DaVita (DVA) 10-K 14 Feb 24 2023 FY Annual report Financial data

Document and Entity Information

Document and Entity Information - USD ($) shares in Millions, $ in Billions	12 Months Ended
	Dec. 31, 2023	Jan. 31, 2024	Jun. 30, 2023
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2023
Current Fiscal Year End Date	--12-31
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 Well-known Seasoned Issuer	Yes
Entity Voluntary Filer	No
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
ICFR Auditor Attestation Flag	true
Entity Shell Company	false
Entity Public Float			$ 9.2
Entity Common Stock, Shares Outstanding		87.7
Amendment Flag	false
Document Financial Statement Error Correction [Flag]	false
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	FY
Entity Central Index Key	0000927066

Audit Information

Audit Information	12 Months Ended
	Dec. 31, 2023
Auditor [Abstract]
Auditor Name	KPMG LLP
Auditor Location	Seattle, WA, USA
Auditor Firm ID	185

CONSOLIDATED STATEMENTS OF INCO

CONSOLIDATED STATEMENTS OF INCOME - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Statement [Abstract]
Dialysis patient service revenues	$ 11,574,941	$ 11,176,464	$ 11,213,515
Other revenues	565,206	433,430	405,282
Total revenues	12,140,147	11,609,894	11,618,797
Operating expenses:
Patient care costs	8,319,717	8,209,553	7,972,414
General and administrative	1,473,984	1,355,197	1,195,335
Depreciation and amortization	745,443	732,602	680,615
Equity investment income, net	(27,864)	(26,520)	(26,937)
Impairment charges	26,083	0	0
Total operating expenses	10,537,363	10,270,832	9,821,427
Operating income	1,602,784	1,339,062	1,797,370
Debt expense	(398,551)	(357,019)	(285,254)
Debt Extinguishment And Modification Costs	(7,962)	0	0
Other (loss) income, net	(19,177)	(15,765)	6,378
Income from continuing operations before income taxes	1,177,094	966,278	1,518,494
Income tax expense	220,116	198,087	306,732
Net income from continuing operations	956,978	768,191	1,211,762
Net income from discontinued operations, net of tax	0	13,452	0
Net income	956,978	781,643	1,211,762
Less: Net income attributable to noncontrolling interests	(265,443)	(221,243)	(233,312)
Net income attributable to DaVita Inc.	$ 691,535	$ 560,400	$ 978,450
Earnings per share attributable to DaVita Inc.:
Basic net income from continuing operations	$ 7.62	$ 5.88	$ 9.30
Basic net income	7.62	6.03	9.30
Diluted net income from continuing operations	7.42	5.71	8.90
Diluted net income	$ 7.42	$ 5.85	$ 8.90
Weighted average shares for earnings per share:
Basic shares (in shares)	90,790,000	92,992,000	105,230,000
Diluted shares (in shares)	93,182,000	95,834,000	109,948,000
Amounts attributable to DaVita Inc.:
Net income from continuing operations	$ 691,535	$ 546,948	$ 978,450
Net income from discontinued operations	0	13,452	0
Net income attributable to DaVita Inc.	$ 691,535	$ 560,400	$ 978,450

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Statement of Comprehensive Income [Abstract]
Net income	$ 956,978	$ 781,643	$ 1,211,762
Unrealized gains on interest rate cap agreements:
Unrealized gains	6,895	108,669	7,155
Reclassification of net realized (gains) losses into net income	(77,727)	(8,806)	4,133
Unrealized losses on foreign currency translation.
Unrealized gains (losses) on foreign currency translation	87,934	(29,802)	(84,381)
Other comprehensive income (loss)	17,102	70,061	(73,093)
Total comprehensive income	974,080	851,704	1,138,669
Less: Comprehensive income attributable to noncontrolling interests	(265,443)	(221,243)	(233,312)
Comprehensive income attributable to DaVita Inc.	$ 708,637	$ 630,461	$ 905,357

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
ASSETS
Cash and cash equivalents	$ 380,063	$ 244,086
Restricted cash and equivalents	84,571	94,903
Short-term investments	11,610	77,693
Accounts receivable	1,986,856	2,132,070
Inventories	143,105	109,122
Other receivables	422,669	413,976
Prepaid and other current assets	102,645	78,839
Income tax receivable	6,387	4,603
Total current assets	3,137,906	3,155,292
Property and equipment, net of accumulated depreciation	3,073,533	3,256,397
Operating lease right-of-use assets	2,501,364	2,666,242
Intangible assets, net of accumulated amortization	203,224	182,687
Equity method and other investments	545,848	231,108
Long-term investments	47,890	44,329
Other long-term assets	271,253	315,587
Goodwill	7,112,560	7,076,610
Assets, Total	16,893,578	16,928,252
LIABILITIES AND EQUITY
Accounts payable	514,533	479,780
Other liabilities	828,878	802,469
Accrued compensation and benefits	752,598	692,654
Current portion of operating lease liabilities	394,399	395,401
Current portion of long-term debt	123,299	231,404
Income tax payable	28,507	18,039
Total current liabilities	2,642,214	2,619,747
Long-term operating lease liabilities	2,330,389	2,503,068
Long-term debt	8,268,334	8,692,617
Other long-term liabilities	183,074	105,233
Deferred income taxes	726,217	782,787
Total liabilities	14,150,228	14,703,452
Commitments and contingencies
Noncontrolling interests subject to put provisions	1,499,288	1,348,908
Equity:
Preferred Stock, Value, Issued	0	0
Common Stock, Value, Issued	89	90
Additional paid-in capital	509,804	606,935
Retained earnings	598,288	174,487
Accumulated other comprehensive loss	(52,084)	(69,186)
Total DaVita Inc. shareholders' equity	1,056,097	712,326
Noncontrolling interests not subject to put provisions	187,965	163,566
Total equity	1,244,062	875,892
Total liabilities and shareholders' equity	$ 16,893,578	$ 16,928,252
Preferred stock, par value (in usd per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	5,000,000	5,000,000
Preferred stock, issued (in shares)	0	0
Common stock, par value (in usd per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	450,000,000	450,000,000
Common stock, shares issued (in shares)	88,824,000	90,411,000

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Dec. 31, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Preferred stock, par value (in usd per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	5,000,000	5,000,000
Preferred stock, issued (in shares)	0	0
Common stock, par value (in usd per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	450,000,000	450,000,000
Common stock, shares outstanding (in shares)	88,824,000	90,411,000

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Cash flows from operating activities:
Net income	$ 956,978	$ 781,643	$ 1,211,762
Adjustments to Reconcile Net Income (Loss) to Cash Provided by (Used in) Operating Activities [Abstract]
Depreciation and amortization	745,443	732,602	680,615
Impairment charges	26,083	0	0
Loss on extinguishment of debt	7,132	0	0
Stock-based compensation expense	112,375	95,427	102,209
Deferred income taxes	(39,354)	(75,669)	60,483
Equity investment loss, net	64,777	8,773	5,215
Other non-cash charges, net	(8,938)	21,693	11,231
Changes in operating assets and liabilities, net of effect of acquisitions and divestitures:
Accounts receivable	172,361	(148,394)	(138,140)
Inventories	(32,132)	(757)	5,720
Other current assets	(43,437)	27,533	128,661
Other long-term assets	(5,792)	(50,549)	(26,387)
Accounts payable	26,890	87,481	(30,320)
Accrued compensation and benefits	56,209	34,536	(16,717)
Other current liabilities	27,082	89,955	(93,645)
Income taxes	1,570	(24,103)	36,921
Other long-term liabilities	(8,216)	(15,601)	(6,732)
Net Cash Provided by (Used in) Operating Activities, Total	2,059,031	1,564,570	1,930,876
Cash flows from investing activities:
Additions of property and equipment	(567,985)	(603,429)	(641,465)
Acquisitions	(26,394)	(57,308)	(187,050)
Proceeds from asset and business sales	30,610	117,582	61,464
Purchase of debt investments held-to-maturity	(37,180)	(129,803)	(30,849)
Purchase of other debt and equity investments	(9,566)	(3,590)	(2,987)
Proceeds from debt investments held-to-maturity	99,639	71,125	15,849
Proceeds from sale of other debt and equity investments	10,365	3,781	12,030
Purchase of equity method investments	(276,202)	(31,885)	(13,924)
Distributions from equity method investments	4,913	3,962	2,944
Payments to Acquire Other Investments	0	(782)	(745)
Net Cash Provided by (Used in) Investing Activities, Total	(771,800)	(630,347)	(784,733)
Cash flows from financing activities:
Borrowings	2,468,341	2,393,116	1,615,370
Payments on long-term debt	(3,020,956)	(2,404,395)	(861,115)
Deferred and debt related financing costs	(69,791)	(3)	(9,091)
Purchase of treasury stock	(272,219)	(802,228)	(1,538,626)
Distributions to noncontrolling interests	(280,938)	(267,946)	(244,033)
Net (payments) receipts related to stock purchases and awards	(48,112)	(37,367)	(60,001)
Contributions from noncontrolling interests	14,773	14,797	31,754
Proceeds from sales of additional noncontrolling interests	50,962	3,673	2,880
Purchases of noncontrolling interests	(12,555)	(20,775)	(20,104)
Net cash used in financing activities	(1,170,495)	(1,121,128)	(1,082,966)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	8,909	(29,066)	(10,007)
Less: Net increase (decrease) in cash, cash equivalents and restricted cash	125,645	(215,971)	53,170
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year	338,989	554,960	501,790
Cash, cash equivalents and restricted cash of continuing operations at end of the year	$ 464,634	$ 338,989	$ 554,960

CONSOLIDATED STATEMENTS OF EQUI

CONSOLIDATED STATEMENTS OF EQUITY - USD ($) $ in Thousands	Total	Non-controlling interests subject to put provisions	Total	Common stock	Additional paid-in capital	Retained earnings	Treasury Stock, Common	Accumulated other comprehensive income (loss)	Non-controlling interests not subject to put provisions
Beginning Balance (in shares) at Dec. 31, 2020				109,933,000			0
Beginning balance at Dec. 31, 2020			$ 1,383,566	$ 110	$ 597,073	$ 852,537	$ 0	$ (66,154)	$ 183,186
Temporary equity, beginning balance at Dec. 31, 2020		$ 1,330,028
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income		160,359
Distributions		(159,259)
Contributions		22,672
Acquisitions and divestitures		5,903
Partial purchases		(588)
Fair value remeasurements		75,717
Temporary equity, ending balance at Dec. 31, 2021		1,434,832
Comprehensive income:
Net income			978,450			978,450			72,953
Other comprehensive income	$ (73,093)		(73,093)					(73,093)
Stock purchase shares issued (in shares)				203,000
Stock purchase plan			19,626	$ 0	19,626
Stock award payment plan (in shares)				1,030,000
Stock award plan			(80,641)	$ 1	(80,642)
Stock-settled stock-based compensation expense			100,714		100,714
Changes in noncontrolling interest from:
Distributions									(84,774)
Contributions									9,082
Acquisitions and divestitures			(264)		(264)
Acquisitions and divestitures									1,250
Partial purchases			(13,853)		(13,853)				1,057
Fair value remeasurements			(75,717)		(75,717)
Purchase of treasury stock (in shares)							(13,877,000)
Purchase of treasury stock			(1,546,016)				$ (1,546,016)
Retirement of treasury stock (in shares)				(13,877,000)			13,877,000
Retirement of treasury stock			0	$ (14)	(69,352)	(1,476,650)	$ 1,546,016
Deferred taxes from partnership buyouts			62,736		62,736
Ending balance at Dec. 31, 2021			755,508	$ 97	540,321	354,337	$ 0	(139,247)	180,640
Ending Balance (in shares) at Dec. 31, 2021				97,289,000			0
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income		151,379
Distributions		(176,957)
Contributions		10,962
Acquisitions and divestitures		2,392
Partial purchases		(11,670)
Fair value remeasurements		(62,487)
Other		457
Temporary equity, ending balance at Dec. 31, 2022		1,348,908
Comprehensive income:
Net income			560,400			560,400			69,864
Other comprehensive income	70,061		70,061					70,061
Stock purchase shares issued (in shares)				285,000
Stock purchase plan			18,061	$ 0	18,061
Stock award payment plan (in shares)				932,000
Stock award plan			(55,920)	$ 1	(55,921)
Stock-settled stock-based compensation expense			95,230		95,230
Changes in noncontrolling interest from:
Distributions									(90,989)
Contributions									3,835
Acquisitions and divestitures			939		939				866
Partial purchases			(6,586)		(6,586)				193
Fair value remeasurements			62,487		62,487
Purchase of treasury stock (in shares)							(8,095,000)
Purchase of treasury stock			(787,854)				$ (787,854)
Retirement of treasury stock (in shares)				(8,095,000)			8,095,000
Retirement of treasury stock			0	$ (8)	(47,596)	(740,250)	$ 787,854
Other									(457)
Ending balance at Dec. 31, 2022	$ 875,892		712,326	$ 90	606,935	174,487	$ 0	(69,186)	163,566
Ending Balance (in shares) at Dec. 31, 2022	90,411,000			90,411,000			0
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income		176,789
Distributions		(184,044)
Contributions		12,878
Acquisitions and divestitures		181
Partial purchases		(5,296)
Fair value remeasurements		149,872
Temporary equity, ending balance at Dec. 31, 2023		$ 1,499,288
Comprehensive income:
Net income			691,535			691,535			88,654
Other comprehensive income	$ 17,102		17,102					17,102
Stock purchase shares issued (in shares)				231,000
Stock purchase plan			18,213	$ 0	18,213
Stock award payment plan (in shares)				1,086,000
Stock award plan			(65,012)	$ 2	(65,014)
Stock-settled stock-based compensation expense			109,813		109,813
Changes in noncontrolling interest from:
Distributions									(96,894)
Contributions									1,895
Acquisitions and divestitures			13,077		13,077				30,776
Partial purchases			5,375		(5,375)				32
Fair value remeasurements			(149,872)		(149,872)
Purchase of treasury stock (in shares)							(2,904,000)
Purchase of treasury stock			(285,710)				$ (285,710)
Retirement of treasury stock (in shares)				(2,904,000)			2,904,000
Retirement of treasury stock			0	$ (3)	(17,973)	(267,734)	$ 285,710
Ending balance at Dec. 31, 2023	$ 1,244,062		$ 1,056,097	$ 89	$ 509,804	$ 598,288	$ 0	$ (52,084)	$ 187,965
Ending Balance (in shares) at Dec. 31, 2023	88,824,000			88,824,000			0

Organization and Summary of Sig

Organization and Summary of Significant Accounting Policies	12 Months Ended
	Dec. 31, 2023
Accounting Policies [Abstract]
Organization and Summary of Significant Accounting Policies	Organization and summary of significant accounting policies Organization The Company's operations are composed of its dialysis and related lab services to patients in the United States (its U.S. dialysis business), its U.S. integrated kidney care (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 largest line of business is its U.S. dialysis business, which operates kidney dialysis centers in the U.S. for patients suffering from chronic kidney failure, also known as end stage renal disease or end stage kidney disease (ESRD or ESKD). As of December 31, 2023, the Company operated or provided administrative services through a network of 2,675 U.S. outpatient dialysis centers in 46 states and the District of Columbia, serving a total of approximately 200,800 patients. In addition, as of December 31, 2023, the Company operated or provided administrative services to a total of 367 outpatient dialysis centers serving approximately 49,400 patients located in 11 countries outside of the U.S. The Company’s 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. Basis of presentation These consolidated financial statements are prepared in accordance with United States generally accepted accounting principles (U.S. GAAP). The financial statements include DaVita Inc. and its subsidiaries, partnerships and other entities in which it maintains a majority voting or other controlling financial interest (collectively, the Company). All significant intercompany transactions and balances have been eliminated. Equity investments in investees over which the Company has significant influence are recorded on the equity method, while investments in other equity securities are recorded at fair value or on the adjusted cost method, as applicable. For the Company’s international subsidiaries, local currencies are considered their functional currencies. Translation adjustments result from translating the financial statements of the Company’s international subsidiaries from their functional currencies into the Company’s reporting currency (the U.S. dollar, or USD). The Company has evaluated subsequent events through the date these consolidated financial statements were issued and has included all necessary adjustments and disclosures. Use of estimates The preparation of financial statements in conformity with U.S. GAAP requires the use of estimates and assumptions that affect the reported amounts of revenues, expenses, assets, liabilities, contingencies and noncontrolling interests subject to put provisions. Although actual results in subsequent periods will differ from these estimates, such estimates are developed based on the best information available to management and management’s best judgments at the time. All significant assumptions and estimates underlying the amounts reported in the financial statements and accompanying notes are regularly reviewed and updated when necessary. Changes in estimates are reflected in the financial statements based upon on-going actual experience trends or subsequent settlements and realizations depending on the nature and predictability of the estimates and contingencies. The most significant assumptions and estimates underlying these consolidated financial statements and accompanying notes involve revenue recognition and accounts receivable, impairments of goodwill, accounting for income taxes, certain fair value estimates and loss contingencies. Specific estimating risks and contingencies are further addressed within these notes to the consolidated financial statements. Revenues 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 this fee schedule. Revenues associated with Medicare and Medicaid programs are estimated based on: (a) the payment rates that are established by statute or regulation for the portion of payment rates paid by the government payor (e.g., 80% for Medicare patients) and (b) for the portion not paid by the primary government payor, estimates of the amounts ultimately collectible from other government programs providing secondary coverage (e.g., Medicaid secondary coverage), the patient’s commercial health plan secondary coverage, or the patient. Under Medicare’s bundled payment rate system, services covered by Medicare are subject to estimating risk, whereby reimbursements from Medicare can vary significantly depending upon certain patient characteristics and other variable factors. Even with the bundled payment rate system, Medicare payments for bad debt claims as established by cost reports require evidence of collection efforts. As a result, billing and collection of Medicare bad debt claims can be delayed significantly and final payment is subject to audit. The Company’s revenue recognition is estimated based on its judgment regarding its ability to collect, which depends upon its ability to effectively capture, document and bill for Medicare’s base payment rate as well as these other variable factors. Medicare Advantage revenues are reimbursed at negotiated contract rates that are generally higher than Medicare fee-for-service rates, but which generally have a slower payment cycle than Medicare fee-for-service payments, and some of which are subject to certain quality or performance adjustments. Medicare Advantage revenues are subject to meaningful estimating risk based on factors similar to those described for commercial health plans below. Medicaid payments, when Medicaid coverage is secondary, can also be difficult to estimate. For many states, Medicaid payment terms and methods differ from Medicare, and may prevent accurate estimation of individual payment amounts prior to billing. Revenues associated with commercial health plans are estimated based on contractual terms for the patients under healthcare plans with which the Company has formal agreements, non-contracted health plan coverage terms if known, estimated secondary collections, historical collection experience, historical trends of refunds and payor payment adjustments (retractions), inefficiencies in the Company’s billing and collection processes that can result in denied claims for payments, delays in collections due to payor payment inefficiencies, and regulatory compliance matters. Commercial revenue recognition also involves significant estimating risks. With many larger commercial insurers, the Company has several different contracts and payment arrangements, and these contracts often include only a subset of the Company’s centers. Some of the Company's commercial revenue contracts are also subject to certain quality or performance adjustments. In certain circumstances, it may not be possible to determine which contract, if any, should be applied prior to billing. In addition, for services provided by non-contracted centers, final collection may require specific negotiation of a payment amount, typically at a significant discount from the Company’s usual and customary rates. As described above, there are significant risks associated with estimating dialysis patient service revenue, many of which take several years to resolve. As these estimates are refined over time, both positive and negative adjustments to revenue are recognized in the current period. 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 and recognized in the period the Company's performance obligations are met, subject to applicable measurement constraints. The Company's 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 and adjusted medical cost targets. For some of the Company's risk-based arrangements (such as its special needs plans), the Company acts as a principal with respect to all medical services provided to the patient by effectively hosting or sponsoring the entire arrangement, and as a result recognizes revenue and expense for all medical services provided to covered patients. However, under its VBC arrangements (including VBC contracts with health plans and via direct government programs), the Company provides health monitoring and care coordination services to patients but does not control or direct the medical services that patients receive from third party providers. As a result, the Company does not include third party medical costs in its reported revenues and expenses for its VBC arrangements, but rather recognizes revenue only for the estimated amount of shared savings or shared losses or related revenues that are directly earned or incurred by the Company, and ultimately paid to or by the Company, under the arrangement. Measurements of revenue for the Company's IKC risk-based arrangements are complex, sensitive to a number of key inputs, and require meaningful estimates for a number of factors, including but not limited to member alignment data, third-party medical claims expense, outcomes on various quality metrics, and ultimate risk adjustment factor (RAF) scores. Information and other measurement limitations on these factors may constrain revenue recognition for a risk-based arrangement until a period after the Company's performance obligations have been met. Other (loss) income, net Other (loss) income includes interest income on cash and cash equivalents and short- and long-term investments, equity investment (loss) income on equity method investments other than dialysis partnerships, realized and unrealized gains and losses recognized on other investments, impairments on investments, and foreign currency transaction gains and losses. Cash and cash equivalents Cash equivalents are short-term highly liquid investments readily convertible to known amounts of cash that typically mature within three months or less at date of purchase. Restricted cash and equivalents Restricted cash and cash equivalents include funds held in trust to satisfy insurer and state regulatory requirements related to wholly-owned captive insurance companies that bear professional and general liability and workers' compensation risks for the Company as well as funds held in escrow. Investments in debt and equity securities The Company classifies certain debt securities as held-to-maturity and records them at amortized cost based on the Company’s intentions and strategies concerning those investments. Equity securities that have readily determinable fair values or redemption values are recorded at estimated fair value with changes in fair value recognized in current earnings within other (loss) income, net. These debt and equity investments are classified as short-term investments or long-term investments on the Company's consolidated balance sheet. See Note 4 for further details. Inventories Inventories are stated at the lower of cost (first-in, first-out) or net realizable value and consist principally of pharmaceuticals and dialysis-related supplies. Rebates related to inventory purchases are recorded when earned and are based on certain qualification requirements which are dependent on a variety of factors including future pricing levels and purchase volume levels from the manufacturer and related data submission. Property and equipment Property and equipment is stated at cost less accumulated depreciation and amortization and is further reduced by any impairments. Maintenance and repairs are charged to expense as incurred. Property and equipment assets are reviewed for possible impairment whenever significant events or changes in circumstances indicate that an impairment may have occurred. Property and equipment impairment assessments are performed at a location or market level, as applicable, based on the specific cash flows they support or protect. If the Company commits to a plan to dispose of a long-lived asset before the end of its previously estimated useful life, cash flow estimates are revised accordingly, and the Company records an asset impairment, if applicable, or accelerates depreciation over the revised estimated useful life. Upon sale or retirement of long-lived assets, the cost and related accumulated depreciation or amortization are removed from the balance sheet and any resulting gain or loss is included in current operating expenses. Leases The Company leases substantially all of its U.S. dialysis facilities. The majority of the Company’s facilities are leased under non-cancellable operating leases which contain renewal options. These renewal options are included in the Company's determination of lease right-of-use assets and related lease liabilities when renewal is considered reasonably certain at the commencement date. The Company's leases are generally subject to fixed escalation clauses or contain consumer price index increases. The Company categorizes leases with contractual terms longer than twelve months as either operating or finance leases. Finance leases are generally those leases that allow the Company to substantially utilize or pay for the entire asset over its estimated life. All other leases are categorized as operating leases. The Company has elected the practical expedient to not separate lease components from non-lease components for its financing and operating leases. For short-term leases with a term of less than 12 months, the Company does not recognize lease right-of-use assets or lease liabilities and instead recognizes short-term lease costs as rent expense directly as incurred. Financing and operating lease liabilities are measured at the net present value of lease payments over the lease term as of the commencement date. Since most of the Company's leases do not provide an implicit rate of return, the Company uses its incremental borrowing rate based on information available at the commencement date or remeasurement date in determining the present value of lease payments. Assets acquired under finance leases are recorded on the balance sheet within property and equipment, net and liabilities for finance lease obligations are recorded within long-term debt. Finance lease assets are amortized to depreciation expense on a straight-line basis over the shorter of their estimated useful lives or the expected lease term. Accretion of interest on finance lease liabilities is included in debt expense. Rights to use assets under operating leases are recorded on the balance sheet as operating lease right-of-use assets and liabilities for operating lease obligations are recorded as operating lease liabilities. Both amortization of operating lease right-of-use assets and interest accretion on operating lease liabilities are recorded to rent expense over the lease term. Rent expenses are included in patient care costs or general and administrative expense, as applicable, based on the business unit or corporate function for which the space is leased. The Company evaluates its lease right-of-use assets for impairments in a similar manner to long-lived assets, as described above in Property and equipment . Amortizable intangibles Amortizable intangible assets include noncompetition agreements, hospital service contracts, and customer relationships arising from other service contracts, each of which have finite useful lives. Amortization expense is computed using the straight-line method over the useful lives of the assets estimated as follows: noncompetition agreements and hospital acute service contracts over the contract term, and customer relationships from other service contracts over the remaining contract term plus expected renewal periods. Amortizable intangible assets are reviewed for possible impairment whenever significant events or changes in circumstances indicate that an impairment may have occurred. Amortizable intangible asset impairment assessments are performed on a location, market or business unit basis, as applicable, based on the specific cash flows they support or protect. Indefinite-lived intangibles Indefinite-lived intangible assets include international licenses and accreditations that allow the Company to be reimbursed for providing dialysis services to patients, each of which has an indefinite useful life. Indefinite-lived intangibles are not amortized, but are assessed for impairment at least annually and whenever significant events or changes in circumstances indicate that an impairment may have occurred. Costs to renew indefinite-lived intangible assets are expensed as incurred. Equity method and other investments Equity investments that do not have readily determinable fair values are carried on the equity method if the Company maintains significant influence over the investee unless the fair value option is elected. Equity investments without readily determinable fair values for which the Company does not maintain significant influence over the investee are carried either on the adjusted cost method or at estimated fair value, as determined on an investment-specific basis. The adjusted cost method represents the Company's cost for an investment, net of any impairments, as adjusted for any subsequent observable price changes. These equity investments are classified as equity method and other investments on the Company's consolidated balance sheet. See Note 8 for further details. Equity method investments are assessed for other-than-temporary impairment when significant events or changes in circumstances indicate that an other-than-temporary impairment may have occurred. An other-than-temporary impairment charge is recorded when the fair value of an investment has fallen below its carrying amount and the shortfall is expected to be indefinitely or permanently unrecoverable. Income and expense from nonconsolidated dialysis partnerships accounted for as equity method investments are recorded within equity investment income, net. For ownership interests accounted for as equity method investments other than dialysis partnerships, income and expense are included on up to a one quarter lag in other (loss) income, net. Goodwill Goodwill represents the difference between the fair value of businesses acquired and the fair value of the identifiable tangible and intangible net assets acquired. Goodwill is not amortized, but is assessed by individual reporting unit for impairment as circumstances warrant and at least annually. An impairment charge is recognized when and to the extent a reporting unit's carrying amount is determined to exceed its fair value. The Company operates multiple reporting units. See Note 9 for further details. Self-insurance The Company predominantly self-insures its professional and general liability, workers' compensation and automobile risks, and a portion of its employment liability practice risks, through its wholly-owned captive insurance companies, with excess or reinsurance coverage for additional protection. The Company is also predominantly self-insured with respect to employee medical and other health benefits. The Company records insurance liabilities for the professional and general liability, workers’ compensation, automobile, employee health benefit and portion of employment liability practice risks that it retains and estimates its liability for those risks using third party actuarial calculations that are based upon historical claims experience and expectations for future claims. Income taxes Federal, state and foreign income taxes are computed at currently enacted tax rates less tax credits using the asset and liability method. Deferred taxes are adjusted both for items that do not currently have tax consequences and for the cumulative effect of any changes in tax rates from those previously used to determine deferred tax assets or liabilities. Tax provisions include amounts that are currently payable, changes in deferred tax assets and liabilities that arise because of temporary differences between the timing of when items of income and expense are recognized for financial reporting and income tax purposes, changes in the recognition of tax positions and any changes in the valuation allowance caused by a change in judgment about the realizability of the related deferred tax assets. A valuation allowance is established when necessary to reduce deferred tax assets to amounts expected to be realized. The Company uses a recognition threshold of more-likely-than-not and a measurement attribute on all tax positions taken or expected to be taken in a tax return in order to be recognized in the financial statements. Once the recognition threshold is met, the tax position is then measured to determine the actual amount of benefit to recognize in the financial statements. Stock-based compensation The Company’s stock-based compensation expense for stock-settled awards is measured at the estimated fair value of awards on the date of grant and recognized on a cumulative straight-line basis over the vesting terms of the awards, unless the stock awards are based on non-market-based performance metrics, in which case expense is adjusted for the ultimate number of shares expected to be issued as of the end of each reporting period. Stock-based compensation expense for cash-settled awards is based on their estimated fair values as of the end of each reporting period. The expense for all stock-based awards is recognized net of expected forfeitures. Stock-based compensation to be settled in shares is recorded to the Company’s shareholders’ contributed capital, while stock-based compensation to be settled in cash is recorded as a liability. Shares issued upon exercise or, when applicable, vesting of stock awards, are issued from authorized but unissued shares. Interest rate cap agreements The Company often carries a combination of current or forward interest rate caps on portions of its variable rate debt as a means of hedging its exposure to changes in Secured Overnight Financing Rate (SOFR) interest rates as part of its overall interest rate risk management strategy. These interest rate caps are not held for trading or speculative purposes and are designated as qualifying cash flow hedges. See Note 12 for further details. Noncontrolling interests Noncontrolling interests represent third-party equity ownership interests in entities which are consolidated by the Company for financial statement reporting purposes. As of December 31, 2023, third parties held noncontrolling equity interests in 696 consolidated legal entities. Fair value estimates Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. Fair value measurements are determined based on the principal or most advantageous market for the item being measured, assume that buyers and sellers are independent, willing and able to transact, and knowledgeable, with access to all information customarily available in such a transaction, and are based on assumptions that market participants would use in pricing the item, not assumptions specific to the reporting entity. The criticality of a particular fair value estimate to the Company's consolidated financial statements depends upon the nature and size of the item being measured, the extent of uncertainties involved and the nature and magnitude or potential effect of assumptions and judgments required. Certain fair value estimates can involve significant uncertainties and require significant judgment on various matters, some of which could be subject to reasonable disagreement. The Company relies on fair value measurements and estimates for purposes that require the recording, reassessment, or adjustment of the carrying amounts of certain assets, liabilities, and noncontrolling interests subject to put provisions (redeemable equity interests classified as temporary equity). These purposes can include the accounting for business combination transactions; impairment assessments for goodwill, other intangible assets, or other long-lived assets; recurrent revaluation of investments in debt and equity securities, contingent earn-out obligations, interest rate cap agreements, and noncontrolling interests subject to put provisions; and the accounting for equity method and other investments and stock-based compensation, as applicable. The Company has classified its assets, liabilities and temporary equity into the fair value hierarchy levels defined by the Financial Accounting Standards Board (FASB) reflecting their differing degrees of uncertainty. See Note 23 for further details. 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. The application of this ASU did not have a material impact on the Company's consolidated financial statements. See Note 12 for further discussion of the Company's debt. In October 2021, the FASB issued ASU No. 2021-08, Business Combinations (Topic 805): Accounting for Acquired Contract Assets and Contract Liabilities (ASU 2021-08) . ASU 2021-08 requires application of ASC 606, Revenue from Contracts with Customers , to recognize and measure assets and liabilities from contracts with customers acquired in a business combination. This ASU created an exception to the general recognition and measurement principle in ASC 805 which results in recognition of contract assets and contract liabilities consistent with those recorded by the acquiree immediately before the acquisition date. The ASU was effective beginning January 1, 2023 and application of this ASU did not have a material impact on the Company's consolidated financial statements. New standards not yet adopted In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures (ASU 2023-07) , which improves reportable segment disclosure requirements, primarily through enhanced disclosures about significant segment expenses. The guidance also requires disclosure of the chief operating decision maker's (CODM) position for each segment and detail of how the CODM uses financial reporting to assess their segment’s performance. ASU 2023-07 is effective for all public entities for fiscal years beginning after December 15, 2023, with early adoption permitted. The Company is currently assessing the effect this guidance may have on its consolidated financial statements. In December 2023, the Financial Accounting Standards Board issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures , which expands income tax disclosure requirements to include additional information related to the rate reconciliation of effective tax rates to statutory rates, as well as additional disaggregation of taxes paid in both U.S. and foreign jurisdictions. The amendments in the ASU also remove disclosures related to certain unrecognized tax benefits and deferred taxes. ASU 2023-09 is effective for fiscal years beginning after December 15, 2024. The amendments may be applied prospectively or retrospectively, and early adoption is permitted. The Company is currently assessing the effect this guidance may have on its consolidated financial statements.

