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Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands | 3 Months Ended
--- | ---
Mar. 31, 2019 | Mar. 31, 2018
Disaggregation of Revenue [Line Items] |  |
Patient service revenues | $ 2,635,152 | $ 2,591,074
Other revenues | 113,423 | 232,825
Total revenues | 2,743,112 | 2,849,444
Intersegment Elimination |  |
Disaggregation of Revenue [Line Items] |  |
Total revenues | (33,977) | (28,621)
Medicare and Medicare Advantage |  |
Disaggregation of Revenue [Line Items] |  |
Patient service revenues | 1,493,516 | 1,485,192
Other revenues | 61,700 | 142,758
Medicaid and Managed Medicaid |  |
Disaggregation of Revenue [Line Items] |  |
Patient service revenues | 154,190 | 157,496
Other revenues | 6 | 15,791
Other Government Payors |  |
Disaggregation of Revenue [Line Items] |  |
Patient service revenues | 190,602 | 189,656
Commercial Payors |  |
Disaggregation of Revenue [Line Items] |  |
Patient service revenues | 821,801 | 802,697
Other revenues | 32,619 | 40,420
Other |  |
Disaggregation of Revenue [Line Items] |  |
Other revenues | 22,655 | 44,055
U.S. dialysis and related lab services |  |
Disaggregation of Revenue [Line Items] |  |
Total revenues | 2,516,510 | 2,519,478
U.S. dialysis and related lab services | Intersegment Elimination |  |
Disaggregation of Revenue [Line Items] |  |
Total revenues | (30,641) | (18,422)
U.S. dialysis and related lab services | Medicare and Medicare Advantage |  |
Disaggregation of Revenue [Line Items] |  |
Patient service revenues | 1,493,516 | 1,485,192
Other revenues | 0 | 0
U.S. dialysis and related lab services | Medicaid and Managed Medicaid |  |
Disaggregation of Revenue [Line Items] |  |
Patient service revenues | 154,190 | 157,496
Other revenues | 0 | 0
U.S. dialysis and related lab services | Other Government Payors |  |
Disaggregation of Revenue [Line Items] |  |
Patient service revenues | 106,127 | 107,119
U.S. dialysis and related lab services | Commercial Payors |  |
Disaggregation of Revenue [Line Items] |  |
Patient service revenues | 788,413 | 782,979
Other revenues | 0 | 0
U.S. dialysis and related lab services | Other |  |
Disaggregation of Revenue [Line Items] |  |
Other revenues | 4,905 | 5,114
Other—Ancillary services and strategic initiatives |  |
Disaggregation of Revenue [Line Items] |  |
Total revenues | 226,602 | 329,966
Other—Ancillary services and strategic initiatives | Intersegment Elimination |  |
Disaggregation of Revenue [Line Items] |  |
Total revenues | (3,336) | (10,199)
Other—Ancillary services and strategic initiatives | Medicare and Medicare Advantage |  |
Disaggregation of Revenue [Line Items] |  |
Patient service revenues | 0 | 0
Other revenues | 61,700 | 142,758
Other—Ancillary services and strategic initiatives | Medicaid and Managed Medicaid |  |
Disaggregation of Revenue [Line Items] |  |
Patient service revenues | 0 | 0
Other revenues | 6 | 15,791
Other—Ancillary services and strategic initiatives | Other Government Payors |  |
Disaggregation of Revenue [Line Items] |  |
Patient service revenues | 84,475 | 82,537
Other—Ancillary services and strategic initiatives | Commercial Payors |  |
Disaggregation of Revenue [Line Items] |  |
Patient service revenues | 33,388 | 19,718
Other revenues | 32,619 | 40,420
Other—Ancillary services and strategic initiatives | Other |  |
Disaggregation of Revenue [Line Items] |  |
Other revenues | $ 17,750 | $ 38,941

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