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Revenue Recognition Segment revenue by major payor (Tables) | 6 Months Ended
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Jun. 30, 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 June 30, 2025 |  | Three months ended June 30, 2024
| U.S. dialysis |  | Other — Ancillary services |  | Consolidated |  | U.S. dialysis |  | Other — Ancillary services |  | Consolidated
Dialysis patient service revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage | $ | 1,659,607 |  |  | $ |  | $ | 1,659,607 |  |  | $ | 1,587,198 |  |  | $ |  | $ | 1,587,198 |
Medicaid and Managed Medicaid | 217,699 |  |  |  |  | 217,699 |  |  | 214,951 |  |  |  |  | 214,951 |
Other government | 83,104 |  |  | 224,937 |  |  | 308,041 |  |  | 80,338 |  |  | 176,524 |  |  | 256,862 |
Commercial | 947,015 |  |  | 91,225 |  |  | 1,038,240 |  |  | 952,625 |  |  | 62,391 |  |  | 1,015,016 |
Other revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage |  |  | 140,149 |  |  | 140,149 |  |  |  |  | 97,433 |  |  | 97,433 |
Medicaid and Managed Medicaid |  |  | — |  |  | — |  |  |  |  | 445 |  |  | 445 |
Commercial |  |  | 8,322 |  |  | 8,322 |  |  |  |  | 10,200 |  |  | 10,200 |
Other(1) | 5,966 |  |  | 21,054 |  |  | 27,020 |  |  | 5,898 |  |  | 15,467 |  |  | 21,365 |
Eliminations of intersegment revenues | (16,716) |  |  | (2,836) |  |  | (19,552) |  |  | (12,925) |  |  | (3,823) |  |  | (16,748) |
Total | $ | 2,896,675 |  |  | $ | 482,851 |  |  | $ | 3,379,526 |  |  | $ | 2,828,085 |  |  | $ | 358,637 |  |  | $ | 3,186,722 |
| Six months ended June 30, 2025 |  | Six months ended June 30, 2024
| U.S. dialysis |  | Other — Ancillary services |  | Consolidated |  | U.S. dialysis |  | Other — Ancillary services |  | Consolidated
Dialysis patient service revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage | $ | 3,268,625 |  |  | $ |  | $ | 3,268,625 |  |  | $ | 3,118,696 |  |  | $ |  | $ | 3,118,696 |
Medicaid and Managed Medicaid | 424,208 |  |  |  |  | 424,208 |  |  | 425,075 |  |  |  |  | 425,075 |
Other government | 159,850 |  |  | 435,301 |  |  | 595,151 |  |  | 162,924 |  |  | 322,309 |  |  | 485,233 |
Commercial | 1,871,903 |  |  | 178,427 |  |  | 2,050,330 |  |  | 1,878,455 |  |  | 132,564 |  |  | 2,011,019 |
Other revenues: |  |  |  |  |  |  |  |  |  |  |
Medicare and Medicare Advantage |  |  | 239,103 |  |  | 239,103 |  |  |  |  | 200,542 |  |  | 200,542 |
Medicaid and Managed Medicaid |  |  | 2 |  |  | 2 |  |  |  |  | 841 |  |  | 841 |
Commercial |  |  | 11,023 |  |  | 11,023 |  |  |  |  | 17,140 |  |  | 17,140 |
Other(1) | 11,974 |  |  | 36,654 |  |  | 48,628 |  |  | 12,021 |  |  | 30,669 |  |  | 42,690 |
Eliminations of intersegment revenues | (28,450) |  |  | (5,565) |  |  | (34,015) |  |  | (37,389) |  |  | (6,570) |  |  | (43,959) |
Total | $ | 5,708,110 |  |  | $ | 894,945 |  |  | $ | 6,603,055 |  |  | $ | 5,559,782 |  |  | $ | 697,495 |  |  | $ | 6,257,277 |
(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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