DaVita (DVA) 10-Q 3 Aug 23 2023 Q2 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares shares in Millions	6 Months Ended
	Jun. 30, 2023	Aug. 01, 2023
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Jun. 30, 2023
Document Transition Report	false
Entity File Number	1-14106
Entity Registrant Name	DAVITA INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	51-0354549
Entity Address, Address Line One	2000 16th Street
Entity Address, City or Town	Denver,
Entity Address, State or Province	CO
Entity Address, Postal Zip Code	80202
City Area Code	720
Local Phone Number	631-2100
Title of 12(b) Security	Common Stock, $0.001 par value
Trading Symbol	DVA
Security Exchange Name	NYSE
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		91.3
Amendment Flag	false
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	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, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Income Statement [Abstract]
Dialysis patient service revenues	$ 2,890,685	$ 2,810,099	$ 5,650,719	$ 5,526,380
Other revenues	109,684	116,658	222,349	217,932
Total revenues	3,000,369	2,926,757	5,873,068	5,744,312
Operating expenses:
Patient care costs	2,055,844	2,016,788	4,114,033	4,035,317
General and administrative	364,016	315,219	695,630	610,039
Depreciation and amortization	183,672	171,176	361,743	344,120
Equity investment income, net	(8,454)	(9,141)	(15,274)	(16,187)
Total operating expenses	2,595,078	2,494,042	5,156,132	4,973,289
Operating income	405,291	432,715	716,936	771,023
Debt expense	(103,507)	(82,586)	(204,281)	(156,377)
Debt prepayment and refinancing charges	7,962	0	7,962	0
Other income (loss), net	1,373	(1,284)	5,125	(3,070)
Income before income taxes	295,195	348,845	509,818	611,576
Income tax expense	48,818	64,229	92,773	121,242
Net income	246,377	284,616	417,045	490,334
Less: Net income attributable to noncontrolling interests	(67,686)	(59,807)	(122,807)	(103,403)
Net income attributable to DaVita Inc.	$ 178,691	$ 224,809	$ 294,238	$ 386,931
Earnings per share attributable to DaVita Inc.:
Basic net income	$ 1.96	$ 2.38	$ 3.24	$ 4.06
Diluted net income	$ 1.91	$ 2.30	$ 3.17	$ 3.90
Weighted average shares for earnings per share:
Basic shares	90,984,000	94,457,000	90,742,000	95,382,000
Diluted shares	93,418,000	97,772,000	92,952,000	99,121,000

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (unaudited) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Statement of Comprehensive Income [Abstract]
Net income	$ 246,377	$ 284,616	$ 417,045	$ 490,334
Unrealized gains on interest rate cap agreements:
Unrealized gains	24,849	13,217	21,310	54,349
Reclassifications of net realized (gains) losses into net income	(18,956)	1,033	(34,698)	2,066
Unrealized gains (losses) on foreign currency translation:	41,961	(91,176)	75,522	(28,964)
Other comprehensive income (loss)	47,854	(76,926)	62,134	27,451
Total comprehensive income	294,231	207,690	479,179	517,785
Less: Comprehensive income attributable to noncontrolling interests	(67,686)	(59,807)	(122,807)	(103,403)
Comprehensive income attributable to DaVita Inc.	$ 226,545	$ 147,883	$ 356,372	$ 414,382

CONSOLIDATED BALANCE SHEETS (un

CONSOLIDATED BALANCE SHEETS (unaudited) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
ASSETS
Cash and Cash Equivalents, at Carrying Value	$ 327,443	$ 244,086
Restricted Cash and Cash Equivalents	94,727	94,903
Short-term investments	12,484	77,693
Accounts receivable, net	2,009,692	2,132,070
Inventories	110,299	109,122
Other receivables	354,921	413,976
Prepaid and other current assets	90,061	78,839
Income tax receivable	2,341	4,603
Total current assets	3,001,968	3,155,292
Property and equipment, net	3,158,450	3,256,397
Operating lease right-of-use assets	2,547,053	2,666,242
Intangible assets, net	191,849	182,687
Equity method and other investments	593,269	231,108
Long-term investments	46,005	44,329
Other long-term assets	314,009	315,587
Goodwill	7,106,242	7,076,610
Total assets	16,958,845	16,928,252
LIABILITIES AND EQUITY
Accounts payable	427,894	479,780
Other liabilities	817,608	802,469
Accrued compensation and benefits	630,289	692,654
Current portion of operating lease liabilities	394,465	395,401
Current portion of long-term debt	101,113	231,404
Income tax payable	32,049	18,039
Total current liabilities	2,403,418	2,619,747
Long-term operating lease liabilities	2,384,471	2,503,068
Long-term debt	8,598,162	8,692,617
Other long-term liabilities	183,137	105,233
Deferred income taxes	760,038	782,787
Total liabilities	14,329,226	14,703,452
Commitments and contingencies:
Noncontrolling interests subject to put provisions	1,423,549	1,348,908
Equity:
Preferred Stock, Value, Issued	0	0
Common Stock, Value, Issued	91	90
Additional paid-in capital	555,680	606,935
Retained earnings	468,725	174,487
Accumulated other comprehensive loss	(7,052)	(69,186)
Total DaVita Inc. shareholders' equity	1,017,444	712,326
Noncontrolling interests not subject to put provisions	188,626	163,566
Total equity	1,206,070	875,892
Total liabilities and equity	$ 16,958,845	$ 16,928,252

CONSOLIDATED BALANCE SHEETS (_2

CONSOLIDATED BALANCE SHEETS (unaudited) (Parenthetical) - USD ($) shares in Thousands, $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Property and equipment, accumulated depreciation	$ 5,503,439	$ 5,265,372
Intangible assets, accumulated amortization	$ 39,766	$ 49,772
Preferred stock, par value (usd per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	5,000	5,000
Preferred stock, issued (in shares)	0	0
Common stock, par value (usd per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	450,000	450,000
Common stock, shares issued (in shares)	91,271	90,411
Common stock, shares outstanding (in shares)	91,271	90,411

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS (unaudited) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022
Cash flows from operating activities:
Net income	$ 417,045	$ 490,334
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	361,743	344,120
Debt prepayment and refinancing charges	7,132	0
Stock-based compensation expense	55,197	50,109
Deferred income taxes	(16,178)	9,069
Equity investment loss, net	14,571	90
Other non-cash charges, net	(5,160)	(32,858)
Changes in operating assets and liabilities, net of effect of acquisitions and divestitures:
Accounts receivable	141,503	(132,043)
Inventories	(116)	(1,927)
Other receivables and prepaid and other current assets	33,182	(61,811)
Other long-term assets	(607)	(49,093)
Accounts payable	(40,615)	24,517
Accrued compensation and benefits	(68,800)	(102,513)
Other current liabilities	17,242	42,517
Income taxes	5,200	(63,638)
Other long-term liabilities	(8,675)	(6,557)
Net cash provided by operating activities	912,664	510,316
Cash flows from investing activities:
Additions of property and equipment	(272,204)	(265,461)
Acquisitions	(2,575)	(9,491)
Proceeds from asset and business sales	21,198	114,829
Purchase of debt investments held-to-maturity	(30,419)	(89,530)
Purchase of other debt and equity investments	(6,366)	(3,010)
Proceeds from debt investments held-to-maturity	94,414	8,415
Proceeds from sale of other debt and equity investments	3,873	3,775
Purchase of equity method investments	(273,336)	(23,806)
Distributions from equity method investments	1,758	1,047
Net cash used in investing activities	(463,657)	(263,232)
Cash flows from financing activities:
Borrowings	2,136,873	1,182,911
Payments on long-term debt	(2,347,120)	(841,687)
Deferred and debt related financing costs	(45,009)	0
Purchase of treasury stock	0	(617,432)
Distributions to noncontrolling interests	(124,178)	(118,315)
Net payments related to stock purchases and awards	(43,612)	(47,866)
Contributions from noncontrolling interests	6,946	9,116
Proceeds from sales of additional noncontrolling interests	50,962	3,673
Purchases of noncontrolling interests	(7,610)	(15,365)
Net cash used in financing activities	(372,748)	(444,965)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	6,922	(1,342)
Net increase (decrease) in cash, cash equivalents and restricted cash	83,181	(199,223)
Cash, cash equivalents and restricted cash at beginning of the year	338,989	554,960
Cash, cash equivalents and restricted cash at end of the period	$ 422,170	$ 355,737

CONSOLIDATED STATEMENTS OF EQUI

CONSOLIDATED STATEMENTS OF EQUITY (unaudited) - USD ($) shares in Thousands, $ in Thousands	Total	Total	Non- controlling interests subject to put provisions	Common stock	Additional paid-in capital	Retained earnings	Treasury stock	Accumulated other comprehensive loss	Non- controlling interests not subject to put provisions
Temporary equity, starting balance at Dec. 31, 2021			$ 1,434,832
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income			73,952
Distributions			(77,259)
Contributions			7,304
Acquisitions and divestitures			2,392
Partial purchases			(11,418)
Fair value remeasurements			(44,439)
Other			457
Temporary equity, ending balance at Jun. 30, 2022			1,385,821
Beginning balance at Dec. 31, 2021		$ 755,508		$ 97	$ 540,321	$ 354,337	$ 0	$ (139,247)	$ 180,640
Common stock, Beginning balance (in shares) at Dec. 31, 2021				97,289
Treasury stock, beginning balance (in shares) at Dec. 31, 2021							0
Comprehensive income:
Net income attributable to DaVita Inc.		386,931				386,931			29,451
Other comprehensive income (loss)	$ 27,451	27,451						27,451
Stock award plan (in shares)				890
Stock award plan				$ 1
Stock options exercised		(54,372)			(54,373)
Stock-settled stock-based compensation expense		50,216			50,216
Changes in noncontrolling interest from:
Distributions									(41,056)
Contributions									1,812
Acquisitions and divestitures		939			939
Partial purchases		(3,270)			(3,270)
Fair value remeasurements		44,439			44,439
Other									(457)
Purchase of treasury stock		(603,058)					$ (603,058)
Purchase of treasury stock (in shares)							(5,973)
Ending balance at Jun. 30, 2022		604,784		$ 98	578,272	741,268	$ (603,058)	(111,796)	170,390
Common stock, Ending balance (in shares) at Jun. 30, 2022				98,179
Treasury stock, ending balance (in shares) at Jun. 30, 2022							(5,973)
Temporary equity, starting balance at Mar. 31, 2022			1,390,757
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income			45,571
Distributions			(34,378)
Contributions			4,107
Acquisitions and divestitures			(29)
Partial purchases			(10,596)
Fair value remeasurements			(9,604)
Other			(7)
Temporary equity, ending balance at Jun. 30, 2022			1,385,821
Beginning balance at Mar. 31, 2022		843,771		$ 97	595,403	516,459	$ (233,318)	(34,870)	174,552
Common stock, Beginning balance (in shares) at Mar. 31, 2022				97,342
Treasury stock, beginning balance (in shares) at Mar. 31, 2022							(2,104)
Comprehensive income:
Net income attributable to DaVita Inc.		224,809				224,809			14,236
Other comprehensive income (loss)	(76,926)	(76,926)						(76,926)
Stock award plan (in shares)				837
Stock award plan				$ 1
Stock options exercised		(50,884)			(50,885)
Stock-settled stock-based compensation expense		25,590			25,590
Changes in noncontrolling interest from:
Distributions									(18,485)
Contributions									80
Acquisitions and divestitures		56			56
Partial purchases		(1,496)			(1,496)
Fair value remeasurements		9,604			9,604
Other									7
Purchase of treasury stock		(369,740)					$ (369,740)
Purchase of treasury stock (in shares)							(3,869)
Ending balance at Jun. 30, 2022		604,784		$ 98	578,272	741,268	$ (603,058)	(111,796)	170,390
Common stock, Ending balance (in shares) at Jun. 30, 2022				98,179
Treasury stock, ending balance (in shares) at Jun. 30, 2022							(5,973)
Temporary equity, starting balance at Dec. 31, 2022			1,348,908
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income			86,951
Distributions			(81,274)
Contributions			5,609
Partial purchases			(700)
Fair value remeasurements			64,055
Temporary equity, ending balance at Jun. 30, 2023			1,423,549
Beginning balance at Dec. 31, 2022	$ 875,892	712,326		$ 90	606,935	174,487	$ 0	(69,186)	163,566
Common stock, Beginning balance (in shares) at Dec. 31, 2022	90,411			90,411
Treasury stock, beginning balance (in shares) at Dec. 31, 2022							0
Comprehensive income:
Net income attributable to DaVita Inc.		294,238				294,238			35,856
Other comprehensive income (loss)	$ 62,134	62,134						62,134
Stock award plan (in shares)				860
Stock award plan				$ 1
Stock options exercised		(48,602)			(48,603)
Stock-settled stock-based compensation expense		53,508			53,508
Changes in noncontrolling interest from:
Distributions									(42,904)
Contributions									1,337
Acquisitions and divestitures		13,077			13,077				30,776
Partial purchases		(5,182)			(5,182)				(5)
Fair value remeasurements		(64,055)			(64,055)
Ending balance at Jun. 30, 2023	$ 1,206,070	1,017,444		$ 91	555,680	468,725	$ 0	(7,052)	188,626
Common stock, Ending balance (in shares) at Jun. 30, 2023	91,271			91,271
Treasury stock, ending balance (in shares) at Jun. 30, 2023							0
Temporary equity, starting balance at Mar. 31, 2023			1,398,829
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income			50,259
Distributions			(45,724)
Contributions			1,861
Partial purchases			(700)
Fair value remeasurements			19,024
Temporary equity, ending balance at Jun. 30, 2023			$ 1,423,549
Beginning balance at Mar. 31, 2023		825,470		$ 91	590,251	290,034	$ 0	(54,906)	194,403
Common stock, Beginning balance (in shares) at Mar. 31, 2023				90,650
Treasury stock, beginning balance (in shares) at Mar. 31, 2023							0
Comprehensive income:
Net income attributable to DaVita Inc.		178,691				178,691			17,427
Other comprehensive income (loss)	$ 47,854	47,854						47,854
Stock award plan (in shares)				621
Stock award plan
Stock options exercised		(39,080)			(39,080)
Stock-settled stock-based compensation expense		28,661			28,661
Changes in noncontrolling interest from:
Distributions									(23,617)
Contributions									360
Acquisitions and divestitures		54			54				58
Partial purchases		(5,182)			(5,182)				(5)
Fair value remeasurements		(19,024)			(19,024)
Ending balance at Jun. 30, 2023	$ 1,206,070	$ 1,017,444		$ 91	$ 555,680	$ 468,725	$ 0	$ (7,052)	$ 188,626
Common stock, Ending balance (in shares) at Jun. 30, 2023	91,271			91,271
Treasury stock, ending balance (in shares) at Jun. 30, 2023							0

Condensed consolidated interim

Condensed consolidated interim financial statements Condensed consolidated interim financial statements	6 Months Ended
	Jun. 30, 2023
Text Block [Abstract]
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block]	Condensed consolidated interim financial statementsThe unaudited condensed consolidated interim financial statements included in this report are prepared by the Company. In the opinion of management, all adjustments necessary for a fair presentation of the results of operations are reflected in these condensed consolidated interim financial statements. All significant intercompany accounts and transactions have been eliminated. The preparation of these financial statements requires management to make estimates and assumptions that affect the reported amounts of revenues, expenses, assets, liabilities, contingencies and noncontrolling interests subject to put provisions. The most significant estimates and assumptions underlying these financial statements and accompanying notes generally involve revenue recognition and accounts receivable, certain fair value estimates, accounting for income taxes and loss contingencies. The results of operations reflected in these interim financial statements may not necessarily be indicative of annual operating results. These condensed consolidated interim financial statements should be read in conjunction with the audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2022 (2022 10-K). Prior period classifications conform to the current period presentation. The Company has evaluated subsequent events through the date these condensed consolidated interim financial statements were issued and has included all necessary adjustments and disclosures.

