Document and Entity Information
Document and Entity Information - shares shares in Millions | 6 Months Ended | |
Jun. 30, 2024 | Aug. 02, 2024 | |
Cover [Abstract] | ||
Document Type | 10-Q | |
Document Quarterly Report | true | |
Document Period End Date | Jun. 30, 2024 | |
Document Transition Report | false | |
Entity File Number | 1-14106 | |
Entity Registrant Name | DAVITA INC. | |
Entity Incorporation, State or Country Code | DE | |
Entity Tax Identification Number | 51-0354549 | |
Entity Address, Address Line One | 2000 16th Street | |
Entity Address, City or Town | Denver, | |
Entity Address, State or Province | CO | |
Entity Address, Postal Zip Code | 80202 | |
City Area Code | 720 | |
Local Phone Number | 631-2100 | |
Title of 12(b) Security | Common Stock, $0.001 par value | |
Trading Symbol | DVA | |
Security Exchange Name | NYSE | |
Entity Current Reporting Status | Yes | |
Entity Interactive Data Current | Yes | |
Entity Filer Category | Large Accelerated Filer | |
Entity Small Business | false | |
Entity Emerging Growth Company | false | |
Entity Shell Company | false | |
Entity Common Stock, Shares Outstanding | 83.9 | |
Amendment Flag | false | |
Document Fiscal Year Focus | 2024 | |
Document Fiscal Period Focus | Q2 | |
Entity Central Index Key | 0000927066 | |
Current Fiscal Year End Date | --12-31 |
CONSOLIDATED STATEMENTS OF INCO
CONSOLIDATED STATEMENTS OF INCOME (unaudited) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2024 | Jun. 30, 2023 | Jun. 30, 2024 | Jun. 30, 2023 | |
Income Statement [Abstract] | ||||
Dialysis patient service revenues | $ 3,061,102 | $ 2,890,685 | $ 6,002,634 | $ 5,650,719 |
Other revenues | 125,620 | 109,684 | 254,643 | 222,349 |
Total revenues | 3,186,722 | 3,000,369 | 6,257,277 | 5,873,068 |
Operating expenses: | ||||
Patient care costs | 2,142,299 | 2,055,844 | 4,221,275 | 4,114,033 |
General and administrative | 367,845 | 364,016 | 730,325 | 695,630 |
Depreciation and amortization | 175,661 | 183,672 | 362,744 | 361,743 |
Equity investment income, net | (5,481) | (8,454) | (12,163) | (15,274) |
Gain on changes in ownership interest | 0 | 0 | (35,147) | 0 |
Total operating expenses | 2,680,324 | 2,595,078 | 5,267,034 | 5,156,132 |
Operating income | 506,398 | 405,291 | 990,243 | 716,936 |
Debt expense | (97,747) | (103,507) | (197,165) | (204,281) |
Debt prepayment, extinguishment and modification costs | (9,732) | (7,962) | (9,732) | (7,962) |
Other (loss) income, net | (27,479) | 1,373 | (40,120) | 5,125 |
Income before income taxes | 371,440 | 295,195 | 743,226 | 509,818 |
Income tax expense | 71,688 | 48,818 | 137,494 | 92,773 |
Net income | 299,752 | 246,377 | 605,732 | 417,045 |
Less: Net income attributable to noncontrolling interests | (77,076) | (67,686) | (143,407) | (122,807) |
Net income attributable to DaVita Inc. | $ 222,676 | $ 178,691 | $ 462,325 | $ 294,238 |
Earnings per share attributable to DaVita Inc.: | ||||
Basic net income | $ 2.56 | $ 1.96 | $ 5.29 | $ 3.24 |
Diluted net income | $ 2.50 | $ 1.91 | $ 5.15 | $ 3.17 |
Weighted average shares for earnings per share: | ||||
Basic shares | 86,899,000 | 90,984,000 | 87,337,000 | 90,742,000 |
Diluted shares | 88,950,000 | 93,418,000 | 89,749,000 | 92,952,000 |
CONSOLIDATED STATEMENTS OF COMP
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (unaudited) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2024 | Jun. 30, 2023 | Jun. 30, 2024 | Jun. 30, 2023 | |
Statement of Comprehensive Income [Abstract] | ||||
Net income | $ 299,752 | $ 246,377 | $ 605,732 | $ 417,045 |
Unrealized gains on interest rate cap agreements: | ||||
Unrealized gains | 5,919 | 24,849 | 19,236 | 21,310 |
Reclassifications of net realized gains into net income | (22,041) | (18,956) | (43,669) | (34,698) |
Unrealized (losses) gains on foreign currency translation: | (78,853) | 41,961 | (118,573) | 75,522 |
Other comprehensive (loss) income | (94,975) | 47,854 | (143,006) | 62,134 |
Total comprehensive income | 204,777 | 294,231 | 462,726 | 479,179 |
Less: Comprehensive income attributable to noncontrolling interests | (77,076) | (67,686) | (143,407) | (122,807) |
Comprehensive income attributable to DaVita Inc. | $ 127,701 | $ 226,545 | $ 319,319 | $ 356,372 |
CONSOLIDATED BALANCE SHEETS (un
CONSOLIDATED BALANCE SHEETS (unaudited) - USD ($) $ in Thousands | Jun. 30, 2024 | Dec. 31, 2023 |
ASSETS | ||
Cash and Cash Equivalents, at Carrying Value | $ 416,493 | $ 380,063 |
Restricted Cash and Cash Equivalents | 86,753 | 84,571 |
Short-term investments | 20,693 | 11,610 |
Accounts receivable, net | 2,303,119 | 1,986,856 |
Inventories | 126,765 | 143,105 |
Other receivables | 420,623 | 422,669 |
Prepaid and other current assets | 83,106 | 102,645 |
Income tax receivable | 9,373 | 6,387 |
Total current assets | 3,466,925 | 3,137,906 |
Property and equipment, net | 2,982,222 | 3,073,533 |
Operating lease right-of-use assets | 2,457,565 | 2,501,364 |
Intangible assets, net | 191,483 | 203,224 |
Equity method and other investments | 453,709 | 545,848 |
Long-term investments | 31,779 | 47,890 |
Other long-term assets | 240,490 | 271,253 |
Goodwill | 7,201,399 | 7,112,560 |
Total assets | 17,025,572 | 16,893,578 |
LIABILITIES AND EQUITY | ||
Accounts payable | 493,534 | 514,533 |
Other liabilities | 888,358 | 828,878 |
Accrued compensation and benefits | 644,865 | 752,598 |
Current portion of operating lease liabilities | 404,820 | 394,399 |
Current portion of long-term debt | 537,991 | 123,299 |
Income tax payable | 25,222 | 28,507 |
Total current liabilities | 2,994,790 | 2,642,214 |
Long-term operating lease liabilities | 2,281,372 | 2,330,389 |
Long-term debt | 8,451,562 | 8,268,334 |
Other long-term liabilities | 179,010 | 183,074 |
Deferred income taxes | 693,982 | 726,217 |
Total liabilities | 14,600,716 | 14,150,228 |
Commitments and contingencies: | ||
Noncontrolling interests subject to put provisions | 1,574,840 | 1,499,288 |
Equity: | ||
Preferred Stock, Value, Issued | 0 | 0 |
Common Stock, Value, Issued | 90 | 89 |
Additional paid-in capital | 383,235 | 509,804 |
Retained earnings | 1,060,613 | 598,288 |
Treasury Stock, Value | (615,948) | 0 |
Accumulated other comprehensive loss | (195,090) | (52,084) |
Total DaVita Inc. shareholders' equity | 632,900 | 1,056,097 |
Noncontrolling interests not subject to put provisions | 217,116 | 187,965 |
Total equity | 850,016 | 1,244,062 |
Total liabilities and equity | $ 17,025,572 | $ 16,893,578 |
CONSOLIDATED BALANCE SHEETS (_2
CONSOLIDATED BALANCE SHEETS (unaudited) (Parenthetical) - USD ($) $ in Thousands | Jun. 30, 2024 | Dec. 31, 2023 |
Statement of Financial Position [Abstract] | ||
Property and equipment, accumulated depreciation | $ 6,058,826 | $ 5,759,514 |
Intangible assets, accumulated amortization | $ 38,752 | $ 38,445 |
Preferred stock, par value (usd per share) | $ 0.001 | $ 0.001 |
Preferred stock, shares authorized (in shares) | 5,000,000 | 5,000,000 |
Preferred stock, issued (in shares) | 0 | 0 |
Common stock, par value (usd per share) | $ 0.001 | |
Common stock, shares authorized (in shares) | 450,000,000 | |
Common stock, shares issued (in shares) | 89,855,000 | 88,824,000 |
Common stock, shares outstanding (in shares) | 85,081,000 | 88,824,000 |
CONSOLIDATED STATEMENTS OF CASH
CONSOLIDATED STATEMENTS OF CASH FLOWS (unaudited) - USD ($) $ in Thousands | 6 Months Ended | |
Jun. 30, 2024 | Jun. 30, 2023 | |
Cash flows from operating activities: | ||
Net income | $ 605,732 | $ 417,045 |
Adjustments to reconcile net income to net cash provided by operating activities: | ||
Depreciation and amortization | 362,744 | 361,743 |
Loss on extinguishment of debt | 2,445 | 7,132 |
Stock-based compensation expense | 48,832 | 55,197 |
Deferred income taxes | (28,643) | (16,178) |
Equity investment loss, net | 54,748 | 14,571 |
Gain on changes in ownership interest | (35,147) | 0 |
Other non-cash losses and (gains), net | 16,570 | (5,160) |
Changes in operating assets and liabilities, net of effect of acquisitions and divestitures: | ||
Accounts receivable | (193,093) | 141,503 |
Increase (Decrease) in Inventories | 22,422 | (116) |
Other current assets | (13,898) | 33,182 |
Other long-term assets | (3,367) | (607) |
Accounts payable | (38,998) | (40,615) |
Accrued compensation and benefits | (122,817) | (68,800) |
Other current liabilities | 1,219 | 17,242 |
Income taxes | (8,097) | 5,200 |
Other long-term liabilities | (6,642) | (8,675) |
Net cash provided by operating activities | 664,010 | 912,664 |
Cash flows from investing activities: | ||
Additions of property and equipment | (245,740) | (272,204) |
Acquisitions | (157,783) | (2,575) |
Proceeds from asset and business sales | 12,779 | 21,198 |
Purchase of debt investments held-to-maturity | (309) | (30,419) |
Purchase of other debt and equity investments | (3,411) | (6,366) |
Proceeds from debt investments held-to-maturity | 7,082 | 94,414 |
Proceeds from sale of other debt and equity investments | 4,564 | 3,873 |
Purchase of equity method investments | (700) | (273,336) |
Distributions from equity method investments | 6,554 | 1,758 |
Net cash used in investing activities | (376,964) | (463,657) |
Cash flows from financing activities: | ||
Borrowings | 3,275,533 | 2,136,873 |
Payments on long-term debt | (2,661,145) | (2,347,120) |
Deferred and debt related financing costs | (19,993) | (45,009) |
Purchase of treasury stock | (612,614) | 0 |
Distributions to noncontrolling interests | (107,210) | (124,178) |
Net payments related to stock purchases and awards | (86,277) | (43,612) |
Contributions from noncontrolling interests | 7,621 | 6,946 |
Proceeds from sales of additional noncontrolling interests | 860 | 50,962 |
Purchases of noncontrolling interests | (40,751) | (7,610) |
Net cash used in financing activities | (243,976) | (372,748) |
Effect of exchange rate changes on cash, cash equivalents and restricted cash | (4,458) | 6,922 |
Net increase in cash, cash equivalents and restricted cash | 38,612 | 83,181 |
Cash, cash equivalents and restricted cash at beginning of the year | 464,634 | 338,989 |
Cash, cash equivalents and restricted cash at end of the period | $ 503,246 | $ 422,170 |
CONSOLIDATED STATEMENTS OF EQUI
CONSOLIDATED STATEMENTS OF EQUITY (unaudited) - USD ($) $ in Thousands | Total | Total | Non- controlling interests subject to put provisions | Common stock | Additional paid-in capital | Retained earnings | Treasury stock | Accumulated other comprehensive loss | Non- controlling interests not subject to put provisions |
Temporary equity, starting balance at Dec. 31, 2022 | $ 1,348,908 | ||||||||
Increase (Decrease) in Temporary Equity [Roll Forward] | |||||||||
Net income | 86,951 | ||||||||
Distributions | (81,274) | ||||||||
Contributions | 5,609 | ||||||||
Partial purchases | (700) | ||||||||
Fair value remeasurements | 64,055 | ||||||||
Temporary equity, ending balance at Jun. 30, 2023 | 1,423,549 | ||||||||
Beginning balance at Dec. 31, 2022 | $ 712,326 | $ 90 | $ 606,935 | $ 174,487 | $ 0 | $ (69,186) | $ 163,566 | ||
Common stock, Beginning balance (in shares) at Dec. 31, 2022 | 90,411,000 | ||||||||
Treasury stock, beginning balance (in shares) at Dec. 31, 2022 | 0 | ||||||||
Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest [Abstract] | |||||||||
Net income attributable to DaVita Inc. | 294,238 | 294,238 | 35,856 | ||||||
Other comprehensive income (loss) | $ 62,134 | 62,134 | 62,134 | ||||||
Stock award plan (in shares) | 860,000 | ||||||||
Stock award plan | $ 1 | ||||||||
Stock award plan | (48,602) | (48,603) | |||||||
Stock-settled stock-based compensation expense | 53,508 | 53,508 | |||||||
Changes in noncontrolling interest from: | |||||||||
Distributions | (42,904) | ||||||||
Contributions | 1,337 | ||||||||
Acquisitions and divestitures | 13,077 | 13,077 | 30,776 | ||||||
Partial purchases | (5,182) | (5,182) | (5) | ||||||
Fair value remeasurements | (64,055) | (64,055) | |||||||
Ending balance at Jun. 30, 2023 | 1,017,444 | $ 91 | 555,680 | 468,725 | $ 0 | (7,052) | 188,626 | ||
Common stock, Ending balance (in shares) at Jun. 30, 2023 | 91,271,000 | ||||||||
Treasury stock, ending balance (in shares) at Jun. 30, 2023 | 0 | ||||||||
Temporary equity, starting balance at Mar. 31, 2023 | 1,398,829 | ||||||||
Increase (Decrease) in Temporary Equity [Roll Forward] | |||||||||
Net income | 50,259 | ||||||||
Distributions | (45,724) | ||||||||
Contributions | 1,861 | ||||||||
Partial purchases | (700) | ||||||||
Fair value remeasurements | 19,024 | ||||||||
Temporary equity, ending balance at Jun. 30, 2023 | 1,423,549 | ||||||||
Beginning balance at Mar. 31, 2023 | 825,470 | $ 91 | 590,251 | 290,034 | $ 0 | (54,906) | 194,403 | ||
Common stock, Beginning balance (in shares) at Mar. 31, 2023 | 90,650,000 | ||||||||
Treasury stock, beginning balance (in shares) at Mar. 31, 2023 | 0 | ||||||||
Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest [Abstract] | |||||||||
Net income attributable to DaVita Inc. | 178,691 | 178,691 | 17,427 | ||||||
Other comprehensive income (loss) | 47,854 | 47,854 | 47,854 | ||||||
Stock award plan (in shares) | 621,000 | ||||||||
Stock award plan | |||||||||
Stock award plan | (39,080) | (39,080) | |||||||
Stock-settled stock-based compensation expense | 28,661 | 28,661 | |||||||
Changes in noncontrolling interest from: | |||||||||
Distributions | (23,617) | ||||||||
Contributions | 360 | ||||||||
Acquisitions and divestitures | 54 | 54 | 58 | ||||||
Partial purchases | (5,182) | (5,182) | (5) | ||||||
Fair value remeasurements | (19,024) | (19,024) | |||||||
Ending balance at Jun. 30, 2023 | 1,017,444 | $ 91 | 555,680 | 468,725 | $ 0 | (7,052) | 188,626 | ||
Common stock, Ending balance (in shares) at Jun. 30, 2023 | 91,271,000 | ||||||||
Treasury stock, ending balance (in shares) at Jun. 30, 2023 | 0 | ||||||||
Temporary equity, starting balance at Dec. 31, 2023 | 1,499,288 | ||||||||
Increase (Decrease) in Temporary Equity [Roll Forward] | |||||||||
Net income | 102,058 | ||||||||
Distributions | (73,081) | ||||||||
Contributions | 6,128 | ||||||||
Partial purchases | (36,499) | ||||||||
Fair value remeasurements | 76,946 | ||||||||
Temporary equity, ending balance at Jun. 30, 2024 | 1,574,840 | ||||||||
Beginning balance at Dec. 31, 2023 | $ 1,244,062 | 1,056,097 | $ 89 | 509,804 | 598,288 | $ 0 | (52,084) | 187,965 | |
Common stock, Beginning balance (in shares) at Dec. 31, 2023 | 88,824,000 | 88,824,000 | |||||||
Treasury stock, beginning balance (in shares) at Dec. 31, 2023 | 0 | 0 | |||||||
Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest [Abstract] | |||||||||
Net income attributable to DaVita Inc. | 462,325 | 462,325 | 41,349 | ||||||
Other comprehensive income (loss) | $ (143,006) | (143,006) | (143,006) | ||||||
Stock award plan (in shares) | 1,031,000 | ||||||||
Stock award plan | $ 1 | ||||||||
Stock award plan | (93,698) | (93,699) | |||||||
Stock-settled stock-based compensation expense | 46,763 | 46,763 | |||||||
Changes in noncontrolling interest from: | |||||||||
Distributions | (34,129) | ||||||||
Contributions | 1,493 | ||||||||
Acquisitions and divestitures | 491 | 491 | 20,438 | ||||||
Partial purchases | (3,178) | (3,178) | |||||||
Fair value remeasurements | (76,946) | (76,946) | |||||||
Purchase of treasury stock | (615,948) | $ (615,948) | |||||||
Purchase of treasury stock (in shares) | (4,774,000) | ||||||||
Ending balance at Jun. 30, 2024 | $ 850,016 | 632,900 | $ 90 | 383,235 | 1,060,613 | $ (615,948) | (195,090) | 217,116 | |
Common stock, Ending balance (in shares) at Jun. 30, 2024 | 85,081,000 | 89,855,000 | |||||||
Treasury stock, ending balance (in shares) at Jun. 30, 2024 | 4,774,000 | (4,774,000) | |||||||
Temporary equity, starting balance at Mar. 31, 2024 | 1,503,474 | ||||||||
Increase (Decrease) in Temporary Equity [Roll Forward] | |||||||||
Net income | 57,867 | ||||||||
Distributions | (20,153) | ||||||||
Contributions | 3,001 | ||||||||
Partial purchases | (35,272) | ||||||||
Fair value remeasurements | 65,923 | ||||||||
