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Revenue Recognition Revenue Recognition | 9 Months Ended
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Sep. 30, 2024
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Revenue Recognition [Text Block] | Revenue recognition The following tables summarize the Company's segment revenues by primary payor source:
| Three months ended September 30, 2024 |  | Three months ended September 30, 2023
| U.S. dialysis |  | Other — Ancillary services |  | Consolidated |  | U.S. dialysis |  | Other — Ancillary services |  | Consolidated
Dialysis patient service revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage | $ | 1,641,645 |  |  | $ |  | $ | 1,641,645 |  |  | $ | 1,515,860 |  |  | $ |  | $ | 1,515,860 |
Medicaid and Managed Medicaid | 216,664 |  |  |  |  | 216,664 |  |  | 207,327 |  |  |  |  | 207,327 |
Other government | 86,680 |  |  | 196,257 |  |  | 282,937 |  |  | 90,549 |  |  | 128,980 |  |  | 219,529 |
Commercial | 954,807 |  |  | 58,648 |  |  | 1,013,455 |  |  | 965,331 |  |  | 68,192 |  |  | 1,033,523 |
Other revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage |  |  | 104,217 |  |  | 104,217 |  |  |  |  | 137,149 |  |  | 137,149 |
Medicaid and Managed Medicaid |  |  | (25) |  |  | (25) |  |  |  |  | 331 |  |  | 331 |
Commercial |  |  | 3,735 |  |  | 3,735 |  |  |  |  | 16,063 |  |  | 16,063 |
Other(1) | 6,204 |  |  | 13,496 |  |  | 19,700 |  |  | 6,239 |  |  | 11,832 |  |  | 18,071 |
Eliminations of intersegment revenues | (16,140) |  |  | (2,598) |  |  | (18,738) |  |  | (24,289) |  |  | (2,232) |  |  | (26,521) |
Total | $ | 2,889,860 |  |  | $ | 373,730 |  |  | $ | 3,263,590 |  |  | $ | 2,761,017 |  |  | $ | 360,315 |  |  | $ | 3,121,332 |
| Nine months ended September 30, 2024 |  | Nine months ended September 30, 2023
| U.S. dialysis |  | Other - Ancillary services |  | Consolidated |  | U.S. dialysis |  | Other - Ancillary services |  | Consolidated
Dialysis patient service revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage | $ | 4,760,340 |  |  | $ |  | $ | 4,760,340 |  |  | $ | 4,538,264 |  |  | $ |  | $ | 4,538,264 |
Medicaid and Managed Medicaid | 641,738 |  |  |  |  | 641,738 |  |  | 629,118 |  |  |  |  | 629,118 |
Other government | 249,605 |  |  | 518,565 |  |  | 768,170 |  |  | 265,119 |  |  | 376,530 |  |  | 641,649 |
Commercial | 2,833,263 |  |  | 191,212 |  |  | 3,024,475 |  |  | 2,676,758 |  |  | 183,578 |  |  | 2,860,336 |
Other revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage |  |  | 304,760 |  |  | 304,760 |  |  |  |  | 317,624 |  |  | 317,624 |
Medicaid and Managed Medicaid |  |  | 816 |  |  | 816 |  |  |  |  | 1,296 |  |  | 1,296 |
Commercial |  |  | 20,875 |  |  | 20,875 |  |  |  |  | 20,888 |  |  | 20,888 |
Other(1) | 18,224 |  |  | 44,165 |  |  | 62,389 |  |  | 18,822 |  |  | 38,108 |  |  | 56,930 |
Eliminations of intersegment revenues | (53,528) |  |  | (9,168) |  |  | (62,696) |  |  | (66,698) |  |  | (5,007) |  |  | (71,705) |
Total | $ | 8,449,642 |  |  | $ | 1,071,225 |  |  | $ | 9,520,867 |  |  | $ | 8,061,383 |  |  | $ | 933,017 |  |  | $ | 8,994,400 |
(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.

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- Definition The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts. + References Reference 1: http://www.xbrl.org/2003/role/disclosureRef -Topic 606 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 9 -Publisher FASB -URI https://asc.fasb.org/1943274/2147479806/606-10-50-9 Reference 2: http://www.xbrl.org/2003/role/disclosureRef -Topic 606 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 10 -Publisher FASB -URI https://asc.fasb.org/1943274/2147479806/606-10-50-10 Reference 3: http://www.xbrl.org/2003/role/disclosureRef -Topic 606 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 15 -Publisher FASB -URI https://asc.fasb.org/1943274/2147479806/606-10-50-15 Reference 4: http://www.xbrl.org/2003/role/disclosureRef -Topic 606 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 12 -Subparagraph (a) -Publisher FASB -URI https://asc.fasb.org/1943274/2147479806/606-10-50-12 Reference 5: http://www.xbrl.org/2003/role/disclosureRef -Topic 606 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 12 -Subparagraph (b) -Publisher FASB -URI https://asc.fasb.org/1943274/2147479806/606-10-50-12 Reference 6: http://www.xbrl.org/2003/role/disclosureRef -Topic 606 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 12 -Subparagraph (c) -Publisher FASB -URI https://asc.fasb.org/1943274/2147479806/606-10-50-12 Reference 7: http://www.xbrl.org/2003/role/disclosureRef -Topic 606 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 12 -Subparagraph (d) -Publisher FASB -URI https://asc.fasb.org/1943274/2147479806/606-10-50-12 Reference 8: http://www.xbrl.org/2003/role/disclosureRef -Topic 606 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 12 -Subparagraph (e) -Publisher FASB -URI https://asc.fasb.org/1943274/2147479806/606-10-50-12 Reference 9: http://www.xbrl.org/2003/role/disclosureRef -Topic 606 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 13 -Subparagraph (b)(2) -Publisher FASB -URI https://asc.fasb.org/1943274/2147479806/606-10-50-13 Reference 10: http://www.xbrl.org/2003/role/disclosureRef -Name Accounting Standards Codification -Topic 606 -Publisher FASB -URI https://asc.fasb.org/606/tableOfContent + Details
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