0000950170-24-091193 | 10-Q | XBRL Viewer | Pediatrix Medical Group INC

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Accounts Receivable and Net Revenue - Schedule of Net Revenue (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Disaggregation of Revenue [Abstract]
Net revenue	$ 504,296	$ 500,577	$ 999,397	$ 991,585
Net patient service revenue
Disaggregation of Revenue [Abstract]
Net revenue	432,847	430,383	854,678	853,567
Hospital contract administrative fees
Disaggregation of Revenue [Abstract]
Net revenue	70,913	69,585	142,716	135,574
Other revenue
Disaggregation of Revenue [Abstract]
Net revenue	$ 536	$ 609	$ 2,003	$ 2,444

- 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

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+ Details

Common and Common Equivalent Shares

6 Months Ended

Jun. 30, 2024

Earnings Per Share [Abstract]

Common and Common Equivalent Shares

9. Common and Common Equivalent Shares:

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 and stock options and is calculated using the treasury stock method.

The calculation of shares used in the basic and diluted net income per common share calculation for the three and six months ended June 30, 2024 and 2023 is as follows (in thousands):


	Three Months Ended June 30,				Six Months Ended June 30,
	2024		2023		2024		2023
Weighted average number of common shares outstanding		83,332		82,399		83,074		82,033
Weighted average number of dilutive common share equivalents (a)		—		265		—		344
Weighted average number of common and common equivalent shares outstanding		83,332		82,664		83,074		82,377
Antidilutive securities (restricted stock and stock options) not included in the diluted net income per common share calculation		916		1,338		661		1,358

(a) Due to a loss for the three and six months ended June 30, 2024, 0.1 million and 0.3 million incremental shares, respectively, are not included because the effect would be antidilutive.

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended				6 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Jun. 30, 2024	Mar. 31, 2024	Jun. 30, 2023	Mar. 31, 2023	Jun. 30, 2024	Jun. 30, 2023
Pay vs Performance Disclosure
Net Income (Loss)	$ (153,025)	$ 4,035	$ 28,282	$ 14,206	$ (148,990)	$ 42,488

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

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+ Details

Accounts Receivable and Net Revenue - Schedule of Accounts Receivable, Net (Detail) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Receivables [Abstract]
Gross accounts receivable	$ 1,490,865	$ 1,379,213
Allowance for contractual adjustments and uncollectibles	(1,216,701)	(1,106,900)
Accounts receivable, net	$ 274,164	$ 272,313

Accounts Receivable and Net Revenue (Tables)

6 Months Ended

Jun. 30, 2024

Text Block [Abstract]

Schedule of Accounts Receivable, Net

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


	June 30, 2024			December 31, 2023

Gross accounts receivable	$	1,490,865		$	1,379,213
Allowance for contractual adjustments and uncollectibles		(1,216,701	)		(1,106,900	)
	$	274,164		$	272,313

Schedule of Net Revenue

The following table summarizes the Company’s net revenue by category (in thousands):


	Three Months Ended June 30,				Six Months Ended June 30,
	2024		2023		2024		2023
Net patient service revenue	$	432,847	$	430,383	$	854,678	$	853,567
Hospital contract administrative fees		70,913		69,585		142,716		135,574
Other revenue		536		609		2,003		2,444
	$	504,296	$	500,577	$	999,397	$	991,585

Schedule of Percentage of Net Revenue

The approximate percentage of net patient service revenue by type of payor was as follows:


	Three Months Ended June 30,						Six Months Ended June 30,
	2024			2023			2024			2023
Contracted managed care		71	%		68	%		71	%		67	%
Government		23			25			24			25
Other third-parties		4			5			3			6
Private-pay patients		2			2			2			2
		100	%		100	%		100	%		100	%

Accounts Payable and Accrued Expenses (Tables)

6 Months Ended

Jun. 30, 2024

Payables and Accruals [Abstract]

Schedule of Accounts Payable and Accrued Expenses

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


	June 30, 2024	December 31, 2023
Accounts payable	$32,000	$34,588
Accrued salaries and incentive compensation	115,093	193,112
Accrued payroll taxes and benefits	28,034	36,545
Accrued professional liabilities	28,966	32,039
Accrued interest	8,258	8,262
Other accrued expenses	54,982	46,252
	$267,333	$350,798

Accounts Payable and Accrued Expenses - Schedule of Accounts Payable and Accrued Expenses (Detail) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Payables and Accruals [Abstract]
Accounts payable	$ 32,000	$ 34,588
Accrued salaries and incentive compensation	115,093	193,112
Accrued payroll taxes and benefits	28,034	36,545
Accrued professional liabilities	28,966	32,039
Accrued interest	8,258	8,262
Other accrued expenses	54,982	46,252
Accounts payable and accrued expenses, total	$ 267,333	$ 350,798

