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Revenue Recognition Revenue Recognition
 6 Months Ended
Jun. 30, 2024
Text Block [Abstract]  
Revenue Recognition [Text Block] Revenue recognition
The following tables summarize the Company's segment revenues by primary payor source:
Three months ended June 30, 2024Three months ended June 30, 2023
U.S. dialysisOther — Ancillary servicesConsolidatedU.S. dialysisOther — Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage$1,587,198 $$1,587,198 $1,539,639 $$1,539,639 
Medicaid and Managed Medicaid214,951 214,951 216,014 216,014 
Other government80,338 176,524 256,862 92,525 125,964 218,489 
Commercial952,625 62,391 1,015,016 876,033 60,871 936,904 
Other revenues:
Medicare and Medicare Advantage97,433 97,433 87,236 87,236 
Medicaid and Managed Medicaid445 445 396 396 
Commercial10,200 10,200 3,619 3,619 
Other(1)
5,898 15,467 21,365 6,404 13,437 19,841 
Eliminations of intersegment revenues(12,925)(3,823)(16,748)(20,361)(1,408)(21,769)
Total$2,828,085 $358,637 $3,186,722 $2,710,254 $290,115 $3,000,369 
Six months ended June 30, 2024Six months ended June 30, 2023
U.S. dialysisOther - Ancillary servicesConsolidatedU.S. dialysisOther - Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage$3,118,696 $$3,118,696 $3,022,405 $$3,022,405 
Medicaid and Managed Medicaid425,075 425,075 421,790 421,790 
Other government162,924 322,309 485,233 174,570 247,550 422,120 
Commercial1,878,455 132,564 2,011,019 1,711,427 115,387 1,826,814 
Other revenues:
Medicare and Medicare Advantage200,542 200,542 180,475 180,475 
Medicaid and Managed Medicaid841 841 965 965 
Commercial17,140 17,140 4,825 4,825 
Other(1)
12,021 30,669 42,690 12,583 26,275 38,858 
Eliminations of intersegment revenues(37,389)(6,570)(43,959)(42,410)(2,774)(45,184)
Total$5,559,782 $697,495 $6,257,277 $5,300,365 $572,703 $5,873,068 
(1)    Consists primarily of management service fees in the Company's U.S. dialysis business and research fees, management fees, and other non-patient service revenues in the Other - ancillary services businesses.
There are significant uncertainties associated with estimating revenue, many of which take several years to resolve. These estimates are subject to ongoing insurance coverage changes, geographic coverage differences, differing interpretations of contract coverage and other payor issues, as well as patient issues, including determination of applicable primary and secondary coverage, changes in patient insurance coverage and coordination of benefits. As these estimates are refined over time, both positive and negative adjustments to revenue are recognized in the current period.
Dialysis patient service revenues. Revenues are recognized based on the Company’s estimate of the transaction price the Company expects to collect as a result of satisfying its performance obligations. Dialysis patient service revenues are recognized in the period services are provided based on these estimates. Revenues consist primarily of payments from government and commercial health plans for dialysis services provided to patients.     
Other revenues. Other revenues consist of revenues earned by the Company's non-dialysis ancillary services as well as fees for management and administrative services to outpatient dialysis businesses that the Company does not consolidate. Other revenues are estimated and recognized in the period the performance obligation is met, subject to applicable measurement constraints. The Company's integrated kidney care (IKC) revenues include revenues earned under risk-based arrangements, including value-based care (VBC) arrangements. Under its VBC arrangements, the Company assumes full or shared financial risk for the total medical cost of care for patients below or above a benchmark. The benchmarks against which the Company incurs profit or loss on these contracts are typically based on the underlying premiums paid to the insuring entity (the Company's counterparty), with adjustments where applicable, or on trended or adjusted medical cost targets.