0000950170-23-003127 | 10-K | XBRL Viewer | Pediatrix Medical Group INC

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Cover Page - USD ($)	12 Months Ended
Cover Page - USD ($)	Dec. 31, 2022	Feb. 10, 2023	Jun. 30, 2022
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Transition Report	false
Amendment Flag	false
Document Period End Date	Dec. 31, 2022
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	FY
Entity Registrant Name	Pediatrix Medical Group, Inc.
Entity Central Index Key	0000893949
Current Fiscal Year End Date	--12-31
Entity Well-known Seasoned Issuer	Yes
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Common Stock, Shares Outstanding		83,032,953
Entity Voluntary Filers	No
Title of 12(b) Security	Common Stock, par value $.01 per share
Trading Symbol	MD
Security Exchange Name	NYSE
Securities Act File Number	001-12111
Entity Incorporation, State or Country Code	FL
Entity Tax Identification Number	26-3667538
Entity Address, Address Line One	1301 Concord Terrace
Entity Address, City or Town	Sunrise
Entity Address, State or Province	FL
Entity Address, Postal Zip Code	33323
City Area Code	954
Local Phone Number	384-0175
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Public Float			$ 1,242,538,627
ICFR Auditor Attestation Flag	true
Auditor Name	PricewaterhouseCoopers LLP
Auditor Location	Hallandale Beach, Florida
Auditor Firm ID	238

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Current assets:
Cash and cash equivalents	$ 9,824	$ 387,391
Short-term investments	93,239	99,715
Accounts receivable, net	296,787	301,775
Prepaid expenses	14,878	18,538
Income taxes receivable	0	14,249
Other current assets	13,261	18,896
Total current assets	427,989	840,564
Property and equipment, net	73,290	70,154
Goodwill	1,532,092	1,505,430
Intangible assets, net	18,491	21,565
Operating and finance lease right-of-use assets	66,924	65,461
Deferred income tax assets	105,925	88,344
Other assets	123,176	131,028
Total assets	2,347,887	2,722,546
Current liabilities:
Accounts payable and accrued expenses	374,225	394,118
Current portion of debt and finance lease liabilities, net	14,898	2,490
Current portion of operating lease liabilities	21,589	19,684
Income taxes payable	16,271	11,074
Total current liabilities	426,983	427,366
Line of credit	4,000	0
Long-term debt and finance lease liabilities, net	632,381	1,002,258
Long-term operating lease liabilities	44,213	41,396
Long-term professional liabilities	275,629	271,093
Deferred income tax liabilities	33,638	41,409
Other liabilities	39,411	42,332
Total liabilities	1,456,255	1,825,854
Commitments and contingencies
Shareholders' equity:
Preferred stock; $.01 par value; 1,000 shares authorized; none issued	0	0
Common stock; $.01 par value; 200,000 shares authorized; 0 and 86,423 shares issued and outstanding, respectively	829	864
Additional paid-in capital	983,601	1,049,696
Accumulated other comprehensive income	(3,735)	1,317
Retained deficit	(89,063)	(155,390)
Total Pediatrix Medical Group, Inc. shareholders' equity	891,632	896,487
Noncontrolling interest	0	205
Total equity	891,632	896,692
Total liabilities and equity	$ 2,347,887	$ 2,722,546

Consolidated Balance Sheets (Parenthetical) - $ / shares	Dec. 31, 2022	Dec. 31, 2021
Statement of Financial Position [Abstract]
Preferred stock, par value	$ 0.01	$ 0.01
Preferred stock, shares authorized	1,000,000	1,000,000
Preferred stock, issued	0	0
Common stock, par value	$ 0.01	$ 0.01
Common stock, shares authorized	200,000,000	200,000,000
Common stock, shares issued	82,947,000	86,423,000
Common stock, shares outstanding	82,947,000	86,423,000

Consolidated Statements Of Income And Comprehensive Income - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Statement [Abstract]
Net revenue	$ 1,972,021	$ 1,911,191	$ 1,733,951
Operating expenses:
Practice salaries and benefits	1,383,319	1,297,477	1,193,940
Practice supplies and other operating expenses	121,669	100,472	90,690
General and administrative expenses	231,397	263,357	248,947
Gain on sale of building	0	(7,280)	0
Depreciation and amortization	35,636	32,147	28,441
Transformational and restructuring related expenses	27,312	22,100	73,801
Total operating expenses	1,799,333	1,708,273	1,635,819
Income from operations	172,688	202,918	98,132
Investment and other income	3,671	13,652	17,913
Interest expense	(39,695)	(68,722)	(110,482)
Loss on early extinguishment of debt	(57,016)	(14,532)	0
Equity in earnings of unconsolidated affiliates	1,722	1,912	1,585
Total non-operating expenses	(91,318)	(67,690)	(90,984)
Income from continuing operations before income taxes	81,370	135,228	7,148
Income tax provision	(18,806)	(27,241)	(16,728)
Income (loss) from continuing operations	62,564	107,987	(9,580)
Income (loss) from discontinued operations, net of tax	3,767	22,950	(786,908)
Net income (loss)	66,331	130,937	(796,488)
Net loss attributable to noncontrolling interests	4	27	0
Net income (loss) attributable to Pediatrix Medical Group, Inc.	66,335	130,964	(796,488)
Unrealized holding (loss) gain on investments, net of tax of $1,694, $742 and $1,157	(5,051)	(2,213)	3,452
Total comprehensive income (loss) attributable to Pediatrix Medical Group, Inc.	$ 61,284	$ 128,751	$ (793,036)
Income (loss) from continuing operations:
Basic	$ 0.75	$ 1.27	$ (0.11)
Diluted	0.74	1.26	(0.11)
Income (loss) from discontinued operations:
Basic	0.04	0.27	(9.44)
Diluted	0.05	0.27	(9.44)
Net income (loss) attributable to Pediatrix Medical Group, Inc.:
Basic	0.79	1.54	(9.55)
Diluted	$ 0.79	$ 1.53	$ (9.55)
Weighted average common shares:
Basic	83,467	84,832	83,395
Diluted	84,121	85,828	83,395

Condensed Consolidated Statements of Income (Parenthetical) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Statement [Abstract]
Net of Tax	$ 1,694	$ 742	$ 1,157

Consolidated Statements of Equity - USD ($)

Total

Common Stock [Member]

Additional Paid-in Capital [Member]

Retained Earnings [Member]

Balance at Dec. 31, 2019

$ 1,498,996,000

$ 842,000

$ 987,942,000

$ 510,212,000

Balance, Shares at Dec. 31, 2019

84,248,000

Net Income (loss)

(796,488,000)

Net loss attributable to noncontrolling interest

Contribution from noncontrolling Interests, net of loss

^[1]

232,000

Unrealized holding gain on investments, net of tax

^[1]

3,452,000

Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan

7,009,000

$ 5,000

7,004,000

Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan, shares

538,000

Issuance of restricted stock and conversion of restricted stock units to common stock

$ 15,000

(15,000)

Issuance of restricted stock and conversion of restricted stock units to common stock, shares

1,450,000

Issuance of restricted stock

1,450,000

Issuance of restricted stock Value

$ 15,000

(15,000)

Stock-based compensation expense

43,009,000

Forfeitures of restricted stock

$ 2,000

(2,000)

Forfeitures of restricted stock, shares

(173,000)

Repurchased common stock

(8,493,000)

$ (4,000)

(8,489,000)

Repurchased common stock, shares

(470,000)

Balance at Dec. 31, 2020

747,717,000

$ 856,000

1,029,453,000

(282,592,000)

Balance, Shares at Dec. 31, 2020

85,593,000

Net Income (loss)

130,964,000

Net loss attributable to noncontrolling interest

(27,000)

^[1]

Unrealized holding gain on investments, net of tax

^[1]

(2,213,000)

Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan

6,852,000

$ 3,000

6,849,000

Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan, shares

321,000

Issuance of restricted stock and conversion of restricted stock units to common stock

$ 7,000

(7,000)

Issuance of restricted stock and conversion of restricted stock units to common stock, shares

736,000

Issuance of restricted stock

736,000

Issuance of restricted stock Value

$ 7,000

(7,000)

Stock-based compensation expense

18,118,000

Forfeitures of restricted stock, shares

(55,000)

Repurchased common stock

(4,719,000)

$ (2,000)

(4,717,000)

Repurchased common stock, shares

(172,000)

Balance at Dec. 31, 2021

896,692,000

$ 864,000

1,049,696,000

(153,868,000)

Balance, Shares at Dec. 31, 2021

86,423,000

Net Income (loss)

66,335,000

Net loss attributable to noncontrolling interest

(4,000)

Dissolution Of And Net Income (Loss) Attributable to Noncontrolling Interest

(206,000)

8,000

(214,000)

Unrealized holding gain on investments, net of tax

(5,051,000)

Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan

5,396,000

$ 3,000

5,393,000

Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan, shares

287,000

Issuance of restricted stock and conversion of restricted stock units to common stock

$ 8,000

(8,000)

Issuance of restricted stock and conversion of restricted stock units to common stock, shares

841,000

Issuance of restricted stock

841,000

Issuance of restricted stock Value

$ 8,000

(8,000)

Stock-based compensation expense

16,977,000

Forfeitures of restricted stock

$ 1,000

(1,000)

Forfeitures of restricted stock, shares

(60,000)

Repurchased common stock

$ (88,511,000)

$ 45,000

88,466,000

Repurchased common stock, shares

4,544,000

Balance at Dec. 31, 2022

$ 891,632,000

$ 829,000

$ 983,601,000

$ 92,798,000

Balance, Shares at Dec. 31, 2022

82,947,000

[1]	Presented within retained (deficit) earnings as the balance is immaterial.

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Cash flows from operating activities:
Net Income (loss)	$ 66,335	$ 130,964	$ (796,488)
(Income) loss from discontinued operations	(3,767)	(22,950)	786,908
Adjustments to reconcile net income (loss) to net cash provided from operating activities:
Depreciation and amortization	35,636	32,147	28,441
Amortization of premiums, discounts and issuance costs	1,765	4,335	7,163
Loss on early extinguishment of debt	57,016	14,532	0
Stock-based compensation expense	16,127	18,968	39,042
Deferred income taxes	(22,771)	(31,239)	36,292
Gain on sale of building	0	(7,280)	0
Other	144	(2,350)	(198)
Changes in assets and liabilities:
Accounts receivable	(5,543)	(72,731)	37,937
Prepaid expenses and other current assets	15,928	41,530	(47,956)
Other long-term assets	17,196	9,799	13,916
Accounts payable and accrued expenses	420	21,326	47,908
Income taxes receivable (payable)	18,225	(2,285)	(6,931)
Payment of contingent consideration liabilities	0	(11)	0
Long-term professional liabilities	5,600	1,523	4,336
Other liabilities	(19,999)	(22,518)	3,518
Net cash provided by operating activities – continuing operations	182,312	113,760	153,888
Net cash (used in) provided by operating activities - discontinued operations	(15,371)	(37,023)	50,732
Net cash provided by operating activities	166,941	76,737	204,620
Cash flows from investing activities:
Acquisition payments, net of cash acquired	(28,167)	(29,930)	(2,225)
Purchases of investments	(17,346)	(15,052)	(61,845)
Proceeds from maturities or sales of investments	16,889	16,496	33,432
Purchases of property and equipment	(29,708)	(32,249)	(28,788)
Proceeds from sale of buildings	0	24,728	0
Strategic investments	0	(20,000)	0
Other	1,378	584	1,080
Net cash (used in) provided by investing activities – continuing operations	(56,954)	(55,423)	(58,346)
Net cash provided by investing activities - discontinued operations	0	2,350	873,857
Net cash (used in) provided by investing activities	(56,954)	(53,073)	815,511
Cash flows from financing activities:
Borrowings on credit agreement	830,000	0	527,500
Payments on credit agreement	(826,000)	0	(527,500)
Redemption of senior notes, including call premium	(1,046,880)	(759,848)	0
Proceeds from issuance of senior notes	650,000	0	0
Payments on term loan	(9,375)	0	0
Payments for credit facility amendment and financing costs	(8,621)	0	(510)
Payments of contingent consideration liabilities	0	(189)	0
Payments on finance lease obligations	(2,916)	(2,809)	(1,161)
Proceeds from issuance of common stock	5,396	6,853	7,009
Repurchases of common stock	(88,511)	(4,719)	(8,493)
Contribution from noncontrolling interests	0	0	245
Other	9,353	596	0
Net cash used in financing activities – continuing operations	(487,554)	(760,116)	(2,910)
Net cash used in financing activities – discontinued operations	0	0	(1,248)
Net cash used in financing activities	(487,554)	(760,116)	(4,158)
Net (decrease) increase in cash and cash equivalents	(377,567)	(736,452)	1,015,973
Cash, cash equivalents at beginning of year	387,391	1,123,843	107,870
Cash and cash equivalents at end of year	9,824	387,391	1,123,843
Supplemental disclosure of cash flow information:
Interest	116,235	86,537	110,488
Income taxes	26,908	54,728	(27,775)
Non-cash investing and financing activities:
Equipment financed through finance leases	282	6,762	12,507
Property and equipment included in accounts payable	$ 2,589	$ 2,300	$ 2,305

General

12 Months Ended

Dec. 31, 2022

Organization, Consolidation and Presentation of Financial Statements [Abstract]

General

1. General:

On July 1, 2022, effective after the close of the market, the Company changed its corporate name from “Mednax, Inc.” to “Pediatrix Medical Group, Inc.” signifying the Company's return to its core focus in caring for women, babies and children. The Company’s common stock continues to trade on the New York Stock Exchange under the ticker symbol “MD.”

The principal business activity of Pediatrix Medical Group, Inc. (“Pediatrix” or the “Company”) and its subsidiaries is to provide neonatal, maternal-fetal and other pediatric subspecialty physician services. The Company has contracts with affiliated business corporations or professional associations, limited liability companies and partnerships (“affiliated professional contractors”), which are separate legal entities that provide physician services in certain states and Puerto Rico. The Company ceased providing services in Puerto Rico effective December 31, 2022. The Company and its affiliated professional contractors also have contracts with hospitals and other healthcare facilities to provide physician services, which include (i) fee-for-service contracts, whereby hospitals and other customers agree, in exchange for the Company’s services, to authorize the Company and its healthcare professionals to bill and collect the charges for medical services rendered by the Company’s affiliated healthcare professionals, and (ii) administrative fee contracts, whereby the Company is assured a minimum revenue level.

