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Segment reporting (Tables) | 9 Months Ended
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Sep. 30, 2024
Segment Reporting [Abstract] |
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes | The following is a summary of segment revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income before income taxes:
| Three months ended September 30, |  | Nine months ended September 30,
| 2024 |  | 2023 |  | 2024 |  | 2023
Segment revenues: |  |  |  |  |  |  |
U.S. dialysis |  |  |  |  |  |  |
Dialysis patient service revenues: |  |  |  |  |  |  |
External sources | $ | 2,883,656 |  |  | $ | 2,754,778 |  |  | $ | 8,431,418 |  |  | $ | 8,042,561 |
Intersegment revenues | 16,140 |  |  | 24,289 |  |  | 53,528 |  |  | 66,698 |
U.S. dialysis patient service revenues | 2,899,796 |  |  | 2,779,067 |  |  | 8,484,946 |  |  | 8,109,259 |
Other revenues: |  |  |  |  |  |  |
External sources | 6,204 |  |  | 6,239 |  |  | 18,224 |  |  | 18,822 |
Total U.S. dialysis revenues | 2,906,000 |  |  | 2,785,306 |  |  | 8,503,170 |  |  | 8,128,081 |
Other—Ancillary services |  |  |  |  |  |  |
Dialysis patient service revenues | 254,905 |  |  | 197,172 |  |  | 709,777 |  |  | 560,108 |
Other external sources | 118,825 |  |  | 163,143 |  |  | 361,448 |  |  | 372,909 |
Intersegment revenues | 2,598 |  |  | 2,232 |  |  | 9,168 |  |  | 5,007 |
Total ancillary services revenues | 376,328 |  |  | 362,547 |  |  | 1,080,393 |  |  | 938,024 |
Total net segment revenues | 3,282,328 |  |  | 3,147,853 |  |  | 9,583,563 |  |  | 9,066,105 |
Elimination of intersegment revenues | (18,738) |  |  | (26,521) |  |  | (62,696) |  |  | (71,705) |
Consolidated revenues | $ | 3,263,590 |  |  | $ | 3,121,332 |  |  | $ | 9,520,867 |  |  | $ | 8,994,400 |
Segment operating margin (loss): |  |  |  |  |  |  |
U.S. dialysis | $ | 549,476 |  |  | $ | 509,135 |  |  | $ | 1,625,399 |  |  | $ | 1,330,992 |
Other—Ancillary services | 13,906 |  |  | 28,098 |  |  | (16,188) |  |  | (18,372) |
Total segment operating margin | 563,382 |  |  | 537,233 |  |  | 1,609,211 |  |  | 1,312,620 |
Reconciliation of segment operating income to consolidated income before income taxes: |  |  |  |  |  |  |
Corporate administrative support | (28,504) |  |  | (41,294) |  |  | (84,090) |  |  | (99,745) |
Consolidated operating income | 534,878 |  |  | 495,939 |  |  | 1,525,121 |  |  | 1,212,875 |
Debt expense | (134,583) |  |  | (98,080) |  |  | (331,748) |  |  | (302,361) |
Debt prepayment, extinguishment and modification costs | (10,081) |  |  | — |  |  | (19,813) |  |  | (7,962) |
Other loss, net | (16,780) |  |  | (19,650) |  |  | (56,900) |  |  | (14,525) |
Consolidated income before income taxes | $ | 373,434 |  |  | $ | 378,209 |  |  | $ | 1,116,660 |  |  | $ | 888,027 |
Summary of Depreciation and Amortization Expense by Reportable Segment | Depreciation and amortization expense by reportable segment was as follows:
| Three months ended September 30, |  | Nine months ended September 30,
| 2024 |  | 2023 |  | 2024 |  | 2023
U.S. dialysis | $ | 170,543 |  |  | $ | 175,908 |  |  | $ | 503,805 |  |  | $ | 514,710 |
Other—Ancillary services | 16,471 |  |  | 12,515 |  |  | 45,953 |  |  | 35,456 |
| $ | 187,014 |  |  | $ | 188,423 |  |  | $ | 549,758 |  |  | $ | 550,166 |
Summary of Expenditures for Property and Equipment by Reportable Segment | Expenditures for property and equipment by reportable segment were as follows:
|  |  | Nine months ended September 30,
|  |  |  |  | 2024 |  | 2023
U.S. dialysis |  |  |  |  | $ | 331,031 |  |  | $ | 363,895 |
Other—Ancillary services |  |  |  |  | 53,755 |  |  | 45,116 |
|  |  |  |  | $ | 384,786 |  |  | $ | 409,011 |

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