Revenue Recognition Revenue Recognition

3 Months Ended

Mar. 31, 2025

Text Block [Abstract]

Revenue Recognition [Text Block]

Revenue recognition

The following tables summarize the Company's segment revenues by primary payor source:

	Three months ended March 31, 2025						Three months ended March 31, 2024
	U.S. dialysis		Other — Ancillary services		Consolidated		U.S. dialysis		Other — Ancillary services		Consolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage	$	1,609,018	$		$	1,609,018	$	1,531,497	$		$	1,531,497
Medicaid and Managed Medicaid	206,509				206,509		210,123				210,123
Other government	76,746		209,747		286,493		82,587		145,785		228,372
Commercial	924,888		87,819		1,012,707		925,831		70,172		996,003
Other revenues:
Medicare and Medicare Advantage			98,954		98,954				103,110		103,110
Medicaid and Managed Medicaid			2		2				395		395
Commercial			2,701		2,701				6,940		6,940
Other(1)	6,008		15,599		21,607		6,122		15,203		21,325
Eliminations of intersegment revenues	(11,734)		(2,728)		(14,462)		(24,463)		(2,747)		(27,210)
Total	$	2,811,435	$	412,094	$	3,223,529	$	2,731,697	$	338,858	$	3,070,555

(1)    Consists primarily of management service fees in the Company's U.S. dialysis business and research fees, management fees, and other non-patient service revenues in the Other - ancillary services businesses.

There are significant uncertainties associated with estimating revenue, many of which take several years to resolve. These estimates are subject to ongoing insurance coverage changes, geographic coverage differences, differing interpretations of contract coverage and other payor issues, as well as patient issues, including determination of applicable primary and secondary coverage, changes in patient insurance coverage and coordination of benefits. As these estimates are refined over time, both positive and negative adjustments to revenue are recognized in the current period.

Dialysis patient service revenues. Revenues are recognized based on the Company’s estimate of the transaction price the Company expects to collect as a result of satisfying its performance obligations. Dialysis patient service revenues are recognized in the period services are provided based on these estimates. Revenues consist primarily of payments from government and commercial health plans for dialysis services provided to patients.

Other revenues. Other revenues consist of revenues earned by the Company's non-dialysis ancillary services as well as fees for management and administrative services to outpatient dialysis businesses that the Company does not consolidate. Other revenues are estimated and recognized in the period the performance obligation is met, subject to applicable measurement

constraints. The Company's integrated kidney care (IKC) revenues include revenues earned under risk-based arrangements, including value-based care (VBC) arrangements. Under its VBC arrangements, the Company assumes full or shared financial risk for the total medical cost of care for patients below or above a benchmark. The benchmarks against which the Company incurs profit or loss on these contracts are typically based on the underlying premiums paid to the insuring entity (the Company's counterparty), with adjustments where applicable, or on trended or adjusted medical cost targets.