Coronavirus Pandemic ("COVID-19")

12 Months Ended

Dec. 31, 2022

Text Block [Abstract]

Coronavirus Pandemic ("COVID-19")

3. Coronavirus Pandemic (“COVID-19”):

COVID-19 has had an impact on the demand for medical services provided by the Company’s affiliated clinicians. Beginning in mid-March 2020, the Company’s affiliated office-based practices, which specialize in maternal-fetal medicine, pediatric cardiology, and numerous pediatric subspecialties, experienced a significant elevation of appointment cancellations compared to historical normal levels. The Company believes COVID-19, either directly or indirectly, also had an impact on its neonatology intensive care unit (“NICU”) patient volumes, and there is no assurance that impacts from COVID-19 will not further adversely affect its NICU patient volumes or otherwise adversely affect its NICU and related neonatology business. Further, in late 2020, the Company saw a shift in the mix of patients reimbursed under government-sponsored healthcare programs, but that shift materially reversed during the year ended December 31, 2021. Overall, the Company’s operating results were significantly impacted by COVID-19 beginning in mid-March 2020, but volumes began to normalize in mid-2020 and substantially recovered throughout 2020 with no material impacts from COVID-19 or its variants in 2021 or 2022.

During 2020, the Company implemented a number of actions to preserve financial flexibility and partially mitigate the significant anticipated impact of COVID-19. These steps included a suspension of most activities related to the Company’s transformational and restructuring programs, limiting these expenditures to those that provide essential support for the Company’s response to COVID-19. In addition, (i) the Company temporarily reduced executive and key management base salaries, including 50% reductions in salaries for its named executive officers during the second quarter of 2020; (ii) the Board of Directors agreed to forego their annual cash retainer and cash meeting payments, also during the second quarter of 2020; (iii) the Company enacted a combination of salary reductions and furloughs for non-clinical employees; (iv) the Company enacted significant operational and practice-specific expense reduction plans across its clinical operations; and (v) the Company amended and restated its Credit Agreement.

Due to the continued uncertainties surrounding the timeline of and impacts from COVID-19 and with multiple variant strains still circulating, the Company is unable to predict the ultimate impact on its business, financial

condition, results of operations, cash flows and the trading price of its securities at this time. The Company, however, believes it will be able to generate sufficient liquidity to satisfy its obligations for the next twelve months.

CARES Act

In March 2020, the Coronavirus Aid, Relief, and Economic Security Act ("CARES Act") was signed into law. The CARES Act is a relief package intended to assist many aspects of the American economy, including providing up to $100 billion in aid to the healthcare industry to reimburse healthcare providers for lost revenue and expenses attributable to COVID-19. The remaining $70 billion in aid is intended to focus on providers in areas particularly impacted by COVID-19, rural providers, providers of services with lower shares of Medicare reimbursement or who predominantly serve the Medicaid population, and providers requesting reimbursement for the treatment of uninsured Americans. It is unknown what, if any, portion of the remaining healthcare industry funding of the CARES Act the Company and its affiliated physician practices will qualify for and receive. The Department of Health and Human Services (“HHS”) is administering this program and began disbursing funds in April 2020, of which the Company’s affiliated physician practices within continuing operations received an aggregate of $13.3 million, $26.1 million and $22.0 million during the years ended December 31, 2022, 2021 and 2020, respectively.

In addition, the CARES Act also provided for deferred payment of the employer portion of social security taxes through the end of 2020, and while the Company utilized this deferral option throughout 2020, it repaid all of the deferred amounts as of December 31, 2022.

Under current tax law, net operating losses can be carried forward indefinitely. The CARES Act enacted rules allowing net operating losses arising in 2020 to be carried back five taxable years. The Company generated a net operating loss for the 2020 tax year which has been carried back to the 2015 tax year under these provisions to obtain a refund of income tax at the prior 35% corporate tax rate.

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2022

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

2. Summary of Significant Accounting Policies:

Principles of Presentation

The consolidated financial statements include all the accounts of the Company and its subsidiaries combined with the accounts of the affiliated professional contractors with which the Company currently has specific management arrangements. The Company’s agreements with affiliated professional contractors provide that the term of the arrangements are in most cases permanent, subject only to termination by the Company, except in the case of gross negligence, fraud or bankruptcy of the Company. The Company has the right to receive income, both as ongoing fees and as proceeds from the sale of its interest in the Company’s affiliated professional contractors, in an amount that fluctuates based on the performance of the affiliated professional contractors and the change in the fair value of the Company’s interest in the affiliated professional contractors. The Company has exclusive responsibility for the provision of all non-medical services required for the day-to-day operation and management of the Company’s affiliated professional contractors and establishes the guidelines for the employment and compensation of the physicians. In addition, the agreements provide that the Company has the right, but not the obligation, to purchase, or to designate a person(s) to purchase, the stock of the Company’s affiliated professional contractors for a nominal amount. Separately, in its sole discretion, the Company has the right to assign its interest in the agreements. Based upon the provisions of these agreements, the Company has determined that the affiliated professional contractors are variable interest entities and that the Company is the primary beneficiary as defined in the accounting guidance for consolidation. All significant intercompany and interaffiliate accounts and transactions have been eliminated.

During the year ended December 31, 2021, the Company made a $20.0 million investment in a pediatric primary, urgent care and telehealth company with which it plans to develop new, innovative pediatric primary urgent care clinics throughout the United States with the goal of significantly enhancing the provision of pediatric care. The Company's investment is recorded as a cost method investment because the Company does not exercise significant influence over the entity in which it invested.

The Company is a party to a joint venture in which it owns a 37.5% economic interest. The Company accounts for this joint venture under the equity method of accounting because the Company exercises significant influence over, but does not control, this entity. The Company is also a party to a joint venture in which it owns a 51% economic interest and for which it is deemed the primary beneficiary. The equity interest of the outside investor in the equity of this consolidated entity is accounted for and presented as noncontrolling interest on the Company’s Consolidated Balance Sheets. The results from operations attributable to the noncontrolling interest are presented separately on the Company’s Consolidated Statements of Income and Comprehensive Income.

In 2020, the Company divested its anesthesiology services and radiology services medical groups. The operating results of these medical groups are reported as discontinued operations in the Company’s Consolidated Statements of Income and Comprehensive Income for the years ended December 31, 2020.

Accounting Estimates and Assumptions

The preparation of financial statements in conformity with accounting principles generally accepted in the United States (“GAAP”) requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the reporting periods. Significant estimates and assumptions are involved in the calculation of the Company's allowance for contractual adjustments and uncollectibles on accounts receivable, liabilities for self-insured amounts and claims incurred but not reported related to the Company’s professional liability risks and the fair value of goodwill. Actual results could differ from those estimates.

Segment Reporting

The Company has one reportable segment, which is also its single reporting unit, for purposes of presenting financial information in accordance with the accounting guidance for segment reporting.

The following table summarizes the Company’s net revenue from continuing operations by service line (in percentages):


	Years Ended December 31,
	2022			2021			2020
Neonatology and other pediatric subspecialties		79	%		77	%		77	%
Maternal-fetal medicine		16	%		18	%		18	%
Pediatric cardiology		5	%		5	%		5	%
		100	%		100	%		100	%

Revenue Recognition

Patient service revenue is recognized at the time services are provided by the Company’s affiliated physicians. The Company’s performance obligations related to the delivery of services to patients are satisfied at the time of service. Accordingly, there are no performance obligations that are unsatisfied or partially unsatisfied at the end of the reporting period with respect to patient service revenue. Almost all of the Company’s patient service revenue is reimbursed by GHC Programs and third-party insurance payors. Payments for services rendered to the Company’s patients are generally less than billed charges. The Company monitors its revenue and receivables from these sources and records an estimated contractual allowance to properly account for the anticipated differences between billed and reimbursed amounts.

Accordingly, patient service revenue is presented net of an estimated provision for contractual adjustments and uncollectibles. The Company estimates allowances for contractual adjustments and uncollectibles on accounts receivable based upon historical experience and other factors, including days sales outstanding (“DSO”) for accounts receivable, evaluation of expected adjustments and delinquency rates, past adjustments and collection experience in relation to amounts billed, an aging of accounts receivable, current contract and reimbursement terms, changes in payor mix and other relevant information. Contractual adjustments result from the difference between the physician rates for services performed and the reimbursements by GHC Programs and third-party insurance payors for such services.

Collection of patient service revenue the Company expects to receive is normally a function of providing complete and correct billing information to the GHC Programs and third-party insurance payors within the various filing deadlines and typically occurs within 30 to 60 days of billing.

Some of the Company’s hospital agreements require hospitals to pay the Company administrative fees. Some agreements provide for fees if the hospital does not generate sufficient patient volume in order to guarantee that the Company receives a specified minimum revenue level. The Company also receives fees from hospitals for

administrative services performed by its affiliated physicians providing medical director or other services at the hospital.

Accounts receivable are primarily amounts due under fee-for-service contracts from third-party payors, such as insurance companies, self-insured employers and patients and GHC Programs geographically dispersed throughout the United States and its territories. Concentration of credit risk relating to accounts receivable is limited by the number, diversity and geographic dispersion of the business units managed by the Company, as well as by the large number of patients and payors, including the various governmental agencies in the states in which the Company provides services. Receivables from GHC Programs made up approximately 21% of net accounts receivable related to continuing operations at December 31, 2022 and 2021.

Cash and Cash Equivalents

Cash equivalents are defined as all highly liquid financial instruments with maturities of 90 days or less from the date of purchase. The Company’s cash equivalents typically consist of demand deposits, amounts on deposit in money market accounts, and funds invested in overnight repurchase agreements. Cash equivalent balances may, at certain times, exceed federally insured limits. Certain cash equivalents carried by the Company are subject to the fair value provisions of the accounting guidance for fair value measurements. See “Fair Value Measurements” below.

Investments

Investments consist primarily of corporate securities, municipal debt securities, federal home loan securities and certificates of deposit. The Company classifies its investments as available for sale. Although there is no stated expectation that the investments will be sold within one year, the investments are available for use, if needed, and accordingly are classified as short-term. Such investments are carried at fair value with any unrealized gains and losses reported as a component of other accumulated comprehensive income or loss.

With respect to the Company's cost method investment in a pediatric primary, urgent care and telehealth company, the Company has elected the measurement alternative to measure cost method investments that do not have a readily determinable fair value at cost less impairment, adjusted by observable price changes with any fair value changes recognized in earnings.

Property and Equipment

Property and equipment are recorded at original purchase cost. Depreciation of property and equipment is computed using the straight-line method over the estimated useful lives of the underlying assets. Estimated useful lives are generally 30 years for buildings; three to seven years for medical equipment, computer equipment, software and furniture; and the lesser of the useful life or the remaining lease term for leasehold improvements and finance leases. Upon sale or retirement of property and equipment, the related cost and accumulated depreciation are eliminated from the respective accounts and any resulting gain or loss is included in earnings.

Business Acquisitions

The Company accounts for all business acquisitions at fair value and expenses acquisition costs as they are incurred. Any identifiable assets acquired and liabilities assumed are recognized and measured at their respective fair values on the acquisition date. If information about facts and circumstances existing as of the acquisition date is incomplete at the end of the reporting period in which a business acquisition occurs, the Company will report provisional amounts for the items for which the accounting is incomplete. The measurement period ends once the Company receives sufficient information to finalize the fair values; however, the period will not exceed one year from the acquisition date. Any adjustments to provisional amounts that are identified during the measurement period are recognized in the reporting period in which the adjustment amounts are determined.

In connection with certain acquisitions, the Company enters into agreements to pay additional amounts in cash or common stock based on the achievement of certain performance measures for up to five years ending after the acquisition dates. The Company measures this contingent consideration at fair value at the acquisition date and records such contingent consideration as a liability or equity on the Company’s Consolidated Balance Sheets on the acquisition

date. The fair value of each contingent consideration liability is remeasured at each reporting period with any change in fair value recognized as income or expense within operations in the Company’s Consolidated Statements of Income and Comprehensive Income.

Goodwill and Other Intangible Assets

The Company records acquired assets and assumed liabilities at their respective fair values under the acquisition method of accounting. Goodwill represents the excess of purchase price over the fair value of the net assets acquired. Intangible assets with finite lives, principally physician and hospital agreements, are recognized apart from goodwill at the time of acquisition based on the contractual-legal and separability criteria established in the accounting guidance. Intangible assets with finite lives are amortized on either an accelerated basis based on the annual undiscounted economic cash flows associated with the particular intangible asset or on a straight-line basis over their estimated useful lives. Intangible assets with finite lives are amortized over periods of one to 20 years.

Goodwill is tested for impairment at a reporting unit level on at least an annual basis in accordance with the subsequent measurement provisions of the accounting guidance for goodwill. When testing goodwill for impairment, the Company may assess qualitative factors for its reporting units to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount, including goodwill. Alternatively, the Company may bypass this qualitative assessment and perform the quantitative goodwill impairment test.

The Company completed annual impairment tests for its continuing operations in the third quarter of each of 2022, 2021 and 2020 and determined that goodwill was not impaired. See Note 8 – Goodwill and Intangible Assets for more information. For 2022, 2021 and 2020, the Company elected to perform the qualitative assessment, focused on various factors including macroeconomic conditions, market trends, specific reporting unit financial performance and other entity specific events, to determine if it was more likely than not that the fair value of its single reporting unit exceeded its carrying value, including goodwill. The Company considered the economic outlook for the healthcare services industry and various other factors during the testing process, including hospital and physician contract changes, local market developments, changes in third-party payor payments, and other publicly available information.

Long-Lived Assets

The Company is required to evaluate long-lived assets, including intangible assets subject to amortization, whenever events or changes in circumstances indicate that the carrying value of the assets may not be fully recoverable. The recoverability of such assets is measured by a comparison of the carrying value of the assets to the future undiscounted cash flows before interest charges to be generated by the assets. If long-lived assets are impaired, the impairment to be recognized is measured as the excess of the carrying value over the fair value. Long-lived assets held for disposal are reported at the lower of the carrying value or fair value less disposal costs. The Company does not believe there are any indicators that would require an adjustment to such assets or their estimated periods of recovery at December 31, 2022 pursuant to current accounting standards.

Common Stock Repurchases

The Company repurchases shares of its common stock as authorized from time to time by its Board of Directors. The Company treats repurchased shares of its common stock as retired as any repurchased shares become authorized but unissued shares. The reacquisition cost of repurchased shares is recorded as a reduction in the respective components of shareholders’ equity.

Professional Liability Coverage

The Company maintains professional liability insurance policies with third-party insurers generally on a claims-made basis, subject to deductibles or self-insured retention, exclusions and other restrictions. The Company’s self-insured retention under its professional liability insurance program is maintained primarily through a wholly owned captive insurance subsidiary. The Company records an estimate of liabilities for self-insured amounts and claims incurred but not reported based on an actuarial valuation using historical loss information, claim emergence patterns and various actuarial assumptions. Liabilities for claims incurred but not reported are not discounted.

