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Segment reporting | 6 Months Ended
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Jun. 30, 2025
Segment Reporting [Abstract] |
Segment Reporting Disclosure | 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. 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 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 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, and its operations in each foreign sovereign jurisdiction. 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. See Note 24 to the Company's consolidated financial statements included in the 2024 10-K for further description of how the Company determines and measures results for its operating segments. The following is a summary of segment revenues, segment operating margin, and a reconciliation of segment operating margin to consolidated income before income taxes:
| Three months ended June 30, |  | Six months ended June 30,
| 2025 |  | 2024 |  | 2025 |  | 2024
Segment revenues: |  |  |  |  |  |  |
U.S. dialysis |  |  |  |  |  |  |
Patient service revenues: |  |  |  |  |  |  |
External sources | $ | 2,890,709 |  |  | $ | 2,822,187 |  |  | $ | 5,696,136 |  |  | $ | 5,547,761 |
Intersegment revenues | 16,716 |  |  | 12,925 |  |  | 28,450 |  |  | 37,389 |
U.S. dialysis patient service revenues | 2,907,425 |  |  | 2,835,112 |  |  | 5,724,586 |  |  | 5,585,150 |
Other revenues |  |  |  |  |  |  |
External sources | 5,966 |  |  | 5,898 |  |  | 11,974 |  |  | 12,021 |
Total U.S. dialysis revenues | 2,913,391 |  |  | 2,841,010 |  |  | 5,736,560 |  |  | 5,597,171 |
Other—Ancillary services |  |  |  |  |  |  |
Patient service revenues | 316,162 |  |  | 238,915 |  |  | 613,728 |  |  | 454,873 |
Other external sources | 166,689 |  |  | 119,722 |  |  | 281,217 |  |  | 242,622 |
Intersegment revenues | 2,836 |  |  | 3,823 |  |  | 5,565 |  |  | 6,570 |
Total ancillary services | 485,687 |  |  | 362,460 |  |  | 900,510 |  |  | 704,065 |
Total net segment revenues | 3,399,078 |  |  | 3,203,470 |  |  | 6,637,070 |  |  | 6,301,236 |
Elimination of intersegment revenues | (19,552) |  |  | (16,748) |  |  | (34,015) |  |  | (43,959) |
Consolidated revenues | $ | 3,379,526 |  |  | $ | 3,186,722 |  |  | $ | 6,603,055 |  |  | $ | 6,257,277 |
Significant segment expenses: |  |  |  |  |  |  |
U.S. dialysis |  |  |  |  |  |  |
Patient care costs | $ | 1,928,462 |  |  | $ | 1,854,541 |  |  | $ | 3,841,890 |  |  | $ | 3,679,120 |
General and administrative | 312,089 |  |  | 281,795 |  |  | 594,768 |  |  | 556,357 |
Depreciation and amortization | 156,782 |  |  | 160,410 |  |  | 313,681 |  |  | 333,262 |
Other segment items(1) | (6,786) |  |  | (5,922) |  |  | (12,396) |  |  | (47,491) |
U.S. dialysis segment expenses | 2,390,547 |  |  | 2,290,824 |  |  | 4,737,943 |  |  | 4,521,248 |
Other - Ancillary services expenses | 428,973 |  |  | 381,052 |  |  | 846,604 |  |  | 734,159 |
Segment operating margin: |  |  |  |  |  |  |
U.S. dialysis | 522,844 |  |  | 550,186 |  |  | 998,617 |  |  | 1,075,923 |
Other—Ancillary services(2) | 56,714 |  |  | (18,592) |  |  | 53,906 |  |  | (30,094) |
Total segment operating margin | 579,558 |  |  | 531,594 |  |  | 1,052,523 |  |  | 1,045,829 |
Reconciliation of segment operating income to consolidated income before income taxes: |  |  |  |  |  |  |
Corporate administrative support | (41,717) |  |  | (25,196) |  |  | (75,745) |  |  | (55,586) |
Consolidated operating income | 537,841 |  |  | 506,398 |  |  | 976,778 |  |  | 990,243 |
Debt expense | (146,062) |  |  | (97,747) |  |  | (281,117) |  |  | (197,165) |
Debt prepayment, extinguishment and modification costs | — |  |  | (9,732) |  |  | — |  |  | (9,732) |
Other loss, net | (22,851) |  |  | (27,479) |  |  | (40,400) |  |  | (40,120) |
Income from continuing operations before income taxes | $ | 368,928 |  |  | $ | 371,440 |  |  | $ | 655,261 |  |  | $ | 743,226 |
(1)Other segment items for our U.S. dialysis segment include equity income from nonconsolidated joint ventures and a gain on changes in ownership interests. (2)Includes depreciation and amortization of $17,923 and $15,251 for the three months ended June 30, 2025 and 2024, respectively, and $37,474 and $29,482 for the six months ended June 30, 2025 and 2024, respectively. Expenditures for property and equipment by reportable segment were as follows:
|  |  | Six months ended June 30,
|  |  |  |  | 2025 |  | 2024
U.S. dialysis |  |  |  |  | $ | 216,902 |  |  | $ | 211,171 |
Other—Ancillary services |  |  |  |  | 47,447 |  |  | 34,569 |
|  |  |  |  | $ | 264,349 |  |  | $ | 245,740 |

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