Stock Incentive Plans and Stock Purchase Plans - Additional Information (Detail) - USD ($) shares in Thousands, $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	$ 2.0	$ 4.9	$ 3.1	$ 6.1
Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			3 years
Aggregate number Shares issued under Stock Purchase Plans			200
Employee Stock Option \| 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
1996 Non-Qualified Employee Stock Purchase Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Aggregate number Shares issued under Stock Purchase Plans			0
Common stock, reserved for issuance	61,000		61,000
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] \| Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares available for future grants and awards under Stock Incentive Plans	6,300		6,300
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			1,400
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%
Common stock, reserved for issuance	1,800		1,800

Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Cash flows from operating activities:
Net income	$ (148,990)	$ 42,488
Adjustments to reconcile net income to net cash from operating activities:
Depreciation and amortization	19,099	17,898
Amortization of premiums, discounts and issuance costs	440	733
Goodwill impairment	154,243	0
Fixed assets impairments	20,112	0
Intangible assets impairments	7,679	0
Loss on disposal of businesses	10,873	0
Stock-based compensation expense	5,019	6,135
Deferred income taxes	(25,028)	8,376
Other	(1,678)	(900)
Changes in assets and liabilities:
Accounts receivable	(934)	28,900
Prepaid expenses and other current assets	3,703	2,141
Other long-term assets	16,955	5,052
Accounts payable and accrued expenses	(82,917)	(97,315)
Income taxes payable	11,735	(12,028)
Long-term professional liabilities	8,039	838
Other liabilities	(11,630)	(10,356)
Net cash used in operating activities - continuing operations	(13,280)	(8,038)
Net cash used in operating activities - discontinued operations	(4,995)	(3,825)
Net cash used in operating activities	(18,275)	(11,863)
Cash flows from investing activities:
Acquisition payments, net of cash acquired	(8,167)	(1,667)
Purchases of investments	(39,915)	(17,761)
Proceeds from maturities or sales of investments	31,244	12,810
Purchases of property and equipment	(12,292)	(15,130)
Net cash used in investing activities	(29,130)	(21,748)
Cash flows from financing activities:
Borrowings on line of credit	235,500	421,000
Payments on line of credit	(235,500)	(384,000)
Payments on term loan	(6,250)	(6,250)
Payment on finance lease obligation	(1,391)	(1,404)
Proceeds from issuance of common stock	2,009	2,689
Repurchases of common stock	(898)	(786)
Other	79	(1,613)
Net cash (used in) provided by financing activities	(6,451)	29,636
Net decrease in cash and cash equivalents	(53,856)	(3,975)
Cash and cash equivalents at beginning of period	73,258	9,824
Cash and cash equivalents at end of period	$ 19,402	$ 5,849

Fair Value Measurements - Schedule of fair value on a recurring basis (Details) - Fair Value, Recurring [Member] - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Fair Value, Inputs, Level 1 [Member]
Assets:
Money market funds	$ 397	$ 2,814
Mutual funds	19,002	17,687
Fair Value, Inputs, Level 2 [Member]
Assets:
Short-term investments	$ 113,795	$ 104,485

Line of Credit and Long Term Debt (Additional Information) (Details) - USD ($) $ in Thousands		6 Months Ended
	Feb. 11, 2022	Jun. 30, 2024	Jun. 30, 2023
Debt Instrument [Line Items]
Debt instrument interest rate		5.375%
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 revolving credit line		$ 235,500	$ 421,000
Long-Term Debt
Debt Instrument [Line Items]
Proceeds from issuance of unsecured debt	$ 250,000
Cash on hand	308,000
Credit Agreement [Member]
Debt Instrument [Line Items]
Line of Credit facility, available balance		450,000
Long term debt		221,900
Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Proceeds from issuance of unsecured debt	100,000
Borrowings on revolving credit line		37,500
Revolving Credit Facility [Member] \| Long-Term Debt
Debt Instrument [Line Items]
Proceeds from issuance of unsecured debt		250,000
Revolving Credit Facility [Member] \| Credit Agreement [Member]
Debt Instrument [Line Items]
Unsecured note issued		$ 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
5.375% 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
Long term debt		$ 400,000
2027 Notes
Debt Instrument [Line Items]
Long term debt	$ 1,000,000

Cover Page - shares	6 Months Ended
Cover Page - shares	Jun. 30, 2024	Aug. 02, 2024
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Transition Report	false
Amendment Flag	false
Document Period End Date	Jun. 30, 2024
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q2
Entity Registrant Name	Pediatrix Medical Group, Inc.
Entity Central Index Key	0000893949
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Title of 12(b) Security	Common Stock, par value $.01 per share
Trading Symbol	MD
Security Exchange Name	NYSE
Entity 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 Common Stock, Shares Outstanding		85,865,841