Income Taxes

The Company records deferred income taxes using the liability method, whereby deferred tax assets and liabilities are determined based on the difference between the financial statement and tax bases of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. If it is more likely than not that all or a portion of deferred tax assets will not be realized, a valuation allowance is provided against such deferred tax assets. In making such determination, the Company considers all available positive and negative evidence, including future reversals of existing taxable temporary differences, projected future taxable income, tax-planning strategies, and results of recent operations.

The accounting guidance for uncertain tax positions prescribes a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The guidance also requires policy disclosures regarding penalties and interest and extensive disclosures regarding increases and decreases in uncertain tax positions as a result of tax positions taken in a current or prior period, settlements with taxing authorities and any lapse of an applicable statute of limitations. Additional qualitative discussion is required for any tax position that may result in a significant increase or decrease in uncertain tax positions within a 12-month period from the Company's reporting date.

Stock Incentive Plans

The Company grants stock-based awards consisting primarily of restricted stock to key employees under its Amended and Restated 2008 Incentive Compensation Plan. The Company measures the cost of employee services received in exchange for stock-based awards based on grant-date fair value and allocates the resulting compensation expense over the corresponding requisite service period using the graded vesting attribution method. The Company also performs analyses to estimate forfeitures of stock-based awards on an annual basis and adjusts the estimates as necessary based on the number of awards that ultimately vest.

Net Income Per Common Share

Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the period. Diluted net income per common share is calculated by dividing net income by the weighted average number of common and potential common shares outstanding during the period. Potential common shares consist of outstanding restricted stock, deferred stock and stock options and is calculated using the treasury stock method.

Fair Value Measurements

The accounting guidance establishes a fair value hierarchy that prioritizes valuation inputs into three levels based on the extent to which inputs used in measuring fair value are observable in the market. Each fair value measurement is reported in one of three levels:

Level 1 – inputs are based upon unadjusted quoted prices for identical instruments traded in active markets.

Level 2 – inputs are based upon quoted prices for similar instruments in active markets, quoted prices for identical or similar instruments in markets that are not active, and model-based valuation techniques for which all significant assumptions are observable in the market or can be corroborated by observable market data for substantially the full term of the assets or liabilities.

Level 3 – inputs are generally unobservable and typically reflect management’s estimates of assumptions that market participants would use in pricing the asset or liability. The fair values are therefore determined using model-based techniques that include option pricing models, discounted cash flow models, and similar techniques.

The following table presents information about the Company’s financial instruments that are accounted for at fair value on a recurring basis at December 31, 2022 and 2021 (in thousands):


		Fair Value
	Fair Value Category	December 31, 2022		December 31, 2021
Assets:
Money market funds	Level 1	$	1,415	$	2,442
Short-term investments	Level 2		93,239		99,715
Mutual funds	Level 1		14,544		18,542

The following table presents information about the Company’s financial instruments that are not carried at fair value at December 31, 2022 and 2021 (in thousands):


	December 31, 2022				December 31, 2021
	Carrying Amount		Fair Value		Carrying Amount		Fair Value
Liabilities:
2027 Notes		—		—		1,000,000		1,047,190
2030 Notes		400,000		344,000		—		—

The Company redeemed the full principal balance of its 6.25% senior unsecured notes due 2027 (the “2027 Notes”) in February 2022.

The carrying amounts of cash equivalents, accounts receivable and accounts payable and accrued expenses approximate fair value due to the short maturities of the respective instruments. The carrying value of the line of credit approximates fair value. If the Company’s line of credit was measured at fair value, it would be categorized as Level 2 in the fair value hierarchy.

Investments

12 Months Ended

Dec. 31, 2022

Investments, Debt and Equity Securities [Abstract]

Investments

4. Investments:

Investments held are summarized as follows (in thousands):


	December 31,
	2022		2021
Corporate securities	$	61,385	$	72,964
Municipal debt securities		14,377		13,215
U.S. Treasury securities		10,205		5,205
Certificates of deposit		3,710		4,404
Federal home loan securities		3,562		3,927
	$	93,239	$	99,715

Accounts Receivable and Net Revenue

12 Months Ended

Dec. 31, 2022

Text Block [Abstract]

Accounts Receivable and Net Revenue

5. Accounts Receivable and Net Revenue:

Accounts receivable, net consists of the following (in thousands):


	December 31,
	2022			2021
Gross accounts receivable	$	1,548,492		$	1,393,584
Allowance for contractual adjustments and uncollectibles		(1,251,705	)		(1,091,809	)
	$	296,787		$	301,775

Net revenue consists of the following (in thousands):


	Years Ended December 31,
	2022		2021		2020
Net patient service revenue	$	1,688,818	$	1,641,323	$	1,481,331
Hospital contract administrative fees		262,931		240,022		218,495
Other revenue		20,272		29,846		34,125
	$	1,972,021	$	1,911,191	$	1,733,951

The following is a summary of the Company’s payor mix, expressed as a percentage of net revenue, exclusive of administrative fees and other miscellaneous revenue, for the periods indicated:


	Years Ended December 31,
	2022			2021			2020
Contracted managed care		66	%		68	%		68	%
Government		26	%		25	%		27	%
Other third-parties		6	%		5	%		4	%
Private-pay patients		2	%		2	%		1	%
		100	%		100	%		100	%

Accounts receivable consist primarily of amounts due from GHC Programs and third-party insurance payors for services provided by the Company’s affiliated physicians.

Net revenue consists primarily of gross billed charges for services provided by the Company’s affiliated physicians less an estimated allowance for contractual adjustments and uncollectibles to properly account for the anticipated differences between gross billed charge amounts and expected reimbursement amounts.

The Company's contractual adjustments and uncollectibles as a percentage of gross patient service revenue vary slightly each year depending on several factors, including improved managed care contracting, changes in reimbursement from state Medicaid programs and other GHC Programs, shifts in the percentage of patient services being reimbursed under GHC Programs and annual price increases.

The Company’s annual price increases typically increase contractual adjustments as a percentage of gross patient service revenue. This increase is primarily due to Medicare, Medicaid and other GHC Programs that generally provide for reimbursements on a fee-schedule basis rather than on a gross charge basis. When the Company bills these programs, like other payors, on a gross-charge basis, it also increases its provision for contractual adjustments and uncollectibles by the amount of any price increase, resulting in a higher contractual adjustment percentage.

Property and Equipment

12 Months Ended

Dec. 31, 2022

Property, Plant and Equipment [Abstract]

Property and Equipment

6. Property and Equipment:

Property and equipment consists of the following (in thousands):


	December 31,
	2022			2021
Building	$	8,286		$	8,286
Land		2,032			2,032
Equipment and other		235,190			224,524
		245,508			234,842
Accumulated depreciation		(172,218	)		(164,688	)
	$	73,290		$	70,154

The Company recorded depreciation expense of $26.7 million, $21.6 million and $19.3 million for the years ended December 31, 2022, 2021 and 2020, respectively.

Business Combinations

12 Months Ended

Dec. 31, 2022

Business Combinations [Abstract]

Business Combinations

7. Business Combinations:

During the year ended December 31, 2022, the Company completed the acquisition of one multi-location pediatric urgent care practice and one pediatric gastroenterology practice for total consideration of $31.3 million, of which $26.5 million was paid in cash at closing and $4.8 million is recorded as contingent consideration liabilities. These acquisitions expanded the Company’s national network of physician practices across women’s and children’s services and particularly expanded its presence in the pediatric primary and urgent care service line. In connection with these acquisitions, the Company recorded tax deductible goodwill of $26.7 million, other intangible assets consisting primarily of physician and hospital agreements of $2.3 million, fixed assets of $2.2 million and other non-current assets of $0.1 million.

During the year ended December 31, 2021, the Company completed the acquisition of nine physician practices consisting of one pediatric orthopedic practice, one multi-location pediatric urgent care practice, one pediatric cardiology practice, two pediatric neurology practices, one maternal-fetal medicine practice, one obstetrics and gynecology practice, one pediatric intensivist practice and one neonatology practice for total consideration of $34.9 million, of which $29.9 was paid in cash at closing and $5.0 million is recorded as current and long-term liabilities for amounts payable in future periods. These acquisitions expanded the Company’s national network of physician practices across women’s and children’s services. In connection with these acquisitions, the Company recorded tax deductible goodwill of $27.9 million, other intangible assets consisting primarily of physician and hospital agreements of $3.5 million and fixed assets of $3.5 million.

Goodwill and Intangible Assets

12 Months Ended

Dec. 31, 2022

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

8. Goodwill and Intangible Assets:

Goodwill was $1.53 billion and $1.51 billion at December 31, 2022 and 2021, respectively. Goodwill is tested for impairment on at least an annual basis, in accordance with the subsequent measurement provisions of the accounting guidance for goodwill. Consistent with prior years, the Company performed its annual impairment test in the third quarter of 2022 and determined that goodwill was not impaired.

Intangible assets, net, consist of the following (in thousands):


	December 31, 2022
	Gross Carrying Value		Accumulated Amortization			Net Carrying Value
Physician and hospital agreements	$	101,325	$	(85,457	)	$	15,868
Other technology		8,695		(6,072	)		2,623
	$	110,020	$	(91,529	)	$	18,491


	December 31, 2021
	Gross Carrying Value		Accumulated Amortization			Net Carrying Value
Physician and hospital agreements	$	101,542	$	(83,440	)	$	18,102
Other technology		7,801		(4,338	)		3,463
	$	109,343	$	(87,778	)	$	21,565

During the year ended December 31, 2022, the Company recorded intangible assets related to acquisitions totaling $2.3 million, consisting primarily of physician and hospital agreements. The weighted-average amortization period for these physician and hospital agreements is approximately 13 years.

Amortization expense for intangible assets was $6.4 million, $8.0 million and $7.6 million for the years ended December 31, 2022, 2021 and 2020, respectively.

Amortization expense for existing intangible assets for the next five years is expected to be as follows (in thousands):


2023	$	5,173
2024		3,561
2025		2,095
2026		1,426
2027		1,140

Discontinued Operations

12 Months Ended

Dec. 31, 2022

Discontinued Operations and Disposal Groups [Abstract]

Discontinued Operations

9. Discontinued Operations:

The Company divested its anesthesiology services medical group in May 2020. During the year ended December 31, 2022, the Company recorded a net decrease to the loss on sale of $3.4 million, primarily for certain transaction related true ups.

The Company divested its radiology services medical group in December 2020. During the year ended December 31, 2022, the Company recorded a net decrease of $0.4 million to the loss on sale, primarily for certain transaction related true ups, with the loss for the year ended December 31, 2022 representing the Company's best estimate of the final working capital true up that is expected to be settled during the first quarter of 2023.

The net changes to the losses on sale are reflected as a component of discontinued operations, net of income taxes, in the Company’s Consolidated Statements of Income and Comprehensive Income for the year ended December 31, 2022 as relevant.

Accounts Payable and Accrued Expenses

12 Months Ended

Dec. 31, 2022

Payables and Accruals [Abstract]

Accounts Payable and Accrued Expenses

10. Accounts Payable and Accrued Expenses:

Accounts payable and accrued expenses consist of the following (in thousands):


	December 31,
	2022		2021

Accounts payable	$	31,857	$	36,645
Accrued salaries and incentive compensation		197,831		213,974
Accrued payroll taxes and benefits		34,983		34,994
Accrued professional liabilities		32,232		37,729
Accrued interest		8,921		29,052
Other accrued expenses		68,401		41,724
	$	374,225	$	394,118

Operating Leases

12 Months Ended

Dec. 31, 2022

Leases [Abstract]

Operating Leases

11. Operating Leases:

The Company primarily leases property under operating leases and had one material equipment operating lease for an aircraft that expired in January 2022. The Company’s property leases are primarily for its regional, medical and business offices, storage space and temporary housing for medical staff.

For leases with terms greater than 12 months, the Company records the related asset and obligation at the present value of the lease payment using a discount rate that reflects the Company’s estimated incremental borrowing rate. Certain of the Company’s leases include rental escalation clauses and renewal options that are factored into the determination of lease payments when appropriate. Operating leases for office equipment are not material, and therefore are excluded from the Company’s Consolidated Balance Sheet.

The table below presents the operating lease-related right-of-use assets and related liabilities recorded on the Company’s balance sheet and the weighted average remaining lease term and discount rate as of December 31, 2022 and 2021 (dollars in thousands):


	December 31,
	2022			2021
Assets:
Operating lease right-of-use assets	$	55,796		$	51,283
Liabilities:
Current portion of operating lease liabilities		21,589			19,684
Long-term portion of operating lease liabilities		44,213			41,396
Other Information:
Weighted-average remaining lease term	3.9 years			3.7 years
Weighted average discount rate		4.6	%		4.7	%

The table below presents certain information related to the lease costs for operating leases during the years ended December 31, 2022 and 2021 (in thousands):


	December 31,
	2022		2021
Operating lease costs	$	22,293	$	19,907
Variable lease costs		6,640		5,060
Other operating lease costs		4,218		4,235
Total operating lease costs	$	33,151	$	29,202

The table below presents supplemental cash flow information related to operating leases during the years ended December 31, 2022 and 2021 (in thousands):


	December 31, 2022		December 31, 2021
Operating cash flows for operating leases	$	37,549	$	34,054

The table below reconciles the undiscounted cash flows for each of the first five years and total of the remaining years to the operating lease liabilities recorded on the balance sheet as of December 31, 2022 (in thousands):


	December 31, 2022
2023	$	21,994
2024		19,242
2025		12,162
2026		7,634
2027		4,496
Thereafter		5,175
Total minimum lease payments		70,703
Less: Amount of payments representing interest		(4,901	)
Present value of future minimum lease payments		65,802
Less: Current obligations		(21,589	)
Long-term portion of operating leases	$	44,213

Accrued Professional Liabilities

12 Months Ended

Dec. 31, 2022

Health Care Organizations [Abstract]

Accrued Professional Liabilities

12. Accrued Professional Liabilities:

At December 31, 2022 and 2021, the Company’s total accrued professional liabilities of $307.9 million and $308.8 million, respectively, included incurred but not reported loss reserves of $215.5 million and $211.2 million, respectively, and loss reserves for reported claims of $92.4 million and $97.6 million, respectively. Of the total liability at December 31, 2022, $32.2 million is classified as a current liability within accounts payable and accrued expenses in the Consolidated Balance Sheet. In addition, there is a corresponding insurance receivable of $54.7 million recorded as a component of other assets for certain professional liability claims that are covered by third-party insurance policies. These reserves include the accrued professional liabilities for the Company’s continuing operations as reflected in the table below as well as certain retained professional liabilities related to the Company’s former anesthesiology and radiology medical groups that were divested in 2020.