Revenue Recognition Revenue Rec

Revenue Recognition Revenue Recognition	6 Months Ended
	Jun. 30, 2023
Text Block [Abstract]
Revenue Recognition [Text Block]	Revenue recognition The following tables summarize the Company's segment revenues by primary payor source: Three months ended June 30, 2023 Three months ended June 30, 2022 U.S. dialysis Other — Ancillary services Consolidated U.S. dialysis Other — Ancillary services Consolidated Dialysis patient service revenues: Medicare and Medicare Advantage $ 1,539,639 $ 1,539,639 $ 1,529,534 $ 1,529,534 Medicaid and Managed Medicaid 216,014 216,014 186,873 186,873 Other government 92,525 $ 125,964 218,489 86,079 $ 116,653 202,732 Commercial 876,033 60,871 936,904 854,662 55,708 910,370 Other revenues: Medicare and Medicare Advantage 87,236 87,236 93,262 93,262 Medicaid and Managed Medicaid 396 396 232 232 Commercial 3,619 3,619 8,207 8,207 Other (1) 6,404 13,437 19,841 6,092 8,844 14,936 Eliminations of intersegment revenues (20,361) (1,408) (21,769) (19,389) (19,389) Total $ 2,710,254 $ 290,115 $ 3,000,369 $ 2,643,851 $ 282,906 $ 2,926,757 (1) Other primarily consists of management service fees earned in the respective Company line of business as well as other non-patient service revenue from the Company's U.S. integrated kidney care (IKC) and other ancillary services and international operations. Six months ended June 30, 2023 Six months ended June 30, 2022 U.S. dialysis Other — Ancillary services Consolidated U.S. dialysis Other — Ancillary services Consolidated Dialysis patient service revenues: Medicare and Medicare Advantage $ 3,022,405 $ 3,022,405 $ 2,993,621 $ 2,993,621 Medicaid and Managed Medicaid 421,790 421,790 376,528 376,528 Other government 174,570 $ 247,550 422,120 166,879 $ 233,548 400,427 Commercial 1,711,427 115,387 1,826,814 1,689,240 108,132 1,797,372 Other revenues: Medicare and Medicare Advantage 180,475 180,475 176,859 176,859 Medicaid and Managed Medicaid 965 965 769 769 Commercial 4,825 4,825 9,546 9,546 Other (1) 12,583 26,275 38,858 12,068 18,680 30,748 Eliminations of intersegment revenues (42,410) (2,774) (45,184) (41,558) (41,558) Total $ 5,300,365 $ 572,703 $ 5,873,068 $ 5,196,778 $ 547,534 $ 5,744,312 (1) Other primarily consists of management service fees earned in the respective Company line of business as well as other non-patient service revenue from the Company's U.S. integrated kidney care (IKC) and other ancillary services and international operations. There are significant uncertainties associated with estimating revenue, many of which take several years to resolve. These estimates are subject to ongoing insurance coverage changes, geographic coverage differences, differing interpretations of contract coverage and other payor issues, as well as patient issues, including determination of applicable primary and secondary coverage, changes in patient insurance coverage and coordination of benefits. As these estimates are refined over time, both positive and negative adjustments to revenue are recognized in the current period. Dialysis patient service revenues. Revenues are recognized based on the Company’s estimate of the transaction price the Company expects to collect as a result of satisfying its performance obligations. Dialysis patient service revenues are recognized in the period services are provided based on these estimates. Revenues consist primarily of payments from government and commercial health plans for dialysis services provided to patients. The Company maintains a usual and customary fee schedule for its dialysis treatments and related lab services; however, actual collectible revenue is normally recognized at a discount from the fee schedule. Other revenues. Other revenues consist of revenues earned by the Company's non-dialysis ancillary services as well as fees for management and administrative services to outpatient dialysis businesses that the Company does not consolidate. Other revenues are estimated in the period services are provided. The Company's integrated kidney care (IKC) revenues include revenues earned under risk-based arrangements, including value-based care (VBC) arrangements. Under its VBC arrangements, the Company assumes full or shared financial risk for the total medical cost of care for patients below or above a benchmark. The benchmarks against which the Company incurs profit or loss on these contracts are typically based on the underlying premiums paid to the insuring entity (the Company's counterparty), with adjustments where applicable, or on trended or adjusted medical cost targets.

Earnings per share (Notes)

Earnings per share (Notes)	6 Months Ended
	Jun. 30, 2023
Earnings Per Share [Abstract]
Earnings Per Share [Text Block]	Earnings per share Basic earnings per share is calculated by dividing net income attributable to the Company by the weighted average number of common shares outstanding. Weighted average common shares outstanding include restricted stock unit awards that are no longer subject to forfeiture because the recipients have satisfied either the explicit vesting terms or retirement eligibility requirements. Diluted earnings per share includes the dilutive effect of outstanding stock-settled stock appreciation rights and unvested stock units as computed under the treasury stock method. The reconciliations of the numerators and denominators used to calculate basic and diluted earnings per share were as follows: Three months ended June 30, Six months ended June 30, 2023 2022 2023 2022 Net income attributable to DaVita Inc. $ 178,691 $ 224,809 $ 294,238 $ 386,931 Weighted average shares outstanding: Basic shares 90,984 94,457 90,742 95,382 Assumed incremental from stock plans 2,434 3,315 2,210 3,739 Diluted shares 93,418 97,772 92,952 99,121 Basic net income per share attributable to DaVita Inc. $ 1.96 $ 2.38 $ 3.24 $ 4.06 Diluted net income per share attributable to DaVita Inc. $ 1.91 $ 2.30 $ 3.17 $ 3.90 Anti-dilutive stock-settled awards excluded from calculation (1) 280 1,201 787 686 (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, 2023
Investments, Debt and Equity Securities [Abstract]
Investments in debt and equity securities	Short-term and long-term investments The Company’s short-term and long-term debt and equity investments, consisting of debt instruments classified as held-to-maturity and equity investments with readily determinable fair values or redemption values, were as follows: June 30, 2023 December 31, 2022 Debt Equity Total Debt Equity Total Certificates of deposit and other time deposits $ 20,426 $ — $ 20,426 $ 82,879 $ — $ 82,879 Investments in mutual funds and common stocks — 38,063 38,063 — 39,143 39,143 $ 20,426 $ 38,063 $ 58,489 $ 82,879 $ 39,143 $ 122,022 Short-term investments $ 5,419 $ 7,065 $ 12,484 $ 67,872 $ 9,821 $ 77,693 Long-term investments 15,007 30,998 46,005 15,007 29,322 44,329 $ 20,426 $ 38,063 $ 58,489 $ 82,879 $ 39,143 $ 122,022 Debt securities. The Company's short-term debt investments are principally bank certificates of deposit with contractual maturities longer than three months but shorter than one year. The Company's long-term debt investments are bank time deposits with contractual maturities longer than one year. These debt securities are accounted for as held-to-maturity and recorded at amortized cost, which approximated their fair values at June 30, 2023 and December 31, 2022. Equity securitie s. The Company holds certain equity investments that have readily determinable fair values from public markets. The Company's remaining short-term and long-term equity investments are held within a trust to fund existing obligations associated with the Company’s non-qualified deferred compensation plans.

Goodwill

Goodwill	6 Months Ended
	Jun. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill	Goodwill Changes in the carrying value of goodwill by reportable segment were as follows: U.S. dialysis Other — Ancillary services Consolidated Balance at December 31, 2021 $ 6,400,162 $ 646,079 $ 7,046,241 Acquisitions 16,750 32,297 49,047 Divestitures (87) (3,263) (3,350) Foreign currency and other adjustments — (15,328) (15,328) Balance at December 31, 2022 $ 6,416,825 $ 659,785 $ 7,076,610 Acquisitions — 690 690 Foreign currency and other adjustments — 28,942 28,942 Balance at June 30, 2023 $ 6,416,825 $ 689,417 $ 7,106,242 Balance at June 30, 2023: Goodwill $ 6,416,825 $ 810,632 $ 7,227,457 Accumulated impairment charges — (121,215) (121,215) $ 6,416,825 $ 689,417 $ 7,106,242 The Company did not recognize any goodwill impairment charges during the six months ended June 30, 2023 and 2022. The Company's operations continue to be impacted by the effects of the coronavirus (COVID-19) pandemic. While the Company does not currently expect a material adverse impact to its business as a result of the ongoing COVID-19 pandemic, there can be no assurance that the magnitude of the cumulative impacts of the pandemic, including certain conditions and developments in the U.S. and global economies, labor market conditions, inflation and monetary policies that may have been intensified by the pandemic, will not have a material adverse impact on one or more of the Company's businesses.

Equity Method and Other Investm

Equity Method and Other Investments	6 Months Ended
	Jun. 30, 2023
Investments, Debt and Equity Securities [Abstract]
Equity Method Investments and Joint Ventures Disclosure	Equity method and other investments The Company maintains equity method and other minor investments in the private securities of certain other healthcare and healthcare-related businesses, comprised as follows: June 30, 2023 December 31, 2022 Mozarc Medical Holdings LLC $ 359,757 APAC joint venture 101,200 $ 99,141 Other equity method partnerships 118,467 116,403 Adjusted cost method and other investments 13,845 15,564 $ 593,269 $ 231,108 During the six months ended June 30, 2023 and 2022 the Company recognized equity investment income of $15,274 and $16,187, respectively, from its equity method investments in nonconsolidated dialysis partnerships. The Company also recognized equity investment losses from other equity method investments of $15,568 and $1,538 in other (loss) income during the six months ended June 30, 2023 and 2022, respectively. On May 25, 2022, the Company entered into an agreement with Medtronic, Inc. and one of its subsidiaries (collectively, Medtronic) to form a new, independent kidney care-focused medical device company (Mozarc Medical Holding LLC, or Mozarc) via a deconsolidating partial interest sale from Medtronic to the Company, which closed effective April 1, 2023. The Company holds a 50% voting equity interest in Mozarc and Medtronic holds the other 50% voting equity interest. The Company does not maintain a controlling financial interest in Mozarc and therefore accounts for this investment on the equity method, with equity method income or loss recognized in Other income (loss), net, on a one-month lag. At the closing, the Company made an estimated purchase price payment, including certain transaction cost adjustments, to Medtronic of $44,651, subject to certain customary post-closing adjustments, and contributed certain other non-cash assets to Mozarc with an estimated value of $14,000. In addition, the Company agreed to pay Medtronic additional consideration of up to $300,000 if certain regulatory, commercial and financial milestones are achieved between 2024 and 2028. At close, the Company and Medtronic also each contributed an additional $224,415 in cash to Mozarc to fund its development initiatives. The Company’s investment in Mozarc was recorded at an initial estimate of $371,026, which represents the sum of the cash amounts paid and contributed for the Company’s investment in Mozarc, the estimated fair value of the non-cash assets contributed, the estimated fair value of the Company’s contingent consideration payable to Medtronic for its interest in Mozarc of $86,300, and direct costs incurred to complete this transaction. The foregoing estimates are based upon the best information available to management but remain subject to change based on finalization of post-closing purchase price adjustments yet to be completed between the parties and finalization of related third-party valuation reports. As of June 30, 2023, the book value of the Company's contingent consideration payable to Medtronic approximates its estimated fair value. The recorded value of the Company's equity method investment in Mozarc, and its prospective equity method income (or loss) from that investment, remain subject to finalization of fair value estimates for the following based on third-party valuation reports: the Company's non-cash assets contributed to Mozarc, the Company's contingent consideration payable to Medtronic, and valuation of Mozarc's underlying net assets, including its intangible assets, fixed assets, leases and certain working capital items, some of which are pending final quantification for certain post-closing purchase price adjustments. See Note 9 to the Company's consolidated financial statements included in the 2022 10-K for further description of the Company's other equity method investments.