Consolidated Statements of Income and Comprehensive Income (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Income Statement [Abstract]
Net revenue	$ 504,296	$ 500,577	$ 999,397	$ 991,585
Operating expenses:
Practice salaries and benefits	357,808	354,032	726,946	716,267
Practice supplies and other operating expenses	32,369	31,089	63,454	61,809
General and administrative expenses	56,565	58,013	116,763	117,072
Depreciation and amortization	8,791	8,945	19,099	17,898
Transformational and restructuring related expenses	13,579	0	22,059	0
Goodwill impairment	154,243	0	154,243	0
Fixed assets impairments	20,112	0	20,112	0
Intangible assets impairments	7,679	0	7,679	0
Loss on disposal of businesses	10,873	0	10,873	0
Total operating expenses	662,019	452,079	1,141,228	913,046
(Loss) income from operations	(157,723)	48,498	(141,831)	78,539
Investment and other (loss) income	(161)	1,189	1,852	1,823
Interest expense	(10,308)	(11,230)	(20,907)	(21,620)
Equity in earnings of unconsolidated affiliate	464	490	982	917
Total non-operating expenses	(10,005)	(9,551)	(18,073)	(18,880)
(Loss) income before income taxes	(167,728)	38,947	(159,904)	59,659
Income tax benefit (provision)	14,703	(10,665)	10,914	(17,171)
Net (loss) income	(153,025)	28,282	(148,990)	42,488
Unrealized holding gain (loss) on investments, net of tax of $66, $126, $86 and $353	200	(387)	260	217
Total comprehensive (loss) income	$ (152,825)	$ 27,895	$ (148,730)	$ 42,705
Net (loss) income:
Basic	$ (1.84)	$ 0.34	$ (1.79)	$ 0.52
Diluted	$ (1.84)	$ 0.34	$ (1.79)	$ 0.52
Weighted average common shares:
Basic	83,332	82,399	83,074	82,033
Diluted	83,332	82,664	83,074	82,377

Basis of Presentation

6 Months Ended

Jun. 30, 2024

Accounting Policies [Abstract]

Basis of Presentation

1. Basis of Presentation:

The accompanying unaudited Consolidated Financial Statements of the Company and the notes thereto presented in this Form 10-Q have been prepared in accordance with the rules and regulations of the Securities and Exchange Commission ("SEC") applicable to interim financial statements, and do not include all disclosures required by accounting principles generally accepted in the United States of America (“GAAP”) for complete financial statements. In the opinion of management, these financial statements include all adjustments, consisting only of normal recurring adjustments, necessary for a fair statement of the results of interim periods. The financial statements include all the accounts of Pediatrix Medical Group, Inc. and its consolidated subsidiaries (collectively, “PMG”) together with the accounts of PMG’s affiliated business corporations or professional associations, professional corporations, limited liability companies and partnerships (the “affiliated professional contractors”). Certain subsidiaries of PMG have contractual management arrangements with its affiliated professional contractors, which are separate legal entities that provide physician services in certain states. The terms “Pediatrix” and the “Company” refer collectively to Pediatrix Medical Group Inc., its subsidiaries and the affiliated professional contractors.

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 consolidated results of operations for the interim periods presented are not necessarily indicative of the results to be experienced for the entire fiscal year. In addition, the accompanying unaudited Consolidated Financial Statements and the notes thereto should be read in conjunction with the Consolidated Financial Statements and the notes thereto included in the Company’s most recent Annual Report on Form 10-K (the “Form 10-K”).

Fair Value Measurements (Tables)

6 Months Ended

Jun. 30, 2024

Fair Value Disclosures [Abstract]

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 June 30, 2024 and December 31, 2023 (in thousands):


		Fair Value
	Fair Value Category	June 30, 2024		December 31, 2023
Assets:
Money market funds	Level 1	$	397	$	2,814
Short-term investments	Level 2		113,795		104,485
Mutual Funds	Level 1		19,002		17,687

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 June 30, 2024 and December 31, 2023 (in thousands):


	June 30, 2024				December 31, 2023
	Carrying Amount		Fair Value		Carrying Amount		Fair Value
Liabilities:
2030 Notes	$	400,000	$	353,760	$	400,000	$	357,000

Cash Equivalents and Investments - Schedule of Investments (Detail) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Available-for-sale [Line Items]
Available-for-sale Securities	$ 113,795	$ 104,485
Corporate securities
Available-for-sale [Line Items]
Available-for-sale Securities	55,777	57,878
U.S. Treasury securities [Member]
Available-for-sale [Line Items]
Available-for-sale Securities	31,456	22,674
Municipal Debt Securities [Member]
Available-for-sale [Line Items]
Available-for-sale Securities	17,377	14,649
Federal Home Loan Securities [Member]
Available-for-sale [Line Items]
Available-for-sale Securities	6,503	5,670
Certificates of Deposit [Member]
Available-for-sale [Line Items]
Available-for-sale Securities	$ 2,682	$ 3,614

- Definition

Amount of investment in debt security measured at fair value with change in fair value recognized in other comprehensive income (available-for-sale).

