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Income Taxes - Significant Components of Deferred Income Tax Assets and Liabilities (Detail) - USD ($) $ in Thousands | Dec. 31, 2019 | Dec. 31, 2018
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Income Tax Disclosure [Abstract] |  |
Allowance for uncollectible accounts | $ 202,464 | $ 194,299
Reserves and accruals | 72,132 | 56,583
Stock-based compensation | 11,393 | 9,201
Loss carryforwards | 36,017 | 24,864
Property and equipment | 388 | 0
Other | 631 | 1,197
Deferred tax assets before valuation allowance | 323,025 | 286,144
Less: Valuation allowance | (24,139) | (2,628)
Deferred tax assets, net of valuation allowance | 298,886 | 283,516
Gross deferred tax liabilities: |  |
Amortization | (119,481) | (247,239)
Accounting method changes | (74,684) | (109,418)
Accrual to cash adjustment |  | (39)
Other | (331) | (491)
Total deferred tax liabilities | (194,496) | (357,187)
Net deferred tax assets | $ 104,390 |
Net deferred tax liabilities |  | $ (73,671)

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