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Goodwill (Tables)
 6 Months Ended
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.