DaVita (DVA) 10-Q 3 Aug 21 2021 Q2 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares shares in Millions	6 Months Ended
	Jun. 30, 2021	Jul. 30, 2021
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Jun. 30, 2021
Document Transition Report	false
Entity File Number	1-14106
Entity Registrant Name	DAVITA INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	51-0354549
Entity Address, Address Line One	2000 16th Street
Entity Address, City or Town	Denver,
Entity Address, State or Province	CO
Entity Address, Postal Zip Code	80202
City Area Code	720
Local Phone Number	631-2100
Title of 12(b) Security	Common Stock, $0.001 par value
Trading Symbol	DVA
Security Exchange Name	NYSE
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		104.8
Amendment Flag	false
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q2
Entity Central Index Key	0000927066
Current Fiscal Year End Date	--12-31

CONSOLIDATED STATEMENTS OF INCO

CONSOLIDATED STATEMENTS OF INCOME (unaudited) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Income Statement [Abstract]
Dialysis patient service revenues	$ 2,817,957	$ 2,758,197	$ 5,532,544	$ 5,471,478
Other revenues	98,553	121,782	203,967	249,738
Total revenues	2,916,510	2,879,979	5,736,511	5,721,216
Operating expenses:
Patient care costs	1,965,277	1,984,564	3,903,607	3,960,013
General and administrative	298,091	316,209	579,517	579,785
Depreciation and amortization	169,689	157,376	335,390	312,055
Equity investment income	(7,023)	(4,342)	(15,081)	(22,185)
Loss on changes in ownership interest, net	0	16,252	0	16,252
Total operating expenses	2,426,034	2,470,059	4,803,433	4,845,920
Operating income	490,476	409,920	933,078	875,296
Debt expense	(73,324)	(81,381)	(140,338)	(169,984)
Debt refinancing charges	0	0	0	(2,948)
Other income, net	15,188	9,545	16,356	5,195
Income from continuing operations before income taxes	432,340	338,084	809,096	707,559
Income tax expense	81,309	83,212	166,520	174,772
Net income from continuing operations	351,031	254,872	642,576	532,787
Net income from discontinued operations, net of tax	0	0	0	9,980
Net income	351,031	254,872	642,576	542,767
Less: Net income attributable to noncontrolling interests	(57,211)	(53,270)	(111,353)	(101,572)
Net income attributable to DaVita Inc.	$ 293,820	$ 201,602	$ 531,223	$ 441,195
Earnings per share attributable to DaVita Inc.:
Basic net income from continuing operations	$ 2.76	$ 1.65	$ 4.94	$ 3.49
Basic net income	2.76	1.65	4.94	3.57
Diluted net income from continuing operations	2.64	1.62	4.72	3.44
Diluted net income	$ 2.64	$ 1.62	$ 4.72	$ 3.52
Weighted average shares for earnings per share:
Basic (in shares)	106,364,000	122,074,000	107,606,000	123,485,000
Diluted (in shares)	111,423,000	124,068,000	112,555,000	125,479,000
Amounts attributable to DaVita Inc.:
Net income from continuing operations	$ 293,820	$ 201,602	$ 531,223	$ 431,215
Net income from discontinued operations	0	0	0	9,980
Net income attributable to DaVita Inc.	$ 293,820	$ 201,602	$ 531,223	$ 441,195

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (unaudited) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Statement of Comprehensive Income [Abstract]
Net income	$ 351,031	$ 254,872	$ 642,576	$ 542,767
Unrealized (losses) gains on interest rate cap agreements:
Unrealized (losses) gains	(2,059)	(1,824)	2,823	(14,842)
Reclassifications of net realized losses into net income	1,033	1,623	2,066	3,246
Unrealized gains (losses) on foreign currency translation	57,910	5,619	(4,634)	(76,013)
Other comprehensive income (loss)	56,884	5,418	255	(87,609)
Total comprehensive income	407,915	260,290	642,831	455,158
Less: Comprehensive income attributable to noncontrolling interests	(57,211)	(53,270)	(111,353)	(101,572)
Comprehensive income attributable to DaVita Inc.	$ 350,704	$ 207,020	$ 531,478	$ 353,586

CONSOLIDATED BALANCE SHEETS (un

CONSOLIDATED BALANCE SHEETS (unaudited) - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020
ASSETS
Cash and cash equivalents	$ 1,043,632	$ 324,958
Restricted cash and equivalents	162,846	176,832
Short-term investments	36,701	20,101
Accounts receivable, net	1,947,466	1,824,282
Inventories	115,369	111,625
Other receivables	541,430	544,376
Prepaid and other current assets	69,360	76,387
Income tax receivable	61,782	70,163
Total current assets	3,978,586	3,148,724
Property and equipment, net	3,485,600	3,521,824
Operating lease right-of-use asset	2,865,320	2,863,089
Intangible assets, net	162,484	166,585
Equity method and other investments	245,389	257,491
Long-term investments	33,777	32,193
Other long-term assets	95,490	79,501
Goodwill	6,943,665	6,919,109
Total assets	17,810,311	16,988,516
LIABILITIES AND EQUITY
Accounts payable	376,264	434,253
Other liabilities	837,284	810,529
Accrued compensation and benefits	593,859	685,555
Current portion of operating lease liabilities	382,342	369,497
Current portion of long-term debt	184,435	168,541
Income tax payable	11,856	7,768
Total current liabilities	2,386,040	2,476,143
Long-term operating lease liabilities	2,727,323	2,738,670
Long-term debt	8,798,263	7,917,263
Other long-term liabilities	157,687	150,060
Deferred income taxes	851,961	809,600
Total liabilities	14,921,274	14,091,736
Commitments and contingencies:
Noncontrolling interests subject to put provisions	1,426,211	1,330,028
Equity:
Preferred Stock, Value, Issued	0	0
Common Stock, Value, Issued	111	110
Additional paid-in capital	523,038	597,073
Retained earnings	1,383,760	852,537
Treasury Stock, Value	(563,230)	0
Accumulated other comprehensive loss	(65,899)	(66,154)
Total DaVita Inc. shareholders' equity	1,277,780	1,383,566
Noncontrolling interests not subject to put provisions	185,046	183,186
Total equity	1,462,826	1,566,752
Total liabilities and equity	$ 17,810,311	$ 16,988,516

CONSOLIDATED BALANCE SHEETS (_2

CONSOLIDATED BALANCE SHEETS (unaudited) (Parenthetical) - USD ($) shares in Thousands, $ in Thousands	Jun. 30, 2021	Dec. 31, 2020
Statement of Financial Position [Abstract]
Property and equipment, accumulated depreciation	$ 4,760,572	$ 4,480,429
Intangible assets, accumulated amortization	$ 73,215	$ 70,141
Preferred stock, par value (usd per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	5,000	5,000
Preferred stock, issued (in shares)	0	0
Common stock, par value (usd per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	450,000	450,000
Common stock, shares issued (in shares)	110,644	109,933
Common stock, shares outstanding (in shares)	105,625	109,933
Treasury Stock, Common, Shares	5,019	0

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS (unaudited) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020
Cash flows from operating activities:
Net income	$ 642,576	$ 542,767
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	335,390	312,055
Debt refinancing charges	0	884
Stock-based compensation expense	51,717	42,125
Deferred income taxes	40,685	132,101
Equity investment income, net	(2,764)	(6,494)
Loss on sales of business interests, net	0	16,252
Other non-cash charges, net	1,274	(5,885)
Changes in operating assets and liabilities, net of effect of acquisitions and divestitures:
Accounts receivable	(117,171)	15,194
Inventories	(3,270)	(696)
Other receivables and prepaid and other current assets	14,465	(131,988)
Other long-term assets	(13,706)	1,950
Accounts payable	(47,390)	(15,858)
Accrued compensation and benefits	(90,381)	(19,325)
Other current liabilities	25,090	146,490
Income taxes	10,753	(4,800)
Other long-term liabilities	(13,232)	(13,269)
Net cash provided by operating activities	834,036	1,011,503
Cash flows from investing activities:
Additions of property and equipment	(294,438)	(291,667)
Acquisitions	(23,890)	(44,267)
Proceeds from asset and business sales	29,774	70,615
Purchase of debt investments held-to-maturity	(7,923)	(142,483)
Purchase of other debt and equity investments	(2,164)	(3,034)
Proceeds from debt investments held-to-maturity	7,923	7,621
Proceeds from sale of other debt and equity investments	11,908	3,438
Purchase of equity method investments	(6,029)	(8,101)
Distributions from equity method investments	1,140	739
Net cash used in investing activities	(283,699)	(407,139)
Cash flows from financing activities:
Borrowings	1,611,086	2,324,300
Payments on long-term debt	(754,407)	(635,695)
Deferred financing costs	(9,089)	(20,375)
Purchase of treasury stock	(560,507)	(321,798)
Distributions to noncontrolling interests	(99,362)	(118,553)
Net payments related to stock purchases and awards	(43,605)	(2,106)
Contributions from noncontrolling interests	15,925	20,582
Purchases of noncontrolling interests	(4,493)	(6,782)
Net cash provided by financing activities	155,548	1,239,573
Effect of exchange rate changes on cash, cash equivalents and restricted cash	(1,197)	(16,936)
Net increase in cash, cash equivalents and restricted cash	704,688	1,827,001
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year	501,790	1,208,718
Cash, cash equivalents and restricted cash of continuing operations at end of the year	1,206,478	3,035,719
Discontinued Operations
Cash flows from financing activities:
Net increase in cash, cash equivalents and restricted cash	0	0
Continuing Operations
Cash flows from financing activities:
Net increase in cash, cash equivalents and restricted cash	$ 704,688	$ 1,827,001

CONSOLIDATED STATEMENTS OF EQUI

CONSOLIDATED STATEMENTS OF EQUITY (unaudited) - USD ($) shares in Thousands, $ in Thousands	Total	Total	Non- controlling interests subject to put provisions	Common stock	Additional paid-in capital	Retained earnings	Treasury stock	Accumulated other comprehensive loss	Non- controlling interests not subject to put provisions
Temporary equity, start balance at Dec. 31, 2019			$ 1,180,376
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income			66,883
Distributions			(77,135)
Contributions			14,095
Acquisitions and divestitures			(3,214)
Partial purchases			(6,673)
Fair value remeasurements			67,605
Temporary equity, ending balance at Jun. 30, 2020			1,241,937
Beginning balance at Dec. 31, 2019		$ 2,133,409		$ 126	$ 749,043	$ 1,431,738	$ 0	$ (47,498)	$ 185,833
Beginning balance (in shares) at Dec. 31, 2019				125,843			0
Comprehensive income:
Net income attributable to DaVita Inc.		441,195				441,195			34,689
Other comprehensive income (loss)	$ (87,609)	(87,609)						(87,609)
Stock award plan		(8,211)			(8,211)
Stock award plan (in shares)				194
Stock-settled stock-based compensation expense		41,678			41,678
Changes in noncontrolling interest from:
Distributions									(41,418)
Contributions									6,487
Acquisitions and divestitures									(1,383)
Partial purchases		4,197			4,197				(4,306)
Fair value remeasurements		(67,605)			(67,605)
Purchase of treasury stock		(303,139)					$ (303,139)
Purchase of treasury stock (in shares)							(4,052)
Ending balance at Jun. 30, 2020		2,153,915		$ 126	719,102	1,872,933	$ (303,139)	(135,107)	179,902
Ending balance (in shares) at Jun. 30, 2020				126,037			(4,052)
Temporary equity, start balance at Mar. 31, 2020			1,228,036
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income			34,707
Distributions			(39,569)
Contributions			8,812
Acquisitions and divestitures			(3,214)
Partial purchases			(6,418)
Fair value remeasurements			19,583
Temporary equity, ending balance at Jun. 30, 2020			1,241,937
Beginning balance at Mar. 31, 2020		1,947,846		$ 126	720,053	1,671,331	$ (303,139)	(140,525)	185,498
Beginning balance (in shares) at Mar. 31, 2020				125,857			(4,052)
Comprehensive income:
Net income attributable to DaVita Inc.		201,602				201,602			18,563
Other comprehensive income (loss)	5,418	5,418						5,418
Stock award plan		(7,891)			(7,891)
Stock award plan (in shares)				180
Stock-settled stock-based compensation expense		21,881			21,881
Changes in noncontrolling interest from:
Distributions									(20,853)
Contributions									2,383
Acquisitions and divestitures									(1,383)
Partial purchases		4,642			4,642				(4,306)
Fair value remeasurements		(19,583)			(19,583)
Purchase of treasury stock
Purchase of treasury stock (in shares)
Ending balance at Jun. 30, 2020		2,153,915		$ 126	719,102	1,872,933	$ (303,139)	(135,107)	179,902
Ending balance (in shares) at Jun. 30, 2020				126,037			(4,052)
Temporary equity, start balance at Dec. 31, 2020			1,330,028
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income			80,592
Distributions			(64,242)
Contributions			10,789
Acquisitions and divestitures
Partial purchases			(552)
Fair value remeasurements			69,596
Temporary equity, ending balance at Jun. 30, 2021			1,426,211
Beginning balance at Dec. 31, 2020	$ 1,566,752	1,383,566		$ 110	597,073	852,537	$ 0	(66,154)	183,186
Beginning balance (in shares) at Dec. 31, 2020	109,933			109,933			0
Comprehensive income:
Net income attributable to DaVita Inc.		531,223				531,223			30,761
Other comprehensive income (loss)	$ 255	255						255
Stock award plan		(51,176)		$ 1	(51,177)
Stock award plan (in shares)				711
Stock-settled stock-based compensation expense		50,513			50,513
Changes in noncontrolling interest from:
Distributions									(35,120)
Contributions									5,136
Acquisitions and divestitures									1,249
Partial purchases		(3,775)			(3,775)				(166)
Fair value remeasurements		(69,596)			(69,596)
Purchase of treasury stock		(563,230)					$ (563,230)
Purchase of treasury stock (in shares)							(5,019)
Ending balance at Jun. 30, 2021	$ 1,462,826	1,277,780		$ 111	523,038	1,383,760	$ (563,230)	(65,899)	185,046
Ending balance (in shares) at Jun. 30, 2021	105,625			110,644			(5,019)
Temporary equity, start balance at Mar. 31, 2021			1,349,160
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income			44,992
Distributions			(29,983)
Contributions			3,094
Partial purchases			(351)
Fair value remeasurements			59,299
Temporary equity, ending balance at Jun. 30, 2021			$ 1,426,211
Beginning balance at Mar. 31, 2021		1,248,106		$ 110	603,172	1,089,940	$ (322,333)	(122,783)	185,109
Beginning balance (in shares) at Mar. 31, 2021				110,027			(2,949)
Comprehensive income:
Net income attributable to DaVita Inc.		293,820				293,820			12,219
Other comprehensive income (loss)	$ 56,884	56,884						56,884
Stock award plan		(44,906)		$ 1	(44,907)
Stock award plan (in shares)				617
Stock-settled stock-based compensation expense		26,958			26,958
Changes in noncontrolling interest from:
Distributions									(15,512)
Contributions									2,142
Acquisitions and divestitures									1,249
Partial purchases		(2,886)			(2,886)				(161)
Fair value remeasurements		(59,299)			(59,299)
Purchase of treasury stock		(240,897)					$ (240,897)
Purchase of treasury stock (in shares)							(2,070)
Ending balance at Jun. 30, 2021	$ 1,462,826	$ 1,277,780		$ 111	$ 523,038	$ 1,383,760	$ (563,230)	$ (65,899)	$ 185,046
Ending balance (in shares) at Jun. 30, 2021	105,625			110,644			(5,019)

