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Acquisitions and divestitures (Tables)
 9 Months Ended
Sep. 30, 2019
Business Acquisition [Line Items]  
Schedule of Business Acquisitions by Acquisition, Contingent Consideration
The following is a reconciliation of changes in contingent earn-out obligations for the nine months ended September 30, 2019:
Beginning balance December 31, 2018
$
2,608

Contingent earn-out obligations associated with acquisitions
19,731

Remeasurement of fair value for contingent earn-out obligations
(2,179
)
Payments on contingent earn-out obligations
(327
)
Ending balance September 30, 2019
$
19,833
Dialysis and other businesses  
Business Acquisition [Line Items]  
Assets Acquired and Liabilities Assumed in Business Acquisitions
The following table summarizes the assets acquired and liabilities assumed in these transactions at their estimated acquisition date fair values: 
Current assets
$
5,238

Property and equipment
3,607

Intangible and other long-term assets
15,848

Goodwill
77,238

Current liabilities
(3,360
)
Long-term liabilities
(1,139
)
Noncontrolling interests
(1,762
)

$
95,670