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Revenue Recognition Segment revenue by major payor (Tables) | 6 Months Ended
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Jun. 30, 2020
Revenues by major payor [Abstract] |
Disaggregation of Revenue [Table Text Block] | The following table summarizes the Company's segment revenues by primary payor source:
| Three months ended June 30, 2020 |  | Three months ended June 30, 2019
| U.S. dialysis |  | Other - Ancillary services |  | Consolidated |  | U.S. dialysis |  | Other - Ancillary services |  | Consolidated
Dialysis patient service revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage | $ | 1,517,309 |  |  | $ |  | $ | 1,517,309 |  |  | $ | 1,520,193 |  |  | $ |  | $ | 1,520,193 |
Medicaid and Managed Medicaid | 182,324 |  |  |  |  |  | 182,324 |  |  | 160,242 |  |  |  |  | 160,242 |
Other government | 116,758 |  |  | 90,813 |  |  | 207,571 |  |  | 110,565 |  |  | 88,770 |  |  | 199,335 |
Commercial | 850,558 |  |  | 35,557 |  |  | 886,115 |  |  | 840,993 |  |  | 33,095 |  |  | 874,088 |
Other revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage |  |  |  | 99,829 |  |  | 99,829 |  |  |  |  | 64,012 |  |  | 64,012 |
Medicaid and Managed Medicaid |  |  |  | 283 |  |  | 283 |  |  |  |  | 94 |  |  | 94 |
Commercial |  |  |  | 9,050 |  |  | 9,050 |  |  |  |  | 32,307 |  |  | 32,307 |
Other(1) | 7,995 |  |  | 9,103 |  |  | 17,098 |  |  | 5,501 |  |  | 20,670 |  |  | 26,171 |
Eliminations of intersegment revenues | (35,429 | ) |  | (4,171 | ) |  | (39,600 | ) |  | (30,334 | ) |  | (3,403 | ) |  | (33,737 | )
Total | $ | 2,639,515 |  |  | $ | 240,464 |  |  | $ | 2,879,979 |  |  | $ | 2,607,160 |  |  | $ | 235,545 |  |  | $ | 2,842,705 |
(1) | Other consists of management service fees earned in the respective Company line of business as well as other revenue from the Company's ancillary services.
| Six months ended June 30, 2020 |  | Six months ended June 30, 2019
| U.S. dialysis |  | Other - Ancillary services |  | Consolidated |  | U.S. dialysis |  | Other - Ancillary services |  | Consolidated
Patient service revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage | $ | 3,019,529 |  |  | $ |  | $ | 3,019,529 |  |  | $ | 3,013,709 |  |  | $ |  | $ | 3,013,709 |
Medicaid and Managed Medicaid | 353,791 |  |  |  |  | 353,791 |  |  | 314,431 |  |  |  |  | 314,431 |
Other government | 228,669 |  |  | 185,387 |  |  | 414,056 |  |  | 216,692 |  |  | 173,245 |  |  | 389,937 |
Commercial | 1,676,140 |  |  | 75,024 |  |  | 1,751,164 |  |  | 1,629,407 |  |  | 66,483 |  |  | 1,695,890 |
Other revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage |  |  | 198,307 |  |  | 198,307 |  |  |  |  | 125,713 |  |  | 125,713 |
Medicaid and Managed Medicaid |  |  | 649 |  |  | 649 |  |  |  |  | 100 |  |  | 100 |
Commercial |  |  | 19,571 |  |  | 19,571 |  |  |  |  | 64,925 |  |  | 64,925 |
Other(1) | 13,438 |  |  | 26,705 |  |  | 40,143 |  |  | 10,406 |  |  | 38,420 |  |  | 48,826 |
Eliminations of intersegment revenues | (67,670 | ) |  | (8,324 | ) |  | (75,994 | ) |  | (60,975 | ) |  | (6,739 | ) |  | (67,714 | )
Total | $ | 5,223,897 |  |  | $ | 497,319 |  |  | $ | 5,721,216 |  |  | $ | 5,123,670 |  |  | $ | 462,147 |  |  | $ | 5,585,817 |
(1) Other consists of management service fees earned in the respective Company line of business as well as other revenue from the Company's ancillary services.

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- Definition Tabular disclosure of disaggregation of revenue into categories depicting how nature, amount, timing, and uncertainty of revenue and cash flows are affected by economic factor. + References Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 5 -URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130545-203045 + Details
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