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Segment reporting (Tables)
 3 Months Ended
Mar. 31, 2018
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
March 31,
 
2018
 
2017
Segment net revenues:
 
 
 
U.S. dialysis and related lab services
 
 
 
Patient service revenues:
 
 
 
External sources
$
2,489,165

 
$
2,360,861

Intersegment revenues
18,422

 
11,799

U.S. dialysis and related lab services patient service revenues
2,507,587

 
2,372,660

Provision for uncollectible accounts
25,199

 
(106,777
)
Net U.S. dialysis and related lab services patient service revenues
2,532,786

 
2,265,883

Other revenues(1)
5,114

 
5,311

Total U.S. dialysis and related lab services revenues
2,537,900

 
2,271,194

Other—Ancillary services and strategic initiatives
 
 
 
Patient service revenues
102,255

 
61,644

Other external sources
227,711

 
310,212

Intersegment revenues
10,199

 
6,369

Total ancillary services and strategic initiatives revenues
340,165

 
378,225

Total net segment revenues
2,878,065

 
2,649,419

Elimination of intersegment revenues
(28,621
)
 
(18,168
)
Consolidated revenues
$
2,849,444

 
$
2,631,251

Segment operating margin:
 
 
 
U.S. dialysis and related lab services
$
433,380

 
$
944,740

Other—Ancillary services and strategic initiatives
(6,990
)
 
(58,220
)
Total segment operating margin
426,390

 
886,520

Reconciliation of segment operating margin to consolidated income before income taxes:
 
 
 
Corporate administrative support
(15,704
)
 
(10,592
)
Consolidated operating income
410,686

 
875,928

Debt expense
(113,516
)
 
(104,397
)
Other income, net
4,582

 
3,986

Consolidated income before income taxes
$
301,752

 
$
775,517

 
(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.
Summary of Depreciation and Amortization Expense by Reportable Segment
Depreciation and amortization expense by reportable segment was as follows:
 
Three months ended
March 31,
 
2018
 
2017
U.S. dialysis and related lab services
$
134,776

 
$
125,029

Other—Ancillary services and strategic initiatives
8,023

 
7,855

 
$
142,799

 
$
132,884
Summary of Assets by Reportable Segment
Assets by reportable segment were as follows: 
 
March 31,
2018
 
December 31,
2017
Segment assets
 

 
 

U.S. dialysis and related lab services (including equity
investments of $84,985 and $84,866, respectively)
$
11,798,202

 
$
11,776,042

Other—Ancillary services and strategic initiatives (including
equity investments of $160,579 and $160,668, respectively)
1,419,905

 
1,410,509

DMG—Held for sale (including equity investments of $11,642 and
$10,321, respectively)
5,724,265

 
5,761,642

Consolidated assets
$
18,942,372

 
$
18,948,193
Summary of Expenditures for Property and Equipment by Reportable Segment
Expenditures for property and equipment by reportable segment were as follows: 
 
Three months ended
March 31,
 
2018
 
2017
U.S. dialysis and related lab services
$
189,049

 
$
173,528

Other—Ancillary services and strategic initiatives
12,345

 
13,219

DMG—Held for sale
31,049

 
27,788

 
$
232,443

 
$
214,535