DaVita (DVA) 10-Q 7 May 19 2019 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares shares in Millions	3 Months Ended
	Mar. 31, 2019	May 03, 2019
Document And Entity Information [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	Q1
Trading Symbol	DVA
Entity Registrant Name	DAVITA INC.
Entity Central Index Key	0000927066
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Common Stock, Shares Outstanding		166.4

CONSOLIDATED STATEMENTS OF INCO

CONSOLIDATED STATEMENTS OF INCOME (unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Income Statement [Abstract]
Dialysis and related lab patient service revenues	$ 2,635,152	$ 2,591,074
Provision for uncollectible accounts	(5,463)	25,545
Net dialysis and related lab patient service revenues	2,629,689	2,616,619
Other revenues	113,423	232,825
Total revenues	2,743,112	2,849,444
Operating expenses and charges:
Patient care costs	1,964,935	2,035,585
General and administrative	250,813	266,529
Depreciation and amortization	148,528	142,799
Equity investment income	(2,708)	(155)
Provision for uncollectible accounts	0	(6,000)
Goodwill impairment charges	41,037	0
Total operating expenses and charges	2,402,605	2,438,758
Operating income	340,507	410,686
Debt expense	(131,519)	(113,516)
Other income, net	6,940	4,582
Income from continuing operations before income taxes	215,928	301,752
Income tax expense	56,746	70,737
Net income from continuing operations	159,182	231,015
Net income (loss) from discontinued operations, net of tax	30,305	(5,786)
Net income	189,487	225,229
Less: Net income attributable to noncontrolling interests	(40,198)	(46,543)
Net income attributable to DaVita Inc.	$ 149,289	$ 178,686
Earnings per share attributable to DaVita Inc.:
Basic net income from continuing operations per share	$ 0.72	$ 1.07
Basic net income per share	0.90	1
Diluted net income from continuing operations per share	0.72	1.05
Diluted net income per share	$ 0.90	$ 0.98
Weighted average shares for earnings per share:
Basic (in shares)	166,387,958	178,957,865
Diluted (in shares)	166,780,657	181,834,547
Amounts attributable to DaVita Inc.:
Net income from continuing operations	$ 120,254	$ 191,015
Net income (loss) from discontinued operations	29,035	(12,329)
Net income attributable to DaVita Inc.	$ 149,289	$ 178,686

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Statement of Comprehensive Income [Abstract]
Net income	$ 189,487	$ 225,229
Unrealized (losses) gains on interest rate cap agreements:
Unrealized (losses) gains	(580)	1,050
Reclassifications of net realized losses into net income	1,606	1,537
Unrealized (losses) gains on foreign currency translation:
Foreign currency translation adjustments	(13,653)	19,881
Other comprehensive (loss) income	(12,627)	22,468
Total comprehensive income	176,860	247,697
Less: Comprehensive income attributable to noncontrolling interests	(40,198)	(46,543)
Comprehensive income attributable to DaVita Inc.	$ 136,662	$ 201,154

CONSOLIDATED BALANCE SHEETS (un

CONSOLIDATED BALANCE SHEETS (unaudited) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
ASSETS
Cash and cash equivalents	$ 459,242	$ 323,038
Restricted cash and equivalents	102,192	92,382
Short-term investments	4,035	2,935
Accounts receivable, net	1,953,422	1,858,608
Inventories	104,236	107,381
Other receivables	489,581	469,796
Income tax receivable	42,650	68,614
Prepaid and other current assets	64,770	111,840
Current assets held for sale, net	6,004,948	5,389,565
Total current assets	9,225,076	8,424,159
Property and equipment, net of accumulated depreciation of $3,538,992 and $3,524,098	3,392,266	3,393,669
Operating lease right-of-use asset	2,736,536	0
Intangible assets, net of accumulated amortization of $82,265 and $80,566	118,324	118,846
Equity method and other investments	226,309	224,611
Long-term investments	34,414	35,424
Other long-term assets	73,651	71,583
Goodwill	6,799,368	6,841,960
Total assets	22,605,944	19,110,252
LIABILITIES AND EQUITY
Accounts payable	365,192	463,270
Other liabilities	572,944	595,850
Accrued compensation and benefits	495,327	658,913
Current portion operating leases	367,413	0
Current portion of long-term debt	4,676,691	1,929,369
Current liabilities held for sale	1,753,310	1,243,759
Total current liabilities	8,230,877	4,891,161
Long-term operating leases	2,625,776	0
Long-term debt	5,787,013	8,172,847
Other long-term liabilities	143,756	450,669
Deferred income taxes	588,805	562,536
Total liabilities	17,376,227	14,077,213
Commitments and contingencies:
Noncontrolling interests subject to put provisions	1,143,044	1,124,641
Equity:
Preferred stock ($0.001 par value, 5,000,000 shares authorized; none issued)	0	0
Common stock ($0.001 par value, 450,000,000 shares authorized; 166,396,147 and 166,387,307 shares issued and outstanding, respectively)	166	166
Additional paid-in capital	990,380	995,006
Retained earnings	2,932,359	2,743,194
Accumulated other comprehensive (loss) income	(47,551)	(34,924)
Total DaVita Inc. shareholders' equity	3,875,354	3,703,442
Noncontrolling interests not subject to put provisions	211,319	204,956
Total equity	4,086,673	3,908,398
Total liabilities and equity	$ 22,605,944	$ 19,110,252

CONSOLIDATED BALANCE SHEETS (_2

CONSOLIDATED BALANCE SHEETS (unaudited) (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Statement of Financial Position [Abstract]
Property and equipment, accumulated depreciation	$ 3,538,992	$ 3,524,098
Intangible assets, accumulated amortization	$ 82,265	$ 80,566
Preferred stock, par value (usd per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	5,000,000	5,000,000
Preferred stock, issued (in shares)	0	0
Common stock, par value (usd per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	450,000,000	450,000,000
Common stock, shares issued (in shares)	166,396,147	166,387,307
Common stock, shares outstanding (in shares)	166,396,147	166,387,307

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS (unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Cash flows from operating activities:
Net income	$ 189,487	$ 225,229
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	148,528	142,799
Impairment charges	41,037	0
Stock-based compensation expense	12,110	9,685
Deferred income taxes	41,372	43,617
Equity investment (loss) income, net	(337)	3,564
Other non-cash charges, net	1,720	9,959
Changes in operating assets and liabilities, net of effect of acquisitions and divestitures:
Accounts receivable	(132,292)	(63,701)
Inventories	3,324	57,621
Other receivables and other current assets	1,199	(34,120)
Other long-term assets	(1,997)	2,054
Accounts payable	(38,537)	(62,830)
Accrued compensation and benefits	(173,583)	(62,550)
Other current liabilities	17,236	49,379
Income taxes	32,502	30,772
Other long-term liabilities	(465)	11,061
Net cash provided by operating activities	141,304	362,539
Cash flows from investing activities:
Additions of property and equipment	(198,878)	(232,443)
Acquisitions	(11,274)	(16,582)
Proceeds from asset and business sales	13,903	18,535
Purchase of other debt and equity investments	(3,290)	(2,646)
Purchase of investments held-to-maturity	(209)	(3,586)
Proceeds from sale of other debt and equity investments	3,302	5,151
Proceeds from investments held-to-maturity	0	31,454
Purchase of equity investments	(4,067)	(2,476)
Distributions received on equity investments	155	2,465
Net cash used in investing activities	(200,358)	(200,128)
Cash flows from financing activities:
Borrowings	17,133,464	13,306,898
Payments on long-term debt and other financing costs	(16,776,267)	(13,202,225)
Purchase of treasury stock	0	(290,377)
Distributions to noncontrolling interests	(44,230)	(45,467)
Stock award exercises and other share issuances, net	1,517
Stock award exercises and other share issuances, net		(1,185)
Contributions from noncontrolling interests	18,947	12,009
Purchases of noncontrolling interests	(8,480)	(2,200)
Net cash provided by (used in) financing activities	324,951	(222,547)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	(921)	6,668
Net increase (decrease) in cash, cash equivalents and restricted cash	264,976	(53,468)
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year	415,420	518,920
Cash, cash equivalents and restricted cash of continuing operations at end of the period	561,434	447,618
Discontinued Operations
Cash flows from financing activities:
Net increase (decrease) in cash, cash equivalents and restricted cash	118,962	17,834
Continuing Operations
Cash flows from financing activities:
Net increase (decrease) in cash, cash equivalents and restricted cash	$ 146,014	$ (71,302)

CONSOLIDATED STATEMENTS OF EQUI

CONSOLIDATED STATEMENTS OF EQUITY (unaudited) - USD ($) $ in Thousands	Total	Total	TotalRestricted Stock Units	TotalStock Appreciation Rights	Non- controlling interests subject to put provisions	Common stock	Common stockRestricted Stock Units	Common stockStock Appreciation Rights	Additional paid-in capital	Additional paid-in capitalRestricted Stock Units	Additional paid-in capitalStock Appreciation Rights	Retained earnings	Treasury stock	Accumulated other comprehensive (loss) income	Non- controlling interests not subject to put provisions
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Cumulative effect of change in accounting principle		$ 0										$ 8,368		$ (8,368)
Temporary equity, start balance at Dec. 31, 2017					$ 1,011,360
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income					24,107
Distributions					(26,166)
Contributions					9,508
Acquisitions and divestitures					688
Fair value remeasurements					15,004
Temporary equity, ending balance at Mar. 31, 2018					1,034,501
Beginning balance at Dec. 31, 2017		4,690,029				$ 182			$ 1,042,899			3,633,713	$ 0	13,235	$ 196,037
Beginning balance (in shares) at Dec. 31, 2017						182,462,000							0
Comprehensive income:
Net income attributable to DaVita Inc.	$ 178,686	178,686										178,686			22,436
Other comprehensive income (loss)	22,468	22,468												22,468
Stock unit shares issued (in shares)							4,000	195,000
Stock-settled SAR shares issued			$ 0	$ (4,886)				$ (1)			$ (4,887)
Stock-settled stock-based compensation expense		9,682							9,682
Changes in noncontrolling interest from:
Distributions															(19,301)
Contributions															2,501
Acquisitions and divestitures		76							76
Acquisitions and divestitures, non-controlling interest															(66)
Partial purchases		(1,994)							(1,994)						(206)
Fair value remeasurements		(15,004)							(15,004)
Purchase of treasury stock (in shares)													(4,197,000)
Purchase of treasury stock		(298,377)											$ (298,377)
Ending balance at Mar. 31, 2018		4,580,680				$ 183			1,030,772			3,820,767	$ (298,377)	27,335	201,401
Ending balance (in shares) at Mar. 31, 2018						182,661,000							(4,197,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Cumulative effect of change in accounting principle		39,876			(38)							39,876			(6)
Temporary equity, start balance at Dec. 31, 2018					1,124,641
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income					25,389
Distributions					(27,565)
Contributions					6,415
Acquisitions and divestitures					1,762
Partial purchases					(1,967)
Fair value remeasurements					14,407
Temporary equity, ending balance at Mar. 31, 2019					$ 1,143,044
Beginning balance at Dec. 31, 2018	$ 3,908,398	3,703,442				$ 166			995,006			2,743,194	$ 0	(34,924)	204,956
Beginning balance (in shares) at Dec. 31, 2018	166,387,307					166,387,000							0
Comprehensive income:
Net income attributable to DaVita Inc.	$ 149,289	149,289										149,289			14,809
Other comprehensive income (loss)	(12,627)	(12,627)												(12,627)
Stock unit shares issued (in shares)							9,000	0
Stock-settled SAR shares issued			$ (104)	$ 0						$ (104)
Stock-settled stock-based compensation expense		12,091							12,091
Changes in noncontrolling interest from:
Distributions															(16,665)
Contributions															12,532
Acquisitions and divestitures		0							0
Acquisitions and divestitures, non-controlling interest															0
Partial purchases		(2,206)							(2,206)						(4,307)
Fair value remeasurements		(14,407)							(14,407)
Ending balance at Mar. 31, 2019	$ 4,086,673	$ 3,875,354				$ 166			$ 990,380			$ 2,932,359	$ 0	$ (47,551)	$ 211,319
Ending balance (in shares) at Mar. 31, 2019	166,396,147					166,396,000							0

Condensed consolidated interim

Condensed consolidated interim financial statements Condensed consolidated interim financial statements	3 Months Ended
	Mar. 31, 2019
Text Block [Abstract]
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block]	Condensed consolidated interim financial statements The condensed consolidated interim financial statements included in this report are prepared by the Company without audit. 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 assets, liabilities, revenues and expenses. The most significant estimates and assumptions underlying these financial statements and accompanying notes generally involve revenue recognition and accounts receivable, leases, impairments of goodwill and investments, accounting for income taxes, consolidation of variable interest entities and certain fair value estimates. The results of operations for the three months ended March 31, 2019 are not necessarily indicative of the operating results for the full year. The 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, 2018

Revenue Recognition Revenue Rec

Revenue Recognition Revenue Recognition	3 Months Ended
	Mar. 31, 2019
Text Block [Abstract]
Revenue Recognition [Text Block]	Revenue recognition The Company’s allowance for doubtful accounts related to performance obligations satisfied in years prior was $42,235 and $52,924 as of March 31, 2019 and December 31, 2018 , respectively. There are significant uncertainties associated with estimating revenue, which generally 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 determining applicable primary and secondary coverage, changes in patient 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. As a result of changes in these estimates, additional revenue of $27,179 was recognized during the three months ended March 31, 2019 associated with performance obligations satisfied prior to January 1, 2019. Additional revenue of $67,410 was recognized during the three months ended March 31, 2018 associated with performance obligations satisfied prior to January 1, 2018, which included $24,000 from electing to apply ASC Topic 606 only to contracts not substantially completed as of January 1, 2018. The following table summarizes the Company's segment revenues by primary payor source: For the three months ended March 31, 2019 March 31, 2018 U.S. dialysis and related lab services Other - Ancillary services and strategic initiatives Consolidated U.S. dialysis and related lab services Other - Ancillary services and strategic initiatives Consolidated Patient service revenues: Medicare and Medicare Advantage $ 1,493,516 $ — $ 1,493,516 $ 1,485,192 $ — $ 1,485,192 Medicaid and Managed Medicaid 154,190 — 154,190 157,496 — 157,496 Other government 106,127 84,475 190,602 107,119 82,537 189,656 Commercial 788,413 33,388 821,801 782,979 19,718 802,697 Other revenues: Medicare and Medicare Advantage — 61,700 61,700 — 142,758 142,758 Medicaid and Managed Medicaid — 6 6 — 15,791 15,791 Commercial — 32,619 32,619 — 40,420 40,420 Other (1) 4,905 17,750 22,655 5,114 38,941 44,055 Eliminations of intersegment revenues (30,641 ) (3,336 ) (33,977 ) (18,422 ) (10,199 ) (28,621 ) Total $ 2,516,510 $ 226,602 $ 2,743,112 $ 2,519,478 $ 329,966 $ 2,849,444 (1) Other consists of management fees and revenue from the Company's ancillary services and strategic initiatives. Dialysis and related lab patient service revenues Dialysis and related lab services patient service revenues are recognized in the period services are provided. Revenues consist primarily of payments from Medicare, Medicaid and commercial health plans for dialysis and related lab services provided to patients. A usual and customary fee schedule is maintained for the Company’s dialysis treatments and related lab services; however, actual collectible revenue is normally recognized at a discount from the fee schedule. Other revenues

Earnings per share

Earnings per share	3 Months Ended
	Mar. 31, 2019
Earnings Per Share [Abstract]
Earnings per share	Earnings per share Basic earnings per share is calculated by dividing net income attributable to the Company, adjusted for any change in noncontrolling interest redemption rights in excess of fair value, by the weighted average number of common shares outstanding, net of the weighted average shares held in escrow that under certain circumstances may have been returned to the Company. Diluted earnings per share includes the dilutive effect of outstanding stock-settled stock appreciation rights (SSARs) and unvested stock units (under the treasury stock method) as well as the weighted average shares held in escrow that were outstanding during the period. The reconciliations of the numerators and denominators used to calculate basic and diluted earnings per share were as follows: Three months ended March 31, 2019 2018 Numerators: Net income from continuing operations attributable to DaVita Inc. $ 120,254 $ 191,015 Net income (loss) from discontinued operations attributable to DaVita Inc. 29,035 (12,329 ) Net income attributable to DaVita Inc. for earnings per share calculation $ 149,289 $ 178,686 Basic: Weighted average shares outstanding during the period 166,388 181,152 Weighted average contingently returnable shares held in escrow for the DaVita HealthCare Partners merger — (2,194 ) Weighted average shares for basic earnings per share calculation 166,388 178,958 Basic net income (loss) attributable to DaVita Inc. from: Continuing operations per share $ 0.72 $ 1.07 Discontinued operations per share 0.18 (0.07 ) Basic net income per share attributable to DaVita Inc. $ 0.90 $ 1.00 Diluted: Weighted average shares outstanding during the period 166,388 181,152 Assumed incremental shares from stock plans 393 683 Weighted average shares for diluted earnings per share calculation 166,781 181,835 Diluted net income (loss) attributable to DaVita Inc. from: Continuing operations per share $ 0.72 $ 1.05 Discontinued operations per share 0.18 (0.07 ) Diluted net income per share attributable to DaVita Inc. $ 0.90 $ 0.98 Anti-dilutive stock-settled awards excluded from calculation (1) 6,150 3,453 (1)

Restricted Cash and equivalents

Restricted Cash and equivalents Restricted Cash and equivalents	3 Months Ended
	Mar. 31, 2019
Restricted Cash [Abstract]
Cash and Cash Equivalents Disclosure [Text Block]	Restricted cash and equivalents The Company had restricted cash and cash equivalents at March 31, 2019 and December 31, 2018

Investments in debt and equity

Investments in debt and equity securities	3 Months Ended
	Mar. 31, 2019
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 consist of the following: March 31, 2019 December 31, 2018 Debt Equity Total Debt Equity Total Certificates of deposit and other time deposits $ 2,235 $ — $ 2,235 $ 2,235 $ — $ 2,235 Investments in mutual funds and common stock — 36,214 36,214 — 36,124 36,124 $ 2,235 $ 36,214 $ 38,449 $ 2,235 $ 36,124 $ 38,359 Short-term investments $ 2,235 $ 1,800 $ 4,035 $ 2,235 $ 700 $ 2,935 Long-term investments — 34,414 34,414 — 35,424 35,424 $ 2,235 $ 36,214 $ 38,449 $ 2,235 $ 36,124 $ 38,359 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. These debt securities are accounted for as held to maturity and recorded at amortized cost, which approximates their fair values at March 31, 2019 and December 31, 2018 . Equity securities: The Company's equity investments in mutual funds and common stock are held within a trust to fund existing obligations associated with several of the Company’s non-qualified deferred compensation plans. During the three months ended March 31, 2019 , the Company recognized pre-tax net gains in the income statement of $1,893 associated with changes in the fair value of these equity securities, comprised of pre-tax realized gains of $170 and a net increase in unrealized gains of $1,723 . During the three months ended March 31, 2018 , the Company recognized pre-tax realized gains in the income statement of $86 associated with changes in the fair value of these equity securities, comprised of pre-tax realized gains of $3,746 and a net decrease in unrealized gains of $3,660

Equity method and other investm

Equity method and other investments	3 Months Ended
	Mar. 31, 2019
Equity Method Investments and Joint Ventures [Abstract]
Equity method and other investments	Equity method and other investments Equity investments in nonconsolidated businesses over which the Company maintains significant influence, but which do not have readily determinable fair values, are carried on the equity method. The Company maintains equity method and minor adjusted cost method investments in the private securities of certain other healthcare and healthcare-related businesses. The Company classifies these investments as "Equity method and other investments" on its consolidated balance sheet. The Company's equity method and other investments were comprised of the following: March 31, 2019 December 31, 2018 APAC joint venture $ 125,062 $ 129,173 Other equity method partnerships 88,861 83,052 Adjusted cost method investments 12,386 12,386 $ 226,309 $ 224,611 During the three months ended March 31, 2019 and 2018, the Company recognized equity investment income of $2,708 and $155 , respectively, from equity method investments in nonconsolidated businesses. The Company's largest equity method investment is its ownership interest in DaVita Care Pte. Ltd. (the APAC joint venture, or APAC JV). The Company's other equity method investments include legal entities for which the Company maintains significant influence but over which it does not have a controlling financial interest. Almost all of these are U.S. partnerships in the form of limited liability companies. The Company's ownership interests in these partnerships vary, but typically range from 30% to 50% . During the three months ended March 31, 2019 and 2018, there have been no

Goodwill

Goodwill	3 Months Ended
	Mar. 31, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill	Goodwill Changes in goodwill by reportable segment were as follows: U.S. dialysis and related lab services Other-ancillary services and strategic initiatives Consolidated total Balance at December 31, 2017 $ 6,144,761 $ 465,518 $ 6,610,279 Acquisitions 130,574 147,774 278,348 Divestitures (331 ) (15,166 ) (15,497 ) Impairment charges — (3,106 ) (3,106 ) Foreign currency and other adjustments — (28,064 ) (28,064 ) Balance at December 31, 2018 $ 6,275,004 $ 566,956 $ 6,841,960 Acquisitions 7,027 1,628 8,655 Impairment charges — (41,037 ) (41,037 ) Foreign currency and other adjustments — (10,210 ) (10,210 ) Balance at March 31, 2019 $ 6,282,031 $ 517,337 $ 6,799,368 Balance at March 31, 2019: Goodwill $ 6,282,031 $ 585,347 $ 6,867,378 Accumulated impairment charges — (68,010 ) (68,010 ) $ 6,282,031 $ 517,337 $ 6,799,368 The Company elected to early adopt ASU No. 2017-04, Intangibles-Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment effective January 1, 2017. The amendments in this ASU simplify the test for goodwill impairment by eliminating the second step in the assessment. All goodwill impairment tests performed since adoption were performed under this new guidance. During the three months ended March 31, 2019 , the Company performed goodwill impairment assessments of certain reporting units previously disclosed as at-risk of significant goodwill impairment. As a result of these assessments, the Company recognized a $41,037 goodwill impairment charge in its Germany kidney care business during the three months ended March 31, 2019 . This charge resulted primarily from a change in relevant discount rates, a decline in current and expected patient census in the quarter and higher than expected current and future costs, primarily due to newly announced legislation that is expected to increase wages in that market. This impairment charge includes an $8,865 increase to the goodwill impairment charge, and reduction to deferred tax expense, related to deferred tax assets that the impairment itself generates. The effect is a $41,037 goodwill impairment charge to operating income and an $8,865 credit to tax expense, for a net $32,172 impact on net income. As of March 31, 2019 , the Company's Germany kidney care business remains at-risk of further goodwill impairment. Further change in expected patient census, increases in operating costs, reductions in reimbursement rates, changes in actual or expected growth rates, or other significant adverse changes in expected future cash flows or valuation assumptions could result in additional goodwill impairment charges in our Germany kidney care business. Reporting unit Goodwill balance as Carrying amount (1) Sensitivities Operating income (2) Discount rate (3) Germany Kidney Care $ 354,182 —% (1.4)% (9.3)% (1) Excess of estimated fair value of the reporting unit over its carrying amount as of the latest assessment date. (2) Potential impact on estimated fair value of a sustained, long-term reduction of 3% in operating income as of the latest assessment date. (3) Potential impact on estimated fair value of an increase in discount rates of 100 basis points as of the latest assessment date. The Company did not recognize any goodwill impairment charges during the three months ended March 31, 2018 . Except as described above and in Note 11 to the Company's consolidated financial statements included in the 10-K, none of the Company's various other reporting units were considered at risk of significant goodwill impairment as of March 31, 2019 . Since the dates of the Company's last annual goodwill impairment assessments there have been certain developments, events, changes in operating performance and other changes in key circumstances that have affected the Company's businesses. However, these changes did not cause management to believe it is more likely than not that the fair values of any of the Company's reporting units would be less than their respective carrying amounts as of March 31, 2019

Income taxes

Income taxes	3 Months Ended
	Mar. 31, 2019
Income Tax Disclosure [Abstract]
Income taxes	Income taxes As of March 31, 2019 , the Company’s total liability for unrecognized tax benefits relating to tax positions that do not meet the more-likely-than-not threshold was $48,384 , of which $45,541 would impact the Company's effective tax rate if recognized. The total balance increased $8,002 from the December 31, 2018 balance of $40,382 . The Company recognizes accrued interest and penalties related to unrecognized tax benefits in its income tax expense. At March 31, 2019 and December 31, 2018 , the Company had approximately $9,903 and $9,019