Condensed consolidated interim

Condensed consolidated interim financial statements Condensed consolidated interim financial statements	6 Months Ended
	Jun. 30, 2021
Text Block [Abstract]
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block]	Condensed consolidated interim financial statementsThe unaudited condensed consolidated interim financial statements included in this report are prepared by the Company. In the opinion of management, all adjustments necessary for a fair presentation of the results of operations are reflected in these condensed consolidated interim financial statements. All significant intercompany accounts and transactions have been eliminated. The preparation of these financial statements requires management to make estimates and assumptions that affect the reported amounts of revenues, expenses, assets, liabilities, contingencies and noncontrolling interests subject to put provisions. The most significant estimates and assumptions underlying these financial statements and accompanying notes generally involve revenue recognition and accounts receivable, impairments of goodwill, accounting for income taxes, certain fair value estimates and loss contingencies. The results of operations reflected in these interim financial statements may not necessarily be indicative of annual operating results. These condensed consolidated interim financial statements should be read in conjunction with the audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2020 (2020 10-K). Prior period classifications have been conformed to the current period presentation. The Company has evaluated subsequent events through the date these condensed consolidated interim financial statements were issued and has included all necessary adjustments and disclosures.

Revenue Recognition Revenue Rec

Revenue Recognition Revenue Recognition	6 Months Ended
	Jun. 30, 2021
Text Block [Abstract]
Revenue Recognition [Text Block]	Revenue recognition The following table summarizes the Company's segment revenues by primary payor source: Three months ended June 30, 2021 Three months ended June 30, 2020 U.S. dialysis Other - Ancillary services Consolidated U.S. dialysis Other - Ancillary services Consolidated Dialysis patient service revenues: Medicare and Medicare Advantage (1) $ 1,562,164 $ $ 1,562,164 $ 1,547,113 $ $ 1,547,113 Medicaid and Managed Medicaid 194,641 194,641 182,324 182,324 Other government (1) 82,317 118,464 200,781 86,954 90,813 177,767 Commercial 830,801 50,817 881,618 850,558 35,557 886,115 Other revenues: Medicare and Medicare Advantage 80,211 80,211 99,829 99,829 Medicaid and Managed Medicaid 305 305 283 283 Commercial 1,189 1,189 9,050 9,050 Other (2) 6,415 10,503 16,918 7,995 9,103 17,098 Eliminations of intersegment revenues (21,317) — (21,317) (35,429) (4,171) (39,600) Total $ 2,655,021 $ 261,489 $ 2,916,510 $ 2,639,515 $ 240,464 $ 2,879,979 (1) During the first quarter of 2021, the Company realigned the classification of revenue previously disclosed in the “Other government” category to the “Medicare and Medicare Advantage” category for certain government-reimbursed plans which have structure and payment characteristics similar to traditional Medicare Advantage plans. The classification of revenue for these plans for the three months ended June 30, 2020 has also been recast to conform to the current period presentation. (2) Other consists of management service fees earned in the respective Company line of business as well as other revenue from the Company's ancillary services. Six months ended June 30, 2021 Six months ended June 30, 2020 U.S. dialysis Other - Ancillary services Consolidated U.S. dialysis Other - Ancillary services Consolidated Dialysis patient service revenues: Medicare and Medicare Advantage (1) $ 3,042,461 $ $ 3,042,461 $ 3,078,146 $ $ 3,078,146 Medicaid and Managed Medicaid 381,884 381,884 353,791 353,791 Other government (1) 162,501 225,293 387,794 170,052 185,387 355,439 Commercial 1,666,280 102,315 1,768,595 1,676,140 75,024 1,751,164 Other revenues: Medicare and Medicare Advantage 165,807 165,807 198,307 198,307 Medicaid and Managed Medicaid 605 605 649 649 Commercial 7,223 7,223 19,571 19,571 Other (2) 13,091 21,665 34,756 13,438 26,705 40,143 Eliminations of intersegment revenues (48,320) (4,294) (52,614) (67,670) (8,324) (75,994) Total $ 5,217,897 $ 518,614 $ 5,736,511 $ 5,223,897 $ 497,319 $ 5,721,216 (1) During the first quarter of 2021, the Company realigned the classification of revenue previously disclosed in the “Other government” category to the “Medicare and Medicare Advantage” category for certain government-reimbursed plans which have structure and payment characteristics similar to traditional Medicare Advantage plans. The classification of revenue for these plans for the six months ended June 30, 2020 has also been recast to conform to the current period presentation. (2) Other consists of management service fees earned in the respective Company line of business as well as other revenue from the Company's ancillary services. 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 determination of applicable primary and secondary coverage, changes in patient insurance coverage and coordination of benefits. As these estimates are refined over time, both positive and negative adjustments to revenue are recognized in the current period. Dialysis patient service revenues. Revenues are recognized based on the Company’s estimate of the transaction price the Company expects to collect as a result of satisfying its performance obligations. Dialysis patient service revenues are recognized in the period services are provided based on these estimates. Revenues consist primarily of payments from government and commercial health plans for dialysis services provided to patients. 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.

Earnings per share (Notes)

Earnings per share (Notes)	6 Months Ended
	Jun. 30, 2021
Earnings Per Share [Abstract]
Earnings Per Share [Text Block]	Earnings per share Basic earnings per share is calculated by dividing net income attributable to the Company by the weighted average number of common shares outstanding. Weighted average common shares outstanding include restricted stock unit awards that are no longer subject to forfeiture because the recipients have satisfied either the explicit vesting terms or retirement eligibility requirements. Diluted earnings per share includes the dilutive effect of outstanding stock-settled stock appreciation rights and unvested stock units as computed under the treasury stock method. The reconciliations of the numerators and denominators used to calculate basic and diluted earnings per share were as follows: Three months ended June 30, Six months ended June 30, 2021 2020 2021 2020 Net income attributable to DaVita Inc.: Continuing operations $ 293,820 $ 201,602 $ 531,223 $ 431,215 Discontinued operations — — — 9,980 Net income attributable to DaVita Inc. $ 293,820 $ 201,602 $ 531,223 $ 441,195 Weighted average shares outstanding: Basic shares 106,364 122,074 107,606 123,485 Assumed incremental from stock plans 5,059 1,994 4,949 1,994 Diluted shares 111,423 124,068 112,555 125,479 Basic net income attributable to DaVita Inc.: Continuing operations per share $ 2.76 $ 1.65 $ 4.94 $ 3.49 Discontinued operations per share — — — 0.08 Basic net income per share attributable to DaVita Inc. $ 2.76 $ 1.65 $ 4.94 $ 3.57 Diluted net income attributable to DaVita Inc.: Continuing operations per share $ 2.64 $ 1.62 $ 4.72 $ 3.44 Discontinued operations per share — — — 0.08 Diluted net income per share attributable to DaVita Inc. $ 2.64 $ 1.62 $ 4.72 $ 3.52 Anti-dilutive stock-settled awards excluded from calculation (1) 141 3,216 84 3,211 (1) Shares associated with stock awards excluded from the diluted denominator calculation because they were anti-dilutive under the treasury stock method.

Investments in debt and equity

Investments in debt and equity securities	6 Months Ended
	Jun. 30, 2021
Investments, Debt and Equity Securities [Abstract]
Investments in debt and equity securities	Short-term and long-term investments The Company’s short-term and long-term debt and equity investments, consisting of debt instruments classified as held-to-maturity and equity investments with readily determinable fair values or redemption values, were as follows: June 30, 2021 December 31, 2020 Debt Equity Total Debt Equity Total Certificates of deposit and other time deposits $ 8,222 $ — $ 8,222 $ 8,217 $ — $ 8,217 Investments in mutual funds and common stocks — 62,256 62,256 — 44,077 44,077 $ 8,222 $ 62,256 $ 70,478 $ 8,217 $ 44,077 $ 52,294 Short-term investments $ 8,222 $ 28,479 $ 36,701 $ 8,217 $ 11,884 $ 20,101 Long-term investments — 33,777 33,777 — 32,193 32,193 $ 8,222 $ 62,256 $ 70,478 $ 8,217 $ 44,077 $ 52,294 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 approximated their fair values at June 30, 2021 and December 31, 2020. Equity securitie s: For the quarter ended June 30, 2021 certain of the Company’s equity investments previously accounted for under the adjusted cost method now have readily determinable fair values from public markets. As a result, these investments were reclassified from equity method and other investments to short-term investments during the quarter ended June 30, 2021. The Company recognized $8,328 in net unrealized gains on these investments during the three months ended June 30, 2021, which were valued at $25,579 as of June 30, 2021. The Company's remaining short-term and long-term equity investments are held within a trust to fund existing obligations associated with the Company’s non-qualified deferred compensation plans.

Goodwill

Goodwill	6 Months Ended
	Jun. 30, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill	Goodwill Changes in goodwill by reportable segments were as follows: U.S. dialysis Other - Ancillary services Consolidated Balance at December 31, 2019 $ 6,287,100 $ 500,535 $ 6,787,635 Acquisitions 24,377 105,680 130,057 Divestitures (1,549) (6,744) (8,293) Foreign currency and other adjustments — 9,710 9,710 Balance at December 31, 2020 $ 6,309,928 $ 609,181 $ 6,919,109 Acquisitions 3,481 24,842 28,323 Foreign currency and other adjustments — (3,767) (3,767) Balance at June 30, 2021 $ 6,313,409 $ 630,256 $ 6,943,665 Balance at June 30, 2021: Goodwill $ 6,313,409 $ 762,407 $ 7,075,816 Accumulated impairment charges — (132,151) (132,151) $ 6,313,409 $ 630,256 $ 6,943,665 The Company did not recognize any goodwill impairment charges during the six months ended June 30, 2021 and 2020. As dialysis treatments are an essential, life-sustaining service for patients who depend on them, the Company's operations have continued throughout the novel coronavirus (COVID-19) pandemic. However, the ultimate impact of the dynamic and evolving COVID-19 pandemic on the Company will depend on future developments that are highly uncertain and difficult to predict, including among other things the ultimate severity and duration of the pandemic, further spread or resurgence of the virus (including as a result of the emergence of new strains of the virus such as the Delta variant), its impact on the chronic kidney disease (CKD) patient population and the Company's patient population, the availability, acceptance, impact and efficacy of COVID-19 vaccines and other treatments, or therapies, the pandemic’s continuing impact on the U.S.

