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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
OPERATING ACTIVITIES      
Net income including non-controlling interest and earnings from unconsolidated affiliates, net $ 57,924 $ 52,491 $ 57,259
Adjustments to reconcile net income including non-controlling interest to net cash provided by operating activities:      
Depreciation and amortization 11,591 10,533 10,095
Provision for credit losses 5,305 4,623 4,858
Equity-based awards compensation expense 7,867 7,917 6,985
Deferred income taxes 5,688 (258) 4,651
Gain on sale of partnership interest 0 (1,091) (5,514)
Derecognition (write-off) of goodwill - closed clinics 0 1,859 0
Earnings in unconsolidated affiliate (112) 0 0
Other (134) 281 96
Changes in operating assets and liabilities:      
(Increase) decrease in patient accounts receivable (9,417) 899 (6,376)
(Increase) decrease in accounts receivable - other (1,538) 1,661 (2,499)
(Increase) decrease in other assets (633) 4,161 (1,878)
Increase (decrease) in accounts payable and accrued expenses 4,657 12,427 (4,209)
Increase (decrease) in other long-term liabilities (4,792) 4,492 (1,020)
Net cash provided by operating activities 76,406 99,995 62,448
INVESTING ACTIVITIES      
Purchase of fixed assets (8,201) (7,639) (10,189)
Purchase of majority interest in businesses, net of cash acquired (86,823) (23,907) (30,597)
Purchase of redeemable non-controlling interest - temporary equity (28,465) (20,385) (8,651)
Purchase of non-controlling interest, permanent equity (1,274) (238) (428)
Proceeds on sale of redeemable non-controlling interest, temporary equity 69 127 207
Proceeds on sales of partnership interest, clinics and fixed assets 275 839 11,665
Distributions from unconsolidated affiliate 152 0 0
Sales of non-controlling interest-permanent 131 0 0
Net cash used in investing activities (124,136) (51,203) (37,993)
FINANCING ACTIVITIES      
Distributions to non-controlling interest, permanent and temporary equity (16,931) (18,331) (16,235)
Cash dividends paid to shareholders (18,765) (4,110) (14,555)
Proceeds from revolving line of credit 316,000 214,000 145,000
Payments on revolving line of credit (218,000) (244,000) (137,000)
Principal payments on notes payable (4,899) (1,037) (1,433)
(Payment) receipt of Medicare Accelerated and Advance Funds (14,054) 14,054 0
Other 28 2 (52)
Net cash provided by (used in) financing activities 43,379 (39,422) (24,275)
Net (decrease) increase in cash and cash equivalents (4,351) 9,370 180
Cash and cash equivalents - beginning of period 32,918 23,548 23,368
Cash and cash equivalents - end of period 28,567 32,918 23,548
Cash paid during the period for:      
Income taxes 12,214 7,677 9,856
Interest 1,352 1,202 1,890
Non-cash investing and financing transactions during the period:      
Purchase of businesses - seller financing portion 3,050 1,121 4,300
Purchase of business - payable to common shareholders of acquired business 0 0 502
Notes payable related to purchase of redeemable non-controlling interest, temporary equity 1,759 136 283
Notes payable due to purchase of non-controlling interest, permanent equity 0 699 103
Notes receivable related to sale of partnership interest - redeemable non-controlling interest 914 0 2,870
Note receivables related to sale of partnership interest $ 0 $ 994 $ 0