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Segment reporting (Tables) | 6 Months Ended
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Jun. 30, 2016
Segment Reporting [Abstract] |
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes | The following is a summary of segment net revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income before income taxes:
|  | Three months ended |  |  | Six months ended |
|  | June 30, |  |  | June 30, |
|  | 2016 |  |  | 2015 |  |  | 2016 |  |  | 2015 |
Segment net revenues: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
U.S. dialysis and related lab services |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Patient service revenues: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
External sources |  | $ | 2,352,574 |  |  | $ | 2,237,630 |  |  | $ | 4,666,236 |  |  | $ | 4,391,924 |
Intersegment revenues |  |  | 14,470 |  |  |  | 13,591 |  |  |  | 28,779 |  |  |  | 25,447 |
Total dialysis and related lab services revenues |  |  | 2,367,044 |  |  |  | 2,251,221 |  |  |  | 4,695,015 |  |  |  | 4,417,371 |
Less: Provision for uncollectible accounts |  |  | (106,515 | ) |  |  | (101,304 | ) |  |  | (211,266 | ) |  |  | (198,781 | )
Net dialysis and related lab services patient service revenues |  |  | 2,260,529 |  |  |  | 2,149,917 |  |  |  | 4,483,749 |  |  |  | 4,218,590 |
Other revenues(1) |  |  | 4,250 |  |  |  | 3,540 |  |  |  | 8,223 |  |  |  | 6,724 |
Total net dialysis and related lab services revenues |  |  | 2,264,779 |  |  |  | 2,153,457 |  |  |  | 4,491,972 |  |  |  | 4,225,314 |
HCP |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
HCP revenues: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Capitated revenues |  |  | 874,119 |  |  |  | 848,595 |  |  |  | 1,740,138 |  |  |  | 1,681,067 |
Net patient service revenues |  |  | 156,307 |  |  |  | 82,236 |  |  |  | 264,545 |  |  |  | 162,446 |
Other revenues(2) |  |  | 29,095 |  |  |  | 35,326 |  |  |  | 43,625 |  |  |  | 50,379 |
Intersegment capitated and other revenues |  |  | 44 |  |  |  | 185 |  |  |  | 115 |  |  |  | 222 |
Total net HCP revenues |  |  | 1,059,565 |  |  |  | 966,342 |  |  |  | 2,048,423 |  |  |  | 1,894,114 |
Other—Ancillary services and strategic initiatives |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Net patient service revenues |  |  | 56,860 |  |  |  | 39,052 |  |  |  | 108,244 |  |  |  | 74,676 |
Capitated revenues |  |  | 23,707 |  |  |  | 17,595 |  |  |  | 44,735 |  |  |  | 35,638 |
Other external sources |  |  | 327,254 |  |  |  | 271,948 |  |  |  | 634,307 |  |  |  | 518,510 |
Intersegment revenues |  |  | 14,720 |  |  |  | 5,543 |  |  |  | 26,546 |  |  |  | 10,485 |
Total ancillary services and strategic initiatives revenues |  |  | 422,541 |  |  |  | 334,138 |  |  |  | 813,832 |  |  |  | 639,309 |
Total net segment revenues |  |  | 3,746,885 |  |  |  | 3,453,937 |  |  |  | 7,354,227 |  |  |  | 6,758,737 |
Elimination of intersegment revenues |  |  | (29,234 | ) |  |  | (19,319 | ) |  |  | (55,440 | ) |  |  | (36,154 | )
Consolidated net revenues |  | $ | 3,717,651 |  |  | $ | 3,434,618 |  |  | $ | 7,298,787 |  |  | $ | 6,722,583 |
Segment operating margin (loss): |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
U.S. dialysis and related lab services |  | $ | 449,190 |  |  | $ | 437,844 |  |  | $ | 889,245 |  |  | $ | 333,355 |
HCP |  |  | (102,059 | ) |  |  | 72,336 |  |  |  | (159,204 | ) |  |  | 132,630 |
Other—Ancillary services and strategic initiatives |  |  | (12,644 | ) |  |  | (26,207 | ) |  |  | (23,745 | ) |  |  | (40,035 | )