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- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

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+ Details

Accounts Receivable and Net Revenue - Schedule of Net Patient Service Revenue by Type of Payor (Detail)	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Disaggregation of Revenue [Line Items]
Percentage of net patient service revenue	100.00%	100.00%	100.00%	100.00%
Contracted Managed Care
Disaggregation of Revenue [Line Items]
Percentage of net patient service revenue	71.00%	68.00%	71.00%	67.00%
Government
Disaggregation of Revenue [Line Items]
Percentage of net patient service revenue	23.00%	25.00%	24.00%	25.00%
Other Third-Parties
Disaggregation of Revenue [Line Items]
Percentage of net patient service revenue	4.00%	5.00%	3.00%	6.00%
Private-Pay Patients
Disaggregation of Revenue [Line Items]
Percentage of net patient service revenue	2.00%	2.00%	2.00%	2.00%

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References + Details

Accounts Payable and Accrued Expenses - Additional Information (Detail) $ in Millions	6 Months Ended
	Jun. 30, 2024 USD ($)
Net decrease in accrued salaries and bonuses	$ 78.0

Accounts Receivable and Net Revenue

6 Months Ended

Jun. 30, 2024

Text Block [Abstract]

Accounts Receivable and Net Revenue

4. Accounts Receivable and Net Revenue:

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


	June 30, 2024			December 31, 2023

Gross accounts receivable	$	1,490,865		$	1,379,213
Allowance for contractual adjustments and uncollectibles		(1,216,701	)		(1,106,900	)
	$	274,164		$	272,313

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 government-sponsored healthcare programs (“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.

The following table summarizes the Company’s net revenue by category (in thousands):


	Three Months Ended June 30,				Six Months Ended June 30,
	2024		2023		2024		2023
Net patient service revenue	$	432,847	$	430,383	$	854,678	$	853,567
Hospital contract administrative fees		70,913		69,585		142,716		135,574
Other revenue		536		609		2,003		2,444
	$	504,296	$	500,577	$	999,397	$	991,585

The approximate percentage of net patient service revenue by type of payor was as follows:


	Three Months Ended June 30,						Six Months Ended June 30,
	2024			2023			2024			2023
Contracted managed care		71	%		68	%		71	%		67	%
Government		23			25			24			25
Other third-parties		4			5			3			6
Private-pay patients		2			2			2			2
		100	%		100	%		100	%		100	%

