|
Acquisitions and Discontinued Operations - Additional Information (Detail) (USD $)
In Thousands, except Share data, unless otherwise specified |
1 Months Ended | 3 Months Ended | 12 Months Ended | 12 Months Ended | 1 Months Ended | 12 Months Ended | 1 Months Ended | 12 Months Ended | 1 Months Ended | 12 Months Ended | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
Sep. 02, 2011
Entity
|
Dec. 31, 2013
|
Sep. 30, 2013
|
Jun. 30, 2013
|
Mar. 31, 2013
|
Dec. 31, 2012
|
Sep. 30, 2012
|
Jun. 30, 2012
|
Mar. 31, 2012
|
Dec. 31, 2013
|
Dec. 31, 2012
|
Dec. 31, 2011
|
Oct. 31, 2011
Entity
|
Sep. 30, 2011
Entity
|
Dec. 31, 2013
Other Accrued Liabilities
|
Dec. 31, 2013
Other long-term liabilities
|
Dec. 31, 2013
Other companies
|
Dec. 31, 2013
Other companies
Scenario 1
|
Dec. 31, 2013
Other companies
Earn-out obligations
|
Dec. 31, 2013
U.S. dialysis and related lab services
|
Dec. 31, 2012
U.S. dialysis and related lab services
|
Dec. 31, 2011
U.S. dialysis and related lab services
|
Dec. 31, 2012
HomeChoice Partners
|
Dec. 31, 2013
HomeChoice Partners
|
Dec. 31, 2012
HomeChoice Partners
Minimum
|
Apr. 30, 2013
HealthCare Partners (HCP)
|
Nov. 01, 2012
HealthCare Partners (HCP)
|
Dec. 31, 2013
HealthCare Partners (HCP)
|
Nov. 01, 2012
HealthCare Partners (HCP)
Customer relationships
|
Nov. 01, 2012
HealthCare Partners (HCP)
Trade names
|
Nov. 01, 2012
HealthCare Partners (HCP)
Noncompetition and other agreements
|
Nov. 01, 2012
HealthCare Partners (HCP)
Provider network and practice management tools
|
Dec. 31, 2013
CDSI I Holding Company, Inc
|
Dec. 31, 2012
CDSI I Holding Company, Inc
|
Dec. 31, 2011
CDSI I Holding Company, Inc
Person
Entity
Location
|
Dec. 31, 2013
Other dialysis acquisitions
|
Dec. 31, 2012
Other dialysis acquisitions
|
Dec. 31, 2011
Other dialysis acquisitions
|
Dec. 31, 2013
Other dialysis acquisitions
U.S. dialysis and related lab services
Entity
|
Dec. 31, 2012
Other dialysis acquisitions
U.S. dialysis and related lab services
Entity
|
Dec. 31, 2011
Other dialysis acquisitions
U.S. dialysis and related lab services
Entity
|
Dec. 31, 2013
Other dialysis acquisitions
Foreign
Entity
|
Dec. 31, 2012
Other dialysis acquisitions
Foreign
Entity
|
Dec. 31, 2011
Other dialysis acquisitions
Foreign
Entity
|
Dec. 31, 2011
Other dialysis acquisitions
Vascular Access Centers
Entity
|
|
| Business Acquisition [Line Items] | |||||||||||||||||||||||||||||||||||||||||||||
| Number of businesses acquired | 113 | 26 | 93 | 57 | 38 | 13 | 8 | ||||||||||||||||||||||||||||||||||||||
| Number of centers | 1 | ||||||||||||||||||||||||||||||||||||||||||||
| Cash paid to acquire business | $ 3,645,759 | $ 723,012 | $ 310,394 | $ 648,318 | $ 354,430 | ||||||||||||||||||||||||||||||||||||||||
| Deferred purchase price obligations | 209 | 6,541 | 24,683 | 6,101 | 12,469 | ||||||||||||||||||||||||||||||||||||||||
| Number of patients | 8,000 | ||||||||||||||||||||||||||||||||||||||||||||
| Number of states | 23 | ||||||||||||||||||||||||||||||||||||||||||||
| Additional transaction and integration costs incurred in association with the acquisition | 21,700 | ||||||||||||||||||||||||||||||||||||||||||||
