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Segment reporting (Tables) | 9 Months Ended
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Sep. 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 |  |  | Nine months ended |
|  | September 30, |  |  | September 30, |
|  | 2016 |  |  | 2015 |  |  | 2016 |  |  | 2015 |
Segment net revenues: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
U.S. dialysis and related lab services |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Patient service revenues: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
External sources |  | $ | 2,412,818 |  |  | $ | 2,287,329 |  |  | $ | 7,079,054 |  |  | $ | 6,679,251 |
Intersegment revenues |  |  | 16,040 |  |  |  | 13,630 |  |  |  | 44,819 |  |  |  | 39,078 |
Total dialysis and related lab services revenues |  |  | 2,428,858 |  |  |  | 2,300,959 |  |  |  | 7,123,873 |  |  |  | 6,718,329 |
Less: Provision for uncollectible accounts |  |  | (109,299 | ) |  |  | (103,543 | ) |  |  | (320,565 | ) |  |  | (302,324 | )
Net dialysis and related lab services patient service revenues |  |  | 2,319,559 |  |  |  | 2,197,416 |  |  |  | 6,803,308 |  |  |  | 6,416,005 |
Other revenues(1) |  |  | 3,912 |  |  |  | 3,490 |  |  |  | 12,134 |  |  |  | 10,214 |
Total net dialysis and related lab services revenues |  |  | 2,323,471 |  |  |  | 2,200,906 |  |  |  | 6,815,442 |  |  |  | 6,426,219 |
DMG |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
DMG revenues: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Capitated revenues |  |  | 846,245 |  |  |  | 906,478 |  |  |  | 2,586,383 |  |  |  | 2,587,545 |
Net patient service revenues |  |  | 153,089 |  |  |  | 78,938 |  |  |  | 417,634 |  |  |  | 241,385 |
Other revenues(2) |  |  | 28,728 |  |  |  | 15,536 |  |  |  | 72,354 |  |  |  | 66,124 |
Intersegment capitated and other revenues |  |  | 75 |  |  |  | 84 |  |  |  | 189 |  |  |  | 96 |
Total net DMG revenues |  |  | 1,028,137 |  |  |  | 1,001,036 |  |  |  | 3,076,560 |  |  |  | 2,895,150 |
Other—Ancillary services and strategic initiatives |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Net patient service revenues |  |  | 57,498 |  |  |  | 41,858 |  |  |  | 165,742 |  |  |  | 116,535 |
Capitated revenues |  |  | 23,045 |  |  |  | 20,369 |  |  |  | 67,780 |  |  |  | 56,007 |
Other external sources |  |  | 314,540 |  |  |  | 275,210 |  |  |  | 948,847 |  |  |  | 793,511 |
Intersegment revenues |  |  | 16,642 |  |  |  | 7,385 |  |  |  | 43,189 |  |  |  | 18,079 |
Total ancillary services and strategic initiatives revenues |  |  | 411,725 |  |  |  | 344,822 |  |  |  | 1,225,558 |  |  |  | 984,132 |
Total net segment revenues |  |  | 3,763,333 |  |  |  | 3,546,764 |  |  |  | 11,117,560 |  |  |  | 10,305,501 |
Elimination of intersegment revenues |  |  | (32,757 | ) |  |  | (21,099 | ) |  |  | (88,197 | ) |  |  | (57,253 | )
Consolidated net revenues |  | $ | 3,730,576 |  |  | $ | 3,525,665 |  |  | $ | 11,029,363 |  |  | $ | 10,248,248 |
Segment operating margin (loss): |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
U.S. dialysis and related lab services |  | $ | 452,187 |  |  | $ | 461,899 |  |  | $ | 1,341,432 |  |  | $ | 795,255 |
DMG |  |  | 33,094 |  |  |  | 82,562 |  |  |  | (126,110 | ) |  |  | 215,192 |
Other—Ancillary services and strategic initiatives |  |  | 361,903 |  |  |  | (30,118 | ) |  |  | 338,159 |  |  |  | (70,153 | )
