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Revenue Recognition Segment revenue by major payor (Tables) | 3 Months Ended
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Mar. 31, 2025
Revenues by major payor [Abstract] |
Disaggregation of Revenue [Table Text Block] | The following tables summarize the Company's segment revenues by primary payor source:
| Three months ended March 31, 2025 |  | Three months ended March 31, 2024
| U.S. dialysis |  | Other — Ancillary services |  | Consolidated |  | U.S. dialysis |  | Other — Ancillary services |  | Consolidated
Dialysis patient service revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage | $ | 1,609,018 |  |  | $ |  | $ | 1,609,018 |  |  | $ | 1,531,497 |  |  | $ |  | $ | 1,531,497 |
Medicaid and Managed Medicaid | 206,509 |  |  |  |  | 206,509 |  |  | 210,123 |  |  |  |  | 210,123 |
Other government | 76,746 |  |  | 209,747 |  |  | 286,493 |  |  | 82,587 |  |  | 145,785 |  |  | 228,372 |
Commercial | 924,888 |  |  | 87,819 |  |  | 1,012,707 |  |  | 925,831 |  |  | 70,172 |  |  | 996,003 |
Other revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage |  |  | 98,954 |  |  | 98,954 |  |  |  |  | 103,110 |  |  | 103,110 |
Medicaid and Managed Medicaid |  |  | 2 |  |  | 2 |  |  |  |  | 395 |  |  | 395 |
Commercial |  |  | 2,701 |  |  | 2,701 |  |  |  |  | 6,940 |  |  | 6,940 |
Other(1) | 6,008 |  |  | 15,599 |  |  | 21,607 |  |  | 6,122 |  |  | 15,203 |  |  | 21,325 |
Eliminations of intersegment revenues | (11,734) |  |  | (2,728) |  |  | (14,462) |  |  | (24,463) |  |  | (2,747) |  |  | (27,210) |
Total | $ | 2,811,435 |  |  | $ | 412,094 |  |  | $ | 3,223,529 |  |  | $ | 2,731,697 |  |  | $ | 338,858 |  |  | $ | 3,070,555 |
(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.

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- Definition Tabular disclosure of disaggregation of revenue into categories depicting how nature, amount, timing, and uncertainty of revenue and cash flows are affected by economic factor. + References Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef -Topic 606 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 5 -Publisher FASB -URI https://asc.fasb.org/1943274/2147479806/606-10-50-5 + Details
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