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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
OPERATING ACTIVITIES      
Net income including non-controlling interest $ 45,600 $ 37,220 $ 43,407
Adjustments to reconcile net income including non-controlling interest to net cash provided by operating activities:      
Depreciation and amortization 18,681 15,695 14,743
Provision for credit losses 6,912 6,172 5,548
Equity-based awards compensation expense 7,823 7,236 7,264
Amortization of debt issue costs 422 420 305
Change in deferred income taxes 5,365 4,490 4,309
Change in revaluation of put-right liability 82 (2,582) 5
Change in fair value of contingent earn-out consideration 219 1,550 (2,520)
Equity of earnings in unconsolidated affiliate (1,014) (955) (1,175)
Loss (gain) on sale of clinics and fixed assets 836 166 (643)
Impairment of goodwill and other intangible assets 0 17,495 9,112
Impairment of assets held for sale 2,418 0 0
Other 0 0 (83)
Changes in operating assets and liabilities:      
Increase in patient accounts receivable (5,346) (5,645) (10,279)
Increase in accounts receivable - other (6,548) (356) (307)
Increase in other current and long term assets (818) (197) (5,940)
Decrease (increase) in accounts payable and accrued expenses 1,713 15 (7,755)
(Increase) decrease in other long-term liabilities (1,405) 1,254 2,546
Net cash provided by operating activities 74,940 81,978 58,537
INVESTING ACTIVITIES      
Purchase of fixed assets (9,186) (9,294) (8,248)
Purchase of majority interest in businesses, net of cash acquired (133,087) (26,582) (59,788)
Purchase of redeemable non-controlling interest, temporary equity (8,052) (10,986) (14,987)
Purchase of non controlling interest, permanent equity (1,004) (281) (280)
Proceeds on sale of non-controlling interest, permanent equity 26 102 0
Proceeds on sale of partnership interest - redeemable non-controlling interest, temporary equity 79 875 402
Distributions from unconsolidated affiliate 1,080 830 1,259
Proceeds on sale of partnership interest, clinics and fixed assets 0 0 373
Other 694 321 0
Net cash used in investing activities (149,450) (45,015) (81,269)
FINANCING ACTIVITIES      
Proceeds from issuance of common stock pursuant to the secondary public offering, net of issuance costs 0 163,646 0
Proceeds from revolving facility 19,000 24,000 101,000
Distributions to non-controlling interest, permanent and temporary equity (14,711) (16,100) (15,348)
Cash dividends paid to shareholders (26,540) (24,128) (21,321)
Payments on revolving facility (8,000) (55,000) (184,000)
Principal payments on notes payable (2,952) (4,400) (930)
Payments on term loan (3,750) (3,750) (1,875)
Proceeds from term loan 0 0 150,000
Payment of deferred financing costs 0 0 (1,779)
Other 0 0 12
Net cash (used in) provided by financing activities (36,953) 84,268 25,759
Net (decrease) increase in cash and cash equivalents (111,463) 121,231 3,027
Cash and cash equivalents - beginning of period 152,825 31,594 28,567
Cash and cash equivalents - end of period 41,362 152,825 31,594
Cash paid during the period for:      
Income taxes 4,832 4,926 7,615
Interest paid 7,209 8,655 5,687
Non-cash investing and financing transactions during the period:      
Purchase of businesses - seller financing portion 2,060 1,815 1,574
Liabilities assumed associated with a purchase of a business 670 524 0
Fair market value of initial contingent consideration related to purchase of businesses 17,672 200 3,357
Notes payable related to purchase of redeemable non-controlling interest, temporary equity 71 1,087 1,074
Notes payable related to purchase of non-controlling interest, permanent equity 0 200 296
Notes receivable related to sale of redeemable non-controlling interest 1,890 4,136 1,580
Notes receivable related to the sale of non-controlling interest, permanent equity 282 458 0
Offset to notes receivable associated with purchase of redeemable non-controlling interest 726 0 0
Issuance of restricted stock related to purchase of business $ 1,500 $ 0 $ 0