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Consolidated Statements of Cash Flows (Unaudited) - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2025
Sep. 30, 2024
Cash flows from operating activities:    
Net income (loss) $ 131,705 $ (129,549)
Adjustments to reconcile net income (loss) to net cash from operating activities:    
Depreciation and amortization 16,196 25,353
Amortization of premiums, discounts and issuance costs 698 703
Impairment losses 0 182,034
Loss on disposal of businesses 0 10,932
Net gain on investments in divested businesses (20,906) 0
Stock-based compensation expense 12,700 9,129
Deferred income taxes 27,639 (15,880)
Other (3,386) (2,006)
Changes in assets and liabilities:    
Accounts receivable 29,101 635
Prepaid expenses and other current assets (784) 5,945
Other long-term assets 16,972 30,569
Accounts payable and accrued expenses (38,833) (34,154)
Payment of contingent consideration liability (318) 0
Income taxes payable 9,377 7,527
Long-term professional liabilities (7,406) 13,239
Other liabilities (12,620) (22,032)
Net cash provided by operating activities - continuing operations 160,135 82,445
Net cash used in operating activities - discontinued operations (3,146) (8,882)
Net cash provided by operating activities 156,989 73,563
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (19,196) (8,167)
Purchases of investments (23,484) (54,402)
Proceeds from maturities or sales of investments 21,424 45,324
Proceeds from investment in divested business 30,000 0
Purchases of property and equipment (13,171) (18,582)
Other (3,587) 2,359
Net cash used in investing activities (8,014) (33,468)
Cash flows from financing activities:    
Borrowings on line of credit 0 235,500
Payments on line of credit 0 (235,500)
Payments on term loan (14,063) (9,375)
Payment on finance lease obligation (1,346) (2,045)
Payment of contingent consideration liability (3,182) 0
Proceeds from issuance of common stock 2,538 2,906
Repurchases of common stock (22,645) (1,060)
Other (158) 52
Net cash provided by financing activities (38,856) (9,522)
Net increase in cash and cash equivalents 110,119 30,573
Cash and cash equivalents at beginning of period 229,940 73,258
Cash and cash equivalents at end of period $ 340,059 $ 103,831