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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
OPERATING ACTIVITIES      
Net income including non-controlling interest and earnings from unconsolidated affiliates, net $ 43,407 $ 57,924 $ 52,491
Adjustments to reconcile net income including non-controlling interest to net cash provided by operating activities:      
Depreciation and amortization 14,743 11,591 10,533
Provision for credit losses 5,548 5,305 4,623
Equity-based awards compensation expense 7,264 7,867 7,917
Deferred income taxes 4,309 5,688 (258)
Gain on sale of partnership interest 0 0 (1,091)
Derecognition (write-off) of goodwill - closed clinics 0 0 1,859
Change in revaluation of put-right liability 5 0 0
Change in fair value of contingent earn-out consideration (2,520) 0 0
(Gain) loss on sale of clinics and fixed assets (643) 0 0
Impairment of Goodwill 9,112 0 0
Earnings in unconsolidated affiliate (1,175) (112) 0
Other (83) (134) 281
Changes in operating assets and liabilities:      
Increase in patient accounts receivable (10,279) (9,417) 899
(Increase) decrease in accounts receivable - other (307) (1,538) 1,661
(Decrease) increase in other assets (5,940) (633) 4,161
(Decrease) Increase in accounts payable and accrued expenses (7,755) 4,657 12,427
(Decrease) increase in other long-term liabilities 2,851 (4,792) 4,492
Net cash provided by operating activities 58,537 76,406 99,995
INVESTING ACTIVITIES      
Purchase of fixed assets (8,248) (8,201) (7,639)
Purchase of majority interest in businesses, net of cash acquired (59,788) (86,823) (23,907)
Purchase of redeemable non-controlling interest, temporary equity (14,987) (28,465) (20,385)
Purchase of non-controlling interest, permanent equity (280) (1,274) (238)
Proceeds on sale of partnership interest - redeemable non-controlling interest 402 69 127
Sales of partnership interest, clinics and fixed assets 373 275 839
Distributions from unconsolidated affiliate 1,259 152 0
Sale of non-controlling interest - permanent 0 131 0
Net cash used in investing activities (81,269) (124,136) (51,203)
FINANCING ACTIVITIES      
Distributions to non-controlling interest, permanent and temporary equity (15,348) (16,931) (18,331)
Cash dividends paid to shareholders (21,321) (18,765) (4,110)
Proceeds from revolving line of credit 101,000 316,000 214,000
Proceeds from term loan 150,000 0 0
Payments on revolving line of credit (184,000) (218,000) (244,000)
Payments on term loan (1,875) 0 0
Principal payments on notes payable (930) (4,899) (1,037)
(Payment) receipt of Medicare Accelerated and Advance Funds 0 (14,054) 14,054
Payment of deferred financing costs (1,779) 0 0
Other 12 28 2
Net cash provided by (used in) financing activities 25,759 43,379 (39,422)
Net decrease in cash and cash equivalents 3,027 (4,351) 9,370
Cash and cash equivalents - beginning of period 28,567 32,918 23,548
Cash and cash equivalents - end of period 31,594 28,567 32,918
Cash paid during the period for:      
Income taxes 7,615 12,214 7,677
Interest paid 5,687 1,352 1,202
Non-cash investing and financing transactions during the period:      
Purchase of businesses - seller financing portion 1,574 3,050 1,121
Notes payable related to purchase of redeemable non-controlling interest, temporary equity 1,074 1,759 136
Notes payable related to purchase of non-controlling interest, permanent equity 296 0 699
Notes receivable related to sale of partnership interest - redeemable non-controlling interest 1,580 914 0
Notes receivable related to sale of partnership interest $ 0 $ 0 $ 994