Revenue Recognition

Revenue Recognition	12 Months Ended
	Dec. 31, 2023
Text Block [Abstract]
Revenue from Contract with Customer	Revenue recognition and accounts receivable The Company's revenues by segment and primary payor source were as follows: Year ended December 31, 2023 U.S. dialysis Other - Ancillary services Consolidated Patient service revenues: Medicare and Medicare Advantage $ 6,100,183 $ $ 6,100,183 Medicaid and Managed Medicaid 833,744 833,744 Other government 354,304 500,137 854,441 Commercial 3,623,516 251,279 3,874,795 Other revenues: Medicare and Medicare Advantage 460,991 460,991 Medicaid and Managed Medicaid 1,733 1,733 Commercial 32,329 32,329 Other (1) 25,251 52,754 78,005 Eliminations of intersegment revenues (88,222) (7,852) (96,074) Total $ 10,848,776 $ 1,291,371 $ 12,140,147 (1) Consists primarily of management service fees in the Company's U.S. dialysis business and research fees, management fees, and other non-patient service revenues in the Other - ancillary services businesses. Year ended December 31, 2022 U.S. dialysis Other - Ancillary services Consolidated Patient service revenues: Medicare and Medicare Advantage $ 6,041,496 $ $ 6,041,496 Medicaid and Managed Medicaid 759,579 759,579 Other government 336,991 464,921 801,912 Commercial 3,437,306 223,216 3,660,522 Other revenues: Medicare and Medicare Advantage 345,340 345,340 Medicaid and Managed Medicaid 1,546 1,546 Commercial 22,211 22,211 Other (1) 24,437 44,092 68,529 Eliminations of intersegment revenues (87,035) (4,206) (91,241) Total $ 10,512,774 $ 1,097,120 $ 11,609,894 (1) Consists primarily of management service fees in the Company's U.S. dialysis business and research fees, management fees, and other non-patient service revenues in the Other - ancillary services businesses. Year ended December 31, 2021 U.S. dialysis Other - Ancillary services Consolidated Patient service revenues: Medicare and Medicare Advantage $ 6,133,235 $ $ 6,133,235 Medicaid and Managed Medicaid 782,430 782,430 Other government 328,256 463,385 791,641 Commercial 3,397,697 199,024 3,596,721 Other revenues: Medicare and Medicare Advantage 326,696 326,696 Medicaid and Managed Medicaid 1,321 1,321 Commercial 15,553 15,553 Other (1) 25,345 40,945 66,290 Eliminations of intersegment revenues (90,796) (4,294) (95,090) Total $ 10,576,167 $ 1,042,630 $ 11,618,797 (1) Consists primarily of management service fees in the Company's U.S. dialysis business and research fees, management fees, and other non-patient service revenues in the Other - ancillary services businesses. The majority of the Company's non-patient service revenues from Medicare and Medicare Advantage, Medicaid and Managed Medicaid, and commercial sources represent risk-based revenues earned by the Company's U.S. IKC business. For its IKC business, the Company recognized revenues for performance obligations satisfied in previous years of $94,361, $34,600, and $11,312 during the years ended December 31, 2023, 2022 and 2021, respectively. The delay in recognition of these amounts resulted predominantly from measurement limitations and recognition constraints on our VBC contracts with health plans, many of which are complex and relatively new arrangements. The Company's revenue recognition for its government Comprehensive Kidney Care Contracting (CKCC) program also remains heavily constrained for plan years 2023 and 2022. See Note 1 "Other revenues" for a description of the Company's accounting for these value-based care arrangements. No single commercial payor accounted for more than 10% of consolidated revenues or consolidated accounts receivable for the periods presented in these consolidated financial statements or at their period-ends, respectively. Dialysis services accounts receivable and other receivables from Medicare, including Medicare Advantage plans, and Medicaid, including managed Medicaid plans, were approximately $817,045 and $1,113,499 as of December 31, 2023 and 2022, respectively. Approximately 19% and 18% of the Company’s patient services accounts receivable balances as of December 31, 2023 and 2022, respectively, were more than six months old. There were no significant balances over one year old at December 31, 2023. The Company's accounts receivable are principally due from Medicare and Medicaid programs and commercial insurance plans.

Earnings Per Share

Earnings Per Share	12 Months Ended
	Dec. 31, 2023
Earnings Per Share [Abstract]
Earnings Per Share	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 their 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: Year ended December 31, 2023 2022 2021 Net income attributable to DaVita Inc.: Continuing operations $ 691,535 $ 546,948 $ 978,450 Discontinued operations — 13,452 — Net income attributable to DaVita Inc. $ 691,535 $ 560,400 $ 978,450 Weighted average shares outstanding: Basic shares 90,790 92,992 105,230 Assumed incremental from stock plans 2,392 2,842 4,718 Diluted shares 93,182 95,834 109,948 Basic net income attributable to DaVita Inc.: Continuing operations per share $ 7.62 $ 5.88 $ 9.30 Discontinued operations per share — 0.15 — Basic net income per share attributable to DaVita Inc. $ 7.62 $ 6.03 $ 9.30 Diluted net income attributable to DaVita Inc.: Continuing operations per share $ 7.42 $ 5.71 $ 8.90 Discontinued operations per share — 0.14 — Diluted net income per share attributable to DaVita Inc. $ 7.42 $ 5.85 $ 8.90 Anti-dilutive stock-settled awards excluded from calculation (1) 531 1,058 116 (1) Shares associated with stock awards excluded from the diluted denominator calculation because they were anti-dilutive under the treasury stock method.

Short-term and long-term invest

Short-term and long-term investments	12 Months Ended
	Dec. 31, 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 investments, consisting of debt instruments classified as held-to-maturity and equity investments with readily determinable fair values or redemption values, were as follows: December 31, 2023 December 31, 2022 Debt Equity Total Debt Equity Total Certificates of deposit and other time deposits $ 22,109 $ — $ 22,109 $ 82,879 $ — $ 82,879 Investments in mutual funds and common stock — 37,391 37,391 — 39,143 39,143 $ 22,109 $ 37,391 $ 59,500 $ 82,879 $ 39,143 $ 122,022 Short-term investments $ 7,110 $ 4,500 $ 11,610 $ 67,872 $ 9,821 $ 77,693 Long-term investments 14,999 32,891 47,890 15,007 29,322 44,329 $ 22,109 $ 37,391 $ 59,500 $ 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 December 31, 2023 and 2022. Equity securities: Substantially all of the Company's 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.

Other Receivables Other Receiva

Other Receivables Other Receivables	12 Months Ended
	Dec. 31, 2023
Receivables [Abstract]
Other Receivables	Other receivables Other receivables comprised the following: December 31, 2023 2022 Customer contract assets: Medicare bad debt claims $ 107,444 $ 110,751 IKC VBC arrangements 127,442 13,932 Supplier rebates and non-trade receivables $ 187,783 $ 289,293 $ 422,669 $ 413,976

Property and Equipment

Property and Equipment	12 Months Ended
	Dec. 31, 2023
Property, Plant and Equipment [Abstract]
Property and Equipment	Property and equipment Property and equipment comprised the following: December 31, 2023 2022 Land $ 35,216 $ 32,656 Buildings 436,460 427,962 Leasehold improvements 4,058,987 3,925,244 Equipment and information systems, including internally developed software 4,125,235 3,759,274 New center and capital asset projects in progress 177,149 376,633 8,833,047 8,521,769 Less accumulated depreciation (5,759,514) (5,265,372) $ 3,073,533 $ 3,256,397 Depreciation and amortization expenses are computed using the straight-line method over the useful lives of the assets estimated as follows: buildings, 25 years to 40 years; leasehold improvements, the shorter of ten years or the expected lease term; and equipment and information systems, including internally developed software, principally three years to 15 years. Depreciation expense on property and equipment was $736,474, $721,133 and $667,755 for 2023, 2022 and 2021, respectively. Interest on debt incurred during the development of new centers and other capital asset projects is capitalized as a component of the asset cost based on the respective in-process capital asset balances. Interest capitalized was $9,178, $12,677 and $15,275 for 2023, 2022 and 2021, respectively.

Intangibles

Intangibles	12 Months Ended
	Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Intangibles	Intangible assets Intangible assets other than goodwill comprised the following: December 31, 2023 2022 Indefinite-lived licenses $ 153,983 $ 127,271 Noncompetition agreements 31,090 51,408 Customer relationships and other 56,596 53,779 241,669 232,458 Accumulated amortization: Noncompetition agreements (23,680) (39,745) Customer relationships and other (14,765) (10,027) $ 203,224 $ 182,687 Noncompetition agreements are generally amortized over four years to 10 years and customer relationships are principally amortized over 10 years to 20 years. The weighted average renewal or extension period of customer relationships was two years as of December 31, 2023 and 2022. Amortization expense from amortizable intangible assets was $8,969, $11,469, and $12,860 for 2023, 2022 and 2021, respectively. For the years ended December 31, 2023, 2022 and 2021, the Company recognized no impairment charges on any intangible assets other than goodwill. See Note 9 for further information regarding goodwill. Scheduled amortization expenses from amortizable intangible assets as of December 31, 2023 were as follows: Noncompetition Customer relationships and other 2024 $ 3,049 $ 3,978 2025 1,921 3,712 2026 1,182 3,642 2027 730 3,525 2028 528 3,472 Thereafter — 23,502 Total $ 7,410 $ 41,831

Equity Method and Other Investm

Equity Method and Other Investments	12 Months Ended
	Dec. 31, 2023
Investments, Debt and Equity Securities [Abstract]
Equity Method Investments and Joint Ventures Disclosure	Equity method and other investments The Company maintains equity method and other minor investments in the private securities of certain other healthcare and healthcare-related businesses as follows: December 31, 2023 2022 Mozarc Medical Holding LLC $ 324,711 $ — APAC joint venture 98,865 99,141 Other equity method partnerships 107,282 116,403 Adjusted cost method and other investments 14,990 15,564 $ 545,848 $ 231,108 During 2023, 2022 and 2021, the Company recognized equity investment income of $27,864, $26,520 and $26,937, respectively, from its equity method investments in nonconsolidated dialysis partnerships. The Company also recognized equity investment losses from other equity method investments of $59,508, $4,703 and $1,292 in other (loss) income, net during 2023, 2022 and 2021, 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 (loss) income, 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 $14,539. 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 estimated cost of $375,326, which represents the sum of the cash amounts paid and contributed for the Company’s investment in Mozarc, the estimated fair value of the non-cash assets contributed, the estimated fair value of the Company’s contingent consideration payable to Medtronic for its interest in Mozarc of $86,200, and direct costs incurred to complete this transaction. The foregoing cost estimates are based upon the best information available to management but remain subject to change based on finalization of post-closing purchase price adjustments yet to be completed between the parties and finalization of related third-party valuation reports. As of December 31, 2023, the book value of the Company's contingent consideration payable to Medtronic approximates its estimated fair value, which is based on level 3 inputs. The recorded cost of the Company's equity method investment in Mozarc, and its equity method income (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. The Company also holds a 75% voting and economic interest in DaVita Care Pte. Ltd. (the APAC joint venture, or APAC JV) and an unrelated noncontrolling investor holds the other 25% voting and economic interest in the joint venture. The Company does not control or consolidate the APAC JV as a result of substantive participating rights retained by the unrelated investor over certain key operating decisions for the joint venture. The Company's other equity method investments include 23 legal entities over which the Company has significant influence but in which it does not maintain a controlling financial interest. Almost all of these are U.S. dialysis partnerships in the form of limited liability companies. The Company's ownership interests in these partnerships vary, and are often subject to blocking rights on certain key operating decisions held by outside investors, but mostly range from 30% to 65%. For the year ended December 31, 2022, the Company recognized impairments and other valuation adjustments on the Company's adjusted cost method and other investments of $20,154 in other (loss) income, net. There were no significant investment impairments or other valuation adjustments for the years ended December 31, 2023 and 2021.

Goodwill

Goodwill	12 Months Ended
	Dec. 31, 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 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 — 25,723 25,723 Impairment charges — (26,083) (26,083) Foreign currency and other adjustments — 36,310 36,310 Balance at December 31, 2023 $ 6,416,825 $ 695,735 $ 7,112,560 Balance at December 31, 2023: Goodwill $ 6,416,825 $ 844,836 $ 7,261,661 Accumulated impairment charges — (149,101) (149,101) $ 6,416,825 $ 695,735 $ 7,112,560 Each of the Company’s operating segments described in Note 24 to these consolidated financial statements represents an individual reporting unit for goodwill impairment assessment purposes. Within the U.S. dialysis operating segment, the Company considers each of its dialysis centers to constitute an individual business for which discrete financial information is available. However, since these dialysis centers have similar operating and economic characteristics, and the allocation of resources and significant investment decisions concerning these businesses are highly centralized and the benefits broadly distributed, the Company has aggregated these centers and deemed them to constitute a single reporting unit. The Company has applied a similar aggregation to the physician practices in its physician services reporting units and to the dialysis centers within each international reporting unit. For the Company’s other operating segments, discrete business components below the operating segment level constitute individual reporting units. When performing quantitative goodwill impairment assessments, the Company estimates fair value using either appraisals developed with an independent third party valuation firm which consider both discounted cash flow estimates for the subject business and observed market multiples for similar businesses, or offer prices received for the subject business that would be acceptable to the Company. During the year ended December 31, 2023, the Company recognized a goodwill impairment charge of $26,083 in its transplant software reporting unit, or $19,575 net of tax. This charge resulted from a reduction in estimated fair value for the business driven primarily from the business not achieving its revenue targets, with reduced revenue expectations for future years, as well as an increase in the risk-free rate. After this impairment charge, the transplant software reporting unit has a goodwill balance of $14,424 remaining, which could be further impaired if the business fails to meet its revised revenue targets and growth expectations. None of the Company’s reporting units were considered at risk of significant goodwill impairment as of December 31, 2023. Since the dates of the Company’s last annual goodwill impairment assessments, there have been certain developments, events, changes in operating performance and other changes in key circumstances that have affected the Company’s businesses. However, these have not caused management to believe it is more likely than not that the fair values of any of the Company’s reporting units would be less than their respective carrying amounts as of December 31, 2023.

Other Liabilities

Other Liabilities	12 Months Ended
	Dec. 31, 2023
Other Liabilities Disclosure [Abstract]
Other Liabilities	Other liabilities Other liabilities comprised the following: December 31, 2023 2022 Payor refunds and retractions $ 448,589 $ 475,195 Insurance and self-insurance accruals 74,337 68,440 Accrued interest 35,914 34,162 Accrued non-income tax liabilities 47,391 42,806 Other 222,647 181,866 $ 828,878 $ 802,469

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2023
Income Tax Disclosure [Abstract]
Income Taxes	Income taxes The Company accounts for income taxes under the asset and liability method, which requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of events that have been included in the consolidated financial statements. Under this method, deferred tax assets and liabilities are determined on the basis of the differences between the financial statement and tax basis of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. Income before income taxes from continuing operations consisted of the following: Year ended December 31, 2023 2022 2021 Domestic $ 1,100,420 $ 926,604 $ 1,463,029 International 76,674 39,674 55,465 $ 1,177,094 $ 966,278 $ 1,518,494 Income tax expense for continuing operations consisted of the following: Year ended December 31, 2023 2022 2021 Current: Federal $ 200,070 $ 201,932 $ 216,539 State 38,370 55,593 15,601 International 21,008 16,253 14,247 Total current income tax 259,448 273,778 246,387 Deferred: Federal (40,234) (66,400) 59,528 State 367 (12,289) 5,342 International 535 2,998 (4,525) Total deferred income tax (39,332) (75,691) 60,345 $ 220,116 $ 198,087 $ 306,732 The reconciliation between the Company’s effective tax rate from continuing operations and the U.S. federal income tax rate is as follows: Year ended December 31, 2023 2022 2021 Federal income tax rate 21.0 % 21.0 % 21.0 % State income taxes, net of federal benefit 2.6 3.8 3.0 Equity compensation (1.1) (1.6) (2.4) Federal and international tax rate adjustments — — 1.3 Nondeductible executive compensation 1.2 1.1 0.8 Political advocacy costs 0.2 2.2 0.2 Unrecognized tax benefits (1.1) (1.1) (0.1) Change in international valuation allowance 0.8 1.2 (1.0) Credits (1.2) (1.2) (0.7) Other 1.9 1.1 1.7 Impact of noncontrolling interests primarily (5.6) (6.0) (3.6) Effective tax rate 18.7 % 20.5 % 20.2 % Deferred tax assets and liabilities arising from temporary differences for continuing operations were as follows: December 31, 2023 2022 Receivables $ 23,075 $ 18,304 Accrued liabilities 81,281 71,346 Operating lease liabilities 533,859 563,972 Net operating loss carryforwards 183,216 173,531 Other 52,142 58,827 Deferred tax assets 873,573 885,980 Valuation allowance (113,237) (106,775) Net deferred tax assets 760,336 779,205 Intangible assets (731,024) (690,914) Property and equipment (127,191) (181,704) Operating lease assets (486,864) (515,026) Investments in partnerships (19,119) (80,876) Other (87,918) (65,766) Deferred tax liabilities (1,452,116) (1,534,286) Net deferred tax liabilities $ (691,780) $ (755,081) Reported as: Deferred tax liabilities $ (726,217) $ (782,787) Deferred tax assets (included in Other long-term assets) 34,437 27,706 $ (691,780) $ (755,081) At December 31, 2023, the Company had federal net operating loss carryforwards of approximately $57,649 that expire through 2036, although a substantial amount expire by 2029. The Company also had state net operating loss carryforwards of $501,405, some of which have an indefinite life, although a substantial amount expire by 2043 and international net operating loss carryforwards of $391,510, some of which will begin to expire in 2026 though the majority have an indefinite life. The Company has a state capital loss carryover of $299,803, the majority of which expires in 2024. The utilization of a portion of these losses may be limited in future years based on the profitability of certain entities. A valuation allowance is recorded to account for the unrealizable balances in the table above. The net increase of $6,462 in the valuation allowance is primarily due to losses generated in state and foreign jurisdictions and from equity investments that the Company does not anticipate being able to utilize. During the year ended December 31, 2021, the Company recorded a true-up to recognize net deferred tax assets related to historical purchases of noncontrolling interests in consolidated partnerships. The effect of this adjustment was an increase of $46,692 to net deferred tax assets, a charge of $16,044 to income tax expense, and an increase of $62,736 to additional paid-in capital. The Company’s prior purchases of this type have not generated significant pre-tax adjustments to additional paid-in capital in any single prior year. The majority of the $16,044 recorded to income tax expense was due to the decrease in the corporate tax rate in 2017. The Company remains indefinitely reinvested in several of the foreign jurisdictions in which it operates as of December 31, 2023. As a result of the passage of the Tax Cuts and Jobs Act (2017 Tax Act), the Company does not expect any significant taxes to be incurred if such earnings were remitted. Unrecognized tax benefits A reconciliation of the beginning and ending liability for unrecognized tax benefits that do not meet the more-likely-than-not threshold is as follows: Year ended December 31, 2023 2022 Beginning balance $ 63,985 $ 73,024 Additions for tax positions related to current year 4,088 3,858 Adjustments for tax positions related to prior years (7,273) 24,683 Reductions related to lapse of applicable statute (5,428) (6,073) Reductions related to settlements with taxing authorities (7,993) (31,507) Ending balance $ 47,379 $ 63,985 As of December 31, 2023, the Company’s total liability for unrecognized tax benefits relating to tax positions that do not meet the more-likely-than-not threshold is $47,379. Of this balance, $31,299 would impact the Company’s effective tax rate if recognized. The Company recognizes accrued interest and penalties related to unrecognized tax benefits in its income tax expense. We recognized a benefit of $138 and an expense of $10,459 related to interest and penalties net of federal tax benefit within tax expense in 2023 and 2022, respectively. At December 31, 2023 and December 31, 2022, the Company had approximately $6,525 and $8,208, respectively, accrued for interest and penalties related to unrecognized tax benefits, net of federal tax benefit. The Company and its subsidiaries are under examination in various state, local and foreign tax jurisdictions. In June 2023 we closed our audit with the IRS for the years 2016 and 2017. In 2022, the Company was able to reach a settlement with the IRS for tax years 2014-2015. Subsequent to the settlement, the Company filed a 2014 refund claim with respect to a contested issue that was included in the IRS examination. During 2023 the IRS denied the refund claim and the Company has until September 2025 to appeal. Except for the 2014 refund claim, the Company is no longer subject to U.S. federal examinations prior to 2020.

