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Segment reporting (Tables) | 9 Months Ended
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Sep. 30, 2021
Segment Reporting [Abstract] |
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes | The following is a summary of segment net revenues, segment operating income (loss), and a reconciliation of segment operating income (loss) to consolidated income before income taxes:
| Three months ended September 30, |  | Nine months ended September 30,
| 2021 |  | 2020 |  | 2021 |  | 2020
Segment revenues: |  |  |  |  |  |  |
U.S. dialysis |  |  |  |  |  |  |
Dialysis patient service revenues: |  |  |  |  |  |  |
External sources | $ | 2,669,823 |  |  | $ | 2,639,761 |  |  | $ | 7,874,759 |  |  | $ | 7,850,828 |
Intersegment revenues | 22,007 |  |  | 37,049 |  |  | 70,196 |  |  | 104,111 |
U.S. dialysis patient service revenues | 2,691,830 |  |  | 2,676,810 |  |  | 7,944,955 |  |  | 7,954,939 |
Other revenues: |  |  |  |  |  |  |
External sources | 6,119 |  |  | 17,141 |  |  | 19,080 |  |  | 29,970 |
Intersegment revenues | 97 |  |  | 268 |  |  | 228 |  |  | 876 |
Total U.S. dialysis revenues | 2,698,046 |  |  | 2,694,219 |  |  | 7,964,263 |  |  | 7,985,785 |
Other—Ancillary services |  |  |  |  |  |  |
Dialysis patient service revenues | 168,117 |  |  | 141,889 |  |  | 495,725 |  |  | 402,300 |
Other external sources | 94,260 |  |  | 125,275 |  |  | 285,266 |  |  | 362,184 |
Intersegment revenues | — |  |  | 4,079 |  |  | 4,294 |  |  | 12,402 |
Total ancillary services revenues | 262,377 |  |  | 271,243 |  |  | 785,285 |  |  | 776,886 |
Total net segment revenues | 2,960,423 |  |  | 2,965,462 |  |  | 8,749,548 |  |  | 8,762,671 |
Elimination of intersegment revenues | (22,104) |  |  | (41,396) |  |  | (74,718) |  |  | (117,389) |
Consolidated revenues | $ | 2,938,319 |  |  | $ | 2,924,066 |  |  | $ | 8,674,830 |  |  | $ | 8,645,282 |
Segment operating income (loss): |  |  |  |  |  |  |
U.S. dialysis | $ | 509,939 |  |  | $ | 470,596 |  |  | $ | 1,523,625 |  |  | $ | 1,484,833 |
Other—Ancillary services | (6,909) |  |  | (7,086) |  |  | (36,577) |  |  | (49,354) |
Total segment operating income | 503,030 |  |  | 463,510 |  |  | 1,487,048 |  |  | 1,435,479 |
Reconciliation of segment operating income to consolidated income from continuing operations before income taxes: |  |  |  |  |  |  |
Corporate administrative support | (28,153) |  |  | (25,841) |  |  | (79,093) |  |  | (122,514) |
Consolidated operating income | 474,877 |  |  | 437,669 |  |  | 1,407,955 |  |  | 1,312,965 |
Debt expense | (72,829) |  |  | (73,658) |  |  | (213,167) |  |  | (243,642) |
Debt prepayment, refinancing and redemption charges | — |  |  | (86,074) |  |  | — |  |  | (89,022) |
Other (loss) income, net | (7,590) |  |  | 5,395 |  |  | 8,766 |  |  | 10,590 |
Consolidated income from continuing operations before income taxes | $ | 394,458 |  |  | $ | 283,332 |  |  | $ | 1,203,554 |  |  | $ | 990,891 |
Summary of Depreciation and Amortization Expense by Reportable Segment | Depreciation and amortization expense by reportable segment was as follows:
| Three months ended September 30, |  | Nine months ended September 30,
| 2021 |  | 2020 |  | 2021 |  | 2020
U.S. dialysis | $ | 161,252 |  |  | $ | 148,221 |  |  | $ | 477,054 |  |  | $ | 442,833 |
Other—Ancillary services | 9,210 |  |  | 8,673 |  |  | 28,798 |  |  | 26,116 |
| $ | 170,462 |  |  | $ | 156,894 |  |  | $ | 505,852 |  |  | $ | 468,949 |
Summary of Expenditures for Property and Equipment by Reportable Segment | Expenditures for property and equipment by reportable segment were as follows:
| Nine months ended September 30,
| 2021 |  | 2020
U.S. dialysis | $ | 415,994 |  |  | $ | 430,646 |
Other—Ancillary services | 35,915 |  |  | 19,250 |
| $ | 451,909 |  |  | $ | 449,896 |
Summary of Assets by Reportable Segment | A summary of assets by reportable segment was as follows:
| September 30, 2021 |  | December 31, 2020
U.S. dialysis | $ | 15,939,286 |  |  | $ | 15,344,647 |
Other—Ancillary services | 1,694,654 |  |  | 1,643,869 |
Consolidated assets | $ | 17,633,940 |  |  | $ | 16,988,516 |

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