Consolidated Statements of Shareholders' Equity (Unaudited) - USD ($) $ in Thousands	Total	Common Stock [Member]	Additional Paid-in Capital [Member]	Accumulated Other Comprehensive Loss [Member]	Retained Deficit [Member]
Balance at Dec. 31, 2022	$ 891,632	$ 829	$ 983,601	$ (3,735)	$ (89,063)
Balance, Shares at Dec. 31, 2022		82,947,000
Net Income (Loss)	14,206				14,206
Unrealized holding gain on investments, net of tax	604			604
Common stock issued under employee stock purchase plan Value	1,095		1,095
Common stock issued under employee stock purchase plan shares		86,000
Issuance of restricted stock		$ 9	(9)
Issuance of restricted stock, shares		871,000
Forfeitures of restricted stock		$ (2)	2
Forfeitures of restricted stock, shares		(221,000)
Stock-based compensation expense	3,009		3,009
Repurchased common stock	(775)		(775)
Repurchased common stock, shares		(49,000)
Balance at Mar. 31, 2023	909,771	$ 836	986,923	(3,131)	(74,857)
Balance, Shares at Mar. 31, 2023		83,634,000
Balance at Dec. 31, 2022	891,632	$ 829	983,601	(3,735)	(89,063)
Balance, Shares at Dec. 31, 2022		82,947,000
Net Income (Loss)	42,488
Balance at Jun. 30, 2023	942,375	$ 838	991,630	(3,518)	(46,575)
Balance, Shares at Jun. 30, 2023		83,841,000
Balance at Mar. 31, 2023	909,771	$ 836	986,923	(3,131)	(74,857)
Balance, Shares at Mar. 31, 2023		83,634,000
Net Income (Loss)	28,282				28,282
Unrealized holding gain on investments, net of tax	(387)			(387)
Common stock issued under employee stock purchase plan Value	1,594	$ 1	1,593
Common stock issued under employee stock purchase plan shares		126,000
Issuance of restricted stock		$ 1	(1)
Issuance of restricted stock, shares		93,000
Forfeitures of restricted stock, shares		(11,000)
Stock-based compensation expense	3,126		3,126
Repurchased common stock	(11)		(11)
Repurchased common stock, shares		(1,000)
Balance at Jun. 30, 2023	942,375	$ 838	991,630	(3,518)	(46,575)
Balance, Shares at Jun. 30, 2023		83,841,000
Balance at Dec. 31, 2023	849,061	$ 840	999,906	(2,214)	(149,471)
Balance, Shares at Dec. 31, 2023		84,018,000
Net Income (Loss)	4,035				4,035
Unrealized holding gain on investments, net of tax	60			60
Common stock issued under employee stock purchase plan Value	860	$ 1	859
Common stock issued under employee stock purchase plan shares		108,000
Forfeitures of restricted stock, shares		(21,000)
Stock-based compensation expense	3,067		3,067
Repurchased common stock	(887)	$ (1)	(886)
Repurchased common stock, shares		(97,000)
Balance at Mar. 31, 2024	856,196	$ 840	1,002,946	(2,154)	(145,436)
Balance, Shares at Mar. 31, 2024		84,008,000
Balance at Dec. 31, 2023	849,061	$ 840	999,906	(2,214)	(149,471)
Balance, Shares at Dec. 31, 2023		84,018,000
Net Income (Loss)	$ (148,990)
Repurchased common stock, shares	0
Balance at Jun. 30, 2024	$ 706,461	$ 858	1,006,018	(1,954)	(298,461)
Balance, Shares at Jun. 30, 2024		85,753,000
Balance at Mar. 31, 2024	856,196	$ 840	1,002,946	(2,154)	(145,436)
Balance, Shares at Mar. 31, 2024		84,008,000
Net Income (Loss)	(153,025)				(153,025)
Unrealized holding gain on investments, net of tax	200			200
Common stock issued under employee stock purchase plan Value	1,149	$ 2	1,147
Common stock issued under employee stock purchase plan shares		139,000
Issuance of restricted stock		$ 16	(16)
Issuance of restricted stock, shares		1,630,000
Forfeitures of restricted stock, shares		(22,000)
Stock-based compensation expense	1,952		1,952
Repurchased common stock	(11)		(11)
Repurchased common stock, shares		(2,000)
Balance at Jun. 30, 2024	$ 706,461	$ 858	$ 1,006,018	$ (1,954)	$ (298,461)
Balance, Shares at Jun. 30, 2024		85,753,000

Business Combinations - Additional information (Detail) $ in Millions	6 Months Ended
	Jun. 30, 2024 USD ($) Number
Goodwill	$ 9.1
Other intangible assets	0.2
Fixed assets	$ 0.4
Maternal Fetal Medicine Practice [Member]
Number of Maternal Fetal Medicine Practices Acquired \| Number	1
Business acquisition total consideration	$ 9.7
Business acquisition consideration paid in cash	6.5
Business combination consideration identifiable as current and long term liabilities	$ 3.2

Common and Common Equivalent Shares (Tables)

6 Months Ended

Jun. 30, 2024

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 common share calculation for the three and six months ended June 30, 2024 and 2023 is as follows (in thousands):


	Three Months Ended June 30,				Six Months Ended June 30,
	2024		2023		2024		2023
Weighted average number of common shares outstanding		83,332		82,399		83,074		82,033
Weighted average number of dilutive common share equivalents (a)		—		265		—		344
Weighted average number of common and common equivalent shares outstanding		83,332		82,664		83,074		82,377
Antidilutive securities (restricted stock and stock options) not included in the diluted net income per common share calculation		916		1,338		661		1,358

(a) Due to a loss for the three and six months ended June 30, 2024, 0.1 million and 0.3 million incremental shares, respectively, are not included because the effect would be antidilutive.

Cash Equivalents and Investments (Tables)

6 Months Ended

Jun. 30, 2024

Investments, Debt and Equity Securities [Abstract]

Schedule of Investments

Investments held are all classified as current and at June 30, 2024 and December 31, 2023 are summarized as follows (in thousands):


	June 30, 2024		December 31, 2023
Corporate securities	$	55,777	$	57,878
U.S. Treasury securities		31,456		22,674
Municipal debt securities		17,377		14,649
Federal home loan securities		6,503		5,670
Certificates of deposit		2,682		3,614
	$	113,795	$	104,485

- Definition

Tabular disclosure of investment in debt security measured at fair value with change in fair value recognized in other comprehensive income (available-for-sale).

