Document and Entity Information
Document and Entity Information - USD ($) shares in Millions, $ in Billions | 12 Months Ended | ||
Dec. 31, 2022 | Jan. 31, 2023 | Jun. 30, 2022 | |
Cover [Abstract] | |||
Document Type | 10-K | ||
Document Annual Report | true | ||
Document Period End Date | Dec. 31, 2022 | ||
Current Fiscal Year End Date | --12-31 | ||
Document Transition Report | false | ||
Entity File Number | 1-14106 | ||
Entity Registrant Name | DAVITA INC. | ||
Entity Incorporation, State or Country Code | DE | ||
Entity Tax Identification Number | 51-0354549 | ||
Entity Address, Address Line One | 2000 16th Street | ||
Entity Address, City or Town | Denver, | ||
Entity Address, State or Province | CO | ||
Entity Address, Postal Zip Code | 80202 | ||
City Area Code | 720 | ||
Local Phone Number | 631-2100 | ||
Title of 12(b) Security | Common Stock, $0.001 par value | ||
Trading Symbol | DVA | ||
Security Exchange Name | NYSE | ||
Entity Well-known Seasoned Issuer | Yes | ||
Entity Voluntary Filer | No | ||
Entity Current Reporting Status | Yes | ||
Entity Interactive Data Current | Yes | ||
Entity Filer Category | Large Accelerated Filer | ||
Entity Small Business | false | ||
Entity Emerging Growth Company | false | ||
ICFR Auditor Attestation Flag | true | ||
Entity Shell Company | false | ||
Entity Public Float | $ 7.4 | ||
Entity Common Stock, Shares Outstanding | 90.4 | ||
Amendment Flag | false | ||
Document Fiscal Year Focus | 2022 | ||
Document Fiscal Period Focus | FY | ||
Entity Central Index Key | 0000927066 |
Audit Information
Audit Information | 12 Months Ended |
Dec. 31, 2022 | |
Auditor [Abstract] | |
Auditor Name | KPMG LLP |
Auditor Location | Seattle, WA, USA |
Auditor Firm ID | 185 |
CONSOLIDATED STATEMENTS OF INCO
CONSOLIDATED STATEMENTS OF INCOME - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Income Statement [Abstract] | |||
Dialysis patient service revenues | $ 11,176,464 | $ 11,213,515 | $ 11,026,251 |
Other revenues | 433,430 | 405,282 | 524,353 |
Total revenues | 11,609,894 | 11,618,797 | 11,550,604 |
Operating expenses: | |||
Patient care costs | 8,209,553 | 7,972,414 | 7,988,613 |
General and administrative | 1,355,197 | 1,195,335 | 1,247,584 |
Depreciation and amortization | 732,602 | 680,615 | 630,435 |
Equity investment income, net | (26,520) | (26,937) | (26,916) |
Loss on changes in ownership interest, net | 0 | 0 | 16,252 |
Total operating expenses | 10,270,832 | 9,821,427 | 9,855,968 |
Operating income | 1,339,062 | 1,797,370 | 1,694,636 |
Debt expense | (357,019) | (285,254) | (304,111) |
Debt prepayment, refinancing and redemption charges | 0 | 0 | (89,022) |
Other (loss) income, net | (15,765) | 6,378 | 16,759 |
Income from continuing operations before income taxes | 966,278 | 1,518,494 | 1,318,262 |
Income tax expense | 198,087 | 306,732 | 313,932 |
Net income from continuing operations | 768,191 | 1,211,762 | 1,004,330 |
Net income (loss) from discontinued operations, net of tax | 13,452 | 0 | (9,653) |
Net income | 781,643 | 1,211,762 | 994,677 |
Less: Net income attributable to noncontrolling interests | (221,243) | (233,312) | (221,035) |
Net income attributable to DaVita Inc. | $ 560,400 | $ 978,450 | $ 773,642 |
Earnings per share attributable to DaVita Inc.: | |||
Basic net income from continuing operations (in usd per share) | $ 5.88 | $ 9.30 | $ 6.54 |
Basic net income (in usd per share) | 6.03 | 9.30 | 6.46 |
Diluted net income from continuing operations (in usd per share) | 5.71 | 8.90 | 6.39 |
Diluted net income (in usd per share) | $ 5.85 | $ 8.90 | $ 6.31 |
Weighted average shares for earnings per share: | |||
Basic shares (in shares) | 92,992,000 | 105,230,000 | 119,797,000 |
Diluted shares (in shares) | 95,834,000 | 109,948,000 | 122,623,000 |
Amounts attributable to DaVita Inc.: | |||
Net income from continuing operations | $ 546,948 | $ 978,450 | $ 783,295 |
Net income (loss) from discontinued operations | 13,452 | 0 | (9,653) |
Net income attributable to DaVita Inc. | $ 560,400 | $ 978,450 | $ 773,642 |
CONSOLIDATED STATEMENTS OF COMP
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Statement of Comprehensive Income [Abstract] | |||
Net income | $ 781,643 | $ 1,211,762 | $ 994,677 |
Unrealized gains (losses) on interest rate cap agreements: | |||
Unrealized gains (losses) | 108,669 | 7,155 | (16,346) |
Reclassification of net realized (gains) losses into net income | (8,806) | 4,133 | 5,313 |
Unrealized losses on foreign currency translation. | |||
Unrealized losses on foreign currency translation | (29,802) | (84,381) | (7,623) |
Other comprehensive income (loss) | 70,061 | (73,093) | (18,656) |
Total comprehensive income | 851,704 | 1,138,669 | 976,021 |
Less: Comprehensive income attributable to noncontrolling interests | (221,243) | (233,312) | (221,035) |
Comprehensive income attributable to DaVita Inc. | $ 630,461 | $ 905,357 | $ 754,986 |
CONSOLIDATED BALANCE SHEETS
CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
ASSETS | ||
Cash and cash equivalents | $ 244,086 | $ 461,900 |
Restricted cash and equivalents | 94,903 | 93,060 |
Short-term investments | 77,693 | 22,310 |
Accounts receivable | 2,132,070 | 1,957,583 |
Inventories | 109,122 | 107,428 |
Other receivables | 413,976 | 427,321 |
Prepaid and other current assets | 78,839 | 72,517 |
Income tax receivable | 4,603 | 25,604 |
Total current assets | 3,155,292 | 3,167,723 |
Property and equipment, net of accumulated depreciation | 3,256,397 | 3,479,972 |
Operating lease right-of-use assets | 2,666,242 | 2,824,787 |
Intangible assets, net of accumulated amortization | 182,687 | 177,693 |
Equity method and other investments | 231,108 | 238,881 |
Long-term investments | 44,329 | 49,514 |
Other long-term assets | 315,587 | 136,677 |
Goodwill | 7,076,610 | 7,046,241 |
Assets, Total | 16,928,252 | 17,121,488 |
LIABILITIES AND EQUITY | ||
Accounts payable | 479,780 | 402,049 |
Other liabilities | 802,469 | 709,345 |
Accrued compensation and benefits | 692,654 | 659,960 |
Current portion of operating lease liabilities | 395,401 | 394,357 |
Current portion of long-term debt | 231,404 | 179,030 |
Income tax payable | 18,039 | 53,792 |
Total current liabilities | 2,619,747 | 2,398,533 |
Long-term operating lease liabilities | 2,503,068 | 2,672,713 |
Long-term debt | 8,692,617 | 8,729,150 |
Other long-term liabilities | 105,233 | 119,158 |
Deferred income taxes | 782,787 | 830,954 |
Total liabilities | 14,703,452 | 14,750,508 |
Commitments and contingencies | ||
Noncontrolling interests subject to put provisions | 1,348,908 | 1,434,832 |
Equity: | ||
Preferred Stock, Value, Issued | 0 | 0 |
Common Stock, Value, Issued | 90 | 97 |
Additional paid-in capital | 606,935 | 540,321 |
Retained earnings | 174,487 | 354,337 |
Accumulated other comprehensive loss | (69,186) | (139,247) |
Total DaVita Inc. shareholders' equity | 712,326 | 755,508 |
Noncontrolling interests not subject to put provisions | 163,566 | 180,640 |
Total equity | 875,892 | 936,148 |
Total liabilities and shareholders' equity | $ 16,928,252 | $ 17,121,488 |
Preferred stock, par value (in usd per share) | $ 0.001 | $ 0.001 |
Preferred stock, shares authorized (in shares) | 5,000,000 | 5,000,000 |
Preferred stock, issued (in shares) | 0 | 0 |
Common stock, par value (in usd per share) | $ 0.001 | $ 0.001 |
Common stock, shares authorized (in shares) | 450,000,000 | 450,000,000 |
Common stock, shares issued (in shares) | 90,411,000 | 97,289,000 |
CONSOLIDATED BALANCE SHEETS (Pa
CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares | Dec. 31, 2022 | Dec. 31, 2021 |
Statement of Financial Position [Abstract] | ||
Preferred stock, par value (in usd per share) | $ 0.001 | $ 0.001 |
Preferred stock, shares authorized (in shares) | 5,000,000 | 5,000,000 |
Preferred stock, issued (in shares) | 0 | 0 |
Common stock, par value (in usd per share) | $ 0.001 | $ 0.001 |
Common stock, shares authorized (in shares) | 450,000,000 | 450,000,000 |
Common stock, shares outstanding (in shares) | 90,411,000 | 97,289,000 |
CONSOLIDATED STATEMENTS OF CASH
CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Cash flows from operating activities: | |||
Net income | $ 781,643 | $ 1,211,762 | $ 994,677 |
Adjustments to Reconcile Net Income (Loss) to Cash Provided by (Used in) Operating Activities [Abstract] | |||
Depreciation and amortization | 732,602 | 680,615 | 630,435 |
Debt prepayment, refinancing and redemption charges | 0 | 0 | 86,957 |
Stock-based compensation expense | 95,427 | 102,209 | 91,458 |
Deferred income taxes | (75,669) | 60,483 | 240,848 |
Equity investment income, net | 8,773 | 5,215 | 13,830 |
Loss on sales of business interests, net | 0 | 0 | 24,248 |
Other non-cash charges, net | 21,693 | 11,231 | 747 |
Changes in operating assets and liabilities, net of effect of acquisitions and divestitures: | |||
Accounts receivable | (148,394) | (138,140) | (21,087) |
Inventories | (757) | 5,720 | (12,349) |
Other receivables and prepaid and other current assets | 27,533 | 128,661 | (79,277) |
Other long-term assets | (50,549) | (26,387) | (6,123) |
Accounts payable | 87,481 | (30,320) | 37,200 |
Accrued compensation and benefits | 34,536 | (16,717) | (20,931) |
Other current liabilities | 89,955 | (93,645) | 105,637 |
Income taxes | (24,103) | 36,921 | (87,391) |
Other long-term liabilities | (15,601) | (6,732) | (19,851) |
Net Cash Provided by (Used in) Operating Activities, Total | 1,564,570 | 1,930,876 | 1,979,028 |
Cash flows from investing activities: | |||
Additions of property and equipment | (603,429) | (641,465) | (674,541) |
Acquisitions | (57,308) | (187,050) | (182,013) |
Proceeds from asset and business sales | 117,582 | 61,464 | 50,139 |
Purchase of debt investments held-to-maturity | (129,803) | (30,849) | (150,701) |
Purchase of other debt and equity investments | (3,590) | (2,987) | (3,757) |
Proceeds from debt investments held-to-maturity | 71,125 | 15,849 | 151,213 |
Proceeds from sale of other debt and equity investments | 3,781 | 12,030 | 3,491 |
Purchase of equity method investments | (31,885) | (13,924) | (22,341) |
Distributions from equity method investments | 3,962 | 2,944 | 3,139 |
Payments to Acquire Other Investments | (782) | (745) | 0 |
Net Cash Provided by (Used in) Investing Activities, Total | (630,347) | (784,733) | (825,371) |
Cash flows from financing activities: | |||
Borrowings | 2,393,116 | 1,615,370 | 4,046,775 |
Payments on long-term debt | (2,404,395) | (861,115) | (4,110,304) |
Deferred financing and debt redemption costs | (3) | (9,091) | (105,848) |
Purchase of treasury stock | (802,228) | (1,538,626) | (1,458,442) |
Distributions to noncontrolling interests | (267,946) | (244,033) | (253,118) |
Net (payments) receipts related to stock purchases and awards | (37,367) | (60,001) | (975) |
Contributions from noncontrolling interests | 14,797 | 31,754 | 42,966 |
Proceeds from sales of additional noncontrolling interests | 3,673 | 2,880 | 0 |
Purchases of noncontrolling interests | (20,775) | (20,104) | (7,831) |
Net cash used in financing activities | (1,121,128) | (1,082,966) | (1,846,777) |
Effect of exchange rate changes on cash, cash equivalents and restricted cash | (29,066) | (10,007) | (13,808) |
Less: Net increase (decrease) in cash, cash equivalents and restricted cash | (215,971) | 53,170 | (706,928) |
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year | 554,960 | 501,790 | 1,208,718 |
Cash, cash equivalents and restricted cash of continuing operations at end of the year | $ 338,989 | $ 554,960 | $ 501,790 |
CONSOLIDATED STATEMENTS OF EQUI
CONSOLIDATED STATEMENTS OF EQUITY - 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 income (loss) | Non-controlling interests not subject to put provisions |
Beginning Balance (in shares) at Dec. 31, 2019 | 125,843,000 | 0 | |||||||
Beginning balance at Dec. 31, 2019 | $ 2,133,409 | $ 126 | $ 749,043 | $ 1,431,738 | $ 0 | $ (47,498) | $ 185,833 | ||
Temporary equity, beginning balance at Dec. 31, 2019 | $ 1,180,376 | ||||||||
Increase (Decrease) in Temporary Equity [Roll Forward] | |||||||||
Net income | 141,879 | ||||||||
Distributions | (163,175) | ||||||||
Contributions | 30,154 | ||||||||
Acquisitions and divestitures | (3,215) | ||||||||
Partial purchases | (7,771) | ||||||||
Fair value remeasurements | 151,780 | ||||||||
Temporary equity, ending balance at Dec. 31, 2020 | 1,330,028 | ||||||||
Comprehensive income: | |||||||||
Net income | 773,642 | 773,642 | 79,156 | ||||||
Other comprehensive income | $ (18,656) | (18,656) | (18,656) | ||||||
Stock purchase shares issued (in shares) | 222,000 | ||||||||
Stock purchase plan | 17,148 | $ 0 | 17,148 | ||||||
Stock award payment plan (in shares) | 345,000 | ||||||||
Stock award plan | (17,801) | $ 0 | (17,801) | ||||||
Stock-settled stock-based compensation expense | 90,007 | 90,007 | |||||||
Changes in noncontrolling interest from: | |||||||||
Distributions | (89,943) | ||||||||
Contributions | 12,812 | ||||||||
Acquisitions and divestitures | 0 | (248) | |||||||
Partial purchases | (4,424) | ||||||||
Partial purchases | 4,364 | 4,364 | |||||||
Fair value remeasurements | (151,780) | (151,780) | |||||||
Purchase of treasury stock (in shares) | (16,477,000) | (16,477,000) | |||||||
Purchase of treasury stock | $ (1,446,767) | (1,446,767) | $ (1,446,767) | ||||||
Retirement of treasury stock (in shares) | (16,477,000) | 16,477,000 | |||||||
Retirement of treasury stock | 0 | $ (16) | (93,908) | (1,352,843) | $ 1,446,767 | ||||
Ending balance at Dec. 31, 2020 | 1,383,566 | $ 110 | 597,073 | 852,537 | $ 0 | (66,154) | 183,186 | ||
Ending Balance (in shares) at Dec. 31, 2020 | 109,933,000 | 0 | |||||||
Increase (Decrease) in Temporary Equity [Roll Forward] | |||||||||
Net income | 160,359 | ||||||||
Distributions | (159,259) | ||||||||
Contributions | 22,672 | ||||||||
Acquisitions and divestitures | 5,903 | ||||||||
Partial purchases | (588) | ||||||||
Fair value remeasurements | 75,717 | ||||||||
Temporary equity, ending balance at Dec. 31, 2021 | 1,434,832 | ||||||||
Comprehensive income: | |||||||||
Net income | 978,450 | 978,450 | 72,953 | ||||||
Other comprehensive income | $ (73,093) | (73,093) | (73,093) | ||||||
Stock purchase shares issued (in shares) | 203,000 | ||||||||
Stock purchase plan | 19,626 | $ 0 | 19,626 | ||||||
Stock award payment plan (in shares) | 1,030,000 | ||||||||
Stock award plan | (80,641) | $ 1 | (80,642) | ||||||
Stock-settled stock-based compensation expense | 100,714 | 100,714 | |||||||
Changes in noncontrolling interest from: | |||||||||
Distributions | (84,774) | ||||||||
Contributions | 9,082 | ||||||||
Acquisitions and divestitures | (264) | (264) | |||||||
Acquisitions and divestitures | 1,250 | ||||||||
Partial purchases | 13,853 | (13,853) | (1,057) | ||||||
Fair value remeasurements | (75,717) | (75,717) | |||||||
Purchase of treasury stock (in shares) | (13,877,000) | (13,877,000) | |||||||
Purchase of treasury stock | $ (1,546,016) | (1,546,016) | $ (1,546,016) | ||||||
Retirement of treasury stock (in shares) | (13,877,000) | 13,877,000 | |||||||
Retirement of treasury stock | 0 | $ (14) | (69,352) | (1,476,650) | $ 1,546,016 | ||||
Deferred taxes from partnership buyouts | 62,736 | 62,736 | |||||||
Ending balance at Dec. 31, 2021 | $ 936,148 | 755,508 | $ 97 | 540,321 | 354,337 | $ 0 | (139,247) | 180,640 | |
Ending Balance (in shares) at Dec. 31, 2021 | 97,289,000 | 97,289,000 | 0 | ||||||
Increase (Decrease) in Temporary Equity [Roll Forward] | |||||||||
Net income | 151,379 | ||||||||
Distributions | (176,957) | ||||||||
Contributions | 10,962 | ||||||||
Acquisitions and divestitures | 2,392 | ||||||||
Partial purchases | (11,670) | ||||||||
Fair value remeasurements | (62,487) | ||||||||
Other | 457 | ||||||||
Temporary equity, ending balance at Dec. 31, 2022 | $ 1,348,908 | ||||||||
Comprehensive income: | |||||||||
Net income | 560,400 | 560,400 | 69,864 | ||||||
Other comprehensive income | $ 70,061 | 70,061 | 70,061 | ||||||
Stock purchase shares issued (in shares) | 285,000 | ||||||||
Stock purchase plan | 18,061 | $ 0 | 18,061 | ||||||
Stock award payment plan (in shares) | 932,000 | ||||||||
Stock award plan | (55,920) | $ 1 | (55,921) | ||||||
Stock-settled stock-based compensation expense | 95,230 | 95,230 | |||||||
Changes in noncontrolling interest from: | |||||||||
Distributions | (90,989) | ||||||||
Contributions | 3,835 | ||||||||
Acquisitions and divestitures | 939 | 939 | 866 | ||||||
Partial purchases | (6,586) | (6,586) | (193) | ||||||
Fair value remeasurements | 62,487 | 62,487 | |||||||
Purchase of treasury stock (in shares) | (8,095,000) | (8,095,000) | |||||||
Purchase of treasury stock | $ (787,854) | (787,854) | $ (787,854) | ||||||
Retirement of treasury stock (in shares) | (8,095,000) | 8,095,000 | |||||||
Retirement of treasury stock | 0 | $ (8) | (47,596) | (740,250) | $ 787,854 | ||||
Other | 0 | (457) | |||||||
Ending balance at Dec. 31, 2022 | $ 875,892 | $ 712,326 | $ 90 | $ 606,935 | $ 174,487 | $ 0 | $ (69,186) | $ 163,566 | |
Ending Balance (in shares) at Dec. 31, 2022 | 90,411,000 | 90,411,000 | 0 |
Organization and Summary of Sig
Organization and Summary of Significant Accounting Policies | 12 Months Ended |
Dec. 31, 2022 | |
Accounting Policies [Abstract] | |
Organization and Summary of Significant Accounting Policies | Organization and summary of significant accounting policies Organization The Company's operations are comprised of its dialysis and related lab services to patients in the United States (its U.S. dialysis business), its U.S. integrated kidney care (IKC) business, its U.S. other ancillary services and its international operations (collectively, its ancillary services), as well as its corporate administrative support. The Company’s largest line of business is its U.S. dialysis business, which operates kidney dialysis centers in the U.S. for patients suffering from chronic kidney failure, also known as end stage renal disease or end stage kidney disease (ESRD or ESKD). As of December 31, 2022, the Company operated or provided administrative services through a network of 2,724 U.S. outpatient dialysis centers in 46 states and the District of Columbia, serving a total of approximately 199,400 patients. In addition, as of December 31, 2022, the Company operated or provided administrative services to a total of 350 outpatient dialysis centers serving approximately 45,600 patients located in 11 countries outside of the U.S. On June 19, 2019, the Company completed the sale of its prior DaVita Medical Group (DMG) business to Collaborative Care Holdings, LLC (Optum), a subsidiary of UnitedHealth Group Inc. The effects of the DMG sale on the Company's consolidated financial statements have been reported in discontinued operations for all periods presented. For information on how the DMG sale has affected these results, see Note 22. The Company’s U.S. dialysis and related lab services business qualifies as a separately reportable segment, and all other operating segments have been combined and disclosed in the other segments category. Basis of presentation These consolidated financial statements are prepared in accordance with United States generally accepted accounting principles (U.S. GAAP). The financial statements include DaVita Inc. and its subsidiaries, partnerships and other entities in which it maintains a majority voting or other controlling financial interest (collectively, the Company). All significant intercompany transactions and balances have been eliminated. Equity investments in investees over which the Company has significant influence are recorded on the equity method, while investments in other equity securities are recorded at fair value or on the adjusted cost method, as applicable. For the Company’s international subsidiaries, local currencies are considered their functional currencies. Translation adjustments result from translating the financial statements of the Company’s international subsidiaries from their functional currencies into the Company’s reporting currency (the U.S. dollar, or USD). Prior year classifications have been conformed to the current year presentation. The Company has evaluated subsequent events through the date these consolidated financial statements were issued and has included all necessary adjustments and disclosures. Use of estimates The preparation of financial statements in conformity with U.S. GAAP requires the use of estimates and assumptions that affect the reported amounts of revenues, expenses, assets, liabilities, contingencies and noncontrolling interests subject to put provisions. Although actual results in subsequent periods will differ from these estimates, such estimates are developed based on the best information available to management and management’s best judgments at the time. All significant assumptions and estimates underlying the amounts reported in the financial statements and accompanying notes are regularly reviewed and updated when necessary. Changes in estimates are reflected in the financial statements based upon on-going actual experience trends or subsequent settlements and realizations depending on the nature and predictability of the estimates and contingencies. The most significant assumptions and estimates underlying these consolidated financial statements and accompanying notes involve revenue recognition and accounts receivable, impairments of goodwill, accounting for income taxes, certain fair value estimates and loss contingencies. Specific estimating risks and contingencies are further addressed within these notes to the consolidated financial statements. Revenues Dialysis patient service revenues Revenues are recognized based on the Company’s estimate of the transaction price the Company expects to collect as a result of satisfying its performance obligations. Dialysis patient service revenues are recognized in the period services are provided based on these estimates. Revenues consist primarily of payments from government and commercial health plans for dialysis services provided to patients. The Company maintains a usual and customary fee schedule for its dialysis treatments and related lab services; however, actual collectible revenue is normally recognized at a discount from this fee schedule. Revenues associated with Medicare and Medicaid programs are estimated based on: (a) the payment rates that are established by statute or regulation for the portion of payment rates paid by the government payor (e.g., 80% for Medicare patients) and (b) for the portion not paid by the primary government payor, estimates of the amounts ultimately collectible from other government programs providing secondary coverage (e.g., Medicaid secondary coverage), the patient’s commercial health plan secondary coverage, or the patient. Under Medicare’s bundled payment rate system, services covered by Medicare are subject to estimating risk, whereby reimbursements from Medicare can vary significantly depending upon certain patient characteristics and other variable factors. Even with the bundled payment rate system, Medicare payments for bad debt claims as established by cost reports require evidence of collection efforts. As a result, billing and collection of Medicare bad debt claims can be delayed significantly and final payment is subject to audit. The Company’s revenue recognition is estimated based on its judgment regarding its ability to collect, which depends upon its ability to effectively capture, document and bill for Medicare’s base payment rate as well as these other variable factors. Medicare Advantage revenues are reimbursed at negotiated contract rates that are generally higher than Medicare fee-for-service rates, but which generally have a slower payment frequency than Medicare fee-for-service payments, and some of which are subject to certain quality or performance adjustments. Medicare Advantage revenues are subject to meaningful estimating risk based on factors similar to those described for commercial health plans below. Medicaid payments, when Medicaid coverage is secondary, can also be difficult to estimate. For many states, Medicaid payment terms and methods differ from Medicare, and may prevent accurate estimation of individual payment amounts prior to billing. Revenues associated with commercial health plans are estimated based on contractual terms for the patients under healthcare plans with which the Company has formal agreements, non-contracted health plan coverage terms if known, estimated secondary collections, historical collection experience, historical trends of refunds and payor payment adjustments (retractions), inefficiencies in the Company’s billing and collection processes that can result in denied claims for payments, delays in collections due to payor payment inefficiencies, and regulatory compliance