Long-term debt

Long-term debt	3 Months Ended
	Mar. 31, 2019
Debt Disclosure [Abstract]
Long-term debt	Long-term debt Long-term debt was comprised of the following: As of March 31, 2019 March 31, 2019 December 31, 2018 Maturity date Interest rate Estimated fair value (2) Senior Secured Credit Facilities: Term Loan A (1) $ 650,000 $ 675,000 12/24/2019 2.00% + LIBOR $ 649,155 Term Loan A-2 (1) 995,000 995,000 12/24/2019 1.00% + LIBOR $ 999,975 Term Loan B 3,333,750 3,342,500 6/24/2021 2.75% + LIBOR (3) $ 3,350,419 Revolver (1) 575,000 175,000 12/24/2019 2.00% + LIBOR $ 575,000 Senior Notes: 5 3/4% Senior Notes 1,250,000 1,250,000 8/15/2022 5.75% $ 1,271,875 5 1/8% Senior Notes 1,750,000 1,750,000 7/15/2024 5.125% $ 1,729,175 5% Senior Notes 1,500,000 1,500,000 5/1/2025 5% $ 1,439,250 Acquisition obligations and other notes payable (4) 181,885 183,979 2019-2026 6.30% $ 181,885 Financing lease obligations (5) 276,564 282,737 2019-2036 4.84% $ 276,564 Total debt principal outstanding 10,512,199 10,154,216 Discount and deferred financing costs (6) (48,495 ) (52,000 ) 10,463,704 10,102,216 Less current portion (4,676,691 ) (1,929,369 ) $ 5,787,013 $ 8,172,847 (1) On May 6, 2019, the Company entered into an agreement to extend the maturity dates of its Term Loan A, Term Loan A-2 and Revolver by six months , to December 24, 2019 . (2) Fair values are based upon quoted market prices for similar instruments, a level 2 input. The balances of acquisition obligations and other notes payable and financing lease obligations are presented in the condensed consolidated financial statements at March 31, 2019 at their approximate fair values due to the short-term nature of their settlements. (3) Term Loan B is subject to a LIBOR component floor of 0.75% . (4) The acquisition obligations and other notes payable interest rate is the weighted average interest rate based on the current interest rate in effect and assuming no changes to the LIBOR based interest rates. (5) The interest rate presented for financing lease obligations is the weighted average discount rate. (6) The carrying amount of the Company’s senior secured credit facilities includes a discount of $5,487 and deferred financing costs of $11,319 , and the carrying amount of the Company’s senior notes includes deferred financing costs of $31,689 as of March 31, 2019 . Scheduled maturities of long-term debt at March 31, 2019 were as follows: 2019 (remainder of the year) (1) 4,654,038 2020 83,658 2021 940,050 2022 1,291,930 2023 52,538 2024 1,784,606 Thereafter 1,705,379 (1) Includes $2,372,764 representing our estimate of Term Loan B principal prepayments expected to be paid in 2019 from net cash proceeds of the DMG sale, as described below. The Company's senior secured credit facilities become subject to partial mandatory prepayment if, and when, the Company consummates the sale of its DMG division to Collaborative Care Holdings, LLC (Optum), a subsidiary of UnitedHealth Group Inc. (the DMG sale). As disclosed in the Company’s current report on Form 8-K filed November 26, 2018 , the first amendment to the credit agreement governing the Company’s senior secured credit facilities amended existing covenants to permit the sale of the DMG business and require net cash proceeds from the sale in excess of $750,000 to be used to prepay debt outstanding under the Company’s credit facilities. As of March 31, 2019 , the Company expects to close the DMG sale in the near term and to prepay debt without immediately drawing down replacement debt. Accordingly, the Company has classified as current its estimate of the portion of its otherwise noncurrent debt that is expected to be prepaid with the expected net proceeds from the sale. During the first three months of 2019 , the Company made mandatory principal payments under its senior secured credit facilities totaling $25,000 on Term Loan A and $8,750 on Term Loan B. As of March 31, 2019 , the Company maintains several interest rate cap agreements entered into in October 2015 that have the economic effect of capping the Company's maximum exposure to LIBOR variable interest rate changes on specific portions of the Company's floating rate debt, including all of Term Loan B and part of Term Loan A. The remaining $483,750 outstanding principal balance of Term Loan A and the entire outstanding balance on Term Loan A-2 and Revolver are subject to LIBOR-based interest rate volatility. The cap agreements are designated as cash flow hedges and, as a result, changes in the fair values of these cap agreements are reported in other comprehensive (loss) income. The amortization of the original cap premium is recognized as a component of debt expense on a straight-line basis over the terms of the cap agreements. These cap agreements do not contain credit-risk contingent features. The following table summarizes the Company’s derivative instruments outstanding as of March 31, 2019 and December 31, 2018 , which are classified in "Other long-term assets" on its consolidated balance sheet: March 31, 2019 Fair value Notional amount LIBOR maximum rate Effective date Expiration date Debt expense Recorded OCI loss March 31, 2019 December 31, 2018 October 2015 caps $ 3,500,000 3.5% 6/29/2018 6/30/2020 $ 2,163 $ 781 $ 70 $ 851 The following table summarizes the effects of the Company’s interest rate cap agreements for the three months ended March 31, 2019 and 2018 : Amount of unrecognized (losses) gains in OCI on interest rate cap agreements Income statement location Reclassification from accumulated other comprehensive income into net income Three months ended March 31, Three months ended March 31, Derivatives designated as cash flow hedges 2019 2018 2019 2018 Interest rate cap agreements $ (781 ) $ 1,414 Debt expense $ 2,163 $ 2,070 Tax expense (benefit) 201 (364 ) Tax expense (557 ) (533 ) Total $ (580 ) $ 1,050 $ 1,606 $ 1,537 See Note 14 to these condensed consolidated financial statements for further details on amounts recorded and reclassified from accumulated other comprehensive income. The Company’s weighted average effective interest rate on the senior secured credit facilities at the end of the first quarter was 5.00% , based on the current margins in effect for Term Loan A, Term Loan A-2, Term Loan B and Revolver, as of March 31, 2019 , as described above. The Company’s overall weighted average effective interest rate during the quarter ended March 31, 2019 was 5.16% and as of March 31, 2019 was 5.14% . As of March 31, 2019 , the Company’s interest rates are fixed on approximately 46.31% of its total debt. As of March 31, 2019 , the Company had $575,000 drawn on its $1,000,000 revolving line of credit under its senior secured credit facilities, of which approximately $38,017 was committed for outstanding letters of credit. The Company also has approximately $40,871 of additional outstanding letters of credit under a separate bilateral secured letter of credit facility, and $211

Leases Leases

Leases Leases	3 Months Ended
	Mar. 31, 2019
Leases [Abstract]
Leases of Lessee Disclosure [Text Block]	Leases The majority of the Company’s facilities are leased under non-cancellable operating leases ranging in terms from five years to fifteen years and which contain renewal options of five years to ten years at the fair rental value at the time of renewal. These renewal options are included in the Company’s determination of the right-of-use assets and related lease liabilities when renewal is considered reasonably certain at the commencement date. Certain of the Company’s leases are subject to periodic consumer price index increases or contain fixed escalation clauses. The Company also leases certain facilities and equipment under finance leases. The Company has elected the practical expedient to not separate lease components from non-lease components related to its real estate financing and operating leases. Financing and operating right-of-use assets are recognized based on the net present value of lease payments over the lease term at the commencement date. Since most of the Company's leases do not provide an implicit rate of return, the Company uses its incremental borrowing rate based on information available at the commencement date in determining the present value of lease payments. As of March 31, 2019 and December 31, 2018 , assets recorded under finance leases were $233,209 and $367,164 , respectively, and accumulated amortization associated with finance leases was $9,972 and $131,971 , respectively, included in property and equipment, net, on the Company's consolidated balance sheet. In certain markets, the Company acquires and develops dialysis centers. Upon completion, the Company sells the center to a third party and leases the space back with the intent of operating the center on a long term basis. Both the sale and leaseback terms are generally market terms. The lease terms are consistent with the Company's other operating leases with the majority of the leases under non-cancellable operating leases ranging in terms from five years to fifteen years and which contain renewal options of five years to ten years at the fair rental value at the time of renewal. The Company adopted Topic 842, Leases beginning on January 1, 2019 through a modified retrospective approach for leases existing at the adoption date with a cumulative effect adjustment. Consequently, financial information was not updated for dates and periods before January 1, 2019. The components of lease expense were as follows: Lease cost Three months ended March 31, 2019 Operating lease cost (1) : Fixed lease expense $ 128,110 Variable lease expense 28,571 Financing lease cost: Amortization of leased assets 5,826 Interest on lease liabilities 3,775 Net lease cost $ 166,282 (1) Includes short-term lease expense and sublease income, which are immaterial. Other information related to leases was as follows: Lease term and discount rate March 31, 2019 Weighted average remaining lease term (years): Operating leases 9.0 Finance leases 10.1 Weighted average discount rate: Operating leases 4.2 % Finance leases 4.8 % Three months ended Other information Gain on sale leaseback, net $ 3,987 Cash paid for amounts included in the measurement of lease Operating cash flows from operating leases $ 153,587 Operating cash flows from finance leases $ 5,661 Financing cash flows from finance leases $ 5,344 Net operating lease assets obtained in exchange for new or modified $ 45,034 Future minimum lease payments under non-cancellable leases as of March 31, 2019 were as follows: Operating leases Finance leases 2019 (remainder of the year) $ 365,155 $ 30,702 2020 474,121 37,974 2021 443,729 33,637 2022 405,176 33,860 2023 358,578 33,975 2024 306,512 33,993 Thereafter 1,275,632 162,183 Total future minimum lease payments $ 3,628,903 $ 366,324 Less portion representing interest (635,714 ) (89,760 ) Present value of lease liabilities $ 2,993,189 $ 276,564 Future minimum lease payments under non-cancellable leases as of December 31, 2018 were as follows: Operating leases Capital leases 2019 $ 483,488 $ 36,754 2020 462,154 41,044 2021 432,950 34,026 2022 395,462 33,690 2023 349,649 33,845 Thereafter 1,589,949 194,611 $ 3,713,652 373,970 Less portion representing interest (91,233 ) Total capital lease obligations, including current portion $ 282,737

Contingencies

Contingencies	3 Months Ended
	Mar. 31, 2019
Commitments and Contingencies Disclosure [Abstract]
Contingencies	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, claims, qui tam suits, governmental investigations and audits (including investigations resulting from its obligation to self-report suspected violations of law) and other legal proceedings. 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 March 31, 2019 and December 31, 2018, the Company’s total recorded accruals, including DMG, 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 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. Inquiries by the Federal Government and Certain Related Civil Proceedings 2016 U.S. Attorney Texas Investigation : In early February 2016, the Company announced that its pharmacy services’ wholly-owned subsidiary, DaVita Rx, LLC (DaVita Rx), received a Civil Investigative Demand (CID) from the U.S. Attorney’s Office, Northern District of Texas. The government is conducting 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. The CID covers the period from January 1, 2006 through the present. In connection with the Company’s ongoing efforts working with the government, the Company learned that a qui tam complaint had been filed covering some of the issues in the CID and practices that had been identified by the Company in a self-disclosure filed with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) in February 2016. In December 2017, the Company finalized and executed a settlement agreement with the government and relators in the qui tam matter that included total monetary consideration of $63,700 , as previously disclosed, of which $41,500 was an incremental cash payment and $22,200 was for amounts previously refunded, and all of which was previously accrued. The government’s investigation into certain of the Company's relationships with pharmaceutical manufacturers is ongoing, and in July 2018 the OIG served the Company with a subpoena seeking additional documents and information relating to those relationships. The Company is continuing to cooperate with the government in this investigation. 2017 U.S. Attorney Massachusetts Investigation : In January 2017, the Company was served with an administrative subpoena for records by the U.S. Attorney’s Office, District of Massachusetts, relating to an investigation into possible federal health care offenses. The subpoena covers the period from January 1, 2007 through the present, and seeks documents relevant to charitable patient assistance organizations, particularly the American Kidney Fund, including documents related to efforts to provide patients with information concerning the availability of charitable assistance. The Company is continuing to cooperate with the government in this investigation. 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, including DMG, DaVita Rx, DaVita Laboratory Services, Inc. (DaVita Labs), and RMS Lifeline Inc. (Lifeline). In August 2018, the Company received a CID from the U.S. Attorney's Office. The CID was issued pursuant to the FCA and covers the period from January 2005 through the present. In connection with the resolution of the 2015 OIG Medicare Advantage Civil Investigation discussed in the 10-K, the Company resolved possible claims relating to DMG in this investigation. The Company is continuing to cooperate with the government in this investigation. 2017 U.S. Attorney Florida Investigation : In November 2017, the U.S. Attorney’s Office, Southern District of Florida informed the Company of an investigation it was conducting into possible federal healthcare offenses involving the Company's wholly-owned subsidiary, Lifeline. The U.S. Attorney's Office, Southern District of Florida notified the court on April 4, 2019 of its decision to elect not to intervene in the matter of Gabriel Valle, M.D., et al, v. RMS Lifeline, Inc., et al . The complaint then was unsealed in the U.S. District Court, Southern District of Florida by order dated April 5, 2019. The U.S. Attorney's Office confirmed that the complaint, which alleges violations of the FCA, was the basis of its investigation initiated in November 2017. The Company has not been served with the complaint. 2018 U.S. Attorney Florida Investigation : In March 2018, DaVita Labs received two CIDs from the U.S. Attorney’s Office, Middle District of Florida that were identical in nature but directed to the two different labs. According to the face of the CIDs, the U.S. Attorney’s Office is conducting an investigation as to whether the Company’s subsidiary submitted claims for blood, urine, and fecal testing, where there were insufficient test validation or stability studies to ensure accurate results, in violation of the FCA. In October 2018, DaVita Labs received a subpoena from the OIG in connection with this matter requesting certain patient records linked to clinical laboratory tests. The Company is continuing to cooperate 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 on-going 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 and/or private civil 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, exclusion from future participation in the Medicare, Medicaid and other federal health care programs and, if criminal proceedings were initiated against the Company, possible criminal penalties, any of which could have a material adverse effect on the Company. Shareholder and Derivative Claims Peace Officers’ Annuity and Benefit Fund of Georgia Securities Class Action Civil Suit : On February 1, 2017, the Peace Officers’ Annuity and Benefit Fund of Georgia filed a putative federal securities class action complaint in the U.S. District Court for the District of Colorado against the Company and certain executives. The complaint covers the time period of August 2015 to October 2016 and alleges, generally, that the Company and its executives violated federal securities laws concerning the Company’s financial results and revenue derived from patients who received charitable premium assistance from an industry-funded non-profit organization. The complaint further alleges that the process by which patients obtained commercial insurance and received charitable premium assistance was improper and "created a false impression of DaVita’s business and operational status and future growth prospects." In November 2017, the court appointed the lead plaintiff and an amended complaint was filed on January 12, 2018. On March 27, 2018, the Company and various individual defendants filed a motion to dismiss. On March 28, 2019, the U.S. District Court for the District of Colorado denied the motion to dismiss. The Company disputes these allegations and intends to defend this action accordingly. In re DaVita Inc. Stockholder Derivative Litigation : On August 15, 2017, the U.S. District Court for the District of Delaware consolidated three previously disclosed shareholder derivative lawsuits: the Blackburn Shareholder action filed on February 10, 2017, the Gabilondo Shareholder action filed on May 30, 2017, and the City of Warren Police and Fire Retirement System Shareholder action filed on June 9, 2017. The complaint covers the time period from 2015 to present and alleges, generally, breach of fiduciary duty, unjust enrichment, abuse of control, gross mismanagement, corporate waste, and misrepresentations and/or failures to disclose certain information in violation of the federal securities laws in connection with an alleged practice to direct patients with government-subsidized health insurance into private health insurance plans to maximize the Company’s profits. An amended complaint was filed in September 2017, and on December 18, 2017, the Company filed a motion to dismiss and a motion to stay proceedings in the alternative. On April 25, 2019, the Court denied the Company's motion to dismiss. The Company is required to now answer the complaint by May 28, 2019. The Company disputes these allegations and intends to defend this action accordingly. Other Proceedings In addition to the foregoing, 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 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 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 11 to these condensed consolidated financial statements, 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

Other commitments

Other commitments	3 Months Ended
	Mar. 31, 2019
Commitments and Contingencies Disclosure [Abstract]
Noncontrolling interests subject to put provisions and other commitments	Other commitments The Company has certain other potential commitments to provide operating capital to a number of dialysis centers that are wholly-owned by third parties or businesses in which the Company maintains a noncontrolling equity interest as well as to physician-owned vascular access clinics or medical practices that the Company operates under management and administrative services agreements of approximately $7,339

Long-term incentive compensatio

Long-term incentive compensation	3 Months Ended
	Mar. 31, 2019
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Long-term incentive compensation	Long-term incentive compensation Long-term incentive program (LTIP) compensation includes both stock-based awards (principally stock-settled stock appreciation rights, restricted stock units, and performance stock units) as well as long-term performance-based cash awards. Long-term incentive compensation expense, which was primarily general and administrative in nature, was attributed to the Company’s U.S. dialysis and related lab services business, corporate administrative support, and ancillary services and strategic initiatives. The Company’s stock-based compensation expense for stock-settled awards is measured at the estimated fair value of awards on the date of grant and recognized on a cumulative straight-line basis over the vesting terms of the awards unless the stock awards are based on non-market based performance metrics, in which case expense is adjusted for expected ultimate payouts as of the end of each reporting period. Stock-based compensation expense for cash-settled awards is based on their estimated fair values as of the end of each reporting period. The expense for all stock-based awards is recognized net of expected forfeitures. During the three months ended March 31, 2019 , the Company granted 7 restricted stock units with an aggregate grant-date fair value of $404 and a weighted-average expected life of approximately 1.6 years . For the three months ended March 31, 2019 and 2018 , the Company recognized $13,107 and $15,215 , respectively, in total LTIP expense, of which $10,301 and $9,155 , respectively, represented stock-based compensation expense for stock appreciation rights, restricted stock units, performance stock units and discounted employee stock plan purchases, which are primarily included in general and administrative expense. The estimated tax benefits recorded for stock-based compensation for the three months ended March 31, 2019 and 2018 was $1,495 and $2,088 , respectively. As of March 31, 2019 , the Company had $88,173 of total estimated but unrecognized compensation expense for outstanding LTIP awards, including $79,499 related to stock-based compensation arrangements under the Company’s equity compensation and employee stock purchase plans. The Company expects to recognize the performance-based cash component of these LTIP expenses over a weighted average remaining period of 0.7 years and the stock-based component of these LTIP expenses over a weighted average remaining period of 1.4 years . For the three months ended March 31, 2019 and 2018 , the Company recognized $151 and $4,895

Accumulated other comprehensive

Accumulated other comprehensive (loss) income	3 Months Ended
	Mar. 31, 2019
Statement of Comprehensive Income [Abstract]
Comprehensive income	Accumulated other comprehensive (loss) income For the three months ended March 31, 2019 For the three months ended March 31, 2018 Interest Foreign Accumulated Interest Investment Foreign Accumulated Beginning balance $ (8,961 ) $ (25,963 ) $ (34,924 ) $ (12,408 ) $ 5,662 $ 19,981 $ 13,235 Cumulative effect of change in (1) — — — (2,706 ) (5,662 ) — (8,368 ) Unrealized (losses) gains (781 ) (13,653 ) (14,434 ) 1,414 — 19,881 21,295 Related income tax benefit 201 — 201 (364 ) — — (364 ) (580 ) (13,653 ) (14,233 ) 1,050 — 19,881 20,931 Reclassification into net income 2,163 — 2,163 2,070 — — 2,070 Related income (557 ) — (557 ) (533 ) — — (533 ) 1,606 — 1,606 1,537 — — 1,537 Ending balance $ (7,935 ) $ (39,616 ) $ (47,551 ) $ (12,527 ) $ — $ 39,862 $ 27,335 (1) Reflects the cumulative effect of a change in accounting principle for ASUs 2016-01 and 2018-03 on classification and measurement of financial instruments and ASU 2018-02 on remeasurement and reclassification of deferred tax effects in accumulated other comprehensive income associated with the Tax Cuts and Jobs Act of 2017. Net cap realized losses reclassified into income are recorded as debt expense in the corresponding consolidated statements of income. See Note 9 to these condensed consolidated financial statements for further details.

Acquisitions and divestitures

Acquisitions and divestitures	3 Months Ended
	Mar. 31, 2019
Business Combinations [Abstract]
Acquisitions and divestitures	Acquisitions and divestitures Routine acquisitions During the three months ended March 31, 2019 , the Company acquired dialysis businesses consisting of two dialysis centers located in the U.S. and two dialysis centers located outside the U.S. for a total of $10,210 in net cash, $1,457 in deferred purchase price obligations, and $898 in liabilities assumed and earn-out obligations. The assets and liabilities for these acquisitions were recorded at their estimated fair values at the dates of the acquisitions and are included in the Company’s condensed consolidated financial statements, as are their operating results, from the designated effective dates of the acquisitions. The initial purchase price allocations for these transactions have been recorded at estimated fair values based on the best information available to management and will be finalized when certain information arranged to be obtained has been received. In particular, certain income tax amounts are pending final evaluation and quantification of pre-acquisition tax contingencies and filing of final tax returns. In addition, valuation of certain working capital items, fixed assets and intangibles are pending final audits and related valuation reports. The following table summarizes the assets acquired and liabilities assumed in these transactions at their estimated acquisition date fair values: Current assets $ 1,117 Property and equipment 923 Intangible and other long-term assets 4,312 Goodwill 8,655 Current liabilities (592 ) Long-term liabilities (88 ) Noncontrolling interests (1,762 ) $ 12,565 Amortizable intangible assets acquired during the first three months of 2019 primarily represent non-compete agreements which had weighted-average estimated useful lives of approximately five years . The total estimated amount of goodwill deductible for tax purposes associated with these acquisitions was approximately $6,945 . Contingent earn-out obligations The Company has several contingent earn-out obligations associated with acquisitions that could result in the Company paying the former owners of acquired companies a total of up to $11,716 if certain EBITDA, operating income performance targets or quality margins are met primarily over the next one year to five years . As of March 31, 2019 , the estimated fair values of these contingent earn-out obligations is $3,432 , of which $650 is included in other liabilities and the remaining $2,782

Held for Sale and Discontinued

Held for Sale and Discontinued Operations Held for Sale and Discontinued Operations	3 Months Ended
	Mar. 31, 2019
Held for Sale and Discontinued Operations [Abstract]
Disposal Groups, Including Discontinued Operations, Disclosure [Text Block]	Held for sale and discontinued operations DaVita Medical Group In December 2017, the Company entered into an agreement to sell its DMG division to Collaborative Care Holdings, LLC (Optum), a subsidiary of UnitedHealth Group Inc., subject to receipt of required regulatory approvals and other customary closing conditions. As a result, the DMG business has been classified as held for sale and its results of operations are reported as discontinued operations for all periods presented in these condensed consolidated financial statements. The contractual termination date under this equity purchase agreement is June 30, 2019 . The following table presents the financial results of discontinued operations related to DMG: Three months ended March 31, 2019 2018 Revenues $ 1,382,281 $ 1,227,932 Expenses 1,338,153 1,226,407 Income from discontinued operations before taxes 44,128 1,525 Income tax expense 13,823 7,311 Net income (loss) from discontinued operations, net of tax $ 30,305 $ (5,786 ) The following table presents the financial position of discontinued operations related to DMG: March 31, 2019 December 31, 2018 Assets Cash and cash equivalents $ 533,615 $ 414,683 Other current assets 613,359 557,403 Property and equipment, net 476,781 458,040 Operating lease right-of-use assets 412,388 — Intangible assets, net 1,317,036 1,316,974 Other long-term assets 120,347 112,127 Goodwill 2,848,262 2,847,178 Valuation allowance on disposal group (316,840 ) (316,840 ) Total current assets held for sale, net $ 6,004,948 $ 5,389,565 Liabilities Other liabilities $ 624,319 $ 479,134 Medical payables 512,523 436,839 Current portion of operating leases liabilities 68,031 — Current portion of long-term debt 2,832 3,122 Long-term operating leases liabilities 387,841 — Long-term debt 33,073 33,425 Other long-term liabilities 124,691 291,239 Total current liabilities held for sale $ 1,753,310 $ 1,243,759 The following table presents cash flows of discontinued operations related to DMG: Three months ended March 31, 2019 2018 Net cash provided by operating activities from discontinued operations $ 68,240 $ 156,248 Net cash used in investing activities from discontinued operations $ (22,809 ) $ (33,068 ) DMG acquisitions During the first three months of 2019, the Company's DMG business acquired one medical business for a total of $1,064 in cash and deferred purchase price of $105

Variable interest entities

Variable interest entities	3 Months Ended
	Mar. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Variable interest entities	Variable interest entities The Company relies on the operating activities of certain legal entities that it does not directly own or control, but over which it has indirect influence and of which it is considered the primary beneficiary. These entities are subject to the consolidation guidance applicable to variable interest entities (VIEs). 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 10-K. At March 31, 2019 , these condensed consolidated financial statements include total assets of VIEs of $1,118,672 and total liabilities and noncontrolling interests of VIEs to third parties of $673,499 , including assets of $737,309 and liabilities and noncontrolling interests of $401,308

Fair value of financial instrum

Fair value of financial instruments	3 Months Ended
	Mar. 31, 2019
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 (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 certain assets, liabilities and temporary equity that are measured at fair value into the appropriate fair value hierarchy levels as defined by the FASB. The following table summarizes the Company’s assets, liabilities and temporary equity that are measured at fair value on a recurring basis as of March 31, 2019 : Total Quoted prices in Significant other Significant Assets Investments in equity securities $ 36,214 $ 36,214 $ — $ — Interest rate cap agreements $ 70 $ — $ 70 $ — Liabilities Contingent earn-out obligations $ 3,432 $ — $ — $ 3,432 Temporary equity Noncontrolling interests subject to put provisions $ 1,143,044 $ — $ — $ 1,143,044 Investments in equity securities represent investments in various open-ended registered investment companies (mutual funds) and common stock and are recorded at estimated fair value based on reported market prices or redemption prices, as applicable. See Note 5 to these condensed consolidated financial statements 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. See Note 9 to these condensed consolidated financial statements for further discussion. The estimated fair value measurements of contingent earn-out obligations are primarily based on unobservable inputs, including projected EBITDA. See Note 15 to these condensed consolidated financial statements for further discussion. See Note 18 to the Company's consolidated financial statements included in the 10-K for a discussion of the Company’s methodology for estimating the fair value of noncontrolling interests subject to put obligations. The Company's senior secured credit facilities and senior notes fair values are based upon quoted market prices for similar instruments, a level 2 input. See Note 9 to these condensed consolidated financial statements for further discussion. Other financial instruments consist primarily of cash and cash equivalents, accounts receivable, accounts payable, other accrued liabilities, lease liabilities and debt. The balances of non-debt financial instruments are presented in these condensed consolidated financial statements at March 31, 2019

