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Revenue Recognition Segment revenue by major payor (Tables) | 9 Months Ended
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Sep. 30, 2018
Revenues by major payor [Abstract] |
Schedule of Revenue Sources, Health Care Organization [Table Text Block] | The following table summarizes the Company's segment revenues by primary payor source:
| For the three months ended
| September 30, 2018 |  | September 30, 2017(1)
| U.S. dialysis and related lab services |  | Other - Ancillary services and strategic initiatives |  | Consolidated |  | U.S. dialysis and related lab services |  | Other - Ancillary services and strategic initiatives |  | Consolidated
Patient service revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage | $ | 1,513,191 |  |  | $ |  | $ | 1,513,191 |  |  | $ | 1,338,155 |  |  | $ |  | $ | 1,338,155 |
Medicaid and Managed Medicaid | 159,165 |  |  |  |  | 159,165 |  |  | 155,113 |  |  |  |  | 155,113 |
Other government | 113,043 |  |  | 80,915 |  |  | 193,958 |  |  | 89,243 |  |  | 72,681 |  |  | 161,924 |
Commercial | 786,470 |  |  | 31,364 |  |  | 817,834 |  |  | 783,171 |  |  | 17,334 |  |  | 800,505 |
Other revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage |  |  | 130,746 |  |  | 130,746 |  |  |  |  | 232,251 |  |  | 232,251 |
Medicaid and Managed Medicaid |  |  | 12,042 |  |  | 12,042 |  |  |  |  | 17,142 |  |  | 17,142 |
Commercial |  |  | 20,205 |  |  | 20,205 |  |  |  |  | 27,222 |  |  | 27,222 |
Other(2) | 4,932 |  |  | 29,042 |  |  | 33,974 |  |  | 4,792 |  |  | 47,438 |  |  | 52,230 |
Eliminations of intersegment revenues | (25,424 | ) |  | (8,361 | ) |  | (33,785 | ) |  | (13,475 | ) |  | (5,996 | ) |  | (19,471 | )
Total | $ | 2,551,377 |  |  | $ | 295,953 |  |  | $ | 2,847,330 |  |  | $ | 2,356,999 |  |  | $ | 408,072 |  |  | $ | 2,765,071 |
(1) | As noted above, prior period amounts have not been adjusted under the cumulative effect method. In this table, the Company's dialysis and related lab services revenues for the three months ended September 30, 2017 has been presented net of the provision for uncollectible accounts of $119,321 to conform to the current period presentation.
(2) | Other consists of management fees and revenue from the Company's ancillary services and strategic initiatives.
| For the nine months ended
| September 30, 2018 |  | September 30, 2017(1)
| U.S. dialysis and related lab services |  | Other - Ancillary services and strategic initiatives |  | Consolidated |  | U.S. dialysis and related lab services |  | Other - Ancillary services and strategic initiatives |  | Consolidated
Patient service revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage | $ | 4,524,449 |  |  | $ |  | $ | 4,524,449 |  |  | $ | 3,924,255 |  |  | $ |  | $ | 3,924,255 |
Medicaid and Managed Medicaid | 466,948 |  |  |  |  | 466,948 |  |  | 450,984 |  |  |  |  | 450,984 |
Other government | 330,500 |  |  | 250,048 |  |  | 580,548 |  |  | 271,947 |  |  | 183,050 |  |  | 454,997 |
Commercial | 2,366,182 |  |  | 70,156 |  |  | 2,436,338 |  |  | 2,304,745 |  |  | 46,537 |  |  | 2,351,282 |
Other revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage |  |  | 427,532 |  |  | 427,532 |  |  |  |  | 682,964 |  |  | 682,964 |
Medicaid and Managed Medicaid |  |  | 43,991 |  |  | 43,991 |  |  |  |  | 54,757 |  |  | 54,757 |
Commercial |  |  | 77,633 |  |  | 77,633 |  |  |  |  | 79,241 |  |  | 79,241 |
Other(2) | 14,965 |  |  | 103,014 |  |  | 117,979 |  |  | 14,951 |  |  | 139,337 |  |  | 154,288 |
Eliminations of intersegment revenues | (63,943 | ) |  | (27,748 | ) |  | (91,691 | ) |  | (38,559 | ) |  | (18,488 | ) |  | (57,047 | )
Total | $ | 7,639,101 |  |  | $ | 944,626 |  |  | $ | 8,583,727 |  |  | $ | 6,928,323 |  |  | $ | 1,167,398 |  |  | $ | 8,095,721 |
(1) | As noted above, prior period amounts have not been adjusted under the cumulative effect method. In this table, the Company's dialysis and related lab services revenues for the nine months ended September 30, 2017 has been presented net of the provision for uncollectible accounts of $335,979 to conform to the current period presentation.

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- Definition Tabular disclosure of patient service revenue (net of contractual allowances and discounts), by major payor source of revenue for health care organizations. + References No definition available. + Details
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