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Acquisitions and Divestitures - Assets Acquired and Liabilities Assumed and Recognized at Acquisition Dates at Estimated Fair Values (Details) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016
--- | --- | --- | ---
Business Acquisition [Line Items] |  |  |
Goodwill | $ 6,841,960 | $ 6,610,279 | $ 6,015,375
Renal Ventures Limited, LLC |  |  |
Business Acquisition [Line Items] |  |  |
Current assets, net of cash acquired | 22,739 |  |
Property and equipment | 36,295 |  |
Amortizable intangible and other long-term assets | 11,547 |  |
Goodwill | 298,200 |  |
Current liabilities | (8,389) |  |
Long-term liabilities | (479) |  |
Aggregate purchase price | $ 359,913 |  |

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- Definition Amount of intangible assets, excluding goodwill, acquired at the acquisition date. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 805 -SubTopic 20 -Section 50 -Paragraph 1 -Subparagraph (c) -URI http://asc.fasb.org/extlink&oid=84161108&loc=d3e4845-128472 + Details
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