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Segment Reporting (Tables) | 12 Months Ended
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Dec. 31, 2024
Segment Reporting [Abstract] |
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income from Continuing Operations Before Income Taxes | The following is a summary of segment revenues, segment operating margin, and a reconciliation of segment operating margin to consolidated income from continuing operations before income taxes:
| Year ended December 31,
| 2024 |  | 2023 |  | 2022
Segment revenues: |  |  |  |  |
U.S. dialysis |  |  |  |  |
Patient service revenues: |  |  |  |  |
External sources | $ | 11,294,614 |  |  | $ | 10,823,525 |  |  | $ | 10,488,327 |
Intersegment revenues | 71,747 |  |  | 88,222 |  |  | 87,045 |
U.S. dialysis patient service revenues | 11,366,361 |  |  | 10,911,747 |  |  | 10,575,372 |
Other revenues |  |  |  |  |
External sources | 24,356 |  |  | 25,251 |  |  | 24,447 |
Intersegment revenues | — |  |  | — |  |  | (10) |
Total U.S. dialysis revenues | 11,390,717 |  |  | 10,936,998 |  |  | 10,599,809 |
Other - Ancillary services |  |  |  |  |
Patient service revenues | 965,761 |  |  | 751,416 |  |  | 688,137 |
Other external sources | 530,819 |  |  | 539,955 |  |  | 408,983 |
Intersegment revenues | 13,910 |  |  | 7,852 |  |  | 4,206 |
Total ancillary services | 1,510,490 |  |  | 1,299,223 |  |  | 1,101,326 |
Total net segment revenues | 12,901,207 |  |  | 12,236,221 |  |  | 11,701,135 |
Elimination of intersegment revenues | (85,657) |  |  | (96,074) |  |  | (91,241) |
Consolidated revenues | $ | 12,815,550 |  |  | $ | 12,140,147 |  |  | $ | 11,609,894 |
Significant segment expenses: |  |  |  |  |
U.S. dialysis |  |  |  |  |
Patient care costs | $ | 7,497,576 |  |  | $ | 7,394,640 |  |  | $ | 7,334,415 |
General and administrative | 1,173,990 |  |  | 1,102,072 |  |  | 1,037,552 |
Depreciation and amortization | 661,181 |  |  | 695,674 |  |  | 690,949 |
Other segment items(1) | (63,037) |  |  | (29,966) |  |  | (28,417) |
U.S. dialysis segment expenses | 9,269,710 |  |  | 9,162,420 |  |  | 9,034,499 |
Other - Ancillary services expenses | 1,427,833 |  |  | 1,307,970 |  |  | 1,197,905 |
Segment operating margin: |  |  |  |  |
U.S. dialysis | $ | 2,121,007 |  |  | 1,774,578 |  |  | 1,565,310 |
Other - Ancillary services(2) | 82,657 |  |  | (8,747) |  |  | (96,579) |
Total segment margin | 2,203,664 |  |  | 1,765,831 |  |  | 1,468,731 |
Reconciliation of segment operating margin to consolidated income from continuing operations before income taxes: |  |  |  |  |
Corporate administrative support | (113,181) |  |  | (163,047) |  |  | (129,669) |
Consolidated operating income | 2,090,483 |  |  | 1,602,784 |  |  | 1,339,062 |
Debt expense | (470,469) |  |  | (398,551) |  |  | (357,019) |
Debt prepayment, extinguishment and modification costs | (19,813) |  |  | (7,962) |  |  | — |
Other loss, net | (69,808) |  |  | (19,177) |  |  | (15,765) |
Income from continuing operations before income taxes | $ | 1,530,393 |  |  | $ | 1,177,094 |  |  | $ | 966,278 |
(1)Other segment items for our U.S. dialysis segment include equity income from nonconsolidated joint ventures and a gain on changes in ownership interest. (2)Segment operating margin (loss) for Other - Ancillary services includes equity investment loss of $1,701, $2,103 and $1,898 in 2024, 2023 and 2022, respectively.
Summary of Depreciation and Amortization Expense by Segment | Depreciation and amortization expense by reportable segment was as follows:
| Year ended December 31,
| 2024 |  | 2023 |  | 2022
U.S. dialysis | $ | 661,181 |  |  | $ | 695,674 |  |  | $ | 690,949 |
Other - Ancillary services | 62,679 |  |  | 49,769 |  |  | 41,653 |
| $ | 723,860 |  |  | $ | 745,443 |  |  | $ | 732,602 |
Summary of Expenditures for Property and Equipment by Segment | Expenditures for property and equipment by reportable segment were as follows:
| Year ended December 31,
| 2024 |  | 2023 |  | 2022
U.S. dialysis | $ | 469,799 |  |  | $ | 501,149 |  |  | $ | 533,600 |
Other - Ancillary services | 85,644 |  |  | 66,836 |  |  | 69,829 |
| $ | 555,443 |  |  | $ | 567,985 |  |  | $ | 603,429 |

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