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UNAUDITED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 3 Months Ended 9 Months Ended 12 Months Ended
Sep. 30, 2025
Sep. 30, 2024
Sep. 30, 2025
Sep. 30, 2024
Dec. 31, 2024
OPERATING ACTIVITIES          
Net income including non-controlling interest $ 17,642 $ 9,777 $ 48,830 $ 33,106  
Adjustments to reconcile net income including non-controlling interest to net cash provided by operating activities:          
Depreciation and amortization     17,756 12,996  
Provision for credit losses 2,073 1,721 5,916 5,065  
Equity-based awards compensation expense     6,151 5,837  
Amortization of debt issue costs     315 317  
Change in deferred income taxes     11,163 605  
Change in revaluation of put-right liability 663 (168) 1,406 136  
Change in fair value of contingent earn-out consideration (5,872) 1,899 (11,484) 5,332  
Equity of earnings in unconsolidated affiliate (361) (231) (1,155) (750)  
Loss on sale of fixed assets     420 280  
Loss on sale of a partnership 0 0 123 0  
Other     0 (169)  
Changes in operating assets and liabilities:          
Patient accounts receivable, net     (13,604) (8,870)  
Accounts receivable - other     3,559 (960)  
Other current and long term assets     (8,155) (1,808)  
Accounts payable and accrued expenses     (10,908) 5,003  
Other long-term liabilities     (207) (589)  
Net cash provided by operating activities     50,126 55,531  
INVESTING ACTIVITIES          
Purchase of fixed assets     (10,145) (6,697)  
Purchase of interest in businesses, net of cash acquired     (15,214) (41,196)  
Purchase of redeemable non-controlling interest, temporary equity     (8,579) (6,957)  
Purchase of non controlling interest, permanent equity     (196) (756)  
Proceeds from the sale of non-controlling interest, permanent equity     9 26  
Proceeds from the sale of partnership interest - redeemable non-controlling interest, temporary equity     149 229  
Repayment of notes receivable related to sales of redeemable non-controlling interest     387 451  
Proceeds from the sale of partnership     700 0  
Distributions from unconsolidated affiliate     1,089 838  
Other     531 (535)  
Net cash (used in) investing activities     (31,269) (54,597)  
FINANCING ACTIVITIES          
Proceeds from revolving facility     146,500 0  
Payments on revolving facility     (131,000) 0  
Distributions to non-controlling interest, permanent and temporary equity     (14,610) (11,399)  
Cash dividends paid to shareholders     (20,520) (19,898)  
Payments on term loan     (7,500) (3,750)  
Principal payments on notes payable     (1,994) (1,726)  
Other     7 (27)  
Net cash (used in) financing activities     (29,117) (36,800)  
Net (decrease) in cash and cash equivalents     (10,260) (35,866)  
Cash and cash equivalents - beginning of period     41,362 152,825 $ 152,825
Cash and cash equivalents - end of period $ 31,102 $ 116,959 31,102 116,959 $ 41,362
Cash paid during the period for:          
Income taxes     11,809 5,759  
Interest paid     7,305 5,630  
Non-cash investing and financing transactions during the period:          
Purchase of businesses - seller financing portion     300 955  
Fair market value of initial contingent consideration related to purchase of businesses     5,731 6,440  
Offset of notes receivable associated with purchase of redeemable non-controlling interest     254 627  
Notes payable related to purchase of redeemable non-controlling interest, temporary equity     135 66  
Notes receivable related to sale of redeemable non-controlling interest, temporary equity     2,017 2,075  
Notes receivable related to the sale of non-controlling interest, permanent equity     $ 29 $ 282