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Consolidated Statements of Cash Flows - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2020
Dec. 31, 2019
Dec. 31, 2018
Cash flows from operating activities:      
Net income $ 33,133 $ 25,237 $ 16,433
Adjustments to reconcile net income to net cash provided by operating activities, net of acquisitions:      
Depreciation and amortization 12,051 10,574 8,642
Deferred income taxes (4,652) (1,063) (375)
Stock-based compensation 6,005 5,766 4,109
Amortization of debt issuance costs under the credit facility 737 716 606
Provision for doubtful accounts 918 343 272 [1]
Contingent consideration     (847)
Loss (gain) on sale and/or impairment of assets 1,256   38
Changes in operating assets and liabilities, net of acquisitions:      
Accounts receivable 23,860 (37,478) (697)
Prepaid expenses and other current assets (1,973) (792) 1,652
Government stimulus advances 19,393    
Accounts payable 2,159 4,638 4,235
Accrued expenses and other liabilities 16,524 4,078 (865)
Net cash provided by operating activities 109,411 12,019 33,203
Cash flows from investing activities:      
Acquisitions of businesses, net of cash acquired (207,660) (184,076) (62,440)
Proceeds on disposal of businesses 255    
Purchases of property and equipment (6,831) (4,621) (5,349)
Net cash used in investing activities (214,236) (188,697) (67,789)
Cash flows from financing activities:      
Proceeds from issuance of common stock, net of issuance costs   172,945 76,618
Borrowings on revolver — credit facility 135,000 23,458 20,000
Borrowings on term loan — credit facility   19,600 60,420
Payments on term loan — credit facility (735) (735) (104,858)
Payments on financing lease obligations (22) (63) (1,013)
Payments for debt issuance costs under the credit facility   (372) (923)
Cash received from exercise of stock options 3,946 3,153 994
Net cash provided by financing activities 138,189 217,986 51,238
Net change in cash 33,364 41,308 16,652
Cash, at beginning of period 111,714 70,406 53,754
Cash, at end of period 145,078 111,714 70,406
Supplemental disclosures of cash flow information:      
Cash paid for interest 2,365 2,320 4,339
Cash paid for income taxes 10,590 7,303 4,097
Supplemental disclosures of non-cash investing and financing activities      
Leasehold improvements acquired through tenant allowances 5,161 682  
Tax benefit related to the amortization of tax goodwill in excess of book basis $ 225 $ 117 $ 117
[1] With the adoption of ASU 2014-09, Revenue from Contracts with Customers, in 2018 and subsequent periods, subsequent adjustments that are determined to be the result of an adverse change in the payor’s ability to pay are recognized as provision for doubtful accounts. We recorded $18.0 million for the year ended December 31, 2018 as a reduction to revenue that would have been recorded as provision for doubtful accounts under the prior revenue recognition guidance.