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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Cash flows from operating activities:      
Net income $ 70.7 $ 1.3 $ 45.1
Adjustments to reconcile net income to net cash provided by operating activities:      
Depreciation and amortization 98.8 94.8 76.5
Non-cash interest expense, net 22.0 4.5 2.5
Equity-based compensation expense 17.4 13.2 10.2
Loss (gain) on disposals, net 2.2 5.7 (4.4)
Impairment charges 0.0 33.5 7.9
Loss on debt extinguishment 9.1 0.0 11.7
Deferred income taxes 8.9 (21.9) 8.5
Income from equity investments, net of distributions received 0.2 0.5 0.3
Non-cash lease expense 39.1 39.4 40.0
Changes in operating assets and liabilities, net of acquisitions and divestitures:      
Accounts receivable (32.1) (46.6) (23.5)
Medicare accelerated payments and deferred governmental grants (73.6) 135.2 0.0
DOJ settlement payments (32.2) (4.0) 0.0
Other operating assets and liabilities (43.4) (8.7) (45.3)
Net cash provided by operating activities 87.1 246.9 129.5
Cash flows from investing activities:      
Purchases of property and equipment (57.6) (42.9) (73.6)
Payments for acquisitions, net of cash acquired (285.8) (104.6) (13.8)
Proceeds from disposals of facilities and other assets 6.0 58.5 17.6
Sale (purchase) of equity investments 5.4 0.0 (15.2)
Other investing activities 0.3 0.6 (0.2)
Net cash used in investing activities (331.7) (88.4) (85.2)
Cash flows from financing activities:      
Principal payments on long-term debt (343.2) (216.3) (490.8)
Borrowings of long-term debt 299.4 429.4 506.9
Payments of debt issuance costs (11.7) (8.5) (8.9)
Proceeds from equity offerings 581.8 0.0 0.0
Payments of equity offering costs (27.6) 0.0 0.0
Payment of premium on debt extinguishment 0.0 0.0 (17.8)
Distributions to non-controlling interest holders (131.0) (109.6) (121.2)
Payments related to ownership transactions with non-controlling interest holders (28.4) (27.4) (3.2)
Payments of preferred dividends (5.1) 0.0 0.0
Other financing activities (17.9) (0.9) (0.9)
Net cash provided by (used in) financing activities 316.3 66.7 (135.9)
Net increase (decrease) in cash, cash equivalents and restricted cash 71.7 225.2 (91.6)
Cash, cash equivalents and restricted cash at beginning of period 318.2 93.0 184.6
Cash, cash equivalents and restricted cash at end of period 389.9 318.2 93.0
Supplemental cash flow information:      
Interest paid, net of interest income received 194.3 203.6 180.3
Cash paid for income taxes 1.5 1.7 1.6
Non-cash purchases of property and equipment $ 22.3 $ 27.7 $ 30.7