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Consolidated Statements of Cash Flows - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2020
Dec. 31, 2019
Dec. 31, 2018
Cash flows from operating activities:      
Net income (loss) $ 1.3 $ 45.1 $ (95.6)
Adjustments to reconcile net income (loss) to net cash provided by operating activities:      
Depreciation and amortization 94.8 76.5 67.4
Non-cash interest expense (income), net 4.5 2.5 (1.4)
Equity-based compensation expense 13.2 10.2 9.3
Loss (gain) on disposals and deconsolidations, net 5.7 (4.4) 31.8
Impairment charges 33.5 7.9 74.4
Loss on debt extinguishment 0.0 11.7 0.0
Deferred income taxes (21.9) 8.5 25.3
Income from equity investments, net of distributions received 0.5 0.3 0.2
Non-cash lease expense 39.4 40.0 0.0
Changes in operating assets and liabilities, net of acquisitions and divestitures:      
Accounts receivable (46.6) (23.5) (22.8)
Medicare accelerated payments and deferred governmental grants 135.2 0.0 0.0
Other operating assets and liabilities (12.7) (45.3) 56.0
Net cash provided by operating activities 246.9 129.5 144.6
Cash flows from investing activities:      
Purchases of property and equipment (42.9) (73.6) (39.8)
Payments for acquisitions, net of cash acquired (104.6) (13.8) (106.8)
Purchase of equity investments 0.0 (15.2) 0.0
Proceeds from disposals of facilities and other assets 58.5 17.6 19.2
Other investing activities 0.6 (0.2) (1.5)
Net cash used in investing activities (88.4) (85.2) (128.9)
Cash flows from financing activities:      
Principal payments on long-term debt (216.3) (490.8) (157.6)
Borrowings of long-term debt 429.4 506.9 282.7
Payments of debt issuance costs (8.5) (8.9) (3.0)
Payment of premium on debt extinguishment 0.0 (17.8) 0.0
Distributions to non-controlling interest holders (109.6) (121.2) (109.0)
Payments related to ownership transactions with non-controlling interest holders (27.4) (3.2) (2.2)
Payments of preferred dividends 0.0 0.0 (7.8)
Repurchase of shares 0.0 0.0 (2.0)
Other financing activities (0.9) (0.9) (7.4)
Net cash provided by (used in) financing activities 66.7 (135.9) (6.3)
Net increase (decrease) in cash, cash equivalents and restricted cash 225.2 (91.6) 9.4
Cash, cash equivalents and restricted cash at beginning of period 93.0 184.6 175.2
Cash, cash equivalents and restricted cash at end of period 318.2 93.0 184.6
Supplemental cash flow information:      
Interest paid, net of interest income received 203.6 180.3 145.4
Cash paid for income taxes 1.7 1.6 2.2
Non-cash purchases of property and equipment $ 27.7 $ 30.7 $ 61.0