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Segment Reporting (Tables) | 12 Months Ended
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Dec. 31, 2021
Segment Reporting [Abstract] |
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income from Continuing Operations Before Income Taxes | 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.
Summary of Depreciation and Amortization Expense by Segment | 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 |
Summary of Expenditures for Property and Equipment by Segment | 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 Segment | 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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