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Segment reporting (Tables)
 9 Months Ended
Sep. 30, 2019
Segment Reporting [Abstract]  
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes
The following is a summary of segment net revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income before income taxes:
 
Three months ended
September 30,
 
Nine months ended
September 30,
 
2019
 
2018
 
2019
 
2018
Segment revenues:
 
 
 
 
 
 
 
U.S. dialysis and related lab services
 
 
 
 
 
 
 
Patient service revenues:
 
 
 
 
 
 
 
External sources
$
2,652,946

 
$
2,559,345

 
$
7,782,435

 
$
7,661,244

Intersegment revenues
32,150

 
25,424

 
92,611

 
63,943

U.S. dialysis and related lab services patient service
revenues
2,685,096

 
2,584,769

 
7,875,046

 
7,725,187

Provision for uncollectible accounts
(3,977
)
 
(12,900
)
 
(19,689
)
 
(37,108
)
Net U.S. dialysis and related lab services patient
service revenues
2,681,119

 
2,571,869

 
7,855,357

 
7,688,079

Other revenues(1):
 
 
 
 
 
 
 
External sources
10,096

 
4,932

 
19,989

 
14,965

Intersegment revenues
212

 
—

 
726

 
—

Total U.S. dialysis and related lab services revenues
2,691,427

 
2,576,801

 
7,876,072

 
7,703,044

Other—Ancillary services and strategic initiatives
 
 
 
 
 
 
 
Patient service revenues, net
128,223

 
112,279

 
367,951

 
320,204

Other external sources
116,790

 
183,674

 
339,209

 
624,422

Intersegment revenues
3,483

 
8,361

 
10,222

 
27,748

Total ancillary services and strategic initiatives revenues
248,496

 
304,314

 
717,382

 
972,374

Total net segment revenues
2,939,923

 
2,881,115

 
8,593,454

 
8,675,418

Elimination of intersegment revenues
(35,845
)
 
(33,785
)
 
(103,559
)
 
(91,691
)
Consolidated revenues
$
2,904,078

 
$
2,847,330

 
$
8,489,895

 
$
8,583,727

Segment operating margin:
 

 
 

 
 

 
 

U.S. dialysis and related lab services
$
500,742

 
$
390,006

 
$
1,416,680

 
$
1,272,828

Other—Ancillary services and strategic initiatives
(97,725
)
 
(60,132
)
 
(170,405
)
 
(64,307
)
Total segment operating margin
403,017

 
329,874

 
1,246,275

 
1,208,521

Reconciliation of segment operating margin to consolidated
income from continuing operations before income taxes:
 
 
 
 
 
 
 
Corporate administrative support
(24,681
)
 
(40,836
)
 
(65,546
)
 
(70,605
)
Consolidated operating income
378,336

 
289,038

 
1,180,729

 
1,137,916

Debt expense
(88,589
)
 
(125,927
)
 
(351,774
)
 
(359,135
)
Debt prepayment, refinancing and redemption charges
(21,242
)
 
—

 
(33,402
)
 
—

Other income, net
5,280

 
4,007

 
17,863

 
10,583

Consolidated income from continuing operations before
income taxes
$
273,785

 
$
167,118

 
$
813,416

 
$
789,364

 
(1)
Includes management fee revenue from providing management and administrative services to dialysis ventures in which the Company owns a noncontrolling equity investment or which are wholly-owned by third parties.
Summary of Assets by Reportable Segment
A summary of assets by reportable segment was as follows:
 
September 30, 2019
 
December 31, 2018
Segment assets
 

 
 

U.S. dialysis and related lab services (including equity
investments of $100,815 and $95,290, respectively)
$
15,997,552

 
$
12,333,641

Other—Ancillary services and strategic initiatives (including
equity investments of $118,571 and $129,321, respectively)
1,454,278

 
1,387,046

DMG—Held for sale (including equity investments of $0 and
$4,833, respectively)
—

 
5,389,565

Consolidated assets
$
17,451,830

 
$
19,110,252
Summary of Depreciation and Amortization Expense by Reportable Segment
Depreciation and amortization expense by reportable segment was as follows:
 
Three months ended
September 30,
 
Nine months ended
September 30,
 
2019
 
2018
 
2019
 
2018
U.S. dialysis and related lab services
$
147,607

 
$
138,669

 
$
433,008

 
$
411,697

Other—Ancillary services and strategic initiatives
8,308

 
7,331

 
23,677

 
24,181

 
$
155,915

 
$
146,000

 
$
456,685

 
$
435,878
Summary of Expenditures for Property and Equipment by Reportable Segment
Expenditures for property and equipment by reportable segment were as follows:
 
Three months ended
September 30,
 
Nine months ended
September 30,
 
2019
 
2018
 
2019
 
2018
U.S. dialysis and related lab services
$
157,721

 
$
214,728

 
$
477,533

 
$
603,186

Other—Ancillary services and strategic initiatives
15,544

 
5,019

 
31,184

 
37,191

DMG—Held for sale
—

 
11,935

 
38,466

 
65,282

 
$
173,265

 
$
231,682

 
$
547,183

 
$
705,659