matters. Commercial revenue recognition also involves significant estimating risks. With many larger commercial insurers, the Company has several different contracts and payment arrangements, and these contracts often include only a subset of the Company’s centers. Some of our commercial revenue contracts are also subject to certain quality or performance adjustments. In certain circumstances, it may not be possible to determine which contract, if any, should be applied prior to billing. In addition, for services provided by non-contracted centers, final collection may require specific negotiation of a payment amount, typically at a significant discount from the Company’s usual and customary rates. Other revenues Other revenues consist of revenues earned by the Company's non-dialysis ancillary services as well as fees for management and administrative services to outpatient dialysis businesses that the Company does not consolidate. Other revenues are estimated in the period services are provided. The Company's IKC revenues include revenues earned under risk-based arrangements, including value-based care (VBC) arrangements. Under its VBC arrangements, the Company assumes full or shared financial risk for the total medical cost of care for patients below or above a benchmark. The benchmarks against which the Company incurs profit or loss on these contracts are typically based on the underlying premiums paid to the insuring entity (the Company's counterparty), with adjustments where applicable, or on trended and adjusted medical cost targets. For some of the Company's risk-based arrangements (such as its special needs plans), the Company acts as a principal with respect to all medical services provided to the patient by effectively hosting or sponsoring the entire arrangement, and as a result recognizes revenue and expense for all medical services provided to covered patients. However, for most of its VBC arrangements, the Company provides health monitoring and care coordination services to patients but does not control or direct the medical services that patients receive from third party providers. As a result, for most of its VBC arrangements the Company does not include third party medical costs in its reported revenues and expenses, but rather recognizes revenue only for the estimated amount of shared savings or shared losses or related revenues that are directly earned or incurred by the Company, and ultimately paid to or by the Company, under the arrangement. Other income Other income includes interest income on cash and cash equivalents and short- and long-term investments, realized and unrealized gains and losses recognized on investments, impairments on investments, and foreign currency transaction gains and losses. Cash and cash equivalents Cash equivalents are short-term highly liquid investments readily convertible to known amounts of cash that typically mature within three months or less at date of purchase. Restricted cash and equivalents Restricted cash and cash equivalents include funds held in trust to satisfy insurer and state regulatory requirements related to wholly-owned captive insurance companies that bear professional and general liability and workers' compensation risks for the Company as well as funds held in escrow. See Note 4 for further details. Investments in debt and equity securities The Company classifies certain debt securities as held-to-maturity and records them at amortized cost based on the Company’s intentions and strategies concerning those investments. Equity securities that have readily determinable fair values or redemption values are recorded at estimated fair value with changes in fair value recognized in current earnings within other income. These debt and equity investments are classified as short-term investments or long-term investments on the Company's consolidated balance sheet. See Note 5 for further details. Inventories Inventories are stated at the lower of cost (first-in, first-out) or net realizable value and consist principally of pharmaceuticals and dialysis-related supplies. Rebates related to inventory purchases are recorded when earned and are based on certain qualification requirements which are dependent on a variety of factors including future pricing levels and purchase volume levels from the manufacturer and related data submission. Property and equipment Property and equipment is stated at cost less accumulated depreciation and amortization and is further reduced by any impairments. Maintenance and repairs are charged to expense as incurred. Property and equipment assets are reviewed for possible impairment whenever significant events or changes in circumstances indicate that an impairment may have occurred. Property and equipment impairment assessments are performed at a location or market level, as applicable, based on the specific cash flows they support or protect. If the Company commits to a plan to dispose of a long-lived asset before the end of its previously estimated useful life, cash flow estimates are revised accordingly, and the Company records an asset impairment, if applicable, or accelerates depreciation over the revised estimated useful life. Upon sale or retirement of long-lived assets, the cost and related accumulated depreciation or amortization are removed from the balance sheet and any resulting gain or loss is included in current operating expenses. Leases The Company leases substantially all of its U.S. dialysis facilities. The majority of the Company’s facilities are leased under non-cancellable operating leases which contain renewal options. These renewal options are included in the Company's determination of the right-of-use assets and related lease liabilities when renewal is considered reasonably certain at the commencement date.The Company's leases are generally subject to fixed escalation clauses or contain consumer price index increases. The Company categorizes leases with contractual terms longer than twelve months as either operating or finance leases. Finance leases are generally those leases that allow the Company to substantially utilize or pay for the entire asset over its estimated life. All other leases are categorized as operating leases. The Company has elected the practical expedient to not separate lease components from non-lease components for its financing and operating leases. For short-term leases with a term of less than 12 months, the Company does not recognize right-of-use assets or lease liabilities and instead recognizes short-term lease costs as rent expense directly as incurred. Financing and operating lease liabilities are measured at the net present value of lease payments over the lease term as of the commencement date. Since most of the Company's leases do not provide an implicit rate of return, the Company uses its incremental borrowing rate based on information available at the commencement date or remeasurement date in determining the present value of lease payments. Assets acquired under finance leases are recorded on the balance sheet within property and equipment, net and liabilities for finance lease obligations are recorded within long-term debt. Finance lease assets are amortized to depreciation expense on a straight-line basis over the shorter of their estimated useful lives or the expected lease term. Accretion of interest on finance lease liabilities is included in debt expense. Rights to use assets under operating leases are recorded on the balance sheet as operating lease right-of-use assets and liabilities for operating lease obligations are recorded as operating lease liabilities. Both amortization of operating lease right-of-use assets, and interest accretion on operating lease liabilities, are recorded to rent expense over the lease term. Rent expenses are included in patient care costs or general and administrative expense, as applicable, based on the business unit or corporate function for which the space is leased. Amortizable intangibles Amortizable intangible assets include noncompetition agreements, hospital service contracts, and customer relationships arising from other service contracts, each of which have finite useful lives. Amortization expense is computed using the straight-line method over the useful lives of the assets estimated as follows: noncompetition agreements and hospital acute service contracts over the contract term, and customer relationships from other service contracts over the remaining contract term plus expected renewal periods. Amortizable intangible assets are reviewed for possible impairment whenever significant events or changes in circumstances indicate that an impairment may have occurred. Amortizable intangible asset impairment assessments are performed on a location, market or business unit basis, as applicable, based on the specific cash flows they support or protect. Indefinite-lived intangibles Indefinite-lived intangible assets include international licenses and accreditations that allow the Company to be reimbursed for providing dialysis services to patients, each of which has an indefinite useful life. Indefinite-lived intangibles are not amortized, but are assessed for impairment at least annually and whenever significant events or changes in circumstances indicate that an impairment may have occurred. Costs to renew indefinite-lived intangible assets are expensed as incurred. Equity method and other investments Equity investments that do not have readily determinable fair values are carried on the equity method if the Company maintains significant influence over the investee unless the fair value option is elected. Equity investments without readily determinable fair values for which the Company does not maintain significant influence over the investee are carried either on the adjusted cost method or at estimated fair value, as determined on an investment-specific basis. The adjusted cost method represents the Company's cost for an investment, net of any impairments, as adjusted for any subsequent observable price changes. These equity investments are classified as equity method and other investments on the Company's consolidated balance sheet. See Note 9 for further details. Equity method investments are assessed for other-than-temporary impairment when significant events or changes in circumstances indicate that an other-than-temporary impairment may have occurred. An other-than-temporary impairment charge is recorded when the fair value of an investment has fallen below its carrying amount and the shortfall is expected to be indefinitely or permanently unrecoverable. Income and expense from nonconsolidated dialysis partnerships accounted for as equity method investments are recorded within equity investment income, net. For ownership interests accounted for as equity method investments other than dialysis partnerships, income and expense are included on up to a one quarter lag in other (loss) income, net. Goodwill Goodwill represents the difference between the fair value of businesses acquired and the fair value of the identifiable tangible and intangible net assets acquired. Goodwill is not amortized, but is assessed by individual reporting unit for impairment as circumstances warrant and at least annually. An impairment charge is recognized when and to the extent a reporting unit's carrying amount is determined to exceed its fair value. The Company operates multiple reporting units. See Note 10 for further details. Self-insurance The Company predominantly self-insures its professional and general liability, workers' compensation and automobile risks, and a portion of its employment liability practice risks, through its wholly-owned captive insurance companies, with excess or reinsurance coverage for additional protection. The Company is also predominantly self-insured with respect to employee medical and other health benefits. The Company records insurance liabilities for the professional and general liability, workers’ compensation, automobile, employee health benefit and portion of employment liability practice risks that it retains and estimates its liability for those risks using third party actuarial calculations that are based upon historical claims experience and expectations for future claims. Income taxes Federal, state and foreign income taxes are computed at currently enacted tax rates less tax credits using the asset and liability method. Deferred taxes are adjusted both for items that do not currently have tax consequences and for the cumulative effect of any changes in tax rates from those previously used to determine deferred tax assets or liabilities. Tax provisions include amounts that are currently payable, changes in deferred tax assets and liabilities that arise because of temporary differences between the timing of when items of income and expense are recognized for financial reporting and income tax purposes, changes in the recognition of tax positions and any changes in the valuation allowance caused by a change in judgment about the realizability of the related deferred tax assets. A valuation allowance is established when necessary to reduce deferred tax assets to amounts expected to be realized. The Company uses a recognition threshold of more-likely-than-not and a measurement attribute on all tax positions taken or expected to be taken in a tax return in order to be recognized in the financial statements. Once the recognition threshold is met, the tax position is then measured to determine the actual amount of benefit to recognize in the financial statements. Stock-based compensation The Company’s stock-based compensation expense for stock-settled awards is measured at the estimated fair value of awards on the date of grant and recognized on a cumulative straight-line basis over the vesting terms of the awards, unless the stock awards are based on non-market-based performance metrics, in which case expense is adjusted for the ultimate number of shares expected to be issued as of the end of each reporting period. Stock-based compensation expense for cash-settled awards is based on their estimated fair values as of the end of each reporting period. The expense for all stock-based awards is recognized net of expected forfeitures. Stock-based compensation to be settled in shares is recorded to the Company’s shareholders’ contributed capital, while stock-based compensation to be settled in cash is recorded as a liability. Shares issued upon exercise or, when applicable, vesting of stock awards, are issued from authorized but unissued shares. Interest rate cap agreements The Company often carries a combination of current or forward interest rate caps on portions of its variable rate debt as a means of hedging its exposure to changes in LIBOR interest rates as part of its overall interest rate risk management strategy. These interest rate caps are not held for trading or speculative purposes and are designated as qualifying cash flow hedges. See Note 13 for further details. Noncontrolling interests Noncontrolling interests represent third-party equity ownership interests in entities which are consolidated by the Company for financial statement reporting purposes. As of December 31, 2022, third parties held noncontrolling equity interests in 689 consolidated legal entities. Fair value estimates Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. Fair value measurements are determined based on the principal or most advantageous market for the item being measured, assume that buyers and sellers are independent, willing and able to transact, and knowledgeable, with access to all information customarily available in such a transaction, and are based on assumptions that market participants would use in pricing the item, not assumptions specific to the reporting entity. The criticality of a particular fair value estimate to the Company's consolidated financial statements depends upon the nature and size of the item being measured, the extent of uncertainties involved and the nature and magnitude or potential effect of assumptions and judgments required. Certain fair value estimates can involve significant uncertainties and require significant judgment on various matters, some of which could be subject to reasonable disagreement. See Note 24 for further details. The Company relies on fair value measurements and estimates for purposes that require the recording, reassessment, or adjustment of the carrying amounts of certain assets, liabilities, and noncontrolling interests subject to put provisions (redeemable equity interests classified as temporary equity). These purposes can include the accounting for business combination transactions; impairment assessments for goodwill, other intangible assets, or other long-lived assets; recurrent revaluation of investments in debt and equity securities, contingent earn-out obligations, interest rate cap agreements, and noncontrolling interests subject to put provisions; and the accounting for equity method and other investments and stock-based compensation, as applicable. The Company has classified its assets, liabilities and temporary equity into the fair value hierarchy levels defined by the Financial Accounting Standards Board (FASB) reflecting their differing degrees of uncertainty. See Note 24 for further details. New accounting standards New standards not yet adopted In March 2020, the FASB issued Accounting Standards Update (ASU) No. 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting (ASU 2020-04) . ASU 2020-04 provides optional expedients and exceptions for applying U.S. GAAP to contract modifications and hedging relationships, subject to meeting certain criteria, that reference LIBOR or another rate that is expected to be discontinued. The amendments in this ASU were effective beginning on March 12, 2020, and the Company could elect to apply the amendments prospectively through December 31, 2022. In December 2022, the FASB issued ASU No. 2022-06, Reference Rate Reform (Topic 848): Deferral of the Sunset Date of Topic 848, which extends the election date to December 31, 2024. Effective January 1, 2022 certain LIBOR tenors that do not affect the Company, including the one-week and two-month U.S. dollar LIBOR rate, ceased or became non-representative. The remaining U.S. dollar LIBOR tenors will cease or become non-representative effective July 1, 2023. This change will have no impact on the Company's ability to borrow. The Company is currently assessing the other effects this guidance may have on its consolidated financial statements. In October 2021, the FASB issued ASU No. 2021-08, Business Combinations (Topic 805): Accounting for Acquired Contract Assets and Contract Liabilities (ASU 2021-08) . ASU 2021-08 requires application of ASC 606, Revenue from Contracts with Customers , to recognize and measure assets and liabilities from contracts with customers acquired in a business combination. This ASU creates an exception to the general recognition and measurement principle in ASC 805 and will result in recognition of contract assets and contract liabilities consistent with those recorded by the acquiree immediately before the acquisition date. ASU 2021-08 is effective for fiscal years beginning after December 15, 2022, including interim periods within those fiscal years. Early adoption is permitted for all entities. The Company does not expect the adoption of this standard to have a material impact on its consolidated financial statements. |
Revenue Recognition
Revenue Recognition | 12 Months Ended |
Dec. 31, 2022 | |
Text Block [Abstract] | |
Revenue from Contract with Customer | Revenue recognition and accounts receivable The Company's revenues by segment and primary payor source were as follows: Year ended December 31, 2022 U.S. dialysis Other - Ancillary services Consolidated Patient service revenues: Medicare and Medicare Advantage $ 6,041,496 $ 6,041,496 Medicaid and Managed Medicaid 759,579 759,579 Other government 336,991 464,921 801,912 Commercial 3,437,306 223,216 3,660,522 Other revenues: Medicare and Medicare Advantage 345,340 345,340 Medicaid and Managed Medicaid 1,546 1,546 Commercial 22,211 22,211 Other (1) 24,437 44,092 68,529 Eliminations of intersegment revenues (87,035) (4,206) (91,241) Total $ 10,512,774 $ 1,097,120 $ 11,609,894 (1) Other consists primarily of management service fees earned in the respective Company line of business as well as other non-patient service revenue from the Company's U.S. IKC and other ancillary services and international operations. Year ended December 31, 2021 U.S. dialysis Other - Ancillary services Consolidated Patient service revenues: Medicare and Medicare Advantage $ 6,133,235 $ $ 6,133,235 Medicaid and Managed Medicaid 782,430 782,430 Other government 328,256 463,385 791,641 Commercial 3,397,697 199,024 3,596,721 Other revenues: Medicare and Medicare Advantage 326,696 326,696 Medicaid and Managed Medicaid 1,321 1,321 Commercial 15,553 15,553 Other (1) 25,345 40,945 66,290 Eliminations of intersegment revenues (90,796) (4,294) (95,090) Total $ 10,576,167 $ 1,042,630 $ 11,618,797 (1) Other consists primarily of management service fees earned in the respective Company line of business as well as other non-patient service revenue from the Company's U.S. IKC and other ancillary services and international operations. Year ended December 31, 2020 U.S. dialysis Other - Ancillary services Consolidated Patient service revenues: Medicare and Medicare Advantage (1) $ 6,169,226 $ $ 6,169,226 Medicaid and Managed Medicaid 744,862 744,862 Other government (1) 334,714 380,584 715,298 Commercial 3,370,562 170,394 3,540,956 Other revenues: Medicare and Medicare Advantage 419,662 419,662 Medicaid and Managed Medicaid 1,227 1,227 Commercial 33,246 33,246 Other (2) 40,571 47,585 88,156 Eliminations of intersegment revenues (145,286) (16,743) (162,029) Total $ 10,514,649 $ 1,035,955 $ 11,550,604 (1) During the first quarter of 2021, the Company realigned the classification of revenue previously disclosed in the "Other government" category to the "Medicare and Medicare Advantage" category for certain government-reimbursed plans which have structure and payment characteristics similar to traditional Medicare Advantage plans. The classification of revenue for these plans for the year ended December 31, 2020 has also been recast to conform to this presentation. (2) Other consists primarily of management service fees earned in the respective Company line of business as well as other non-patient revenue from the Company's U.S. IKC and other ancillary services and international operations. The majority of the Company's non-patient service revenues from Medicare and Medicare Advantage, Medicaid and Managed Medicaid, and commercial sources represent risk-based revenues earned by the Company's U.S. integrated care and disease management business. As described in Note 1, there are significant risks 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 determining applicable primary and secondary coverage, changes in patient coverage and coordination of benefits. As these estimates are refined over time, both positive and negative adjustments to revenue are recognized in the current period. No single commercial payor accounted for more than 10% of consolidated revenues or consolidated accounts receivable for the periods presented in these consolidated financial statements or at their period-ends, respectively. Dialysis services accounts receivable and other receivables from Medicare, including Medicare Advantage plans, and Medicaid, including managed Medicaid plans, were approximately $1,113,499 and $1,174,123 as of December 31, 2022 and 2021, respectively. Approximately 18% and 16% of the Company’s patient services accounts receivable balances as of December 31, 2022 and 2021, respectively, were more than six months old. There were no significant balances over one year old at December 31, 2022. The Company's accounts receivable are principally due from Medicare and Medicaid programs and commercial insurance plans. |
Earnings Per Share
Earnings Per Share | 12 Months Ended |
Dec. 31, 2022 | |
Earnings Per Share [Abstract] | |