Temporary equity, ending balance at Jun. 30, 2024 | $ 1,574,840 | ||||||||
Beginning balance at Mar. 31, 2024 | 925,997 | $ 90 | 428,202 | 837,937 | $ (240,117) | (100,115) | 206,516 | ||
Common stock, Beginning balance (in shares) at Mar. 31, 2024 | 89,822,000 | ||||||||
Treasury stock, beginning balance (in shares) at Mar. 31, 2024 | (2,119,000) | ||||||||
Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest [Abstract] | |||||||||
Net income attributable to DaVita Inc. | 222,676 | 222,676 | 19,209 | ||||||
Other comprehensive income (loss) | $ (94,975) | (94,975) | (94,975) | ||||||
Stock award plan (in shares) | 33,000 | ||||||||
Stock award plan | |||||||||
Stock award plan | (3,067) | (3,067) | |||||||
Stock-settled stock-based compensation expense | 23,714 | 23,714 | |||||||
Changes in noncontrolling interest from: | |||||||||
Distributions | (9,709) | ||||||||
Contributions | 895 | ||||||||
Acquisitions and divestitures | 491 | 491 | 205 | ||||||
Partial purchases | (182) | (182) | |||||||
Fair value remeasurements | (65,923) | (65,923) | |||||||
Purchase of treasury stock | (375,831) | $ (375,831) | |||||||
Purchase of treasury stock (in shares) | (2,655,000) | ||||||||
Ending balance at Jun. 30, 2024 | $ 850,016 | $ 632,900 | $ 90 | $ 383,235 | $ 1,060,613 | $ (615,948) | $ (195,090) | $ 217,116 | |
Common stock, Ending balance (in shares) at Jun. 30, 2024 | 85,081,000 | 89,855,000 | |||||||
Treasury stock, ending balance (in shares) at Jun. 30, 2024 | 4,774,000 | (4,774,000) |
Condensed consolidated interim
Condensed consolidated interim financial statements Condensed consolidated interim financial statements | 6 Months Ended |
Jun. 30, 2024 | |
Text Block [Abstract] | |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block] | Condensed consolidated interim financial statements The unaudited condensed consolidated interim financial statements included in this report are prepared by the Company. In the opinion of management, all adjustments necessary for a fair presentation of the results of operations are reflected in these condensed consolidated interim financial statements. All significant intercompany accounts and transactions have been eliminated. The preparation of these financial statements requires management to make estimates and assumptions that affect the reported amounts of revenues, expenses, assets, liabilities, contingencies, and noncontrolling interests subject to put provisions. The most significant estimates and assumptions underlying these financial statements and accompanying notes generally involve revenue recognition and accounts receivable, certain fair value estimates, accounting for income taxes, and loss contingencies. The results of operations reflected in these interim financial statements may not necessarily be indicative of annual operating results. These condensed consolidated interim financial statements should be read in conjunction with the audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2023 (2023 10-K). Prior period classifications conform to the current period presentation. |
Revenue Recognition Revenue Rec
Revenue Recognition Revenue Recognition | 6 Months Ended |
Jun. 30, 2024 | |
Text Block [Abstract] | |
Revenue Recognition [Text Block] | Revenue recognition The following tables summarize the Company's segment revenues by primary payor source: Three months ended June 30, 2024 Three months ended June 30, 2023 U.S. dialysis Other — Ancillary services Consolidated U.S. dialysis Other — Ancillary services Consolidated Dialysis patient service revenues: Medicare and Medicare Advantage $ 1,587,198 $ $ 1,587,198 $ 1,539,639 $ $ 1,539,639 Medicaid and Managed Medicaid 214,951 214,951 216,014 216,014 Other government 80,338 176,524 256,862 92,525 125,964 218,489 Commercial 952,625 62,391 1,015,016 876,033 60,871 936,904 Other revenues: Medicare and Medicare Advantage 97,433 97,433 87,236 87,236 Medicaid and Managed Medicaid 445 445 396 396 Commercial 10,200 10,200 3,619 3,619 Other (1) 5,898 15,467 21,365 6,404 13,437 19,841 Eliminations of intersegment revenues (12,925) (3,823) (16,748) (20,361) (1,408) (21,769) Total $ 2,828,085 $ 358,637 $ 3,186,722 $ 2,710,254 $ 290,115 $ 3,000,369 Six months ended June 30, 2024 Six months ended June 30, 2023 U.S. dialysis Other - Ancillary services Consolidated U.S. dialysis Other - Ancillary services Consolidated Dialysis patient service revenues: Medicare and Medicare Advantage $ 3,118,696 $ $ 3,118,696 $ 3,022,405 $ $ 3,022,405 Medicaid and Managed Medicaid 425,075 425,075 421,790 421,790 Other government 162,924 322,309 485,233 174,570 247,550 422,120 Commercial 1,878,455 132,564 2,011,019 1,711,427 115,387 1,826,814 Other revenues: Medicare and Medicare Advantage 200,542 200,542 180,475 180,475 Medicaid and Managed Medicaid 841 841 965 965 Commercial 17,140 17,140 4,825 4,825 Other (1) 12,021 30,669 42,690 12,583 26,275 38,858 Eliminations of intersegment revenues (37,389) (6,570) (43,959) (42,410) (2,774) (45,184) Total $ 5,559,782 $ 697,495 $ 6,257,277 $ 5,300,365 $ 572,703 $ 5,873,068 (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. There are significant uncertainties associated with estimating revenue, many of which take several years to resolve. These estimates are subject to ongoing insurance coverage changes, geographic coverage differences, differing interpretations of contract coverage and other payor issues, as well as patient issues, including determination of applicable primary and secondary coverage, changes in patient insurance coverage and coordination of benefits. As these estimates are refined over time, both positive and negative adjustments to revenue are recognized in the current period. Dialysis patient service revenues. Revenues are recognized based on the Company’s estimate of the transaction price the Company expects to collect as a result of satisfying its performance obligations. Dialysis patient service revenues are recognized in the period services are provided based on these estimates. Revenues consist primarily of payments from government and commercial health plans for dialysis services provided to patients. Other revenues. Other revenues consist of revenues earned by the Company's non-dialysis ancillary services as well as fees for management and administrative services to outpatient dialysis businesses that the Company does not consolidate. Other revenues are estimated and recognized in the period the performance obligation is met, subject to applicable measurement constraints. The Company's integrated kidney care (IKC) revenues include revenues earned under risk-based arrangements, including value-based care (VBC) arrangements. Under its VBC arrangements, the Company assumes full or shared financial risk for the total medical cost of care for patients below or above a benchmark. The benchmarks against which the Company incurs profit or loss on these contracts are typically based on the underlying premiums paid to the insuring entity (the Company's counterparty), with adjustments where applicable, or on trended or adjusted medical cost targets. |
Earnings per share (Notes)
Earnings per share (Notes) | 6 Months Ended |
Jun. 30, 2024 | |
Earnings Per Share [Abstract] | |
Earnings Per Share [Text Block] | Earnings per share Basic earnings per share is calculated by dividing net income attributable to the Company by the weighted average number of common shares outstanding. Weighted average common shares outstanding include restricted stock unit awards that are no longer subject to forfeiture because the recipients have satisfied either the explicit vesting terms or retirement eligibility requirements. Diluted earnings per share includes the dilutive effect of outstanding stock-settled stock appreciation rights and unvested stock units as computed under the treasury stock method. The reconciliations of the numerators and denominators used to calculate basic and diluted earnings per share were as follows: Three months ended June 30, Six months ended June 30, 2024 2023 2024 2023 Net income attributable to DaVita Inc. $ 222,676 $ 178,691 $ 462,325 $ 294,238 Weighted average shares outstanding: Basic shares 86,899 90,984 87,337 90,742 Assumed incremental from stock plans 2,051 2,434 2,412 2,210 Diluted shares 88,950 93,418 89,749 92,952 Basic net income per share attributable to DaVita Inc. $ 2.56 $ 1.96 $ 5.29 $ 3.24 Diluted net income per share attributable to DaVita Inc. $ 2.50 $ 1.91 $ 5.15 $ 3.17 Anti-dilutive stock-settled awards excluded from calculation (1) 4 280 197 787 (1) Shares associated with stock awards excluded from the diluted denominator calculation because they were anti-dilutive under the treasury stock method. |
Investments in debt and equity
Investments in debt and equity securities | 6 Months Ended |
Jun. 30, 2024 | |
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: June 30, 2024 December 31, 2023 Debt Equity Total Debt Equity Total Certificates of deposit and other time deposits $ 15,293 $ — $ 15,293 $ 22,109 $ — $ 22,109 Investments in mutual funds and common stocks — 37,179 37,179 — 37,391 37,391 $ 15,293 $ 37,179 $ 52,472 $ 22,109 $ 37,391 $ 59,500 Short-term investments $ 15,293 $ 5,400 $ 20,693 $ 7,110 $ 4,500 $ 11,610 Long-term investments — 31,779 31,779 14,999 32,891 47,890 $ 15,293 $ 37,179 $ 52,472 $ 22,109 $ 37,391 $ 59,500 Debt securities. The Company's short-term debt investments are principally bank certificates of deposit with contractual maturities longer than three months but shorter than one year. The Company's long-term debt investments are bank time deposits with contractual maturities longer than one year. These debt securities are accounted for as held-to-maturity and recorded at amortized cost, which approximated their fair values at June 30, 2024 and December 31, 2023. Equity securitie s. 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. |
Goodwill
Goodwill | 6 Months Ended |
Jun. 30, 2024 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Goodwill | Goodwill Changes in the carrying value of goodwill by reportable segment were as follows: U.S. dialysis Other — Ancillary services Consolidated Balance at December 31, 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 Acquisitions 102,082 35,735 137,817 Divestitures (1,687) — (1,687) Foreign currency and other adjustments — (47,291) (47,291) Balance at June 30, 2024 $ 6,517,220 $ 684,179 $ 7,201,399 Balance at June 30, 2024: Goodwill $ 6,517,220 $ 829,684 $ 7,346,904 Accumulated impairment charges — (145,505) (145,505) $ 6,517,220 $ 684,179 $ 7,201,399 The Company did not recognize any goodwill impairment charges during the six months ended June 30, 2024 or the six months ended June 30, 2023. |
Equity Method and Other Investm
Equity Method and Other Investments | 6 Months Ended |
Jun. 30, 2024 | |
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: June 30, 2024 December 31, 2023 Mozarc Medical Holding LLC $ 265,303 $ 324,711 APAC joint venture 67,241 98,865 Other equity method partnerships 104,355 107,282 Adjusted cost method and other investments 16,810 14,990 $ 453,709 $ 545,848 During the six months ended June 30, 2024 and 2023 the Company recognized equity investment income of $12,163 and $15,274, respectively, from its equity method investments in nonconsolidated dialysis partnerships. The Company also recognized equity investment losses from other equity method investments of $(54,633) and $(15,568) in other (loss) income, net during the six months ended June 30, 2024 and 2023, respectively. See Note 8 to the Company's consolidated financial statements included in the 2023 10-K for further description of the Company's equity method investments. |
Long-term debt
Long-term debt | 6 Months Ended |
Jun. 30, 2024 | |
Debt Disclosure [Abstract] | |
Long-term debt | Long-term debt Long-term debt comprised the following: As of June 30, 2024 June 30, December 31, 2023 Maturity date Interest rate Estimated fair value (1) Senior Secured Credit Facilities: Term Loan A-1 $ 1,218,750 $ 1,234,375 (2) Base +1.75% (3) $ 1,212,656 Term Loan B-1 949,819 2,603,786 8/12/2026 Base +1.75% (3) $ 949,819 Extended Term Loan B-1 1,640,251 5/9/2031 SOFR + 2.00% $ 1,636,150 Revolving line of credit 260,000 — (2) Base +1.75% (3) $ 260,000 Senior Notes: 4.625% Senior Notes 2,750,000 2,750,000 6/1/2030 4.625 % $ 2,488,750 3.75% Senior Notes 1,500,000 1,500,000 2/15/2031 3.75 % $ 1,280,625 Acquisition obligations and other notes payable (4) 92,129 102,328 2024-2036 6.73 % $ 92,129 Financing lease obligations (5) 244,262 255,491 2025-2040 4.63 % CHC temporary funding assistance (6) 392,984 — % $ 392,984 Total debt principal outstanding 9,048,195 8,445,980 Discount, premium and deferred financing costs (7) (58,642) (54,347) 8,989,553 8,391,633 Less current portion (537,991) (123,299) $ 8,451,562 $ 8,268,334 (1) For the Company's senior secured credit facilities, fair value estimates are based on bid and ask quotes, a level 2 input. For the Company's 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. For the CHC temporary funding assistance, the carrying value presented here approximates the estimated fair value based on the short-term nature of settlement. (2) Outstanding Term Loan A-1 and the 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 Revolving line of credit balances become due at that 91 day date (May 13, 2026). (3) The Company's senior secured credit facilities bear interest at Term SOFR, plus an interest rate margin, with certain portions also subject to a credit spread adjustment (CSA). Term SOFR plus CSA is referred to as "Base" in the table above. The Term Loan A-1 and revolving line of credit bear a CSA of 0.10%. As of June 30, 2024, the CSA for all tranches outstanding on the Company's Term Loan B-1 was 0.11%. (4) The interest rate presented for acquisition obligations and other notes payable is their weighted average interest rate based on the current fixed and variable interest rate components in effect as of June 30, 2024. (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) The Change Healthcare (CHC) temporary funding assistance, as described below, is interest-free and amounts provided under this program are subject to repayment within 45 business days from a future date to be mutually agreed to by the parties. The balance is included in the Company's current portion of long-term debt as of June 30, 2024. (7) As of June 30, 2024, the carrying amount of the Company's senior secured credit facilities has been reduced by a discount of $9,433 and deferred financing costs of $31,257, and the carrying amount of the Company's senior notes has been reduced by deferred financing costs of $29,136 and increased by a debt premium of $11,184. As of December 31, 2023, the carrying amount of the Company's senior secured credit facilities was reduced by a discount of $2,487 and deferred financing costs of $32,498, and the carrying amount of the Company's senior notes was reduced by deferred financing costs of $31,491 and increased by a debt premium of $12,129. Scheduled maturities of long-term debt at June 30, 2024 were as follows: 2024 (remainder of the year) $ 465,033 2025 $ 147,057 2026 $ 1,040,219 2027 $ 134,619 2028 $ 1,295,333 2029 $ 41,171 Thereafter $ 5,924,763 On May 9, 2024 (Fourth Amendment Effective Date), the Company entered into the Fourth Amendment (the Fourth Amendment) to its senior secured credit agreement dated as of August 12, 2019 (as amended, restated, supplemented or otherwise modified from time to time, including by the Fourth Amendment, the Credit Agreement). The Fourth Amendment modifies the Credit Agreement to, among other things, extend the maturity date for a portion of its Term Loan B-1 in the aggregate principal amount of $911,598 and extend an additional incremental principal amount of $728,653 (together, referred to as the Extended Term Loan B-1). The Company used the incremental proceeds from the Extended Term Loan B-1 to prepay a proportionate amount of the principal balance still outstanding on its Term Loan B-1. The Extended Term Loan B-1 bears interest at the Company’s option, based on (i) the Base Rate (as defined below) plus the Applicable Margin (as defined below), or (ii) the forward-looking term rate based on the secured overnight financing rate that is published by CME Group Benchmark Administration Limited (Term SOFR) plus the Applicable Margin. The “Base Rate” is defined as the highest of (i) the Federal Funds Rate, as published by the Federal Reserve Bank of New York, plus 0.50%, (ii) the prime commercial lending rate of Wells Fargo as established from time to time and (iii) Term SOFR for an interest period of one month plus 1.00%; provided that if Term SOFR or the Base Rate is less than 0.00% such rate shall be deemed to be 0.00% for purposes of the Credit Agreement. The “Applicable Margin” for the Extended Term Loan B-1 is 2.00% in the case of Term SOFR loans, and 1.00% in the case of Base Rate loans. The Extended Term Loan B-1 requires quarterly principal payments beginning on December 31, 2024 of 0.25% of the aggregate principal amount of the Extended Term Loan B-1 outstanding on the Fourth Amendment Effective Date, with the balance due on May 9, 2031. 