Long-term debt

Long-term debt	6 Months Ended
	Jun. 30, 2023
Debt Disclosure [Abstract]
Long-term debt	Long-term debt Long-term debt was comprised of the following: As of June 30, 2023 June 30, December 31, 2022 Maturity date Interest rate Estimated fair value (1) Senior Secured Credit Facilities: Term Loan A-1 $ 1,250,000 $ — (2) SOFR+CSA+2.00% $ 1,237,500 Term Loan B-1 2,617,501 2,660,831 8/12/2026 SOFR+CSA+1.75% $ 2,578,239 New Revolving line of credit 285,000 — (2) SOFR+CSA+2.00% $ 285,000 Prior Term Loan A — 1,498,438 8/12/2024 (3) $ — Prior Revolving line of credit — 165,000 8/12/2024 (3) $ — Senior Notes: 4.625% Senior Notes 2,750,000 2,750,000 6/1/2030 4.625 % $ 2,358,125 3.75% Senior Notes 1,500,000 1,500,000 2/15/2031 3.75 % $ 1,201,875 Acquisition obligations and other notes payable (4) 99,904 120,562 2023-2036 6.81 % $ 99,904 Financing lease obligations (5) 257,423 273,688 2024-2039 4.50 % Total debt principal outstanding 8,759,828 8,968,519 Discount, premium and deferred financing costs (6) (60,553) (44,498) 8,699,275 8,924,021 Less current portion (101,113) (231,404) $ 8,598,162 $ 8,692,617 (1) For the Company's senior secured credit facilities and senior notes, fair value estimates are based upon bid and ask quotes, typically a level 2 input. For acquisition obligations and other notes payable, the carrying values presented approximate their estimated fair values, based on estimates of their present values using level 2 interest rate inputs. (2) Outstanding Term Loan A-1 and the new Revolving line of credit balances are due on April 28, 2028, unless any of Term Loan B-1 remains outstanding 91 days prior to the Term Loan B-1 maturity date, in which case the outstanding Term Loan A-1 and the new Revolving line of credit balances become due at that 91 day date (May 13, 2026). (3) At March 31, 2023, the interest rate on the Company's then-existing credit facilities was LIBOR plus an interest rate margin in effect of 1.75% for the prior Term Loan A and prior revolving line of credit. (4) The interest rate presented for acquisition obligations and other notes payable is their weighted average interest rate based on the current fixed and variable interest rate components in effect as of June 30, 2023. (5) 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. (6) As of June 30, 2023, the carrying amount of the Company's senior secured credit facilities have been reduced by a discount of $2,961 and deferred financing costs of $36,819, and the carrying amount of the Company's senior notes have been reduced by deferred financing costs of $33,847 and increased by a debt premium of $13,074. As of December 31, 2022, the carrying amount of the Company's senior secured credit facilities were reduced by a discount of $3,497 and deferred financing costs of $18,816, and the carrying amount of the Company's senior notes were reduced by deferred financing costs of $36,203 and increased by a debt premium of $14,018. Scheduled maturities of long-term debt at June 30, 2023 were as follows: 2023 (remainder of the year) $ 52,244 2024 $ 115,626 2025 $ 129,805 2026 $ 2,660,615 2027 $ 113,373 2028 $ 1,298,981 Thereafter $ 4,389,184 On April 3, 2023, the Company entered into the Second Amendment (the Second Amendment) to its senior secured credit agreement (the Credit Agreement). The Second Amendment modifies the Credit Agreement to, among other things, transition the interest pricing on Term Loan B-1 from LIBOR + 1.75% to a forward-looking term rate (Term SOFR) based on the Secured Overnight Financing Rate (SOFR) + 1.75% plus an additional credit spread adjustment (CSA), provided that this adjusted rate shall never be less than 0.00%, as well as to update the successor interest rate provisions in the Credit Agreement with respect to Term Loan B-1. As of June 30, 2023, the CSA for all tranches outstanding on the Company's Term Loan B-1 was 0.11%. The Company adopted Accounting Standards Update (ASU) No. 2020-04 and ASU No. 2022-06 regarding reference rate reform during the second quarter and applied one of their practical expedients to treat the amendment of Term Loan B-1 as a non-substantial modification. On April 28, 2023 (Third Amendment Effective Date), the Company entered into the Third Amendment (the Third Amendment, and together with the Second Amendment, the Amendments) to the Credit Agreement. The Third Amendment modifies the Credit Agreement to, among other things, refinance its Term Loan A and revolving line of credit with a secured Term Loan A-1 facility in the aggregate principal amount of $1,250,000 and a secured revolving line of credit in the aggregate principal amount of up to $1,500,000 (the foregoing referred to as the new Term Loan A-1 and new revolving line of credit, respectively). The new Term Loan A-1 and new revolving line of credit initially bear interest at Term SOFR, plus a CSA of 0.10% and an interest rate margin of 2.00%, which is subject to adjustment depending upon the Company's leverage ratio under the Credit Agreement, as amended, and which can range from 1.25% to 2.25%, provided that this adjusted rate shall never be less than 0.0%. The new Term Loan A-1 requires amortizing quarterly principal payments beginning on September 30, 2023 of $7,813 per quarter for the first four payments, $15,625 per quarter for the fifth through sixteenth payments, $23,438 per quarter for the seventeenth through nineteenth payments, with the balance due on April 28, 2028. The new revolving line of credit has a five-year term. However, under the Third Amendment, Term Loan A-1 and the new revolving line of credit become due if any of Term Loan B-1 remains outstanding 91 days prior to the Term Loan B-1 maturity date, in which case the Term Loan A-1 balance and any outstanding balance on the new revolving line of credit become due at that 91 day date (May 13, 2026). Borrowings under the Company's senior secured credit facilities are guaranteed and secured by substantially all of DaVita Inc.'s and certain of the Company’s domestic subsidiaries' assets and rank senior to all unsecured indebtedness. Borrowings under the new Term Loan A-1, Term Loan B-1 and new revolving line of credit rank equal in priority for that security and related subsidiary guarantees under the facility's terms. The Credit Agreement, as amended, contains certain customary affirmative and negative covenants such as various restrictions or limitations on permitted amounts of investments (including acquisitions), share repurchases, payment of dividends, and redemptions and incurrence of other indebtedness. Many of these restrictions and limitations will not apply as long as the Company’s leverage ratio calculated in accordance with the Amendments is below 4.00:1.00. In addition, the Amendments require compliance with a maximum leverage ratio covenant, tested quarterly, of 5.00:1.00 through June 30, 2026 and 4.50:1.00 thereafter. In the second quarter of 2023, the Company used a portion of the proceeds from the new Term Loan A-1 and initial borrowing of $400,000 on the new revolving line of credit to pay off the remaining principal balance outstanding and accrued interest and fees on its prior Term Loan A and prior revolving line of credit in the amount of $1,602,199. The remaining borrowings added cash to the balance sheet for general corporate purposes. In addition to the prepayments described above, during the first six months of 2023, the Company made regularly scheduled and other principal payments under its senior secured credit facilities totaling $54,011 on its prior Term Loan A and $43,330 on Term Loan B-1. As a result of the transactions described above, the Company recognized debt prepayment and refinancing charges of $7,962 in the second quarter of 2023 comprised partially of fees incurred for this transaction and partially of deferred financing costs written off for the portion of debt considered extinguished and reborrowed as a result of the repayment of all principal balances outstanding on the Company's prior Term Loan A and prior revolving line of credit. For the portion of the debt that was considered extinguished and reborrowed, the Company recognized constructive financing cash outflows and financing cash inflows on the statement of cash flows of $434,393 and $150,000 for the Term Loan A and prior revolving line of credit, respectively, even though no funds were actually paid or received. Another $715,019 of the debt considered extinguished in this refinancing represented a non-cash financing activity. After June 30, 2023, the Company's 2019 interest rate cap agreements described below have the economic effect of capping the Company's maximum exposure to SOFR variable interest rate changes on equivalent amounts of the Company's floating rate debt, including all of Term Loan B-1 and a portion of new Term Loan A-1. The remaining $367,501 outstanding principal balance of new Term Loan A-1 and the $285,000 balance outstanding on the revolving line of credit are subject to SOFR-based interest rate volatility. These cap agreements are designated as cash flow hedges and, as a result, changes in their fair values are reported in other comprehensive income. The original premiums paid for the caps are amortized to debt expense on a straight-line basis over the term of each cap agreement starting from its effective date. These cap agreements do not contain credit risk-contingent features. In the second quarter of 2023 the Company entered into several forward interest rate cap agreements, described below, that have the economic effect of capping the Company's exposure to SOFR variable interest rate changes on specific portions of the Company's floating rate debt (2023 cap agreements). These 2023 cap agreements are designated as cash flow hedges and, as a result, changes in their fair values will be reported in other comprehensive income. These 2023 cap agreements have notional amounts that amortize downward over time, do not contain credit-risk contingent features, and become effective and expire as described in the table below. Finally, during and as of the end of the second quarter, the Company transitioned the variable rate base on its senior secured credit facilities and related hedging interest rate caps from LIBOR to SOFR. This transition involved a SOFR-to-LIBOR rate mismatch between this debt and the 2019 interest rate caps for a portion of this quarter, but the Company’s interest rate hedges remained highly effective throughout the transition and thereafter. This transition was accomplished through the Amendments to the Credit Agreement for the Company's senior secured credit facility debt and, for the Company's 2019 interest rate caps outstanding, through the the International Swaps and Derivatives Association (ISDA)'s Interbank Offered Rate (IBOR) Fallbacks Supplement and IBOR Fallbacks Protocol which were established in anticipation of the cessation of LIBOR. That ISDA protocol incorporated fallbacks for derivatives linked to LIBOR which facilitated their transition to a replacement reference rate. The Company has adhered to this ISDA protocol and as of June 30, 2023 has transitioned all of its LIBOR-based derivative exposure to SOFR. The following table summarizes the Company’s interest rate cap agreements outstanding as of June 30, 2023 and December 31, 2022, which are classified in other long-term assets on its consolidated balance sheet: Six months ended Fair value Notional amount Variable rate maximum (1) Effective date Expiration date Debt expense (offset) Recorded OCI gain June 30, December 31, 2022 2019 cap agreements $ 3,500,000 2.00% 6/30/2020 6/30/2024 $ (46,232) $ 24,215 $ 114,983 $ 139,755 2023 cap agreements $ 200,000 3.75% 6/28/2024 12/31/2025 $ 671 $ 1,862 2023 cap agreements $ 1,000,000 4.00% (2) 6/28/2024 12/31/2025 $ 1,119 $ 10,356 2023 cap agreements $ 800,000 3.75% 6/30/2024 12/31/2025 $ 2,388 $ 7,353 (1) The Company's cap agreements have the effect of capping SOFR-based variable rate payments made by the Company. (2) Effective January 1, 2025, the maximum rate of 4.00% decreases to 3.75% for these interest rate caps. See Note 10 for further details on amounts reclassified from accumulated other comprehensive loss and recorded as debt expense (offset) related to the Company’s interest rate cap agreements for the three and six months ended June 30, 2023 and 2022. As a result of the variable rate cap from the Company's 2019 interest rate cap agreements, the Company’s weighted average effective interest rate on its senior secured credit facilities at the end of the second quarter of 2023 was 4.90%, based on the current margins in effect for its senior secured credit facilities as of June 30, 2023, as detailed in the table above. The Company’s weighted average effective interest rate on all debt, including the effect of interest rate caps and amortization of debt discount, for the three and six months ended June 30, 2023 was 4.67% and 4.61% and as of June 30, 2023 was 4.66%. As of June 30, 2023, the Company’s interest rates were fixed and economically fixed on approximately 52% and 92% of its total debt, respectively. As of June 30, 2023, the Company had $1,215,000 available and $285,000 drawn on its $1,500,000 revolving line of credit under its senior secured credit facilities. Credit available under this revolving line of credit is reduced by the amount of any letters of credit outstanding under the facility, of which there were none as of June 30, 2023. The Company also had letters of credit of approximately $151,395 outstanding under a separate bilateral secured letter of credit facility as of June 30, 2023.