The activity related to the Company’s accrued professional liability for continuing operations, excluding the retained professional liabilities related to the Company’s former anesthesiology and radiology medical groups, for the years ended December 31, 2022, 2021, and 2020 is as follows (in thousands):


	Years Ended December 31,
	2022			2021			2020
Balance at beginning of year	$	190,127		$	174,803		$	151,397
Liabilities recognized, offset by insurance receivable		(2,692	)		(2,299	)		3,922
Provision (adjustment) for losses related to:
Current year		53,180			56,016			45,674
Prior years		(4,056	)		(14,231	)		(1,551	)
Total provision for losses		49,124			41,785			44,123
Claim payments related to:
Current year		(73	)		(59	)		(59	)
Prior years		(36,925	)		(24,103	)		(24,580	)
Total payments		(36,998	)		(24,162	)		(24,639	)
Balance at end of year	$	199,561		$	190,127		$	174,803

The net increases in the Company’s total accrued professional liability for the years ended December 31, 2022 and 2021 were primarily related to certain changes in the Company’s claims experience that impacted its provision for losses.

Line of Credit, Long-Term Debt and Finance Lease Obligations

12 Months Ended

Dec. 31, 2022

Debt Disclosure [Abstract]

Line of Credit, Long-Term Debt and Finance Lease Obligations

13. Line of Credit, Long-Term Debt and Finance Lease Obligations:

On February 11, 2022, the Company issued $400.0 million of 5.375% unsecured senior notes due 2030 (the “2030 Notes”). The Company used the net proceeds from the issuance of the 2030 Notes, together with $100.0

million drawn under the Revolving Credit Line (as defined below), $250.0 million of Term A Loan (as defined below) and approximately $308.0 million of cash on hand, to redeem (the “Redemption”) the 2027 Notes, which had an outstanding principal balance of $1.0 billion, and to pay costs, fees and expenses associated with the Redemption and the Credit Agreement Amendment (as defined below).

Interest on the 2030 Notes accrues at the rate of 5.375% per annum, or $21.5 million, and is payable semi-annually in arrears on February 15 and August 15, beginning on August 15, 2022. The Company's obligations under the 2030 Notes are guaranteed on an unsecured senior basis by the same subsidiaries and affiliated professional contractors that guarantee the Amended Credit Agreement (as defined below). The indenture under which the 2030 Notes are issued, among other things, limits the Company's ability to (1) incur liens and (2) enter into sale and lease-back transactions, and also limits the Company's ability to merge or dispose of all or substantially all of its assets, in all cases, subject to a number of customary exceptions. Although the Company is not required to make mandatory redemption or sinking fund payments with respect to the 2030 Notes, upon the occurrence of a change in control, the Company may be required to repurchase the 2030 Notes at a purchase price equal to 101% of the aggregate principal amount of the 2030 Notes repurchased plus accrued and unpaid interest.

Also in connection with the Redemption, the Company amended its credit agreement (the “Credit Agreement”, and such amendment, the "Credit Agreement Amendment"), concurrently with the issuance of the 2030 Notes. The Credit Agreement Amendment, among other things, (i) refinanced the prior unsecured revolving credit facility with a $450 million unsecured revolving credit facility, including a $37.5 million sub-facility for the issuance of letters of credit (the “Revolving Credit Line”), and a new $250 million term A loan facility (“Term A Loan”) and (ii) removed JPMorgan Chase Bank, N.A., as the administrative agent under the Credit Agreement and appointed Bank of America, N.A. as the administrative agent for the lenders.

The Credit Agreement, as amended by the Credit Agreement Amendment (the “Amended Credit Agreement”) matures on February 11, 2027 and is guaranteed on an unsecured basis by substantially all of the Company's subsidiaries and affiliated professional contractors. At the Company's option, borrowings under the Amended Credit Agreement bear interest at (i) the Alternate Base Rate (defined as the highest of (a) the prime rate as announced by Bank of America, N.A., (b) the Federal Funds Rate plus 0.50% and (c) Term Secured Overnight Financing Rate ("SOFR") for an interest period of one month plus 1.00% with a 1.00% floor) plus an applicable margin rate of 0.50% for the first two fiscal quarters after the date of the Credit Agreement Amendment, and thereafter at an applicable margin rate ranging from 0.125% to 0.750% based on the Company's consolidated net leverage ratio or (ii) Term SOFR rate (calculated as the Secured Overnight Financing Rate published on the applicable Reuters screen page plus a spread adjustment of 0.10%, 0.15% or 0.25% depending on if the Company selects a one-month, three-month or six-month interest period, respectively, for the applicable loan with a 0% floor), plus an applicable margin rate of 1.50% for the first two full fiscal quarters after the date of the Credit Agreement Amendment, and thereafter at an applicable margin rate ranging from 1.125% to 1.750% based on the Company's consolidated net leverage ratio. The Amended Credit Agreement also provides for other customary fees and charges, including an unused commitment fee with respect to the Revolving Credit Line ranging from 0.150% to 0.200% of the unused lending commitments under the Revolving Credit Line, based on the Company's consolidated net leverage ratio.

The Amended Credit Agreement contains customary covenants and restrictions, including covenants that require the Company to maintain a minimum interest coverage ratio, a maximum consolidated total consolidated net leverage ratio and to comply with laws, and restrictions on the ability to pay dividends, incur indebtedness or liens and make certain other distributions subject to baskets and exceptions, in each case, as specified therein. Failure to comply with these covenants would constitute an event of default under the Amended Credit Agreement, notwithstanding the ability of the Company to meet its debt service obligations. The Amended Credit Agreement includes various customary remedies for the lenders following an event of default, including the acceleration of repayment of outstanding amounts under the Amended Credit Agreement. In addition, the Company may increase the principal amount of the Revolving Credit Line or incur additional term loans under the Amended Credit Agreement in an aggregate principal amount such that on a pro forma basis after giving effect to such increase or additional term loans, the Company would be in compliance with the financial covenants, subject to the satisfaction of specified conditions and additional caps in the event that the Amended Credit Agreement is secured.

The carrying value of the Company’s long-term debt was $637.2 million and $989.7 million at December 31, 2022 and 2021, respectively, and consisted of the following (in thousands):


	December 31, 2022
	Principal		Unamortized Debt Issuance Costs			Total
Senior notes	$	400,000	$	(5,069	)	$	394,931
Revolving line of credit		4,000		(1,489	)		2,511
Term A loan		240,625		(827	)		239,798
Total	$	644,625	$	(7,385	)	$	637,240


	December 31, 2021
	Principal		Unamortized Debt Issuance Costs			Total
Senior notes	$	1,000,000	$	(9,712	)	$	990,288
Revolving line of credit		—		(628	)		(628	)
Total	$	1,000,000	$	(10,340	)	$	989,660

The Company presents issuance costs related to long-term debt liabilities, other than revolving credit and term loan arrangements, as a direct deduction from the carrying value of that long-term debt. The Company had no outstanding letters of credit at December 31, 2022. At December 31, 2022, the Company had an available balance on its Amended Credit Agreement of $446.0 million.

The carrying values of the Company’s variable rate revolving line of credit and term A loan approximate fair value due to the short-term nature of the interest rates. The estimated fair value of the Company’s 2027 Notes and 2030 Notes, for relevant periods, were estimated using trading prices as of December 31, 2022 and 2021, respectively, as Level 2 inputs to estimate fair value for relevant periods and are summarized as follows (in thousands):


	December 31,
	2022		2021
2027 Notes	$	—	$	1,047,190
2030 Notes		344,000		—

The Company redeemed the full principal balance of its 2027 Notes in February 2022.

The Company’s finance lease obligations, related to equipment used in its newborn hearing screen program, consist of the following (in thousands):


	December 31,
	2022			2021
Finance lease obligations	$	11,128		$	14,178
Less: Current portion		(2,398	)		(2,490	)
Long-term portion	$	8,730		$	11,688

Income Taxes

12 Months Ended

Dec. 31, 2022

Income Tax Disclosure [Abstract]

Income Taxes

14. Income Taxes:

The components of the income tax provision (benefit) are as follows (in thousands):


	December 31,
	2022			2021			2020
Federal:
Current	$	38,877		$	41,592		$	(16,610	)
Deferred		(19,679	)		(20,373	)		28,719
		19,198			21,219			12,109
State:
Current		2,700			16,888			(2,954	)
Deferred		(3,092	)		(10,866	)		7,573
		(392	)		6,022			4,619
Total	$	18,806		$	27,241		$	16,728

The Company files its tax return on a consolidated basis with its subsidiaries, and its affiliated professional contractors file tax returns on an individual basis.

The effective tax rate for continuing operations was 23.1%, 20.1% and 234.0% for the years ended December 31, 2022, 2021 and 2020, respectively. The effective tax rate for the year ended December 31, 2021 includes a $10.8 million benefit related to a change in estimate of an income tax receivable based on loss carryback provisions under the CARES Act which allow 2020 net operating loss to be carried back for refund at prior 35% federal tax rate. The income tax receivable resulted from a mutual agreement reached with the buyer of our former anesthesiology services medical group to treat a portion of the divestiture as an asset sale for tax purposes. The effective tax rate for the year ended December 31, 2020 was not meaningful due to a significant reduction in pre-tax income as a result of the impacts from transformational and restructuring related expenses and COVID-19.

The differences between the effective rate and the United States federal income tax statutory rate are as follows:


	December 31,
	2022			2021			2020
Tax at statutory rate		21.00	%		21.00	%		21.00	%
State income tax, net of federal benefit		1.53			4.72			24.34
Non-deductible expenses		1.48			3.42			60.44
Equity compensation adjustments		1.35			0.77			98.61
Change in accrual estimates relating to uncertain tax positions		(3.28	)		(1.08	)		4.22
Change in valuation allowance		1.72			(0.26	)		23.67
Other, net		(0.69	)		(0.46	)		1.71
Change in tax law	─				(7.97	)	─
Income tax provision		23.11	%		20.14	%		233.99	%

All of the Company’s deferred tax assets and liabilities are classified as long-term. The significant components of deferred income tax assets and liabilities are as follows (in thousands):


	December 31,
	2022			2021
Allowance for uncollectible accounts	$	152,526		$	135,280
Reserves and accruals		66,969			55,549
Stock-based compensation		3,694			3,303
Operating loss and other carryforwards		28,773			29,045
Capital loss carryforwards		422,793			428,805
Operating lease assets		19,096			18,960
Property and equipment		2,481			1,967
Other		256			686
Deferred tax assets before valuation allowance		696,588			673,595
Less: Valuation allowance		(429,260	)		(441,529	)
Deferred tax assets, net of valuation allowance		267,328			232,066
Gross deferred tax liabilities:
Amortization		(176,398	)		(168,505	)
Operating lease liabilities		(16,510	)		(16,439	)
Other		(2,133	)		(187	)
Total deferred tax liabilities		(195,041	)		(185,131	)
Net deferred tax assets	$	72,287		$	46,935

The Company’s net deferred tax assets were $72.3 million as of December 31, 2022, as compared to $46.9 million at December 31, 2021. The increase in net deferred tax assets of $25.4 million during the year ended December 31, 2022 was primarily related to an increase in deferred tax assets related to the allowance for uncollectible accounts of $17.2 million, valuation allowance of $12.2 million and reserves and accruals of $11.4 million, partially offset by an increase in deferred tax liabilities for amortization of $7.9 million. The decrease in valuation allowance was predominantly offset by adjustments to the carrying value of corresponding deferred tax assets.

For the years ended December 31, 2022, 2021 and 2020, income tax expense of $1.1 million, $1.0 million and $7.1 million, respectively, was recognized for excess tax deficiencies associated with equity compensation.

The Company has $1.71 billion of capital loss carryforwards as of December 31, 2022 which were generated from disposal of its former anesthesiology and radiology services medical groups, of which $1.69 billion expire in 2025 and $25.9 million expire in 2027. As of December 31, 2022, management has determined that it is more likely than not that the tax benefits related to these carryforwards will not be realized and has recorded a full valuation allowance against the related deferred tax assets. Additionally, the Company has net operating loss carryforwards for federal and state tax purposes totaling $46.7 million, $61.7 million and $35.4 million at December 31, 2022, 2021 and 2020, respectively. With respect to the December 31, 2022 balance, $26.4 million expires at various times from 2033 through 2042, and $20.3 million does not expire.

As of December 31, 2022, 2021 and 2020, the Company’s liability for uncertain tax positions, excluding accrued interest and penalties, was $2.8 million, $4.9 million and $6.2 million, respectively. As of December 31, 2022, the Company had $2.8 million of uncertain tax positions that, if recognized, would favorably impact its effective tax rate.

The following table summarizes the activity related to the Company’s liability for uncertain tax positions for the years ended December 31, 2022, 2021 and 2020 (in thousands):


	Years Ended December 31,
	2022			2021			2020
Balance at beginning of year	$	4,928		$	6,168		$	7,409
Increases (decreases) related to prior year tax positions		379			—			(1,041	)
Increases related to current year tax positions		800			900			100
Decreases related to divestitures		—			—			(300	)
Decreases related to lapse of statutes of limitation		(3,269	)		(2,140	)		—
Balance at end of year	$	2,838		$	4,928		$	6,168

During the year ended December 31, 2022, the Company decreased its liability for uncertain tax positions by $2.1 million, primarily related to expiration of statutes of limitation, partially offset by additional taxes on current year and prior year positions. During the year ended December 31, 2021, the Company decreased its liability for uncertain tax positions by $1.2 million, primarily related to expiration of statutes of limitation, partially offset by additional taxes on current year positions. In addition, the Company anticipates that its liability for uncertain tax positions will increase by $0.5 million over the next 12 months.

The Company includes interest and penalties related to income tax liabilities in income tax expense. During the year ended December 31, 2022, 2021 and 2020, the Company included $0.3 million, $0.4 million and $0.5 million, respectively, of interest and penalties in income tax expense. At December 31, 2022 and 2021, the Company's accrued liability for interest and penalties related to income tax liabilities totaled $0.2 million and $0.8 million, respectively.

The Company is currently subject to U.S. Federal and various state income tax examinations for the tax years 2019 through 2021.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Common and Common Equivalent Shares

12 Months Ended

Dec. 31, 2022

Earnings Per Share [Abstract]

Common and Common Equivalent Shares

15. Common and Common Equivalent Shares:

The calculation of shares used in the basic and diluted net income per share calculation for the years ended December 31, 2022, 2021, and 2020 is as follows (in thousands):


	Years Ended December 31,
	2022		2021		2020
Weighted average number of common shares outstanding		83,467		84,832		83,395
Weighted average number of dilutive common share equivalents (a)		654		996		—
Weighted average number of common and common equivalent shares outstanding		84,121		85,828		83,395
Antidilutive securities (restricted stock and stock options) not included in the diluted net income per common share calculation		406		11		1,034

(a)

Due to a loss from continuing operations for the year ended December 31, 2020, incremental shares of 0.6 million are not included because the effect would be antidilutive.

