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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2019
Dec. 31, 2018
Dec. 31, 2017
OPERATING ACTIVITIES      
Net income including non-controlling interests $ 57,259 $ 48,842 $ 27,724
Adjustments to reconcile net income including non-controlling interests to net cash provided by operating activities:      
Depreciation and amortization 10,095 9,755 9,710
Provision for doubtful accounts 4,858 4,603 3,672
Equity-based awards compensation expense 6,985 5,939 5,032
Deferred income taxes 4,651 4,813 (4,864)
Gain on sale of partnership interest (5,514) 0 0
Gain on derecognition of Debt 0 (1,846) 0
Other 96 167 621
Changes in operating assets and liabilities:      
Increase in patient accounts receivable (6,376) (3,434) (3,447)
Increase in accounts receivable - other (2,499) (1,087) (3,022)
(Increase) decrease in other assets (1,878) 345 2,086
(Decrease) increase in accounts payable and accrued expenses (4,209) 4,876 6,979
Increase in mandatorily redeemable non-controlling interests 0 0 11,579
(Decrease) increase in other liabilities (1,020) 32 456
Net cash provided by operating activities 62,448 73,005 56,526
INVESTING ACTIVITIES      
Purchase of fixed assets (10,189) (7,193) (7,095)
Purchase of majority interest in businesses (30,597) (16,367) (36,682)
Purchase of redeemable non-controlling interest, temporary equity (8,651) 0 0
Purchase of non-controlling interest, permanent equity (428) (350) 0
Sales of non controlling interest-permanent equity 207 0 121
Proceeds on sale of partnership interest, net 11,601 0 0
Proceeds on sale of fixed assets 64 1 81
Net cash used in investing activities (37,993) (23,909) (43,575)
FINANCING ACTIVITIES      
Distributions to non-controlling interests, permanent and temporary equity (16,235) (15,646) (5,572)
Cash dividends paid to shareholders (14,555) (11,664) (10,066)
Proceeds from revolving line of credit 145,000 103,000 93,000
Payments on revolving line of credit (137,000) (119,000) (85,000)
Payments to settle mandatorily redeemable non-controlling interests 0 (265) (2,361)
Principal payments on notes payable (1,433) (4,044) (1,227)
Other (52) (42) 161
Net cash used in financing activities (24,275) (47,661) (11,065)
Net increase in cash and cash equivalents 180 1,435 1,886
Cash and cash equivalents - beginning of period 23,368 21,933 20,047
Cash and cash equivalents - end of period 23,548 23,368 21,933
Cash paid during the period for:      
Income taxes 9,856 9,183 8,543
Interest 1,890 2,357 2,113
Non-cash investing and financing transactions during the period:      
Purchase of businesses - seller financing portion 4,300 950 2,150
Purchase of business - payable to common shareholders of acquired business 502 0 0
Notes payable related to purchase of redeemable non-controlling interest, temporary equity 283 0 0
Notes payable related to purchase of non-controlling interest, permanent equity 103 0 0
Notes receivable related to sale of partnership interest - redeemable non-controlling interest $ 2,870 $ 0 $ 0