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Goodwill (Tables) | 6 Months Ended
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Jun. 30, 2017
Goodwill and Intangible Assets Disclosure [Abstract] |
Changes in Goodwill by Reportable Segments | Changes in 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, 2016 | $ | 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 |
Acquisitions | 427,299 |  |  | 31,796 |  |  | 113,669 |  |  | 572,764 |
Divestitures | (32,260 | ) |  | (29 | ) |  | (54 | ) |  | (32,343 | )
Goodwill impairment charges | — |  |  | (50,619 | ) |  | (34,696 | ) |  | (85,315 | )
Foreign currency and other adjustments | — |  |  | — |  |  | 27,368 |  |  | 27,368 |
Balance at June 30, 2017 | $ | 6,086,626 |  |  | $ | 3,373,090 |  |  | $ | 430,075 |  |  | $ | 9,889,791 |
Balance at June 30, 2017: |  |  |  |  |  |  |
Goodwill | $ | 6,086,626 |  |  | $ | 3,865,478 |  |  | $ | 499,095 |  |  | $ | 10,451,199 |
Accumulated impairment charges | — |  |  | (492,388 | ) |  | (69,020 | ) |  | (561,408 | )
| $ | 6,086,626 |  |  | $ | 3,373,090 |  |  | $ | 430,075 |  |  | $ | 9,889,791 |
Schedule of Reporting Units Goodwill Balances |
|  | Goodwill balance as of June 30, 2017 |  | Carrying amount coverage(1) |  | Sensitivities
|  |  |  | Operating income(2) |  | Discount rate(3)
Reporting unit |  |  |  |
DMG Nevada |  | $ | 275,914 |  |  | 17.0 | % |  | (2.4 | )% |  | (3.8 | )%
DMG Florida |  | $ | 397,127 |  |  | — | % |  | (1.6 | )% |  | (2.8 | )%
DMG New Mexico |  | $ | 70,253 |  |  | — | % |  | (1.6 | )% |  | (2.4 | )%
DMG Washington |  | $ | 247,552 |  |  | 9.3 | % |  | (1.7 | )% |  | (3.6 | )%
(1) | Excess of estimated fair value of the reporting unit over its 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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