Segment Reporting (Tables)

12 Months Ended

Dec. 31, 2018

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,
	2018			2017			2016
Segment revenues:(1)
U.S. dialysis and related lab services
Patient service revenues:
External sources	$	10,274,046		$	9,767,123		$	9,524,067
Intersegment revenues	92,950			55,176			27,355
Total U.S. dialysis and related lab services revenues	10,366,996			9,822,299			9,551,422
Provision for uncollectible accounts	(50,927		)	(481,973		)	(429,878		)
Net U.S. dialysis and related lab services patient service revenues	10,316,069			9,340,326			9,121,544
Other revenues(2)	19,880			19,739			16,645
Total net U.S. dialysis and related lab services revenues	10,335,949			9,360,065			9,138,189
Other - Ancillary services and strategic initiatives
Net patient service revenues	437,275			323,156			201,867
Other external sources	724,577			1,248,589			1,394,766
Intersegment revenues	34,236			24,603			24,739
Total ancillary services and strategic initiatives revenues	1,196,088			1,596,348			1,621,372
Total net segment revenues	11,532,037			10,956,413			10,759,561
Elimination of intersegment revenues	(127,186		)	(79,779		)	(52,094		)
Consolidated net revenues	$	11,404,851		$	10,876,634		$	10,707,467
Segment operating margin (loss):
U.S. dialysis and related lab services	$	1,709,721		$	2,297,198		$	1,777,014
Other—Ancillary services and strategic initiatives	(93,789		)	(439,477		)	266,324
Total segment margin	1,615,932			1,857,721			2,043,338
Reconciliation of segment operating margin to consolidated income from continuing operations before income taxes:
Corporate administrative support	(90,108		)	(44,966		)	(13,628		)
Consolidated operating income	1,525,824			1,812,755			2,029,710
Debt expense	(487,435		)	(430,634		)	(414,116		)
Other income	10,089			17,665			7,511
Income from continuing operations before income taxes	$	1,048,478		$	1,399,786		$	1,623,105

(1) On January 1, 2018, the Company adopted Revenue from Contracts with Customers (Topic 606) using the cumulative effect method for those contracts that were not substantially completed as of January 1, 2018. Results related to performance obligations satisfied beginning on and after January 1, 2018 are presented under Topic 606, while results related to the satisfaction of performance obligations in prior periods continue to be reported in accordance with the Company's historical accounting under Revenue Recognition (Topic 605). See Notes 1 and 2 of these consolidated financial statements for further discussion of the Company's adoption of Topic 606.

(2)

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 reportable segment is as follows: 

	Year ended December 31,
	2018		2017		2016
U.S. dialysis and related lab services	$	558,810	$	520,965	$	482,768
Other - Ancillary services and strategic initiatives	32,225		38,946		26,729
	$	591,035	$	559,911	$	509,497

Summary of Assets by Segment

 

	Year ended December 31,
	2018		2017		2016
U.S. dialysis and related lab services	$	558,810	$	520,965	$	482,768
Other - Ancillary services and strategic initiatives	32,225		38,946		26,729
	$	591,035	$	559,911	$	509,497

Summary of assets by reportable segment is as follows:

	Year ended December 31,
	2018		2017
Segment assets
U.S. dialysis and related lab services (including equity investments of $95,290 and $84,866, respectively)	$	12,333,641	$	11,802,131
Other - Ancillary services and strategic initiatives(1) (including equity investments of $129,321 and $160,668, respectively)	1,387,046		1,410,763
DMG - Held for sale (including equity investments of $4,833 and $10,321, respectively)	5,389,565		5,761,642
Consolidated assets	$	19,110,252	$	18,974,536

(1)

Includes approximately $136,052 and $125,932 in 2018 and 2017, 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 reportable segment is as follows: 

	Year ended December 31,
	2018		2017		2016
U.S. dialysis and related lab services	$	856,108	$	769,732	$	675,994
Other - Ancillary services and strategic initiatives	45,806		40,377		68,702
DMG - Held for sale	85,224		95,141		84,399
	$	987,138	$	905,250	$	829,095