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Revenue Recognition and Accounts Receivable Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2024 | Dec. 31, 2023 | Dec. 31, 2022
Revenue Recognition |  |  |
Other revenues | $ 555,175 | $ 565,206 | $ 433,430
Total revenue net of intersegment revenue | $ 12,815,550 | $ 12,140,147 | 11,609,894
Accounts Receivable |  |  |
Revenue Recognition |  |  |
Percentage Of Accounts Receivable Six Months Or More Past Due | 23.00% | 19.00% |
Intersegment Elimination |  |  |
Revenue Recognition |  |  |
Eliminations of intersegment revenues | $ (85,657) | $ (96,074) | (91,241)
Medicare and Medicare Advantage |  |  |
Revenue Recognition |  |  |
Patient service revenues | 6,374,882 | 6,100,183 | 6,041,496
Other revenues | 463,731 | 460,991 | 345,340
Medicaid and Managed Medicaid |  |  |
Revenue Recognition |  |  |
Patient service revenues | 863,947 | 833,744 | 759,579
Other revenues | 740 | 1,733 | 1,546
Other Government Payors |  |  |
Revenue Recognition |  |  |
Patient service revenues | 1,061,440 | 854,441 | 801,912
Commercial Payors |  |  |
Revenue Recognition |  |  |
Patient service revenues | 4,031,853 | 3,874,795 | 3,660,522
Other revenues | 21,396 | 32,329 | 22,211
Other |  |  |
Revenue Recognition |  |  |
Other revenues | 83,218 | 78,005 | 68,529
U.S. dialysis |  |  |
Revenue Recognition |  |  |
Total revenue net of intersegment revenue | 11,318,970 | 10,848,776 | 10,512,774
U.S. dialysis | Intersegment Elimination |  |  |
Revenue Recognition |  |  |
Eliminations of intersegment revenues | (71,747) | (88,222) | (87,035)
U.S. dialysis | Medicare and Medicare Advantage |  |  |
Revenue Recognition |  |  |
Patient service revenues | 6,374,882 | 6,100,183 | 6,041,496
U.S. dialysis | Medicaid and Managed Medicaid |  |  |
Revenue Recognition |  |  |
Patient service revenues | 863,947 | 833,744 | 759,579
U.S. dialysis | Other Government Payors |  |  |
Revenue Recognition |  |  |
Patient service revenues | 343,705 | 354,304 | 336,991
U.S. dialysis | Commercial Payors |  |  |
Revenue Recognition |  |  |
Patient service revenues | 3,783,827 | 3,623,516 | 3,437,306
U.S. dialysis | Other |  |  |
Revenue Recognition |  |  |
Other revenues | 24,356 | 25,251 | 24,437
Other - Ancillary services |  |  |
Revenue Recognition |  |  |
Total revenue net of intersegment revenue | 1,496,580 | 1,291,371 | 1,097,120
Other - Ancillary services | Intersegment Elimination |  |  |
Revenue Recognition |  |  |
Eliminations of intersegment revenues | (13,910) | (7,852) | (4,206)
Other - Ancillary services | Medicare and Medicare Advantage |  |  |
Revenue Recognition |  |  |
Other revenues | 463,731 | 460,991 | 345,340
Other - Ancillary services | Medicaid and Managed Medicaid |  |  |
Revenue Recognition |  |  |
Other revenues | 740 | 1,733 | 1,546
Other - Ancillary services | Other Government Payors |  |  |
Revenue Recognition |  |  |
Patient service revenues | 717,735 | 500,137 | 464,921
Other - Ancillary services | Commercial Payors |  |  |
Revenue Recognition |  |  |
Patient service revenues | 248,026 | 251,279 | 223,216
Other revenues | 21,396 | 32,329 | 22,211
Other - Ancillary services | Other |  |  |
Revenue Recognition |  |  |
Other revenues | $ 58,862 | $ 52,754 | $ 44,092

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