Total segment operating margin |  |  | 334,487 |  |  |  | 483,973 |  |  |  | 706,296 |  |  |  | 425,950 |
Reconciliation of segment operating margin to consolidated income before income taxes: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Corporate administrative support |  |  | (5,417 | ) |  |  | (3,425 | ) |  |  | (12,337 | ) |  |  | (9,558 | )
Consolidated operating income |  |  | 329,070 |  |  |  | 480,548 |  |  |  | 693,959 |  |  |  | 416,392 |
Debt expense |  |  | (102,894 | ) |  |  | (104,248 | ) |  |  | (205,778 | ) |  |  | (201,640 | )
Debt redemption and refinancing charges |  |  | — |  |  |  | (48,072 | ) |  |  | — |  |  |  | (48,072 | )
Other income, net |  |  | 3,215 |  |  |  | 2,311 |  |  |  | 6,191 |  |  |  | 1,778 |
Consolidated income before income taxes |  | $ | 229,391 |  |  | $ | 330,539 |  |  | $ | 494,372 |  |  | $ | 168,458 |
(1) | Includes management fees for providing management and administrative services to dialysis centers that are wholly-owned by third parties or centers in which the Company owns a noncontrolling equity investment.
(2) | Includes payments received for medical consulting services and management fees for providing management and administrative services to an unconsolidated joint venture that provides medical services in which the Company owns a 50% interest, as well as revenue related to the maintenance of existing physician networks.
Summary of Depreciation and Amortization Expense by Reportable Segment | Depreciation and amortization expense by reportable segment is as follows:
|  | Three months ended |  |  | Six months ended |
|  | June 30, |  |  | June 30, |
|  | 2016 |  |  | 2015 |  |  | 2016 |  |  | 2015 |
U.S. dialysis and related lab services |  | $ | 119,350 |  |  | $ | 109,461 |  |  | $ | 235,887 |  |  | $ | 214,453 |
HCP |  |  | 54,211 |  |  |  | 43,088 |  |  |  | 100,473 |  |  |  | 86,367 |
Ancillary services and strategic initiatives |  |  | 6,820 |  |  |  | 6,294 |  |  |  | 13,376 |  |  |  | 11,812 |
|  | $ | 180,381 |  |  | $ | 158,843 |  |  | $ | 349,736 |  |  | $ | 312,632 |
Summary of Assets by Reportable Segment | Summary of assets by reportable segment is as follows:
|  | June 30, |  |  | December 31, |
|  | 2016 |  |  | 2015 |
Segment assets |  |  |  |  |  |  |  |
U.S. dialysis and related lab services (including equity investments of $34,688 and $29,801, respectively) |  | $ | 11,532,690 |  |  | $ | 11,591,507 |
HCP (including equity investments of $9,796 and $22,714, respectively) |  |  | 6,239,567 |  |  |  | 6,150,666 |
Other—Ancillary services and strategic initiatives (including equity investments of $19,936 and $20,853, respectively) |  |  | 919,373 |  |  |  | 772,702 |
Consolidated assets |  | $ | 18,691,630 |  |  | $ | 18,514,875 |
Summary of Expenditures for Property and Equipment by Reportable Segment | Expenditures for property and equipment by reportable segment is as follows:
|  | Three months ended |  |  | Six months ended |
|  | June 30, |  |  | June 30, |
|  | 2016 |  |  | 2015 |  |  | 2016 |  |  | 2015 |
U.S. dialysis and related lab services |  | $ | 150,932 |  |  | $ | 141,656 |  |  | $ | 284,380 |  |  | $ | 247,051 |
HCP |  |  | 18,098 |  |  |  | 12,951 |  |  |  | 38,243 |  |  |  | 17,985 |
Ancillary services and strategic initiatives |  |  | 16,410 |  |  |  | 14,845 |  |  |  | 36,004 |  |  |  | 25,837 |
|  | $ | 185,440 |  |  | $ | 169,452 |  |  | $ | 358,627 |  |  | $ | 290,873 |

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