Long-Term Debt

Long-Term Debt	12 Months Ended
	Dec. 31, 2023
Debt Disclosure [Abstract]
Long-Term Debt	Long-term debt Long-term debt comprised the following: December 31, As of December 31, 2023 2023 2022 Maturity date Interest rate Estimated fair value (1) Senior Secured Credit Facilities: Term Loan A-1 $ 1,234,375 $ (2) SOFR+CSA+1.75% $ 1,209,688 Term Loan B-1 2,603,786 2,660,831 8/12/2026 SOFR+CSA+1.75% $ 2,600,531 New Revolving line of credit — (2) SOFR+CSA+1.75% $ — 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 % $ 2,416,563 3.75% Senior Notes 1,500,000 1,500,000 2/15/2031 3.75 % $ 1,235,625 Acquisition obligations and other notes payable (4) 102,328 120,562 2024-2036 6.69 % $ 102,328 Financing lease obligations (5) 255,491 273,688 2024-2038 4.58 % Total debt principal outstanding 8,445,980 8,968,519 Discount, premium and deferred financing costs (6) (54,347) (44,498) 8,391,633 8,924,021 Less current portion (123,299) (231,404) $ 8,268,334 $ 8,692,617 (1) For the Company's senior secured credit facilities, fair value estimates are based upon bid and ask quotes, a level 2 input. For our senior notes, fair value estimates are based on market level 1 inputs. For acquisition obligations and other notes payable, the carrying values presented here approximate their estimated fair values, based on estimates of their present values typically 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 December 31, 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 December 31, 2023, the carrying amount of the Company's senior secured credit facilities have been reduced by a discount of $2,487 and deferred financing costs of $32,498 and the carrying amount of the Company's senior notes have been reduced by deferred financing costs of $31,491 and increased by a debt premium of $12,129. As of December 31, 2022, the carrying amount of the Company's senior secured credit facilities was reduced by a discount of $3,497 and deferred financing costs of $18,816, and the carrying amounts 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 December 31, 2023 were as follows: 2024 $ 123,299 2025 $ 132,878 2026 $ 2,663,669 2027 $ 116,712 2028 $ 1,017,856 Thereafter $ 4,391,566 Senior Secured Credit Facilities 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 December 31, 2023, the CSA for all tranches outstanding on the Company's Term Loan B-1 was 0.11%. The Company adopted Accounting Standards Update (ASU) No. 2020-04 and ASU No. 2022-06 regarding reference rate reform during the second quarter and applied one of their practical expedients to treat the amendment of Term Loan B-1 as a non-substantial modification. On April 28, 2023, the Company entered into the Third Amendment (the Third Amendment, and together with the Second Amendment, the Amendments) to the Credit Agreement. The Third Amendment modifies the Credit Agreement to, among other things, refinance its Term Loan A and revolving line of credit with a secured Term Loan A-1 facility in the aggregate principal amount of $1,250,000 and a secured revolving line of credit in the aggregate principal amount of up to $1,500,000 (the foregoing referred to as the new Term Loan A-1 and new revolving line of credit, respectively). The new Term Loan A-1 and new revolving line of credit initially bore interest at Term SOFR, plus a CSA of 0.10% and an interest rate margin of 2.00%, which was subject to adjustment depending upon the Company's leverage ratio under the Credit Agreement, as amended, and which can range from 1.25% to 2.25%, provided that this adjusted rate shall never be less than 0.00%. The new Term Loan A-1 requires amortizing quarterly principal payments that began 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 2023, the Company made regularly scheduled and other principal payments under its senior secured credit facilities totaling $54,010 on its prior Term Loan A, $15,625 on Term Loan A-1 and $57,046 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 composed partially of fees incurred for these transactions 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. As of December 31, 2023, the Company had undrawn capacity on the revolving line of credit under its senior secured credit facilities of $1,500,000. Credit available under this revolving line of credit is reduced by the amount of any letters of credit outstanding thereunder, of which there were none as of December 31, 2023. The Company also had letters of credit of approximately $151,403 outstanding under a separate bilateral secured letter of credit facility as of December 31, 2023. As of December 31, 2023, the Company's 2019 interest rate cap agreements described below had 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 Term Loan A-1. The remaining $338,161 outstanding principal balance of Term Loan A-1 is subject to SOFR-based interest rate volatility. These cap agreements are designated as cash flow hedges and, as a result, changes in their fair values are reported in other comprehensive income. The original premiums paid for the caps are amortized to debt expense on a straight-line basis over the term of each cap agreement starting from its effective date. These cap agreements do not contain credit risk-contingent features. Senior Notes The Senior Notes are unsecured obligations, rank equally in right of payment with the Company’s existing and future unsecured senior indebtedness and require semi-annual interest payments. The Company may redeem some or all of the Senior Notes at any time on or after certain specific dates and at certain specific redemption prices as outlined in each senior note agreement. Interest rates on the Senior Notes are fixed by their terms. Interest rate cap agreements During 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. Additionally, during and as of the end of the second quarter of 2023, the Company transitioned the variable rate base on its senior secured credit facilities and related hedging interest rate caps from LIBOR to SOFR. This transition involved a SOFR-to-LIBOR rate mismatch between this debt and the 2019 interest rate caps for a portion of the second quarter of 2023, 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 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 transitioned all of its LIBOR-based derivative exposure to SOFR. The following table summarizes the Company’s interest rate cap agreements outstanding as of December 31, 2023: Notional reduction or contractual maturity date Year cap agreements executed Notional amount SOFR maximum rate Approximate effective date 2024 (1) 2025 2026 2019 $ 3,500,000 2.00% 6/30/2020 $ 3,500,000 2023 $ 1,000,000 3.75% 6/30/2024 $ 500,000 $ 500,000 2023 $ 1,000,000 4.00% (2) 6/30/2024 $ 250,000 $ 750,000 2023 $ 1,000,000 4.75% (3) 6/30/2024 $ 250,000 $ 750,000 2023 $ 500,000 5.00% (4) 6/30/2024 $ 500,000 2023 $ 250,000 4.50% 12/31/2024 $ 250,000 2023 $ 750,000 4.00% 12/31/2024 $ 250,000 $ 500,000 (1) The Company's 2019 cap agreements mature on June 30, 2024. (2) Effective January 1, 2025, the maximum rate of 4.00% decreases to 3.75% for these interest rate caps. (3) Effective January 1, 2025, the maximum rate of 4.75% decreases to 4.00% for these interest rate caps. (4) Effective January 1, 2025, the maximum rate of 5.00% decreases to 4.50% for these interest rate caps. The following table summarizes the effects of the Company’s interest rate cap agreements for the years ended December 31, 2023, 2022 and 2021: Amount of unrealized gains (losses) in OCI on interest rate cap agreements Location in Consolidated Statements of Income Reclassification from accumulated other comprehensive income into net income Year ended December 31, Year ended December 31, Derivatives designated as cash flow hedges 2023 2022 2021 2023 2022 2021 Interest rate cap agreements $ 9,186 $ 144,793 $ 9,532 Debt expense $ (103,567) $ (11,732) $ 5,509 Related income tax (2,291) (36,124) (2,377) Related income tax 25,840 2,926 (1,376) Total $ 6,895 $ 108,669 $ 7,155 $ (77,727) $ (8,806) $ 4,133 The fair value of the Company's interest rate cap agreements, which are classified in other long-term assets on its consolidated balance sheet, were $79,805 and $139,755 for the years ended December 31, 2023 and December 31, 2022, respectively. See Note 19 for further details on amounts recorded and reclassified from accumulated other comprehensive (loss) income and recorded as debt expense (offset) related to the Company’s interest rate cap agreements for the year ended December 31, 2023. 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 December 31, 2023 was 4.39%, based on the current margins in effect for its senior secured credit facilities as of December 31, 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, was 4.52% for the year ended December 31, 2023 and 4.42% as of December 31, 2023. As of December 31, 2023, the Company’s interest rates were fixed and economically fixed on approximately 54% and 96% of its total debt, respectively. Debt expense Debt expense consisted of interest expense of $373,951, $339,247 and $267,049 and the amortization and accretion of debt discounts and premiums, amortization of deferred financing costs, costs for the undrawn portion of the revolving line of credit and the amortization of interest rate cap agreements of $24,600, $17,772 and $18,205 for 2023, 2022 and 2021, respectively. These interest expense amounts are net of capitalized interest.

Leases

Leases	12 Months Ended
	Dec. 31, 2023
Leases [Abstract]
Leases Disclosure	Leases The Company leases substantially all of its dialysis facilities. The majority of the Company’s facilities are leased under non-cancellable operating leases which range in terms from five years to 15 years and which contain renewal options of five years to ten years at the fair rental value at the time of renewal. The Company's leases are generally subject to fixed escalation clauses or contain consumer price index increases. See Note 1 for further information on how the Company accounts for leases. As of December 31, 2023 and December 31, 2022, assets recorded under finance leases In certain markets, the Company acquires and develops dialysis centers. Upon completion, the Company sells the center to a third party and leases the space back with the intent of operating the center on a long-term basis. Both the sale and leaseback terms are generally market terms. Substantially all of the lease terms are consistent with the Company's other operating leases with the majority of the leases under non-cancellable operating leases ranging in terms from ten years to 15 years and containing renewal options of five years to ten years at the fair rental value at the time of renewal. The components of lease expense were as follows: Year ended December 31, Lease cost 2023 2022 2021 Operating lease cost (1) : Fixed lease expense $ 556,844 $ 552,194 $ 547,923 Variable lease expense 135,990 127,621 125,981 Financing lease cost: Amortization of leased assets 26,964 27,079 26,846 Interest on lease liabilities 11,724 12,776 13,988 Net lease cost $ 731,522 $ 719,670 $ 714,738 (1) Includes short-term lease expense and sublease income, which are immaterial. Other information related to leases was as follows: Year ended December 31, Lease term and discount rate 2023 2022 2021 Weighted average remaining lease term (years): Operating leases 7.6 8.2 8.3 Finance leases 8.5 9.4 10.5 Weighted average discount rate: Operating leases 4.0 % 3.6 % 3.5 % Finance leases 4.6 % 4.5 % 4.5 % Year ended December 31, Other information 2023 2022 2021 Gains on sale leasebacks, net $ 3,387 $ 28,005 $ 17,137 Cash paid for amounts included in the Operating cash flows for operating leases $ 708,162 $ 696,291 $ 684,186 Operating cash flows for finance leases $ 19,246 $ 20,103 $ 21,343 Financing cash flows for finance leases $ 26,455 $ 24,329 $ 22,445 Net operating lease assets obtained in exchange $ 269,564 $ 278,108 $ 361,101 Future minimum lease payments under non-cancellable leases as of December 31, 2023 are as follows: Operating leases Finance leases 2024 $ 495,809 $ 37,173 2025 507,616 40,859 2026 455,477 39,639 2027 388,869 38,410 2028 324,153 34,976 Thereafter 989,253 112,904 Total future minimum lease payments 3,161,177 303,961 Less portion representing interest (436,389) (48,470) Present value of lease liabilities $ 2,724,788 $ 255,491 Rent expense under all operating leases for 2023, 2022 and 2021 was $692,834, $679,815 and $673,904, respectively. Rent expense is recorded on a straight-line basis over the term of the lease, including leases that contain fixed escalation clauses or include abatement provisions. Leasehold improvement incentives reduce the carrying value of right-of-use assets and are amortized to rent expense over the term of the lease. Finance lease obligations are included in long-term debt. See Note 12 for further details on long-term debt.

Employee Benefit Plans

Employee Benefit Plans	12 Months Ended
	Dec. 31, 2023
Retirement Benefits [Abstract]
Employee Benefit Plans	Employee benefit plans The Company has a 401(k) retirement savings plan for substantially all of its U.S. employees which has been established pursuant to applicable provisions of the Internal Revenue Code (IRC). The plan allows for employees to contribute a percentage of their base annual salaries on a tax-deferred basis not to exceed IRC limitations. The Company maintains a 401(k) matching program under which the Company matches 50% of the employee's contribution up to 6% of the employee's salary, subject to certain limitations. The matching contributions are subject to certain eligibility and vesting conditions. For the years ended December 31, 2023, 2022 and 2021, the Company accrued matching contributions totaling approximately $73,725, $70,084 and $68,658, respectively. The Company also maintains a voluntary compensation deferral plan, the Deferred Compensation Plan. The Deferred Compensation Plan is non-qualified and permits certain employees whose annualized base salary equals or exceeds a minimum annual threshold amount as set by the Company to elect to defer all or a portion of their annual bonus payment and up to 50% of their base salary into a deferral account maintained by the Company. Total contributions to this plan in 2023, 2022 and 2021 were $2,695, $3,573 and $2,962, respectively. Deferred amounts are generally paid out in cash at the participant’s election either in the first or second year following retirement or in a specified future period at least three to four years after the deferral election was effective. During 2023, 2022 and 2021 the Company distributed $3,899, $3,731 and $11,887, respectively, to participants from its deferred compensation plans. Participants are credited with their proportional amount of annual earnings from the plans. The assets of these plans are held in rabbi trusts subject to the claims of the Company’s general creditors in the event of its bankruptcy. As of December 31, 2023 and 2022, the total fair value of assets held in these plans' trusts was $36,936 and $32,944, respectively. The assets of these plans are recorded at fair value with changes in fair value recorded in other (loss) income, net. See Note 4 for further details. Any fair value changes to the corresponding liability balance are recorded as compensation expense.

Contingencies

Contingencies	12 Months Ended
	Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Contingencies	Contingencies The majority of the Company’s revenues are from government programs and may be subject to adjustment as a result of: (i) examination by government agencies or contractors, for which the resolution of any matters raised may take extended periods of time to finalize; (ii) differing interpretations of government regulations by different Medicare contractors or regulatory authorities; (iii) differing opinions regarding a patient’s medical diagnosis or the medical necessity of services provided; and (iv) retroactive applications or interpretations of governmental requirements. In addition, the Company’s revenues from commercial payors may be subject to adjustment as a result of potential claims for refunds, as a result of government actions or as a result of other claims by commercial payors. The Company operates in a highly regulated industry and is a party to various lawsuits, 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. Excluding amounts stated below, as of December 31, 2023 and December 31, 2022, the Company’s total recorded accruals with respect to legal proceedings and regulatory matters, net of anticipated third party recoveries, were immaterial. While these accruals reflect the Company’s best estimate of the probable loss for those matters as of the dates of those accruals, the recorded amounts may differ materially from the actual amount of the losses for those matters, and any anticipated third party recoveries for any such losses may not ultimately be recoverable. Additionally, in some cases, no estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made because of the inherently unpredictable nature of legal proceedings and regulatory matters, which also may be impacted by various factors, including, without limitation, that they may involve indeterminate claims for monetary damages or may involve fines, penalties or non-monetary remedies; present novel legal theories or legal uncertainties; involve disputed facts; represent a shift in regulatory policy; are in the early stages of the proceedings; or may result in a change of business practices. Further, there may be various levels of judicial review available to the Company in connection with any such proceeding. The following is a description of certain lawsuits, claims, governmental investigations and audits and other legal proceedings to which the Company is subject. Certain Governmental Inquiries and Related Proceedings 2017 U.S. Attorney Colorado Investigation : In November 2017, the U.S. Attorney’s Office, District of Colorado informed the Company of an investigation it was conducting into possible federal healthcare offenses involving DaVita Kidney Care, as well as several of the Company’s wholly-owned subsidiaries. In addition to DaVita Kidney Care, the matter currently includes an investigation into DaVita Rx, DaVita Laboratory Services, Inc. (DaVita Labs), and RMS Lifeline Inc. (Lifeline). In each of August 2018, May 2019, and July 2021, the Company received a CID pursuant to the FCA from the U.S. Attorney's Office relating to this investigation. In May 2020, the Company sold its interest in Lifeline, but the Company retained certain liabilities of the Lifeline business, including those related to this investigation. The Company is engaged in discussions with the U.S. Attorney's Office and the Civil Division of the United States Department of Justice to resolve this matter. The Company can make no assurance as to the final outcome. The Company has reserved $40 million for this matter, which includes any potential payment of attorneys' fees. 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. On November 8, 2023, the private party relator filed a fourth amended complaint. On November 29, 2023, the Company filed a motion to dismiss the fourth 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 15, 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 Subjec

Noncontrolling Interests Subject to Put Provisions and Other Commitments	12 Months Ended
	Dec. 31, 2023
Accounting Policies [Abstract]
Noncontrolling Interests Subject to Put Provisions and Other Commitments	Noncontrolling interests subject to put provisions and other commitments Noncontrolling interests subject to put provisions The Company has potential obligations to purchase the equity interests held by third parties in many of its majority-owned dialysis partnerships and other nonconsolidated entities. These noncontrolling interests subject to put provisions constitute redeemable equity interests and are therefore classified as temporary equity and carried at estimated fair value on the Company's balance sheet. Specifically, these obligations are in the form of put provisions that are exercisable at the third-party owners’ discretion within specified periods outlined in each specific put provision. If these put provisions were exercised, the Company would be required to purchase the third-party owners’ equity interests, generally at the appraised fair market value of the equity interests or in certain cases at a predetermined multiple of earnings or cash flows attributable to the equity interests put to the Company, intended to approximate fair value. The methodology the Company uses to estimate the fair values of noncontrolling interests subject to put provisions assumes the higher of either a liquidation value of net assets or an average multiple of earnings, based on historical earnings, patient mix and other performance indicators that can affect future results, as well as other factors. The estimated fair values of noncontrolling interests subject to put provisions are a critical accounting estimate that involves significant judgments and assumptions and may not be indicative of the actual values at which the noncontrolling interests may ultimately be settled, which could vary significantly from the Company’s current estimates. The estimated fair values of noncontrolling interests subject to put provisions can fluctuate and the implicit multiple of earnings at which these noncontrolling interests obligations may be settled will vary significantly depending upon market conditions including potential purchasers’ access to the capital markets, which can impact the level of competition for dialysis and non-dialysis related businesses, the economic performance of these businesses and the restricted marketability of the third-party owners’ equity interests. The amount of noncontrolling interests subject to put provisions that employ a contractually predetermined multiple of earnings rather than fair value is immaterial. Certain consolidated dialysis partnerships are originally contractually scheduled to dissolve after terms ranging from ten years to 50 years. While noncontrolling interests in these limited life entities qualify as mandatorily redeemable financial instruments, they are subject to a classification and measurement scope exception from the accounting guidance generally applicable to other mandatorily redeemable financial instruments. Future distributions upon dissolution of these entities would be valued below the related noncontrolling interest carrying balances in the consolidated balance sheet. Other commitments The Company has agreements with various suppliers to purchase established amounts of dialysis equipment, parts, pharmaceuticals and supplies. As of December 31, 2023, the remaining minimum purchase commitments under these arrangements were approximately $663,498, $541,683, $551,187, $175,707 and $178,559 for the years 2024, 2025, 2026, 2027 and 2028, respectively. If the Company fails to meet the minimum purchase commitments under these contracts during any year, it is required to pay the difference to the supplier. 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 $8,852. Other than the letters of credit disclosed in Note 12 to these consolidated financial statements, and the arrangements as described above, the Company has no off balance sheet financing arrangements as of December 31, 2023.

Stock-based compensation

Stock-based compensation	12 Months Ended
	Dec. 31, 2023
Share-Based Payment Arrangement [Abstract]
Long-term Incentive Compensation and Shareholders’ Equity	Stock-based compensation Stock-based compensation Stock-based compensation consists primarily of stock-settled stock appreciation rights, restricted stock units and performance stock units. Stock-based compensation, which is primarily general and administrative in nature, is attributed to the Company’s U.S. dialysis business, its corporate administrative support, and its ancillary services. See Note 1 "Organization and summary of significant accounting policies" for more information on how the Company measures and recognizes stock-based compensation expense. Long-term incentive compensation plans The DaVita Inc. 2020 Incentive Award Plan (the 2020 Plan) is the Company’s current omnibus equity compensation plan and provides for grants of stock-based awards to employees, directors and other individuals providing services to the Company, except that incentive stock options may only be awarded to employees. The 2020 Plan provides for the grant of stock appreciation rights, nonqualified stock options, incentive stock options, restricted stock units, restricted stock, performance stock awards, dividend equivalents, stock payments, deferred stock unit awards, deferred stock awards and performance cash awards. The 2020 Plan mandates a maximum award term of 10 years for stock appreciation rights and stock options and stipulates that awards of these types be granted with a base or exercise price per share of not less than the fair market value of the Company's common stock on the date of grant. Shares available under the 2020 Plan are stated on a full value share basis. The 2020 Plan therefore provides that shares available for issuance under the plan are reduced by one share available for every four shares underlying stock appreciation rights and stock options, and are reduced by one share available for every one share underlying stock-based awards other than stock appreciation rights and stock options. At December 31, 2023, there were 5,570 shares available for future grants under the 2020 Plan. The Company’s stock awards granted under the 2020 Plan generally vest over 36 months to 48 months from the date of grant. A summary of the status of the Company’s stock-settled awards, including base shares for stock-settled stock appreciation rights (SSARs) and stock-settled stock unit awards is as follows: Year ended December 31, 2023 Stock appreciation rights Stock units Awards Weighted Weighted Awards Weighted Outstanding at beginning of year 5,390 $ 66.00 3,072 Granted — 1,383 Added by performance factor 66 Exercised/Vested (1,872) $ 63.75 (1,067) Canceled (47) $ 52.41 (231) Outstanding at end of period 3,471 $ 67.40 0.91 3,223 2.21 Exercisable at end of period 3,076 $ 63.42 0.75 — — Weighted-average fair value of grants: 2023 $ 77.61 2022 $ 35.13 $ 107.60 2021 $ 32.15 $ 109.50 Awards Outstanding Weighted average exercise price Awards exercisable Weighted average exercise price Range of SSARs base prices $50.01–$60.00 945 $ 52.41 945 $ 52.41 $60.01–$70.00 2,000 $ 67.80 2,000 $ 67.80 $70.01–$80.00 264 $ 75.95 131 $ 75.95 $100.01–$110.00 132 $ 108.93 $110.01–$120.00 130 $ 110.63 Total 3,471 $ 67.40 3,076 $ 63.42 For the years ended December 31, 2023, 2022 and 2021, the aggregate intrinsic value of stock-based awards exercised was $168,500, $149,442 and $208,585, respectively. At December 31, 2023, the aggregate intrinsic value of stock-based awards outstanding was $475,918 and the aggregate intrinsic value of stock awards exercisable was $128,229. Estimated fair value of stock-based compensation awards The Company has estimated the grant-date fair value of stock-settled stock appreciation rights awards using the Black-Scholes-Merton valuation model and stock-settled stock unit awards at intrinsic value on the date of grant, except for portions of the Company’s performance stock unit awards for which a Monte Carlo simulation was used to estimate the grant-date fair value. The following assumptions were used in estimating these values and determining the related stock-based compensation expense attributable to the current period: Expected term of the awards: The expected term of awards granted represents the period of time that they are expected to remain outstanding from the date of grant. The Company determines the expected term of its stock awards based on its historical experience with similar awards, considering the Company’s historical exercise and post-vesting termination patterns. Expected volatility: Expected volatility represents the volatility anticipated over the expected term of the award. The Company determines the expected volatility for its awards based on the volatility of the price of its common stock over the most recent retrospective period commensurate with the expected term of the award, considering the volatilities expected by peer companies in near industries. Expected dividend yield: The Company has not paid dividends on its common stock and does not currently expect to pay dividends during the term of stock awards granted. Risk-free interest rate: The Company bases the expected risk-free interest rate on the implied yield currently available on stripped interest coupons of U.S. Treasury issues with a remaining term equivalent to the expected term of the award. A summary of the weighted average valuation inputs described above used for estimating the grant-date fair value of SSAR awards granted in the periods indicated is as follows: 2022 2021 Expected term 4.5 4.5 Expected volatility 34.3 % 34.3 % Expected dividend yield — % — % Risk-free interest rate 2.1 % 0.7 % The Company estimates expected forfeitures based upon historical experience with separate groups of employees that have exhibited similar forfeiture behavior in the past. Stock-based compensation expense is recorded only for awards that are expected to vest. Employee stock purchase plan The Employee Stock Purchase Plan entitles qualifying employees to purchase up to $25 of the Company’s common stock during each calendar year. The amounts used to purchase stock are accumulated through payroll withholdings or through optional lump sum payments made in advance of the first day of the purchase right period. This compensatory plan allows employees to purchase stock for the lesser of 100% of its fair market value on the first day of the purchase right period or 85% of its fair market value on the last day of the purchase right period. Purchase right periods begin on January 1 and July 1, and end on December 31. Contributions used to purchase the Company’s common stock under this plan for the 2023, 2022 and 2021 purchase periods were $18,213, $18,061 and $19,626, respectively. Shares purchased pursuant to the plan’s 2023, 2022 and 2021 purchase periods were 231, 285 and 203, respectively. At December 31, 2023, there were 5,471 shares remaining available for future grants under this plan. The fair value of participants’ purchase rights was estimated as of the beginning dates of the purchase right periods using the Black-Scholes-Merton valuation model with the following weighted average assumptions for purchase right periods in 2023, 2022 and 2021, respectively: expected volatility of 41.3%, 31.7% and 39.0%; risk-free interest rates of 4.9%, 1.3% and 0.1%; and no dividends. Using these assumptions, the weighted average estimated per share fair value of each purchase right was $25.25, $26.50 and $34.94 for 2023, 2022 and 2021, respectively. Stock-based compensation expense and proceeds For the years ended December 31, 2023, 2022 and 2021, the Company recognized $112,375, $95,427 and $102,209 in stock-based compensation expense for stock appreciation rights, stock units and discounted employee stock purchase plan purchases, which are primarily included in general and administrative expenses. The estimated tax benefits recorded for stock-based compensation in 2023, 2022 and 2021 were $16,536, $14,723 and $13,853, respectively. As of December 31, 2023, there was $134,720 of total estimated but unrecognized stock-based compensation expense under the Company’s equity compensation plans. The Company expects to recognize this expense over a weighted average remaining period of 1.3 years. For the years ended December 31, 2023, 2022 and 2021, the Company received $25,629, $24,805 and $46,990, respectively, in actual tax benefits upon the exercise or vesting of stock awards. Since the Company issues stock-settled stock appreciation rights rather than stock options, there were no cash proceeds from stock option exercises.

Stockholder's equity

Stockholder's equity	12 Months Ended
	Dec. 31, 2023
Equity [Abstract]
Stockholder's equity	Shareholders’ equity Stock repurchases The following table summarizes the Company's repurchases of its common stock during the years ended December 31, 2023, 2022 and 2021: 2023 2022 2021 Open market repurchases Shares 2,904 8,095 13,877 Amounts paid (1) $ 285,710 $ 787,854 $ 1,546,016 Average price paid per share (2) $ 97.82 $ 97.30 $ 111.38 (1) Includes commissions and the 1% excise tax imposed on certain stock repurchases made after December 31, 2022 by the Inflation Reduction Act of 2022. The excise tax is recorded as part of the cost basis of treasury stock repurchased and, as such, is included in stockholders’ equity. (2) Excludes commissions and the excise tax described above. The Company repurchased 1,507 shares of its common stock for $164,366 at an average price paid of $107.97 per share subsequent to December 31, 2023 through February 12, 2024. As of December 31, 2023, the Company is authorized to make share repurchases pursuant to a December 17, 2021 Board authorized repurchase plan of $2,000,000. This authorization allows the Company to make purchases from time to time in the open market or in privately negotiated transactions, including without limitation, through accelerated share repurchase transactions, derivative transactions, tender offers, Rule 10b5-1 plans or any combination of the foregoing, depending upon market conditions and other considerations. As of February 12, 2024, the Company has a total of $1,149,192, excluding excise taxes, available under the current authorization for additional share repurchases. Although this share repurchase authorization does not have an expiration date, the Company remains subject to share repurchase limitations, including under the terms of its senior secured credit facilities. The Company retired all shares held in its treasury effective as of December 31, 2023 and December 31, 2022. Charter documents & Delaware law The Company’s charter documents include provisions that may deter hostile takeovers, delay or prevent changes of control or changes in management, or limit the ability of stockholders to approve transactions that they may otherwise determine to be in their best interests. These include provisions prohibiting stockholders from acting by written consent, requiring 90 days advance notice for director nominations and stockholder proposals and granting the Company's Board of Directors the authority to issue up to 5,000 shares of preferred stock and to determine the rights and preferences of the preferred stock without the need for further stockholder approval. The Company is also subject to Section 203 of the Delaware General Corporation Law which, subject to exceptions, prohibits the Company from engaging in any business combinations with any interested stockholder, as defined in that section, for a period of three years following the date on which that stockholder became an interested stockholder. The provisions described above may discourage, delay or prevent an acquisition of the Company at a price that stockholders may find attractive. Changes in DaVita Inc.’s ownership interests in consolidated subsidiaries The effects of changes in DaVita Inc.’s ownership interests in consolidated subsidiaries on the Company’s consolidated equity were as follows: Year ended December 31, 2023 2022 2021 Net income attributable to DaVita Inc. $ 691,535 $ 560,400 $ 978,450 Changes in paid-in capital for: Purchases of noncontrolling interests (5,375) (6,586) (13,853) Sales of noncontrolling interest 13,077 939 (264) Net transfers in noncontrolling interests 7,702 (5,647) (14,117) Net income attributable to DaVita Inc. net of transfers in $ 699,237 $ 554,753 $ 964,333 The Company acquired additional ownership interests in several existing majority-owned partnerships for $12,555, $20,775 and $20,104 in 2023, 2022 and 2021, respectively.