Income Taxes

Income Taxes	6 Months Ended
	Jun. 30, 2021
Income Tax Disclosure [Abstract]
Income taxes	Income taxesThe Company's effective tax rate was 18.8% and 24.6% for the three months ended June 30, 2021 and 2020, respectively, and 20.6% and 24.7% for the six months ended June 30, 2021 and 2020, respectively. The decrease in the Company's effective tax rate for the three and six months ended June 30, 2021 compared to the prior year is primarily due to an increase in tax benefits from stock-based compensation deductions in the second quarter of 2021 as well as a reduction in nondeductible advocacy expenses in 2021.

Long-term debt

Long-term debt	6 Months Ended
	Jun. 30, 2021
Debt Disclosure [Abstract]
Long-term debt	Long-term debt Long-term debt was comprised of the following: As of June 30, 2021 June 30, 2021 December 31, 2020 Maturity date Interest rate Estimated fair value (1) Senior Secured Credit Facilities: Term Loan A $ 1,640,625 $ 1,684,375 8/12/2024 LIBOR + 1.50% $ 1,640,625 Term Loan B-1 2,701,978 2,715,694 8/12/2026 LIBOR + 1.75% $ 2,691,846 Revolving line of credit — 75,000 8/12/2024 LIBOR + 1.50% Senior Notes: 4.625% Senior Notes 2,750,000 1,750,000 6/1/2030 4.625 % $ 2,825,625 3.75% Senior Notes 1,500,000 1,500,000 2/15/2031 3.750 % $ 1,443,750 Acquisition obligations and other notes payable (2) 151,425 164,160 2021-2036 4.99 % $ 151,425 Financing lease obligations (3) 301,535 274,292 2022-2038 4.68 % Total debt principal outstanding 9,045,563 8,163,521 Discount, premium and deferred financing costs (4) (62,865) (77,717) 8,982,698 8,085,804 Less current portion (184,435) (168,541) $ 8,798,263 $ 7,917,263 (1) For the Company's senior secured credit facilities and senior notes, fair value estimates are based upon bid and ask quotes, typically a level 2 input. For acquisition obligations and other notes payable, the carrying values presented approximate their estimated fair values, based on estimates of their present values using level 2 interest rate inputs. (2) The interest rate presented for acquisition obligations and other notes payable is their weighted average interest rate based on the current fixed and LIBOR interest rate components in effect as of June 30, 2021. (3) Financing lease obligations are measured at their approximate present values at inception. The interest rate presented is the weighted average discount rate embedded in financing leases outstanding. The term of one ground lease runs to 2070, in addition to the other lease maturity dates presented in the table above. (4) As of June 30, 2021, the carrying amount of the Company's senior secured credit facilities is reduced by a discount of $4,965 and deferred financing costs of $31,488 and the carrying amount of the Company's senior notes is reduced by deferred financing costs of $43,266 and increased by a debt premium of $16,854. As of December 31, 2020, the carrying amount of the Company's senior secured credit facilities is reduced by a discount of $5,461 and deferred financing costs of $35,825, and the carrying amount of the Company's senior notes is reduced by deferred financing costs of $36,431. During the first six months of 2021, the Company made regularly scheduled mandatory principal payments under its senior secured credit facilities totaling $43,750 on Term Loan A and $13,716 on Term Loan B-1. On February 26, 2021, the Company completed an unregistered add-on offering of $1,000,000 aggregate principal amount to the existing 4.625% senior notes due June 1, 2030 (the Additional 2030 Notes) pursuant to Rule 144A and Regulation S under the Securities Act of 1933, as amended. The Additional 2030 Notes were issued at an offering price of 101.750% of face amount, plus an interest payment advance to the Company for interest that would have accrued from December 1, 2020 (the last interest payment date) through the closing date, and began bearing full six months' semi-annual coupon interest payments as of June 1, 2021. The terms of the Additional 2030 Notes, other than their issue date, offering price and first interest payment date, are identical to the terms of the $1,750,000 principal amount of the Company’s 4.625% Senior Notes due June 1, 2030 previously issued by the Company on June 9, 2020. The Additional 2030 Notes are unsecured senior obligations and rank equally in right of payment with the Company's existing and future unsecured senior indebtedness. During the six months ended June 30, 2021, the Company incurred $9,089 in fees and other professional expenses associated with this transaction, which were capitalized and will amortize over the term of the Additional 2030 Notes. As of June 30, 2021, the Company's 2019 interest rate cap agreements have the economic effect of capping the Company's maximum exposure to LIBOR variable interest rate changes on equivalent amounts of the Company's floating rate debt, including all of Term Loan B-1 and a portion of Term Loan A. The remaining $842,603 outstanding principal balance of Term Loan A is subject to LIBOR-based interest rate volatility. These cap agreements are designated as cash flow hedges and, as a result, changes in the fair values of the cap agreements are reported in other comprehensive income. The original premiums paid for the caps are amortized to debt expense on a straight-line basis over the term of each cap agreement starting from its effective date. These cap agreements do not contain credit risk-contingent features. The following table summarizes the Company’s interest rate cap agreements outstanding as of June 30, 2021 and December 31, 2020, which are classified in "Other long-term assets" on its consolidated balance sheet: Six months ended Fair value Notional amount LIBOR maximum rate Effective date Expiration date Debt expense Recorded OCI gain June 30, December 31, 2020 2019 cap agreements $ 3,500,000 2.00% 6/30/2020 6/30/2024 $ 2,754 $ 3,761 $ 6,432 $ 2,671 See Note 10 for further details on amounts reclassified from accumulated other comprehensive loss and recorded as debt expense related to the Company’s interest rate cap agreements for the three and six months ended June 30, 2021 and 2020. The Company’s weighted average effective interest rate on its senior secured credit facilities at the end of the second quarter of 2021 was 2.16%, based on the current margins in effect for its senior secured credit facilities as of June 30, 2021, as described above. The Company’s overall weighted average effective interest rate for the three and six months ended June 30, 2021 was 3.36% and 3.22%, respectively, and as of June 30, 2021 was 3.33%. As of June 30, 2021, the Company’s interest rates were fixed on approximately 51% of its total debt.

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2021
Commitments and Contingencies Disclosure [Abstract]
Contingencies	Commitments and contingencies provided; and (iv) retroactive applications or interpretations of governmental requirements. In addition, the Company’s revenues from commercial payors may be subject to adjustment as a result of potential claims for refunds, as a result of government actions or as a result of other claims by commercial payors. The Company operates in a highly regulated industry and is a party to various lawsuits, demands, claims, qui tam suits, governmental investigations (which frequently arise from qui tam suits) and audits (including, without limitation, investigations or other actions resulting from its obligation to self-report suspected violations of law) and other legal proceedings, including, without limitation, those described below. The Company records accruals for certain legal proceedings and regulatory matters to the extent that the Company determines an unfavorable outcome is probable and the amount of the loss can be reasonably estimated. As of June 30, 2021 and December 31, 2020, the Company’s total recorded accruals with respect to legal proceedings and regulatory matters, net of anticipated third party recoveries, were immaterial. While these accruals reflect the Company’s best estimate of the probable loss for those matters as of the dates of those accruals, the recorded amounts may differ materially from the actual amount of the losses for those matters, and any anticipated third party recoveries for any such losses may not ultimately be recoverable. Additionally, in some cases, no estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made because of the inherently unpredictable nature of legal proceedings and regulatory matters, which also may be impacted by various factors, including, without limitation, that they may involve indeterminate claims for monetary damages or may involve fines, penalties or non-monetary remedies; present novel legal theories or legal uncertainties; involve disputed facts; represent a shift in regulatory policy; are in the early stages of the proceedings; or may result in a change of business practices. Further, there may be various levels of judicial review available to the Company in connection with any such proceeding. The following is a description of certain lawsuits, claims, governmental investigations and audits and other legal proceedings to which the Company is subject. Certain Governmental Inquiries and Related Proceedings 2016 U.S. Attorney Texas Investigation : In February 2016, DaVita Rx, LLC (DaVita Rx), a wholly-owned subsidiary of the Company, received a Civil Investigative Demand (CID) from the U.S. Attorney’s Office, Northern District of Texas. The government 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 government’s investigation covers the period from January 1, 2006 through December 31, 2018. In December 2017, the Company finalized and executed a settlement agreement that resolved certain of the issues in the government’s investigation and 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 is ongoing with respect to issues related to DaVita Rx’s historic relationships with certain pharmaceutical manufacturers, and in July 2018 the Office of Inspector General (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 Colorado Investigation : In November 2017, the U.S. Attorney’s Office, District of Colorado informed the Company of an investigation it was conducting into possible federal healthcare offenses involving DaVita Kidney Care, as well as several of the Company’s wholly-owned subsidiaries. In addition to DaVita Kidney Care, the matter currently includes an investigation into DaVita Rx, DaVita Laboratory Services, Inc. (DaVita Labs), and RMS Lifeline Inc. (Lifeline). In each of August 2018, May 2019, and July 2021, the Company received a CID pursuant to the FCA from the U.S. Attorney's Office relating to this investigation. In May 2020, the Company sold its interest in Lifeline, but the Company retained certain liabilities of the Lifeline business, including those related to this investigation. The Company is continuing to cooperate with the government in this investigation. 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. On September 30, 2019, the U.S. Attorney’s Office notified the U.S. District Court, Middle District of Florida, of its decision not to elect to intervene at this time in the matter of U.S. ex rel. Lorne Holland, et al. v. DaVita Healthcare Partners, Inc., et al . The court then unsealed the complaint, which alleges violations of the FCA, by order dated the same day. In January 2020, the private party relators served the Company and DaVita Labs with an amended complaint. On February 24, 2020, the Company and DaVita Labs filed a motion to dismiss the amended complaint. On June 25, 2020, the court denied the motion to dismiss. The Company and DaVita Labs answered the complaint on July 23, 2020. The Company and DaVita Labs dispute these allegations and intend to defend this action accordingly. 2020 U.S. Attorney New Jersey Investigation : In March 2020, the U.S. Attorney’s Office, District of New Jersey served the Company with a subpoena and a CID relating to an investigation being conducted by that office and the U.S. Attorney’s Office, Eastern District of Pennsylvania. The subpoena and CID request information on several topics, including certain of the Company’s joint venture arrangements with physicians and physician groups, medical director agreements, and compliance with its five-year Corporate Integrity Agreement, the term of which expired October 22, 2019. The Company is cooperating with the government in this investigation. 2020 California Department of Insurance Investigation : In April 2020, the California Department of Insurance (CDI) sent the Company an Investigative Subpoena relating to an investigation being conducted by that office. CDI issued a superseding subpoena in September 2020. The subpoena, as revised, requests information on a number of topics, including but not limited to the Company’s communications with patients about insurance plans and financial assistance from the American Kidney Fund (AKF), analyses of the potential impact of patients’ decisions to change insurance providers, and documents relating to donations or contributions to the AKF. The Company is cooperating with CDI in this investigation. 2020 Department of Justice Investigation : In October 2020, the Company received a CID from the Department of Justice pursuant to a False Claims Act investigation concerning allegations that DaVita Medical Group (DMG) may have submitted undocumented or unsupported diagnosis codes in connection with Medicare Advantage beneficiaries. The CID covers the period from January 1, 2015 through June 19, 2019, the date the Company completed the divestiture of DMG to Collaborative Care Holdings, LLC. The Company is cooperating with the government in this investigation. * * * Although the Company cannot predict whether or when proceedings might be initiated or when these matters may be resolved (other than as may be described above), it is not unusual for inquiries such as these to continue for a considerable period of time through the various phases of document and witness requests and 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, many of which relate to qui tam complaints filed by relators. Negative findings or terms and conditions that the Company might agree to accept as part of a negotiated resolution of pending or future government inquiries or relator proceedings could result in, among other things, substantial financial penalties or awards against the Company, substantial payments made by the Company, harm to the Company’s reputation, required changes to the Company’s business practices, an impact on the Company's various relationships and/or contracts related to the Company's business, exclusion from future participation in the Medicare, Medicaid and other federal health care programs and, if criminal proceedings were initiated against the Company, members of its board of directors or management, possible criminal penalties, any of which could have a material adverse effect on the Company. Other Proceedings 2021 Antitrust Indictment and Putative Class Action Suit : On July 14, 2021, an indictment was returned by a grand jury in the U.S. District Court, District of Colorado against the Company and its former chief executive officer in the matter of U.S. v. DaVita Inc., et al. The two count indictment alleges that purported agreements entered into by its former chief executive officer not to solicit senior-level employees violate Section 1 of the Sherman Act. On July 16, 2021, a former DaVita employee filed a putative class action complaint in the matter of Pena v. Surgical Care Affiliates, LLC , et al. in the U.S. District Court, Northern District of Illinois based on the allegations in the matter of U.S. v. DaVita Inc., et al . The complaint seeks to bring an action on behalf of the defendant and similarly situated individuals, including without limitation those employed by the Company between February 1, 2012 through June 30, 2019 as senior-level employees. The Company disputes the allegations in the indictment and the class action complaint, as well as the asserted violations of the Sherman Act, and intends to defend these actions accordingly. Additionally, from time to time the Company is subject to other lawsuits, demands, claims, governmental investigations and audits and legal proceedings that arise due to the nature of its business, including, without limitation, contractual disputes, such as with payors, suppliers and others, employee-related matters and professional and general liability claims. From time to time, the Company also initiates litigation or other legal proceedings as a plaintiff arising out of contracts or other matters. * * * Other than as may be described above, the Company cannot predict the ultimate outcomes of the various legal proceedings and regulatory matters to which the Company is or may be subject from time to time, including those described in this Note 8, or the timing of their resolution or the ultimate losses or impact of developments in those matters, which could have a material adverse effect on the Company’s revenues, earnings and cash flows. Further, any legal proceedings or regulatory matters involving the Company, whether meritorious or not, are time consuming, and often require management’s attention and result in significant legal expense, and may result in the diversion of significant operational resources, may impact the Company's various relationships and/or contracts related to the Company's business or otherwise harm the Company’s business, results of operations, financial condition, cash flows or reputation. Resolved Matters 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." While the Company continues to dispute the allegations, it reached an agreement to resolve this matter without admitting to any liability. Settlement of this matter was covered primarily with insurance proceeds. The Company contributed an amount that did not have a material impact on the Company’s consolidated financial position, results of operations or cash flows. On April 13, 2021, the court granted final approval of the settlement. 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. While the defendants continue to dispute the allegations, an agreement was reached to resolve this matter without admitting to any liability and the court approved the settlement on January 29, 2021. As part of the settlement, the Company agreed to certain corporate governance policies, but did not make any financial contribution towards the settlement. * * *
Noncontrolling interests subject to put provisions and other commitments	Other Commitments The Company also has certain potential commitments to provide working capital funding, if necessary, to certain nonconsolidated outpatient dialysis businesses that the Company manages and in which the Company owns a noncontrolling equity interest or which are wholly-owned by third parties of approximately $11,455.

