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Goodwill (Tables)
 9 Months Ended
Sep. 30, 2017
Goodwill and Intangible Assets Disclosure [Abstract]  
Changes in Goodwill by Reportable Segments
As a result of these assessments, the Company recognized goodwill impairment charges as shown and discussed below:

 
Three months ended
 
Nine months ended
Reporting unit
 
September 30,
2017
 
September 30,
2016
 
September 30,
2017
 
September 30,
2016
DMG California
 
$
560,756

 
$
—

 
$
560,756

 
$
—

DMG Florida
 
26,324

 
—

 
76,270

 
91,200

DMG New Mexico
 
13,960

 
—

 
14,633

 
—

DMG Nevada
 
—

 
—

 
—

 
161,800

Vascular access
 
—

 
—

 
34,696

 
—

Total
 
$
601,040

 
$
—

 
$
686,355

 
$
253,000

Changes in goodwill by reportable segment 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
441,486

 
132,778

 
113,611

 
687,875

Divestitures
(32,260
)
 
(29
)
 
(54
)
 
(32,343
)
Goodwill impairment charges
—

 
(651,659
)
 
(34,696
)
 
(686,355
)
Foreign currency and other adjustments
—

 
—

 
39,383

 
39,383

Balance at September 30, 2017
$
6,100,813

 
$
2,873,032

 
$
442,032

 
$
9,415,877

 
 
 
 
 
 
 
 
Balance at September 30, 2017:
 
 
 
 
 
 
 
Goodwill
$
6,100,813

 
$
3,966,460

 
$
511,052

 
$
10,578,325

Accumulated impairment charges
—

 
(1,093,428
)
 
(69,020
)
 
(1,162,448
)
 
$
6,100,813

 
$
2,873,032

 
$
442,032

 
$
9,415,877
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 as of September 30, 2017:
 
 
Goodwill balance
as of
September 30, 2017
 
Carrying
amount
coverage(1)
 
Sensitivities
Reporting unit
 
 
 
Operating
income(2)
 
Discount
rate(3)
DMG California
 
$
1,888,609

 
—
%
 
(3.0
)%
 
(5.8
)%
DMG Florida
 
$
378,071

 
—
%
 
(0.9
)%
 
(3.3
)%
DMG New Mexico
 
$
56,293

 
—
%
 
(1.1
)%
 
(2.1
)%
DMG Washington
 
$
247,552

 
17.1
%
 
(1.7
)%
 
(3.4
)%
 
(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.