Segment reporting

Segment reporting	3 Months Ended
	Mar. 31, 2019
Segment Reporting [Abstract]
Segment reporting	Segment reporting The Company has consisted of two major divisions, DaVita Kidney Care (Kidney Care) and DMG. The Kidney Care division is comprised of the Company’s U.S. dialysis and related lab services business, various ancillary services and strategic initiatives, including its international operations, and the Company’s corporate administrative support. The Company’s separate operating segments include its U.S. dialysis and related lab services business, each of its ancillary services and strategic initiatives, its kidney care operations in each foreign sovereign jurisdiction, its other health operations in each foreign sovereign jurisdiction, and its equity method investment in the APAC JV. The U.S. dialysis and related lab services business qualifies as a separately reportable segment, and all other ancillary services and strategic initiatives operating segments, including the international operating segments, have been combined and disclosed in the other segments category. The Company’s operating segment financial information included in this report is prepared on the internal management reporting basis that the chief operating decision maker uses to allocate resources and assess the financial performance of the Company's operating segments. For internal management reporting, segment operations include direct segment operating expenses but generally exclude corporate administrative support costs, which consist primarily of indirect labor, benefits and long-term incentive-based compensation expenses of certain departments which provide support to all of the Company’s various operating lines of business, except to the extent that such costs are charged to and borne by certain ancillary services and strategic initiatives via internal management fees. These corporate administrative support costs are reduced by internal management fees received from the Company’s ancillary lines of business. The following is a summary of segment net revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income before income taxes: Three months ended March 31, 2019 2018 Segment revenues: U.S. dialysis and related lab services Patient service revenues: External sources $ 2,517,289 $ 2,489,165 Intersegment revenues 30,420 18,422 U.S. dialysis and related lab services patient service revenues 2,547,709 2,507,587 Provision for uncollectible accounts (5,463 ) 25,199 Net U.S. dialysis and related lab services patient service revenues 2,542,246 2,532,786 Other revenues (1) : External sources 4,684 5,114 Intersegment revenues 221 — Total U.S. dialysis and related lab services revenues $ 2,547,151 $ 2,537,900 Other—Ancillary services and strategic initiatives Patient service revenues, net $ 117,863 $ 102,255 Other external sources 108,739 227,711 Intersegment revenues 3,336 10,199 Total ancillary services and strategic initiatives revenues 229,938 340,165 Total net segment revenues 2,777,089 2,878,065 Elimination of intersegment revenues (33,977 ) (28,621 ) Consolidated revenues $ 2,743,112 $ 2,849,444 Segment operating margin: U.S. dialysis and related lab services $ 416,981 $ 433,380 Other—Ancillary services and strategic initiatives (57,630 ) (6,990 ) Total segment operating margin 359,351 426,390 Reconciliation of segment operating margin to consolidated income from continuing Corporate administrative support (18,844 ) (15,704 ) Consolidated operating income 340,507 410,686 Debt expense (131,519 ) (113,516 ) Other income, net 6,940 4,582 Consolidated income from continuing operations before income taxes $ 215,928 $ 301,752 (1) Includes management fee revenue from providing management and administrative services to dialysis ventures in which the Company owns a noncontrolling equity investment or which are wholly-owned by third parties. A summary of assets by reportable segment was as follows: March 31, 2019 December 31, 2018 Segment assets U.S. dialysis and related lab services (including equity $ 15,095,326 $ 12,333,641 Other—Ancillary services and strategic initiatives (including 1,505,670 1,387,046 DMG—Held for sale (including equity investments of $5,282 and 6,004,948 5,389,565 Consolidated assets $ 22,605,944 $ 19,110,252 Depreciation and amortization expense by reportable segment was as follows: Three months ended March 31, 2019 2018 U.S. dialysis and related lab services $ 140,780 $ 134,776 Other — Ancillary services and strategic initiatives 7,748 8,023 $ 148,528 $ 142,799 Expenditures for property and equipment by reportable segment were as follows: Three months ended 2019 2018 U.S. dialysis and related lab services $ 170,548 $ 191,406 Other—Ancillary services and strategic initiatives 8,578 9,988 DMG—Held for sale 19,752 31,049 $ 198,878 $ 232,443

Changes in DaVita Inc.'s owners

Changes in DaVita Inc.'s ownership interest in consolidated subsidiaries	3 Months Ended
	Mar. 31, 2019
Noncontrolling Interest [Abstract]
Changes in DaVita Inc.'s ownership interest in consolidated subsidiaries	Changes in DaVita Inc.’s ownership interests in consolidated subsidiaries The effects of changes in DaVita Inc.’s ownership interests in consolidated subsidiaries on the Company’s consolidated equity were as follows: Three months ended March 31, 2019 2018 Net income attributable to DaVita Inc. $ 149,289 $ 178,686 Changes in paid-in capital for: Sales of noncontrolling interests — 76 Purchases of noncontrolling interests (2,206 ) (1,994 ) Net transfers to noncontrolling interests (2,206 ) (1,918 ) Net income attributable to DaVita Inc., net of transfers to noncontrolling interests $ 147,083 $ 176,768

New accounting standards

New accounting standards	3 Months Ended
	Mar. 31, 2019
Accounting Changes and Error Corrections [Abstract]
New accounting standards	New accounting standards In February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842) . The amendments in Topic 842 revise the accounting related to lessee accounting. Under the new guidance, lessees are required to recognize a lease liability and a right-of-use asset for substantially all leases with lease terms in excess of twelve months. The new lease guidance also simplifies the accounting for sale and leaseback transactions primarily because lessees must recognize lease assets and lease liabilities. The Company adopted Topic 842 beginning on January 1, 2019 through a modified retrospective approach for leases existing at the adoption date with a cumulative effect adjustment. The Company elected to apply the package of practical expedients to not recast prior conclusions related to contracts containing leases, lease classification and initial direct costs. Adoption of the new standard resulted in the recording of operating right-of-use assets of $2,783,784 , operating lease liabilities of $3,001,354 and an adjustment to retained earnings of $39,876 , primarily related to deferred gains on prior sale leaseback transactions as of January 1, 2019. The standard did not materially impact the Company's consolidated net earnings and had no impact on cash flows. See Note 10 to these condensed consolidated financial statements for further details. In August 2017, the FASB issued ASU No. 2017-12, Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities. The amendments in this ASU better align an entity’s risk management activities and financial reporting for hedging relationships through changes to both the designation and measurement guidance for qualifying hedging relationships and the presentation of hedge results. The amendments in this ASU were effective for the Company on January 1, 2019 and are to be applied prospectively. The adoption of this ASU did not have a material impact on the Company’s consolidated financial statements when adopted on January 1, 2019. In August 2018, the FASB issued ASU No. 2018-13, Fair Value Measurement (Topic 820): Disclosure Framework -Changes to the Disclosure Requirements for Fair Value Measurement

Condensed consolidating financi

Condensed consolidating financial statements	3 Months Ended
	Mar. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Condensed consolidating financial statements	Condensed consolidating financial statements The following information is presented in accordance with Rule 3-10 of Regulation S-X. The operating and investing activities of the separate legal entities included in the Company’s condensed consolidated financial statements are fully interdependent and integrated. Revenues and operating expenses of the separate legal entities include intercompany charges for management and other administrative services. The Company’s senior notes are guaranteed by a substantial majority of its domestic subsidiaries as measured by revenue, income and assets. The subsidiary guarantors have guaranteed the senior notes on a joint and several basis. However, a subsidiary guarantor will be released from its obligations under its guarantee of the senior notes and the indentures governing the senior notes if, in general, there is a sale or other disposition of all or substantially all of the assets of such subsidiary guarantor, including by merger or consolidation, or a sale or other disposition of all of the equity interests in such subsidiary guarantor held by the Company and its restricted subsidiaries, as defined in the indentures; such subsidiary guarantor is designated by the Company as an unrestricted subsidiary, as defined in the indentures, or otherwise ceases to be a restricted subsidiary of the Company, in each case in accordance with the indentures; or such subsidiary guarantor no longer guarantees any other indebtedness, as defined in the indentures, of the Company or any of its restricted subsidiaries, except for guarantees that are contemporaneously released. The senior notes are not guaranteed by certain of the Company’s domestic subsidiaries, any of the Company’s foreign subsidiaries, or any entities that do not constitute subsidiaries within the meaning of the indentures, such as corporations in which the Company holds capital stock with less than a majority of the voting power, joint ventures and partnerships in which the Company holds less than a majority of the equity or voting interests, non-owned entities and third parties. Condensed Consolidating Statements of Operations DaVita Inc. Guarantor subsidiaries Non- Guarantor subsidiaries Consolidating adjustments Consolidated total For the three months ended March 31, 2019 Patient services revenues $ — $ 1,777,246 $ 918,604 $ (60,698 ) $ 2,635,152 Provision for uncollectible accounts — (3,970 ) (1,493 ) — (5,463 ) Net patient service revenues — 1,773,276 917,111 (60,698 ) 2,629,689 Other revenues 188,836 111,141 35,619 (222,173 ) 113,423 Total net revenues 188,836 1,884,417 952,730 (282,871 ) 2,743,112 Operating expenses and charges 143,659 1,660,453 881,364 (282,871 ) 2,402,605 Operating income 45,177 223,964 71,366 — 340,507 Debt expense (133,595 ) (52,479 ) (10,719 ) 65,274 (131,519 ) Other income, net 110,198 2,596 9,111 (114,965 ) 6,940 Income tax expense 7,026 46,544 3,176 — 56,746 Equity earnings in subsidiaries 134,535 46,151 — (180,686 ) — Net income from continuing operations 149,289 173,688 66,582 (230,377 ) 159,182 Net (loss) income from discontinued operations, net of tax — (39,153 ) 19,767 49,691 30,305 Net income 149,289 134,535 86,349 (180,686 ) 189,487 Less: Net income attributable to noncontrolling interests — — — (40,198 ) (40,198 ) Net income attributable to DaVita Inc. $ 149,289 $ 134,535 $ 86,349 $ (220,884 ) $ 149,289 Guarantor Non- Consolidating Consolidated For the three months ended March 31, 2018 DaVita Inc. Patient service revenues $ — $ 1,790,188 $ 848,401 $ (47,515 ) $ 2,591,074 Provision for uncollectible accounts — 9,628 15,917 — 25,545 Net patient service revenues — 1,799,816 864,318 (47,515 ) 2,616,619 Other revenues 195,565 204,960 70,933 (238,633 ) 232,825 Total net revenues 195,565 2,004,776 935,251 (286,148 ) 2,849,444 Operating expenses 133,356 1,791,094 800,456 (286,148 ) 2,438,758 Operating income 62,209 213,682 134,795 — 410,686 Debt expense (114,334 ) (52,197 ) (7,375 ) 60,390 (113,516 ) Other income 104,081 2,523 5,704 (107,726 ) 4,582 Income tax expense 14,387 48,944 7,406 — 70,737 Equity earnings in subsidiaries 141,117 66,496 — (207,613 ) — Net income from continuing operations 178,686 181,560 125,718 (254,949 ) 231,015 Net loss from discontinued operations, net of tax — (40,443 ) (12,679 ) 47,336 (5,786 ) Net income 178,686 141,117 113,039 (207,613 ) 225,229 Less: Net income attributable to noncontrolling interests — — — (46,543 ) (46,543 ) Net income attributable to DaVita Inc. $ 178,686 $ 141,117 $ 113,039 $ (254,156 ) $ 178,686 Condensed Consolidating Statements of Comprehensive Income Guarantor Non- Consolidating Consolidated For the three months ended March 31, 2019 DaVita Inc. Net income $ 149,289 $ 134,535 $ 86,349 $ (180,686 ) $ 189,487 Other comprehensive income (loss) 1,026 — (13,653 ) — (12,627 ) Total comprehensive income 150,315 134,535 72,696 (180,686 ) 176,860 Less: Comprehensive income attributable to noncontrolling interest — — — (40,198 ) (40,198 ) Comprehensive income attributable to DaVita Inc. $ 150,315 $ 134,535 $ 72,696 $ (220,884 ) $ 136,662 Guarantor Non- Consolidating Consolidated For the three months ended March 31, 2018 DaVita Inc. Net income $ 178,686 $ 141,117 $ 113,039 $ (207,613 ) $ 225,229 Other comprehensive income 2,587 — 19,881 — 22,468 Total comprehensive income 181,273 141,117 132,920 (207,613 ) 247,697 Less: Comprehensive income attributable to noncontrolling interest — — — (46,543 ) (46,543 ) Comprehensive income attributable to DaVita Inc. $ 181,273 $ 141,117 $ 132,920 $ (254,156 ) $ 201,154 Condensed Consolidating Balance Sheets Guarantor Non- Consolidating Consolidated As of March 31, 2019 DaVita Inc. Cash and cash equivalents $ 194,347 $ — $ 264,895 $ — $ 459,242 Restricted cash and equivalents 1,006 12,114 89,072 — 102,192 Accounts receivable, net — 1,349,185 604,237 — 1,953,422 Other current assets 37,185 568,029 100,058 — 705,272 Current assets held for sale, net — 4,842,062 1,162,886 — 6,004,948 Total current assets 232,538 6,771,390 2,221,148 — 9,225,076 Property and equipment, net 503,677 1,610,442 1,278,147 — 3,392,266 Operating lease right-of-use assets 107,237 1,594,411 1,034,888 — 2,736,536 Intangible assets, net 130 39,813 78,381 — 118,324 Investments in subsidiaries 10,191,084 3,323,518 — (13,514,602 ) — Intercompany receivables 3,756,675 — 1,496,009 (5,252,684 ) — Other long-term assets and investments 53,978 84,137 196,259 — 334,374 Goodwill — 4,812,366 1,987,002 — 6,799,368 Total assets $ 14,845,319 $ 18,236,077 $ 8,291,834 $ (18,767,286 ) $ 22,605,944 Current liabilities $ 4,702,717 $ 1,182,342 $ 592,508 $ — $ 6,477,567 Current liabilities held for sale — 1,084,512 668,798 — 1,753,310 Intercompany payables — 3,648,453 1,604,231 (5,252,684 ) — Long-term operating leases liabilities 133,936 1,502,922 988,918 — 2,625,776 Long-term debt and other long-term liabilities 5,520,830 626,764 371,980 — 6,519,574 Noncontrolling interests subject to put provisions 612,482 — — 530,562 1,143,044 Total DaVita Inc. shareholders' equity 3,875,354 10,191,084 3,323,518 (13,514,602 ) 3,875,354 Noncontrolling interests not subject to put — — 741,881 (530,562 ) 211,319 Total equity 3,875,354 10,191,084 4,065,399 (14,045,164 ) 4,086,673 Total liabilities and equity $ 14,845,319 $ 18,236,077 $ 8,291,834 $ (18,767,286 ) $ 22,605,944 Guarantor Non- Consolidating Consolidated As of December 31, 2018 DaVita Inc. Cash and cash equivalents $ 60,653 $ — $ 262,385 $ — $ 323,038 Restricted cash and equivalents 1,005 12,048 79,329 — 92,382 Accounts receivable, net — 1,264,290 594,318 — 1,858,608 Other current assets 37,185 601,318 122,063 — 760,566 Current assets held for sale — 4,440,953 948,612 — 5,389,565 Total current assets 98,843 6,318,609 2,006,707 — 8,424,159 Property and equipment, net 491,462 1,624,835 1,277,372 — 3,393,669 Intangible assets, net 153 42,933 75,760 — 118,846 Investments in subsidiaries 10,102,750 3,239,862 — (13,342,612 ) — Intercompany receivables 3,419,448 — 1,471,203 (4,890,651 ) — Other long-term assets and investments 53,385 80,537 197,696 — 331,618 Goodwill — 4,812,365 2,029,595 — 6,841,960 Total assets $ 14,166,041 $ 16,119,141 $ 7,058,333 $ (18,233,263 ) $ 19,110,252 Current liabilities $ 1,945,943 $ 1,251,534 $ 449,925 $ — $ 3,647,402 Current liabilities held for sale — 722,766 520,993 — 1,243,759 Intercompany payables — 3,327,026 1,563,625 (4,890,651 ) — Long-term debt and other long-term liabilities 7,918,581 715,065 552,406 — 9,186,052 Noncontrolling interests subject to put provisions 598,075 — — 526,566 1,124,641 Total DaVita Inc. shareholders' equity 3,703,442 10,102,750 3,239,862 (13,342,612 ) 3,703,442 Noncontrolling interests not subject to put — — 731,522 (526,566 ) 204,956 Total equity 3,703,442 10,102,750 3,971,384 (13,869,178 ) 3,908,398 Total liabilities and equity $ 14,166,041 $ 16,119,141 $ 7,058,333 $ (18,233,263 ) $ 19,110,252 Condensed Consolidating Statements of Cash Flows Guarantor Non- Consolidating Consolidated For the three months ended March 31, 2019 DaVita Inc. Cash flows from operating activities: Net income $ 149,289 $ 134,535 $ 86,349 $ (180,686 ) $ 189,487 Changes in operating assets and liabilities and non-cash (124,409 ) (197,096 ) 92,636 180,686 (48,183 ) Net cash provided by (used in) operating activities 24,880 (62,561 ) 178,985 — 141,304 Cash flows from investing activities: Additions of property and equipment (38,942 ) (112,376 ) (47,560 ) — (198,878 ) Acquisitions — — (11,274 ) — (11,274 ) Proceeds from asset and business sales — 1,456 12,447 — 13,903 Proceeds (purchases) from investment sales and other items, net 1,804 (4,558 ) (1,355 ) — (4,109 ) Net cash used in investing activities (37,138 ) (115,478 ) (47,742 ) — (200,358 ) Cash flows from financing activities: Long-term debt and related financing costs, net 365,133 (2,439 ) (5,497 ) — 357,197 Intercompany borrowing (payments) (220,697 ) 229,211 (8,514 ) — — Other items 1,517 (8,480 ) (25,283 ) — (32,246 ) Net cash provided by (used in) financing activities 145,953 218,292 (39,294 ) — 324,951 Effect of exchange rate changes on cash, cash — — (921 ) — (921 ) Net increase in cash, cash equivalents and 133,695 40,253 91,028 — 264,976 Less: Net increase in cash, cash equivalents and restricted cash from discontinued operations — 40,187 78,775 — 118,962 Net increase in cash, cash equivalents and restricted cash from continuing operations 133,695 66 12,253 — 146,014 Cash, cash equivalents and restricted cash of continuing 61,658 12,048 341,714 — 415,420 Cash, cash equivalents and restricted cash of continuing $ 195,353 $ 12,114 $ 353,967 $ — $ 561,434 Guarantor Non- Consolidating Consolidated For the three months ended March 31, 2018 DaVita Inc. Cash flows from operating activities: Net income $ 178,686 $ 141,117 $ 113,039 $ (207,613 ) $ 225,229 Changes in operating assets and liabilities and non-cash (82,391 ) 32,484 (20,396 ) 207,613 137,310 Net cash provided by operating activities 96,295 173,601 92,643 — 362,539 Cash flows from investing activities: Additions of property and equipment (27,356 ) (125,375 ) (79,712 ) — (232,443 ) Acquisitions — (4,417 ) (12,165 ) — (16,582 ) Proceeds from asset and business sales — 18,535 — — 18,535 Proceeds (purchases) from investment sales and other items, net 31,665 (762 ) (541 ) — 30,362 Net cash provided by (used in) investing activities 4,309 (112,019 ) (92,418 ) — (200,128 ) Cash flows from financing activities: Long-term debt and related financing costs, net 116,307 (3,377 ) (8,257 ) — 104,673 Intercompany borrowing (payments) 47,394 (49,783 ) 2,389 — — Other items (291,562 ) (2,200 ) (33,458 ) — (327,220 ) Net cash used in financing activities (127,861 ) (55,360 ) (39,326 ) — (222,547 ) Effect of exchange rate changes on cash, cash — — 6,668 — 6,668 Net decrease in cash, cash equivalents and restricted cash (27,257 ) 6,222 (32,433 ) — (53,468 ) Less: Net increase in cash, cash equivalents and restricted cash from discontinued operations — 6,185 11,649 — 17,834 Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations (27,257 ) 37 (44,082 ) — (71,302 ) Cash, cash equivalents and restricted cash of continuing 150,307 9,384 359,229 — 518,920 Cash, cash equivalents and restricted cash of continuing $ 123,050 $ 9,421 $ 315,147 $ — $ 447,618

Supplemental data

Supplemental data	3 Months Ended
	Mar. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Supplemental data	Supplemental data The following information is presented as supplemental data as required by the indentures governing the Company’s senior notes. Condensed Consolidating Statements of Income Consolidated Total Physician Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) For the three months ended March 31, 2019 Patient service operating revenues $ 2,635,152 $ — $ — $ 2,635,152 Provision for uncollectible accounts (5,463 ) — — (5,463 ) Net patient service operating revenues 2,629,689 — — 2,629,689 Other revenues 113,423 — — 113,423 Total net operating revenues 2,743,112 — — 2,743,112 Operating expenses 2,402,605 — — 2,402,605 Operating income 340,507 — — 340,507 Debt expense (131,519 ) — — (131,519 ) Other income 6,940 — — 6,940 Income tax expense 56,746 — — 56,746 Net income from continuing operations 159,182 — — 159,182 Net income from discontinued operations, net of tax 30,305 9,237 463 20,605 Net income 189,487 9,237 463 179,787 Less: Net income attributable to noncontrolling interests (40,198 ) (1,255 ) — (38,943 ) Net income attributable to DaVita Inc. $ 149,289 $ 7,982 $ 463 $ 140,844 (1) After elimination of the unrestricted subsidiaries and the physician groups. Condensed Consolidating Statements of Comprehensive Income Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) For the three months ended March 31, 2019 Net income $ 189,487 $ 9,237 $ 463 $ 179,787 Other comprehensive loss (12,627 ) — — (12,627 ) Total comprehensive income 176,860 9,237 463 167,160 Less: Comprehensive income attributable to the noncontrolling (40,198 ) (1,255 ) — (38,943 ) Comprehensive income attributable to DaVita Inc. $ 136,662 $ 7,982 $ 463 $ 128,217 (1) After elimination of the unrestricted subsidiaries and the physician groups. Condensed Consolidating Balance Sheets Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) As of March 31, 2019 Cash and cash equivalents $ 459,242 $ — $ — $ 459,242 Restricted cash and equivalents 102,192 — — 102,192 Accounts receivable, net 1,953,422 — — 1,953,422 Other current assets 705,272 — — 705,272 Current assets held for sale, net 6,004,948 629,422 3,288 5,372,238 Total current assets 9,225,076 629,422 3,288 8,592,366 Property and equipment, net 3,392,266 — — 3,392,266 Operating lease right-of-use assets 2,736,536 — — 2,736,536 Amortizable intangibles, net 118,324 — — 118,324 Other long-term assets 334,374 — — 334,374 Goodwill 6,799,368 — — 6,799,368 Total assets $ 22,605,944 $ 629,422 $ 3,288 $ 21,973,234 Current liabilities $ 6,477,567 $ — $ — $ 6,477,567 Current liabilities held for sale 1,753,310 412,368 — 1,340,942 Payables to parent — 72,539 3,288 (75,827 ) Long-term operating leases liabilities 2,625,776 — — 2,625,776 Long-term debt and other long-term liabilities 6,519,574 — — 6,519,574 Noncontrolling interests subject to put provisions 1,143,044 — — 1,143,044 Total DaVita Inc. shareholders’ equity 3,875,354 144,515 — 3,730,839 Noncontrolling interests not subject to put provisions 211,319 — — 211,319 Shareholders’ equity 4,086,673 144,515 — 3,942,158 Total liabilities and shareholder’s equity $ 22,605,944 $ 629,422 $ 3,288 $ 21,973,234 (1) After elimination of the unrestricted subsidiaries and the physician groups. Condensed Consolidating Statements of Cash Flows Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) For the three months ended March 31, 2019 Cash flows from operating activities: Net income $ 189,487 $ 9,237 $ 463 $ 179,787 Changes in operating and intercompany assets and liabilities and (48,183 ) 9,696 (463 ) (57,416 ) Net cash provided by operating activities 141,304 18,933 — 122,371 Cash flows from investing activities: Additions of property and equipment (198,878 ) (229 ) — (198,649 ) Acquisitions (11,274 ) — — (11,274 ) Proceeds from asset and business sales 13,903 — — 13,903 Investments and other items (4,109 ) (1,355 ) — (2,754 ) Net cash used in investing activities (200,358 ) (1,584 ) — (198,774 ) Cash flows from financing activities: Long-term debt 357,197 — — 357,197 Intercompany — 28,965 — (28,965 ) Other items (32,246 ) — — (32,246 ) Net cash (used in) provided by financing activities 324,951 28,965 — 295,986 Effect of exchange rate changes on cash, cash equivalents and (921 ) — — (921 ) Net increase in cash, cash equivalents and restricted cash 264,976 46,314 — 218,662 Less: Net increase in cash, cash equivalents and restricted cash from discontinued operations 118,962 46,314 — 72,648 Net increase in cash, cash equivalents and restricted cash from continuing operations 146,014 — — 146,014 Cash, cash equivalents and restricted cash of continuing operations 415,420 — — 415,420 Cash, cash equivalents and restricted cash of continuing operations $ 561,434 $ — $ — $ 561,434 (1)

