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Segment Reporting | 12 Months Ended
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Dec. 31, 2023
Segment Reporting [Abstract] |
Segment Reporting | Segment reporting The Company's operating divisions are composed 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. 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 operations in each foreign sovereign jurisdiction, and its equity method investment in its Asia Pacific joint venture (APAC JV). 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 assess the financial performance of and allocate resources among 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 more than one of the Company’s various operating lines of business. The chief operating decision maker uses segment operating margin to assess segment profitability. The chief operating decision maker does not use total assets by segment to make decisions regarding resources; therefore, the total assets by segment disclosure has not been included. 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,
| 2023 |  | 2022 |  | 2021
Segment revenues: |  |  |  |  |
U.S. dialysis |  |  |  |  |
Patient service revenues: |  |  |  |  |
External sources | $ | 10,823,525 |  |  | $ | 10,488,327 |  |  | $ | 10,551,106 |
Intersegment revenues | 88,222 |  |  | 87,045 |  |  | 90,512 |
U.S. dialysis patient service revenues | 10,911,747 |  |  | 10,575,372 |  |  | 10,641,618 |
Other revenues |  |  |  |  |
External sources | 25,251 |  |  | 24,447 |  |  | 25,061 |
Intersegment revenues | — |  |  | (10) |  |  | 284 |
Total U.S. dialysis revenues | 10,936,998 |  |  | 10,599,809 |  |  | 10,666,963 |
Other - Ancillary services |  |  |  |  |
Patient service revenues | 751,416 |  |  | 688,137 |  |  | 662,409 |
Other external sources | 539,955 |  |  | 408,983 |  |  | 380,221 |
Intersegment revenues | 7,852 |  |  | 4,206 |  |  | 4,294 |
Total ancillary services | 1,299,223 |  |  | 1,101,326 |  |  | 1,046,924 |
Total net segment revenues | 12,236,221 |  |  | 11,701,135 |  |  | 11,713,887 |
Elimination of intersegment revenues | (96,074) |  |  | (91,241) |  |  | (95,090) |
Consolidated revenues | $ | 12,140,147 |  |  | $ | 11,609,894 |  |  | $ | 11,618,797 |
Segment operating margin (loss): |  |  |  |  |
U.S. dialysis | $ | 1,774,578 |  |  | $ | 1,565,310 |  |  | $ | 1,974,988 |
Other - Ancillary services(1) | (8,747) |  |  | (96,579) |  |  | (66,003) |
Total segment margin | 1,765,831 |  |  | 1,468,731 |  |  | 1,908,985 |
Reconciliation of segment operating margin to consolidated income from continuing operations before income taxes: |  |  |  |  |
Corporate administrative support | (163,047) |  |  | (129,669) |  |  | (111,615) |
Consolidated operating income | 1,602,784 |  |  | 1,339,062 |  |  | 1,797,370 |
Debt expense | (398,551) |  |  | (357,019) |  |  | (285,254) |
Debt extinguishment and modification costs | (7,962) |  |  | — |  |  | — |
Other (loss) income, net | (19,177) |  |  | (15,765) |  |  | 6,378 |
Income from continuing operations before income taxes | $ | 1,177,094 |  |  | $ | 966,278 |  |  | $ | 1,518,494 |
(1)Segment operating loss for Other - Ancillary services includes equity investment loss of $2,103, $1,898 and $3,177 in 2023, 2022 and 2021, respectively. Depreciation and amortization expense by reportable segment was as follows:
| Year ended December 31,
| 2023 |  | 2022 |  | 2021
U.S. dialysis | $ | 695,674 |  |  | $ | 690,949 |  |  | $ | 642,711 |
Other - Ancillary services | 49,769 |  |  | 41,653 |  |  | 37,904 |
| $ | 745,443 |  |  | $ | 732,602 |  |  | $ | 680,615 |
Expenditures for property and equipment by reportable segment were as follows:
| Year ended December 31,
| 2023 |  | 2022 |  | 2021
U.S. dialysis | $ | 501,149 |  |  | $ | 533,600 |  |  | $ | 589,662 |
Other - Ancillary services | 66,836 |  |  | 69,829 |  |  | 51,803 |
| $ | 567,985 |  |  | $ | 603,429 |  |  | $ | 641,465 |
The Company's international operations include approximately $240,742 and $207,162 in 2023 and 2022, respectively, of net property and equipment.
Net Property and Equipment International Operations | The Company's international operations include approximately $240,742 and $207,162 in 2023 and 2022, respectively, of net property and equipment.

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- Definition The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments. + References Reference 1: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 22 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-22 Reference 2: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 15 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-15 Reference 3: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 31 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-31 Reference 4: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 32 -Subparagraph (d) -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-32 Reference 5: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 42 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-42 Reference 6: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 32 -Subparagraph (f) -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-32 Reference 7: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 40 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-40 Reference 8: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -Name Accounting Standards Codification -Publisher FASB -URI https://asc.fasb.org//280/tableOfContent Reference 9: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 26 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-26 Reference 10: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 34 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-34 Reference 11: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 41 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-41 Reference 12: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 21 -Subparagraph (a) -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-21 Reference 13: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 21 -Subparagraph (b) -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-21 Reference 14: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 32 -Subparagraph (e) -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-32 + Details
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