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Segment Information (Tables) | 12 Months Ended
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Dec. 31, 2019
Summary of Reconciliation of Segment EBITDA to Income before Income Taxes | The following tables set forth the financial information by operating segment, including a reconciliation of Segment EBITDA to income before income taxes (in thousands):
|  | Year Ended December 31, |
|  | 2019 |  |  | 2018 |  |  | 2017 |
Revenue: |  |  |  |  |  |  |  |  |  |  |  |
U.S. Facilities |  | $ | 2,008,381 |  |  | $ | 1,904,695 |  |  | $ | 1,809,844 |
U.K. Facilities |  |  | 1,099,081 |  |  |  | 1,107,747 |  |  |  | 1,026,472 |
Corporate and Other |  |  | — |  |  |  | — |  |  |  | — |
|  | $ | 3,107,462 |  |  | $ | 3,012,442 |  |  | $ | 2,836,316 |
Segment EBITDA (1) : |  |  |  |  |  |  |  |  |  |  |  |
U.S. Facilities |  | $ | 503,358 |  |  | $ | 488,207 |  |  | $ | 475,260 |
U.K. Facilities |  |  | 166,693 |  |  |  | 185,755 |  |  |  | 198,566 |
Corporate and Other |  |  | (84,168 | ) |  |  | (80,386 | ) |  |  | (69,467 | )
|  | $ | 585,883 |  |  | $ | 593,576 |  |  | $ | 604,359 |
|  | Year Ended December 31, |
|  | 2019 |  |  | 2018 |  |  | 2017 |
Segment EBITDA(1) |  | $ | 585,883 |  |  | $ | 593,576 |  |  | $ | 604,359 |
Plus (less): |  |  |  |  |  |  |  |  |  |  |  |
Equity-based compensation expense |  |  | (17,307 | ) |  |  | (22,001 | ) |  |  | (23,467 | )
Debt extinguishment costs |  |  | — |  |  |  | (1,815 | ) |  |  | (810 | )
Legal settlements expense |  |  | — |  |  |  | (22,076 | ) |  |  | — |
Loss on impairment |  |  | (54,386 | ) |  |  | (337,889 | ) |  |  | — |
Transaction-related expenses |  |  | (27,064 | ) |  |  | (34,507 | ) |  |  | (24,267 | )
Interest expense, net |  |  | (187,094 | ) |  |  | (185,410 | ) |  |  | (176,007 | )
Depreciation and amortization |  |  | (164,044 | ) |  |  | (158,832 | ) |  |  | (143,010 | )
Income (loss) before income taxes |  | $ | 135,988 |  |  | $ | (168,954 | ) |  | $ | 236,798 |
Summary of Assets by Operating Segment |
|  | December 31, |
|  | 2019 |  |  | 2018 |
Assets (2) : |  |  |  |  |  |  |  |
U.S. Facilities |  | $ | 4,037,968 |  |  | $ | 3,779,040 |
U.K. Facilities |  |  | 2,610,357 |  |  |  | 2,175,809 |
Corporate and Other |  |  | 230,817 |  |  |  | 217,655 |
|  | $ | 6,879,142 |  |  | $ | 6,172,504 |
(1) | Segment EBITDA is defined as income before provision for income taxes, equity-based compensation expense, debt extinguishment costs, legal settlements expense, loss on impairment, transaction-related expenses, interest expense and depreciation and amortization. The Company uses Segment EBITDA as an analytical indicator to measure the performance of the Company’s segments and to develop strategic objectives and operating plans for those segments. Segment EBITDA is commonly used as an analytical indicator within the health care industry, and also serves as a measure of leverage capacity and debt service ability. Segment EBITDA should not be considered as a measure of financial performance under GAAP, and the items excluded from Segment EBITDA are significant components in understanding and assessing financial performance. Because Segment EBITDA is not a measurement determined in accordance with GAAP and is thus susceptible to varying calculations, Segment EBITDA, as presented, may not be comparable to other similarly titled measures of other companies.
(2) | Assets include property and equipment for the U.S. Facilities of $1.4 billion, U.K. Facilities of $1.7 billion and corporate and other of $50.9 million at December 31, 2019. Assets include property and equipment for the U.S. Facilities of $1.4 billion, U.K. Facilities of $1.7 billion and corporate and other of $44.9 million at December 31, 2018.
Goodwill [Member] |
Summary of Assets by Operating Segment |
|  | U.S. Facilities |  |  | U.K. Facilities |  |  | Corporate and Other |  |  | Consolidated |
Goodwill: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Balance at January 1, 2018 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Goodwill |  | $ | 2,042,592 |  |  | $ | 708,582 |  |  | $ | — |  |  | $ | 2,751,174 |
Accumulated impairment loss |  |  | — |  |  |  | — |  |  |  | — |  |  |  | — |
Net goodwill at January 1, 2018 |  |  | 2,042,592 |  |  |  | 708,582 |  |  |  | — |  |  |  | 2,751,174 |
Loss on impairment |  |  | — |  |  |  | (325,875 | ) |  |  | — |  |  |  | (325,875 | )
Increase from contribution of redeemable noncontrolling interests |  |  | 2,245 |  |  |  | — |  |  |  | — |  |  |  | 2,245 |
Foreign currency translation loss |  |  | — |  |  |  | (31,894 | ) |  |  | — |  |  |  | (31,894 | )
Prior year purchase price adjustments |  |  | — |  |  |  | 762 |  |  |  | — |  |  |  | 762 |
Balance at December 31, 2018 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Goodwill |  |  | 2,044,837 |  |  |  | 677,450 |  |  |  | — |  |  |  | 2,722,287 |
Accumulated impairment loss |  |  | — |  |  |  | (325,875 | ) |  |  | — |  |  |  | (325,875 | )
Net goodwill at December 31, 2018 |  |  | 2,044,837 |  |  |  | 351,575 |  |  |  | — |  |  |  | 2,396,412 |
Increase from contribution of redeemable noncontrolling interests |  |  | 3,300 |  |  |  | — |  |  |  | — |  |  |  | 3,300 |
Increase from 2019 acquisitions |  |  | 36,967 |  |  |  | — |  |  |  | — |  |  |  | 36,967 |
Foreign currency translation gain |  |  | — |  |  |  | 12,452 |  |  |  | — |  |  |  | 12,452 |
Balance at December 31, 2019 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Goodwill |  |  | 2,085,104 |  |  |  | 689,902 |  |  |  | — |  |  |  | 2,775,006 |
Accumulated impairment loss |  |  | — |  |  |  | (325,875 | ) |  |  | — |  |  |  | (325,875 | )
Net goodwill at December 31, 2019 |  | $ | 2,085,104 |  |  | $ | 364,027 |  |  | $ | — |  |  | $ | 2,449,131 |

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