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Segment Reporting (Tables) | 12 Months Ended
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Dec. 31, 2018
Segment Reporting [Abstract] |
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income from Continuing Operations Before Income Taxes | The following is a summary of segment revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income from continuing operations before income taxes:
| Year ended December 31,
| 2018 |  | 2017 |  | 2016
Segment revenues:(1) |  |  |  |  |  |  |  |
U.S. dialysis and related lab services |  |  |  |  |  |  |  |
Patient service revenues: |  |  |  |  |  |  |  |
External sources | $ | 10,274,046 |  |  | $ | 9,767,123 |  |  | $ | 9,524,067 |
Intersegment revenues | 92,950 |  |  | 55,176 |  |  | 27,355 |
Total U.S. dialysis and related lab services revenues | 10,366,996 |  |  | 9,822,299 |  |  | 9,551,422 |
Provision for uncollectible accounts | (50,927 | ) |  | (481,973 | ) |  | (429,878 | )
Net U.S. dialysis and related lab services patient service revenues | 10,316,069 |  |  | 9,340,326 |  |  | 9,121,544 |
Other revenues(2) | 19,880 |  |  | 19,739 |  |  | 16,645 |
Total net U.S. dialysis and related lab services revenues | 10,335,949 |  |  | 9,360,065 |  |  | 9,138,189 |
Other - Ancillary services and strategic initiatives |  |  |  |  |  |  |  |
Net patient service revenues | 437,275 |  |  | 323,156 |  |  | 201,867 |
Other external sources | 724,577 |  |  | 1,248,589 |  |  | 1,394,766 |
Intersegment revenues | 34,236 |  |  | 24,603 |  |  | 24,739 |
Total ancillary services and strategic initiatives revenues | 1,196,088 |  |  | 1,596,348 |  |  | 1,621,372 |
Total net segment revenues | 11,532,037 |  |  | 10,956,413 |  |  | 10,759,561 |
Elimination of intersegment revenues | (127,186 | ) |  | (79,779 | ) |  | (52,094 | )
Consolidated net revenues | $ | 11,404,851 |  |  | $ | 10,876,634 |  |  | $ | 10,707,467 |
Segment operating margin (loss): |  |  |  |  |  |  |  |
U.S. dialysis and related lab services | $ | 1,709,721 |  |  | $ | 2,297,198 |  |  | $ | 1,777,014 |
Other—Ancillary services and strategic initiatives | (93,789 | ) |  | (439,477 | ) |  | 266,324 |
Total segment margin | 1,615,932 |  |  | 1,857,721 |  |  | 2,043,338 |
Reconciliation of segment operating margin to consolidated income from continuing operations before income taxes: |  |  |  |  |  |  |  |
Corporate administrative support | (90,108 | ) |  | (44,966 | ) |  | (13,628 | )
Consolidated operating income | 1,525,824 |  |  | 1,812,755 |  |  | 2,029,710 |
Debt expense | (487,435 | ) |  | (430,634 | ) |  | (414,116 | )
Other income | 10,089 |  |  | 17,665 |  |  | 7,511 |
Income from continuing operations before income taxes | $ | 1,048,478 |  |  | $ | 1,399,786 |  |  | $ | 1,623,105 |
(1) | On January 1, 2018, the Company adopted Revenue from Contracts with Customers (Topic 606) using the cumulative effect method for those contracts that were not substantially completed as of January 1, 2018. Results related to performance obligations satisfied beginning on and after January 1, 2018 are presented under Topic 606, while results related to the satisfaction of performance obligations in prior periods continue to be reported in accordance with the Company's historical accounting under Revenue Recognition (Topic 605). See Notes 1 and 2 of these consolidated financial statements for further discussion of the Company's adoption of Topic 606.
(2) Includes management fee revenues from providing management and administrative services to dialysis ventures in which the Company owns a noncontrolling interest or which are wholly-owned by third parties.
Summary of Depreciation and Amortization Expense by Segment | Depreciation and amortization expense by reportable segment is as follows:
| Year ended December 31,
| 2018 |  | 2017 |  | 2016
U.S. dialysis and related lab services | $ | 558,810 |  |  | $ | 520,965 |  |  | $ | 482,768 |
Other - Ancillary services and strategic initiatives | 32,225 |  |  | 38,946 |  |  | 26,729 |
| $ | 591,035 |  |  | $ | 559,911 |  |  | $ | 509,497 |
Summary of Assets by Segment |
| Year ended December 31,
| 2018 |  | 2017 |  | 2016
U.S. dialysis and related lab services | $ | 558,810 |  |  | $ | 520,965 |  |  | $ | 482,768 |
Other - Ancillary services and strategic initiatives | 32,225 |  |  | 38,946 |  |  | 26,729 |
| $ | 591,035 |  |  | $ | 559,911 |  |  | $ | 509,497 |
Summary of assets by reportable segment is as follows:
| Year ended December 31,
| 2018 |  | 2017
Segment assets |  |  |  |  |
U.S. dialysis and related lab services (including equity investments of $95,290 and $84,866, respectively) | $ | 12,333,641 |  |  | $ | 11,802,131 |
Other - Ancillary services and strategic initiatives(1) (including equity investments of $129,321 and $160,668, respectively) | 1,387,046 |  |  | 1,410,763 |
DMG - Held for sale (including equity investments of $4,833 and $10,321, respectively) | 5,389,565 |  |  | 5,761,642 |
Consolidated assets | $ | 19,110,252 |  |  | $ | 18,974,536 |
(1) Includes approximately $136,052 and $125,932 in 2018 and 2017, respectively, of net property and equipment related to the Company’s international operations.
Summary of Expenditures for Property and Equipment by Segment | Expenditures for property and equipment by reportable segment is as follows:
| Year ended December 31,
| 2018 |  | 2017 |  | 2016
U.S. dialysis and related lab services | $ | 856,108 |  |  | $ | 769,732 |  |  | $ | 675,994 |
Other - Ancillary services and strategic initiatives | 45,806 |  |  | 40,377 |  |  | 68,702 |
DMG - Held for sale | 85,224 |  |  | 95,141 |  |  | 84,399 |
| $ | 987,138 |  |  | $ | 905,250 |  |  | $ | 829,095 |

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