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Segment reporting (Tables) | 12 Months Ended
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Dec. 31, 2016
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, |
|  | 2016 |  |  | 2015 |  |  | 2014 |
Segment revenues: |  |  |  |  |  |  |  |  |  |  |  |
U.S. dialysis and related lab services |  |  |  |  |  |  |  |  |  |  |  |
Patient service revenues: |  |  |  |  |  |  |  |  |  |  |  |
External sources |  | $ | 9,482,648 |  |  | $ | 8,980,515 |  |  | $ | 8,513,089 |
Intersegment revenues |  |  | 68,774 |  |  |  | 53,476 |  |  |  | 37,112 |
Total dialysis and related lab services revenues |  |  | 9,551,422 |  |  |  | 9,033,991 |  |  |  | 8,550,201 |
Less: Provision for uncollectible accounts |  |  | (429,882 | ) |  |  | (406,530 | ) |  |  | (353,028 | )
Net dialysis and related lab services patient service revenues |  |  | 9,121,540 |  |  |  | 8,627,461 |  |  |  | 8,197,173 |
Other revenues(1) |  |  | 16,649 |  |  |  | 13,971 |  |  |  | 13,498 |
Total net dialysis and related lab services revenues |  |  | 9,138,189 |  |  |  | 8,641,432 |  |  |  | 8,210,671 |
DMG |  |  |  |  |  |  |  |  |  |  |  |
DMG revenues: |  |  |  |  |  |  |  |  |  |  |  |
Capitated revenues |  | $ | 3,430,576 |  |  | $ | 3,436,705 |  |  | $ | 3,190,903 |
Net patient service revenues |  |  | 621,583 |  |  |  | 317,950 |  |  |  | 219,306 |
Other revenues(2) |  |  | 61,040 |  |  |  | 82,470 |  |  |  | 91,374 |
Intersegment capitated and other revenues |  |  | 215 |  |  |  | 136 |  |  |  | 716 |
Total revenues |  | $ | 4,113,414 |  |  | $ | 3,837,261 |  |  | $ | 3,502,299 |
Other - Ancillary services and strategic initiatives |  |  |  |  |  |  |  |  |  |  |  |
Net patient service revenues |  | $ | 228,459 |  |  | $ | 160,484 |  |  | $ | 122,087 |
Capitated revenues |  |  | 88,103 |  |  |  | 72,390 |  |  |  | 70,385 |
Other external sources |  |  | 1,245,929 |  |  |  | 1,123,882 |  |  |  | 927,492 |
Intersegment revenues |  |  | 58,881 |  |  |  | 25,674 |  |  |  | 19,535 |
Total ancillary services and strategic initiatives revenues |  |  | 1,621,372 |  |  |  | 1,382,430 |  |  |  | 1,139,499 |
Total net segment revenues |  |  | 14,872,975 |  |  |  | 13,861,123 |  |  |  | 12,852,469 |
Elimination of intersegment revenues |  |  | (127,870 | ) |  |  | (79,286 | ) |  |  | (57,363 | )
Consolidated net revenues |  | $ | 14,745,105 |  |  | $ | 13,781,837 |  |  | $ | 12,795,106 |
Segment operating margin (loss): |  |  |  |  |  |  |  |  |  |  |  |
U.S. dialysis and related lab services |  | $ | 1,777,014 |  |  | $ | 1,259,632 |  |  | $ | 1,637,626 |
DMG |  |  | (104,233 | ) |  |  | 33,929 |  |  |  | 214,983 |
Other—Ancillary services and strategic initiatives |  |  | 266,323 |  |  |  | (103,901 | ) |  |  | (24,456 | )
Total segment margin |  |  | 1,939,104 |  |  |  | 1,189,660 |  |  |  | 1,828,153 |
Reconciliation of segment operating margin to consolidated income from continuing operations before income taxes: |  |  |  |  |  |  |  |  |  |  |  |
Corporate administrative support(3) |  |  | (44,561 | ) |  |  | (18,965 | ) |  |  | (13,012 | )
Consolidated operating income |  |  | 1,894,543 |  |  |  | 1,170,695 |  |  |  | 1,815,141 |
Debt expense |  |  | (414,382 | ) |  |  | (408,380 | ) |  |  | (410,294 | )
Debt refinancing and redemption charges |  |  | — |  |  |  | (48,072 | ) |  |  | (97,548 | )
Other income |  |  | 8,734 |  |  |  | 8,893 |  |  |  | 2,374 |
Consolidated income from continuing operations before income taxes |  | $ | 1,488,895 |  |  | $ | 723,136 |  |  | $ | 1,309,673 |
| (1) | Includes management fees for providing management and administrative services to dialysis centers in which the Company owns a noncontrolling interest or which are wholly-owned by third parties.
| (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 in 2016 also include $30,934 of an adjustment to reduce a tax asset associated with the DMG acquisition escrow provisions.
Summary of Depreciation and Amortization Expense by Segment | Depreciation and amortization expense by segment is as follows:
|  | December 31, |
|  | 2016 |  |  | 2015 |  |  | 2014 |
U.S. dialysis and related lab services |  | $ | 482,768 |  |  | $ | 438,238 |  |  | $ | 402,767 |
DMG |  |  | 210,755 |  |  |  | 174,118 |  |  |  | 169,485 |
Other - Ancillary services and strategic initiatives |  |  | 26,729 |  |  |  | 25,668 |  |  |  | 18,683 |
|  | $ | 720,252 |  |  | $ | 638,024 |  |  | $ | 590,935 |
Summary of Assets by Segment | Summary of assets by segment is as follows:
|  | December 31, |
|  | 2016 |  |  | 2015 |
Segment assets |  |  |  |  |  |  |  |
U.S. dialysis and related lab services (including equity investments of $66,924 and $29,801, respectively) |  | $ | 11,438,100 |  |  | $ | 11,591,507 |
DMG (including equity investments of $10,350 and $22,714, respectively) |  |  | 6,213,091 |  |  |  | 6,150,666 |
Other - Ancillary services and strategic initiatives(1) (including equity investments of $425,115 and $20,853, respectively) |  |  | 1,090,066 |  |  |  | 772,702 |
Consolidated assets |  | $ | 18,741,257 |  |  | $ | 18,514,875 |
| (1) | Includes approximately $96,396 and $ 69,519 in 2016 and 2015, 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, |
|  | 2016 |  |  | 2015 |  |  | 2014 |
U.S. dialysis and related lab services |  | $ | 675,994 |  |  | $ | 584,513 |  |  | $ | 560,610 |
DMG |  |  | 84,399 |  |  |  | 66,800 |  |  |  | 27,885 |
Other - Ancillary services and strategic initiatives |  |  | 68,702 |  |  |  | 56,685 |  |  |  | 52,835 |
|  | $ | 829,095 |  |  | $ | 707,998 |  |  | $ | 641,330 |

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