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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
OPERATING ACTIVITIES      
Net income including non-controlling interest $ 58,005 $ 45,600 $ 37,220
Adjustments to reconcile net income including non-controlling interest to net cash provided by operating activities:      
Depreciation and amortization 22,391 18,681 15,695
Provision for credit losses 7,647 6,912 6,172
Equity-based awards compensation expense 8,270 7,823 7,236
Amortization of debt issue costs 422 422 420
Change in deferred income taxes 11,406 5,365 4,490
Change in revaluation of put-right liability 1,322 82 (2,582)
Change in fair value of contingent earn-out consideration (6,244) 219 1,550
Equity of earnings in unconsolidated affiliate (1,477) (1,014) (955)
Loss on sale of clinics and fixed assets 383 836 166
Loss on sale of partnership 123 0 0
Impairment of goodwill and other intangible assets 0 0 17,495
Impairment of assets held for sale 0 2,418 0
Changes in operating assets and liabilities:      
Patient accounts receivable, net (11,955) (5,346) (5,645)
Accounts receivable - other 2,895 (6,548) (356)
Other current and long term assets (10,418) (818) (197)
Accounts payable and accrued expenses (7,798) 1,713 15
Other long-term liabilities 86 (1,405) 1,254
Net cash provided by operating activities 75,058 74,940 81,978
INVESTING ACTIVITIES      
Purchase of fixed assets (14,071) (9,186) (9,294)
Purchase of majority interest in businesses, net of cash acquired (15,674) (133,087) (26,582)
Purchase of redeemable non-controlling interest, temporary equity (9,917) (8,052) (10,986)
Purchase of non controlling interest, permanent equity (273) (1,004) (281)
Proceeds on sale of non-controlling interest, permanent equity 30 26 102
Repayment of notes receivable related to sales of redeemable non-controlling interest 531 551 510
Proceeds on sale of partnership interest - redeemable non-controlling interest, temporary equity 186 79 875
Distributions from unconsolidated affiliate 1,411 1,080 830
Proceeds on sale of partnership interest, clinics and fixed assets 700 0 0
Other 364 143 (189)
Net cash used in investing activities (36,713) (149,450) (45,015)
FINANCING ACTIVITIES      
Proceeds from issuance of common stock pursuant to the secondary public offering, net of issuance costs 0 0 163,646
Proceeds from revolving facility 189,500 19,000 24,000
Distributions to non-controlling interest, permanent and temporary equity (19,269) (14,711) (16,100)
Cash dividends paid to shareholders (27,362) (26,540) (24,128)
Payments on revolving facility (170,000) (8,000) (55,000)
Payments on term loan (9,375) (3,750) (3,750)
Cash used for the repurchase of common stock (5,566) 0 0
Principal payments on notes payable (2,065) (2,952) (4,400)
Net cash (used in) provided by financing activities (44,137) (36,953) 84,268
Net (decrease) increase in cash and cash equivalents (5,792) (111,463) 121,231
Cash and cash equivalents - beginning of period 41,362 152,825 31,594
Cash and cash equivalents - end of period 35,570 41,362 152,825
Cash paid during the period for:      
Income taxes 14,348 4,823 4,926
Interest paid 9,431 7,209 8,655
Non-cash investing and financing transactions during the period:      
Purchase of businesses - seller financing portion 300 2,060 1,815
Liabilities assumed associated with a purchase of a business 0 670 524
Fair market value of initial contingent consideration related to purchase of businesses 5,292 17,672 200
Notes payable related to purchase of redeemable non-controlling interest, temporary equity 173 71 1,087
Payable related to the purchase of redeemable non-controlling interest, temporary equity 3,934 0 0
Offset to notes receivable associated with purchase of redeemable non-controlling interest 358 726 0
Notes receivable related to sale of redeemable non-controlling interest 0 1,890 4,136
Notes payable related to the purchase of non-controlling interest, permanent equity 0 0 200
Payable related to the purchase of non-controlling interest, permanent equity 8,144 0 0
Notes receivable related to the sale of non-controlling interest, permanent equity 73 282 458
Issuance of restricted stock related to purchase of business $ 0 $ 1,500 $ 0