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Revenue Recognition Revenue Recognition
 9 Months Ended
Sep. 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 September 30, 2024Three months ended September 30, 2023
U.S. dialysisOther — Ancillary servicesConsolidatedU.S. dialysisOther — Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage$1,641,645 $$1,641,645 $1,515,860 $$1,515,860 
Medicaid and Managed Medicaid216,664 216,664 207,327 207,327 
Other government86,680 196,257 282,937 90,549 128,980 219,529 
Commercial954,807 58,648 1,013,455 965,331 68,192 1,033,523 
Other revenues:
Medicare and Medicare Advantage104,217 104,217 137,149 137,149 
Medicaid and Managed Medicaid(25)(25)331 331 
Commercial3,735 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, 2024Nine months ended September 30, 2023
U.S. dialysisOther - Ancillary servicesConsolidatedU.S. dialysisOther - Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage$4,760,340 $$4,760,340 $4,538,264 $$4,538,264 
Medicaid and Managed Medicaid641,738 641,738 629,118 629,118 
Other government249,605 518,565 768,170 265,119 376,530 641,649 
Commercial2,833,263 191,212 3,024,475 2,676,758 183,578 2,860,336 
Other revenues:
Medicare and Medicare Advantage304,760 304,760 317,624 317,624 
Medicaid and Managed Medicaid816 816 1,296 1,296 
Commercial20,875 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.