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Segment reporting (Tables) | 12 Months Ended
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Dec. 31, 2015
Segment Reporting [Abstract] |
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income from Continuing Operations Before Income Taxes | The following is a summary of segment revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income from continuing operations before income taxes:
|  | Year ended December 31, |
|  | 2015 |  |  | 2014 |  |  | 2013 |
Segment revenues: |  |  |  |  |  |  |  |  |  |  |  |
U.S. dialysis and related lab services |  |  |  |  |  |  |  |  |  |  |  |
Patient service revenues: |  |  |  |  |  |  |  |  |  |  |  |
External sources |  | $ | 8,980,515 |  |  | $ | 8,513,089 |  |  | $ | 7,998,692 |
Intersegment revenues |  |  | 53,476 |  |  |  | 37,112 |  |  |  | 34,080 |
Total dialysis and related lab services revenues |  |  | 9,033,991 |  |  |  | 8,550,201 |  |  |  | 8,032,772 |
Less: Provision for uncollectible accounts |  |  | (406,530 | ) |  |  | (353,028 | ) |  |  | (281,146 | )
Net dialysis and related lab services patient service revenues |  |  | 8,627,461 |  |  |  | 8,197,173 |  |  |  | 7,751,626 |
Other revenues(1) |  |  | 13,971 |  |  |  | 13,498 |  |  |  | 12,600 |
Total net dialysis and related lab services revenues |  |  | 8,641,432 |  |  |  | 8,210,671 |  |  |  | 7,764,226 |
HCP |  |  |  |  |  |  |  |  |  |  |  |
HCP revenues: |  |  |  |  |  |  |  |  |  |  |  |
Capitated revenues |  | $ | 3,436,705 |  |  | $ | 3,190,903 |  |  | $ | 2,919,964 |
Net patient service revenues |  |  | 317,950 |  |  |  | 219,306 |  |  |  | 220,251 |
Other revenues(2) |  |  | 82,470 |  |  |  | 91,374 |  |  |  | 55,723 |
Intersegment capitated and other revenues |  |  | 136 |  |  |  | 716 |  |  |  | 250 |
Total revenues |  | $ | 3,837,261 |  |  | $ | 3,502,299 |  |  | $ | 3,196,188 |
Other - Ancillary services and strategic initiatives |  |  |  |  |  |  |  |  |  |  |  |
Net patient service revenues |  | $ | 160,484 |  |  | $ | 122,087 |  |  | $ | 75,852 |
Capitated revenues |  |  | 72,390 |  |  |  | 70,385 |  |  |  | 67,351 |
Other external sources |  |  | 1,123,882 |  |  |  | 927,492 |  |  |  | 694,763 |
Intersegment revenues |  |  | 25,674 |  |  |  | 19,535 |  |  |  | 13,916 |
Total ancillary services and strategic initiatives revenues |  |  | 1,382,430 |  |  |  | 1,139,499 |  |  |  | 851,882 |
Total net segment revenues |  |  | 13,861,123 |  |  |  | 12,852,469 |  |  |  | 11,812,296 |
Elimination of intersegment revenues |  |  | (79,286 | ) |  |  | (57,363 | ) |  |  | (48,246 | )
Consolidated net revenues |  | $ | 13,781,837 |  |  | $ | 12,795,106 |  |  | $ | 11,764,050 |
Segment operating margin (loss):(3) |  |  |  |  |  |  |  |  |  |  |  |
U.S. dialysis and related lab services |  | $ | 1,259,632 |  |  | $ | 1,637,626 |  |  | $ | 1,200,198 |
HCP |  |  | 33,929 |  |  |  | 214,983 |  |  |  | 385,253 |
Other—Ancillary services and strategic initiatives |  |  | (103,901 | ) |  |  | (24,456 | ) |  |  | (38,595 | )
Total segment margin |  |  | 1,189,660 |  |  |  | 1,828,153 |  |  |  | 1,546,856 |
Reconciliation of segment operating margin to consolidated income from continuing operations before income taxes: |  |  |  |  |  |  |  |  |  |  |  |
Contingent earn-out obligation adjustment |  |  | — |  |  |  | — |  |  |  | 56,977 |
Corporate administrative support(4) |  |  | (18,965 | ) |  |  | (13,012 | ) |  |  | (53,699 | )
Consolidated operating income |  |  | 1,170,695 |  |  |  | 1,815,141 |  |  |  | 1,550,134 |
Debt expense |  |  | (408,380 | ) |  |  | (410,294 | ) |  |  | (429,943 | )
Debt refinancing and redemption charges |  |  | (48,072 | ) |  |  | (97,548 | ) |  |  | — |
Other income |  |  | 8,893 |  |  |  | 2,374 |  |  |  | 4,787 |
Consolidated income from continuing operations before income taxes |  | $ | 723,136 |  |  | $ | 1,309,673 |  |  | $ | 1,124,978 |
(1) | Includes management fees for providing management and administrative services to dialysis centers in which the Company owns a minority equity investment or which are wholly-owned by third parties.
(2) | Other revenues primarily relate to providing medical consulting services.
(3) | Certain costs previously reported in the ancillary services and strategic initiatives have been reclassified to U.S. dialysis and related lab services to conform to the current year presentation.
(4) | Corporate administrative support costs in 2013 also include $7,721 of an adjustment to reduce a tax asset associated with the HCP acquisition escrow provisions.
Summary of Depreciation and Amortization Expense by Segment | Depreciation and amortization expense by segment is as follows:
|  | December 31, |
|  | 2015 |  |  | 2014 |  |  | 2013 |
U.S. dialysis and related lab services |  | $ | 438,238 |  |  | $ | 402,767 |  |  | $ | 355,879 |
HCP |  |  | 174,118 |  |  |  | 169,485 |  |  |  | 158,356 |
Other - Ancillary services and strategic initiatives |  |  | 25,668 |  |  |  | 18,683 |  |  |  | 14,502 |
|  | $ | 638,024 |  |  | $ | 590,935 |  |  | $ | 528,737 |
Summary of Assets by Segment | Summary of assets by segment is as follows:
|  | December 31, |
|  | 2015 |  |  | 2014 |
Segment assets |  |  |  |  |  |  |  |
U.S. dialysis and related lab services (including equity investments of $29,801 and $28,138, respectively) |  | $ | 11,591,507 |  |  | $ | 10,633,813 |
HCP (including equity investments of $22,714 and $15,393, respectively) |  |  | 6,150,666 |  |  |  | 6,285,984 |
Other - Ancillary services and strategic initiatives(1) (including equity investments of $20,853 and $22,106, respectively) |  |  | 772,702 |  |  |  | 697,635 |
Consolidated assets |  | $ | 18,514,875 |  |  | $ | 17,617,432 |
(1) | Includes approximately $69,519 and $ 44,146 in 2015 and 2014, respectively, of net property and equipment related to the Company’s international operations.
Summary of Expenditures for Property and Equipment by Segment | Expenditures for property and equipment by segment is as follows:
|  | December 31, |
|  | 2015 |  |  | 2014 |  |  | 2013 |
U.S. dialysis and related lab services |  | $ | 584,513 |  |  | $ | 560,610 |  |  | $ | 554,345 |
HCP |  |  | 66,800 |  |  |  | 27,885 |  |  |  | 31,582 |
Other - Ancillary services and strategic initiatives |  |  | 56,685 |  |  |  | 52,835 |  |  |  | 31,670 |
|  | $ | 707,998 |  |  | $ | 641,330 |  |  | $ | 617,597 |

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