Earnings Per Share | Earnings per share Basic earnings per share is calculated by dividing net income attributable to the Company by the weighted average number of common shares outstanding. Weighted average common shares outstanding include restricted stock unit awards that are no longer subject to forfeiture because the recipients have satisfied either their explicit vesting terms or retirement eligibility requirements. Diluted earnings per share includes the dilutive effect of outstanding stock-settled stock appreciation rights and unvested stock units as computed under the treasury stock method. The reconciliations of the numerators and denominators used to calculate basic and diluted earnings per share were as follows: Year ended December 31, 2022 2021 2020 Net income (loss) attributable to DaVita Inc.: Continuing operations $ 546,948 $ 978,450 $ 783,295 Discontinued operations 13,452 — (9,653) Net income attributable to DaVita Inc. $ 560,400 $ 978,450 $ 773,642 Weighted average shares outstanding: Basic shares 92,992 105,230 119,797 Assumed incremental from stock plans 2,842 4,718 2,826 Diluted shares 95,834 109,948 122,623 Basic net income (loss) attributable to DaVita Inc.: Continuing operations per share $ 5.88 $ 9.30 $ 6.54 Discontinued operations per share 0.15 — (0.08) Basic net income per share attributable to DaVita Inc. $ 6.03 $ 9.30 $ 6.46 Diluted net income (loss) attributable to DaVita Inc.: Continuing operations per share $ 5.71 $ 8.90 $ 6.39 Discontinued operations per share 0.14 — (0.08) Diluted net income per share attributable to DaVita Inc. $ 5.85 $ 8.90 $ 6.31 Anti-dilutive stock-settled awards excluded from calculation (1) 1,058 116 2,301 (1) Shares associated with stock awards excluded from the diluted denominator calculation because they were anti-dilutive under the treasury stock method. |
Restricted Cash Restricted Cash
Restricted Cash Restricted Cash | 12 Months Ended |
Dec. 31, 2022 | |
Restricted Cash [Abstract] | |
Restricted Cash and Cash Equivalents Disclosure [Text Block] | Restricted cash and equivalentsThe Company had restricted cash and cash equivalents of $94,903 and $93,060 at December 31, 2022 and 2021, respectively. Substantially all of the restricted cash and equivalents balance at December 31, 2022 is held in trust to satisfy insurer and state regulatory requirements related to the wholly-owned captive insurance companies that bear professional and general liability and workers' compensation risks for the Company and the remaining restricted cash and cash equivalents held at December 31, 2022 represents cash pledged to third parties in connection with the Company's ancillary operations. |
Short-term and long-term invest
Short-term and long-term investments | 12 Months Ended |
Dec. 31, 2022 | |
Investments, Debt and Equity Securities [Abstract] | |
Investments in Debt and Equity Securities | Short-term and long-term investments The Company’s short-term and long-term investments, consisting of debt instruments classified as held-to-maturity and equity investments with readily determinable fair values or redemption values, were as follows: December 31, 2022 December 31, 2021 Debt Equity Total Debt Equity Total Certificates of deposit and other time deposits $ 82,879 $ — $ 82,879 $ 23,226 $ — $ 23,226 Investments in mutual funds and common stock — 39,143 39,143 — 48,598 48,598 $ 82,879 $ 39,143 $ 122,022 $ 23,226 $ 48,598 $ 71,824 Short-term investments $ 67,872 $ 9,821 $ 77,693 $ 8,227 $ 14,083 $ 22,310 Long-term investments 15,007 29,322 44,329 14,999 34,515 49,514 $ 82,879 $ 39,143 $ 122,022 $ 23,226 $ 48,598 $ 71,824 Debt securities: The Company's short-term debt investments are principally bank certificates of deposit with contractual maturities longer than three months but shorter than one year. The Company's long-term debt investments are bank time deposits with contractual maturities longer than one year. These debt securities are accounted for as held-to-maturity and recorded at amortized cost, which approximated their fair values at December 31, 2022 and 2021. Equity securities: The Company holds certain equity investments that have readily determinable fair values from public markets. The Company's remaining short-term and long-term equity investments are held within a trust to fund existing obligations associated with the Company’s non-qualified deferred compensation plans. |
Other Receivables Other Receiva
Other Receivables Other Receivables | 12 Months Ended |
Dec. 31, 2022 | |
Receivables [Abstract] | |
Other Receivables | Other receivables Other receivables were comprised of the following: December 31, 2022 2021 Supplier rebates and non-trade receivables $ 303,225 $ 294,574 Medicare bad debt claims 110,751 132,747 $ 413,976 $ 427,321 |
Property and Equipment
Property and Equipment | 12 Months Ended |
Dec. 31, 2022 | |
Property, Plant and Equipment [Abstract] | |
Property and Equipment | Property and equipment Property and equipment were comprised of the following: December 31, 2022 2021 Land $ 32,656 $ 34,009 Buildings 427,962 496,455 Leasehold improvements 3,925,244 3,828,404 Equipment and information systems, including internally developed software 3,759,274 3,292,176 New center and capital asset projects in progress 376,633 592,063 8,521,769 8,243,107 Less accumulated depreciation (5,265,372) (4,763,135) $ 3,256,397 $ 3,479,972 Depreciation and amortization expenses are computed using the straight-line method over the useful lives of the assets estimated as follows: buildings, 25 years to 40 years; leasehold improvements, the shorter of ten years or the expected lease term; and equipment and information systems, including internally developed software, principally three years to 15 years. Depreciation expense on property and equipment was $721,133, $667,755 and $616,626 for 2022, 2021 and 2020, respectively. Interest on debt incurred during the development of new centers and other capital asset projects is capitalized as a component of the asset cost based on the respective in-process capital asset balances. Interest capitalized was $12,677, $15,275 and $17,944 for 2022, 2021 and 2020, respectively. |
Intangibles
Intangibles | 12 Months Ended |
Dec. 31, 2022 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Intangibles | Intangible assets Intangible assets other than goodwill were comprised of the following: December 31, 2022 2021 Indefinite-lived licenses $ 127,271 $ 104,214 Noncompetition agreements 51,408 70,495 Customer relationships and other 53,779 63,714 232,458 238,423 Accumulated amortization: Noncompetition agreements (39,745) (52,813) Customer relationships and other (10,027) (7,917) $ 182,687 $ 177,693 Noncompetition agreements are generally amortized over three years to 10 years and customer relationships are principally amortized over 10 years to 20 years. The weighted average renewal or extension period of customer relationships was two years and three years as of December 31, 2022 and 2021, respectively. Amortization expense from amortizable intangible assets was $11,469, $12,860, and $13,809 for 2022, 2021 and 2020, respectively. For the years ended December 31, 2022, 2021 and 2020, the Company recognized no impairment charges on any intangible assets. Scheduled amortization expenses from amortizable intangible assets as of December 31, 2022 were as follows: Noncompetition Customer relationships and other 2023 $ 4,742 $ 4,084 2024 2,849 3,956 2025 1,721 3,489 2026 1,092 3,489 2027 730 3,382 Thereafter 529 25,352 Total $ 11,663 $ 43,752 |
Equity Method and Other Investm
Equity Method and Other Investments | 12 Months Ended |
Dec. 31, 2022 | |
Investments, Debt and Equity Securities [Abstract] | |
Equity Method Investments and Joint Ventures Disclosure | Equity method and other investments The Company maintains equity method and other minor investments in the private securities of certain other healthcare and healthcare-related businesses, comprised as follows: December 31, 2022 2021 APAC joint venture $ 99,141 $ 109,153 Other equity method partnerships 116,403 115,185 Adjusted cost method and other investments 15,564 14,543 $ 231,108 $ 238,881 During 2022, 2021 and 2020, the Company recognized equity investment income of $26,520, $26,937 and $26,916, respectively, from its equity method investments in nonconsolidated dialysis partnerships. The Company also recognized equity investment losses from other equity method investments of $4,703 and $1,292 in other (loss) income during 2022 and 2021, respectively. There were no equity investment losses from other equity method investments in 2020. The Company's largest equity method investment is its ownership interest in DaVita Care Pte. Ltd. (the APAC joint venture, or APAC JV). The Company holds a 75% voting and economic interest in the APAC JV and an unrelated noncontrolling investor holds the other 25% voting and economic interest in the joint venture, however the Company does not control or consolidate the APAC JV as a result of substantive participating rights retained by the unrelated investor over certain key operating decisions for the joint venture. The Company's other equity method investments include 23 legal entities over which the Company has significant influence but in which it does not maintain a controlling financial interest. Almost all of these are U.S. dialysis partnerships in the form of limited liability companies. The Company's ownership interests in these partnerships vary, and are often subject to blocking rights on certain key operating decisions held by outside investors, but mostly range from 30% to 65%. For the year ended December 31, 2022, the Company recognized impairments and other valuation adjustments on the Company's adjusted cost method and other investments of $20,154 in other (loss) income, net. There were no significant investment impairments or other valuation adjustments for the years ended December 31, 2021 and 2020. |
Goodwill
Goodwill | 12 Months Ended |
Dec. 31, 2022 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Goodwill | Goodwill Changes in the carrying value of goodwill by reportable segment were as follows: U.S. dialysis Other - Ancillary Consolidated Balance at December 31, 2020 $ 6,309,928 $ 609,181 $ 6,919,109 Acquisitions 91,979 81,265 173,244 Divestitures (1,745) — (1,745) Foreign currency and other adjustments — (44,367) (44,367) Balance at December 31, 2021 $ 6,400,162 $ 646,079 $ 7,046,241 Acquisitions 16,750 32,297 49,047 Divestitures (87) (3,263) (3,350) Foreign currency and other adjustments — (15,328) (15,328) Balance at December 31, 2022 $ 6,416,825 $ 659,785 $ 7,076,610 Balance at December 31, 2022: Goodwill $ 6,416,825 $ 778,774 $ 7,195,599 Accumulated impairment charges — (118,989) (118,989) $ 6,416,825 $ 659,785 $ 7,076,610 The Company's operations continue to be impacted by the effects of the coronavirus (COVID-19) pandemic. While the Company does not currently expect a material adverse impact to its business as a result of the ongoing COVID-19 pandemic, there can be no assurance that the magnitude of the cumulative impacts of the COVID-19 pandemic, including certain conditions and developments in the U.S. and global economies, labor market conditions, inflation and monetary policies that may have been intensified by the pandemic, will not have a material adverse impact on one or more of the Company's businesses. Each of the Company’s operating segments described in Note 25 to these consolidated financial statements represents an individual reporting unit for goodwill impairment assessment purposes. Within the U.S. dialysis operating segment, the Company considers each of its dialysis centers to constitute an individual business for which discrete financial information is available. However, since these dialysis centers have similar operating and economic characteristics, and the allocation of resources and significant investment decisions concerning these businesses are highly centralized and the benefits broadly distributed, the Company has aggregated these centers and deemed them to constitute a single reporting unit. The Company has applied a similar aggregation to the physician practices in its physician services reporting units, to the dialysis centers and other health operations within each international reporting unit, and to the vascular access service centers in its former vascular access services reporting unit. For the Company’s other operating segments, discrete business components below the operating segment level constitute individual reporting units. When performing quantitative goodwill impairment assessments, the Company estimates fair value using either appraisals developed with an independent third party valuation firm which consider both discounted cash flow estimates for the subject business and observed market multiples for similar businesses, or offer prices received for the subject business that would be acceptable to the Company. Based on its most recent assessments, the Company determined that changes in its forecast concerning expected patient census, the timing or amount of expected reimbursement rate increases, expected treatment growth rates, or other significant adverse changes in expected future cash flows or other valuation assumptions could result in goodwill impairment charges in the future for the following reporting unit, which remains at risk of goodwill impairment as of December 31, 2022: Reporting unit Goodwill Carrying amount (1) Sensitivities Operating (2) Discount (3) Germany kidney care $ 281,781 18.9 % (2.0) % (9.2) % (1) Excess of estimated fair value of the reporting unit over its carrying amount as of the latest assessment date. (2) Potential impact on estimated fair value of a sustained, long-term reduction of 3% in operating income as of the latest assessment date. (3) Potential impact on estimated fair value of an increase in discount rates of 100 basis points as of the latest assessment date. |
Other Liabilities
Other Liabilities | 12 Months Ended |
Dec. 31, 2022 | |
Other Liabilities Disclosure [Abstract] | |
Other Liabilities | Other liabilities Other liabilities were comprised of the following: December 31, 2022 2021 Payor refunds and retractions $ 475,195 $ 410,038 Insurance and self-insurance accruals 68,440 55,548 Accrued interest 34,162 32,926 Accrued non-income tax liabilities 42,806 41,784 Other 181,866 169,049 $ 802,469 $ 709,345 |
Income Taxes
Income Taxes | 12 Months Ended |
Dec. 31, 2022 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | Income taxes The Company accounts for income taxes under the asset and liability method, which requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of events that have been included in the consolidated financial statements. Under this method, deferred tax assets and liabilities are determined on the basis of the differences between the financial statement and tax basis of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. Income before income taxes from continuing operations consisted of the following: Year ended December 31, 2022 2021 2020 Domestic $ 926,604 $ 1,463,029 $ 1,287,976 International 39,674 55,465 30,286 $ 966,278 $ 1,518,494 $ 1,318,262 Income tax expense for continuing operations consisted of the following: Year ended December 31, 2022 2021 2020 Current: Federal $ 201,932 $ 216,539 $ 47,171 State 55,593 15,601 21,442 International 16,253 14,247 17,481 Total current income tax 273,778 246,387 86,094 Deferred: Federal (66,400) 59,528 198,623 State (12,289) 5,342 27,206 International 2,998 (4,525) 2,009 Total deferred income tax (75,691) 60,345 227,838 $ 198,087 $ 306,732 $ 313,932 Income taxes are allocated between continuing and discontinued operations as follows: Year ended December 31, 2022 2021 2020 Continuing operations $ 198,087 $ 306,732 $ 313,932 Discontinued operations — — 1,657 $ 198,087 $ 306,732 $ 315,589 The reconciliation between the Company’s effective tax rate from continuing operations and the U.S. federal income tax rate is as follows: Year ended December 31, 2022 2021 2020 Federal income tax rate 21.0 % 21.0 % 21.0 % State income taxes, net of federal benefit 3.8 3.0 3.4 Equity compensation (1.6) (2.4) — Federal and international tax rate adjustments — 1.3 — Nondeductible executive compensation 1.1 0.8 1.2 Political advocacy costs 2.2 0.2 1.7 Unrecognized tax benefits (1.1) (0.1) 0.4 Change in international valuation allowance 1.2 (1.0) 1.5 Credits (1.2) (0.7) (0.7) Other 1.1 1.7 0.1 Impact of noncontrolling interests primarily (6.0) (3.6) (4.8) Effective tax rate 20.5 % 20.2 % 23.8 % Deferred tax assets and liabilities arising from temporary differences for continuing operations were as follows: December 31, 2022 2021 Receivables $ 18,304 $ 8,430 Accrued liabilities 71,346 67,993 Operating lease liabilities 563,972 581,199 Net operating loss carryforwards 173,531 162,987 Other 58,827 52,434 Deferred tax assets 885,980 873,043 Valuation allowance (106,775) (100,616) Net deferred tax assets 779,205 772,427 Intangible assets (690,914) (644,039) Property and equipment (181,704) (283,913) Operating lease assets (515,026) (530,839) Investments in partnerships (80,876) (84,407) Other (65,766) (37,274) Deferred tax liabilities (1,534,286) (1,580,472) Net deferred tax liabilities $ (755,081) $ (808,045) Reported as: Deferred tax liabilities $ (782,787) $ (830,954) Deferred tax assets (included in Other long-term assets) 27,706 22,909 $ (755,081) $ (808,045) At December 31, 2022, the Company had federal net operating loss carryforwards of approximately $71,049 that expire through 2036, although a substantial amount expire by 2029. The Company also had state net operating loss carryforwards of $618,883, some of which have an indefinite life, although a substantial amount expire by 2042 and international net operating loss carryforwards of $357,266, some of which will begin to expire in 2023 though the majority have an indefinite life. The Company has a state capital loss carryover of $306,949, the majority of which expires in 2024. The utilization of a portion of these losses may be limited in future years based on the profitability of certain entities. A valuation allowance is recorded to account for the unrealizable balances in the table above. The net increase of $6,159 in the valuation allowance is primarily due to newly created net operating loss carryforwards in state and foreign jurisdictions that the Company does not anticipate being able to utilize. During the year ended December 31, 2021, the Company recorded a true-up to recognize net deferred tax assets related to historical purchases of noncontrolling interests in consolidated partnerships. The effect of this adjustment was an increase of $46,692 to net deferred tax assets, a charge of $16,044 to income tax expense, and an increase of $62,736 to additional paid-in capital. The Company’s prior purchases of this type have not generated significant pre-tax adjustments to additional paid-in capital in any single prior year. The majority of the $16,044 recorded to income tax expense was due to the decrease in the corporate tax rate in 2017. The Company remains indefinitely reinvested in a majority of the foreign jurisdictions in which it operates as of December 31, 2022. As a result of the passage of the Tax Cuts and Jobs Act (2017 Tax Act), the Company does not expect any significant taxes to be incurred if such earnings were remitted. Unrecognized tax benefits A reconciliation of the beginning and ending liability for unrecognized tax benefits that do not meet the more-likely-than-not threshold is as follows: Year ended December 31, 2022 2021 Beginning balance $ 73,024 $ 70,202 Additions for tax positions related to current year 3,858 3,335 Additions for tax positions related to prior years 24,683 22,616 Reductions related to lapse of applicable statute (6,073) (751) Reductions related to settlements with taxing authorities (31,507) (22,378) Ending balance $ 63,985 $ 73,024 As of December 31, 2022, the Company’s total liability for unrecognized tax benefits relating to tax positions that do not meet the more-likely-than-not threshold is $63,985, of which $45,825 would impact the Company’s effective tax rate if recognized. The Company recognizes accrued interest and penalties related to unrecognized tax benefits in income tax expense. The Company recognized an expense of $10,459 and a benefit of $2,589 related to interest and penalties net of federal tax benefit within tax expense in 2022 and 2021, respectively. At December 31, 2022 and 2021, the Company had approximately $8,208 and $15,275, respectively, accrued for interest and penalties related to unrecognized tax benefits, net of federal tax benefit. The Company and its subsidiaries are under examination in various state, local and foreign tax jurisdictions. The Company's federal tax returns are under examination by the Internal Revenue Service (IRS) for the years 2016 and 2017. In 2022, the Company was able to reach a settlement with the IRS for tax years 2014 and 2015. Subsequent to the settlement, the Company filed a 2014 refund claim with respect to a contested issue that was included in the IRS examination. The refund claim is currently subject to IRS review. The Company is also open to U.S. federal examination for 2019 onward, and is no longer subject to U.S. state examinations by tax authorities for years before 2014. |
Long-Term Debt
Long-Term Debt | 12 Months Ended |
Dec. 31, 2022 | |
Debt Disclosure [Abstract] | |
Long-Term Debt | Long-term debt Long-term debt was comprised of the following: December 31, As of December 31, 2022 2022 2021 Maturity date Interest rate Estimated fair value (1) Senior Secured Credit Facilities: Term Loan A $ 1,498,438 $ 1,596,875 8/12/2024 LIBOR + 1.75% $ 1,468,469 Term Loan B-1 2,660,831 2,688,263 8/12/2026 LIBOR + 1.75% $ 2,587,658 Revolving line of credit 165,000 — 8/12/2024 LIBOR + 1.75% $ 165,000 Senior Notes: 4.625% Senior Notes 2,750,000 2,750,000 6/1/2030 4.625 % $ 2,224,063 3.75% Senior Notes 1,500,000 1,500,000 2/15/2031 3.75 % $ 1,115,625 Acquisition obligations and other notes (2) 120,562 130,599 2023-2036 6.56 % $ 120,562 Financing lease obligations (3) 273,688 299,128 2023-2038 4.51 % Total debt principal outstanding 8,968,519 8,964,865 Discount and deferred financing costs (4) (44,498) (56,685) 8,924,021 8,908,180 Less current portion (231,404) (179,030) $ 8,692,617 $ 8,729,150 (1) For the Company's senior secured credit facilities and senior notes, fair value estimates are based upon bid and ask quotes, typically a level 2 input. For acquisition obligations and other notes payable, the carrying values presented here approximate their estimated fair values, based on estimates of their present values using level 2 interest rate inputs. (2) The interest rate presented for acquisition obligations and other notes payable is their weighted average interest rate based on the current fixed and LIBOR interest rate components in effect as of December 31, 2022. (3) Financing lease obligations are measured at their approximate present values at inception. The interest rate presented is the weighted average discount rate embedded in financing leases outstanding. (4) As of December 31, 2022, the carrying amount of the Company's senior secured credit facilities have been reduced by a discount of $3,497 and deferred financing costs of $18,816 and the carrying amount of the Company's senior notes have been reduced by deferred financing costs of $36,203 and increased by a debt premium of $14,018. As of December 31, 2021, the carrying amount of the Company's senior secured credit facilities was reduced by a discount of $4,473 and deferred financing costs of $27,207, and the carrying amount of the Company's senior notes was reduced by deferred financing costs of $40,914 and increased by a debt premium of $15,909. Scheduled maturities of long-term debt at December 31, 2022 were as follows: 2023 $ 231,404 2024 $ 1,587,867 2025 $ 67,112 2026 $ 2,627,310 2027 $ 35,176 Thereafter $ 4,419,650 During the year ended December 31, 2022, the Company made regularly scheduled mandatory principal payments under its senior secured credit facilities totaling $98,437 on Term Loan A and $27,432 on Term Loan B-1. Senior Secured Credit Facilities 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 are senior to all unsecured indebtedness. Borrowings under this facility's Term Loan A, Term Loan B-1 and revolving line of credit rank equal in priority for that security and related subsidiary guarantees under the facility's terms. Borrowings under this credit facility are based on the London Interbank Offered Rate (LIBOR), unless another base rate is elected. This facility also provides a mechanism for transition to an alternative variable base rate upon cessation of LIBOR. Outstanding borrowings under Term Loan A and Term Loan B-1 consist of tranches that can range in maturity from one month to 12 months. As of December 31, 2022, all outstanding term loan tranches are one month in duration. For Term Loan A and Term Loan B-1, each tranche bears interest at a LIBOR rate determined by the duration of such tranche plus an interest rate margin. The LIBOR variable component of the interest rate for each tranche is reset as the tranche matures and a new tranche is established. At December 31, 2022, the overall weighted average interest rate for Term Loan A and Term Loan B-1 was determined based upon the LIBOR