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 Term Loan A-1, Term Loan B-1, Extended Term Loan B-1 and revolving line of credit rank equal in priority for that security and related subsidiary guarantees. The Credit Agreement 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 Credit Agreement is below 4.00:1.00. In addition, the Credit Agreement requires compliance with a maximum leverage ratio covenant, tested quarterly, of 5.00:1.00 through June 30, 2026 and 4.50:1.00 thereafter (subject to an increase to 5.00:1.00 during the four fiscal quarters following a material acquisition). In addition to the prepayment of Term Loan B-1, as described above, during the first six months of 2024, the Company made regularly scheduled principal payments under its senior secured credit facilities totaling $15,625 on Term Loan A-1 and $13,716 on Term Loan B-1. As a result of the transaction described above, the Company recognized debt prepayment, extinguishment and modification costs of $9,732 in the second quarter of 2024 comprised partially of fees incurred for this transaction and partially of deferred financing costs and original issue discount written off for the portion of debt considered extinguished and reborrowed as a result of the Fourth Amendment. 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 $6,302 and $728,653 for the Extended Term Loan B-1, respectively, and constructive financing cash outflows of $722,351 for the prepayment of a portion of Term Loan B-1, even though no funds were actually paid or received. Another $13,282 of the debt considered extinguished related to the Extended Term Loan B-1 represented a non-cash financing activity. On March 1, 2024, Change Healthcare (CHC), a subsidiary of UnitedHealth Group launched a temporary assistance funding program (CHC Funding) to help bridge the gap in short-term cash flow needs for providers impacted by the disruption of CHC's services. Under the program, CHC provides funding to providers for amounts that would otherwise have been received (with certain limitations), but for the disruption in processing electronic claims as a result of the outage. Amounts provided under this program are subject to repayment within 45 business days from a future date to be mutually agreed to by CHC and the Company. CHC has restored the majority of claims submission functionality and the Company has resumed submission of most of its commercial claims through CHC's platform, although the Company continues to experience payment collection delays. As of June 30, 2024, the remaining CHC Funding amount outstanding was $392,984. The Company's 2019 interest rate cap agreements expired on June 30, 2024 and a portion of the Company's 2023 cap agreements became effective on or prior to June 30, 2024, as detailed in the table below. As of June 30, 2024, the effective portion of the Company's 2023 interest rate cap agreements have the economic effect of capping the Company's maximum exposure to SOFR variable interest rate changes on equivalent amounts of the Company's floating rate debt, including all of Term Loan B-1, Extended Term Loan B-1, and a portion of Term Loan A-1. The remaining $308,820 outstanding principal balance of Term Loan A-1 and $260,000 balance outstanding on the revolving line of credit are subject to SOFR-based interest rate volatility. These cap agreements are designated as cash flow hedges and, as a result, changes in their fair values are reported in other comprehensive income. The original premiums paid for the caps are amortized to debt expense on a straight-line basis over the term of each cap agreement starting from its effective date. These cap agreements do not contain credit risk-contingent features. In the second quarter of 2024 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 (2024 cap agreements). These 2024 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 2024 cap agreements do not contain credit-risk contingent features and become effective and expire as described in the table below. The following table summarizes the Company’s interest rate cap agreements outstanding as of June 30, 2024: Year cap agreements executed Notional amount SOFR maximum rate Approximate effective date Notional reduction or contractual maturity date 2024 (1) 2025 2026 2027 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 2024 $ 1,000,000 4.50% (5) 12/31/2025 $ 500,000 $ 500,000 (1) The Company's 2019 cap agreements matured 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. (5) Effective December 31, 2026, the maximum rate of 4.50% increases to 4.75% for these interest rate caps. The fair value of the Company's interest rate cap agreements, which are classified in other long-term assets on its consolidated balance sheet, was $51,223 and $79,805 as of June 30, 2024 and December 31, 2023, respectively. See Note 10 for further details on amounts reclassified from accumulated other comprehensive loss and recorded as debt expense (offset) related to the Company’s interest rate cap agreements for the three and six months ended June 30, 2024 and 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 the second quarter of 2024 was 4.62%, based on the current margins in effect for its senior secured credit facilities as of June 30, 2024, as detailed in the table above. The Company’s weighted average effective interest rate on all debt, including the effect of interest rate caps and amortization of debt discount, for the three and six months ended June 30, 2024 was 4.27% and 4.39% and as of June 30, 2024 was 4.33%. As of June 30, 2024, the Company’s interest rates were fixed and economically fixed on approximately 55% and 93% of its total debt, respectively. As of June 30, 2024, the Company had $1,240,000 available and $260,000 drawn on its $1,500,000 revolving line of credit under its senior secured credit facilities. Credit available under this revolving line of credit is reduced by the amount of any letters of credit outstanding under the facility, of which there were none as of June 30, 2024. The Company also had letters of credit of approximately $154,341 outstanding under a separate bilateral secured letter of credit facility as of June 30, 2024. |
Commitments and Contingencies
Commitments and Contingencies | 6 Months Ended |
Jun. 30, 2024 | |
Commitments and Contingencies Disclosure [Abstract] | |
Contingencies | Commitments and contingencies The Company operates in a highly regulated industry and is a party to various lawsuits, demands, claims, qui tam suits, governmental investigations (which frequently arise from qui tam suits) and audits (including, without limitation, investigations or other actions resulting from its obligation to self-report suspected violations of law) and other legal proceedings, including, without limitation, those described below. The Company records accruals for certain legal proceedings and regulatory matters to the extent that the Company determines an unfavorable outcome is probable and the amount of the loss can be reasonably estimated. As of June 30, 2024 and December 31, 2023, 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 included 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 Civil Investigative Demand (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. On May 6, 2024, the Company finalized and executed a settlement agreement with the government and the relator in a qui tam matter that included a settlement amount of $34,487 for this matter. On May 7, 2024, the government notified the U.S. District Court, District of Colorado of its decision to intervene for purposes of settlement in the matter of U.S. ex rel. Kogod v. DaVita Inc., et al . The government and the relator agreed to voluntarily dismiss all substantive claims in the matter, and, on July 18, 2024, the District Court dismissed all claims except for the relator’s statutory claim for expenses, attorney’s fees, and costs. The Company disputes the relator’s request for expenses, attorney’s fees, and costs, and intends to defend accordingly. 2020 U.S. Attorney New Jersey Investigation : In March 2020, the U.S. Attorney’s Office, District of New Jersey served the Company with a subpoena and a CID relating to an investigation being conducted by that office and the U.S. Attorney’s Office, Eastern District of Pennsylvania. The subpoena and CID request information on several topics, including certain of the Company’s joint venture arrangements with physicians and physician groups, medical director agreements, and compliance with its five-year Corporate Integrity Agreement, the term of which expired October 22, 2019. 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. 2024 Federal Trade Commission Investigation : In April 2024, the Company received from the Federal Trade Commission (FTC) two CIDs in connection with an industry investigation under Section 5 of the Federal Trade Commission Act regarding the acquisition of Medical Director services and provision of dialysis services. The CIDs cover the period from January 1, 2016 to the present and generally seek information relating to restrictive covenants, such as non-competes, with physicians. The Company is cooperating with the government in this investigation. * * * Although the Company cannot predict whether or when proceedings might be initiated or when these matters may be resolved (other than as may be described above), it is not unusual for inquiries such as these to continue for a considerable period of time through the various phases of document and witness requests and ongoing discussions with regulators and to develop over the course of time. In addition to the inquiries and proceedings specifically identified above, the Company frequently is subject to other inquiries by state or federal government agencies, many of which relate to qui tam complaints filed by relators. Negative findings or terms and conditions that the Company might agree to accept as part of a negotiated resolution of pending or future government inquiries or relator proceedings could result in, among other things, substantial financial penalties or awards against the Company, substantial payments made by the Company, harm to the Company’s reputation, required changes to the Company’s business practices, an impact on the Company's various relationships and/or contracts related to the Company's business, exclusion from future participation in the Medicare, Medicaid and other federal health care programs and, if criminal proceedings were initiated against the Company, members of its board of directors or management, possible criminal penalties, any of which could have a material adverse effect on the Company. Other Proceedings 2021 Antitrust Indictment and Putative Class Action Suit : On July 14, 2021, an indictment was returned by a grand jury in the U.S. District Court, District of Colorado against the Company and its former chief executive officer in the matter of U.S. v. DaVita Inc., et al. alleging that purported agreements entered into by DaVita's former chief executive officer not to solicit senior-level employees violated Section 1 of the Sherman Act. On April 15, 2022, a jury returned a verdict in the Company’s favor, acquitting both the Company and its former chief executive officer on all counts. On April 20, 2022, the court entered judgments of acquittal and closed the case. On August 9, 2021, DaVita Inc. and its former chief executive officer were added as defendants in a consolidated putative class action complaint in the matter of In re Outpatient Medical Center Employee Antitrust Litigation in the U.S. District Court, Northern District of Illinois. This class action complaint asserts that the defendants violated Section 1 of the Sherman Act and seeks to bring an action on behalf of certain groups of individuals employed by the Company between February 1, 2012 and January 5, 2021. On September 26, 2022, the court denied the Company's motion to dismiss. The Company disputes the allegations in the class action complaint, as well as the asserted violations of the Sherman Act, and intends to defend this action accordingly. Additionally, from time to time the Company is subject to other lawsuits, demands, claims, governmental investigations and audits and legal proceedings that arise due to the nature of its business, including, without limitation, contractual disputes, such as with payors, suppliers and others, employee-related matters and professional and general liability claims. From time to time, the Company also initiates litigation or other legal proceedings as a plaintiff arising out of contracts or other matters. * * * Other than as may be described above, the Company cannot predict the ultimate outcomes of the various legal proceedings and regulatory matters to which the Company is or may be subject from time to time, including those described in this Note 8, or the timing of their resolution or the ultimate losses or impact of developments in those matters, which could have a material adverse effect on the Company’s revenues, earnings and cash flows. Further, any legal proceedings or regulatory matters involving the Company, whether meritorious or not, are time consuming, and often require management’s attention and result in significant legal expense, and may result in the diversion of significant operational resources, may impact the Company's various relationships and/or contracts related to the Company's business or otherwise harm the Company’s business, results of operations, financial condition, cash flows or reputation. * * * |
Noncontrolling interests subject to put provisions and other commitments | Other Commitments The Company also has certain potential commitments to provide working capital funding, if necessary, to certain nonconsolidated dialysis businesses that the Company manages and in which the Company owns a noncontrolling equity interest or which are wholly-owned by third parties of approximately $7,992. |
Shareholders' equity
Shareholders' equity | 6 Months Ended |
Jun. 30, 2024 | |
Equity [Abstract] | |
Stock-based compensation | Shareholders' equity Stock-based compensation During the six months ended June 30, 2024, the Company granted 701 stock-settled restricted and performance stock units with an aggregate grant-date fair value of $96,954 and a weighted average expected life of approximately 3.4 years. As of June 30, 2024, the Company had $174,104 in total estimated but unrecognized stock-based compensation expense under the Company's equity compensation and employee stock purchase plans. The Company expects to recognize this expense over a weighted average remaining period of 1.4 years. |