Stock Incentive Plans and Stock Purchase Plans

12 Months Ended

Dec. 31, 2022

Share-Based Payment Arrangement [Abstract]

Stock Incentive Plans and Stock Purchase Plans

16. Stock Incentive Plans and Stock Purchase Plans:

On May 12, 2021, the Company’s shareholders approved the Company’s Amended and Restated 2008 Incentive Compensation Plan (the “Amended and Restated 2008 Incentive Plan”). The amendments, among other things, increased the number of shares of common stock reserved for delivery under the Amended and Restated 2008

Incentive Plan from 27,775,000 shares to 34,975,000 shares, as well as extended the expiration date to 10 years from the effective date of approval. The Amended and Restated 2008 Incentive Plan provides for grants of stock options, stock appreciation rights, restricted stock, deferred stock, and other stock-related awards and performance awards that may be settled in cash, stock or other property.

Under the Amended and Restated 2008 Incentive Plan, options to purchase shares of common stock may be granted at a price not less than the fair market value of the shares on the date of grant. The options must be exercised within 10 years from the date of grant and generally become exercisable on a pro rata basis over a three-year period from the date of grant. The Company issues new shares of its common stock upon exercise of its stock options. Restricted stock awards generally vest over periods of three years upon the fulfillment of specified service-based conditions and in certain instances performance-based conditions. Deferred stock awards generally vest upon the satisfaction of specified performance-based conditions and service-based conditions. The Company recognizes compensation expense related to its restricted stock and deferred stock awards ratably over the corresponding vesting periods. During the year ended December 31, 2022, the Company granted 0.8 million shares of restricted stock to its employees and non-employee directors under the Amended and Restated 2008 Incentive Plan. At December 31, 2022, the Company had 9.3 million shares available for future grants and awards under the Amended and Restated 2008 Incentive Plan.

On May 12, 2021, the Company’s shareholders approved the Company’s Amended and Restated 1996 Non-Qualified Employee Stock Purchase Plan (the “ESPP”) to increase the number of shares issuable under the ESPP to 9.9 million shares. Under the ESPP, employees are permitted to purchase the Company's common stock at 85% of market value on January 1st, April 1st, July 1st and October 1st of each year. Under the Company’s 2015 Non-Qualified Stock Purchase Plan (the “SPP”), certain eligible non-employee service providers are permitted to purchase the Company’s common stock at 90% of market value on January 1st, April 1st, July 1st and October 1st of each year.

The Company recognizes stock-based compensation expense for the discount received by participating employees and non-employee service providers. During the year ended December 31, 2022, approximately 0.3 million shares were issued under the ESPP. At December 31, 2022, the Company had approximately 2.5 million shares reserved for issuance under the ESPP. At December 31, 2022, the Company had approximately 61,000 shares reserved for issuance under the SPP. No shares have been issued under the SPP in 2022.

The Company recognized $14.4 million, $19.0 million and $21.1 million of stock-based compensation expense related to its stock incentive plans, the ESPP and the SPP during the years ended December 31, 2022, 2021 and 2020, respectively. This excludes accelerated stock-based compensation expense related to certain position eliminations that is included within transformational and restructuring related expenses.

The activity related to the Company's restricted stock awards and the corresponding weighted average grant-date fair values for the year ended December 31, 2022 are as follows:


	Number of Shares			Weighted Average Fair Value
Non-vested shares at January 1, 2022		1,143,806		$	25.68
Awarded		841,196		$	22.64
Forfeited		(59,555	)	$	24.46
Vested		(730,050	)	$	26.14
Non-vested shares at December 31, 2022		1,195,397		$	23.32

The aggregate fair value of the restricted stock that vested during the years ended December 31, 2022, 2021 and 2020 was $19.1 million, $25.1 million and $59.3 million, respectively.

The weighted average grant-date fair value of restricted stock awards that were granted during the years ended December 31, 2022, 2021 and 2020 was $22.64, $25.17 and $23.54, respectively.

At December 31, 2022, the total stock-based compensation cost related to non-vested restricted stock remaining to be recognized as compensation expense over a weighted-average period of 1.5 years was $10.7 million.

The activity and certain other information related to the Company’s outstanding stock option awards for the year ended December 31, 2022 are as follows:


	Number of Stock Options		Weighted Average Exercise Price		Weighted Average Remaining Contractual Term (in years)		Aggregate Intrinsic Value (in millions)
Outstanding at January 1, 2022		887,731	$	16.91
Awarded		—
Exercised		—
Expired		—
Outstanding at December 31, 2022		887,731	$	16.91		0.88	$	—
Exercisable at December 31, 2022		887,731	$	16.91		0.88	$	—

At December 31, 2022, there was no remaining unrecognized stock compensation expense for stock options.

Common Stock Repurchase Programs

12 Months Ended

Dec. 31, 2022

Text Block [Abstract]

Common Stock Repurchase Programs

17. Common Stock Repurchase Programs:

In July 2013, the Company’s Board of Directors authorized the repurchase of shares of the Company’s common stock up to an amount sufficient to offset the dilutive impact from the issuance of shares under the Company’s equity compensation programs. The share repurchase program allows the Company to make open market purchases from time-to-time based on general economic and market conditions and trading restrictions. The repurchase program also allows for the repurchase of shares of the Company’s common stock to offset the dilutive impact from the issuance of shares, if any, related to the Company’s acquisition program. No shares were purchased under this program during the year ended December 31, 2022.

In August 2018, the Company announced that its Board of Directors had authorized the repurchase of up to $500.0 million of the Company’s common stock in addition to its existing share repurchase program, of which $5.5 million remained available for repurchase as of December 31, 2022. Under this share repurchase program, during the year ended December 31, 2022, the Company purchased 4.5 million shares of its common stock for $88.5 million, of which 0.2 million shares and $2.9 million, respectively, were for shares withheld to satisfy minimum statutory withholding obligations in connection with the vesting of restricted stock.

During the year ended December 31, 2021, the Company repurchased 0.2 million shares of its common stock for $4.7 million to satisfy minimum statutory withholding obligations in connection with the vesting of restricted stock.

The Company intends to utilize various methods to effect any future share repurchases, including, among others, open market purchases and accelerated share repurchase programs. The amount and timing of repurchases will depend upon several factors, including general economic and market conditions and trading restrictions.

Retirement Plans

12 Months Ended

Dec. 31, 2022

Retirement Benefits [Abstract]

Retirement Plans

18. Retirement Plans:

The Company maintained two qualified contributory savings plans as allowed under Section 401(k) of the Internal Revenue Code and Section 1165(e) of the Puerto Rico Income Tax Act of 1954 (the “401(k) Plans”) through December 31, 2022. The 401(k) Plans permit participant contributions and allow elective and, in certain situations, non-elective Company contributions based on each participant’s contribution or a specified percentage of eligible wages. Participants may defer a percentage of their annual compensation subject to the limits defined in the 401(k) Plans. The Company recorded expense for its continuing operations of $22.6 million, $21.0 million and $19.9 million

for the years ended December 31, 2022, 2021 and 2020, respectively, primarily related to the 401(k) Plans. The Company ceased providing services in Puerto Rico on December 31, 2022, and accordingly, the Puerto Rico 401(k) Plan will no longer be maintained beginning on January 1, 2023.

- Definition

The entire disclosure for retirement benefits.

+ References

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+ Details

Commitments and Contingencies

12 Months Ended

Dec. 31, 2022

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

19. Commitments and Contingencies:

The Company expects that audits, inquiries and investigations from government authorities and agencies will occur in the ordinary course of business. Such audits, inquiries and investigations and their ultimate resolutions, individually or in the aggregate, could have a material adverse effect on the Company's business, financial condition, results of operations, cash flows and the trading price of its securities. The Company has not included an accrual for these matters as of December 31, 2022 in its Consolidated Financial Statements, as the variables affecting any potential eventual liability depend on the currently unknown facts and circumstances that arise out of, and are specific to, any particular future audit, inquiry and investigation and cannot be reasonably estimated at this time.

In the ordinary course of business, the Company becomes involved in pending and threatened legal actions and proceedings, most of which involve claims of medical malpractice related to medical services provided by the Company's affiliated physicians. The Company's contracts with hospitals generally require the Company to indemnify them and their affiliates for losses resulting from the negligence of the Company's affiliated physicians. The Company may also become subject to other lawsuits which could involve large claims and significant costs. The Company believes, based upon a review of pending actions and proceedings, that the outcome of such legal actions and proceedings will not have a material adverse effect on its business, financial condition, results of operations, cash flows and the trading price of its securities. The outcome of such actions and proceedings, however, cannot be predicted with certainty and an unfavorable resolution of one or more of them could have a material adverse effect on the Company's business, financial condition, results of operations, cash flows and the trading price of its securities.

Although the Company currently maintains liability insurance coverage intended to cover professional liability and certain other claims, the Company cannot assure that its insurance coverage will be adequate to cover liabilities arising out of claims asserted against it in the future where the outcomes of such claims are unfavorable. With respect to professional liability risk, the Company generally self-insures a portion of this risk through its wholly owned captive insurance subsidiary. Liabilities in excess of the Company's insurance coverage, including coverage for professional liability and certain other claims, could have a material adverse effect on the Company's business, financial condition, results of operations, cash flows and the trading price of its securities.

EXHIBITS AND FINANCIAL STATEMENT SCHEDULE

12 Months Ended

Dec. 31, 2022

SEC Schedule, 12-09, Valuation and Qualifying Accounts [Abstract]

Exhibits and Financial Statement Schedule

(a)(1) Financial Statements

The information required by this Item is included in Item 8 of Part II of this Form 10-K.

(a)(2) Financial Statement Schedule

The following financial statement schedule for the years ended December 31, 2022, 2021 and 2020, is included in this Form 10-K as set forth below (in thousands).

Pediatrix Medical Group, Inc.

Schedule II: Valuation and Qualifying Accounts


	Years Ended December 31,
	2022			2021			2020
Allowance for contractual adjustments and uncollectibles:
Balance at beginning of year	$	1,091,310		$	791,842		$	746,388
Amount charged against operating revenue		5,921,519			5,436,786			4,776,447
Accounts receivable contractual adjustments and write-offs (net of recoveries)		(5,761,124	)		(5,137,318	)		(4,730,993	)
Balance at end of year	$	1,251,705		$	1,091,310		$	791,842

All other schedules have been omitted because they are not applicable, not required or the information is included elsewhere herein.

(a)(3) Exhibits

See Item 15(b) of this Form 10-K.

Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2022

Accounting Policies [Abstract]

Principles of Presentation

Accounting Estimates and Assumptions

Segment Reporting

The Company has one reportable segment, which is also its single reporting unit, for purposes of presenting financial information in accordance with the accounting guidance for segment reporting.

The following table summarizes the Company’s net revenue from continuing operations by service line (in percentages):


	Years Ended December 31,
	2022			2021			2020
Neonatology and other pediatric subspecialties		79	%		77	%		77	%
Maternal-fetal medicine		16	%		18	%		18	%
Pediatric cardiology		5	%		5	%		5	%
		100	%		100	%		100	%

Revenue Recognition

administrative services performed by its affiliated physicians providing medical director or other services at the hospital.

Cash and Cash Equivalents

Investments

Property and Equipment

Business Acquisitions

Goodwill and Other Intangible Assets

Long-Lived Assets

Common Stock Repurchases

Professional Liability Coverage

Income Taxes

Stock Incentive Plans

Net Income Per Common Share

Fair Value Measurements

Level 1 – inputs are based upon unadjusted quoted prices for identical instruments traded in active markets.

The following table presents information about the Company’s financial instruments that are accounted for at fair value on a recurring basis at December 31, 2022 and 2021 (in thousands):


		Fair Value
	Fair Value Category	December 31, 2022		December 31, 2021
Assets:
Money market funds	Level 1	$	1,415	$	2,442
Short-term investments	Level 2		93,239		99,715
Mutual funds	Level 1		14,544		18,542

The following table presents information about the Company’s financial instruments that are not carried at fair value at December 31, 2022 and 2021 (in thousands):


	December 31, 2022				December 31, 2021
	Carrying Amount		Fair Value		Carrying Amount		Fair Value
Liabilities:
2027 Notes		—		—		1,000,000		1,047,190
2030 Notes		400,000		344,000		—		—

The Company redeemed the full principal balance of its 6.25% senior unsecured notes due 2027 (the “2027 Notes”) in February 2022.

Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2022

Accounting Policies [Abstract]

Schedule of Net Revenue by Service Line

The following table summarizes the Company’s net revenue from continuing operations by service line (in percentages):


	Years Ended December 31,
	2022			2021			2020
Neonatology and other pediatric subspecialties		79	%		77	%		77	%
Maternal-fetal medicine		16	%		18	%		18	%
Pediatric cardiology		5	%		5	%		5	%
		100	%		100	%		100	%

Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis

The following table presents information about the Company’s financial instruments that are accounted for at fair value on a recurring basis at December 31, 2022 and 2021 (in thousands):


		Fair Value
	Fair Value Category	December 31, 2022		December 31, 2021
Assets:
Money market funds	Level 1	$	1,415	$	2,442
Short-term investments	Level 2		93,239		99,715
Mutual funds	Level 1		14,544		18,542

Financial Instruments Measured At Carrying Amount

The following table presents information about the Company’s financial instruments that are not carried at fair value at December 31, 2022 and 2021 (in thousands):


	December 31, 2022				December 31, 2021
	Carrying Amount		Fair Value		Carrying Amount		Fair Value
Liabilities:
2027 Notes		—		—		1,000,000		1,047,190
2030 Notes		400,000		344,000		—		—

Investments (Tables)

12 Months Ended

Dec. 31, 2022

Investments, Debt and Equity Securities [Abstract]

Schedule of Investments

Investments held are summarized as follows (in thousands):


	December 31,
	2022		2021
Corporate securities	$	61,385	$	72,964
Municipal debt securities		14,377		13,215
U.S. Treasury securities		10,205		5,205
Certificates of deposit		3,710		4,404
Federal home loan securities		3,562		3,927
	$	93,239	$	99,715

Accounts Receivable and Net Revenue (Tables)

12 Months Ended

Dec. 31, 2022

Text Block [Abstract]

Schedule of Accounts Receivable, Net

Accounts receivable, net consists of the following (in thousands):


	December 31,
	2022			2021
Gross accounts receivable	$	1,548,492		$	1,393,584
Allowance for contractual adjustments and uncollectibles		(1,251,705	)		(1,091,809	)
	$	296,787		$	301,775

Schedule of Net Revenue

Net revenue consists of the following (in thousands):


	Years Ended December 31,
	2022		2021		2020
Net patient service revenue	$	1,688,818	$	1,641,323	$	1,481,331
Hospital contract administrative fees		262,931		240,022		218,495
Other revenue		20,272		29,846		34,125
	$	1,972,021	$	1,911,191	$	1,733,951

Schedule of Percentage of Net Revenue

The following is a summary of the Company’s payor mix, expressed as a percentage of net revenue, exclusive of administrative fees and other miscellaneous revenue, for the periods indicated:


