DaVita (DVA) 10-Q7 Nov 232023 Q3 Quarterly reportFinancial data

Company Profile

Document and Entity Information

Document and Entity Information - shares shares in Millions	9 Months Ended
Document and Entity Information - shares shares in Millions	Sep. 30, 2023	Nov. 03, 2023
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2023
Document Transition Report	false
Entity File Number	1-14106
Entity Registrant Name	DAVITA INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	51-0354549
Entity Address, Address Line One	2000 16th Street
Entity Address, City or Town	Denver,
Entity Address, State or Province	CO
Entity Address, Postal Zip Code	80202
City Area Code	720
Local Phone Number	631-2100
Title of 12(b) Security	Common Stock, $0.001 par value
Trading Symbol	DVA
Security Exchange Name	NYSE
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		91.3
Amendment Flag	false
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q3
Entity Central Index Key	0000927066
Current Fiscal Year End Date	--12-31

CONSOLIDATED STATEMENTS OF INCO

CONSOLIDATED STATEMENTS OF INCOME (unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Income Statement [Abstract]
Dialysis patient service revenues	$ 2,951,950	$ 2,846,494	$ 8,602,669	$ 8,372,874
Other revenues	169,382	102,200	391,731	320,132
Total revenues	3,121,332	2,948,694	8,994,400	8,693,006
Operating expenses:
Patient care costs	2,067,315	2,085,555	6,181,348	6,120,872
General and administrative	376,883	365,447	1,072,513	975,486
Depreciation and amortization	188,423	194,414	550,166	538,534
Equity investment income, net	(7,228)	(8,509)	(22,502)	(24,696)
Total operating expenses	2,625,393	2,636,907	7,781,525	7,610,196
Operating income	495,939	311,787	1,212,875	1,082,810
Debt expense	(98,080)	(99,680)	(302,361)	(256,057)
Debt Extinguishment And Modification Costs	0	0	7,962	0
Other loss, net	(19,650)	(4,898)	(14,525)	(7,968)
Income before income taxes	378,209	207,209	888,027	818,785
Income tax expense	68,848	42,515	161,621	163,757
Net income	309,361	164,694	726,406	655,028
Less: Net income attributable to noncontrolling interests	(62,729)	(59,328)	(185,536)	(162,731)
Net income attributable to DaVita Inc.	$ 246,632	$ 105,366	$ 540,870	$ 492,297
Earnings per share attributable to DaVita Inc.:
Basic net income	$ 2.70	$ 1.16	$ 5.95	$ 5.24
Diluted net income	$ 2.62	$ 1.13	$ 5.80	$ 5.07
Weighted average shares for earnings per share:
Basic shares	91,322,000	91,160,000	90,937,000	93,959,000
Diluted shares	94,041,000	93,263,000	93,317,000	97,153,000

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Statement of Comprehensive Income [Abstract]
Net income	$ 309,361	$ 164,694	$ 726,406	$ 655,028
Unrealized gains on interest rate cap agreements:
Unrealized gains	6,996	41,312	28,305	95,660
Reclassifications of net realized (gains) losses into net income	(21,198)	1,033	(55,895)	3,100
Unrealized (losses) gains on foreign currency translation:	(47,644)	(66,100)	27,878	(95,064)
Other comprehensive (loss) income	(61,846)	(23,755)	288	3,696
Total comprehensive income	247,515	140,939	726,694	658,724
Less: Comprehensive income attributable to noncontrolling interests	(62,729)	(59,328)	(185,536)	(162,731)
Comprehensive income attributable to DaVita Inc.	$ 184,786	$ 81,611	$ 541,158	$ 495,993

CONSOLIDATED BALANCE SHEETS (un

CONSOLIDATED BALANCE SHEETS (unaudited) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
ASSETS
Cash and Cash Equivalents, at Carrying Value	$ 449,458	$ 244,086
Restricted Cash and Cash Equivalents	95,667	94,903
Short-term investments	11,713	77,693
Accounts receivable, net	2,024,827	2,132,070
Inventories	109,620	109,122
Other receivables	352,965	413,976
Prepaid and other current assets	91,109	78,839
Income tax receivable	0	4,603
Total current assets	3,135,359	3,155,292
Property and equipment, net	3,097,483	3,256,397
Operating lease right-of-use assets	2,509,416	2,666,242
Intangible assets, net	185,403	182,687
Equity method and other investments	565,394	231,108
Long-term investments	45,320	44,329
Other long-term assets	302,142	315,587
Goodwill	7,088,223	7,076,610
Total assets	16,928,740	16,928,252
LIABILITIES AND EQUITY
Accounts payable	435,417	479,780
Other liabilities	808,000	802,469
Accrued compensation and benefits	770,184	692,654
Current portion of operating lease liabilities	393,440	395,401
Current portion of long-term debt	108,558	231,404
Income tax payable	22,331	18,039
Total current liabilities	2,537,930	2,619,747
Long-term operating lease liabilities	2,342,170	2,503,068
Long-term debt	8,285,146	8,692,617
Other long-term liabilities	184,944	105,233
Deferred income taxes	753,871	782,787
Total liabilities	14,104,061	14,703,452
Commitments and contingencies:
Noncontrolling interests subject to put provisions	1,445,403	1,348,908
Equity:
Preferred Stock, Value, Issued	0	0
Common Stock, Value, Issued	91	90
Additional paid-in capital	552,651	606,935
Retained earnings	715,357	174,487
Accumulated other comprehensive loss	(68,898)	(69,186)
Total DaVita Inc. shareholders' equity	1,199,201	712,326
Noncontrolling interests not subject to put provisions	180,075	163,566
Total equity	1,379,276	875,892
Total liabilities and equity	$ 16,928,740	$ 16,928,252

CONSOLIDATED BALANCE SHEETS (_2

CONSOLIDATED BALANCE SHEETS (unaudited) (Parenthetical) - USD ($) shares in Thousands, $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Property and equipment, accumulated depreciation	$ 5,650,912	$ 5,265,372
Intangible assets, accumulated amortization	$ 37,738	$ 49,772
Preferred stock, par value (usd per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	5,000	5,000
Preferred stock, issued (in shares)	0	0
Common stock, par value (usd per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	450,000	450,000
Common stock, shares issued (in shares)	91,348	90,411
Common stock, shares outstanding (in shares)	91,348	90,411

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS (unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Cash flows from operating activities:
Net income	$ 726,406	$ 655,028
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	550,166	538,534
Loss on extinguishment of debt	7,132	0
Stock-based compensation expense	82,313	77,904
Deferred income taxes	(17,767)	(35,637)
Equity investment loss (income), net	40,121	(417)
Other non-cash charges, net	1,633	16,035
Changes in operating assets and liabilities, net of effect of acquisitions and divestitures:
Accounts receivable	118,148	(135,632)
Other current assets	32,132	43,739
Other long-term assets	1,101	(49,326)
Accounts payable	(33,837)	38,870
Accrued compensation and benefits	65,279	35,491
Other current liabilities	10,822	87,248
Income taxes	(1,878)	(37,770)
Other long-term liabilities	(7,945)	(13,219)
Net cash provided by operating activities	1,573,826	1,220,848
Cash flows from investing activities:
Additions of property and equipment	(409,011)	(409,391)
Acquisitions	(7,990)	(43,811)
Proceeds from asset and business sales	24,907	116,088
Purchase of debt investments held-to-maturity	(30,419)	(94,602)
Purchase of other debt and equity investments	(6,693)	(3,322)
Proceeds from debt investments held-to-maturity	94,414	40,660
Proceeds from sale of other debt and equity investments	3,930	3,763
Other	0	(782)
Purchase of equity method investments	(276,006)	(28,176)
Distributions from equity method investments	3,364	2,490
Net cash used in investing activities	(603,504)	(417,083)
Cash flows from financing activities:
Borrowings	2,468,335	1,705,913
Payments on long-term debt	(2,992,248)	(1,557,358)
Deferred and debt related financing costs	(53,466)	0
Purchase of treasury stock	0	(802,228)
Distributions to noncontrolling interests	(203,381)	(188,592)
Net payments related to stock purchases and awards	(41,155)	(42,248)
Contributions from noncontrolling interests	11,579	11,382
Proceeds from sales of additional noncontrolling interests	50,962	3,673
Purchases of noncontrolling interests	(7,875)	(20,770)
Net cash used in financing activities	(767,249)	(890,228)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	3,063	(6,283)
Net increase (decrease) in cash, cash equivalents and restricted cash	206,136	(92,746)
Cash, cash equivalents and restricted cash at beginning of the year	338,989	554,960
Cash, cash equivalents and restricted cash at end of the period	$ 545,125	$ 462,214

CONSOLIDATED STATEMENTS OF EQUI

CONSOLIDATED STATEMENTS OF EQUITY (unaudited) - USD ($) shares in Thousands, $ in Thousands	Total	Total	Non- controlling interests subject to put provisions	Common stock	Additional paid-in capital	Retained earnings	Treasury stock	Accumulated other comprehensive loss	Non- controlling interests not subject to put provisions
Temporary equity, starting balance at Dec. 31, 2021			$ 1,434,832
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income			113,157
Distributions			(125,534)
Contributions			9,300
Temporary Equity, Increase Due To Acquisitions And Divestitures			2,392
Temporary Equity, Decrease Purchase Of Interests			(11,633)
Temporary Equity, Accretion to Redemption Value			(52,218)
Other			457
Temporary equity, ending balance at Sep. 30, 2022			1,370,753
Beginning balance at Dec. 31, 2021		$ 755,508		$ 97	$ 540,321	$ 354,337	$ 0	$ (139,247)	$ 180,640
Common stock, Beginning balance (in shares) at Dec. 31, 2021				97,289
Treasury stock, beginning balance (in shares) at Dec. 31, 2021							0
Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest [Abstract]
Net income attributable to DaVita Inc.		492,297				492,297			49,574
Other comprehensive income (loss)	$ 3,696	3,696						3,696
Stock award plan (in shares)				910
Stock award plan				$ 1
Stock options exercised		(55,358)			(55,359)
Stock-settled stock-based compensation expense		77,835			77,835
Changes in noncontrolling interest from:
Distributions									(63,058)
Contributions									2,082
Acquisitions and divestitures		939			939				867
Partial purchases		(6,609)			(6,609)				(193)
Fair value remeasurements		52,218			52,218
Other									(457)
Purchase of treasury stock		(787,854)					$ (787,854)
Purchase of treasury stock (in shares)							(8,095)
Ending balance at Sep. 30, 2022		532,672		$ 98	609,345	846,634	$ (787,854)	(135,551)	169,455
Common stock, Ending balance (in shares) at Sep. 30, 2022				98,199
Treasury stock, ending balance (in shares) at Sep. 30, 2022							(8,095)
Temporary equity, starting balance at Jun. 30, 2022			1,385,821
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income			39,205
Distributions			(48,275)
Contributions			1,996
Temporary Equity, Decrease Purchase Of Interests			(215)
Temporary Equity, Accretion to Redemption Value			(7,779)
Temporary equity, ending balance at Sep. 30, 2022			1,370,753
Beginning balance at Jun. 30, 2022		604,784		$ 98	578,272	741,268	$ (603,058)	(111,796)	170,390
Common stock, Beginning balance (in shares) at Jun. 30, 2022				98,179
Treasury stock, beginning balance (in shares) at Jun. 30, 2022							(5,973)
Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest [Abstract]
Net income attributable to DaVita Inc.		105,366				105,366			20,123
Other comprehensive income (loss)	(23,755)	(23,755)						(23,755)
Stock award plan (in shares)				20
Stock options exercised		(986)			(986)
Stock-settled stock-based compensation expense		27,619			27,619
Changes in noncontrolling interest from:
Distributions									(22,002)
Contributions									270
Acquisitions and divestitures									867
Partial purchases		(3,339)			(3,339)				(193)
Fair value remeasurements		7,779			7,779
Purchase of treasury stock		(184,796)					$ (184,796)
Purchase of treasury stock (in shares)							(2,122)
Ending balance at Sep. 30, 2022		532,672		$ 98	609,345	846,634	$ (787,854)	(135,551)	169,455
Common stock, Ending balance (in shares) at Sep. 30, 2022				98,199
Treasury stock, ending balance (in shares) at Sep. 30, 2022							(8,095)
Temporary equity, starting balance at Dec. 31, 2022			1,348,908
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income			131,523
Distributions			(133,656)
Contributions			10,102
Temporary Equity, Decrease Purchase Of Interests			(700)
Temporary Equity, Accretion to Redemption Value			89,226
Temporary equity, ending balance at Sep. 30, 2023			1,445,403
Beginning balance at Dec. 31, 2022	$ 875,892	712,326		$ 90	606,935	174,487	$ 0	(69,186)	163,566
Common stock, Beginning balance (in shares) at Dec. 31, 2022	90,411			90,411
Treasury stock, beginning balance (in shares) at Dec. 31, 2022							0
Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest [Abstract]
Net income attributable to DaVita Inc.		540,870				540,870			54,013
Other comprehensive income (loss)	$ 288	288						288
Stock award plan (in shares)				937
Stock award plan				$ 1
Stock options exercised		(53,352)			(53,353)
Stock-settled stock-based compensation expense		80,579			80,579
Changes in noncontrolling interest from:
Distributions									(69,725)
Contributions									1,477
Acquisitions and divestitures		13,077			13,077				30,776
Partial purchases		(5,361)			(5,361)				(32)
Fair value remeasurements		(89,226)			(89,226)
Ending balance at Sep. 30, 2023	$ 1,379,276	1,199,201		$ 91	552,651	715,357	$ 0	(68,898)	180,075
Common stock, Ending balance (in shares) at Sep. 30, 2023	91,348			91,348
Treasury stock, ending balance (in shares) at Sep. 30, 2023							0
Temporary equity, starting balance at Jun. 30, 2023			1,423,549
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income			44,572
Distributions			(52,382)
Contributions			4,493
Temporary Equity, Accretion to Redemption Value			25,171
Temporary equity, ending balance at Sep. 30, 2023			$ 1,445,403
Beginning balance at Jun. 30, 2023		1,017,444		$ 91	555,680	468,725	$ 0	(7,052)	188,626
Common stock, Beginning balance (in shares) at Jun. 30, 2023				91,271
Treasury stock, beginning balance (in shares) at Jun. 30, 2023							0
Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest [Abstract]
Net income attributable to DaVita Inc.		246,632				246,632			18,157
Other comprehensive income (loss)	$ (61,846)	(61,846)						(61,846)
Stock award plan (in shares)				77
Stock options exercised		(4,750)			(4,750)
Stock-settled stock-based compensation expense		27,071			27,071
Changes in noncontrolling interest from:
Distributions									(26,821)
Contributions									140
Partial purchases		(179)			(179)				(27)
Fair value remeasurements		(25,171)			(25,171)
Ending balance at Sep. 30, 2023	$ 1,379,276	$ 1,199,201		$ 91	$ 552,651	$ 715,357	$ 0	$ (68,898)	$ 180,075
Common stock, Ending balance (in shares) at Sep. 30, 2023	91,348			91,348
Treasury stock, ending balance (in shares) at Sep. 30, 2023							0

Condensed consolidated interim

Condensed consolidated interim financial statements Condensed consolidated interim financial statements	9 Months Ended
	Sep. 30, 2023
Text Block [Abstract]
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block]	Condensed consolidated interim financial statementsThe unaudited condensed consolidated interim financial statements included in this report are prepared by the Company. In the opinion of management, all adjustments necessary for a fair presentation of the results of operations are reflected in these condensed consolidated interim financial statements. All significant intercompany accounts and transactions have been eliminated. The preparation of these financial statements requires management to make estimates and assumptions that affect the reported amounts of revenues, expenses, assets, liabilities, contingencies and noncontrolling interests subject to put provisions. The most significant estimates and assumptions underlying these financial statements and accompanying notes generally involve revenue recognition and accounts receivable, certain fair value estimates, accounting for income taxes and loss contingencies. The results of operations reflected in these interim financial statements may not necessarily be indicative of annual operating results. These condensed consolidated interim financial statements should be read in conjunction with the audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2022 (2022 10-K). Prior period classifications conform to the current period presentation. The Company has evaluated subsequent events through the date these condensed consolidated interim financial statements were issued and has included all necessary adjustments and disclosures.

