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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Cash flows from operating activities:      
Net income $ 135.3 $ 87.0 $ 70.7
Adjustments to reconcile net income to net cash provided by operating activities:      
Depreciation and amortization 118.1 114.8 98.8
Non-cash lease expense 35.2 34.8 39.1
Non-cash interest expense, net 25.0 25.9 22.0
Equity-based compensation expense 17.7 18.4 17.4
Net loss on disposals, consolidations and deconsolidations 14.4 11.1 2.2
Loss on debt extinguishment 15.5 14.9 9.1
Deferred income taxes (1.7) 21.9 8.9
Equity in earnings of unconsolidated affiliates, net of distributions received (2.2) (1.8) 0.2
Other non-cash income 0.0 (7.5) 0.0
Changes in operating assets and liabilities, net of acquisitions and divestitures:      
Accounts receivable (47.2) (35.3) (32.1)
Medicare accelerated payments and deferred governmental grants (1.2) (58.4) (73.6)
DOJ settlement payments 0.0 0.0 (32.2)
Other operating assets and liabilities (15.1) (67.0) (43.4)
Net cash provided by operating activities 293.8 158.8 87.1
Cash flows from investing activities:      
Purchases of property and equipment (88.8) (80.6) (57.6)
Payments for acquisitions, net of cash acquired (80.0) (146.4) (285.8)
Proceeds from disposals of facilities and other assets 25.8 12.9 6.0
Purchases of equity investments (50.3) (95.1) 0.0
Proceeds from sales of equity investments 1.4 12.8 5.4
Other investing activities (33.7) (11.5) 0.3
Net cash used in investing activities (225.6) (307.9) (331.7)
Cash flows from financing activities:      
Principal payments on long-term debt (807.1) (862.0) (343.2)
Borrowings of long-term debt 826.6 217.8 299.4
Payments of debt issuance costs (24.3) 0.0 (11.7)
Payment of premium on debt extinguishment 0.0 (11.3) 0.0
Proceeds from equity offerings 0.0 882.9 581.8
Payments of equity offering costs 0.0 (25.2) (27.6)
Distributions to non-controlling interest holders (146.1) (146.8) (131.0)
Proceeds (payments) related to ownership transactions with non-controlling interest holders 8.2 (3.4) (28.4)
Payments of preferred dividends 0.0 0.0 (5.1)
Other financing activities (12.5) (9.9) (17.9)
Net cash (used in) provided by financing activities (155.2) 42.1 316.3
Net (decrease) increase in cash and cash equivalents (87.0) (107.0) 71.7
Cash and cash equivalents at beginning of period 282.9 389.9 318.2
Cash and cash equivalents at end of period 195.9 282.9 389.9
Supplemental cash flow information:      
Interest paid, net of interest income received 169.6 218.7 194.3
Cash paid for income taxes 1.4 1.8 1.5
Non-cash purchases of property and equipment $ 18.0 $ 29.9 $ 22.3