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Leases - Lease Costs (Details) - USD ($) $ in Thousands | 3 Months Ended
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Mar. 31, 2019 | Mar. 31, 2018
Leases [Abstract] |  |
Facility operating expense | $ 4,625 |
Facility lease expense | 68,668 | $ 80,400
Operating lease expense | 73,293 |
Operating lease expense adjustment | 4,383 |
Operating cash flows from operating leases | 77,676 |
Non-cash recognition of right-of-use assets obtained in exchange for new operating lease obligations | 1,358 |
Depreciation and amortization | 11,678 |
Interest expense: financing lease obligations | 16,743 | $ 22,931
Financing lease expense | 28,421 |
Financing cash flows from financing leases | 5,453 |
Operating cash flows from financing leases | 16,743 |
Total cash flows from financing leases | $ 22,196 |

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- Definition Amount of interest expense on finance lease liability. + References Reference 1: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 842 -SubTopic 20 -Section 50 -Paragraph 4 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=77888426&loc=SL77918686-209980 Reference 2: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 842 -SubTopic 20 -Section 45 -Paragraph 4 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=77888419&loc=SL77918638-209977 Reference 3: http://www.xbrl.org/2003/role/exampleRef -Publisher FASB -Name Accounting Standards Codification -Topic 842 -SubTopic 20 -Section 55 -Paragraph 53 -URI http://asc.fasb.org/extlink&oid=77888399&loc=SL77918982-209971 + Details
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- Definition Amount of operating lease expense. Excludes sublease income. + References Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef -Publisher FASB -Name Accounting Standards Codification -Topic 842 -SubTopic 20 -Section 45 -Paragraph 4 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=77888419&loc=SL77918638-209977 + Details
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- Definition Amount of increase in right-of-use asset obtained in exchange for operating lease liability. + References Reference 1: http://www.xbrl.org/2003/role/exampleRef -Publisher FASB -Name Accounting Standards Codification -Topic 842 -SubTopic 20 -Section 55 -Paragraph 53 -URI http://asc.fasb.org/extlink&oid=77888399&loc=SL77918982-209971 Reference 2: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 842 -SubTopic 20 -Section 50 -Paragraph 4 -Subparagraph (g)(2) -URI http://asc.fasb.org/extlink&oid=77888426&loc=SL77918686-209980 + Details
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