Shareholders' equity

Shareholders' equity	6 Months Ended
	Jun. 30, 2021
Equity [Abstract]
Long-term incentive compensation	Shareholders' equity Stock-based compensation During the six months ended June 30, 2021, the Company granted 714 restricted and performance stock units with an aggregate grant-date fair value of $78,287 and a weighted-average expected life of approximately 3.5 years and 132 stock-settled stock appreciation rights with an aggregate grant-date fair value of $4,250 and a weighted-average expected life of approximately 4.5 years. As of June 30, 2021, the Company had $204,649 in total estimated but unrecognized stock-based compensation expense under the Company's equity compensation and employee stock purchase plans. The Company expects to recognize this expense over a weighted average remaining period of 1.4 years.
Share repurchases	Share repurchases The following table summarizes the Company's common stock repurchases during the three and six months ended June 30, 2021 and 2020: Three months ended June 30, Six months ended June 30, Open market repurchases: 2021 2020 2021 2020 Shares 2,070 — 5,019 4,052 Amount paid $ 240,897 $ — $ 563,230 $ 303,139 Average paid per share $ 116.38 $ — $ 112.21 $ 74.81 The Company repurchased 890 shares of its common stock for $107,199 at an average cost of $120.50 per share subsequent to June 30, 2021 through August 2, 2021. Effective on December 10, 2020, the Company's Board of Directors (Board) terminated all remaining prior share repurchase authorizations available to the Company and approved a new share repurchase authorization of $2,000,000. As of August 2, 2021, the Company had a total of $1,259,527 available under the current authorization for additional share repurchases. Although this share repurchase authorization does not have an expiration date, the Company remains subject to share repurchase limitations including under the terms of its current senior secured credit facilities.

Accumulated other comprehensive

Accumulated other comprehensive (loss) income	6 Months Ended
	Jun. 30, 2021
Statement of Comprehensive Income [Abstract]
Comprehensive income	Accumulated other comprehensive loss Three months ended June 30, 2021 Six months ended June 30, 2021 Interest Foreign Accumulated Interest Foreign Accumulated Beginning balance $ (6,551) $ (116,232) $ (122,783) $ (12,466) $ (53,688) $ (66,154) Unrealized (losses) gains (2,744) 57,910 55,166 3,761 (4,634) (873) Related income tax 685 — 685 (938) — (938) (2,059) 57,910 55,851 2,823 (4,634) (1,811) Reclassification into net income 1,377 — 1,377 2,754 — 2,754 Related income tax (344) — (344) (688) — (688) 1,033 — 1,033 2,066 — 2,066 Ending balance $ (7,577) $ (58,322) $ (65,899) $ (7,577) $ (58,322) $ (65,899) Three months ended June 30, 2020 Six months ended June 30, 2020 Interest Foreign Accumulated Interest Foreign Accumulated Beginning balance $ (12,828) $ (127,697) $ (140,525) $ (1,433) $ (46,065) $ (47,498) Unrealized (losses) gains (2,431) 5,619 3,188 (19,777) (76,013) (95,790) Related income tax 607 — 607 4,935 — 4,935 (1,824) 5,619 3,795 (14,842) (76,013) (90,855) Reclassification into net income 2,163 — 2,163 4,326 — 4,326 Related income tax (540) — (540) (1,080) — (1,080) 1,623 — 1,623 3,246 — 3,246 Ending balance $ (13,029) $ (122,078) $ (135,107) $ (13,029) $ (122,078) $ (135,107) The interest rate cap agreement net realized losses reclassified into net income are recorded as debt expense in the corresponding consolidated statements of income. See Note 7 for further details.

Acquisitions and divestitures

Acquisitions and divestitures	6 Months Ended
	Jun. 30, 2021
Business Combinations [Abstract]
Acquisitions and divestitures	Acquisitions and divestitures Routine acquisitions During the six months ended June 30, 2021, the Company acquired dialysis businesses consisting of one dialysis center located in the U.S. and seven dialysis centers located outside the U.S. for a total of $23,890 in net cash, contingent earn-out obligations of $2,694 and deferred purchase price and liabilities assumed of $3,301. 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 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 any pre-acquisition tax contingencies. In addition, valuation of intangibles, leases and certain other working capital items relating to several of these acquisitions are pending final quantification. The following table summarizes the assets acquired and liabilities assumed in these transactions and recognized at their acquisition dates at estimated fair values, as well as the estimated fair value of the noncontrolling interests assumed in these transactions: Current assets $ 3,832 Property and equipment 1,853 Other long-term assets 2,259 Indefinite-lived licenses 1,593 Goodwill 28,323 Liabilities assumed (6,726) Noncontrolling interests (1,249) $ 29,885 Goodwill deductible for tax purposes associated with acquisitions completed during the six months ended June 30, 2021 was $27,159. 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 approximately $42,581 if certain performance targets or quality margins are met over the next one year to five years. Contingent earn-out obligations are remeasured to fair value at each reporting date until the contingencies are resolved with changes in the liability due to the remeasurement recognized in earnings. As of June 30, 2021, the Company estimated the fair value of these contingent earn-out obligations to be $28,342, of which $11,389 is included in other current liabilities and the remaining $16,953 is included in other long-term liabilities in the Company’s consolidated balance sheet. The following is a reconciliation of changes in contingent earn-out obligations for the three and six months ended June 30, 2021: Three months ended Six months ended Beginning balance $ 28,225 $ 30,248 Acquisitions 2,156 2,694 Foreign currency translation 3,055 975 Fair value remeasurements 60 (154) Payments (5,154) (5,421) Ending balance $ 28,342 $ 28,342
Discontinued operations	Discontinued operations On June 19, 2019, the Company completed the sale of its DaVita Medical Group (DMG) business to Collaborative Care Holdings, LLC (Optum), a subsidiary of UnitedHealth Group Inc. At close of the DMG sale, the Company's ultimate net sale proceeds remained subject to resolution of certain post-closing purchase price adjustments described in the equity purchase agreement, which adjustments were finalized in the fourth quarter of 2020. During the first six months of 2020, the Company recognized $9,980 in additional tax benefits under the Coronavirus Aid, Relief, and Economic Security Act related to its period of DMG ownership, which were recognized as an adjustment to the Company's loss on sale of the DMG business.

Variable interest entities

Variable interest entities	6 Months Ended
	Jun. 30, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Variable interest entities	Variable interest entities (VIEs)At June 30, 2021, these condensed consolidated financial statements include total assets of VIEs of $316,881 and total liabilities and noncontrolling interests of VIEs to third parties of $206,326. 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 2020 10-K.

Fair value of financial instrum

Fair value of financial instruments	6 Months Ended
	Jun. 30, 2021
Fair Value Disclosures [Abstract]
Fair value of financial instruments	Fair values of financial instrumentsThe Company measures the fair value of certain assets, liabilities and noncontrolling interests subject to put provisions (redeemable equity interests classified as temporary equity) based upon certain valuation techniques that include observable or unobservable inputs and assumptions that market participants would use in pricing these assets, liabilities, temporary equity and commitments. The Company has also classified assets, liabilities and temporary equities that are measured at fair value on a recurring basis into the appropriate fair value hierarchy levels as defined by the Financial Accounting Standards Board (FASB). The following table summarizes the Company’s assets, liabilities and temporary equities measured at fair value on a recurring basis as of June 30, 2021: Total Quoted prices in Significant other Significant Assets Investments in equity securities $ 62,256 $ 62,256 $ — $ — Interest rate cap agreements $ 6,432 $ — $ 6,432 $ — Liabilities Contingent earn-out obligations $ 28,342 $ — $ — $ 28,342 Temporary equity Noncontrolling interests subject to put provisions $ 1,426,211 $ — $ — $ 1,426,211 For reconciliations of changes in contingent earn-out obligations and noncontrolling interests subject to put provisions during the three and six months ended June 30, 2021, see Note 11 and the consolidated statement of equity, respectively. Investments in equity securities represent investments in various open-ended registered investment companies (mutual funds) and common stocks, some of which are held within a trust to fund existing obligations associated with several of the Company's non-qualified deferred compensation plans. These investments are recorded at fair value estimated based on reported market prices or redemption prices, as applicable. See Note 4 for further discussion. Interest rate cap agreements are recorded at fair value estimated from valuation models utilizing the income approach and commonly accepted valuation techniques that use inputs from closing prices for similar assets and liabilities in active markets as well as other relevant observable market inputs at quoted intervals such as current interest rates, forward yield curves, implied volatility and credit default swap pricing. The Company does not believe the ultimate amount that could be realized upon settlement of these interest rate cap agreements would be materially different from the fair value estimates currently reported. See Note 7 for further discussion. The estimated fair value measurements of contingent earn-out obligations are primarily based on unobservable inputs, including projected earnings before interest, taxes, depreciation, and amortization (EBITDA), revenue and certain operating metrics. The estimated fair values of these contingent earn-out obligations are remeasured as of each reporting date and could fluctuate based upon any significant changes in key assumptions, such as changes in the Company's credit risk adjusted rate that is used to discount obligations to present value. See Note 11 for further discussion. The estimated fair value of noncontrolling interests subject to put provisions is based principally on the higher of either estimated liquidation value of net assets or a multiple of earnings for each subject dialysis partnership, based on historical earnings, revenue mix, and other performance indicators that can affect future results. The multiples used for these valuations are derived from observed ownership transactions for dialysis businesses between unrelated parties in the U.S. in recent years, and the specific valuation multiple applied to each dialysis partnership is principally determined by its recent and expected revenue mix and contribution margin. As of June 30, 2021, an increase or decrease in the weighted average multiple used in these valuations of one times EBITDA would change the estimated fair value of these noncontrolling interests by approximately $180,000. See Note 17 and Note 24 to the Company's consolidated financial statements included in the 2020 10-K for further discussion of the Company’s methodology for estimating the fair value of noncontrolling interests subject to put obligations. The Company's fair value estimates for its senior secured credit facilities and senior notes are based upon bid and ask quotes for these instruments, typically a level 2 input. See Note 7 for further discussion of the Company's debt. Other financial instruments consist primarily of cash and cash equivalents, restricted cash and cash equivalents, accounts receivable, accounts payable, other accrued liabilities, lease liabilities and debt. The balances of financial instruments other than debt and lease liabilities are presented in these condensed consolidated financial statements at June 30, 2021 at their approximate fair values due to the short-term nature of their settlements.