interest rates in effect for all of their individual tranches plus the respective interest rate margins presented in the table above. As of December 31, 2022, the Company had $165,000 outstanding on the $1,000,000 revolving line of credit under its senior secured credit facilities. Each of these borrowings were priced on one-month LIBOR variable base rates as well. Credit available under this revolving line of credit is reduced by the amount of any letters of credit outstanding thereunder, of which there were none as of December 31, 2022. The Company also had letters of credit of approximately $108,826 outstanding under a separate bilateral secured letter of credit facility as of December 31, 2022. As of December 31, 2022, the Company's 2019 interest rate cap agreements described below had the economic effect of capping the Company's maximum exposure to LIBOR variable interest rate changes on equivalent amounts of the Company's floating rate debt, including all of Term Loan B-1 and a portion of Term Loan A. The remaining $659,269 outstanding principal balance of Term Loan A and the $165,000 balance outstanding on the revolving line of credit are subject to LIBOR-based interest rate volatility. Senior Notes The Senior Notes are unsecured obligations, rank equally in right of payment with the Company’s existing and future unsecured senior indebtedness and require semi-annual interest payments. The Company may redeem some or all of the Senior Notes at any time on or after certain specific dates and at certain specific redemption prices as outlined in each senior note agreement. Interest rates on the Senior Notes are fixed by their terms. Interest rate cap agreements The Company's interest rate cap agreements are designated as cash flow hedges and, as a result, changes in their fair values are reported in other comprehensive income. These cap agreements have variable legs priced at LIBOR to match the variable rates incurred on the senior secured credit facility borrowings that they hedge. Like the senior secured credit facilities, these interest rate cap agreements include a mechanism for transition to an alternative variable base rate upon cessation of LIBOR. The original premiums paid for the caps are amortized to debt expense on a straight-line basis over the term of each cap agreement starting from its effective date. These cap agreements do not contain credit-risk contingent features. The following table summarizes the Company’s interest rate cap agreements outstanding as of December 31, 2022 and December 31, 2021, which are classified in other long-term assets on its consolidated balance sheet: Year ended December 31, LIBOR maximum rate December 31, 2022 2022 2021 Notional amount Effective date Expiration date Debt expense Recorded OCI gain Fair value 2019 interest rate cap agreements $ 3,500,000 2.00% 6/30/2020 6/30/2024 $ (11,732) $ 144,793 $ 139,755 $ 12,203 The following table summarizes the effects of the Company’s interest rate cap agreements for the years ended December 31, 2022, 2021 and 2020: Amount of unrealized gains (losses) in OCI on interest rate cap agreements Location of losses Reclassification from accumulated other comprehensive income into net income Year ended December 31, Year ended December 31, Derivatives designated as cash flow hedges 2022 2021 2020 2022 2021 2020 Interest rate cap agreements $ 144,793 $ 9,532 $ (21,781) Debt expense $ (11,732) $ 5,509 $ 7,081 Related income tax (36,124) (2,377) 5,435 Related income tax 2,926 (1,376) (1,768) Total $ 108,669 $ 7,155 $ (16,346) $ (8,806) $ 4,133 $ 5,313 See Note 20 for further details on amounts recorded and reclassified from accumulated other comprehensive (loss) income. The Company’s weighted average effective interest rate on its senior secured credit facilities at the end of 2022 was 4.59%, based upon the current margins in effect for its senior secured credit facilities as of December 31, 2022. The Company’s weighted average effective interest rate on all debt, including the effect of interest rate caps and amortization of debt discount, was 3.96% for the year ended December 31, 2022 and 4.52% as of December 31, 2022. As of December 31, 2022, the Company’s interest rates were fixed on approximately 51.3% of its total debt. Debt expense Debt expense consisted of interest expense of $339,247, $267,049 and $282,932 and the amortization and accretion of debt discounts and premiums, amortization of deferred financing costs and the amortization of interest rate cap agreements of $17,772, $18,205 and $21,179 for 2022, 2021 and 2020, respectively. These interest expense amounts are net of capitalized interest. |
Leases
Leases | 12 Months Ended |
Dec. 31, 2022 | |
Leases [Abstract] | |
Leases Disclosure | Leases The Company leases substantially all of its U.S. dialysis facilities. The majority of the Company’s facilities are leased under non-cancellable operating leases which range in terms from five years to 15 years and which contain renewal options of five years to ten years at the fair rental value at the time of renewal. The Company's leases are generally subject to fixed escalation clauses or contain consumer price index increases. See Note 1 for further information on how the Company accounts for leases. As of December 31, 2022 and December 31, 2021, assets recorded under finance leases In certain markets, the Company acquires and develops dialysis centers. Upon completion, the Company sells the center to a third party and leases the space back with the intent of operating the center on a long term basis. Both the sale and leaseback terms are generally market terms. The lease terms are consistent with the Company's other operating leases with the majority of the leases under non-cancellable operating leases ranging in terms from five years to 15 years and which contain renewal options of five years to ten years at the fair rental value at the time of renewal. The components of lease expense were as follows: Year ended December 31, Lease cost 2022 2021 2020 Operating lease cost (1) : Fixed lease expense $ 552,194 $ 547,923 $ 541,090 Variable lease expense 127,621 125,981 122,729 Financing lease cost: Amortization of leased assets 27,079 26,846 24,720 Interest on lease liabilities 12,776 13,988 14,421 Net lease cost $ 719,670 $ 714,738 $ 702,960 (1) Includes short-term lease expense and sublease income, which are immaterial. Other information related to leases was as follows: Year ended December 31, Lease term and discount rate 2022 2021 2020 Weighted average remaining lease term (years): Operating leases 8.2 8.3 8.7 Finance leases 9.4 10.5 10.5 Weighted average discount rate: Operating leases 3.6 % 3.5 % 3.8 % Finance leases 4.5 % 4.5 % 5.1 % Year ended December 31, Other information 2022 2021 2020 Gains on sale leasebacks, net $ 28,005 $ 17,137 $ 34,301 Cash paid for amounts included in the Operating cash flows for operating leases $ 696,291 $ 684,186 $ 661,318 Operating cash flows for finance leases $ 20,103 $ 21,343 $ 20,981 Financing cash flows for finance leases $ 24,329 $ 22,445 $ 24,780 Net operating lease assets obtained in exchange $ 278,108 $ 361,101 $ 401,559 Future minimum lease payments under non-cancellable leases as of December 31, 2022 are as follows: Operating leases Finance leases 2023 $ 492,566 $ 37,442 2024 500,422 37,951 2025 452,080 38,125 2026 400,879 36,908 2027 333,580 35,569 Thereafter 1,175,340 145,987 Total future minimum lease payments 3,354,867 331,982 Less portion representing interest (456,398) (58,294) Present value of lease liabilities $ 2,898,469 $ 273,688 Rent expense under all operating leases for 2022, 2021 and 2020 was $679,815, $673,904 and $663,819, respectively. Rent expense is recorded on a straight-line basis over the term of the lease, including leases that contain fixed escalation clauses |
Employee Benefit Plans
Employee Benefit Plans | 12 Months Ended |
Dec. 31, 2022 | |
Retirement Benefits [Abstract] | |
Employee Benefit Plans | Employee benefit plans The Company has a 401(k) retirement savings plan for substantially all of its U.S. employees which has been established pursuant to applicable provisions of the Internal Revenue Code (IRC). The plan allows for employees to contribute a percentage of their base annual salaries on a tax-deferred basis not to exceed IRC limitations. The Company maintains a 401(k) matching program under which the Company matches 50% of the employee's contribution up to 6% of the employee's salary, subject to certain limitations. The matching contributions are subject to certain eligibility and vesting conditions. For the years ended December 31, 2022, 2021 and 2020, the Company accrued matching contributions totaling approximately $70,084, $68,658 and $70,180, respectively. The Company also maintains a voluntary compensation deferral plan, the Deferred Compensation Plan, as well as other legacy deferral plans. The Deferred Compensation Plan is non-qualified and permits certain employees whose annualized base salary equals or exceeds a minimum annual threshold amount as set by the Company to elect to defer all or a portion of their annual bonus payment and up to 50% of their base salary into a deferral account maintained by the Company. Total contributions to this plan in 2022, 2021 and 2020 were $3,573, $2,962 and $3,637, respectively. Deferred amounts are generally paid out in cash at the participant’s election either in the first or second year following retirement or in a specified future period at least three to four years after the deferral election was effective. During 2022, 2021 and 2020 the Company distributed $3,731, $11,887 and $3,139, respectively, to participants from its deferred compensation plans. Participants are credited with their proportional amount of annual earnings from the plans. The assets of these plans are held in rabbi trusts subject to the claims of the Company’s general creditors in the event of its bankruptcy. As of December 31, 2022 and 2021, the total fair value of assets held in these plans' trusts was $32,944 and $38,019, respectively. The assets of these plans are recorded at fair value with changes in fair value recorded in other income. See Note 5 for further details. Any fair value changes to the corresponding liability balance are recorded as compensation expense. |
Contingencies
Contingencies | 12 Months Ended |
Dec. 31, 2022 | |
Commitments and Contingencies Disclosure [Abstract] | |
Contingencies | Contingencies The majority of the Company’s revenues are from government programs and may be subject to adjustment as a result of: (i) examination by government agencies or contractors, for which the resolution of any matters raised may take extended periods of time to finalize; (ii) differing interpretations of government regulations by different Medicare contractors or regulatory authorities; (iii) differing opinions regarding a patient’s medical diagnosis or the medical necessity of services provided; and (iv) retroactive applications or interpretations of governmental requirements. In addition, the Company’s revenues from commercial payors may be subject to adjustment as a result of potential claims for refunds, as a result of government actions or as a result of other claims by commercial payors. The Company operates in a highly regulated industry and is a party to various lawsuits, demands, claims, qui tam suits, governmental investigations (which frequently arise from qui tam suits) and audits (including, without limitation, investigations or other actions resulting from its obligation to self-report suspected violations of law) and other legal proceedings, including, without limitation, those described below. The Company records accruals for certain legal proceedings and regulatory matters to the extent that the Company determines an unfavorable outcome is probable and the amount of the loss can be reasonably estimated. As of December 31, 2022 and December 31, 2021, the Company’s total recorded accruals with respect to legal proceedings and regulatory matters, net of anticipated third party recoveries, were immaterial. While these accruals reflect the Company’s best estimate of the probable loss for those matters as of the dates of those accruals, the recorded amounts may differ materially from the actual amount of the losses for those matters, and any anticipated third party recoveries for any such losses may not ultimately be recoverable. Additionally, in some cases, no estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made because of the inherently unpredictable nature of legal proceedings and regulatory matters, which also may be impacted by various factors, including, without limitation, that they may involve indeterminate claims for monetary damages or may involve fines, penalties or non-monetary remedies; present novel legal theories or legal uncertainties; involve disputed facts; represent a shift in regulatory policy; are in the early stages of the proceedings; or may result in a change of business practices. Further, there may be various levels of judicial review available to the Company in connection with any such proceeding. The following is a description of certain lawsuits, claims, governmental investigations and audits and other legal proceedings to which the Company is subject. Certain Governmental Inquiries and Related Proceedings 2016 U.S. Attorney Texas Investigation : In February 2016, DaVita Rx, LLC (DaVita Rx), a wholly-owned subsidiary of the Company, received a Civil Investigative Demand (CID) from the U.S. Attorney’s Office, Northern District of Texas. The government is conducting a federal False Claims Act (FCA) investigation concerning allegations that DaVita Rx presented or caused to be presented false claims for payment to the government for prescription medications, as well as an investigation into the Company’s relationships with pharmaceutical manufacturers. The government's investigation covers the period from January 1, 2006 through December 31, 2018. In December 2017, the Company finalized and executed a settlement agreement that resolved certain of the issues in the government's investigation and that included total monetary consideration of $63,700, as previously disclosed, of which $41,500 was an incremental cash payment and $22,200 was for amounts previously refunded, and all of which was previously accrued. The government’s investigation is ongoing with respect to issues related to DaVita Rx's historic relationships with certain pharmaceutical manufacturers, and in July 2018 the Office of Inspector General (OIG) served the Company with a subpoena seeking additional documents and information relating to those relationships. On September 15, 2021, the U.S. Attorney’s Office notified the U.S. District Court, Northern District of Texas, of its decision and the decision of 31 states not to elect to intervene at this time in the matter of U.S. ex rel. Doe v. DaVita Inc., et al . The court then unsealed the complaint, which alleges violations of the FCA, by order dated September 17, 2021. The complaint was not served on the Company. In December 2021, the private party relator filed a notice of voluntary dismissal of all claims and the court entered an order dismissing the claims without prejudice. The Company is continuing to cooperate with the government in this investigation. 2017 U.S. Attorney Colorado Investigation : In November 2017, the U.S. Attorney’s Office, District of Colorado informed the Company of an investigation it was conducting into possible federal healthcare offenses involving DaVita Kidney Care, as well as several of the Company’s wholly-owned subsidiaries. In addition to DaVita Kidney Care, the matter currently includes an investigation into DaVita Rx, DaVita Laboratory Services, Inc. (DaVita Labs), and RMS Lifeline Inc. (Lifeline). In each of August 2018, May 2019, and July 2021, the Company received a CID pursuant to the FCA from the U.S. Attorney's Office relating to this investigation. In May 2020, the Company sold its interest in Lifeline, but the Company retained certain liabilities of the Lifeline business, including those related to this investigation. The Company is continuing to cooperate with the government in this investigation. 2020 U.S. Attorney New Jersey Investigation : In March 2020, the U.S. Attorney’s Office, District of New Jersey served the Company with a subpoena and a CID relating to an investigation being conducted by that office and the U.S. Attorney’s Office, Eastern District of Pennsylvania. The subpoena and CID request information on several topics, including certain of the Company’s joint venture arrangements with physicians and physician groups, medical director agreements, and compliance with its five-year Corporate Integrity Agreement, the term of which expired October 22, 2019. In November 2022, the Company learned that, on April 1, 2022, the U.S. Attorney’s Office for the District of New Jersey notified the U.S. District Court for the District of New Jersey of its decision not to elect to intervene in the matter of U.S. ex rel. Doe v. DaVita, Inc. and filed a Stipulation of Dismissal. On April 13, 2022, the U.S. District Court for the District of New Jersey dismissed the case without prejudice. On October 12, 2022, the U.S. Attorney’s Office for the Eastern District of Pennsylvania notified the U.S. District Court, Eastern District of Pennsylvania, of its decision not to elect to intervene at this time in the matter of U.S. ex rel. Bayne v. DaVita Inc., et al. The court then unsealed an amended complaint, which alleges violations of federal and state False Claims Acts, by order dated October 14, 2022. In January 2023, the private party relator served the Company with the amended complaint. The Company is continuing to cooperate with the government in this investigation. 2020 California Department of Insurance Investigation : In April 2020, the California Department of Insurance (CDI) sent the Company an Investigative Subpoena relating to an investigation being conducted by that office. CDI issued a superseding subpoena in September 2020, 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. 2020 Department of Justice Investigation : In October 2020, the Company received a CID from the Department of Justice pursuant to an FCA investigation concerning allegations that DaVita Medical Group (DMG) may have submitted undocumented or unsupported diagnosis codes in connection with Medicare Advantage beneficiaries. The CID covers the period from January 1, 2015 through June 19, 2019, the date the Company completed the divestiture of DMG to Collaborative Care Holdings, LLC. In February 2023, the Department of Justice notified the Company that it had closed its investigation. 2023 District of Columbia Office of Attorney General Investigation : In January 2023, the Company received a CID from the Office of the Attorney General for the District of Columbia in connection with an antitrust investigation concerning the American Kidney Fund (AKF). The CID covers the period from January 1, 2016 to the present. The CID requests information on a number of topics, including but not limited to the Company’s communications with AKF, documents relating to donations to the AKF, and communications with patients, providers, and insurers regarding the AKF. The Company is cooperating with the government in this investigation. * * * Although the Company cannot predict whether or when proceedings might be initiated or when these matters may be resolved (other than as may be described above), it is not unusual for inquiries such as these to continue for a considerable period of time through the various phases of document and witness requests and ongoing discussions with regulators and to develop over the course of time. In addition to the inquiries and proceedings specifically identified above, the Company frequently is subject to other inquiries by state or federal government agencies, many of which relate to qui tam complaints filed by relators. Negative findings or terms and conditions that the Company might agree to accept as part of a negotiated resolution of pending or future government inquiries or relator proceedings could result in, among other things, substantial financial penalties or awards against the Company, substantial payments made by the Company, harm to the Company’s reputation, required changes to the Company’s business practices, an impact on the Company's various relationships and/or contracts related to the Company's business, exclusion from future participation in the Medicare, Medicaid and other federal health care programs and, if criminal proceedings were initiated against the Company, members of its board of directors or management, possible criminal penalties, any of which could have a material adverse effect on the Company. Other Proceedings 2021 Antitrust Indictment and Putative Class Action Suit : On July 14, 2021, an indictment was returned by a grand jury in the U.S. District Court, District of Colorado against the Company and its former chief executive officer in the matter of U.S. v. DaVita Inc., et al. alleging that purported agreements entered into by DaVita's former chief executive officer not to solicit senior-level employees violated Section 1 of the Sherman Act. On April 15, 2022, a jury returned a verdict in the Company’s favor, acquitting both the Company and its former chief executive officer on all counts. On April 20, 2022, the court entered judgments of acquittal and closed the case. On August 9, 2021, DaVita 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. Marietta Memorial Hospital Employee Health Benefit Plan, et al. v. DaVita Inc. et al. No. 20-1641 : On November 5, 2021, the United States Supreme Court granted certiorari of an appeal by an employer group health plan, the plan sponsor, and the plan’s advisor of the U.S. Court of Appeals for the Sixth Circuit (Sixth Circuit) decision in the Company's favor. The questions presented involved whether the health plan violates the Medicare Secondary Payor Act (MSPA) by "taking into account" that plan beneficiaries are eligible for Medicare and/or by "differentiating" between the benefits that the plan offers to patients with dialysis versus others. On December 23, 2021, the Solicitor General on behalf of the United States filed an amicus brief supporting the petitioners' request to overturn the Sixth Circuit decision. On January 19, 2022, the Company filed its brief in support of the Sixth Circuit decision. On June 21, 2022, the United States Supreme Court reversed the Sixth Circuit decision and held that the employee health plan for Marietta Memorial Hospital did not violate the MSPA. The case has been remanded back to the lower court for resolution of the outstanding claims. 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 16, 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 |
Noncontrolling Interests Subjec
Noncontrolling Interests Subject to Put Provisions and Other Commitments | 12 Months Ended |
Dec. 31, 2022 | |
Accounting Policies [Abstract] | |
