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Segment Reporting
 12 Months Ended
Dec. 31, 2024
Segment Reporting [Abstract]  
Segment Reporting Segment reporting
The Company's operating divisions are composed of its U.S. dialysis and related lab services business (its U.S. dialysis business), its U.S. integrated kidney care business, its U.S. other ancillary services and its international operations (collectively, its ancillary services), as well as its corporate administrative support functions. See Note 1 "Organization" for a summary description of the Company's businesses.
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. integrated kidney care business, its U.S. other ancillary services, its operations in each foreign sovereign jurisdiction, and, until its reconsolidation in the fourth quarter of 2024, the Company's equity method investment in its Asia Pacific joint venture (APAC JV). The U.S. dialysis and related lab services business qualifies as a separately reportable segment, and all other 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 assess the financial performance of and allocate resources among 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 more than one of the Company’s various operating lines of business. The chief operating decision maker uses segment operating margin to assess segment profitability and resource allocation. The chief operating decision maker does not review total assets by segment to make decisions regarding resources; therefore, the total assets by segment disclosure has not been included.
The following is a summary of segment revenues, segment operating margin, and a reconciliation of segment operating margin to consolidated income from continuing operations before income taxes:
 Year ended December 31,
 202420232022
Segment revenues:   
U.S. dialysis   
Patient service revenues:   
External sources$11,294,614 $10,823,525 $10,488,327 
Intersegment revenues71,747 88,222 87,045 
U.S. dialysis patient service revenues11,366,361 10,911,747 10,575,372 
Other revenues
External sources24,356 25,251 24,447 
Intersegment revenues— — (10)
Total U.S. dialysis revenues11,390,717 10,936,998 10,599,809 
Other - Ancillary services
Patient service revenues965,761 751,416 688,137 
Other external sources530,819 539,955 408,983 
Intersegment revenues13,910 7,852 4,206 
Total ancillary services1,510,490 1,299,223 1,101,326 
Total net segment revenues12,901,207 12,236,221 11,701,135 
Elimination of intersegment revenues(85,657)(96,074)(91,241)
Consolidated revenues$12,815,550 $12,140,147 $11,609,894 
Significant segment expenses:
U.S. dialysis
Patient care costs$7,497,576 $7,394,640 $7,334,415 
General and administrative1,173,990 1,102,072 1,037,552 
Depreciation and amortization661,181 695,674 690,949 
Other segment items(1)
(63,037)(29,966)(28,417)
U.S. dialysis segment expenses9,269,710 9,162,420 9,034,499 
Other - Ancillary services expenses1,427,833 1,307,970 1,197,905 
Segment operating margin:
U.S. dialysis$2,121,007 1,774,578 1,565,310 
Other - Ancillary services(2)
82,657 (8,747)(96,579)
Total segment margin2,203,664 1,765,831 1,468,731 
Reconciliation of segment operating margin to consolidated income from continuing operations before income taxes:
Corporate administrative support(113,181)(163,047)(129,669)
Consolidated operating income2,090,483 1,602,784 1,339,062 
Debt expense(470,469)(398,551)(357,019)
Debt prepayment, extinguishment and modification costs(19,813)(7,962)— 
Other loss, net(69,808)(19,177)(15,765)
Income from continuing operations before income taxes$1,530,393 $1,177,094 $966,278 
 
(1)Other segment items for our U.S. dialysis segment include equity income from nonconsolidated joint ventures and a gain on changes in ownership interest.
(2)Segment operating margin (loss) for Other - Ancillary services includes equity investment loss of $1,701, $2,103 and $1,898 in 2024, 2023 and 2022, respectively.
Depreciation and amortization expense by reportable segment was as follows:
 Year ended December 31,
 202420232022
U.S. dialysis$661,181 $695,674 $690,949 
Other - Ancillary services62,679 49,769 41,653 
 $723,860 $745,443 $732,602 
Expenditures for property and equipment by reportable segment were as follows: 
 Year ended December 31,
 202420232022
U.S. dialysis$469,799 $501,149 $533,600 
Other - Ancillary services85,644 66,836 69,829 
 $555,443 $567,985 $603,429 
The Company's international operations include approximately $317,488 and $240,742 in 2024 and 2023, respectively, of net property and equipment.
Net Property and Equipment International Operations
The Company's international operations include approximately $317,488 and $240,742 in 2024 and 2023, respectively, of net property and equipment.