Share repurchases | Share repurchases The following table summarizes the Company's common stock repurchases during the three and six months ended June 30, 2024: Three months ended June 30, 2024 Six months ended June 30, 2024 Shares repurchased Amount paid (1) Average price paid per share (2) Shares repurchased Amount paid (1) Average price paid per share (2) Open market repurchases: 2,655 $ 375,831 $ 140.14 4,774 $ 615,948 $ 127.98 (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. Subsequent to June 30, 2024 through August 2, 2024, the Company repurchased $1,134 shares of its common stock for $158,962 at an average price paid of $138.81 per share. The Company did not repurchase any shares during the three and six months ended June 30, 2023. As of June 30, 2024, 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 August 2, 2024, the Company has a total of $543,360, 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. |
Accumulated other comprehensive
Accumulated other comprehensive (loss) income | 6 Months Ended |
Jun. 30, 2024 | |
Statement of Comprehensive Income [Abstract] | |
Comprehensive income | Accumulated other comprehensive loss Three months ended June 30, 2024 Six months ended June 30, 2024 Interest Foreign Accumulated Interest Foreign Accumulated Beginning balance $ 19,542 $ (119,657) $ (100,115) $ 27,853 $ (79,937) $ (52,084) Unrealized gains (losses) 7,887 (78,853) (70,966) 25,632 (118,573) (92,941) Related income tax (1,968) — (1,968) (6,396) — (6,396) 5,919 (78,853) (72,934) 19,236 (118,573) (99,337) Reclassification into net income (29,368) — (29,368) (58,186) — (58,186) Related income tax 7,327 — 7,327 14,517 — 14,517 (22,041) — (22,041) (43,669) — (43,669) Ending balance $ 3,420 $ (198,510) $ (195,090) $ 3,420 $ (198,510) $ (195,090) Three months ended June 30, 2023 Six months ended June 30, 2023 Interest Foreign Accumulated Interest Foreign Accumulated Beginning balance $ 79,404 $ (134,310) $ (54,906) $ 98,685 $ (167,871) $ (69,186) Unrealized gains 33,109 41,961 75,070 28,393 75,522 103,915 Related income tax (8,260) — (8,260) (7,083) — (7,083) 24,849 41,961 66,810 21,310 75,522 96,832 Reclassification into net income (25,257) — (25,257) (46,232) — (46,232) Related income tax 6,301 — 6,301 11,534 — 11,534 (18,956) — (18,956) (34,698) — (34,698) Ending balance $ 85,297 $ (92,349) $ (7,052) $ 85,297 $ (92,349) $ (7,052) The interest rate cap agreement net realized gains reclassified into net income are recorded as debt expense in the corresponding consolidated statements of income. See Note 7 for further details. |
Acquisitions and divestitures
Acquisitions and divestitures | 6 Months Ended |
Jun. 30, 2024 | |
Business Combination, Asset Acquisition, and Joint Venture Formation [Abstract] | |
Acquisitions and divestitures | Acquisitions and divestitures During the six months ended June 30, 2024 the Company acquired dialysis businesses, as follows: Six months ended June 30, 2024 Cash paid, net of cash acquired $ 157,783 Liabilities assumed $ 51,768 Fair value of previously held equity method investments $ 67,526 Number of dialysis centers acquired — U.S. 12 Number of dialysis centers acquired — International 90 Included in these transactions, the Company acquired a controlling interest in a previously nonconsolidated U.S. dialysis partnership for which it recognized a non-cash gain of $35,147 on its prior investment upon consolidation. The Company estimated the fair value of its previously held equity interests using appraisals developed with independent third party valuation firms. 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 acquisitions have been recorded at estimated fair values based on information that was available to management and will be finalized when certain information arranged to be obtained is received. In particular, certain income tax amounts are pending final evaluation and quantification of any pre-acquisition tax contingencies. In addition, valuation of intangibles, contingent earn-outs, property and equipment, leases, and certain other working capital items relating to 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: Six months ended June 30, 2024 Current assets $ 149,308 Property and equipment 46,473 Right-of-use lease assets and other long-term assets 51,300 Indefinite-lived licenses 8,854 Goodwill 137,817 Liabilities assumed (96,417) Noncontrolling interests assumed (20,258) $ 277,077 The amount of goodwill related to these acquisitions recognized or adjusted during the six months ended June 30, 2024 that is deductible for tax purposes was $60,065. |
Variable interest entities
Variable interest entities | 6 Months Ended |
Jun. 30, 2024 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Variable interest entities | Variable interest entities (VIEs) At June 30, 2024, these condensed consolidated financial statements include total assets of VIEs of $343,772 and total liabilities and noncontrolling interests of VIEs to third parties of $157,627. There have been no material changes in the nature of the Company's arrangements with VIEs or its judgments concerning them from those described in Note 22 to the Company's consolidated financial statements included in the 2023 10-K. |
Fair value of financial instrum
Fair value of financial instruments | 6 Months Ended |
Jun. 30, 2024 | |
Fair Value Disclosures [Abstract] | |
Fair value of financial instruments | Fair values of financial instruments The Company measures the fair value of certain assets, liabilities and noncontrolling interests subject to put provisions (redeemable equity interests classified as temporary equity) based upon certain valuation techniques that include observable or unobservable inputs and assumptions that market participants would use in pricing these assets, liabilities, temporary equity and commitments. The Company has also classified assets, liabilities and temporary equities that are measured at fair value on a recurring basis into the appropriate fair value hierarchy levels as defined by the Financial Accounting Standards Board (FASB). The following table summarizes the Company’s assets, liabilities and temporary equities measured at fair value on a recurring basis as of June 30, 2024: Total Quoted prices in Significant other Significant Assets Investments in equity securities $ 37,179 $ 37,179 Interest rate cap agreements $ 51,223 $ 51,223 Liabilities Contingent earn-out obligations for acquisitions $ 17,898 $ 17,898 Temporary equity Noncontrolling interests subject to put provisions $ 1,574,840 $ 1,574,840 Investments in equity securities represent investments in various open-ended registered investment companies (mutual funds) and common stocks and are recorded at fair value estimated based on reported market prices or redemption prices, as applicable. See Note 4 for further discussion. Interest rate cap agreements are recorded at fair value estimated from valuation models utilizing the income approach and commonly accepted valuation techniques that use inputs from closing prices for similar assets and liabilities in active markets as well as other relevant observable market inputs at quoted intervals such as current interest rates, forward yield curves, implied volatility and credit default swap pricing. The Company does not believe the ultimate amount that could be realized upon settlement of these interest rate cap agreements would be materially different from the fair value estimates currently reported. See Note 7 for further discussion. As of June 30, 2024, the Company had contingent earn-out obligations associated with business acquisitions that could result in the Company paying the former owners a total of up to approximately $53,279 if certain performance targets or quality margins are met over the next one year to four years. The estimated fair value measurements of these contingent earn-out obligations are primarily based on unobservable inputs, including key financial metrics such as projected earnings before interest, taxes, depreciation, and amortization (EBITDA), revenue and other key performance indicators. The estimated fair values of these contingent earn-out obligations are remeasured as of each reporting date and could fluctuate based upon any significant changes in key assumptions, such as changes in the Company's credit risk adjusted rate that is used to discount obligations to present value. The estimated fair value of noncontrolling interests subject to put provisions is based principally on the higher of either estimated liquidation value of net assets or a multiple of earnings for each subject dialysis partnership, based on historical earnings, revenue mix, and other performance indicators that can affect future results. The multiples used for these valuations are derived from observed ownership transactions for dialysis businesses between unrelated parties in the U.S. in recent years, and the specific valuation multiple applied to each dialysis partnership is principally determined by its recent and expected revenue mix and contribution margin. As of June 30, 2024, 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 $205,000. See Notes 16 and 23 to the Company's consolidated financial statements included in the 2023 10-K for further discussion of the Company’s methodology for estimating the fair value of noncontrolling interests subject to put obligations. For a reconciliation of changes in noncontrolling interests subject to put provisions for the three and six months ended June 30, 2024, see the consolidated statement 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 7 for further discussion of the Company's debt. The book value of the Company's contingent consideration payable to Medtronic, Inc. for its interest in Mozarc Medical Holdings LLC approximates its estimated fair value, which is based on level 3 inputs. Other financial instruments consist primarily of cash and cash equivalents, restricted cash and cash equivalents, accounts receivable, accounts payable, other accrued liabilities, lease liabilities and debt. The balances of financial instruments other than debt and lease liabilities are presented in these condensed consolidated financial statements at June 30, 2024 at their approximate fair values due to the short-term nature of their settlements. |
Segment reporting
Segment reporting | 6 Months Ended |
Jun. 30, 2024 | |
Segment Reporting [Abstract] | |
Segment Reporting Disclosure | 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. 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 the Asia Pacific joint venture (APAC JV). The U.S. dialysis and related lab services business qualifies as a separately reportable segment, and all other operating segments have been combined and disclosed in the other segments category. See Note 24 to the Company's consolidated financial statements included in the 2023 10-K for further description of how the Company determines and measures results for its operating segments. The following is a summary of segment revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income before income taxes: Three months ended June 30, Six months ended June 30, 2024 2023 2024 2023 Segment revenues: U.S. dialysis Dialysis patient service revenues: External sources $ 2,822,187 $ 2,703,850 $ 5,547,761 $ 5,287,782 Intersegment revenues 12,925 20,361 37,389 42,410 U.S. dialysis patient service revenues 2,835,112 2,724,211 5,585,150 5,330,192 Other revenues: External sources 5,898 6,404 12,021 12,583 Total U.S. dialysis revenues 2,841,010 2,730,615 5,597,171 5,342,775 Other—Ancillary services Dialysis patient service revenues 238,915 186,835 454,873 362,937 Other external sources 119,722 103,280 242,622 209,766 Intersegment revenues 3,823 1,408 6,570 2,774 Total ancillary services revenues 362,460 291,523 704,065 575,477 Total net segment revenues 3,203,470 3,022,138 6,301,236 5,918,252 Elimination of intersegment revenues (16,748) (21,769) (43,959) (45,184) Consolidated revenues $ 3,186,722 $ 3,000,369 $ 6,257,277 $ 5,873,068 Segment operating margin (loss): U.S. dialysis $ 550,186 $ 460,759 $ 1,075,923 $ 821,857 Other—Ancillary services (18,592) (21,604) (30,094) (46,469) Total segment operating margin 531,594 439,155 1,045,829 775,388 Reconciliation of segment operating income to consolidated Corporate administrative support (25,196) (33,864) (55,586) (58,452) Consolidated operating income 506,398 405,291 990,243 716,936 Debt expense (97,747) (103,507) (197,165) (204,281) Debt prepayment, extinguishment and modification costs (9,732) (7,962) (9,732) (7,962) Other (loss) income, net (27,479) 1,373 (40,120) 5,125 Consolidated income before income taxes $ 371,440 $ 295,195 $ 743,226 $ 509,818 Depreciation and amortization expense by reportable segment was as follows: Three months ended June 30, Six months ended June 30, 2024 2023 2024 2023 U.S. dialysis $ 160,410 $ 171,842 $ 333,262 $ 338,803 Other—Ancillary services 15,251 11,830 29,482 22,940 $ 175,661 $ 183,672 $ 362,744 $ 361,743 Expenditures for property and equipment by reportable segment were as follows: Six months ended June 30, 2024 2023 U.S. dialysis $ 211,171 $ 240,474 Other—Ancillary services 34,569 31,730 $ 245,740 $ 272,204 |
New accounting standards
New accounting standards | 6 Months Ended |
Jun. 30, 2024 | |
Accounting Changes and Error Corrections [Abstract] | |
New Accounting Standards | New accounting standards 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, and interim periods within fiscal years beginning after December 15, 2024, with early adoption permitted. The Company has completed its initial assessment of the impact of this new guidance and does not expect it to have a material impact on the Company's 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 statement disclosures. |
Pay vs Performance Disclosure
Pay vs Performance Disclosure - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2024 | Jun. 30, 2023 | Jun. 30, 2024 | Jun. 30, 2023 | |
Pay vs Performance Disclosure | ||||
Net Income (Loss) | $ 222,676 | $ 178,691 | $ 462,325 | $ 294,238 |
Insider Trading Arrangements
Insider Trading Arrangements | 6 Months Ended |
Jun. 30, 2024 | |
Trading Arrangements, by Individual | |
Rule 10b5-1 Arrangement Adopted | false |
Non-Rule 10b5-1 Arrangement Adopted | false |
Rule 10b5-1 Arrangement Terminated | false |
Non-Rule 10b5-1 Arrangement Terminated | false |
Condensed consolidated interi_2
Condensed consolidated interim financial statements Condensed consolidaed interim financial statements (Policies) | 6 Months Ended |
Jun. 30, 2024 | |
Accounting Policies [Abstract] | |
Condensed consolidated interim financial statements | Condensed consolidated interim financial statements The unaudited condensed consolidated interim financial statements included in this report are prepared by the Company. In the opinion of management, all adjustments necessary for a fair presentation of the results of operations are reflected in these condensed consolidated interim financial statements. All significant intercompany accounts and transactions have been eliminated. The preparation of these financial statements requires management to make estimates and assumptions that affect the reported amounts of revenues, expenses, assets, liabilities, contingencies, and noncontrolling interests subject to put provisions. The most significant estimates and assumptions underlying these financial statements and accompanying notes generally involve revenue recognition and accounts receivable, certain fair value estimates, accounting for income taxes, and loss contingencies. The results of operations reflected in these interim financial statements may not necessarily be indicative of annual operating results. These condensed consolidated interim financial statements should be read in conjunction with the audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2023 (2023 10-K). Prior period classifications conform to the current period presentation. |
