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Segment Reporting
 12 Months Ended
Dec. 31, 2022
Segment Reporting [Abstract]  
Segment Reporting Segment reporting
The Company's operating divisions are comprised of its U.S. dialysis and related lab services business (its U.S. dialysis business), its U.S. integrated kidney care business, its U.S. other ancillary services 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. integrated kidney care business, its U.S. other ancillary services, its kidney care 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 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,
 202220212020
Segment revenues:   
U.S. dialysis   
Patient service revenues:   
External sources$10,488,327 $10,551,106 $10,475,273 
Intersegment revenues87,045 90,512 144,091 
U.S. dialysis patient service revenues10,575,372 10,641,618 10,619,364 
Other revenues
External sources24,447 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 revenues688,137 662,409 550,978 
Other external sources408,983 380,221 484,977 
Intersegment revenues4,206 4,294 16,743 
Total ancillary services1,101,326 1,046,924 1,052,698 
Total net segment revenues11,701,135 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 margin1,468,731 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 income1,339,062 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.
Depreciation and amortization expense by reportable segment was as follows:
 Year ended December 31,
 202220212020
U.S. dialysis$690,949 $642,711 $594,552 
Other - Ancillary services41,653 37,904 35,883 
 $732,602 $680,615 $630,435 
Expenditures for property and equipment by reportable segment were as follows: 
 Year ended December 31,
 202220212020
U.S. dialysis533,600 $589,662 $646,870 
Other - Ancillary services69,829 51,803 27,671 
 $603,429 $641,465 $674,541 
Summary of assets by reportable segment was as follows:
 Year ended December 31,
 20222021
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.