Accumulated Other Comprehensive

Accumulated Other Comprehensive (Loss) Income	12 Months Ended
	Dec. 31, 2023
Statement of Comprehensive Income [Abstract]
Other Comprehensive (Loss) Income	Accumulated other comprehensive loss Charges and credits to other comprehensive (loss) income have been as follows: Interest rate Foreign currency Accumulated other Balance at December 31, 2020 $ (12,466) $ (53,688) $ (66,154) Unrealized gains (losses) 9,532 (83,375) (73,843) Related income tax (2,377) (1,006) (3,383) 7,155 (84,381) (77,226) Reclassification of loss into net income 5,509 — 5,509 Related income tax (1,376) — (1,376) 4,133 — 4,133 Balance at December 31, 2021 $ (1,178) $ (138,069) $ (139,247) Unrealized gains (losses) 144,793 (30,554) 114,239 Related income tax (36,124) 752 (35,372) 108,669 (29,802) 78,867 Reclassification of income into net income (11,732) — (11,732) Related income tax 2,926 — 2,926 (8,806) — (8,806) Balance at December 31, 2022 $ 98,685 $ (167,871) $ (69,186) Unrealized gains 9,186 89,055 98,241 Related income tax (2,291) (1,121) (3,412) 6,895 87,934 94,829 Reclassification of income into net income (103,567) — (103,567) Related income tax 25,840 — 25,840 (77,727) — (77,727) Balance at December 31, 2023 $ 27,853 $ (79,937) $ (52,084) The reclassification of net interest rate cap realized losses into income are recorded as debt expense in the corresponding consolidated statements of income. See Note 12 for further details.

Acquisitions and Divestitures

Acquisitions and Divestitures	12 Months Ended
	Dec. 31, 2023
Business Combinations [Abstract]
Acquisitions and Divestitures	Acquisitions and divestitures Routine acquisitions During 2023, 2022 and 2021, the Company acquired dialysis businesses and other businesses, as follows: Year ended Year ended December 31, 2023 2022 2021 Cash paid, net of cash acquired $ 26,394 $ 57,308 $ 187,050 Contingent earn-out obligations 11,065 4,261 14,854 Deferred purchase price and liabilities assumed 8,736 15,076 10,226 Aggregate consideration $ 46,195 $ 76,645 $ 212,130 Number of dialysis centers acquired — U.S. — 5 19 Number of dialysis centers acquired — International 12 11 17 The assets and liabilities for these acquisitions were recorded at their estimated fair values at the dates of the acquisitions and are included in the Company’s consolidated financial statements, as are their operating results, from the designated effective dates of the acquisitions. The initial purchase price allocations for these transactions have been recorded at estimated fair values based on information available to management and will be finalized when certain information arranged to be obtained has been received. For several of the 2023 acquisitions, certain income tax amounts are pending final evaluation and quantification of any pre- acquisition tax contingencies. In addition, valuation of contingent earn-outs, intangibles, fixed assets, leases and certain working capital items relating to several of these acquisitions are pending final quantification. The following table summarizes the assets acquired and liabilities assumed in these transactions and recognized at their acquisition dates at estimated fair values, as well as the estimated fair value of noncontrolling interests assumed in these transactions: Year ended December 31, 2023 2022 2021 Current assets $ 6,128 $ 6,389 $ 9,134 Property and equipment 4,130 7,481 9,277 Customer relationships — — 17,200 Noncompetition agreements and other long-term assets 785 1,066 9,964 Indefinite-lived licenses 15,789 19,610 11,432 Goodwill 25,723 49,047 173,244 Liabilities assumed (6,179) (6,081) (14,200) Noncontrolling interests assumed (181) (867) (3,921) $ 46,195 $ 76,645 $ 212,130 The following summarizes weighted-average estimated useful lives of amortizable intangible assets acquired during 2023, 2022 and 2021, as well as goodwill deductible for tax purposes associated with these acquisitions: Year ended December 31, 2023 2022 2021 Weighted-average estimated useful lives (in years): Customer relationships — — 10 Noncompetition agreements 3 4 6 Goodwill deductible for tax purposes $ 17,836 $ 49,047 $ 169,014 Pro forma financial information (unaudited) The following summary, prepared on a pro forma basis, combines the results of operations as if all acquisitions within continuing operations in 2023 and 2022 had been consummated as of the beginning of 2022, including the impact of certain adjustments such as amortization of intangibles, interest expense on acquisition financing and income tax effects. Year ended December 31, 2023 2022 (unaudited) Pro forma total revenues $ 12,160,466 $ 11,651,311 Pro forma net income from continuing operations attributable to $ 694,854 $ 550,245 Pro forma basic net income per share from continuing operations $ 7.65 $ 5.92 Pro forma diluted net income per share from continuing operations $ 7.46 $ 5.74 Contingent earn-out obligations The Company has contingent earn-out obligations associated with acquisitions that could result in the Company paying the former owners of acquired businesses a total of up to approximately $66,299 if certain performance targets or quality margins are met over the next one year to five years. Contingent earn-out obligations are remeasured to fair value at each reporting date until the contingencies are resolved with changes in the liability due to the remeasurement recognized in earnings. See Note 23 for further details. As of December 31, 2023, the Company estimated the fair value of these contingent earn-out obligations to be $23,088, of which a total of $6,431 is included in other current liabilities, and the remaining $16,657 is included in other long-term liabilities in the Company’s consolidated balance sheet. The following is a reconciliation of changes in contingent earn-out liabilities for the years ended December 31, 2023 and 2022: Year ended December 31, 2023 2022 Beginning balance $ 25,422 $ 33,600 Acquisitions 11,065 4,261 Foreign currency translation 1,611 840 Fair value remeasurements (11,170) (5,921) Payments or other settlements (3,840) (7,358) Ending balance $ 23,088 $ 25,422

Held for Sale and Discontinued

Held for Sale and Discontinued Operations	12 Months Ended
	Dec. 31, 2023
Discontinued Operations and Disposal Groups [Abstract]
Held for Sale and Discontinued Operations	Discontinued operations previously held for sale DaVita Medical Group (DMG) On June 19, 2019, the Company completed the sale of its prior DMG business to Optum, a subsidiary of UnitedHealth Group Inc. At close, the Company's ultimate net proceeds from this sale remained subject to resolution of certain post-closing adjustments. Shortly after December 31, 2022, Optum made an additional purchase price payment of $13,452 to the Company after resolution of one such post-closing matter, which represented a contingent gain to the Company for the fourth quarter of 2022. The Company recognized no DMG operating, financing or investing cash flows for the years ended December 31, 2023, 2022 and 2021. Under the equity purchase agreement, the Company also has certain continuing indemnification obligations that could require payments to the buyer relating to the Company's previous ownership and operation of the DMG business. Potential payments under these provisions, if any, remain subject to continuing uncertainties and the amounts of such payments could be significant to the Company.

Variable Interest Entities

Variable Interest Entities	12 Months Ended
	Dec. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Variable Interest Entities	Variable interest entities The Company manages or maintains an ownership interest in certain legal entities subject to the consolidation guidance applicable to variable interest entities (VIEs). Almost all of the VIEs the Company consolidates are either U.S. dialysis partnerships encumbered by guaranteed debt, U.S. dialysis limited partnerships, U.S. integrated kidney care subsidiaries, or other legal entities subject to nominee ownership arrangements. Under U.S. GAAP, VIEs typically include entities for which (i) the entity’s equity is not sufficient to finance its activities without additional subordinated financial support; (ii) the equity holders as a group lack the power to direct the activities that most significantly influence the entity’s economic performance, the obligation to absorb the entity’s expected losses, or the right to receive the entity’s expected returns; or (iii) the voting rights of some investors are not proportional to their obligations to absorb the entity’s losses. The substantial majority of VIEs the Company is associated with are U.S. dialysis partnerships which the Company manages and in which it maintains a controlling majority ownership interest. These U.S. dialysis partnerships are considered VIEs either because they are (i) encumbered by debt guaranteed proportionately by the partners that is considered necessary to finance the partnership's activities, or (ii) in the form of limited partnerships for which the limited partners are not considered to have substantive kick-out or participating rights. The Company consolidates virtually all such U.S. dialysis partnerships. Also, certain wholly-owned entities employed in the Company's integrated kidney care business constitute VIEs since by design these entities require additional subordinated financial support. The Company believes it has the most power over these entities' most significant activities and the Company is fully exposed to all or almost all of their expected losses. The Company therefore consolidates these wholly-owned entities as its subsidiaries. Finally, some of the Company's business units rely on the operating activities of certain nominee-owned legal entities in which it does not maintain a controlling ownership interest but over which it has indirect influence and of which it is considered the primary beneficiary. These entities are subject to transfer restriction, management and other agreements that effectively transfer substantial ultimate powers over, and economic responsibility for, these entities to the Company. The Company consolidates all of the nominee-owned entities with which it is most closely associated. In addition to the consolidated entities described above, the Company maintains minor equity method or other venture capital investments in certain development-stage investees which qualify as VIEs based on their capitalization. The Company has concluded that it is not the primary beneficiary of any of these investees. For the VIEs described above, these consolidated financial statements include total assets of $256,542 and total liabilities and noncontrolling interests to third parties of $139,443 at December 31, 2023. The Company also sponsors certain non-qualified deferred compensation plans whose trusts qualify as VIEs and the Company consolidates these plans as their primary beneficiary. The assets of these plans are recorded in short-term or long-term investments with related liabilities recorded in accrued compensation and benefits and other long-term liabilities. See Notes 4 and 14 for disclosures concerning the assets of these consolidated non-qualified deferred compensation plans.

Fair Values of Financial Instru

Fair Values of Financial Instruments	12 Months Ended
	Dec. 31, 2023
Fair Value Disclosures [Abstract]
Fair Values 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 equity that are measured at fair value on a recurring basis into the appropriate fair value hierarchy levels as defined by the FASB. The following table summarizes the Company’s assets, liabilities and temporary equity measured at fair value on a recurring basis as of December 31, 2023 and 2022: December 31, 2023 Total Quoted prices in Significant other Significant Assets Investments in equity securities $ 37,391 $ 37,391 Interest rate cap agreements $ 79,805 $ 79,805 Liabilities Contingent earn-out obligations for acquisitions $ 23,088 $ 23,088 Temporary equity Noncontrolling interests subject to put provisions $ 1,499,288 $ 1,499,288 December 31, 2022 Assets Investments in equity securities $ 39,143 $ 39,143 Interest rate cap agreements $ 139,755 $ 139,755 Liabilities Contingent earn-out obligations for acquisitions $ 25,422 $ 25,422 Temporary equity Noncontrolling interests subject to put provisions $ 1,348,908 $ 1,348,908 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 12 for further discussion. The estimated fair value measurements of these contingent earn-out obligations are primarily based on unobservable inputs, including projected earnings before interest, taxes, depreciation, and amortization (EBITDA), revenue and key performance indicators. The estimated fair value of these contingent earn-out obligations is remeasured as of each reporting date and could fluctuate based upon any significant changes in key assumptions, such as changes in the Company credit risk adjusted rate that is used to discount obligations to present value. See Note 20 for further discussion and a reconciliation of changes. 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 December 31, 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 $190,000. See Note 16 for a discussion of the Company’s methodology for estimating the fair values of noncontrolling interests subject to put obligations and the reconciliation of changes on the consolidated statements of equity. 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 12 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 the consolidated financial statements at December 31, 2023 and 2022 at their approximate fair values due to the short-term nature of their settlements.

Segment Reporting

Segment Reporting	12 Months Ended
	Dec. 31, 2023
Segment Reporting [Abstract]
Segment Reporting	Segment reporting The Company's operating divisions are composed of its U.S. dialysis and related lab services business (its U.S. dialysis business), its U.S. integrated kidney care business, its U.S. other ancillary services and its international operations (collectively, its ancillary services), as well as its corporate administrative support. See Note 1 "Organization" for a summary description of the Company's businesses. The Company’s operating segments have been defined based on the separate financial information that is regularly produced and reviewed by the Company’s chief operating decision maker in making decisions about allocating resources to and assessing the financial performance of the Company’s various operating lines of business. The chief operating decision maker for the Company is its Chief Executive Officer. The Company’s separate operating segments include its U.S. dialysis and related lab services business, its U.S. integrated kidney care business, its U.S. other ancillary services, its operations in each foreign sovereign jurisdiction, and its equity method investment in its Asia Pacific joint venture (APAC JV). 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. The Company’s operating segment financial information included in this report is prepared on the internal management reporting basis that the chief operating decision maker uses to assess the financial performance of and allocate resources among the Company's operating segments. For internal management reporting, segment operations include direct segment operating expenses but generally exclude corporate administrative support costs, which consist primarily of indirect labor, benefits and long-term incentive compensation expenses of certain departments which provide support to more than one of the Company’s various operating lines of business. The chief operating decision maker uses segment operating margin to assess segment profitability. The chief operating decision maker does not use total assets by segment to make decisions regarding resources; therefore, the total assets by segment disclosure has not been included. The following is a summary of segment revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income from continuing operations before income taxes: Year ended December 31, 2023 2022 2021 Segment revenues: U.S. dialysis Patient service revenues: External sources $ 10,823,525 $ 10,488,327 $ 10,551,106 Intersegment revenues 88,222 87,045 90,512 U.S. dialysis patient service revenues 10,911,747 10,575,372 10,641,618 Other revenues External sources 25,251 24,447 25,061 Intersegment revenues — (10) 284 Total U.S. dialysis revenues 10,936,998 10,599,809 10,666,963 Other - Ancillary services Patient service revenues 751,416 688,137 662,409 Other external sources 539,955 408,983 380,221 Intersegment revenues 7,852 4,206 4,294 Total ancillary services 1,299,223 1,101,326 1,046,924 Total net segment revenues 12,236,221 11,701,135 11,713,887 Elimination of intersegment revenues (96,074) (91,241) (95,090) Consolidated revenues $ 12,140,147 $ 11,609,894 $ 11,618,797 Segment operating margin (loss): U.S. dialysis $ 1,774,578 $ 1,565,310 $ 1,974,988 Other - Ancillary services (1) (8,747) (96,579) (66,003) Total segment margin 1,765,831 1,468,731 1,908,985 Reconciliation of segment operating margin to consolidated income from Corporate administrative support (163,047) (129,669) (111,615) Consolidated operating income 1,602,784 1,339,062 1,797,370 Debt expense (398,551) (357,019) (285,254) Debt extinguishment and modification costs (7,962) — — Other (loss) income, net (19,177) (15,765) 6,378 Income from continuing operations before income taxes $ 1,177,094 $ 966,278 $ 1,518,494 (1) Segment operating loss for Other - Ancillary services includes equity investment loss of $2,103, $1,898 and $3,177 in 2023, 2022 and 2021, respectively. Depreciation and amortization expense by reportable segment was as follows: Year ended December 31, 2023 2022 2021 U.S. dialysis $ 695,674 $ 690,949 $ 642,711 Other - Ancillary services 49,769 41,653 37,904 $ 745,443 $ 732,602 $ 680,615 Expenditures for property and equipment by reportable segment were as follows: Year ended December 31, 2023 2022 2021 U.S. dialysis $ 501,149 $ 533,600 $ 589,662 Other - Ancillary services 66,836 69,829 51,803 $ 567,985 $ 603,429 $ 641,465 The Company's international operations include approximately $240,742 and $207,162 in 2023 and 2022, respectively, of net property and equipment.
Net Property and Equipment International Operations	The Company's international operations include approximately $240,742 and $207,162 in 2023 and 2022, respectively, of net property and equipment.

Supplemental Cash Flow Informat

Supplemental Cash Flow Information	12 Months Ended
	Dec. 31, 2023
Supplemental Cash Flow Elements [Abstract]
Supplemental Cash Flow Information	Supplemental cash flow information The table below provides supplemental cash flow information: Year ended December 31, 2023 2022 2021 Cash paid: Income taxes, net $ 268,091 $ 344,430 $ 209,754 Interest, net $ 387,661 $ 350,999 $ 279,002 Non-cash investing and financing activities: Fixed assets under financing lease obligations $ 13,269 $ 1,928 $ 31,690

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Pay vs Performance Disclosure
Net (loss) income attributable to DaVita Inc.	$ 691,535	$ 560,400	$ 978,450

Insider Trading Arrangements

Insider Trading Arrangements	12 Months Ended
	Dec. 31, 2023
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Organization and Summary of S_2