Revenue | There are significant uncertainties associated with estimating revenue, many of which take several years to resolve. These estimates are subject to ongoing insurance coverage changes, geographic coverage differences, differing interpretations of contract coverage and other payor issues, as well as patient issues, including determination of applicable primary and secondary coverage, changes in patient insurance coverage and coordination of benefits. As these estimates are refined over time, both positive and negative adjustments to revenue are recognized in the current period. Dialysis patient service revenues. Revenues are recognized based on the Company’s estimate of the transaction price the Company expects to collect as a result of satisfying its performance obligations. Dialysis patient service revenues are recognized in the period services are provided based on these estimates. Revenues consist primarily of payments from government and commercial health plans for dialysis services provided to patients. Other revenues. Other revenues consist of revenues earned by the Company's non-dialysis ancillary services as well as fees for management and administrative services to outpatient dialysis businesses that the Company does not consolidate. Other revenues are estimated and recognized in the period the performance obligation is met, subject to applicable measurement constraints. The Company's integrated kidney care (IKC) revenues include revenues earned under risk-based arrangements, including value-based care (VBC) arrangements. Under its VBC arrangements, the Company assumes full or shared financial risk for the total medical cost of care for patients below or above a benchmark. The benchmarks against which the Company incurs profit or loss on these contracts are typically based on the underlying premiums paid to the insuring entity (the Company's counterparty), with adjustments where applicable, or on trended or adjusted medical cost targets. For its IKC business, the Company recognized revenues for performance obligations satisfied in previous years of $31,309 and $23,303 during the six months ended June 30, 2024 and 2023, respectively. The delay in recognition of these amounts resulted predominantly from measurement limitations and recognition constraints on the Company's 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 constrained for plan year 2023. 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. |
Earnings Per Share | Basic earnings per share is calculated by dividing net income attributable to the Company by the weighted average number of common shares outstanding. Weighted average common shares outstanding include restricted stock unit awards that are no longer subject to forfeiture because the recipients have satisfied either the explicit vesting terms or retirement eligibility requirements. Diluted earnings per share includes the dilutive effect of outstanding stock-settled stock appreciation rights and unvested stock units as computed under the treasury stock method. |
Short-term and Long-term Investments | Debt securities. The Company's short-term debt investments are principally bank certificates of deposit with contractual maturities longer than three months but shorter than one year. The Company's long-term debt investments are bank time deposits with contractual maturities longer than one year. These debt securities are accounted for as held-to-maturity and recorded at amortized cost, which approximated their fair values at June 30, 2024 and December 31, 2023. Equity securitie s. 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. |
Long-term debt | These cap agreements are designated as cash flow hedges and, as a result, changes in their fair values are reported in other comprehensive income. The original premiums paid for the caps are amortized to debt expense on a straight-line basis over the term of each cap agreement starting from its effective date. These cap agreements do not contain credit risk-contingent features. In the second quarter of 2024 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 (2024 cap agreements). These 2024 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 2024 cap agreements do not contain credit-risk contingent features and become effective and expire as described in the table below. |
Fair Value of Financial Instruments | Interest rate cap agreements are recorded at fair value estimated from valuation models utilizing the income approach and commonly accepted valuation techniques that use inputs from closing prices for similar assets and liabilities in active markets as well as other relevant observable market inputs at quoted intervals such as current interest rates, forward yield curves, implied volatility and credit default swap pricing. The Company does not believe the ultimate amount that could be realized upon settlement of these interest rate cap agreements would be materially different from the fair value estimates currently reported. See Note 7 for further discussion. As of June 30, 2024, the Company had contingent earn-out obligations associated with business acquisitions that could result in the Company paying the former owners a total of up to approximately $53,279 if certain performance targets or quality margins are met over the next one year to four years. The estimated fair value measurements of these contingent earn-out obligations are primarily based on unobservable inputs, including key financial metrics such as projected earnings before interest, taxes, depreciation, and amortization (EBITDA), revenue and other key performance indicators. The estimated fair values of these contingent earn-out obligations are remeasured as of each reporting date and could fluctuate based upon any significant changes in key assumptions, such as changes in the Company's credit risk adjusted rate that is used to discount obligations to present value. |
New Accounting Standards | New accounting standards 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, and interim periods within fiscal years beginning after December 15, 2024, with early adoption permitted. The Company has completed its initial assessment of the impact of this new guidance and does not expect it to have a material impact on the Company's 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 statement disclosures. |
Fair Value Measures and Disclos
Fair Value Measures and Disclosures (Policies) | 6 Months Ended |
Jun. 30, 2024 | |
Fair Value Disclosures [Abstract] | |
Fair Value of Financial Instruments | Interest rate cap agreements are recorded at fair value estimated from valuation models utilizing the income approach and commonly accepted valuation techniques that use inputs from closing prices for similar assets and liabilities in active markets as well as other relevant observable market inputs at quoted intervals such as current interest rates, forward yield curves, implied volatility and credit default swap pricing. The Company does not believe the ultimate amount that could be realized upon settlement of these interest rate cap agreements would be materially different from the fair value estimates currently reported. See Note 7 for further discussion. As of June 30, 2024, the Company had contingent earn-out obligations associated with business acquisitions that could result in the Company paying the former owners a total of up to approximately $53,279 if certain performance targets or quality margins are met over the next one year to four years. The estimated fair value measurements of these contingent earn-out obligations are primarily based on unobservable inputs, including key financial metrics such as projected earnings before interest, taxes, depreciation, and amortization (EBITDA), revenue and other key performance indicators. The estimated fair values of these contingent earn-out obligations are remeasured as of each reporting date and could fluctuate based upon any significant changes in key assumptions, such as changes in the Company's credit risk adjusted rate that is used to discount obligations to present value. |
Revenue Recognition Segment rev
Revenue Recognition Segment revenue by major payor (Tables) | 6 Months Ended |
Jun. 30, 2024 | |
Revenues by major payor [Abstract] | |
Disaggregation of Revenue [Table Text Block] | The following tables summarize the Company's segment revenues by primary payor source: Three months ended June 30, 2024 Three months ended June 30, 2023 U.S. dialysis Other — Ancillary services Consolidated U.S. dialysis Other — Ancillary services Consolidated Dialysis patient service revenues: Medicare and Medicare Advantage $ 1,587,198 $ $ 1,587,198 $ 1,539,639 $ $ 1,539,639 Medicaid and Managed Medicaid 214,951 214,951 216,014 216,014 Other government 80,338 176,524 256,862 92,525 125,964 218,489 Commercial 952,625 62,391 1,015,016 876,033 60,871 936,904 Other revenues: Medicare and Medicare Advantage 97,433 97,433 87,236 87,236 Medicaid and Managed Medicaid 445 445 396 396 Commercial 10,200 10,200 3,619 3,619 Other (1) 5,898 15,467 21,365 6,404 13,437 19,841 Eliminations of intersegment revenues (12,925) (3,823) (16,748) (20,361) (1,408) (21,769) Total $ 2,828,085 $ 358,637 $ 3,186,722 $ 2,710,254 $ 290,115 $ 3,000,369 Six months ended June 30, 2024 Six months ended June 30, 2023 U.S. dialysis Other - Ancillary services Consolidated U.S. dialysis Other - Ancillary services Consolidated Dialysis patient service revenues: Medicare and Medicare Advantage $ 3,118,696 $ $ 3,118,696 $ 3,022,405 $ $ 3,022,405 Medicaid and Managed Medicaid 425,075 425,075 421,790 421,790 Other government 162,924 322,309 485,233 174,570 247,550 422,120 Commercial 1,878,455 132,564 2,011,019 1,711,427 115,387 1,826,814 Other revenues: Medicare and Medicare Advantage 200,542 200,542 180,475 180,475 Medicaid and Managed Medicaid 841 841 965 965 Commercial 17,140 17,140 4,825 4,825 Other (1) 12,021 30,669 42,690 12,583 26,275 38,858 Eliminations of intersegment revenues (37,389) (6,570) (43,959) (42,410) (2,774) (45,184) Total $ 5,559,782 $ 697,495 $ 6,257,277 $ 5,300,365 $ 572,703 $ 5,873,068 (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 Earnings Per
Earnings per share Earnings Per Share (Tables) | 6 Months Ended |
Jun. 30, 2024 | |
Earnings Per Share [Abstract] | |
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block] | The reconciliations of the numerators and denominators used to calculate basic and diluted earnings per share were as follows: Three months ended June 30, Six months ended June 30, 2024 2023 2024 2023 Net income attributable to DaVita Inc. $ 222,676 $ 178,691 $ 462,325 $ 294,238 Weighted average shares outstanding: Basic shares 86,899 90,984 87,337 90,742 Assumed incremental from stock plans 2,051 2,434 2,412 2,210 Diluted shares 88,950 93,418 89,749 92,952 Basic net income per share attributable to DaVita Inc. $ 2.56 $ 1.96 $ 5.29 $ 3.24 Diluted net income per share attributable to DaVita Inc. $ 2.50 $ 1.91 $ 5.15 $ 3.17 Anti-dilutive stock-settled awards excluded from calculation (1) 4 280 197 787 (1) Shares associated with stock awards excluded from the diluted denominator calculation because they were anti-dilutive under the treasury stock method. |
Investments in debt and equit_2
Investments in debt and equity securities (Tables) | 6 Months Ended |
Jun. 30, 2024 | |
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: June 30, 2024 December 31, 2023 Debt Equity Total Debt Equity Total Certificates of deposit and other time deposits $ 15,293 $ — $ 15,293 $ 22,109 $ — $ 22,109 Investments in mutual funds and common stocks — 37,179 37,179 — 37,391 37,391 $ 15,293 $ 37,179 $ 52,472 $ 22,109 $ 37,391 $ 59,500 Short-term investments $ 15,293 $ 5,400 $ 20,693 $ 7,110 $ 4,500 $ 11,610 Long-term investments — 31,779 31,779 14,999 32,891 47,890 $ 15,293 $ 37,179 $ 52,472 $ 22,109 $ 37,391 $ 59,500 |
Goodwill (Tables)
Goodwill (Tables) | 6 Months Ended |
Jun. 30, 2024 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Changes in Goodwill by Reportable Segments [Text Block] | Changes in the carrying value of goodwill by reportable segment were as follows: U.S. dialysis Other — Ancillary services Consolidated Balance at December 31, 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 Acquisitions 102,082 35,735 137,817 Divestitures (1,687) — (1,687) Foreign currency and other adjustments — (47,291) (47,291) Balance at June 30, 2024 $ 6,517,220 $ 684,179 $ 7,201,399 Balance at June 30, 2024: Goodwill $ 6,517,220 $ 829,684 $ 7,346,904 Accumulated impairment charges — (145,505) (145,505) $ 6,517,220 $ 684,179 $ 7,201,399 |
Equity Method and Other Inves_2
Equity Method and Other Investments Equity Method and Other Investments (Tables) | 6 Months Ended |
Jun. 30, 2024 | |
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: June 30, 2024 December 31, 2023 Mozarc Medical Holding LLC $ 265,303 $ 324,711 APAC joint venture 67,241 98,865 Other equity method partnerships 104,355 107,282 Adjusted cost method and other investments 16,810 14,990 $ 453,709 $ 545,848 |
Long-term debt (Tables)
Long-term debt (Tables) | 6 Months Ended |
Jun. 30, 2024 | |
Debt Disclosure [Abstract] | |
Long-term Debt | Long-term debt comprised the following: As of June 30, 2024 June 30, December 31, 2023 Maturity date Interest rate Estimated fair value (1) Senior Secured Credit Facilities: Term Loan A-1 $ 1,218,750 $ 1,234,375 (2) Base +1.75% (3) $ 1,212,656 Term Loan B-1 949,819 2,603,786 8/12/2026 Base +1.75% (3) $ 949,819 Extended Term Loan B-1 1,640,251 5/9/2031 SOFR + 2.00% $ 1,636,150 Revolving line of credit 260,000 — (2) Base +1.75% (3) $ 260,000 Senior Notes: 4.625% Senior Notes 2,750,000 2,750,000 6/1/2030 4.625 % $ 2,488,750 3.75% Senior Notes 1,500,000 1,500,000 2/15/2031 3.75 % $ 1,280,625 Acquisition obligations and other notes payable (4) 92,129 102,328 2024-2036 6.73 % $ 92,129 Financing lease obligations (5) 244,262 255,491 2025-2040 4.63 % CHC temporary funding assistance (6) 392,984 — % $ 392,984 Total debt principal outstanding 9,048,195 8,445,980 Discount, premium and deferred financing costs (7) (58,642) (54,347) 8,989,553 8,391,633 Less current portion (537,991) (123,299) $ 8,451,562 $ 8,268,334 (1) For the Company's senior secured credit facilities, fair value estimates are based on bid and ask quotes, a level 2 input. For the Company's 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. For the CHC temporary funding assistance, the carrying value presented here approximates the estimated fair value based on the short-term nature of settlement. (2) Outstanding Term Loan A-1 and the 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 Revolving line of credit balances become due at that 91 day date (May 13, 2026). (3) The Company's senior secured credit facilities bear interest at Term SOFR, plus an interest rate margin, with certain portions also subject to a credit spread adjustment (CSA). Term SOFR plus CSA is referred to as "Base" in the table above. The Term Loan A-1 and revolving line of credit bear a CSA of 0.10%. As of June 30, 2024, the CSA for all tranches outstanding on the Company's Term Loan B-1 was 0.11%. (4) The interest rate presented for acquisition obligations and other notes payable is their weighted average interest rate based on the current fixed and variable interest rate components in effect as of June 30, 2024. (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) The Change Healthcare (CHC) temporary funding assistance, as described below, is interest-free and amounts provided under this program are subject to repayment within 45 business days from a future date to be mutually agreed to by the parties. The balance is included in the Company's current portion of long-term debt as of June 30, 2024. (7) As of June 30, 2024, the carrying amount of the Company's senior secured credit facilities has been reduced by a discount of $9,433 and deferred financing costs of $31,257, and the carrying amount of the Company's senior notes has been reduced by deferred financing costs of $29,136 and increased by a debt premium of $11,184. As of December 31, 2023, the carrying amount of the Company's senior secured credit facilities was reduced by a discount of $2,487 and deferred financing costs of $32,498, and the carrying amount of the Company's senior notes was reduced by deferred financing costs of $31,491 and increased by a debt premium of $12,129. |
