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CONSOLIDATED STATEMENTS OF CASH FLOWS (unaudited) - USD ($)
$ in Thousands
 3 Months Ended 9 Months Ended 12 Months Ended
Sep. 30, 2020
Sep. 30, 2019
Sep. 30, 2020
Sep. 30, 2019
Dec. 31, 2019
OPERATING ACTIVITIES          
Net income including non-controlling interests $ 15,763 $ 13,069 $ 33,864 $ 45,244  
Adjustments to reconcile net income including non-controlling interests to net cash provided by operating activities:          
Depreciation and amortization     8,066 7,377  
Provision for doubtful accounts 1,279 962 3,379 3,408  
Equity-based awards compensation expense     5,325 5,262  
Deferred income taxes     (834) 3,680  
Loss on sale of fixed assets     346 0  
Gain on sale of partnership interest     (1,091) (5,823)  
Write-off of goodwill - closed clinics 0 0 1,859 0 $ 0
Other     0 120  
Changes in operating assets and liabilities:          
Decrease (increase) in patient accounts receivable     4,117 (8,171)  
Decrease (increase) in accounts receivable - other     730 (1,006)  
Decrease (increase) in other assets     5,404 (2,744)  
Increase (decrease) in accounts payable and accrued expenses     13,495 (440)  
Decrease in other long-term liabilities     (58) (443)  
Net cash provided by operating activities     74,602 46,464  
INVESTING ACTIVITIES          
Purchase of fixed assets     (5,494) (7,428)  
Purchase of majority interest in businesses, net of cash acquired     (15,322) (30,365)  
Purchase of redeemable non-controlling interest, temporary equity     (3,087) (5,699)  
Purchase of non-controlling interest, permanent equity     (184) (138)  
Proceeds on sale of redeemable non-controlling interest, temporary equity     54 11,601  
Proceeds on sales of partnership interest and clinics     674 0  
Proceeds on sale of fixed assets     444 64  
Net cash used in investing activities     (22,915) (31,965)  
FINANCING ACTIVITIES          
Distributions to non-controlling interests, permanent and temporary equity     (14,223) (10,862)  
Cash dividends paid to shareholders     (4,110) (10,723)  
Proceeds from revolving line of credit     134,000 110,000  
Payments on revolving line of credit     (173,000) (97,000)  
Principal payments on notes payable     (700) (1,409)  
Medicare Accelerated and Advance Payment Funds     12,924 0  
Other     3 (17)  
Net cash used in financing activities     (45,106) (10,011)  
Net increase in cash and cash equivalents     6,581 4,488  
Cash and cash equivalents - beginning of period     23,548 23,368 23,368
Cash and cash equivalents - end of period 30,129 27,856 30,129 27,856 $ 23,548
Cash paid during the period for:          
Income taxes     4,421 9,458  
Interest     1,202 1,412  
Non-cash investing and financing transactions during the period:          
Purchase of businesses - seller financing portion     796 4,300  
Purchase of business - payable to common shareholders of acquired business     0 502  
Purchase of redeemable non-controlling interest - notes payable 137 0 137 0  
Payable due to purchase of redeemable non-controlling interest $ 699 $ 283 699 283  
Receivables related to sale of partnership interest     386 0  
Notes receivables related to sale of partnership interest     $ 670 $ 2,780