Condensed consolidated interi_2

Condensed consolidated interim financial statements Condensed consolidaed interim financial statements (Policies)	3 Months Ended
	Mar. 31, 2019
Accounting Policies [Abstract]
Condensed consolidated interim financial statements	The condensed consolidated interim financial statements included in this report are prepared by the Company without audit. 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 assets, liabilities, revenues and expenses. The most significant estimates and assumptions underlying these financial statements and accompanying notes generally involve revenue recognition and accounts receivable, leases, impairments of goodwill and investments, accounting for income taxes, consolidation of variable interest entities and certain fair value estimates. The results of operations for the three months ended March 31, 2019 are not necessarily indicative of the operating results for the full year. The 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, 2018
Earnings Per Share	Basic earnings per share is calculated by dividing net income attributable to the Company, adjusted for any change in noncontrolling interest redemption rights in excess of fair value, by the weighted average number of common shares outstanding, net of the weighted average shares held in escrow that under certain circumstances may have been returned to the Company.Diluted earnings per share includes the dilutive effect of outstanding stock-settled stock appreciation rights (SSARs) and unvested stock units (under the treasury stock method) as well as the weighted average shares held in escrow that were outstanding during the period.
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. These debt securities are accounted for as held to maturity and recorded at amortized cost, which approximates their fair values at March 31, 2019 and December 31, 2018 . Equity securities:
Income Taxes	The Company recognizes accrued interest and penalties related to unrecognized tax benefits in its income tax expense.
Long-term debt	The cap agreements are designated as cash flow hedges and, as a result, changes in the fair values of these cap agreements are reported in other comprehensive (loss) income. The amortization of the original cap premium is recognized as a component of debt expense on a straight-line basis over the terms of the cap agreements. These cap agreements do not contain credit-risk contingent features.
Long-term incentive compensation	The Company’s stock-based compensation expense for stock-settled awards is measured at the estimated fair value of awards on the date of grant and recognized on a cumulative straight-line basis over the vesting terms of the awards unless the stock awards are based on non-market based performance metrics, in which case expense is adjusted for expected ultimate payouts as of the end of each reporting period. Stock-based compensation expense for cash-settled awards is based on their estimated fair values as of the end of each reporting period. The expense for all stock-based awards is recognized net of expected forfeitures.
Comprehensive Income	Prior to January 1, 2018, unrealized gains and losses on available-for-sale equity securities were recorded to accumulated other comprehensive income and reclassified to other income when realized. From January 1, 2018, unrealized gains and losses on investment securities are recorded directly to other income rather than to accumulated other comprehensive income.
Variable Interest Entities	The Company relies on the operating activities of certain legal entities that it does not directly own or control, but over which it has indirect influence and of which it is considered the primary beneficiary. These entities are subject to the consolidation guidance applicable to variable interest entities (VIEs). 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 10-K.
Fair Value of Financial Instruments	Investments in equity securities represent investments in various open-ended registered investment companies (mutual funds) and common stock and are recorded at estimated fair value based on reported market prices or redemption prices, as applicable. See Note 5 to these condensed consolidated financial statements 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. See Note 9 to these condensed consolidated financial statements for further discussion.
New Accounting Standards	In February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842) . The amendments in Topic 842 revise the accounting related to lessee accounting. Under the new guidance, lessees are required to recognize a lease liability and a right-of-use asset for substantially all leases with lease terms in excess of twelve months. The new lease guidance also simplifies the accounting for sale and leaseback transactions primarily because lessees must recognize lease assets and lease liabilities. The Company adopted Topic 842 beginning on January 1, 2019 through a modified retrospective approach for leases existing at the adoption date with a cumulative effect adjustment. The Company elected to apply the package of practical expedients to not recast prior conclusions related to contracts containing leases, lease classification and initial direct costs. Adoption of the new standard resulted in the recording of operating right-of-use assets of $2,783,784 , operating lease liabilities of $3,001,354 and an adjustment to retained earnings of $39,876 , primarily related to deferred gains on prior sale leaseback transactions as of January 1, 2019. The standard did not materially impact the Company's consolidated net earnings and had no impact on cash flows. See Note 10 to these condensed consolidated financial statements for further details. In August 2017, the FASB issued ASU No. 2017-12, Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities. The amendments in this ASU better align an entity’s risk management activities and financial reporting for hedging relationships through changes to both the designation and measurement guidance for qualifying hedging relationships and the presentation of hedge results. The amendments in this ASU were effective for the Company on January 1, 2019 and are to be applied prospectively. The adoption of this ASU did not have a material impact on the Company’s consolidated financial statements when adopted on January 1, 2019. In August 2018, the FASB issued ASU No. 2018-13, Fair Value Measurement (Topic 820): Disclosure Framework -Changes to the Disclosure Requirements for Fair Value Measurement

Revenue Recognition Segment rev

Revenue Recognition Segment revenue by major payor (Tables)	3 Months Ended
	Mar. 31, 2019
Revenues by major payor [Abstract]
Schedule of Revenue Sources, Health Care Organization [Table Text Block]	The following table summarizes the Company's segment revenues by primary payor source: For the three months ended March 31, 2019 March 31, 2018 U.S. dialysis and related lab services Other - Ancillary services and strategic initiatives Consolidated U.S. dialysis and related lab services Other - Ancillary services and strategic initiatives Consolidated Patient service revenues: Medicare and Medicare Advantage $ 1,493,516 $ — $ 1,493,516 $ 1,485,192 $ — $ 1,485,192 Medicaid and Managed Medicaid 154,190 — 154,190 157,496 — 157,496 Other government 106,127 84,475 190,602 107,119 82,537 189,656 Commercial 788,413 33,388 821,801 782,979 19,718 802,697 Other revenues: Medicare and Medicare Advantage — 61,700 61,700 — 142,758 142,758 Medicaid and Managed Medicaid — 6 6 — 15,791 15,791 Commercial — 32,619 32,619 — 40,420 40,420 Other (1) 4,905 17,750 22,655 5,114 38,941 44,055 Eliminations of intersegment revenues (30,641 ) (3,336 ) (33,977 ) (18,422 ) (10,199 ) (28,621 ) Total $ 2,516,510 $ 226,602 $ 2,743,112 $ 2,519,478 $ 329,966 $ 2,849,444 (1) Other consists of management fees and revenue from the Company's ancillary services and strategic initiatives.

Earnings per share (Tables)

Earnings per share (Tables)	3 Months Ended
	Mar. 31, 2019
Earnings Per Share [Abstract]
Reconciliations of Numerators and Denominators Used to Calculate Basic and Diluted Earnings Per Share	The reconciliations of the numerators and denominators used to calculate basic and diluted earnings per share were as follows: Three months ended March 31, 2019 2018 Numerators: Net income from continuing operations attributable to DaVita Inc. $ 120,254 $ 191,015 Net income (loss) from discontinued operations attributable to DaVita Inc. 29,035 (12,329 ) Net income attributable to DaVita Inc. for earnings per share calculation $ 149,289 $ 178,686 Basic: Weighted average shares outstanding during the period 166,388 181,152 Weighted average contingently returnable shares held in escrow for the DaVita HealthCare Partners merger — (2,194 ) Weighted average shares for basic earnings per share calculation 166,388 178,958 Basic net income (loss) attributable to DaVita Inc. from: Continuing operations per share $ 0.72 $ 1.07 Discontinued operations per share 0.18 (0.07 ) Basic net income per share attributable to DaVita Inc. $ 0.90 $ 1.00 Diluted: Weighted average shares outstanding during the period 166,388 181,152 Assumed incremental shares from stock plans 393 683 Weighted average shares for diluted earnings per share calculation 166,781 181,835 Diluted net income (loss) attributable to DaVita Inc. from: Continuing operations per share $ 0.72 $ 1.05 Discontinued operations per share 0.18 (0.07 ) Diluted net income per share attributable to DaVita Inc. $ 0.90 $ 0.98 Anti-dilutive stock-settled awards excluded from calculation (1) 6,150 3,453 (1)

Investments in debt and equit_2

Investments in debt and equity securities (Tables)	3 Months Ended
	Mar. 31, 2019
Investments, Debt and Equity Securities [Abstract]
Investments	The Company’s short-term and long-term debt and equity investments consist of the following: March 31, 2019 December 31, 2018 Debt Equity Total Debt Equity Total Certificates of deposit and other time deposits $ 2,235 $ — $ 2,235 $ 2,235 $ — $ 2,235 Investments in mutual funds and common stock — 36,214 36,214 — 36,124 36,124 $ 2,235 $ 36,214 $ 38,449 $ 2,235 $ 36,124 $ 38,359 Short-term investments $ 2,235 $ 1,800 $ 4,035 $ 2,235 $ 700 $ 2,935 Long-term investments — 34,414 34,414 — 35,424 35,424 $ 2,235 $ 36,214 $ 38,449 $ 2,235 $ 36,124 $ 38,359

Equity method and other inves_2

Equity method and other investments Equity Method and Other Investments (Tables)	3 Months Ended
	Mar. 31, 2019
Equity Method Investments and Joint Ventures [Abstract]
Equity Method Investments	The Company's equity method and other investments were comprised of the following: March 31, 2019 December 31, 2018 APAC joint venture $ 125,062 $ 129,173 Other equity method partnerships 88,861 83,052 Adjusted cost method investments 12,386 12,386 $ 226,309 $ 224,611

Goodwill (Tables)

Goodwill (Tables)	3 Months Ended
	Mar. 31, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Changes in Goodwill by Reportable Segments [Text Block]	Changes in goodwill by reportable segment were as follows: U.S. dialysis and related lab services Other-ancillary services and strategic initiatives Consolidated total Balance at December 31, 2017 $ 6,144,761 $ 465,518 $ 6,610,279 Acquisitions 130,574 147,774 278,348 Divestitures (331 ) (15,166 ) (15,497 ) Impairment charges — (3,106 ) (3,106 ) Foreign currency and other adjustments — (28,064 ) (28,064 ) Balance at December 31, 2018 $ 6,275,004 $ 566,956 $ 6,841,960 Acquisitions 7,027 1,628 8,655 Impairment charges — (41,037 ) (41,037 ) Foreign currency and other adjustments — (10,210 ) (10,210 ) Balance at March 31, 2019 $ 6,282,031 $ 517,337 $ 6,799,368 Balance at March 31, 2019: Goodwill $ 6,282,031 $ 585,347 $ 6,867,378 Accumulated impairment charges — (68,010 ) (68,010 ) $ 6,282,031 $ 517,337 $ 6,799,368
Schedule Of Reporting Units Goodwill Balances [Text Block]	Reporting unit Goodwill balance as Carrying amount (1) Sensitivities Operating income (2) Discount rate (3) Germany Kidney Care $ 354,182 —% (1.4)% (9.3)% (1) Excess of estimated fair value of the reporting unit over its carrying amount as of the latest assessment date. (2) Potential impact on estimated fair value of a sustained, long-term reduction of 3% in operating income as of the latest assessment date. (3)

Long-term debt (Tables)

Long-term debt (Tables)	3 Months Ended
	Mar. 31, 2019
Debt Disclosure [Abstract]
Long-term Debt	Long-term debt was comprised of the following: As of March 31, 2019 March 31, 2019 December 31, 2018 Maturity date Interest rate Estimated fair value (2) Senior Secured Credit Facilities: Term Loan A (1) $ 650,000 $ 675,000 12/24/2019 2.00% + LIBOR $ 649,155 Term Loan A-2 (1) 995,000 995,000 12/24/2019 1.00% + LIBOR $ 999,975 Term Loan B 3,333,750 3,342,500 6/24/2021 2.75% + LIBOR (3) $ 3,350,419 Revolver (1) 575,000 175,000 12/24/2019 2.00% + LIBOR $ 575,000 Senior Notes: 5 3/4% Senior Notes 1,250,000 1,250,000 8/15/2022 5.75% $ 1,271,875 5 1/8% Senior Notes 1,750,000 1,750,000 7/15/2024 5.125% $ 1,729,175 5% Senior Notes 1,500,000 1,500,000 5/1/2025 5% $ 1,439,250 Acquisition obligations and other notes payable (4) 181,885 183,979 2019-2026 6.30% $ 181,885 Financing lease obligations (5) 276,564 282,737 2019-2036 4.84% $ 276,564 Total debt principal outstanding 10,512,199 10,154,216 Discount and deferred financing costs (6) (48,495 ) (52,000 ) 10,463,704 10,102,216 Less current portion (4,676,691 ) (1,929,369 ) $ 5,787,013 $ 8,172,847 (1) On May 6, 2019, the Company entered into an agreement to extend the maturity dates of its Term Loan A, Term Loan A-2 and Revolver by six months , to December 24, 2019 . (2) Fair values are based upon quoted market prices for similar instruments, a level 2 input. The balances of acquisition obligations and other notes payable and financing lease obligations are presented in the condensed consolidated financial statements at March 31, 2019 at their approximate fair values due to the short-term nature of their settlements. (3) Term Loan B is subject to a LIBOR component floor of 0.75% . (4) The acquisition obligations and other notes payable interest rate is the weighted average interest rate based on the current interest rate in effect and assuming no changes to the LIBOR based interest rates. (5) The interest rate presented for financing lease obligations is the weighted average discount rate. (6) The carrying amount of the Company’s senior secured credit facilities includes a discount of $5,487 and deferred financing costs of $11,319 , and the carrying amount of the Company’s senior notes includes deferred financing costs of $31,689 as of March 31, 2019
Scheduled Maturities of Long-term Debt	Scheduled maturities of long-term debt at March 31, 2019 were as follows: 2019 (remainder of the year) (1) 4,654,038 2020 83,658 2021 940,050 2022 1,291,930 2023 52,538 2024 1,784,606 Thereafter 1,705,379
Schedule of Derivative Instruments	The following table summarizes the Company’s derivative instruments outstanding as of March 31, 2019 and December 31, 2018 , which are classified in "Other long-term assets" on its consolidated balance sheet: March 31, 2019 Fair value Notional amount LIBOR maximum rate Effective date Expiration date Debt expense Recorded OCI loss March 31, 2019 December 31, 2018 October 2015 caps $ 3,500,000 3.5% 6/29/2018 6/30/2020 $ 2,163 $ 781 $ 70 $ 851
Effects of Interest Rate Swap and Cap Agreements	The following table summarizes the effects of the Company’s interest rate cap agreements for the three months ended March 31, 2019 and 2018 : Amount of unrecognized (losses) gains in OCI on interest rate cap agreements Income statement location Reclassification from accumulated other comprehensive income into net income Three months ended March 31, Three months ended March 31, Derivatives designated as cash flow hedges 2019 2018 2019 2018 Interest rate cap agreements $ (781 ) $ 1,414 Debt expense $ 2,163 $ 2,070 Tax expense (benefit) 201 (364 ) Tax expense (557 ) (533 ) Total $ (580 ) $ 1,050 $ 1,606 $ 1,537

Leases Leases (Tables)

Leases Leases (Tables)	3 Months Ended
	Mar. 31, 2019
Leases [Abstract]
Lease Expense Components	The components of lease expense were as follows: Lease cost Three months ended March 31, 2019 Operating lease cost (1) : Fixed lease expense $ 128,110 Variable lease expense 28,571 Financing lease cost: Amortization of leased assets 5,826 Interest on lease liabilities 3,775 Net lease cost $ 166,282 (1) Includes short-term lease expense and sublease income, which are immaterial.
Leases Other Information	Other information related to leases was as follows: Lease term and discount rate March 31, 2019 Weighted average remaining lease term (years): Operating leases 9.0 Finance leases 10.1 Weighted average discount rate: Operating leases 4.2 % Finance leases 4.8 % Three months ended Other information Gain on sale leaseback, net $ 3,987 Cash paid for amounts included in the measurement of lease Operating cash flows from operating leases $ 153,587 Operating cash flows from finance leases $ 5,661 Financing cash flows from finance leases $ 5,344 Net operating lease assets obtained in exchange for new or modified $ 45,034
Schedule Of Minimum Lease Payments	Future minimum lease payments under non-cancellable leases as of December 31, 2018 were as follows: Operating leases Capital leases 2019 $ 483,488 $ 36,754 2020 462,154 41,044 2021 432,950 34,026 2022 395,462 33,690 2023 349,649 33,845 Thereafter 1,589,949 194,611 $ 3,713,652 373,970 Less portion representing interest (91,233 ) Total capital lease obligations, including current portion $ 282,737 Operating leases Finance leases 2019 (remainder of the year) $ 365,155 $ 30,702 2020 474,121 37,974 2021 443,729 33,637 2022 405,176 33,860 2023 358,578 33,975 2024 306,512 33,993 Thereafter 1,275,632 162,183 Total future minimum lease payments $ 3,628,903 $ 366,324 Less portion representing interest (635,714 ) (89,760 ) Present value of lease liabilities $ 2,993,189 $ 276,564

Accumulated other comprehensi_2

Accumulated other comprehensive (loss) income (Tables)	3 Months Ended
	Mar. 31, 2019
Statement of Comprehensive Income [Abstract]
Comprehensive income	For the three months ended March 31, 2019 For the three months ended March 31, 2018 Interest Foreign Accumulated Interest Investment Foreign Accumulated Beginning balance $ (8,961 ) $ (25,963 ) $ (34,924 ) $ (12,408 ) $ 5,662 $ 19,981 $ 13,235 Cumulative effect of change in (1) — — — (2,706 ) (5,662 ) — (8,368 ) Unrealized (losses) gains (781 ) (13,653 ) (14,434 ) 1,414 — 19,881 21,295 Related income tax benefit 201 — 201 (364 ) — — (364 ) (580 ) (13,653 ) (14,233 ) 1,050 — 19,881 20,931 Reclassification into net income 2,163 — 2,163 2,070 — — 2,070 Related income (557 ) — (557 ) (533 ) — — (533 ) 1,606 — 1,606 1,537 — — 1,537 Ending balance $ (7,935 ) $ (39,616 ) $ (47,551 ) $ (12,527 ) $ — $ 39,862 $ 27,335 (1)

Acquisitions and divestitures (

Acquisitions and divestitures (Tables)	3 Months Ended
	Mar. 31, 2019
Dialysis and other businesses
Business Acquisition [Line Items]
Assets Acquired and Liabilities Assumed in Business Acquisitions	The following table summarizes the assets acquired and liabilities assumed in these transactions at their estimated acquisition date fair values: Current assets $ 1,117 Property and equipment 923 Intangible and other long-term assets 4,312 Goodwill 8,655 Current liabilities (592 ) Long-term liabilities (88 ) Noncontrolling interests (1,762 ) $ 12,565

Held for Sale and Discontinue_2

Held for Sale and Discontinued Operations (Tables)	3 Months Ended
	Mar. 31, 2019
Discontinued Operations and Disposal Groups [Abstract]
Disposal Groups, Including Discontinued Operations [Table Text Block]	The following table presents the financial results of discontinued operations related to DMG: Three months ended March 31, 2019 2018 Revenues $ 1,382,281 $ 1,227,932 Expenses 1,338,153 1,226,407 Income from discontinued operations before taxes 44,128 1,525 Income tax expense 13,823 7,311 Net income (loss) from discontinued operations, net of tax $ 30,305 $ (5,786 ) The following table presents the financial position of discontinued operations related to DMG: March 31, 2019 December 31, 2018 Assets Cash and cash equivalents $ 533,615 $ 414,683 Other current assets 613,359 557,403 Property and equipment, net 476,781 458,040 Operating lease right-of-use assets 412,388 — Intangible assets, net 1,317,036 1,316,974 Other long-term assets 120,347 112,127 Goodwill 2,848,262 2,847,178 Valuation allowance on disposal group (316,840 ) (316,840 ) Total current assets held for sale, net $ 6,004,948 $ 5,389,565 Liabilities Other liabilities $ 624,319 $ 479,134 Medical payables 512,523 436,839 Current portion of operating leases liabilities 68,031 — Current portion of long-term debt 2,832 3,122 Long-term operating leases liabilities 387,841 — Long-term debt 33,073 33,425 Other long-term liabilities 124,691 291,239 Total current liabilities held for sale $ 1,753,310 $ 1,243,759 The following table presents cash flows of discontinued operations related to DMG: Three months ended March 31, 2019 2018 Net cash provided by operating activities from discontinued operations $ 68,240 $ 156,248 Net cash used in investing activities from discontinued operations $ (22,809 ) $ (33,068 )

Fair value of financial instr_2

Fair value of financial instruments (Tables)	3 Months Ended
	Mar. 31, 2019
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 equity that are measured at fair value on a recurring basis as of March 31, 2019 : Total Quoted prices in Significant other Significant Assets Investments in equity securities $ 36,214 $ 36,214 $ — $ — Interest rate cap agreements $ 70 $ — $ 70 $ — Liabilities Contingent earn-out obligations $ 3,432 $ — $ — $ 3,432 Temporary equity Noncontrolling interests subject to put provisions $ 1,143,044 $ — $ — $ 1,143,044

Segment reporting (Tables)

Segment reporting (Tables)	3 Months Ended
	Mar. 31, 2019
Segment Reporting [Abstract]
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes	The following is a summary of segment net revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income before income taxes: Three months ended March 31, 2019 2018 Segment revenues: U.S. dialysis and related lab services Patient service revenues: External sources $ 2,517,289 $ 2,489,165 Intersegment revenues 30,420 18,422 U.S. dialysis and related lab services patient service revenues 2,547,709 2,507,587 Provision for uncollectible accounts (5,463 ) 25,199 Net U.S. dialysis and related lab services patient service revenues 2,542,246 2,532,786 Other revenues (1) : External sources 4,684 5,114 Intersegment revenues 221 — Total U.S. dialysis and related lab services revenues $ 2,547,151 $ 2,537,900 Other—Ancillary services and strategic initiatives Patient service revenues, net $ 117,863 $ 102,255 Other external sources 108,739 227,711 Intersegment revenues 3,336 10,199 Total ancillary services and strategic initiatives revenues 229,938 340,165 Total net segment revenues 2,777,089 2,878,065 Elimination of intersegment revenues (33,977 ) (28,621 ) Consolidated revenues $ 2,743,112 $ 2,849,444 Segment operating margin: U.S. dialysis and related lab services $ 416,981 $ 433,380 Other—Ancillary services and strategic initiatives (57,630 ) (6,990 ) Total segment operating margin 359,351 426,390 Reconciliation of segment operating margin to consolidated income from continuing Corporate administrative support (18,844 ) (15,704 ) Consolidated operating income 340,507 410,686 Debt expense (131,519 ) (113,516 ) Other income, net 6,940 4,582 Consolidated income from continuing operations before income taxes $ 215,928 $ 301,752 (1)
Summary of Assets by Reportable Segment	A summary of assets by reportable segment was as follows: March 31, 2019 December 31, 2018 Segment assets U.S. dialysis and related lab services (including equity $ 15,095,326 $ 12,333,641 Other—Ancillary services and strategic initiatives (including 1,505,670 1,387,046 DMG—Held for sale (including equity investments of $5,282 and 6,004,948 5,389,565 Consolidated assets $ 22,605,944 $ 19,110,252
Summary of Depreciation and Amortization Expense by Reportable Segment	Depreciation and amortization expense by reportable segment was as follows: Three months ended March 31, 2019 2018 U.S. dialysis and related lab services $ 140,780 $ 134,776 Other — Ancillary services and strategic initiatives 7,748 8,023 $ 148,528 $ 142,799
Summary of Expenditures for Property and Equipment by Reportable Segment	Expenditures for property and equipment by reportable segment were as follows: Three months ended 2019 2018 U.S. dialysis and related lab services $ 170,548 $ 191,406 Other—Ancillary services and strategic initiatives 8,578 9,988 DMG—Held for sale 19,752 31,049 $ 198,878 $ 232,443

Changes in DaVita Inc.'s owne_2

Changes in DaVita Inc.'s ownership interest in consolidated subsidiaries (Tables)	3 Months Ended
	Mar. 31, 2019
Noncontrolling Interest [Abstract]
Effects of Changes in DaVita Inc's Ownership Interest on Company's Equity	The effects of changes in DaVita Inc.’s ownership interests in consolidated subsidiaries on the Company’s consolidated equity were as follows: Three months ended March 31, 2019 2018 Net income attributable to DaVita Inc. $ 149,289 $ 178,686 Changes in paid-in capital for: Sales of noncontrolling interests — 76 Purchases of noncontrolling interests (2,206 ) (1,994 ) Net transfers to noncontrolling interests (2,206 ) (1,918 ) Net income attributable to DaVita Inc., net of transfers to noncontrolling interests $ 147,083 $ 176,768

