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Goodwill | 12 Months Ended
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Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract] |
Goodwill | Goodwill Changes in the carrying value of goodwill by reportable segment were as follows:
| U.S. dialysis |  | Other - Ancillary services |  | Consolidated
Balance at December 31, 2021 | $ | 6,400,162 |  |  | $ | 646,079 |  |  | $ | 7,046,241 |
Acquisitions | 16,750 |  |  | 32,297 |  |  | 49,047 |
Divestitures | (87) |  |  | (3,263) |  |  | (3,350) |
Foreign currency and other adjustments | — |  |  | (15,328) |  |  | (15,328) |
Balance at December 31, 2022 | $ | 6,416,825 |  |  | $ | 659,785 |  |  | $ | 7,076,610 |
Acquisitions | — |  |  | 25,723 |  |  | 25,723 |
Impairment charges | — |  |  | (26,083) |  |  | (26,083) |
Foreign currency and other adjustments | — |  |  | 36,310 |  |  | 36,310 |
Balance at December 31, 2023 | $ | 6,416,825 |  |  | $ | 695,735 |  |  | $ | 7,112,560 |
Balance at December 31, 2023: |  |  |  |  |
Goodwill | $ | 6,416,825 |  |  | $ | 844,836 |  |  | $ | 7,261,661 |
Accumulated impairment charges | — |  |  | (149,101) |  |  | (149,101) |
| $ | 6,416,825 |  |  | $ | 695,735 |  |  | $ | 7,112,560 |
Each of the Company’s operating segments described in Note 24 to these consolidated financial statements represents an individual reporting unit for goodwill impairment assessment purposes. Within the U.S. dialysis operating segment, the Company considers each of its dialysis centers to constitute an individual business for which discrete financial information is available. However, since these dialysis centers have similar operating and economic characteristics, and the allocation of resources and significant investment decisions concerning these businesses are highly centralized and the benefits broadly distributed, the Company has aggregated these centers and deemed them to constitute a single reporting unit. The Company has applied a similar aggregation to the physician practices in its physician services reporting units and to the dialysis centers within each international reporting unit. For the Company’s other operating segments, discrete business components below the operating segment level constitute individual reporting units. When performing quantitative goodwill impairment assessments, the Company estimates fair value using either appraisals developed with an independent third party valuation firm which consider both discounted cash flow estimates for the subject business and observed market multiples for similar businesses, or offer prices received for the subject business that would be acceptable to the Company. During the year ended December 31, 2023, the Company recognized a goodwill impairment charge of $26,083 in its transplant software reporting unit, or $19,575 net of tax. This charge resulted from a reduction in estimated fair value for the business driven primarily from the business not achieving its revenue targets, with reduced revenue expectations for future years, as well as an increase in the risk-free rate. After this impairment charge, the transplant software reporting unit has a goodwill balance of $14,424 remaining, which could be further impaired if the business fails to meet its revised revenue targets and growth expectations. None of the Company’s reporting units were considered at risk of significant goodwill impairment as of December 31, 2023. Since the dates of the Company’s last annual goodwill impairment assessments, there have been certain developments, events, changes in operating performance and other changes in key circumstances that have affected the Company’s businesses. However, these have not caused management to believe it is more likely than not that the fair values of any of the Company’s reporting units would be less than their respective carrying amounts as of December 31, 2023.

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