	Years Ended December 31,
	2022			2021			2020
Contracted managed care		66	%		68	%		68	%
Government		26	%		25	%		27	%
Other third-parties		6	%		5	%		4	%
Private-pay patients		2	%		2	%		1	%
		100	%		100	%		100	%

Property and Equipment (Tables)

12 Months Ended

Dec. 31, 2022

Property, Plant and Equipment [Abstract]

Schedule of Property and Equipment

Property and equipment consists of the following (in thousands):


	December 31,
	2022			2021
Building	$	8,286		$	8,286
Land		2,032			2,032
Equipment and other		235,190			224,524
		245,508			234,842
Accumulated depreciation		(172,218	)		(164,688	)
	$	73,290		$	70,154

Goodwill and Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2022

Goodwill and Intangible Assets Disclosure [Abstract]

Summary of Intangible Assets, Net

Intangible assets, net, consist of the following (in thousands):


	December 31, 2022
	Gross Carrying Value		Accumulated Amortization			Net Carrying Value
Physician and hospital agreements	$	101,325	$	(85,457	)	$	15,868
Other technology		8,695		(6,072	)		2,623
	$	110,020	$	(91,529	)	$	18,491


	December 31, 2021
	Gross Carrying Value		Accumulated Amortization			Net Carrying Value
Physician and hospital agreements	$	101,542	$	(83,440	)	$	18,102
Other technology		7,801		(4,338	)		3,463
	$	109,343	$	(87,778	)	$	21,565

Amortization Expenses for Existing Intangible Assets for the Next Five Years

Amortization expense for existing intangible assets for the next five years is expected to be as follows (in thousands):


2023	$	5,173
2024		3,561
2025		2,095
2026		1,426
2027		1,140

Accounts Payable and Accrued Expenses (Tables)

12 Months Ended

Dec. 31, 2022

Payables and Accruals [Abstract]

Schedule of Accounts Payable and Accrued Expenses

Accounts payable and accrued expenses consist of the following (in thousands):


	December 31,
	2022		2021

Accounts payable	$	31,857	$	36,645
Accrued salaries and incentive compensation		197,831		213,974
Accrued payroll taxes and benefits		34,983		34,994
Accrued professional liabilities		32,232		37,729
Accrued interest		8,921		29,052
Other accrued expenses		68,401		41,724
	$	374,225	$	394,118

Operating Leases (Tables)

12 Months Ended

Dec. 31, 2022

Leases [Abstract]

Operating Lease Related Assets And Liabilities And Other Related Information


	December 31,
	2022			2021
Assets:
Operating lease right-of-use assets	$	55,796		$	51,283
Liabilities:
Current portion of operating lease liabilities		21,589			19,684
Long-term portion of operating lease liabilities		44,213			41,396
Other Information:
Weighted-average remaining lease term	3.9 years			3.7 years
Weighted average discount rate		4.6	%		4.7	%

Lease, Cost

The table below presents certain information related to the lease costs for operating leases during the years ended December 31, 2022 and 2021 (in thousands):


	December 31,
	2022		2021
Operating lease costs	$	22,293	$	19,907
Variable lease costs		6,640		5,060
Other operating lease costs		4,218		4,235
Total operating lease costs	$	33,151	$	29,202

Operating Leases Cash Flow Related Information

The table below presents supplemental cash flow information related to operating leases during the years ended December 31, 2022 and 2021 (in thousands):


	December 31, 2022		December 31, 2021
Operating cash flows for operating leases	$	37,549	$	34,054

Lessee, Operating Lease, Liability, Maturity


	December 31, 2022
2023	$	21,994
2024		19,242
2025		12,162
2026		7,634
2027		4,496
Thereafter		5,175
Total minimum lease payments		70,703
Less: Amount of payments representing interest		(4,901	)
Present value of future minimum lease payments		65,802
Less: Current obligations		(21,589	)
Long-term portion of operating leases	$	44,213

Accrued Professional Liabilities (Tables)

12 Months Ended

Dec. 31, 2022

Health Care Organizations [Abstract]

Schedule of Accrued Professional Liability


	Years Ended December 31,
	2022			2021			2020
Balance at beginning of year	$	190,127		$	174,803		$	151,397
Liabilities recognized, offset by insurance receivable		(2,692	)		(2,299	)		3,922
Provision (adjustment) for losses related to:
Current year		53,180			56,016			45,674
Prior years		(4,056	)		(14,231	)		(1,551	)
Total provision for losses		49,124			41,785			44,123
Claim payments related to:
Current year		(73	)		(59	)		(59	)
Prior years		(36,925	)		(24,103	)		(24,580	)
Total payments		(36,998	)		(24,162	)		(24,639	)
Balance at end of year	$	199,561		$	190,127		$	174,803

Line of Credit, Long-Term Debt and Finance Lease Obligations (Tables)

12 Months Ended

Dec. 31, 2022

Debt Disclosure [Abstract]

Schedule of Long-Term Debt

The carrying value of the Company’s long-term debt was $637.2 million and $989.7 million at December 31, 2022 and 2021, respectively, and consisted of the following (in thousands):


	December 31, 2022
	Principal		Unamortized Debt Issuance Costs			Total
Senior notes	$	400,000	$	(5,069	)	$	394,931
Revolving line of credit		4,000		(1,489	)		2,511
Term A loan		240,625		(827	)		239,798
Total	$	644,625	$	(7,385	)	$	637,240


	December 31, 2021
	Principal		Unamortized Debt Issuance Costs			Total
Senior notes	$	1,000,000	$	(9,712	)	$	990,288
Revolving line of credit		—		(628	)		(628	)
Total	$	1,000,000	$	(10,340	)	$	989,660

Summary of Estimated Fair Value of Notes

The estimated fair value of the Company’s 2027 Notes and 2030 Notes, for relevant periods, were estimated using trading prices as of December 31, 2022 and 2021, respectively, as Level 2 inputs to estimate fair value for relevant periods and are summarized as follows (in thousands):


	December 31,
	2022		2021
2027 Notes	$	—	$	1,047,190
2030 Notes		344,000		—

Schedule of Financial Lease Obligations

The Company redeemed the full principal balance of its 2027 Notes in February 2022.

The Company’s finance lease obligations, related to equipment used in its newborn hearing screen program, consist of the following (in thousands):


	December 31,
	2022			2021
Finance lease obligations	$	11,128		$	14,178
Less: Current portion		(2,398	)		(2,490	)
Long-term portion	$	8,730		$	11,688

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2022

Income Tax Disclosure [Abstract]

Summary of Components of Income Tax Provision

The components of the income tax provision (benefit) are as follows (in thousands):


	December 31,
	2022			2021			2020
Federal:
Current	$	38,877		$	41,592		$	(16,610	)
Deferred		(19,679	)		(20,373	)		28,719
		19,198			21,219			12,109
State:
Current		2,700			16,888			(2,954	)
Deferred		(3,092	)		(10,866	)		7,573
		(392	)		6,022			4,619
Total	$	18,806		$	27,241		$	16,728

Schedule of Differences Between Effective Rate and United States Federal Income Tax Statutory Rate

The differences between the effective rate and the United States federal income tax statutory rate are as follows:


	December 31,
	2022			2021			2020
Tax at statutory rate		21.00	%		21.00	%		21.00	%
State income tax, net of federal benefit		1.53			4.72			24.34
Non-deductible expenses		1.48			3.42			60.44
Equity compensation adjustments		1.35			0.77			98.61
Change in accrual estimates relating to uncertain tax positions		(3.28	)		(1.08	)		4.22
Change in valuation allowance		1.72			(0.26	)		23.67
Other, net		(0.69	)		(0.46	)		1.71
Change in tax law	─				(7.97	)	─
Income tax provision		23.11	%		20.14	%		233.99	%

Significant Components of Deferred Income Tax Assets and Liabilities

All of the Company’s deferred tax assets and liabilities are classified as long-term. The significant components of deferred income tax assets and liabilities are as follows (in thousands):


	December 31,
	2022			2021
Allowance for uncollectible accounts	$	152,526		$	135,280
Reserves and accruals		66,969			55,549
Stock-based compensation		3,694			3,303
Operating loss and other carryforwards		28,773			29,045
Capital loss carryforwards		422,793			428,805
Operating lease assets		19,096			18,960
Property and equipment		2,481			1,967
Other		256			686
Deferred tax assets before valuation allowance		696,588			673,595
Less: Valuation allowance		(429,260	)		(441,529	)
Deferred tax assets, net of valuation allowance		267,328			232,066
Gross deferred tax liabilities:
Amortization		(176,398	)		(168,505	)
Operating lease liabilities		(16,510	)		(16,439	)
Other		(2,133	)		(187	)
Total deferred tax liabilities		(195,041	)		(185,131	)
Net deferred tax assets	$	72,287		$	46,935

Schedule of Activity Related to Gross Unrecognized Tax Benefits

The following table summarizes the activity related to the Company’s liability for uncertain tax positions for the years ended December 31, 2022, 2021 and 2020 (in thousands):


	Years Ended December 31,
	2022			2021			2020
Balance at beginning of year	$	4,928		$	6,168		$	7,409
Increases (decreases) related to prior year tax positions		379			—			(1,041	)
Increases related to current year tax positions		800			900			100
Decreases related to divestitures		—			—			(300	)
Decreases related to lapse of statutes of limitation		(3,269	)		(2,140	)		—
Balance at end of year	$	2,838		$	4,928		$	6,168

Common and Common Equivalent Shares (Tables)

12 Months Ended

Dec. 31, 2022

Earnings Per Share [Abstract]

Schedule of Calculation of Shares Used in Basic and Diluted Net Income Per Share

The calculation of shares used in the basic and diluted net income per share calculation for the years ended December 31, 2022, 2021, and 2020 is as follows (in thousands):


	Years Ended December 31,
	2022		2021		2020
Weighted average number of common shares outstanding		83,467		84,832		83,395
Weighted average number of dilutive common share equivalents (a)		654		996		—
Weighted average number of common and common equivalent shares outstanding		84,121		85,828		83,395
Antidilutive securities (restricted stock and stock options) not included in the diluted net income per common share calculation		406		11		1,034

(a)

Due to a loss from continuing operations for the year ended December 31, 2020, incremental shares of 0.6 million are not included because the effect would be antidilutive.

Stock Incentive Plans and Stock Purchase Plans (Tables)

12 Months Ended

Dec. 31, 2022

Share-Based Payment Arrangement [Abstract]

Schedule of Restricted Stock and Deferred Stock Awards

The activity related to the Company's restricted stock awards and the corresponding weighted average grant-date fair values for the year ended December 31, 2022 are as follows:


	Number of Shares			Weighted Average Fair Value
Non-vested shares at January 1, 2022		1,143,806		$	25.68
Awarded		841,196		$	22.64
Forfeited		(59,555	)	$	24.46
Vested		(730,050	)	$	26.14
Non-vested shares at December 31, 2022		1,195,397		$	23.32

Schedule of Activity and Certain Other Information Related to Stock Option Awards

The activity and certain other information related to the Company’s outstanding stock option awards for the year ended December 31, 2022 are as follows:


	Number of Stock Options		Weighted Average Exercise Price		Weighted Average Remaining Contractual Term (in years)		Aggregate Intrinsic Value (in millions)
Outstanding at January 1, 2022		887,731	$	16.91
Awarded		—
Exercised		—
Expired		—
Outstanding at December 31, 2022		887,731	$	16.91		0.88	$	—
Exercisable at December 31, 2022		887,731	$	16.91		0.88	$	—

Coronavirus Pandemic ("COVID-19") - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Mar. 27, 2020
Line of credit remaining borrowing capacity	$ 446,000
Letters of Credit [Member]
Letters of credit	0
COVID-19 [Member]
Reimbursement of Lost Revenue				$ 100,000,000
Proceeds From Contribution In Aid Of Reimbursement of Lost Revenue	$ 13,300	$ 26,100	$ 22,000
COVID-19 [Member] \| Rural Area [Member]
Reimbursement of Lost Revenue				$ 70,000,000
COVID-19 [Member] \| Two Thousand Twenty Tax Year [Member]
Percentage Of Refund Of Income Tax At The Prior Period Corporate Tax Rate	35.00%
COVID-19 [Member] \| Executive Officer [Member]
Decrease In Salary \| %	50.00%

Summary of Significant Accounting Policies - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Feb. 28, 2022
Summary Of Significant Accounting Policies [Line Items]
Investment in pediatric primary, urgent care and telehealth company		$ 20.0
Cash and cash equivalents maturity description	90
Additional amounts to be paid in cash or common stock based on achievement of performance measures within period, maximum years	5 years
GAAP Senior Notes [Member] \| Six Point Two Five Percentage Senior Notes Due Two Thousand Twenty Seven [Member]
Summary Of Significant Accounting Policies [Line Items]
Debt instrument, interest rate, effective percentage			6.25%
Unnamed Corporate Joint Venture One [Member]
Summary Of Significant Accounting Policies [Line Items]
Equity method ownership percentage in joint venture	37.50%
Unnamed Corporate Joint Venture Two [Member]
Summary Of Significant Accounting Policies [Line Items]
Equity method ownership percentage in joint venture	51.00%
Buildings [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years	30 years
United States [Member] \| Credit Concentration Risk [Member] \| Accounts Receivable [Member]
Summary Of Significant Accounting Policies [Line Items]
Percentage of net accounts receivable	21.00%	21.00%
Maximum [Member]
Summary Of Significant Accounting Policies [Line Items]
Short-Term investments maturity period, in years	1 year
Intangible assets finite lives	20 years
Maximum [Member] \| Medical Equipment [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years	7 years
Maximum [Member] \| Computer Equipment [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years	7 years
Maximum [Member] \| Software and Software Development Costs [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years	7 years
Maximum [Member] \| Furniture [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years	7 years
Minimum [Member]
Summary Of Significant Accounting Policies [Line Items]
Intangible assets finite lives	1 year
Minimum [Member] \| Medical Equipment [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years	3 years
Minimum [Member] \| Computer Equipment [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years	3 years
Minimum [Member] \| Software and Software Development Costs [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years	3 years
Minimum [Member] \| Furniture [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years	3 years

Summary of Significant Accounting Policies - Schedule of Net Revenue by Service Line (Detail) - Product Concentration Risk [Member] - Sales Revenue, Services, Net [Member]	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Segment Reporting Information [Line Items]
Net revenue in percentage	100.00%	100.00%	100.00%
Neonatology and Other Pediatric Subspecialties [Member]
Segment Reporting Information [Line Items]
Net revenue in percentage	79.00%	77.00%	77.00%
Maternal-Fetal Medicine [Member]
Segment Reporting Information [Line Items]
Net revenue in percentage	16.00%	18.00%	18.00%
Pediatric Cardiology [Member]
Segment Reporting Information [Line Items]
Net revenue in percentage	5.00%	5.00%	5.00%

