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Revenue Recognition and Accounts Receivable Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021
Revenue Recognition |  |  |
Other revenues | $ 565,206 | $ 433,430 | $ 405,282
Total revenues | 12,140,147 | 11,609,894 | 11,618,797
Intersegment Elimination |  |  |
Revenue Recognition |  |  |
Total revenues | (96,074) | (91,241) | (95,090)
Medicare and Medicare Advantage |  |  |
Revenue Recognition |  |  |
Patient service revenues | 6,100,183 | 6,041,496 | 6,133,235
Other revenues | 460,991 | 345,340 | 326,696
Medicaid and Managed Medicaid |  |  |
Revenue Recognition |  |  |
Patient service revenues | 833,744 | 759,579 | 782,430
Other revenues | 1,733 | 1,546 | 1,321
Other Government Payors |  |  |
Revenue Recognition |  |  |
Patient service revenues | 854,441 | 801,912 | 791,641
Commercial Payors |  |  |
Revenue Recognition |  |  |
Patient service revenues | 3,874,795 | 3,660,522 | 3,596,721
Other revenues | 32,329 | 22,211 | 15,553
Other |  |  |
Revenue Recognition |  |  |
Other revenues | 78,005 | 68,529 | 66,290
U.S. dialysis |  |  |
Revenue Recognition |  |  |
Total revenues | 10,848,776 | 10,512,774 | 10,576,167
U.S. dialysis | Intersegment Elimination |  |  |
Revenue Recognition |  |  |
Total revenues | (88,222) | (87,035) | (90,796)
U.S. dialysis | Medicare and Medicare Advantage |  |  |
Revenue Recognition |  |  |
Patient service revenues | 6,100,183 | 6,041,496 | 6,133,235
U.S. dialysis | Medicaid and Managed Medicaid |  |  |
Revenue Recognition |  |  |
Patient service revenues | 833,744 | 759,579 | 782,430
U.S. dialysis | Other Government Payors |  |  |
Revenue Recognition |  |  |
Patient service revenues | 354,304 | 336,991 | 328,256
U.S. dialysis | Commercial Payors |  |  |
Revenue Recognition |  |  |
Patient service revenues | 3,623,516 | 3,437,306 | 3,397,697
U.S. dialysis | Other |  |  |
Revenue Recognition |  |  |
Other revenues | 25,251 | 24,437 | 25,345
Other - Ancillary services |  |  |
Revenue Recognition |  |  |
Total revenues | 1,291,371 | 1,097,120 | 1,042,630
Other - Ancillary services | Intersegment Elimination |  |  |
Revenue Recognition |  |  |
Total revenues | (7,852) | (4,206) | (4,294)
Other - Ancillary services | Medicare and Medicare Advantage |  |  |
Revenue Recognition |  |  |
Other revenues | 460,991 | 345,340 | 326,696
Other - Ancillary services | Medicaid and Managed Medicaid |  |  |
Revenue Recognition |  |  |
Other revenues | 1,733 | 1,546 | 1,321
Other - Ancillary services | Other Government Payors |  |  |
Revenue Recognition |  |  |
Patient service revenues | 500,137 | 464,921 | 463,385
Other - Ancillary services | Commercial Payors |  |  |
Revenue Recognition |  |  |
Patient service revenues | 251,279 | 223,216 | 199,024
Other revenues | 32,329 | 22,211 | 15,553
Other - Ancillary services | Other |  |  |
Revenue Recognition |  |  |
Other revenues | $ 52,754 | $ 44,092 | $ 40,945

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