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Goodwill (Tables)
 3 Months Ended
Mar. 31, 2017
Goodwill and Intangible Assets Disclosure [Abstract]  
Changes in Goodwill by Reportable Segments
Changes in goodwill by reportable segments were as follows:
 
U.S. dialysis and
related lab services
 
DMG
 
Other-ancillary
services and
strategic initiatives
 
Consolidated total
Balance at January 1, 2016
$
5,629,183

 
$
3,398,264

 
$
267,032

 
$
9,294,479

Acquisitions
75,295

 
248,901

 
123,632

 
447,828

Divestitures
(12,891
)
 
(2,223
)
 
(29,645
)
 
(44,759
)
Goodwill impairment charges
—

 
(253,000
)
 
(28,415
)
 
(281,415
)
Foreign currency and other adjustments
—

 
—

 
(8,816
)
 
(8,816
)
Balance at December 31, 2016
$
5,691,587

 
$
3,391,942

 
$
323,788

 
$
9,407,317

Acquisitions
46,569

 
14,989

 
17,171

 
78,729

Divestitures
(14,110
)
 
(29
)
 
—

 
(14,139
)
Goodwill impairment charges
—

 
—

 
(24,198
)
 
(24,198
)
Foreign currency and other adjustments
—

 
—

 
4,761

 
4,761

Balance at March 31, 2017
$
5,724,046

 
$
3,406,902

 
$
321,522

 
$
9,452,470

 
 
 
 
 
 
 
 
Balance at March 31, 2017:
 
 
 
 
 
 
 
Goodwill
5,724,046

 
3,848,671

 
380,044

 
9,952,761

Accumulated impairment charges
—

 
(441,769
)
 
(58,522
)
 
(500,291
)
 
$
5,724,046

 
3,406,902

 
321,522

 
9,452,470
Schedule of Goodwill and Indefinite Lived Intangible Asset Impairment Charges
e Company has recognized goodwill impairment charges as shown and discussed below:
 
 
Three months ended
Reporting unit
 
March 31, 2017
 
March 31, 2016
DMG Nevada
 
$
—

 
$
77,000

Vascular access
 
24,198

 
—

Total
 
$
24,198

 
$
77,000
Schedule of Reporting Units Goodwill Balances
Further reductions in reimbursement rates, increases in medical cost or utilization trends, or other significant adverse changes in expected future cash flows or valuation assumptions could result in goodwill impairment charges in the future for the following reporting units, which remain at risk of goodwill impairment:
 
Goodwill balance
as of
March 31, 2017
 
Carrying
amount
coverage(1)
 
Sensitivities
 
 
 
Operating
income(2)
 
Discount
rate(3)
Reporting unit
 
 
 
DMG Nevada
$
261,204

 
14.0
%
 
(2.7
)%
 
(3.9
)%
DMG Florida
$
447,073

 
10.5
%
 
(1.6
)%
 
(2.8
)%
DMG New Mexico
$
70,926

 
4.9
%
 
(1.5
)%
 
(2.3
)%
DMG Washington
$
245,576

 
2.0
%
 
(1.7
)%
 
(3.0
)%
Vascular Access
$
10,498

 
0.0
%
 
(1.7
)%
 
(4.9
)%
 
(1)
Excess of estimated fair value of the reporting unit over carrying amount as of the latest assessment date.
(2)
Potential impact on estimated fair value of a sustained, long-term reduction of 3% in operating income as of the latest assessment date.
(3)
Potential impact on estimated fair value of an increase in discount rates of 100 basis points as of the latest assessment date.