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Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands | 3 Months Ended
--- | ---
Mar. 31, 2024 | Mar. 31, 2023
Disaggregation of Revenue [Line Items] |  |
Other revenues | $ 129,023 | $ 112,665
Total revenues | 3,070,555 | 2,872,699
Contract with Customer, Performance Obligation Satisfied in Previous Period | 19,450 | 12,821
Elimination of intersegment revenues |  |
Disaggregation of Revenue [Line Items] |  |
Total revenues | (27,210) | (23,415)
Medicare and Medicare Advantage |  |
Disaggregation of Revenue [Line Items] |  |
Dialysis patient service revenues | 1,531,497 | 1,482,767
Other revenues | 103,110 | 93,238
Medicaid and Managed Medicaid |  |
Disaggregation of Revenue [Line Items] |  |
Dialysis patient service revenues | 210,123 | 205,776
Other revenues | 395 | 570
Other Government Payors |  |
Disaggregation of Revenue [Line Items] |  |
Dialysis patient service revenues | 228,372 | 203,629
Commercial Payors |  |
Disaggregation of Revenue [Line Items] |  |
Dialysis patient service revenues | 996,003 | 889,909
Other revenues | 6,940 | 1,206
Other |  |
Disaggregation of Revenue [Line Items] |  |
Other revenues | 21,325 | 19,019
U.S. dialysis |  |
Disaggregation of Revenue [Line Items] |  |
Total revenues | 2,731,697 | 2,590,113
U.S. dialysis | Elimination of intersegment revenues |  |
Disaggregation of Revenue [Line Items] |  |
Total revenues | (24,463) | (22,047)
U.S. dialysis | Medicare and Medicare Advantage |  |
Disaggregation of Revenue [Line Items] |  |
Dialysis patient service revenues | 1,531,497 | 1,482,767
U.S. dialysis | Medicaid and Managed Medicaid |  |
Disaggregation of Revenue [Line Items] |  |
Dialysis patient service revenues | 210,123 | 205,776
U.S. dialysis | Other Government Payors |  |
Disaggregation of Revenue [Line Items] |  |
Dialysis patient service revenues | 82,587 | 82,044
U.S. dialysis | Commercial Payors |  |
Disaggregation of Revenue [Line Items] |  |
Dialysis patient service revenues | 925,831 | 835,393
U.S. dialysis | Other |  |
Disaggregation of Revenue [Line Items] |  |
Other revenues | 6,122 | 6,180
Other—Ancillary services |  |
Disaggregation of Revenue [Line Items] |  |
Total revenues | 338,858 | 282,586
Other—Ancillary services | Elimination of intersegment revenues |  |
Disaggregation of Revenue [Line Items] |  |
Total revenues | (2,747) | (1,368)
Other—Ancillary services | Medicare and Medicare Advantage |  |
Disaggregation of Revenue [Line Items] |  |
Other revenues | 103,110 | 93,238
Other—Ancillary services | Medicaid and Managed Medicaid |  |
Disaggregation of Revenue [Line Items] |  |
Other revenues | 395 | 570
Other—Ancillary services | Other Government Payors |  |
Disaggregation of Revenue [Line Items] |  |
Dialysis patient service revenues | 145,785 | 121,585
Other—Ancillary services | Commercial Payors |  |
Disaggregation of Revenue [Line Items] |  |
Dialysis patient service revenues | 70,172 | 54,516
Other revenues | 6,940 | 1,206
Other—Ancillary services | Other |  |
Disaggregation of Revenue [Line Items] |  |
Other revenues | $ 15,203 | $ 12,839

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