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2023
Commitments and Contingencies Disclosure [Abstract]
Contingencies	Commitments and contingencies The majority of the Company’s revenues are from government programs and may be subject to adjustment as a result of: (i) examination by government agencies or contractors, for which the resolution of any matters raised may take extended periods of time to finalize; (ii) differing interpretations of government regulations by different Medicare contractors or regulatory authorities; (iii) differing opinions regarding a patient’s medical diagnosis or the medical necessity of services provided; and (iv) retroactive applications or interpretations of governmental requirements. In addition, the Company’s revenues from commercial payors may be subject to adjustment as a result of potential claims for refunds, as a result of government actions or as a result of other claims by commercial payors. The Company operates in a highly regulated industry and is a party to various lawsuits, demands, claims, qui tam suits, governmental investigations (which frequently arise from qui tam suits) and audits (including, without limitation, investigations or other actions resulting from its obligation to self-report suspected violations of law) and other legal proceedings, including, without limitation, those described below. The Company records accruals for certain legal proceedings and regulatory matters to the extent that the Company determines an unfavorable outcome is probable and the amount of the loss can be reasonably estimated. As of June 30, 2023 and December 31, 2022, the Company’s total recorded accruals with respect to legal proceedings and regulatory matters, net of anticipated third party recoveries, were immaterial. While these accruals reflect the Company’s best estimate of the probable loss for those matters as of the dates of those accruals, the recorded amounts may differ materially from the actual amount of the losses for those matters, and any anticipated third party recoveries for any such losses may not ultimately be recoverable. Additionally, in some cases, no estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made because of the inherently unpredictable nature of legal proceedings and regulatory matters, which also may be impacted by various factors, including, without limitation, that they may involve indeterminate claims for monetary damages or may involve fines, penalties or non-monetary remedies; present novel legal theories or legal uncertainties; involve disputed facts; represent a shift in regulatory policy; are in the early stages of the proceedings; or may result in a change of business practices. Further, there may be various levels of judicial review available to the Company in connection with any such proceeding. The following is a description of certain lawsuits, claims, governmental investigations and audits and other legal proceedings to which the Company is subject. Certain Governmental Inquiries and Related Proceedings 2016 U.S. Attorney Texas Investigation : In February 2016, DaVita Rx, LLC (DaVita Rx), a wholly-owned subsidiary of the Company, received a Civil Investigative Demand (CID) from the U.S. Attorney’s Office, Northern District of Texas. The government conducted a federal False Claims Act (FCA) investigation concerning allegations that DaVita Rx presented or caused to be presented false claims for payment to the government for prescription medications, as well as an investigation into the Company’s relationships with pharmaceutical manufacturers. After its investigation, the government and the named states declined to intervene in the matter, and on April 5, 2023, the U.S. District Court, Northern District of Texas, entered an order unsealing the complaint in the matter of U.S. ex rel. Grenon v. DaVita Rx, LLC et al . The complaint was not served on the Company. On May 31, 2023, the private party relator filed a notice of voluntary dismissal of all claims. On June 1, 2023, the U.S. District Court for the Northern District of Texas dismissed the matter without prejudice. 2017 U.S. Attorney Colorado Investigation : In November 2017, the U.S. Attorney’s Office, District of Colorado informed the Company of an investigation it was conducting into possible federal healthcare offenses involving DaVita Kidney Care, as well as several of the Company’s wholly-owned subsidiaries. In addition to DaVita Kidney Care, the matter currently includes an investigation into DaVita Rx, DaVita Laboratory Services, Inc. (DaVita Labs), and RMS Lifeline Inc. (Lifeline). In each of August 2018, May 2019, and July 2021, the Company received a CID pursuant to the FCA from the U.S. Attorney's Office relating to this investigation. In May 2020, the Company sold its interest in Lifeline, but the Company retained certain liabilities of the Lifeline business, including those related to this investigation. The Company is continuing to cooperate with the government in this investigation. 2020 U.S. Attorney New Jersey Investigation : In March 2020, the U.S. Attorney’s Office, District of New Jersey served the Company with a subpoena and a CID relating to an investigation being conducted by that office and the U.S. Attorney’s Office, Eastern District of Pennsylvania. The subpoena and CID request information on several topics, including certain of the Company’s joint venture arrangements with physicians and physician groups, medical director agreements, and compliance with its five-year Corporate Integrity Agreement, the term of which expired October 22, 2019. In November 2022, the Company learned that, on April 1, 2022, the U.S. Attorney’s Office for the District of New Jersey notified the U.S. District Court for the District of New Jersey of its decision not to elect to intervene in the matter of U.S. ex rel. Doe v. DaVita Inc. and filed a Stipulation of Dismissal. On April 13, 2022, the U.S. District Court for the District of New Jersey dismissed the case without prejudice. On October 12, 2022, the U.S. Attorney’s Office for the Eastern District of Pennsylvania notified the U.S. District Court, Eastern District of Pennsylvania, of its decision not to elect to intervene at this time in the matter of U.S. ex rel. Bayne v. DaVita Inc., et al. The court then unsealed an amended complaint, which alleges violations of federal and state False Claims Acts, by order dated October 14, 2022. In May 2023, the private party relator served the Company with a second amended complaint. On July 14, 2023, the Company filed a motion to dismiss the second amended complaint. 2020 California Department of Insurance Investigation : In April 2020, the California Department of Insurance (CDI) sent the Company an Investigative Subpoena relating to an investigation being conducted by that office. CDI issued a superseding subpoena in September 2020 and an additional subpoena in September 2021. Those subpoenas request information on a number of topics, including but not limited to the Company’s communications with patients about insurance plans and financial assistance from the American Kidney Fund (AKF), analyses of the potential impact of patients’ decisions to change insurance providers, and documents relating to donations or contributions to the AKF. The Company is continuing to cooperate with CDI in this investigation. 2023 District of Columbia Office of Attorney General Investigation : In January 2023, the Office of the Attorney General for the District of Columbia issued a CID to the Company in connection with an antitrust investigation into the AKF. The CID covers the period from January 1, 2016 to the present. The CID requests information on a number of topics, including but not limited to the Company’s communications with AKF, documents relating to donations to the AKF, and communications with patients, providers, and insurers regarding the AKF. The Company is cooperating with the government in this investigation. * * * Although the Company cannot predict whether or when proceedings might be initiated or when these matters may be resolved (other than as may be described above), it is not unusual for inquiries such as these to continue for a considerable period of time through the various phases of document and witness requests and ongoing discussions with regulators and to develop over the course of time. In addition to the inquiries and proceedings specifically identified above, the Company frequently is subject to other inquiries by state or federal government agencies, many of which relate to qui tam complaints filed by relators. Negative findings or terms and conditions that the Company might agree to accept as part of a negotiated resolution of pending or future government inquiries or relator proceedings could result in, among other things, substantial financial penalties or awards against the Company, substantial payments made by the Company, harm to the Company’s reputation, required changes to the Company’s business practices, an impact on the Company's various relationships and/or contracts related to the Company's business, exclusion from future participation in the Medicare, Medicaid and other federal health care programs and, if criminal proceedings were initiated against the Company, members of its board of directors or management, possible criminal penalties, any of which could have a material adverse effect on the Company. Other Proceedings 2021 Antitrust Indictment and Putative Class Action Suit : On July 14, 2021, an indictment was returned by a grand jury in the U.S. District Court, District of Colorado against the Company and its former chief executive officer in the matter of U.S. v. DaVita Inc., et al. alleging that purported agreements entered into by DaVita's former chief executive officer not to solicit senior-level employees violated Section 1 of the Sherman Act. On April 15, 2022, a jury returned a verdict in the Company’s favor, acquitting both the Company and its former chief executive officer on all counts. On April 20, 2022, the court entered judgments of acquittal and closed the case. On August 9, 2021, DaVita Inc. and its former chief executive officer were added as defendants in a consolidated putative class action complaint in the matter of In re Outpatient Medical Center Employee Antitrust Litigation in the U.S. District Court, Northern District of Illinois. This class action complaint asserts that the defendants violated Section 1 of the Sherman Act and seeks to bring an action on behalf of certain groups of individuals employed by the Company between February 1, 2012 and January 5, 2021. On September 26, 2022, the court denied the Company's motion to dismiss. The Company disputes the allegations in the class action complaint, as well as the asserted violations of the Sherman Act, and intends to defend this action accordingly. Additionally, from time to time the Company is subject to other lawsuits, demands, claims, governmental investigations and audits and legal proceedings that arise due to the nature of its business, including, without limitation, contractual disputes, such as with payors, suppliers and others, employee-related matters and professional and general liability claims. From time to time, the Company also initiates litigation or other legal proceedings as a plaintiff arising out of contracts or other matters. * * * Other than as may be described above, the Company cannot predict the ultimate outcomes of the various legal proceedings and regulatory matters to which the Company is or may be subject from time to time, including those described in this Note 8, or the timing of their resolution or the ultimate losses or impact of developments in those matters, which could have a material adverse effect on the Company’s revenues, earnings and cash flows. Further, any legal proceedings or regulatory matters involving the Company, whether meritorious or not, are time consuming, and often require management’s attention and result in significant legal expense, and may result in the diversion of significant operational resources, may impact the Company's various relationships and/or contracts related to the Company's business or otherwise harm the Company’s business, results of operations, financial condition, cash flows or reputation. * * *
Noncontrolling interests subject to put provisions and other commitments	Other Commitments The Company also has certain potential commitments to provide working capital funding, if necessary, to certain nonconsolidated dialysis businesses that the Company manages and in which the Company owns a noncontrolling equity interest or which are wholly-owned by third parties of approximately $9,696.

Shareholders' equity

Shareholders' equity	6 Months Ended
	Jun. 30, 2023
Equity [Abstract]
Stock-based compensation	Shareholders' equity Stock-based compensation During the six months ended June 30, 2023, the Company granted 1,338 stock-settled restricted and performance stock units with an aggregate grant-date fair value of $102,999 and a weighted average expected life of approximately 3.4 years. As of June 30, 2023, the Company had $175,710 in total estimated but unrecognized stock-based compensation expense under the Company's equity compensation and employee stock purchase plans. The Company expects to recognize this expense over a weighted average remaining period of 1.4 years.
Share repurchases	Share repurchases The Company has not repurchased any shares subsequent to December 31, 2022.

Accumulated other comprehensive

Accumulated other comprehensive (loss) income	6 Months Ended
	Jun. 30, 2023
Statement of Comprehensive Income [Abstract]
Comprehensive income	Accumulated other comprehensive loss Three months ended June 30, 2023 Six months ended June 30, 2023 Interest Foreign Accumulated Interest Foreign Accumulated Beginning balance $ 79,404 $ (134,310) $ (54,906) $ 98,685 $ (167,871) $ (69,186) Unrealized gains 33,109 41,961 75,070 28,393 75,522 103,915 Related income tax (8,260) — (8,260) (7,083) — (7,083) 24,849 41,961 66,810 21,310 75,522 96,832 Reclassification into net income (25,257) — (25,257) (46,232) — (46,232) Related income tax 6,301 — 6,301 11,534 — 11,534 (18,956) — (18,956) (34,698) — (34,698) Ending balance $ 85,297 $ (92,349) $ (7,052) $ 85,297 $ (92,349) $ (7,052) Three months ended June 30, 2022 Six months ended June 30, 2022 Interest Foreign Accumulated Interest Foreign Accumulated Beginning balance $ 40,987 $ (75,857) $ (34,870) $ (1,178) $ (138,069) $ (139,247) Unrealized gains (losses) 17,610 (91,176) (73,566) 72,416 (28,964) 43,452 Related income tax (4,393) — (4,393) (18,067) — (18,067) 13,217 (91,176) (77,959) 54,349 (28,964) 25,385 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 $ 55,237 $ (167,033) $ (111,796) $ 55,237 $ (167,033) $ (111,796) The interest rate cap agreement net realized losses reclassified into net income are recorded as debt expense in the corresponding consolidated statements of income. See Note 7 for further details.

Variable interest entities

Variable interest entities	6 Months Ended
	Jun. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Variable interest entities	Variable interest entities (VIEs)At June 30, 2023, these condensed consolidated financial statements include total assets of VIEs of $297,355 and total liabilities and noncontrolling interests of VIEs to third parties of $165,916. There have been no material changes in the nature of the Company's arrangements with VIEs or its judgments concerning them from those described in Note 23 to the Company's consolidated financial statements included in the 2022 10-K.

Fair value of financial instrum

Fair value of financial instruments	6 Months Ended
	Jun. 30, 2023
Fair Value Disclosures [Abstract]
Fair value of financial instruments	Fair values of financial instruments The Company measures the fair value of certain assets, liabilities and noncontrolling interests subject to put provisions (redeemable equity interests classified as temporary equity) based upon certain valuation techniques that include observable or unobservable inputs and assumptions that market participants would use in pricing these assets, liabilities, temporary equity and commitments. The Company has also classified assets, liabilities and temporary equities that are measured at fair value on a recurring basis into the appropriate fair value hierarchy levels as defined by the Financial Accounting Standards Board (FASB). The following table summarizes the Company’s assets, liabilities and temporary equities measured at fair value on a recurring basis as of June 30, 2023: Total Quoted prices in Significant other Significant Assets Investments in equity securities $ 38,063 $ 38,063 $ — $ — Interest rate cap agreements $ 134,554 $ — $ 134,554 $ — Liabilities Contingent earn-out obligations for acquisitions $ 23,499 $ — $ — $ 23,499 Temporary equity Noncontrolling interests subject to put provisions $ 1,423,549 $ — $ — $ 1,423,549 For a reconciliation of changes in noncontrolling interests subject to put provisions during the three and six months ended June 30, 2023, see the consolidated statement of equity. Investments in equity securities represent investments in various open-ended registered investment companies (mutual funds) and common stocks and are recorded at fair value estimated based on reported market prices or redemption prices, as applicable. See Note 4 for further discussion. Interest rate cap agreements are recorded at fair value estimated from valuation models utilizing the income approach and commonly accepted valuation techniques that use inputs from closing prices for similar assets and liabilities in active markets as well as other relevant observable market inputs at quoted intervals such as current interest rates, forward yield curves, implied volatility and credit default swap pricing. The Company does not believe the ultimate amount that could be realized upon settlement of these interest rate cap agreements would be materially different from the fair value estimates currently reported. See Note 7 for further discussion. As of June 30, 2023, the Company had contingent earn-out obligations associated with business acquisitions that could result in the Company paying the former owners a total of up to approximately $55,970 if certain performance targets or quality margins are met over the next one year to five years. The estimated fair value measurements of these contingent earn-out obligations are primarily based on unobservable inputs, including key financial metrics such as projected earnings before interest, taxes, depreciation, and amortization (EBITDA), revenue and other key performance indicators. The estimated fair values of these contingent earn-out obligations are remeasured as of each reporting date and could fluctuate based upon any significant changes in key assumptions, such as changes in the Company's credit risk adjusted rate that is used to discount obligations to present value. The estimated fair value of noncontrolling interests subject to put provisions is based principally on the higher of either estimated liquidation value of net assets or a multiple of earnings for each subject dialysis partnership, based on historical earnings, revenue mix, and other performance indicators that can affect future results. The multiples used for these valuations are derived from observed ownership transactions for dialysis businesses between unrelated parties in the U.S. in recent years, and the specific valuation multiple applied to each dialysis partnership is principally determined by its recent and expected revenue mix and contribution margin. As of June 30, 2023, an increase or decrease in the weighted average multiple used in these valuations of one times EBITDA would change the estimated fair value of these noncontrolling interests by approximately $180,000. See Notes 17 and 24 to the Company's consolidated financial statements included in the 2022 10-K for further discussion of the Company’s methodology for estimating the fair value of noncontrolling interests subject to put obligations. The Company's fair value estimates for its senior secured credit facilities and senior notes are based upon quoted bid and ask prices for these instruments, typically a level 2 input. See Note 7 for further discussion of the Company's debt. Other financial instruments consist primarily of cash and cash equivalents, restricted cash and cash equivalents, accounts receivable, accounts payable, other accrued liabilities, lease liabilities and debt. The balances of financial instruments other than debt and lease liabilities are presented in these condensed consolidated financial statements at June 30, 2023 at their approximate fair values due to the short-term nature of their settlements.

