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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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