Revenue Recognition Revenue Rec

Revenue Recognition Revenue Recognition	9 Months Ended
Revenue Recognition Revenue Recognition	Sep. 30, 2023
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 September 30, 2023 Three months ended September 30, 2022 U.S. dialysis Other — Ancillary services Consolidated U.S. dialysis Other — Ancillary services Consolidated Dialysis patient service revenues: Medicare and Medicare Advantage $ 1,515,860 $ 1,515,860 $ 1,535,680 $ 1,535,680 Medicaid and Managed Medicaid 207,327 207,327 193,853 193,853 Other government 90,549 $ 128,980 219,529 86,852 $ 116,084 202,936 Commercial 965,331 68,192 1,033,523 880,812 56,170 936,982 Other revenues: Medicare and Medicare Advantage 137,149 137,149 78,345 78,345 Medicaid and Managed Medicaid 331 331 412 412 Commercial 16,063 16,063 6,484 6,484 Other (1) 6,239 11,832 18,071 6,056 10,903 16,959 Eliminations of intersegment revenues (24,289) (2,232) (26,521) (22,957) — (22,957) Total $ 2,761,017 $ 360,315 $ 3,121,332 $ 2,680,296 $ 268,398 $ 2,948,694 (1) Other primarily consists of management service fees earned in the respective Company line of business as well as other non-patient service revenue from the Company's U.S. integrated kidney care (IKC) and other ancillary services and international operations. Nine months ended September 30, 2023 Nine months ended September 30, 2022 U.S. dialysis Other — Ancillary services Consolidated U.S. dialysis Other — Ancillary services Consolidated Dialysis patient service revenues: Medicare and Medicare Advantage $ 4,538,264 $ 4,538,264 $ 4,529,300 $ 4,529,300 Medicaid and Managed Medicaid 629,118 629,118 570,380 570,380 Other government 265,119 $ 376,530 641,649 253,731 $ 349,633 603,364 Commercial 2,676,758 183,578 2,860,336 2,570,054 164,302 2,734,356 Other revenues: Medicare and Medicare Advantage 317,624 317,624 255,204 255,204 Medicaid and Managed Medicaid 1,296 1,296 1,181 1,181 Commercial 20,888 20,888 16,029 16,029 Other (1) 18,822 38,108 56,930 18,124 29,584 47,708 Eliminations of intersegment revenues (66,698) (5,007) (71,705) (64,516) — (64,516) Total $ 8,061,383 $ 933,017 $ 8,994,400 $ 7,877,073 $ 815,933 $ 8,693,006 (1) Other primarily consists of management service fees earned in the respective Company line of business as well as other non-patient service revenue from the Company's U.S. integrated kidney care (IKC) and other ancillary services and international operations. 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 in the period services are provided. 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.

Earnings per share (Notes)

Earnings per share (Notes)	9 Months Ended
Earnings per share (Notes)	Sep. 30, 2023
Earnings Per Share [Abstract]
Earnings Per Share [Text Block]	Earnings per share Basic earnings per share is calculated by dividing net income attributable to the Company by the weighted average number of common shares outstanding. Weighted average common shares outstanding include restricted stock unit awards that are no longer subject to forfeiture because the recipients have satisfied either the explicit vesting terms or retirement eligibility requirements. Diluted earnings per share includes the dilutive effect of outstanding stock-settled stock appreciation rights and unvested stock units as computed under the treasury stock method. The reconciliations of the numerators and denominators used to calculate basic and diluted earnings per share were as follows: Three months ended September 30, Nine months ended September 30, 2023 2022 2023 2022 Net income attributable to DaVita Inc. $ 246,632 $ 105,366 $ 540,870 $ 492,297 Weighted average shares outstanding: Basic shares 91,322 91,160 90,937 93,959 Assumed incremental from stock plans 2,719 2,103 2,380 3,194 Diluted shares 94,041 93,263 93,317 97,153 Basic net income per share attributable to DaVita Inc. $ 2.70 $ 1.16 $ 5.95 $ 5.24 Diluted net income per share attributable to DaVita Inc. $ 2.62 $ 1.13 $ 5.80 $ 5.07 Anti-dilutive stock-settled awards excluded from calculation (1) 271 1,260 615 878 (1) Shares associated with stock awards excluded from the diluted denominator calculation because they were anti-dilutive under the treasury stock method.

Investments in debt and equity

Investments in debt and equity securities	9 Months Ended
Investments in debt and equity securities	Sep. 30, 2023
Investments, Debt and Equity Securities [Abstract]
Investments in debt and equity securities	Short-term and long-term investments The Company’s short-term and long-term debt and equity investments, consisting of debt instruments classified as held-to-maturity and equity investments with readily determinable fair values or redemption values, were as follows: September 30, 2023 December 31, 2022 Debt Equity Total Debt Equity Total Certificates of deposit and other time deposits $ 20,430 $ — $ 20,430 $ 82,879 $ — $ 82,879 Investments in mutual funds and common stocks — 36,603 36,603 — 39,143 39,143 $ 20,430 $ 36,603 $ 57,033 $ 82,879 $ 39,143 $ 122,022 Short-term investments $ 5,419 $ 6,294 $ 11,713 $ 67,872 $ 9,821 $ 77,693 Long-term investments 15,011 30,309 45,320 15,007 29,322 44,329 $ 20,430 $ 36,603 $ 57,033 $ 82,879 $ 39,143 $ 122,022 Debt securities. The Company's short-term debt investments are principally bank certificates of deposit with contractual maturities longer than three months but shorter than one year. The Company's long-term debt investments are bank time deposits with contractual maturities longer than one year. These debt securities are accounted for as held-to-maturity and recorded at amortized cost, which approximated their fair values at September 30, 2023 and December 31, 2022. Equity securitie s. The Company holds certain equity investments that have readily determinable fair values from public markets. The Company's remaining short-term and long-term equity investments are held within a trust to fund existing obligations associated with the Company’s non-qualified deferred compensation plans.

Goodwill

Goodwill	9 Months Ended
Goodwill	Sep. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill	Goodwill Changes in the carrying value of goodwill by reportable segment were as follows: U.S. dialysis Other — Ancillary services Consolidated Balance at December 31, 2021 $ 6,400,162 $ 646,079 $ 7,046,241 Acquisitions 16,750 32,297 49,047 Divestitures (87) (3,263) (3,350) Foreign currency and other adjustments — (15,328) (15,328) Balance at December 31, 2022 $ 6,416,825 $ 659,785 $ 7,076,610 Acquisitions — 4,688 4,688 Foreign currency and other adjustments — 6,925 6,925 Balance at September 30, 2023 $ 6,416,825 $ 671,398 $ 7,088,223 Balance at September 30, 2023: Goodwill $ 6,416,825 $ 789,338 $ 7,206,163 Accumulated impairment charges — (117,940) (117,940) $ 6,416,825 $ 671,398 $ 7,088,223 The Company did not recognize any goodwill impairment charges during the nine months ended September 30, 2023 and 2022. The Company's business continues to be impacted by the effects of the coronavirus (COVID-19). While the Company does not currently expect a material adverse impact to its business as a result of COVID-19, there can be no assurance that the magnitude of the cumulative impacts from COVID-19 will not have a material adverse impact on one or more of the Company's businesses. These cumulative impacts from COVID-19 may include, among other things, the cumulative impact on mortality rates for the kidney patient population and the cumulative impact on certain conditions and developments in the U.S. and global economies, labor market conditions, inflation and monetary policies.

Equity Method and Other Investm

Equity Method and Other Investments	9 Months Ended
Equity Method and Other Investments	Sep. 30, 2023
Investments, Debt and Equity Securities [Abstract]
Equity Method Investments and Joint Ventures Disclosure	Equity method and other investments The Company maintains equity method and other minor investments in the private securities of certain other healthcare and healthcare-related businesses as follows: September 30, 2023 December 31, 2022 Mozarc Medical Holdings LLC $ 342,315 APAC joint venture 98,215 $ 99,141 Other equity method partnerships 112,305 116,403 Adjusted cost method and other investments 12,559 15,564 $ 565,394 $ 231,108 During the nine months ended September 30, 2023 and 2022 the Company recognized equity investment income of $22,502 and $24,696, respectively, from its equity method investments in nonconsolidated dialysis partnerships. The Company also recognized equity investment losses from other equity method investments of $38,653 and $1,974 in other (loss) income during the nine months ended September 30, 2023 and 2022, respectively. On May 25, 2022, the Company entered into an agreement with Medtronic, Inc. and one of its subsidiaries (collectively, Medtronic) to form a new, independent kidney care-focused medical device company (Mozarc Medical Holding LLC, or Mozarc) via a deconsolidating partial interest sale from Medtronic to the Company, which closed effective April 1, 2023. The Company holds a 50% voting equity interest in Mozarc and Medtronic holds the other 50% voting equity interest. The Company does not maintain a controlling financial interest in Mozarc and therefore accounts for this investment on the equity method, with equity method income or loss recognized in Other income (loss), net, on a one-month lag. At the closing, the Company made an estimated purchase price payment, including certain transaction cost adjustments, to Medtronic of $44,651, subject to certain customary post-closing adjustments, and contributed certain other non-cash assets to Mozarc with an estimated value of $14,000. In addition, the Company agreed to pay Medtronic additional consideration of up to $300,000 if certain regulatory, commercial and financial milestones are achieved between 2024 and 2028. At close, the Company and Medtronic also each contributed an additional $224,415 in cash to Mozarc to fund its development initiatives. The Company’s investment in Mozarc was recorded at an initial estimated cost of $375,326, which represents the sum of the cash amounts paid and contributed for the Company’s investment in Mozarc, the estimated fair value of the non-cash assets contributed, the estimated fair value of the Company’s contingent consideration payable to Medtronic for its interest in Mozarc of $86,200, and direct costs incurred to complete this transaction. The foregoing cost estimates are based upon the best information available to management but remain subject to change based on finalization of post-closing purchase price adjustments yet to be completed between the parties and finalization of related third-party valuation reports. As of September 30, 2023, the book value of the Company's contingent consideration payable to Medtronic approximates its estimated fair value. The recorded cost of the Company's equity method investment in Mozarc, and its prospective equity method income (or loss) from that investment, remain subject to finalization of fair value estimates for the following based on third-party valuation reports: the Company's non-cash assets contributed to Mozarc, the Company's contingent consideration payable to Medtronic, and valuation of Mozarc's underlying net assets, including its intangible assets, fixed assets, leases and certain working capital items, some of which are pending final quantification for certain post-closing purchase price adjustments. See Note 9 to the Company's consolidated financial statements included in the 2022 10-K for further description of the Company's other equity method investments.

