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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 3 Months Ended 9 Months Ended 12 Months Ended
Sep. 30, 2021
Sep. 30, 2020
Sep. 30, 2021
Sep. 30, 2020
Dec. 31, 2020
OPERATING ACTIVITIES          
Net income including non-controlling interest $ 14,123 $ 15,763 $ 43,481 $ 33,864  
Adjustments to reconcile net income including non-controlling interest to net cash provided by operating activities:          
Depreciation and amortization     8,519 8,066  
Provision for credit losses 1,358 1,279 3,922 3,379  
Equity-based awards compensation expense     6,280 5,325  
Deferred income taxes     1,292 (834)  
Loss on sale of fixed assets     113 346  
Gain on sale of partnership interest     0 (1,091)  
Derecognition (write-off) of goodwill - closed clinics 0 0 0 1,859 $ 1,859
Changes in operating assets and liabilities:          
(Increase) decrease in patient accounts receivable     (7,513) 4,117  
(Increase) decrease in accounts receivable - other     (738) 730  
(Increase) decrease in other assets     (195) 5,404  
Increase in accounts payable and accrued expenses     4,529 13,495  
Increase (decrease) in other long-term liabilities     811 (58)  
Net cash provided by operating activities     60,501 74,602  
INVESTING ACTIVITIES          
Purchase of fixed assets     (5,996) (5,494)  
Purchase of majority interest in businesses, net of cash acquired     (22,589) (15,322)  
Purchase of redeemable non-controlling interest - temporary equity     (14,916) (3,087)  
Purchase of non-controlling interest, permanent equity     (1,093) (184)  
Proceeds on sale of redeemable non-controlling interest, temporary equity     69 54  
Proceeds on sales of partnership interest, clinics and fixed assets     136 1,118  
Sales of non-controlling interest-permanent     131 0  
Net cash used in investing activities     (44,258) (22,915)  
FINANCING ACTIVITIES          
Distributions to non-controlling interest, permanent and temporary equity     (14,330) (14,223)  
Cash dividends paid to shareholders     (13,934) (4,110)  
Proceeds from revolving line of credit     193,000 134,000  
Payments on revolving line of credit     (176,000) (173,000)  
Principal payments on notes payable     (4,662) (700)  
(Payment) receipt of Medicare Accelerated and Advance Funds     (14,054) 12,924  
Short swing profit settlement     20 0  
Other     (13) 3  
Net cash used in financing activities     (29,973) (45,106)  
Net (decrease) increase in cash and cash equivalents     (13,730) 6,581  
Cash and cash equivalents - beginning of period     32,918 23,548 23,548
Cash and cash equivalents - end of period 19,188 30,129 19,188 30,129 $ 32,918
Cash paid during the period for:          
Income taxes     10,777 4,421  
Interest     1,195 1,202  
Non-cash investing and financing transactions during the period:          
Purchase of businesses - seller financing portion     1,800 796  
Purchase of redeemable non-controlling interest - notes payable 1,302 137 1,302 137  
Notes payable due to purchase of non-controlling interest, permanent equity $ 0 $ 699 0 699  
Receivables related to sale of partnership interest     0 386  
Note receivables related to sale of partnership interest     $ 914 $ 670