Total segment operating margin |  |  | 847,184 |  |  |  | 514,343 |  |  |  | 1,553,481 |  |  |  | 940,294 |
Reconciliation of segment operating margin to consolidated income before income taxes: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Corporate administrative support(3) |  |  | (28,028 | ) |  |  | (4,975 | ) |  |  | (40,366 | ) |  |  | (14,534 | )
Consolidated operating income |  |  | 819,156 |  |  |  | 509,368 |  |  |  | 1,513,115 |  |  |  | 925,760 |
Debt expense |  |  | (104,581 | ) |  |  | (103,481 | ) |  |  | (310,359 | ) |  |  | (305,121 | )
Debt redemption and refinancing charges |  |  | — |  |  |  | — |  |  |  | — |  |  |  | (48,072 | )
Other income, net |  |  | 1,876 |  |  |  | 2,484 |  |  |  | 8,067 |  |  |  | 4,262 |
Consolidated income before income taxes |  | $ | 716,451 |  |  | $ | 408,371 |  |  | $ | 1,210,823 |  |  | $ | 576,829 |
(1) | Includes management fees for providing management and administrative services to dialysis centers that are wholly-owned by third parties and legal entities in which the Company owns a noncontrolling equity investment.
(2) | Includes medical consulting service fees and management fees for providing management and administrative services to unconsolidated joint ventures, as well as revenue related to the maintenance of existing physician networks.
(3) | Corporate administrative support costs also include $27,040 of an adjustment to reduce a receivable associated with the DMG acquisition escrow provision relating to an income tax item.
Summary of Depreciation and Amortization Expense by Reportable Segment | Depreciation and amortization expense by reportable segment is as follows:
|  | Three months ended |  |  | Nine months ended |
|  | September 30, |  |  | September 30, |
|  | 2016 |  |  | 2015 |  |  | 2016 |  |  | 2015 |
U.S. dialysis and related lab services |  | $ | 122,540 |  |  | $ | 111,828 |  |  | $ | 358,427 |  |  | $ | 326,281 |
DMG |  |  | 52,595 |  |  |  | 43,523 |  |  |  | 153,068 |  |  |  | 129,890 |
Ancillary services and strategic initiatives |  |  | 6,604 |  |  |  | 6,711 |  |  |  | 19,980 |  |  |  | 18,523 |
|  | $ | 181,739 |  |  | $ | 162,062 |  |  | $ | 531,475 |  |  | $ | 474,694 |
Summary of Assets by Reportable Segment | Summary of assets by reportable segment is as follows:
|  | September 30, |  |  | December 31, |
|  | 2016 |  |  | 2015 |
Segment assets |  |  |  |  |  |  |  |
U.S. dialysis and related lab services (including equity investments of $41,624 and $34,801, respectively) |  | $ | 11,460,732 |  |  | $ | 11,591,507 |
DMG (including equity investments of $11,293 and $22,714, respectively) |  |  | 6,218,912 |  |  |  | 6,150,666 |
Other—Ancillary services and strategic initiatives (including equity investments of $463,466 and $20,853, respectively) |  |  | 1,246,009 |  |  |  | 772,702 |
Consolidated assets |  | $ | 18,925,653 |  |  | $ | 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 |  |  | Nine months ended |
|  | September 30, |  |  | September 30, |
|  | 2016 |  |  | 2015 |  |  | 2016 |  |  | 2015 |
U.S. dialysis and related lab services |  | $ | 182,741 |  |  | $ | 138,683 |  |  | $ | 467,121 |  |  | $ | 385,734 |
DMG |  |  | 17,396 |  |  |  | 18,885 |  |  |  | 55,639 |  |  |  | 36,870 |
Ancillary services and strategic initiatives |  |  | 16,479 |  |  |  | 13,772 |  |  |  | 52,483 |  |  |  | 39,609 |
|  | $ | 216,616 |  |  | $ | 171,340 |  |  | $ | 575,243 |  |  | $ | 462,213 |

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