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Schedule of intangible assets (Detail) - USD ($) | 3 Months Ended | 12 Months Ended
--- | --- | ---
Mar. 31, 2019 | Dec. 31, 2018
Finite-Lived Intangible Assets [Line Items] |  |
Intangible Assets, Gross | $ 144,476,000 | $ 144,476,000
Accumulated Amortization | (61,419,342) | (57,600,117)
Intangible Assets, Net | 83,056,658 | 86,875,883
Medicare License | Indefinite-lived Intangible Assets [Member] |  |
Finite-Lived Intangible Assets [Line Items] |  |
Intangible Assets, Gross | 1,994,000 | 1,994,000
Accumulated Amortization | 0 | 0
Intangible Assets, Net | 1,994,000 | 1,994,000
Network relationships | Finite-Lived Intangible Assets [Member] |  |
Finite-Lived Intangible Assets [Line Items] |  |
Intangible Assets, Gross | 109,883,000 | 109,883,000
Accumulated Amortization | (51,215,352) | (48,361,773)
Intangible Assets, Net | $ 58,667,648 | $ 61,521,227
Network relationships | Indefinite-lived Intangible Assets [Member] | Maximum [Member] |  |
Finite-Lived Intangible Assets [Line Items] |  |
Weighted Average Life (Yrs) | 15 years | 15 years
Network relationships | Indefinite-lived Intangible Assets [Member] | Minimum [Member] |  |
Finite-Lived Intangible Assets [Line Items] |  |
Weighted Average Life (Yrs) | 11 years | 11 years
Trade name | Finite-Lived Intangible Assets [Member] |  |
Finite-Lived Intangible Assets [Line Items] |  |
Weighted Average Life (Yrs) | 20 years | 20 years
Intangible Assets, Gross | $ 1,011,000 | $ 1,011,000
Accumulated Amortization | (67,400) | (54,763)
Intangible Assets, Net | $ 943,600 | $ 956,237
Management contracts [Member] | Finite-Lived Intangible Assets [Member] |  |
Finite-Lived Intangible Assets [Line Items] |  |
Weighted Average Life (Yrs) | 15 years | 15 years
Intangible Assets, Gross | $ 22,832,000 | $ 22,832,000
Accumulated Amortization | (8,031,971) | (7,447,581)
Intangible Assets, Net | $ 14,800,029 | 15,384,419
Member relationships [Member] | Finite-Lived Intangible Assets [Member] |  |
Finite-Lived Intangible Assets [Line Items] |  |
Weighted Average Life (Yrs) | 12 years |
Intangible Assets, Gross | $ 6,696,000 | 6,696,000
Accumulated Amortization | (1,555,286) | (1,289,667)
Intangible Assets, Net | $ 5,140,714 | $ 5,406,333
Member relationships [Member] | Finite-Lived Intangible Assets [Member] | Minimum [Member] |  |
Finite-Lived Intangible Assets [Line Items] |  |
Weighted Average Life (Yrs) |  | 12 years
Patient management platform [Member] | Finite-Lived Intangible Assets [Member] |  |
Finite-Lived Intangible Assets [Line Items] |  |
Weighted Average Life (Yrs) | 5 years | 5 years
Intangible Assets, Gross | $ 2,060,000 | $ 2,060,000
Accumulated Amortization | (549,333) | (446,333)
Intangible Assets, Net | $ 1,510,667 | $ 1,613,667

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