Segment reporting

Segment reporting	6 Months Ended
	Jun. 30, 2023
Segment Reporting [Abstract]
Segment Reporting Disclosure	Segment reporting The Company’s operating divisions are comprised of its U.S. dialysis and related lab services business (its U.S. dialysis business), its U.S. IKC business, its U.S. other ancillary services and its international operations (collectively, its ancillary services), as well as its corporate administrative support. The Company’s separate operating segments include its U.S. dialysis and related lab services business, its U.S. IKC business, its U.S. other ancillary services, its kidney care operations in each foreign sovereign jurisdiction, and its equity method investments in each of the Asia Pacific joint venture (APAC JV) and Mozarc. The U.S. dialysis and related lab services business qualifies as a separately reportable segment, and all other operating segments have been combined and disclosed in the other segments category. See Note 25 to the Company's consolidated financial statements included in the 2022 10-K for further description of how the Company determines and measures results for its operating segments. The following is a summary of segment revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income before income taxes: Three months ended June 30, Six months ended June 30, 2023 2022 2023 2022 Segment revenues: U.S. dialysis Dialysis patient service revenues: External sources $ 2,703,850 $ 2,637,738 $ 5,287,782 $ 5,184,700 Intersegment revenues 20,361 19,410 42,410 41,568 U.S. dialysis patient service revenues 2,724,211 2,657,148 5,330,192 5,226,268 Other revenues: External sources 6,404 6,113 12,583 12,078 Intersegment revenues — (21) — (10) Total U.S. dialysis revenues 2,730,615 2,663,240 5,342,775 5,238,336 Other—Ancillary services Dialysis patient service revenues 186,835 172,361 362,937 341,680 Other external sources 103,280 110,545 209,766 205,854 Intersegment revenues 1,408 — 2,774 — Total ancillary services revenues 291,523 282,906 575,477 547,534 Total net segment revenues 3,022,138 2,946,146 5,918,252 5,785,870 Elimination of intersegment revenues (21,769) (19,389) (45,184) (41,558) Consolidated revenues $ 3,000,369 $ 2,926,757 $ 5,873,068 $ 5,744,312 Segment operating margin (loss): U.S. dialysis $ 460,759 $ 472,801 $ 821,857 $ 879,241 Other—Ancillary services (21,604) (9,113) (46,469) (41,418) Total segment operating margin 439,155 463,688 775,388 837,823 Reconciliation of segment operating income to Corporate administrative support (33,864) (30,973) (58,452) (66,800) Consolidated operating income 405,291 432,715 716,936 771,023 Debt expense (103,507) (82,586) (204,281) (156,377) Debt prepayment and refinancing charges (7,962) — (7,962) — Other income (loss), net 1,373 (1,284) 5,125 (3,070) Consolidated income before income taxes $ 295,195 $ 348,845 $ 509,818 $ 611,576 Depreciation and amortization expense by reportable segment was as follows: Three months ended June 30, Six months ended June 30, 2023 2022 2023 2022 U.S. dialysis $ 171,842 $ 160,612 $ 338,803 $ 322,632 Other—Ancillary services 11,830 10,564 22,940 21,488 $ 183,672 $ 171,176 $ 361,743 $ 344,120 Expenditures for property and equipment by reportable segment were as follows: Six months ended June 30, 2023 2022 U.S. dialysis $ 240,474 $ 237,686 Other—Ancillary services 31,730 27,775 $ 272,204 $ 265,461 A summary of assets by reportable segment were as follows: June 30, 2023 December 31, 2022 U.S. dialysis $ 14,592,384 $ 15,084,454 Other—Ancillary services 2,366,461 1,843,798 Consolidated assets $ 16,958,845 $ 16,928,252

New accounting standards

New accounting standards	6 Months Ended
	Jun. 30, 2023
Accounting Changes and Error Corrections [Abstract]
New Accounting Standards	New accounting standards New standards recently adopted In March 2020, the FASB issued Accounting Standards Update (ASU) No. 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting. ASU No. 2020-04 provides optional expedients and exceptions for applying U.S. GAAP to contract modifications and hedging relationships, subject to certain criteria, that reference LIBOR or another rate that is expected to be discontinued. The amendments in this ASU were effective beginning on March 12, 2020, and the Company could elect to apply the amendments prospectively through December 31, 2022. In December 2022, the FASB issued ASU No. 2022-06, Reference Rate Reform (Topic 848): Deferral of the Sunset Date of Topic 848 , which extended the election date to December 31, 2024. Effective January 1, 2022 certain LIBOR tenors that do not affect the Company, including the one-week and two-month U.S. dollar LIBOR rate, ceased or became non-representative. The remaining U.S. dollar LIBOR tenors ceased or became non-representative effective July 1, 2023. This change will have no impact on the Company's ability to borrow. The application of this ASU did not have a material impact on its consolidated financial statements. See Note 7 for further discussion of the Company's debt.

Condensed consolidated interi_2

Condensed consolidated interim financial statements Condensed consolidaed interim financial statements (Policies)	6 Months Ended
	Jun. 30, 2023
Accounting Policies [Abstract]
Condensed consolidated interim financial statements	Condensed consolidated interim financial statementsThe unaudited condensed consolidated interim financial statements included in this report are prepared by the Company. In the opinion of management, all adjustments necessary for a fair presentation of the results of operations are reflected in these condensed consolidated interim financial statements. All significant intercompany accounts and transactions have been eliminated. The preparation of these financial statements requires management to make estimates and assumptions that affect the reported amounts of revenues, expenses, assets, liabilities, contingencies and noncontrolling interests subject to put provisions. The most significant estimates and assumptions underlying these financial statements and accompanying notes generally involve revenue recognition and accounts receivable, certain fair value estimates, accounting for income taxes and loss contingencies. The results of operations reflected in these interim financial statements may not necessarily be indicative of annual operating results. These condensed consolidated interim financial statements should be read in conjunction with the audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2022 (2022 10-K). Prior period classifications conform to the current period presentation. The Company has evaluated subsequent events through the date these condensed consolidated interim financial statements were issued and has included all necessary adjustments and disclosures.
Revenue	There are significant uncertainties associated with estimating revenue, many of which take several years to resolve. These estimates are subject to ongoing insurance coverage changes, geographic coverage differences, differing interpretations of contract coverage and other payor issues, as well as patient issues, including determination of applicable primary and secondary coverage, changes in patient insurance coverage and coordination of benefits. As these estimates are refined over time, both positive and negative adjustments to revenue are recognized in the current period. Dialysis patient service revenues. Revenues are recognized based on the Company’s estimate of the transaction price the Company expects to collect as a result of satisfying its performance obligations. Dialysis patient service revenues are recognized in the period services are provided based on these estimates. Revenues consist primarily of payments from government and commercial health plans for dialysis services provided to patients. The Company maintains a usual and customary fee schedule for its dialysis treatments and related lab services; however, actual collectible revenue is normally recognized at a discount from the fee schedule. Other revenues. Other revenues consist of revenues earned by the Company's non-dialysis ancillary services as well as fees for management and administrative services to outpatient dialysis businesses that the Company does not consolidate. Other revenues are estimated in the period services are provided. The Company's integrated kidney care (IKC) revenues include revenues earned under risk-based arrangements, including value-based care (VBC) arrangements. Under its VBC arrangements, the Company assumes full or shared financial risk for the total medical cost of care for patients below or above a benchmark. The benchmarks against which the Company incurs profit or loss on these contracts are typically based on the underlying premiums paid to the insuring entity (the Company's counterparty), with adjustments where applicable, or on trended or adjusted medical cost targets.
Earnings Per Share	Basic earnings per share is calculated by dividing net income attributable to the Company by the weighted average number of common shares outstanding. Weighted average common shares outstanding include restricted stock unit awards that are no longer subject to forfeiture because the recipients have satisfied either the explicit vesting terms or retirement eligibility requirements. Diluted earnings per share includes the dilutive effect of outstanding stock-settled stock appreciation rights and unvested stock units as computed under the treasury stock method.
Short-term and Long-term Investments	Debt securities. The Company's short-term debt investments are principally bank certificates of deposit with contractual maturities longer than three months but shorter than one year. The Company's long-term debt investments are bank time deposits with contractual maturities longer than one year. These debt securities are accounted for as held-to-maturity and recorded at amortized cost, which approximated their fair values at June 30, 2023 and December 31, 2022. Equity securitie s. The Company holds certain equity investments that have readily determinable fair values from public markets. The Company's remaining short-term and long-term equity investments are held within a trust to fund existing obligations associated with the Company’s non-qualified deferred compensation plans.
Long-term debt	These cap agreements are designated as cash flow hedges and, as a result, changes in their fair values are reported in other comprehensive income. The original premiums paid for the caps are amortized to debt expense on a straight-line basis over the term of each cap agreement starting from its effective date. These cap agreements do not contain credit risk-contingent features. In the second quarter of 2023 the Company entered into several forward interest rate cap agreements, described below, that have the economic effect of capping the Company's exposure to SOFR variable interest rate changes on specific portions of the Company's floating rate debt (2023 cap agreements). These 2023 cap agreements are designated as cash flow hedges and, as a result, changes in their fair values will be reported in other comprehensive income. These 2023 cap agreements have notional amounts that amortize downward over time, do not contain credit-risk contingent features, and become effective and expire as described in the table below. Finally, during and as of the end of the second quarter, the Company transitioned the variable rate base on its senior secured credit facilities and related hedging interest rate caps from LIBOR to SOFR. This transition involved a SOFR-to-LIBOR rate mismatch between this debt and the 2019 interest rate caps for a portion of this quarter, but the Company’s interest rate hedges remained highly effective throughout the transition and thereafter. This transition was accomplished through the Amendments to the Credit Agreement for the Company's senior secured credit facility debt and, for the Company's 2019 interest rate caps outstanding, through the the International Swaps and Derivatives Association (ISDA)'s Interbank Offered Rate (IBOR) Fallbacks Supplement and IBOR Fallbacks Protocol which were established in anticipation of the cessation of LIBOR. That ISDA protocol incorporated fallbacks for derivatives linked to LIBOR which facilitated their transition to a replacement reference rate. The Company has adhered to this ISDA protocol and as of June 30, 2023 has transitioned all of its LIBOR-based derivative exposure to SOFR.
Fair Value of Financial Instruments	Interest rate cap agreements are recorded at fair value estimated from valuation models utilizing the income approach and commonly accepted valuation techniques that use inputs from closing prices for similar assets and liabilities in active markets as well as other relevant observable market inputs at quoted intervals such as current interest rates, forward yield curves, implied volatility and credit default swap pricing. The Company does not believe the ultimate amount that could be realized upon settlement of these interest rate cap agreements would be materially different from the fair value estimates currently reported.
New Accounting Standards	New accounting standards New standards recently adopted In March 2020, the FASB issued Accounting Standards Update (ASU) No. 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting. ASU No. 2020-04 provides optional expedients and exceptions for applying U.S. GAAP to contract modifications and hedging relationships, subject to certain criteria, that reference LIBOR or another rate that is expected to be discontinued. The amendments in this ASU were effective beginning on March 12, 2020, and the Company could elect to apply the amendments prospectively through December 31, 2022. In December 2022, the FASB issued ASU No. 2022-06, Reference Rate Reform (Topic 848): Deferral of the Sunset Date of Topic 848 , which extended the election date to December 31, 2024. Effective January 1, 2022 certain LIBOR tenors that do not affect the Company, including the one-week and two-month U.S. dollar LIBOR rate, ceased or became non-representative. The remaining U.S. dollar LIBOR tenors ceased or became non-representative effective July 1, 2023. This change will have no impact on the Company's ability to borrow. The application of this ASU did not have a material impact on its consolidated financial statements. See Note 7 for further discussion of the Company's debt.

Revenue Recognition Segment rev

Revenue Recognition Segment revenue by major payor (Tables)	6 Months Ended
	Jun. 30, 2023
Revenues by major payor [Abstract]
Disaggregation of Revenue [Table Text Block]	The following tables summarize the Company's segment revenues by primary payor source: Three months ended June 30, 2023 Three months ended June 30, 2022 U.S. dialysis Other — Ancillary services Consolidated U.S. dialysis Other — Ancillary services Consolidated Dialysis patient service revenues: Medicare and Medicare Advantage $ 1,539,639 $ 1,539,639 $ 1,529,534 $ 1,529,534 Medicaid and Managed Medicaid 216,014 216,014 186,873 186,873 Other government 92,525 $ 125,964 218,489 86,079 $ 116,653 202,732 Commercial 876,033 60,871 936,904 854,662 55,708 910,370 Other revenues: Medicare and Medicare Advantage 87,236 87,236 93,262 93,262 Medicaid and Managed Medicaid 396 396 232 232 Commercial 3,619 3,619 8,207 8,207 Other (1) 6,404 13,437 19,841 6,092 8,844 14,936 Eliminations of intersegment revenues (20,361) (1,408) (21,769) (19,389) (19,389) Total $ 2,710,254 $ 290,115 $ 3,000,369 $ 2,643,851 $ 282,906 $ 2,926,757 (1) Other primarily consists of management service fees earned in the respective Company line of business as well as other non-patient service revenue from the Company's U.S. integrated kidney care (IKC) and other ancillary services and international operations. Six months ended June 30, 2023 Six months ended June 30, 2022 U.S. dialysis Other — Ancillary services Consolidated U.S. dialysis Other — Ancillary services Consolidated Dialysis patient service revenues: Medicare and Medicare Advantage $ 3,022,405 $ 3,022,405 $ 2,993,621 $ 2,993,621 Medicaid and Managed Medicaid 421,790 421,790 376,528 376,528 Other government 174,570 $ 247,550 422,120 166,879 $ 233,548 400,427 Commercial 1,711,427 115,387 1,826,814 1,689,240 108,132 1,797,372 Other revenues: Medicare and Medicare Advantage 180,475 180,475 176,859 176,859 Medicaid and Managed Medicaid 965 965 769 769 Commercial 4,825 4,825 9,546 9,546 Other (1) 12,583 26,275 38,858 12,068 18,680 30,748 Eliminations of intersegment revenues (42,410) (2,774) (45,184) (41,558) (41,558) Total $ 5,300,365 $ 572,703 $ 5,873,068 $ 5,196,778 $ 547,534 $ 5,744,312 (1) Other primarily consists of management service fees earned in the respective Company line of business as well as other non-patient service revenue from the Company's U.S. integrated kidney care (IKC) and other ancillary services and international operations.

