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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Cash flows from operating activities:      
Net income $ 12.5 $ 135.3 $ 87.0
Adjustments to reconcile net income to net cash provided by operating activities:      
Depreciation and amortization 152.6 118.1 114.8
Non-cash lease expense 38.9 35.2 34.8
Non-cash interest expense, net 6.5 25.0 25.9
Equity-based compensation expense 33.3 17.7 18.4
Net loss on disposals, consolidations and deconsolidations 40.6 14.4 11.1
Loss on debt extinguishment 5.1 15.5 14.9
Deferred income taxes 131.5 (1.7) 21.9
Equity in earnings of unconsolidated affiliates, net of distributions received (2.0) (2.2) (1.8)
Other non-cash income 0.0 0.0 (7.5)
Changes in operating assets and liabilities, net of acquisitions and divestitures:      
Accounts receivable (72.1) (47.2) (35.3)
Medicare accelerated payments and deferred governmental grants 0.0 (1.2) (58.4)
Other operating assets and liabilities (46.8) (15.1) (67.0)
Net cash provided by operating activities 300.1 293.8 158.8
Cash flows from investing activities:      
Purchases of property and equipment (90.4) (88.8) (80.6)
Payments for acquisitions, net of cash acquired (378.8) (80.0) (146.4)
Proceeds from disposals of facilities and other assets 2.6 25.8 12.9
Purchases of equity investments (1.7) (50.3) (95.1)
Proceeds from sales of equity investments 4.6 1.4 12.8
Other investing activities (24.8) (33.7) (11.5)
Net cash used in investing activities (488.5) (225.6) (307.9)
Cash flows from financing activities:      
Principal payments on long-term debt (1,279.3) (807.1) (862.0)
Borrowings of long-term debt 1,729.7 826.6 217.8
Payments of debt issuance costs (14.9) (24.3) 0.0
Payment of premium on debt extinguishment 0.0 0.0 (11.3)
Proceeds from equity offerings 0.0 0.0 882.9
Payments of equity offering costs 0.0 0.0 (25.2)
Distributions to non-controlling interest holders (170.5) (146.1) (146.8)
Proceeds (payments) related to ownership transactions with non-controlling interest holders 9.6 8.2 (3.4)
Other financing activities (12.6) (12.5) (9.9)
Net cash provided by (used in) financing activities 262.0 (155.2) 42.1
Net increase (decrease) in cash and cash equivalents 73.6 (87.0) (107.0)
Cash and cash equivalents at beginning of period 195.9 282.9 389.9
Cash and cash equivalents at end of period 269.5 195.9 282.9
Supplemental cash flow information:      
Interest paid, net of interest income received 199.7 169.6 218.7
Cash paid for income taxes 1.6 1.4 1.8
Non-cash purchases of property and equipment $ 12.9 $ 18.0 $ 29.9