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Consolidated Statements of Cash Flows (Unaudited) - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2023
Sep. 30, 2022
Cash flows from operating activities:    
Net income $ 63,879 $ 36,676
Loss from discontinued operations 0 1,892
Adjustments to reconcile net income to net cash from operating activities:    
Depreciation and amortization 27,109 26,500
Amortization of premiums, discounts and issuance costs 1,015 1,346
Loss on early extinguishment of debt 0 57,016
Stock-based compensation expense 9,299 12,891
Deferred income taxes 10,589 (8,702)
Other (1,607) (2,379)
Changes in assets and liabilities:    
Accounts receivable 22,095 (501)
Prepaid expenses and other current assets 4,290 22,709
Other long-term assets 13,343 11,160
Accounts payable and accrued expenses (56,118) (76,439)
Income taxes payable (5,154) 799
Long-term professional liabilities 838 7,360
Other liabilities (16,500) (10,309)
Net cash provided by operating activities - continuing operations 73,078 80,019
Net cash used in operating activities - discontinued operations (5,003) (11,764)
Net cash provided by operating activities 68,075 68,255
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (1,667) (28,167)
Purchases of investments (26,477) (14,938)
Proceeds from maturities or sales of investments 16,560 15,889
Purchases of property and equipment (24,284) (20,650)
Other 116 2,153
Net cash used in investing activities (35,752) (45,713)
Cash flows from financing activities:    
Borrowings on credit agreement 470,000 674,500
Payments on credit agreement (474,000) (579,500)
Payments on term loan (9,375) (6,250)
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 (8,621)
Payment on finance lease obligation (2,105) (2,176)
Proceeds from issuance of common stock 3,876 4,220
Repurchases of common stock (919) (87,041)
Other (8,445) 483
Net cash used in financing activities (20,968) (401,265)
Net increase (decrease) in cash and cash equivalents 11,355 (378,723)
Cash and cash equivalents at beginning of period 9,824 387,391
Cash and cash equivalents at end of period $ 21,179 $ 8,668