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Consolidated Statements of Cash Flows (Unaudited) - USD ($)
$ in Thousands
 6 Months Ended
Jun. 30, 2022
Jun. 30, 2021
Cash flows from operating activities:    
Net income $ 5,948 $ 52,653
(Loss) income from discontinued operations 3,812 (16,768)
Adjustments to reconcile net income (loss) to net cash from operating activities:    
Depreciation and amortization 17,544 16,137
Amortization of premiums, discounts and issuance costs 857 1,838
Loss on early extinguishment of debt 57,016 14,532
Stock-based compensation expense 8,771 9,452
Deferred income taxes (1,894) (17,033)
Other (1,577) (1,205)
Gain on sale of building 0 (7,280)
Changes in assets and liabilities:    
Accounts receivable (15,950) (26,005)
Prepaid expenses and other current assets 17,044 40,800
Other long-term assets 6,970 (1,859)
Accounts payable and accrued expenses (90,986) (54,453)
Income taxes receivable (12,254) (28,165)
Long-term professional liabilities (2,768) (715)
Other liabilities (867) (10,413)
Net cash used in operating activities – continuing operations (8,334) (28,484)
Net cash used in provided by operating activities - discontinued operations (6,741) (117)
Net cash used in operating activities (15,075) (28,601)
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (28,167) (7,207)
Purchases of investments (12,983) (8,355)
Proceeds from maturities or sales of investments 14,039 10,745
Purchases of property and equipment (13,703) (18,536)
Proceeds from sale of building 0 24,728
Other 1,189 0
Net cash (used in) provided by investing activities - continuing operations (39,625) 1,375
Net cash provided by investing activities-discontinued operations 0 2,350
Net cash (used in) provided by investing activities (39,625) 3,725
Cash flows from financing activities:    
Borrowings on credit agreement 475,000 0
Payments on credit agreement (321,500) 0
Payments on term loan (3,125) 0
Redemption of senior notes, including call premium (1,046,880) (759,848)
Proceeds from senior notes and term loan 650,000
Payments for financing costs (8,394)
Payment on Finance lease obligation (1,262) (1,106)
Proceeds from issuance of common stock 2,838 2,578
Repurchases of common stock (65,564) (2,245)
Other 284 (189)
Net cash used in financing activities - continuing operations (318,603) (760,810)
Net cash used in financing activities - discontinued operations 0 0
Net cash used in financing activities (318,603) (760,810)
Net decrease in cash and cash equivalents (373,303) (785,686)
Cash and cash equivalents at beginning of period 387,391 1,123,843
Cash and cash equivalents at end of period $ 14,088 $ 338,157