Noncontrolling Interests Subject to Put Provisions and Other Commitments | Noncontrolling interests subject to put provisions and other commitments Noncontrolling interests subject to put provisions The Company has potential obligations to purchase the equity interests held by third parties in many of its majority-owned dialysis partnerships and other nonconsolidated entities. These noncontrolling interests subject to put provisions constitute redeemable equity interests and are therefore classified as temporary equity and carried at estimated fair value on the Company's balance sheet. Specifically, these obligations are in the form of put provisions that are exercisable at the third-party owners’ discretion within specified periods outlined in each specific put provision. If these put provisions were exercised, the Company would be required to purchase the third-party owners’ equity interests, generally at the appraised fair market value of the equity interests or in certain cases at a predetermined multiple of earnings or cash flows attributable to the equity interests put to the Company, intended to approximate fair value. The methodology the Company uses to estimate the fair values of noncontrolling interests subject to put provisions assumes the higher of either a liquidation value of net assets or an average multiple of earnings, based on historical earnings, patient mix and other performance indicators that can affect future results, as well as other factors. The estimated fair values of noncontrolling interests subject to put provisions are a critical accounting estimate that involves significant judgments and assumptions and may not be indicative of the actual values at which the noncontrolling interests may ultimately be settled, which could vary significantly from the Company’s current estimates. The estimated fair values of noncontrolling interests subject to put provisions can fluctuate and the implicit multiple of earnings at which these noncontrolling interests obligations may be settled will vary significantly depending upon market conditions including potential purchasers’ access to the capital markets, which can impact the level of competition for dialysis and non-dialysis related businesses, the economic performance of these businesses and the restricted marketability of the third-party owners’ equity interests. The amount of noncontrolling interests subject to put provisions that employ a contractually predetermined multiple of earnings rather than fair value is immaterial. Certain consolidated dialysis partnerships are originally contractually scheduled to dissolve after terms ranging from ten years to 50 years. While noncontrolling interests in these limited life entities qualify as mandatorily redeemable financial instruments, they are subject to a classification and measurement scope exception from the accounting guidance generally applicable to other mandatorily redeemable financial instruments. Future distributions upon dissolution of these entities would be valued below the related noncontrolling interest carrying balances in the consolidated balance sheet. Other commitments The Company has agreements with various suppliers to purchase established amounts of dialysis equipment, parts, pharmaceuticals and supplies. As of December 31, 2022, the remaining minimum purchase commitments under these arrangements were approximately $712,802, $469,760, $362,431 and $379,832 for the years 2023, 2024, 2025 and 2026, respectively. If the Company fails to meet the minimum purchase commitments under these contracts during any year, it is required to pay the difference to the supplier. The Company also has certain potential commitments to provide working capital funding, if necessary, to certain nonconsolidated dialysis businesses that the Company manages and in which the Company owns a noncontrolling equity interest or which are wholly-owned by third parties of approximately $9,038. Other than the letters of credit disclosed in Note 13 to these consolidated financial statements, and the arrangements as described above, the Company has no off balance sheet financing arrangements as of December 31, 2022. |
Stock-based compensation
Stock-based compensation | 12 Months Ended |
Dec. 31, 2022 | |
Share-Based Payment Arrangement [Abstract] | |
Long-term Incentive Compensation and Shareholders’ Equity | Stock-based compensation Stock-based compensation Stock-based compensation consists primarily of stock-settled stock appreciation rights, restricted stock units and performance stock units. Stock-based compensation, which is primarily general and administrative in nature, is attributed to the Company’s U.S. dialysis business, its corporate administrative support, and its ancillary services. See Note 1 "Organization and summary of significant accounting policies" for more information on how the Company measures and recognizes stock-based compensation expense. Long-term incentive compensation plans The DaVita Inc. 2020 Incentive Award Plan (the 2020 Plan) is the Company’s current omnibus equity compensation plan and provides for grants of stock-based awards to employees, directors and other individuals providing services to the Company, except that incentive stock options may only be awarded to employees. The 2020 Plan provides for the grant of stock appreciation rights, nonqualified stock options, incentive stock options, restricted stock units, restricted stock, performance stock awards, dividend equivalents, stock payments, deferred stock unit awards, deferred stock awards and performance cash awards. The 2020 Plan mandates a maximum award term of 10 years for stock appreciation rights and stock options and stipulates that awards of these types be granted with a base or exercise price per share of not less than the fair market value of the Company's common stock on the date of grant. Shares available under the 2020 Plan are also stated on a full value share basis rather than on an option-equivalent basis. The 2020 Plan therefore provides that shares available for issuance under the plan are reduced by one share available for every four shares underlying stock appreciation rights and stock options, and are reduced by one share available for every one share underlying stock-based awards other than stock appreciation rights and stock options. At December 31, 2022, there were 6,815 shares available for future grants under the 2020 Plan. The Company’s stock awards granted under the 2020 Plan generally vest over 36 months to 48 months from the date of grant. The DaVita Healthcare Partners Inc. 2011 Incentive Award Plan (the 2011 Plan) was the Company’s prior omnibus equity compensation plan and authorized the Company to award stock options, stock appreciation rights, restricted stock units, restricted stock, and other stock-based or performance-based awards. The 2011 Plan mandated a maximum award term of five years and stipulated that stock appreciation rights and stock options be granted with prices not less than fair market value on the date of grant. The 2011 Plan also required that full value share awards such as restricted stock units reduce shares available under the 2011 Plan at a ratio of 3.5:1. The Company’s stock appreciation rights and stock units awarded under the 2011 Plan generally vest over 36 months to 48 months from the date of grant. The 2011 Plan was terminated with respect to any new awards upon stockholder approval of the 2020 Plan. A combined summary of the status of the Company’s stock-settled awards under both the 2020 Plan and 2011 Plan, including base shares for stock-settled stock appreciation rights (SSARs) and stock-settled stock unit awards is as follows: Year ended December 31, 2022 Stock appreciation rights Stock units Awards Weighted Weighted Awards Weighted Outstanding at beginning of year 5,943 $ 64.66 3,385 Granted 130 $ 110.63 1,152 Added by performance factor 136 Exercised/Vested (619) $ 63.59 (1,269) Canceled (64) $ 55.53 (332) Outstanding at end of period 5,390 $ 66.00 1.62 3,072 1.93 Exercisable at end of period 2,618 $ 64.93 1.32 — — Weighted-average fair value of grants: 2022 $ 35.13 $ 107.60 2021 $ 32.15 $ 109.50 2020 $ 26.70 $ 77.83 Awards Outstanding Weighted average exercise price Awards exercisable Weighted average exercise price Range of SSARs base prices $50.01–$60.00 1,397 $ 52.41 401 $ 52.41 $60.01–$70.00 3,462 $ 67.41 2,212 $ 67.18 $70.01–$80.00 269 $ 75.85 5 $ 70.32 $100.01–$110.00 132 $ 108.93 — $ — $110.01–$120.00 130 $ 110.63 — $ — Total 5,390 $ 66.00 2,618 $ 64.93 For the years ended December 31, 2022, 2021 and 2020, the aggregate intrinsic value of stock-based awards exercised was $149,442, $208,585 and $49,258, respectively. At December 31, 2022, the aggregate intrinsic value of stock-based awards outstanding was $289,942 and the aggregate intrinsic value of stock awards exercisable was $25,508. Estimated fair value of stock-based compensation awards The Company has estimated the grant-date fair value of stock-settled stock appreciation rights awards using the Black-Scholes-Merton valuation model and stock-settled stock unit awards at intrinsic value on the date of grant, except for portions of the Company’s performance stock unit awards for which a Monte Carlo simulation was used to estimate the grant-date fair value. The following assumptions were used in estimating these values and determining the related stock-based compensation expense attributable to the current period: Expected term of the awards: The expected term of awards granted represents the period of time that they are expected to remain outstanding from the date of grant. The Company determines the expected term of its stock awards based on its historical experience with similar awards, considering the Company’s historical exercise and post-vesting termination patterns. Expected volatility: Expected volatility represents the volatility anticipated over the expected term of the award. The Company determines the expected volatility for its awards based on the volatility of the price of its common stock over the most recent retrospective period commensurate with the expected term of the award, considering the volatilities expected by peer companies in near industries. Expected dividend yield: The Company has not paid dividends on its common stock and does not currently expect to pay dividends during the term of stock awards granted. Risk-free interest rate: The Company bases the expected risk-free interest rate on the implied yield currently available on stripped interest coupons of U.S. Treasury issues with a remaining term equivalent to the expected term of the award. A summary of the weighted average valuation inputs described above used for estimating the grant-date fair value of SSAR awards granted in the periods indicated is as follows: Year ended December 31, 2022 2021 2020 Expected term 4.5 4.5 4.8 Expected volatility 34.3 % 34.3 % 28.2 % Expected dividend yield — % — % — % Risk-free interest rate 2.1 % 0.7 % 1.5 % The Company estimates expected forfeitures based upon historical experience with separate groups of employees that have exhibited similar forfeiture behavior in the past. Stock-based compensation expense is recorded only for awards that are expected to vest. Employee stock purchase plan The Employee Stock Purchase Plan entitles qualifying employees to purchase up to $25 of the Company’s common stock during each calendar year. The amounts used to purchase stock are accumulated through payroll withholdings or through optional lump sum payments made in advance of the first day of the purchase right period. This compensatory plan allows employees to purchase stock for the lesser of 100% of its fair market value on the first day of the purchase right period or 85% of its fair market value on the last day of the purchase right period. Purchase right periods begin on January 1 and July 1, and end on December 31. Contributions used to purchase the Company’s common stock under this plan for the 2022, 2021 and 2020 purchase periods were $18,061, $19,626 and $17,148, respectively. Shares purchased pursuant to the plan’s 2022, 2021 and 2020 purchase periods were 285, 203 and 222, respectively. At December 31, 2022, there were 5,702 shares remaining available for future grants under this plan. The fair value of participants’ purchase rights was estimated as of the beginning dates of the purchase right periods using the Black-Scholes-Merton valuation model with the following weighted average assumptions for purchase right periods in 2022, 2021 and 2020, respectively: expected volatility of 31.7%, 39.0% and 40.4%; risk-free interest rates of 1.3%, 0.1% and 1.0%; and no dividends. Using these assumptions, the weighted average estimated per share fair value of each purchase right was $26.50, $34.94 and $22.06 for 2022, 2021 and 2020, respectively. Stock-based compensation expense and proceeds For the years ended December 31, 2022, 2021 and 2020, the Company recognized $95,427, $102,209 and $91,458 in stock-based compensation expense for stock appreciation rights, stock units and discounted employee stock purchase plan purchases, which are primarily included in general and administrative expenses. The estimated tax benefits recorded for stock-based compensation in 2022, 2021 and 2020 were $14,723, $13,853 and $11,775, respectively. As of December 31, 2022, there was $149,081 of 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 1.3 years. For the years ended December 31, 2022, 2021 and 2020, the Company received $24,805, $46,990 and $8,957, respectively, in actual tax benefits upon the exercise or vesting of stock awards. Since the Company issues stock-settled stock appreciation rights rather than stock options, there were no cash proceeds from stock option exercises. |
Stockholder's equity
Stockholder's equity | 12 Months Ended |
Dec. 31, 2022 | |
Equity [Abstract] | |
Stockholder's equity | Shareholders’ equity Stock repurchases The following table summarizes the Company's repurchases of its common stock during the years ended December 31, 2022, 2021 and 2020: 2022 2021 2020 Open market repurchases Shares 8,095 13,877 8,495 Amounts paid $ 787,854 $ 1,546,016 $ 741,850 Average paid per share $ 97.33 $ 111.41 $ 87.32 Tender offer (1) Shares — — 7,982 Amounts paid $ — $ — 704,917 Average paid per share $ — $ — 88.32 Total Shares 8,095 13,877 16,477 Amounts paid $ 787,854 $ 1,546,016 $ 1,446,767 Average paid per share $ 97.33 $ 111.41 $ 87.80 (1) The aggregate amounts paid for shares repurchased pursuant to the Company's 2020 tender offer for its shares during the year ended 2020, include the clearing price of $88.00 per share, plus related fees and expenses of $2,529. Subsequent to December 31, 2022 through February 22, 2023, the Company did not repurchase any shares. Effective on December 10, 2020, the Board terminated all remaining prior share repurchase authorizations available to the Company and approved a new share repurchase authorization of $2,000,000. Effective on December 17, 2021, the Board increased the Company's existing authorization by $2,000,000. The Company is authorized to make purchases from time to time in the open market or in privately negotiated transactions, including without limitation, through accelerated share repurchase transactions, derivative transactions, tender offers, Rule 10b5-1 plans or any combination of the foregoing, depending upon market conditions and other considerations. As of February 22, 2023, the Company has a total of $1,596,085 available under the current authorization for additional share repurchases. Although this share repurchase authorization does not have an expiration date, the Company remains subject to share repurchase limitations, including under the terms of its senior secured credit facilities. The Company retired all shares held in its treasury effective as of December 31, 2022 and December 31, 2021. Charter documents & Delaware law The Company’s charter documents include provisions that may deter hostile takeovers, delay or prevent changes of control or changes in management, or limit the ability of stockholders to approve transactions that they may otherwise determine to be in their best interests. These include provisions prohibiting stockholders from acting by written consent, requiring 90 days advance notice for director nominations and stockholder proposals and granting the Company's Board of Directors the authority to issue up to 5,000 shares of preferred stock and to determine the rights and preferences of the preferred stock without the need for further stockholder approval. The Company is also subject to Section 203 of the Delaware General Corporation Law which, subject to exceptions, prohibits the Company from engaging in any business combinations with any interested stockholder, as defined in that section, for a period of three years following the date on which that stockholder became an interested stockholder. The provisions described above may discourage, delay or prevent an acquisition of the Company at a price that stockholders may find attractive. Changes in DaVita Inc.’s ownership interests in consolidated subsidiaries The effects of changes in DaVita Inc.’s ownership interests in consolidated subsidiaries on the Company’s consolidated equity were as follows: Year ended December 31, 2022 2021 2020 Net income attributable to DaVita Inc. $ 560,400 $ 978,450 $ 773,642 Changes in paid-in capital for: Purchases of noncontrolling interests (6,586) (13,853) 4,364 Sales of noncontrolling interest 939 (264) — Net transfers in noncontrolling interests (5,647) (14,117) 4,364 Net income attributable to DaVita Inc. net of transfers in $ 554,753 $ 964,333 $ 778,006 The Company acquired additional ownership interests in several existing majority-owned partnerships for $20,775, $20,104 and $7,831 in 2022, 2021 and 2020, respectively. |
Accumulated Other Comprehensive
Accumulated Other Comprehensive (Loss) Income | 12 Months Ended |
Dec. 31, 2022 | |
Statement of Comprehensive Income [Abstract] | |
Other Comprehensive (Loss) Income | Accumulated other comprehensive loss Charges and credits to other comprehensive (loss) income have been as follows: Interest rate Foreign currency Accumulated other Balance at December 31, 2019 $ (1,433) $ (46,065) $ (47,498) Unrealized losses (21,781) (7,080) (28,861) Related income tax 5,435 (543) 4,892 (16,346) (7,623) (23,969) Reclassification of loss into net income 7,081 — 7,081 Related income tax (1,768) — (1,768) 5,313 — 5,313 Balance at December 31, 2020 $ (12,466) $ (53,688) $ (66,154) Unrealized gains (losses) 9,532 (83,375) (73,843) Related income tax (2,377) (1,006) (3,383) 7,155 (84,381) (77,226) Reclassification of loss into net income 5,509 — 5,509 Related income tax (1,376) — (1,376) 4,133 — 4,133 Balance at December 31, 2021 $ (1,178) $ (138,069) $ (139,247) Unrealized gains (losses) 144,793 (30,554) 114,239 Related income tax (36,124) 752 (35,372) 108,669 (29,802) 78,867 Reclassification of income into net income (11,732) — (11,732) Related income tax 2,926 — 2,926 (8,806) — (8,806) Balance at December 31, 2022 $ 98,685 $ (167,871) $ (69,186) The reclassification of net interest rate cap realized losses into income are recorded as debt expense in the corresponding consolidated statements of income. See Note 13 for further details. |
Acquisitions and Divestitures
Acquisitions and Divestitures | 12 Months Ended |
Dec. 31, 2022 | |
Business Combinations [Abstract] | |
Acquisitions and Divestitures | Acquisitions and divestitures Routine acquisitions During 2022, 2021 and 2020, the Company acquired dialysis businesses and other businesses, including a transplant software company, as follows: Year ended Year ended December 31, 2022 2021 2020 Cash paid, net of cash acquired $ 57,308 $ 187,050 $ 182,013 Contingent earn-out obligations 4,261 14,854 14,042 Deferred purchase price and liabilities assumed 15,076 10,226 20,415 Non-cash gain — — 1,821 Aggregate consideration $ 76,645 $ 212,130 $ 218,291 Number of dialysis centers acquired — U.S. 5 19 8 Number of dialysis centers acquired — International 11 17 66 The assets and liabilities for these acquisitions were recorded at their estimated fair values at the dates of the acquisitions and are included in the Company’s consolidated financial statements, as are their operating results, from the designated effective dates of the acquisitions. The initial purchase price allocations for these transactions have been recorded at estimated fair values based on information available to management and will be finalized when certain information arranged to be obtained has been received. For several of the 2022 acquisitions, certain income tax amounts are pending final evaluation and quantification of any pre-acquisition tax contingencies. In addition, valuation of contingent earn-outs, intangibles, fixed assets, leases and certain working capital items relating to several of these acquisitions are pending final quantification. The following table summarizes the assets acquired and liabilities assumed in these transactions and recognized at their acquisition dates at estimated fair values, as well as the estimated fair value of noncontrolling interests assumed in these transactions: Year ended December 31, 2022 2021 2020 Current assets $ 6,389 $ 9,134 $ 23,607 Property and equipment 7,481 9,277 37,457 Customer relationships — 17,200 34,625 Noncompetition agreements and other long-term assets 1,066 9,964 10,168 Indefinite-lived licenses 19,610 11,432 22,136 Goodwill 49,047 173,244 130,057 Deferred income taxes — — (3,962) Liabilities assumed (6,081) (14,200) (34,068) Noncontrolling interests assumed (867) (3,921) (1,729) $ 76,645 $ 212,130 $ 218,291 The following summarizes weighted-average estimated useful lives of amortizable intangible assets acquired during 2022, 2021 and 2020, as well as goodwill deductible for tax purposes associated with these acquisitions: Year ended December 31, 2022 2021 2020 Weighted-average estimated useful lives (in years): Customer relationships — 10 18 Noncompetition agreements 4 6 5 Goodwill deductible for tax purposes $ 49,047 $ 169,014 $ 94,318 Pro forma financial information (unaudited) The following summary, prepared on a pro forma basis, combines the results of operations as if all acquisitions within continuing operations in 2022 and 2021 had been consummated as of the beginning of 2021, including the impact of certain adjustments such as amortization of intangibles, interest expense on acquisition financing and income tax effects. Year ended December 31, 2022 2021 (unaudited) Pro forma total revenues $ 11,624,270 $ 11,706,823 Pro forma net income from continuing operations attributable to $ 545,859 $ 984,227 Pro forma basic net income per share from continuing operations $ 5.87 $ 9.35 Pro forma diluted net income per share from continuing operations $ 5.70 $ 8.95 Sale of RMS Lifeline The Company divested its prior vascular access business, RMS Lifeline, Inc., effective May 1, 2020 and recognized a loss on sale of approximately $16,252. Contingent earn-out obligations The Company has contingent earn-out obligations associated with acquisitions that could result in the Company paying the former owners of acquired businesses a total of up to approximately $58,947 if certain performance targets or quality margins are met over the next one year to five years. Contingent earn-out obligations are remeasured to fair value at each reporting date until the contingencies are resolved with changes in the liability due to the remeasurement recognized in earnings. See Note 24 for further details. As of December 31, 2022, the Company estimated the fair value of these contingent earn-out obligations to be $25,422, of which a total of $11,308 is included in other current liabilities, and the remaining $14,114 is included in other long-term liabilities in the Company’s consolidated balance sheet. The following is a reconciliation of changes in contingent earn-out liabilities for the years ended December 31, 2022 and 2021: Year ended December 31, 2022 2021 Beginning balance $ 33,600 $ 30,248 Acquisitions 4,261 14,854 Foreign currency translation 840 (1,674) Fair value remeasurements (5,921) (1,292) Payments or other settlements (7,358) (8,536) Ending balance $ 25,422 $ 33,600 |
Held for Sale and Discontinued
Held for Sale and Discontinued Operations | 12 Months Ended |
Dec. 31, 2022 | |
Discontinued Operations and Disposal Groups [Abstract] | |
Held for Sale and Discontinued Operations | Discontinued operations previously held for sale DaVita Medical Group (DMG) On June 19, 2019, the Company completed the sale of its prior DMG business to Optum, a subsidiary of UnitedHealth Group Inc. At close, the Company's ultimate net proceeds from this sale remained subject to resolution of certain post-closing adjustments. Shortly after December 31, 2022, Optum made an additional purchase price payment of $13,452 to the Company after resolution of one such post-closing matter, which represented a contingent gain to the Company for the fourth quarter of 2022. Upon resolution of certain prior post-closing adjustments with Optum in 2020, the Company recognized an additional loss on sale of $17,976, which was partially offset by $9,980 in additional tax benefits recognized under the Coronavirus Aid, Relief and Economic Security Act related to the Company's period of DMG ownership, and a related income tax benefit to the Company of $1,657. The Company recognized no DMG operating, financing or investing cash flows for the years ended December 31, 2022, 2021 and 2020. Under the equity purchase agreement, the Company also has certain continuing indemnification obligations that could require payments to the buyer relating to the Company's previous ownership and operation of the DMG business. Potential payments under these provisions, if any, remain subject to continuing uncertainties and the amounts of such payments could be significant to the Company. |
Variable Interest Entities
Variable Interest Entities | 12 Months Ended |
