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Consolidated Statements of Cash Flows (Unaudited) - USD ($)
$ in Thousands
 6 Months Ended
Jun. 30, 2023
Jun. 30, 2022
Cash flows from operating activities:    
Net income $ 42,488 $ 5,948
Loss from discontinued operations 0 3,812
Adjustments to reconcile net income to net cash from operating activities:    
Depreciation and amortization 17,898 17,544
Amortization of premiums, discounts and issuance costs 733 857
Loss on early extinguishment of debt 0 57,016
Stock-based compensation expense 6,135 8,771
Deferred income taxes 8,376 (1,894)
Other (900) (1,577)
Changes in assets and liabilities:    
Accounts receivable 28,900 (15,950)
Prepaid expenses and other current assets 2,141 17,044
Other long-term assets 5,052 6,970
Accounts payable and accrued expenses (97,315) (90,986)
Income taxes payable (12,028) (12,254)
Long-term professional liabilities 838 (2,768)
Other liabilities (10,356) (867)
Net cash used in operating activities - continuing operations (8,038) (8,334)
Net cash used in operating activities - discontinued operations (3,825) (6,741)
Net cash used in operating activities (11,863) (15,075)
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (1,667) (28,167)
Purchases of investments (17,761) (12,983)
Proceeds from maturities or sales of investments 12,810 14,039
Purchases of property and equipment (15,130) (13,703)
Other 0 1,189
Net cash used in investing activities (21,748) (39,625)
Cash flows from financing activities:    
Borrowings on credit agreement 421,000 475,000
Payments on credit agreement (384,000) (321,500)
Payments on term loan (6,250) (3,125)
Redemption of senior notes, including call premium 0 (1,046,880)
Proceeds from senior notes and term loan 0 650,000
Payments for financing costs 0 (8,394)
Payment on finance lease obligation (1,404) (1,262)
Proceeds from issuance of common stock 2,689 2,838
Repurchases of common stock (786) (65,564)
Other (1,613) 284
Net cash used in financing activities 29,636 (318,603)
Net decrease in cash and cash equivalents (3,975) (373,303)
Cash and cash equivalents at beginning of period 9,824 387,391
Cash and cash equivalents at end of period $ 5,849 $ 14,088