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Goodwill (Tables) | 12 Months Ended
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Dec. 31, 2016
Goodwill And Intangible Assets Disclosure [Abstract] |
Changes in Carrying Value of Goodwill by Reportable Segments | Changes in the carrying value of goodwill by reportable segments were as follows:
|  | U.S. dialysis and related lab services |  |  | DMG |  |  | Other ancillary services and strategic initiatives |  |  | Consolidated total |
Balance at January 1, 2015 |  | $ | 5,610,643 |  |  | $ | 3,562,534 |  |  | $ | 242,118 |  |  | $ | 9,415,295 |
Acquisitions |  |  | 21,910 |  |  |  | 29,910 |  |  |  | 45,273 |  |  | $ | 97,093 |
Divestitures |  |  | (3,370 | ) |  |  | (5,411 | ) |  |  | — |  |  | $ | (8,781 | )
Goodwill impairment charges |  |  | — |  |  |  | (188,769 | ) |  |  | (4,065 | ) |  | $ | (192,834 | )
Foreign currency and other adjustments |  |  | — |  |  |  | — |  |  |  | (16,294 | ) |  | $ | (16,294 | )
Balance at December 31, 2015 |  | $ | 5,629,183 |  |  | $ | 3,398,264 |  |  | $ | 267,032 |  |  | $ | 9,294,479 |
Acquisitions |  |  | 75,295 |  |  |  | 248,901 |  |  |  | 123,632 |  |  | $ | 447,828 |
Divestitures |  |  | (12,891 | ) |  |  | (2,223 | ) |  |  | (29,645 | ) |  | $ | (44,759 | )
Goodwill impairment charges |  |  | — |  |  |  | (253,000 | ) |  |  | (28,415 | ) |  | $ | (281,415 | )
Foreign currency and other adjustments |  |  | — |  |  |  | — |  |  |  | (8,816 | ) |  | $ | (8,816 | )
Balance at December 31, 2016 |  | $ | 5,691,587 |  |  | $ | 3,391,942 |  |  | $ | 323,788 |  |  | $ | 9,407,317 |
Balance at December 31, 2016: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Goodwill |  | $ | 5,691,587 |  |  | $ | 3,833,711 |  |  | $ | 358,112 |  |  | $ | 9,883,410 |
Accumulated impairment charges |  |  | — |  |  |  | (441,769 | ) |  |  | (34,324 | ) |  | $ | (476,093 | )
|  | $ | 5,691,587 |  |  | $ | 3,391,942 |  |  | $ | 323,788 |  |  | $ | 9,407,317 |
Schedule of Goodwill and Indefinite-Lived Intangible Asset Impairment Charges | As a result of the assessments described above, the Company has recognized the goodwill impairment charges below:
|  | Year ended December 31, |
Reporting unit |  | 2016 |  |  | 2015 |  |  | 2014 |
DMG Nevada |  | $ | 161,800 |  |  | $ | 181,253 |  |  | $ | — |
DMG Florida |  |  | 91,200 |  |  |  | 5,800 |  |  |  | — |
DMG Arizona |  |  | — |  |  |  | 1,716 |  |  |  | — |
Vascular access |  |  | 28,415 |  |  |  | — |  |  |  | — |
International operations |  |  | — |  |  |  | 4,065 |  |  |  | 1,000 |
Total |  | $ | 281,415 |  |  | $ | 192,834 |  |  | $ | 1,000 |
Schedule of Reporting Units Goodwill Balances | Further reductions in reimbursement rates, increases in medical cost or utilization trends, or other significant adverse changes in expected future cash flows or valuation assumptions could result in goodwill impairment charges in the future for the following reporting units, which remain at risk of goodwill impairment:
|  | Goodwill balance |  |  | Carrying |  |  | Sensitivities |
Reporting unit |  | as of December 31, 2016 |  |  | amount coverage(1) |  |  | Operating income(2) |  |  | Discount rate(3) |
DMG Nevada |  | $ | 261,204 |  |  |  | 11.4% |  |  |  | -2.2% |  |  |  | -3.9% |
DMG Florida |  | $ | 442,835 |  |  |  | 7.1% |  |  |  | -1.7% |  |  |  | -3.2% |
DMG New Mexico |  | $ | 70,926 |  |  |  | 2.6% |  |  |  | -1.5% |  |  |  | -2.2% |
DMG Washington |  | $ | 244,502 |  |  |  | 3.7% |  |  |  | -1.8% |  |  |  | -3.4% |
Vascular access |  | $ | 34,696 |  |  |  | 4.3% |  |  |  | -2.7% |  |  |  | -5.3% |
| (1) | Excess of estimated fair value of the reporting unit over carrying amount as of the latest assessment date.
| (2) | Potential impact on estimated fair value of a sustained, long-term reduction of 3% in operating income as of the latest assessment date.
| (3) | Potential impact on estimated fair value of an increase in discount rates of 100 basis points as of the latest assessment date.

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