Segment Reporting (Tables)

12 Months Ended

Dec. 31, 2019

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,
	2019			2018			2017
Segment revenues:(1)
U.S. dialysis
Patient service revenues:
External sources	$	10,421,401		$	10,274,046		$	9,767,123
Intersegment revenues	131,199			92,950			55,176
Total U.S. dialysis revenues	10,552,600			10,366,996			9,822,299
Provision for uncollectible accounts	(21,715		)	(50,927		)	(481,973		)
Net U.S. dialysis patient service revenues	10,530,885			10,316,069			9,340,326
Other revenues(2)
External sources	30,895			19,880			19,739
Intersegment revenues	1,126			—			—
Total net U.S. dialysis revenues	$	10,562,906		$	10,335,949		$	9,360,065
Other - Ancillary services
Net patient service revenues	$	497,021		$	437,275		$	323,156
Other external sources	460,877			724,577			1,248,589
Intersegment revenues	14,030			34,236			24,603
Total ancillary services	$	971,928		$	1,196,088		$	1,596,348
Total net segment revenues	11,534,834			11,532,037			10,956,413
Elimination of intersegment revenues	(146,355		)	(127,186		)	(79,779		)
Consolidated revenues	$	11,388,479		$	11,404,851		$	10,876,634
Segment operating margin (loss):
U.S. dialysis	$	1,924,826		$	1,709,721		$	2,297,198
Other - Ancillary services	(189,174		)	(93,789		)	(439,477		)
Total segment margin	1,735,652			1,615,932			1,857,721
Reconciliation of segment operating margin to consolidated income from continuing operations before income taxes:
Corporate administrative support	(92,335		)	(90,108		)	(44,966		)
Consolidated operating income	1,643,317			1,525,824			1,812,755
Debt expense	(443,824		)	(487,435		)	(430,634		)
Debt prepayment, refinancing and redemption charges	(33,402		)	—			—
Other income	29,348			10,089			17,665
Income from continuing operations before income taxes	$	1,195,439		$	1,048,478		$	1,399,786

 

(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. See Notes 1 and 2 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 was as follows:

	Year ended December 31,
	2019		2018		2017
U.S. dialysis	$	583,454	$	558,810	$	520,965
Other - Ancillary services	31,698		32,225		38,946
	$	615,152	$	591,035	$	559,911

Summary of Assets by Segment

Summary of assets by reportable segment was as follows:

	Year ended December 31,
	2019		2018
Segment assets
U.S. dialysis (including equity investments of $124,188 and $95,290, respectively)	$	15,778,880	$	12,333,641
Other - Ancillary services(1) (including equity investments of $117,795 and $129,321, respectively)	1,532,514		1,387,046
DMG - Discontinued operations (including equity investments of $0 and $4,833 respectively)	—		5,389,565
Consolidated assets	$	17,311,394	$	19,110,252

(1)

Includes approximately $154,572 and $136,052 in 2019 and 2018, 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 were as follows: 

	Year ended December 31,
	2019		2018		2017
U.S. dialysis	$	681,339	$	856,108	$	769,732
Other - Ancillary services	46,741		45,806		40,377
DMG - Discontinued operations	38,466		85,224		95,141
	$	766,546	$	987,138	$	905,250