Segment reporting

Segment reporting	6 Months Ended
	Jun. 30, 2021
Segment Reporting [Abstract]
Segment Reporting Disclosure	Segment reporting The Company’s operations are comprised of its U.S. dialysis and related lab services business (its U.S. dialysis business), its various ancillary services including its international operations (collectively, its ancillary services), and its corporate administrative support. The Company’s separate operating segments include its U.S. dialysis and related lab services business, each of its ancillary services, 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 Asia Pacific joint venture (APAC JV). The U.S. dialysis and related lab services business qualifies as a separately reportable segment, and all other ancillary services operating segments, including the international operating segments, have been combined and disclosed in the other segments category. See Note 25 to the Company's consolidated financial statements included in the 2020 10-K for further description of how the Company determines and measures results for its operating segments. The following is a summary of segment net revenues, segment operating income (loss), and a reconciliation of segment operating income (loss) to consolidated income before income taxes: Three months ended June 30, Six months ended June 30, 2021 2020 2021 2020 Segment revenues: U.S. dialysis Dialysis patient service revenues: External sources $ 2,648,676 $ 2,631,827 $ 5,204,936 $ 5,211,067 Intersegment revenues 21,247 35,122 48,190 67,062 U.S. dialysis patient service revenues 2,669,923 2,666,949 5,253,126 5,278,129 Other revenues (1) : External sources 6,345 7,688 12,961 12,830 Intersegment revenues 70 307 130 608 Total U.S. dialysis revenues 2,676,338 2,674,944 5,266,217 5,291,567 Other—Ancillary services Dialysis patient service revenues 169,281 126,370 327,608 260,411 Other external sources 92,208 114,094 191,006 236,908 Intersegment revenues — 4,171 4,294 8,324 Total ancillary services revenues 261,489 244,635 522,908 505,643 Total net segment revenues 2,937,827 2,919,579 5,789,125 5,797,210 Elimination of intersegment revenues (21,317) (39,600) (52,614) (75,994) Consolidated revenues $ 2,916,510 $ 2,879,979 $ 5,736,511 $ 5,721,216 Segment operating income (loss): U.S. dialysis $ 533,779 $ 522,630 $ 1,013,686 $ 1,014,236 Other—Ancillary services (17,808) (39,622) (29,668) (42,268) Total segment operating income 515,971 483,008 984,018 971,968 Reconciliation of segment operating income to consolidated Corporate administrative support (25,495) (73,088) (50,940) (96,672) Consolidated operating income 490,476 409,920 933,078 875,296 Debt expense (73,324) (81,381) (140,338) (169,984) Debt refinancing charges — — — (2,948) Other income, net 15,188 9,545 16,356 5,195 Consolidated income from continuing operations $ 432,340 $ 338,084 $ 809,096 $ 707,559 (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. Depreciation and amortization expense by reportable segment was as follows: Three months ended June 30, Six months ended June 30, 2021 2020 2021 2020 U.S. dialysis $ 159,856 $ 148,312 $ 315,802 $ 294,612 Other—Ancillary services 9,833 9,064 19,588 17,443 $ 169,689 $ 157,376 $ 335,390 $ 312,055 Expenditures for property and equipment by reportable segment were as follows: Six months ended June 30, 2021 2020 U.S. dialysis $ 271,884 $ 280,801 Other—Ancillary services 22,554 10,866 $ 294,438 $ 291,667 A summary of assets by reportable segment was as follows: June 30, 2021 December 31, 2020 U.S. dialysis $ 16,084,542 $ 15,344,647 Other—Ancillary services 1,725,769 1,643,869 Consolidated assets $ 17,810,311 $ 16,988,516

New accounting standards

New accounting standards	6 Months Ended
	Jun. 30, 2021
Accounting Changes and Error Corrections [Abstract]
Accounting Standards Update and Change in Accounting Principle	New accounting standards New standards recently adopted In December 2019, the FASB issued Accounting Standards Update (ASU) No. 2019-12 , Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes . ASU No. 2019-12 attempts to simplify aspects of accounting for franchise taxes and enacted changes in tax laws or rates, and clarifies the accounting for transactions that result in a step-up in the tax basis of goodwill. The amendments in this ASU became effective for the Company beginning on January 1, 2021. The adoption of ASU No. 2019-12 did not have a material impact on the Company's consolidated financial statements. New standards not yet adopted In March 2020, the FASB issued ASU No. 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting. ASU No. 2020-04 provides optional expedients and exceptions for applying U.S. generally accepted accounting principles to contract modifications and hedging relationships, subject to certain criteria, that reference LIBOR or another rate that is expected to be discontinued. The amendments in this ASU were effective beginning on March 12, 2020, and the Company may elect to apply the amendments prospectively through December 31, 2022. The Company is currently assessing the effect this guidance may have on its consolidated financial statements.

Condensed consolidated interi_2

Condensed consolidated interim financial statements Condensed consolidaed interim financial statements (Policies)	6 Months Ended
	Jun. 30, 2021
Accounting Policies [Abstract]
Condensed consolidated interim financial statements	The unaudited condensed consolidated interim financial statements included in this report are prepared by the Company. In the opinion of management, all adjustments necessary for a fair presentation of the results of operations are reflected in these condensed consolidated interim financial statements. All significant intercompany accounts and transactions have been eliminated. The preparation of these financial statements requires management to make estimates and assumptions that affect the reported amounts of revenues, expenses, assets, liabilities, contingencies and noncontrolling interests subject to put provisions. The most significant estimates and assumptions underlying these financial statements and accompanying notes generally involve revenue recognition and accounts receivable, impairments of goodwill, accounting for income taxes, certain fair value estimates and loss contingencies. The results of operations reflected in these interim financial statements may not necessarily be indicative of annual operating results. These condensed consolidated interim financial statements should be read in conjunction with the audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2020 (2020 10-K). Prior period classifications have been conformed to the current period presentation. The Company has evaluated subsequent events through the date these condensed consolidated interim financial statements were issued and has included all necessary adjustments and disclosures.
Earnings Per Share	Basic earnings per share is calculated by dividing net income attributable to the Company by the weighted average number of common shares outstanding. Weighted average common shares outstanding include restricted stock unit awards that are no longer subject to forfeiture because the recipients have satisfied either the explicit vesting terms or retirement eligibility requirements. Diluted earnings per share includes the dilutive effect of outstanding stock-settled stock appreciation rights and unvested stock units as computed under the treasury stock method.
Short-term and Long-term Investments	Debt securities: The Company's short-term debt investments are principally bank certificates of deposit with contractual maturities longer than three months but shorter than one year. These debt securities are accounted for as held to maturity and recorded at amortized cost, which approximated their fair values at June 30, 2021 and December 31, 2020.
Long-term debt	These cap agreements are designated as cash flow hedges and, as a result, changes in the fair values of the cap agreements are reported in other comprehensive income. The original premiums paid for the caps are amortized to debt expense on a straight-line basis over the term of each cap agreement starting from its effective date.
Accumulated other comprehensive Income	The interest rate cap agreement net realized losses reclassified into net income are recorded as debt expense in the corresponding consolidated statements of income.
Fair Value of Financial Instruments	Interest rate cap agreements are recorded at fair value estimated from valuation models utilizing the income approach and commonly accepted valuation techniques that use inputs from closing prices for similar assets and liabilities in active markets as well as other relevant observable market inputs at quoted intervals such as current interest rates, forward yield curves, implied volatility and credit default swap pricing. The Company does not believe the ultimate amount that could be realized upon settlement of these interest rate cap agreements would be materially different from the fair value estimates currently reported. See Note 7 for further discussion.The estimated fair value measurements of contingent earn-out obligations are primarily based on unobservable inputs, including projected earnings before interest, taxes, depreciation, and amortization (EBITDA), revenue and certain operating metrics. The estimated fair values of these contingent earn-out obligations are remeasured as of each reporting date and could fluctuate based upon any significant changes in key assumptions, such as changes in the Company's credit risk adjusted rate that is used to discount obligations to present value.
New Accounting Standards	New standards recently adopted In December 2019, the FASB issued Accounting Standards Update (ASU) No. 2019-12 , Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes . ASU No. 2019-12 attempts to simplify aspects of accounting for franchise taxes and enacted changes in tax laws or rates, and clarifies the accounting for transactions that result in a step-up in the tax basis of goodwill. The amendments in this ASU became effective for the Company beginning on January 1, 2021. The adoption of ASU No. 2019-12 did not have a material impact on the Company's consolidated financial statements. New standards not yet adopted In March 2020, the FASB issued ASU No. 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting. ASU No. 2020-04 provides optional expedients and exceptions for applying U.S. generally accepted accounting principles to contract modifications and hedging relationships, subject to certain criteria, that reference LIBOR or another rate that is expected to be discontinued. The amendments in this ASU were effective beginning on March 12, 2020, and the Company may elect to apply the amendments prospectively through December 31, 2022. The Company is currently assessing the effect this guidance may have on its consolidated financial statements.

Revenue Recognition Segment rev

Revenue Recognition Segment revenue by major payor (Tables)	6 Months Ended
	Jun. 30, 2021
Revenues by major payor [Abstract]
Disaggregation of Revenue [Table Text Block]	The following table summarizes the Company's segment revenues by primary payor source: Three months ended June 30, 2021 Three months ended June 30, 2020 U.S. dialysis Other - Ancillary services Consolidated U.S. dialysis Other - Ancillary services Consolidated Dialysis patient service revenues: Medicare and Medicare Advantage (1) $ 1,562,164 $ $ 1,562,164 $ 1,547,113 $ $ 1,547,113 Medicaid and Managed Medicaid 194,641 194,641 182,324 182,324 Other government (1) 82,317 118,464 200,781 86,954 90,813 177,767 Commercial 830,801 50,817 881,618 850,558 35,557 886,115 Other revenues: Medicare and Medicare Advantage 80,211 80,211 99,829 99,829 Medicaid and Managed Medicaid 305 305 283 283 Commercial 1,189 1,189 9,050 9,050 Other (2) 6,415 10,503 16,918 7,995 9,103 17,098 Eliminations of intersegment revenues (21,317) — (21,317) (35,429) (4,171) (39,600) Total $ 2,655,021 $ 261,489 $ 2,916,510 $ 2,639,515 $ 240,464 $ 2,879,979 (1) During the first quarter of 2021, the Company realigned the classification of revenue previously disclosed in the “Other government” category to the “Medicare and Medicare Advantage” category for certain government-reimbursed plans which have structure and payment characteristics similar to traditional Medicare Advantage plans. The classification of revenue for these plans for the three months ended June 30, 2020 has also been recast to conform to the current period presentation. (2) Other consists of management service fees earned in the respective Company line of business as well as other revenue from the Company's ancillary services. Six months ended June 30, 2021 Six months ended June 30, 2020 U.S. dialysis Other - Ancillary services Consolidated U.S. dialysis Other - Ancillary services Consolidated Dialysis patient service revenues: Medicare and Medicare Advantage (1) $ 3,042,461 $ $ 3,042,461 $ 3,078,146 $ $ 3,078,146 Medicaid and Managed Medicaid 381,884 381,884 353,791 353,791 Other government (1) 162,501 225,293 387,794 170,052 185,387 355,439 Commercial 1,666,280 102,315 1,768,595 1,676,140 75,024 1,751,164 Other revenues: Medicare and Medicare Advantage 165,807 165,807 198,307 198,307 Medicaid and Managed Medicaid 605 605 649 649 Commercial 7,223 7,223 19,571 19,571 Other (2) 13,091 21,665 34,756 13,438 26,705 40,143 Eliminations of intersegment revenues (48,320) (4,294) (52,614) (67,670) (8,324) (75,994) Total $ 5,217,897 $ 518,614 $ 5,736,511 $ 5,223,897 $ 497,319 $ 5,721,216 (1) During the first quarter of 2021, the Company realigned the classification of revenue previously disclosed in the “Other government” category to the “Medicare and Medicare Advantage” category for certain government-reimbursed plans which have structure and payment characteristics similar to traditional Medicare Advantage plans. The classification of revenue for these plans for the six months ended June 30, 2020 has also been recast to conform to the current period presentation. (2) Other consists of management service fees earned in the respective Company line of business as well as other revenue from the Company's ancillary services.

Earnings per share Earnings Per

Earnings per share Earnings Per Share (Tables)	6 Months Ended
	Jun. 30, 2021
Earnings Per Share [Abstract]
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]	The reconciliations of the numerators and denominators used to calculate basic and diluted earnings per share were as follows: Three months ended June 30, Six months ended June 30, 2021 2020 2021 2020 Net income attributable to DaVita Inc.: Continuing operations $ 293,820 $ 201,602 $ 531,223 $ 431,215 Discontinued operations — — — 9,980 Net income attributable to DaVita Inc. $ 293,820 $ 201,602 $ 531,223 $ 441,195 Weighted average shares outstanding: Basic shares 106,364 122,074 107,606 123,485 Assumed incremental from stock plans 5,059 1,994 4,949 1,994 Diluted shares 111,423 124,068 112,555 125,479 Basic net income attributable to DaVita Inc.: Continuing operations per share $ 2.76 $ 1.65 $ 4.94 $ 3.49 Discontinued operations per share — — — 0.08 Basic net income per share attributable to DaVita Inc. $ 2.76 $ 1.65 $ 4.94 $ 3.57 Diluted net income attributable to DaVita Inc.: Continuing operations per share $ 2.64 $ 1.62 $ 4.72 $ 3.44 Discontinued operations per share — — — 0.08 Diluted net income per share attributable to DaVita Inc. $ 2.64 $ 1.62 $ 4.72 $ 3.52 Anti-dilutive stock-settled awards excluded from calculation (1) 141 3,216 84 3,211 (1) Shares associated with stock awards excluded from the diluted denominator calculation because they were anti-dilutive under the treasury stock method.