Organization and Summary of Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2023
Accounting Policies [Abstract]
Basis of presentation	Basis of presentation These consolidated financial statements are prepared in accordance with United States generally accepted accounting principles (U.S. GAAP). The financial statements include DaVita Inc. and its subsidiaries, partnerships and other entities in which it maintains a majority voting or other controlling financial interest (collectively, the Company). All significant intercompany transactions and balances have been eliminated. Equity investments in investees over which the Company has significant influence are recorded on the equity method, while investments in other equity securities are recorded at fair value or on the adjusted cost method, as applicable. For the Company’s international subsidiaries, local currencies are considered their functional currencies. Translation adjustments result from translating the financial statements of the Company’s international subsidiaries from their functional currencies into the Company’s reporting currency (the U.S. dollar, or USD). The Company has evaluated subsequent events through the date these consolidated financial statements were issued and has included all necessary adjustments and disclosures.
Use of estimates	Use of estimates The preparation of financial statements in conformity with U.S. GAAP requires the use of estimates and assumptions that affect the reported amounts of revenues, expenses, assets, liabilities, contingencies and noncontrolling interests subject to put provisions. Although actual results in subsequent periods will differ from these estimates, such estimates are developed based on the best information available to management and management’s best judgments at the time. All significant assumptions and estimates underlying the amounts reported in the financial statements and accompanying notes are regularly reviewed and updated when necessary. Changes in estimates are reflected in the financial statements based upon on-going actual experience trends or subsequent settlements and realizations depending on the nature and predictability of the estimates and contingencies. The most significant assumptions and estimates underlying these consolidated financial statements and accompanying notes involve revenue recognition and accounts receivable, impairments of goodwill, accounting for income taxes, certain fair value estimates and loss contingencies. Specific estimating risks and contingencies are further addressed within these notes to the consolidated financial statements.
Patient service net revenues and accounts receivable	Revenues 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 this fee schedule. Revenues associated with Medicare and Medicaid programs are estimated based on: (a) the payment rates that are established by statute or regulation for the portion of payment rates paid by the government payor (e.g., 80% for Medicare patients) and (b) for the portion not paid by the primary government payor, estimates of the amounts ultimately collectible from other government programs providing secondary coverage (e.g., Medicaid secondary coverage), the patient’s commercial health plan secondary coverage, or the patient. Under Medicare’s bundled payment rate system, services covered by Medicare are subject to estimating risk, whereby reimbursements from Medicare can vary significantly depending upon certain patient characteristics and other variable factors. Even with the bundled payment rate system, Medicare payments for bad debt claims as established by cost reports require evidence of collection efforts. As a result, billing and collection of Medicare bad debt claims can be delayed significantly and final payment is subject to audit. The Company’s revenue recognition is estimated based on its judgment regarding its ability to collect, which depends upon its ability to effectively capture, document and bill for Medicare’s base payment rate as well as these other variable factors. Medicare Advantage revenues are reimbursed at negotiated contract rates that are generally higher than Medicare fee-for-service rates, but which generally have a slower payment cycle than Medicare fee-for-service payments, and some of which are subject to certain quality or performance adjustments. Medicare Advantage revenues are subject to meaningful estimating risk based on factors similar to those described for commercial health plans below. Medicaid payments, when Medicaid coverage is secondary, can also be difficult to estimate. For many states, Medicaid payment terms and methods differ from Medicare, and may prevent accurate estimation of individual payment amounts prior to billing. Revenues associated with commercial health plans are estimated based on contractual terms for the patients under healthcare plans with which the Company has formal agreements, non-contracted health plan coverage terms if known, estimated secondary collections, historical collection experience, historical trends of refunds and payor payment adjustments (retractions), inefficiencies in the Company’s billing and collection processes that can result in denied claims for payments, delays in collections due to payor payment inefficiencies, and regulatory compliance matters. Commercial revenue recognition also involves significant estimating risks. With many larger commercial insurers, the Company has several different contracts and payment arrangements, and these contracts often include only a subset of the Company’s centers. Some of the Company's commercial revenue contracts are also subject to certain quality or performance adjustments. In certain circumstances, it may not be possible to determine which contract, if any, should be applied prior to billing. In addition, for services provided by non-contracted centers, final collection may require specific negotiation of a payment amount, typically at a significant discount from the Company’s usual and customary rates. As described above, there are significant risks associated with estimating dialysis patient service revenue, many of which take several years to resolve. As these estimates are refined over time, both positive and negative adjustments to revenue are recognized in the current period. 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 and recognized in the period the Company's performance obligations are met, subject to applicable measurement constraints. The Company's 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 and adjusted medical cost targets. For some of the Company's risk-based arrangements (such as its special needs plans), the Company acts as a principal with respect to all medical services provided to the patient by effectively hosting or sponsoring the entire arrangement, and as a result recognizes revenue and expense for all medical services provided to covered patients. However, under its VBC arrangements (including VBC contracts with health plans and via direct government programs), the Company provides health monitoring and care coordination services to patients but does not control or direct the medical services that patients receive from third party providers. As a result, the Company does not include third party medical costs in its reported revenues and expenses for its VBC arrangements, but rather recognizes revenue only for the estimated amount of shared savings or shared losses or related revenues that are directly earned or incurred by the Company, and ultimately paid to or by the Company, under the arrangement. Measurements of revenue for the Company's IKC risk-based arrangements are complex, sensitive to a number of key inputs, and require meaningful estimates for a number of factors, including but not limited to member alignment data, third-party medical claims expense, outcomes on various quality metrics, and ultimate risk adjustment factor (RAF) scores. Information and other measurement limitations on these factors may constrain revenue recognition for a risk-based arrangement until a period after the Company's performance obligations have been met.
Other income	Other (loss) income, net Other (loss) income includes interest income on cash and cash equivalents and short- and long-term investments, equity investment (loss) income on equity method investments other than dialysis partnerships, realized and unrealized gains and losses recognized on other investments, impairments on investments, and foreign currency transaction gains and losses.
Cash and cash equivalents	Cash and cash equivalents Cash equivalents are short-term highly liquid investments readily convertible to known amounts of cash that typically mature within three months or less at date of purchase.
Restricted cash and equivalents	Restricted cash and equivalents Restricted cash and cash equivalents include funds held in trust to satisfy insurer and state regulatory requirements related to wholly-owned captive insurance companies that bear professional and general liability and workers' compensation risks for the Company as well as funds held in escrow.
Investments in debt and equity securities	Investments in debt and equity securities The Company classifies certain debt securities as held-to-maturity and records them at amortized cost based on the Company’s intentions and strategies concerning those investments. Equity securities that have readily determinable fair values or redemption values are recorded at estimated fair value with changes in fair value recognized in current earnings within other (loss) income, net. These debt and equity investments are classified as short-term investments or long-term investments on the Company's consolidated balance sheet. See Note 4 for further details.
Inventories	Inventories Inventories are stated at the lower of cost (first-in, first-out) or net realizable value and consist principally of pharmaceuticals and dialysis-related supplies. Rebates related to inventory purchases are recorded when earned and are based on certain qualification requirements which are dependent on a variety of factors including future pricing levels and purchase volume levels from the manufacturer and related data submission.
Property and equipment	Property and equipment Property and equipment is stated at cost less accumulated depreciation and amortization and is further reduced by any impairments. Maintenance and repairs are charged to expense as incurred. Property and equipment assets are reviewed for possible impairment whenever significant events or changes in circumstances indicate that an impairment may have occurred. Property and equipment impairment assessments are performed at a location or market level, as applicable, based on the specific cash flows they support or protect. If the Company commits to a plan to dispose of a long-lived asset before the end of its previously estimated useful life, cash flow estimates are revised accordingly, and the Company records an asset impairment, if applicable, or accelerates depreciation over the revised estimated useful life. Upon sale or retirement of long-lived assets, the cost and related accumulated depreciation or amortization are removed from the balance sheet and any resulting gain or loss is included in current operating expenses.
Leases	Leases The Company leases substantially all of its U.S. dialysis facilities. The majority of the Company’s facilities are leased under non-cancellable operating leases which contain renewal options. These renewal options are included in the Company's determination of lease right-of-use assets and related lease liabilities when renewal is considered reasonably certain at the commencement date. The Company's leases are generally subject to fixed escalation clauses or contain consumer price index increases. The Company categorizes leases with contractual terms longer than twelve months as either operating or finance leases. Finance leases are generally those leases that allow the Company to substantially utilize or pay for the entire asset over its estimated life. All other leases are categorized as operating leases. The Company has elected the practical expedient to not separate lease components from non-lease components for its financing and operating leases. For short-term leases with a term of less than 12 months, the Company does not recognize lease right-of-use assets or lease liabilities and instead recognizes short-term lease costs as rent expense directly as incurred. Financing and operating lease liabilities are measured at the net present value of lease payments over the lease term as of the commencement date. Since most of the Company's leases do not provide an implicit rate of return, the Company uses its incremental borrowing rate based on information available at the commencement date or remeasurement date in determining the present value of lease payments. Assets acquired under finance leases are recorded on the balance sheet within property and equipment, net and liabilities for finance lease obligations are recorded within long-term debt. Finance lease assets are amortized to depreciation expense on a straight-line basis over the shorter of their estimated useful lives or the expected lease term. Accretion of interest on finance lease liabilities is included in debt expense. Rights to use assets under operating leases are recorded on the balance sheet as operating lease right-of-use assets and liabilities for operating lease obligations are recorded as operating lease liabilities. Both amortization of operating lease right-of-use assets and interest accretion on operating lease liabilities are recorded to rent expense over the lease term. Rent expenses are included in patient care costs or general and administrative expense, as applicable, based on the business unit or corporate function for which the space is leased. The Company evaluates its lease right-of-use assets for impairments in a similar manner to long-lived assets, as described above in Property and equipment .
Amortizable intangibles	Amortizable intangibles Amortizable intangible assets include noncompetition agreements, hospital service contracts, and customer relationships arising from other service contracts, each of which have finite useful lives. Amortization expense is computed using the straight-line method over the useful lives of the assets estimated as follows: noncompetition agreements and hospital acute service contracts over the contract term, and customer relationships from other service contracts over the remaining contract term plus expected renewal periods. Amortizable intangible assets are reviewed for possible impairment whenever significant events or changes in circumstances indicate that an impairment may have occurred. Amortizable intangible asset impairment assessments are performed on a location, market or business unit basis, as applicable, based on the specific cash flows they support or protect.
Indefinite-lived intangibles	Indefinite-lived intangibles Indefinite-lived intangible assets include international licenses and accreditations that allow the Company to be reimbursed for providing dialysis services to patients, each of which has an indefinite useful life. Indefinite-lived intangibles are not amortized, but are assessed for impairment at least annually and whenever significant events or changes in circumstances indicate that an impairment may have occurred. Costs to renew indefinite-lived intangible assets are expensed as incurred.
Equity investments and other investments	Equity method and other investments Equity investments that do not have readily determinable fair values are carried on the equity method if the Company maintains significant influence over the investee unless the fair value option is elected. Equity investments without readily determinable fair values for which the Company does not maintain significant influence over the investee are carried either on the adjusted cost method or at estimated fair value, as determined on an investment-specific basis. The adjusted cost method represents the Company's cost for an investment, net of any impairments, as adjusted for any subsequent observable price changes. These equity investments are classified as equity method and other investments on the Company's consolidated balance sheet. See Note 8 for further details. Equity method investments are assessed for other-than-temporary impairment when significant events or changes in circumstances indicate that an other-than-temporary impairment may have occurred. An other-than-temporary impairment charge is recorded when the fair value of an investment has fallen below its carrying amount and the shortfall is expected to be indefinitely or permanently unrecoverable. Income and expense from nonconsolidated dialysis partnerships accounted for as equity method investments are recorded within equity investment income, net. For ownership interests accounted for as equity method investments other than dialysis partnerships, income and expense are included on up to a one quarter lag in other (loss) income, net.
Goodwill	Goodwill Goodwill represents the difference between the fair value of businesses acquired and the fair value of the identifiable tangible and intangible net assets acquired. Goodwill is not amortized, but is assessed by individual reporting unit for impairment as circumstances warrant and at least annually. An impairment charge is recognized when and to the extent a reporting unit's carrying amount is determined to exceed its fair value. The Company operates multiple reporting units. See Note 9 for further details.
Self insurance	Self-insurance
Income taxes	Income taxes Federal, state and foreign income taxes are computed at currently enacted tax rates less tax credits using the asset and liability method. Deferred taxes are adjusted both for items that do not currently have tax consequences and for the cumulative effect of any changes in tax rates from those previously used to determine deferred tax assets or liabilities. Tax provisions include amounts that are currently payable, changes in deferred tax assets and liabilities that arise because of temporary differences between the timing of when items of income and expense are recognized for financial reporting and income tax purposes, changes in the recognition of tax positions and any changes in the valuation allowance caused by a change in judgment about the realizability of the related deferred tax assets. A valuation allowance is established when necessary to reduce deferred tax assets to amounts expected to be realized. The Company uses a recognition threshold of more-likely-than-not and a measurement attribute on all tax positions taken or expected to be taken in a tax return in order to be recognized in the financial statements. Once the recognition threshold is met, the tax position is then measured to determine the actual amount of benefit to recognize in the financial statements. The Company accounts for income taxes under the asset and liability method, which requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of events that have been included in the consolidated financial statements. Under this method, deferred tax assets and liabilities are determined on the basis of the differences between the financial statement and tax basis of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse.
Stock-based compensation	Stock-based compensation The Company’s stock-based compensation expense for stock-settled awards is measured at the estimated fair value of awards on the date of grant and recognized on a cumulative straight-line basis over the vesting terms of the awards, unless the stock awards are based on non-market-based performance metrics, in which case expense is adjusted for the ultimate number of shares expected to be issued as of the end of each reporting period. Stock-based compensation expense for cash-settled awards is based on their estimated fair values as of the end of each reporting period. The expense for all stock-based awards is recognized net of expected forfeitures. Stock-based compensation to be settled in shares is recorded to the Company’s shareholders’ contributed capital, while stock-based compensation to be settled in cash is recorded as a liability. Shares issued upon exercise or, when applicable, vesting of stock awards, are issued from authorized but unissued shares.
Interest rate swap and cap agreements	Interest rate cap agreements The Company often carries a combination of current or forward interest rate caps on portions of its variable rate debt as a means of hedging its exposure to changes in Secured Overnight Financing Rate (SOFR) interest rates as part of its overall interest rate risk management strategy. These interest rate caps are not held for trading or speculative purposes and are designated as qualifying cash flow hedges. See Note 12 for further details.
Noncontrolling interests	Noncontrolling interests Noncontrolling interests represent third-party equity ownership interests in entities which are consolidated by the Company for financial statement reporting purposes. As of December 31, 2023, third parties held noncontrolling equity interests in 696 consolidated legal entities. Noncontrolling interests subject to put provisions The Company has potential obligations to purchase the equity interests held by third parties in many of its majority-owned dialysis partnerships and other nonconsolidated entities. These noncontrolling interests subject to put provisions constitute redeemable equity interests and are therefore classified as temporary equity and carried at estimated fair value on the Company's balance sheet. Specifically, these obligations are in the form of put provisions that are exercisable at the third-party owners’ discretion within specified periods outlined in each specific put provision. If these put provisions were exercised, the Company would be required to purchase the third-party owners’ equity interests, generally at the appraised fair market value of the equity interests or in certain cases at a predetermined multiple of earnings or cash flows attributable to the equity interests put to the Company, intended to approximate fair value. The methodology the Company uses to estimate the fair values of noncontrolling interests subject to put provisions assumes the higher of either a liquidation value of net assets or an average multiple of earnings, based on historical earnings, patient mix and other performance indicators that can affect future results, as well as other factors. The estimated fair values of noncontrolling interests subject to put provisions are a critical accounting estimate that involves significant judgments and assumptions and may not be indicative of the actual values at which the noncontrolling interests may ultimately be settled, which could vary significantly from the Company’s current estimates. The estimated fair values of noncontrolling interests subject to put provisions can fluctuate and the implicit multiple of earnings at which these noncontrolling interests obligations may be settled will vary significantly depending upon market conditions including potential purchasers’ access to the capital markets, which can impact the level of competition for dialysis and non-dialysis related businesses, the economic performance of these businesses and the restricted marketability of the third-party owners’ equity interests. The amount of noncontrolling interests subject to put provisions that employ a contractually predetermined multiple of earnings rather than fair value is immaterial.
Fair value estimates	Fair value estimates Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. Fair value measurements are determined based on the principal or most advantageous market for the item being measured, assume that buyers and sellers are independent, willing and able to transact, and knowledgeable, with access to all information customarily available in such a transaction, and are based on assumptions that market participants would use in pricing the item, not assumptions specific to the reporting entity. The criticality of a particular fair value estimate to the Company's consolidated financial statements depends upon the nature and size of the item being measured, the extent of uncertainties involved and the nature and magnitude or potential effect of assumptions and judgments required. Certain fair value estimates can involve significant uncertainties and require significant judgment on various matters, some of which could be subject to reasonable disagreement. The Company relies on fair value measurements and estimates for purposes that require the recording, reassessment, or adjustment of the carrying amounts of certain assets, liabilities, and noncontrolling interests subject to put provisions (redeemable equity interests classified as temporary equity). These purposes can include the accounting for business combination transactions; impairment assessments for goodwill, other intangible assets, or other long-lived assets; recurrent revaluation of investments in debt and equity securities, contingent earn-out obligations, interest rate cap agreements, and noncontrolling interests subject to put provisions; and the accounting for equity method and other investments and stock-based compensation, as applicable. The Company has classified its assets, liabilities and temporary equity into the fair value hierarchy levels defined by the Financial Accounting Standards Board (FASB) reflecting their differing degrees of uncertainty. See Note 23 for further details.
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. The application of this ASU did not have a material impact on the Company's consolidated financial statements. See Note 12 for further discussion of the Company's debt. In October 2021, the FASB issued ASU No. 2021-08, Business Combinations (Topic 805): Accounting for Acquired Contract Assets and Contract Liabilities (ASU 2021-08) . ASU 2021-08 requires application of ASC 606, Revenue from Contracts with Customers , to recognize and measure assets and liabilities from contracts with customers acquired in a business combination. This ASU created an exception to the general recognition and measurement principle in ASC 805 which results in recognition of contract assets and contract liabilities consistent with those recorded by the acquiree immediately before the acquisition date. The ASU was effective beginning January 1, 2023 and application of this ASU did not have a material impact on the Company's consolidated financial statements. New standards not yet adopted In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures (ASU 2023-07) , which improves reportable segment disclosure requirements, primarily through enhanced disclosures about significant segment expenses. The guidance also requires disclosure of the chief operating decision maker's (CODM) position for each segment and detail of how the CODM uses financial reporting to assess their segment’s performance. ASU 2023-07 is effective for all public entities for fiscal years beginning after December 15, 2023, with early adoption permitted. The Company is currently assessing the effect this guidance may have on its consolidated financial statements. In December 2023, the Financial Accounting Standards Board issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures , which expands income tax disclosure requirements to include additional information related to the rate reconciliation of effective tax rates to statutory rates, as well as additional disaggregation of taxes paid in both U.S. and foreign jurisdictions. The amendments in the ASU also remove disclosures related to certain unrecognized tax benefits and deferred taxes. ASU 2023-09 is effective for fiscal years beginning after December 15, 2024. The amendments may be applied prospectively or retrospectively, and early adoption is permitted. The Company is currently assessing the effect this guidance may have on its consolidated financial statements.
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 their 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 December 31, 2023 and 2022. Equity securities: Substantially all of the Company's 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.
Other Comprehensive (Loss) Income	The reclassification of net interest rate cap realized losses into income are recorded as debt expense in the corresponding consolidated statements of income.
Variable Interest Entities	The Company manages or maintains an ownership interest in certain legal entities subject to the consolidation guidance applicable to variable interest entities (VIEs). Almost all of the VIEs the Company consolidates are either U.S. dialysis partnerships encumbered by guaranteed debt, U.S. dialysis limited partnerships, U.S. integrated kidney care subsidiaries, or other legal entities subject to nominee ownership arrangements. Under U.S. GAAP, VIEs typically include entities for which (i) the entity’s equity is not sufficient to finance its activities without additional subordinated financial support; (ii) the equity holders as a group lack the power to direct the activities that most significantly influence the entity’s economic performance, the obligation to absorb the entity’s expected losses, or the right to receive the entity’s expected returns; or (iii) the voting rights of some investors are not proportional to their obligations to absorb the entity’s losses. The substantial majority of VIEs the Company is associated with are U.S. dialysis partnerships which the Company manages and in which it maintains a controlling majority ownership interest. These U.S. dialysis partnerships are considered VIEs either because they are (i) encumbered by debt guaranteed proportionately by the partners that is considered necessary to finance the partnership's activities, or (ii) in the form of limited partnerships for which the limited partners are not considered to have substantive kick-out or participating rights. The Company consolidates virtually all such U.S. dialysis partnerships. Also, certain wholly-owned entities employed in the Company's integrated kidney care business constitute VIEs since by design these entities require additional subordinated financial support. The Company believes it has the most power over these entities' most significant activities and the Company is fully exposed to all or almost all of their expected losses. The Company therefore consolidates these wholly-owned entities as its subsidiaries. Finally, some of the Company's business units rely on the operating activities of certain nominee-owned legal entities in which it does not maintain a controlling ownership interest but over which it has indirect influence and of which it is considered the primary beneficiary. These entities are subject to transfer restriction, management and other agreements that effectively transfer substantial ultimate powers over, and economic responsibility for, these entities to the Company. The Company consolidates all of the nominee-owned entities with which it is most closely associated. In addition to the consolidated entities described above, the Company maintains minor equity method or other venture capital investments in certain development-stage investees which qualify as VIEs based on their capitalization. The Company has concluded that it is not the primary beneficiary of any of these investees.

Revenue Recognition and Account

Revenue Recognition and Accounts Receivable Segment revenue by major payor (Tables)	12 Months Ended
	Dec. 31, 2023
Disaggregation of Revenue [Abstract]
Disaggregation of Revenue	The Company's revenues by segment and primary payor source were as follows: Year ended December 31, 2023 U.S. dialysis Other - Ancillary services Consolidated Patient service revenues: Medicare and Medicare Advantage $ 6,100,183 $ $ 6,100,183 Medicaid and Managed Medicaid 833,744 833,744 Other government 354,304 500,137 854,441 Commercial 3,623,516 251,279 3,874,795 Other revenues: Medicare and Medicare Advantage 460,991 460,991 Medicaid and Managed Medicaid 1,733 1,733 Commercial 32,329 32,329 Other (1) 25,251 52,754 78,005 Eliminations of intersegment revenues (88,222) (7,852) (96,074) Total $ 10,848,776 $ 1,291,371 $ 12,140,147 (1) Consists primarily of management service fees in the Company's U.S. dialysis business and research fees, management fees, and other non-patient service revenues in the Other - ancillary services businesses. Year ended December 31, 2022 U.S. dialysis Other - Ancillary services Consolidated Patient service revenues: Medicare and Medicare Advantage $ 6,041,496 $ $ 6,041,496 Medicaid and Managed Medicaid 759,579 759,579 Other government 336,991 464,921 801,912 Commercial 3,437,306 223,216 3,660,522 Other revenues: Medicare and Medicare Advantage 345,340 345,340 Medicaid and Managed Medicaid 1,546 1,546 Commercial 22,211 22,211 Other (1) 24,437 44,092 68,529 Eliminations of intersegment revenues (87,035) (4,206) (91,241) Total $ 10,512,774 $ 1,097,120 $ 11,609,894 (1) Consists primarily of management service fees in the Company's U.S. dialysis business and research fees, management fees, and other non-patient service revenues in the Other - ancillary services businesses. Year ended December 31, 2021 U.S. dialysis Other - Ancillary services Consolidated Patient service revenues: Medicare and Medicare Advantage $ 6,133,235 $ $ 6,133,235 Medicaid and Managed Medicaid 782,430 782,430 Other government 328,256 463,385 791,641 Commercial 3,397,697 199,024 3,596,721 Other revenues: Medicare and Medicare Advantage 326,696 326,696 Medicaid and Managed Medicaid 1,321 1,321 Commercial 15,553 15,553 Other (1) 25,345 40,945 66,290 Eliminations of intersegment revenues (90,796) (4,294) (95,090) Total $ 10,576,167 $ 1,042,630 $ 11,618,797 (1) Consists primarily of management service fees in the Company's U.S. dialysis business and research fees, management fees, and other non-patient service revenues in the Other - ancillary services businesses.

Earnings Per Share (Tables)

Earnings Per Share (Tables)	12 Months Ended
	Dec. 31, 2023
Earnings Per Share [Abstract]
Reconciliations of Numerators and Denominators Used to Calculate Basic and Diluted Net Income Per Share	The reconciliations of the numerators and denominators used to calculate basic and diluted earnings per share were as follows: Year ended December 31, 2023 2022 2021 Net income attributable to DaVita Inc.: Continuing operations $ 691,535 $ 546,948 $ 978,450 Discontinued operations — 13,452 — Net income attributable to DaVita Inc. $ 691,535 $ 560,400 $ 978,450 Weighted average shares outstanding: Basic shares 90,790 92,992 105,230 Assumed incremental from stock plans 2,392 2,842 4,718 Diluted shares 93,182 95,834 109,948 Basic net income attributable to DaVita Inc.: Continuing operations per share $ 7.62 $ 5.88 $ 9.30 Discontinued operations per share — 0.15 — Basic net income per share attributable to DaVita Inc. $ 7.62 $ 6.03 $ 9.30 Diluted net income attributable to DaVita Inc.: Continuing operations per share $ 7.42 $ 5.71 $ 8.90 Discontinued operations per share — 0.14 — Diluted net income per share attributable to DaVita Inc. $ 7.42 $ 5.85 $ 8.90 Anti-dilutive stock-settled awards excluded from calculation (1) 531 1,058 116 (1) Shares associated with stock awards excluded from the diluted denominator calculation because they were anti-dilutive under the treasury stock method.

Short-term and long-term invesm

Short-term and long-term invesmtents (Tables)	12 Months Ended
	Dec. 31, 2023
Investments, Debt and Equity Securities [Abstract]
Schedule of Investments	The Company’s short-term and long-term investments, consisting of debt instruments classified as held-to-maturity and equity investments with readily determinable fair values or redemption values, were as follows: December 31, 2023 December 31, 2022 Debt Equity Total Debt Equity Total Certificates of deposit and other time deposits $ 22,109 $ — $ 22,109 $ 82,879 $ — $ 82,879 Investments in mutual funds and common stock — 37,391 37,391 — 39,143 39,143 $ 22,109 $ 37,391 $ 59,500 $ 82,879 $ 39,143 $ 122,022 Short-term investments $ 7,110 $ 4,500 $ 11,610 $ 67,872 $ 9,821 $ 77,693 Long-term investments 14,999 32,891 47,890 15,007 29,322 44,329 $ 22,109 $ 37,391 $ 59,500 $ 82,879 $ 39,143 $ 122,022

Other Receivables (Tables)

Other Receivables (Tables)	12 Months Ended
	Dec. 31, 2023
Receivables [Abstract]
Schedule of Other Receivables	Other receivables comprised the following: December 31, 2023 2022 Customer contract assets: Medicare bad debt claims $ 107,444 $ 110,751 IKC VBC arrangements 127,442 13,932 Supplier rebates and non-trade receivables $ 187,783 $ 289,293 $ 422,669 $ 413,976

Property and Equipment (Tables)

Property and Equipment (Tables)	12 Months Ended
	Dec. 31, 2023
Property, Plant and Equipment [Abstract]
Property and Equipment	Property and equipment comprised the following: December 31, 2023 2022 Land $ 35,216 $ 32,656 Buildings 436,460 427,962 Leasehold improvements 4,058,987 3,925,244 Equipment and information systems, including internally developed software 4,125,235 3,759,274 New center and capital asset projects in progress 177,149 376,633 8,833,047 8,521,769 Less accumulated depreciation (5,759,514) (5,265,372) $ 3,073,533 $ 3,256,397

Intangibles (Tables)

Intangibles (Tables)	12 Months Ended
	Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Intangible Assets other than Goodwill	Intangible assets other than goodwill comprised the following: December 31, 2023 2022 Indefinite-lived licenses $ 153,983 $ 127,271 Noncompetition agreements 31,090 51,408 Customer relationships and other 56,596 53,779 241,669 232,458 Accumulated amortization: Noncompetition agreements (23,680) (39,745) Customer relationships and other (14,765) (10,027) $ 203,224 $ 182,687
Scheduled Amortization Charges from Intangible Assets and Liabilities	Scheduled amortization expenses from amortizable intangible assets as of December 31, 2023 were as follows: Noncompetition Customer relationships and other 2024 $ 3,049 $ 3,978 2025 1,921 3,712 2026 1,182 3,642 2027 730 3,525 2028 528 3,472 Thereafter — 23,502 Total $ 7,410 $ 41,831

Equity Method and Other Inves_2

Equity Method and Other Investmetns Equity Method and Other Investments (Tables)	12 Months Ended
	Dec. 31, 2023
Equity Method Investments and Joint Ventures [Abstract]
Equity Method Investments	The Company maintains equity method and other minor investments in the private securities of certain other healthcare and healthcare-related businesses as follows: December 31, 2023 2022 Mozarc Medical Holding LLC $ 324,711 $ — APAC joint venture 98,865 99,141 Other equity method partnerships 107,282 116,403 Adjusted cost method and other investments 14,990 15,564 $ 545,848 $ 231,108

Goodwill (Tables)

Goodwill (Tables)	12 Months Ended
	Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Changes in Carrying Value of Goodwill by Reportable Segments	Changes in the carrying value of goodwill by reportable segment were as follows: U.S. dialysis Other - Ancillary 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 — 25,723 25,723 Impairment charges — (26,083) (26,083) Foreign currency and other adjustments — 36,310 36,310 Balance at December 31, 2023 $ 6,416,825 $ 695,735 $ 7,112,560 Balance at December 31, 2023: Goodwill $ 6,416,825 $ 844,836 $ 7,261,661 Accumulated impairment charges — (149,101) (149,101) $ 6,416,825 $ 695,735 $ 7,112,560

Other Liabilities (Tables)

Other Liabilities (Tables)	12 Months Ended
	Dec. 31, 2023
Other Liabilities Disclosure [Abstract]
Schedule of Other Liabilities	Other liabilities comprised the following: December 31, 2023 2022 Payor refunds and retractions $ 448,589 $ 475,195 Insurance and self-insurance accruals 74,337 68,440 Accrued interest 35,914 34,162 Accrued non-income tax liabilities 47,391 42,806 Other 222,647 181,866 $ 828,878 $ 802,469

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2023
Income Tax Disclosure [Abstract]
Schedule of Income Before Income Taxes	Income before income taxes from continuing operations consisted of the following: Year ended December 31, 2023 2022 2021 Domestic $ 1,100,420 $ 926,604 $ 1,463,029 International 76,674 39,674 55,465 $ 1,177,094 $ 966,278 $ 1,518,494
Components of Income Tax Expense (Benefit)	Income tax expense for continuing operations consisted of the following: Year ended December 31, 2023 2022 2021 Current: Federal $ 200,070 $ 201,932 $ 216,539 State 38,370 55,593 15,601 International 21,008 16,253 14,247 Total current income tax 259,448 273,778 246,387 Deferred: Federal (40,234) (66,400) 59,528 State 367 (12,289) 5,342 International 535 2,998 (4,525) Total deferred income tax (39,332) (75,691) 60,345 $ 220,116 $ 198,087 $ 306,732
Reconciliation between U.S. Federal Income Tax Rate and Effective Tax Rate	The reconciliation between the Company’s effective tax rate from continuing operations and the U.S. federal income tax rate is as follows: Year ended December 31, 2023 2022 2021 Federal income tax rate 21.0 % 21.0 % 21.0 % State income taxes, net of federal benefit 2.6 3.8 3.0 Equity compensation (1.1) (1.6) (2.4) Federal and international tax rate adjustments — — 1.3 Nondeductible executive compensation 1.2 1.1 0.8 Political advocacy costs 0.2 2.2 0.2 Unrecognized tax benefits (1.1) (1.1) (0.1) Change in international valuation allowance 0.8 1.2 (1.0) Credits (1.2) (1.2) (0.7) Other 1.9 1.1 1.7 Impact of noncontrolling interests primarily (5.6) (6.0) (3.6) Effective tax rate 18.7 % 20.5 % 20.2 %
Deferred Tax Assets and Liabilities Arising from Temporary Differences	Deferred tax assets and liabilities arising from temporary differences for continuing operations were as follows: December 31, 2023 2022 Receivables $ 23,075 $ 18,304 Accrued liabilities 81,281 71,346 Operating lease liabilities 533,859 563,972 Net operating loss carryforwards 183,216 173,531 Other 52,142 58,827 Deferred tax assets 873,573 885,980 Valuation allowance (113,237) (106,775) Net deferred tax assets 760,336 779,205 Intangible assets (731,024) (690,914) Property and equipment (127,191) (181,704) Operating lease assets (486,864) (515,026) Investments in partnerships (19,119) (80,876) Other (87,918) (65,766) Deferred tax liabilities (1,452,116) (1,534,286) Net deferred tax liabilities $ (691,780) $ (755,081) Reported as: Deferred tax liabilities $ (726,217) $ (782,787) Deferred tax assets (included in Other long-term assets) 34,437 27,706 $ (691,780) $ (755,081)
Reconciliation of the Beginning and Ending Liability for Unrecognized Tax Benefits that Do Not Meet the More-Likely-Than-Not Threshold	A reconciliation of the beginning and ending liability for unrecognized tax benefits that do not meet the more-likely-than-not threshold is as follows: Year ended December 31, 2023 2022 Beginning balance $ 63,985 $ 73,024 Additions for tax positions related to current year 4,088 3,858 Adjustments for tax positions related to prior years (7,273) 24,683 Reductions related to lapse of applicable statute (5,428) (6,073) Reductions related to settlements with taxing authorities (7,993) (31,507) Ending balance $ 47,379 $ 63,985

Long-Term Debt (Tables)

Long-Term Debt (Tables)	12 Months Ended
	Dec. 31, 2023
Debt Disclosure [Abstract]
Long-term Debt	Long-term debt Long-term debt comprised the following: December 31, As of December 31, 2023 2023 2022 Maturity date Interest rate Estimated fair value (1) Senior Secured Credit Facilities: Term Loan A-1 $ 1,234,375 $ (2) SOFR+CSA+1.75% $ 1,209,688 Term Loan B-1 2,603,786 2,660,831 8/12/2026 SOFR+CSA+1.75% $ 2,600,531 New Revolving line of credit — (2) SOFR+CSA+1.75% $ — 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 % $ 2,416,563 3.75% Senior Notes 1,500,000 1,500,000 2/15/2031 3.75 % $ 1,235,625 Acquisition obligations and other notes payable (4) 102,328 120,562 2024-2036 6.69 % $ 102,328 Financing lease obligations (5) 255,491 273,688 2024-2038 4.58 % Total debt principal outstanding 8,445,980 8,968,519 Discount, premium and deferred financing costs (6) (54,347) (44,498) 8,391,633 8,924,021 Less current portion (123,299) (231,404) $ 8,268,334 $ 8,692,617 (1) For the Company's senior secured credit facilities, fair value estimates are based upon bid and ask quotes, a level 2 input. For our senior notes, fair value estimates are based on market level 1 inputs. For acquisition obligations and other notes payable, the carrying values presented here approximate their estimated fair values, based on estimates of their present values typically 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 December 31, 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 December 31, 2023, the carrying amount of the Company's senior secured credit facilities have been reduced by a discount of $2,487 and deferred financing costs of $32,498 and the carrying amount of the Company's senior notes have been reduced by deferred financing costs of $31,491 and increased by a debt premium of $12,129. As of December 31, 2022, the carrying amount of the Company's senior secured credit facilities was reduced by a discount of $3,497 and deferred financing costs of $18,816, and the carrying amounts 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 December 31, 2023 were as follows: 2024 $ 123,299 2025 $ 132,878 2026 $ 2,663,669 2027 $ 116,712 2028 $ 1,017,856 Thereafter $ 4,391,566
Derivative Instruments	The following table summarizes the Company’s interest rate cap agreements outstanding as of December 31, 2023: Notional reduction or contractual maturity date Year cap agreements executed Notional amount SOFR maximum rate Approximate effective date 2024 (1) 2025 2026 2019 $ 3,500,000 2.00% 6/30/2020 $ 3,500,000 2023 $ 1,000,000 3.75% 6/30/2024 $ 500,000 $ 500,000 2023 $ 1,000,000 4.00% (2) 6/30/2024 $ 250,000 $ 750,000 2023 $ 1,000,000 4.75% (3) 6/30/2024 $ 250,000 $ 750,000 2023 $ 500,000 5.00% (4) 6/30/2024 $ 500,000 2023 $ 250,000 4.50% 12/31/2024 $ 250,000 2023 $ 750,000 4.00% 12/31/2024 $ 250,000 $ 500,000 (1) The Company's 2019 cap agreements mature on June 30, 2024. (2) Effective January 1, 2025, the maximum rate of 4.00% decreases to 3.75% for these interest rate caps. (3) Effective January 1, 2025, the maximum rate of 4.75% decreases to 4.00% for these interest rate caps. (4) Effective January 1, 2025, the maximum rate of 5.00% decreases to 4.50% for these interest rate caps.
Effects of Interest Rate Swap and Cap Agreements	The following table summarizes the effects of the Company’s interest rate cap agreements for the years ended December 31, 2023, 2022 and 2021: Amount of unrealized gains (losses) in OCI on interest rate cap agreements Location in Consolidated Statements of Income Reclassification from accumulated other comprehensive income into net income Year ended December 31, Year ended December 31, Derivatives designated as cash flow hedges 2023 2022 2021 2023 2022 2021 Interest rate cap agreements $ 9,186 $ 144,793 $ 9,532 Debt expense $ (103,567) $ (11,732) $ 5,509 Related income tax (2,291) (36,124) (2,377) Related income tax 25,840 2,926 (1,376) Total $ 6,895 $ 108,669 $ 7,155 $ (77,727) $ (8,806) $ 4,133

