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Acquisitions and Divestitures - Divestitures (Details)
$ in Thousands
1 Months Ended 12 Months Ended
Jul. 01, 2019
USD ($)
dialysis_clinic
Mar. 01, 2019
USD ($)
dialysis_clinic
Aug. 01, 2017
USD ($)
Mar. 31, 2018
USD ($)
Dec. 31, 2019
USD ($)
Dec. 31, 2018
USD ($)
Dec. 31, 2017
USD ($)
dialysis_clinic
Mar. 01, 2018
Jun. 02, 2017
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]                  
Goodwill expected to be deductible for tax purposes         $ 4,774   $ 647    
Reduction of goodwill on sale of dialysis clinics         4,365 $ 1,806      
Two Dialysis Clinics In Florida | Disposal Group, Disposed of by Sale, Not Discontinued Operations                  
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]                  
Ownership interest disposed   100.00%              
Number of dialysis clinics disposed | dialysis_clinic   2              
Proceeds from sale of dialysis clinics   $ 3,300              
Gain (loss) on sale of dialysis clinics         512        
Reduction of goodwill on sale of dialysis clinics         2,210        
Two Dialysis Clinics In Maryland | Disposal Group, Disposed of by Sale, Not Discontinued Operations                  
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]                  
Ownership interest disposed 100.00%                
Number of dialysis clinics disposed | dialysis_clinic 2                
Proceeds from sale of dialysis clinics $ 3,000                
Gain (loss) on sale of dialysis clinics         (228)        
Reduction of goodwill on sale of dialysis clinics         $ 2,155        
Dialysis Clinic In Florida | Disposal Group, Disposed of by Sale, Not Discontinued Operations                  
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]                  
Ownership interest disposed     100.00%         100.00%  
Proceeds from sale of dialysis clinics     $ 1,075 $ 2,500          
Gain (loss) on sale of dialysis clinics           262      
Reduction of goodwill on sale of dialysis clinics           $ 1,806      
Dialysis Clinic In Massachusetts | Disposal Group, Disposed of by Sale, Not Discontinued Operations                  
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]                  
Ownership interest disposed                 100.00%
Dialysis Clinic In Massachusetts And Florida | Disposal Group, Disposed of by Sale, Not Discontinued Operations                  
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]                  
Gain (loss) on sale of dialysis clinics             615    
Reduction of goodwill on sale of dialysis clinics             $ 563    
Four Dialysis Clinics | Disposal Group, Not Discontinued Operations                  
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]                  
Number of dialysis clinics disposed | dialysis_clinic             2    
Gain (loss) on sale of dialysis clinics             $ (107)    
Reduction of goodwill on sale of dialysis clinics             $ 109