Long-term debt

Long-term debt	9 Months Ended
Long-term debt	Sep. 30, 2023
Debt Disclosure [Abstract]
Long-term debt	Long-term debt Long-term debt comprised the following: As of September 30, 2023 September 30, December 31, 2022 Maturity date Interest rate Estimated fair value (1) Senior Secured Credit Facilities: Term Loan A-1 (2) $ 1,242,188 (3) SOFR+CSA+2.00% $ 1,220,449 Term Loan B-1 2,610,643 $ 2,660,831 8/12/2026 SOFR+CSA+1.75% $ 2,578,010 New Revolving line of credit (2) — (3) SOFR+CSA+2.00% $ — Prior Term Loan A — 1,498,438 8/12/2024 (4) $ — Prior Revolving line of credit — 165,000 8/12/2024 (4) $ — Senior Notes: 4.625% Senior Notes 2,750,000 2,750,000 6/1/2030 4.625 % $ 2,258,438 3.75% Senior Notes 1,500,000 1,500,000 2/15/2031 3.75 % $ 1,143,750 Acquisition obligations and other notes payable (5) 97,657 120,562 2023-2036 6.89 % $ 97,657 Financing lease obligations (6) 250,695 273,688 2024-2039 4.48 % Total debt principal outstanding 8,451,183 8,968,519 Discount, premium and deferred financing costs (7) (57,479) (44,498) 8,393,704 8,924,021 Less current portion (108,558) (231,404) $ 8,285,146 $ 8,692,617 (1) For the Company's senior secured credit facilities and senior notes, fair value estimates are based upon bid and ask quotes, typically a level 2 input. For acquisition obligations and other notes payable, the carrying values presented approximate their estimated fair values, based on estimates of their present values using level 2 interest rate inputs. (2) The Company's interest rate in its Term Loan A-1 and new revolving line of credit is subject to adjustment depending upon the Company's leverage ratio under the credit agreement governing its senior secured credit facilities. Based on the Company's leverage ratio as of September 30, 2023, the Company's interest rate effective in the fourth quarter of 2023 will be SOFR plus CSA plus 1.75% for its Term Loan A-1 and new revolving line of credit. (3) Outstanding Term Loan A-1 and new revolving line of credit balances are due on April 28, 2028, unless any of Term Loan B-1 remains outstanding 91 days prior to the Term Loan B-1 maturity date, in which case the outstanding Term Loan A-1 and the new revolving line of credit balances become due at that 91 day date (May 13, 2026). (4) At March 31, 2023, the interest rate on the Company's then-existing credit facilities was LIBOR plus an interest rate margin in effect of 1.75% for the prior Term Loan A and prior revolving line of credit. (5) The interest rate presented for acquisition obligations and other notes payable is their weighted average interest rate based on the current fixed and variable interest rate components in effect as of September 30, 2023. (6) Financing lease obligations are measured at their approximate present values at inception. The interest rate presented is the weighted average discount rate embedded in financing leases outstanding. (7) As of September 30, 2023, the carrying amount of the Company's senior secured credit facilities have been reduced by a discount of $2,724 and deferred financing costs of $34,688, and the carrying amount of the Company's senior notes have been reduced by deferred financing costs of $32,668 and increased by a debt premium of $12,601. As of December 31, 2022, the carrying amount of the Company's senior secured credit facilities were reduced by a discount of $3,497 and deferred financing costs of $18,816, and the carrying amount of the Company's senior notes were reduced by deferred financing costs of $36,203 and increased by a debt premium of $14,018. Scheduled maturities of long-term debt at September 30, 2023 were as follows: 2023 (remainder of the year) $ 29,877 2024 $ 110,271 2025 $ 129,871 2026 $ 2,660,604 2027 $ 113,551 2028 $ 1,014,649 Thereafter $ 4,392,360 On April 3, 2023, the Company entered into the Second Amendment (the Second Amendment) to its senior secured credit agreement (the Credit Agreement). The Second Amendment modifies the Credit Agreement to, among other things, transition the interest pricing on Term Loan B-1 from LIBOR + 1.75% to a forward-looking term rate (Term SOFR) based on the Secured Overnight Financing Rate (SOFR) + 1.75% plus an additional credit spread adjustment (CSA), provided that this adjusted rate shall never be less than 0.00%, as well as to update the successor interest rate provisions in the Credit Agreement with respect to Term Loan B-1. As of September 30, 2023, the CSA for all tranches outstanding on the Company's Term Loan B-1 was 0.11%. The Company adopted Accounting Standards Update (ASU) No. 2020-04 and ASU No. 2022-06 regarding reference rate reform during the second quarter and applied one of their practical expedients to treat the amendment of Term Loan B-1 as a non-substantial modification. On April 28, 2023, the Company entered into the Third Amendment (the Third Amendment, and together with the Second Amendment, the Amendments) to the Credit Agreement. The Third Amendment modifies the Credit Agreement to, among other things, refinance its Term Loan A and revolving line of credit with a secured Term Loan A-1 facility in the aggregate principal amount of $1,250,000 and a secured revolving line of credit in the aggregate principal amount of up to $1,500,000 (the foregoing referred to as the new Term Loan A-1 and new revolving line of credit, respectively). The new Term Loan A-1 and new revolving line of credit initially bear interest at Term SOFR, plus a CSA of 0.10% and an interest rate margin of 2.00%, which is subject to adjustment depending upon the Company's leverage ratio under the Credit Agreement, as amended, and which can range from 1.25% to 2.25%, provided that this adjusted rate shall never be less than 0.00%. The new Term Loan A-1 requires amortizing quarterly principal payments beginning on September 30, 2023 of $7,813 per quarter for the first four payments, $15,625 per quarter for the fifth through sixteenth payments, $23,438 per quarter for the seventeenth through nineteenth payments, with the balance due on April 28, 2028. The new revolving line of credit has a five-year term. However, under the Third Amendment, Term Loan A-1 and the new revolving line of credit become due if any of Term Loan B-1 remains outstanding 91 days prior to the Term Loan B-1 maturity date, in which case the Term Loan A-1 balance and any outstanding balance on the new revolving line of credit become due at that 91 day date (May 13, 2026). Borrowings under the Company's senior secured credit facilities are guaranteed and secured by substantially all of DaVita Inc.'s and certain of the Company’s domestic subsidiaries' assets and rank senior to all unsecured indebtedness. Borrowings under the new Term Loan A-1, Term Loan B-1 and new revolving line of credit rank equal in priority for that security and related subsidiary guarantees under the facility's terms. The Credit Agreement, as amended, contains certain customary affirmative and negative covenants such as various restrictions or limitations on permitted amounts of investments (including acquisitions), share repurchases, payment of dividends, and redemptions and incurrence of other indebtedness. Many of these restrictions and limitations will not apply as long as the Company’s leverage ratio calculated in accordance with the Amendments is below 4.00:1.00. In addition, the Amendments require compliance with a maximum leverage ratio covenant, tested quarterly, of 5.00:1.00 through June 30, 2026 and 4.50:1.00 thereafter. In the second quarter of 2023, the Company used a portion of the proceeds from the new Term Loan A-1 and initial borrowing of $400,000 on the new revolving line of credit to pay off the remaining principal balance outstanding and accrued interest and fees on its prior Term Loan A and prior revolving line of credit in the amount of $1,602,199. The remaining borrowings added cash to the balance sheet for general corporate purposes. In addition to the prepayments described above, during the first nine months of 2023, the Company made regularly scheduled and other principal payments under its senior secured credit facilities totaling $54,011 on its prior Term Loan A, $7,813 on Term Loan A-1 and $50,188 on Term Loan B-1. As a result of the transactions described above, the Company recognized debt extinguishment and modification costs of $7,962 in the second quarter of 2023 composed partially of deferred financing costs written off for the portion of debt considered extinguished and reborrowed as a result of the repayment of all principal balances outstanding on the Company's prior Term Loan A and prior revolving line of credit and partially of fees incurred for this transaction. For the portion of the debt that was considered extinguished and reborrowed, the Company recognized constructive financing cash outflows and financing cash inflows on the statement of cash flows of $434,393 and $150,000 for the Term Loan A and prior revolving line of credit, respectively, even though no funds were actually paid or received. Another $715,019 of the debt considered extinguished in this refinancing represented a non-cash financing activity. After September 30, 2023, the Company's 2019 interest rate cap agreements described below have the economic effect of capping the Company's maximum exposure to SOFR variable interest rate changes on equivalent amounts of the Company's floating rate debt, including all of Term Loan B-1 and a portion of new Term Loan A-1. The remaining $352,831 outstanding principal balance of new Term Loan A-1 is subject to SOFR-based interest rate volatility. These cap agreements are designated as cash flow hedges and, as a result, changes in their fair values are reported in other comprehensive income. The original premiums paid for the caps are amortized to debt expense on a straight-line basis over the term of each cap agreement starting from its effective date. These cap agreements do not contain credit risk-contingent features. In the second and third quarters of 2023 the Company entered into several forward interest rate cap agreements, described below, that have the economic effect of capping the Company's exposure to SOFR variable interest rate changes on specific portions of the Company's floating rate debt (2023 cap agreements). These 2023 cap agreements are designated as cash flow hedges and, as a result, changes in their fair values will be reported in other comprehensive income. These 2023 cap agreements, do not contain credit-risk contingent features, and become effective and expire as described in the table below. Certain of these 2023 cap agreements have notional amounts that amortize downward over time. On October 18, 2023, the Company entered into several forward interest rate cap agreements with an aggregate notional amount of $500,000 that become effective on June 28, 2024 and expire on December 31, 2026, and a forward interest rate cap agreement with an aggregate notional amount of $250,000 that becomes effective on December 31, 2024 and expires on December 31, 2025 (together, the October 2023 cap agreements). These October 2023 cap agreements have the economic effect of capping the Company's exposure to SOFR variable interest rate changes on specific portions of the Company's floating rate debt and do not contain credit-risk contingent features. Additionally, the October 2023 cap agreements are designated as cash flow hedges and, as a result, changes in their fair values will be reported in other comprehensive income. Finally, during and as of the end of the second quarter, the Company transitioned the variable rate base on its senior secured credit facilities and related hedging interest rate caps from LIBOR to SOFR. This transition involved a SOFR-to-LIBOR rate mismatch between this debt and the 2019 interest rate caps for a portion of the second quarter, but the Company’s interest rate hedges remained highly effective throughout the transition and thereafter. This transition was accomplished through the Amendments to the Credit Agreement for the Company's senior secured credit facility debt and, for the Company's 2019 interest rate caps outstanding, through the the International Swaps and Derivatives Association (ISDA)'s Interbank Offered Rate (IBOR) Fallbacks Supplement and IBOR Fallbacks Protocol which were established in anticipation of the cessation of LIBOR. That ISDA protocol incorporated fallbacks for derivatives linked to LIBOR which facilitated their transition to a replacement reference rate. The Company has adhered to this ISDA protocol and as of June 30, 2023 has transitioned all of its LIBOR-based derivative exposure to SOFR. The following table summarizes the Company’s interest rate cap agreements outstanding as of September 30, 2023 and December 31, 2022, which are classified in other long-term assets on its consolidated balance sheet: Nine months ended Fair value Notional amount SOFR rate maximum Effective date Expiration date Debt expense (offset) Recorded OCI gain September 30, December 31, 2022 2019 cap agreements $ 3,500,000 2.00% 6/30/2020 6/30/2024 $ (74,475) $ 28,901 $ 90,048 $ 139,755 2023 cap agreements $ 200,000 3.75% 6/28/2024 12/31/2025 $ 1,047 $ 2,238 2023 cap agreements $ 1,000,000 4.00% (1) 6/28/2024 12/31/2025 $ 3,142 $ 12,379 2023 cap agreements $ 1,000,000 4.75% (2) 6/28/2024 12/31/2025 $ 751 $ 9,056 2023 cap agreements $ 800,000 3.75% 6/30/2024 12/31/2025 $ 3,871 $ 8,836 (1) Effective January 1, 2025, the maximum rate of 4.00% decreases to 3.75% for these interest rate caps. (2) Effective January 1, 2025, the maximum rate of 4.75% decreases to 4.00% for these interest rate caps. See Note 10 for further details on amounts reclassified from accumulated other comprehensive loss and recorded as debt expense (offset) related to the Company’s interest rate cap agreements for the three and nine months ended September 30, 2023 and 2022. As a result of the variable rate cap from the Company's 2019 interest rate cap agreements, the Company’s weighted average effective interest rate on its senior secured credit facilities at the end of the third quarter of 2023 was 4.70%, based on the current margins in effect for its senior secured credit facilities as of September 30, 2023, as detailed in the table above. The Company’s weighted average effective interest rate on all debt, including the effect of interest rate caps and amortization of debt discount, for the three and nine months ended September 30, 2023 was 4.61% and as of September 30, 2023 was 4.56%. As of September 30, 2023, the Company’s interest rates were fixed and economically fixed on approximately 54% and 95% of its total debt, respectively. As of September 30, 2023, the Company had an undrawn revolving line of credit under its senior secured credit facilities of $1,500,000. Credit available under this revolving line of credit is reduced by the amount of any letters of credit outstanding under the facility, of which there were none as of September 30, 2023. The Company also had letters of credit of approximately $151,387 outstanding under a separate bilateral secured letter of credit facility as of September 30, 2023.

