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Segment Reporting
 12 Months Ended
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,
 202320222021
Segment revenues:   
U.S. dialysis   
Patient service revenues:   
External sources$10,823,525 $10,488,327 $10,551,106 
Intersegment revenues88,222 87,045 90,512 
U.S. dialysis patient service revenues10,911,747 10,575,372 10,641,618 
Other revenues
External sources25,251 24,447 25,061 
Intersegment revenues— (10)284 
Total U.S. dialysis revenues10,936,998 10,599,809 10,666,963 
Other - Ancillary services
Patient service revenues751,416 688,137 662,409 
Other external sources539,955 408,983 380,221 
Intersegment revenues7,852 4,206 4,294 
Total ancillary services1,299,223 1,101,326 1,046,924 
Total net segment revenues12,236,221 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 margin1,765,831 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 income1,602,784 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,
 202320222021
U.S. dialysis$695,674 $690,949 $642,711 
Other - Ancillary services49,769 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,
 202320222021
U.S. dialysis$501,149 $533,600 $589,662 
Other - Ancillary services66,836 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.