Condensed Consolidating finan_2

Condensed Consolidating financial statements (Tables)	3 Months Ended
	Mar. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Condensed Consolidating Statements of Operations	Condensed Consolidating Statements of Operations DaVita Inc. Guarantor subsidiaries Non- Guarantor subsidiaries Consolidating adjustments Consolidated total For the three months ended March 31, 2019 Patient services revenues $ — $ 1,777,246 $ 918,604 $ (60,698 ) $ 2,635,152 Provision for uncollectible accounts — (3,970 ) (1,493 ) — (5,463 ) Net patient service revenues — 1,773,276 917,111 (60,698 ) 2,629,689 Other revenues 188,836 111,141 35,619 (222,173 ) 113,423 Total net revenues 188,836 1,884,417 952,730 (282,871 ) 2,743,112 Operating expenses and charges 143,659 1,660,453 881,364 (282,871 ) 2,402,605 Operating income 45,177 223,964 71,366 — 340,507 Debt expense (133,595 ) (52,479 ) (10,719 ) 65,274 (131,519 ) Other income, net 110,198 2,596 9,111 (114,965 ) 6,940 Income tax expense 7,026 46,544 3,176 — 56,746 Equity earnings in subsidiaries 134,535 46,151 — (180,686 ) — Net income from continuing operations 149,289 173,688 66,582 (230,377 ) 159,182 Net (loss) income from discontinued operations, net of tax — (39,153 ) 19,767 49,691 30,305 Net income 149,289 134,535 86,349 (180,686 ) 189,487 Less: Net income attributable to noncontrolling interests — — — (40,198 ) (40,198 ) Net income attributable to DaVita Inc. $ 149,289 $ 134,535 $ 86,349 $ (220,884 ) $ 149,289 Guarantor Non- Consolidating Consolidated For the three months ended March 31, 2018 DaVita Inc. Patient service revenues $ — $ 1,790,188 $ 848,401 $ (47,515 ) $ 2,591,074 Provision for uncollectible accounts — 9,628 15,917 — 25,545 Net patient service revenues — 1,799,816 864,318 (47,515 ) 2,616,619 Other revenues 195,565 204,960 70,933 (238,633 ) 232,825 Total net revenues 195,565 2,004,776 935,251 (286,148 ) 2,849,444 Operating expenses 133,356 1,791,094 800,456 (286,148 ) 2,438,758 Operating income 62,209 213,682 134,795 — 410,686 Debt expense (114,334 ) (52,197 ) (7,375 ) 60,390 (113,516 ) Other income 104,081 2,523 5,704 (107,726 ) 4,582 Income tax expense 14,387 48,944 7,406 — 70,737 Equity earnings in subsidiaries 141,117 66,496 — (207,613 ) — Net income from continuing operations 178,686 181,560 125,718 (254,949 ) 231,015 Net loss from discontinued operations, net of tax — (40,443 ) (12,679 ) 47,336 (5,786 ) Net income 178,686 141,117 113,039 (207,613 ) 225,229 Less: Net income attributable to noncontrolling interests — — — (46,543 ) (46,543 ) Net income attributable to DaVita Inc. $ 178,686 $ 141,117 $ 113,039 $ (254,156 ) $ 178,686 Consolidated Total Physician Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) For the three months ended March 31, 2019 Patient service operating revenues $ 2,635,152 $ — $ — $ 2,635,152 Provision for uncollectible accounts (5,463 ) — — (5,463 ) Net patient service operating revenues 2,629,689 — — 2,629,689 Other revenues 113,423 — — 113,423 Total net operating revenues 2,743,112 — — 2,743,112 Operating expenses 2,402,605 — — 2,402,605 Operating income 340,507 — — 340,507 Debt expense (131,519 ) — — (131,519 ) Other income 6,940 — — 6,940 Income tax expense 56,746 — — 56,746 Net income from continuing operations 159,182 — — 159,182 Net income from discontinued operations, net of tax 30,305 9,237 463 20,605 Net income 189,487 9,237 463 179,787 Less: Net income attributable to noncontrolling interests (40,198 ) (1,255 ) — (38,943 ) Net income attributable to DaVita Inc. $ 149,289 $ 7,982 $ 463 $ 140,844 (1)
Condensed Consolidating Statements of Comprehensive Income	Condensed Consolidating Statements of Comprehensive Income Guarantor Non- Consolidating Consolidated For the three months ended March 31, 2019 DaVita Inc. Net income $ 149,289 $ 134,535 $ 86,349 $ (180,686 ) $ 189,487 Other comprehensive income (loss) 1,026 — (13,653 ) — (12,627 ) Total comprehensive income 150,315 134,535 72,696 (180,686 ) 176,860 Less: Comprehensive income attributable to noncontrolling interest — — — (40,198 ) (40,198 ) Comprehensive income attributable to DaVita Inc. $ 150,315 $ 134,535 $ 72,696 $ (220,884 ) $ 136,662 Guarantor Non- Consolidating Consolidated For the three months ended March 31, 2018 DaVita Inc. Net income $ 178,686 $ 141,117 $ 113,039 $ (207,613 ) $ 225,229 Other comprehensive income 2,587 — 19,881 — 22,468 Total comprehensive income 181,273 141,117 132,920 (207,613 ) 247,697 Less: Comprehensive income attributable to noncontrolling interest — — — (46,543 ) (46,543 ) Comprehensive income attributable to DaVita Inc. $ 181,273 $ 141,117 $ 132,920 $ (254,156 ) $ 201,154 Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) For the three months ended March 31, 2019 Net income $ 189,487 $ 9,237 $ 463 $ 179,787 Other comprehensive loss (12,627 ) — — (12,627 ) Total comprehensive income 176,860 9,237 463 167,160 Less: Comprehensive income attributable to the noncontrolling (40,198 ) (1,255 ) — (38,943 ) Comprehensive income attributable to DaVita Inc. $ 136,662 $ 7,982 $ 463 $ 128,217 (1)
Condensed Consolidating Balance Sheets	Condensed Consolidating Balance Sheets Guarantor Non- Consolidating Consolidated As of March 31, 2019 DaVita Inc. Cash and cash equivalents $ 194,347 $ — $ 264,895 $ — $ 459,242 Restricted cash and equivalents 1,006 12,114 89,072 — 102,192 Accounts receivable, net — 1,349,185 604,237 — 1,953,422 Other current assets 37,185 568,029 100,058 — 705,272 Current assets held for sale, net — 4,842,062 1,162,886 — 6,004,948 Total current assets 232,538 6,771,390 2,221,148 — 9,225,076 Property and equipment, net 503,677 1,610,442 1,278,147 — 3,392,266 Operating lease right-of-use assets 107,237 1,594,411 1,034,888 — 2,736,536 Intangible assets, net 130 39,813 78,381 — 118,324 Investments in subsidiaries 10,191,084 3,323,518 — (13,514,602 ) — Intercompany receivables 3,756,675 — 1,496,009 (5,252,684 ) — Other long-term assets and investments 53,978 84,137 196,259 — 334,374 Goodwill — 4,812,366 1,987,002 — 6,799,368 Total assets $ 14,845,319 $ 18,236,077 $ 8,291,834 $ (18,767,286 ) $ 22,605,944 Current liabilities $ 4,702,717 $ 1,182,342 $ 592,508 $ — $ 6,477,567 Current liabilities held for sale — 1,084,512 668,798 — 1,753,310 Intercompany payables — 3,648,453 1,604,231 (5,252,684 ) — Long-term operating leases liabilities 133,936 1,502,922 988,918 — 2,625,776 Long-term debt and other long-term liabilities 5,520,830 626,764 371,980 — 6,519,574 Noncontrolling interests subject to put provisions 612,482 — — 530,562 1,143,044 Total DaVita Inc. shareholders' equity 3,875,354 10,191,084 3,323,518 (13,514,602 ) 3,875,354 Noncontrolling interests not subject to put — — 741,881 (530,562 ) 211,319 Total equity 3,875,354 10,191,084 4,065,399 (14,045,164 ) 4,086,673 Total liabilities and equity $ 14,845,319 $ 18,236,077 $ 8,291,834 $ (18,767,286 ) $ 22,605,944 Guarantor Non- Consolidating Consolidated As of December 31, 2018 DaVita Inc. Cash and cash equivalents $ 60,653 $ — $ 262,385 $ — $ 323,038 Restricted cash and equivalents 1,005 12,048 79,329 — 92,382 Accounts receivable, net — 1,264,290 594,318 — 1,858,608 Other current assets 37,185 601,318 122,063 — 760,566 Current assets held for sale — 4,440,953 948,612 — 5,389,565 Total current assets 98,843 6,318,609 2,006,707 — 8,424,159 Property and equipment, net 491,462 1,624,835 1,277,372 — 3,393,669 Intangible assets, net 153 42,933 75,760 — 118,846 Investments in subsidiaries 10,102,750 3,239,862 — (13,342,612 ) — Intercompany receivables 3,419,448 — 1,471,203 (4,890,651 ) — Other long-term assets and investments 53,385 80,537 197,696 — 331,618 Goodwill — 4,812,365 2,029,595 — 6,841,960 Total assets $ 14,166,041 $ 16,119,141 $ 7,058,333 $ (18,233,263 ) $ 19,110,252 Current liabilities $ 1,945,943 $ 1,251,534 $ 449,925 $ — $ 3,647,402 Current liabilities held for sale — 722,766 520,993 — 1,243,759 Intercompany payables — 3,327,026 1,563,625 (4,890,651 ) — Long-term debt and other long-term liabilities 7,918,581 715,065 552,406 — 9,186,052 Noncontrolling interests subject to put provisions 598,075 — — 526,566 1,124,641 Total DaVita Inc. shareholders' equity 3,703,442 10,102,750 3,239,862 (13,342,612 ) 3,703,442 Noncontrolling interests not subject to put — — 731,522 (526,566 ) 204,956 Total equity 3,703,442 10,102,750 3,971,384 (13,869,178 ) 3,908,398 Total liabilities and equity $ 14,166,041 $ 16,119,141 $ 7,058,333 $ (18,233,263 ) $ 19,110,252 Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) As of March 31, 2019 Cash and cash equivalents $ 459,242 $ — $ — $ 459,242 Restricted cash and equivalents 102,192 — — 102,192 Accounts receivable, net 1,953,422 — — 1,953,422 Other current assets 705,272 — — 705,272 Current assets held for sale, net 6,004,948 629,422 3,288 5,372,238 Total current assets 9,225,076 629,422 3,288 8,592,366 Property and equipment, net 3,392,266 — — 3,392,266 Operating lease right-of-use assets 2,736,536 — — 2,736,536 Amortizable intangibles, net 118,324 — — 118,324 Other long-term assets 334,374 — — 334,374 Goodwill 6,799,368 — — 6,799,368 Total assets $ 22,605,944 $ 629,422 $ 3,288 $ 21,973,234 Current liabilities $ 6,477,567 $ — $ — $ 6,477,567 Current liabilities held for sale 1,753,310 412,368 — 1,340,942 Payables to parent — 72,539 3,288 (75,827 ) Long-term operating leases liabilities 2,625,776 — — 2,625,776 Long-term debt and other long-term liabilities 6,519,574 — — 6,519,574 Noncontrolling interests subject to put provisions 1,143,044 — — 1,143,044 Total DaVita Inc. shareholders’ equity 3,875,354 144,515 — 3,730,839 Noncontrolling interests not subject to put provisions 211,319 — — 211,319 Shareholders’ equity 4,086,673 144,515 — 3,942,158 Total liabilities and shareholder’s equity $ 22,605,944 $ 629,422 $ 3,288 $ 21,973,234 (1)
Condensed Consolidating Statements of Cash Flows	Condensed Consolidating Statements of Cash Flows Guarantor Non- Consolidating Consolidated For the three months ended March 31, 2019 DaVita Inc. Cash flows from operating activities: Net income $ 149,289 $ 134,535 $ 86,349 $ (180,686 ) $ 189,487 Changes in operating assets and liabilities and non-cash (124,409 ) (197,096 ) 92,636 180,686 (48,183 ) Net cash provided by (used in) operating activities 24,880 (62,561 ) 178,985 — 141,304 Cash flows from investing activities: Additions of property and equipment (38,942 ) (112,376 ) (47,560 ) — (198,878 ) Acquisitions — — (11,274 ) — (11,274 ) Proceeds from asset and business sales — 1,456 12,447 — 13,903 Proceeds (purchases) from investment sales and other items, net 1,804 (4,558 ) (1,355 ) — (4,109 ) Net cash used in investing activities (37,138 ) (115,478 ) (47,742 ) — (200,358 ) Cash flows from financing activities: Long-term debt and related financing costs, net 365,133 (2,439 ) (5,497 ) — 357,197 Intercompany borrowing (payments) (220,697 ) 229,211 (8,514 ) — — Other items 1,517 (8,480 ) (25,283 ) — (32,246 ) Net cash provided by (used in) financing activities 145,953 218,292 (39,294 ) — 324,951 Effect of exchange rate changes on cash, cash — — (921 ) — (921 ) Net increase in cash, cash equivalents and 133,695 40,253 91,028 — 264,976 Less: Net increase in cash, cash equivalents and restricted cash from discontinued operations — 40,187 78,775 — 118,962 Net increase in cash, cash equivalents and restricted cash from continuing operations 133,695 66 12,253 — 146,014 Cash, cash equivalents and restricted cash of continuing 61,658 12,048 341,714 — 415,420 Cash, cash equivalents and restricted cash of continuing $ 195,353 $ 12,114 $ 353,967 $ — $ 561,434 Guarantor Non- Consolidating Consolidated For the three months ended March 31, 2018 DaVita Inc. Cash flows from operating activities: Net income $ 178,686 $ 141,117 $ 113,039 $ (207,613 ) $ 225,229 Changes in operating assets and liabilities and non-cash (82,391 ) 32,484 (20,396 ) 207,613 137,310 Net cash provided by operating activities 96,295 173,601 92,643 — 362,539 Cash flows from investing activities: Additions of property and equipment (27,356 ) (125,375 ) (79,712 ) — (232,443 ) Acquisitions — (4,417 ) (12,165 ) — (16,582 ) Proceeds from asset and business sales — 18,535 — — 18,535 Proceeds (purchases) from investment sales and other items, net 31,665 (762 ) (541 ) — 30,362 Net cash provided by (used in) investing activities 4,309 (112,019 ) (92,418 ) — (200,128 ) Cash flows from financing activities: Long-term debt and related financing costs, net 116,307 (3,377 ) (8,257 ) — 104,673 Intercompany borrowing (payments) 47,394 (49,783 ) 2,389 — — Other items (291,562 ) (2,200 ) (33,458 ) — (327,220 ) Net cash used in financing activities (127,861 ) (55,360 ) (39,326 ) — (222,547 ) Effect of exchange rate changes on cash, cash — — 6,668 — 6,668 Net decrease in cash, cash equivalents and restricted cash (27,257 ) 6,222 (32,433 ) — (53,468 ) Less: Net increase in cash, cash equivalents and restricted cash from discontinued operations — 6,185 11,649 — 17,834 Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations (27,257 ) 37 (44,082 ) — (71,302 ) Cash, cash equivalents and restricted cash of continuing 150,307 9,384 359,229 — 518,920 Cash, cash equivalents and restricted cash of continuing $ 123,050 $ 9,421 $ 315,147 $ — $ 447,618 Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) For the three months ended March 31, 2019 Cash flows from operating activities: Net income $ 189,487 $ 9,237 $ 463 $ 179,787 Changes in operating and intercompany assets and liabilities and (48,183 ) 9,696 (463 ) (57,416 ) Net cash provided by operating activities 141,304 18,933 — 122,371 Cash flows from investing activities: Additions of property and equipment (198,878 ) (229 ) — (198,649 ) Acquisitions (11,274 ) — — (11,274 ) Proceeds from asset and business sales 13,903 — — 13,903 Investments and other items (4,109 ) (1,355 ) — (2,754 ) Net cash used in investing activities (200,358 ) (1,584 ) — (198,774 ) Cash flows from financing activities: Long-term debt 357,197 — — 357,197 Intercompany — 28,965 — (28,965 ) Other items (32,246 ) — — (32,246 ) Net cash (used in) provided by financing activities 324,951 28,965 — 295,986 Effect of exchange rate changes on cash, cash equivalents and (921 ) — — (921 ) Net increase in cash, cash equivalents and restricted cash 264,976 46,314 — 218,662 Less: Net increase in cash, cash equivalents and restricted cash from discontinued operations 118,962 46,314 — 72,648 Net increase in cash, cash equivalents and restricted cash from continuing operations 146,014 — — 146,014 Cash, cash equivalents and restricted cash of continuing operations 415,420 — — 415,420 Cash, cash equivalents and restricted cash of continuing operations $ 561,434 $ — $ — $ 561,434 (1)

Supplemental Data (Tables)

Supplemental Data (Tables)	3 Months Ended
	Mar. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Condensed Consolidating Statements of Operations	Condensed Consolidating Statements of Operations DaVita Inc. Guarantor subsidiaries Non- Guarantor subsidiaries Consolidating adjustments Consolidated total For the three months ended March 31, 2019 Patient services revenues $ — $ 1,777,246 $ 918,604 $ (60,698 ) $ 2,635,152 Provision for uncollectible accounts — (3,970 ) (1,493 ) — (5,463 ) Net patient service revenues — 1,773,276 917,111 (60,698 ) 2,629,689 Other revenues 188,836 111,141 35,619 (222,173 ) 113,423 Total net revenues 188,836 1,884,417 952,730 (282,871 ) 2,743,112 Operating expenses and charges 143,659 1,660,453 881,364 (282,871 ) 2,402,605 Operating income 45,177 223,964 71,366 — 340,507 Debt expense (133,595 ) (52,479 ) (10,719 ) 65,274 (131,519 ) Other income, net 110,198 2,596 9,111 (114,965 ) 6,940 Income tax expense 7,026 46,544 3,176 — 56,746 Equity earnings in subsidiaries 134,535 46,151 — (180,686 ) — Net income from continuing operations 149,289 173,688 66,582 (230,377 ) 159,182 Net (loss) income from discontinued operations, net of tax — (39,153 ) 19,767 49,691 30,305 Net income 149,289 134,535 86,349 (180,686 ) 189,487 Less: Net income attributable to noncontrolling interests — — — (40,198 ) (40,198 ) Net income attributable to DaVita Inc. $ 149,289 $ 134,535 $ 86,349 $ (220,884 ) $ 149,289 Guarantor Non- Consolidating Consolidated For the three months ended March 31, 2018 DaVita Inc. Patient service revenues $ — $ 1,790,188 $ 848,401 $ (47,515 ) $ 2,591,074 Provision for uncollectible accounts — 9,628 15,917 — 25,545 Net patient service revenues — 1,799,816 864,318 (47,515 ) 2,616,619 Other revenues 195,565 204,960 70,933 (238,633 ) 232,825 Total net revenues 195,565 2,004,776 935,251 (286,148 ) 2,849,444 Operating expenses 133,356 1,791,094 800,456 (286,148 ) 2,438,758 Operating income 62,209 213,682 134,795 — 410,686 Debt expense (114,334 ) (52,197 ) (7,375 ) 60,390 (113,516 ) Other income 104,081 2,523 5,704 (107,726 ) 4,582 Income tax expense 14,387 48,944 7,406 — 70,737 Equity earnings in subsidiaries 141,117 66,496 — (207,613 ) — Net income from continuing operations 178,686 181,560 125,718 (254,949 ) 231,015 Net loss from discontinued operations, net of tax — (40,443 ) (12,679 ) 47,336 (5,786 ) Net income 178,686 141,117 113,039 (207,613 ) 225,229 Less: Net income attributable to noncontrolling interests — — — (46,543 ) (46,543 ) Net income attributable to DaVita Inc. $ 178,686 $ 141,117 $ 113,039 $ (254,156 ) $ 178,686 Consolidated Total Physician Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) For the three months ended March 31, 2019 Patient service operating revenues $ 2,635,152 $ — $ — $ 2,635,152 Provision for uncollectible accounts (5,463 ) — — (5,463 ) Net patient service operating revenues 2,629,689 — — 2,629,689 Other revenues 113,423 — — 113,423 Total net operating revenues 2,743,112 — — 2,743,112 Operating expenses 2,402,605 — — 2,402,605 Operating income 340,507 — — 340,507 Debt expense (131,519 ) — — (131,519 ) Other income 6,940 — — 6,940 Income tax expense 56,746 — — 56,746 Net income from continuing operations 159,182 — — 159,182 Net income from discontinued operations, net of tax 30,305 9,237 463 20,605 Net income 189,487 9,237 463 179,787 Less: Net income attributable to noncontrolling interests (40,198 ) (1,255 ) — (38,943 ) Net income attributable to DaVita Inc. $ 149,289 $ 7,982 $ 463 $ 140,844 (1)
Condensed Consolidating Statements of Comprehensive Income	Condensed Consolidating Statements of Comprehensive Income Guarantor Non- Consolidating Consolidated For the three months ended March 31, 2019 DaVita Inc. Net income $ 149,289 $ 134,535 $ 86,349 $ (180,686 ) $ 189,487 Other comprehensive income (loss) 1,026 — (13,653 ) — (12,627 ) Total comprehensive income 150,315 134,535 72,696 (180,686 ) 176,860 Less: Comprehensive income attributable to noncontrolling interest — — — (40,198 ) (40,198 ) Comprehensive income attributable to DaVita Inc. $ 150,315 $ 134,535 $ 72,696 $ (220,884 ) $ 136,662 Guarantor Non- Consolidating Consolidated For the three months ended March 31, 2018 DaVita Inc. Net income $ 178,686 $ 141,117 $ 113,039 $ (207,613 ) $ 225,229 Other comprehensive income 2,587 — 19,881 — 22,468 Total comprehensive income 181,273 141,117 132,920 (207,613 ) 247,697 Less: Comprehensive income attributable to noncontrolling interest — — — (46,543 ) (46,543 ) Comprehensive income attributable to DaVita Inc. $ 181,273 $ 141,117 $ 132,920 $ (254,156 ) $ 201,154 Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) For the three months ended March 31, 2019 Net income $ 189,487 $ 9,237 $ 463 $ 179,787 Other comprehensive loss (12,627 ) — — (12,627 ) Total comprehensive income 176,860 9,237 463 167,160 Less: Comprehensive income attributable to the noncontrolling (40,198 ) (1,255 ) — (38,943 ) Comprehensive income attributable to DaVita Inc. $ 136,662 $ 7,982 $ 463 $ 128,217 (1)
Condensed Consolidating Balance Sheets	Condensed Consolidating Balance Sheets Guarantor Non- Consolidating Consolidated As of March 31, 2019 DaVita Inc. Cash and cash equivalents $ 194,347 $ — $ 264,895 $ — $ 459,242 Restricted cash and equivalents 1,006 12,114 89,072 — 102,192 Accounts receivable, net — 1,349,185 604,237 — 1,953,422 Other current assets 37,185 568,029 100,058 — 705,272 Current assets held for sale, net — 4,842,062 1,162,886 — 6,004,948 Total current assets 232,538 6,771,390 2,221,148 — 9,225,076 Property and equipment, net 503,677 1,610,442 1,278,147 — 3,392,266 Operating lease right-of-use assets 107,237 1,594,411 1,034,888 — 2,736,536 Intangible assets, net 130 39,813 78,381 — 118,324 Investments in subsidiaries 10,191,084 3,323,518 — (13,514,602 ) — Intercompany receivables 3,756,675 — 1,496,009 (5,252,684 ) — Other long-term assets and investments 53,978 84,137 196,259 — 334,374 Goodwill — 4,812,366 1,987,002 — 6,799,368 Total assets $ 14,845,319 $ 18,236,077 $ 8,291,834 $ (18,767,286 ) $ 22,605,944 Current liabilities $ 4,702,717 $ 1,182,342 $ 592,508 $ — $ 6,477,567 Current liabilities held for sale — 1,084,512 668,798 — 1,753,310 Intercompany payables — 3,648,453 1,604,231 (5,252,684 ) — Long-term operating leases liabilities 133,936 1,502,922 988,918 — 2,625,776 Long-term debt and other long-term liabilities 5,520,830 626,764 371,980 — 6,519,574 Noncontrolling interests subject to put provisions 612,482 — — 530,562 1,143,044 Total DaVita Inc. shareholders' equity 3,875,354 10,191,084 3,323,518 (13,514,602 ) 3,875,354 Noncontrolling interests not subject to put — — 741,881 (530,562 ) 211,319 Total equity 3,875,354 10,191,084 4,065,399 (14,045,164 ) 4,086,673 Total liabilities and equity $ 14,845,319 $ 18,236,077 $ 8,291,834 $ (18,767,286 ) $ 22,605,944 Guarantor Non- Consolidating Consolidated As of December 31, 2018 DaVita Inc. Cash and cash equivalents $ 60,653 $ — $ 262,385 $ — $ 323,038 Restricted cash and equivalents 1,005 12,048 79,329 — 92,382 Accounts receivable, net — 1,264,290 594,318 — 1,858,608 Other current assets 37,185 601,318 122,063 — 760,566 Current assets held for sale — 4,440,953 948,612 — 5,389,565 Total current assets 98,843 6,318,609 2,006,707 — 8,424,159 Property and equipment, net 491,462 1,624,835 1,277,372 — 3,393,669 Intangible assets, net 153 42,933 75,760 — 118,846 Investments in subsidiaries 10,102,750 3,239,862 — (13,342,612 ) — Intercompany receivables 3,419,448 — 1,471,203 (4,890,651 ) — Other long-term assets and investments 53,385 80,537 197,696 — 331,618 Goodwill — 4,812,365 2,029,595 — 6,841,960 Total assets $ 14,166,041 $ 16,119,141 $ 7,058,333 $ (18,233,263 ) $ 19,110,252 Current liabilities $ 1,945,943 $ 1,251,534 $ 449,925 $ — $ 3,647,402 Current liabilities held for sale — 722,766 520,993 — 1,243,759 Intercompany payables — 3,327,026 1,563,625 (4,890,651 ) — Long-term debt and other long-term liabilities 7,918,581 715,065 552,406 — 9,186,052 Noncontrolling interests subject to put provisions 598,075 — — 526,566 1,124,641 Total DaVita Inc. shareholders' equity 3,703,442 10,102,750 3,239,862 (13,342,612 ) 3,703,442 Noncontrolling interests not subject to put — — 731,522 (526,566 ) 204,956 Total equity 3,703,442 10,102,750 3,971,384 (13,869,178 ) 3,908,398 Total liabilities and equity $ 14,166,041 $ 16,119,141 $ 7,058,333 $ (18,233,263 ) $ 19,110,252 Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) As of March 31, 2019 Cash and cash equivalents $ 459,242 $ — $ — $ 459,242 Restricted cash and equivalents 102,192 — — 102,192 Accounts receivable, net 1,953,422 — — 1,953,422 Other current assets 705,272 — — 705,272 Current assets held for sale, net 6,004,948 629,422 3,288 5,372,238 Total current assets 9,225,076 629,422 3,288 8,592,366 Property and equipment, net 3,392,266 — — 3,392,266 Operating lease right-of-use assets 2,736,536 — — 2,736,536 Amortizable intangibles, net 118,324 — — 118,324 Other long-term assets 334,374 — — 334,374 Goodwill 6,799,368 — — 6,799,368 Total assets $ 22,605,944 $ 629,422 $ 3,288 $ 21,973,234 Current liabilities $ 6,477,567 $ — $ — $ 6,477,567 Current liabilities held for sale 1,753,310 412,368 — 1,340,942 Payables to parent — 72,539 3,288 (75,827 ) Long-term operating leases liabilities 2,625,776 — — 2,625,776 Long-term debt and other long-term liabilities 6,519,574 — — 6,519,574 Noncontrolling interests subject to put provisions 1,143,044 — — 1,143,044 Total DaVita Inc. shareholders’ equity 3,875,354 144,515 — 3,730,839 Noncontrolling interests not subject to put provisions 211,319 — — 211,319 Shareholders’ equity 4,086,673 144,515 — 3,942,158 Total liabilities and shareholder’s equity $ 22,605,944 $ 629,422 $ 3,288 $ 21,973,234 (1)
Condensed Consolidating Statements of Cash Flows	Condensed Consolidating Statements of Cash Flows Guarantor Non- Consolidating Consolidated For the three months ended March 31, 2019 DaVita Inc. Cash flows from operating activities: Net income $ 149,289 $ 134,535 $ 86,349 $ (180,686 ) $ 189,487 Changes in operating assets and liabilities and non-cash (124,409 ) (197,096 ) 92,636 180,686 (48,183 ) Net cash provided by (used in) operating activities 24,880 (62,561 ) 178,985 — 141,304 Cash flows from investing activities: Additions of property and equipment (38,942 ) (112,376 ) (47,560 ) — (198,878 ) Acquisitions — — (11,274 ) — (11,274 ) Proceeds from asset and business sales — 1,456 12,447 — 13,903 Proceeds (purchases) from investment sales and other items, net 1,804 (4,558 ) (1,355 ) — (4,109 ) Net cash used in investing activities (37,138 ) (115,478 ) (47,742 ) — (200,358 ) Cash flows from financing activities: Long-term debt and related financing costs, net 365,133 (2,439 ) (5,497 ) — 357,197 Intercompany borrowing (payments) (220,697 ) 229,211 (8,514 ) — — Other items 1,517 (8,480 ) (25,283 ) — (32,246 ) Net cash provided by (used in) financing activities 145,953 218,292 (39,294 ) — 324,951 Effect of exchange rate changes on cash, cash — — (921 ) — (921 ) Net increase in cash, cash equivalents and 133,695 40,253 91,028 — 264,976 Less: Net increase in cash, cash equivalents and restricted cash from discontinued operations — 40,187 78,775 — 118,962 Net increase in cash, cash equivalents and restricted cash from continuing operations 133,695 66 12,253 — 146,014 Cash, cash equivalents and restricted cash of continuing 61,658 12,048 341,714 — 415,420 Cash, cash equivalents and restricted cash of continuing $ 195,353 $ 12,114 $ 353,967 $ — $ 561,434 Guarantor Non- Consolidating Consolidated For the three months ended March 31, 2018 DaVita Inc. Cash flows from operating activities: Net income $ 178,686 $ 141,117 $ 113,039 $ (207,613 ) $ 225,229 Changes in operating assets and liabilities and non-cash (82,391 ) 32,484 (20,396 ) 207,613 137,310 Net cash provided by operating activities 96,295 173,601 92,643 — 362,539 Cash flows from investing activities: Additions of property and equipment (27,356 ) (125,375 ) (79,712 ) — (232,443 ) Acquisitions — (4,417 ) (12,165 ) — (16,582 ) Proceeds from asset and business sales — 18,535 — — 18,535 Proceeds (purchases) from investment sales and other items, net 31,665 (762 ) (541 ) — 30,362 Net cash provided by (used in) investing activities 4,309 (112,019 ) (92,418 ) — (200,128 ) Cash flows from financing activities: Long-term debt and related financing costs, net 116,307 (3,377 ) (8,257 ) — 104,673 Intercompany borrowing (payments) 47,394 (49,783 ) 2,389 — — Other items (291,562 ) (2,200 ) (33,458 ) — (327,220 ) Net cash used in financing activities (127,861 ) (55,360 ) (39,326 ) — (222,547 ) Effect of exchange rate changes on cash, cash — — 6,668 — 6,668 Net decrease in cash, cash equivalents and restricted cash (27,257 ) 6,222 (32,433 ) — (53,468 ) Less: Net increase in cash, cash equivalents and restricted cash from discontinued operations — 6,185 11,649 — 17,834 Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations (27,257 ) 37 (44,082 ) — (71,302 ) Cash, cash equivalents and restricted cash of continuing 150,307 9,384 359,229 — 518,920 Cash, cash equivalents and restricted cash of continuing $ 123,050 $ 9,421 $ 315,147 $ — $ 447,618 Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) For the three months ended March 31, 2019 Cash flows from operating activities: Net income $ 189,487 $ 9,237 $ 463 $ 179,787 Changes in operating and intercompany assets and liabilities and (48,183 ) 9,696 (463 ) (57,416 ) Net cash provided by operating activities 141,304 18,933 — 122,371 Cash flows from investing activities: Additions of property and equipment (198,878 ) (229 ) — (198,649 ) Acquisitions (11,274 ) — — (11,274 ) Proceeds from asset and business sales 13,903 — — 13,903 Investments and other items (4,109 ) (1,355 ) — (2,754 ) Net cash used in investing activities (200,358 ) (1,584 ) — (198,774 ) Cash flows from financing activities: Long-term debt 357,197 — — 357,197 Intercompany — 28,965 — (28,965 ) Other items (32,246 ) — — (32,246 ) Net cash (used in) provided by financing activities 324,951 28,965 — 295,986 Effect of exchange rate changes on cash, cash equivalents and (921 ) — — (921 ) Net increase in cash, cash equivalents and restricted cash 264,976 46,314 — 218,662 Less: Net increase in cash, cash equivalents and restricted cash from discontinued operations 118,962 46,314 — 72,648 Net increase in cash, cash equivalents and restricted cash from continuing operations 146,014 — — 146,014 Cash, cash equivalents and restricted cash of continuing operations 415,420 — — 415,420 Cash, cash equivalents and restricted cash of continuing operations $ 561,434 $ — $ — $ 561,434 (1)