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
Commitments and Contingencies	Sep. 30, 2023
Commitments and Contingencies Disclosure [Abstract]
Contingencies	Commitments and contingencies The majority of the Company’s revenues are from government programs and may be subject to adjustment as a result of: (i) examination by government agencies or contractors, for which the resolution of any matters raised may take extended periods of time to finalize; (ii) differing interpretations of government regulations by different Medicare contractors or regulatory authorities; (iii) differing opinions regarding a patient’s medical diagnosis or the medical necessity of services provided; and (iv) retroactive applications or interpretations of governmental requirements. In addition, the Company’s revenues from commercial payors may be subject to adjustment as a result of potential claims for refunds, as a result of government actions or as a result of other claims by commercial payors. The Company operates in a highly regulated industry and is a party to various lawsuits, demands, claims, qui tam suits, governmental investigations (which frequently arise from qui tam suits) and audits (including, without limitation, investigations or other actions resulting from its obligation to self-report suspected violations of law) and other legal proceedings, including, without limitation, those described below. The Company records accruals for certain legal proceedings and regulatory matters to the extent that the Company determines an unfavorable outcome is probable and the amount of the loss can be reasonably estimated. As of September 30, 2023 and December 31, 2022, the Company’s total recorded accruals with respect to legal proceedings and regulatory matters, net of anticipated third party recoveries, were immaterial. While these accruals reflect the Company’s best estimate of the probable loss for those matters as of the dates of those accruals, the recorded amounts may differ materially from the actual amount of the losses for those matters, and any anticipated third party recoveries for any such losses may not ultimately be recoverable. Additionally, in some cases, no estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made because of the inherently unpredictable nature of legal proceedings and regulatory matters, which also may be impacted by various factors, including, without limitation, that they may involve indeterminate claims for monetary damages or may involve fines, penalties or non-monetary remedies; present novel legal theories or legal uncertainties; involve disputed facts; represent a shift in regulatory policy; are in the early stages of the proceedings; or may result in a change of business practices. Further, there may be various levels of judicial review available to the Company in connection with any such proceeding. The following is a description of certain lawsuits, claims, governmental investigations and audits and other legal proceedings to which the Company is subject. Certain Governmental Inquiries and Related Proceedings 2017 U.S. Attorney Colorado Investigation : In November 2017, the U.S. Attorney’s Office, District of Colorado informed the Company of an investigation it was conducting into possible federal healthcare offenses involving DaVita Kidney Care, as well as several of the Company’s wholly-owned subsidiaries. In addition to DaVita Kidney Care, the matter currently includes an investigation into DaVita Rx, DaVita Laboratory Services, Inc. (DaVita Labs), and RMS Lifeline Inc. (Lifeline). In each of August 2018, May 2019, and July 2021, the Company received a CID pursuant to the FCA from the U.S. Attorney's Office relating to this investigation. In May 2020, the Company sold its interest in Lifeline, but the Company retained certain liabilities of the Lifeline business, including those related to this investigation. The Company is continuing to cooperate with the government in this investigation. 2020 U.S. Attorney New Jersey Investigation : In March 2020, the U.S. Attorney’s Office, District of New Jersey served the Company with a subpoena and a CID relating to an investigation being conducted by that office and the U.S. Attorney’s Office, Eastern District of Pennsylvania. The subpoena and CID request information on several topics, including certain of the Company’s joint venture arrangements with physicians and physician groups, medical director agreements, and compliance with its five-year Corporate Integrity Agreement, the term of which expired October 22, 2019. In November 2022, the Company learned that, on April 1, 2022, the U.S. Attorney’s Office for the District of New Jersey notified the U.S. District Court for the District of New Jersey of its decision not to elect to intervene in the matter of U.S. ex rel. Doe v. DaVita Inc. and filed a Stipulation of Dismissal. On April 13, 2022, the U.S. District Court for the District of New Jersey dismissed the case without prejudice. On October 12, 2022, the U.S. Attorney’s Office for the Eastern District of Pennsylvania notified the U.S. District Court, Eastern District of Pennsylvania, of its decision not to elect to intervene at this time in the matter of U.S. ex rel. Bayne v. DaVita Inc., et al. The court then unsealed an amended complaint, which alleges violations of federal and state False Claims Acts, by order dated October 14, 2022. In May 2023, the private party relator served the Company with a second amended complaint. On July 14, 2023, the Company filed a motion to dismiss the second amended complaint. On August 4, 2023, the private party relator filed a third amended complaint. On October 18, 2023, the Company filed a motion to dismiss the third amended complaint. 2020 California Department of Insurance Investigation : In April 2020, the California Department of Insurance (CDI) sent the Company an Investigative Subpoena relating to an investigation being conducted by that office. CDI issued a superseding subpoena in September 2020 and an additional subpoena in September 2021. Those subpoenas request information on a number of topics, including but not limited to the Company’s communications with patients about insurance plans and financial assistance from the American Kidney Fund (AKF), analyses of the potential impact of patients’ decisions to change insurance providers, and documents relating to donations or contributions to the AKF. The Company is continuing to cooperate with CDI in this investigation. 2023 District of Columbia Office of Attorney General Investigation : In January 2023, the Office of the Attorney General for the District of Columbia issued a CID to the Company in connection with an antitrust investigation into the AKF. The CID covers the period from January 1, 2016 to the present. The CID requests information on a number of topics, including but not limited to the Company’s communications with AKF, documents relating to donations to the AKF, and communications with patients, providers, and insurers regarding the AKF. The Company is cooperating with the government in this investigation. * * * Although the Company cannot predict whether or when proceedings might be initiated or when these matters may be resolved (other than as may be described above), it is not unusual for inquiries such as these to continue for a considerable period of time through the various phases of document and witness requests and ongoing discussions with regulators and to develop over the course of time. In addition to the inquiries and proceedings specifically identified above, the Company frequently is subject to other inquiries by state or federal government agencies, many of which relate to qui tam complaints filed by relators. Negative findings or terms and conditions that the Company might agree to accept as part of a negotiated resolution of pending or future government inquiries or relator proceedings could result in, among other things, substantial financial penalties or awards against the Company, substantial payments made by the Company, harm to the Company’s reputation, required changes to the Company’s business practices, an impact on the Company's various relationships and/or contracts related to the Company's business, exclusion from future participation in the Medicare, Medicaid and other federal health care programs and, if criminal proceedings were initiated against the Company, members of its board of directors or management, possible criminal penalties, any of which could have a material adverse effect on the Company. Other Proceedings 2021 Antitrust Indictment and Putative Class Action Suit : On July 14, 2021, an indictment was returned by a grand jury in the U.S. District Court, District of Colorado against the Company and its former chief executive officer in the matter of U.S. v. DaVita Inc., et al. alleging that purported agreements entered into by DaVita's former chief executive officer not to solicit senior-level employees violated Section 1 of the Sherman Act. On April 15, 2022, a jury returned a verdict in the Company’s favor, acquitting both the Company and its former chief executive officer on all counts. On April 20, 2022, the court entered judgments of acquittal and closed the case. On August 9, 2021, DaVita Inc. and its former chief executive officer were added as defendants in a consolidated putative class action complaint in the matter of In re Outpatient Medical Center Employee Antitrust Litigation in the U.S. District Court, Northern District of Illinois. This class action complaint asserts that the defendants violated Section 1 of the Sherman Act and seeks to bring an action on behalf of certain groups of individuals employed by the Company between February 1, 2012 and January 5, 2021. On September 26, 2022, the court denied the Company's motion to dismiss. The Company disputes the allegations in the class action complaint, as well as the asserted violations of the Sherman Act, and intends to defend this action accordingly. Additionally, from time to time the Company is subject to other lawsuits, demands, claims, governmental investigations and audits and legal proceedings that arise due to the nature of its business, including, without limitation, contractual disputes, such as with payors, suppliers and others, employee-related matters and professional and general liability claims. From time to time, the Company also initiates litigation or other legal proceedings as a plaintiff arising out of contracts or other matters. * * * Other than as may be described above, the Company cannot predict the ultimate outcomes of the various legal proceedings and regulatory matters to which the Company is or may be subject from time to time, including those described in this Note 8, or the timing of their resolution or the ultimate losses or impact of developments in those matters, which could have a material adverse effect on the Company’s revenues, earnings and cash flows. Further, any legal proceedings or regulatory matters involving the Company, whether meritorious or not, are time consuming, and often require management’s attention and result in significant legal expense, and may result in the diversion of significant operational resources, may impact the Company's various relationships and/or contracts related to the Company's business or otherwise harm the Company’s business, results of operations, financial condition, cash flows or reputation. Resolved Matters 2016 U.S. Attorney Texas Investigation : In February 2016, DaVita Rx, LLC (DaVita Rx), a wholly-owned subsidiary of the Company, received a Civil Investigative Demand (CID) from the U.S. Attorney’s Office, Northern District of Texas. The government conducted a federal False Claims Act (FCA) investigation concerning allegations that DaVita Rx presented or caused to be presented false claims for payment to the government for prescription medications, as well as an investigation into the Company’s relationships with pharmaceutical manufacturers. After its investigation, the government and the named states declined to intervene in the matter, and on April 5, 2023, the U.S. District Court, Northern District of Texas, entered an order unsealing the complaint in the matter of U.S. ex rel. Grenon v. DaVita Rx, LLC et al . The complaint was not served on the Company. On May 31, 2023, the private party relator filed a notice of voluntary dismissal of all claims. On June 1, 2023, the U.S. District Court for the Northern District of Texas dismissed the matter without prejudice. * * *
Noncontrolling interests subject to put provisions and other commitments	Other Commitments The Company also has certain potential commitments to provide working capital funding, if necessary, to certain nonconsolidated dialysis businesses that the Company manages and in which the Company owns a noncontrolling equity interest or which are wholly-owned by third parties of approximately $9,279.

Shareholders' equity

Shareholders' equity	9 Months Ended
Shareholders' equity	Sep. 30, 2023
Equity [Abstract]
Stock-based compensation	Shareholders' equity Stock-based compensation During the nine months ended September 30, 2023, the Company granted 1,343 stock-settled restricted and performance stock units with an aggregate grant-date fair value of $103,599 and a weighted average expected life of approximately 3.4 years. As of September 30, 2023, the Company had $149,839 in total estimated but unrecognized stock-based compensation expense under the Company's equity compensation and employee stock purchase plans. The Company expects to recognize this expense over a weighted average remaining period of 1.4 years.
Share repurchases	Share repurchases The Company has not repurchased any shares subsequent to December 31, 2022.

Accumulated other comprehensive

Accumulated other comprehensive (loss) income	9 Months Ended
Accumulated other comprehensive (loss) income	Sep. 30, 2023
Statement of Comprehensive Income [Abstract]
Comprehensive income	Accumulated other comprehensive loss Three months ended September 30, 2023 Nine months ended September 30, 2023 Interest Foreign Accumulated Interest Foreign Accumulated Beginning balance $ 85,297 $ (92,349) $ (7,052) $ 98,685 $ (167,871) $ (69,186) Unrealized gains (losses) 9,319 (47,644) (38,325) 37,712 27,878 65,590 Related income tax (2,323) — (2,323) (9,407) — (9,407) 6,996 (47,644) (40,648) 28,305 27,878 56,183 Reclassification into net income (28,244) — (28,244) (74,475) — (74,475) Related income tax 7,046 — 7,046 18,580 — 18,580 (21,198) — (21,198) (55,895) — (55,895) Ending balance $ 71,095 $ (139,993) $ (68,898) $ 71,095 $ (139,993) $ (68,898) Three months ended September 30, 2022 Nine months ended September 30, 2022 Interest Foreign Accumulated Interest Foreign Accumulated Beginning balance $ 55,237 $ (167,033) $ (111,796) $ (1,178) $ (138,069) $ (139,247) Unrealized gains (losses) 55,045 (66,100) (11,055) 127,460 (95,064) 32,396 Related income tax (13,733) — (13,733) (31,800) — (31,800) 41,312 (66,100) (24,788) 95,660 (95,064) 596 Reclassification into net income 1,377 — 1,377 4,132 — 4,132 Related income tax (344) — (344) (1,032) — (1,032) 1,033 — 1,033 3,100 — 3,100 Ending balance $ 97,582 $ (233,133) $ (135,551) $ 97,582 $ (233,133) $ (135,551) The interest rate cap agreement net realized losses reclassified into net income are recorded as debt expense in the corresponding consolidated statements of income. See Note 7 for further details.

Variable interest entities

Variable interest entities	9 Months Ended
Variable interest entities	Sep. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Variable interest entities	Variable interest entities (VIEs)At September 30, 2023, these condensed consolidated financial statements include total assets of VIEs of $284,761 and total liabilities and noncontrolling interests of VIEs to third parties of $160,526. There have been no material changes in the nature of the Company's arrangements with VIEs or its judgments concerning them from those described in Note 23 to the Company's consolidated financial statements included in the 2022 10-K.

Fair value of financial instrum

Fair value of financial instruments	9 Months Ended
Fair value of financial instruments	Sep. 30, 2023
Fair Value Disclosures [Abstract]
Fair value of financial instruments	Fair values of financial instruments The Company measures the fair value of certain assets, liabilities and noncontrolling interests subject to put provisions (redeemable equity interests classified as temporary equity) based upon certain valuation techniques that include observable or unobservable inputs and assumptions that market participants would use in pricing these assets, liabilities, temporary equity and commitments. The Company has also classified assets, liabilities and temporary equities that are measured at fair value on a recurring basis into the appropriate fair value hierarchy levels as defined by the Financial Accounting Standards Board (FASB). The following table summarizes the Company’s assets, liabilities and temporary equities measured at fair value on a recurring basis as of September 30, 2023: Total Quoted prices in Significant other Significant Assets Investments in equity securities $ 36,603 $ 36,603 $ — $ — Interest rate cap agreements $ 122,557 $ — $ 122,557 $ — Liabilities Contingent earn-out obligations for acquisitions $ 19,377 $ — $ — $ 19,377 Temporary equity Noncontrolling interests subject to put provisions $ 1,445,403 $ — $ — $ 1,445,403 For a reconciliation of changes in noncontrolling interests subject to put provisions during the three and nine months ended September 30, 2023, see the consolidated statement of equity. Investments in equity securities represent investments in various open-ended registered investment companies (mutual funds) and common stocks and are recorded at fair value estimated based on reported market prices or redemption prices, as applicable. See Note 4 for further discussion. Interest rate cap agreements are recorded at fair value estimated from valuation models utilizing the income approach and commonly accepted valuation techniques that use inputs from closing prices for similar assets and liabilities in active markets as well as other relevant observable market inputs at quoted intervals such as current interest rates, forward yield curves, implied volatility and credit default swap pricing. The Company does not believe the ultimate amount that could be realized upon settlement of these interest rate cap agreements would be materially different from the fair value estimates currently reported. See Note 7 for further discussion. As of September 30, 2023, the Company had contingent earn-out obligations associated with business acquisitions that could result in the Company paying the former owners a total of up to approximately $54,387 if certain performance targets or quality margins are met over the next one year to five years. The estimated fair value measurements of these contingent earn-out obligations are primarily based on unobservable inputs, including key financial metrics such as projected earnings before interest, taxes, depreciation, and amortization (EBITDA), revenue and other key performance indicators. The estimated fair values of these contingent earn-out obligations are remeasured as of each reporting date and could fluctuate based upon any significant changes in key assumptions, such as changes in the Company's credit risk adjusted rate that is used to discount obligations to present value. The estimated fair value of noncontrolling interests subject to put provisions is based principally on the higher of either estimated liquidation value of net assets or a multiple of earnings for each subject dialysis partnership, based on historical earnings, revenue mix, and other performance indicators that can affect future results. The multiples used for these valuations are derived from observed ownership transactions for dialysis businesses between unrelated parties in the U.S. in recent years, and the specific valuation multiple applied to each dialysis partnership is principally determined by its recent and expected revenue mix and contribution margin. As of September 30, 2023, an increase or decrease in the weighted average multiple used in these valuations of one times EBITDA would change the estimated fair value of these noncontrolling interests by approximately $185,000. See Notes 17 and 24 to the Company's consolidated financial statements included in the 2022 10-K for further discussion of the Company’s methodology for estimating the fair value of noncontrolling interests subject to put obligations. The Company's fair value estimates for its senior secured credit facilities and senior notes are based upon quoted bid and ask prices for these instruments, typically a level 2 input. See Note 7 for further discussion of the Company's debt. Other financial instruments consist primarily of cash and cash equivalents, restricted cash and cash equivalents, accounts receivable, accounts payable, other accrued liabilities, lease liabilities and debt. The balances of financial instruments other than debt and lease liabilities are presented in these condensed consolidated financial statements at September 30, 2023 at their approximate fair values due to the short-term nature of their settlements.

