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Segment Reporting (Tables) | 12 Months Ended
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Dec. 31, 2020
Segment Reporting [Abstract] |
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income from Continuing Operations Before Income Taxes | The following is a summary of segment revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income from continuing operations before income taxes:
| Year ended December 31,
| 2020 |  | 2019 |  | 2018
Segment revenues: |  |  |  |  |
U.S. dialysis |  |  |  |  |
Patient service revenues: |  |  |  |  |
External sources | $ | 10,488,731 |  |  | $ | 10,421,401 |  |  | $ | 10,274,046 |
Intersegment revenues | 144,091 |  |  | 131,199 |  |  | 92,950 |
U.S. dialysis revenues before provision | 10,632,822 |  |  | 10,552,600 |  |  | 10,366,996 |
Provision for uncollectible accounts | (13,458) |  |  | (21,715) |  |  | (50,927) |
U.S. dialysis patient service revenues | 10,619,364 |  |  | 10,530,885 |  |  | 10,316,069 |
Other revenues(1) |  |  |  |  |
External sources | 39,376 |  |  | 30,895 |  |  | 19,880 |
Intersegment revenues | 1,195 |  |  | 1,126 |  |  | — |
Total U.S. dialysis revenues | $ | 10,659,935 |  |  | $ | 10,562,906 |  |  | $ | 10,335,949 |
Other - Ancillary services |  |  |  |  |
Net patient service revenues | 550,978 |  |  | 497,021 |  |  | 437,275 |
Other external sources | 484,977 |  |  | 460,877 |  |  | 724,577 |
Intersegment revenues | 16,743 |  |  | 14,030 |  |  | 34,236 |
Total ancillary services | 1,052,698 |  |  | 971,928 |  |  | 1,196,088 |
Total net segment revenues | 11,712,633 |  |  | 11,534,834 |  |  | 11,532,037 |
Elimination of intersegment revenues | (162,029) |  |  | (146,355) |  |  | (127,186) |
Consolidated revenues | $ | 11,550,604 |  |  | $ | 11,388,479 |  |  | $ | 11,404,851 |
Segment operating margin (loss): |  |  |  |  |
U.S. dialysis | $ | 1,917,604 |  |  | $ | 1,924,826 |  |  | $ | 1,709,721 |
Other - Ancillary services(2) | (76,261) |  |  | (189,174) |  |  | (93,789) |
Total segment margin | 1,841,343 |  |  | 1,735,652 |  |  | 1,615,932 |
Reconciliation of segment operating margin to consolidated income from continuing operations before income taxes: |  |  |  |  |
Corporate administrative support | (146,707) |  |  | (92,335) |  |  | (90,108) |
Consolidated operating income | 1,694,636 |  |  | 1,643,317 |  |  | 1,525,824 |
Debt expense | (304,111) |  |  | (443,824) |  |  | (487,435) |
Debt prepayment, refinancing and redemption charges | (89,022) |  |  | (33,402) |  |  | — |
Other income | 16,759 |  |  | 29,348 |  |  | 10,089 |
Income from continuing operations before income taxes | $ | 1,318,262 |  |  | $ | 1,195,439 |  |  | $ | 1,048,478 |
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(1)Includes management fee revenues from providing management and administrative services to dialysis ventures in which the Company owns a noncontrolling interest or which are wholly-owned by third parties. (2)Includes equity investment income of $5,866, $9,366, and $24,866 in 2020, 2019 and 2018, respectively.
Summary of Depreciation and Amortization Expense by Segment | Depreciation and amortization expense by reportable segment was as follows:
| Year ended December 31,
| 2020 |  | 2019 |  | 2018
U.S. dialysis | $ | 594,552 |  |  | $ | 583,454 |  |  | $ | 558,810 |
Other - Ancillary services | 35,883 |  |  | 31,698 |  |  | 32,225 |
| $ | 630,435 |  |  | $ | 615,152 |  |  | $ | 591,035 |
Summary of Assets by Segment | Summary of assets by reportable segment was as follows:
| Year ended December 31,
| 2020 |  | 2019
Segment assets |  |  |
U.S. dialysis(1) | $ | 15,344,647 |  |  | $ | 15,778,880 |
Other - Ancillary services(2) | 1,643,869 |  |  | 1,532,514 |
Consolidated assets | $ | 16,988,516 |  |  | $ | 17,311,394 |
(1)Includes equity method and other investments of $122,974 and $124,188 in 2020 and 2019, respectively. (2)Includes equity method and other investments of $134,517 and 117,795 in 2020 and 2019, respectively and includes approximately $181,137 and $154,572 in 2020 and 2019, respectively, of net property and equipment related to the Company’s international operations.
Summary of Expenditures for Property and Equipment by Segment | Expenditures for property and equipment by reportable segment were as follows:
| Year ended December 31,
| 2020 |  | 2019 |  | 2018
U.S. dialysis | 646,870 |  |  | $ | 681,339 |  |  | $ | 856,108 |
Other - Ancillary services | 27,671 |  |  | 46,741 |  |  | 45,806 |
DMG - Discontinued operations | — |  |  | 38,466 |  |  | 85,224 |
| $ | 674,541 |  |  | $ | 766,546 |  |  | $ | 987,138 |

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