Investments in debt and equit_2

Investments in debt and equity securities (Tables)	6 Months Ended
	Jun. 30, 2021
Investments, Debt and Equity Securities [Abstract]
Schedule of Investments	The Company’s short-term and long-term debt and equity investments, consisting of debt instruments classified as held-to-maturity and equity investments with readily determinable fair values or redemption values, were as follows: June 30, 2021 December 31, 2020 Debt Equity Total Debt Equity Total Certificates of deposit and other time deposits $ 8,222 $ — $ 8,222 $ 8,217 $ — $ 8,217 Investments in mutual funds and common stocks — 62,256 62,256 — 44,077 44,077 $ 8,222 $ 62,256 $ 70,478 $ 8,217 $ 44,077 $ 52,294 Short-term investments $ 8,222 $ 28,479 $ 36,701 $ 8,217 $ 11,884 $ 20,101 Long-term investments — 33,777 33,777 — 32,193 32,193 $ 8,222 $ 62,256 $ 70,478 $ 8,217 $ 44,077 $ 52,294

Goodwill (Tables)

Goodwill (Tables)	6 Months Ended
	Jun. 30, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Changes in Goodwill by Reportable Segments [Text Block]	Changes in goodwill by reportable segments were as follows: U.S. dialysis Other - Ancillary services Consolidated Balance at December 31, 2019 $ 6,287,100 $ 500,535 $ 6,787,635 Acquisitions 24,377 105,680 130,057 Divestitures (1,549) (6,744) (8,293) Foreign currency and other adjustments — 9,710 9,710 Balance at December 31, 2020 $ 6,309,928 $ 609,181 $ 6,919,109 Acquisitions 3,481 24,842 28,323 Foreign currency and other adjustments — (3,767) (3,767) Balance at June 30, 2021 $ 6,313,409 $ 630,256 $ 6,943,665 Balance at June 30, 2021: Goodwill $ 6,313,409 $ 762,407 $ 7,075,816 Accumulated impairment charges — (132,151) (132,151) $ 6,313,409 $ 630,256 $ 6,943,665

Long-term debt (Tables)

Long-term debt (Tables)	6 Months Ended
	Jun. 30, 2021
Debt Disclosure [Abstract]
Long-term Debt	Long-term debt was comprised of the following: As of June 30, 2021 June 30, 2021 December 31, 2020 Maturity date Interest rate Estimated fair value (1) Senior Secured Credit Facilities: Term Loan A $ 1,640,625 $ 1,684,375 8/12/2024 LIBOR + 1.50% $ 1,640,625 Term Loan B-1 2,701,978 2,715,694 8/12/2026 LIBOR + 1.75% $ 2,691,846 Revolving line of credit — 75,000 8/12/2024 LIBOR + 1.50% Senior Notes: 4.625% Senior Notes 2,750,000 1,750,000 6/1/2030 4.625 % $ 2,825,625 3.75% Senior Notes 1,500,000 1,500,000 2/15/2031 3.750 % $ 1,443,750 Acquisition obligations and other notes payable (2) 151,425 164,160 2021-2036 4.99 % $ 151,425 Financing lease obligations (3) 301,535 274,292 2022-2038 4.68 % Total debt principal outstanding 9,045,563 8,163,521 Discount, premium and deferred financing costs (4) (62,865) (77,717) 8,982,698 8,085,804 Less current portion (184,435) (168,541) $ 8,798,263 $ 7,917,263 (1) For the Company's senior secured credit facilities and senior notes, fair value estimates are based upon bid and ask quotes, typically a level 2 input. For acquisition obligations and other notes payable, the carrying values presented approximate their estimated fair values, based on estimates of their present values using level 2 interest rate inputs. (2) The interest rate presented for acquisition obligations and other notes payable is their weighted average interest rate based on the current fixed and LIBOR interest rate components in effect as of June 30, 2021. (3) Financing lease obligations are measured at their approximate present values at inception. The interest rate presented is the weighted average discount rate embedded in financing leases outstanding. The term of one ground lease runs to 2070, in addition to the other lease maturity dates presented in the table above. (4) As of June 30, 2021, the carrying amount of the Company's senior secured credit facilities is reduced by a discount of $4,965 and deferred financing costs of $31,488 and the carrying amount of the Company's senior notes is reduced by deferred financing costs of $43,266 and increased by a debt premium of $16,854. As of December 31, 2020, the carrying amount of the Company's senior secured
Schedule of Derivative Instruments	The following table summarizes the Company’s interest rate cap agreements outstanding as of June 30, 2021 and December 31, 2020, which are classified in "Other long-term assets" on its consolidated balance sheet: Six months ended Fair value Notional amount LIBOR maximum rate Effective date Expiration date Debt expense Recorded OCI gain June 30, December 31, 2020 2019 cap agreements $ 3,500,000 2.00% 6/30/2020 6/30/2024 $ 2,754 $ 3,761 $ 6,432 $ 2,671

Share repurchases Share Repurch

Share repurchases Share Repurchases (Tables)	6 Months Ended
	Jun. 30, 2021
Treasury Stock, Value [Abstract]
Class of Treasury Stock [Table Text Block]	The following table summarizes the Company's common stock repurchases during the three and six months ended June 30, 2021 and 2020: Three months ended June 30, Six months ended June 30, Open market repurchases: 2021 2020 2021 2020 Shares 2,070 — 5,019 4,052 Amount paid $ 240,897 $ — $ 563,230 $ 303,139 Average paid per share $ 116.38 $ — $ 112.21 $ 74.81

Accumulated other comprehensi_2

Accumulated other comprehensive (loss) income (Tables)	6 Months Ended
	Jun. 30, 2021
Statement of Comprehensive Income [Abstract]
Comprehensive income	Three months ended June 30, 2021 Six months ended June 30, 2021 Interest Foreign Accumulated Interest Foreign Accumulated Beginning balance $ (6,551) $ (116,232) $ (122,783) $ (12,466) $ (53,688) $ (66,154) Unrealized (losses) gains (2,744) 57,910 55,166 3,761 (4,634) (873) Related income tax 685 — 685 (938) — (938) (2,059) 57,910 55,851 2,823 (4,634) (1,811) Reclassification into net income 1,377 — 1,377 2,754 — 2,754 Related income tax (344) — (344) (688) — (688) 1,033 — 1,033 2,066 — 2,066 Ending balance $ (7,577) $ (58,322) $ (65,899) $ (7,577) $ (58,322) $ (65,899) Three months ended June 30, 2020 Six months ended June 30, 2020 Interest Foreign Accumulated Interest Foreign Accumulated Beginning balance $ (12,828) $ (127,697) $ (140,525) $ (1,433) $ (46,065) $ (47,498) Unrealized (losses) gains (2,431) 5,619 3,188 (19,777) (76,013) (95,790) Related income tax 607 — 607 4,935 — 4,935 (1,824) 5,619 3,795 (14,842) (76,013) (90,855) Reclassification into net income 2,163 — 2,163 4,326 — 4,326 Related income tax (540) — (540) (1,080) — (1,080) 1,623 — 1,623 3,246 — 3,246 Ending balance $ (13,029) $ (122,078) $ (135,107) $ (13,029) $ (122,078) $ (135,107)

Acquisitions and divestitures (

Acquisitions and divestitures (Tables)	6 Months Ended
	Jun. 30, 2021
Business Combinations [Abstract]
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed [Table Text Block]	The following table summarizes the assets acquired and liabilities assumed in these transactions and recognized at their acquisition dates at estimated fair values, as well as the estimated fair value of the noncontrolling interests assumed in these transactions: Current assets $ 3,832 Property and equipment 1,853 Other long-term assets 2,259 Indefinite-lived licenses 1,593 Goodwill 28,323 Liabilities assumed (6,726) Noncontrolling interests (1,249) $ 29,885
Schedule of Business Acquisitions by Acquisition, Contingent Consideration	The following is a reconciliation of changes in contingent earn-out obligations for the three and six months ended June 30, 2021: Three months ended Six months ended Beginning balance $ 28,225 $ 30,248 Acquisitions 2,156 2,694 Foreign currency translation 3,055 975 Fair value remeasurements 60 (154) Payments (5,154) (5,421) Ending balance $ 28,342 $ 28,342

Fair value of financial instr_2

Fair value of financial instruments (Tables)	6 Months Ended
	Jun. 30, 2021
Fair Value Disclosures [Abstract]
Assets, Liabilities and Temporary Equity Measured at Fair Value on a Recurring Basis	The following table summarizes the Company’s assets, liabilities and temporary equities measured at fair value on a recurring basis as of June 30, 2021: Total Quoted prices in Significant other Significant Assets Investments in equity securities $ 62,256 $ 62,256 $ — $ — Interest rate cap agreements $ 6,432 $ — $ 6,432 $ — Liabilities Contingent earn-out obligations $ 28,342 $ — $ — $ 28,342 Temporary equity Noncontrolling interests subject to put provisions $ 1,426,211 $ — $ — $ 1,426,211

Segment reporting (Tables)

Segment reporting (Tables)	6 Months Ended
	Jun. 30, 2021
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 income (loss), and a reconciliation of segment operating income (loss) to consolidated income before income taxes: Three months ended June 30, Six months ended June 30, 2021 2020 2021 2020 Segment revenues: U.S. dialysis Dialysis patient service revenues: External sources $ 2,648,676 $ 2,631,827 $ 5,204,936 $ 5,211,067 Intersegment revenues 21,247 35,122 48,190 67,062 U.S. dialysis patient service revenues 2,669,923 2,666,949 5,253,126 5,278,129 Other revenues (1) : External sources 6,345 7,688 12,961 12,830 Intersegment revenues 70 307 130 608 Total U.S. dialysis revenues 2,676,338 2,674,944 5,266,217 5,291,567 Other—Ancillary services Dialysis patient service revenues 169,281 126,370 327,608 260,411 Other external sources 92,208 114,094 191,006 236,908 Intersegment revenues — 4,171 4,294 8,324 Total ancillary services revenues 261,489 244,635 522,908 505,643 Total net segment revenues 2,937,827 2,919,579 5,789,125 5,797,210 Elimination of intersegment revenues (21,317) (39,600) (52,614) (75,994) Consolidated revenues $ 2,916,510 $ 2,879,979 $ 5,736,511 $ 5,721,216 Segment operating income (loss): U.S. dialysis $ 533,779 $ 522,630 $ 1,013,686 $ 1,014,236 Other—Ancillary services (17,808) (39,622) (29,668) (42,268) Total segment operating income 515,971 483,008 984,018 971,968 Reconciliation of segment operating income to consolidated Corporate administrative support (25,495) (73,088) (50,940) (96,672) Consolidated operating income 490,476 409,920 933,078 875,296 Debt expense (73,324) (81,381) (140,338) (169,984) Debt refinancing charges — — — (2,948) Other income, net 15,188 9,545 16,356 5,195 Consolidated income from continuing operations $ 432,340 $ 338,084 $ 809,096 $ 707,559 (1) Includes management fee revenue from providing management and administrative services to dialysis ventures in which the Company owns a noncontrolling equity investment or which are wholly-owned by third parties.
Summary of Depreciation and Amortization Expense by Reportable Segment	Depreciation and amortization expense by reportable segment was as follows: Three months ended June 30, Six months ended June 30, 2021 2020 2021 2020 U.S. dialysis $ 159,856 $ 148,312 $ 315,802 $ 294,612 Other—Ancillary services 9,833 9,064 19,588 17,443 $ 169,689 $ 157,376 $ 335,390 $ 312,055
Summary of Expenditures for Property and Equipment by Reportable Segment	Expenditures for property and equipment by reportable segment were as follows: Six months ended June 30, 2021 2020 U.S. dialysis $ 271,884 $ 280,801 Other—Ancillary services 22,554 10,866 $ 294,438 $ 291,667
Summary of Assets by Reportable Segment	A summary of assets by reportable segment was as follows: June 30, 2021 December 31, 2020 U.S. dialysis $ 16,084,542 $ 15,344,647 Other—Ancillary services 1,725,769 1,643,869 Consolidated assets $ 17,810,311 $ 16,988,516