+ References

Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 9
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-9

Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-3

Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-2

Reference 4: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-2

Reference 5: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-2

Reference 6: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (aa)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-2

Reference 7: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (aaa)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-2

Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-2

Reference 9: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-3

Reference 10: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-3

Reference 11: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-3

Reference 12: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-3

+ Details

Stock Incentive Plans and Stock Purchase Plans

6 Months Ended

Jun. 30, 2024

Share-Based Payment Arrangement [Abstract]

Stock Incentive Plans and Stock Purchase Plans

10. Stock Incentive Plans and Stock Purchase Plans:

The Company’s Amended and Restated 2008 Incentive Compensation Plan (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 six months ended June 30, 2024, the Company granted 1.4 million shares of restricted stock to its employees and non-employee directors under the Amended and Restated 2008 Incentive Plan. At June 30, 2024, the Company had 6.3 million shares available for future grants and awards under the Amended and Restated 2008 Incentive Plan.

Under the Company’s Amended and Restated 1996 Non-Qualified Employee Stock Purchase Plan, as amended (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 six months ended June 30, 2024, approximately 0.2 million shares were issued under the ESPP. At June 30, 2024, the Company had approximately 1.8 million shares reserved for issuance under the ESPP. At June 30, 2024, the Company had approximately 61,000 shares in the aggregate reserved for issuance under the SPP. No shares have been issued under the SPP since 2020.

During the three and six months ended June 30, 2024 and 2023, the Company recognized stock-based compensation expense of $2.0 million and $4.9 million and $3.1 million and $6.1 million, respectively.

Cash Equivalents and Investments

6 Months Ended

Jun. 30, 2024

Investments, Debt and Equity Securities [Abstract]

Cash Equivalents and Investments

2. Cash Equivalents and Investments:

As of June 30, 2024 and December 31, 2023, the Company's cash equivalents consisted entirely of money market funds totaling $0.4 million and $2.8 million, respectively.

Investments held are all classified as current and at June 30, 2024 and December 31, 2023 are summarized as follows (in thousands):


	June 30, 2024		December 31, 2023
Corporate securities	$	55,777	$	57,878
U.S. Treasury securities		31,456		22,674
Municipal debt securities		17,377		14,649
Federal home loan securities		6,503		5,670
Certificates of deposit		2,682		3,614
	$	113,795	$	104,485

Basis of Presentation - Additional Information (Detail)	Jun. 30, 2024
Unnamed Corporate Joint Venture One [Member]
Basis Of Presentation [Line Items]
Equity method ownership percentage in joint venture	37.50%

Cash Equivalents and Investments - Additional Information (Detail) - USD ($) $ in Millions	Jun. 30, 2024	Dec. 31, 2023
Cash Equivalents [Member]
Cash Equivalents And Investments [Line Items]
Cash equivalents	$ 0.4	$ 2.8

Consolidated Balance Sheets (Unaudited) (Parenthetical) - $ / shares	Jun. 30, 2024	Dec. 31, 2023
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	85,753,258	84,018,023
Common stock, shares outstanding	85,753,258	84,018,023

Common and Common Equivalent Shares - Schedule of Calculation of Shares Used in Basic and Diluted Net Income Per Share (Parenthetical) (Details) - shares shares in Millions	3 Months Ended	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2024
Earnings Per Share [Abstract]
Incremental shares not Included due to anti dilutive effect	0.1	0.3

Fair Value Measurements - Schedule of financial instruments that are not carried at fair value (Details) - 2030 Notes [Member] - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Liabilities:
Notes Payable	$ 400,000	$ 400,000
Liabilities:
Notes Payable Fair Value Disclosure	$ 353,760	$ 357,000

Goodwill and Long-Lived Asset Impairments (Additional Information) (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Fixed assets impairments	$ 20,112	$ 0	$ 20,112	$ 0
Intangible assets impairments	7,679	0	7,679	0
Operating lease right-of-use asset impairments			8,100
Additional Deferred Tax Assets	24,200		24,200
Loss on disposal of businesses	10,873	0	10,873	0
Non cash charges			154,200
Incremental Non Cash Charge			24,200
Goodwill impairment	$ 154,243	$ 0	$ 154,243	$ 0
Change in Rate of Control Premium			1.00%
Intangible asset impairments			$ 6,500
Good will Impairment Loss excluding Deferred Tax Assets Charge			$ 130,000

Insider Trading Arrangements	3 Months Ended
Insider Trading Arrangements	Jun. 30, 2024
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false

Common Stock Repurchase Programs

6 Months Ended

Jun. 30, 2024

Equity [Abstract]

Common Stock Repurchase Programs

11. 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 six months ended June 30, 2024.

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 $4.6 million remained available for repurchase as of December 31, 2023. Under this share repurchase program, during the six months ended June 30, 2024, the Company purchased a nominal number of shares of its common stock for $0.9 million representing shares withheld to satisfy minimum statutory withholding obligations in connection with the vesting of restricted stock, resulting in $3.7 million remaining available for repurchase under this authorization as of June 30, 2024.

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.

Commitments and Contingencies

6 Months Ended

Jun. 30, 2024

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

12. 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 June 30, 2024 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.

