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Segment Reporting (Tables) | 12 Months Ended
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Dec. 31, 2022
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,
| 2022 |  | 2021 |  | 2020
Segment revenues: |  |  |  |  |
U.S. dialysis |  |  |  |  |
Patient service revenues: |  |  |  |  |
External sources | $ | 10,488,327 |  |  | $ | 10,551,106 |  |  | $ | 10,475,273 |
Intersegment revenues | 87,045 |  |  | 90,512 |  |  | 144,091 |
U.S. dialysis patient service revenues | 10,575,372 |  |  | 10,641,618 |  |  | 10,619,364 |
Other revenues |  |  |  |  |
External sources | 24,447 |  |  | 25,061 |  |  | 39,376 |
Intersegment revenues | (10) |  |  | 284 |  |  | 1,195 |
Total U.S. dialysis revenues | $ | 10,599,809 |  |  | $ | 10,666,963 |  |  | $ | 10,659,935 |
Other - Ancillary services |  |  |  |  |
Net patient service revenues | 688,137 |  |  | 662,409 |  |  | 550,978 |
Other external sources | 408,983 |  |  | 380,221 |  |  | 484,977 |
Intersegment revenues | 4,206 |  |  | 4,294 |  |  | 16,743 |
Total ancillary services | 1,101,326 |  |  | 1,046,924 |  |  | 1,052,698 |
Total net segment revenues | 11,701,135 |  |  | 11,713,887 |  |  | 11,712,633 |
Elimination of intersegment revenues | (91,241) |  |  | (95,090) |  |  | (162,029) |
Consolidated revenues | $ | 11,609,894 |  |  | $ | 11,618,797 |  |  | $ | 11,550,604 |
Segment operating margin (loss): |  |  |  |  |
U.S. dialysis | $ | 1,565,310 |  |  | $ | 1,974,988 |  |  | $ | 1,917,604 |
Other - Ancillary services(1) | (96,579) |  |  | (66,003) |  |  | (76,261) |
Total segment margin | 1,468,731 |  |  | 1,908,985 |  |  | 1,841,343 |
Reconciliation of segment operating margin to consolidated income from continuing operations before income taxes: |  |  |  |  |
Corporate administrative support | (129,669) |  |  | (111,615) |  |  | (146,707) |
Consolidated operating income | 1,339,062 |  |  | 1,797,370 |  |  | 1,694,636 |
Debt expense | (357,019) |  |  | (285,254) |  |  | (304,111) |
Debt prepayment, refinancing and redemption charges | — |  |  | — |  |  | (89,022) |
Other (loss) income, net | (15,765) |  |  | 6,378 |  |  | 16,759 |
Income from continuing operations before income taxes | $ | 966,278 |  |  | $ | 1,518,494 |  |  | $ | 1,318,262 |
(1)Includes equity investment income of $1,898, $3,177 and $5,866 in 2022, 2021 and 2020, respectively.
Summary of Depreciation and Amortization Expense by Segment | Depreciation and amortization expense by reportable segment was as follows:
| Year ended December 31,
| 2022 |  | 2021 |  | 2020
U.S. dialysis | $ | 690,949 |  |  | $ | 642,711 |  |  | $ | 594,552 |
Other - Ancillary services | 41,653 |  |  | 37,904 |  |  | 35,883 |
| $ | 732,602 |  |  | $ | 680,615 |  |  | $ | 630,435 |
Summary of Expenditures for Property and Equipment by Segment | Expenditures for property and equipment by reportable segment were as follows:
| Year ended December 31,
| 2022 |  | 2021 |  | 2020
U.S. dialysis | 533,600 |  |  | $ | 589,662 |  |  | $ | 646,870 |
Other - Ancillary services | 69,829 |  |  | 51,803 |  |  | 27,671 |
| $ | 603,429 |  |  | $ | 641,465 |  |  | $ | 674,541 |
Summary of Assets by Segment | Summary of assets by reportable segment was as follows:
| Year ended December 31,
| 2022 |  | 2021
Segment assets |  |  |
U.S. dialysis(1) | $ | 15,084,454 |  |  | $ | 15,375,000 |
Other - Ancillary services(2) | 1,843,798 |  |  | 1,746,488 |
Consolidated assets | $ | 16,928,252 |  |  | $ | 17,121,488 |
(1)Includes equity method and other investments of $113,781 and $112,500 in 2022 and 2021, respectively. (2)Includes equity method and other investments of $117,327 and $126,381 in 2022 and 2021, respectively and includes approximately $207,162 and $190,029 in 2022 and 2021, respectively, of net property and equipment related to the Company’s international operations.

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