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Acquisitions of Businesses, Variable Interest Entities (Details) - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2025
Mar. 31, 2024
Dec. 31, 2024
Assets and liabilities of the VIEs:      
Total assets $ 1,179,687   $ 1,167,467
Total liabilities 420,679   408,421
Operating results of the VIEs:      
Net revenue 183,788 $ 155,675  
Operating cost:      
Salaries and related costs 111,249 93,731  
Rent, supplies, contract labor and other 33,844 27,904  
Provision for credit losses 1,848 1,627  
Total operating cost 152,723 127,274  
Gross profit 31,065 28,401  
Other expense 2,314 172  
Income before taxes 17,328 $ 14,756  
Variable Interest Entities [Member]      
Assets and liabilities of the VIEs:      
Total assets 232,100   231,300
Total liabilities 31,400   $ 31,900
Operating results of the VIEs:      
Net revenue 19,806    
Operating cost:      
Salaries and related costs 12,905    
Rent, supplies, contract labor and other 5,304    
Provision for credit losses 197    
Total operating cost 18,406    
Gross profit 1,400    
Other expense 4    
Income before taxes $ 1,396