Dec. 31, 2022 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Variable Interest Entities | Variable interest entities The Company manages or maintains an ownership interest in certain legal entities subject to the consolidation guidance applicable to variable interest entities (VIEs). Almost all of the VIEs the Company consolidates are either U.S. dialysis partnerships encumbered by guaranteed debt, U.S. dialysis limited partnerships, U.S. integrated care subsidiaries, or other legal entities subject to nominee ownership arrangements. Under U.S. GAAP, VIEs typically include entities for which (i) the entity’s equity is not sufficient to finance its activities without additional subordinated financial support; (ii) the equity holders as a group lack the power to direct the activities that most significantly influence the entity’s economic performance, the obligation to absorb the entity’s expected losses, or the right to receive the entity’s expected returns; or (iii) the voting rights of some investors are not proportional to their obligations to absorb the entity’s losses. The substantial majority of VIEs the Company is associated with are U.S. dialysis partnerships which the Company manages and in which it maintains a controlling majority ownership interest. These U.S. dialysis partnerships are considered VIEs either because they are (i) encumbered by debt guaranteed proportionately by the partners that is considered necessary to finance the partnership's activities, or (ii) in the form of limited partnerships for which the limited partners are not considered to have substantive kick-out or participating rights. The Company consolidates virtually all such U.S. dialysis partnerships. Also, certain wholly-owned entities employed in the Company's integrated kidney care business constitute VIEs since by design these entities require additional subordinated financial support. The Company wholly owns but does not wholly control these entities. However, the Company believes it has the most power over these entities' most significant activities, and the Company is fully exposed to their expected losses. The Company therefore consolidates these wholly-owned entities as its subsidiaries. Finally, one of the Company's business units relies on the operating activities of certain nominee-owned legal entities in which it does not maintain a controlling ownership interest but over which it has indirect influence and of which it is considered the primary beneficiary. These entities are subject to transfer restriction, management and other agreements that effectively transfer substantial ultimate powers over, and economic responsibility for, these entities to the Company. The Company consolidates all of the nominee-owned entities with which it is most closely associated. In addition to the consolidated entities described above, the Company maintains minor equity method or other venture capital investments in certain development-stage investees which qualify as VIEs based on their capitalization. The Company has concluded that it is not the primary beneficiary of any of these investees. For the VIEs described above, these consolidated financial statements include total assets of $316,639 and total liabilities and noncontrolling interests to third parties of $191,357 at December 31, 2022. The Company also sponsors certain non-qualified deferred compensation plans whose trusts qualify as VIEs and the Company consolidates these plans as their primary beneficiary. The assets of these plans are recorded in short-term or long-term investments with related liabilities recorded in accrued compensation and benefits and other long-term liabilities. See Notes 5 and 15 for disclosures concerning the assets of these consolidated non-qualified deferred compensation plans. |
Fair Values of Financial Instru
Fair Values of Financial Instruments | 12 Months Ended |
Dec. 31, 2022 | |
Fair Value Disclosures [Abstract] | |
Fair Values of Financial Instruments | Fair values of financial instrumentsThe Company measures the fair value of certain assets, liabilities, and noncontrolling interests subject to put provisions (redeemable equity interests classified as temporary equity) based upon certain valuation techniques that include observable or unobservable inputs and assumptions that market participants would use in pricing these assets, liabilities, temporary equity and commitments. The Company has also classified assets, liabilities and temporary equity that are measured at fair value on a recurring basis into the appropriate fair value hierarchy levels as defined by the FASB. The following table summarizes the Company’s assets, liabilities and temporary equity measured at fair value on a recurring basis as of December 31, 2022 and 2021: December 31, 2022 Total Quoted prices in Significant other Significant Assets Investments in equity securities $ 39,143 $ 39,143 $ — $ — Interest rate cap agreements $ 139,755 $ — $ 139,755 $ — Liabilities Contingent earn-out obligations $ 25,422 $ — $ — $ 25,422 Temporary equity Noncontrolling interests subject to put provisions $ 1,348,908 $ — $ — $ 1,348,908 December 31, 2021 Assets Investments in equity securities $ 48,598 $ 48,598 $ — $ — Interest rate cap agreements $ 12,203 $ — $ 12,203 $ — Liabilities Contingent earn-out obligations $ 33,600 $ — $ — $ 33,600 Temporary equity Noncontrolling interests subject to put provisions $ 1,434,832 $ — $ — $ 1,434,832 For reconciliations of changes in contingent earn-out obligations and noncontrolling interests subject to put provisions during the year ended at December 31, 2022 and 2021, see Note 21 and the consolidated statements of equity, respectively. 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 5 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 13 for further discussion. The estimated fair value measurements of contingent earn-out obligations are primarily based on unobservable inputs, including projected earnings before interest, taxes, depreciation, and amortization (EBITDA), revenue and key performance indicators. The estimated fair value of these contingent earn-out obligations is remeasured as of each reporting date and could fluctuate based upon any significant changes in key assumptions, such as changes in the Company credit risk adjusted rate that is used to discount obligations to present value. See Note 21 for further discussion. The estimated fair value of noncontrolling interests subject to put provisions is based principally on the higher of either estimated liquidation value of net assets or a multiple of earnings for each subject dialysis partnership, based on historical earnings, revenue mix, and other performance indicators that can affect future results. The multiples used for these valuations are derived from observed ownership transactions for dialysis businesses between unrelated parties in the U.S. in recent years, and the specific valuation multiple applied to each dialysis partnership is principally determined by its recent and expected revenue mix and contribution margin. As of December 31, 2022, 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 $168,000. See Note 17 for a discussion of the Company’s methodology for estimating the fair values of noncontrolling interests subject to put obligations. The Company's fair value estimates for its senior secured credit facilities and senior notes are based upon quoted bid and ask prices for these instruments, typically a level 2 input. See Note 13 for further discussion of the Company's debt. |
Segment Reporting
Segment Reporting | 12 Months Ended |
Dec. 31, 2022 | |
Segment Reporting [Abstract] | |
Segment Reporting | Segment reporting The Company's operating divisions are comprised of its U.S. dialysis and related lab services business (its U.S. dialysis business), its U.S. integrated kidney care business, its U.S. other ancillary services and its international operations (collectively, its ancillary services), as well as its corporate administrative support. See Note 1 "Organization" for a summary description of the Company's businesses. On June 19, 2019, the Company completed the sale of its prior DMG business to Optum. As a result of this transaction, DMG's results of operations have been reported as discontinued operations for all periods presented. The Company’s operating segments have been defined based on the separate financial information that is regularly produced and reviewed by the Company’s chief operating decision maker in making decisions about allocating resources to and assessing the financial performance of the Company’s various operating lines of business. The chief operating decision maker for the Company is its Chief Executive Officer. The Company’s separate operating segments include its U.S. dialysis and related lab services business, its U.S. integrated kidney care business, its U.S. other ancillary services, its kidney care operations in each foreign sovereign jurisdiction, and its equity method investment in the APAC joint venture. The U.S. dialysis and related lab services business qualifies as a separately reportable segment, and all other operating segments have been combined and disclosed in the other segments category. The Company’s operating segment financial information included in this report is prepared on the internal management reporting basis that the chief operating decision maker uses to allocate resources and assess the financial performance of the Company's operating segments. For internal management reporting, segment operations include direct segment operating expenses but generally exclude corporate administrative support costs, which consist primarily of indirect labor, benefits and long-term incentive compensation expenses of certain departments which provide support to all of the Company’s various operating lines of business. The following is a summary of segment revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income from continuing operations before income taxes: Year ended December 31, 2022 2021 2020 Segment revenues: U.S. dialysis Patient service revenues: External sources $ 10,488,327 $ 10,551,106 $ 10,475,273 Intersegment revenues 87,045 90,512 144,091 U.S. dialysis patient service revenues 10,575,372 10,641,618 10,619,364 Other revenues External sources 24,447 25,061 39,376 Intersegment revenues (10) 284 1,195 Total U.S. dialysis revenues $ 10,599,809 $ 10,666,963 $ 10,659,935 Other - Ancillary services Net patient service revenues 688,137 662,409 550,978 Other external sources 408,983 380,221 484,977 Intersegment revenues 4,206 4,294 16,743 Total ancillary services 1,101,326 1,046,924 1,052,698 Total net segment revenues 11,701,135 11,713,887 11,712,633 Elimination of intersegment revenues (91,241) (95,090) (162,029) Consolidated revenues $ 11,609,894 $ 11,618,797 $ 11,550,604 Segment operating margin (loss): U.S. dialysis $ 1,565,310 $ 1,974,988 $ 1,917,604 Other - Ancillary services (1) (96,579) (66,003) (76,261) Total segment margin 1,468,731 1,908,985 1,841,343 Reconciliation of segment operating margin to consolidated income from Corporate administrative support (129,669) (111,615) (146,707) Consolidated operating income 1,339,062 1,797,370 1,694,636 Debt expense (357,019) (285,254) (304,111) Debt prepayment, refinancing and redemption charges — — (89,022) Other (loss) income, net (15,765) 6,378 16,759 Income from continuing operations before income taxes $ 966,278 $ 1,518,494 $ 1,318,262 (1) Includes equity investment income of $1,898, $3,177 and $5,866 in 2022, 2021 and 2020, respectively. Depreciation and amortization expense by reportable segment was as follows: Year ended December 31, 2022 2021 2020 U.S. dialysis $ 690,949 $ 642,711 $ 594,552 Other - Ancillary services 41,653 37,904 35,883 $ 732,602 $ 680,615 $ 630,435 Expenditures for property and equipment by reportable segment were as follows: Year ended December 31, 2022 2021 2020 U.S. dialysis 533,600 $ 589,662 $ 646,870 Other - Ancillary services 69,829 51,803 27,671 $ 603,429 $ 641,465 $ 674,541 Summary of assets by reportable segment was as follows: Year ended December 31, 2022 2021 Segment assets U.S. dialysis (1) $ 15,084,454 $ 15,375,000 Other - Ancillary services (2) 1,843,798 1,746,488 Consolidated assets $ 16,928,252 $ 17,121,488 (1) Includes equity method and other investments of $113,781 and $112,500 in 2022 and 2021, respectively. (2) Includes equity method and other investments of $117,327 and $126,381 in 2022 and 2021, respectively and includes approximately $207,162 and $190,029 in 2022 and 2021, respectively, of net property and equipment related to the Company’s international operations. |
Supplemental Cash Flow Informat
Supplemental Cash Flow Information | 12 Months Ended |
Dec. 31, 2022 | |
Supplemental Cash Flow Elements [Abstract] | |
Supplemental Cash Flow Information | Supplemental cash flow information The table below provides supplemental cash flow information: Year ended December 31, 2022 2021 2020 Cash paid: Income taxes, net $ 344,430 $ 209,754 $ 154,850 Interest, net $ 350,999 $ 279,002 $ 326,165 Non-cash investing and financing activities: Fixed assets under financing lease obligations $ 1,928 $ 31,690 $ 22,042 |
SCHEDULE II-VALUATION AND QUALI
SCHEDULE II-VALUATION AND QUALIFYING ACCOUNTS | 12 Months Ended |
Dec. 31, 2022 | |
SEC Schedule, 12-09, Valuation and Qualifying Accounts [Abstract] | |
SCHEDULE II-VALUATION AND QUALIFYING ACCOUNTS | SCHEDULE II—VALUATION AND QUALIFYING ACCOUNTS Balance at Acquisitions Amounts Amounts written off Balance Description (dollars in thousands) Allowance for uncollectible accounts: Year ended December 31, 2022 $ — $ — $ — $ — $ — Year ended December 31, 2021 $ — $ — $ — $ — $ — Year ended December 31, 2020 $ 8,328 $ — $ 13,458 $ 21,786 $ — |
Organization and Summary of S_2
Organization and Summary of Significant Accounting Policies (Policies) | 12 Months Ended |
Dec. 31, 2022 | |
Accounting Policies [Abstract] | |
Basis of presentation | Basis of presentation These consolidated financial statements are prepared in accordance with United States generally accepted accounting principles (U.S. GAAP). The financial statements include DaVita Inc. and its subsidiaries, partnerships and other entities in which it maintains a majority voting or other controlling financial interest (collectively, the Company). All significant intercompany transactions and balances have been eliminated. Equity investments in investees over which the Company has significant influence are recorded on the equity method, while investments in other equity securities are recorded at fair value or on the adjusted cost method, as applicable. For the Company’s international subsidiaries, local currencies are considered their functional currencies. Translation adjustments result from translating the financial statements of the Company’s international subsidiaries from their functional currencies into the Company’s reporting currency (the U.S. dollar, or USD). Prior year classifications have been conformed to the current year presentation. The Company has evaluated subsequent events through the date these consolidated financial statements were issued and has included all necessary adjustments and disclosures. |
Use of estimates | Use of estimates The preparation of financial statements in conformity with U.S. GAAP requires the use of estimates and assumptions that affect the reported amounts of revenues, expenses, assets, liabilities, contingencies and noncontrolling interests subject to put provisions. Although actual results in subsequent periods will differ from these estimates, such estimates are developed based on the best information available to management and management’s best judgments at the time. All significant assumptions and estimates underlying the amounts reported in the financial statements and accompanying notes are regularly reviewed and updated when necessary. Changes in estimates are reflected in the financial statements based upon on-going actual experience trends or subsequent settlements and realizations depending on the nature and predictability of the estimates and contingencies. The most significant assumptions and estimates underlying these consolidated financial statements and accompanying notes involve revenue recognition and accounts receivable, impairments of goodwill, accounting for income taxes, certain fair value estimates and loss contingencies. Specific estimating risks and contingencies are further addressed within these notes to the consolidated financial statements. |
Patient service net revenues and accounts receivable | Revenues Dialysis patient service revenues Revenues are recognized based on the Company’s estimate of the transaction price the Company expects to collect as a result of satisfying its performance obligations. Dialysis patient service revenues are recognized in the period services are provided based on these estimates. Revenues consist primarily of payments from government and commercial health plans for dialysis services provided to patients. The Company maintains a usual and customary fee schedule for its dialysis treatments and related lab services; however, actual collectible revenue is normally recognized at a discount from this fee schedule. Revenues associated with Medicare and Medicaid programs are estimated based on: (a) the payment rates that are established by statute or regulation for the portion of payment rates paid by the government payor (e.g., 80% for Medicare patients) and (b) for the portion not paid by the primary government payor, estimates of the amounts ultimately collectible from other government programs providing secondary coverage (e.g., Medicaid secondary coverage), the patient’s commercial health plan secondary coverage, or the patient. Under Medicare’s bundled payment rate system, services covered by Medicare are subject to estimating risk, whereby reimbursements from Medicare can vary significantly depending upon certain patient characteristics and other variable factors. Even with the bundled payment rate system, Medicare payments for bad debt claims as established by cost reports require evidence of collection efforts. As a result, billing and collection of Medicare bad debt claims can be delayed significantly and final payment is subject to audit. The Company’s revenue recognition is estimated based on its judgment regarding its ability to collect, which depends upon its ability to effectively capture, document and bill for Medicare’s base payment rate as well as these other variable factors. Medicare Advantage revenues are reimbursed at negotiated contract rates that are generally higher than Medicare fee-for-service rates, but which generally have a slower payment frequency than Medicare fee-for-service payments, and some of which are subject to certain quality or performance adjustments. Medicare Advantage revenues are subject to meaningful estimating risk based on factors similar to those described for commercial health plans below. Medicaid payments, when Medicaid coverage is secondary, can also be difficult to estimate. For many states, Medicaid payment terms and methods differ from Medicare, and may prevent accurate estimation of individual payment amounts prior to billing. Revenues associated with commercial health plans are estimated based on contractual terms for the patients under healthcare plans with which the Company has formal agreements, non-contracted health plan coverage terms if known, estimated secondary collections, historical collection experience, historical trends of refunds and payor payment adjustments (retractions), inefficiencies in the Company’s billing and collection processes that can result in denied claims for payments, delays in collections due to payor payment inefficiencies, and regulatory compliance matters. Commercial revenue recognition also involves significant estimating risks. With many larger commercial insurers, the Company has several different contracts and payment arrangements, and these contracts often include only a subset of the Company’s centers. Some of our commercial revenue contracts are also subject to certain quality or performance adjustments. In certain circumstances, it may not be possible to determine which contract, if any, should be applied prior to billing. In addition, for services provided by non-contracted centers, final collection may require specific negotiation of a payment amount, typically at a significant discount from the Company’s usual and customary rates. Other revenues Other revenues consist of revenues earned by the Company's non-dialysis ancillary services as well as fees for management and administrative services to outpatient dialysis businesses that the Company does not consolidate. Other revenues are estimated in the period services are provided. The Company's IKC revenues include revenues earned under risk-based arrangements, including value-based care (VBC) arrangements. Under its VBC arrangements, the Company assumes full or shared financial risk for the total medical cost of care for patients below or above a benchmark. The benchmarks against which the Company incurs profit or loss on these contracts are typically based on the underlying premiums paid to the insuring entity (the Company's counterparty), with adjustments where applicable, or on trended and adjusted medical cost targets. For some of the Company's risk-based arrangements (such as its special needs plans), the Company acts as a principal with respect to all medical services provided to the patient by effectively hosting or sponsoring the entire arrangement, and as a result recognizes revenue and expense for all medical services provided to covered patients. However, for most of its VBC arrangements, the Company provides health monitoring and care coordination services to patients but does not control or direct the medical services that patients receive from third party providers. As a result, for most of its VBC arrangements the Company does not include third party medical costs in its reported revenues and expenses, but rather recognizes revenue only for the estimated amount of shared savings or shared losses or related revenues that are directly earned or incurred by the Company, and ultimately paid to or by the Company, under the arrangement. |
Other income | Other income Other income includes interest income on cash and cash equivalents and short- and long-term investments, realized and unrealized gains and losses recognized on investments, impairments on investments, and foreign currency transaction gains and losses. |
Cash and cash equivalents | Cash and cash equivalents Cash equivalents are short-term highly liquid investments readily convertible to known amounts of cash that typically mature within three months or less at date of purchase. |
Restricted cash and equivalents | Restricted cash and equivalents Restricted cash and cash equivalents include funds held in trust to satisfy insurer and state regulatory requirements related to wholly-owned captive insurance companies that bear professional and general liability and workers' compensation risks for the Company as well as funds held in escrow. See Note 4 for further details. |
Investments in debt and equity securities | Investments in debt and equity securities The Company classifies certain debt securities as held-to-maturity and records them at amortized cost based on the Company’s intentions and strategies concerning those investments. Equity securities that have readily determinable fair values or redemption values are recorded at estimated fair value with changes in fair value recognized in current earnings within other income. These debt and equity investments are classified as short-term investments or long-term investments on the Company's consolidated balance sheet. See Note 5 for further details. |
Inventories | Inventories Inventories are stated at the lower of cost (first-in, first-out) or net realizable value and consist principally of pharmaceuticals and dialysis-related supplies. Rebates related to inventory purchases are recorded when earned and are based on certain qualification requirements which are dependent on a variety of factors including future pricing levels and purchase volume levels from the manufacturer and related data submission. |
Property and equipment | Property and equipment Property and equipment is stated at cost less accumulated depreciation and amortization and is further reduced by any impairments. Maintenance and repairs are charged to expense as incurred. Property and equipment assets are reviewed for possible impairment whenever significant events or changes in circumstances indicate that an impairment may have occurred. Property and equipment impairment assessments are performed at a location or market level, as applicable, based on the specific cash flows they support or protect. If the Company commits to a plan to dispose of a long-lived asset before the end of its previously estimated useful life, cash flow estimates are revised accordingly, and the Company records an asset impairment, if applicable, or accelerates depreciation over the revised estimated useful life. Upon sale or retirement of long-lived assets, the cost and related accumulated depreciation or amortization are removed from the balance sheet and any resulting gain or loss is included in current operating expenses. |
