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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2020
Dec. 31, 2019
Dec. 31, 2018
OPERATING ACTIVITIES      
Net income including non-controlling interests $ 52,491 $ 57,259 $ 48,842
Adjustments to reconcile net income including non-controlling interests to net cash provided by operating activities:      
Depreciation and amortization 10,533 10,095 9,755
Provision for credit losses 4,623 4,858 4,603
Equity-based awards compensation expense 7,917 6,985 5,939
Deferred income taxes (258) 4,651 4,813
Gain on sale of partnership interest (1,091) (5,514) (1,846)
Write-off of goodwill - closed clinics 1,859 0 0
Other 281 96 167
Changes in operating assets and liabilities:      
Decrease (increase) in patient accounts receivable 899 (6,376) (3,434)
Decrease (increase) in accounts receivable - other 1,661 (2,499) (1,087)
Decrease (increase) in other assets 4,161 (1,878) 345
Increase (decrease) in accounts payable and accrued expenses 12,427 (4,209) 4,876
Increase (decrease) in other long-term liabilities 4,492 (1,020) 32
Net cash provided by operating activities 99,995 62,448 73,005
INVESTING ACTIVITIES      
Purchase of fixed assets (7,639) (10,189) (7,193)
Purchase of majority interest in businesses, net of cash acquired (23,907) (30,597) (16,367)
Purchase of redeemable non-controlling interest, temporary equity (20,385) (8,651) 0
Purchase of non-controlling interest, permanent equity (238) (428) (350)
Proceeds on sale of redeemable non-controlling interest, temporary equity 127 207 0
Proceeds on sales of partnership interest, clinics and fixed assets 839 11,665 1
Net cash used in investing activities (51,203) (37,993) (23,909)
FINANCING ACTIVITIES      
Distributions to non-controlling interests, permanent and temporary equity (18,331) (16,235) (15,646)
Cash dividends paid to shareholders (4,110) (14,555) (11,664)
Proceeds from revolving line of credit 214,000 145,000 103,000
Payments on revolving line of credit (244,000) (137,000) (119,000)
Payments to settle mandatorily redeemable non-controlling interests 0 0 (265)
Principal payments on notes payable (1,037) (1,433) (4,044)
Medicare accelerated and advance payment funds 14,054 0 0
Other 2 (52) (42)
Net cash used in financing activities (39,422) (24,275) (47,661)
Net increase in cash and cash equivalents 9,370 180 1,435
Cash and cash equivalents - beginning of period 23,548 23,368 21,933
Cash and cash equivalents - end of period 32,918 23,548 23,368
Cash paid during the period for:      
Income taxes 7,677 9,856 9,183
Interest 1,202 1,890 2,357
Non-cash investing and financing transactions during the period:      
Purchase of businesses - seller financing portion 1,121 4,300 950
Purchase of business - payable to common shareholders of acquired business 0 502 0
Notes payable related to purchase of redeemable non-controlling interest, temporary equity 136 283 0
Notes payable related to purchase of non-controlling interest, permanent equity 699 103 0
Notes receivable related to sale of partnership interest - redeemable non-controlling interest 0 2,870 0
Notes receivables related to sale of partnership interest $ 994 $ 0 $ 0