Revenue Recognition Segment R_2

Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Disaggregation of Revenue [Line Items]
Other revenues	$ 98,553	$ 121,782	$ 203,967	$ 249,738
Total revenues	2,916,510	2,879,979	5,736,511	5,721,216
Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(21,317)	(39,600)	(52,614)	(75,994)
Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Patient service revenues	1,562,164	1,547,113	3,042,461	3,078,146
Other revenues	80,211	99,829	165,807	198,307
Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Patient service revenues	194,641	182,324	381,884	353,791
Other revenues	305	283	605	649
Other Government Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	200,781	177,767	387,794	355,439
Commercial Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	881,618	886,115	1,768,595	1,751,164
Other revenues	1,189	9,050	7,223	19,571
Other
Disaggregation of Revenue [Line Items]
Other revenues	16,918	17,098	34,756	40,143
U.S. dialysis
Disaggregation of Revenue [Line Items]
Total revenues	2,655,021	2,639,515	5,217,897	5,223,897
U.S. dialysis | Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(21,317)	(35,429)	(48,320)	(67,670)
U.S. dialysis | Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Patient service revenues	1,562,164	1,547,113	3,042,461	3,078,146
U.S. dialysis | Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Patient service revenues	194,641	182,324	381,884	353,791
U.S. dialysis | Other Government Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	82,317	86,954	162,501	170,052
U.S. dialysis | Commercial Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	830,801	850,558	1,666,280	1,676,140
U.S. dialysis | Other
Disaggregation of Revenue [Line Items]
Other revenues	6,415	7,995	13,091	13,438
Other—Ancillary services
Disaggregation of Revenue [Line Items]
Total revenues	261,489	240,464	518,614	497,319
Other—Ancillary services | Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	0	(4,171)	(4,294)	(8,324)
Other—Ancillary services | Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Other revenues	80,211	99,829	165,807	198,307
Other—Ancillary services | Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Other revenues	305	283	605	649
Other—Ancillary services | Other Government Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	118,464	90,813	225,293	185,387
Other—Ancillary services | Commercial Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	50,817	35,557	102,315	75,024
Other revenues	1,189	9,050	7,223	19,571
Other—Ancillary services | Other
Disaggregation of Revenue [Line Items]
Other revenues	$ 10,503	$ 9,103	$ 21,665	$ 26,705

Earnings per share Earnings p_2

Earnings per share Earnings per share - Reconciliation of numberators and denominators used to calculate basic and diluted earnings per share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Numerators:
Net income from continuing operations attributable to DaVita Inc.	$ 293,820	$ 201,602	$ 531,223	$ 431,215
Net income from discontinued operations attributable to DaVita Inc.	0	0	0	9,980
Net income attributable to DaVita Inc.	$ 293,820	$ 201,602	$ 531,223	$ 441,195
Weighted average shares outstanding during period	106,364,000	122,074,000	107,606,000	123,485,000
Assumed incremental from stock plans	5,059,000	1,994,000	4,949,000	1,994,000
Weighted average shares for diluted earnings per share calculation	111,423,000	124,068,000	112,555,000	125,479,000
Basic:
Basic net income from continuing operations	$ 2.76	$ 1.65	$ 4.94	$ 3.49
Basic net income (loss) from discontinued operations per share	0	0	0	0.08
Basic net income per share attributable to DaVita Inc.	2.76	1.65	4.94	3.57
Diluted:
Diluted net income from continuing operations	2.64	1.62	4.72	3.44
Diluted net income from discontinued operations per share	0	0	0	0.08
Diluted net income per share attributable to DaVita Inc.	$ 2.64	$ 1.62	$ 4.72	$ 3.52
Anti-dilutive stock-settled awards excluded from calculation	141,000	3,216,000	84,000	3,211,000

Investments in debt and equit_3

Investments in debt and equity securities (Detail) - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020
Investment Holdings [Line Items]
Debt securities	$ 8,222	$ 8,217
Investments in equity securities	62,256	44,077
Total	70,478	52,294
Debt securities, short-term investments	8,222	8,217
Total, short-term investments	36,701	20,101
Debt securities, long-term investments	0	0
Total, long-term investments	33,777	32,193
Certificates of deposit and other time deposits
Investment Holdings [Line Items]
Debt securities	8,222	8,217
Investments in equity securities	0	0
Total	8,222	8,217
Investments in mutual funds and common stocks
Investment Holdings [Line Items]
Debt securities	0	0
Investments in equity securities	62,256	44,077
Total	62,256	44,077
Short-term Investments
Investment Holdings [Line Items]
Investments in equity securities	28,479	11,884
Long-term Investments
Investment Holdings [Line Items]
Investments in equity securities	$ 33,777	$ 32,193

Short-term and Long-term Invest

Short-term and Long-term Investments (Details) $ in Thousands	3 Months Ended
	Jun. 30, 2021USD ($)
Investment Holdings [Line Items]
Equity Securities, FV-NI, Unrealized Gain	$ 8,328
Short-term Investments
Investment Holdings [Line Items]
Equity Securities Fv Ni Reclassified To Short Term Investments	$ 25,579

Goodwill - Changes in Goodwill

Goodwill - Changes in Goodwill by Reportable Segments (Detail) - USD ($) $ in Thousands	6 Months Ended	12 Months Ended
	Jun. 30, 2021	Dec. 31, 2020
Goodwill [Roll Forward]
Beginning balance	$ 6,919,109	$ 6,787,635
Acquisitions	28,323	130,057
Divestitures		(8,293)
Foreign currency and other adjustments	(3,767)	9,710
Ending balance	6,943,665	6,919,109
Goodwill, before accumulated impairment charges	7,075,816
Accumulated impairment charges	(132,151)
Ending balance	6,943,665	6,919,109
U.S. dialysis
Goodwill [Roll Forward]
Beginning balance	6,309,928	6,287,100
Acquisitions	3,481	24,377
Divestitures		(1,549)
Foreign currency and other adjustments	0	0
Ending balance	6,313,409	6,309,928
Goodwill, before accumulated impairment charges	6,313,409
Accumulated impairment charges	0
Ending balance	6,313,409	6,309,928
Other—Ancillary services
Goodwill [Roll Forward]
Beginning balance	609,181	500,535
Acquisitions	24,842	105,680
Divestitures		(6,744)
Foreign currency and other adjustments	(3,767)	9,710
Ending balance	630,256	609,181
Goodwill, before accumulated impairment charges	762,407
Accumulated impairment charges	(132,151)
Ending balance	$ 630,256	$ 609,181

Goodwill - Narrative (Details)

Goodwill - Narrative (Details) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2021segment	Jun. 30, 2021USD ($)	Jun. 30, 2020USD ($)
Goodwill [Line Items]
Goodwill impairment charges | $		$ 0	$ 0
Other Health Operations
Goodwill [Line Items]
Number of Reportable Segments | segment	0

Income Taxes (Details)

Income Taxes (Details)	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Income Tax Disclosure [Abstract]
Effective Income Tax Rate Reconciliation, Percent	18.80%	24.60%	20.60%	24.70%

Long-term debt (Detail)

Long-term debt (Detail) - USD ($) $ in Thousands	Feb. 26, 2021	Jun. 09, 2020	Jun. 30, 2021	Jun. 30, 2021	Dec. 31, 2020
Senior Secured Credit Facilities
Debt interest rate during period			3.36%	3.22%
Long-term debt, weighted average interest rate, at point in time			3.33%	3.33%
Total debt principal outstanding			$ 9,045,563	$ 9,045,563	$ 8,163,521
Discount and deferred financing costs			(62,865)	(62,865)	(77,717)
Carrying amount of long-term debt, net of unamortized discounts			8,982,698	8,982,698	8,085,804
Less current portion			(184,435)	(184,435)	(168,541)
Total long-term debt			8,798,263	8,798,263	7,917,263
Senior Notes Four Point Six Two Five Percent Due Twenty Thirty
Senior Secured Credit Facilities
Senior Notes		$ 1,750,000	2,750,000	$ 2,750,000	1,750,000
Debt interest rate during period		4.625%		4.625%
Debt Instrument, Maturity Date	Jun. 1, 2030			Jun. 1, 2030
Debt Instrument, Fair Value Disclosure			2,825,625	$ 2,825,625
Senior Notes Three Point Seven Five Percent Due Twenty Thirty One
Senior Secured Credit Facilities
Senior Notes			1,500,000	$ 1,500,000	1,500,000
Debt interest rate during period				3.75%
Debt Instrument, Maturity Date				Feb. 15, 2031
Debt Instrument, Fair Value Disclosure			1,443,750	$ 1,443,750
Acquisition obligations and other notes payable
Senior Secured Credit Facilities
Acquisition obligations and other notes payable			$ 151,425	$ 151,425	164,160
Debt instrument, maturity date, description				2021-2036
Long-term debt, weighted average interest rate, at point in time			4.99%	4.99%
Acquisition obligations and other notes payable, fair value			$ 151,425	$ 151,425
Financing lease obligations
Senior Secured Credit Facilities
Financing lease obligations			$ 301,535	$ 301,535	274,292
Debt instrument, maturity date, description				2022-2038
Finance lease, weighted average discount rate, percent			4.68%	4.68%
Revolving line of credit
Senior Secured Credit Facilities
Secured Debt			$ 0	$ 0	75,000
Debt Instrument, Description of Variable Rate Basis				LIBOR + 1.50%
Debt Instrument, Maturity Date				Aug. 12, 2024
Term Loan A
Senior Secured Credit Facilities
Secured Debt			1,640,625	$ 1,640,625	1,684,375
Debt Instrument, Description of Variable Rate Basis				LIBOR + 1.50%
Debt Instrument, Maturity Date				Aug. 12, 2024
Debt Instrument, Fair Value Disclosure			1,640,625	$ 1,640,625
Term Loan B-1
Senior Secured Credit Facilities
Secured Debt			2,701,978	$ 2,701,978	2,715,694
Debt Instrument, Description of Variable Rate Basis				LIBOR + 1.75%
Debt Instrument, Maturity Date				Aug. 12, 2026
Debt Instrument, Fair Value Disclosure			$ 2,691,846	$ 2,691,846
Senior Secured Credit Facilities
Senior Secured Credit Facilities
Long-term debt, weighted average interest rate, at point in time			2.16%	2.16%
Debt Instrument, table footnotes
Debt Instrument, Unamortized Discount			$ 4,965	$ 4,965	5,461
Deferred Offering Costs			31,488	31,488	35,825
Senior Notes
Debt Instrument, table footnotes
Debt Instrument, Unamortized Premium			(16,854)	(16,854)
Deferred Offering Costs			$ 43,266	$ 43,266	$ 36,431

Long-term debt Schedule of Deri

Long-term debt Schedule of Derivative Instruments (Details) - 2019 Interest Rate Cap Agreements Effective June 30, 2020 - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2021	Dec. 31, 2020
Derivative [Line Items]
Derivative, effective date	Jun. 30, 2020
Derivative, expiration date	Jun. 30, 2024
Other Long-term Assets
Derivative [Line Items]
Derivative asset, fair value, gross asset	$ 6,432	$ 2,671
Debt Expense | Cash Flow Hedging
Derivative [Line Items]
Amount of debt expense reclassified from accumulated OCI into income	2,754
Other Comprehensive Income (Loss), Unrealized Gain (Loss) on Derivatives Arising During Period, before Tax	3,761
Term Loan Facility | Maximum
Derivative [Line Items]
Notional amounts of interest rate agreements	$ 3,500,000
LIBOR plus interest rate margin	2.00%

Long-term debt - Additional Inf

Long-term debt - Additional Information (Detail) - USD ($) $ in Thousands	Feb. 26, 2021	Jun. 09, 2020	Jun. 30, 2021	Jun. 30, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Weighted average effective interest rate at quarter end			3.33%	3.33%
Weighted average effective interest rate during quarter			3.36%	3.22%
Percentage of debt instruments bearing fixed interest rate			51.00%	51.00%
Senior Notes Four Point Six Two Five Percent Due Twenty Thirty
Debt Instrument [Line Items]
Additional Debt Principal Amount Due To New Agreement	$ 1,000,000
Debt Instrument Offering Price Percentage Of Face Amount	101.75%
Debt Instrument, Maturity Date	Jun. 1, 2030			Jun. 1, 2030
Senior Notes		$ 1,750,000	$ 2,750,000	$ 2,750,000	$ 1,750,000
Debt Instrument related fees, discounts, and other professional expenses			9,089	$ 9,089
Weighted average effective interest rate during quarter		4.625%		4.625%
Revolving line of credit
Debt Instrument [Line Items]
Debt Instrument, Maturity Date				Aug. 12, 2024
Maximum borrowing capacity on the revolving credit facilities			1,000,000	$ 1,000,000
Letter of Credit
Debt Instrument [Line Items]
Letters of credit outstanding			0	0
Bilateral Secured Letter Of Credit Facility
Debt Instrument [Line Items]
Letters of credit outstanding			69,405	69,405
Term Loan A
Debt Instrument [Line Items]
Debt Instrument, Periodic Payment, Principal				$ 43,750
Debt Instrument, Maturity Date				Aug. 12, 2024
Secured Debt Outstanding Principal Balance Subject To LIBOR			$ 842,603	$ 842,603
Term Loan B-1
Debt Instrument [Line Items]
Debt Instrument, Periodic Payment, Principal				$ 13,716
Debt Instrument, Maturity Date				Aug. 12, 2026
Senior Secured Credit Facilities
Debt Instrument [Line Items]
Weighted average effective interest rate at quarter end			2.16%	2.16%