Revenue Recognition Revenue R_2

Revenue Recognition Revenue Recognition (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018	Dec. 31, 2018
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Allowance for Doubtful Accounts Receivable	$ 42,235		$ 52,924
Difference between Revenue Guidance in Effect before and after Topic 606 [Member]
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Contract with Customer, Performance Obligation Satisfied in Previous Period	$ 27,179	$ 67,410
Contract With Customer Performance Obligation Not Substantially Completed		$ 24,000

Revenue Recognition Segment R_2

Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Disaggregation of Revenue [Line Items]
Patient service revenues	$ 2,635,152	$ 2,591,074
Other revenues	113,423	232,825
Total revenues	2,743,112	2,849,444
Intersegment Elimination
Disaggregation of Revenue [Line Items]
Total revenues	(33,977)	(28,621)
Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Patient service revenues	1,493,516	1,485,192
Other revenues	61,700	142,758
Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Patient service revenues	154,190	157,496
Other revenues	6	15,791
Other Government Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	190,602	189,656
Commercial Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	821,801	802,697
Other revenues	32,619	40,420
Other
Disaggregation of Revenue [Line Items]
Other revenues	22,655	44,055
U.S. dialysis and related lab services
Disaggregation of Revenue [Line Items]
Total revenues	2,516,510	2,519,478
U.S. dialysis and related lab services | Intersegment Elimination
Disaggregation of Revenue [Line Items]
Total revenues	(30,641)	(18,422)
U.S. dialysis and related lab services | Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Patient service revenues	1,493,516	1,485,192
Other revenues	0	0
U.S. dialysis and related lab services | Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Patient service revenues	154,190	157,496
Other revenues	0	0
U.S. dialysis and related lab services | Other Government Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	106,127	107,119
U.S. dialysis and related lab services | Commercial Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	788,413	782,979
Other revenues	0	0
U.S. dialysis and related lab services | Other
Disaggregation of Revenue [Line Items]
Other revenues	4,905	5,114
Other—Ancillary services and strategic initiatives
Disaggregation of Revenue [Line Items]
Total revenues	226,602	329,966
Other—Ancillary services and strategic initiatives | Intersegment Elimination
Disaggregation of Revenue [Line Items]
Total revenues	(3,336)	(10,199)
Other—Ancillary services and strategic initiatives | Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Patient service revenues	0	0
Other revenues	61,700	142,758
Other—Ancillary services and strategic initiatives | Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Patient service revenues	0	0
Other revenues	6	15,791
Other—Ancillary services and strategic initiatives | Other Government Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	84,475	82,537
Other—Ancillary services and strategic initiatives | Commercial Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	33,388	19,718
Other revenues	32,619	40,420
Other—Ancillary services and strategic initiatives | Other
Disaggregation of Revenue [Line Items]
Other revenues	$ 17,750	$ 38,941

Earnings per share - Reconcilia

Earnings per share - Reconciliations of Numerators and Denominators Used to Calculate Basic and Diluted Earnings Per Share (Detail) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Earnings Per Share [Abstract]
Net income from continuing operations	$ 120,254	$ 191,015
Net income (loss) from discontinued operations	29,035	(12,329)
Net income attributable to DaVita Inc.	$ 149,289	$ 178,686
Basic:
Weighted average shares outstanding during the period	166,388,000	181,152,000
Weighted average contingently returnable shares held in escrow from the DaVita HealthCare Partners merger (in shares)	0	(2,194,000)
Weighted average shares for basic earnings per share calculation (in shares)	166,387,958	178,957,865
Basic net income from continuing operations per share	$ 0.72	$ 1.07
Basic net income (loss) from discontinued operations per share	0.18	(0.07)
Basic net (loss) income per share attributable to DaVita Inc. (usd per share)	$ 0.90	$ 1
Diluted:
Weighted average shares outstanding during the period	166,388,000	181,152,000
Assumed incremental shares from stock plans (in shares)	393,000	683,000
Weighted average shares for diluted earnings per share calculation (in shares)	166,780,657	181,834,547
Diluted net income from continuing operations per share	$ 0.72	$ 1.05
Discontinued Operation, Income (Loss) from Discontinued Operation, Net of Tax, Per Diluted Share	0.18	(0.07)
Diluted net (loss) income per share attributable to DaVita Inc. (usd per share)	$ 0.90	$ 0.98
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount	6,150,000	3,453,000

Investments in debt and equit_3

Investments in debt and equity securities (Detail) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Investment Holdings [Line Items]
Held to maturity	$ 2,235	$ 2,235
Held to maturity, short-term investments	2,235	2,235
Held to maturity, long-term investments	0	0
Equity Securities, FV-NI	36,214	36,124
Total	38,449	38,359
Total, short-term investments	4,035	2,935
Total, long-term investments	34,414	35,424
Certificates of deposit and other time deposits
Investment Holdings [Line Items]
Held to maturity	2,235	2,235
Equity Securities, FV-NI	0	0
Total	2,235	2,235
Investments in mutual funds and common stock
Investment Holdings [Line Items]
Held to maturity	0	0
Equity Securities, FV-NI	36,214	36,124
Total	36,214	36,124
Short-term Investments
Investment Holdings [Line Items]
Equity Securities, FV-NI	1,800	700
Long-term Investments
Investment Holdings [Line Items]
Equity Securities, FV-NI	$ 34,414	$ 35,424

Investments in debt and equit_4

Investments in debt and equity securities - Additional Information (Detail) - Investments in mutual funds and common stock - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Schedule Of Trading Securities And Other Trading Assets [Line Items]
Pre-tax Net Gain (Loss) recognized in Income Statement	$ 1,893
Pre-tax Realized Gain (Loss) on Securities Arising During Period	170	$ 86
Net Increase (Decrease) in Unrealized Gain on Equity Securities due to changes in Fair Value	$ 1,723	3,660
Gain on Sale Of Equity Securities After Tax		$ 3,746

Equity method and other inves_3

Equity method and other investments Equity Method and Other Investments (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Schedule of Equity Method Investments [Line Items]
Equity method and other investments	$ 226,309	$ 224,611
Adjusted cost method investments
Schedule of Equity Method Investments [Line Items]
Equity method and other investments	12,386	12,386
Other Ownership Interest
Schedule of Equity Method Investments [Line Items]
Equity method and other investments	88,861	83,052
Deconsolidated Noncontrolling Entity
Schedule of Equity Method Investments [Line Items]
Equity method and other investments	$ 125,062	$ 129,173

Equity method and other inves_4

Equity method and other investments - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Noncontrolling Interest [Line Items]
Equity investment income	$ 2,708	$ 155
Valuation Adjustment	$ 0
Minimum
Noncontrolling Interest [Line Items]
Current economic interest in the APAC JV, Owned by the Parent Company	30.00%
Maximum
Noncontrolling Interest [Line Items]
Current economic interest in the APAC JV, Owned by the Parent Company	50.00%

Goodwill - Changes in Goodwill

Goodwill - Changes in Goodwill by Reportable Segments (Detail) - USD ($) $ in Thousands	3 Months Ended		12 Months Ended
	Mar. 31, 2019	Mar. 31, 2018	Dec. 31, 2018
Goodwill [Roll Forward]
Beginning balance	$ 6,841,960	$ 6,610,279	$ 6,610,279
Acquisitions	8,655		278,348
Divestitures			(15,497)
Impairment charges	(41,037)	0	(3,106)
Foreign currency and other adjustments	(10,210)		(28,064)
Ending balance	6,799,368		6,841,960
Goodwill	6,867,378
Accumulated impairment charges	(68,010)
Ending balance	6,799,368		6,841,960
U.S. dialysis and related lab services
Goodwill [Roll Forward]
Beginning balance	6,275,004	6,144,761	6,144,761
Acquisitions	7,027		130,574
Divestitures			(331)
Impairment charges	0		0
Foreign currency and other adjustments	0		0
Ending balance	6,282,031		6,275,004
Goodwill	6,282,031
Accumulated impairment charges	0
Ending balance	6,282,031		6,275,004
Other—Ancillary services and strategic initiatives
Goodwill [Roll Forward]
Beginning balance	566,956	$ 465,518	465,518
Acquisitions	1,628		147,774
Divestitures			(15,166)
Impairment charges	(41,037)		(3,106)
Foreign currency and other adjustments	(10,210)		(28,064)
Ending balance	517,337		566,956
Goodwill	585,347
Accumulated impairment charges	(68,010)
Ending balance	$ 517,337		$ 566,956

Goodwill Goodwill - Schedule of

Goodwill Goodwill - Schedule of Reporting Units Goodwill Balances (Details) (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Goodwill [Line Items]
Goodwill	$ 6,799,368	$ 6,841,960	$ 6,610,279
Percentage Change In Operating Income Used To Evaluate Fair Value Of Reporting Unit For Goodwill Assessment	3.00%
Percentage Change In Discount Rate Used To Evaluate Fair Value Of Reporting Unit For Goodwill Assessment	1.00%
GERMANY | Kidney Care
Goodwill [Line Items]
Goodwill	$ 354,182
Reporting Unit Percentage Of Fair Value In Excess Of Short Of Carrying Amount	0.00%
Potential Impact On Fair Value For Reduction In Operating Income	(1.40%)
Potential Impact On Fair Value For Basis Point Increase In Discount Rate	(9.30%)

Goodwill - Narrative (Details)

Goodwill - Narrative (Details) $ in Thousands	3 Months Ended		12 Months Ended
	Mar. 31, 2019USD ($)segment	Mar. 31, 2018USD ($)	Dec. 31, 2018USD ($)
Goodwill [Line Items]
Goodwill impairment charges	$ 41,037	$ 0	$ 3,106
Number of Reportable Segments | segment	2
Reporting Units Other Than DaVita Medical Group which were at risk of goodwill impairment
Goodwill [Line Items]
Number of Reportable Segments | segment	0
GERMANY | Kidney Care
Goodwill [Line Items]
Goodwill impairment charges	$ 41,037
Goodwill, Subsequent Recognition of Deferred Tax Asset	8,865
Goodwill, Impairment Loss, Net of Tax	$ 32,172

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Liability for unrecognized tax benefits	$ 48,384	$ 40,382
Unrecognized Tax Benefits that Would Impact Effective Tax Rate	45,541
Increase in liability for unrecognized tax benefits	8,002
Accrued interest and penalties related to unrecognized tax benefits, net of federal tax benefits	$ 9,903	$ 9,019

Long-term debt (Detail)

Long-term debt (Detail) - USD ($) $ in Thousands	May 06, 2019	Mar. 31, 2019	Dec. 31, 2018
Debt Instrument [Line Items]
Debt Instrument, Maturity Date		Dec. 24, 2019
Senior Notes
Acquisition obligations and other notes payable		$ 181,885	$ 183,979
Finance Lease, Liability		$ 276,564	282,737
Debt Instrument, Interest Rate During Period		5.16%
Long-term Debt, Weighted Average Interest Rate, at Point in Time		5.14%
Total debt principal outstanding		$ 10,512,199	10,154,216
Discount and deferred financing costs		(48,495)	(52,000)
Total amount of long-term debt		10,463,704	10,102,216
Less current portion		(4,676,691)	(1,929,369)
Long-term debt		$ 5,787,013	8,172,847
Debt Instrument, table footnotes
Term Loan A, Term Loan A-2, and Revolver debt Instruments, Maturity Date		Dec. 24, 2019
Senior Notes Five Point Seven Five Percentage Senior Notes
Debt Instrument [Line Items]
Debt Instrument, Maturity Date		Aug. 15, 2022
Debt Instrument, Fair Value Disclosure		$ 1,271,875
Senior Notes
Senior Notes		$ 1,250,000	1,250,000
Debt Instrument, Interest Rate During Period		5.75%
Debt Instrument, table footnotes
Term Loan A, Term Loan A-2, and Revolver debt Instruments, Maturity Date		Aug. 15, 2022
Senior Notes Five Point One Two Five Percent Due Twenty Twenty Four
Debt Instrument [Line Items]
Debt Instrument, Maturity Date		Jul. 15, 2024
Debt Instrument, Fair Value Disclosure		$ 1,729,175
Senior Notes
Senior Notes		$ 1,750,000	1,750,000
Debt Instrument, Interest Rate During Period		5.125%
Debt Instrument, table footnotes
Term Loan A, Term Loan A-2, and Revolver debt Instruments, Maturity Date		Jul. 15, 2024
Senior Notes Five Point Zero Percent Due Twenty Twenty Five
Debt Instrument [Line Items]
Debt Instrument, Maturity Date		May 1, 2025
Debt Instrument, Fair Value Disclosure		$ 1,439,250
Senior Notes
Senior Notes		$ 1,500,000	1,500,000
Debt Instrument, Interest Rate During Period		5.00%
Debt Instrument, table footnotes
Term Loan A, Term Loan A-2, and Revolver debt Instruments, Maturity Date		May 1, 2025
Notes Payable, Other Payables
Senior Notes
Long-term Debt, Weighted Average Interest Rate, at Point in Time		6.30%
Debt Instrument, Maturity Date, Description		2019-2026
Finance Lease
Senior Notes
Finance Lease, Weighted Average Discount Rate, Percent		4.84%
Debt Instrument, Maturity Date, Description		2019-2036
Senior Secured Credit Facilities
Senior Notes
Long-term Debt, Weighted Average Interest Rate, at Point in Time		5.00%
Debt Instrument, table footnotes
Debt Instrument, Unamortized Discount		$ 5,487
Deferred Offering Costs		11,319
Senior Notes
Debt Instrument, table footnotes
Deferred Offering Costs		31,689
Term Loan A
Debt Instrument [Line Items]
Senior Secured Credit Facilities		$ 650,000	675,000
Debt Instrument, Description of Variable Rate Basis		2.00% + LIBOR
Debt Instrument, Maturity Date		Dec. 24, 2019
Debt Instrument, Fair Value Disclosure		$ 649,155
Debt Instrument, table footnotes
Term Loan A, Term Loan A-2, and Revolver debt Instruments, Maturity Date		Dec. 24, 2019
Term Loan A-2
Debt Instrument [Line Items]
Senior Secured Credit Facilities		$ 995,000	995,000
Debt Instrument, Description of Variable Rate Basis		1.00% + LIBOR
Debt Instrument, Maturity Date		Dec. 24, 2019
Debt Instrument, Fair Value Disclosure		$ 999,975
Debt Instrument, table footnotes
Term Loan A, Term Loan A-2, and Revolver debt Instruments, Maturity Date		Dec. 24, 2019
Term Loan B
Debt Instrument [Line Items]
Senior Secured Credit Facilities		$ 3,333,750	3,342,500
Debt Instrument, Description of Variable Rate Basis		2.75% + LIBOR
Debt Instrument, Maturity Date		Jun. 24, 2021
Debt Instrument, Fair Value Disclosure		$ 3,350,419
Debt Instrument, table footnotes
Term Loan A, Term Loan A-2, and Revolver debt Instruments, Maturity Date		Jun. 24, 2021
Revolver
Debt Instrument [Line Items]
Senior Secured Credit Facilities		$ 575,000	$ 175,000
Debt Instrument, Description of Variable Rate Basis		2.00% + LIBOR
Debt Instrument, Maturity Date		Dec. 24, 2019
Debt Instrument, Fair Value Disclosure		$ 575,000
Debt Instrument, table footnotes
Term Loan A, Term Loan A-2, and Revolver debt Instruments, Maturity Date		Dec. 24, 2019
Minimum | London Interbank Offered Rate (LIBOR) | Term Loan B
Debt Instrument, table footnotes
LIBOR plus interest rate margin		0.75%
Subsequent Event
Debt Instrument, table footnotes
Long-Term Debt Maturity Extension Term	6 months

Long-term debt - Scheduled Matu

Long-term debt - Scheduled Maturities of Long-term Debt (Detail) $ in Thousands	Mar. 31, 2019USD ($)
Debt Instrument [Line Items]
2019 (remainder of the year)	$ 4,654,038
2020	83,658
2021	940,050
2022	1,291,930
2023	52,538
2024	1,784,606
Thereafter	1,705,379
Term Loan B
Debt Instrument [Line Items]
2019 (remainder of the year)	$ 2,372,764

Long-term debt Schedule of Deri

Long-term debt Schedule of Derivative Instruments (Details) - USD ($)	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018	Dec. 31, 2018
Interest Rate Cap Agreements Effective June 29, 2018
Derivative [Line Items]
Derivative, Effective Date	Jun. 29, 2018
Derivative, expiration date	Jun. 30, 2020
Derivative Asset, Fair Value, Gross Asset	$ 70,000		$ 851,000
Term Loan Facility | Interest Rate Cap One | Maximum
Derivative [Line Items]
Notional amounts of interest rate agreements	$ 3,500,000,000
LIBOR plus interest rate margin	3.50%
Cash Flow Hedging
Derivative [Line Items]
Amount of losses reclassified from accumulated OCI into income	$ (1,606,000)	$ (1,537,000)
Amount of unrecognized (losses) gains in OCI on interest rate cap agreements	580,000	(1,050,000)
Debt Expense | Cash Flow Hedging | Interest rate cap agreements
Derivative [Line Items]
Amount of losses reclassified from accumulated OCI into income	(2,163,000)	(2,070,000)
Amount of unrecognized (losses) gains in OCI on interest rate cap agreements	$ 781,000	$ (1,414,000)

Long-term debt - Effects of Int

Long-term debt - Effects of Interest Rate Swap and Cap Agreements (Detail) - Cash Flow Hedging - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Derivative Instruments Gain Loss [Line Items]
Amount of unrecognized (losses) gains in OCI on interest rate cap agreements	$ (580)	$ 1,050
Reclassification from accumulated other comprehensive income into net income	1,606	1,537
Tax benefit (expense)
Derivative Instruments Gain Loss [Line Items]
Amount of unrecognized (losses) gains in OCI on interest rate cap agreements	201	(364)
Reclassification from accumulated other comprehensive income into net income	(557)	(533)
Interest rate cap agreements | Debt Expense
Derivative Instruments Gain Loss [Line Items]
Amount of unrecognized (losses) gains in OCI on interest rate cap agreements	(781)	1,414
Reclassification from accumulated other comprehensive income into net income	$ 2,163	$ 2,070

Long-term debt - Additional Inf

Long-term debt - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Dec. 31, 2018
Debt Instrument [Line Items]
Weighted average effective interest rate at quarter end	5.14%
Weighted average effective interest rate during quarter	5.16%
Percentage of debt instruments bearing fixed interest rate	46.31%
U.S. dialysis and related lab services
Debt Instrument [Line Items]
Letters of credit outstanding	$ 40,871
DMG
Debt Instrument [Line Items]
Letters of credit outstanding	211
Revolving Credit Facility
Debt Instrument [Line Items]
Proceeds from Long-term Lines of Credit	575,000
Undrawn revolving credit facilities	1,000,000
Letter of Credit
Debt Instrument [Line Items]
Letters of credit outstanding	$ 38,017
Senior Secured Credit Facilities
Debt Instrument [Line Items]
Weighted average effective interest rate at quarter end	5.00%
Term Loan A
Debt Instrument [Line Items]
Mandatory principal payments	$ 25,000
Secured Debt	650,000	$ 675,000
Term Loan B
Debt Instrument [Line Items]
Mandatory principal payments	8,750
Secured Debt	3,333,750	$ 3,342,500
Term Loan A subject to uncapped portion of variability of LIBOR
Debt Instrument [Line Items]
Secured Debt	483,750
Maximum
Debt Instrument [Line Items]
Unrestricted Proceeds From Divestiture Of Business	$ 750,000

Leases Lease Expense Components

Leases Lease Expense Components (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)
Operating lease cost:
Fixed Lease Expense	$ 128,110
Variable Lease Expense	28,571
Finance lease cost:
Finance Lease, Right-of-Use Asset, Amortization	5,826
Finance Lease, Interest Expense	3,775
Lease, Cost	$ 166,282