Segment reporting

Segment reporting	9 Months Ended
Segment reporting	Sep. 30, 2023
Segment Reporting [Abstract]
Segment Reporting Disclosure	Segment reporting The Company’s operating divisions comprises its U.S. dialysis and related lab services business (its U.S. dialysis business), its U.S. IKC business, its U.S. other ancillary services and its international operations (collectively, its ancillary services), as well as its corporate administrative support. The Company’s separate operating segments include its U.S. dialysis and related lab services business, its U.S. IKC business, its U.S. other ancillary services, its kidney care operations in each foreign sovereign jurisdiction, and its equity method investments in each of the Asia Pacific joint venture (APAC JV) and Mozarc. 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. See Note 25 to the Company's consolidated financial statements included in the 2022 10-K for further description of how the Company determines and measures results for its operating segments. The following is a summary of segment 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, 2023 2022 2023 2022 Segment revenues: U.S. dialysis Dialysis patient service revenues: External sources $ 2,754,778 $ 2,674,240 $ 8,042,561 $ 7,858,939 Intersegment revenues 24,289 22,957 66,698 64,526 U.S. dialysis patient service revenues 2,779,067 2,697,197 8,109,259 7,923,465 Other revenues: External sources 6,239 6,056 18,822 18,134 Intersegment revenues — — — (10) Total U.S. dialysis revenues 2,785,306 2,703,253 8,128,081 7,941,589 Other—Ancillary services Dialysis patient service revenues 197,172 172,254 560,108 513,935 Other external sources 163,143 96,144 372,909 301,998 Intersegment revenues 2,232 — 5,007 — Total ancillary services revenues 362,547 268,398 938,024 815,933 Total net segment revenues 3,147,853 2,971,651 9,066,105 8,757,522 Elimination of intersegment revenues (26,521) (22,957) (71,705) (64,516) Consolidated revenues $ 3,121,332 $ 2,948,694 $ 8,994,400 $ 8,693,006 Segment operating margin (loss): U.S. dialysis $ 509,135 $ 351,474 $ 1,330,992 $ 1,230,715 Other—Ancillary services 28,098 (15,271) (18,372) (56,689) Total segment operating margin 537,233 336,203 1,312,620 1,174,026 Reconciliation of segment operating income to Corporate administrative support (41,294) (24,417) (99,745) (91,217) Consolidated operating income 495,939 311,787 1,212,875 1,082,810 Debt expense (98,080) (99,680) (302,361) (256,057) Debt extinguishment and modification costs — — (7,962) — Other loss, net (19,650) (4,898) (14,525) (7,968) Consolidated income before income taxes $ 378,209 $ 207,209 $ 888,027 $ 818,785 Depreciation and amortization expense by reportable segment was as follows: Three months ended September 30, Nine months ended September 30, 2023 2022 2023 2022 U.S. dialysis $ 175,908 $ 184,688 $ 514,710 $ 507,320 Other—Ancillary services 12,515 9,726 35,456 31,214 $ 188,423 $ 194,414 $ 550,166 $ 538,534 Expenditures for property and equipment by reportable segment were as follows: Nine months ended September 30, 2023 2022 U.S. dialysis $ 363,895 $ 363,046 Other—Ancillary services 45,116 46,345 $ 409,011 $ 409,391 A summary of assets by reportable segment were as follows: September 30, 2023 December 31, 2022 U.S. dialysis $ 14,574,707 $ 15,084,454 Other—Ancillary services 2,354,033 1,843,798 Consolidated assets $ 16,928,740 $ 16,928,252

New accounting standards

New accounting standards	9 Months Ended
New accounting standards	Sep. 30, 2023
Accounting Changes and Error Corrections [Abstract]
New Accounting Standards	New accounting standards New standards recently adopted In March 2020, the FASB issued Accounting Standards Update (ASU) No. 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting. ASU No. 2020-04 provides optional expedients and exceptions for applying U.S. GAAP to contract modifications and hedging relationships, subject to certain criteria, that reference LIBOR or another rate that is expected to be discontinued. The amendments in this ASU were effective beginning on March 12, 2020, and the Company could elect to apply the amendments prospectively through December 31, 2022. In December 2022, the FASB issued ASU No. 2022-06, Reference Rate Reform (Topic 848): Deferral of the Sunset Date of Topic 848 , which extended the election date to December 31, 2024. Effective January 1, 2022 certain LIBOR tenors that do not affect the Company, including the one-week and two-month U.S. dollar LIBOR rate, ceased or became non-representative. The remaining U.S. dollar LIBOR tenors ceased or became non-representative effective July 1, 2023. This change will have no impact on the Company's ability to borrow. The application of this ASU did not have a material impact on its consolidated financial statements. See Note 7 for further discussion of the Company's debt.

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Pay vs Performance Disclosure
Net Income (Loss)	$ 246,632	$ 105,366	$ 540,870	$ 492,297

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended
Insider Trading Arrangements	Sep. 30, 2023
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Condensed consolidated interi_2

Condensed consolidated interim financial statements Condensed consolidaed interim financial statements (Policies)	9 Months Ended
	Sep. 30, 2023
Accounting Policies [Abstract]
Condensed consolidated interim financial statements	Condensed consolidated interim financial statementsThe unaudited condensed consolidated interim financial statements included in this report are prepared by the Company. In the opinion of management, all adjustments necessary for a fair presentation of the results of operations are reflected in these condensed consolidated interim financial statements. All significant intercompany accounts and transactions have been eliminated. The preparation of these financial statements requires management to make estimates and assumptions that affect the reported amounts of revenues, expenses, assets, liabilities, contingencies and noncontrolling interests subject to put provisions. The most significant estimates and assumptions underlying these financial statements and accompanying notes generally involve revenue recognition and accounts receivable, certain fair value estimates, accounting for income taxes and loss contingencies. The results of operations reflected in these interim financial statements may not necessarily be indicative of annual operating results. These condensed consolidated interim financial statements should be read in conjunction with the audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2022 (2022 10-K). Prior period classifications conform to the current period presentation. The Company has evaluated subsequent events through the date these condensed consolidated interim financial statements were issued and has included all necessary adjustments and disclosures.
Revenue	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 in the period services are provided. 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.
Earnings Per Share	Basic earnings per share is calculated by dividing net income attributable to the Company by the weighted average number of common shares outstanding. Weighted average common shares outstanding include restricted stock unit awards that are no longer subject to forfeiture because the recipients have satisfied either the explicit vesting terms or retirement eligibility requirements. Diluted earnings per share includes the dilutive effect of outstanding stock-settled stock appreciation rights and unvested stock units as computed under the treasury stock method.
Short-term and Long-term Investments	Debt securities. The Company's short-term debt investments are principally bank certificates of deposit with contractual maturities longer than three months but shorter than one year. The Company's long-term debt investments are bank time deposits with contractual maturities longer than one year. These debt securities are accounted for as held-to-maturity and recorded at amortized cost, which approximated their fair values at September 30, 2023 and December 31, 2022. Equity securitie s. The Company holds certain equity investments that have readily determinable fair values from public markets. The Company's remaining short-term and long-term equity investments are held within a trust to fund existing obligations associated with the Company’s non-qualified deferred compensation plans.
Long-term debt	These cap agreements are designated as cash flow hedges and, as a result, changes in their fair values are reported in other comprehensive income. The original premiums paid for the caps are amortized to debt expense on a straight-line basis over the term of each cap agreement starting from its effective date. These cap agreements do not contain credit risk-contingent features. In the second and third quarters of 2023 the Company entered into several forward interest rate cap agreements, described below, that have the economic effect of capping the Company's exposure to SOFR variable interest rate changes on specific portions of the Company's floating rate debt (2023 cap agreements). These 2023 cap agreements are designated as cash flow hedges and, as a result, changes in their fair values will be reported in other comprehensive income. These 2023 cap agreements, do not contain credit-risk contingent features, and become effective and expire as described in the table below. Certain of these 2023 cap agreements have notional amounts that amortize downward over time. On October 18, 2023, the Company entered into several forward interest rate cap agreements with an aggregate notional amount of $500,000 that become effective on June 28, 2024 and expire on December 31, 2026, and a forward interest rate cap agreement with an aggregate notional amount of $250,000 that becomes effective on December 31, 2024 and expires on December 31, 2025 (together, the October 2023 cap agreements). These October 2023 cap agreements have the economic effect of capping the Company's exposure to SOFR variable interest rate changes on specific portions of the Company's floating rate debt and do not contain credit-risk contingent features. Additionally, the October 2023 cap agreements are designated as cash flow hedges and, as a result, changes in their fair values will be reported in other comprehensive income. Finally, during and as of the end of the second quarter, the Company transitioned the variable rate base on its senior secured credit facilities and related hedging interest rate caps from LIBOR to SOFR. This transition involved a SOFR-to-LIBOR rate mismatch between this debt and the 2019 interest rate caps for a portion of the second quarter, but the Company’s interest rate hedges remained highly effective throughout the transition and thereafter. This transition was accomplished through the Amendments to the Credit Agreement for the Company's senior secured credit facility debt and, for the Company's 2019 interest rate caps outstanding, through the the International Swaps and Derivatives Association (ISDA)'s Interbank Offered Rate (IBOR) Fallbacks Supplement and IBOR Fallbacks Protocol which were established in anticipation of the cessation of LIBOR. That ISDA protocol incorporated fallbacks for derivatives linked to LIBOR which facilitated their transition to a replacement reference rate. The Company has adhered to this ISDA protocol and as of June 30, 2023 has transitioned all of its LIBOR-based derivative exposure to SOFR.
Fair Value of Financial Instruments	Interest rate cap agreements are recorded at fair value estimated from valuation models utilizing the income approach and commonly accepted valuation techniques that use inputs from closing prices for similar assets and liabilities in active markets as well as other relevant observable market inputs at quoted intervals such as current interest rates, forward yield curves, implied volatility and credit default swap pricing. The Company does not believe the ultimate amount that could be realized upon settlement of these interest rate cap agreements would be materially different from the fair value estimates currently reported.
New Accounting Standards	New accounting standards New standards recently adopted In March 2020, the FASB issued Accounting Standards Update (ASU) No. 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting. ASU No. 2020-04 provides optional expedients and exceptions for applying U.S. GAAP to contract modifications and hedging relationships, subject to certain criteria, that reference LIBOR or another rate that is expected to be discontinued. The amendments in this ASU were effective beginning on March 12, 2020, and the Company could elect to apply the amendments prospectively through December 31, 2022. In December 2022, the FASB issued ASU No. 2022-06, Reference Rate Reform (Topic 848): Deferral of the Sunset Date of Topic 848 , which extended the election date to December 31, 2024. Effective January 1, 2022 certain LIBOR tenors that do not affect the Company, including the one-week and two-month U.S. dollar LIBOR rate, ceased or became non-representative. The remaining U.S. dollar LIBOR tenors ceased or became non-representative effective July 1, 2023. This change will have no impact on the Company's ability to borrow. The application of this ASU did not have a material impact on its consolidated financial statements. See Note 7 for further discussion of the Company's debt.

Revenue Recognition Segment rev

Revenue Recognition Segment revenue by major payor (Tables)	9 Months Ended
Revenue Recognition Segment revenue by major payor (Tables)	Sep. 30, 2023
Revenues by major payor [Abstract]
Disaggregation of Revenue [Table Text Block]	The following tables summarize the Company's segment revenues by primary payor source: Three months ended September 30, 2023 Three months ended September 30, 2022 U.S. dialysis Other — Ancillary services Consolidated U.S. dialysis Other — Ancillary services Consolidated Dialysis patient service revenues: Medicare and Medicare Advantage $ 1,515,860 $ 1,515,860 $ 1,535,680 $ 1,535,680 Medicaid and Managed Medicaid 207,327 207,327 193,853 193,853 Other government 90,549 $ 128,980 219,529 86,852 $ 116,084 202,936 Commercial 965,331 68,192 1,033,523 880,812 56,170 936,982 Other revenues: Medicare and Medicare Advantage 137,149 137,149 78,345 78,345 Medicaid and Managed Medicaid 331 331 412 412 Commercial 16,063 16,063 6,484 6,484 Other (1) 6,239 11,832 18,071 6,056 10,903 16,959 Eliminations of intersegment revenues (24,289) (2,232) (26,521) (22,957) — (22,957) Total $ 2,761,017 $ 360,315 $ 3,121,332 $ 2,680,296 $ 268,398 $ 2,948,694 (1) Other primarily consists of management service fees earned in the respective Company line of business as well as other non-patient service revenue from the Company's U.S. integrated kidney care (IKC) and other ancillary services and international operations. Nine months ended September 30, 2023 Nine months ended September 30, 2022 U.S. dialysis Other — Ancillary services Consolidated U.S. dialysis Other — Ancillary services Consolidated Dialysis patient service revenues: Medicare and Medicare Advantage $ 4,538,264 $ 4,538,264 $ 4,529,300 $ 4,529,300 Medicaid and Managed Medicaid 629,118 629,118 570,380 570,380 Other government 265,119 $ 376,530 641,649 253,731 $ 349,633 603,364 Commercial 2,676,758 183,578 2,860,336 2,570,054 164,302 2,734,356 Other revenues: Medicare and Medicare Advantage 317,624 317,624 255,204 255,204 Medicaid and Managed Medicaid 1,296 1,296 1,181 1,181 Commercial 20,888 20,888 16,029 16,029 Other (1) 18,822 38,108 56,930 18,124 29,584 47,708 Eliminations of intersegment revenues (66,698) (5,007) (71,705) (64,516) — (64,516) Total $ 8,061,383 $ 933,017 $ 8,994,400 $ 7,877,073 $ 815,933 $ 8,693,006 (1) Other primarily consists of management service fees earned in the respective Company line of business as well as other non-patient service revenue from the Company's U.S. integrated kidney care (IKC) and other ancillary services and international operations.

Earnings per share Earnings Per

Earnings per share Earnings Per Share (Tables)	9 Months Ended
Earnings per share Earnings Per Share (Tables)	Sep. 30, 2023
Earnings Per Share [Abstract]
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]	The reconciliations of the numerators and denominators used to calculate basic and diluted earnings per share were as follows: Three months ended September 30, Nine months ended September 30, 2023 2022 2023 2022 Net income attributable to DaVita Inc. $ 246,632 $ 105,366 $ 540,870 $ 492,297 Weighted average shares outstanding: Basic shares 91,322 91,160 90,937 93,959 Assumed incremental from stock plans 2,719 2,103 2,380 3,194 Diluted shares 94,041 93,263 93,317 97,153 Basic net income per share attributable to DaVita Inc. $ 2.70 $ 1.16 $ 5.95 $ 5.24 Diluted net income per share attributable to DaVita Inc. $ 2.62 $ 1.13 $ 5.80 $ 5.07 Anti-dilutive stock-settled awards excluded from calculation (1) 271 1,260 615 878 (1) Shares associated with stock awards excluded from the diluted denominator calculation because they were anti-dilutive under the treasury stock method.

