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Segment reporting | 6 Months Ended
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Jun. 30, 2016
Segment Reporting [Abstract] |
Segment reporting |
17. | Segment reporting
The Company operates two major divisions, Kidney Care and HCP. The Kidney Care division is comprised of the Company’s U.S. dialysis and related lab services business, various other ancillary services and strategic initiatives, including its international dialysis operations, and the Company’s corporate administrative support. The Company’s U.S. dialysis and related lab services business is its largest line of business, and is a leading provider of kidney dialysis services in the U.S. for patients suffering from chronic kidney failure, also known as ESRD. The Company’s HCP division is a patient- and physician-focused integrated health care delivery and management company with over two decades of providing coordinated outcomes-based medical care in a cost-effective manner. The Company’s ancillary services and strategic initiatives consist primarily of pharmacy services, disease management services, vascular access services, clinical research programs, physician services, direct primary care and the Company’s international dialysis operations. The Company’s operating segments have been defined based on the separate financial information that is regularly produced and reviewed by the Company’s chief operating decision maker in making decisions about allocating resources to and assessing the financial performance of the Company’s various operating lines of business. The chief operating decision maker for the Company is its Chief Executive Officer. The Company’s separate operating segments include its U.S. dialysis and related lab services business, its HCP operations in each region, each of its ancillary services and strategic initiatives, and its international operations in the Asia Pacific, Latin America, and European and Middle Eastern markets, and under the Saudi Ministry of Health charter. The U.S. dialysis and related lab services business and the HCP business each qualify as separately reportable segments, and all of the other ancillary services and strategic initiatives operating segments, including the international operating segments, have been combined and disclosed in the other segments category. The Company’s operating segment financial information included in this report is prepared on the internal management reporting basis that the chief operating decision maker uses to allocate resources and assess the financial performance of the operating segments. For internal management reporting, segment operations include direct segment operating expenses but exclude corporate administrative support costs, which consist primarily of indirect labor, benefits and long-term incentive based compensation of certain departments which provide support to all of the Company’s various operating lines of business. Corporate administrative support costs are reduced by internal management fees received from the Company’s ancillary lines of businesses. 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.
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 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 |
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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- Definition The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 34 -URI http://asc.fasb.org/extlink&oid=68060357&loc=d3e8981-108599 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 41 -URI http://asc.fasb.org/extlink&oid=68060357&loc=d3e9038-108599 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 33 -URI http://asc.fasb.org/extlink&oid=68060357&loc=d3e8971-108599 Reference 4: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 12 -URI http://asc.fasb.org/extlink&oid=68060357&loc=d3e8595-108599 Reference 5: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 1 -URI http://asc.fasb.org/extlink&oid=68060357&loc=d3e8380-108599 Reference 6: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 32 -URI http://asc.fasb.org/extlink&oid=68060357&loc=d3e8933-108599 Reference 7: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 26 -URI http://asc.fasb.org/extlink&oid=68060357&loc=d3e8844-108599 Reference 8: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 35 -URI http://asc.fasb.org/extlink&oid=68060357&loc=d3e8984-108599 Reference 9: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 40 -URI http://asc.fasb.org/extlink&oid=68060357&loc=d3e9031-108599 Reference 10: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 42 -URI http://asc.fasb.org/extlink&oid=68060357&loc=d3e9054-108599 Reference 11: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 10 -URI http://asc.fasb.org/extlink&oid=68060357&loc=d3e8538-108599 Reference 12: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 29 -URI http://asc.fasb.org/extlink&oid=68060357&loc=d3e8864-108599 Reference 13: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 31 -URI http://asc.fasb.org/extlink&oid=68060357&loc=d3e8924-108599 Reference 14: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 30 -URI http://asc.fasb.org/extlink&oid=68060357&loc=d3e8906-108599 + Details
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