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Revenue Recognition Revenue Recognition
 6 Months Ended
Jun. 30, 2025
Text Block [Abstract]  
Revenue Recognition [Text Block] Revenue recognition
The following tables summarize the Company's segment revenues by primary payor source:
Three months ended June 30, 2025Three months ended June 30, 2024
U.S. dialysisOther — Ancillary servicesConsolidatedU.S. dialysisOther — Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage$1,659,607 $$1,659,607 $1,587,198 $$1,587,198 
Medicaid and Managed Medicaid217,699 217,699 214,951 214,951 
Other government83,104 224,937 308,041 80,338 176,524 256,862 
Commercial947,015 91,225 1,038,240 952,625 62,391 1,015,016 
Other revenues:
Medicare and Medicare Advantage140,149 140,149 97,433 97,433 
Medicaid and Managed Medicaid— — 445 445 
Commercial8,322 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, 2025Six months ended June 30, 2024
U.S. dialysisOther — Ancillary servicesConsolidatedU.S. dialysisOther — Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage$3,268,625 $$3,268,625 $3,118,696 $$3,118,696 
Medicaid and Managed Medicaid424,208 424,208 425,075 425,075 
Other government159,850 435,301 595,151 162,924 322,309 485,233 
Commercial1,871,903 178,427 2,050,330 1,878,455 132,564 2,011,019 
Other revenues:
Medicare and Medicare Advantage239,103 239,103 200,542 200,542 
Medicaid and Managed Medicaid2 2 841 841 
Commercial11,023 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.
There are significant uncertainties associated with estimating revenue, many of which take several years to resolve. These estimates are subject to ongoing insurance coverage changes, geographic coverage differences, differing interpretations of contract coverage and other payor issues, as well as patient issues, including determination of applicable primary and secondary coverage, changes in patient insurance coverage and coordination of benefits. As these estimates are refined over time, both positive and negative adjustments to revenue are recognized in the current period.
Dialysis patient service revenues. Revenues are recognized based on the Company’s estimate of the transaction price the Company expects to collect as a result of satisfying its performance obligations. Dialysis patient service revenues are recognized in the period services are provided based on these estimates. Revenues consist primarily of payments from government and commercial health plans for dialysis services provided to patients.
Other revenues. Other revenues consist of revenues earned by the Company's non-dialysis ancillary services as well as fees for management and administrative services to outpatient dialysis businesses that the Company does not consolidate. Other revenues are estimated and recognized in the period the performance obligation is met, subject to applicable measurement constraints. The Company's integrated kidney care (IKC) revenues include revenues earned under risk-based arrangements, including value-based care (VBC) arrangements. Under its VBC arrangements, the Company assumes full or shared financial risk for the total medical cost of care for patients below or above a benchmark. The benchmarks against which the Company incurs profit or loss on these contracts are typically based on the underlying premiums paid to the insuring entity (the Company's counterparty), with adjustments where applicable, or on trended or adjusted medical cost targets.