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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