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Revenue Recognition Segment Revenue by Payor (Details) - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2021
Mar. 31, 2020
Disaggregation of Revenue [Line Items]    
Other revenues $ 105,414 $ 127,956
Total revenues 2,820,001 2,841,237
Elimination of intersegment revenues    
Disaggregation of Revenue [Line Items]    
Total revenues (31,296) (36,394)
Medicare and Medicare Advantage    
Disaggregation of Revenue [Line Items]    
Patient service revenues 1,480,297 1,531,033
Other revenues 85,595 98,478
Medicaid and Managed Medicaid    
Disaggregation of Revenue [Line Items]    
Patient service revenues 187,243 171,467
Other revenues 300 366
Other Government Payors    
Disaggregation of Revenue [Line Items]    
Patient service revenues 187,014 177,673
Commercial Payors    
Disaggregation of Revenue [Line Items]    
Patient service revenues 886,977 865,049
Other revenues 6,034 10,521
Other    
Disaggregation of Revenue [Line Items]    
Other revenues 17,837 23,044
U.S. dialysis    
Disaggregation of Revenue [Line Items]    
Total revenues 2,562,875 2,584,381
U.S. dialysis | Elimination of intersegment revenues    
Disaggregation of Revenue [Line Items]    
Total revenues (27,003) (32,242)
U.S. dialysis | Medicare and Medicare Advantage    
Disaggregation of Revenue [Line Items]    
Patient service revenues 1,480,297 1,531,033
U.S. dialysis | Medicaid and Managed Medicaid    
Disaggregation of Revenue [Line Items]    
Patient service revenues 187,243 171,467
U.S. dialysis | Other Government Payors    
Disaggregation of Revenue [Line Items]    
Patient service revenues 80,184 83,099
U.S. dialysis | Commercial Payors    
Disaggregation of Revenue [Line Items]    
Patient service revenues 835,479 825,582
U.S. dialysis | Other    
Disaggregation of Revenue [Line Items]    
Other revenues 6,675 5,442
Other—Ancillary services    
Disaggregation of Revenue [Line Items]    
Total revenues 257,126 256,856
Other—Ancillary services | Elimination of intersegment revenues    
Disaggregation of Revenue [Line Items]    
Total revenues (4,293) (4,152)
Other—Ancillary services | Medicare and Medicare Advantage    
Disaggregation of Revenue [Line Items]    
Other revenues 85,595 98,478
Other—Ancillary services | Medicaid and Managed Medicaid    
Disaggregation of Revenue [Line Items]    
Other revenues 300 366
Other—Ancillary services | Other Government Payors    
Disaggregation of Revenue [Line Items]    
Patient service revenues 106,830 94,574
Other—Ancillary services | Commercial Payors    
Disaggregation of Revenue [Line Items]    
Patient service revenues 51,498 39,467
Other revenues 6,034 10,521
Other—Ancillary services | Other    
Disaggregation of Revenue [Line Items]    
Other revenues $ 11,162 $ 17,602