| Amortizable intangible assets acquired, weighted-average estimated useful lives | 17 years 2 months 12 days | 20 years | 10 years 7 months 6 days | 5 years 8 months 12 days | 7 years | 14 years | 15 years | 9 years | |||||||||||||||||||||||||||||||||||||
| Goodwill deductible for tax purposes associated with acquisitions | 2,426,986 | 221,454 | 491,457 | 560,000 | |||||||||||||||||||||||||||||||||||||||||
| Revenues | 3,063,209 | 2,999,586 | 2,871,673 | 2,829,582 | 2,477,853 | 1,945,888 | 1,913,006 | 1,849,533 | 8,307,195 | 7,351,902 | 6,470,540 | 8,032,772 | 7,316,818 | 6,473,952 | 3,200,000 | ||||||||||||||||||||||||||||||
| Operating income | 484,179 | 377,074 | 522,020 | 166,861 | 388,056 | 340,885 | 247,261 | 320,882 | 1,550,134 | 1,297,084 | 1,154,713 | 385,000 | |||||||||||||||||||||||||||||||||
| Total consideration paid | 4,701,231 | ||||||||||||||||||||||||||||||||||||||||||||
| Common stock share issued to acquire business | 18,760,624 | ||||||||||||||||||||||||||||||||||||||||||||
| Approximate value of common stock share issued | 1,055,472 | ||||||||||||||||||||||||||||||||||||||||||||
| Cash paid for post-closing working capital adjustment | 5,251 | ||||||||||||||||||||||||||||||||||||||||||||
| Additional cash consideration in the form of earn-out payments | 275,000 | ||||||||||||||||||||||||||||||||||||||||||||
| Amortizable intangible assets | 1,882,818 | 1,453,410 | 170,494 | 74,650 | 184,686 | ||||||||||||||||||||||||||||||||||||||||
| Goodwill deductible period for tax purpose | 15 years | ||||||||||||||||||||||||||||||||||||||||||||
| Contingent consideration payment | 136,954 | 68,750 | |||||||||||||||||||||||||||||||||||||||||||
| Contingent earn-out obligation adjustment | (56,977) | 56,977 | |||||||||||||||||||||||||||||||||||||||||||
| Additional cash consideration in the form of earn-out payments | 6,577 | 142,244 | 6,577 | 142,244 | 118,600 | ||||||||||||||||||||||||||||||||||||||||
| Earn out consideration payment period | 3 years | 5 years | |||||||||||||||||||||||||||||||||||||||||||
| Fair value of contingent earn-out consideration | 28,058 | ||||||||||||||||||||||||||||||||||||||||||||
| Contingent earn-out obligations | 28,058 | 292,042 | 28,058 | 292,042 | 6,736 | 21,322 | |||||||||||||||||||||||||||||||||||||||
| Proceeds from sale of discontinued operations | 70,000 | ||||||||||||||||||||||||||||||||||||||||||||
| Additional consideration if certain performance amounts exceed certain thresholds over the next two years | 20,000 | ||||||||||||||||||||||||||||||||||||||||||||
| Performance amounts thresholds measurement period | 2 years | ||||||||||||||||||||||||||||||||||||||||||||
| Contingent receivable | 0 | ||||||||||||||||||||||||||||||||||||||||||||
| Gain recorded on account of divestitures | 13,375 | (4,756) | 13,375 | ||||||||||||||||||||||||||||||||||||||||||
| Number of outpatient dialysis centers to be divested | 30 | ||||||||||||||||||||||||||||||||||||||||||||
| Number of outpatient dialysis centers divested | 2 | 28 | |||||||||||||||||||||||||||||||||||||||||||
| Proceeds from sale of discontinued operations | 84,000 | ||||||||||||||||||||||||||||||||||||||||||||
| Loss recorded on account of divestitures | $ (4,756) | ||||||||||||||||||||||||||||||||||||||||||||