Investments in debt and equit_2

Investments in debt and equity securities (Tables)	9 Months Ended
Investments in debt and equity securities (Tables)	Sep. 30, 2023
Investments, Debt and Equity Securities [Abstract]
Schedule of Investments	The Company’s short-term and long-term debt and equity investments, consisting of debt instruments classified as held-to-maturity and equity investments with readily determinable fair values or redemption values, were as follows: September 30, 2023 December 31, 2022 Debt Equity Total Debt Equity Total Certificates of deposit and other time deposits $ 20,430 $ — $ 20,430 $ 82,879 $ — $ 82,879 Investments in mutual funds and common stocks — 36,603 36,603 — 39,143 39,143 $ 20,430 $ 36,603 $ 57,033 $ 82,879 $ 39,143 $ 122,022 Short-term investments $ 5,419 $ 6,294 $ 11,713 $ 67,872 $ 9,821 $ 77,693 Long-term investments 15,011 30,309 45,320 15,007 29,322 44,329 $ 20,430 $ 36,603 $ 57,033 $ 82,879 $ 39,143 $ 122,022

Goodwill (Tables)

Goodwill (Tables)	9 Months Ended
Goodwill (Tables)	Sep. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Changes in Goodwill by Reportable Segments [Text Block]	Changes in the carrying value of goodwill by reportable segment were as follows: U.S. dialysis Other — Ancillary services Consolidated Balance at December 31, 2021 $ 6,400,162 $ 646,079 $ 7,046,241 Acquisitions 16,750 32,297 49,047 Divestitures (87) (3,263) (3,350) Foreign currency and other adjustments — (15,328) (15,328) Balance at December 31, 2022 $ 6,416,825 $ 659,785 $ 7,076,610 Acquisitions — 4,688 4,688 Foreign currency and other adjustments — 6,925 6,925 Balance at September 30, 2023 $ 6,416,825 $ 671,398 $ 7,088,223 Balance at September 30, 2023: Goodwill $ 6,416,825 $ 789,338 $ 7,206,163 Accumulated impairment charges — (117,940) (117,940) $ 6,416,825 $ 671,398 $ 7,088,223

Equity Method and Other Inves_2

Equity Method and Other Investments Equity Method and Other Investments (Tables)	9 Months Ended
	Sep. 30, 2023
Equity Method Investments and Joint Ventures [Abstract]
Equity Method Investments	The Company maintains equity method and other minor investments in the private securities of certain other healthcare and healthcare-related businesses as follows: September 30, 2023 December 31, 2022 Mozarc Medical Holdings LLC $ 342,315 APAC joint venture 98,215 $ 99,141 Other equity method partnerships 112,305 116,403 Adjusted cost method and other investments 12,559 15,564 $ 565,394 $ 231,108

Long-term debt (Tables)

Long-term debt (Tables)	9 Months Ended
Long-term debt (Tables)	Sep. 30, 2023
Debt Disclosure [Abstract]
Long-term Debt	Long-term debt comprised the following: As of September 30, 2023 September 30, December 31, 2022 Maturity date Interest rate Estimated fair value (1) Senior Secured Credit Facilities: Term Loan A-1 (2) $ 1,242,188 (3) SOFR+CSA+2.00% $ 1,220,449 Term Loan B-1 2,610,643 $ 2,660,831 8/12/2026 SOFR+CSA+1.75% $ 2,578,010 New Revolving line of credit (2) — (3) SOFR+CSA+2.00% $ — Prior Term Loan A — 1,498,438 8/12/2024 (4) $ — Prior Revolving line of credit — 165,000 8/12/2024 (4) $ — Senior Notes: 4.625% Senior Notes 2,750,000 2,750,000 6/1/2030 4.625 % $ 2,258,438 3.75% Senior Notes 1,500,000 1,500,000 2/15/2031 3.75 % $ 1,143,750 Acquisition obligations and other notes payable (5) 97,657 120,562 2023-2036 6.89 % $ 97,657 Financing lease obligations (6) 250,695 273,688 2024-2039 4.48 % Total debt principal outstanding 8,451,183 8,968,519 Discount, premium and deferred financing costs (7) (57,479) (44,498) 8,393,704 8,924,021 Less current portion (108,558) (231,404) $ 8,285,146 $ 8,692,617 (1) For the Company's senior secured credit facilities and senior notes, fair value estimates are based upon bid and ask quotes, typically a level 2 input. For acquisition obligations and other notes payable, the carrying values presented approximate their estimated fair values, based on estimates of their present values using level 2 interest rate inputs. (2) The Company's interest rate in its Term Loan A-1 and new revolving line of credit is subject to adjustment depending upon the Company's leverage ratio under the credit agreement governing its senior secured credit facilities. Based on the Company's leverage ratio as of September 30, 2023, the Company's interest rate effective in the fourth quarter of 2023 will be SOFR plus CSA plus 1.75% for its Term Loan A-1 and new revolving line of credit. (3) Outstanding Term Loan A-1 and new revolving line of credit balances are due on April 28, 2028, unless any of Term Loan B-1 remains outstanding 91 days prior to the Term Loan B-1 maturity date, in which case the outstanding Term Loan A-1 and the new revolving line of credit balances become due at that 91 day date (May 13, 2026). (4) At March 31, 2023, the interest rate on the Company's then-existing credit facilities was LIBOR plus an interest rate margin in effect of 1.75% for the prior Term Loan A and prior revolving line of credit. (5) The interest rate presented for acquisition obligations and other notes payable is their weighted average interest rate based on the current fixed and variable interest rate components in effect as of September 30, 2023. (6) Financing lease obligations are measured at their approximate present values at inception. The interest rate presented is the weighted average discount rate embedded in financing leases outstanding. (7) As of September 30, 2023, the carrying amount of the Company's senior secured credit facilities have been reduced by a discount of $2,724 and deferred financing costs of $34,688, and the carrying amount of the Company's senior notes have been reduced by deferred financing costs of $32,668 and increased by a debt premium of $12,601. As of December 31, 2022, the carrying amount of the Company's senior secured credit facilities were reduced by a discount of $3,497 and deferred financing costs of $18,816, and the carrying amount of the Company's senior notes were reduced by deferred financing costs of $36,203 and increased by a debt premium of $14,018.
Scheduled Maturities of Long-term Debt	Scheduled maturities of long-term debt at September 30, 2023 were as follows: 2023 (remainder of the year) $ 29,877 2024 $ 110,271 2025 $ 129,871 2026 $ 2,660,604 2027 $ 113,551 2028 $ 1,014,649 Thereafter $ 4,392,360
Schedule of Derivative Instruments	The following table summarizes the Company’s interest rate cap agreements outstanding as of September 30, 2023 and December 31, 2022, which are classified in other long-term assets on its consolidated balance sheet: Nine months ended Fair value Notional amount SOFR rate maximum Effective date Expiration date Debt expense (offset) Recorded OCI gain September 30, December 31, 2022 2019 cap agreements $ 3,500,000 2.00% 6/30/2020 6/30/2024 $ (74,475) $ 28,901 $ 90,048 $ 139,755 2023 cap agreements $ 200,000 3.75% 6/28/2024 12/31/2025 $ 1,047 $ 2,238 2023 cap agreements $ 1,000,000 4.00% (1) 6/28/2024 12/31/2025 $ 3,142 $ 12,379 2023 cap agreements $ 1,000,000 4.75% (2) 6/28/2024 12/31/2025 $ 751 $ 9,056 2023 cap agreements $ 800,000 3.75% 6/30/2024 12/31/2025 $ 3,871 $ 8,836 (1) Effective January 1, 2025, the maximum rate of 4.00% decreases to 3.75% for these interest rate caps. (2) Effective January 1, 2025, the maximum rate of 4.75% decreases to 4.00% for these interest rate caps.

Accumulated other comprehensi_2

Accumulated other comprehensive (loss) income (Tables)	9 Months Ended
Accumulated other comprehensive (loss) income (Tables)	Sep. 30, 2023
Statement of Comprehensive Income [Abstract]
Comprehensive income	Three months ended September 30, 2023 Nine months ended September 30, 2023 Interest Foreign Accumulated Interest Foreign Accumulated Beginning balance $ 85,297 $ (92,349) $ (7,052) $ 98,685 $ (167,871) $ (69,186) Unrealized gains (losses) 9,319 (47,644) (38,325) 37,712 27,878 65,590 Related income tax (2,323) — (2,323) (9,407) — (9,407) 6,996 (47,644) (40,648) 28,305 27,878 56,183 Reclassification into net income (28,244) — (28,244) (74,475) — (74,475) Related income tax 7,046 — 7,046 18,580 — 18,580 (21,198) — (21,198) (55,895) — (55,895) Ending balance $ 71,095 $ (139,993) $ (68,898) $ 71,095 $ (139,993) $ (68,898) Three months ended September 30, 2022 Nine months ended September 30, 2022 Interest Foreign Accumulated Interest Foreign Accumulated Beginning balance $ 55,237 $ (167,033) $ (111,796) $ (1,178) $ (138,069) $ (139,247) Unrealized gains (losses) 55,045 (66,100) (11,055) 127,460 (95,064) 32,396 Related income tax (13,733) — (13,733) (31,800) — (31,800) 41,312 (66,100) (24,788) 95,660 (95,064) 596 Reclassification into net income 1,377 — 1,377 4,132 — 4,132 Related income tax (344) — (344) (1,032) — (1,032) 1,033 — 1,033 3,100 — 3,100 Ending balance $ 97,582 $ (233,133) $ (135,551) $ 97,582 $ (233,133) $ (135,551)

Fair value of financial instr_2

Fair value of financial instruments (Tables)	9 Months Ended
Fair value of financial instruments (Tables)	Sep. 30, 2023
Fair Value Disclosures [Abstract]
Assets, Liabilities and Temporary Equity Measured at Fair Value on a Recurring Basis	The following table summarizes the Company’s assets, liabilities and temporary equities measured at fair value on a recurring basis as of September 30, 2023: Total Quoted prices in Significant other Significant Assets Investments in equity securities $ 36,603 $ 36,603 $ — $ — Interest rate cap agreements $ 122,557 $ — $ 122,557 $ — Liabilities Contingent earn-out obligations for acquisitions $ 19,377 $ — $ — $ 19,377 Temporary equity Noncontrolling interests subject to put provisions $ 1,445,403 $ — $ — $ 1,445,403 For a reconciliation of changes in noncontrolling interests subject to put provisions during the three and nine months ended September 30, 2023, see the consolidated statement of equity.

Segment reporting (Tables)

Segment reporting (Tables)	9 Months Ended
Segment reporting (Tables)	Sep. 30, 2023
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 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, 2023 2022 2023 2022 Segment revenues: U.S. dialysis Dialysis patient service revenues: External sources $ 2,754,778 $ 2,674,240 $ 8,042,561 $ 7,858,939 Intersegment revenues 24,289 22,957 66,698 64,526 U.S. dialysis patient service revenues 2,779,067 2,697,197 8,109,259 7,923,465 Other revenues: External sources 6,239 6,056 18,822 18,134 Intersegment revenues — — — (10) Total U.S. dialysis revenues 2,785,306 2,703,253 8,128,081 7,941,589 Other—Ancillary services Dialysis patient service revenues 197,172 172,254 560,108 513,935 Other external sources 163,143 96,144 372,909 301,998 Intersegment revenues 2,232 — 5,007 — Total ancillary services revenues 362,547 268,398 938,024 815,933 Total net segment revenues 3,147,853 2,971,651 9,066,105 8,757,522 Elimination of intersegment revenues (26,521) (22,957) (71,705) (64,516) Consolidated revenues $ 3,121,332 $ 2,948,694 $ 8,994,400 $ 8,693,006 Segment operating margin (loss): U.S. dialysis $ 509,135 $ 351,474 $ 1,330,992 $ 1,230,715 Other—Ancillary services 28,098 (15,271) (18,372) (56,689) Total segment operating margin 537,233 336,203 1,312,620 1,174,026 Reconciliation of segment operating income to Corporate administrative support (41,294) (24,417) (99,745) (91,217) Consolidated operating income 495,939 311,787 1,212,875 1,082,810 Debt expense (98,080) (99,680) (302,361) (256,057) Debt extinguishment and modification costs — — (7,962) — Other loss, net (19,650) (4,898) (14,525) (7,968) Consolidated income before income taxes $ 378,209 $ 207,209 $ 888,027 $ 818,785
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, 2023 2022 2023 2022 U.S. dialysis $ 175,908 $ 184,688 $ 514,710 $ 507,320 Other—Ancillary services 12,515 9,726 35,456 31,214 $ 188,423 $ 194,414 $ 550,166 $ 538,534
Summary of Expenditures for Property and Equipment by Reportable Segment	Expenditures for property and equipment by reportable segment were as follows: Nine months ended September 30, 2023 2022 U.S. dialysis $ 363,895 $ 363,046 Other—Ancillary services 45,116 46,345 $ 409,011 $ 409,391
Summary of Assets by Reportable Segment	A summary of assets by reportable segment were as follows: September 30, 2023 December 31, 2022 U.S. dialysis $ 14,574,707 $ 15,084,454 Other—Ancillary services 2,354,033 1,843,798 Consolidated assets $ 16,928,740 $ 16,928,252

Revenue Recognition Segment R_2

Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Disaggregation of Revenue [Line Items]
Other revenues	$ 169,382	$ 102,200	$ 391,731	$ 320,132
Total revenues	3,121,332	2,948,694	8,994,400	8,693,006
Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(26,521)	(22,957)	(71,705)	(64,516)
Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	1,515,860	1,535,680	4,538,264	4,529,300
Other revenues	137,149	78,345	317,624	255,204
Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	207,327	193,853	629,118	570,380
Other revenues	331	412	1,296	1,181
Other Government Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	219,529	202,936	641,649	603,364
Commercial Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	1,033,523	936,982	2,860,336	2,734,356
Other revenues	16,063	6,484	20,888	16,029
Other
Disaggregation of Revenue [Line Items]
Other revenues	18,071	16,959	56,930	47,708
U.S. dialysis
Disaggregation of Revenue [Line Items]
Total revenues	2,761,017	2,680,296	8,061,383	7,877,073
U.S. dialysis \| Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(24,289)	(22,957)	(66,698)	(64,516)
U.S. dialysis \| Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	1,515,860	1,535,680	4,538,264	4,529,300
U.S. dialysis \| Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	207,327	193,853	629,118	570,380
U.S. dialysis \| Other Government Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	90,549	86,852	265,119	253,731
U.S. dialysis \| Commercial Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	965,331	880,812	2,676,758	2,570,054
U.S. dialysis \| Other
Disaggregation of Revenue [Line Items]
Other revenues	6,239	6,056	18,822	18,124
Other—Ancillary services
Disaggregation of Revenue [Line Items]
Total revenues	360,315	268,398	933,017	815,933
Other—Ancillary services \| Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(2,232)		(5,007)
Other—Ancillary services \| Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Other revenues	137,149	78,345	317,624	255,204
Other—Ancillary services \| Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Other revenues	331	412	1,296	1,181
Other—Ancillary services \| Other Government Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	128,980	116,084	376,530	349,633
Other—Ancillary services \| Commercial Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	68,192	56,170	183,578	164,302
Other revenues	16,063	6,484	20,888	16,029
Other—Ancillary services \| Other
Disaggregation of Revenue [Line Items]
Other revenues	$ 11,832	$ 10,903	$ 38,108	$ 29,584

Earnings per share Earnings p_2

Earnings per share Earnings per share - Reconciliation of numerators and denominators used to calculate basic and diluted earnings per share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Numerators:
Net income attributable to DaVita Inc.	$ 246,632	$ 105,366	$ 540,870	$ 492,297
Weighted average basic shares outstanding during period	91,322,000	91,160,000	90,937,000	93,959,000
Assumed incremental from stock plans	2,719,000	2,103,000	2,380,000	3,194,000
Weighted average diluted shares outstanding during period	94,041,000	93,263,000	93,317,000	97,153,000
Basic net income per share attributable to DaVita Inc.	$ 2.70	$ 1.16	$ 5.95	$ 5.24
Diluted net income per share attributable to DaVita Inc.	$ 2.62	$ 1.13	$ 5.80	$ 5.07
Anti-dilutive stock-settled awards excluded from calculation	271,000	1,260,000	615,000	878,000