Earnings per share Earnings Per

Earnings per share Earnings Per Share (Tables)	6 Months Ended
	Jun. 30, 2023
Earnings Per Share [Abstract]
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]	The reconciliations of the numerators and denominators used to calculate basic and diluted earnings per share were as follows: Three months ended June 30, Six months ended June 30, 2023 2022 2023 2022 Net income attributable to DaVita Inc. $ 178,691 $ 224,809 $ 294,238 $ 386,931 Weighted average shares outstanding: Basic shares 90,984 94,457 90,742 95,382 Assumed incremental from stock plans 2,434 3,315 2,210 3,739 Diluted shares 93,418 97,772 92,952 99,121 Basic net income per share attributable to DaVita Inc. $ 1.96 $ 2.38 $ 3.24 $ 4.06 Diluted net income per share attributable to DaVita Inc. $ 1.91 $ 2.30 $ 3.17 $ 3.90 Anti-dilutive stock-settled awards excluded from calculation (1) 280 1,201 787 686 (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, 2023
Investments, Debt and Equity Securities [Abstract]
Schedule of Investments	The Company’s short-term and long-term debt and equity investments, consisting of debt instruments classified as held-to-maturity and equity investments with readily determinable fair values or redemption values, were as follows: June 30, 2023 December 31, 2022 Debt Equity Total Debt Equity Total Certificates of deposit and other time deposits $ 20,426 $ — $ 20,426 $ 82,879 $ — $ 82,879 Investments in mutual funds and common stocks — 38,063 38,063 — 39,143 39,143 $ 20,426 $ 38,063 $ 58,489 $ 82,879 $ 39,143 $ 122,022 Short-term investments $ 5,419 $ 7,065 $ 12,484 $ 67,872 $ 9,821 $ 77,693 Long-term investments 15,007 30,998 46,005 15,007 29,322 44,329 $ 20,426 $ 38,063 $ 58,489 $ 82,879 $ 39,143 $ 122,022

Goodwill (Tables)

Goodwill (Tables)	6 Months Ended
	Jun. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Changes in Goodwill by Reportable Segments [Text Block]	Changes in the carrying value of goodwill by reportable segment were as follows: U.S. dialysis Other — Ancillary services Consolidated Balance at December 31, 2021 $ 6,400,162 $ 646,079 $ 7,046,241 Acquisitions 16,750 32,297 49,047 Divestitures (87) (3,263) (3,350) Foreign currency and other adjustments — (15,328) (15,328) Balance at December 31, 2022 $ 6,416,825 $ 659,785 $ 7,076,610 Acquisitions — 690 690 Foreign currency and other adjustments — 28,942 28,942 Balance at June 30, 2023 $ 6,416,825 $ 689,417 $ 7,106,242 Balance at June 30, 2023: Goodwill $ 6,416,825 $ 810,632 $ 7,227,457 Accumulated impairment charges — (121,215) (121,215) $ 6,416,825 $ 689,417 $ 7,106,242

Equity Method and Other Inves_2

Equity Method and Other Investments Equity Method and Other Investments (Tables)	6 Months Ended
	Jun. 30, 2023
Equity Method Investments and Joint Ventures [Abstract]
Equity Method Investments	The Company maintains equity method and other minor investments in the private securities of certain other healthcare and healthcare-related businesses, comprised as follows: June 30, 2023 December 31, 2022 Mozarc Medical Holdings LLC $ 359,757 APAC joint venture 101,200 $ 99,141 Other equity method partnerships 118,467 116,403 Adjusted cost method and other investments 13,845 15,564 $ 593,269 $ 231,108

Long-term debt (Tables)

Long-term debt (Tables)	6 Months Ended
	Jun. 30, 2023
Debt Disclosure [Abstract]
Long-term Debt	Long-term debt was comprised of the following: As of June 30, 2023 June 30, December 31, 2022 Maturity date Interest rate Estimated fair value (1) Senior Secured Credit Facilities: Term Loan A-1 $ 1,250,000 $ — (2) SOFR+CSA+2.00% $ 1,237,500 Term Loan B-1 2,617,501 2,660,831 8/12/2026 SOFR+CSA+1.75% $ 2,578,239 New Revolving line of credit 285,000 — (2) SOFR+CSA+2.00% $ 285,000 Prior Term Loan A — 1,498,438 8/12/2024 (3) $ — Prior Revolving line of credit — 165,000 8/12/2024 (3) $ — Senior Notes: 4.625% Senior Notes 2,750,000 2,750,000 6/1/2030 4.625 % $ 2,358,125 3.75% Senior Notes 1,500,000 1,500,000 2/15/2031 3.75 % $ 1,201,875 Acquisition obligations and other notes payable (4) 99,904 120,562 2023-2036 6.81 % $ 99,904 Financing lease obligations (5) 257,423 273,688 2024-2039 4.50 % Total debt principal outstanding 8,759,828 8,968,519 Discount, premium and deferred financing costs (6) (60,553) (44,498) 8,699,275 8,924,021 Less current portion (101,113) (231,404) $ 8,598,162 $ 8,692,617 (1) For the Company's senior secured credit facilities and senior notes, fair value estimates are based upon bid and ask quotes, typically a level 2 input. For acquisition obligations and other notes payable, the carrying values presented approximate their estimated fair values, based on estimates of their present values using level 2 interest rate inputs. (2) Outstanding Term Loan A-1 and the new Revolving line of credit balances are due on April 28, 2028, unless any of Term Loan B-1 remains outstanding 91 days prior to the Term Loan B-1 maturity date, in which case the outstanding Term Loan A-1 and the new Revolving line of credit balances become due at that 91 day date (May 13, 2026). (3) At March 31, 2023, the interest rate on the Company's then-existing credit facilities was LIBOR plus an interest rate margin in effect of 1.75% for the prior Term Loan A and prior revolving line of credit. (4) The interest rate presented for acquisition obligations and other notes payable is their weighted average interest rate based on the current fixed and variable interest rate components in effect as of June 30, 2023. (5) 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. (6) As of June 30, 2023, the carrying amount of the Company's senior secured credit facilities have been reduced by a discount of $2,961 and deferred financing costs of $36,819, and the carrying amount of the Company's senior notes have been reduced by deferred financing costs of $33,847 and increased by a debt premium of $13,074. As of December 31, 2022, the carrying amount of the Company's senior secured credit facilities were reduced by a discount of $3,497 and deferred financing costs of $18,816, and the carrying amount of the Company's senior notes were reduced by deferred financing costs of $36,203 and increased by a debt premium of $14,018.
Scheduled Maturities of Long-term Debt	Scheduled maturities of long-term debt at June 30, 2023 were as follows: 2023 (remainder of the year) $ 52,244 2024 $ 115,626 2025 $ 129,805 2026 $ 2,660,615 2027 $ 113,373 2028 $ 1,298,981 Thereafter $ 4,389,184
Schedule of Derivative Instruments	The following table summarizes the Company’s interest rate cap agreements outstanding as of June 30, 2023 and December 31, 2022, which are classified in other long-term assets on its consolidated balance sheet: Six months ended Fair value Notional amount Variable rate maximum (1) Effective date Expiration date Debt expense (offset) Recorded OCI gain June 30, December 31, 2022 2019 cap agreements $ 3,500,000 2.00% 6/30/2020 6/30/2024 $ (46,232) $ 24,215 $ 114,983 $ 139,755 2023 cap agreements $ 200,000 3.75% 6/28/2024 12/31/2025 $ 671 $ 1,862 2023 cap agreements $ 1,000,000 4.00% (2) 6/28/2024 12/31/2025 $ 1,119 $ 10,356 2023 cap agreements $ 800,000 3.75% 6/30/2024 12/31/2025 $ 2,388 $ 7,353 (1) The Company's cap agreements have the effect of capping SOFR-based variable rate payments made by the Company. (2) Effective January 1, 2025, the maximum rate of 4.00% decreases to 3.75% for these interest rate caps.

Accumulated other comprehensi_2

Accumulated other comprehensive (loss) income (Tables)	6 Months Ended
	Jun. 30, 2023
Statement of Comprehensive Income [Abstract]
Comprehensive income	Three months ended June 30, 2023 Six months ended June 30, 2023 Interest Foreign Accumulated Interest Foreign Accumulated Beginning balance $ 79,404 $ (134,310) $ (54,906) $ 98,685 $ (167,871) $ (69,186) Unrealized gains 33,109 41,961 75,070 28,393 75,522 103,915 Related income tax (8,260) — (8,260) (7,083) — (7,083) 24,849 41,961 66,810 21,310 75,522 96,832 Reclassification into net income (25,257) — (25,257) (46,232) — (46,232) Related income tax 6,301 — 6,301 11,534 — 11,534 (18,956) — (18,956) (34,698) — (34,698) Ending balance $ 85,297 $ (92,349) $ (7,052) $ 85,297 $ (92,349) $ (7,052) Three months ended June 30, 2022 Six months ended June 30, 2022 Interest Foreign Accumulated Interest Foreign Accumulated Beginning balance $ 40,987 $ (75,857) $ (34,870) $ (1,178) $ (138,069) $ (139,247) Unrealized gains (losses) 17,610 (91,176) (73,566) 72,416 (28,964) 43,452 Related income tax (4,393) — (4,393) (18,067) — (18,067) 13,217 (91,176) (77,959) 54,349 (28,964) 25,385 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 $ 55,237 $ (167,033) $ (111,796) $ 55,237 $ (167,033) $ (111,796)

Fair value of financial instr_2

Fair value of financial instruments (Tables)	6 Months Ended
	Jun. 30, 2023
Fair Value Disclosures [Abstract]
Assets, Liabilities and Temporary Equity Measured at Fair Value on a Recurring Basis	The following table summarizes the Company’s assets, liabilities and temporary equities measured at fair value on a recurring basis as of June 30, 2023: Total Quoted prices in Significant other Significant Assets Investments in equity securities $ 38,063 $ 38,063 $ — $ — Interest rate cap agreements $ 134,554 $ — $ 134,554 $ — Liabilities Contingent earn-out obligations for acquisitions $ 23,499 $ — $ — $ 23,499 Temporary equity Noncontrolling interests subject to put provisions $ 1,423,549 $ — $ — $ 1,423,549 For a reconciliation of changes in noncontrolling interests subject to put provisions during the three and six months ended June 30, 2023, see the consolidated statement of equity.

Segment reporting (Tables)

Segment reporting (Tables)	6 Months Ended
	Jun. 30, 2023
Segment Reporting [Abstract]
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes	The following is a summary of segment revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income before income taxes: Three months ended June 30, Six months ended June 30, 2023 2022 2023 2022 Segment revenues: U.S. dialysis Dialysis patient service revenues: External sources $ 2,703,850 $ 2,637,738 $ 5,287,782 $ 5,184,700 Intersegment revenues 20,361 19,410 42,410 41,568 U.S. dialysis patient service revenues 2,724,211 2,657,148 5,330,192 5,226,268 Other revenues: External sources 6,404 6,113 12,583 12,078 Intersegment revenues — (21) — (10) Total U.S. dialysis revenues 2,730,615 2,663,240 5,342,775 5,238,336 Other—Ancillary services Dialysis patient service revenues 186,835 172,361 362,937 341,680 Other external sources 103,280 110,545 209,766 205,854 Intersegment revenues 1,408 — 2,774 — Total ancillary services revenues 291,523 282,906 575,477 547,534 Total net segment revenues 3,022,138 2,946,146 5,918,252 5,785,870 Elimination of intersegment revenues (21,769) (19,389) (45,184) (41,558) Consolidated revenues $ 3,000,369 $ 2,926,757 $ 5,873,068 $ 5,744,312 Segment operating margin (loss): U.S. dialysis $ 460,759 $ 472,801 $ 821,857 $ 879,241 Other—Ancillary services (21,604) (9,113) (46,469) (41,418) Total segment operating margin 439,155 463,688 775,388 837,823 Reconciliation of segment operating income to Corporate administrative support (33,864) (30,973) (58,452) (66,800) Consolidated operating income 405,291 432,715 716,936 771,023 Debt expense (103,507) (82,586) (204,281) (156,377) Debt prepayment and refinancing charges (7,962) — (7,962) — Other income (loss), net 1,373 (1,284) 5,125 (3,070) Consolidated income before income taxes $ 295,195 $ 348,845 $ 509,818 $ 611,576
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, 2023 2022 2023 2022 U.S. dialysis $ 171,842 $ 160,612 $ 338,803 $ 322,632 Other—Ancillary services 11,830 10,564 22,940 21,488 $ 183,672 $ 171,176 $ 361,743 $ 344,120
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, 2023 2022 U.S. dialysis $ 240,474 $ 237,686 Other—Ancillary services 31,730 27,775 $ 272,204 $ 265,461
Summary of Assets by Reportable Segment	A summary of assets by reportable segment were as follows: June 30, 2023 December 31, 2022 U.S. dialysis $ 14,592,384 $ 15,084,454 Other—Ancillary services 2,366,461 1,843,798 Consolidated assets $ 16,958,845 $ 16,928,252

Revenue Recognition Segment R_2

Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Disaggregation of Revenue [Line Items]
Other revenues	$ 109,684	$ 116,658	$ 222,349	$ 217,932
Total revenues	3,000,369	2,926,757	5,873,068	5,744,312
Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(21,769)	(19,389)	(45,184)	(41,558)
Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	1,539,639	1,529,534	3,022,405	2,993,621
Other revenues	87,236	93,262	180,475	176,859
Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	216,014	186,873	421,790	376,528
Other revenues	396	232	965	769
Other Government Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	218,489	202,732	422,120	400,427
Commercial Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	936,904	910,370	1,826,814	1,797,372
Other revenues	3,619	8,207	4,825	9,546
Other
Disaggregation of Revenue [Line Items]
Other revenues	19,841	14,936	38,858	30,748
U.S. dialysis
Disaggregation of Revenue [Line Items]
Total revenues	2,710,254	2,643,851	5,300,365	5,196,778
U.S. dialysis | Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(20,361)	(19,389)	(42,410)	(41,558)
U.S. dialysis | Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	1,539,639	1,529,534	3,022,405	2,993,621
U.S. dialysis | Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	216,014	186,873	421,790	376,528
U.S. dialysis | Other Government Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	92,525	86,079	174,570	166,879
U.S. dialysis | Commercial Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	876,033	854,662	1,711,427	1,689,240
U.S. dialysis | Other
Disaggregation of Revenue [Line Items]
Other revenues	6,404	6,092	12,583	12,068
Other—Ancillary services
Disaggregation of Revenue [Line Items]
Total revenues	290,115	282,906	572,703	547,534
Other—Ancillary services | Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(1,408)		(2,774)
Other—Ancillary services | Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Other revenues	87,236	93,262	180,475	176,859
Other—Ancillary services | Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Other revenues	396	232	965	769
Other—Ancillary services | Other Government Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	125,964	116,653	247,550	233,548
Other—Ancillary services | Commercial Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	60,871	55,708	115,387	108,132
Other revenues	3,619	8,207	4,825	9,546
Other—Ancillary services | Other
Disaggregation of Revenue [Line Items]
Other revenues	$ 13,437	$ 8,844	$ 26,275	$ 18,680