Accounts Payable and Accrued Expenses

6 Months Ended

Jun. 30, 2024

Payables and Accruals [Abstract]

Accounts Payable and Accrued Expenses

7. Accounts Payable and Accrued Expenses:

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


	June 30, 2024	December 31, 2023
Accounts payable	$32,000	$34,588
Accrued salaries and incentive compensation	115,093	193,112
Accrued payroll taxes and benefits	28,034	36,545
Accrued professional liabilities	28,966	32,039
Accrued interest	8,258	8,262
Other accrued expenses	54,982	46,252
	$267,333	$350,798

The net decrease in accrued salaries and incentive compensation of $78.0 million, from December 31, 2023 to June 30, 2024, is primarily due to the payment of performance-based incentive compensation, principally to the Company’s affiliated physicians, partially offset by performance-based incentive compensation accrued during the six months ended June 30, 2024. A majority of the Company’s payments for performance-based incentive compensation is paid annually during the first quarter.

Consolidated Statements of Income and Comprehensive Income (Unaudited) (Parenthetical) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Income Statement [Abstract]
Unrealized holding gain (loss) on investments, net of tax	$ 66	$ 126	$ 86	$ 353

Common Stock Repurchase Programs - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended				6 Months Ended
	Jun. 30, 2024	Mar. 31, 2024	Jun. 30, 2023	Mar. 31, 2023	Jun. 30, 2024	Jun. 30, 2023	Dec. 31, 2023	Aug. 31, 2018
Common Stock [Line Items]
Repurchased common stock, shares					0
Common stock authorized for repurchase								$ 500,000
Company's Common stock repurchased							$ 4,600
Payments for repurchase of common stock					$ 898	$ 786
Common Stock [Member]
Common Stock [Line Items]
Repurchased common stock, shares	(2,000)	(97,000)	(1,000)	(49,000)
Payments for repurchase of common stock					900
Restricted Stock [Member]
Common Stock [Line Items]
Company's Common stock repurchased	$ 3,700				$ 3,700

- Definition

Number of shares that have been repurchased during the period and have not been retired and are not held in treasury. Some state laws may govern the circumstances under which an entity may acquire its own stock and prescribe the accounting treatment therefore. This element is used when state law does not recognize treasury stock.

+ References + Details

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

3 Months Ended

6 Months Ended

Jun. 30, 2024

Jun. 30, 2023

Jun. 30, 2024

Jun. 30, 2023

Earnings Per Share [Abstract]

Weighted average number of common shares outstanding

83,332,000

82,399,000

83,074,000

82,033,000

Weighted average number of dilutive common share equivalents

^[1]

265,000

344,000

Weighted average number of common and common equivalent shares outstanding

83,332,000

82,664,000

83,074,000

82,377,000

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

916,000

1,338,000

661,000

1,358,000

[1]	Due to a loss for the three and six months ended June 30, 2024, 0.1 million and 0.3 million incremental shares, respectively, are not included because the effect would be antidilutive.

Business Combinations

6 Months Ended

Jun. 30, 2024

Business Combinations [Abstract]

Business Combinations

5. Business Combinations

During the six months ended June 30, 2024, the Company completed the acquisition of one maternal-fetal medicine practice for total consideration of $9.7 million, of which $6.5 million was paid in cash at closing and $3.2 million was recorded as a contingent consideration liability. The acquisition expanded the Company’s national network of physician practices across women’s and children’s services. In connection with this acquisition, the Company recorded tax deductible goodwill of $9.1 million, fixed assets of $0.4 million and other intangible assets consisting primarily of physician and hospital agreements of $0.2 million.

Consolidated Balance Sheets (Unaudited) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Current assets:
Cash and cash equivalents	$ 19,402	$ 73,258
Short-term investments	113,795	104,485
Accounts receivable, net	274,164	272,313
Prepaid expenses	11,910	13,525
Income taxes receivable	0	7,565
Other current assets	9,941	12,308
Total current assets	429,212	483,454
Property and equipment, net	47,893	75,639
Goodwill	1,239,007	1,384,166
Intangible assets, net	10,193	21,240
Operating and finance lease right-of-use assets	65,392	70,294
Deferred income tax assets	124,115	102,852
Other assets	79,539	82,165
Total assets	1,995,351	2,219,810
Current liabilities:
Accounts payable and accrued expenses	267,333	350,798
Current portion of debt and finance lease liabilities, net	17,730	14,913
Current portion of operating lease liabilities	18,764	21,076
Income taxes payable	6,329	2,159
Total current liabilities	310,156	388,946
Long-term debt and finance lease liabilities, net	612,640	618,421
Long-term operating lease liabilities	49,176	47,238
Long-term professional liabilities	254,770	251,284
Deferred income tax liabilities	30,627	34,308
Other liabilities	31,521	30,552
Total liabilities	1,288,890	1,370,749
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; 85,753,258 and 84,018,023 shares issued and outstanding, respectively	858	840
Additional paid-in capital	1,006,018	999,906
Accumulated other comprehensive loss	(1,954)	(2,214)
Retained deficit	(298,461)	(149,471)
Total shareholders' equity	706,461	849,061
Total liabilities and shareholders' equity	$ 1,995,351	$ 2,219,810