Investments in debt and equit_3

Investments in debt and equity securities (Detail) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Investment Holdings [Line Items]
Debt securities	$ 20,430	$ 82,879
Investments in equity securities	36,603	39,143
Equity Securities, FV-NI	36,603	39,143
Total	57,033	122,022
Debt securities, short-term investments	5,419	67,872
Short-term investments	11,713	77,693
Debt securities, long-term investments	15,011	15,007
Long-term investments	45,320	44,329
Certificates of deposit and other time deposits
Investment Holdings [Line Items]
Debt securities	20,430	82,879
Investments in equity securities	0	0
Total	20,430	82,879
Investments in mutual funds and common stocks
Investment Holdings [Line Items]
Debt securities	0	0
Investments in equity securities	36,603	39,143
Total	36,603	39,143
Short-term Investments
Investment Holdings [Line Items]
Investments in equity securities	6,294	9,821
Long-term Investments
Investment Holdings [Line Items]
Equity Securities, FV-NI, Noncurrent	$ 30,309	$ 29,322

Goodwill - Changes in Goodwill

Goodwill - Changes in Goodwill by Reportable Segments (Detail) - USD ($) $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2023	Dec. 31, 2022
Goodwill [Roll Forward]
Beginning balance	$ 7,076,610	$ 7,046,241
Acquisitions	4,688	49,047
Divestitures		(3,350)
Foreign currency and other adjustments	6,925	(15,328)
Ending balance	7,088,223	7,076,610
Goodwill, before accumulated impairment charges	7,206,163
Accumulated impairment charges	(117,940)
Ending balance	7,088,223	7,076,610
U.S. dialysis
Goodwill [Roll Forward]
Beginning balance	6,416,825	6,400,162
Acquisitions	0	16,750
Divestitures		(87)
Foreign currency and other adjustments	0	0
Ending balance	6,416,825	6,416,825
Goodwill, before accumulated impairment charges	6,416,825
Accumulated impairment charges	0
Ending balance	6,416,825	6,416,825
Other—Ancillary services
Goodwill [Roll Forward]
Beginning balance	659,785	646,079
Acquisitions	4,688	32,297
Divestitures		(3,263)
Foreign currency and other adjustments	6,925	(15,328)
Ending balance	671,398	659,785
Goodwill, before accumulated impairment charges	789,338
Accumulated impairment charges	(117,940)
Ending balance	$ 671,398	$ 659,785

Goodwill - Narrative (Details)

Goodwill - Narrative (Details) $ in Thousands	3 Months Ended	9 Months Ended
Goodwill - Narrative (Details) $ in Thousands	Sep. 30, 2023 segment	Sep. 30, 2023 USD ($)
Goodwill [Line Items]
Goodwill impairment charges \| $		$ 0
Other Health Operations
Goodwill [Line Items]
Number of Reportable Segments \| segment	0

Equity Method and Other Inves_3

Equity Method and Other Investments Equity Method and Other Investments (Details) - USD ($) $ in Thousands	Apr. 01, 2023	Sep. 30, 2023	Dec. 31, 2022
Schedule of Equity Method and Other Investments [Line Items]
Equity method and other investments		$ 565,394	$ 231,108
Mozarc Medical Holdings LLC
Schedule of Equity Method and Other Investments [Line Items]
Transaction Agreement Date	May 25, 2022
Transaction Agreement Effective Closing Date	Apr. 01, 2023
Payments to Medtronic	$ 44,651
Maximum Additional Consideration to be paid between 2024 through 2028	300,000
Contributed Other Non-Cash Assets	14,000
Fair value of Contingent Consideration payable to Medtronic	86,200
Additional Cash Contributed	224,415
Equity Method Investment, Initial Aggregate Cost	$ 375,326
Mozarc Medical Holdings LLC
Schedule of Equity Method and Other Investments [Line Items]
Equity method and other investments		342,315
Voting Equity Interest in Mozarc, Owned by Medtronic	50%
Voting Equity Interest by the Company	50%
APAC joint venture
Schedule of Equity Method and Other Investments [Line Items]
Equity method and other investments		98,215	99,141
Adjusted cost method and other investments
Schedule of Equity Method and Other Investments [Line Items]
Equity method and other investments		12,559	15,564
Other equity method partnerships
Schedule of Equity Method and Other Investments [Line Items]
Equity method and other investments		$ 112,305	$ 116,403

Equity Method and Other Inves_4

Equity Method and Other Investments - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Equity Method Investment income from equity method investments
Equity investment income (loss) from equity method investments in nonconsolidated dialysis partnerships.	$ 7,228	$ 8,509	$ 22,502	$ 24,696
Other Nonoperating Income (Expense)
Equity Method Investment income from equity method investments
Equity investment income (loss) from other equity method investments			(38,653)	(1,974)
Equity Method Investments In Nonconsolidated Dialysis Partnerships [Member]
Equity Method Investment income from equity method investments
Equity investment income (loss) from equity method investments in nonconsolidated dialysis partnerships.			$ 22,502	$ 24,696

Long-term debt (Detail)

Long-term debt (Detail) - USD ($) $ in Thousands		3 Months Ended				9 Months Ended
Long-term debt (Detail) - USD ($) $ in Thousands	Apr. 28, 2023	Dec. 31, 2023	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Total debt principal outstanding			$ 8,451,183			$ 8,451,183	$ 8,968,519
Discount Premium And Deferred Financing Costs			(57,479)			(57,479)	(44,498)
Carrying amount of long-term debt, net of unamortized discounts			8,393,704			8,393,704	8,924,021
Less current portion			(108,558)			(108,558)	(231,404)
Total long-term debt			$ 8,285,146			$ 8,285,146	8,692,617
Debt interest rate during period			4.61%			4.61%
Long-term debt, weighted average interest rate, at point in time			4.56%			4.56%
4.625% Senior Notes
Debt Instrument [Line Items]
Senior Notes			$ 2,750,000			$ 2,750,000	2,750,000
Debt Instrument, Maturity Date						Jun. 01, 2030
Debt interest rate during period						4.625%
Debt Instrument, Fair Value Disclosure			2,258,438			$ 2,258,438
3.75% Senior Notes
Debt Instrument [Line Items]
Senior Notes			1,500,000			$ 1,500,000	1,500,000
Debt Instrument, Maturity Date						Feb. 15, 2031
Debt interest rate during period						3.75%
Debt Instrument, Fair Value Disclosure			1,143,750			$ 1,143,750
Acquisition obligations and other notes payable
Debt Instrument [Line Items]
Acquisition obligations and other notes payable			$ 97,657			$ 97,657	120,562
Debt instrument, maturity date, description						2023-2036
Long-term debt, weighted average interest rate, at point in time			6.89%			6.89%
Acquisition obligations and other notes payable, fair value			$ 97,657			$ 97,657
Financing lease obligations
Debt Instrument [Line Items]
Financing lease obligations			$ 250,695			$ 250,695	273,688
Debt instrument, maturity date, description						2024-2039
Finance lease, weighted average discount rate, percent			4.48%			4.48%
Prior Revolving line of credit
Debt Instrument [Line Items]
Secured Debt			$ 0			$ 0	165,000
Debt Instrument, Maturity Date						Aug. 12, 2024
Revolving line of credit, fair value of amount outstanding			0			$ 0
Constructive Financing Cash Outflows And Financing Cash Inflows				$ 150,000
New Revolving line of credit
Debt Instrument [Line Items]
Secured Debt			0			0
Revolving line of credit, fair value of amount outstanding			0			$ 0
Initial Borrowing on the New Revolving Line Of Credit	$ 400,000
New Revolving line of credit \| SOFR
Debt Instrument [Line Items]
Debt Instrument, Description of the Variable Rate Basis						SOFR+CSA+2.00%
Prior Term Loan A
Debt Instrument [Line Items]
Secured Debt			0			$ 0	1,498,438
Debt Instrument, Maturity Date						Aug. 12, 2024
Debt Instrument, Fair Value Disclosure			0			$ 0
Constructive Financing Cash Outflows And Financing Cash Inflows				434,393
Other Significant Noncash Financing Activity				$ 715,019
Prior Term Loan A \| Prior Revolving line of credit \| LIBOR
Debt Instrument [Line Items]
LIBOR					1.75%
Term Loan A-1
Debt Instrument [Line Items]
Secured Debt	$ 1,250,000		1,242,188			1,242,188
Debt Instrument, Fair Value Disclosure			$ 1,220,449			$ 1,220,449
Term Loan A-1 \| SOFR
Debt Instrument [Line Items]
Debt Instrument, Description of the Variable Rate Basis						SOFR+CSA+2.00%
Term Loan A-1 \| New Revolving line of credit
Debt Instrument [Line Items]
Debt Instrument Period Before Maturity Date When Unpaid Amount Triggers Change In Due Date			May 13, 2026
Term Loan A-1 \| New Revolving line of credit \| Minimum
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin			0%
Term Loan A-1 \| New Revolving line of credit \| SOFR
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin			2%
Term Loan A-1 \| New Revolving line of credit \| SOFR \| Minimum
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin			1.25%
Term Loan A-1 \| New Revolving line of credit \| SOFR \| Maximum
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin			2.25%
Term Loan A-1 \| New Revolving line of credit \| SOFR \| Subsequent Event
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin		1.75%
Term Loan A-1 \| New Revolving line of credit \| Adjusted Rate
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin			0.10%
Term Loan B-1
Debt Instrument [Line Items]
Secured Debt			$ 2,610,643			$ 2,610,643	$ 2,660,831
Debt Instrument, Maturity Date						Aug. 12, 2026
Debt Instrument, Fair Value Disclosure			$ 2,578,010			$ 2,578,010
Term Loan B-1 \| Minimum
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin			0%
Term Loan B-1 \| SOFR
Debt Instrument [Line Items]
Debt Instrument, Description of the Variable Rate Basis						SOFR+CSA+1.75%
SOFR Plus Interest Rate Margin			1.75%
Term Loan B-1 \| Adjusted Rate
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin			0.11%
Senior Secured Credit Facilities
Debt Instrument [Line Items]
Long-term debt, weighted average interest rate, at point in time			4.70%			4.70%

Long-term debt - Additional Inf

Long-term debt - Additional Information (Detail) $ in Thousands			3 Months Ended			9 Months Ended
	Apr. 28, 2023 USD ($)	Apr. 03, 2023	Sep. 30, 2023 USD ($)	Jun. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Dec. 31, 2022 USD ($)
Debt Instrument [Line Items]
Weighted average effective interest rate at quarter end			4.56%			4.56%
Weighted average effective interest rate during quarter			4.61%			4.61%
Percentage of debt instruments bearing fixed interest rate			54%			54%
Long Term Debt Percentage Bearing Economically Fixed Interest Rate			95%			95%
Debt Extinguishment And Modification Costs			$ 0	$ 7,962	$ 0	$ 7,962	$ 0
New Revolving line of credit
Debt Instrument [Line Items]
Maximum borrowing capacity on the revolving credit facilities	$ 1,500,000		1,500,000			1,500,000
Line of Credit Facility [Line Items]
Line of Credit Facility, Remaining Borrowing Capacity			1,500,000			1,500,000
Letter of Credit
Debt Instrument [Line Items]
Letters of credit outstanding			0			0
Bilateral Secured Letter Of Credit Facility
Debt Instrument [Line Items]
Letters of credit outstanding			151,387			151,387
Prior Term Loan A
Debt Instrument [Line Items]
Debt Instrument, Periodic Payment, Principal						54,011
Prior Term Loan A and Prior Revolving Line Of Credit
Debt Instrument [Line Items]
Repayments of Debt				$ 1,602,199
Term Loan B-1
Debt Instrument [Line Items]
Debt Instrument, Periodic Payment, Principal						50,188
Debt Instrument, effective date		Apr. 03, 2023
Term Loan A-1
Debt Instrument [Line Items]
Debt Instrument, Periodic Payment, Principal						7,813
Secured Debt Outstanding Principal Balance Subject To SOFR			$ 352,831			352,831
Debt Instrument, effective date	Apr. 28, 2023
Debt Instrument Quarterly Payment Start Date			Sep. 30, 2023
Debt Instrument, Quarterly Payment, First Four payments			$ (7,813)			(7,813)
Debt Instrument, Quarterly Payment For The Fifth Through Sixteenth Payments During Year Two, Three, Four			(15,625)			(15,625)
Debt Instrument, Quarterly Payment For The Seventeenth Through Nineteenth Payments During Year Five			(23,438)			(23,438)
Debt Instrument, Periodic Payment Terms, Balloon Payment to be Paid			$ (960,934)			$ (960,934)
Debt Instrument, Periodic Payment Terms, Date Balloon Payment to be Paid			Apr. 28, 2028
Credit Agreement As Amended \| Maximum
Debt Instrument [Line Items]
Leverage Ratio Covenant			4			4
Leverage Ratio Covenant Through Jun 30, 2026			5			5
Leverage Ratio Covenant after Jun 30, 2026			4.50			4.50
Senior Secured Credit Facilities
Debt Instrument [Line Items]
Weighted average effective interest rate at quarter end			4.70%			4.70%
Debt Instrument, Unamortized Discount			$ 2,724			$ 2,724		$ 3,497
Deferred Financing Costs			34,688			34,688		18,816
Senior Notes
Debt Instrument [Line Items]
Deferred Financing Costs			32,668			32,668		36,203
Debt Instrument, Unamortized Premium			$ 12,601			$ 12,601		$ 14,018

Long-Term Debt - Scheduled Matu

Long-Term Debt - Scheduled Maturities of Long-term Debt (Details) $ in Thousands	Sep. 30, 2023 USD ($)
Debt Disclosure [Abstract]
2023 (remainder of the year)	$ 29,877
2024	110,271
2025	129,871
2026	2,660,604
2027	113,551
2028	1,014,649
Thereafter	$ 4,392,360

