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Segment Reporting - Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income from Continuing Operations Before Income Taxes (Details) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended
--- | --- | ---
Dec. 31, 2020 | Sep. 30, 2020 | Jun. 30, 2020 | Mar. 31, 2020 | Dec. 31, 2019 | Sep. 30, 2019 | Jun. 30, 2019 | Mar. 31, 2019 | Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Dialysis patient service revenues before provision |  |  |  |  |  |  |  |  | $ 11,039,709 | $ 10,918,421 | $ 10,709,981
Provision for uncollectible accounts |  |  |  |  |  |  |  |  | (13,458) | (21,715) | (49,587)
Dialysis patient service revenues |  |  |  |  |  |  |  |  | 11,026,251 | 10,896,706 | 10,660,394
Other revenues |  |  |  |  |  |  |  |  | 524,353 | 491,773 | 744,457
Total revenues | $ 2,905,322 | $ 2,924,066 | $ 2,879,979 | $ 2,841,237 | $ 2,898,584 | $ 2,904,078 | $ 2,842,705 | $ 2,743,112 | 11,550,604 | 11,388,479 | 11,404,851
Operating income | $ 381,671 | $ 437,669 | $ 409,920 | $ 465,376 | $ 462,588 | $ 378,336 | $ 461,886 | $ 340,507 | 1,694,636 | 1,643,317 | 1,525,824
Corporate administrative support |  |  |  |  |  |  |  |  | (146,707) | (92,335) | (90,108)
Debt expense |  |  |  |  |  |  |  |  | (304,111) | (443,824) | (487,435)
Debt prepayment, refinancing and redemption charges |  |  |  |  |  |  |  |  | (89,022) | (33,402) | 0
Other income |  |  |  |  |  |  |  |  | 16,759 | 29,348 | 10,089
Income (Loss) from Continuing Operations before Equity Method Investments, Income Taxes, Noncontrolling Interest, Total |  |  |  |  |  |  |  |  | 1,318,262 | 1,195,439 | 1,048,478
Segment Reporting Information footnote: |  |  |  |  |  |  |  |  |  |  |
Equity investment (loss) income |  |  |  |  |  |  |  |  | 26,916 | 12,679 | (4,484)
U.S. dialysis |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Total revenues |  |  |  |  |  |  |  |  | 10,514,649 | 10,430,581 | 10,242,999
Other - Ancillary services |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Total revenues |  |  |  |  |  |  |  |  | 1,035,955 | 957,898 | 1,161,852
Operating Segments |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Total revenues |  |  |  |  |  |  |  |  | 11,712,633 | 11,534,834 | 11,532,037
Operating income |  |  |  |  |  |  |  |  | 1,841,343 | 1,735,652 | 1,615,932
Operating Segments | U.S. dialysis |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Dialysis patient service revenues before provision |  |  |  |  |  |  |  |  | 10,632,822 | 10,552,600 | 10,366,996
Provision for uncollectible accounts |  |  |  |  |  |  |  |  | (13,458) | (21,715) | (50,927)
Dialysis patient service revenues |  |  |  |  |  |  |  |  | 10,619,364 | 10,530,885 | 10,316,069
Total revenues |  |  |  |  |  |  |  |  | 10,659,935 | 10,562,906 | 10,335,949
Operating income |  |  |  |  |  |  |  |  | 1,917,604 | 1,924,826 | 1,709,721
Operating Segments | U.S. dialysis | External Sources |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Dialysis patient service revenues before provision |  |  |  |  |  |  |  |  | 10,488,731 | 10,421,401 | 10,274,046
Other revenues |  |  |  |  |  |  |  |  | 39,376 | 30,895 | 19,880
Operating Segments | U.S. dialysis | Intersubsegment Eliminations |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Dialysis patient service revenues before provision |  |  |  |  |  |  |  |  | 144,091 | 131,199 | 92,950
Other revenues |  |  |  |  |  |  |  |  | 1,195 | 1,126 | 0
Operating Segments | Other - Ancillary services |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Dialysis patient service revenues before provision |  |  |  |  |  |  |  |  | 550,978 | 497,021 | 437,275
Other revenues |  |  |  |  |  |  |  |  | 484,977 | 460,877 | 724,577
Total revenues |  |  |  |  |  |  |  |  | 1,052,698 | 971,928 | 1,196,088
Operating income |  |  |  |  |  |  |  |  | (76,261) | (189,174) | (93,789)
Segment Reporting Information footnote: |  |  |  |  |  |  |  |  |  |  |
Equity investment (loss) income |  |  |  |  |  |  |  |  | 5,866 | 9,366 | 24,866
Operating Segments | Other - Ancillary services | Intersubsegment Eliminations |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Dialysis patient service revenues before provision |  |  |  |  |  |  |  |  | 16,743 | 14,030 | 34,236
Intersegment Elimination |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Total revenues |  |  |  |  |  |  |  |  | (162,029) | (146,355) | (127,186)
Intersegment Elimination | U.S. dialysis |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Total revenues |  |  |  |  |  |  |  |  | (145,286) | (132,325) | (92,950)
Intersegment Elimination | Other - Ancillary services |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Total revenues |  |  |  |  |  |  |  |  | $ (16,743) | $ (14,030) | $ (34,236)

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