Leases | Leases The Company leases substantially all of its U.S. dialysis facilities. The majority of the Company’s facilities are leased under non-cancellable operating leases which contain renewal options. These renewal options are included in the Company's determination of the right-of-use assets and related lease liabilities when renewal is considered reasonably certain at the commencement date.The Company's leases are generally subject to fixed escalation clauses or contain consumer price index increases. The Company categorizes leases with contractual terms longer than twelve months as either operating or finance leases. Finance leases are generally those leases that allow the Company to substantially utilize or pay for the entire asset over its estimated life. All other leases are categorized as operating leases. The Company has elected the practical expedient to not separate lease components from non-lease components for its financing and operating leases. For short-term leases with a term of less than 12 months, the Company does not recognize right-of-use assets or lease liabilities and instead recognizes short-term lease costs as rent expense directly as incurred. Financing and operating lease liabilities are measured at the net present value of lease payments over the lease term as of the commencement date. Since most of the Company's leases do not provide an implicit rate of return, the Company uses its incremental borrowing rate based on information available at the commencement date or remeasurement date in determining the present value of lease payments. Assets acquired under finance leases are recorded on the balance sheet within property and equipment, net and liabilities for finance lease obligations are recorded within long-term debt. Finance lease assets are amortized to depreciation expense on a straight-line basis over the shorter of their estimated useful lives or the expected lease term. Accretion of interest on finance lease liabilities is included in debt expense. Rights to use assets under operating leases are recorded on the balance sheet as operating lease right-of-use assets and liabilities for operating lease obligations are recorded as operating lease liabilities. Both amortization of operating lease right-of-use assets, and interest accretion on operating lease liabilities, are recorded to rent expense over the lease term. Rent expenses are included in patient care costs or general and administrative expense, as applicable, based on the business unit or corporate function for which the space is leased. |
Amortizable intangibles | Amortizable intangibles Amortizable intangible assets include noncompetition agreements, hospital service contracts, and customer relationships arising from other service contracts, each of which have finite useful lives. Amortization expense is computed using the straight-line method over the useful lives of the assets estimated as follows: noncompetition agreements and hospital acute service contracts over the contract term, and customer relationships from other service contracts over the remaining contract term plus expected renewal periods. Amortizable intangible assets are reviewed for possible impairment whenever significant events or changes in circumstances indicate that an impairment may have occurred. Amortizable intangible asset impairment assessments are performed on a location, market or business unit basis, as applicable, based on the specific cash flows they support or protect. |
Indefinite-lived intangibles | Indefinite-lived intangibles Indefinite-lived intangible assets include international licenses and accreditations that allow the Company to be reimbursed for providing dialysis services to patients, each of which has an indefinite useful life. Indefinite-lived intangibles are not amortized, but are assessed for impairment at least annually and whenever significant events or changes in circumstances indicate that an impairment may have occurred. Costs to renew indefinite-lived intangible assets are expensed as incurred. |
Equity investments and other investments | Equity method and other investments Equity investments that do not have readily determinable fair values are carried on the equity method if the Company maintains significant influence over the investee unless the fair value option is elected. Equity investments without readily determinable fair values for which the Company does not maintain significant influence over the investee are carried either on the adjusted cost method or at estimated fair value, as determined on an investment-specific basis. The adjusted cost method represents the Company's cost for an investment, net of any impairments, as adjusted for any subsequent observable price changes. These equity investments are classified as equity method and other investments on the Company's consolidated balance sheet. See Note 9 for further details. Equity method investments are assessed for other-than-temporary impairment when significant events or changes in circumstances indicate that an other-than-temporary impairment may have occurred. An other-than-temporary impairment charge is recorded when the fair value of an investment has fallen below its carrying amount and the shortfall is expected to be indefinitely or permanently unrecoverable. Income and expense from nonconsolidated dialysis partnerships accounted for as equity method investments are recorded within equity investment income, net. For ownership interests accounted for as equity method investments other than dialysis partnerships, income and expense are included on up to a one quarter lag in other (loss) income, net. |
Goodwill | Goodwill Goodwill represents the difference between the fair value of businesses acquired and the fair value of the identifiable tangible and intangible net assets acquired. Goodwill is not amortized, but is assessed by individual reporting unit for impairment as circumstances warrant and at least annually. An impairment charge is recognized when and to the extent a reporting unit's carrying amount is determined to exceed its fair value. The Company operates multiple reporting units. See Note 10 for further details. |
Self insurance | Self-insuranceThe Company predominantly self-insures its professional and general liability, workers' compensation and automobile risks, and a portion of its employment liability practice risks, through its wholly-owned captive insurance companies, with excess or reinsurance coverage for additional protection. The Company is also predominantly self-insured with respect to employee medical and other health benefits. The Company records insurance liabilities for the professional and general liability, workers’ compensation, automobile, employee health benefit and portion of employment liability practice risks that it retains and estimates its liability for those risks using third party actuarial calculations that are based upon historical claims experience and expectations for future claims. |
Income taxes | Income taxes Federal, state and foreign income taxes are computed at currently enacted tax rates less tax credits using the asset and liability method. Deferred taxes are adjusted both for items that do not currently have tax consequences and for the cumulative effect of any changes in tax rates from those previously used to determine deferred tax assets or liabilities. Tax provisions include amounts that are currently payable, changes in deferred tax assets and liabilities that arise because of temporary differences between the timing of when items of income and expense are recognized for financial reporting and income tax purposes, changes in the recognition of tax positions and any changes in the valuation allowance caused by a change in judgment about the realizability of the related deferred tax assets. A valuation allowance is established when necessary to reduce deferred tax assets to amounts expected to be realized. The Company uses a recognition threshold of more-likely-than-not and a measurement attribute on all tax positions taken or expected to be taken in a tax return in order to be recognized in the financial statements. Once the recognition threshold is met, the tax position is then measured to determine the actual amount of benefit to recognize in the financial statements. |
Stock-based compensation | Stock-based compensation The Company’s stock-based compensation expense for stock-settled awards is measured at the estimated fair value of awards on the date of grant and recognized on a cumulative straight-line basis over the vesting terms of the awards, unless the stock awards are based on non-market-based performance metrics, in which case expense is adjusted for the ultimate number of shares expected to be issued as of the end of each reporting period. Stock-based compensation expense for cash-settled awards is based on their estimated fair values as of the end of each reporting period. The expense for all stock-based awards is recognized net of expected forfeitures. Stock-based compensation to be settled in shares is recorded to the Company’s shareholders’ contributed capital, while stock-based compensation to be settled in cash is recorded as a liability. Shares issued upon exercise or, when applicable, vesting of stock awards, are issued from authorized but unissued shares. |
Interest rate swap and cap agreements | Interest rate cap agreements The Company often carries a combination of current or forward interest rate caps on portions of its variable rate debt as a means of hedging its exposure to changes in LIBOR interest rates as part of its overall interest rate risk management strategy. These interest rate caps are not held for trading or speculative purposes and are designated as qualifying cash flow hedges. See Note 13 for further details. |
Noncontrolling interests | Noncontrolling interestsNoncontrolling interests represent third-party equity ownership interests in entities which are consolidated by the Company for financial statement reporting purposes. Noncontrolling interests subject to put provisions The Company has potential obligations to purchase the equity interests held by third parties in many of its majority-owned dialysis partnerships and other nonconsolidated entities. These noncontrolling interests subject to put provisions constitute redeemable equity interests and are therefore classified as temporary equity and carried at estimated fair value on the Company's balance sheet. Specifically, these obligations are in the form of put provisions that are exercisable at the third-party owners’ discretion within specified periods outlined in each specific put provision. If these put provisions were exercised, the Company would be required to purchase the third-party owners’ equity interests, generally at the appraised fair market value of the equity interests or in certain cases at a predetermined multiple of earnings or cash flows attributable to the equity interests put to the Company, intended to approximate fair value. The methodology the Company uses to estimate the fair values of noncontrolling interests subject to put provisions assumes the higher of either a liquidation value of net assets or an average multiple of earnings, based on historical earnings, patient mix and other performance indicators that can affect future results, as well as other factors. The estimated fair values of noncontrolling interests subject to put provisions are a critical accounting estimate that involves significant judgments and assumptions and may not be indicative of the actual values at which the noncontrolling interests may ultimately be settled, which could vary significantly from the Company’s current estimates. The estimated fair values of noncontrolling interests subject to put provisions can fluctuate and the implicit multiple of earnings at which these noncontrolling interests obligations may be settled will vary significantly depending upon market conditions including potential purchasers’ access to the capital markets, which can impact the level of competition for dialysis and non-dialysis related businesses, the economic performance of these businesses and the restricted marketability of the third-party owners’ equity interests. The amount of noncontrolling interests subject to put provisions that employ a contractually predetermined multiple of earnings rather than fair value is immaterial. |
Fair value estimates | Fair value estimates Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. Fair value measurements are determined based on the principal or most advantageous market for the item being measured, assume that buyers and sellers are independent, willing and able to transact, and knowledgeable, with access to all information customarily available in such a transaction, and are based on assumptions that market participants would use in pricing the item, not assumptions specific to the reporting entity. The criticality of a particular fair value estimate to the Company's consolidated financial statements depends upon the nature and size of the item being measured, the extent of uncertainties involved and the nature and magnitude or potential effect of assumptions and judgments required. Certain fair value estimates can involve significant uncertainties and require significant judgment on various matters, some of which could be subject to reasonable disagreement. See Note 24 for further details. The Company relies on fair value measurements and estimates for purposes that require the recording, reassessment, or adjustment of the carrying amounts of certain assets, liabilities, and noncontrolling interests subject to put provisions (redeemable equity interests classified as temporary equity). These purposes can include the accounting for business combination transactions; impairment assessments for goodwill, other intangible assets, or other long-lived assets; recurrent revaluation of investments in debt and equity securities, contingent earn-out obligations, interest rate cap agreements, and noncontrolling interests subject to put provisions; and the accounting for equity method and other investments and stock-based compensation, as applicable. The Company has classified its assets, liabilities and temporary equity into the fair value hierarchy levels defined by the Financial Accounting Standards Board (FASB) reflecting their differing degrees of uncertainty. See Note 24 for further details. |
New accounting standards | New accounting standards New standards not yet adopted In March 2020, the FASB issued Accounting Standards Update (ASU) No. 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting (ASU 2020-04) . ASU 2020-04 provides optional expedients and exceptions for applying U.S. GAAP to contract modifications and hedging relationships, subject to meeting certain criteria, that reference LIBOR or another rate that is expected to be discontinued. The amendments in this ASU were effective beginning on March 12, 2020, and the Company could elect to apply the amendments prospectively through December 31, 2022. In December 2022, the FASB issued ASU No. 2022-06, Reference Rate Reform (Topic 848): Deferral of the Sunset Date of Topic 848, which extends the election date to December 31, 2024. Effective January 1, 2022 certain LIBOR tenors that do not affect the Company, including the one-week and two-month U.S. dollar LIBOR rate, ceased or became non-representative. The remaining U.S. dollar LIBOR tenors will cease or become non-representative effective July 1, 2023. This change will have no impact on the Company's ability to borrow. The Company is currently assessing the other effects this guidance may have on its consolidated financial statements. In October 2021, the FASB issued ASU No. 2021-08, Business Combinations (Topic 805): Accounting for Acquired Contract Assets and Contract Liabilities (ASU 2021-08) . ASU 2021-08 requires application of ASC 606, Revenue from Contracts with Customers , to recognize and measure assets and liabilities from contracts with customers acquired in a business combination. This ASU creates an exception to the general recognition and measurement principle in ASC 805 and will result in recognition of contract assets and contract liabilities consistent with those recorded by the acquiree immediately before the acquisition date. ASU 2021-08 is effective for fiscal years beginning after December 15, 2022, including interim periods within those fiscal years. Early adoption is permitted for all entities. The Company does not expect the adoption of this standard to have a material impact on its consolidated financial statements. |
Earnings per share | Basic earnings per share is calculated by dividing net income attributable to the Company by the weighted average number of common shares outstanding. Weighted average common shares outstanding include restricted stock unit awards that are no longer subject to forfeiture because the recipients have satisfied either their explicit vesting terms or retirement eligibility requirements. Diluted earnings per share includes the dilutive effect of outstanding stock-settled stock appreciation rights and unvested stock units as computed under the treasury stock method. |
Short-term and long-term investments | Debt securities: The Company's short-term debt investments are principally bank certificates of deposit with contractual maturities longer than three months but shorter than one year. The Company's long-term debt investments are bank time deposits with contractual maturities longer than one year. These debt securities are accounted for as held-to-maturity and recorded at amortized cost, which approximated their fair values at December 31, 2022 and 2021. Equity securities: The Company holds certain equity investments that have readily determinable fair values from public markets. The Company's remaining short-term and long-term equity investments are held within a trust to fund existing obligations associated with the Company’s non-qualified deferred compensation plans. |
Other Comprehensive (Loss) Income | The reclassification of net interest rate cap realized losses into income are recorded as debt expense in the corresponding consolidated statements of income. |
Variable Interest Entities | The Company manages or maintains an ownership interest in certain legal entities subject to the consolidation guidance applicable to variable interest entities (VIEs). Almost all of the VIEs the Company consolidates are either U.S. dialysis partnerships encumbered by guaranteed debt, U.S. dialysis limited partnerships, U.S. integrated care subsidiaries, or other legal entities subject to nominee ownership arrangements. Under U.S. GAAP, VIEs typically include entities for which (i) the entity’s equity is not sufficient to finance its activities without additional subordinated financial support; (ii) the equity holders as a group lack the power to direct the activities that most significantly influence the entity’s economic performance, the obligation to absorb the entity’s expected losses, or the right to receive the entity’s expected returns; or (iii) the voting rights of some investors are not proportional to their obligations to absorb the entity’s losses. The substantial majority of VIEs the Company is associated with are U.S. dialysis partnerships which the Company manages and in which it maintains a controlling majority ownership interest. These U.S. dialysis partnerships are considered VIEs either because they are (i) encumbered by debt guaranteed proportionately by the partners that is considered necessary to finance the partnership's activities, or (ii) in the form of limited partnerships for which the limited partners are not considered to have substantive kick-out or participating rights. The Company consolidates virtually all such U.S. dialysis partnerships. Also, certain wholly-owned entities employed in the Company's integrated kidney care business constitute VIEs since by design these entities require additional subordinated financial support. The Company wholly owns but does not wholly control these entities. However, the Company believes it has the most power over these entities' most significant activities, and the Company is fully exposed to their expected losses. The Company therefore consolidates these wholly-owned entities as its subsidiaries. Finally, one of the Company's business units relies on the operating activities of certain nominee-owned legal entities in which it does not maintain a controlling ownership interest but over which it has indirect influence and of which it is considered the primary beneficiary. These entities are subject to transfer restriction, management and other agreements that effectively transfer substantial ultimate powers over, and economic responsibility for, these entities to the Company. The Company consolidates all of the nominee-owned entities with which it is most closely associated. In addition to the consolidated entities described above, the Company maintains minor equity method or other venture capital investments in certain development-stage investees which qualify as VIEs based on their capitalization. The Company has concluded that it is not the primary beneficiary of any of these investees. |
Revenue Recognition and Account
Revenue Recognition and Accounts Receivable Segment revenue by major payor (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Disaggregation of Revenue [Abstract] | |
Disaggregation of Revenue | The Company's revenues by segment and primary payor source were as follows: Year ended December 31, 2022 U.S. dialysis Other - Ancillary services Consolidated Patient service revenues: Medicare and Medicare Advantage $ 6,041,496 $ 6,041,496 Medicaid and Managed Medicaid 759,579 759,579 Other government 336,991 464,921 801,912 Commercial 3,437,306 223,216 3,660,522 Other revenues: Medicare and Medicare Advantage 345,340 345,340 Medicaid and Managed Medicaid 1,546 1,546 Commercial 22,211 22,211 Other (1) 24,437 44,092 68,529 Eliminations of intersegment revenues (87,035) (4,206) (91,241) Total $ 10,512,774 $ 1,097,120 $ 11,609,894 (1) Other consists primarily of management service fees earned in the respective Company line of business as well as other non-patient service revenue from the Company's U.S. IKC and other ancillary services and international operations. Year ended December 31, 2021 U.S. dialysis Other - Ancillary services Consolidated Patient service revenues: Medicare and Medicare Advantage $ 6,133,235 $ $ 6,133,235 Medicaid and Managed Medicaid 782,430 782,430 Other government 328,256 463,385 791,641 Commercial 3,397,697 199,024 3,596,721 Other revenues: Medicare and Medicare Advantage 326,696 326,696 Medicaid and Managed Medicaid 1,321 1,321 Commercial 15,553 15,553 Other (1) 25,345 40,945 66,290 Eliminations of intersegment revenues (90,796) (4,294) (95,090) Total $ 10,576,167 $ 1,042,630 $ 11,618,797 (1) Other consists primarily of management service fees earned in the respective Company line of business as well as other non-patient service revenue from the Company's U.S. IKC and other ancillary services and international operations. Year ended December 31, 2020 U.S. dialysis Other - Ancillary services Consolidated Patient service revenues: Medicare and Medicare Advantage (1) $ 6,169,226 $ $ 6,169,226 Medicaid and Managed Medicaid 744,862 744,862 Other government (1) 334,714 380,584 715,298 Commercial 3,370,562 170,394 3,540,956 Other revenues: Medicare and Medicare Advantage 419,662 419,662 Medicaid and Managed Medicaid 1,227 1,227 Commercial 33,246 33,246 Other (2) 40,571 47,585 88,156 Eliminations of intersegment revenues (145,286) (16,743) (162,029) Total $ 10,514,649 $ 1,035,955 $ 11,550,604 (1) During the first quarter of 2021, the Company realigned the classification of revenue previously disclosed in the "Other government" category to the "Medicare and Medicare Advantage" category for certain government-reimbursed plans which have structure and payment characteristics similar to traditional Medicare Advantage plans. The classification of revenue for these plans for the year ended December 31, 2020 has also been recast to conform to this presentation. (2) Other consists primarily of management service fees earned in the respective Company line of business as well as other non-patient revenue from the Company's U.S. IKC and other ancillary services and international operations. |
Earnings Per Share (Tables)
Earnings Per Share (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Earnings Per Share [Abstract] | |