Summary of Significant Accounting Policies - Schedule of fair value on a recurring basis (Detail) - Fair Value, Recurring [Member] - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Fair Value, Inputs, Level 1 [Member]
Assets:
Money market funds	$ 1,415	$ 2,442
Mutual funds	14,544	18,542
Fair Value, Inputs, Level 2 [Member]
Assets:
Short-term investments	$ 93,239	$ 99,715

Summary of Significant Accounting Policies - Schedule of financial instruments that are not carried at fair value (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
2027 Notes [Member]
Liabilities:
Notes Payable	$ 0	$ 1,000,000
Liabilities:
Notes Payable Fair Value Disclosure	0	1,047,190
2030 Notes [Member]
Liabilities:
Notes Payable	400,000	0
Liabilities:
Notes Payable Fair Value Disclosure	$ 344,000	$ 0

Investments - Schedule of Investments (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Debt Securities, Held-to-Maturity, Allowance for Credit Loss [Line Items]
Available-for-sale Securities	$ 93,239	$ 99,715
Corporate Securities [Member]
Debt Securities, Held-to-Maturity, Allowance for Credit Loss [Line Items]
Available-for-sale Securities	61,385	72,964
Municipal Debt Securities [Member]
Debt Securities, Held-to-Maturity, Allowance for Credit Loss [Line Items]
Available-for-sale Securities	14,377	13,215
Federal Home Loan Securities [Member]
Debt Securities, Held-to-Maturity, Allowance for Credit Loss [Line Items]
Available-for-sale Securities	3,562	3,927
Certificates of Deposit [Member]
Debt Securities, Held-to-Maturity, Allowance for Credit Loss [Line Items]
Available-for-sale Securities	3,710	4,404
US Treasury Securities [Member]
Debt Securities, Held-to-Maturity, Allowance for Credit Loss [Line Items]
Available-for-sale Securities	$ 10,205	$ 5,205

Accounts Receivable and Net Revenue - Schedule of Accounts Receivable, Net (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Receivables [Abstract]
Gross accounts receivable	$ 1,548,492	$ 1,393,584
Allowance for contractual adjustments and uncollectibles	(1,251,705)	(1,091,809)
Accounts receivable, net	$ 296,787	$ 301,775

Accounts Receivable and Net Revenue - Schedule of Net Revenue (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Disaggregation of Revenue [Abstract]
Net revenue	$ 1,972,021	$ 1,911,191	$ 1,733,951
Net patient service revenue [Member]
Disaggregation of Revenue [Abstract]
Net revenue	1,688,818	1,641,323	1,481,331
Hospital contract administrative fees [Member]
Disaggregation of Revenue [Abstract]
Net revenue	262,931	240,022	218,495
Other revenue [Member]
Disaggregation of Revenue [Abstract]
Net revenue	$ 20,272	$ 29,846	$ 34,125

- Definition

Amount, including tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value-added and excise.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 41
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e9038-108599

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 5
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130545-203045

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8933-108599

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8933-108599

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8906-108599

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8736-108599

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8736-108599

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 4
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130543-203045

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 42
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e9054-108599

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 40
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e9031-108599

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 924
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SAB Topic 11.L)
-URI https://asc.fasb.org/extlink&oid=6472922&loc=d3e499488-122856

+ Details

Accounts Receivable and Net Revenue - Schedule of Net Patient Service Revenue by Type of Payor (Detail)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	100.00%	100.00%	100.00%
Contracted Managed Care [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	66.00%	68.00%	68.00%
Government [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	26.00%	25.00%	27.00%
Other Third-Parties [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	6.00%	5.00%	4.00%
Private-Pay Patients [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	2.00%	2.00%	1.00%

Property Plant and Equipment - Schedule of Property and Equipment (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Property, Plant and Equipment [Abstract]
Building	$ 8,286	$ 8,286
Land	2,032	2,032
Equipment and other	235,190	224,524
Property and equipment, gross	245,508	234,842
Accumulated depreciation	(172,218)	(164,688)
Property and equipment, net	$ 73,290	$ 70,154

Property and Equipment - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Property, Plant and Equipment [Line Items]
Recorded depreciation expense	$ 26.7	$ 21.6	$ 19.3

Business Combinations - Additional Information (Detail) $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($) Number	Dec. 31, 2021 USD ($) Number
Business Acquisition [Line Items]
Number of Pediatric Neurology Practices Acquired \| Number		2
Number of Maternal Fetal Medicine Practices Acquired \| Number		1
Number Of Pediatric Intensivist Practice Acquired \| Number		1
Number Of Obstetrics And Gynecology Practices Acquired \| Number		1
Business Acquisition, Goodwill, Expected Tax Deductible Amount	$ 26,700
Other intangible assets	2,300
Fixed assets	2,200
Number Of Physician Group Practices Acquired \| Number		9
Number Of Neonatology Practices Acquired \| Number		1
Number Of Pediatric Subspecialty Practices Acquired \| Number		1
Number Of Pediatric Cardiology Acquired \| Number		1
Other non-current assets	123,176	$ 131,028
Pediatric Gastroenterology And Gynecology practice And Multi Location Pediatric Urgent Care Practice [Member]
Business Acquisition [Line Items]
Total business acquisition consideration	$ 31,300
Number of other multi location pediatric urgent care practice acquired \| Number	1
One pediatric gastroenterology practice \| Number	1
Business acquisition consiideration paid in cash	$ 26,500
Business acquisitions contingent consideration liability	4,800
Pediatric Subspecialty Practice [Member]
Business Acquisition [Line Items]
Other non-current assets	$ 100
Multi Location Pediatric Urgent Care Practice [Member]
Business Acquisition [Line Items]
Number of other pediatric orthopedic practice acquired \| Number		1
Pediatric Orthopedic Multi Location Urgent Care Cardiology Neurology And Maternal Fetal Medicine Practice [Member]
Business Acquisition [Line Items]
Total business acquisition consideration		$ 34,900
Goodwill		27,900
Other intangible assets		3,500
Fixed assets		3,500
Business acquisition consiideration paid in cash		29,900
Business acquisitions contingent consideration liability		$ 5,000

Goodwill and Intangible Assets - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Goodwill And Other Intangible Assets [Line Items]
Goodwill	$ 1,532,092	$ 1,505,430
Intangible assets related to acquisitions	2,300
Amortization expense for intangible assets	$ 6,400	$ 8,000	$ 7,600
Weighted-average amortization period	13 years

- Definition

Amount after accumulated impairment loss of an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

+ References + Details

Goodwill and Intangible Assets - Summary of Intangible Assets, Net (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	$ 110,020	$ 109,343
Accumulated Amortization	(91,529)	(87,778)
Net Carrying Value	18,491	21,565
Physician And Hospital Agreements [Member]
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	101,325	101,542
Accumulated Amortization	(85,457)	(83,440)
Net Carrying Value	15,868	18,102
Other Technology [Member]
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	8,695	7,801
Accumulated Amortization	(6,072)	(4,338)
Net Carrying Value	$ 2,623	$ 3,463

Goodwill and Intangible Assets - Amortization Expenses for Existing Intangible Assets for the Next Five Years (Detail) $ in Thousands	Dec. 31, 2022 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
2023	$ 5,173
2024	3,561
2025	2,095
2026	1,426
2027	$ 1,140

Discontinued Operations - Additional Information (Detail) $ in Millions	12 Months Ended
	Dec. 31, 2022 USD ($)
Radiology Services Medical Group [Member]
Decrease to the loss on sale, net	$ 0.4
Anesthesiology Services Medical Group [Member]
Decrease to the loss on sale, net	$ 3.4

- Definition

Amount after tax of income (loss) from a discontinued operation attributable to the parent. Includes, but is not limited to, the income (loss) from operations during the phase-out period, gain (loss) on disposal, gain (loss) for reversal of write-down (write-down) to fair value, less cost to sell, and adjustments to a prior period gain (loss) on disposal.

+ References + Details

Accounts Payable and Accrued Expenses - Schedule of Accounts Payable and Accrued Expenses (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Payables and Accruals [Abstract]
Accounts payable	$ 31,857	$ 36,645
Accrued salaries and incentive compensation	197,831	213,974
Accrued payroll taxes and benefits	34,983	34,994
Accrued professional liabilities	32,232	37,729
Accrued interest	8,921	29,052
Other accrued expenses	68,401	41,724
Accounts payable and accrued expenses, total	$ 374,225	$ 394,118

Operating Leases - Schedule of operating lease-related right-of-use assets and related liabilities recorded on the Company's balance sheet and the weighted average remaining lease term and discount rate (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Assets:
Operating Lease, Right-of-Use Asset, Statement of Financial Position [Extensible Enumeration]	Operating And Finance Lease Right Of Use Assets	Operating And Finance Lease Right Of Use Assets
Operating lease right-of-use assets	$ 55,796	$ 51,283
Liabilities:
Current portion of operating lease liabilities	$ 21,589	$ 19,684
Finance Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration]	Current portion of operating lease liabilities	Current portion of operating lease liabilities
Operating Lease, Liability, Noncurrent	$ 44,213	$ 41,396
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration]	Operating Lease, Liability, Noncurrent	Operating Lease, Liability, Noncurrent
Other Information:
Weighted-average remaining lease term	3 years 10 months 24 days	3 years 8 months 12 days
Weighted average discount rate	4.60%	4.70%

Operating Leases - Schedule of lease costs for operating leases (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Operating lease costs	$ 22,293	$ 19,907
Variable lease costs	6,640	5,060
Other operating lease costs	4,218	4,235
Total operating lease costs	$ 33,151	$ 29,202

Operating Leases - Schedule of supplemental cash flow information related to operating leases (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Operating cash flows for operating leases	$ 37,549	$ 34,054

Operating Leases - Schedule of operating lease liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
2023	$ 21,994
2024	19,242
2025	12,162
2026	7,634
2027	4,496
Thereafter	5,175
Total minimum lease payments	70,703
Less: Amount of payments representing interest	(4,901)
Present value of future minimum lease payments	65,802
Less: Current obligations	(21,589)	$ (19,684)
Long-term portion of operating leases	$ 44,213	$ 41,396

Accrued Professional Liabilities - Additional Information (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Payables and Accruals [Abstract]
Total accrued professional liability	$ 307,900	$ 308,800
Accrued professional liability incurred but loss reserves not reported for claims	215,500	211,200
Accrued professional liability incurred and loss reserves reported for claims	92,400	97,600
Accrued professional liabilities	32,232	$ 37,729
Insurance receivables	$ 54,700

Accrued Professional Liabilities - Schedule of Accrued Professional Liability (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Payables and Accruals [Abstract]
Balance at beginning of year	$ 190,127	$ 174,803	$ 151,397
Liabilities recognized, offset by insurance receivable	(2,692)	(2,299)	3,922
Provision (adjustment) for losses related to Current year	53,180	56,016	45,674
Provision (adjustment) for losses related to Prior years	(4,056)	(14,231)	(1,551)
Total provision for losses	49,124	41,785	44,123
Claim payments related to Current year	(73)	(59)	(59)
Claim payments related to Prior years	(36,925)	(24,103)	(24,580)
Total payments	(36,998)	(24,162)	(24,639)
Balance at end of year	$ 199,561	$ 190,127	$ 174,803

Line of Credit, Long-Term Debt and Finance Lease Obligations - Additional Information (Detail) - USD ($) $ in Thousands		12 Months Ended
	Feb. 11, 2022	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Debt Instrument, Frequency of Periodic Payment		payable semi-annually in arrears on February 15 and August 15, beginning on August 15, 2022
Debt Instrument, Description		Notes are guaranteed on an unsecured senior basis by the same subsidiaries and affiliated professional contractors that guarantee the Amended Credit Agreement (as defined below). The indenture under which the 2030 Notes are issued, among other things, limits the Company's ability to (1) incur liens and (2) enter into sale and lease-back transactions, and also limits the Company's ability to merge or dispose of all or substantially all of its assets, in all cases, subject to a number of customary exceptions
Purchase Price		101.00%
Borrowings on credit agreement		$ 830,000	$ 0	$ 527,500
Debt instrument interest rate		5.375%
Debt instrument maturity date description		February 2022
Long term debt		$ 637,200	$ 989,700
Line of Credit facility, available balance		446,000
Long-Term Debt
Debt Instrument [Line Items]
Unsecured Long-Term Debt	$ 250,000
Cash	308,000
5.37% Unsecured Senior Notes Due 2030 Member
Debt Instrument [Line Items]
Senior Notes	$ 400,000
Debt instrument interest rate	5.375%
Debt instrument, maturity year	2030
Interest accrued periodically		21,500
Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Proceeds from Issuance of Unsecured Debt	$ 100,000
Borrowings on credit agreement		37,500
Revolving Credit Facility [Member] \| Long-Term Debt
Debt Instrument [Line Items]
Unsecured Long-Term Debt		250,000
Revolving Credit Facility [Member] \| Credit Agreement [Member]
Debt Instrument [Line Items]
Unsecured Debt		$ 450,000
Interest Rate, description		(i) the Alternate Base Rate (defined as the highest of (a) the prime rate as announced by Bank of America, N.A., (b) the Federal Funds Rate plus 0.50% and (c) Term Secured Overnight Financing Rate ("SOFR") for an interest period of one month plus 1.00% with a 1.00% floor) plus an applicable margin rate of 0.50% for the first two fiscal quarters after the date of the Credit Agreement Amendment, and thereafter at an applicable margin rate ranging from 0.125% to 0.750% based on the Company's consolidated net leverage ratio or (ii) Term SOFR rate (calculated as the Secured Overnight Financing Rate published on the applicable Reuters screen page plus a spread adjustment of 0.10%, 0.15% or 0.25% depending on if the Company selects a one-month, three-month or six-month interest period, respectively, for the applicable loan with a 0% floor), plus an applicable margin rate of 1.50% for the first two full fiscal quarters after the date of the Credit Agreement Amendment, and thereafter at an applicable margin rate ranging from 1.125% to 1.750% based on the Company's consolidated net leverage ratio. The Amended Credit Agreement also provides for other customary fees and charges, including an unused commitment fee with respect to the Revolving Credit Line ranging from 0.150% to 0.200% of the unused lending commitments under the Revolving Credit Line
Letters of Credit [Member]
Debt Instrument [Line Items]
Letters of credit outstanding amount		$ 0
2027 Notes
Debt Instrument [Line Items]
Long term debt	$ 1,000,000

