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Revenue Recognition Segment Revenue by Payor (Details) - USD ($)
$ in Thousands
3 Months Ended 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Sep. 30, 2022
Sep. 30, 2021
Disaggregation of Revenue [Line Items]        
Other revenues $ 102,200 $ 100,379 $ 320,132 $ 304,346
Total revenues 2,948,694 2,938,319 8,693,006 8,674,830
Elimination of intersegment revenues        
Disaggregation of Revenue [Line Items]        
Total revenues (22,957) (22,104) (64,516) (74,718)
Medicare and Medicare Advantage        
Disaggregation of Revenue [Line Items]        
Patient service revenues 1,535,680 1,543,819 4,529,300 4,586,278
Other revenues 78,345 77,277 255,204 243,085
Medicaid and Managed Medicaid        
Disaggregation of Revenue [Line Items]        
Patient service revenues 193,853 203,169 570,380 585,053
Other revenues 412 377 1,181 981
Other Government Payors        
Disaggregation of Revenue [Line Items]        
Patient service revenues 202,936 195,884 603,364 583,678
Commercial Payors        
Disaggregation of Revenue [Line Items]        
Patient service revenues 936,982 917,075 2,734,356 2,685,671
Other revenues 6,484 7,164 16,029 14,387
Other        
Disaggregation of Revenue [Line Items]        
Other revenues 16,959 15,658 47,708 50,415
U.S. dialysis        
Disaggregation of Revenue [Line Items]        
Total revenues 2,680,296 2,675,942 7,877,073 7,893,839
U.S. dialysis | Elimination of intersegment revenues        
Disaggregation of Revenue [Line Items]        
Total revenues (22,957) (22,104) (64,516) (70,424)
U.S. dialysis | Medicare and Medicare Advantage        
Disaggregation of Revenue [Line Items]        
Patient service revenues 1,535,680 1,543,819 4,529,300 4,586,278
U.S. dialysis | Medicaid and Managed Medicaid        
Disaggregation of Revenue [Line Items]        
Patient service revenues 193,853 203,169 570,380 585,053
U.S. dialysis | Other Government Payors        
Disaggregation of Revenue [Line Items]        
Patient service revenues 86,852 82,624 253,731 245,125
U.S. dialysis | Commercial Payors        
Disaggregation of Revenue [Line Items]        
Patient service revenues 880,812 862,218 2,570,054 2,528,499
U.S. dialysis | Other        
Disaggregation of Revenue [Line Items]        
Other revenues 6,056 6,216 18,124 19,308
Other—Ancillary services        
Disaggregation of Revenue [Line Items]        
Total revenues 268,398 262,377 815,933 780,991
Other—Ancillary services | Elimination of intersegment revenues        
Disaggregation of Revenue [Line Items]        
Total revenues (4,294)
Other—Ancillary services | Medicare and Medicare Advantage        
Disaggregation of Revenue [Line Items]        
Other revenues 78,345 77,277 255,204 243,085
Other—Ancillary services | Medicaid and Managed Medicaid        
Disaggregation of Revenue [Line Items]        
Other revenues 412 377 1,181 981
Other—Ancillary services | Other Government Payors        
Disaggregation of Revenue [Line Items]        
Patient service revenues 116,084 113,260 349,633 338,553
Other—Ancillary services | Commercial Payors        
Disaggregation of Revenue [Line Items]        
Patient service revenues 56,170 54,857 164,302 157,172
Other revenues 6,484 7,164 16,029 14,387
Other—Ancillary services | Other        
Disaggregation of Revenue [Line Items]        
Other revenues $ 10,903 $ 9,442 $ 29,584 $ 31,107