Earnings per share Earnings p_2

Earnings per share Earnings per share - Reconciliation of numerators and denominators used to calculate basic and diluted earnings per share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Numerators:
Net income attributable to DaVita Inc.	$ 178,691	$ 224,809	$ 294,238	$ 386,931
Weighted average basic shares outstanding during period	90,984,000	94,457,000	90,742,000	95,382,000
Assumed incremental from stock plans	2,434,000	3,315,000	2,210,000	3,739,000
Weighted average diluted shares outstanding during period	93,418,000	97,772,000	92,952,000	99,121,000
Basic net income per share attributable to DaVita Inc.	$ 1.96	$ 2.38	$ 3.24	$ 4.06
Diluted net income per share attributable to DaVita Inc.	$ 1.91	$ 2.30	$ 3.17	$ 3.90
Anti-dilutive stock-settled awards excluded from calculation	280,000	1,201,000	787,000	686,000

Investments in debt and equit_3

Investments in debt and equity securities (Detail) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Investment Holdings [Line Items]
Debt securities	$ 20,426	$ 82,879
Investments in equity securities	38,063	39,143
Equity Securities, FV-NI	38,063	39,143
Total	58,489	122,022
Debt securities, short-term investments	5,419	67,872
Short-term investments	12,484	77,693
Debt securities, long-term investments	15,007	15,007
Long-term investments	46,005	44,329
Certificates of deposit and other time deposits
Investment Holdings [Line Items]
Debt securities	20,426	82,879
Investments in equity securities	0	0
Total	20,426	82,879
Investments in mutual funds and common stocks
Investment Holdings [Line Items]
Debt securities	0	0
Investments in equity securities	38,063	39,143
Total	38,063	39,143
Short-term Investments
Investment Holdings [Line Items]
Investments in equity securities	7,065	9,821
Long-term Investments
Investment Holdings [Line Items]
Equity Securities, FV-NI, Noncurrent	$ 30,998	$ 29,322

Goodwill - Changes in Goodwill

Goodwill - Changes in Goodwill by Reportable Segments (Detail) - USD ($) $ in Thousands	6 Months Ended	12 Months Ended
	Jun. 30, 2023	Dec. 31, 2022
Goodwill [Roll Forward]
Beginning balance	$ 7,076,610	$ 7,046,241
Acquisitions	690	49,047
Divestitures		(3,350)
Foreign currency and other adjustments	28,942	(15,328)
Ending balance	7,106,242	7,076,610
Goodwill, before accumulated impairment charges	7,227,457
Accumulated impairment charges	(121,215)
Ending balance	7,106,242	7,076,610
U.S. dialysis
Goodwill [Roll Forward]
Beginning balance	6,416,825	6,400,162
Acquisitions	0	16,750
Divestitures		(87)
Foreign currency and other adjustments	0	0
Ending balance	6,416,825	6,416,825
Goodwill, before accumulated impairment charges	6,416,825
Accumulated impairment charges	0
Ending balance	6,416,825	6,416,825
Other—Ancillary services
Goodwill [Roll Forward]
Beginning balance	659,785	646,079
Acquisitions	690	32,297
Divestitures		(3,263)
Foreign currency and other adjustments	28,942	(15,328)
Ending balance	689,417	659,785
Goodwill, before accumulated impairment charges	810,632
Accumulated impairment charges	(121,215)
Ending balance	$ 689,417	$ 659,785

Goodwill - Narrative (Details)

Goodwill - Narrative (Details) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2023 segment	Jun. 30, 2023 USD ($)	Jun. 30, 2022 USD ($)
Goodwill [Line Items]
Goodwill impairment charges | $		$ 0	$ 0
Other Health Operations
Goodwill [Line Items]
Number of Reportable Segments | segment	0

Equity Method and Other Inves_3

Equity Method and Other Investments Equity Method and Other Investments (Details) - USD ($) $ in Thousands	Apr. 01, 2023	Jun. 30, 2023	Dec. 31, 2022
Schedule of Equity Method and Other Investments [Line Items]
Equity method and other investments		$ 593,269	$ 231,108
Mozarc Medical Holdings LLC
Schedule of Equity Method and Other Investments [Line Items]
Transaction Agreement Date	May 25, 2022
Transaction Agreement Effective Closing Date	Apr. 01, 2023
Payments to Medtronic	$ 44,651
Other Commitment, to be Paid, between 2024 through 2028	300,000
Contributed Other Non-Cash Assets	14,000
Fair value of Contingent Consideration payable to Medtronic	86,300
Additional Cash Contributed	224,415
Equity Method Investment, Initial Aggregate Cost	$ 371,026
Mozarc Medical Holdings LLC
Schedule of Equity Method and Other Investments [Line Items]
Equity method and other investments		359,757
Current Voting Equity Interest in Mozarc, Owned by Medtronic	50%
Parent Company And Restricted Subsidiaries
Schedule of Equity Method and Other Investments [Line Items]
Voting Equity Interest by the Company	50%
APAC joint venture
Schedule of Equity Method and Other Investments [Line Items]
Equity method and other investments		101,200	99,141
Adjusted cost method and other investments
Schedule of Equity Method and Other Investments [Line Items]
Equity method and other investments		13,845	15,564
Other equity method partnerships
Schedule of Equity Method and Other Investments [Line Items]
Equity method and other investments		$ 118,467	$ 116,403

Equity Method and Other Inves_4

Equity Method and Other Investments - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Equity Method Investment income from equity method investments
Equity investment income (loss) from equity method investments in nonconsolidated dialysis partnerships.	$ 8,454	$ 9,141	$ 15,274	$ 16,187
Other Nonoperating Income (Expense)
Equity Method Investment income from equity method investments
Income (Loss ) From Other Equity Method Investments			(15,568)	(1,538)
Equity Method Investments In Nonconsolidated Dialysis Partnerships [Member]
Equity Method Investment income from equity method investments
Equity investment income (loss) from equity method investments in nonconsolidated dialysis partnerships.			$ 15,274	$ 16,187

Long-term debt (Detail)

Long-term debt (Detail) - USD ($) $ in Thousands			3 Months Ended		6 Months Ended
	Jan. 01, 2025	Apr. 28, 2023	Jun. 30, 2023	Mar. 31, 2023	Jun. 30, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Total debt principal outstanding			$ 8,759,828		$ 8,759,828	$ 8,968,519
Discount, premium and deferred financing costs(6)			(60,553)		(60,553)	(44,498)
Carrying amount of long-term debt, net of unamortized discounts			8,699,275		8,699,275	8,924,021
Less current portion			(101,113)		(101,113)	(231,404)
Total long-term debt			$ 8,598,162		$ 8,598,162	8,692,617
Debt interest rate during period			4.67%		4.61%
Long-term debt, weighted average interest rate, at point in time			4.66%		4.66%
4.625% Senior Notes
Debt Instrument [Line Items]
Senior Notes			$ 2,750,000		$ 2,750,000	2,750,000
Debt Instrument, Maturity Date					Jun. 01, 2030
Debt interest rate during period					4.625%
Debt Instrument, Fair Value Disclosure			2,358,125		$ 2,358,125
3.75% Senior Notes
Debt Instrument [Line Items]
Senior Notes			1,500,000		$ 1,500,000	1,500,000
Debt Instrument, Maturity Date					Feb. 15, 2031
Debt interest rate during period					3.75%
Debt Instrument, Fair Value Disclosure			1,201,875		$ 1,201,875
Acquisition obligations and other notes payable(4)
Debt Instrument [Line Items]
Acquisition obligations and other notes payable			$ 99,904		$ 99,904	120,562
Debt instrument, maturity date, description					2023-2036
Long-term debt, weighted average interest rate, at point in time			6.81%		6.81%
Acquisition obligations and other notes payable, fair value			$ 99,904		$ 99,904
Financing lease obligations(5)
Debt Instrument [Line Items]
Financing lease obligations			$ 257,423		$ 257,423	273,688
Debt instrument, maturity date, description					2024-2039
Finance lease, weighted average discount rate, percent			4.50%		4.50%
Term Loan Facility | Maximum | 2023 cap agreements
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin					4%
Term Loan Facility | Subsequent Event | Maximum | 2023 cap agreements
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin	3.75%
New Revolving line of credit
Debt Instrument [Line Items]
Secured Debt			$ 285,000		$ 285,000	0
Revolving line of credit, fair value of amount outstanding			285,000		$ 285,000
Initial Borrowing on the New Revolving Line Of Credit		$ 400,000
New Revolving line of credit | SOFR
Debt Instrument [Line Items]
Debt Instrument, Description of the Variable Rate Basis					SOFR+CSA+2.00%
Prior Revolving line of credit
Debt Instrument [Line Items]
Secured Debt			0		$ 0	165,000
Debt Instrument, Maturity Date					Aug. 12, 2024
Revolving line of credit, fair value of amount outstanding			0		$ 0
Constructive Financing Cash Outflows And Financing Cash Inflows			$ 150,000
Term Loan A-1 and Revolver
Debt Instrument [Line Items]
Debt Instrument, Periodic Payment Terms, Date Balloon Payment to be Paid			Apr. 28, 2028
Debt Instrument Period Before Maturity Date When Unpaid Amount Triggers Change In Due Date			May 13, 2026
Term Loan A-1 and Revolver | Minimum
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin			0%
Term Loan A-1
Debt Instrument [Line Items]
Secured Debt		$ 1,250,000	$ 1,250,000		1,250,000	0
Debt Instrument, Fair Value Disclosure			$ 1,237,500		$ 1,237,500
Term Loan A-1 | SOFR
Debt Instrument [Line Items]
Debt Instrument, Description of the Variable Rate Basis					SOFR+CSA+2.00%
SOFR Plus Interest Rate Margin			2%
Term Loan A-1 | Adjusted Rate
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin			0.10%
Term Loan A-1 | New Revolving line of credit | SOFR | Minimum
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin			1.25%
Term Loan A-1 | New Revolving line of credit | SOFR | Maximum
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin			2.25%
Term Loan B-1
Debt Instrument [Line Items]
Secured Debt			$ 2,617,501		$ 2,617,501	2,660,831
Debt Instrument, Maturity Date					Aug. 12, 2026
Debt Instrument, Fair Value Disclosure			$ 2,578,239		$ 2,578,239
Term Loan B-1 | Minimum
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin			0%
Term Loan B-1 | SOFR
Debt Instrument [Line Items]
Debt Instrument, Description of the Variable Rate Basis					SOFR+CSA+1.75%
SOFR Plus Interest Rate Margin			1.75%
Term Loan B-1 | Adjusted Rate
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin			0.11%
Prior Term Loan A
Debt Instrument [Line Items]
Secured Debt			$ 0		$ 0	$ 1,498,438
Debt Instrument, Maturity Date					Aug. 12, 2024
Debt Instrument, Fair Value Disclosure			0		$ 0
Constructive Financing Cash Outflows And Financing Cash Inflows			434,393
Other Significant Noncash Financing Activity			$ 715,019
Prior Term Loan A | Prior Revolving line of credit | LIBOR
Debt Instrument [Line Items]
LIBOR				1.75%
Senior Secured Credit Facilities
Debt Instrument [Line Items]
Long-term debt, weighted average interest rate, at point in time			4.90%		4.90%

