Senior Notes:
Senior Notes						$ 1,500,000	1,500,000
Long-term debt disclosure
Debt Instrument, Maturity Date						Feb. 15, 2031
Debt, interest rate at a point in time.						3.75%
Debt Instrument, Fair Value Disclosure						$ 1,301,250
Senior Notes 6.875% due 2032
Senior Notes:
Senior Notes	$ 1,000,000					$ 1,000,000
Long-term debt disclosure
Debt Instrument, Maturity Date	Sep. 01, 2032					Sep. 01, 2032
Debt, interest rate at a point in time.	6.875%					6.875%
Debt Instrument, Fair Value Disclosure						$ 1,007,500
Debt Instrument, footnotes to the table
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, 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 at 106.875% of the aggregate principal amount from the proceeds of one or more equity offerings, plus accrued and unpaid interest.
Debt Instrument, Fee Amount	$ 11,421
Debt Instrument, Redemption Price, Percentage Any time Prior to September 1, 2027	106.875%
Debt Instrument, Redemption Price, if change of control	101.00%
Acquisition obligations and other notes payable
Long-term debt disclosure
Long-term debt, weighted average interest rate, at point in time						5.58%
Acquisition obligations and other notes payable						$ 56,483	102,328
Acquisition obligations and other notes payable, fair value						$ 56,483
Debt instrument, maturity date, description						2025-2038
Financing lease obligations
Long-term debt disclosure
Financing lease obligations						$ 216,401	$ 255,491
Finance lease, weighted average discount rate, percent						4.58%	4.58%	4.51%
Debt instrument, maturity date, description						2025-2039
Change Healthcare Temporary Funding Assistance
Long-term debt disclosure
Debt, interest rate at a point in time.						0.00%
Debt Instrument, footnotes to the table
CHC Temporary Funding Assistance						$ 92,777
CHC Temporary Funding Assistance, Fair Value						92,777
Change Healthcare Temporary Funding Assistance \| Subsequent Event
Debt Instrument, footnotes to the table
CHC Temporary Funding Assistance									$ 70,000
Revolving line of credit
Senior Secured Credit Facilities:
Secured Debt						$ 0	$ 0
Long-term debt disclosure
Debt Instrument, Maturity Date						Apr. 28, 2028
Line of Credit Facility, Fair Value of Amount Outstanding						$ 0
Debt Instrument, footnotes to the table
Maximum borrowing capacity on revolving credit facilities						$ 1,500,000
Term Loan A-1 and Revolver \| SOFR
Debt Instrument, footnotes to the table
Debt Instrument, Description of Variable Rate Basis						Base + 1.75%
Term Loan A-1 and Revolver \| Adjusted Rate
Debt Instrument, footnotes to the table
Debt Instrument, Basis Spread on Variable Rate						0.10%
Term Loan A-1
Senior Secured Credit Facilities:
Secured Debt						$ 2,259,295	1,234,375
Long-term debt disclosure
Debt Instrument, Maturity Date						Apr. 28, 2028
Debt Instrument, Fair Value Disclosure						$ 2,256,471
Debt Instrument, footnotes to the table
Secured Debt Outstanding Principal Balance Subject To SOFR						395,445
Debt Instrument, Periodic Payment, Principal						75,080
Increased Term Loan A-1
Long-term debt disclosure
Debt Instrument, Maturity Date	Apr. 28, 2028
Debt Instrument, footnotes to the table
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, Maturity Date Range, Start	Sep. 30, 2024
Debt Instrument, Effective Date	Aug. 13, 2024	Aug. 07, 2024
Debt Instrument, Description		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, Date of First Required Payment	Sep. 30, 2024
Debt Instrument, Maturity Date Range, End	Apr. 28, 2028
Other Significant Noncash Financing Activity				$ 861,282
Debt Instrument, Periodic Payment Terms, Balloon Payment to be Paid						$ 1,828,245
Debt Instrument, Frequency of Periodic Payment	quarterly