Leases Leases Other Information

Leases Leases Other Information (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)
Leases term and discount rate
Operating Lease, Weighted Average Remaining Lease Term	9 years
Finance Lease, Weighted Average Remaining Lease Term	10 years 1 month 6 days
Operating Lease, Weighted Average Discount Rate, Percent	4.20%
Leases other information
Sale and Leaseback Transaction, Gain (Loss), Net	$ 3,987
Cash paid for amounts included in the measurement of lease liabilities
Operating Lease, Payments	153,587
Finance Lease, Interest Payment on Liability	5,661
Finance Lease, Principal Payments	5,344
Net Operating Lease Assets Obtained In Exchange For Lease Liabilities	$ 45,034
Finance Lease
Leases term and discount rate
Finance Lease, Weighted Average Discount Rate, Percent	4.84%

Leases Schedule of Minimum Leas

Leases Schedule of Minimum Lease Payments (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Operating Lease Liabilities, Payments Due
Lessee, Operating Lease, Liability, Payments, Remainder of Fiscal Year	$ 365,155
Lessee, Operating Lease, Liability, Payments, Due Next Twelve Months	474,121
Lessee, Operating Lease, Liability, Payments, Due Year Two	443,729
Lessee, Operating Lease, Liability, Payments, Due Year Three	405,176
Lessee, Operating Lease, Liability, Payments, Due Year Four	358,578
Lessee, Operating Lease, Liability, Payments, Due Year Five	306,512
Lessee, Operating Lease, Liability, Payments, Due after Year Five	1,275,632
Lessee, Operating Lease, Liability, Payments, Due	3,628,903
Less Portion Representing Interest, Operating Lease Liability	(635,714)
Operating Lease, Liability	2,993,189
Finance Lease Liabilities, Payments, Due
Finance Lease, Liability, Payments, Remainder of Fiscal Year	30,702
Finance Lease, Liability, Payments, Due Next Twelve Months	37,974
Finance Lease, Liability, Payments, Due Year Two	33,637
Finance Lease, Liability, Payments, Due Year Three	33,860
Finance Lease, Liability, Payments, Due Year Four	33,975
Finance Lease, Liability, Payments, Due Year Five	33,993
Finance Lease, Liability, Payments, Due after Year Five	162,183
Finance Lease, Liability, Payments, Due	366,324
Less Portion Representing Interest, Finance Lease Liability	(89,760)
Finance Lease, Liability	$ 276,564	$ 282,737
Operating Leases Liabilities, Future Payments, Due
Operating Leases, Future Minimum Payments Due, Next Twelve Months		483,488
Operating Leases, Future Minimum Payments, Due in Two Years		462,154
Operating Leases, Future Minimum Payments, Due in Three Years		432,950
Operating Leases, Future Minimum Payments, Due in Four Years		395,462
Operating Leases, Future Minimum Payments, Due in Five Years		349,649
Operating Leases, Future Minimum Payments, Due Thereafter		1,589,949
Operating Leases, Future Minimum Payments Due		3,713,652
Capital Leases Liabilities, Future Payments, Due
Capital Leases, Future Minimum Payments Due, Next Twelve Months		36,754
Capital Leases, Future Minimum Payments Due in Two Years		41,044
Capital Leases, Future Minimum Payments Due in Three Years		34,026
Capital Leases, Future Minimum Payments Due in Four Years		33,690
Capital Leases, Future Minimum Payments Due in Five Years		33,845
Capital Leases, Future Minimum Payments Due Thereafter		194,611
Capital Leases, Future Minimum Payments Due		373,970
Capital Leases, Future Minimum Payments, Interest Included in Payments		(91,233)
Capital Leases, Future Minimum Payments, Present Value of Net Minimum Payments		$ 282,737

Leases Leases - Additional Info

Leases Leases - Additional Information (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Lessee, Lease, Description [Line Items]
Finance Lease, Right-of-Use Asset	$ 233,209	$ 367,164
Finance Lease Accumulated Depreciation	$ 9,972	$ 131,971
Minimum
Lessee, Lease, Description [Line Items]
Lessee, Operating Lease, Term of Contract	5 years
Lessee, Operating Lease, Renewal Term	5 years
Maximum
Lessee, Lease, Description [Line Items]
Lessee, Operating Lease, Term of Contract	15 years
Lessee, Operating Lease, Renewal Term	10 years

Contingencies - Additional Info

Contingencies - Additional Information (Detail) - US Attorney Prescription Drug Investigation $ in Thousands	1 Months Ended
	Dec. 31, 2017USD ($)
Other Commitments [Line Items]
Litigation Settlement, Amount Awarded to Other Party	$ 63,700
Incremental Cash Portion
Other Commitments [Line Items]
Litigation Settlement, Amount Awarded to Other Party	41,500
Cash Paid For Portion Previously Refunded
Other Commitments [Line Items]
Litigation Settlement, Amount Awarded to Other Party	$ 22,200

Other commitments - additional

Other commitments - additional information (Detail) $ in Thousands	Mar. 31, 2019USD ($)
Commitments to provide operating capital
Other Commitments [Line Items]
Other potential commitments to provide operating capital to several dialysis centers	$ 7,339

Long-term incentive compensat_2

Long-term incentive compensation - Additional Information (Detail) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Long-term incentive program (LTIP) expense	$ 13,107	$ 15,215
Stock-based compensation expense	12,110	9,685
Estimated tax benefits recorded for stock-based compensation	1,495	2,088
Unrecognized compensation cost related to outstanding LTIP awards	88,173
Unrecognized compensation cost related to nonvested stock-based compensation arrangements under equity compensation and stock purchase plans	$ 79,499
Unrecognized compensation cost related to nonvested stock-based compensation arrangements under performance-based cash component of LTIP costs, weighted average remaining period (in years)	8 months 12 days
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
Employee Service Share-based Compensation, Tax Benefit from Compensation Expense	$ 151	4,895
Stock Appreciation Rights
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock granted (in shares)	0
Restricted Stock Units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock granted (in shares)	7
Aggregate grant-date fair value	$ 404
Weighted-average expected life (in years)	1 year 7 months 6 days
General and Administrative Expense
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock-based compensation expense	$ 10,301	$ 9,155

Accumulated other comprehensi_3

Accumulated other comprehensive (loss) income (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018	Jan. 01, 2019	Jan. 01, 2018
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance	$ 3,908,398
Ending balance	4,086,673
Interest rate cap and swap agreements
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance	(8,961)	$ (12,408)
Cumulative effect of change in accounting principle			$ 0	$ (2,706)
Unrealized (losses) gains	(781)	1,414
Related income tax benefit	201	(364)
Unrealized (losses) gains net	(580)	1,050
Reclassification into net income	2,163	2,070
Related income	(557)	(533)
Reclassification from accumulated other comprehensive income into net income net of tax	1,606	1,537
Ending balance	(7,935)	(12,527)
Investment securities
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance		5,662
Cumulative effect of change in accounting principle				(5,662)
Unrealized (losses) gains		0
Related income tax benefit		0
Unrealized (losses) gains net		0
Reclassification into net income		0
Related income		0
Reclassification from accumulated other comprehensive income into net income net of tax		0
Ending balance		0
Foreign currency translation adjustments
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance	(25,963)	19,981
Cumulative effect of change in accounting principle			0	0
Unrealized (losses) gains	(13,653)	19,881
Related income tax benefit	0	0
Unrealized (losses) gains net	(13,653)	19,881
Reclassification into net income	0	0
Related income	0	0
Reclassification from accumulated other comprehensive income into net income net of tax	0	0
Ending balance	(39,616)	39,862
Accumulated other comprehensive (loss) income
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance	(34,924)	13,235
Cumulative effect of change in accounting principle			$ 0	$ (8,368)
Unrealized (losses) gains	(14,434)	21,295
Related income tax benefit	201	(364)
Unrealized (losses) gains net	(14,233)	20,931
Reclassification into net income	2,163	2,070
Related income	(557)	(533)
Reclassification from accumulated other comprehensive income into net income net of tax	1,606	1,537
Ending balance	$ (47,551)	$ 27,335

Acquisitions and divestitures -

Acquisitions and divestitures - Additional Information (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)clinic	Mar. 31, 2018USD ($)
Business Acquisition [Line Items]
Cash paid to acquire businesses	$ 11,274	$ 16,582
Contingent earn-out obligations and liabilities assumed associated with acquisitions	11,716
Other Accrued Liabilities
Business Acquisition [Line Items]
Contingent earn-out obligations	650
Other long-term liabilities
Business Acquisition [Line Items]
Contingent earn-out obligations	2,782
Other companies
Business Acquisition [Line Items]
Contingent earn-out obligations	$ 3,432
Minimum | Other companies | EBITDA or Operating Income Performance Targets or Quality Margins
Business Acquisition [Line Items]
Earn-out consideration payment period	1 year
Maximum | Other companies | EBITDA or Operating Income Performance Targets or Quality Margins
Business Acquisition [Line Items]
Earn-out consideration payment period	5 years
Dialysis and other businesses
Business Acquisition [Line Items]
Cash paid to acquire businesses	$ 10,210
Deferred purchase price obligations	1,457
Contingent earn-out obligations and liabilities assumed associated with acquisitions	898
Goodwill deductible for tax purposes associated with acquisitions	$ 6,945
Noncompete Agreements
Business Acquisition [Line Items]
Amortizable intangible assets acquired, weighted-average estimated useful lives	5 years
U.S. dialysis and related lab services | Dialysis and other businesses
Business Acquisition [Line Items]
Number of businesses acquired | clinic	2
Foreign Dialysis Centers | Dialysis and other businesses
Business Acquisition [Line Items]
Number of businesses acquired | clinic	2

Acquisitions and divestitures_2

Acquisitions and divestitures - Aggregate Purchase Cost Allocations for Acquisitions (Detail) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Business Acquisition [Line Items]
Goodwill	$ 6,799,368	$ 6,841,960	$ 6,610,279
Dialysis and other businesses
Business Acquisition [Line Items]
Current assets	1,117
Property and equipment	923
Intangible and other long-term assets	4,312
Goodwill	8,655
Current liabilities	(592)
Long-term liabilities	(88)
Noncontrolling interests	(1,762)
Aggregate purchase price	$ 12,565

Held for Sale and Discontinue_3

Held for Sale and Discontinued Operations Schedule of Financial Results of DMG's Discontinued Operations (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Net income (loss) from discontinued operations, net of tax	$ 30,305	$ (5,786)
DMG held for sale | Discontinued Operations, Held-for-sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Revenues	1,382,281	1,227,932
Expenses	1,338,153	1,226,407
Income from discontinued operations before taxes	44,128	1,525
Income tax expense	$ 13,823	$ 7,311

Held for Sale and Discontinue_4

Held for Sale and Discontinued Operations Schedule of Financial Position of Discontinued Operations Related to DMG (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Assets
Operating lease right-of-use asset	$ 2,736,536	$ 0
Total current assets held for sale, net	6,004,948	5,389,565
Liabilities
Current portion operating leases	367,413	0
Long-term operating leases	2,625,776	0
Total current liabilities held for sale	1,753,310	1,243,759
DMG held for sale | Discontinued Operations, Held-for-sale
Assets
Cash and cash equivalents	533,615	414,683
Other current assets	613,359	557,403
Property and equipment, net	476,781	458,040
Operating lease right-of-use asset	412,388	0
Intangible assets, net	1,317,036	1,316,974
Other long-term assets	120,347	112,127
Goodwill	2,848,262	2,847,178
Valuation Allowance On Disposal Group	(316,840)	(316,840)
Liabilities
Other liabilities	624,319	479,134
Medical payables	512,523	436,839
Current portion operating leases	68,031	0
Current portion of long-term debt	2,832	3,122
Long-term operating leases	387,841	0
Long-term debt	33,073	33,425
Other long-term liabilities	$ 124,691	$ 291,239

Held for Sale and Discontinue_5

Held for Sale and Discontinued Operations Schedule of Cash Flows of Discontinued Operations Related to DMG (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Discontinued Operations and Disposal Groups [Abstract]
Net cash provided by operating activities from discontinued operations	$ 68,240	$ 156,248
Net cash used in investing activities from discontinued operations	$ (22,809)	$ (33,068)

Held for Sale and Discontinue_6

Held for Sale and Discontinued Operations Additional Information (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)clinic	Mar. 31, 2018USD ($)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Payments to Acquire Businesses, Gross	$ 11,274	$ 16,582
Series of Individually Immaterial Business Acquisitions
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Payments to Acquire Businesses, Gross	$ 10,210
Series of Individually Immaterial Business Acquisitions | DMG held for sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of businesses acquired | clinic	1
Payments to Acquire Businesses, Gross	$ 1,064
Business Combination, Consideration Transferred, Other	$ 105
Discontinued Operations, Held-for-sale | DMG held for sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Contractual Termination Date	Jun. 30, 2019

Variable interest entities - Ad

Variable interest entities - Additional Information (Detail) $ in Thousands	Mar. 31, 2019USD ($)
Variable Interest Entity [Line Items]
Total assets of variable interest entities	$ 1,118,672
Total liabilities of variable interest entities	673,499
DMG held for sale
Variable Interest Entity [Line Items]
Total assets of variable interest entities	737,309
Total liabilities of variable interest entities	$ 401,308

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	Mar. 31, 2019	Dec. 31, 2018
Assets
Investments in equity securities	$ 36,214	$ 36,124
Fair Value, Measurements, Recurring
Assets
Investments in equity securities	36,214
Liabilities
Contingent earn-out obligations	3,432
Temporary equity
Noncontrolling interests subject to put provisions	1,143,044
Fair Value, Measurements, Recurring | Interest rate cap agreements
Assets
Interest rate cap agreements	70
Fair Value, Measurements, Recurring | Quoted prices in active markets for identical assets (Level 1)
Assets
Investments in equity securities	36,214
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	70
Fair Value, Measurements, Recurring | Significant unobservable inputs (Level 3)
Assets
Investments in equity securities	0
Liabilities
Contingent earn-out obligations	3,432
Temporary equity
Noncontrolling interests subject to put provisions	1,143,044
Fair Value, Measurements, Recurring | Significant unobservable inputs (Level 3) | Interest rate cap agreements
Assets
Interest rate cap agreements	$ 0

Segment reporting - Additional

Segment reporting - Additional Information (Detail)	3 Months Ended
	Mar. 31, 2019segment
Segment Reporting [Abstract]
Number of Operating Segments	2

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
	Mar. 31, 2019	Mar. 31, 2018
Segment Reporting Information [Line Items]
Dialysis and related lab patient service revenues	$ 2,635,152	$ 2,591,074
Provision for uncollectible accounts	(5,463)	25,545
Net U.S. dialysis and related lab services patient service revenues	2,629,689	2,616,619
Other revenues	113,423	232,825
Total revenues	2,743,112	2,849,444
Operating income (loss)	340,507	410,686
Corporate administrative support	(18,844)	(15,704)
Debt expense	(131,519)	(113,516)
Other income, net	6,940	4,582
Income from continuing operations before income taxes	215,928	301,752
U.S. dialysis and related lab services
Segment Reporting Information [Line Items]
Total revenues	2,516,510	2,519,478
Other—Ancillary services and strategic initiatives
Segment Reporting Information [Line Items]
Total revenues	226,602	329,966
Operating Segments
Segment Reporting Information [Line Items]
Total revenues	2,777,089	2,878,065
Operating income (loss)	359,351	426,390
Operating Segments | U.S. dialysis and related lab services
Segment Reporting Information [Line Items]
Dialysis and related lab patient service revenues	2,547,709	2,507,587
Provision for uncollectible accounts	(5,463)	25,199
Net U.S. dialysis and related lab services patient service revenues	2,542,246	2,532,786
Total revenues	2,547,151	2,537,900
Operating income (loss)	416,981	433,380
Operating Segments | U.S. dialysis and related lab services | External Sources
Segment Reporting Information [Line Items]
Dialysis and related lab patient service revenues	2,517,289	2,489,165
Other revenues	4,684	5,114
Operating Segments | U.S. dialysis and related lab services | Intersubsegment Eliminations
Segment Reporting Information [Line Items]
Dialysis and related lab patient service revenues	30,420	18,422
Other revenues	221	0
Operating Segments | Other—Ancillary services and strategic initiatives
Segment Reporting Information [Line Items]
Dialysis and related lab patient service revenues	117,863	102,255
Other revenues	108,739	227,711
Total revenues	229,938	340,165
Operating income (loss)	(57,630)	(6,990)
Operating Segments | Other—Ancillary services and strategic initiatives | Intersubsegment Eliminations
Segment Reporting Information [Line Items]
Dialysis and related lab patient service revenues	3,336	10,199
Intersegment Elimination
Segment Reporting Information [Line Items]
Total revenues	(33,977)	(28,621)
Intersegment Elimination | U.S. dialysis and related lab services
Segment Reporting Information [Line Items]
Total revenues	(30,641)	(18,422)
Intersegment Elimination | Other—Ancillary services and strategic initiatives
Segment Reporting Information [Line Items]
Total revenues	$ (3,336)	$ (10,199)

Segment reporting - Summary o_2

Segment reporting - Summary of Assets by Segment (Detail) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
ASSETS
Total assets	$ 22,605,944	$ 19,110,252
U.S. dialysis and related lab services
ASSETS
Total assets	15,095,326	12,333,641
Other—Ancillary services and strategic initiatives
ASSETS
Total assets	1,505,670	1,387,046
DMG held for sale
ASSETS
Total assets	$ 6,004,948	$ 5,389,565

Segment reporting - Summary o_3

Segment reporting - Summary of Assets by Segment (Phantom) (Detail) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Segment Reporting Information [Line Items]
Equity method and other investments	$ 226,309	$ 224,611
U.S. dialysis and related lab services
Segment Reporting Information [Line Items]
Equity method and other investments	101,173	95,290
Other—Ancillary services and strategic initiatives
Segment Reporting Information [Line Items]
Equity method and other investments	125,136	129,321
DMG held for sale
Segment Reporting Information [Line Items]
Equity method and other investments	$ 5,282	$ 4,833

Segment reporting - Summary o_4

Segment reporting - Summary of Depreciation and Amortization Expense by Segment (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 148,528	$ 142,799
U.S. dialysis and related lab services
Segment Reporting Information [Line Items]
Depreciation and amortization	140,780	134,776
Other—Ancillary services and strategic initiatives
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 7,748	$ 8,023

Segment reporting - Summary o_5

Segment reporting - Summary of Expenditures for Property and Equipment by Segment (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Segment Reporting Information [Line Items]
Expenditures for property and equipment	$ 198,878	$ 232,443
U.S. dialysis and related lab services
Segment Reporting Information [Line Items]
Expenditures for property and equipment	170,548	191,406
Other—Ancillary services and strategic initiatives
Segment Reporting Information [Line Items]
Expenditures for property and equipment	8,578	9,988
DMG held for sale
Segment Reporting Information [Line Items]
Expenditures for property and equipment	$ 19,752	$ 31,049

Changes in DaVita Inc.'s owne_3

Changes in DaVita Inc.'s ownership interest in consolidated subsidiaries - Effects of Changes in DaVita Inc's Ownership Interest on Company's Equity (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Change Due to Net Income Attributable to Parent and Effects of Changes, Net [Abstract]
Net income attributable to DaVita Inc.	$ 149,289	$ 178,686
Changes in paid-in capital for:
Sales of noncontrolling interests	0	76
Purchases of noncontrolling interests	(2,206)	(1,994)
Net income attributable to DaVita Inc., net of transfers to noncontrolling interests	147,083	176,768
Net transfers to noncontrolling interests	$ (2,206)	$ (1,918)

New accounting standards New ac

New accounting standards New accounting standards (Details) - USD ($) $ in Thousands	Jan. 01, 2019	Dec. 31, 2018	Dec. 31, 2017
Accounting Standards Update 2016-02 | Lease Assets
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
New Accounting Pronouncement or Change in Accounting Principle, Effect of Adoption, Quantification	$ 2,783,784
Accounting Standards Update 2016-02 | Lease Liabilities
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
New Accounting Pronouncement or Change in Accounting Principle, Effect of Adoption, Quantification	3,001,354
Cash Flow Impact | Accounting Standards Update 2016-02
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
New Accounting Pronouncement or Change in Accounting Principle, Effect of Adoption, Quantification	$ 0
Retained earnings
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Cumulative effect of change in accounting principle		$ 39,876	$ 8,368

Condensed consolidating finan_3

Condensed consolidating financial statements - Condensed Consolidating Statements of Operations (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Condensed Income Statements Captions [Line Items]
Dialysis and related lab patient service revenues	$ 2,635,152	$ 2,591,074
Less: Provision for uncollectible accounts	(5,463)	25,545
Net dialysis and related lab patient service revenues	2,629,689	2,616,619
Other revenues	113,423	232,825
Total revenues	2,743,112	2,849,444
Operating expenses and charges	2,402,605	2,438,758
Operating income	340,507	410,686
Debt expense	(131,519)	(113,516)
Other income, net	6,940	4,582
Income tax expense	56,746	70,737
Equity earnings in subsidiaries	0	0
Net income from continuing operations	159,182	231,015
Net income (loss) from discontinued operations, net of tax	30,305	(5,786)
Net income	189,487	225,229
Less: Net income attributable to noncontrolling interests	(40,198)	(46,543)
Net income attributable to DaVita Inc.	149,289	178,686
Consolidating adjustments
Condensed Income Statements Captions [Line Items]
Dialysis and related lab patient service revenues	(60,698)	(47,515)
Less: Provision for uncollectible accounts	0	0
Net dialysis and related lab patient service revenues	(60,698)	(47,515)
Other revenues	(222,173)	(238,633)
Total revenues	(282,871)	(286,148)
Operating expenses and charges	(282,871)	(286,148)
Operating income	0	0
Debt expense	65,274	60,390
Other income, net	(114,965)	(107,726)
Income tax expense	0	0
Equity earnings in subsidiaries	(180,686)	(207,613)
Net income from continuing operations	(230,377)	(254,949)
Net income (loss) from discontinued operations, net of tax	49,691	47,336
Net income	(180,686)	(207,613)
Less: Net income attributable to noncontrolling interests	(40,198)	(46,543)
Net income attributable to DaVita Inc.	(220,884)	(254,156)
DaVita Inc. | Reportable Legal Entities
Condensed Income Statements Captions [Line Items]
Dialysis and related lab patient service revenues	0	0
Less: Provision for uncollectible accounts	0	0
Net dialysis and related lab patient service revenues	0	0
Other revenues	188,836	195,565
Total revenues	188,836	195,565
Operating expenses and charges	143,659	133,356
Operating income	45,177	62,209
Debt expense	(133,595)	(114,334)
Other income, net	110,198	104,081
Income tax expense	7,026	14,387
Equity earnings in subsidiaries	134,535	141,117
Net income from continuing operations	149,289	178,686
Net income (loss) from discontinued operations, net of tax	0	0
Net income	149,289	178,686
Less: Net income attributable to noncontrolling interests	0	0
Net income attributable to DaVita Inc.	149,289	178,686
Guarantor subsidiaries | Reportable Legal Entities
Condensed Income Statements Captions [Line Items]
Dialysis and related lab patient service revenues	1,777,246	1,790,188
Less: Provision for uncollectible accounts	(3,970)	9,628
Net dialysis and related lab patient service revenues	1,773,276	1,799,816
Other revenues	111,141	204,960
Total revenues	1,884,417	2,004,776
Operating expenses and charges	1,660,453	1,791,094
Operating income	223,964	213,682
Debt expense	(52,479)	(52,197)
Other income, net	2,596	2,523
Income tax expense	46,544	48,944
Equity earnings in subsidiaries	46,151	66,496
Net income from continuing operations	173,688	181,560
Net income (loss) from discontinued operations, net of tax	(39,153)	(40,443)
Net income	134,535	141,117
Less: Net income attributable to noncontrolling interests	0	0
Net income attributable to DaVita Inc.	134,535	141,117
Non- Guarantor subsidiaries | Reportable Legal Entities
Condensed Income Statements Captions [Line Items]
Dialysis and related lab patient service revenues	918,604	848,401
Less: Provision for uncollectible accounts	(1,493)	15,917
Net dialysis and related lab patient service revenues	917,111	864,318
Other revenues	35,619	70,933
Total revenues	952,730	935,251
Operating expenses and charges	881,364	800,456
Operating income	71,366	134,795
Debt expense	(10,719)	(7,375)
Other income, net	9,111	5,704
Income tax expense	3,176	7,406
Equity earnings in subsidiaries	0	0
Net income from continuing operations	66,582	125,718
Net income (loss) from discontinued operations, net of tax	19,767	(12,679)
Net income	86,349	113,039
Less: Net income attributable to noncontrolling interests	0	0
Net income attributable to DaVita Inc.	$ 86,349	$ 113,039

Condensed consolidating finan_4

Condensed consolidating financial statements - Condensed Consolidating Statements of Comprehensive Income (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Condensed Financial Statements Captions [Line Items]
Net income	$ 189,487	$ 225,229
Other comprehensive loss	(12,627)	22,468
Total comprehensive income	176,860	247,697
Less: Comprehensive income attributable to noncontrolling interests	(40,198)	(46,543)
Comprehensive income attributable to DaVita Inc.	136,662	201,154
Consolidating adjustments
Condensed Financial Statements Captions [Line Items]
Net income	(180,686)	(207,613)
Other comprehensive loss	0	0
Total comprehensive income	(180,686)	(207,613)
Less: Comprehensive income attributable to noncontrolling interests	(40,198)	(46,543)
Comprehensive income attributable to DaVita Inc.	(220,884)	(254,156)
DaVita Inc. | Reportable Legal Entities
Condensed Financial Statements Captions [Line Items]
Net income	149,289	178,686
Other comprehensive loss	1,026	2,587
Total comprehensive income	150,315	181,273
Less: Comprehensive income attributable to noncontrolling interests	0	0
Comprehensive income attributable to DaVita Inc.	150,315	181,273
Guarantor subsidiaries | Reportable Legal Entities
Condensed Financial Statements Captions [Line Items]
Net income	134,535	141,117
Other comprehensive loss	0	0
Total comprehensive income	134,535	141,117
Less: Comprehensive income attributable to noncontrolling interests	0	0
Comprehensive income attributable to DaVita Inc.	134,535	141,117
Non- Guarantor subsidiaries | Reportable Legal Entities
Condensed Financial Statements Captions [Line Items]
Net income	86,349	113,039
Other comprehensive loss	(13,653)	19,881
Total comprehensive income	72,696	132,920
Less: Comprehensive income attributable to noncontrolling interests	0	0
Comprehensive income attributable to DaVita Inc.	$ 72,696	$ 132,920