Long-term debt Schedule of Deri

Long-term debt Schedule of Derivative Instruments (Details) - USD ($) $ in Thousands			9 Months Ended
	Jan. 01, 2025	Oct. 18, 2023	Sep. 30, 2023	Dec. 31, 2022
Derivative [Line Items]
Derivative Instrument, Gain (Loss) Reclassified from AOCI into Income, Effective Portion, Statement of Income or Comprehensive Income [Extensible Enumeration]			Interest and Debt Expense
2019 cap agreements
Derivative [Line Items]
Derivative, effective date			Jun. 30, 2020
Derivative, expiration date			Jun. 30, 2024
2023 cap agreements
Derivative [Line Items]
Derivative, effective date			Jun. 28, 2024
Derivative, expiration date			Dec. 31, 2025
2023 cap agreements
Derivative [Line Items]
Derivative, effective date			Jun. 28, 2024
Derivative, expiration date			Dec. 31, 2025
2023 cap agreements
Derivative [Line Items]
Derivative, effective date			Jun. 28, 2024
Derivative, expiration date			Dec. 31, 2025
2023 cap agreements
Derivative [Line Items]
Derivative, effective date			Jun. 30, 2024
Derivative, expiration date			Dec. 31, 2025
October 2023 Cap Agreements \| Subsequent Event
Derivative [Line Items]
Derivative, effective date		Jun. 28, 2024
Derivative, expiration date		Dec. 31, 2026
October 2023 Cap Agreements \| Subsequent Event
Derivative [Line Items]
Derivative, effective date		Dec. 31, 2024
Derivative, expiration date		Dec. 31, 2025
Other Long-term Assets \| 2019 cap agreements
Derivative [Line Items]
Derivative asset, fair value, gross asset			$ 90,048	$ 139,755
Other Long-term Assets \| 2023 cap agreements
Derivative [Line Items]
Derivative asset, fair value, gross asset			2,238
Other Long-term Assets \| 2023 cap agreements
Derivative [Line Items]
Derivative asset, fair value, gross asset			12,379
Other Long-term Assets \| 2023 cap agreements
Derivative [Line Items]
Derivative asset, fair value, gross asset			9,056
Other Long-term Assets \| 2023 cap agreements
Derivative [Line Items]
Derivative asset, fair value, gross asset			8,836
Cash Flow Hedging \| 2019 cap agreements
Derivative [Line Items]
Amount of debt expense reclassified from accumulated OCI into income			(74,475)
Other Comprehensive Income (Loss), Unrealized Gain (Loss) on Derivatives Arising During Period, before Tax			28,901
Cash Flow Hedging \| 2023 cap agreements
Derivative [Line Items]
Other Comprehensive Income (Loss), Unrealized Gain (Loss) on Derivatives Arising During Period, before Tax			1,047
Cash Flow Hedging \| 2023 cap agreements
Derivative [Line Items]
Other Comprehensive Income (Loss), Unrealized Gain (Loss) on Derivatives Arising During Period, before Tax			3,142
Cash Flow Hedging \| 2023 cap agreements
Derivative [Line Items]
Other Comprehensive Income (Loss), Unrealized Gain (Loss) on Derivatives Arising During Period, before Tax			751
Cash Flow Hedging \| 2023 cap agreements
Derivative [Line Items]
Other Comprehensive Income (Loss), Unrealized Gain (Loss) on Derivatives Arising During Period, before Tax			3,871
Term Loan Facility \| Maximum \| 2019 cap agreements
Derivative [Line Items]
Notional amounts of interest rate agreements			$ 3,500,000
SOFR Plus Interest Rate Margin			2%
Term Loan Facility \| Maximum \| 2023 cap agreements
Derivative [Line Items]
Notional amounts of interest rate agreements			$ 200,000
SOFR Plus Interest Rate Margin			3.75%
Term Loan Facility \| Maximum \| 2023 cap agreements
Derivative [Line Items]
Notional amounts of interest rate agreements			$ 1,000,000
SOFR Plus Interest Rate Margin			4%
Term Loan Facility \| Maximum \| 2023 cap agreements \| Subsequent Event
Derivative [Line Items]
SOFR Plus Interest Rate Margin	3.75%
Term Loan Facility \| Maximum \| 2023 cap agreements
Derivative [Line Items]
Notional amounts of interest rate agreements			$ 1,000,000
SOFR Plus Interest Rate Margin			4.75%
Term Loan Facility \| Maximum \| 2023 cap agreements \| Subsequent Event
Derivative [Line Items]
SOFR Plus Interest Rate Margin	4%
Term Loan Facility \| Maximum \| 2023 cap agreements
Derivative [Line Items]
Notional amounts of interest rate agreements			$ 800,000
SOFR Plus Interest Rate Margin			3.75%
Term Loan Facility \| Maximum \| October 2023 Cap Agreements \| Subsequent Event
Derivative [Line Items]
Notional amounts of interest rate agreements		$ 500,000
Term Loan Facility \| Maximum \| October 2023 Cap Agreements \| Subsequent Event
Derivative [Line Items]
Notional amounts of interest rate agreements		$ 250,000

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Detail) - USD ($) $ in Thousands		9 Months Ended
	Oct. 22, 2019	Sep. 30, 2023
Commitments and Contingencies:
Corporate Integrity Agreement Period		5 years
Corporate Integrity Agreement Expiration Date	Oct. 22, 2019
Commitments to provide operating capital
Commitments and Contingencies:
Other potential commitments to provide operating capital to several dialysis centers		$ 9,279

Stock-based compensation (Detai

Stock-based compensation (Details) $ in Thousands	9 Months Ended
Stock-based compensation (Details) $ in Thousands	Sep. 30, 2023 USD ($) shares
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Unrecognized compensation cost related to nonvested stock-based compensation arrangements under equity compensation and stock purchase plans	$ 149,839
Unrecognized compensation cost related to nonvested stock-based compensation arrangements under stock-based component of LTIP costs, weighted average remaining period (in years)	1 year 4 months 24 days
Restricted stock units and Performance stock units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period \| shares	1,343,000
Aggregate grant-date fair value	$ 103,599
Weighted-average expected life (in years)	3 years 4 months 24 days

Share repurchases (Details)

Share repurchases (Details) shares in Thousands	1 Months Ended
Share repurchases (Details) shares in Thousands	Nov. 03, 2023 shares
Subsequent Event
Equity, Class of Treasury Stock [Line Items]
Repurchase of common stock (in shares)	0

Accumulated other comprehensi_3

Accumulated other comprehensive (loss) income (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance			$ (69,186)
Ending balance	$ (68,898)		(68,898)
Interest rate cap agreements
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance	85,297	$ 55,237	98,685	$ (1,178)
Unrealized gains (losses)	9,319	55,045	37,712	127,460
Related income tax benefit	(2,323)	(13,733)	(9,407)	(31,800)
Unrealized (losses) gains net	6,996	41,312	28,305	95,660
Reclassification into net income	(28,244)	1,377	(74,475)	4,132
Related income tax	7,046	(344)	18,580	(1,032)
Reclassification from accumulated other comprehensive income into net income net of tax	(21,198)	1,033	(55,895)	3,100
Ending balance	71,095	97,582	71,095	97,582
Foreign currency translation adjustments
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance	(92,349)	(167,033)	(167,871)	(138,069)
Unrealized gains (losses)	(47,644)	(66,100)	27,878	(95,064)
Related income tax benefit	0	0	0	0
Unrealized (losses) gains net	(47,644)	(66,100)	27,878	(95,064)
Reclassification into net income	0	0	0	0
Related income tax	0	0	0	0
Reclassification from accumulated other comprehensive income into net income net of tax	0	0	0	0
Ending balance	(139,993)	(233,133)	(139,993)	(233,133)
Accumulated other comprehensive (loss) income
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance	(7,052)	(111,796)	(69,186)	(139,247)
Unrealized gains (losses)	(38,325)	(11,055)	65,590	32,396
Related income tax benefit	(2,323)	(13,733)	(9,407)	(31,800)
Unrealized (losses) gains net	(40,648)	(24,788)	56,183	596
Reclassification into net income	(28,244)	1,377	(74,475)	4,132
Related income tax	7,046	(344)	18,580	(1,032)
Reclassification from accumulated other comprehensive income into net income net of tax	(21,198)	1,033	(55,895)	3,100
Ending balance	$ (68,898)	$ (135,551)	$ (68,898)	$ (135,551)

Variable interest entities - Ad

Variable interest entities - Additional Information (Detail) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Total assets	$ 16,928,740	$ 16,928,252
Total liabilities and noncontrolling interests	14,104,061	$ 14,703,452
Variable Interest Entity
Total assets	284,761
Total liabilities and noncontrolling interests	$ 160,526

Fair value of financial instr_3

Fair value of financial instruments - Assets, Liabilities and Temporary Equity Measured at Fair Value on Recurring Basis (Detail) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Assets
Investments in equity securities	$ 36,603	$ 39,143
Fair Value, Measurements, Recurring
Assets
Investments in equity securities	36,603
Liabilities
Contingent earn-out obligations	19,377
Temporary equity
Noncontrolling interests subject to put provisions	1,445,403
Fair Value, Measurements, Recurring \| Interest rate cap agreements
Assets
Interest rate cap agreements	122,557
Fair Value, Measurements, Recurring \| Quoted prices in active markets for identical assets (Level 1)
Assets
Investments in equity securities	36,603
Liabilities
Contingent earn-out obligations	0
Temporary equity
Noncontrolling interests subject to put provisions	0
Fair Value, Measurements, Recurring \| Quoted prices in active markets for identical assets (Level 1) \| Interest rate cap agreements
Assets
Interest rate cap agreements	0
Fair Value, Measurements, Recurring \| Significant other observable inputs (Level 2)
Assets
Investments in equity securities	0
Liabilities
Contingent earn-out obligations	0
Temporary equity
Noncontrolling interests subject to put provisions	0
Fair Value, Measurements, Recurring \| Significant other observable inputs (Level 2) \| Interest rate cap agreements
Assets
Interest rate cap agreements	122,557
Fair Value, Measurements, Recurring \| Significant unobservable inputs (Level 3)
Assets
Investments in equity securities	0
Liabilities
Contingent earn-out obligations	19,377
Temporary equity
Noncontrolling interests subject to put provisions	1,445,403
Fair Value, Measurements, Recurring \| Significant unobservable inputs (Level 3) \| Interest rate cap agreements
Assets
Interest rate cap agreements	$ 0

Fair value of financial instr_4

Fair value of financial instruments (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2023 USD ($)
Fair Value Net Derivative Asset Liability Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Potential Increase Decrease In Fair Value Of Noncontrolling Interests Due To Change In Weighted Average EBITDA Multiple	$ 185,000
Minimum \| EBITDA or Operating Income Performance Targets or Quality Margins \| Other companies
Fair Value Net Derivative Asset Liability Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Earn-out consideration payment period	1 year
Maximum
Fair Value Net Derivative Asset Liability Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Business Combination Contingent Consideration Acquisitions	$ 54,387
Maximum \| EBITDA or Operating Income Performance Targets or Quality Margins \| Other companies
Fair Value Net Derivative Asset Liability Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Earn-out consideration payment period	5 years

Segment reporting - Summary of

Segment reporting - Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes (Detail) - USD ($) $ in Thousands	3 Months Ended			9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Segment Reporting Information [Line Items]
Other revenues	$ 169,382		$ 102,200	$ 391,731	$ 320,132
Total revenues	3,121,332		2,948,694	8,994,400	8,693,006
Operating income (loss)	495,939		311,787	1,212,875	1,082,810
Corporate administrative support	(41,294)		(24,417)	(99,745)	(91,217)
Debt expense	(98,080)		(99,680)	(302,361)	(256,057)
Debt extinguishment and modification costs	0	$ (7,962)	0	(7,962)	0
Other loss, net	(19,650)		(4,898)	(14,525)	(7,968)
Income before income taxes	378,209		207,209	888,027	818,785
U.S. dialysis
Segment Reporting Information [Line Items]
Total revenues	2,761,017		2,680,296	8,061,383	7,877,073
Other—Ancillary services
Segment Reporting Information [Line Items]
Total revenues	360,315		268,398	933,017	815,933
Operating Segments
Segment Reporting Information [Line Items]
Total revenues	3,147,853		2,971,651	9,066,105	8,757,522
Operating income (loss)	537,233		336,203	1,312,620	1,174,026
Operating Segments \| U.S. dialysis
Segment Reporting Information [Line Items]
Dialysis patient service revenues	2,779,067		2,697,197	8,109,259	7,923,465
Total revenues	2,785,306		2,703,253	8,128,081	7,941,589
Operating income (loss)	509,135		351,474	1,330,992	1,230,715
Operating Segments \| U.S. dialysis \| External Sources
Segment Reporting Information [Line Items]
Dialysis patient service revenues	2,754,778		2,674,240	8,042,561	7,858,939
Other revenues	6,239		6,056	18,822	18,134
Operating Segments \| U.S. dialysis \| Intersubsegment Eliminations
Segment Reporting Information [Line Items]
Dialysis patient service revenues	24,289		22,957	66,698	64,526
Other revenues	0		0	0	(10)
Operating Segments \| Other—Ancillary services
Segment Reporting Information [Line Items]
Dialysis patient service revenues	197,172		172,254	560,108	513,935
Other revenues	163,143		96,144	372,909	301,998
Total revenues	362,547		268,398	938,024	815,933
Operating income (loss)	28,098		(15,271)	(18,372)	(56,689)
Operating Segments \| Other—Ancillary services \| Intersubsegment Eliminations
Segment Reporting Information [Line Items]
Dialysis patient service revenues	2,232		0	5,007	0
Intersegment Elimination
Segment Reporting Information [Line Items]
Total revenues	(26,521)		(22,957)	(71,705)	(64,516)
Intersegment Elimination \| U.S. dialysis
Segment Reporting Information [Line Items]
Total revenues	(24,289)		$ (22,957)	(66,698)	$ (64,516)
Intersegment Elimination \| Other—Ancillary services
Segment Reporting Information [Line Items]
Total revenues	$ (2,232)			$ (5,007)

Segment reporting - Summary o_2

Segment reporting - Summary of Depreciation and Amortization Expense by Segment (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 188,423	$ 194,414	$ 550,166	$ 538,534
U.S. dialysis
Segment Reporting Information [Line Items]
Depreciation and amortization	175,908	184,688	514,710	507,320
Other—Ancillary services
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 12,515	$ 9,726	$ 35,456	$ 31,214

Segment reporting - Summary o_3

Segment reporting - Summary of Expenditures for Property and Equipment by Segment (Detail) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Segment Reporting Information [Line Items]
Expenditures for property and equipment	$ 409,011	$ 409,391
U.S. dialysis
Segment Reporting Information [Line Items]
Expenditures for property and equipment	363,895	363,046
Other—Ancillary services
Segment Reporting Information [Line Items]
Expenditures for property and equipment	$ 45,116	$ 46,345

Segment reporting - Summary o_4

Segment reporting - Summary of Assets by Segment (Detail) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
ASSETS
Total assets	$ 16,928,740	$ 16,928,252
U.S. dialysis
ASSETS
Total assets	14,574,707	15,084,454
Other—Ancillary services
ASSETS
Total assets	$ 2,354,033	$ 1,843,798

New accounting standards (Detai

New accounting standards (Details) $ in Thousands	Jul. 01, 2023 USD ($)
Accounting Standards Update
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Change in Accounting Principle impact ability to borrow	$ 0