Segment reporting (Tables)

9 Months Ended

Sep. 30, 2018

Segment Reporting [Abstract]

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

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

	Three months ended September 30,						Nine months ended September 30,
	2018			2017			2018			2017
Segment net revenues:
U.S. dialysis and related lab services
Patient service revenues:
External sources	$	2,559,345		$	2,470,169		$	7,661,244		$	7,247,403
Intersegment revenues	25,424			13,475			63,943			38,559
U.S. dialysis and related lab services patient service revenues	2,584,769			2,483,644			7,725,187			7,285,962
Provision for uncollectible accounts	(12,900		)	(117,962		)	(37,108		)	(334,031		)
Net U.S. dialysis and related lab services patient service revenues	2,571,869			2,365,682			7,688,079			6,951,931
Other revenues(1)	4,932			4,792			14,965			14,951
Total U.S. dialysis and related lab services revenues	2,576,801			2,370,474			7,703,044			6,966,882
Other—Ancillary services and strategic initiatives
Patient service revenues, net	112,279			90,015			320,204			229,587
Other external sources	183,674			318,057			624,422			937,811
Intersegment revenues	8,361			5,996			27,748			18,488
Total ancillary services and strategic initiatives revenues	304,314			414,068			972,374			1,185,886
Total net segment revenues	2,881,115			2,784,542			8,675,418			8,152,768
Elimination of intersegment revenues	(33,785		)	(19,471		)	(91,691		)	(57,047		)
Consolidated revenues	$	2,847,330		$	2,765,071		$	8,583,727		$	8,095,721
Segment operating margin:
U.S. dialysis and related lab services	$	390,006		$	442,777		$	1,272,828		$	1,837,989
Other—Ancillary services and strategic initiatives	(60,132		)	(36,518		)	(64,307		)	(142,984		)
Total segment operating margin	329,874			406,259			1,208,521			1,695,005
Reconciliation of segment operating margin to consolidated income from continuing operations before income taxes:
Corporate administrative support	(40,836		)	(10,965		)	(70,605		)	(32,587		)
Consolidated operating income	289,038			395,294			1,137,916			1,662,418
Debt expense	(125,927		)	(109,306		)	(359,135		)	(321,637		)
Other income, net	4,007			3,396			10,583			12,180
Consolidated income from continuing operations before income taxes	$	167,118		$	289,384		$	789,364		$	1,352,961

(1) Includes management fees for providing management and administrative services to dialysis centers that are wholly-owned by third parties and legal entities in which the Company owns a noncontrolling equity investment.

Summary of Depreciation and Amortization Expense by Reportable Segment

Depreciation and amortization expense by reportable segment was as follows:

	Three months ended September 30,				Nine months ended September 30,
	2018		2017		2018		2017
U.S. dialysis and related lab services	$	138,669	$	132,112	$	411,697	$	387,142
Other—Ancillary services and strategic initiatives	7,331		10,522		24,181		28,402
	$	146,000	$	142,634	$	435,878	$	415,544

Summary of Assets by Reportable Segment

Assets by reportable segment were as follows:

	September 30, 2018		December 31, 2017
Segment assets
U.S. dialysis and related lab services (including equity investments of $94,144 and $84,866, respectively)	$	12,101,111	$	11,776,042
Other—Ancillary services and strategic initiatives (including equity investments of $146,676 and $160,668, respectively)	1,308,892		1,410,509
DMG—Held for sale (including equity investments of $5,060 and $10,321, respectively)	5,947,786		5,761,642
Consolidated assets	$	19,357,789	$	18,948,193

Summary of Expenditures for Property and Equipment by Reportable Segment

Expenditures for property and equipment by reportable segment were as follows:

	Three months ended September 30,				Nine months ended September 30,
	2018		2017		2018		2017
U.S. dialysis and related lab services	$	214,728	$	207,472	$	603,186	$	538,620
Other—Ancillary services and strategic initiatives	5,019		9,135		37,191		28,256
DMG—Held for sale	11,935		24,282		65,282		72,953
	$	231,682	$	240,889	$	705,659	$	639,829