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Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended
--- | --- | ---
Jun. 30, 2025 | Jun. 30, 2024 | Jun. 30, 2025 | Jun. 30, 2024
Disaggregation of Revenue [Line Items] |  |  |  |
Other revenues | $ 172,655 | $ 125,620 | $ 293,191 | $ 254,643
Total revenues | 3,379,526 | 3,186,722 | 6,603,055 | 6,257,277
Contract with Customer, Performance Obligation Satisfied in Previous Period |  |  | 95,911 | 31,309
Elimination of intersegment revenues |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Total revenues | (19,552) | (16,748) | (34,015) | (43,959)
Medicare and Medicare Advantage |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Dialysis patient service revenues | 1,659,607 | 1,587,198 | 3,268,625 | 3,118,696
Other revenues | 140,149 | 97,433 | 239,103 | 200,542
Medicaid and Managed Medicaid |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Dialysis patient service revenues | 217,699 | 214,951 | 424,208 | 425,075
Other revenues | 0 | 445 | 2 | 841
Other Government Payors |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Dialysis patient service revenues | 308,041 | 256,862 | 595,151 | 485,233
Commercial Payors |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Dialysis patient service revenues | 1,038,240 | 1,015,016 | 2,050,330 | 2,011,019
Other revenues | 8,322 | 10,200 | 11,023 | 17,140
Other |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Other revenues | 27,020 | 21,365 | 48,628 | 42,690
U. S. Dialysis And Related Lab Services |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Total revenues | 2,896,675 | 2,828,085 | 5,708,110 | 5,559,782
U. S. Dialysis And Related Lab Services | Elimination of intersegment revenues |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Total revenues | (16,716) | (12,925) | (28,450) | (37,389)
U. S. Dialysis And Related Lab Services | Medicare and Medicare Advantage |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Dialysis patient service revenues | 1,659,607 | 1,587,198 | 3,268,625 | 3,118,696
U. S. Dialysis And Related Lab Services | Medicaid and Managed Medicaid |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Dialysis patient service revenues | 217,699 | 214,951 | 424,208 | 425,075
U. S. Dialysis And Related Lab Services | Other Government Payors |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Dialysis patient service revenues | 83,104 | 80,338 | 159,850 | 162,924
U. S. Dialysis And Related Lab Services | Commercial Payors |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Dialysis patient service revenues | 947,015 | 952,625 | 1,871,903 | 1,878,455
U. S. Dialysis And Related Lab Services | Other |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Other revenues | 5,966 | 5,898 | 11,974 | 12,021
Other Operating Segment |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Total revenues | 482,851 | 358,637 | 894,945 | 697,495
Other Operating Segment | Elimination of intersegment revenues |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Total revenues | (2,836) | (3,823) | (5,565) | (6,570)
Other Operating Segment | Medicare and Medicare Advantage |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Other revenues | 140,149 | 97,433 | 239,103 | 200,542
Other Operating Segment | Medicaid and Managed Medicaid |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Other revenues | 0 | 445 | 2 | 841
Other Operating Segment | Other Government Payors |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Dialysis patient service revenues | 224,937 | 176,524 | 435,301 | 322,309
Other Operating Segment | Commercial Payors |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Dialysis patient service revenues | 91,225 | 62,391 | 178,427 | 132,564
Other revenues | 8,322 | 10,200 | 11,023 | 17,140
Other Operating Segment | Other |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Other revenues | $ 21,054 | $ 15,467 | $ 36,654 | $ 30,669

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