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Goodwill - Changes in Carrying Value of Goodwill by Reportable Segments (Details) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended
--- | --- | ---
Sep. 30, 2019 | Dec. 31, 2019 | Dec. 31, 2018 | Dec. 31, 2017
Goodwill [Roll Forward] |  |  |  |
Beginning balance |  | $ 6,841,960 | $ 6,610,279 |
Acquisitions |  | 90,226 | 278,348 |
Divestitures |  |  | (15,497) |
Impairment charges |  | (124,892) | (3,106) | $ (36,196)
Foreign currency and other adjustments |  | (19,659) | (28,064) |
Ending balance |  | 6,787,635 | 6,841,960 | 6,610,279
Goodwill |  | 6,940,970 |  |
Accumulated impairment charges |  | (153,335) |  |
U.S. dialysis |  |  |  |
Goodwill [Roll Forward] |  |  |  |
Beginning balance |  | 6,275,004 | 6,144,761 |
Acquisitions |  | 18,089 | 130,574 |
Divestitures |  |  | (331) |
Impairment charges |  | 0 | 0 |
Foreign currency and other adjustments |  | (5,993) | 0 |
Ending balance |  | 6,287,100 | 6,275,004 | 6,144,761
Goodwill |  | 6,287,100 |  |
Accumulated impairment charges |  | 0 |  |
Other - Ancillary services |  |  |  |
Goodwill [Roll Forward] |  |  |  |
Beginning balance |  | 566,956 | 465,518 |
Acquisitions |  | 72,137 | 147,774 |
Divestitures |  |  | (15,166) |
Impairment charges | $ (83,855) | (124,892) | (3,106) |
Foreign currency and other adjustments |  | (13,666) | (28,064) |
Ending balance |  | 500,535 | $ 566,956 | $ 465,518
Goodwill |  | 653,870 |  |
Accumulated impairment charges |  | $ (153,335) |  |

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