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Consolidated Statements of Cash Flows (Unaudited) - USD ($)
$ in Thousands
 6 Months Ended
Jun. 30, 2024
Jun. 30, 2023
Cash flows from operating activities:    
Net income $ (148,990) $ 42,488
Adjustments to reconcile net income to net cash from operating activities:    
Depreciation and amortization 19,099 17,898
Amortization of premiums, discounts and issuance costs 440 733
Goodwill impairment 154,243 0
Fixed assets impairments 20,112 0
Intangible assets impairments 7,679 0
Loss on disposal of businesses 10,873 0
Stock-based compensation expense 5,019 6,135
Deferred income taxes (25,028) 8,376
Other (1,678) (900)
Changes in assets and liabilities:    
Accounts receivable (934) 28,900
Prepaid expenses and other current assets 3,703 2,141
Other long-term assets 16,955 5,052
Accounts payable and accrued expenses (82,917) (97,315)
Income taxes payable 11,735 (12,028)
Long-term professional liabilities 8,039 838
Other liabilities (11,630) (10,356)
Net cash used in operating activities - continuing operations (13,280) (8,038)
Net cash used in operating activities - discontinued operations (4,995) (3,825)
Net cash used in operating activities (18,275) (11,863)
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (8,167) (1,667)
Purchases of investments (39,915) (17,761)
Proceeds from maturities or sales of investments 31,244 12,810
Purchases of property and equipment (12,292) (15,130)
Net cash used in investing activities (29,130) (21,748)
Cash flows from financing activities:    
Borrowings on line of credit 235,500 421,000
Payments on line of credit (235,500) (384,000)
Payments on term loan (6,250) (6,250)
Payment on finance lease obligation (1,391) (1,404)
Proceeds from issuance of common stock 2,009 2,689
Repurchases of common stock (898) (786)
Other 79 (1,613)
Net cash (used in) provided by financing activities (6,451) 29,636
Net decrease in cash and cash equivalents (53,856) (3,975)
Cash and cash equivalents at beginning of period 73,258 9,824
Cash and cash equivalents at end of period $ 19,402 $ 5,849