Schedule of Derivative Instruments | The following table summarizes the Company’s interest rate cap agreements outstanding as of June 30, 2024: Year cap agreements executed Notional amount SOFR maximum rate Approximate effective date Notional reduction or contractual maturity date 2024 (1) 2025 2026 2027 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 2024 $ 1,000,000 4.50% (5) 12/31/2025 $ 500,000 $ 500,000 (1) The Company's 2019 cap agreements matured 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. (5) Effective December 31, 2026, the maximum rate of 4.50% increases to 4.75% for these interest rate caps. |
Accumulated other comprehensi_2
Accumulated other comprehensive (loss) income (Tables) | 6 Months Ended |
Jun. 30, 2024 | |
Statement of Comprehensive Income [Abstract] | |
Comprehensive income | Three months ended June 30, 2024 Six months ended June 30, 2024 Interest Foreign Accumulated Interest Foreign Accumulated Beginning balance $ 19,542 $ (119,657) $ (100,115) $ 27,853 $ (79,937) $ (52,084) Unrealized gains (losses) 7,887 (78,853) (70,966) 25,632 (118,573) (92,941) Related income tax (1,968) — (1,968) (6,396) — (6,396) 5,919 (78,853) (72,934) 19,236 (118,573) (99,337) Reclassification into net income (29,368) — (29,368) (58,186) — (58,186) Related income tax 7,327 — 7,327 14,517 — 14,517 (22,041) — (22,041) (43,669) — (43,669) Ending balance $ 3,420 $ (198,510) $ (195,090) $ 3,420 $ (198,510) $ (195,090) Three months ended June 30, 2023 Six months ended June 30, 2023 Interest Foreign Accumulated Interest Foreign Accumulated Beginning balance $ 79,404 $ (134,310) $ (54,906) $ 98,685 $ (167,871) $ (69,186) Unrealized gains 33,109 41,961 75,070 28,393 75,522 103,915 Related income tax (8,260) — (8,260) (7,083) — (7,083) 24,849 41,961 66,810 21,310 75,522 96,832 Reclassification into net income (25,257) — (25,257) (46,232) — (46,232) Related income tax 6,301 — 6,301 11,534 — 11,534 (18,956) — (18,956) (34,698) — (34,698) Ending balance $ 85,297 $ (92,349) $ (7,052) $ 85,297 $ (92,349) $ (7,052) |
Acquisitions and Divestitures (
Acquisitions and Divestitures (Tables) | 6 Months Ended |
Jun. 30, 2024 | |
Business Combination, Asset Acquisition, and Joint Venture Formation [Abstract] | |
Schedule of Noncash or Part Noncash Acquisitions | During the six months ended June 30, 2024 the Company acquired dialysis businesses, as follows: Six months ended June 30, 2024 Cash paid, net of cash acquired $ 157,783 Liabilities assumed $ 51,768 Fair value of previously held equity method investments $ 67,526 Number of dialysis centers acquired — U.S. 12 Number of dialysis centers acquired — International 90 |
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed [Table Text Block] | The following table summarizes the assets acquired and liabilities assumed in these transactions and recognized at their acquisition dates at estimated fair values, as well as the estimated fair value of noncontrolling interests assumed in these transactions: Six months ended June 30, 2024 Current assets $ 149,308 Property and equipment 46,473 Right-of-use lease assets and other long-term assets 51,300 Indefinite-lived licenses 8,854 Goodwill 137,817 Liabilities assumed (96,417) Noncontrolling interests assumed (20,258) $ 277,077 |
Fair value of financial instr_2
Fair value of financial instruments (Tables) | 6 Months Ended |
Jun. 30, 2024 | |
Fair Value Disclosures [Abstract] | |
Assets, Liabilities and Temporary Equity Measured at Fair Value on a Recurring Basis | The following table summarizes the Company’s assets, liabilities and temporary equities measured at fair value on a recurring basis as of June 30, 2024: Total Quoted prices in Significant other Significant Assets Investments in equity securities $ 37,179 $ 37,179 Interest rate cap agreements $ 51,223 $ 51,223 Liabilities Contingent earn-out obligations for acquisitions $ 17,898 $ 17,898 Temporary equity Noncontrolling interests subject to put provisions $ 1,574,840 $ 1,574,840 |
Segment reporting (Tables)
Segment reporting (Tables) | 6 Months Ended |
Jun. 30, 2024 | |
Segment Reporting [Abstract] | |
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes | The following is a summary of segment revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income before income taxes: Three months ended June 30, Six months ended June 30, 2024 2023 2024 2023 Segment revenues: U.S. dialysis Dialysis patient service revenues: External sources $ 2,822,187 $ 2,703,850 $ 5,547,761 $ 5,287,782 Intersegment revenues 12,925 20,361 37,389 42,410 U.S. dialysis patient service revenues 2,835,112 2,724,211 5,585,150 5,330,192 Other revenues: External sources 5,898 6,404 12,021 12,583 Total U.S. dialysis revenues 2,841,010 2,730,615 5,597,171 5,342,775 Other—Ancillary services Dialysis patient service revenues 238,915 186,835 454,873 362,937 Other external sources 119,722 103,280 242,622 209,766 Intersegment revenues 3,823 1,408 6,570 2,774 Total ancillary services revenues 362,460 291,523 704,065 575,477 Total net segment revenues 3,203,470 3,022,138 6,301,236 5,918,252 Elimination of intersegment revenues (16,748) (21,769) (43,959) (45,184) Consolidated revenues $ 3,186,722 $ 3,000,369 $ 6,257,277 $ 5,873,068 Segment operating margin (loss): U.S. dialysis $ 550,186 $ 460,759 $ 1,075,923 $ 821,857 Other—Ancillary services (18,592) (21,604) (30,094) (46,469) Total segment operating margin 531,594 439,155 1,045,829 775,388 Reconciliation of segment operating income to consolidated Corporate administrative support (25,196) (33,864) (55,586) (58,452) Consolidated operating income 506,398 405,291 990,243 716,936 Debt expense (97,747) (103,507) (197,165) (204,281) Debt prepayment, extinguishment and modification costs (9,732) (7,962) (9,732) (7,962) Other (loss) income, net (27,479) 1,373 (40,120) 5,125 Consolidated income before income taxes $ 371,440 $ 295,195 $ 743,226 $ 509,818 |
Summary of Depreciation and Amortization Expense by Reportable Segment | Depreciation and amortization expense by reportable segment was as follows: Three months ended June 30, Six months ended June 30, 2024 2023 2024 2023 U.S. dialysis $ 160,410 $ 171,842 $ 333,262 $ 338,803 Other—Ancillary services 15,251 11,830 29,482 22,940 $ 175,661 $ 183,672 $ 362,744 $ 361,743 |
Summary of Expenditures for Property and Equipment by Reportable Segment | Expenditures for property and equipment by reportable segment were as follows: Six months ended June 30, 2024 2023 U.S. dialysis $ 211,171 $ 240,474 Other—Ancillary services 34,569 31,730 $ 245,740 $ 272,204 |
Revenue Recognition Segment R_2
Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2024 | Jun. 30, 2023 | Jun. 30, 2024 | Jun. 30, 2023 | |
Disaggregation of Revenue [Line Items] | ||||
Other revenues | $ 125,620 | $ 109,684 | $ 254,643 | $ 222,349 |
Total revenues | 3,186,722 | 3,000,369 | 6,257,277 | 5,873,068 |
Contract with Customer, Performance Obligation Satisfied in Previous Period | 31,309 | 23,303 | ||
Elimination of intersegment revenues | ||||
Disaggregation of Revenue [Line Items] | ||||
Total revenues | (16,748) | (21,769) | (43,959) | (45,184) |
Medicare and Medicare Advantage | ||||
Disaggregation of Revenue [Line Items] | ||||
Dialysis patient service revenues | 1,587,198 | 1,539,639 | 3,118,696 | 3,022,405 |
Other revenues | 97,433 | 87,236 | 200,542 | 180,475 |
Medicaid and Managed Medicaid | ||||
Disaggregation of Revenue [Line Items] | ||||
Dialysis patient service revenues | 214,951 | 216,014 | 425,075 | 421,790 |
Other revenues | 445 | 396 | 841 | 965 |
Other Government Payors | ||||
Disaggregation of Revenue [Line Items] | ||||
Dialysis patient service revenues | 256,862 | 218,489 | 485,233 | 422,120 |
Commercial Payors | ||||
Disaggregation of Revenue [Line Items] | ||||
Dialysis patient service revenues | 1,015,016 | 936,904 | 2,011,019 | 1,826,814 |
Other revenues | 10,200 | 3,619 | 17,140 | 4,825 |
Other | ||||
Disaggregation of Revenue [Line Items] | ||||
Other revenues | 21,365 | 19,841 | 42,690 | 38,858 |
U.S. dialysis | ||||
Disaggregation of Revenue [Line Items] | ||||
Total revenues | 2,828,085 | 2,710,254 | 5,559,782 | 5,300,365 |
U.S. dialysis | Elimination of intersegment revenues | ||||
Disaggregation of Revenue [Line Items] | ||||
Total revenues | (12,925) | (20,361) | (37,389) | (42,410) |
U.S. dialysis | Medicare and Medicare Advantage | ||||
Disaggregation of Revenue [Line Items] | ||||
Dialysis patient service revenues | 1,587,198 | 1,539,639 | 3,118,696 | 3,022,405 |
U.S. dialysis | Medicaid and Managed Medicaid | ||||
Disaggregation of Revenue [Line Items] | ||||
Dialysis patient service revenues | 214,951 | 216,014 | 425,075 | 421,790 |
U.S. dialysis | Other Government Payors | ||||
Disaggregation of Revenue [Line Items] | ||||
Dialysis patient service revenues | 80,338 | 92,525 | 162,924 | 174,570 |
U.S. dialysis | Commercial Payors | ||||
Disaggregation of Revenue [Line Items] | ||||
Dialysis patient service revenues | 952,625 | 876,033 | 1,878,455 | 1,711,427 |
U.S. dialysis | Other | ||||
Disaggregation of Revenue [Line Items] | ||||
Other revenues | 5,898 | 6,404 | 12,021 | 12,583 |
Other—Ancillary services | ||||
Disaggregation of Revenue [Line Items] | ||||
Total revenues | 358,637 | 290,115 | 697,495 | 572,703 |
Other—Ancillary services | Elimination of intersegment revenues | ||||
Disaggregation of Revenue [Line Items] | ||||
Total revenues | (3,823) | (1,408) | (6,570) | (2,774) |
Other—Ancillary services | Medicare and Medicare Advantage | ||||
Disaggregation of Revenue [Line Items] | ||||
Other revenues | 97,433 | 87,236 | 200,542 | 180,475 |
Other—Ancillary services | Medicaid and Managed Medicaid | ||||
Disaggregation of Revenue [Line Items] | ||||
Other revenues | 445 | 396 | 841 | 965 |
Other—Ancillary services | Other Government Payors | ||||
Disaggregation of Revenue [Line Items] | ||||
Dialysis patient service revenues | 176,524 | 125,964 | 322,309 | 247,550 |
Other—Ancillary services | Commercial Payors | ||||
Disaggregation of Revenue [Line Items] | ||||
Dialysis patient service revenues | 62,391 | 60,871 | 132,564 | 115,387 |
Other revenues | 10,200 | 3,619 | 17,140 | 4,825 |
Other—Ancillary services | Other | ||||
Disaggregation of Revenue [Line Items] | ||||
Other revenues | $ 15,467 | $ 13,437 | $ 30,669 | $ 26,275 |
Earnings per share Earnings p_2
Earnings per share Earnings per share - Reconciliation of numerators and denominators used to calculate basic and diluted earnings per share (Details) - USD ($) $ / shares in Units, $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2024 | Jun. 30, 2023 | Jun. 30, 2024 | Jun. 30, 2023 | |
Numerators: | ||||
Net income attributable to DaVita Inc. | $ 222,676 | $ 178,691 | $ 462,325 | $ 294,238 |
Weighted average basic shares outstanding during period | 86,899,000 | 90,984,000 | 87,337,000 | 90,742,000 |
Assumed incremental from stock plans | 2,051,000 | 2,434,000 | 2,412,000 | 2,210,000 |
Weighted average diluted shares outstanding during period | 88,950,000 | 93,418,000 | 89,749,000 | 92,952,000 |
Basic net income per share attributable to DaVita Inc. | $ 2.56 | $ 1.96 | $ 5.29 | $ 3.24 |
Diluted net income per share attributable to DaVita Inc. | $ 2.50 | $ 1.91 | $ 5.15 | $ 3.17 |
Anti-dilutive stock-settled awards excluded from calculation | 4,000 | 280,000 | 197,000 | 787,000 |
Investments in debt and equit_3
Investments in debt and equity securities (Detail) - USD ($) $ in Thousands | Jun. 30, 2024 | Dec. 31, 2023 |
Investment Holdings [Line Items] | ||
Debt securities | $ 15,293 | $ 22,109 |
Investments in equity securities | 37,179 | 37,391 |
Equity Securities, FV-NI | 37,179 | 37,391 |
Total | 52,472 | 59,500 |
Debt securities, short-term investments | 15,293 | 7,110 |
Short-term investments | 20,693 | 11,610 |
Debt securities, long-term investments | 0 | 14,999 |
Long-term investments | 31,779 | 47,890 |
Certificates of deposit and other time deposits | ||
Investment Holdings [Line Items] | ||
Debt securities | 15,293 | 22,109 |
Investments in equity securities | 0 | 0 |
Total | 15,293 | 22,109 |
Investments in mutual funds and common stocks | ||
Investment Holdings [Line Items] | ||
Debt securities | 0 | 0 |
Investments in equity securities | 37,179 | 37,391 |
Total | 37,179 | 37,391 |
Short-term Investments | ||
Investment Holdings [Line Items] | ||
Investments in equity securities | 5,400 | 4,500 |
Long-term Investments | ||
Investment Holdings [Line Items] | ||
Equity Securities, FV-NI, Noncurrent | $ 31,779 | $ 32,891 |
Goodwill - Changes in Goodwill
Goodwill - Changes in Goodwill by Reportable Segments (Detail) - USD ($) $ in Thousands | 6 Months Ended | 12 Months Ended | |
Jun. 30, 2024 | Jun. 30, 2023 | Dec. 31, 2023 | |
Goodwill [Roll Forward] | |||
Beginning balance | $ 7,112,560 | $ 7,076,610 | $ 7,076,610 |
Acquisitions | 137,817 | 25,723 | |
Divestitures | (1,687) | ||
Goodwill impairment charges | 0 | 0 | (26,083) |
Foreign currency and other adjustments | (47,291) | 36,310 | |
Ending balance | 7,201,399 | 7,112,560 | |
Goodwill, before accumulated impairment charges | 7,346,904 | ||
Accumulated impairment charges | (145,505) | ||
Ending balance | 7,201,399 | 7,112,560 | |
U.S. dialysis | |||
Goodwill [Roll Forward] | |||
Beginning balance | 6,416,825 | 6,416,825 | 6,416,825 |
Acquisitions | 102,082 | 0 | |
Divestitures | (1,687) | ||
Goodwill impairment charges | 0 | ||
Foreign currency and other adjustments | 0 | 0 | |
Ending balance | 6,517,220 | 6,416,825 | |
Goodwill, before accumulated impairment charges | 6,517,220 | ||
Accumulated impairment charges | 0 | ||
Ending balance | 6,517,220 | 6,416,825 | |
Other—Ancillary services | |||
Goodwill [Roll Forward] | |||
Beginning balance | 695,735 | $ 659,785 | 659,785 |
Acquisitions | 35,735 | 25,723 | |
Divestitures | 0 | ||
Goodwill impairment charges | (26,083) | ||
Foreign currency and other adjustments | (47,291) | 36,310 | |
Ending balance | 684,179 | 695,735 | |
Goodwill, before accumulated impairment charges | 829,684 | ||
Accumulated impairment charges | (145,505) | ||
Ending balance | $ 684,179 | $ 695,735 |
Goodwill - Narrative (Details)
Goodwill - Narrative (Details) $ in Thousands | 3 Months Ended | 6 Months Ended | 12 Months Ended | |
Jun. 30, 2024 segment | Jun. 30, 2024 USD ($) | Jun. 30, 2023 USD ($) | Dec. 31, 2023 USD ($) | |
Goodwill [Line Items] | ||||
Goodwill impairment charges | $ | $ 0 | $ 0 | $ (26,083) | |
Other Health Operations | ||||
Goodwill [Line Items] | ||||
Number of Reportable Segments | segment | 0 |
Equity Method and Other Inves_3
Equity Method and Other Investments Equity Method and Other Investments (Details) - USD ($) $ in Thousands | Jun. 30, 2024 | Dec. 31, 2023 |
Schedule of Equity Method and Other Investments [Line Items] | ||
Equity method and other investments | $ 453,709 | $ 545,848 |
Mozarc Medical Holding LLC | ||
Schedule of Equity Method and Other Investments [Line Items] | ||
Equity method and other investments | 265,303 | 324,711 |
APAC joint venture | ||
Schedule of Equity Method and Other Investments [Line Items] | ||
Equity method and other investments | 67,241 | 98,865 |
Adjusted cost method and other investments | ||
Schedule of Equity Method and Other Investments [Line Items] | ||
Equity method and other investments | 16,810 | 14,990 |
Other equity method partnerships | ||
Schedule of Equity Method and Other Investments [Line Items] | ||
Equity method and other investments | $ 104,355 | $ 107,282 |
Equity Method and Other Inves_4
Equity Method and Other Investments - Additional Information (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2024 | Jun. 30, 2023 | Jun. 30, 2024 | Jun. 30, 2023 | |
Equity Method Investment income from equity method investments | ||||
