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Segment reporting (Tables)

12 Months Ended

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

X

- Definition

Reconciliation of capital expenditures for property and equipment from segment to consolidated.

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Tabular disclosure of all significant reconciling items in the reconciliation of total assets from reportable segments to the entity's consolidated assets.

+ References

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-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=51669610&loc=d3e8906-108599

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-Name Accounting Standards Codification
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-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
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-Section 50
-Paragraph 31
-URI http://asc.fasb.org/extlink&oid=51669610&loc=d3e8924-108599

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-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
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