Proceeds from Issuance of Debt	$ 1,100,000
Debt Instrument, Quarterly Payment Through June 30, 2027	29,728
Debt Instrument, Quarterly Payment From September 30, 2027 Through March 31, 2028	$ 44,591
Increased Term Loan A-1 \| Minimum
Debt Instrument, footnotes to the table
Debt Instrument, Variable Rate	0.00%
Increased Term Loan A-1 \| SOFR \| Minimum
Debt Instrument, footnotes to the table
Debt Instrument, Basis Spread on Variable Rate	1.25%
Increased Term Loan A-1 \| SOFR \| Maximum
Debt Instrument, footnotes to the table
Debt Instrument, Basis Spread on Variable Rate	2.25%
Increased Term Loan A-1 \| Adjusted Rate
Debt Instrument, footnotes to the table
Debt Instrument, Basis Spread on Variable Rate						0.10%
Term Loan B-1
Senior Secured Credit Facilities:
Secured Debt						$ 0	2,603,786
Long-term debt disclosure
Debt Instrument, Fair Value Disclosure						0
Debt Instrument, footnotes to the table
Constructive Financing Cash Outflow					722,351
Repayments of Debt	$ 949,819				728,653
Debt Instrument, Periodic Payment, Principal						13,716
Extended Term Loan B-1
Senior Secured Credit Facilities:
Secured Debt						$ 1,636,150
Long-term debt disclosure
Debt Instrument, Maturity Date			May 09, 2031			May 09, 2031
Debt Instrument, Fair Value Disclosure						$ 1,638,195
Debt Instrument, footnotes to the table
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, Maturity Date Range, Start			Dec. 31, 2024
Constructive Financing Cash Outflow					6,302
Constructive Financing Cash Inflow					728,653
Debt Instrument, Effective Date			May 09, 2024
Debt Instrument, Date of First Required Payment			Dec. 31, 2024
Debt Instrument, Maturity Date Range, End			May 09, 2031
Other Significant Noncash Financing Activity					13,282
Debt Instrument, Periodic Payment Terms, Balloon Payment to be Paid						1,533,635
Debt Instrument, Frequency of Periodic Payment			quarterly
Secured Debt, Extended Maturity			$ 911,598
Debt Instrument, Increase (Decrease), Net					$ 728,653
Debt Instrument, Quarterly Payment, % of Beginning Balance Outstanding			0.25%
Debt Instrument, Periodic Payment, Principal						$ 4,101
Extended Term Loan B-1 \| Minimum
Debt Instrument, footnotes to the table
Debt Instrument, Variable Rate			0.00%
Extended Term Loan B-1 \| SOFR
Debt Instrument, footnotes to the table
Debt Instrument, Description of Variable Rate Basis						SOFR + 2.00%
Extended Term Loan B-1 \| SOFR \| SOFR Loans
Debt Instrument, footnotes to the table
Debt Instrument, Basis Spread on Variable Rate			2.00%
Extended Term Loan B-1 \| Adjusted Rate \| Base Rate Loans
Debt Instrument, footnotes to the table
Debt Instrument, Basis Spread on Variable Rate			1.00%
Extended Term Loan B-1 \| Fed Funds Effective Rate Overnight Index Swap Rate \| Maximum \| Base Rate Loans
Debt Instrument, footnotes to the table
Debt Instrument, Basis Spread on Variable Rate			0.50%
Extended Term Loan B-1 \| 1-Month SOFR \| Maximum \| Base Rate Loans
Debt Instrument, footnotes to the table
Debt Instrument, Basis Spread on Variable Rate			1.00%
Extended Term Loan B-1 \| Prime Rate \| Maximum \| Base Rate Loans
Debt Instrument, footnotes to the table
Debt Instrument, Description of Variable Rate Basis			prime commercial lending rate
Senior Notes
Debt Instrument, footnotes to the table
Deferred Financing Costs						$ 37,612	31,491
Debt Instrument, Unamortized Premium						$ 10,239	12,129
Senior Secured Credit Facilities
Long-term debt disclosure
Long-term debt, weighted average interest rate, at point in time						6.91%
Debt Instrument, footnotes to the table
Debt Instrument, Unamortized Discount						$ 8,084	2,487
Deferred Financing Costs						$ 28,879	$ 32,498