Leases (Tables)

Leases (Tables)	12 Months Ended
	Dec. 31, 2023
Leases [Abstract]
Lease Expense Components	The components of lease expense were as follows: Year ended December 31, Lease cost 2023 2022 2021 Operating lease cost (1) : Fixed lease expense $ 556,844 $ 552,194 $ 547,923 Variable lease expense 135,990 127,621 125,981 Financing lease cost: Amortization of leased assets 26,964 27,079 26,846 Interest on lease liabilities 11,724 12,776 13,988 Net lease cost $ 731,522 $ 719,670 $ 714,738
Lease Other Information	Other information related to leases was as follows: Year ended December 31, Lease term and discount rate 2023 2022 2021 Weighted average remaining lease term (years): Operating leases 7.6 8.2 8.3 Finance leases 8.5 9.4 10.5 Weighted average discount rate: Operating leases 4.0 % 3.6 % 3.5 % Finance leases 4.6 % 4.5 % 4.5 % Year ended December 31, Other information 2023 2022 2021 Gains on sale leasebacks, net $ 3,387 $ 28,005 $ 17,137 Cash paid for amounts included in the Operating cash flows for operating leases $ 708,162 $ 696,291 $ 684,186 Operating cash flows for finance leases $ 19,246 $ 20,103 $ 21,343 Financing cash flows for finance leases $ 26,455 $ 24,329 $ 22,445 Net operating lease assets obtained in exchange $ 269,564 $ 278,108 $ 361,101
Schedule Of Minimum Lease Payments	Future minimum lease payments under non-cancellable leases as of December 31, 2023 are as follows: Operating leases Finance leases 2024 $ 495,809 $ 37,173 2025 507,616 40,859 2026 455,477 39,639 2027 388,869 38,410 2028 324,153 34,976 Thereafter 989,253 112,904 Total future minimum lease payments 3,161,177 303,961 Less portion representing interest (436,389) (48,470) Present value of lease liabilities $ 2,724,788 $ 255,491

Stock-based compensation and Sh

Stock-based compensation and Shareholders’ Equity (Tables)	12 Months Ended
	Dec. 31, 2023
Share-Based Payment Arrangement [Abstract]
Summary of Status of Awards Under Stock-Based Compensation Plans and Agreements	A summary of the status of the Company’s stock-settled awards, including base shares for stock-settled stock appreciation rights (SSARs) and stock-settled stock unit awards is as follows: Year ended December 31, 2023 Stock appreciation rights Stock units Awards Weighted Weighted Awards Weighted Outstanding at beginning of year 5,390 $ 66.00 3,072 Granted — 1,383 Added by performance factor 66 Exercised/Vested (1,872) $ 63.75 (1,067) Canceled (47) $ 52.41 (231) Outstanding at end of period 3,471 $ 67.40 0.91 3,223 2.21 Exercisable at end of period 3,076 $ 63.42 0.75 — — Weighted-average fair value of grants: 2023 $ 77.61 2022 $ 35.13 $ 107.60 2021 $ 32.15 $ 109.50
Summary of Range of Exercise Prices	Awards Outstanding Weighted average exercise price Awards exercisable Weighted average exercise price Range of SSARs base prices $50.01–$60.00 945 $ 52.41 945 $ 52.41 $60.01–$70.00 2,000 $ 67.80 2,000 $ 67.80 $70.01–$80.00 264 $ 75.95 131 $ 75.95 $100.01–$110.00 132 $ 108.93 $110.01–$120.00 130 $ 110.63 Total 3,471 $ 67.40 3,076 $ 63.42
Summary of Weighted Average Valuation Inputs	A summary of the weighted average valuation inputs described above used for estimating the grant-date fair value of SSAR awards granted in the periods indicated is as follows: 2022 2021 Expected term 4.5 4.5 Expected volatility 34.3 % 34.3 % Expected dividend yield — % — % Risk-free interest rate 2.1 % 0.7 %

Stockholder's equity (Tables)

Stockholder's equity (Tables)	12 Months Ended
	Dec. 31, 2023
Equity [Abstract]
Shares repurchases summary table	The following table summarizes the Company's repurchases of its common stock during the years ended December 31, 2023, 2022 and 2021: 2023 2022 2021 Open market repurchases Shares 2,904 8,095 13,877 Amounts paid (1) $ 285,710 $ 787,854 $ 1,546,016 Average price paid per share (2) $ 97.82 $ 97.30 $ 111.38 (1) Includes commissions and the 1% excise tax imposed on certain stock repurchases made after December 31, 2022 by the Inflation Reduction Act of 2022. The excise tax is recorded as part of the cost basis of treasury stock repurchased and, as such, is included in stockholders’ equity. (2) Excludes commissions and the excise tax described above.
Net effect of transfers from to noncontrolling interests on stock holders equity disclosure	The effects of changes in DaVita Inc.’s ownership interests in consolidated subsidiaries on the Company’s consolidated equity were as follows: Year ended December 31, 2023 2022 2021 Net income attributable to DaVita Inc. $ 691,535 $ 560,400 $ 978,450 Changes in paid-in capital for: Purchases of noncontrolling interests (5,375) (6,586) (13,853) Sales of noncontrolling interest 13,077 939 (264) Net transfers in noncontrolling interests 7,702 (5,647) (14,117) Net income attributable to DaVita Inc. net of transfers in $ 699,237 $ 554,753 $ 964,333

Accumulated Other Comprehensi_2

Accumulated Other Comprehensive (Loss) Income (Tables)	12 Months Ended
	Dec. 31, 2023
Statement of Comprehensive Income [Abstract]
Changes in Other Comprehensive (Loss) Income	Charges and credits to other comprehensive (loss) income have been as follows: Interest rate Foreign currency Accumulated other Balance at December 31, 2020 $ (12,466) $ (53,688) $ (66,154) Unrealized gains (losses) 9,532 (83,375) (73,843) Related income tax (2,377) (1,006) (3,383) 7,155 (84,381) (77,226) Reclassification of loss into net income 5,509 — 5,509 Related income tax (1,376) — (1,376) 4,133 — 4,133 Balance at December 31, 2021 $ (1,178) $ (138,069) $ (139,247) Unrealized gains (losses) 144,793 (30,554) 114,239 Related income tax (36,124) 752 (35,372) 108,669 (29,802) 78,867 Reclassification of income into net income (11,732) — (11,732) Related income tax 2,926 — 2,926 (8,806) — (8,806) Balance at December 31, 2022 $ 98,685 $ (167,871) $ (69,186) Unrealized gains 9,186 89,055 98,241 Related income tax (2,291) (1,121) (3,412) 6,895 87,934 94,829 Reclassification of income into net income (103,567) — (103,567) Related income tax 25,840 — 25,840 (77,727) — (77,727) Balance at December 31, 2023 $ 27,853 $ (79,937) $ (52,084)

Acquisitions and Divestitures (

Acquisitions and Divestitures (Tables)	12 Months Ended
	Dec. 31, 2023
Business Combinations [Abstract]
Schedule of Components of Routine Acquisitions	During 2023, 2022 and 2021, the Company acquired dialysis businesses and other businesses, as follows: Year ended Year ended December 31, 2023 2022 2021 Cash paid, net of cash acquired $ 26,394 $ 57,308 $ 187,050 Contingent earn-out obligations 11,065 4,261 14,854 Deferred purchase price and liabilities assumed 8,736 15,076 10,226 Aggregate consideration $ 46,195 $ 76,645 $ 212,130 Number of dialysis centers acquired — U.S. — 5 19 Number of dialysis centers acquired — International 12 11 17
Aggregate Purchase Cost Allocations for Acquisitions	The following table summarizes the assets acquired and liabilities assumed in these transactions and recognized at their acquisition dates at estimated fair values, as well as the estimated fair value of noncontrolling interests assumed in these transactions: Year ended December 31, 2023 2022 2021 Current assets $ 6,128 $ 6,389 $ 9,134 Property and equipment 4,130 7,481 9,277 Customer relationships — — 17,200 Noncompetition agreements and other long-term assets 785 1,066 9,964 Indefinite-lived licenses 15,789 19,610 11,432 Goodwill 25,723 49,047 173,244 Liabilities assumed (6,179) (6,081) (14,200) Noncontrolling interests assumed (181) (867) (3,921) $ 46,195 $ 76,645 $ 212,130
Schedule of other information related to acquired intangibles and goodwill	The following summarizes weighted-average estimated useful lives of amortizable intangible assets acquired during 2023, 2022 and 2021, as well as goodwill deductible for tax purposes associated with these acquisitions: Year ended December 31, 2023 2022 2021 Weighted-average estimated useful lives (in years): Customer relationships — — 10 Noncompetition agreements 3 4 6 Goodwill deductible for tax purposes $ 17,836 $ 49,047 $ 169,014
Pro Forma Summary of Results of Operations	The following summary, prepared on a pro forma basis, combines the results of operations as if all acquisitions within continuing operations in 2023 and 2022 had been consummated as of the beginning of 2022, including the impact of certain adjustments such as amortization of intangibles, interest expense on acquisition financing and income tax effects. Year ended December 31, 2023 2022 (unaudited) Pro forma total revenues $ 12,160,466 $ 11,651,311 Pro forma net income from continuing operations attributable to $ 694,854 $ 550,245 Pro forma basic net income per share from continuing operations $ 7.65 $ 5.92 Pro forma diluted net income per share from continuing operations $ 7.46 $ 5.74
Reconciliation of Changes in Contingent Earn-Out Obligations	The following is a reconciliation of changes in contingent earn-out liabilities for the years ended December 31, 2023 and 2022: Year ended December 31, 2023 2022 Beginning balance $ 25,422 $ 33,600 Acquisitions 11,065 4,261 Foreign currency translation 1,611 840 Fair value remeasurements (11,170) (5,921) Payments or other settlements (3,840) (7,358) Ending balance $ 23,088 $ 25,422

Fair Values of Financial Inst_2

Fair Values of Financial Instruments (Tables)	12 Months Ended
	Dec. 31, 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 equity measured at fair value on a recurring basis as of December 31, 2023 and 2022: December 31, 2023 Total Quoted prices in Significant other Significant Assets Investments in equity securities $ 37,391 $ 37,391 Interest rate cap agreements $ 79,805 $ 79,805 Liabilities Contingent earn-out obligations for acquisitions $ 23,088 $ 23,088 Temporary equity Noncontrolling interests subject to put provisions $ 1,499,288 $ 1,499,288 December 31, 2022 Assets Investments in equity securities $ 39,143 $ 39,143 Interest rate cap agreements $ 139,755 $ 139,755 Liabilities Contingent earn-out obligations for acquisitions $ 25,422 $ 25,422 Temporary equity Noncontrolling interests subject to put provisions $ 1,348,908 $ 1,348,908

Segment Reporting (Tables)

Segment Reporting (Tables)	12 Months Ended
	Dec. 31, 2023
Segment Reporting [Abstract]
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income from Continuing Operations 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 from continuing operations before income taxes: Year ended December 31, 2023 2022 2021 Segment revenues: U.S. dialysis Patient service revenues: External sources $ 10,823,525 $ 10,488,327 $ 10,551,106 Intersegment revenues 88,222 87,045 90,512 U.S. dialysis patient service revenues 10,911,747 10,575,372 10,641,618 Other revenues External sources 25,251 24,447 25,061 Intersegment revenues — (10) 284 Total U.S. dialysis revenues 10,936,998 10,599,809 10,666,963 Other - Ancillary services Patient service revenues 751,416 688,137 662,409 Other external sources 539,955 408,983 380,221 Intersegment revenues 7,852 4,206 4,294 Total ancillary services 1,299,223 1,101,326 1,046,924 Total net segment revenues 12,236,221 11,701,135 11,713,887 Elimination of intersegment revenues (96,074) (91,241) (95,090) Consolidated revenues $ 12,140,147 $ 11,609,894 $ 11,618,797 Segment operating margin (loss): U.S. dialysis $ 1,774,578 $ 1,565,310 $ 1,974,988 Other - Ancillary services (1) (8,747) (96,579) (66,003) Total segment margin 1,765,831 1,468,731 1,908,985 Reconciliation of segment operating margin to consolidated income from Corporate administrative support (163,047) (129,669) (111,615) Consolidated operating income 1,602,784 1,339,062 1,797,370 Debt expense (398,551) (357,019) (285,254) Debt extinguishment and modification costs (7,962) — — Other (loss) income, net (19,177) (15,765) 6,378 Income from continuing operations before income taxes $ 1,177,094 $ 966,278 $ 1,518,494 (1) Segment operating loss for Other - Ancillary services includes equity investment loss of $2,103, $1,898 and $3,177 in 2023, 2022 and 2021, respectively.
Summary of Depreciation and Amortization Expense by Segment	Depreciation and amortization expense by reportable segment was as follows: Year ended December 31, 2023 2022 2021 U.S. dialysis $ 695,674 $ 690,949 $ 642,711 Other - Ancillary services 49,769 41,653 37,904 $ 745,443 $ 732,602 $ 680,615
Summary of Expenditures for Property and Equipment by Segment	Expenditures for property and equipment by reportable segment were as follows: Year ended December 31, 2023 2022 2021 U.S. dialysis $ 501,149 $ 533,600 $ 589,662 Other - Ancillary services 66,836 69,829 51,803 $ 567,985 $ 603,429 $ 641,465

Supplemental Cash Flow Inform_2

Supplemental Cash Flow Information (Tables)	12 Months Ended
	Dec. 31, 2023
Supplemental Cash Flow Elements [Abstract]
Supplemental Cash Flow Information	The table below provides supplemental cash flow information: Year ended December 31, 2023 2022 2021 Cash paid: Income taxes, net $ 268,091 $ 344,430 $ 209,754 Interest, net $ 387,661 $ 350,999 $ 279,002 Non-cash investing and financing activities: Fixed assets under financing lease obligations $ 13,269 $ 1,928 $ 31,690

Organization and Summary of S_3

Organization and Summary of Significant Accounting Policies - Additional Information (Details)	12 Months Ended
	Dec. 31, 2023 patient country clinic state entity
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items]
Medicare Payment Rate Established By Statute Or Regulation For The Portion Of Payment Rates Paid By The Government Payor	80%
Number of legal entities that third parties held noncontrolling equity interests | entity	696
United States
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items]
Number of dialysis centers that the company operated or provided administrative services | clinic	2,675
Number of states where dialysis centers are located | state	46
Number of patients served | patient	200,800
International Operations
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items]
Number of dialysis centers that the company operated or provided administrative services | clinic	367
Number of patients served | patient	49,400
Number of countries in which dialysis centers located | country	11

Revenue Recognition and Accou_2

Revenue Recognition and Accounts Receivable Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Revenue Recognition
Other revenues	$ 565,206	$ 433,430	$ 405,282
Total revenues	12,140,147	11,609,894	11,618,797
Intersegment Elimination
Revenue Recognition
Total revenues	(96,074)	(91,241)	(95,090)
Medicare and Medicare Advantage
Revenue Recognition
Patient service revenues	6,100,183	6,041,496	6,133,235
Other revenues	460,991	345,340	326,696
Medicaid and Managed Medicaid
Revenue Recognition
Patient service revenues	833,744	759,579	782,430
Other revenues	1,733	1,546	1,321
Other Government Payors
Revenue Recognition
Patient service revenues	854,441	801,912	791,641
Commercial Payors
Revenue Recognition
Patient service revenues	3,874,795	3,660,522	3,596,721
Other revenues	32,329	22,211	15,553
Other
Revenue Recognition
Other revenues	78,005	68,529	66,290
U.S. dialysis
Revenue Recognition
Total revenues	10,848,776	10,512,774	10,576,167
U.S. dialysis | Intersegment Elimination
Revenue Recognition
Total revenues	(88,222)	(87,035)	(90,796)
U.S. dialysis | Medicare and Medicare Advantage
Revenue Recognition
Patient service revenues	6,100,183	6,041,496	6,133,235
U.S. dialysis | Medicaid and Managed Medicaid
Revenue Recognition
Patient service revenues	833,744	759,579	782,430
U.S. dialysis | Other Government Payors
Revenue Recognition
Patient service revenues	354,304	336,991	328,256
U.S. dialysis | Commercial Payors
Revenue Recognition
Patient service revenues	3,623,516	3,437,306	3,397,697
U.S. dialysis | Other
Revenue Recognition
Other revenues	25,251	24,437	25,345
Other - Ancillary services
Revenue Recognition
Total revenues	1,291,371	1,097,120	1,042,630
Other - Ancillary services | Intersegment Elimination
Revenue Recognition
Total revenues	(7,852)	(4,206)	(4,294)
Other - Ancillary services | Medicare and Medicare Advantage
Revenue Recognition
Other revenues	460,991	345,340	326,696
Other - Ancillary services | Medicaid and Managed Medicaid
Revenue Recognition
Other revenues	1,733	1,546	1,321
Other - Ancillary services | Other Government Payors
Revenue Recognition
Patient service revenues	500,137	464,921	463,385
Other - Ancillary services | Commercial Payors
Revenue Recognition
Patient service revenues	251,279	223,216	199,024
Other revenues	32,329	22,211	15,553
Other - Ancillary services | Other
Revenue Recognition
Other revenues	$ 52,754	$ 44,092	$ 40,945

Revenue Recognition and Accou_3

Revenue Recognition and Accounts Receivable - Additional Information (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)
Revenue Recognition
Accounts receivable	$ 1,986,856	$ 2,132,070
Contract with Customer, Performance Obligation Satisfied in Previous Period	94,361	34,600	$ 11,312
Medicare bad debt claims
Revenue Recognition
Accounts receivable	817,045	$ 1,113,499
Accounts Receivable
Revenue Recognition
Accounts receivable	$ 0
Percentage Of Accounts Receivable Six Months Or More Past Due	19%	18%
Accounts Receivable Period Outstanding		6 months
Accounts Receivable, Noncurrent, Threshold Period Past Due	1 year
Customer Concentration Risk | Accounts Receivable | Third-Party Payor
Revenue Recognition
Number of concentration risk customers	0	0
Concentration risk percentage	10%	10%

Earnings Per Share - Reconcilia

Earnings Per Share - Reconciliations of Numerators and Denominators Used to Calculate Basic and Diluted Net Income Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Net income attributable to DaVita Inc.:
Net income from continuing operations	$ 691,535	$ 546,948	$ 978,450
Net income from discontinued operations	0	13,452	0
Net income attributable to DaVita Inc.	$ 691,535	$ 560,400	$ 978,450
Weighted average shares outstanding:
Weighted average shares outstanding during the period (in shares)	90,790,000	92,992,000	105,230,000
Assumed incremental shares from stock plans (in shares)	2,392,000	2,842,000	4,718,000
Weighted average shares - diluted (in shares)	93,182,000	95,834,000	109,948,000
Basic net income attributable to DaVita Inc.:
Basic net income from continuing operations	$ 7.62	$ 5.88	$ 9.30
Basic net loss from discontinued operations per share attributable to DaVita Inc.	0	0.15	0
Basic net income per share attributable to DaVita Inc.	7.62	6.03	9.30
Diluted net income attributable to DaVita Inc.:
Diluted net income from continuing operations per share attributable to DaVita Inc.	7.42	5.71	8.90
Diluted net loss from discontinued operations per share attributable to DaVita Inc.	0	0.14	0
Diluted net income per share attributable to DaVita Inc.	$ 7.42	$ 5.85	$ 8.90
Anti-dilutive stock-settled awards excluded from calculation (in shares)	531,000	1,058,000	116,000

Short-term and long-term inve_2

Short-term and long-term investments (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Investment Holdings [Line Items]
Debt securities	$ 22,109	$ 82,879
Equity securities, FV-NI	37,391	39,143
Total	59,500	122,022
Debt securities, short-term investments	7,110	67,872
Total Short-term investments	11,610	77,693
Debt securities, long-term investments	14,999	15,007
Total Long-term investments	47,890	44,329
Certificates of deposit and other time deposits
Investment Holdings [Line Items]
Debt securities	22,109	82,879
Equity securities, FV-NI	0	0
Total	22,109	82,879
Investments in mutual funds and common stock
Investment Holdings [Line Items]
Debt securities	0	0
Equity securities, FV-NI	37,391	39,143
Total	37,391	39,143
Short-term Investments
Investment Holdings [Line Items]
Equity securities, FV-NI	4,500	9,821
Other long-term Investments
Investment Holdings [Line Items]
Equity securities, FV-NI	$ 32,891	$ 29,322

Other Receivables (Details)

Other Receivables (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Accounts, Notes, Loans and Financing Receivable [Line Items]
Other receivables	$ 422,669	$ 413,976
Supplier rebates and non-trade receivables
Accounts, Notes, Loans and Financing Receivable [Line Items]
Other receivables	187,783	289,293
Medicare bad debt claims
Accounts, Notes, Loans and Financing Receivable [Line Items]
Other receivables	107,444	110,751
IKC VBC arrangements
Accounts, Notes, Loans and Financing Receivable [Line Items]
Other receivables	$ 127,442	$ 13,932

Property and Equipment (Details

Property and Equipment (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Property, Plant and Equipment [Abstract]
Land	$ 35,216	$ 32,656
Buildings	436,460	427,962
Leasehold improvements	4,058,987	3,925,244
Equipment and information systems, including internally developed software	4,125,235	3,759,274
New center and capital asset projects in progress	177,149	376,633
Property, plant and equipment, gross, total	8,833,047	8,521,769
Less accumulated depreciation	(5,759,514)	(5,265,372)
Property and equipment, net	$ 3,073,533	$ 3,256,397

Property and Equipment - Additi

Property and Equipment - Additional Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Property, Plant and Equipment [Line Items]
Depreciation expense on property and equipment	$ 736,474	$ 721,133	$ 667,755
Capitalized interest	$ 9,178	$ 12,677	$ 15,275
Buildings | Minimum
Property, Plant and Equipment [Line Items]
Property, and equipment useful lives	25 years
Buildings | Maximum
Property, Plant and Equipment [Line Items]
Property, and equipment useful lives	40 years
Leasehold Improvements | Maximum
Property, Plant and Equipment [Line Items]
Property, and equipment useful lives	10 years
Equipment and Information Systems | Minimum
Property, Plant and Equipment [Line Items]
Property, and equipment useful lives	3 years
Equipment and Information Systems | Maximum
Property, Plant and Equipment [Line Items]
Property, and equipment useful lives	15 years

Intangibles - Amortizable Intan

Intangibles - Amortizable Intangible Assets Other Than Goodwill (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Indefinite-lived licenses	$ 153,983	$ 127,271
Finite-Lived Intangible Assets [Line Items]
Noncompetition agreements	31,090	51,408
Customer relationships and other	56,596	53,779
Intangible assets, gross (excluding goodwill)	241,669	232,458
Total intangible assets Net	203,224	182,687
Noncompetition agreements
Finite-Lived Intangible Assets [Line Items]
Accumulated Amortization	(23,680)	(39,745)
Customer relationships and other
Finite-Lived Intangible Assets [Line Items]
Accumulated Amortization	$ (14,765)	$ (10,027)

Intangibles - Scheduled Amortiz

Intangibles - Scheduled Amortization Charges from Intangible Assets and Liabilities (Details) $ in Thousands	Dec. 31, 2023 USD ($)
Noncompetition agreements
Expected Amortization Expense [Line Items]
2024	$ 3,049
2025	1,921
2026	1,182
2027	730
2028	528
Thereafter	0
Total	7,410
Customer relationships and other
Expected Amortization Expense [Line Items]
2024	3,978
2025	3,712
2026	3,642
2027	3,525
2028	3,472
Thereafter	23,502
Total	$ 41,831

Intangibles - Additional Inform

Intangibles - Additional Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Finite-Lived Intangible Assets [Line Items]
Amortization expense from amortizable intangible assets, other than lease agreements	$ 8,969	$ 11,469	$ 12,860
Impairment of Intangible Assets (Excluding Goodwill)	$ 0	$ 0	$ 0
Noncompetition agreements | Minimum
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Assets, Remaining Amortization Period	4 years
Noncompetition agreements | Maximum
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Assets, Remaining Amortization Period	10 years
Customer Relationships
Finite-Lived Intangible Assets [Line Items]
Acquired Finite-lived Intangible Asset, Weighted-Average Period before Renewal or Extension	2 years	2 years
Customer Relationships | Minimum
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Assets, Remaining Amortization Period	10 years
Customer Relationships | Maximum
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Assets, Remaining Amortization Period	20 years

Equity Method and Other Inves_3

Equity Method and Other Investmetns Equity Method and Other Investments (Details) - USD ($) $ in Thousands	Apr. 01, 2023	Dec. 31, 2023	Dec. 31, 2022
Schedule of Equity Method Investments [Line Items]
Equity method and other investments		$ 545,848	$ 231,108
Mozarc Medical Holding LLC
Schedule of Equity Method Investments [Line Items]
Transaction Agreement Date	May 25, 2022
Transaction Agreement Effective Closing Date	Apr. 01, 2023
Payments to Medtronic	$ 44,651
Maximum Additional Consideration to be paid between 2024 through 2028	300,000
Contributed Other Non-Cash Assets	14,539
Fair value of Contingent Consideration payable to Medtronic	86,200
Additional Cash Contributed	224,415
Equity Method Investment, Initial Aggregate Cost	$ 375,326
Mozarc Medical Holding LLC
Schedule of Equity Method Investments [Line Items]
Equity method and other investments		324,711	0
Voting Equity Interest by the Company	50%
Voting Equity Interest in Mozarc, Owned by Medtronic	50%
APAC joint venture
Schedule of Equity Method Investments [Line Items]
Equity method and other investments		$ 98,865	99,141
Voting Equity Interest by the Company		75%
Current economic interest in the APAC JV, Owned by Other Noncontrolling Investors		25%
Adjusted cost method and other investments
Schedule of Equity Method Investments [Line Items]
Equity method and other investments		$ 14,990	15,564
Other equity method partnerships
Schedule of Equity Method Investments [Line Items]
Equity method and other investments		$ 107,282	$ 116,403

