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Business Acquisitions - Additional Information (Detail) (USD $)
 12 Months Ended
Dec. 31, 2013
Company
Dec. 31, 2012
Company
Business Acquisition [Line Items]    
Number of physician group practices acquired 11 16
Business acquisition, total consideration $ 250,100,000 $ 451,100,000
Cash consideration 236,700,000 436,400,000
Contingent consideration 13,400,000 14,700,000
Goodwill recorded in connection with acquisitions 2,393,731,000 2,165,672,000
Other intangible assets 29,600,000 48,200,000
Other liabilities 8,100,000 12,000,000
Contingent consideration payments related to prior-period acquisitions 13,400,000  
Assumed payment probability of contingent consideration payment 100.00%  
Range of the undiscounted amount under contingent consideration agreement, low 0  
Range of the undiscounted amount under contingent consideration agreement, high 14,600,000  
Time period for achievement of certain performance measures for payment of contingent consideration, years 5 years  
Contingent consideration increase in fair value 2,700,000  
Contingent consideration decrease in fair value 900,000  
Contingent consideration Net change in fair value 1,800,000  
Eleven Physician Group Practices Acquisition [Member]
    
Business Acquisition [Line Items]    
Goodwill recorded in connection with acquisitions 228,600,000  
Prior-Period Acquisition [Member]
    
Business Acquisition [Line Items]    
Contingent consideration payments related to prior-period acquisitions 13,000,000  
Prior-period acquisition of other assets 500,000  
Sixteen Physician Group Practices Acquisition [Member]
    
Business Acquisition [Line Items]    
Goodwill recorded in connection with acquisitions   414,300,000
Fixed assets   600,000
Prior-Period Acquisitions [Member]
    
Business Acquisition [Line Items]    
Contingent consideration 43,000,000  
Contingent consideration payments related to prior-period acquisitions $ 45,400,000  
Minimum [Member]
    
Business Acquisition [Line Items]    
Assumed discount rates for acquisition-date fair value 2.50%  
Eligibility criteria for payments of contingent purchase price (in years) 3 years  
Maximum [Member]
    
Business Acquisition [Line Items]    
Assumed discount rates for acquisition-date fair value 4.00%  
Eligibility criteria for payments of contingent purchase price (in years) 5 years