Segment Reporting (Tables)

12 Months Ended

Dec. 31, 2017

Segment Reporting [Abstract]

Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income from Continuing Operations Before Income Taxes

The following is a summary of segment revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income from continuing operations before income taxes:

	Year ended December 31,
	2017			2016			2015
Segment revenues:
U.S. dialysis and related lab services
Patient service revenues:
External sources	$	9,767,123		$	9,524,067		$	9,014,577
Intersegment revenues	55,175			27,355			19,414
Total U.S. dialysis and related lab services revenues	9,822,298			9,551,422			9,033,991
Less: Provision for uncollectible accounts	(482,007		)	(429,882		)	(406,530		)
Net U.S. dialysis and related lab services patient service revenues	9,340,291			9,121,540			8,627,461
Other revenues(1)	19,774			16,649			13,971
Total net U.S. dialysis and related lab services revenues	9,360,065			9,138,189			8,641,432
Other - Ancillary services and strategic initiatives
Net patient service revenues	323,156			201,867			134,496
Other external sources	1,248,588			1,394,766			1,225,731
Intersegment revenues	24,603			24,739			22,204
Total ancillary services and strategic initiatives revenues	1,596,347			1,621,372			1,382,431
Total net segment revenues	10,956,412			10,759,561			10,023,863
Elimination of intersegment revenues	(79,778		)	(52,094		)	(41,618		)
Consolidated net revenues	$	10,876,634		$	10,707,467		$	9,982,245
Segment operating margin (loss):
U.S. dialysis and related lab services	$	2,297,198		$	1,777,014		$	1,259,632
Other—Ancillary services and strategic initiatives	(439,477		)	266,324			(103,901		)
Total segment margin	1,857,721			2,043,338			1,155,731
Reconciliation of segment operating margin to consolidated income from continuing operations before income taxes:
Corporate administrative support	(44,966		)	(13,628		)	(18,965		)
Consolidated operating income	1,812,755			2,029,710			1,136,766
Debt expense	(430,634		)	(414,116		)	(408,380		)
Debt redemption charges	—			—			(48,072		)
Other income	17,665			7,511			8,073
Consolidated income from continuing operations before income taxes	$	1,399,786		$	1,623,105		$	688,387

(1) Includes management fee revenues from providing management and administrative services to dialysis ventures in which the Company owns a noncontrolling interest or which are wholly-owned by third parties.

Summary of Depreciation and Amortization Expense by Segment

Depreciation and amortization expense by segment is as follows: 

	Year ended December 31,
	2017		2016		2015
U.S. dialysis and related lab services	$	520,965	$	482,768	$	438,238
Other - Ancillary services and strategic initiatives	38,946		26,729		25,667
	$	559,911	$	509,497	$	463,905

Summary of Assets by Segment

Summary of assets by segment is as follows:

	Year ended December 31,
	2017		2016
Segment assets
U.S. dialysis and related lab services (including equity investments of $84,866 and $66,924, respectively)	$	11,776,042	$	11,108,386
Other - Ancillary services and strategic initiatives(1) (including equity investments of $160,668 and $425,115, respectively)	1,410,509		1,434,299
DMG - Held for sale (including equity investments of $10,321 and $10,350, respectively)	5,761,642		6,213,091
Consolidated assets	$	18,948,193	$	18,755,776

(1) Includes approximately $125,932 and $96,396 in 2017 and 2016, respectively, of net property and equipment related to the Company’s international operations.

Summary of Expenditures for Property and Equipment by Segment

Expenditures for property and equipment by segment is as follows: 

	Year ended December 31,
	2017		2016		2015
U.S. dialysis and related lab services	$	759,218	$	675,994	$	584,513
Other - Ancillary services and strategic initiatives	50,891		68,702		56,685
DMG - Held for sale	95,141		84,399		66,800
	$	905,250	$	829,095	$	707,998