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Segment Reporting | 12 Months Ended
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Dec. 31, 2024
Segment Reporting [Abstract] |
Segment Reporting | 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 functions. See Note 1 "Organization" for a summary description of the Company's businesses. The Company’s operating segments have been defined based on the separate financial information that is regularly produced and reviewed by the Company’s chief operating decision maker in making decisions about allocating resources to and assessing the financial performance of the Company’s various operating lines of business. The chief operating decision maker for the Company is its Chief Executive Officer. 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, until its reconsolidation in the fourth quarter of 2024, the Company's equity method investment in its 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. The Company’s operating segment financial information included in this report is prepared on the internal management reporting basis that the chief operating decision maker uses to assess the financial performance of and allocate resources among the Company's operating segments. For internal management reporting, segment operations include direct segment operating expenses but generally exclude corporate administrative support costs, which consist primarily of indirect labor, benefits and long-term incentive compensation expenses of certain departments which provide support to more than one of the Company’s various operating lines of business. The chief operating decision maker uses segment operating margin to assess segment profitability and resource allocation. The chief operating decision maker does not review total assets by segment to make decisions regarding resources; therefore, the total assets by segment disclosure has not been included. 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. 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 |
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 |
The Company's international operations include approximately $317,488 and $240,742 in 2024 and 2023, respectively, of net property and equipment.
Net Property and Equipment International Operations | The Company's international operations include approximately $317,488 and $240,742 in 2024 and 2023, respectively, of net property and equipment.

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- Definition The entire disclosure for reporting segments including data and tables. 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