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Revenue Recognition Segment revenue by major payor (Tables) | 9 Months Ended
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Sep. 30, 2021
Revenues by major payor [Abstract] |
Disaggregation of Revenue [Table Text Block] | The following table summarizes the Company's segment revenues by primary payor source:
| Three months ended September 30, 2021 |  | Three months ended September 30, 2020
| U.S. dialysis |  | Other - Ancillary services |  | Consolidated |  | U.S. dialysis |  | Other - Ancillary services |  | Consolidated
Dialysis patient service revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage(1) | $ | 1,543,819 |  |  | $ |  | $ | 1,543,819 |  |  | $ | 1,541,707 |  |  | $ |  | $ | 1,541,707 |
Medicaid and Managed Medicaid | 203,169 |  |  |  |  | 203,169 |  |  | 193,254 |  |  |  |  | 193,254 |
Other government(1) | 82,624 |  |  | 113,260 |  |  | 195,884 |  |  | 83,602 |  |  | 98,044 |  |  | 181,646 |
Commercial | 862,218 |  |  | 54,857 |  |  | 917,075 |  |  | 858,247 |  |  | 43,845 |  |  | 902,092 |
Other revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage |  |  | 77,277 |  |  | 77,277 |  |  |  |  | 111,248 |  |  | 111,248 |
Medicaid and Managed Medicaid |  |  | 377 |  |  | 377 |  |  |  |  | 412 |  |  | 412 |
Commercial |  |  | 7,164 |  |  | 7,164 |  |  |  |  | 7,799 |  |  | 7,799 |
Other(2) | 6,216 |  |  | 9,442 |  |  | 15,658 |  |  | 17,409 |  |  | 9,895 |  |  | 27,304 |
Eliminations of intersegment revenues | (22,104) |  |  | — |  |  | (22,104) |  |  | (37,317) |  |  | (4,079) |  |  | (41,396) |
Total | $ | 2,675,942 |  |  | $ | 262,377 |  |  | $ | 2,938,319 |  |  | $ | 2,656,902 |  |  | $ | 267,164 |  |  | $ | 2,924,066 |
(1)During the first quarter of 2021, the Company realigned the classification of revenue previously disclosed in the “Other government” category to the “Medicare and Medicare Advantage” category for certain government-reimbursed plans which have structure and payment characteristics similar to traditional Medicare Advantage plans. The classification of revenue for these plans for the three months ended September 30, 2020 has also been recast to conform to the current period presentation. (2)Other consists of management service fees earned in the respective Company line of business as well as other revenue from the Company's ancillary services.
| Nine months ended September 30, 2021 |  | Nine months ended September 30, 2020
| U.S. dialysis |  | Other - Ancillary services |  | Consolidated |  | U.S. dialysis |  | Other - Ancillary services |  | Consolidated
Dialysis patient service revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage(1) | $ | 4,586,278 |  |  | $ |  | $ | 4,586,278 |  |  | $ | 4,619,852 |  |  | $ |  | $ | 4,619,852 |
Medicaid and Managed Medicaid | 585,053 |  |  |  |  | 585,053 |  |  | 547,045 |  |  |  |  | 547,045 |
Other government(1) | 245,125 |  |  | 338,553 |  |  | 583,678 |  |  | 253,654 |  |  | 283,431 |  |  | 537,085 |
Commercial | 2,528,499 |  |  | 157,172 |  |  | 2,685,671 |  |  | 2,534,388 |  |  | 118,869 |  |  | 2,653,257 |
Other revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage |  |  | 243,085 |  |  | 243,085 |  |  |  |  | 309,555 |  |  | 309,555 |
Medicaid and Managed Medicaid |  |  | 981 |  |  | 981 |  |  |  |  | 1,061 |  |  | 1,061 |
Commercial |  |  | 14,387 |  |  | 14,387 |  |  |  |  | 27,370 |  |  | 27,370 |
Other(2) | 19,308 |  |  | 31,107 |  |  | 50,415 |  |  | 30,846 |  |  | 36,600 |  |  | 67,446 |
Eliminations of intersegment revenues | (70,424) |  |  | (4,294) |  |  | (74,718) |  |  | (104,987) |  |  | (12,402) |  |  | (117,389) |
Total | $ | 7,893,839 |  |  | $ | 780,991 |  |  | $ | 8,674,830 |  |  | $ | 7,880,798 |  |  | $ | 764,484 |  |  | $ | 8,645,282 |
(1)During the first quarter of 2021, the Company realigned the classification of revenue previously disclosed in the “Other government” category to the “Medicare and Medicare Advantage” category for certain government-reimbursed plans which have structure and payment characteristics similar to traditional Medicare Advantage plans. The classification of revenue for these plans for the nine months ended September 30, 2020 has also been recast to conform to the current period presentation. (2)Other consists of management service fees earned in the respective Company line of business as well as other revenue from the Company's ancillary services.

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- Definition Tabular disclosure of disaggregation of revenue into categories depicting how nature, amount, timing, and uncertainty of revenue and cash flows are affected by economic factor. + References Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 5 -URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130545-203045 + Details
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