Segment Reporting

12 Months Ended

Dec. 31, 2021

Segment Reporting [Abstract]

Segment Reporting

Segment reporting

The Company's operations are comprised of its U.S. dialysis and related lab services business (its U.S. dialysis business), its U.S. ancillary services and strategic initiatives and its international operations (collectively, its ancillary services), as well as its corporate administrative support. See Note 1 "Organization" for a summary description of the Company's businesses.

On June 19, 2019, the Company completed the sale of its prior DMG business to Optum. As a result of this transaction, DMG's results of operations have been reported as discontinued operations for all periods presented.

The Company’s operating segments have been defined based on the separate financial information that is regularly produced and reviewed by the Company’s chief operating decision maker in making decisions about allocating resources to and assessing the financial performance of the Company’s various operating lines of business. The chief operating decision maker for the Company is its Chief Executive Officer.

The Company’s separate operating segments include its U.S. dialysis and related lab services business, its U.S. ancillary services and strategic initiatives, its kidney care operations in each foreign sovereign jurisdiction, its other health operations in each foreign sovereign jurisdiction, and its equity method investment in the APAC joint venture. The U.S. dialysis and related lab services business qualifies as a separately reportable segment, and all other operating segments, including the international operating segments, have been combined and disclosed in the other segments category.

The Company’s operating segment financial information included in this report is prepared on the internal management reporting basis that the chief operating decision maker uses to allocate resources and assess the financial performance of the Company's operating segments. For internal management reporting, segment operations include direct segment operating expenses but generally exclude corporate administrative support costs, which consist primarily of indirect labor, benefits and long-term incentive compensation expenses of certain departments which provide support to all of the Company’s various operating lines of business.

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,
	2021		2020		2019
Segment revenues:
U.S. dialysis
Patient service revenues:
External sources	$	10,551,106	$	10,475,273	$	10,399,686
Intersegment revenues	90,512		144,091		131,199
U.S. dialysis patient service revenues	10,641,618		10,619,364		10,530,885
Other revenues
External sources	25,061		39,376		30,895
Intersegment revenues	284		1,195		1,126
Total U.S. dialysis revenues	$	10,666,963	$	10,659,935	$	10,562,906
Other - Ancillary services
Net patient service revenues	662,409		550,978		497,021
Other external sources	380,221		484,977		460,877
Intersegment revenues	4,294		16,743		14,030
Total ancillary services	1,046,924		1,052,698		971,928
Total net segment revenues	11,713,887		11,712,633		11,534,834
Elimination of intersegment revenues	(95,090)		(162,029)		(146,355)
Consolidated revenues	$	11,618,797	$	11,550,604	$	11,388,479
Segment operating margin (loss):
U.S. dialysis	$	1,974,988	$	1,917,604	$	1,924,826
Other - Ancillary services(1)	(66,003)		(76,261)		(189,174)
Total segment margin	1,908,985		1,841,343		1,735,652
Reconciliation of segment operating margin to consolidated income from  continuing operations before income taxes:
Corporate administrative support	(111,615)		(146,707)		(92,335)
Consolidated operating income	1,797,370		1,694,636		1,643,317
Debt expense	(285,254)		(304,111)		(443,824)
Debt prepayment, refinancing and redemption charges	—		(89,022)		(33,402)
Other income, net	6,378		16,759		29,348
Income from continuing operations before income taxes	$	1,518,494	$	1,318,262	$	1,195,439

 

(1)Includes equity investment income of $3,177, $5,866, and $9,366 in 2021, 2020 and 2019, respectively.

Depreciation and amortization expense by reportable segment was as follows:

	Year ended December 31,
	2021		2020		2019
U.S. dialysis	$	642,711	$	594,552	$	583,454
Other - Ancillary services	37,904		35,883		31,698
	$	680,615	$	630,435	$	615,152

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

	Year ended December 31,
	2021		2020		2019
U.S. dialysis	589,662		$	646,870	$	681,339
Other - Ancillary services	51,803		27,671		46,741
DMG - Discontinued operations	—		—		38,466
	$	641,465	$	674,541	$	766,546

Summary of assets by reportable segment was as follows:

	Year ended December 31,
	2021		2020
Segment assets
U.S. dialysis(1)	$	15,375,000	$	15,344,647
Other - Ancillary services(2)	1,746,488		1,643,869
Consolidated assets	$	17,121,488	$	16,988,516

(1)Includes equity method and other investments of $112,500 and $122,974 in 2021 and 2020, respectively.

(2)Includes equity method and other investments of $126,381 and 134,517 in 2021 and 2020, respectively and includes approximately $190,029 and $181,137 in 2021 and 2020, respectively, of net property and equipment related to the Company’s international operations.