Equity Method and Other Inves_4

Equity Method and Other Investments - Additional Information (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)
Equity Method Investment income from equity method investments
Equity investment income (loss) from equity method investments in nonconsolidated dialysis partnerships.	$ 27,864	$ 26,520	$ 26,937
Minimum | Company and Restricted Subsidiaries(1)
Equity Method Investment income from equity method investments
Ownership percentage by the Company	30%
Maximum | Company and Restricted Subsidiaries(1)
Equity Method Investment income from equity method investments
Ownership percentage by the Company	65%
Other Nonoperating Income (Expense)
Equity Method Investment income from equity method investments
Equity method investment, significant impairments and other valuation adjustments	$ 0	20,154	0
Equity investment income (loss) from other equity method investments	(59,508)	(4,703)	(1,292)
Equity Method Investments In Nonconsolidated Dialysis Partnerships
Equity Method Investment income from equity method investments
Equity investment income (loss) from equity method investments in nonconsolidated dialysis partnerships.	$ 27,864	$ 26,520	$ 26,937
Number of equity method investments	23

Goodwill - Changes in Carrying

Goodwill - Changes in Carrying Value of Goodwill by Reportable Segments (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Goodwill [Roll Forward]
Beginning balance	$ 7,076,610	$ 7,046,241
Acquisitions	25,723	49,047
Divestitures		(3,350)
Impairment charges	(26,083)	0	$ 0
Foreign currency and other adjustments	36,310	(15,328)
Ending balance	7,112,560	7,076,610	7,046,241
Goodwill	7,261,661
Accumulated impairment charges	(149,101)
Transplant Software Reporting Unit
Goodwill [Roll Forward]
Impairment charges	(26,083)
Ending balance	14,424
U.S. dialysis
Goodwill [Roll Forward]
Beginning balance	6,416,825	6,400,162
Acquisitions	0	16,750
Divestitures		(87)
Impairment charges	0
Foreign currency and other adjustments	0	0
Ending balance	6,416,825	6,416,825	6,400,162
Goodwill	6,416,825
Accumulated impairment charges	0
Other - Ancillary services
Goodwill [Roll Forward]
Beginning balance	659,785	646,079
Acquisitions	25,723	32,297
Divestitures		(3,263)
Impairment charges	(26,083)
Foreign currency and other adjustments	36,310	(15,328)
Ending balance	695,735	$ 659,785	$ 646,079
Goodwill	844,836
Accumulated impairment charges	$ (149,101)

Goodwill - Schedule of Reportin

Goodwill - Schedule of Reporting Units Goodwill Balances (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Goodwill [Line Items]
Goodwill	$ 7,112,560	$ 7,076,610	$ 7,046,241
Impairment charges	26,083	$ 0	$ 0
Transplant Software Reporting Unit
Goodwill [Line Items]
Goodwill	14,424
Goodwill, Impairment Loss, Net of Tax	19,575
Impairment charges	$ 26,083

Goodwill - Additional Informati

Goodwill - Additional Information (Details)	12 Months Ended
	Dec. 31, 2023 segment
Other reporting units
Goodwill [Line Items]
Number of operating segments that were considered at risk of significant goodwill impairment	0

Other Liabilities (Details)

Other Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Other Liabilities Disclosure [Abstract]
Payor refunds and retractions	$ 448,589	$ 475,195
Insurance and self-insurance accruals	74,337	68,440
Accrued interest	35,914	34,162
Accrued non-income tax liabilities	47,391	42,806
Other	222,647	181,866
Other liabilities	$ 828,878	$ 802,469

Income Taxes - Schedule of Inco

Income Taxes - Schedule of Income Before Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Domestic	$ 1,100,420	$ 926,604	$ 1,463,029
International	76,674	39,674	55,465
Income from continuing operations before income taxes	$ 1,177,094	$ 966,278	$ 1,518,494

Income Taxes - Components of In

Income Taxes - Components of Income Tax Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Current:
Federal	$ 200,070	$ 201,932	$ 216,539
State	38,370	55,593	15,601
International	21,008	16,253	14,247
Total current income tax	259,448	273,778	246,387
Deferred:
Federal	(40,234)	(66,400)	59,528
State	367	(12,289)	5,342
International	535	2,998	(4,525)
Total deferred income tax	(39,332)	(75,691)	60,345
Income Tax Expense (Benefit), Total	$ 220,116	$ 198,087	$ 306,732

Income Taxes - Reconciliation B

Income Taxes - Reconciliation Between U.S. Federal Income Tax Rate and Our Effective Tax Rate From Continuing Operations (Details)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Federal income tax rate	21%	21%	21%
State income taxes, net of federal benefit	2.60%	3.80%	3%
Equity compensation	(1.10%)	(1.60%)	(2.40%)
Federal and international tax rate adjustments	0%	0%	1.30%
Nondeductible executive compensation	1.20%	1.10%	0.80%
Political advocacy costs	0.20%	2.20%	0.20%
Unrecognized tax benefits	(1.10%)	(1.10%)	(0.10%)
Change in international valuation allowance	0.80%	1.20%	(1.00%)
Credits	(1.20%)	(1.20%)	(0.70%)
Other	1.90%	1.10%	1.70%
Impact of noncontrolling interests primarily attributable to non-tax paying entities	(5.60%)	(6.00%)	(3.60%)
Effective tax rate	18.70%	20.50%	20.20%

Income Taxes - Deferred Tax and

Income Taxes - Deferred Tax and Liabilities Arising from Temporary Differences (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Income Taxes [Line Items]
Receivables	$ 23,075	$ 18,304
Accrued liabilities	81,281	71,346
Operating lease liabilities	533,859	563,972
Net operating loss carryforwards	183,216	173,531
Other	52,142	58,827
Deferred tax assets	873,573	885,980
Valuation allowance	(113,237)	(106,775)
Net deferred tax assets	760,336	779,205
Intangible assets	(731,024)	(690,914)
Property and equipment	(127,191)	(181,704)
Operating lease assets	(486,864)	(515,026)
Investments in partnerships	(19,119)	(80,876)
Other	(87,918)	(65,766)
Deferred tax liabilities	(1,452,116)	(1,534,286)
Net deferred tax liabilities	(691,780)	(755,081)
Deferred tax liabilities
Income Taxes [Line Items]
Net deferred tax liabilities	(726,217)	(782,787)
Other long-term assets
Income Taxes [Line Items]
Net deferred tax assets	$ 34,437	$ 27,706

Income Taxes - Reconciliation o

Income Taxes - Reconciliation of Beginning and Ending Liability for Unrecognized Tax Benefits that Do Not Meet More-Likely-Than-Not Threshold (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Beginning balance	$ 63,985	$ 73,024
Additions for tax positions related to current year	4,088	3,858
Adjustments for tax positions related to prior years	(7,273)
Adjustments for tax positions related to prior years		24,683
Reductions related to lapse of applicable statute	(5,428)	(6,073)
Reductions related to settlements with taxing authorities	(7,993)	(31,507)
Ending balance	$ 47,379	$ 63,985

Income Taxes - Additional Infor

Income Taxes - Additional Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Taxes [Line Items]
Increase In Deferred Tax Assets Net			$ 46,692
Income tax expense	$ 220,116	$ 198,087	306,732
Liability for unrecognized tax benefits	47,379	63,985	73,024
Unrecognized tax benefits that would impact effective tax rate	31,299
Unrecognized tax expense (benefit), income tax penalties and interest expense	(138)	10,459
Accrued interest and penalties related to unrecognized tax benefits, net of federal tax benefits	6,525	$ 8,208
Additional paid-in capital
Income Taxes [Line Items]
Deferred taxes from partnership buyouts			62,736
Indefinite Life Net Operating Losses
Income Taxes [Line Items]
Increase (decrease) in valuation allowance related to changes in the estimated tax benefit	6,462
Purchases Of Noncontrolling Interests In Consolidated Partnerships
Income Taxes [Line Items]
Income tax expense			$ 16,044
Capital Loss Carryforward
Income Taxes [Line Items]
State capital loss carryforward, amount	$ 299,803
State capital loss carryforward, expiration date	Dec. 31, 2024
Domestic Tax Authority
Income Taxes [Line Items]
Net operating loss carryforwards	$ 57,649
Operating loss carryforwards, expiration date	Dec. 31, 2036
Domestic Tax Authority | Tax Year 2029
Income Taxes [Line Items]
Operating loss carryforwards, expiration date	Dec. 31, 2029
State
Income Taxes [Line Items]
Net operating loss carryforwards	$ 501,405
Operating loss carryforwards, expiration date	Dec. 31, 2043
Foreign Tax Authority
Income Taxes [Line Items]
Net operating loss carryforwards	$ 391,510
Operating loss carryforwards, expiration date	Dec. 31, 2026

Long-Term Debt - Schedule of Lo

Long-Term Debt - Schedule of Long-Term Debt (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Apr. 28, 2023	Dec. 31, 2022	Dec. 31, 2021
Long-term debt disclosure
Debt interest rate during period	4.52%
Long-term debt, weighted average interest rate, at point in time	4.42%
Financing lease obligations	$ 255,491
Long-term debt totals:
Total debt principal outstanding	8,445,980		$ 8,968,519
Discount and deferred financing costs	(54,347)		(44,498)
Carrying amount of long-term debt, net of unamortized discounts	8,391,633		8,924,021
Less current portion	(123,299)		(231,404)
Total long-term debt	8,268,334		8,692,617
Senior Notes 4.625% due 2030
Senior Notes:
Senior Notes	$ 2,750,000		2,750,000
Long-term debt disclosure
Debt Instrument, Maturity Date	Jun. 01, 2030
Debt interest rate during period	4.625%
Debt Instrument, Fair Value Disclosure	$ 2,416,563
Senior Notes 3.75% due 2031
Senior Notes:
Senior Notes	$ 1,500,000		1,500,000
Long-term debt disclosure
Debt Instrument, Maturity Date	Feb. 15, 2031
Debt interest rate during period	3.75%
Debt Instrument, Fair Value Disclosure	$ 1,235,625
Acquisition obligations and other notes payable
Long-term debt disclosure
Acquisition obligations and other notes payable	102,328		120,562
Acquisition obligations and other notes payable, fair value	$ 102,328
Long-term debt, weighted average interest rate, at point in time	6.69%
Debt instrument, maturity date, description	2024-2036
Financing lease obligations
Long-term debt disclosure
Financing lease obligations	$ 255,491		$ 273,688
Finance lease, weighted average discount rate, percent	4.58%		4.50%	4.50%
Debt instrument, maturity date, description	2024-2038
New Revolving line of credit
Senior Secured Credit Facilities:
Secured Debt	$ 0
Long-term debt disclosure
Line of Credit Facility, Fair Value of Amount Outstanding	$ 0
New Revolving line of credit | SOFR
Senior Secured Credit Facilities:
Debt Instrument, Description of Variable Rate Basis	SOFR+CSA+1.75%
Prior Revolving Line Of Credit
Senior Secured Credit Facilities:
Secured Debt	$ 0		165,000
Long-term debt disclosure
Debt Instrument, Maturity Date	Aug. 12, 2024
Term Loan A-1
Senior Secured Credit Facilities:
Secured Debt	$ 1,234,375	$ 1,250,000
Long-term debt disclosure
Debt Instrument, Fair Value Disclosure	$ 1,209,688
Debt Instrument, footnotes to the table
Debt Instrument, Periodic Payment Terms, Date Balloon Payment to be Paid	Apr. 28, 2028
Term Loan A-1 | SOFR
Senior Secured Credit Facilities:
Debt Instrument, Description of Variable Rate Basis	SOFR+CSA+1.75%
Term Loan A-1 | New Revolving line of credit
Debt Instrument, footnotes to the table
Debt Instrument Becomes Due Before Maturity Date When Unpaid Amount Triggers Change In Due Date	May 13, 2026
Term Loan B-1
Senior Secured Credit Facilities:
Secured Debt	$ 2,603,786		2,660,831
Long-term debt disclosure
Debt Instrument, Maturity Date	Aug. 12, 2026
Debt Instrument, Fair Value Disclosure	$ 2,600,531
Term Loan B-1 | SOFR
Senior Secured Credit Facilities:
Debt Instrument, Description of Variable Rate Basis	SOFR+CSA+1.75%
Prior Term Loan A
Senior Secured Credit Facilities:
Secured Debt	$ 0		1,498,438
Long-term debt disclosure
Debt Instrument, Maturity Date	Aug. 12, 2024
Senior Secured Credit Facilities
Long-term debt disclosure
Long-term debt, weighted average interest rate, at point in time	4.39%
Debt Instrument, footnotes to the table
Debt Instrument, Unamortized Discount	$ 2,487		3,497
Deferred Offering Costs	32,498		18,816
Senior Notes
Debt Instrument, footnotes to the table
Deferred Offering Costs	31,491		36,203
Debt Instrument, Unamortized Premium	$ 12,129		$ 14,018

Long-Term Debt - Scheduled Matu

Long-Term Debt - Scheduled Maturities of Long-term Debt (Details) $ in Thousands	Dec. 31, 2023 USD ($)
Debt Disclosure [Abstract]
2024	$ 123,299
2025	132,878
2026	2,663,669
2027	116,712
2028	1,017,856
Thereafter	$ 4,391,566

Long-Term Debt - Derivative Ins

Long-Term Debt - Derivative Instruments (Details) - USD ($) $ in Thousands		12 Months Ended
	Jan. 01, 2025	Dec. 31, 2023
2019 Interest Rate Cap Agreements Effective June 30, 2020
Derivative [Line Items]
Derivative, effective date		Jun. 30, 2020
Derivative, contractual maturity date		Jun. 30, 2024
Notional Amount Amortizable By Maturity Date		$ 3,500,000
2019 Interest Rate Cap Agreements Effective June 30, 2020 | Term Loan Facility | Maximum
Derivative [Line Items]
Notional amounts of interest rate agreements		$ 3,500,000
Debt Instrument, Basis Spread on Variable Rate		2%
2023 Interest Rate Cap Agreements 4.00% Effective June 30 2024
Derivative [Line Items]
Derivative, effective date		Jun. 30, 2024
Derivative, contractual maturity date		Dec. 31, 2025
Notional Amount Amortizable By December 31, 2024		$ 250,000
Notional Amount Amortizable By Maturity Date		750,000
2023 Interest Rate Cap Agreements 4.00% Effective June 30 2024 | Term Loan Facility | Maximum
Derivative [Line Items]
Notional amounts of interest rate agreements		$ 1,000,000
Debt Instrument, Basis Spread on Variable Rate		4%
2023 Interest Rate Cap Agreements 4.00% Effective June 30 2024 | Term Loan Facility | Maximum | Subsequent Event
Derivative [Line Items]
Debt Instrument, Basis Spread on Variable Rate	3.75%
2023 Interest Rate Cap Agreements 4.75% Effective June 30 2024
Derivative [Line Items]
Derivative, effective date		Jun. 30, 2024
Derivative, contractual maturity date		Dec. 31, 2025
Notional Amount Amortizable By December 31, 2024		$ 250,000
Notional Amount Amortizable By Maturity Date		750,000
2023 Interest Rate Cap Agreements 4.75% Effective June 30 2024 | Term Loan Facility | Maximum
Derivative [Line Items]
Notional amounts of interest rate agreements		$ 1,000,000
Debt Instrument, Basis Spread on Variable Rate		4.75%
2023 Interest Rate Cap Agreements 4.75% Effective June 30 2024 | Term Loan Facility | Maximum | Subsequent Event
Derivative [Line Items]
Debt Instrument, Basis Spread on Variable Rate	4%
2023 Interest Rate Cap Agreements 5.00% Effective June 30 2024
Derivative [Line Items]
Derivative, effective date		Jun. 30, 2024
Derivative, contractual maturity date		Dec. 31, 2026
Notional Amount Amortizable By Maturity Date		$ 500,000
2023 Interest Rate Cap Agreements 5.00% Effective June 30 2024 | Term Loan Facility | Maximum
Derivative [Line Items]
Notional amounts of interest rate agreements		$ 500,000
Debt Instrument, Basis Spread on Variable Rate		5%
2023 Interest Rate Cap Agreements 5.00% Effective June 30 2024 | Term Loan Facility | Maximum | Subsequent Event
Derivative [Line Items]
Debt Instrument, Basis Spread on Variable Rate	4.50%
2023 Interest Rate Cap Agreements 4.50% Effective December 31 2024
Derivative [Line Items]
Derivative, effective date		Dec. 31, 2024
Derivative, contractual maturity date		Dec. 31, 2025
Notional Amount Amortizable By Maturity Date		$ 250,000
2023 Interest Rate Cap Agreements 4.50% Effective December 31 2024 | Term Loan Facility | Maximum
Derivative [Line Items]
Notional amounts of interest rate agreements		$ 250,000
Debt Instrument, Basis Spread on Variable Rate		4.50%
2023 Interest Rate Cap Agreements 4.00% Effective December 31 2024
Derivative [Line Items]
Derivative, effective date		Dec. 31, 2024
Derivative, contractual maturity date		Dec. 31, 2026
Notional Amount Amortizable By December 31, 2025		$ 250,000
Notional Amount Amortizable By Maturity Date		500,000
2023 Interest Rate Cap Agreements 4.00% Effective December 31 2024 | Term Loan Facility | Maximum
Derivative [Line Items]
Notional amounts of interest rate agreements		$ 750,000
Debt Instrument, Basis Spread on Variable Rate		4%
2023 Interest Rate Cap Agreements 3.75% Effective June 30 2024
Derivative [Line Items]
Derivative, effective date		Jun. 30, 2024
Derivative, contractual maturity date		Dec. 31, 2025
Notional Amount Amortizable By December 31, 2024		$ 500,000
Notional Amount Amortizable By Maturity Date		500,000
2023 Interest Rate Cap Agreements 3.75% Effective June 30 2024 | Term Loan Facility | Maximum
Derivative [Line Items]
Notional amounts of interest rate agreements		$ 1,000,000
Debt Instrument, Basis Spread on Variable Rate		3.75%

Long-Term Debt - Effects of Int

Long-Term Debt - Effects of Interest Rate Swap and Cap Agreements (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Derivative Instruments, Gain (Loss) [Line Items]
Amount of unrealized gains (losses) in OCI on interest rate cap agreements	$ 6,895	$ 108,669	$ 7,155
Cash Flow Hedging
Derivative Instruments, Gain (Loss) [Line Items]
Amount of unrealized gains (losses) in OCI on interest rate cap agreements	6,895	108,669	7,155
Reclassification from accumulated other comprehensive income into net income	(77,727)	(8,806)	4,133
Income Tax Related To Cash Flow Hedges | Cash Flow Hedging
Derivative Instruments, Gain (Loss) [Line Items]
Amount of unrealized gains (losses) in OCI on interest rate cap agreements	(2,291)	(36,124)	(2,377)
Reclassification from accumulated other comprehensive income into net income	$ 25,840	2,926	(1,376)
Derivative Instrument, Gain (Loss) Reclassified from AOCI into Income, Effective Portion, Statement of Income or Comprehensive Income [Extensible Enumeration]	Income tax expense
Interest Rate Cap | Cash Flow Hedging
Derivative Instruments, Gain (Loss) [Line Items]
Amount of unrealized gains (losses) in OCI on interest rate cap agreements	$ 9,186	144,793	9,532
Reclassification from accumulated other comprehensive income into net income	$ (103,567)	(11,732)	$ 5,509
Derivative Instrument, Gain (Loss) Reclassified from AOCI into Income, Effective Portion, Statement of Income or Comprehensive Income [Extensible Enumeration]	Interest and Debt Expense
Other long-term assets | Interest Rate Cap
Derivative [Line Items]
Derivative Asset, Fair Value, Gross Asset	$ 79,805	$ 139,755

Long-Term Debt - Additional inf

Long-Term Debt - Additional information (Detail) $ in Thousands				3 Months Ended		12 Months Ended
	Sep. 30, 2023	Apr. 28, 2023 USD ($)	Apr. 03, 2023	Jun. 30, 2023 USD ($)	Mar. 31, 2023	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)
Debt Instrument [Line Items]
Letters of Credit Outstanding, Amount						$ 0
Long-term Debt, Percentage Bearing Fixed Interest, Percentage Rate						54%
Interest Expense, Debt						$ 373,951	$ 339,247	$ 267,049
Amortization of Debt Discounts, Premiums and Deferred Financing Costs						$ 24,600	17,772	18,205
Long Term Debt Percentage Bearing Economically Fixed Interest Rate						96%
Debt Extinguishment And Modification Costs				$ 7,962		$ 7,962	0	$ 0
New Revolving line of credit
Debt Instrument [Line Items]
Secured debt, outstanding principal balance						0
Maximum borrowing capacity on revolving credit facilities		$ 1,500,000				1,500,000
Proceeds from Issuance of Secured Debt		400,000
Secured Letter of Credit
Debt Instrument [Line Items]
Letters of Credit Outstanding, Amount						151,403
Prior Revolving Line Of Credit
Debt Instrument [Line Items]
Secured debt, outstanding principal balance						0	165,000
Constructive Financing Cash Outflows And Financing Cash Inflows				150,000
Term Loan B-1
Debt Instrument [Line Items]
Debt Instrument, Periodic Payment, Principal						57,046
Secured debt, outstanding principal balance						$ 2,603,786	2,660,831
Debt Instrument, Issuance Date			Apr. 03, 2023
Term Loan B-1 | SOFR
Debt Instrument [Line Items]
Debt Instrument, Basis Spread on Variable Rate						1.75%
Term Loan B-1 | Adjusted Rate
Debt Instrument [Line Items]
Debt Instrument, Basis Spread on Variable Rate						0.11%
Term Loan B-1 | Minimum
Debt Instrument [Line Items]
Debt Instrument, Basis Spread on Variable Rate						0%
Term Loan A-1
Debt Instrument [Line Items]
Debt Instrument, Periodic Payment, Principal						$ 15,625
Secured debt, outstanding principal balance		$ 1,250,000				1,234,375
Secured Debt Outstanding Principal Balance Subject To SOFR						338,161
Debt Instrument Quarterly Payment Start Date	Sep. 30, 2023
Debt Instrument, Issuance Date		Apr. 28, 2023
Debt Instrument, Quarterly Payment, Year One						(7,813)
Debt Instrument, Quarterly Payment, Year Two, Three, Four						(15,625)
Debt Instrument, Quarterly Payment, Year Five						(23,438)
Debt Instrument, Periodic Payment Terms, Balloon Payment to be Paid						$ (960,934)
Term Loan A-1 | New Revolving line of credit | SOFR
Debt Instrument [Line Items]
Debt Instrument, Basis Spread on Variable Rate						2%
Term Loan A-1 | New Revolving line of credit | Adjusted Rate
Debt Instrument [Line Items]
Debt Instrument, Basis Spread on Variable Rate						0.10%
Term Loan A-1 | New Revolving line of credit | Minimum
Debt Instrument [Line Items]
Debt Instrument, Basis Spread on Variable Rate						0%
Term Loan A-1 | New Revolving line of credit | Minimum | SOFR
Debt Instrument [Line Items]
Debt Instrument, Basis Spread on Variable Rate						1.25%
Term Loan A-1 | New Revolving line of credit | Maximum | SOFR
Debt Instrument [Line Items]
Debt Instrument, Basis Spread on Variable Rate						2.25%
Prior Term Loan A
Debt Instrument [Line Items]
Debt Instrument, Periodic Payment, Principal						$ 54,010
Secured debt, outstanding principal balance						$ 0	$ 1,498,438
Other Significant Noncash Financing Activity				715,019
Constructive Financing Cash Outflows And Financing Cash Inflows				434,393
Prior Term Loan A | Prior Revolving Line Of Credit | LIBOR
Debt Instrument [Line Items]
LIBOR					1.75%
Prior Term Loan A and Prior Revolving Line Of Credit
Debt Instrument [Line Items]
Repayments of Debt				$ 1,602,199
New Credit Agreement - Amended | Maximum
Debt Instrument [Line Items]
Leverage Ratio Covenant						4
Leverage Ratio Covenant Through Jun 30, 2026						5
Leverage Ratio Covenant after Jun 30, 2026						4.50

Leases Lease Expense Components

Leases Lease Expense Components (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Operating lease cost:
Fixed lease expense	$ 556,844	$ 552,194	$ 547,923
Variable lease expense	135,990	127,621	125,981
Operating Lease, Cost	692,834	679,815	673,904
Financing lease cost:
Amortization of leased assets	26,964	27,079	26,846
Interest on lease liabilities	11,724	12,776	13,988
Net lease cost	$ 731,522	$ 719,670	$ 714,738

Leases Leases Other Information

Leases Leases Other Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Leases term and discount rate
Operating Lease, Weighted Average Remaining Lease Term	7 years 7 months 6 days	8 years 2 months 12 days	8 years 3 months 18 days
Finance Lease, Weighted Average Remaining Lease Term	8 years 6 months	9 years 4 months 24 days	10 years 6 months
Operating Lease, Weighted Average Discount Rate, Percent	4%	3.60%	3.50%
Leases Other Information [Abstract]
Sale and Leaseback Transaction, Gain (Loss), Net	$ 3,387	$ 28,005	$ 17,137
Cash paid for amounts included in the measurement of lease liabilities:
Operating Lease, Payments	708,162	696,291	684,186
Finance Lease, Interest Payment on Liability	19,246	20,103	21,343
Finance Lease, Principal Payments	26,455	24,329	22,445
Net Operating Lease Assets Obtained In Exchange For Lease Liabilities	$ 269,564	$ 278,108	$ 361,101
Finance Lease
Leases term and discount rate
Finance lease, weighted average discount rate, percent	4.58%	4.50%	4.50%

Leases - Future Minimum Lease P

Leases - Future Minimum Lease Payments Under Non-Cancelable Operating and Capital Leases (Details) $ in Thousands	Dec. 31, 2023 USD ($)
Operating leases
2024	$ 495,809
2025	507,616
2026	455,477
2027	388,869
2028	324,153
Thereafter	989,253
Total future minimum lease payments due under operating leases	3,161,177
Less portion representing interest, operating lease liabilities	(436,389)
Present value of lease liabilities, operating leases	$ 2,724,788
Operating Lease, Liability, Statement of Financial Position [Extensible Enumeration]	Current portion of operating lease liabilities, Long-term operating lease liabilities
Finance leases
2024	$ 37,173
2025	40,859
2026	39,639
2027	38,410
2028	34,976
Thereafter	112,904
Total future minimum payments due under finance leases	303,961
Less portion representing interest, financing lease liabilities	(48,470)
Financing lease obligations	$ 255,491
Finance Lease, Liability, Statement of Financial Position [Extensible Enumeration]	Long-term debt, Current portion of long-term debt

