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Segment Reporting (Tables) | 6 Months Ended
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Jun. 30, 2017
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 June 30, |  | Six months ended June 30,
| 2017 |  | 2016 |  | 2017 |  | 2016
Segment net revenues: |  |  |  |  |  |  |
U.S. dialysis and related lab services |  |  |  |  |  |  |
Patient service revenues: |  |  |  |  |  |  |
External sources | $ | 2,403,222 |  |  | $ | 2,352,574 |  |  | $ | 4,752,123 |  |  | $ | 4,666,236 |
Intersegment revenues | 26,436 |  |  | 14,470 |  |  | 50,196 |  |  | 28,779 |
Total dialysis and related lab services revenues | 2,429,658 |  |  | 2,367,044 |  |  | 4,802,319 |  |  | 4,695,015 |
Less: Provision for uncollectible accounts | (109,335 | ) |  | (106,515 | ) |  | (216,105 | ) |  | (211,266 | )
Net dialysis and related lab services patient service revenues | 2,320,323 |  |  | 2,260,529 |  |  | 4,586,214 |  |  | 4,483,749 |
Other revenues(1) | 4,891 |  |  | 4,250 |  |  | 10,194 |  |  | 8,223 |
Total net dialysis and related lab services revenues | 2,325,214 |  |  | 2,264,779 |  |  | 4,596,408 |  |  | 4,491,972 |
DMG |  |  |  |  |  |  |
DMG revenues: |  |  |  |  |  |  |
Capitated revenues | 987,420 |  |  | 874,119 |  |  | 1,877,105 |  |  | 1,740,138 |
Net patient service revenues | 189,529 |  |  | 169,167 |  |  | 368,501 |  |  | 281,601 |
Other revenues(2) | 19,070 |  |  | 16,235 |  |  | 37,339 |  |  | 26,569 |
Intersegment capitated and other revenues | 47 |  |  | 44 |  |  | 105 |  |  | 115 |
Total net DMG revenues | 1,196,066 |  |  | 1,059,565 |  |  | 2,283,050 |  |  | 2,048,423 |
Other—Ancillary services and strategic initiatives |  |  |  |  |  |  |
Net patient service revenues | 83,566 |  |  | 56,860 |  |  | 150,858 |  |  | 108,244 |
Capitated revenues | 34,658 |  |  | 25,866 |  |  | 63,009 |  |  | 47,855 |
Other external sources | 264,456 |  |  | 325,095 |  |  | 531,736 |  |  | 631,187 |
Intersegment revenues | 10,913 |  |  | 14,720 |  |  | 26,216 |  |  | 26,546 |
Total ancillary services and strategic initiatives revenues | 393,593 |  |  | 422,541 |  |  | 771,819 |  |  | 813,832 |
Total net segment revenues | 3,914,873 |  |  | 3,746,885 |  |  | 7,651,277 |  |  | 7,354,227 |
Elimination of intersegment revenues | (37,396 | ) |  | (29,234 | ) |  | (76,517 | ) |  | (55,440 | )
Consolidated net revenues | $ | 3,877,477 |  |  | $ | 3,717,651 |  |  | $ | 7,574,760 |  |  | $ | 7,298,787 |
Segment operating margin (loss): |  |  |  |  |  |  |
U.S. dialysis and related lab services(3) | $ | 450,472 |  |  | $ | 449,190 |  |  | $ | 1,395,212 |  |  | $ | 889,245 |
DMG | (12,880 | ) |  | (102,059 | ) |  | (572 | ) |  | (159,204 | )
Other—Ancillary services and strategic initiatives | (48,245 | ) |  | (12,644 | ) |  | (106,466 | ) |  | (23,745 | )
Total segment operating margin | 389,347 |  |  | 334,487 |  |  | 1,288,174 |  |  | 706,296 |
Reconciliation of segment operating margin to consolidated income before income taxes: |  |  |  |  |  |  |
Corporate administrative support | (11,031 | ) |  | (5,417 | ) |  | (21,622 | ) |  | (12,337 | )
Consolidated operating income | 378,316 |  |  | 329,070 |  |  | 1,266,552 |  |  | 693,959 |
Debt expense | (107,962 | ) |  | (102,894 | ) |  | (212,391 | ) |  | (205,778 | )
Other income, net | 5,253 |  |  | 3,215 |  |  | 9,496 |  |  | 6,191 |
Consolidated income before income taxes | $ | 275,607 |  |  | $ | 229,391 |  |  | $ | 1,063,657 |  |  | $ | 494,372 |
(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 and revenue related to the maintenance of existing physician networks.
(3) | U.S. dialysis and related lab services operating income includes the net gain on the settlement with the VA.
Summary of Depreciation and Amortization Expense by Reportable Segment |
| Three months ended June 30, |  | Six months ended June 30,
| 2017 |  | 2016 |  | 2017 |  | 2016
U.S. dialysis and related lab services | $ | 130,002 |  |  | $ | 119,350 |  |  | $ | 255,030 |  |  | $ | 235,887 |
DMG | 60,011 |  |  | 54,211 |  |  | 117,334 |  |  | 100,473 |
Ancillary services and strategic initiatives | 10,025 |  |  | 6,820 |  |  | 17,880 |  |  | 13,376 |
| $ | 200,038 |  |  | $ | 180,381 |  |  | $ | 390,244 |  |  | $ | 349,736 |
Summary of Assets by Reportable Segment | Subsequent to the issuance of the Company’s fiscal year 2016 consolidated financial statements and their inclusion in its Annual Report on Form 10-K filed with the Securities and Exchange Commission on February 24, 2017 (the “2016 10-K”), the Company determined that it had misstated its disclosure of segment assets at December 31, 2016 in Note 25 to those consolidated financial statements. This misstatement resulted in an overstatement of “U.S. dialysis and related lab services” segment assets of $338,963 and a corresponding understatement of “Other - ancillary services and strategic initiatives” segment assets of the same amount. The Company performed an assessment of the materiality of this misstatement and concluded that this misstatement as originally disclosed was not materially misleading in its 2016 consolidated financial statements taken as a whole. The Company therefore has not amended its financial statements filed on its 2016 10-K to correct this misstatement, but has provided the corrected disclosure here. Summary of assets by reportable segment is as follows:
| June 30, 2017 |  | December 31, 2016
Segment assets |  |  |  |  |
U.S. dialysis and related lab services (including equity investments of $83,102 and $66,924, respectively) | $ | 11,500,974 |  |  | $ | 11,099,137 |
DMG (including equity investments of $13,169 and $10,350, respectively) | 6,282,819 |  |  | 6,213,091 |
Other—Ancillary services and strategic initiatives (including equity investments of $446,197 and $425,115, respectively) | 1,557,991 |  |  | 1,429,029 |
Consolidated assets | $ | 19,341,784 |  |  | $ | 18,741,257 |
Summary of Expenditures for Property and Equipment by Reportable Segment | Expenditures for property and equipment by reportable segment is as follows:
| Three months ended June 30, |  | Six months ended June 30,
| 2017 |  | 2016 |  | 2017 |  | 2016
U.S. dialysis and related lab services | $ | 152,233 |  |  | $ | 150,932 |  |  | $ | 325,761 |  |  | $ | 284,380 |
DMG | 20,883 |  |  | 18,098 |  |  | 48,671 |  |  | 38,243 |
Ancillary services and strategic initiatives | 11,289 |  |  | 16,410 |  |  | 24,508 |  |  | 36,004 |
| $ | 184,405 |  |  | $ | 185,440 |  |  | $ | 398,940 |  |  | $ | 358,627 |

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