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Segment reporting | 9 Months Ended
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Sep. 30, 2024
Segment Reporting [Abstract] |
Segment Reporting Disclosure | 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. 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 the 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. See Note 24 to the Company's consolidated financial statements included in the 2023 10-K for further description of how the Company determines and measures results for its operating segments. 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 |
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 |
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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