Leases - Additional Information

Leases - Additional Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Leases Disclosure [Line Items]
Finance Lease, Right-of-Use Asset	$ 322,844	$ 319,546
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible Enumeration]	Property and equipment, net of accumulated depreciation	Property and equipment, net of accumulated depreciation
Finance Lease Accumulated Depreciation	$ 122,286	$ 101,361
Rent Expense, Operating Leases	692,834	679,815	$ 673,904
Operating Lease
Leases Disclosure [Line Items]
Rent Expense, Operating Leases	$ 692,834	$ 679,815	$ 673,904
Minimum
Leases Disclosure [Line Items]
Lessee, Operating Lease, Term of Contract	5 years
Lessee, Operating Lease, Renewal Term	5 years
Sale Leaseback Transaction, Lease Term	10 years
Maximum
Leases Disclosure [Line Items]
Lessee, Operating Lease, Term of Contract	15 years
Lessee, Operating Lease, Renewal Term	10 years
Sale Leaseback Transaction, Lease Term	15 years

Employee Benefit Plans - Additi

Employee Benefit Plans - Additional Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Defined Benefit Plan Disclosure [Line Items]
Employer matching contribution, percent of match	50%
Defined Benefit Plan, Benefit Obligation, Benefits Paid	$ 73,725	$ 70,084	$ 68,658
Minimum
Defined Benefit Plan Disclosure [Line Items]
Voluntary Deferral Plan Contribution Cash Payout Period After Individuals Retirement Date	1 year
Voluntary Deferral Plan Contribution Cash Payout Period After Deferral Election	3 years
Maximum
Defined Benefit Plan Disclosure [Line Items]
Employer matching contribution, percent of employees' gross wages	6%
Voluntary Deferral Plan Contribution Cash Payout Period After Individuals Retirement Date	2 years
Voluntary Deferral Plan Contribution Cash Payout Period After Deferral Election	4 years
Deferred Compensation Plan
Defined Benefit Plan Disclosure [Line Items]
Maximum percentage of employees' base salary to be maintained into deferral account	50%
Non-qualified deferred compensation plan, contributions	$ 2,695	3,573	2,962
Deferred compensation plan, distributions	3,899	3,731	$ 11,887
Deferred Compensation Plan | Rabbi trusts
Defined Benefit Plan Disclosure [Line Items]
Total fair value of assets held in trust	$ 36,936	$ 32,944

Noncontrolling Interests Subj_2

Noncontrolling Interests Subject to Put Provisions and Other Commitments - Additional Information (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2023 USD ($)
Commitments And Contingencies Disclosure [Line Items]
Purchase Obligation, Due in Next Twelve Months	$ 663,498
Purchase Obligation, Due in Second Year	541,683
Purchase Obligation, Due in Third Year	551,187
Purchase Obligation, to be Paid, Year Four	175,707
Purchase Obligation, to be Paid, Year Five	178,559
Off -Balance Sheet Financing Arrangements	$ 0
Minimum
Commitments And Contingencies Disclosure [Line Items]
Scheduled dissolution term of joint ventures	10 years
Maximum
Commitments And Contingencies Disclosure [Line Items]
Scheduled dissolution term of joint ventures	50 years
Commitments to Provide Operating Capital
Commitments And Contingencies Disclosure [Line Items]
Other potential commitments to provide operating capital to nonconsolidated dialysis centers	$ 8,852

Long-term Incentive Compensatio

Long-term Incentive Compensation and Shareholders’ Equity - Summary of Status of Awards Under Stock-Based Compensation Plans and Agreements (Details) - $ / shares	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Stock Appreciation Rights (SARs)
Awards
Outstanding at beginning of year (in shares)	5,390,000
Granted (in shares)	0
Exercised/ Vested (in shares)	(1,872,000)
Canceled (in shares)	(47,000)
Outstanding at end of period (in shares)	3,471,000	5,390,000
Exercisable at end of period (in shares)	3,076,000
Weighted-average fair value of grants		$ 35.13	$ 32.15
Weighted average exercise price
Outstanding at beginning of year (USD per share)	66
Granted (USD per share)
Exercised (USD per share)	63.75
Canceled (USD per share)	52.41
Outstanding at end of period (USD per share)	67.40	$ 66
Exercisable at end of period (USD per share)	$ 63.42
Weighted average remaining contractual life
Outstanding at end of period	10 months 28 days
Exercisable at end of period	9 months
Stock units
Awards
Outstanding at beginning of year (in shares)	3,072,000
Granted (in shares)	1,383,000
Added by performance factor (in shares)	66,000
Exercised/ Vested (in shares)	(1,067,000)
Canceled (in shares)	(231,000)
Outstanding at end of period (in shares)	3,223,000	3,072,000
Exercisable at end of period (in shares)	0
Weighted-average fair value of grants (USD per share)	$ 77.61	$ 107.60	$ 109.50
Weighted average remaining contractual life
Outstanding at end of period	2 years 2 months 15 days
Exercisable at end of period	0 years

Long-term Incentive Compensat_2

Long-term Incentive Compensation and Shareholders’ Equity - Summary of Range of Exercise Prices (Details)	12 Months Ended
	Dec. 31, 2023 $ / shares shares
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Awards outstanding (in shares) | shares	3,471,000
Weighted average exercise price (USD per share)	$ 67.40
Awards exercisable (in shares) | shares	3,076,000
Weighted average exercise price (USD per share)	$ 63.42
$50.01–$60.00
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Awards outstanding (in shares) | shares	945,000
Weighted average exercise price (USD per share)	$ 52.41
Awards exercisable (in shares) | shares	945,000
Weighted average exercise price (USD per share)	$ 52.41
Range of exercise prices, lower range (USD per share)	50.01
Range of exercise prices, upper range (USD per share)	$ 60
$60.01–$70.00
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Awards outstanding (in shares) | shares	2,000,000
Weighted average exercise price (USD per share)	$ 67.80
Awards exercisable (in shares) | shares	2,000,000
Weighted average exercise price (USD per share)	$ 67.80
Range of exercise prices, lower range (USD per share)	60.01
Range of exercise prices, upper range (USD per share)	$ 70
$70.01–$80.00
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Awards outstanding (in shares) | shares	264,000
Weighted average exercise price (USD per share)	$ 75.95
Awards exercisable (in shares) | shares	131,000
Weighted average exercise price (USD per share)	$ 75.95
Range of exercise prices, lower range (USD per share)	70.01
Range of exercise prices, upper range (USD per share)	$ 80
$100.01–$110.00
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Awards outstanding (in shares) | shares	132,000
Weighted average exercise price (USD per share)	$ 108.93
Awards exercisable (in shares) | shares
Weighted average exercise price (USD per share)
Range of exercise prices, lower range (USD per share)	100.01
Range of exercise prices, upper range (USD per share)	$ 110
$110.01–$120.00
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Awards outstanding (in shares) | shares	130,000
Weighted average exercise price (USD per share)	$ 110.63
Awards exercisable (in shares) | shares
Weighted average exercise price (USD per share)
Range of exercise prices, lower range (USD per share)	110.01
Range of exercise prices, upper range (USD per share)	$ 120

Long-term Incentive Compensat_3

Long-term Incentive Compensation and Shareholders Equity - Summary of Weighted Average Valuation Inputs (Details) - Stock-settled Stock Appreciation Rights	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected term	4 years 6 months	4 years 6 months
Expected volatility	34.30%	34.30%
Expected dividend yield	0%	0%
Risk-free interest rate	2.10%	0.70%

Long-term Incentive Compensat_4

Long-term Incentive Compensation and Shareholders’ Equity - Additional Information (Details) - USD ($)				12 Months Ended
	Dec. 31, 2023	Jul. 01, 2023	Jan. 01, 2023	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Aggregate intrinsic value of stock awards exercised				$ 168,500,000	$ 149,442,000	$ 208,585,000
Aggregate intrinsic value of stock awards outstanding	$ 475,918,000			475,918,000
Aggregate intrinsic value of stock awards exercisable	128,229,000			128,229,000
Payments of ordinary dividends, common stock				0	0	0
Stock-based compensation expense				112,375,000	95,427,000	102,209,000
Estimated tax benefits recorded for stock-based compensation				16,536,000	14,723,000	13,853,000
Unrecognized compensation cost related to nonvested stock-based compensation arrangements under equity compensation and stock purchase plans	$ 134,720,000			$ 134,720,000
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 3 months 18 days
Share-based Payment Arrangement, Expense, Tax Benefit				$ 25,629,000	24,805,000	46,990,000
Cash proceeds from stock option exercises				$ 0	0	0
Employee stock purchase plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares available for future grants	5,471,000			5,471,000
Employee entitlement for purchase of the Company's common stock during each calendar year				$ 25,000
Stock purchase price as percentage of fair market value	85%	100%	100%
Contributions used to purchase shares, employee-related current liabilities	$ 18,213,000			$ 18,213,000	$ 18,061,000	$ 19,626,000
Stock issued for employee stock purchase plans				231,000	285,000	203,000
Expected volatility Rate				41.30%	31.70%	39%
Risk-free interest rate				4.90%	1.30%	0.10%
Share-based awards, fair value assumptions, expected dividend				$ 0	$ 0	$ 0
Weighted average fair value				$ 25.25	$ 26.50	$ 34.94
Stock Incentive 2020 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based Compensation Number Of Shares Available For Issuance Reduced By One Share Available For Every Four Shares Underlying SARS And Stock Options				1
Stock-based Compensation Number Of Shares Underlying SARS And Stock Options, For One Full Share Available For Issuance				4
Stock-based Compensation Number Of Shares Available For Issuance Reduced By One Share Available For Every One Share Underlying Other Full Share Type Of Award				1
Stock-based Compensation Number Of Shares Underlying Full Share Types Of Stock-based Awards, For One Full Share Available For Issuance				1
Shares available for future grants	5,570,000			5,570,000
Stock Incentive 2020 Plan | Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period				36 months
Stock Incentive 2020 Plan | Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Terms of award (in years)				10 years
Vesting period				48 months

Stock Repurchases Tender Offer

Stock Repurchases Tender Offer (Details) - Open Market Purchases - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Equity, Class of Treasury Stock [Line Items]
Repurchase of common stock (in shares)	2,904	8,095	13,877
Value of treasury stock acquired	$ 285,710	$ 787,854	$ 1,546,016
Treasury stock acquired, average cost per share	$ 97.82	$ 97.30	$ 111.38

Shareholder's equity Effects of

Shareholder's equity Effects of Changes in DaVita Inc's Ownership Interest (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items]
Net (loss) income attributable to DaVita Inc.	$ 691,535	$ 560,400	$ 978,450
Additional paid-in capital
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Changes, Net [Abstract]
Purchase of noncontrolling interests	(5,375)	(6,586)	(13,853)
Sale of noncontrolling interest	13,077	939
Sale of noncontrolling interest			(264)
Noncontrolling Interest, Period Increase (Decrease)	7,702	(5,647)	(14,117)
Net Income Attributable To Parent Net Of Transfers To Noncontrolling Interests.	$ 699,237	$ 554,753	$ 964,333

Shareholder's equity (Details)

Shareholder's equity (Details) - USD ($) $ / shares in Units, $ in Thousands	1 Months Ended	12 Months Ended
	Feb. 12, 2024	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 17, 2021	Dec. 10, 2020
Stock repurchases
Terminated Remaining Prior Share Repurchases Authorized, Amount						$ 329,302
Stock Repurchase Program, Authorized Amount					$ 2,000,000
Charter documents and Delaware law:
Preferred stock, shares authorized (in shares)		5,000,000	5,000,000
Period During Which The Company Is Subject To Section 203 Of The Delaware General Corporation Law Limitation		3 years
Payments to Noncontrolling Interests		$ 12,555	$ 20,775	$ 20,104
Open Market Purchases
Stock repurchases
Repurchase of common stock (in shares)		2,904,000	8,095,000	13,877,000
Charter documents and Delaware law:
Treasury stock acquired, average cost per share		$ 97.82	$ 97.30	$ 111.38
Value of treasury stock acquired		$ 285,710	$ 787,854	$ 1,546,016
Treasury Stock, Common
Stock repurchases
Repurchase of common stock (in shares)		2,904,000	8,095,000	13,877,000
Retirement of treasury stock (in shares)		2,904,000	8,095,000	13,877,000
Charter documents and Delaware law:
Value of treasury stock acquired		$ 285,710	$ 787,854	$ 1,546,016
Subsequent Event
Stock repurchases
Stock Repurchase Program, Remaining Authorized Repurchase Amount	$ 1,149,192
Subsequent Event | Open Market Purchases
Stock repurchases
Repurchase of common stock (in shares)	1,507,000
Charter documents and Delaware law:
Treasury stock acquired, average cost per share	$ 107.97
Value of treasury stock acquired	$ 164,366

Accumulated Other Comprehensi_3

Accumulated Other Comprehensive (Loss) Income (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Comprehensive Income (Loss) [Line Items]
Beginning Balance of AOCI	$ (69,186)
Ending Balance of AOCI	(52,084)	$ (69,186)
Interest rate cap agreements
Comprehensive Income (Loss) [Line Items]
Beginning Balance of AOCI	98,685	(1,178)	$ (12,466)
Unrealized gains (losses)	9,186	144,793	9,532
Related income tax	(2,291)	(36,124)	(2,377)
Unrealized (losses) gains net	6,895	108,669	7,155
Reclassification from accumulated other comprehensive losses (income) into net income	(103,567)	(11,732)	5,509
Related income tax	25,840	2,926	(1,376)
Reclassification from accumulated other comprehensive income (loss) into net income net of tax	(77,727)	(8,806)	4,133
Ending Balance of AOCI	27,853	98,685	(1,178)
Foreign currency translation adjustments
Comprehensive Income (Loss) [Line Items]
Beginning Balance of AOCI	(167,871)	(138,069)	(53,688)
Unrealized gains (losses)	89,055	(30,554)	(83,375)
Related income tax	(1,121)	752	(1,006)
Unrealized (losses) gains net	87,934	(29,802)	(84,381)
Reclassification from accumulated other comprehensive losses (income) into net income	0	0	0
Related income tax	0	0	0
Reclassification from accumulated other comprehensive income (loss) into net income net of tax	0	0	0
Ending Balance of AOCI	(79,937)	(167,871)	(138,069)
Accumulated other comprehensive (loss) income
Comprehensive Income (Loss) [Line Items]
Beginning Balance of AOCI	(69,186)	(139,247)	(66,154)
Unrealized gains (losses)	98,241	114,239	(73,843)
Related income tax	(3,412)	(35,372)	(3,383)
Unrealized (losses) gains net	94,829	78,867	(77,226)
Reclassification from accumulated other comprehensive losses (income) into net income	(103,567)	(11,732)	5,509
Related income tax	25,840	2,926	(1,376)
Reclassification from accumulated other comprehensive income (loss) into net income net of tax	(77,727)	(8,806)	4,133
Ending Balance of AOCI	$ (52,084)	$ (69,186)	$ (139,247)

Acquisitions - Components of Ro

Acquisitions - Components of Routine Acquisitions (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2023 USD ($) Clinic	Dec. 31, 2022 USD ($) Clinic	Dec. 31, 2021 USD ($) Clinic
Business Acquisition [Line Items]
Cash paid to acquire business	$ 26,394	$ 57,308	$ 187,050
Series of individually immaterial business acquisitions
Business Acquisition [Line Items]
Cash paid to acquire business	26,394	57,308	187,050
Business combination contingent consideration acquisitions, earn-outs	11,065	4,261	14,854
Deferred Purchase price and liabilities assumed	8,736	15,076	10,226
Aggregate purchase cost recognized	$ 46,195	$ 76,645	$ 212,130
Series of individually immaterial business acquisitions | U.S. dialysis
Business Acquisition [Line Items]
Number of businesses acquired | Clinic	0	5	19
Series of individually immaterial business acquisitions | Foreign Dialysis Centers
Business Acquisition [Line Items]
Number of businesses acquired | Clinic	12	11	17

Acquisitions - Assets acquired

Acquisitions - Assets acquired and liabilities assumed (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Business Acquisition [Line Items]
Goodwill	$ 7,112,560	$ 7,076,610	$ 7,046,241
Series of individually immaterial business acquisitions
Business Acquisition [Line Items]
Current assets	6,128	6,389	9,134
Property and equipment	4,130	7,481	9,277
Customer relationships	0	0	17,200
Noncompetition agreements and other long-term assets	785	1,066	9,964
Indefinite-lived licenses	15,789	19,610	11,432
Goodwill	25,723	49,047	173,244
Liabilities Assumed	(6,179)	(6,081)	(14,200)
Noncontrolling interests assumed	(181)	(867)	(3,921)
Aggregate purchase price	$ 46,195	$ 76,645	$ 212,130

Schedule Of Other Information R

Schedule Of Other Information Related To Acquired Intangibles and Goodwill (Details) - Series of individually immaterial business acquisitions - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Business Acquisition [Line Items]
Goodwill deductible for tax purposes associated with acquisitions	$ 17,836	$ 49,047	$ 169,014
Customer Relationships
Business Acquisition [Line Items]
Amortizable intangible assets acquired, weighted-average estimated useful lives	0 years	0 years	10 years
Noncompetition agreements
Business Acquisition [Line Items]
Amortizable intangible assets acquired, weighted-average estimated useful lives	3 years	4 years	6 years

Acquisitions and Divestitures -

Acquisitions and Divestitures - Pro Forma Summary of Results of Operation (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Business Combinations [Abstract]
Pro forma total revenues	$ 12,160,466	$ 11,651,311
Pro forma net income from continuing operations attributable to DaVita Inc.	$ 694,854	$ 550,245
Pro forma basic net income per share from continuing operations attributable to DaVita Inc.	$ 7.65	$ 5.92
Pro forma diluted net income per share from continuing operations attributable to DaVita Inc.	$ 7.46	$ 5.74

Acquisitions and Divestitures_2

Acquisitions and Divestitures - Reconciliation of Changes in Contingent Earn-Out Obligations (Details) - Series of individually immaterial business acquisitions - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Business Acquisition [Line Items]
Beginning balance	$ 25,422	$ 33,600
Acquisitions	11,065	4,261	$ 14,854
Foreign currency translation	1,611	840
Fair value remeasurements	(11,170)	(5,921)
Payments or other settlements	(3,840)	(7,358)
Ending balance	$ 23,088	$ 25,422	$ 33,600

Acquisitions and Divestitures_3

Acquisitions and Divestitures - Additional Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Series of individually immaterial business acquisitions
Business Acquisition [Line Items]
Contingent earn-out obligations for acquisitions	$ 66,299
Fair value of contingent earn-out consideration	23,088	$ 25,422	$ 33,600
Other Current Liabilities | Series of individually immaterial business acquisitions
Business Acquisition [Line Items]
Fair value of contingent earn-out consideration	6,431
Other Long-term Liabilities | Series of individually immaterial business acquisitions
Business Acquisition [Line Items]
Fair value of contingent earn-out consideration	16,657
Other companies | Series of individually immaterial business acquisitions
Business Acquisition [Line Items]
Fair value of contingent earn-out consideration	$ 23,088
Minimum | Other companies | Performance Targets or Quality Margins
Business Acquisition [Line Items]
Earn-out consideration payment period	1 year
Maximum | Other companies | Performance Targets or Quality Margins
Business Acquisition [Line Items]
Earn-out consideration payment period	5 years

Held for Sale and Discontinue_2

Held for Sale and Discontinued Operations - Additional Information (Details) - DMG - discontinued operations - USD ($) $ in Thousands		12 Months Ended
	Jun. 19, 2019	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Cash Provided by (Used in) Operating Activities, Discontinued Operations		$ 0	$ 0	$ 0
Cash Provided by (Used in) Financing Activities, Discontinued Operations		0	0	0
Cash Provided by (Used in) Investing Activities, Discontinued Operations		$ 0	0	$ 0
Discontinued Operations, Held-for-sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Business Sale, Effective Date Of Sale	Jun. 19, 2019
Gain on disposition of business, additional purchase price payment			$ 13,452

Variable Interest Entities - Ad

Variable Interest Entities - Additional Information (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Variable Interest Entity
Assets	$ 16,893,578	$ 16,928,252
Liabilities	14,150,228	$ 14,703,452
Variable Interest Entity, Primary Beneficiary
Variable Interest Entity
Assets	256,542
Liabilities	$ 139,443

Fair Values of Financial Inst_3

Fair Values of Financial Instruments - Assets, Liabilities and Temporary Equity Measured at Fair Value on Recurring Basis (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Assets
Investments in equity securities	$ 37,391	$ 39,143
Fair Value, Measurements, Recurring
Assets
Investments in equity securities	37,391	39,143
Liabilities
Contingent earn-out obligations for acquisitions	23,088	25,422
Temporary equity
Noncontrolling interests subject to put provisions	1,499,288	1,348,908
Fair Value, Measurements, Recurring | Interest Rate Cap
Assets
Interest rate cap agreements	79,805	139,755
Fair Value, Measurements, Recurring | Quoted prices in active markets for identical assets (Level 1)
Assets
Investments in equity securities	37,391	39,143
Liabilities
Contingent earn-out obligations for acquisitions
Temporary equity
Noncontrolling interests subject to put provisions
Fair Value, Measurements, Recurring | Quoted prices in active markets for identical assets (Level 1) | Interest Rate Cap
Assets
Interest rate cap agreements
Fair Value, Measurements, Recurring | Significant other observable inputs (Level 2)
Assets
Investments in equity securities
Liabilities
Contingent earn-out obligations for acquisitions
Temporary equity
Noncontrolling interests subject to put provisions
Fair Value, Measurements, Recurring | Significant other observable inputs (Level 2) | Interest Rate Cap
Assets
Interest rate cap agreements	79,805	139,755
Fair Value, Measurements, Recurring | Significant unobservable inputs (Level 3)
Assets
Investments in equity securities
Liabilities
Contingent earn-out obligations for acquisitions	23,088	25,422
Temporary equity
Noncontrolling interests subject to put provisions	1,499,288	1,348,908
Fair Value, Measurements, Recurring | Significant unobservable inputs (Level 3) | Interest Rate Cap
Assets
Interest rate cap agreements

Fair Values of Financial Inst_4

Fair Values of Financial Instruments (Details) $ in Thousands	Dec. 31, 2023 USD ($)
Fair Value Disclosures [Abstract]
Potential Increase Decrease In Fair Value Of Noncontrolling Interests Due To Change In Weighted Average EBITDA Multiple	$ 190

Segment Reporting - Summary of

Segment Reporting - Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income from Continuing Operations Before Income Taxes (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Jun. 30, 2023	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Segment Reporting Information [Line Items]
Other revenues		$ 565,206	$ 433,430	$ 405,282
Total revenues		12,140,147	11,609,894	11,618,797
Operating Income (Loss)		1,602,784	1,339,062	1,797,370
Corporate administrative support		(163,047)	(129,669)	(111,615)
Debt expense		(398,551)	(357,019)	(285,254)
Debt Extinguishment And Modification Costs	$ 7,962	7,962	0	0
Other (loss) income, net		(19,177)	(15,765)	6,378
Income from continuing operations before income taxes		1,177,094	966,278	1,518,494
Segment Reporting Information footnote:
Equity investment income (loss) from equity method investments in nonconsolidated dialysis partnerships.		27,864	26,520	26,937
Property and equipment, net of accumulated depreciation		3,073,533	3,256,397
U.S. dialysis
Segment Reporting Information [Line Items]
Total revenues		10,848,776	10,512,774	10,576,167
Other - Ancillary services
Segment Reporting Information [Line Items]
Total revenues		1,291,371	1,097,120	1,042,630
Operating Segments
Segment Reporting Information [Line Items]
Total revenues		12,236,221	11,701,135	11,713,887
Operating Income (Loss)		1,765,831	1,468,731	1,908,985
Operating Segments | U.S. dialysis
Segment Reporting Information [Line Items]
Dialysis patient service revenues before provision		10,911,747	10,575,372	10,641,618
Total revenues		10,936,998	10,599,809	10,666,963
Operating Income (Loss)		1,774,578	1,565,310	1,974,988
Operating Segments | U.S. dialysis | External Sources
Segment Reporting Information [Line Items]
Dialysis patient service revenues before provision		10,823,525	10,488,327	10,551,106
Other revenues		25,251	24,447	25,061
Operating Segments | U.S. dialysis | Intersubsegment Eliminations
Segment Reporting Information [Line Items]
Dialysis patient service revenues before provision		88,222	87,045	90,512
Other revenues		0	(10)	284
Operating Segments | Other - Ancillary services
Segment Reporting Information [Line Items]
Dialysis patient service revenues before provision		751,416	688,137	662,409
Other revenues		539,955	408,983	380,221
Total revenues		1,299,223	1,101,326	1,046,924
Operating Income (Loss)		(8,747)	(96,579)	(66,003)
Segment Reporting Information footnote:
Equity investment income (loss) from equity method investments in nonconsolidated dialysis partnerships.		(2,103)	(1,898)	(3,177)
Operating Segments | Other - Ancillary services | Intersubsegment Eliminations
Segment Reporting Information [Line Items]
Dialysis patient service revenues before provision		7,852	4,206	4,294
Intersegment Elimination
Segment Reporting Information [Line Items]
Total revenues		(96,074)	(91,241)	(95,090)
Intersegment Elimination | U.S. dialysis
Segment Reporting Information [Line Items]
Total revenues		(88,222)	(87,035)	(90,796)
Intersegment Elimination | Other - Ancillary services
Segment Reporting Information [Line Items]
Total revenues		$ (7,852)	$ (4,206)	$ (4,294)

Segment Reporting - Summary o_2

Segment Reporting - Summary of Depreciation and Amortization Expense by Segment (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 745,443	$ 732,602	$ 680,615
U.S. dialysis
Segment Reporting Information [Line Items]
Depreciation and amortization	695,674	690,949	642,711
Other - Ancillary services
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 49,769	$ 41,653	$ 37,904

Segment Reporting - Summary o_3

Segment Reporting - Summary of Expenditures for Property and Equipment by Segment (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Segment Reporting Information [Line Items]
Segment, Expenditure, Addition to Long-Lived Assets	$ 567,985	$ 603,429	$ 641,465
U.S. dialysis
Segment Reporting Information [Line Items]
Segment, Expenditure, Addition to Long-Lived Assets	501,149	533,600	589,662
Other - Ancillary services
Segment Reporting Information [Line Items]
Segment, Expenditure, Addition to Long-Lived Assets	$ 66,836	$ 69,829	$ 51,803

Segment Reporting - Summary o_4

Segment Reporting - Summary of Assets by Segment (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
ASSETS
Assets	$ 16,893,578	$ 16,928,252
Equity method and other investments	545,848	231,108
Property and equipment, net of accumulated depreciation	3,073,533	3,256,397
Other - Ancillary services | International
ASSETS
Property and equipment, net of accumulated depreciation	$ 240,742	$ 207,162

Supplemental Cash Flow Inform_3

Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Cash paid:
Income taxes, net	$ 268,091	$ 344,430	$ 209,754
Interest, net	387,661	350,999	279,002
Non-cash investing and financing activities:
Fixed assets under financing lease obligations	$ 13,269	$ 1,928	$ 31,690