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Revenue Recognition and Accounts Receivable Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020
Revenue Recognition |  |  |
Other revenues | $ 433,430 | $ 405,282 | $ 524,353
Total revenues | 11,609,894 | 11,618,797 | 11,550,604
Intersegment Elimination |  |  |
Revenue Recognition |  |  |
Total revenues | (91,241) | (95,090) | (162,029)
Medicare and Medicare Advantage |  |  |
Revenue Recognition |  |  |
Patient service revenues | 6,041,496 | 6,133,235 | 6,169,226
Other revenues | 345,340 | 326,696 | 419,662
Medicaid and Managed Medicaid |  |  |
Revenue Recognition |  |  |
Patient service revenues | 759,579 | 782,430 | 744,862
Other revenues | 1,546 | 1,321 | 1,227
Other Government Payors |  |  |
Revenue Recognition |  |  |
Patient service revenues | 801,912 | 791,641 | 715,298
Commercial Payors |  |  |
Revenue Recognition |  |  |
Patient service revenues | 3,660,522 | 3,596,721 | 3,540,956
Other revenues | 22,211 | 15,553 | 33,246
Other |  |  |
Revenue Recognition |  |  |
Other revenues | 68,529 | 66,290 | 88,156
U.S. dialysis |  |  |
Revenue Recognition |  |  |
Total revenues | 10,512,774 | 10,576,167 | 10,514,649
U.S. dialysis | Intersegment Elimination |  |  |
Revenue Recognition |  |  |
Total revenues | (87,035) | (90,796) | (145,286)
U.S. dialysis | Medicare and Medicare Advantage |  |  |
Revenue Recognition |  |  |
Patient service revenues | 6,041,496 | 6,133,235 | 6,169,226
U.S. dialysis | Medicaid and Managed Medicaid |  |  |
Revenue Recognition |  |  |
Patient service revenues | 759,579 | 782,430 | 744,862
U.S. dialysis | Other Government Payors |  |  |
Revenue Recognition |  |  |
Patient service revenues | 336,991 | 328,256 | 334,714
U.S. dialysis | Commercial Payors |  |  |
Revenue Recognition |  |  |
Patient service revenues | 3,437,306 | 3,397,697 | 3,370,562
U.S. dialysis | Other |  |  |
Revenue Recognition |  |  |
Other revenues | 24,437 | 25,345 | 40,571
Other - Ancillary services |  |  |
Revenue Recognition |  |  |
Total revenues | 1,097,120 | 1,042,630 | 1,035,955
Other - Ancillary services | Intersegment Elimination |  |  |
Revenue Recognition |  |  |
Total revenues | (4,206) | (4,294) | (16,743)
Other - Ancillary services | Medicare and Medicare Advantage |  |  |
Revenue Recognition |  |  |
Other revenues | 345,340 | 326,696 | 419,662
Other - Ancillary services | Medicaid and Managed Medicaid |  |  |
Revenue Recognition |  |  |
Other revenues | 1,546 | 1,321 | 1,227
Other - Ancillary services | Other Government Payors |  |  |
Revenue Recognition |  |  |
Patient service revenues | 464,921 | 463,385 | 380,584
Other - Ancillary services | Commercial Payors |  |  |
Revenue Recognition |  |  |
Patient service revenues | 223,216 | 199,024 | 170,394
Other revenues | 22,211 | 15,553 | 33,246
Other - Ancillary services | Other |  |  |
Revenue Recognition |  |  |
Other revenues | $ 44,092 | $ 40,945 | $ 47,585

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