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Segment reporting (Tables) | 9 Months Ended
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Sep. 30, 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 September 30, |  | Nine months ended September 30,
| 2018 |  | 2017 |  | 2018 |  | 2017
Segment net revenues: |  |  |  |  |  |  |
U.S. dialysis and related lab services |  |  |  |  |  |  |
Patient service revenues: |  |  |  |  |  |  |
External sources | $ | 2,559,345 |  |  | $ | 2,470,169 |  |  | $ | 7,661,244 |  |  | $ | 7,247,403 |
Intersegment revenues | 25,424 |  |  | 13,475 |  |  | 63,943 |  |  | 38,559 |
U.S. dialysis and related lab services patient service revenues | 2,584,769 |  |  | 2,483,644 |  |  | 7,725,187 |  |  | 7,285,962 |
Provision for uncollectible accounts | (12,900 | ) |  | (117,962 | ) |  | (37,108 | ) |  | (334,031 | )
Net U.S. dialysis and related lab services patient service revenues | 2,571,869 |  |  | 2,365,682 |  |  | 7,688,079 |  |  | 6,951,931 |
Other revenues(1) | 4,932 |  |  | 4,792 |  |  | 14,965 |  |  | 14,951 |
Total U.S. dialysis and related lab services revenues | 2,576,801 |  |  | 2,370,474 |  |  | 7,703,044 |  |  | 6,966,882 |
Other—Ancillary services and strategic initiatives |  |  |  |  |  |  |
Patient service revenues, net | 112,279 |  |  | 90,015 |  |  | 320,204 |  |  | 229,587 |
Other external sources | 183,674 |  |  | 318,057 |  |  | 624,422 |  |  | 937,811 |
Intersegment revenues | 8,361 |  |  | 5,996 |  |  | 27,748 |  |  | 18,488 |
Total ancillary services and strategic initiatives revenues | 304,314 |  |  | 414,068 |  |  | 972,374 |  |  | 1,185,886 |
Total net segment revenues | 2,881,115 |  |  | 2,784,542 |  |  | 8,675,418 |  |  | 8,152,768 |
Elimination of intersegment revenues | (33,785 | ) |  | (19,471 | ) |  | (91,691 | ) |  | (57,047 | )
Consolidated revenues | $ | 2,847,330 |  |  | $ | 2,765,071 |  |  | $ | 8,583,727 |  |  | $ | 8,095,721 |
Segment operating margin: |  |  |  |  |  |  |
U.S. dialysis and related lab services | $ | 390,006 |  |  | $ | 442,777 |  |  | $ | 1,272,828 |  |  | $ | 1,837,989 |
Other—Ancillary services and strategic initiatives | (60,132 | ) |  | (36,518 | ) |  | (64,307 | ) |  | (142,984 | )
Total segment operating margin | 329,874 |  |  | 406,259 |  |  | 1,208,521 |  |  | 1,695,005 |
Reconciliation of segment operating margin to consolidated income from continuing operations before income taxes: |  |  |  |  |  |  |
Corporate administrative support | (40,836 | ) |  | (10,965 | ) |  | (70,605 | ) |  | (32,587 | )
Consolidated operating income | 289,038 |  |  | 395,294 |  |  | 1,137,916 |  |  | 1,662,418 |
Debt expense | (125,927 | ) |  | (109,306 | ) |  | (359,135 | ) |  | (321,637 | )
Other income, net | 4,007 |  |  | 3,396 |  |  | 10,583 |  |  | 12,180 |
Consolidated income from continuing operations before income taxes | $ | 167,118 |  |  | $ | 289,384 |  |  | $ | 789,364 |  |  | $ | 1,352,961 |
(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 September 30, |  | Nine months ended September 30,
| 2018 |  | 2017 |  | 2018 |  | 2017
U.S. dialysis and related lab services | $ | 138,669 |  |  | $ | 132,112 |  |  | $ | 411,697 |  |  | $ | 387,142 |
Other—Ancillary services and strategic initiatives | 7,331 |  |  | 10,522 |  |  | 24,181 |  |  | 28,402 |
| $ | 146,000 |  |  | $ | 142,634 |  |  | $ | 435,878 |  |  | $ | 415,544 |
Summary of Assets by Reportable Segment | Assets by reportable segment were as follows:
| September 30, 2018 |  | December 31, 2017
Segment assets |  |  |  |  |
U.S. dialysis and related lab services (including equity investments of $94,144 and $84,866, respectively) | $ | 12,101,111 |  |  | $ | 11,776,042 |
Other—Ancillary services and strategic initiatives (including equity investments of $146,676 and $160,668, respectively) | 1,308,892 |  |  | 1,410,509 |
DMG—Held for sale (including equity investments of $5,060 and $10,321, respectively) | 5,947,786 |  |  | 5,761,642 |
Consolidated assets | $ | 19,357,789 |  |  | $ | 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 September 30, |  | Nine months ended September 30,
| 2018 |  | 2017 |  | 2018 |  | 2017
U.S. dialysis and related lab services | $ | 214,728 |  |  | $ | 207,472 |  |  | $ | 603,186 |  |  | $ | 538,620 |
Other—Ancillary services and strategic initiatives | 5,019 |  |  | 9,135 |  |  | 37,191 |  |  | 28,256 |
DMG—Held for sale | 11,935 |  |  | 24,282 |  |  | 65,282 |  |  | 72,953 |
| $ | 231,682 |  |  | $ | 240,889 |  |  | $ | 705,659 |  |  | $ | 639,829 |

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