Operating Cash Flow Activities
Year Ended December 31, 2019 Compared with the Year Ended December 31, 2018
Net cash provided by operating activities – continuing operations decreased during the year ended December 31, 2019 compared with prior year. The decrease in income from operations and the increase in non-cash adjustments to net income in 2019 partially related to the absence in the gains on sale of divestitures, such as OneContent in 2018.
The increase in non-cash adjustments to net loss in 2019 also related to higher depreciation and the amortization of right-to-use assets. The net loss and the cash impact of changes in operating assets and liabilities during 2019 reflects the $145 million settlement with the DOJ in connection with the Practice Fusion investigations.
Net cash used in operating activities – discontinued operations during the year ended December 31, 2019 reflects an advance income tax payment related to the gain realized on the sale of our investment in Netsmart on December 31, 2018.
Year Ended December 31, 2018 Compared with the Year Ended December 31, 2017
Net cash provided by operating activities – continuing operations decreased during the year ended December 31, 2018 compared with the prior year primarily due to working capital changes and higher costs during the year ended December 31, 2018 compared with the prior year, which primarily included higher interest expense, transaction-related and legal expenses, and incentive-based compensation payments.
The decrease in non-cash adjustments to net loss was primarily driven by lower non-cash impairment charges associated with long-term investments, intangibles and goodwill during the year ended December 31, 2018 compared with the prior year.
Net cash provided by operating activities – discontinued operations decreased during the year ended December 31, 2018 compared with the prior year primarily driven by the additional tax provision relating to the gain from the sale of our investment in Netsmart on December 31, 2018. Netsmart generated cash from operations during both 2018 and 2017. During 2018, Netsmart’s cash provided by operations decreased by approximately $16 million primarily driven by higher interest expenses paid attributable to Netsmart’s credit facilities.
Table:
 |  | Year Ended December 31, |  |  | 
(In thousands) | 2019 | 2018 | 2017 | 2019 $ Change from 2018 | 2018 $ Change from 2017
Net (loss) income | $ (182,602) | $ 407,807 | $ (154,175) | $ (590,409) | $ 561,982
Less: Loss from discontinued operations | 0 | 395,138 | 30,348 | (395,138) | 364,790
(Loss) income from continuing operations | (182,602) | 12,669 | (184,523) | (195,271) | 197,192
Non-cash adjustments to net (loss) income | 277,217 | 136,651 | 351,835 | 140,566 | (215,184)
Cash impact of changes in operating assets and liabilities | (18,361) | (60,086) | 57,746 | 41,725 | (117,832)
Net cash provided by operating activities - continuing operations | 76,254 | 89,234 | 225,058 | (12,980) | (135,824)
Net cash (used in) provided by operating activities - discontinued operations | (30,000) | (21,343) | 54,357 | (8,657) | (75,700)
Net cash provided by operating activities | $ 46,254 | $ 67,891 | $ 279,415 | $ (21,637) | $ (211,524)


Question: What led to decreased Net cash provided by operating activities – continuing operations during the year ended December 31, 2018 compared to the prior year?
Answer: due to working capital changes and higher costs during the year ended December 31, 2018 compared with the prior year, which primarily included higher interest expense, transaction-related and legal expenses, and incentive-based compensation payments.