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Acquisitions and Divestitures - Additional Information (Details) $ in Thousands |  | 3 Months Ended | 12 Months Ended
--- | --- | --- | ---
May 01, 2020 USD ($) | Jun. 30, 2020 USD ($) | Dec. 31, 2020 USD ($) clinic | Dec. 31, 2019 USD ($) clinic | Dec. 31, 2018 USD ($) clinic
Business Acquisition [Line Items] |  |  |  |  |
Cash paid to acquire business |  |  | $ 182,013 | $ 100,861 | $ 183,156
Business combination contingent consideration acquisitions, earn-outs |  |  | 14,042 | 23,536 |
Non-cash gain on acquiring additional ownership in business acquisition |  |  |  |  | 28,152
Contingent earn-out obligations |  |  | 42,378 |  |
Fair value of contingent earn-out consideration |  |  | 30,248 | 24,586 | 2,608
RMS Lifeline |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |
Gain (Loss) on Divestiture | $ 16,252 | $ 16,252 |  |  |
Other Long-term Liabilities |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |
Fair value of contingent earn-out consideration |  |  | 17,223 |  |
Other Current Liabilities |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |
Fair value of contingent earn-out consideration |  |  | 13,025 |  |
Other companies |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |
Fair value of contingent earn-out consideration |  |  | $ 30,248 |  |
Minimum | Other companies | EBITDA or Operating Income Performance Targets or Quality Margins |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |
Earn-out consideration payment period |  |  | 1 year |  |
Maximum | Other companies | EBITDA or Operating Income Performance Targets or Quality Margins |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |
Earn-out consideration payment period |  |  | 5 years |  |
Series of individually immaterial business acquisitions |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |
Cash paid to acquire business |  |  | $ 182,013 | 98,836 | 176,161
Business combination contingent consideration acquisitions, earn-outs |  |  | 14,042 | 23,536 | 1,246
Deferred Purchase price and liabilities assumed |  |  | 20,415 | $ 4,326 | $ 34,394
Non-cash gain on acquiring additional ownership in business acquisition |  |  | $ 1,821 |  |
U S Dialysis And Related Lab Services | Series of individually immaterial business acquisitions |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |
Number of businesses acquired | clinic |  |  | 8 | 7 | 18
Foreign Dialysis Centers | Series of individually immaterial business acquisitions |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |
Number of businesses acquired | clinic |  |  | 66 | 16 | 28

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