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Consolidated Statements of Cash Flows (Unaudited) - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2024
Sep. 30, 2023
Cash flows from operating activities:    
Net (loss) income $ (129,549) $ 63,879
Adjustments to reconcile net (loss) income to net cash provided by operating activities:    
Depreciation and amortization 25,353 27,109
Amortization of premiums, discounts and issuance costs 703 1,015
Goodwill impairment 154,243 0
Fixed assets impairments 20,112 0
Intangible assets impairments 7,679 0
Loss on disposal of businesses 10,932 0
Stock-based compensation expense 9,129 9,299
Deferred income taxes (15,880) 10,589
Other (2,006) (1,607)
Changes in assets and liabilities:    
Accounts receivable 635 22,095
Prepaid expenses and other current assets 5,945 4,290
Other long-term assets 30,569 13,343
Accounts payable and accrued expenses (34,154) (56,118)
Income taxes payable 7,527 (5,154)
Long-term professional liabilities 13,239 838
Other liabilities (22,032) (16,500)
Net cash provided by operating activities - continuing operations 82,445 73,078
Net cash used in operating activities - discontinued operations (8,882) (5,003)
Net cash provided by operating activities 73,563 68,075
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (8,167) (1,667)
Purchases of investments (54,402) (26,477)
Proceeds from maturities or sales of investments 45,324 16,560
Purchases of property and equipment (18,582) (24,284)
Other 2,359 116
Net cash used in investing activities (33,468) (35,752)
Cash flows from financing activities:    
Borrowings on line of credit 235,500 470,000
Payments on line of credit (235,500) (474,000)
Payments on term loan (9,375) (9,375)
Payments on finance lease obligations (2,045) (2,105)
Proceeds from issuance of common stock 2,906 3,876
Repurchases of common stock (1,060) (919)
Other 52 (8,445)
Net cash used in financing activities (9,522) (20,968)
Net decrease in cash and cash equivalents 30,573 11,355
Cash and cash equivalents at beginning of period 73,258 9,824
Cash and cash equivalents at end of period $ 103,831 $ 21,179