Goodwill and Long-Lived Asset Impairments

6 Months Ended

Jun. 30, 2024

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill, Long-Lived Asset Impairments and Loss on Disposal of Businesses

6. Goodwill, Long-Lived Asset Impairments and Loss on Disposal of Businesses:

During the second quarter of 2024, the Company formalized its practice portfolio management plans, resulting in a decision to exit almost all of its affiliated office-based practices, other than maternal-fetal medicine. The practice exits are expected to be completed by December 31, 2024. Accordingly, a recoverability assessment for each individual physician practice was performed, and the estimated future cash flows related to the physician practices did not support the carrying value of the specifically identified individual long-lived assets. As a result, the Company recorded fixed asset impairments of $20.1 million, intangible asset impairments of $7.7 million and operating lease right-of-use asset impairments of $8.1 million. The operating lease right-of-use impairments are recorded within the transformational and restructuring related expenses line item.

During the second quarter of 2024, the Company made the decision to exit its primary and urgent care service line based on a review of the cost and time that would be required to build the platform to scale. The Company divested one of its two previously acquired primary and urgent care practices during the second quarter and divested of the second of its two acquired primary and urgent care practices subsequent to the end of the second quarter. The total loss on disposal of these two businesses was $10.9 million, resulting from the loss on sale for one practice and marking the net assets to their fair value less costs to sell for the other practice.

During the second quarter of 2024, the Company experienced a triggering event, due to a sustained decline in its stock price and a market capitalization below the Company's book equity value. As the Company consists of only one reporting unit, and is publicly traded, management estimates the fair value of its reporting unit utilizing the Company’s market capitalization, multiplying the number of actual shares outstanding on June 30, 2024 by its stock price on June 30, 2024 and applying an additional premium to give effect to the Company’s best estimate of a control premium. With respect to the estimated control premium used in its analysis, the Company believes that it is reasonable to expect that a market participant would pay a premium to obtain a controlling interest in the Company. The Company considered information from the public markets for premiums on acquisitions in its industry and also considered other factors, such as the value that may arise from the ability to take advantage of synergies and other benefits that flow from control over another entity.

This assessment resulted in a non-cash impairment charge of $130.0 million, representing the amount by which the Company's book value exceeded its implied fair value, based on its market capitalization plus an estimated control premium. Consideration was first given to other individual and group long-lived assets, and no impairment was considered necessary on such assets.

Recognition of this non-cash charge against goodwill resulted in a tax benefit which generated an additional deferred tax asset of $24.2 million that increased the Company's book value. An incremental non-cash charge was required to reduce the

Company's book value to its previously determined fair value. Accordingly, the Company recorded the incremental non-cash charge of $24.2 million for a total non-cash charge of $154.2 million. A 1% change in the control premium used would have impacted the non-cash impairment charge by approximately $6.5 million.

Fair Value Measurements

6 Months Ended

Jun. 30, 2024

Fair Value Disclosures [Abstract]

Fair Value Measurements

3. 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 June 30, 2024 and December 31, 2023 (in thousands):


		Fair Value
	Fair Value Category	June 30, 2024		December 31, 2023
Assets:
Money market funds	Level 1	$	397	$	2,814
Short-term investments	Level 2		113,795		104,485
Mutual Funds	Level 1		19,002		17,687

The following table presents information about the Company’s financial instruments that are not carried at fair value at June 30, 2024 and December 31, 2023 (in thousands):


	June 30, 2024				December 31, 2023
	Carrying Amount		Fair Value		Carrying Amount		Fair Value
Liabilities:
2030 Notes	$	400,000	$	353,760	$	400,000	$	357,000

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.

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 107
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482078/820-10-55-107

Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 100
-Publisher FASB
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+ Details

Line of Credit and Long Term Debt

6 Months Ended

Jun. 30, 2024

Debt Disclosure [Abstract]

Line of Credit and Long Term Debt

8. Line of Credit and Long-Term Debt:

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 $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.

At June 30, 2024, the Company had an outstanding principal balance on the Amended Credit Agreement of $221.9 million, composed of the Term A Loan. There was no outstanding balance under the Revolving Credit Line. The Company had $450.0 million available on its Amended Credit Agreement at June 30, 2024.

At June 30, 2024, the Company had an outstanding principal balance of $400.0 million on the 2030 Notes.