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Segment Reporting | 12 Months Ended
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Dec. 31, 2021
Segment Reporting [Abstract] |
Segment Reporting | Segment reporting The Company's operations are comprised of its U.S. dialysis and related lab services business (its U.S. dialysis business), its U.S. ancillary services and strategic initiatives and its international operations (collectively, its ancillary services), as well as its corporate administrative support. See Note 1 "Organization" for a summary description of the Company's businesses. On June 19, 2019, the Company completed the sale of its prior DMG business to Optum. As a result of this transaction, DMG's results of operations have been reported as discontinued operations for all periods presented. The Company’s operating segments have been defined based on the separate financial information that is regularly produced and reviewed by the Company’s chief operating decision maker in making decisions about allocating resources to and assessing the financial performance of the Company’s various operating lines of business. The chief operating decision maker for the Company is its Chief Executive Officer. The Company’s separate operating segments include its U.S. dialysis and related lab services business, its U.S. ancillary services and strategic initiatives, its kidney care operations in each foreign sovereign jurisdiction, its other health operations in each foreign sovereign jurisdiction, and its equity method investment in the APAC joint venture. The U.S. dialysis and related lab services business qualifies as a separately reportable segment, and all other operating segments, including the international operating segments, have been combined and disclosed in the other segments category. The Company’s operating segment financial information included in this report is prepared on the internal management reporting basis that the chief operating decision maker uses to allocate resources and assess the financial performance of the Company's operating segments. For internal management reporting, segment operations include direct segment operating expenses but generally exclude corporate administrative support costs, which consist primarily of indirect labor, benefits and long-term incentive compensation expenses of certain departments which provide support to all of the Company’s various operating lines of business. 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,
| 2021 |  | 2020 |  | 2019
Segment revenues: |  |  |  |  |
U.S. dialysis |  |  |  |  |
Patient service revenues: |  |  |  |  |
External sources | $ | 10,551,106 |  |  | $ | 10,475,273 |  |  | $ | 10,399,686 |
Intersegment revenues | 90,512 |  |  | 144,091 |  |  | 131,199 |
U.S. dialysis patient service revenues | 10,641,618 |  |  | 10,619,364 |  |  | 10,530,885 |
Other revenues |  |  |  |  |
External sources | 25,061 |  |  | 39,376 |  |  | 30,895 |
Intersegment revenues | 284 |  |  | 1,195 |  |  | 1,126 |
Total U.S. dialysis revenues | $ | 10,666,963 |  |  | $ | 10,659,935 |  |  | $ | 10,562,906 |
Other - Ancillary services |  |  |  |  |
Net patient service revenues | 662,409 |  |  | 550,978 |  |  | 497,021 |
Other external sources | 380,221 |  |  | 484,977 |  |  | 460,877 |
Intersegment revenues | 4,294 |  |  | 16,743 |  |  | 14,030 |
Total ancillary services | 1,046,924 |  |  | 1,052,698 |  |  | 971,928 |
Total net segment revenues | 11,713,887 |  |  | 11,712,633 |  |  | 11,534,834 |
Elimination of intersegment revenues | (95,090) |  |  | (162,029) |  |  | (146,355) |
Consolidated revenues | $ | 11,618,797 |  |  | $ | 11,550,604 |  |  | $ | 11,388,479 |
Segment operating margin (loss): |  |  |  |  |
U.S. dialysis | $ | 1,974,988 |  |  | $ | 1,917,604 |  |  | $ | 1,924,826 |
Other - Ancillary services(1) | (66,003) |  |  | (76,261) |  |  | (189,174) |
Total segment margin | 1,908,985 |  |  | 1,841,343 |  |  | 1,735,652 |
Reconciliation of segment operating margin to consolidated income from continuing operations before income taxes: |  |  |  |  |
Corporate administrative support | (111,615) |  |  | (146,707) |  |  | (92,335) |
Consolidated operating income | 1,797,370 |  |  | 1,694,636 |  |  | 1,643,317 |
Debt expense | (285,254) |  |  | (304,111) |  |  | (443,824) |
Debt prepayment, refinancing and redemption charges | — |  |  | (89,022) |  |  | (33,402) |
Other income, net | 6,378 |  |  | 16,759 |  |  | 29,348 |
Income from continuing operations before income taxes | $ | 1,518,494 |  |  | $ | 1,318,262 |  |  | $ | 1,195,439 |
(1)Includes equity investment income of $3,177, $5,866, and $9,366 in 2021, 2020 and 2019, respectively. Depreciation and amortization expense by reportable segment was as follows:
| Year ended December 31,
| 2021 |  | 2020 |  | 2019
U.S. dialysis | $ | 642,711 |  |  | $ | 594,552 |  |  | $ | 583,454 |
Other - Ancillary services | 37,904 |  |  | 35,883 |  |  | 31,698 |
| $ | 680,615 |  |  | $ | 630,435 |  |  | $ | 615,152 |
Expenditures for property and equipment by reportable segment were as follows:
| Year ended December 31,
| 2021 |  | 2020 |  | 2019
U.S. dialysis | 589,662 |  |  | $ | 646,870 |  |  | $ | 681,339 |
Other - Ancillary services | 51,803 |  |  | 27,671 |  |  | 46,741 |
DMG - Discontinued operations | — |  |  | — |  |  | 38,466 |
| $ | 641,465 |  |  | $ | 674,541 |  |  | $ | 766,546 |
Summary of assets by reportable segment was as follows:
| Year ended December 31,
| 2021 |  | 2020
Segment assets |  |  |
U.S. dialysis(1) | $ | 15,375,000 |  |  | $ | 15,344,647 |
Other - Ancillary services(2) | 1,746,488 |  |  | 1,643,869 |
Consolidated assets | $ | 17,121,488 |  |  | $ | 16,988,516 |
(1)Includes equity method and other investments of $112,500 and $122,974 in 2021 and 2020, respectively. (2)Includes equity method and other investments of $126,381 and 134,517 in 2021 and 2020, respectively and includes approximately $190,029 and $181,137 in 2021 and 2020, respectively, of net property and equipment related to the Company’s international operations.

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- Definition The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments. + References Reference 1: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 31 -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8924-108599 Reference 2: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 34 -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8981-108599 Reference 3: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 21 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8721-108599 Reference 4: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 40 -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e9031-108599 Reference 5: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 32 -Subparagraph (f) -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599 Reference 6: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 32 -Subparagraph (e) -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599 Reference 7: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 26 -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8844-108599 Reference 8: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 41 -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e9038-108599 Reference 9: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 32 -Subparagraph (d) -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599 Reference 10: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 22 -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8736-108599 Reference 11: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 42 -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e9054-108599 Reference 12: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 15 -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8657-108599 Reference 13: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 21 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8721-108599 Reference 14: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -URI http://asc.fasb.org/topic&trid=2134510 + Details
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