Long-term debt - Additional Inf

Long-term debt - Additional Information (Detail) $ in Thousands			3 Months Ended		6 Months Ended
	Apr. 28, 2023 USD ($)	Apr. 03, 2023	Jun. 30, 2023 USD ($)	Jun. 30, 2022 USD ($)	Jun. 30, 2023 USD ($)	Jun. 30, 2022 USD ($)	Dec. 31, 2022 USD ($)
Debt Instrument [Line Items]
Weighted average effective interest rate at quarter end			4.66%		4.66%
Weighted average effective interest rate during quarter			4.67%		4.61%
Percentage of debt instruments bearing fixed interest rate			52%		52%
Long Term Debt Percentage Bearing Economically Fixed Interest Rate			92%		92%
Debt prepayment and refinancing charges			$ 7,962	$ 0	$ 7,962	$ 0
New Revolving line of credit
Debt Instrument [Line Items]
Maximum borrowing capacity on the revolving credit facilities	$ 1,500,000		1,500,000		1,500,000
Line of Credit Facility [Line Items]
Line of Credit Facility, Remaining Borrowing Capacity			1,215,000		$ 1,215,000
New Revolving line of credit | SOFR
Debt Instrument [Line Items]
Debt Instrument, Description of the Variable Rate Basis					SOFR+CSA+2.00%
Letter of Credit
Debt Instrument [Line Items]
Letters of credit outstanding			0		$ 0
Bilateral Secured Letter Of Credit Facility
Debt Instrument [Line Items]
Letters of credit outstanding			$ 151,395		151,395
Prior Term Loan A
Debt Instrument [Line Items]
Debt Instrument, Periodic Payment, Principal					54,011
Term Loan B-1
Debt Instrument [Line Items]
Debt Instrument, Periodic Payment, Principal					$ 43,330
Debt Instrument, effective date		Apr. 03, 2023
Term Loan B-1 | Minimum
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin			0%
Term Loan B-1 | SOFR
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin			1.75%
Debt Instrument, Description of the Variable Rate Basis					SOFR+CSA+1.75%
Senior Secured Credit Facilities
Debt Instrument [Line Items]
Weighted average effective interest rate at quarter end			4.90%		4.90%
Debt Instrument, Unamortized Discount			$ 2,961		$ 2,961		$ 3,497
Deferred Financing Costs			36,819		36,819		18,816
Term Loan A-1
Debt Instrument [Line Items]
Secured Debt Outstanding Principal Balance Subject To SOFR			$ 367,501		367,501
Debt Instrument, effective date	Apr. 28, 2023
Debt Instrument Quarterly Payment Start Date			Sep. 30, 2023
Debt Instrument, Quarterly Payment, First Four payments			$ (7,813)		(7,813)
Debt Instrument, Quarterly Payment, Year Two, Three, Four			(15,625)		(15,625)
Debt Instrument, Quarterly Payment, Year Five			$ (23,438)		$ (23,438)
Term Loan A-1 | SOFR
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin			2%
Debt Instrument, Description of the Variable Rate Basis					SOFR+CSA+2.00%
Term Loan A-1 | New Revolving line of credit | SOFR | Minimum
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin			1.25%
Term Loan A-1 | New Revolving line of credit | SOFR | Maximum
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin			2.25%
Prior Term Loan A and Prior Revolving Line Of Credit
Debt Instrument [Line Items]
Repayments of Debt			$ 1,602,199
Credit Agreement As Amended | Maximum
Debt Instrument [Line Items]
Leverage Ratio Covenant			4		4
Leverage Ratio Covenant Through Jun 30, 2026			5		5
Leverage Ratio Covenant after Jun 30, 2026			4.50		4.50
Senior Notes
Debt Instrument [Line Items]
Deferred Financing Costs			$ 33,847		$ 33,847		36,203
Debt Instrument, Unamortized Premium			$ 13,074		$ 13,074		$ 14,018

Long-Term Debt - Scheduled Matu

Long-Term Debt - Scheduled Maturities of Long-term Debt (Details) $ in Thousands	Jun. 30, 2023 USD ($)
Debt Disclosure [Abstract]
2023 (remainder of the year)	$ 52,244
2024	115,626
2025	129,805
2026	2,660,615
2027	113,373
2028	1,298,981
Thereafter	$ 4,389,184

Long-term debt Schedule of Deri

Long-term debt Schedule of Derivative Instruments (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2023	Dec. 31, 2022
Derivative [Line Items]
Derivative Instrument, Gain (Loss) Reclassified from AOCI into Income, Effective Portion, Statement of Income or Comprehensive Income [Extensible Enumeration]	Interest and Debt Expense
2019 cap agreements
Derivative [Line Items]
Derivative, effective date	Jun. 30, 2020
Derivative, expiration date	Jun. 30, 2024
2023 cap agreements
Derivative [Line Items]
Derivative, effective date	Jun. 28, 2024
Derivative, expiration date	Dec. 31, 2025
2023 cap agreements
Derivative [Line Items]
Derivative, effective date	Jun. 28, 2024
Derivative, expiration date	Dec. 31, 2025
2023 cap agreements
Derivative [Line Items]
Derivative, effective date	Jun. 30, 2024
Derivative, expiration date	Dec. 31, 2025
Other Long-term Assets | 2019 cap agreements
Derivative [Line Items]
Derivative asset, fair value, gross asset	$ 114,983	$ 139,755
Other Long-term Assets | 2023 cap agreements
Derivative [Line Items]
Derivative asset, fair value, gross asset	1,862
Other Long-term Assets | 2023 cap agreements
Derivative [Line Items]
Derivative asset, fair value, gross asset	10,356
Other Long-term Assets | 2023 cap agreements
Derivative [Line Items]
Derivative asset, fair value, gross asset	7,353
Cash Flow Hedging | 2019 cap agreements
Derivative [Line Items]
Amount of debt expense reclassified from accumulated OCI into income	(46,232)
Other Comprehensive Income (Loss), Unrealized Gain (Loss) on Derivatives Arising During Period, before Tax	24,215
Cash Flow Hedging | 2023 cap agreements
Derivative [Line Items]
Other Comprehensive Income (Loss), Unrealized Gain (Loss) on Derivatives Arising During Period, before Tax	671
Cash Flow Hedging | 2023 cap agreements
Derivative [Line Items]
Other Comprehensive Income (Loss), Unrealized Gain (Loss) on Derivatives Arising During Period, before Tax	1,119
Cash Flow Hedging | 2023 cap agreements
Derivative [Line Items]
Other Comprehensive Income (Loss), Unrealized Gain (Loss) on Derivatives Arising During Period, before Tax	2,388
Term Loan Facility | Maximum | 2019 cap agreements
Derivative [Line Items]
Notional amounts of interest rate agreements	$ 3,500,000
SOFR Plus Interest Rate Margin	2%
Term Loan Facility | Maximum | 2023 cap agreements
Derivative [Line Items]
Notional amounts of interest rate agreements	$ 200,000
SOFR Plus Interest Rate Margin	3.75%
Term Loan Facility | Maximum | 2023 cap agreements
Derivative [Line Items]
Notional amounts of interest rate agreements	$ 1,000,000
SOFR Plus Interest Rate Margin	4%
Term Loan Facility | Maximum | 2023 cap agreements
Derivative [Line Items]
Notional amounts of interest rate agreements	$ 800,000
SOFR Plus Interest Rate Margin	3.75%

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Detail) - USD ($) $ in Thousands		6 Months Ended
	Oct. 22, 2019	Jun. 30, 2023
Commitments and Contingencies:
Corporate Integrity Agreement Period		5 years
Corporate Integrity Agreement Expiration Date	Oct. 22, 2019
Commitments to provide operating capital
Commitments and Contingencies:
Other potential commitments to provide operating capital to several dialysis centers		$ 9,696

Stock-based compensation (Detai

Stock-based compensation (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2023 USD ($) shares
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Unrecognized compensation cost related to nonvested stock-based compensation arrangements under equity compensation and stock purchase plans	$ 175,710
Unrecognized compensation cost related to nonvested stock-based compensation arrangements under stock-based component of LTIP costs, weighted average remaining period (in years)	1 year 4 months 24 days
Restricted stock units and Performance stock units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period | shares	1,338,000
Aggregate grant-date fair value	$ 102,999
Weighted-average expected life (in years)	3 years 4 months 24 days

Share repurchases (Details)

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

Accumulated other comprehensi_3

Accumulated other comprehensive (loss) income (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance			$ (69,186)
Ending balance	$ (7,052)		(7,052)
Interest rate cap agreements
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance	79,404	$ 40,987	98,685	$ (1,178)
Unrealized gains (losses)	33,109	17,610	28,393	72,416
Related income tax benefit	(8,260)	(4,393)	(7,083)	(18,067)
Unrealized (losses) gains net	24,849	13,217	21,310	54,349
Reclassification into net income	(25,257)	1,377	(46,232)	2,754
Related income tax	6,301	(344)	11,534	(688)
Reclassification from accumulated other comprehensive income into net income net of tax	(18,956)	1,033	(34,698)	2,066
Ending balance	85,297	55,237	85,297	55,237
Foreign currency translation adjustments
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance	(134,310)	(75,857)	(167,871)	(138,069)
Unrealized gains (losses)	41,961	(91,176)	75,522	(28,964)
Related income tax benefit	0	0	0	0
Unrealized (losses) gains net	41,961	(91,176)	75,522	(28,964)
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	(92,349)	(167,033)	(92,349)	(167,033)
Accumulated other comprehensive (loss) income
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance	(54,906)	(34,870)	(69,186)	(139,247)
Unrealized gains (losses)	75,070	(73,566)	103,915	43,452
Related income tax benefit	(8,260)	(4,393)	(7,083)	(18,067)
Unrealized (losses) gains net	66,810	(77,959)	96,832	25,385
Reclassification into net income	(25,257)	1,377	(46,232)	2,754
Related income tax	6,301	(344)	11,534	(688)
Reclassification from accumulated other comprehensive income into net income net of tax	(18,956)	1,033	(34,698)	2,066
Ending balance	$ (7,052)	$ (111,796)	$ (7,052)	$ (111,796)

Variable interest entities - Ad

Variable interest entities - Additional Information (Detail) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Total assets	$ 16,958,845	$ 16,928,252
Total liabilities and noncontrolling interests	14,329,226	$ 14,703,452
Variable Interest Entity
Total assets	297,355
Total liabilities and noncontrolling interests	$ 165,916

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, 2023	Dec. 31, 2022
Assets
Investments in equity securities	$ 38,063	$ 39,143
Fair Value, Measurements, Recurring
Assets
Investments in equity securities	38,063
Liabilities
Contingent earn-out obligations	23,499
Temporary equity
Noncontrolling interests subject to put provisions	1,423,549
Fair Value, Measurements, Recurring | Interest rate cap agreements
Assets
Interest rate cap agreements	134,554
Fair Value, Measurements, Recurring | Quoted prices in active markets for identical assets (Level 1)
Assets
Investments in equity securities	38,063
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	134,554
Fair Value, Measurements, Recurring | Significant unobservable inputs (Level 3)
Assets
Investments in equity securities	0
Liabilities
Contingent earn-out obligations	23,499
Temporary equity
Noncontrolling interests subject to put provisions	1,423,549
Fair Value, Measurements, Recurring | Significant unobservable inputs (Level 3) | Interest rate cap agreements
Assets
Interest rate cap agreements	$ 0

Fair value of financial instr_4

Fair value of financial instruments (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2023 USD ($)
Fair Value Net Derivative Asset Liability Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Potential Increase Decrease In Fair Value Of Noncontrolling Interests Due To Change In Weighted Average EBITDA Multiple	$ 180,000
Minimum | EBITDA or Operating Income Performance Targets or Quality Margins | Other companies
Fair Value Net Derivative Asset Liability Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Earn-out consideration payment period	1 year
Maximum
Fair Value Net Derivative Asset Liability Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Business Combination Contingent Consideration Acquisitions	$ 55,970
Maximum | EBITDA or Operating Income Performance Targets or Quality Margins | Other companies
Fair Value Net Derivative Asset Liability Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Earn-out consideration payment period	5 years

Segment reporting - Summary of

Segment reporting - Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Segment Reporting Information [Line Items]
Other revenues	$ 109,684	$ 116,658	$ 222,349	$ 217,932
Total revenues	3,000,369	2,926,757	5,873,068	5,744,312
Operating income (loss)	405,291	432,715	716,936	771,023
Corporate administrative support	(33,864)	(30,973)	(58,452)	(66,800)
Debt expense	(103,507)	(82,586)	(204,281)	(156,377)
Debt prepayment and refinancing charges	(7,962)	0	(7,962)	0
Other income (loss), net	1,373	(1,284)	5,125	(3,070)
Income before income taxes	295,195	348,845	509,818	611,576
U.S. dialysis
Segment Reporting Information [Line Items]
Total revenues	2,710,254	2,643,851	5,300,365	5,196,778
Other—Ancillary services
Segment Reporting Information [Line Items]
Total revenues	290,115	282,906	572,703	547,534
Operating Segments
Segment Reporting Information [Line Items]
Total revenues	3,022,138	2,946,146	5,918,252	5,785,870
Operating income (loss)	439,155	463,688	775,388	837,823
Operating Segments | U.S. dialysis
Segment Reporting Information [Line Items]
Dialysis patient service revenues	2,724,211	2,657,148	5,330,192	5,226,268
Total revenues	2,730,615	2,663,240	5,342,775	5,238,336
Operating income (loss)	460,759	472,801	821,857	879,241
Operating Segments | U.S. dialysis | External Sources
Segment Reporting Information [Line Items]
Dialysis patient service revenues	2,703,850	2,637,738	5,287,782	5,184,700
Other revenues	6,404	6,113	12,583	12,078
Operating Segments | U.S. dialysis | Intersubsegment Eliminations
Segment Reporting Information [Line Items]
Dialysis patient service revenues	20,361	19,410	42,410	41,568
Other revenues	0	(21)	0	(10)
Operating Segments | Other—Ancillary services
Segment Reporting Information [Line Items]
Dialysis patient service revenues	186,835	172,361	362,937	341,680
Other revenues	103,280	110,545	209,766	205,854
Total revenues	291,523	282,906	575,477	547,534
Operating income (loss)	(21,604)	(9,113)	(46,469)	(41,418)
Operating Segments | Other—Ancillary services | Intersubsegment Eliminations
Segment Reporting Information [Line Items]
Dialysis patient service revenues	1,408	0	2,774	0
Intersegment Elimination
Segment Reporting Information [Line Items]
Total revenues	(21,769)	(19,389)	(45,184)	(41,558)
Intersegment Elimination | U.S. dialysis
Segment Reporting Information [Line Items]
Total revenues	(20,361)	$ (19,389)	(42,410)	$ (41,558)
Intersegment Elimination | Other—Ancillary services
Segment Reporting Information [Line Items]
Total revenues	$ (1,408)		$ (2,774)

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, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 183,672	$ 171,176	$ 361,743	$ 344,120
U.S. dialysis
Segment Reporting Information [Line Items]
Depreciation and amortization	171,842	160,612	338,803	322,632
Other—Ancillary services
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 11,830	$ 10,564	$ 22,940	$ 21,488

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, 2023	Jun. 30, 2022
Segment Reporting Information [Line Items]
Expenditures for property and equipment	$ 272,204	$ 265,461
U.S. dialysis
Segment Reporting Information [Line Items]
Expenditures for property and equipment	240,474	237,686
Other—Ancillary services
Segment Reporting Information [Line Items]
Expenditures for property and equipment	$ 31,730	$ 27,775

Segment reporting - Summary o_4

Segment reporting - Summary of Assets by Segment (Detail) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
ASSETS
Total assets	$ 16,958,845	$ 16,928,252
U.S. dialysis
ASSETS
Total assets	14,592,384	15,084,454
Other—Ancillary services
ASSETS
Total assets	$ 2,366,461	$ 1,843,798

New accounting standards (Detai

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