Condensed consolidating finan_5

Condensed consolidating financial statements - Condensed Consolidating Balance Sheets (Detail) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Condensed Balance Sheet Statements Captions [Line Items]
Cash and cash equivalents	$ 459,242	$ 323,038
Restricted cash and equivalents	102,192	92,382
Accounts receivable, net	1,953,422	1,858,608
Other current assets	705,272	760,566
Current assets held for sale, net	6,004,948	5,389,565
Total current assets	9,225,076	8,424,159
Property and equipment, net	3,392,266	3,393,669
Operating lease right-of-use asset	2,736,536	0
Intangible assets, net	118,324	118,846
Investments in subsidiaries	0	0
Intercompany receivables	0	0
Other long-term assets and investments	334,374	331,618
Goodwill	6,799,368	6,841,960	$ 6,610,279
Total assets	22,605,944	19,110,252
Current liabilities	6,477,567	3,647,402
Current liabilities held for sale	1,753,310	1,243,759
Intercompany payables	0	0
Long-term operating leases	2,625,776	0
Long-term debt and other long-term liabilities	6,519,574	9,186,052
Noncontrolling interests subject to put provisions	1,143,044	1,124,641
Total DaVita Inc. shareholders' equity	3,875,354	3,703,442
Noncontrolling interests not subject to put provisions	211,319	204,956
Total equity	4,086,673	3,908,398
Total liabilities and equity	22,605,944	19,110,252
Consolidating adjustments
Condensed Balance Sheet Statements Captions [Line Items]
Cash and cash equivalents	0	0
Restricted cash and equivalents	0	0
Accounts receivable, net	0	0
Other current assets	0	0
Current assets held for sale, net	0	0
Total current assets	0	0
Property and equipment, net	0	0
Operating lease right-of-use asset	0
Intangible assets, net	0	0
Investments in subsidiaries	(13,514,602)	(13,342,612)
Intercompany receivables	(5,252,684)	(4,890,651)
Other long-term assets and investments	0	0
Goodwill	0	0
Total assets	(18,767,286)	(18,233,263)
Current liabilities	0	0
Current liabilities held for sale	0	0
Intercompany payables	(5,252,684)	(4,890,651)
Long-term operating leases	0
Long-term debt and other long-term liabilities	0	0
Noncontrolling interests subject to put provisions	530,562	526,566
Total DaVita Inc. shareholders' equity	(13,514,602)	(13,342,612)
Noncontrolling interests not subject to put provisions	(530,562)	(526,566)
Total equity	(14,045,164)	(13,869,178)
Total liabilities and equity	(18,767,286)	(18,233,263)
DaVita Inc. | Reportable Legal Entities
Condensed Balance Sheet Statements Captions [Line Items]
Cash and cash equivalents	194,347	60,653
Restricted cash and equivalents	1,006	1,005
Accounts receivable, net	0	0
Other current assets	37,185	37,185
Current assets held for sale, net	0	0
Total current assets	232,538	98,843
Property and equipment, net	503,677	491,462
Operating lease right-of-use asset	107,237
Intangible assets, net	130	153
Investments in subsidiaries	10,191,084	10,102,750
Intercompany receivables	3,756,675	3,419,448
Other long-term assets and investments	53,978	53,385
Goodwill	0	0
Total assets	14,845,319	14,166,041
Current liabilities	4,702,717	1,945,943
Current liabilities held for sale	0	0
Intercompany payables	0	0
Long-term operating leases	133,936
Long-term debt and other long-term liabilities	5,520,830	7,918,581
Noncontrolling interests subject to put provisions	612,482	598,075
Total DaVita Inc. shareholders' equity	3,875,354	3,703,442
Noncontrolling interests not subject to put provisions	0	0
Total equity	3,875,354	3,703,442
Total liabilities and equity	14,845,319	14,166,041
Guarantor subsidiaries | Reportable Legal Entities
Condensed Balance Sheet Statements Captions [Line Items]
Cash and cash equivalents	0	0
Restricted cash and equivalents	12,114	12,048
Accounts receivable, net	1,349,185	1,264,290
Other current assets	568,029	601,318
Current assets held for sale, net	4,842,062	4,440,953
Total current assets	6,771,390	6,318,609
Property and equipment, net	1,610,442	1,624,835
Operating lease right-of-use asset	1,594,411
Intangible assets, net	39,813	42,933
Investments in subsidiaries	3,323,518	3,239,862
Intercompany receivables	0	0
Other long-term assets and investments	84,137	80,537
Goodwill	4,812,366	4,812,365
Total assets	18,236,077	16,119,141
Current liabilities	1,182,342	1,251,534
Current liabilities held for sale	1,084,512	722,766
Intercompany payables	3,648,453	3,327,026
Long-term operating leases	1,502,922
Long-term debt and other long-term liabilities	626,764	715,065
Noncontrolling interests subject to put provisions	0	0
Total DaVita Inc. shareholders' equity	10,191,084	10,102,750
Noncontrolling interests not subject to put provisions	0	0
Total equity	10,191,084	10,102,750
Total liabilities and equity	18,236,077	16,119,141
Non- Guarantor subsidiaries | Reportable Legal Entities
Condensed Balance Sheet Statements Captions [Line Items]
Cash and cash equivalents	264,895	262,385
Restricted cash and equivalents	89,072	79,329
Accounts receivable, net	604,237	594,318
Other current assets	100,058	122,063
Current assets held for sale, net	1,162,886	948,612
Total current assets	2,221,148	2,006,707
Property and equipment, net	1,278,147	1,277,372
Operating lease right-of-use asset	1,034,888
Intangible assets, net	78,381	75,760
Investments in subsidiaries	0	0
Intercompany receivables	1,496,009	1,471,203
Other long-term assets and investments	196,259	197,696
Goodwill	1,987,002	2,029,595
Total assets	8,291,834	7,058,333
Current liabilities	592,508	449,925
Current liabilities held for sale	668,798	520,993
Intercompany payables	1,604,231	1,563,625
Long-term operating leases	988,918
Long-term debt and other long-term liabilities	371,980	552,406
Noncontrolling interests subject to put provisions	0	0
Total DaVita Inc. shareholders' equity	3,323,518	3,239,862
Noncontrolling interests not subject to put provisions	741,881	731,522
Total equity	4,065,399	3,971,384
Total liabilities and equity	$ 8,291,834	$ 7,058,333

Condensed consolidating finan_6

Condensed consolidating financial statements - Condensed Consolidating Statements of Cash Flows (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Cash flows from operating activities:
Net income	$ 189,487	$ 225,229
Changes in operating assets and liabilities and non-cash items included in net income	(48,183)	137,310
Net cash provided by operating activities	141,304	362,539
Cash flows from investing activities:
Additions of property and equipment	(198,878)	(232,443)
Acquisitions	(11,274)	(16,582)
Proceeds from asset and business sales	13,903	18,535
Proceeds (purchases) from investment sales and other items, net	(4,109)	30,362
Net cash used in investing activities	(200,358)	(200,128)
Cash flows from financing activities:
Long-term debt and related financing costs, net	357,197	104,673
Intercompany borrowing (payments)	0	0
Other items	(32,246)	(327,220)
Net cash used in financing activities	324,951	(222,547)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	(921)	6,668
Net increase (decrease) in cash, cash equivalents and restricted cash	264,976	(53,468)
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year	415,420	518,920
Cash, cash equivalents and restricted cash of continuing operations at end of the period	561,434	447,618
Consolidating adjustments
Cash flows from operating activities:
Net income	(180,686)	(207,613)
Changes in operating assets and liabilities and non-cash items included in net income	180,686	207,613
Net cash provided by operating activities	0	0
Cash flows from investing activities:
Additions of property and equipment	0	0
Acquisitions	0	0
Proceeds from asset and business sales	0	0
Proceeds (purchases) from investment sales and other items, net	0	0
Net cash used in investing activities	0	0
Cash flows from financing activities:
Long-term debt and related financing costs, net	0	0
Intercompany borrowing (payments)	0	0
Other items	0	0
Net cash used in financing activities	0	0
Effect of exchange rate changes on cash, cash equivalents and restricted cash	0	0
Net increase (decrease) in cash, cash equivalents and restricted cash	0	0
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year	0	0
Cash, cash equivalents and restricted cash of continuing operations at end of the period	0	0
DaVita Inc. | Reportable Legal Entities
Cash flows from operating activities:
Net income	149,289	178,686
Changes in operating assets and liabilities and non-cash items included in net income	(124,409)	(82,391)
Net cash provided by operating activities	24,880	96,295
Cash flows from investing activities:
Additions of property and equipment	(38,942)	(27,356)
Acquisitions	0
Proceeds from asset and business sales	0	0
Proceeds (purchases) from investment sales and other items, net	1,804	31,665
Net cash used in investing activities	(37,138)	4,309
Cash flows from financing activities:
Long-term debt and related financing costs, net	365,133	116,307
Intercompany borrowing (payments)	(220,697)	47,394
Other items	1,517	(291,562)
Net cash used in financing activities	145,953	(127,861)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	0	0
Net increase (decrease) in cash, cash equivalents and restricted cash	133,695	(27,257)
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year	61,658	150,307
Cash, cash equivalents and restricted cash of continuing operations at end of the period	195,353	123,050
Guarantor subsidiaries | Reportable Legal Entities
Cash flows from operating activities:
Net income	134,535	141,117
Changes in operating assets and liabilities and non-cash items included in net income	(197,096)	32,484
Net cash provided by operating activities	(62,561)	173,601
Cash flows from investing activities:
Additions of property and equipment	(112,376)	(125,375)
Acquisitions	0	(4,417)
Proceeds from asset and business sales	1,456	18,535
Proceeds (purchases) from investment sales and other items, net	(4,558)	(762)
Net cash used in investing activities	(115,478)	(112,019)
Cash flows from financing activities:
Long-term debt and related financing costs, net	(2,439)	(3,377)
Intercompany borrowing (payments)	229,211	(49,783)
Other items	(8,480)	(2,200)
Net cash used in financing activities	218,292	(55,360)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	0	0
Net increase (decrease) in cash, cash equivalents and restricted cash	40,253	6,222
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year	12,048	9,384
Cash, cash equivalents and restricted cash of continuing operations at end of the period	12,114	9,421
Non- Guarantor subsidiaries | Reportable Legal Entities
Cash flows from operating activities:
Net income	86,349	113,039
Changes in operating assets and liabilities and non-cash items included in net income	92,636	(20,396)
Net cash provided by operating activities	178,985	92,643
Cash flows from investing activities:
Additions of property and equipment	(47,560)	(79,712)
Acquisitions	(11,274)	(12,165)
Proceeds from asset and business sales	12,447	0
Proceeds (purchases) from investment sales and other items, net	(1,355)	(541)
Net cash used in investing activities	(47,742)	(92,418)
Cash flows from financing activities:
Long-term debt and related financing costs, net	(5,497)	(8,257)
Intercompany borrowing (payments)	(8,514)	2,389
Other items	(25,283)	(33,458)
Net cash used in financing activities	(39,294)	(39,326)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	(921)	6,668
Net increase (decrease) in cash, cash equivalents and restricted cash	91,028	(32,433)
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year	341,714	359,229
Cash, cash equivalents and restricted cash of continuing operations at end of the period	353,967	315,147
Discontinued Operations
Cash flows from financing activities:
Net increase (decrease) in cash, cash equivalents and restricted cash	118,962	17,834
Discontinued Operations | Consolidating adjustments
Cash flows from financing activities:
Net increase (decrease) in cash, cash equivalents and restricted cash	0	0
Discontinued Operations | DaVita Inc. | Reportable Legal Entities
Cash flows from financing activities:
Net increase (decrease) in cash, cash equivalents and restricted cash	0	0
Discontinued Operations | Guarantor subsidiaries | Reportable Legal Entities
Cash flows from financing activities:
Net increase (decrease) in cash, cash equivalents and restricted cash	40,187	6,185
Discontinued Operations | Non- Guarantor subsidiaries | Reportable Legal Entities
Cash flows from financing activities:
Net increase (decrease) in cash, cash equivalents and restricted cash	78,775	11,649
Continuing Operations
Cash flows from financing activities:
Net increase (decrease) in cash, cash equivalents and restricted cash	146,014	(71,302)
Continuing Operations | Consolidating adjustments
Cash flows from financing activities:
Net increase (decrease) in cash, cash equivalents and restricted cash	0	0
Continuing Operations | DaVita Inc. | Reportable Legal Entities
Cash flows from financing activities:
Net increase (decrease) in cash, cash equivalents and restricted cash	133,695	(27,257)
Continuing Operations | Guarantor subsidiaries | Reportable Legal Entities
Cash flows from financing activities:
Net increase (decrease) in cash, cash equivalents and restricted cash	66	37
Continuing Operations | Non- Guarantor subsidiaries | Reportable Legal Entities
Cash flows from financing activities:
Net increase (decrease) in cash, cash equivalents and restricted cash	$ 12,253	$ (44,082)

Supplemental Data - Condensed C

Supplemental Data - Condensed Consolidating Statements of Income (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Condensed Income Statements Captions [Line Items]
Dialysis and related lab patient service revenues	$ 2,635,152	$ 2,591,074
Less: Provision for uncollectible accounts	(5,463)	25,545
Net dialysis and related lab patient service revenues	2,629,689	2,616,619
Other revenues	113,423	232,825
Total revenues	2,743,112	2,849,444
Operating expenses	2,402,605	2,438,758
Operating income	340,507	410,686
Debt expense, including refinancing charges	(131,519)
Other income	6,940	4,582
Income tax expense	56,746	70,737
Net income from continuing operations	159,182	231,015
Net income (loss) from discontinued operations, net of tax	30,305	(5,786)
Net income	189,487	225,229
Less: Net income attributable to noncontrolling interests	(40,198)	(46,543)
Net income attributable to DaVita Inc.	149,289	$ 178,686
Physician Groups
Condensed Income Statements Captions [Line Items]
Dialysis and related lab patient service revenues	0
Less: Provision for uncollectible accounts	0
Net dialysis and related lab patient service revenues	0
Other revenues	0
Total revenues	0
Operating expenses	0
Operating income	0
Debt expense, including refinancing charges	0
Other income	0
Income tax expense	0
Net income from continuing operations	0
Net income (loss) from discontinued operations, net of tax	9,237
Net income	9,237
Less: Net income attributable to noncontrolling interests	(1,255)
Net income attributable to DaVita Inc.	7,982
Unrestricted Subsidiaries
Condensed Income Statements Captions [Line Items]
Dialysis and related lab patient service revenues	0
Less: Provision for uncollectible accounts	0
Net dialysis and related lab patient service revenues	0
Other revenues	0
Total revenues	0
Operating expenses	0
Operating income	0
Debt expense, including refinancing charges	0
Other income	0
Income tax expense	0
Net income from continuing operations	0
Net income (loss) from discontinued operations, net of tax	463
Net income	463
Less: Net income attributable to noncontrolling interests	0
Net income attributable to DaVita Inc.	463
Company and Restricted Subsidiaries
Condensed Income Statements Captions [Line Items]
Dialysis and related lab patient service revenues	2,635,152
Less: Provision for uncollectible accounts	(5,463)
Net dialysis and related lab patient service revenues	2,629,689
Other revenues	113,423
Total revenues	2,743,112
Operating expenses	2,402,605
Operating income	340,507
Debt expense, including refinancing charges	(131,519)
Other income	6,940
Income tax expense	56,746
Net income from continuing operations	159,182
Net income (loss) from discontinued operations, net of tax	20,605
Net income	179,787
Less: Net income attributable to noncontrolling interests	(38,943)
Net income attributable to DaVita Inc.	$ 140,844

Supplemental Data - Condensed_2

Supplemental Data - Condensed Consolidating Statements of Comprehensive Income (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Condensed Financial Statements Captions [Line Items]
Net income	$ 189,487	$ 225,229
Other comprehensive loss	(12,627)	22,468
Total comprehensive income	176,860	247,697
Less: Comprehensive income attributable to noncontrolling interests	(40,198)	(46,543)
Comprehensive income attributable to DaVita Inc.	136,662	$ 201,154
Physician Groups
Condensed Financial Statements Captions [Line Items]
Net income	9,237
Other comprehensive loss	0
Total comprehensive income	9,237
Less: Comprehensive income attributable to noncontrolling interests	(1,255)
Comprehensive income attributable to DaVita Inc.	7,982
Unrestricted Subsidiaries
Condensed Financial Statements Captions [Line Items]
Net income	463
Other comprehensive loss	0
Total comprehensive income	463
Less: Comprehensive income attributable to noncontrolling interests	0
Comprehensive income attributable to DaVita Inc.	463
Company and Restricted Subsidiaries
Condensed Financial Statements Captions [Line Items]
Net income	179,787
Other comprehensive loss	(12,627)
Total comprehensive income	167,160
Less: Comprehensive income attributable to noncontrolling interests	(38,943)
Comprehensive income attributable to DaVita Inc.	$ 128,217

Supplemental Data - Condensed_3

Supplemental Data - Condensed Consolidating Balance Sheets (Detail) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Condensed Balance Sheet Statements Captions [Line Items]
Cash and cash equivalents	$ 459,242	$ 323,038
Restricted cash and equivalents	102,192	92,382
Accounts receivable, net	1,953,422	1,858,608
Other current assets	705,272	760,566
Current assets held for sale, net	6,004,948	5,389,565
Total current assets	9,225,076	8,424,159
Property and equipment, net	3,392,266	3,393,669
Operating lease right-of-use asset	2,736,536	0
Intangible assets, net	118,324	118,846
Other long-term assets	334,374	331,618
Goodwill	6,799,368	6,841,960	$ 6,610,279
Total assets	22,605,944	19,110,252
Current liabilities	6,477,567	3,647,402
Current liabilities held for sale	1,753,310	1,243,759
Payables to parent	0
Long-term operating leases	2,625,776	0
Long-term debt and other long-term liabilities	6,519,574	9,186,052
Noncontrolling interests subject to put provisions	1,143,044	1,124,641
Total DaVita Inc. shareholders’ equity	3,875,354	3,703,442
Noncontrolling interests not subject to put provisions	211,319	204,956
Total equity	4,086,673	3,908,398
Total liabilities and equity	22,605,944	$ 19,110,252
Physician Groups
Condensed Balance Sheet Statements Captions [Line Items]
Cash and cash equivalents	0
Restricted cash and equivalents	0
Accounts receivable, net	0
Other current assets	0
Current assets held for sale, net	629,422
Total current assets	629,422
Property and equipment, net	0
Operating lease right-of-use asset	0
Intangible assets, net	0
Other long-term assets	0
Goodwill	0
Total assets	629,422
Current liabilities	0
Current liabilities held for sale	412,368
Payables to parent	72,539
Long-term operating leases	0
Long-term debt and other long-term liabilities	0
Noncontrolling interests subject to put provisions	0
Total DaVita Inc. shareholders’ equity	144,515
Noncontrolling interests not subject to put provisions	0
Total equity	144,515
Total liabilities and equity	629,422
Unrestricted Subsidiaries
Condensed Balance Sheet Statements Captions [Line Items]
Cash and cash equivalents	0
Restricted cash and equivalents	0
Accounts receivable, net	0
Other current assets	0
Current assets held for sale, net	3,288
Total current assets	3,288
Property and equipment, net	0
Operating lease right-of-use asset	0
Intangible assets, net	0
Other long-term assets	0
Goodwill	0
Total assets	3,288
Current liabilities	0
Current liabilities held for sale	0
Payables to parent	3,288
Long-term operating leases	0
Long-term debt and other long-term liabilities	0
Noncontrolling interests subject to put provisions	0
Total DaVita Inc. shareholders’ equity	0
Noncontrolling interests not subject to put provisions	0
Total equity	0
Total liabilities and equity	3,288
Parent Company And Restricted Subsidiaries
Condensed Balance Sheet Statements Captions [Line Items]
Cash and cash equivalents	459,242
Restricted cash and equivalents	102,192
Accounts receivable, net	1,953,422
Other current assets	705,272
Current assets held for sale, net	5,372,238
Total current assets	8,592,366
Property and equipment, net	3,392,266
Operating lease right-of-use asset	2,736,536
Intangible assets, net	118,324
Other long-term assets	334,374
Goodwill	6,799,368
Total assets	21,973,234
Current liabilities	6,477,567
Current liabilities held for sale	1,340,942
Payables to parent	(75,827)
Long-term operating leases	2,625,776
Long-term debt and other long-term liabilities	6,519,574
Noncontrolling interests subject to put provisions	1,143,044
Total DaVita Inc. shareholders’ equity	3,730,839
Noncontrolling interests not subject to put provisions	211,319
Total equity	3,942,158
Total liabilities and equity	$ 21,973,234

Supplemental Data - Condensed_4

Supplemental Data - Condensed Consolidating Statements of Cash Flows (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Cash flows from operating activities:
Net income	$ 189,487	$ 225,229
Changes in operating and intercompany assets and liabilities and non-cash items included in net income	(48,183)	137,310
Net cash provided by operating activities	141,304	362,539
Cash flows from investing activities:
Additions of property and equipment	(198,878)	(232,443)
Acquisitions	(11,274)
Proceeds from asset and business sales	13,903	18,535
Investments and other items	(4,109)	30,362
Net cash used in investing activities	(200,358)	(200,128)
Cash flows from financing activities:
Long-term debt	357,197	104,673
Intercompany	0	0
Other items	(32,246)	(327,220)
Net cash used in financing activities	324,951	(222,547)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	(921)	6,668
Net increase (decrease) in cash, cash equivalents and restricted cash	264,976	(53,468)
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year	415,420	518,920
Cash, cash equivalents and restricted cash of continuing operations at end of the period	561,434	447,618
Physician Groups
Cash flows from operating activities:
Net income	9,237
Changes in operating and intercompany assets and liabilities and non-cash items included in net income	9,696
Net cash provided by operating activities	18,933
Cash flows from investing activities:
Additions of property and equipment	(229)
Acquisitions	0
Proceeds from asset and business sales	0
Investments and other items	(1,355)
Net cash used in investing activities	(1,584)
Cash flows from financing activities:
Long-term debt	0
Intercompany	28,965
Other items	0
Net cash used in financing activities	28,965
Effect of exchange rate changes on cash, cash equivalents and restricted cash	0
Net increase (decrease) in cash, cash equivalents and restricted cash	46,314
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year	0
Cash, cash equivalents and restricted cash of continuing operations at end of the period	0
Unrestricted Subsidiaries
Cash flows from operating activities:
Net income	463
Changes in operating and intercompany assets and liabilities and non-cash items included in net income	(463)
Net cash provided by operating activities	0
Cash flows from investing activities:
Additions of property and equipment	0
Acquisitions	0
Proceeds from asset and business sales	0
Investments and other items	0
Net cash used in investing activities	0
Cash flows from financing activities:
Long-term debt	0
Intercompany	0
Other items	0
Net cash used in financing activities	0
Effect of exchange rate changes on cash, cash equivalents and restricted cash	0
Net increase (decrease) in cash, cash equivalents and restricted cash	0
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year	0
Cash, cash equivalents and restricted cash of continuing operations at end of the period	0
Company and Restricted Subsidiaries
Cash flows from operating activities:
Net income	179,787
Changes in operating and intercompany assets and liabilities and non-cash items included in net income	(57,416)
Net cash provided by operating activities	122,371
Cash flows from investing activities:
Additions of property and equipment	(198,649)
Acquisitions	(11,274)
Proceeds from asset and business sales	13,903
Investments and other items	(2,754)
Net cash used in investing activities	(198,774)
Cash flows from financing activities:
Long-term debt	357,197
Intercompany	(28,965)
Other items	(32,246)
Net cash used in financing activities	295,986
Effect of exchange rate changes on cash, cash equivalents and restricted cash	(921)
Net increase (decrease) in cash, cash equivalents and restricted cash	218,662
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year	415,420
Cash, cash equivalents and restricted cash of continuing operations at end of the period	561,434
Discontinued Operations
Cash flows from financing activities:
Net increase (decrease) in cash, cash equivalents and restricted cash	118,962	17,834
Discontinued Operations | Physician Groups
Cash flows from financing activities:
Net increase (decrease) in cash, cash equivalents and restricted cash	46,314
Discontinued Operations | Unrestricted Subsidiaries
Cash flows from financing activities:
Net increase (decrease) in cash, cash equivalents and restricted cash	0
Discontinued Operations | Company and Restricted Subsidiaries
Cash flows from financing activities:
Net increase (decrease) in cash, cash equivalents and restricted cash	72,648
Continuing Operations
Cash flows from financing activities:
Net increase (decrease) in cash, cash equivalents and restricted cash	146,014	$ (71,302)
Continuing Operations | Physician Groups
Cash flows from financing activities:
Net increase (decrease) in cash, cash equivalents and restricted cash	0
Continuing Operations | Unrestricted Subsidiaries
Cash flows from financing activities:
Net increase (decrease) in cash, cash equivalents and restricted cash	0
Continuing Operations | Company and Restricted Subsidiaries
Cash flows from financing activities:
Net increase (decrease) in cash, cash equivalents and restricted cash	$ 146,014