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UNAUDITED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2024
Sep. 30, 2023
OPERATING ACTIVITIES    
Net income including non-controlling interest $ 33,106 $ 38,513
Adjustments to reconcile net income including non-controlling interest to net cash provided by operating activities:    
Depreciation and amortization 12,996 11,582
Provision for credit losses 5,065 4,600
Equity-based awards compensation expense 5,837 5,451
Amortization of debt issue costs 317 315
Change in deferred income taxes 605 5,393
Change in revaluation of put-right liability 136 344
Change in fair value of contingent earn-out consideration 5,332 (197)
Equity of earnings in unconsolidated affiliate (750) (806)
Loss (gain) on sale of fixed assets 280 (106)
Others (169) 0
Changes in operating assets and liabilities:    
Increase in patient accounts receivable (8,870) (5,415)
Increase in accounts receivable - other (960) (1,631)
(Increase) decrease in other current and long term assets (1,808) 2,489
Increase (decrease) in accounts payable and accrued expenses 5,003 (5,609)
(Decrease) increase in other long-term liabilities (589) 220
Net cash provided by operating activities 55,531 55,143
INVESTING ACTIVITIES    
Purchase of fixed assets (6,697) (7,074)
Purchase of majority interest in businesses, net of cash acquired (41,196) (22,994)
Purchase of redeemable non-controlling interest, temporary equity (6,957) (7,804)
Purchase of non controlling interest, permanent equity (756) (262)
Proceeds on sale of redeemable non-controlling interest, temporary equity 229 815
Proceeds on sale of non-controlling interest, permanent equity 26 30
Distributions from unconsolidated affiliate 838 681
Other (84) 7
Net cash used in investing activities (54,597) (36,601)
FINANCING ACTIVITIES    
Cash dividends paid to shareholders (19,898) (17,683)
Distributions to non-controlling interest, permanent and temporary equity (11,399) (11,777)
Principal payments on notes payable (1,726) (2,874)
Payments on term loan (3,750) (2,813)
Payments on revolving facility 0 (55,000)
Proceeds from issuance of common stock pursuant to the secondary public offering, net of issuance costs 0 163,646
Proceeds from revolving facility 0 24,000
Other (27) 50
Net cash (used in) provided by financing activities (36,800) 97,549
Net (decrease) increase in cash and cash equivalents (35,866) 116,091
Cash and cash equivalents - beginning of period 152,825 31,594
Cash and cash equivalents - end of period 116,959 147,685
Cash paid during the period for:    
Income taxes 5,759 2,731
Interest paid 5,630 6,992
Non-cash investing and financing transactions during the period:    
Purchase of interest in businesses - seller financing portion 7,395 1,860
Initial contingent consideration related to purchase of interest of businesses 5,940 200
Offset of notes receivable associated with purchase of redeemable non-controlling interest 627 0
Notes payable related to purchase of redeemable non-controlling interest, temporary equity 66 1,017
Notes payable related to purchase of non-controlling interest, permanent equity 0 200
Notes receivable related to sale of redeemable non-controlling interest, temporary equity 2,075 3,064
Notes receivable related to the sale of non-controlling interest, permanent equity $ 282 $ 397