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Revenue Recognition and Accounts Receivable Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019
Disaggregation of Revenue [Line Items] |  |  |
Other revenues | $ 405,282 | $ 524,353 | $ 491,773
Total revenues | 11,618,797 | 11,550,604 | 11,388,479
Intersegment Elimination |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Total revenues | (95,090) | (162,029) | (146,355)
Medicare and Medicare Advantage |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Patient service revenues | 6,133,235 | 6,169,226 | 6,246,636
Other revenues | 326,696 | 419,662 | 264,538
Medicaid and Managed Medicaid |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Patient service revenues | 782,430 | 744,862 | 669,089
Other revenues | 1,321 | 1,227 | 606
Other Government Payors |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Patient service revenues | 791,641 | 715,298 | 681,836
Commercial Payors |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Patient service revenues | 3,596,721 | 3,540,956 | 3,430,345
Other revenues | 15,553 | 33,246 | 130,823
Other |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Other revenues | 66,290 | 88,156 | 110,961
U.S. dialysis |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Total revenues | 10,576,167 | 10,514,649 | 10,430,581
U.S. dialysis | Intersegment Elimination |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Total revenues | (90,796) | (145,286) | (132,325)
U.S. dialysis | Medicare and Medicare Advantage |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Patient service revenues | 6,133,235 | 6,169,226 | 6,246,636
U.S. dialysis | Medicaid and Managed Medicaid |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Patient service revenues | 782,430 | 744,862 | 669,089
U.S. dialysis | Other Government Payors |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Patient service revenues | 328,256 | 334,714 | 329,071
U.S. dialysis | Commercial Payors |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Patient service revenues | 3,397,697 | 3,370,562 | 3,286,089
U.S. dialysis | Other |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Other revenues | 25,345 | 40,571 | 32,021
Other - Ancillary services |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Total revenues | 1,042,630 | 1,035,955 | 957,898
Other - Ancillary services | Intersegment Elimination |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Total revenues | (4,294) | (16,743) | (14,030)
Other - Ancillary services | Medicare and Medicare Advantage |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Other revenues | 326,696 | 419,662 | 264,538
Other - Ancillary services | Medicaid and Managed Medicaid |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Other revenues | 1,321 | 1,227 | 606
Other - Ancillary services | Other Government Payors |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Patient service revenues | 463,385 | 380,584 | 352,765
Other - Ancillary services | Commercial Payors |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Patient service revenues | 199,024 | 170,394 | 144,256
Other revenues | 15,553 | 33,246 | 130,823
Other - Ancillary services | Other |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Other revenues | $ 40,945 | $ 47,585 | $ 78,940

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