Line of Credit, Long-Term Debt and Finance Lease Obligations - Schedule of Long-Term Debt (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Debt Instrument [Line Items]
Debt instrument principal amount	$ 644,625	$ 1,000,000
Unamortized debt issuance cost	(7,385)	(10,340)
Long term debt	637,240	989,660
2030 Notes
Debt Instrument [Line Items]
Debt instrument principal amount	400,000
Unamortized debt issuance cost	(5,069)
Long term debt	394,931
2027 Notes
Debt Instrument [Line Items]
Debt instrument principal amount		1,000,000
Unamortized debt issuance cost		(9,712)
Long term debt		990,288
Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Debt instrument principal amount	4,000	0
Unamortized debt issuance cost	(1,489)	(628)
Long term debt	2,511	$ (628)
Term A loan
Debt Instrument [Line Items]
Debt instrument principal amount	240,625
Unamortized debt issuance cost	(827)
Long term debt	$ 239,798

Line of Credit, Long-Term Debt and Finance Lease Obligations - Summary of Estimated Fair Value of Notes (Detail) - Level 2 [Member] - Estimate of Fair Value Measurement [Member] - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
2030 Notes
Debt Instrument Fair Value [Line Items]
Estimated fair value	$ 344,000	$ 0
2027 Notes
Debt Instrument Fair Value [Line Items]
Estimated fair value	$ 0	$ 1,047,190

Line of Credit, Long-Term Debt and Financial Lease Obligations - Schedule of Financial Lease Obligations (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Debt Disclosure [Abstract]
Finance lease obligations	$ 11,128	$ 14,178
Less: Current portion	$ (2,398)	$ (2,490)
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration]	Operating Lease, Liability, Noncurrent	Operating Lease, Liability, Noncurrent
Long-term portion	$ 8,730	$ 11,688

Income Taxes - Summary of Components of Income Tax Provision (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Federal, Current	$ 38,877	$ 41,592	$ (16,610)
Federal, Deferred	(19,679)	(20,373)	28,719
Federal income tax provision, Total	19,198	21,219	12,109
State, Current	2,700	16,888	(2,954)
State, Deferred	(3,092)	(10,866)	7,573
State income tax provision, Total	(392)	6,022	4,619
Income tax provision, Total	$ 18,806	$ 27,241	$ 16,728

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Tax [Line Items]
Effective tax rate	23.11%	20.14%	233.99%
Increase (decrease) in net deferred tax liability	$ 7,900
Income tax expense for excess tax deficiencies	1,100	$ 1,000	$ 7,100
Net operating loss carryforwards for federal and state tax	46,700	61,700	35,400
Operating loss carryforwards subject to expiration	26,400
Operating loss carryforwards not subject to expiration		20,300
Uncertain tax position liability	2,838	4,928	6,168	$ 7,409
Unrecognized tax benefits that would impact effective tax rate	2,800
Increase (decrease) in uncertain tax position	500
Company's accrued liability for interest and penalties related to income tax liabilities	200	800
Net deferred tax assets	72,287	46,935
Capital losses incurred		25,900
Capital loss carryforwards	1,710,000
Income Tax , Penalties and Interest Expense	$ 300	400	$ 500
Benefit related to a change in estimate of an income tax receivable		$ 10,800
Federal tax rate	21.00%	21.00%	21.00%
Increase in net deferred tax assets	$ 25,400
Increase Decrease In Uncollectible Accounts	17,200
Increase decrease reserves and accruals	11,400
Increase decrease in valuation allowance	12,200
Radiology Services Medical Group [Member]
Income Tax [Line Items]
Capital losses incurred	$ 1,690
Earliest Tax Year [Member]
Income Tax [Line Items]
Increase (decrease) in uncertain tax position		$ 1,200
Federal and state income tax examinations	2019
Latest Tax Year [Member]
Income Tax [Line Items]
Increase (decrease) in uncertain tax position	$ 2,100
Federal and state income tax examinations		2021
2020 [Member]
Income Tax [Line Items]
Federal tax rate		35.00%
Minimum [Member]
Income Tax [Line Items]
Expiration period of operating loss carryforwards	2033
Minimum [Member] \| Latest Tax Year [Member] \| Radiology Services Medical Group [Member]
Income Tax [Line Items]
Expiration period of operating loss carryforwards	2025
Maximum [Member]
Income Tax [Line Items]
Expiration period of operating loss carryforwards	2042
Maximum [Member] \| Earliest Tax Year [Member] \| Radiology Services Medical Group [Member]
Income Tax [Line Items]
Expiration period of operating loss carryforwards		2027

Income Taxes - Schedule of Differences Between Effective Rate and United States Federal Income Tax Statutory Rate (Detail)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Tax at statutory rate	21.00%	21.00%	21.00%
State income tax, net of federal benefit	1.53%	4.72%	24.34%
Non-deductible expenses	1.48%	3.42%	60.44%
Equity compensation adjustments	1.35%	0.77%	98.61%
Change in accrual estimates relating to uncertain tax positions	(3.28%)	(1.08%)	4.22%
Change in valuation allowance	1.72%	(0.26%)	23.67%
Other, net	(0.69%)	(0.46%)	1.71%
Change in tax law		(7.97%)
Income tax provision	23.11%	20.14%	233.99%

Income Taxes - Significant Components of Deferred Income Tax Assets and Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Allowance for uncollectible accounts	$ 152,526	$ 135,280
Reserves and accruals	66,969	55,549
Stock-based compensation	3,694	3,303
Operating loss and other carryforwards	28,773	29,045
Capital loss carryforwards	422,793	428,805
Operating lease assets	19,096	18,960
Property and equipment	2,481	1,967
Other	256	686
Deferred tax assets before valuation allowance	696,588	673,595
Less: Valuation allowance	(429,260)	(441,529)
Deferred tax assets, net of valuation allowance	267,328	232,066
Gross deferred tax liabilities:
Amortization	(176,398)	(168,505)
Operating lease liabilities	(16,510)	(16,439)
Other	(2,133)	(187)
Total deferred tax liabilities	(195,041)	(185,131)
Net deferred tax assets	$ 72,287	$ 46,935

Income Taxes - Schedule of Activity Related to Gross Unrecognized Tax Benefits (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Balance at beginning of year	$ 4,928	$ 6,168	$ 7,409
Increases (decreases) related to prior year tax positions	(379)		(1,041)
Increases related to current year tax positions	800	900	100
Decreases related to divestitures			(300)
Decreases related to lapse of statutes of limitation	(3,269)	(2,140)
Balance at end of year	$ 2,838	$ 4,928	$ 6,168

Common and Common Equivalent Shares - Schedule of Calculation of Shares Used in Basic and Diluted Net Income Per Share (Detail) - shares
shares in Thousands

12 Months Ended

Dec. 31, 2022

Dec. 31, 2021

Dec. 31, 2020

Earnings Per Share [Abstract]

Weighted average number of common shares outstanding

83,467

84,832

83,395

Weighted average number of dilutive common share equivalents

^[1]

654

996

Weighted average number of common and common equivalent shares outstanding

84,121

85,828

83,395

Antidilutive securities (restricted stock and stock options) not included in the diluted net income per common share calculation

406

1,034

Incremental Shares In Continuing operation

600

[1]	Due to a loss from continuing operations for the year ended December 31, 2020, incremental shares of 0.6 million are not included because the effect would be antidilutive.

Stock Incentive Plans and Stock Purchase Plans - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	May 12, 2021	May 11, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period	841,196
Common stock, aggregate shares authorized	200,000,000	200,000,000
Stock-based compensation expense	$ 14,400,000	$ 19,000,000.0	$ 21,100,000
Aggregate fair value of restricted and deferred stocks vested	$ 19,100,000	$ 25,100,000	$ 59,300,000
Weighted average grant-date fair value of restricted and deferred stock awards granted	$ 22.64	$ 25.17	$ 23.54
Stock Option, Share Based Compensation Cost Not Yet Recognized Period For Recognition	$ 0
Stock Option [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period	3 years
Stock Option [Member] \| Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period of options, maximum years	10 years
Restricted Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period	3 years
Restricted and Deferred Stock Units [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation expense related to non-vested restricted stock, weighted-average period in years	1 year 6 months
Unrecognized compensation expense related to non-vested restricted shares	$ 10,700
1996 Non-Qualified Employee Stock Purchase Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares common stock reserved				9,900,000
2015 Non-Qualified Stock Purchase Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of market value of common stock at which employees are permitted to purchase	90.00%
Amended and Restated 2008 Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares common stock reserved				34,975,000	27,775,000
Amended and Restated 2008 Plan [Member] \| Stock Option [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares available for future grants and awards under Stock Incentive Plans	9,300,000
Amended and Restated 2008 Plan [Member] \| Restricted Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period	800,000
1996 Non-Qualified Employee Stock Purchase Plan and 2015 Non-Qualified Stock Purchase Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of market value of common stock at which employees are permitted to purchase	85.00%
Aggregate number Shares issued under Stock Purchase Plans	300,000
Common stock, reserved for issuance	2,500,000
1996 Non-Qualified Employee Stock Purchase Plan and 2015 Non-Qualified Stock Purchase Plan [Member] \| Stock Option [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock, reserved for issuance	61,000,000,000

Stock Incentive Plans and Stock Purchase Plans - Schedule of Restricted Stock and Deferred Stock Awards (Detail) - $ / shares	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Share-Based Payment Arrangement [Abstract]
Number of Shares, Non-vested shares at January 1, 2022	1,143,806
Number of Shares, Awarded	841,196
Number of Shares, Forfeited	(59,555)
Number of Shares, Vested	(730,050)
Number of Shares, Non-vested shares at December 31, 2022	1,195,397	1,143,806
Weighted Average Fair Value, Non-vested shares at January 1, 2022	$ 25.68
Weighted Average Fair Value, Awarded	22.64	$ 25.17	$ 23.54
Weighted Average Fair Value, Forfeited	24.46
Weighted Average Fair Value, Vested	26.14
Weighted Average Fair Value, Non-vested shares at December 31, 2022	$ 23.32	$ 25.68

Stock Incentive Plans and Stock Purchase Plans - Schedule of Activity and Certain Other Information Related to Stock Option Awards (Detail) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2022 USD ($) $ / shares shares
Share-Based Payment Arrangement [Abstract]
Number of Shares, Outstanding at January 1, 2022	887,731
Number of Stock Options Awarded	0
Number of Stock Options Exercised	0
Number of Stock Options Expired	0
Number of Shares, Outstanding at December 31, 2022	887,731
Number of Shares, Exercisable at December 31, 2022	887,731
Weighted Average Exercise Price, Outstanding at January 1, 2022 \| $ / shares	$ 16.91
Weighted Average Exercise Price, Outstanding at December 31, 2022 \| $ / shares	16.91
Weighted Average Exercise Price, Exercisable at December 31, 2022 \| $ / shares	$ 16.91
Weighted Average Remaining Contractual Term (in years), Outstanding at December 31, 2022	10 months 17 days
Weighted Average Remaining Contractual Term (in years), Exercisable at December 31, 2022	10 months 17 days
Aggregate Intrinsic Value, Outstanding at December 31, 2022 \| $	$ 0
Aggregate Intrinsic Value, Exercisable at December 31, 2022 \| $	$ 0

Common Stock Repurchase Programs - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Aug. 31, 2018
Common Stock [Line Items]
Common stock authorized for repurchase				$ 500,000,000.0
Common stock repurchased	$ 88,511,000	$ 4,719,000	$ 8,493,000
Company's Common stock repurchased				$ 5,500,000
Repurchased common stock, shares	0
Stock Repurchase Program, Number of Shares Authorized to be Repurchased	4,500,000
Payments for Repurchase of Common Stock	$ 88,511,000	4,719,000	$ 8,493,000
Common Stock [Member]
Common Stock [Line Items]
Common stock repurchased		$ 4,700,000
Repurchased common stock, shares		200,000
Restricted Stock [Member]
Common Stock [Line Items]
Common stock repurchased	$ 2,900,000
Repurchased common stock, shares	200,000

Retirement Plans - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Retirement Benefits [Abstract]
Expense of retirement plans related to the 401(k) Plans	$ 22.6	$ 21.0	$ 19.9

Subsequent Events Additional Information (Detail) $ in Millions	12 Months Ended
	Dec. 31, 2022 USD ($)
Line of Credit Facility [Line Items]
Debt instrument interest rate	5.375%
Debt instrument maturity date description	February 2022
Line of credit remaining borrowing capacity	$ 446.0

Selected Quarterly Financial Information - Summary of Company's Selected Quarterly Financial Information (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Quarterly Financial Information Disclosure [Abstract]
Net revenue	$ 1,972,021	$ 1,911,191	$ 1,733,951
Practice salaries and benefits	1,383,319	1,297,477	1,193,940
Practice supplies and other operating expenses	121,669	100,472	90,690
General and administrative expenses	231,397	263,357	248,947
Gain on sale of building	0	(7,280)	0
Depreciation and amortization	35,636	32,147	28,441
Transformational and restructuring related expenses	27,312	22,100	73,801
Total operating expenses	1,799,333	1,708,273	1,635,819
Income from operations	172,688	202,918	98,132
Investment and other (expense) income	3,671	13,652	17,913
Interest expense	(39,695)	(68,722)	(110,482)
Loss on early extinguishment of debt	(57,016)	(14,532)	0
Equity in earnings of unconsolidated affiliates	1,722	1,912	1,585
Total non-operating expenses	(91,318)	(67,690)	(90,984)
(Loss) income from continuing operations before income taxes	81,370	135,228	7,148
Income tax benefit (provision)	(18,806)	(27,241)	(16,728)
Income (loss) from continuing operations	62,564	107,987	(9,580)
(Loss) income from discontinued operations, net of tax	3,767	22,950	(786,908)
Net income (loss)	66,331	130,937	(796,488)
Net income (loss) attributable to Pediatrix Medical Group, Inc.	$ 66,335	$ 130,964	$ (796,488)
Income from continuing operations, Basic	$ 0.75	$ 1.27	$ (0.11)
Income from continuing operations, Diluted	0.74	1.26	(0.11)
Loss from discontinued operations, Basic	0.04	0.27	(9.44)
Loss from discontinued operations, Diluted	0.05	0.27	(9.44)
Earnings Per Share, Basic	0.79	1.54	(9.55)
Earnings Per Share, Diluted	$ 0.79	$ 1.53	$ (9.55)
Weighted Average Number of Shares Outstanding, Basic	83,467	84,832	83,395
Weighted average shares, Diluted	84,121	85,828	83,395

EXHIBITS AND FINANCIAL STATEMENT SCHEDULE - Valuation and Qualifying Accounts (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
SEC Schedule, 12-09, Valuation and Qualifying Accounts [Abstract]
Balance at beginning of year	$ 1,091,310	$ 791,842	$ 746,388
Amount charged against operating revenue	5,921,519	5,436,786	4,776,447
Accounts receivable contractual adjustments and write-offs (net of recoveries)	(5,761,124)	(5,137,318)	(4,730,993)
Balance at end of year	$ 1,251,705	$ 1,091,310	$ 791,842