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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Cash flows from operating activities:      
Net income $ 87.0 $ 70.7 $ 1.3
Adjustments to reconcile net income to net cash provided by operating activities:      
Depreciation and amortization 114.8 98.8 94.8
Non-cash lease expense 34.8 39.1 39.4
Non-cash interest expense, net 25.9 22.0 4.5
Equity-based compensation expense 18.4 17.4 13.2
Loss on disposals and deconsolidations, net 11.1 2.2 5.7
Loss on debt extinguishment 14.9 9.1 0.0
Deferred income taxes 21.9 8.9 (21.9)
Equity in earnings of unconsolidated affiliates, net of distributions received (1.8) 0.2 0.5
Impairment charges 0.0 0.0 33.5
Other non-cash income (7.5) 0.0 0.0
Changes in operating assets and liabilities, net of acquisitions and divestitures:      
Accounts receivable (35.3) (32.1) (46.6)
Medicare accelerated payments and deferred governmental grants (58.4) (73.6) 135.2
DOJ settlement payments 0.0 (32.2) (4.0)
Other operating assets and liabilities (67.0) (43.4) (8.7)
Net cash provided by operating activities 158.8 87.1 246.9
Cash flows from investing activities:      
Purchases of property and equipment (80.6) (57.6) (42.9)
Payments for acquisitions, net of cash acquired (146.4) (285.8) (104.6)
Proceeds from disposals of facilities and other assets 12.9 6.0 58.5
Purchases of equity investments (95.1) 0.0 0.0
Proceeds from sales of equity investments 12.8 5.4 0.0
Other investing activities (11.5) 0.3 0.6
Net cash used in investing activities (307.9) (331.7) (88.4)
Cash flows from financing activities:      
Principal payments on long-term debt (862.0) (343.2) (216.3)
Borrowings of long-term debt 217.8 299.4 429.4
Payment of premium on debt extinguishment (11.3) 0.0 0.0
Proceeds from equity offerings 882.9 581.8 0.0
Payments of equity offering costs (25.2) (27.6) 0.0
Distributions to non-controlling interest holders (146.8) (131.0) (109.6)
Payments related to ownership transactions with non-controlling interest holders (3.4) (28.4) (27.4)
Payments of debt issuance costs 0.0 (11.7) (8.5)
Payments of preferred dividends 0.0 (5.1) 0.0
Other financing activities (9.9) (17.9) (0.9)
Net cash provided by financing activities 42.1 316.3 66.7
Net (decrease) increase in cash and cash equivalents (107.0) 71.7 225.2
Cash and cash equivalents at beginning of period 389.9 318.2 93.0
Cash and cash equivalents at end of period 282.9 389.9 318.2
Supplemental cash flow information:      
Interest paid, net of interest income received 218.7 194.3 203.6
Cash paid for income taxes 1.8 1.5 1.7
Non-cash purchases of property and equipment $ 29.9 $ 22.3 $ 27.7