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Detail) $ in Thousands	Aug. 15, 2017legal_matter	Dec. 31, 2017USD ($)	Jun. 30, 2021USD ($)
Commitments and Contingencies:
Corporate Integrity Agreement Period			5 years
Corporate Integrity Agreement Expiration Date			Oct. 22, 2019
Commitments to provide operating capital
Commitments and Contingencies:
Other potential commitments to provide operating capital to several dialysis centers			$ 11,455
US Attorney Prescription Drug Investigation
Commitments and Contingencies:
Litigation Settlement, Amount Awarded to Other Party		$ 63,700
Stockholder Derivative Litigation
Commitments and Contingencies:
Loss Contingency Number of Previously Disclosed Lawsuits Consolidated Into One | legal_matter	3
Incremental Cash Portion | US Attorney Prescription Drug Investigation
Commitments and Contingencies:
Litigation Settlement, Amount Awarded to Other Party		41,500
Cash Paid For Portion Previously Refunded | US Attorney Prescription Drug Investigation
Commitments and Contingencies:
Litigation Settlement, Amount Awarded to Other Party		$ 22,200

Long-term incentive compensatio

Long-term incentive compensation (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2021USD ($)shares
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Unrecognized compensation cost related to nonvested stock-based compensation arrangements under equity compensation and stock purchase plans	$ 204,649
Unrecognized compensation cost related to nonvested stock-based compensation arrangements under stock-based component of LTIP costs, weighted average remaining period (in years)	1 year 4 months 24 days
Restricted stock units and Performance stock units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period | shares	714,000
Aggregate grant-date fair value	$ 78,287
Weighted-average expected life (in years)	3 years 6 months
Stock Appreciation Rights
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Aggregate grant-date fair value	$ 4,250
Weighted-average expected life (in years)	4 years 6 months
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Net of Forfeitures | shares	132,000

Share repurchases Share Repur_2

Share repurchases Share Repurchase Table (Details) - Open Market Purchases - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Equity, Class of Treasury Stock [Line Items]
Repurchase of common stock (in shares)	2,070	0	5,019	4,052
Treasury Stock, Value, Acquired, Cost Method	$ 240,897	$ 0	$ 563,230	$ 303,139
Treasury Stock Acquired, Average Cost Per Share	$ 116.38	$ 0	$ 112.21	$ 74.81

Share repurchases (Details)

Share repurchases (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	1 Months Ended
	Aug. 02, 2021	Dec. 10, 2020
Equity, Class of Treasury Stock [Line Items]
Stock Repurchase Program, Authorized Amount		$ 2,000,000
Terminated Remaining Prior Share Repurchases Authorized, Amount		$ 329,302
Subsequent Event
Equity, Class of Treasury Stock [Line Items]
Repurchase of common stock (in shares)	890
Treasury Stock, Value, Acquired, Cost Method	$ 107,199
Treasury Stock Acquired, Average Cost Per Share	$ 120.50
Stock Repurchase Program, Remaining Authorized Repurchase Amount	$ 1,259,527

Accumulated other comprehensi_3

Accumulated other comprehensive (loss) income (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance			$ (66,154)
Ending balance	$ (65,899)		(65,899)
Interest rate cap agreements
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance	(6,551)	$ (12,828)	(12,466)	$ (1,433)
Unrealized gains (losses)	(2,744)	(2,431)	3,761	(19,777)
Related income tax benefit	685	607	(938)	4,935
Unrealized (losses) gains net	(2,059)	(1,824)	2,823	(14,842)
Reclassification into net income	1,377	2,163	2,754	4,326
Related income tax	(344)	(540)	(688)	(1,080)
Reclassification from accumulated other comprehensive income into net income net of tax	1,033	1,623	2,066	3,246
Ending balance	(7,577)	(13,029)	(7,577)	(13,029)
Foreign currency translation adjustments
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance	(116,232)	(127,697)	(53,688)	(46,065)
Unrealized gains (losses)	57,910	5,619	(4,634)	(76,013)
Related income tax benefit	0	0	0	0
Unrealized (losses) gains net	57,910	5,619	(4,634)	(76,013)
Reclassification into net income	0	0	0	0
Related income tax	0	0	0	0
Reclassification from accumulated other comprehensive income into net income net of tax	0	0	0	0
Ending balance	(58,322)	(122,078)	(58,322)	(122,078)
Accumulated other comprehensive (loss) income
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance	(122,783)	(140,525)	(66,154)	(47,498)
Unrealized gains (losses)	55,166	3,188	(873)	(95,790)
Related income tax benefit	685	607	(938)	4,935
Unrealized (losses) gains net	55,851	3,795	(1,811)	(90,855)
Reclassification into net income	1,377	2,163	2,754	4,326
Related income tax	(344)	(540)	(688)	(1,080)
Reclassification from accumulated other comprehensive income into net income net of tax	1,033	1,623	2,066	3,246
Ending balance	$ (65,899)	$ (135,107)	$ (65,899)	$ (135,107)

Acquisitions and Divestitures A

Acquisitions and Divestitures Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020	Dec. 31, 2019
Business Acquisition [Line Items]
Goodwill	$ 6,943,665	$ 6,919,109	$ 6,787,635
Dialysis and other businesses
Business Acquisition [Line Items]
Current assets	3,832
Property and equipment	1,853
Other long-term assets	2,259
Indefinite-lived licenses	1,593
Goodwill	28,323
Liabilities assumed	6,726
Noncontrolling interests	1,249
Total assets acquired and liabilities assumed	$ 29,885

Acquisitions and divestitures C

Acquisitions and divestitures Contingent Earn-out obligations (Details) - Dialysis and other businesses - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2021
Business Acquisition [Line Items]
Contingent Earn-out Obligations, Beginning balance	$ 28,225	$ 30,248
Acquisitions	2,156	2,694
Foreign currency translation	3,055	975
Fair value remeasurements	60	(154)
Payments	(5,154)	(5,421)
Contingent Earn-out Obligations, Ending balance	$ 28,342	$ 28,342

Acquisitions and divestitures -

Acquisitions and divestitures - Additional Information (Detail) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021USD ($)	Jun. 30, 2020USD ($)	Jun. 30, 2021USD ($)clinic	Jun. 30, 2020USD ($)
Business Acquisition [Line Items]
Cash paid to acquire businesses			$ 23,890	$ 44,267
Goodwill deductible for tax purposes associated with acquisitions	$ 27,159		27,159
Additional tax benefits recognized under the Coronavirus Aid, Relied, and Economic Security Act	0	$ 0	0	$ 9,980
Other current liabilities
Business Acquisition [Line Items]
Contingent earn-out obligations	11,389		11,389
Other long-term liabilities
Business Acquisition [Line Items]
Contingent earn-out obligations	16,953		16,953
Other companies
Business Acquisition [Line Items]
Contingent earn-out obligations	$ 28,342		$ 28,342
Minimum | Other companies | EBITDA or Operating Income Performance Targets or Quality Margins
Business Acquisition [Line Items]
Earn-out consideration payment period			1 year
Maximum
Business Acquisition [Line Items]
Contingent earn-out obligations and liabilities assumed associated with acquisitions			$ 42,581
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			$ 23,890
Contingent earn-out obligations and liabilities assumed associated with acquisitions			2,694
Deferred purchase price obligations			$ 3,301
U.S. dialysis | Dialysis and other businesses
Business Acquisition [Line Items]
Number of businesses acquired | clinic			1
Foreign Dialysis Centers | Dialysis and other businesses
Business Acquisition [Line Items]
Number of businesses acquired | clinic			7

Variable interest entities - Ad

Variable interest entities - Additional Information (Detail) - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020
Assets	$ 17,810,311	$ 16,988,516
Liabilities	14,921,274	$ 14,091,736
Variable Interest Entity
Assets	316,881
Liabilities	$ 206,326

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	Jun. 30, 2021	Dec. 31, 2020
Assets
Investments in equity securities	$ 62,256	$ 44,077
Fair Value, Measurements, Recurring
Assets
Investments in equity securities	62,256
Liabilities
Contingent earn-out obligations	28,342
Temporary equity
Noncontrolling interests subject to put provisions	1,426,211
Fair Value, Measurements, Recurring | Interest rate cap agreements
Assets
Interest rate cap agreements	6,432
Fair Value, Measurements, Recurring | Quoted prices in active markets for identical assets (Level 1)
Assets
Investments in equity securities	62,256
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	6,432
Fair Value, Measurements, Recurring | Significant unobservable inputs (Level 3)
Assets
Investments in equity securities	0
Liabilities
Contingent earn-out obligations	28,342
Temporary equity
Noncontrolling interests subject to put provisions	1,426,211
Fair Value, Measurements, Recurring | Significant unobservable inputs (Level 3) | Interest rate cap agreements
Assets
Interest rate cap agreements	$ 0

Fair value of financial instr_4

Fair value of financial instruments Fair Value of Financial Instruments (Details) $ in Thousands	3 Months Ended
	Jun. 30, 2021USD ($)
Fair Value Disclosures [Abstract]
Potential Increase Decrease In Fair Value Of Noncontrolling Interests Due To Change In Weighted Average EBITDA Multiple	$ 180,000

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		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Segment Reporting Information [Line Items]
Other revenues	$ 98,553	$ 121,782	$ 203,967	$ 249,738
Total revenues	2,916,510	2,879,979	5,736,511	5,721,216
Operating income (loss)	490,476	409,920	933,078	875,296
Corporate administrative support	(25,495)	(73,088)	(50,940)	(96,672)
Debt expense	(73,324)	(81,381)	(140,338)	(169,984)
Debt refinancing charges	0	0	0	(2,948)
Other income, net	15,188	9,545	16,356	5,195
Income from continuing operations before income taxes	432,340	338,084	809,096	707,559
U.S. dialysis
Segment Reporting Information [Line Items]
Total revenues	2,655,021	2,639,515	5,217,897	5,223,897
Other—Ancillary services
Segment Reporting Information [Line Items]
Total revenues	261,489	240,464	518,614	497,319
Operating Segments
Segment Reporting Information [Line Items]
Total revenues	2,937,827	2,919,579	5,789,125	5,797,210
Operating income (loss)	515,971	483,008	984,018	971,968
Operating Segments | U.S. dialysis
Segment Reporting Information [Line Items]
Dialysis patient service revenues	2,669,923	2,666,949	5,253,126	5,278,129
Total revenues	2,676,338	2,674,944	5,266,217	5,291,567
Operating income (loss)	533,779	522,630	1,013,686	1,014,236
Operating Segments | U.S. dialysis | External Sources
Segment Reporting Information [Line Items]
Dialysis patient service revenues	2,648,676	2,631,827	5,204,936	5,211,067
Other revenues	6,345	7,688	12,961	12,830
Operating Segments | U.S. dialysis | Intersubsegment Eliminations
Segment Reporting Information [Line Items]
Dialysis patient service revenues	21,247	35,122	48,190	67,062
Other revenues	70	307	130	608
Operating Segments | Other—Ancillary services
Segment Reporting Information [Line Items]
Dialysis patient service revenues	169,281	126,370	327,608	260,411
Other revenues	92,208	114,094	191,006	236,908
Total revenues	261,489	244,635	522,908	505,643
Operating income (loss)	(17,808)	(39,622)	(29,668)	(42,268)
Operating Segments | Other—Ancillary services | Intersubsegment Eliminations
Segment Reporting Information [Line Items]
Dialysis patient service revenues	0	4,171	4,294	8,324
Intersegment Elimination
Segment Reporting Information [Line Items]
Total revenues	(21,317)	(39,600)	(52,614)	(75,994)
Intersegment Elimination | U.S. dialysis
Segment Reporting Information [Line Items]
Total revenues	(21,317)	(35,429)	(48,320)	(67,670)
Intersegment Elimination | Other—Ancillary services
Segment Reporting Information [Line Items]
Total revenues	$ 0	$ (4,171)	$ (4,294)	$ (8,324)

Segment reporting - Summary o_2

Segment reporting - Summary of Depreciation and Amortization Expense by Segment (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 169,689	$ 157,376	$ 335,390	$ 312,055
U.S. dialysis
Segment Reporting Information [Line Items]
Depreciation and amortization	159,856	148,312	315,802	294,612
Other—Ancillary services
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 9,833	$ 9,064	$ 19,588	$ 17,443

Segment reporting - Summary o_3

Segment reporting - Summary of Expenditures for Property and Equipment by Segment (Detail) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020
Segment Reporting Information [Line Items]
Expenditures for property and equipment	$ 294,438	$ 291,667
U.S. dialysis
Segment Reporting Information [Line Items]
Expenditures for property and equipment	271,884	280,801
Other—Ancillary services
Segment Reporting Information [Line Items]
Expenditures for property and equipment	$ 22,554	$ 10,866

Segment reporting - Summary o_4

Segment reporting - Summary of Assets by Segment (Detail) - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020
ASSETS
Total assets	$ 17,810,311	$ 16,988,516
U.S. dialysis
ASSETS
Total assets	16,084,542	15,344,647
Other—Ancillary services
ASSETS
Total assets	$ 1,725,769	$ 1,643,869