Equity investment income (loss) from equity method investments in nonconsolidated dialysis partnerships. | $ 5,481 | $ 8,454 | $ 12,163 | $ 15,274 |
Other Nonoperating Income (Expense) | ||||
Equity Method Investment income from equity method investments | ||||
Equity investment income (loss) from other equity method investments | (54,633) | (15,568) | ||
Equity Method Investments In Nonconsolidated Dialysis Partnerships [Member] | ||||
Equity Method Investment income from equity method investments | ||||
Equity investment income (loss) from equity method investments in nonconsolidated dialysis partnerships. | $ 12,163 | $ 15,274 |
Long-term debt (Detail)
Long-term debt (Detail) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | |
Jun. 30, 2024 | Jun. 30, 2024 | Dec. 31, 2023 | |
Debt Instrument [Line Items] | |||
Total debt principal outstanding | $ 9,048,195 | $ 9,048,195 | $ 8,445,980 |
Discount Premium And Deferred Financing Costs | (58,642) | (58,642) | (54,347) |
Carrying amount of long-term debt, net of unamortized discounts | 8,989,553 | 8,989,553 | 8,391,633 |
Less current portion | (537,991) | (537,991) | (123,299) |
Total long-term debt | $ 8,451,562 | $ 8,451,562 | 8,268,334 |
Debt interest rate during period | 4.27% | 4.39% | |
Long-term debt, weighted average interest rate, at point in time | 4.33% | 4.33% | |
4.625% Senior Notes | |||
Debt Instrument [Line Items] | |||
Senior Notes | $ 2,750,000 | $ 2,750,000 | 2,750,000 |
Debt Instrument, Maturity Date | Jun. 01, 2030 | ||
Debt interest rate during period | 4.625% | ||
Debt Instrument, Fair Value Disclosure | 2,488,750 | $ 2,488,750 | |
3.75% Senior Notes | |||
Debt Instrument [Line Items] | |||
Senior Notes | 1,500,000 | $ 1,500,000 | 1,500,000 |
Debt Instrument, Maturity Date | Feb. 15, 2031 | ||
Debt interest rate during period | 3.75% | ||
Debt Instrument, Fair Value Disclosure | 1,280,625 | $ 1,280,625 | |
Acquisition obligations and other notes payable | |||
Debt Instrument [Line Items] | |||
Acquisition obligations and other notes payable | $ 92,129 | $ 92,129 | 102,328 |
Debt instrument, maturity date, description | 2024-2036 | ||
Long-term debt, weighted average interest rate, at point in time | 6.73% | 6.73% | |
Acquisition obligations and other notes payable, fair value | $ 92,129 | $ 92,129 | |
Financing lease obligations | |||
Debt Instrument [Line Items] | |||
Financing lease obligations | $ 244,262 | $ 244,262 | 255,491 |
Debt instrument, maturity date, description | 2025-2040 | ||
Finance lease, weighted average discount rate, percent | 4.63% | 4.63% | |
Change Healthcare Temporary Funding Assistance | |||
Debt Instrument [Line Items] | |||
Debt interest rate during period | 0% | ||
CHC Temporary Funding Assistance, Fair Value | $ 392,984 | $ 392,984 | |
CHC Temporary Funding Assistance | $ 392,984 | 392,984 | |
CHC Repayment Terms | within 45 business | ||
Term Loan A-1 | |||
Debt Instrument [Line Items] | |||
Secured Debt | $ 1,218,750 | 1,218,750 | 1,234,375 |
Debt Instrument, Fair Value Disclosure | 1,212,656 | 1,212,656 | |
Debt Instrument, Periodic Payment, Principal | $ 15,625 | ||
Term Loan A-1 | SOFR | |||
Debt Instrument [Line Items] | |||
Debt Instrument, Description of Variable Rate Basis | Base + 1.75% | ||
Term Loan B-1 | |||
Debt Instrument [Line Items] | |||
Secured Debt | 949,819 | $ 949,819 | $ 2,603,786 |
Debt Instrument, Maturity Date | Aug. 12, 2026 | ||
Debt Instrument, Fair Value Disclosure | $ 949,819 | $ 949,819 | |
SOFR Plus Interest Rate Margin | 0.11% | ||
Debt Instrument, Periodic Payment, Principal | $ 13,716 | ||
Prepayment of Term Loan B 1 | $ 728,653 | ||
Constructive Financing Cash Outflows | $ 722,351 | ||
Term Loan B-1 | SOFR | |||
Debt Instrument [Line Items] | |||
Debt Instrument, Description of Variable Rate Basis | Base + 1.75% | ||
Term Loan A-1 and Revolver | |||
Debt Instrument [Line Items] | |||
SOFR Plus Interest Rate Margin | 0.10% | ||
Debt Instrument Period Before Maturity Date When Unpaid Amount Triggers Change In Due Date | May 13, 2026 | ||
Debt Instrument, Periodic Payment Terms, Date Balloon Payment to be Paid | Apr. 28, 2028 |
Long-term debt - Additional Inf
Long-term debt - Additional Information (Detail) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||||
May 09, 2024 | Jun. 30, 2024 | Jun. 30, 2023 | Jun. 30, 2024 | Jun. 30, 2023 | Dec. 31, 2023 | |
Debt Instrument [Line Items] | ||||||
Weighted average effective interest rate at quarter end | 4.33% | 4.33% | ||||
Weighted average effective interest rate during quarter | 4.27% | 4.39% | ||||
Percentage of debt instruments bearing fixed interest rate | 55% | 55% | ||||
Long Term Debt Percentage Bearing Economically Fixed Interest Rate | 93% | 93% | ||||
Leverage Ratio Covenant | 4 | 4 | ||||
Leverage Ratio Covenant Through Jun 30, 2026 | 5 | 5 | ||||
Leverage Ratio Covenant after Jun 30, 2026 | 4.50 | 4.50 | ||||
Leverage Ratio Covenant after Jun 30, 2026 - Subject to Increase during four fiscal quarters following a material acquisition | 5 | 5 | ||||
Debt Prepayment, Extinguishment And Modification Costs | $ 9,732 | $ 7,962 | $ 9,732 | $ 7,962 | ||
Revolving line of credit | ||||||
Debt Instrument [Line Items] | ||||||
Secured Debt Outstanding Principal Balance Subject To SOFR | 260,000 | 260,000 | ||||
Secured Debt | 260,000 | 260,000 | $ 0 | |||
Revolving line of credit, fair value of amount outstanding | 260,000 | 260,000 | ||||
Line of Credit Facility [Line Items] | ||||||
Line of Credit Facility, Remaining Borrowing Capacity | 1,240,000 | 1,240,000 | ||||
Maximum borrowing capacity on the revolving credit facilities | 1,500,000 | $ 1,500,000 | ||||
Revolving line of credit | SOFR | ||||||
Debt Instrument [Line Items] | ||||||
Debt Instrument, Description of Variable Rate Basis | Base + 1.75% | |||||
Letter of Credit | ||||||
Debt Instrument [Line Items] | ||||||
Letters of credit outstanding | 0 | $ 0 | ||||
Bilateral Secured Letter Of Credit Facility | ||||||
Debt Instrument [Line Items] | ||||||
Letters of credit outstanding | 154,341 | 154,341 | ||||
Term Loan A-1 | ||||||
Debt Instrument [Line Items] | ||||||
Secured Debt Outstanding Principal Balance Subject To SOFR | 308,820 | 308,820 | ||||
Secured Debt | 1,218,750 | 1,218,750 | 1,234,375 | |||
Debt Instrument, Fair Value Disclosure | $ 1,212,656 | $ 1,212,656 | ||||
Term Loan A-1 | SOFR | ||||||
Debt Instrument [Line Items] | ||||||
Debt Instrument, Description of Variable Rate Basis | Base + 1.75% | |||||
Senior Secured Credit Facilities | ||||||
Debt Instrument [Line Items] | ||||||
Weighted average effective interest rate at quarter end | 4.62% | 4.62% | ||||
Debt Instrument, Unamortized Discount | $ 9,433 | $ 9,433 | 2,487 | |||
Deferred Financing Costs | 31,257 | 31,257 | 32,498 | |||
Senior Notes | ||||||
Debt Instrument [Line Items] | ||||||
Deferred Financing Costs | 29,136 | 29,136 | 31,491 | |||
Debt Instrument, Unamortized Premium | 11,184 | $ 11,184 | $ 12,129 | |||
Extended Term Loan B-1 | ||||||
Debt Instrument [Line Items] | ||||||
Constructive Financing Cash Outflows | 6,302 | |||||
Constructive Financing Cash Inflow | 728,653 | |||||
Other Significant Noncash Financing Activity | 13,282 | |||||
Secured Debt, Extended Maturity | $ 911,598 | |||||
Debt Instrument Quarterly Payment Start Date | Dec. 31, 2024 | |||||
Debt Instrument, Quarterly Payment, % of Aggregate Principal Outstanding | 0.25% | 0.25% | ||||
Debt Instrument, effective date | May 09, 2024 | |||||
Debt Instrument, Periodic Payment Terms, Balloon Payment to be Paid | $ 1,533,635 | $ 1,533,635 | ||||
Secured Debt | 1,640,251 | $ 1,640,251 | ||||
Debt Instrument, Maturity Date | May 09, 2031 | |||||
Debt Instrument, Fair Value Disclosure | 1,636,150 | $ 1,636,150 | ||||
Extended Term Loan B 1 - Additional Incremental Principal | $ 728,653 | |||||
Extended Term Loan B-1 | Adjusted Rate | Base Rate Loans | ||||||
Debt Instrument [Line Items] | ||||||
Term SOFR or Base Rate Plus Interest Rate Margin | 1% | |||||
Extended Term Loan B-1 | SOFR | ||||||
Debt Instrument [Line Items] | ||||||
Debt Instrument, Description of Variable Rate Basis | SOFR + 2.00% | |||||
Extended Term Loan B-1 | SOFR | SOFR Loans | ||||||
Debt Instrument [Line Items] | ||||||
Term SOFR or Base Rate Plus Interest Rate Margin | 2% | |||||
Extended Term Loan B-1 | Maximum | 1-Month SOFR | Base Rate Loans | ||||||
Debt Instrument [Line Items] | ||||||
Term SOFR or Base Rate Plus Interest Rate Margin | 1% | |||||
Extended Term Loan B-1 | Maximum | Prime Rate | Base Rate Loans | ||||||
Debt Instrument [Line Items] | ||||||
Debt Instrument, Description of Variable Rate Basis | prime commercial lending rate | |||||
Extended Term Loan B-1 | Maximum | Fed Funds Effective Rate Overnight Index Swap Rate | Base Rate Loans | ||||||
Debt Instrument [Line Items] | ||||||
Term SOFR or Base Rate Plus Interest Rate Margin | 0.50% | |||||
Extended Term Loan B-1 | Minimum | ||||||
Debt Instrument [Line Items] | ||||||
Term SOFR or Base Rate Plus Interest Rate Margin | 0% |
Long-Term Debt - Scheduled Matu
Long-Term Debt - Scheduled Maturities of Long-term Debt (Details) $ in Thousands | Jun. 30, 2024 USD ($) |
Debt Disclosure [Abstract] | |
2024 (remainder of the year) | $ 465,033 |
2025 | 147,057 |
2026 | 1,040,219 |
2027 | 134,619 |
2028 | 1,295,333 |
2029 | 41,171 |
Thereafter | $ 5,924,763 |
Long-term debt Schedule of Deri
Long-term debt Schedule of Derivative Instruments (Details) - USD ($) $ in Thousands | 6 Months Ended | |||
Dec. 31, 2026 | Jan. 01, 2025 | Jun. 30, 2024 | Dec. 31, 2023 | |
2019 Interest Rate Cap Agreements Effective June 30, 2020 | ||||
Derivative [Line Items] | ||||
Derivative, effective date | Jun. 30, 2020 | |||
Derivative, Maturity date | Jun. 30, 2024 | |||
Notional Amount Amortizable By Maturity Date | $ 3,500,000 | |||
2023 Interest Rate Cap Agreements 3.75% Effective June 30 2024 | ||||
Derivative [Line Items] | ||||
Derivative, effective date | Jun. 30, 2024 | |||
Derivative, Maturity date | Dec. 31, 2025 | |||
Notional Amount Amortizable By Maturity Date | $ 500,000 | |||
Notional Amount Amortizable By December 31, 2024 | $ 500,000 | |||
2023 Interest Rate Cap Agreements 4.00% Effective June 30 2024 | ||||
Derivative [Line Items] | ||||
Derivative, effective date | Jun. 30, 2024 | |||
Derivative, Maturity date | Dec. 31, 2025 | |||
Notional Amount Amortizable By Maturity Date | $ 750,000 | |||
Notional Amount Amortizable By December 31, 2024 | $ 250,000 | |||
2023 Interest Rate Cap Agreements 4.75% Effective June 30 2024 | ||||
Derivative [Line Items] | ||||
Derivative, effective date | Jun. 30, 2024 | |||
Derivative, Maturity date | Dec. 31, 2025 | |||
Notional Amount Amortizable By Maturity Date | $ 750,000 | |||
Notional Amount Amortizable By December 31, 2024 | $ 250,000 | |||
2023 Interest Rate Cap Agreements 5.00% Effective June 30 2024 | ||||
Derivative [Line Items] | ||||
Derivative, effective date | Jun. 30, 2024 | |||
Derivative, Maturity date | Dec. 31, 2026 | |||
Notional Amount Amortizable By Maturity Date | $ 500,000 | |||
2023 Interest Rate Cap Agreements 4.50% Effective December 31 2024 | ||||
Derivative [Line Items] | ||||
Derivative, effective date | Dec. 31, 2024 | |||
Derivative, Maturity date | Dec. 31, 2025 | |||
Notional Amount Amortizable By Maturity Date | $ 250,000 | |||
2023 Interest Rate Cap Agreements 4.00% Effective December 31 2024 | ||||
Derivative [Line Items] | ||||
Derivative, effective date | Dec. 31, 2024 | |||
Derivative, Maturity date | Dec. 31, 2026 | |||
Notional Amount Amortizable By Maturity Date | $ 500,000 | |||
Notional Amount Amortizable By December 31, 2025 | $ 250,000 | |||
2024 Interest Rate Cap Agreements 4.50% Effective December 31 2025 | ||||
Derivative [Line Items] | ||||
Derivative, effective date | Dec. 31, 2025 | |||
Derivative, Maturity date | Dec. 31, 2027 | |||
Notional Amount Amortizable By Maturity Date | $ 500,000 | |||
Notional Amount Amortizable By December 31, 2026 | 500,000 | |||
Other Long-term Assets | Interest rate cap agreements | ||||
Derivative [Line Items] | ||||
Derivative asset, fair value, gross asset | 51,223 | $ 79,805 | ||
Term Loan Facility | Maximum | 2019 Interest Rate Cap Agreements Effective June 30, 2020 | ||||
Derivative [Line Items] | ||||
Notional amounts of interest rate agreements | $ 3,500,000 | |||
SOFR Plus Interest Rate Margin | 2% | |||
Term Loan Facility | Maximum | 2023 Interest Rate Cap Agreements 3.75% Effective June 30 2024 | ||||
Derivative [Line Items] | ||||
Notional amounts of interest rate agreements | $ 1,000,000 | |||
SOFR Plus Interest Rate Margin | 3.75% | |||
Term Loan Facility | Maximum | 2023 Interest Rate Cap Agreements 4.00% Effective June 30 2024 | ||||
Derivative [Line Items] | ||||
Notional amounts of interest rate agreements | $ 1,000,000 | |||
SOFR Plus Interest Rate Margin | 4% | |||
Term Loan Facility | Maximum | 2023 Interest Rate Cap Agreements 4.00% Effective June 30 2024 | Subsequent Event | ||||
Derivative [Line Items] | ||||
SOFR Plus Interest Rate Margin | 3.75% | |||
Term Loan Facility | Maximum | 2023 Interest Rate Cap Agreements 4.75% Effective June 30 2024 | ||||
Derivative [Line Items] | ||||
Notional amounts of interest rate agreements | $ 1,000,000 | |||
SOFR Plus Interest Rate Margin | 4.75% | |||
Term Loan Facility | Maximum | 2023 Interest Rate Cap Agreements 4.75% Effective June 30 2024 | Subsequent Event | ||||
Derivative [Line Items] | ||||
SOFR Plus Interest Rate Margin | 4% | |||
Term Loan Facility | Maximum | 2023 Interest Rate Cap Agreements 5.00% Effective June 30 2024 | ||||
Derivative [Line Items] | ||||
Notional amounts of interest rate agreements | $ 500,000 | |||
SOFR Plus Interest Rate Margin | 5% | |||
Term Loan Facility | Maximum | 2023 Interest Rate Cap Agreements 5.00% Effective June 30 2024 | Subsequent Event | ||||
Derivative [Line Items] | ||||
SOFR Plus Interest Rate Margin | 4.50% | |||
Term Loan Facility | Maximum | 2023 Interest Rate Cap Agreements 4.50% Effective December 31 2024 | ||||
Derivative [Line Items] | ||||
Notional amounts of interest rate agreements | $ 250,000 | |||
SOFR Plus Interest Rate Margin | 4.50% | |||
Term Loan Facility | Maximum | 2023 Interest Rate Cap Agreements 4.00% Effective December 31 2024 | ||||
Derivative [Line Items] | ||||
Notional amounts of interest rate agreements | $ 750,000 | |||
SOFR Plus Interest Rate Margin | 4% | |||
Term Loan Facility | Maximum | 2024 Interest Rate Cap Agreements 4.50% Effective December 31 2025 | ||||
Derivative [Line Items] | ||||
Notional amounts of interest rate agreements | $ 1,000,000 | |||
SOFR Plus Interest Rate Margin | 4.50% | |||
Term Loan Facility | Maximum | 2024 Interest Rate Cap Agreements 4.50% Effective December 31 2025 | Subsequent Event | ||||
Derivative [Line Items] | ||||
SOFR Plus Interest Rate Margin | 4.75% |
Commitments and Contingencies -
Commitments and Contingencies - Additional Information (Detail) - USD ($) $ in Thousands | 6 Months Ended | |
Oct. 22, 2019 | Jun. 30, 2024 | |
Commitments and Contingencies: | ||
Corporate Integrity Agreement Period | 5 years | |
Corporate Integrity Agreement Expiration Date | Oct. 22, 2019 | |
Commitments to provide operating capital | ||
Commitments and Contingencies: | ||
Other potential commitments to provide operating capital to several dialysis centers | $ 7,992 | |
2017 U S Attorney Colorado Investigation | ||
Loss Contingencies [Line Items] | ||
Litigation Settlement, Amount Awarded to Other Party | $ 34,487 |
Stock-based compensation (Detai
Stock-based compensation (Details) $ in Thousands | 6 Months Ended |
Jun. 30, 2024 USD ($) shares | |
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |
Unrecognized compensation cost related to nonvested stock-based compensation arrangements under equity compensation and stock purchase plans | $ 174,104 |
Unrecognized compensation cost related to nonvested stock-based compensation arrangements under stock-based component of LTIP costs, weighted average remaining period (in years) | 1 year 4 months 24 days |
Restricted stock units and Performance stock units | |
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period | shares | 701,000 |
Aggregate grant-date fair value | $ 96,954 |
Weighted-average expected life (in years) | 3 years 4 months 24 days |
Share repurchases (Details)
Share repurchases (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands | 1 Months Ended | 3 Months Ended | 6 Months Ended | ||
Aug. 02, 2024 | Jun. 30, 2024 | Jun. 30, 2024 | Jun. 30, 2023 | Dec. 17, 2021 | |
Equity, Class of Treasury Stock [Line Items] | |||||
Stock Repurchase Program, Authorized Amount | $ 2,000,000 | ||||
Open Market Purchases | |||||
Equity, Class of Treasury Stock [Line Items] | |||||
Repurchase of common stock (in shares) | 2,655 | 4,774 | 0 | ||
Treasury Stock, Value, Acquired, Cost Method | $ 375,831 | $ 615,948 | |||
Treasury Stock Acquired, Average Cost Per Share | $ 140.14 | $ 127.98 | |||
Subsequent Event | |||||
Equity, Class of Treasury Stock [Line Items] | |||||
Stock Repurchase Program, Remaining Authorized Repurchase Amount | $ 543,360 | ||||
Subsequent Event | Open Market Purchases | |||||
Equity, Class of Treasury Stock [Line Items] | |||||
Repurchase of common stock (in shares) | 1,134 | ||||
Treasury Stock, Value, Acquired, Cost Method | $ 158,962 | ||||
Treasury Stock Acquired, Average Cost Per Share | $ 138.81 |
Related Party Transactions (Det
Related Party Transactions (Details) - Berkshire | 3 Months Ended | ||
Aug. 02, 2024 | Jun. 30, 2024 | Jun. 30, 2024 | |
Berkshire Share Repurchase Agreement | Berkshire share repurchase agreement On April 30, 2024, the Company entered into an agreement (the share repurchase agreement) with Berkshire Hathaway Inc. on behalf of itself and its affiliates (collectively, Berkshire). Under the share repurchase agreement, at any time Berkshire beneficially owns at least 45.0% of the issued and outstanding common stock of the Company in the aggregate, the Company shall repurchase from Berkshire, and Berkshire shall sell to the Company, on a quarterly basis, a number of shares of common stock sufficient to return Berkshire’s aggregate beneficial ownership to 45.0% of the Company's issued and outstanding common stock. The per share price the Company will pay Berkshire for any such share repurchase will be the volume-weighted average price per share paid by the Company for any shares of common stock repurchased by the Company from public stockholders pursuant to the Company’s share repurchase plan during the applicable repurchase period. Under this agreement, repurchases of common stock by the Company from Berkshire will occur on the date that is two business days prior to the date of the Company’s regular quarterly or annual investor call to publicly report earnings; however, if at any time the Company determines that Berkshire beneficially owns or will beneficially own shares of common stock representing more than 49.5% of the issued and outstanding common stock in the aggregate, such determination will trigger immediate share repurchases under this agreement. As of June 30, 2024 and August 2, 2024, Berkshire beneficially owned less than 45.0% of the issued and outstanding common stock of the Company and, as a result, no repurchase obligation exists at either date. | ||
Repurchase Agreement, Date | Apr. 30, 2024 | ||
Related Party Transaction, Terms and Manner of Settlement | two business days prior to the date of the Company’s regular quarterly or annual investor call to publicly report earnings | ||
Owns Beneficially At Least In Aggregate | Berkshire beneficially owns at least 45.0% | ||
Trigger Immediate Share Repurchase | Berkshire beneficially owns or will beneficially own shares of common stock representing more than 49.5% of the issued and outstanding common stock in the aggregate, such determination will trigger immediate share repurchases under this agreement | ||
Owns Beneficially as at date | As of June 30, 2024 and August 2, 2024, Berkshire beneficially owned less than 45.0% of the issued and outstanding common stock of the Company and, as a result, no repurchase obligation exists at either date. | ||
Subsequent Event | |||
Owns Beneficially as at date | As of June 30, 2024 and August 2, 2024, Berkshire beneficially owned less than 45.0% of the issued and outstanding common stock of the Company and, as a result, no repurchase obligation exists at either date. |
Accumulated other comprehensi_3
Accumulated other comprehensive (loss) income (Detail) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2024 | Jun. 30, 2023 | Jun. 30, 2024 | Jun. 30, 2023 | |
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward] | ||||
Beginning balance | $ (52,084) | |||
Ending balance | $ (195,090) | (195,090) | ||
Interest rate cap agreements | ||||
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward] | ||||
Beginning balance | 19,542 | $ 79,404 | 27,853 | $ 98,685 |
Unrealized gains (losses) | 7,887 | 33,109 | 25,632 | 28,393 |
Related income tax benefit | (1,968) | (8,260) | (6,396) | (7,083) |
Unrealized (losses) gains net | 5,919 | 24,849 | 19,236 | 21,310 |
Reclassification into net income | (29,368) | (25,257) | (58,186) | (46,232) |
Related income tax | 7,327 | 6,301 | 14,517 | 11,534 |
Reclassification from accumulated other comprehensive income into net income net of tax | (22,041) | (18,956) | (43,669) | (34,698) |
Ending balance | 3,420 | 85,297 | 3,420 | 85,297 |
Foreign currency translation adjustments | ||||
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward] | ||||
Beginning balance | (119,657) | (134,310) | (79,937) | (167,871) |
Unrealized gains (losses) | (78,853) | 41,961 | (118,573) | 75,522 |
Related income tax benefit | 0 | 0 | 0 | 0 |
Unrealized (losses) gains net | (78,853) | 41,961 | (118,573) | 75,522 |
Reclassification into net income | 0 | 0 | 0 | 0 |
Related income tax | 0 | 0 | 0 | 0 |
Reclassification from accumulated other comprehensive income into net income net of tax | 0 | 0 | 0 | 0 |
Ending balance | (198,510) | (92,349) | (198,510) | (92,349) |
Accumulated other comprehensive (loss) income | ||||
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward] | ||||
Beginning balance | (100,115) | (54,906) | (52,084) | (69,186) |
Unrealized gains (losses) | (70,966) | 75,070 | (92,941) | 103,915 |
Related income tax benefit | (1,968) | (8,260) | (6,396) | (7,083) |
Unrealized (losses) gains net | (72,934) | 66,810 | (99,337) | 96,832 |
Reclassification into net income | (29,368) | (25,257) | (58,186) | (46,232) |
Related income tax | 7,327 | 6,301 | 14,517 | 11,534 |
Reclassification from accumulated other comprehensive income into net income net of tax | (22,041) | (18,956) | (43,669) | (34,698) |
Ending balance | $ (195,090) | $ (7,052) | $ (195,090) | $ (7,052) |
Acquisitions and divestitures A
Acquisitions and divestitures Assets And Liabilities Assumed (Details) - USD ($) $ in Thousands | Jun. 30, 2024 | Dec. 31, 2023 | Dec. 31, 2022 |
Business Acquisition [Line Items] | |||
Goodwill | $ 7,201,399 | $ 7,112,560 | $ 7,076,610 |
Goodwill deductible for tax purposes associated with acquisitions | 60,065 | ||
Dialysis and other businesses | |||
Business Acquisition [Line Items] | |||
Current assets | 149,308 | ||
Property and equipment | 46,473 | ||
Right-of-use lease assets and other long-term assets | 51,300 | ||
Indefinite-lived licenses | 8,854 | ||
Goodwill | 137,817 | ||
Liabilities assumed | (96,417) | ||
Noncontrolling interests assumed | (20,258) | ||
Total assets acquired and liabilities assumed | 277,077 | ||
U.S. dialysis | |||
Business Acquisition [Line Items] | |||
Goodwill | $ 6,517,220 | $ 6,416,825 | $ 6,416,825 |
Acquisitions and divestitures_2
Acquisitions and divestitures (Details) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2024 USD ($) | Jun. 30, 2023 USD ($) | Jun. 30, 2024 USD ($) Clinic | Jun. 30, 2023 USD ($) | |
Business Acquisition [Line Items] | ||||
Cash paid to acquire businesses | $ 157,783 | $ 2,575 | ||
Gain on changes in ownership interest | $ 0 | $ 0 | 35,147 | $ 0 |
Dialysis and other businesses | ||||
Business Acquisition [Line Items] | ||||
Cash paid to acquire businesses | 157,783 | |||
Deferred purchase price obligations | 51,768 | |||
Business Combination, Step Acquisition, Equity Interest in Acquiree, Fair Value | 67,526 | |||
Gain on changes in ownership interest | $ 35,147 | |||
Dialysis and other businesses | U.S. dialysis | ||||
Business Acquisition [Line Items] | ||||
Number of businesses acquired | Clinic | 12 | |||
Dialysis and other businesses | Foreign Dialysis Centers | ||||
Business Acquisition [Line Items] | ||||
Number of businesses acquired | Clinic | 90 |
Variable interest entities - Ad
Variable interest entities - Additional Information (Detail) - USD ($) $ in Thousands | Jun. 30, 2024 | Dec. 31, 2023 |
Total assets | $ 17,025,572 | $ 16,893,578 |
Total liabilities and noncontrolling interests | 14,600,716 | $ 14,150,228 |
Variable Interest Entity | ||
Total assets | 343,772 | |
Total liabilities and noncontrolling interests | $ 157,627 |
Fair value of financial instr_3
Fair value of financial instruments - Assets, Liabilities and Temporary Equity Measured at Fair Value on Recurring Basis (Detail) - USD ($) $ in Thousands | Jun. 30, 2024 | Dec. 31, 2023 |
Assets | ||
Investments in equity securities | $ 37,179 | $ 37,391 |
Fair Value, Measurements, Recurring | ||
Assets | ||
Investments in equity securities | 37,179 | |
Liabilities | ||
Contingent earn-out obligations | 17,898 | |
Temporary equity | ||
Noncontrolling interests subject to put provisions | 1,574,840 | |
Fair Value, Measurements, Recurring | Interest rate cap agreements | ||
Assets | ||
Interest rate cap agreements | 51,223 | |
Fair Value, Measurements, Recurring | Quoted prices in active markets for identical assets (Level 1) | ||
Assets | ||
Investments in equity securities | 37,179 | |
Liabilities | ||
Contingent earn-out obligations | ||
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 agreements | ||
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 | ||
Temporary equity | ||
Noncontrolling interests subject to put provisions | ||
Fair Value, Measurements, Recurring | Significant other observable inputs (Level 2) | Interest rate cap agreements | ||
Assets | ||
Interest rate cap agreements | 51,223 | |
Fair Value, Measurements, Recurring | Significant unobservable inputs (Level 3) | ||
Assets | ||
Investments in equity securities | ||
Liabilities | ||
Contingent earn-out obligations | 17,898 | |
Temporary equity | ||
Noncontrolling interests subject to put provisions | 1,574,840 | |
Fair Value, Measurements, Recurring | Significant unobservable inputs (Level 3) | Interest rate cap agreements | ||
Assets | ||
Interest rate cap agreements |
Fair value of financial instr_4
Fair value of financial instruments (Details) $ in Thousands | 6 Months Ended |
Jun. 30, 2024 USD ($) | |
Fair Value Net Derivative Asset Liability Measured On Recurring Basis Unobservable Input Reconciliation [Line Items] | |
Potential Increase Decrease In Fair Value Of Noncontrolling Interests Due To Change In Weighted Average EBITDA Multiple | $ 205,000 |
Maximum | |
Fair Value Net Derivative Asset Liability Measured On Recurring Basis Unobservable Input Reconciliation [Line Items] | |
Business Combination Contingent Consideration Acquisitions | $ 53,279 |
Maximum | EBITDA or Operating Income Performance Targets or Quality Margins | Other companies | |
Fair Value Net Derivative Asset Liability Measured On Recurring Basis Unobservable Input Reconciliation [Line Items] | |
Earn-out consideration payment period | 4 years |
Segment reporting - Summary of
Segment reporting - Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes (Detail) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2024 | Jun. 30, 2023 | Jun. 30, 2024 | Jun. 30, 2023 | |
Segment Reporting Information [Line Items] | ||||
Other revenues | $ 125,620 | $ 109,684 | $ 254,643 | $ 222,349 |
Total revenues | 3,186,722 | 3,000,369 | 6,257,277 | 5,873,068 |
Operating income (loss) | 506,398 | 405,291 | 990,243 | 716,936 |
Corporate administrative support | (25,196) | (33,864) | (55,586) | (58,452) |
Debt expense | (97,747) | (103,507) | (197,165) | (204,281) |
Debt prepayment, extinguishment and modification costs | (9,732) | (7,962) | (9,732) | (7,962) |
Other (loss) income, net | (27,479) | 1,373 | (40,120) | 5,125 |
Income before income taxes | 371,440 | 295,195 | 743,226 | 509,818 |
U.S. dialysis | ||||
Segment Reporting Information [Line Items] | ||||
Total revenues | 2,828,085 | 2,710,254 | 5,559,782 | 5,300,365 |
Other—Ancillary services | ||||
Segment Reporting Information [Line Items] | ||||
Total revenues | 358,637 | 290,115 | 697,495 | 572,703 |
Operating Segments | ||||
Segment Reporting Information [Line Items] | ||||
Total revenues | 3,203,470 | 3,022,138 | 6,301,236 | 5,918,252 |
Operating income (loss) | 531,594 | 439,155 | 1,045,829 | 775,388 |
Operating Segments | U.S. dialysis | ||||
Segment Reporting Information [Line Items] | ||||
Dialysis patient service revenues | 2,835,112 | 2,724,211 | 5,585,150 | 5,330,192 |
Total revenues | 2,841,010 | 2,730,615 | 5,597,171 | 5,342,775 |
Operating income (loss) | 550,186 | 460,759 | 1,075,923 | 821,857 |
Operating Segments | U.S. dialysis | External Sources | ||||
Segment Reporting Information [Line Items] | ||||
Dialysis patient service revenues | 2,822,187 | 2,703,850 | 5,547,761 | 5,287,782 |
Other revenues | 5,898 | 6,404 | 12,021 | 12,583 |
Operating Segments | U.S. dialysis | Intersubsegment Eliminations | ||||
Segment Reporting Information [Line Items] | ||||
Dialysis patient service revenues | 12,925 | 20,361 | 37,389 | 42,410 |
Operating Segments | Other—Ancillary services | ||||
Segment Reporting Information [Line Items] | ||||
Dialysis patient service revenues | 238,915 | 186,835 | 454,873 | 362,937 |
Other revenues | 119,722 | 103,280 | 242,622 | 209,766 |
Total revenues | 362,460 | 291,523 | 704,065 | 575,477 |
Operating income (loss) | (18,592) | (21,604) | (30,094) | (46,469) |
Operating Segments | Other—Ancillary services | Intersubsegment Eliminations | ||||
Segment Reporting Information [Line Items] | ||||
Dialysis patient service revenues | 3,823 | 1,408 | 6,570 | 2,774 |
Intersegment Elimination | ||||
Segment Reporting Information [Line Items] | ||||
Total revenues | (16,748) | (21,769) | (43,959) | (45,184) |
Intersegment Elimination | U.S. dialysis | ||||
Segment Reporting Information [Line Items] | ||||
Total revenues | (12,925) | (20,361) | (37,389) | (42,410) |
Intersegment Elimination | Other—Ancillary services | ||||
Segment Reporting Information [Line Items] | ||||
Total revenues | $ (3,823) | $ (1,408) | $ (6,570) | $ (2,774) |
Segment reporting - Summary o_2
Segment reporting - Summary of Depreciation and Amortization Expense by Segment (Detail) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2024 | Jun. 30, 2023 | Jun. 30, 2024 | Jun. 30, 2023 | |
Segment Reporting Information [Line Items] | ||||
Depreciation and amortization | $ 175,661 | $ 183,672 | $ 362,744 | $ 361,743 |
U.S. dialysis | ||||
Segment Reporting Information [Line Items] | ||||
Depreciation and amortization | 160,410 | 171,842 | 333,262 | 338,803 |
Other—Ancillary services | ||||
Segment Reporting Information [Line Items] | ||||
Depreciation and amortization | $ 15,251 | $ 11,830 | $ 29,482 | $ 22,940 |
Segment reporting - Summary o_3
Segment reporting - Summary of Expenditures for Property and Equipment by Segment (Detail) - USD ($) $ in Thousands | 6 Months Ended | |
Jun. 30, 2024 | Jun. 30, 2023 | |
Segment Reporting Information [Line Items] | ||
Expenditures for property and equipment | $ 245,740 | $ 272,204 |
Segment, Expenditure, Addition to Long-Lived Assets | 245,740 | 272,204 |
U.S. dialysis | ||
Segment Reporting Information [Line Items] | ||
Segment, Expenditure, Addition to Long-Lived Assets | 211,171 | 240,474 |
Other—Ancillary services | ||
Segment Reporting Information [Line Items] | ||
Segment, Expenditure, Addition to Long-Lived Assets | $ 34,569 | $ 31,730 |