Reconciliations of Numerators and Denominators Used to Calculate Basic and Diluted Net Income Per Share | The reconciliations of the numerators and denominators used to calculate basic and diluted earnings per share were as follows: Year ended December 31, 2022 2021 2020 Net income (loss) attributable to DaVita Inc.: Continuing operations $ 546,948 $ 978,450 $ 783,295 Discontinued operations 13,452 — (9,653) Net income attributable to DaVita Inc. $ 560,400 $ 978,450 $ 773,642 Weighted average shares outstanding: Basic shares 92,992 105,230 119,797 Assumed incremental from stock plans 2,842 4,718 2,826 Diluted shares 95,834 109,948 122,623 Basic net income (loss) attributable to DaVita Inc.: Continuing operations per share $ 5.88 $ 9.30 $ 6.54 Discontinued operations per share 0.15 — (0.08) Basic net income per share attributable to DaVita Inc. $ 6.03 $ 9.30 $ 6.46 Diluted net income (loss) attributable to DaVita Inc.: Continuing operations per share $ 5.71 $ 8.90 $ 6.39 Discontinued operations per share 0.14 — (0.08) Diluted net income per share attributable to DaVita Inc. $ 5.85 $ 8.90 $ 6.31 Anti-dilutive stock-settled awards excluded from calculation (1) 1,058 116 2,301 (1) Shares associated with stock awards excluded from the diluted denominator calculation because they were anti-dilutive under the treasury stock method. |
Short-term and long-term invesm
Short-term and long-term invesmtents (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Investments, Debt and Equity Securities [Abstract] | |
Schedule of Investments | The Company’s short-term and long-term investments, consisting of debt instruments classified as held-to-maturity and equity investments with readily determinable fair values or redemption values, were as follows: December 31, 2022 December 31, 2021 Debt Equity Total Debt Equity Total Certificates of deposit and other time deposits $ 82,879 $ — $ 82,879 $ 23,226 $ — $ 23,226 Investments in mutual funds and common stock — 39,143 39,143 — 48,598 48,598 $ 82,879 $ 39,143 $ 122,022 $ 23,226 $ 48,598 $ 71,824 Short-term investments $ 67,872 $ 9,821 $ 77,693 $ 8,227 $ 14,083 $ 22,310 Long-term investments 15,007 29,322 44,329 14,999 34,515 49,514 $ 82,879 $ 39,143 $ 122,022 $ 23,226 $ 48,598 $ 71,824 |
Other Receivables (Tables)
Other Receivables (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Receivables [Abstract] | |
Schedule of Other Receivables | Other receivables were comprised of the following: December 31, 2022 2021 Supplier rebates and non-trade receivables $ 303,225 $ 294,574 Medicare bad debt claims 110,751 132,747 $ 413,976 $ 427,321 |
Property and Equipment (Tables)
Property and Equipment (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Property, Plant and Equipment [Abstract] | |
Property and Equipment | Property and equipment were comprised of the following: December 31, 2022 2021 Land $ 32,656 $ 34,009 Buildings 427,962 496,455 Leasehold improvements 3,925,244 3,828,404 Equipment and information systems, including internally developed software 3,759,274 3,292,176 New center and capital asset projects in progress 376,633 592,063 8,521,769 8,243,107 Less accumulated depreciation (5,265,372) (4,763,135) $ 3,256,397 $ 3,479,972 |
Intangibles (Tables)
Intangibles (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Schedule of Intangible Assets other than Goodwill | Intangible assets other than goodwill were comprised of the following: December 31, 2022 2021 Indefinite-lived licenses $ 127,271 $ 104,214 Noncompetition agreements 51,408 70,495 Customer relationships and other 53,779 63,714 232,458 238,423 Accumulated amortization: Noncompetition agreements (39,745) (52,813) Customer relationships and other (10,027) (7,917) $ 182,687 $ 177,693 |
Scheduled Amortization Charges from Intangible Assets and Liabilities | Scheduled amortization expenses from amortizable intangible assets as of December 31, 2022 were as follows: Noncompetition Customer relationships and other 2023 $ 4,742 $ 4,084 2024 2,849 3,956 2025 1,721 3,489 2026 1,092 3,489 2027 730 3,382 Thereafter 529 25,352 Total $ 11,663 $ 43,752 |
Equity Method and Other Inves_2
Equity Method and Other Investmetns Equity Method and Other Investments (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Equity Method Investments and Joint Ventures [Abstract] | |
Equity Method Investments | The Company maintains equity method and other minor investments in the private securities of certain other healthcare and healthcare-related businesses, comprised as follows: December 31, 2022 2021 APAC joint venture $ 99,141 $ 109,153 Other equity method partnerships 116,403 115,185 Adjusted cost method and other investments 15,564 14,543 $ 231,108 $ 238,881 |
Goodwill (Tables)
Goodwill (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Changes in Carrying Value of Goodwill by Reportable Segments | Changes in the carrying value of goodwill by reportable segment were as follows: U.S. dialysis Other - Ancillary Consolidated Balance at December 31, 2020 $ 6,309,928 $ 609,181 $ 6,919,109 Acquisitions 91,979 81,265 173,244 Divestitures (1,745) — (1,745) Foreign currency and other adjustments — (44,367) (44,367) Balance at December 31, 2021 $ 6,400,162 $ 646,079 $ 7,046,241 Acquisitions 16,750 32,297 49,047 Divestitures (87) (3,263) (3,350) Foreign currency and other adjustments — (15,328) (15,328) Balance at December 31, 2022 $ 6,416,825 $ 659,785 $ 7,076,610 Balance at December 31, 2022: Goodwill $ 6,416,825 $ 778,774 $ 7,195,599 Accumulated impairment charges — (118,989) (118,989) $ 6,416,825 $ 659,785 $ 7,076,610 |
Schedule of Reporting Units Goodwill Balances | Reporting unit Goodwill Carrying amount (1) Sensitivities Operating (2) Discount (3) Germany kidney care $ 281,781 18.9 % (2.0) % (9.2) % (1) Excess of estimated fair value of the reporting unit over its carrying amount as of the latest assessment date. (2) Potential impact on estimated fair value of a sustained, long-term reduction of 3% in operating income as of the latest assessment date. (3) Potential impact on estimated fair value of an increase in discount rates of 100 basis points as of the latest assessment date. |
Other Liabilities (Tables)
Other Liabilities (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Other Liabilities Disclosure [Abstract] | |
Schedule of Other Liabilities | Other liabilities were comprised of the following: December 31, 2022 2021 Payor refunds and retractions $ 475,195 $ 410,038 Insurance and self-insurance accruals 68,440 55,548 Accrued interest 34,162 32,926 Accrued non-income tax liabilities 42,806 41,784 Other 181,866 169,049 $ 802,469 $ 709,345 |
Income Taxes (Tables)
Income Taxes (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Income Tax Disclosure [Abstract] | |
Schedule of Income Before Income Taxes | Income before income taxes from continuing operations consisted of the following: Year ended December 31, 2022 2021 2020 Domestic $ 926,604 $ 1,463,029 $ 1,287,976 International 39,674 55,465 30,286 $ 966,278 $ 1,518,494 $ 1,318,262 |
Components of Income Tax Expense (Benefit) | Income tax expense for continuing operations consisted of the following: Year ended December 31, 2022 2021 2020 Current: Federal $ 201,932 $ 216,539 $ 47,171 State 55,593 15,601 21,442 International 16,253 14,247 17,481 Total current income tax 273,778 246,387 86,094 Deferred: Federal (66,400) 59,528 198,623 State (12,289) 5,342 27,206 International 2,998 (4,525) 2,009 Total deferred income tax (75,691) 60,345 227,838 $ 198,087 $ 306,732 $ 313,932 |
Schedule of allocation of income tax expense (benefit) between continuing and discontinued operations. | Income taxes are allocated between continuing and discontinued operations as follows: Year ended December 31, 2022 2021 2020 Continuing operations $ 198,087 $ 306,732 $ 313,932 Discontinued operations — — 1,657 $ 198,087 $ 306,732 $ 315,589 |
Reconciliation between U.S. Federal Income Tax Rate and Effective Tax Rate | The reconciliation between the Company’s effective tax rate from continuing operations and the U.S. federal income tax rate is as follows: Year ended December 31, 2022 2021 2020 Federal income tax rate 21.0 % 21.0 % 21.0 % State income taxes, net of federal benefit 3.8 3.0 3.4 Equity compensation (1.6) (2.4) — Federal and international tax rate adjustments — 1.3 — Nondeductible executive compensation 1.1 0.8 1.2 Political advocacy costs 2.2 0.2 1.7 Unrecognized tax benefits (1.1) (0.1) 0.4 Change in international valuation allowance 1.2 (1.0) 1.5 Credits (1.2) (0.7) (0.7) Other 1.1 1.7 0.1 Impact of noncontrolling interests primarily (6.0) (3.6) (4.8) Effective tax rate 20.5 % 20.2 % 23.8 % |
Deferred Tax Assets and Liabilities Arising from Temporary Differences | Deferred tax assets and liabilities arising from temporary differences for continuing operations were as follows: December 31, 2022 2021 Receivables $ 18,304 $ 8,430 Accrued liabilities 71,346 67,993 Operating lease liabilities 563,972 581,199 Net operating loss carryforwards 173,531 162,987 Other 58,827 52,434 Deferred tax assets 885,980 873,043 Valuation allowance (106,775) (100,616) Net deferred tax assets 779,205 772,427 Intangible assets (690,914) (644,039) Property and equipment (181,704) (283,913) Operating lease assets (515,026) (530,839) Investments in partnerships (80,876) (84,407) Other (65,766) (37,274) Deferred tax liabilities (1,534,286) (1,580,472) Net deferred tax liabilities $ (755,081) $ (808,045) Reported as: Deferred tax liabilities $ (782,787) $ (830,954) Deferred tax assets (included in Other long-term assets) 27,706 22,909 $ (755,081) $ (808,045) |
Reconciliation of the Beginning and Ending Liability for Unrecognized Tax Benefits that Do Not Meet the More-Likely-Than-Not Threshold | A reconciliation of the beginning and ending liability for unrecognized tax benefits that do not meet the more-likely-than-not threshold is as follows: Year ended December 31, 2022 2021 Beginning balance $ 73,024 $ 70,202 Additions for tax positions related to current year 3,858 3,335 Additions for tax positions related to prior years 24,683 22,616 Reductions related to lapse of applicable statute (6,073) (751) Reductions related to settlements with taxing authorities (31,507) (22,378) Ending balance $ 63,985 $ 73,024 |
Long-Term Debt (Tables)
Long-Term Debt (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Debt Disclosure [Abstract] | |
Long-term Debt | Long-term debt Long-term debt was comprised of the following: December 31, As of December 31, 2022 2022 2021 Maturity date Interest rate Estimated fair value (1) Senior Secured Credit Facilities: Term Loan A $ 1,498,438 $ 1,596,875 8/12/2024 LIBOR + 1.75% $ 1,468,469 Term Loan B-1 2,660,831 2,688,263 8/12/2026 LIBOR + 1.75% $ 2,587,658 Revolving line of credit 165,000 — 8/12/2024 LIBOR + 1.75% $ 165,000 Senior Notes: 4.625% Senior Notes 2,750,000 2,750,000 6/1/2030 4.625 % $ 2,224,063 3.75% Senior Notes 1,500,000 1,500,000 2/15/2031 3.75 % $ 1,115,625 Acquisition obligations and other notes (2) 120,562 130,599 2023-2036 6.56 % $ 120,562 Financing lease obligations (3) 273,688 299,128 2023-2038 4.51 % Total debt principal outstanding 8,968,519 8,964,865 Discount and deferred financing costs (4) (44,498) (56,685) 8,924,021 8,908,180 Less current portion (231,404) (179,030) $ 8,692,617 $ 8,729,150 (1) For the Company's senior secured credit facilities and senior notes, fair value estimates are based upon bid and ask quotes, typically a level 2 input. For acquisition obligations and other notes payable, the carrying values presented here approximate their estimated fair values, based on estimates of their present values using level 2 interest rate inputs. (2) The interest rate presented for acquisition obligations and other notes payable is their weighted average interest rate based on the current fixed and LIBOR interest rate components in effect as of December 31, 2022. (3) Financing lease obligations are measured at their approximate present values at inception. The interest rate presented is the weighted average discount rate embedded in financing leases outstanding. (4) As of December 31, 2022, the carrying amount of the Company's senior secured credit facilities have been reduced by a discount of $3,497 and deferred financing costs of $18,816 and the carrying amount of the Company's senior notes have been reduced by deferred financing costs of $36,203 and increased by a debt premium of $14,018. As of December 31, 2021, the carrying amount of the Company's senior secured credit facilities was reduced by a discount of $4,473 and deferred financing costs of $27,207, and the carrying amount of the Company's senior notes was reduced by deferred financing costs of $40,914 and increased by a debt premium of $15,909. |
Scheduled Maturities of Long-term Debt | Scheduled maturities of long-term debt at December 31, 2022 were as follows: 2023 $ 231,404 2024 $ 1,587,867 2025 $ 67,112 2026 $ 2,627,310 2027 $ 35,176 Thereafter $ 4,419,650 |
Derivative Instruments | The following table summarizes the Company’s interest rate cap agreements outstanding as of December 31, 2022 and December 31, 2021, which are classified in other long-term assets on its consolidated balance sheet: Year ended December 31, LIBOR maximum rate December 31, 2022 2022 2021 Notional amount Effective date Expiration date Debt expense Recorded OCI gain Fair value 2019 interest rate cap agreements $ 3,500,000 2.00% 6/30/2020 6/30/2024 $ (11,732) $ 144,793 $ 139,755 $ 12,203 |
Effects of Interest Rate Swap and Cap Agreements | The following table summarizes the effects of the Company’s interest rate cap agreements for the years ended December 31, 2022, 2021 and 2020: Amount of unrealized gains (losses) in OCI on interest rate cap agreements Location of losses Reclassification from accumulated other comprehensive income into net income Year ended December 31, Year ended December 31, Derivatives designated as cash flow hedges 2022 2021 2020 2022 2021 2020 Interest rate cap agreements $ 144,793 $ 9,532 $ (21,781) Debt expense $ (11,732) $ 5,509 $ 7,081 Related income tax (36,124) (2,377) 5,435 Related income tax 2,926 (1,376) (1,768) Total $ 108,669 $ 7,155 $ (16,346) $ (8,806) $ 4,133 $ 5,313 |
Leases (Tables)
Leases (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Leases [Abstract] | |
Lease Expense Components | The components of lease expense were as follows: Year ended December 31, Lease cost 2022 2021 2020 Operating lease cost (1) : Fixed lease expense $ 552,194 $ 547,923 $ 541,090 Variable lease expense 127,621 125,981 122,729 Financing lease cost: Amortization of leased assets 27,079 26,846 24,720 Interest on lease liabilities 12,776 13,988 14,421 Net lease cost $ 719,670 $ 714,738 $ 702,960 |
Lease Other Information | Other information related to leases was as follows: Year ended December 31, Lease term and discount rate 2022 2021 2020 Weighted average remaining lease term (years): Operating leases 8.2 8.3 8.7 Finance leases 9.4 10.5 10.5 Weighted average discount rate: Operating leases 3.6 % 3.5 % 3.8 % Finance leases 4.5 % 4.5 % 5.1 % Year ended December 31, Other information 2022 2021 2020 Gains on sale leasebacks, net $ 28,005 $ 17,137 $ 34,301 Cash paid for amounts included in the Operating cash flows for operating leases $ 696,291 $ 684,186 $ 661,318 Operating cash flows for finance leases $ 20,103 $ 21,343 $ 20,981 Financing cash flows for finance leases $ 24,329 $ 22,445 $ 24,780 Net operating lease assets obtained in exchange $ 278,108 $ 361,101 $ 401,559 |
Schedule Of Minimum Lease Payments | Future minimum lease payments under non-cancellable leases as of December 31, 2022 are as follows: Operating leases Finance leases 2023 $ 492,566 $ 37,442 2024 500,422 37,951 2025 452,080 38,125 2026 400,879 36,908 2027 333,580 35,569 Thereafter 1,175,340 145,987 Total future minimum lease payments 3,354,867 331,982 Less portion representing interest (456,398) (58,294) Present value of lease liabilities $ 2,898,469 $ 273,688 |
Stock-based compensation and Sh
Stock-based compensation and Shareholders’ Equity (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Share-Based Payment Arrangement [Abstract] | |
Summary of Status of Awards Under Stock-Based Compensation Plans and Agreements | A combined summary of the status of the Company’s stock-settled awards under both the 2020 Plan and 2011 Plan, including base shares for stock-settled stock appreciation rights (SSARs) and stock-settled stock unit awards is as follows: Year ended December 31, 2022 Stock appreciation rights Stock units Awards Weighted Weighted Awards Weighted Outstanding at beginning of year 5,943 $ 64.66 3,385 Granted 130 $ 110.63 1,152 Added by performance factor 136 Exercised/Vested (619) $ 63.59 (1,269) Canceled (64) $ 55.53 (332) Outstanding at end of period 5,390 $ 66.00 1.62 3,072 1.93 Exercisable at end of period 2,618 $ 64.93 1.32 — — Weighted-average fair value of grants: 2022 $ 35.13 $ 107.60 2021 $ 32.15 $ 109.50 2020 $ 26.70 $ 77.83 |
Summary of Range of Exercise Prices | Awards Outstanding Weighted average exercise price Awards exercisable Weighted average exercise price Range of SSARs base prices $50.01–$60.00 1,397 $ 52.41 401 $ 52.41 $60.01–$70.00 3,462 $ 67.41 2,212 $ 67.18 $70.01–$80.00 269 $ 75.85 5 $ 70.32 $100.01–$110.00 132 $ 108.93 — $ — $110.01–$120.00 130 $ 110.63 — $ — Total 5,390 $ 66.00 2,618 $ 64.93 |
Summary of Weighted Average Valuation Inputs | A summary of the weighted average valuation inputs described above used for estimating the grant-date fair value of SSAR awards granted in the periods indicated is as follows: Year ended December 31, 2022 2021 2020 Expected term 4.5 4.5 4.8 Expected volatility 34.3 % 34.3 % 28.2 % Expected dividend yield — % — % — % Risk-free interest rate 2.1 % 0.7 % 1.5 % |
Stockholder's equity (Tables)
Stockholder's equity (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Equity [Abstract] | |
Shares repurchases summary table | The following table summarizes the Company's repurchases of its common stock during the years ended December 31, 2022, 2021 and 2020: 2022 2021 2020 Open market repurchases Shares 8,095 13,877 8,495 Amounts paid $ 787,854 $ 1,546,016 $ 741,850 Average paid per share $ 97.33 $ 111.41 $ 87.32 Tender offer (1) Shares — — 7,982 Amounts paid $ — $ — 704,917 Average paid per share $ — $ — 88.32 Total Shares 8,095 13,877 16,477 Amounts paid $ 787,854 $ 1,546,016 $ 1,446,767 Average paid per share $ 97.33 $ 111.41 $ 87.80 (1) The aggregate amounts paid for shares repurchased pursuant to the Company's 2020 tender offer for its shares during the year ended 2020, include the clearing price of $88.00 per share, plus related fees and expenses of $2,529. |
Net effect of transfers from to noncontrolling interests on stock holders equity disclosure | The effects of changes in DaVita Inc.’s ownership interests in consolidated subsidiaries on the Company’s consolidated equity were as follows: Year ended December 31, 2022 2021 2020 Net income attributable to DaVita Inc. $ 560,400 $ 978,450 $ 773,642 Changes in paid-in capital for: Purchases of noncontrolling interests (6,586) (13,853) 4,364 Sales of noncontrolling interest 939 (264) — Net transfers in noncontrolling interests (5,647) (14,117) 4,364 Net income attributable to DaVita Inc. net of transfers in $ 554,753 $ 964,333 $ 778,006 |
Accumulated Other Comprehensi_2
Accumulated Other Comprehensive (Loss) Income (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Statement of Comprehensive Income [Abstract] | |
Changes in Other Comprehensive (Loss) Income | Charges and credits to other comprehensive (loss) income have been as follows: Interest rate Foreign currency Accumulated other Balance at December 31, 2019 $ (1,433) $ (46,065) $ (47,498) Unrealized losses (21,781) (7,080) (28,861) Related income tax 5,435 (543) 4,892 (16,346) (7,623) (23,969) Reclassification of loss into net income 7,081 — 7,081 Related income tax (1,768) — (1,768) 5,313 — 5,313 Balance at December 31, 2020 $ (12,466) $ (53,688) $ (66,154) Unrealized gains (losses) 9,532 (83,375) (73,843) Related income tax (2,377) (1,006) (3,383) 7,155 (84,381) (77,226) Reclassification of loss into net income 5,509 — 5,509 Related income tax (1,376) — (1,376) 4,133 — 4,133 Balance at December 31, 2021 $ (1,178) $ (138,069) $ (139,247) Unrealized gains (losses) 144,793 (30,554) 114,239 Related income tax (36,124) 752 (35,372) 108,669 (29,802) 78,867 Reclassification of income into net income (11,732) — (11,732) Related income tax 2,926 — 2,926 (8,806) — (8,806) Balance at December 31, 2022 $ 98,685 $ (167,871) $ (69,186) |
Acquisitions and Divestitures (
Acquisitions and Divestitures (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Business Combinations [Abstract] | |
Schedule of Components of Routine Acquisitions | During 2022, 2021 and 2020, the Company acquired dialysis businesses and other businesses, including a transplant software company, as follows: Year ended Year ended December 31, 2022 2021 2020 Cash paid, net of cash acquired $ 57,308 $ 187,050 $ 182,013 Contingent earn-out obligations 4,261 14,854 14,042 Deferred purchase price and liabilities assumed 15,076 10,226 20,415 Non-cash gain — — 1,821 Aggregate consideration $ 76,645 $ 212,130 $ 218,291 Number of dialysis centers acquired — U.S. 5 19 8 Number of dialysis centers acquired — International 11 17 66 |
Aggregate Purchase Cost Allocations for Acquisitions | The following table summarizes the assets acquired and liabilities assumed in these transactions and recognized at their acquisition dates at estimated fair values, as well as the estimated fair value of noncontrolling interests assumed in these transactions: Year ended December 31, 2022 2021 2020 Current assets $ 6,389 $ 9,134 $ 23,607 Property and equipment 7,481 9,277 37,457 Customer relationships — 17,200 34,625 Noncompetition agreements and other long-term assets 1,066 9,964 10,168 Indefinite-lived licenses 19,610 11,432 22,136 Goodwill 49,047 173,244 130,057 Deferred income taxes — — (3,962) Liabilities assumed (6,081) (14,200) (34,068) Noncontrolling interests assumed (867) (3,921) (1,729) $ 76,645 $ 212,130 $ 218,291 |
Schedule of other information related to acquired intangibles and goodwill | The following summarizes weighted-average estimated useful lives of amortizable intangible assets acquired during 2022, 2021 and 2020, as well as goodwill deductible for tax purposes associated with these acquisitions: Year ended December 31, 2022 2021 2020 Weighted-average estimated useful lives (in years): Customer relationships — 10 18 Noncompetition agreements 4 6 5 Goodwill deductible for tax purposes $ 49,047 $ 169,014 $ 94,318 |
Pro Forma Summary of Results of Operations | The following summary, prepared on a pro forma basis, combines the results of operations as if all acquisitions within continuing operations in 2022 and 2021 had been consummated as of the beginning of 2021, including the impact of certain adjustments such as amortization of intangibles, interest expense on acquisition financing and income tax effects. Year ended December 31, 2022 2021 (unaudited) Pro forma total revenues $ 11,624,270 $ 11,706,823 Pro forma net income from continuing operations attributable to $ 545,859 $ 984,227 Pro forma basic net income per share from continuing operations $ 5.87 $ 9.35 Pro forma diluted net income per share from continuing operations $ 5.70 $ 8.95 |
Reconciliation of Changes in Contingent Earn-Out Obligations | The following is a reconciliation of changes in contingent earn-out liabilities for the years ended December 31, 2022 and 2021: Year ended December 31, 2022 2021 Beginning balance $ 33,600 $ 30,248 Acquisitions 4,261 14,854 Foreign currency translation 840 (1,674) Fair value remeasurements (5,921) (1,292) Payments or other settlements (7,358) (8,536) Ending balance $ 25,422 $ 33,600 |
Fair Values of Financial Inst_2
Fair Values of Financial Instruments (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Fair Value Disclosures [Abstract] | |
Assets, Liabilities and Temporary Equity Measured at Fair Value on a Recurring Basis | The following table summarizes the Company’s assets, liabilities and temporary equity measured at fair value on a recurring basis as of December 31, 2022 and 2021: December 31, 2022 Total Quoted prices in Significant other Significant Assets Investments in equity securities $ 39,143 $ 39,143 $ — $ — Interest rate cap agreements $ 139,755 $ — $ 139,755 $ — Liabilities Contingent earn-out obligations $ 25,422 $ — $ — $ 25,422 Temporary equity Noncontrolling interests subject to put provisions $ 1,348,908 $ — $ — $ 1,348,908 December 31, 2021 Assets Investments in equity securities $ 48,598 $ 48,598 $ — $ — Interest rate cap agreements $ 12,203 $ — $ 12,203 $ — Liabilities Contingent earn-out obligations $ 33,600 $ — $ — $ 33,600 Temporary equity Noncontrolling interests subject to put provisions $ 1,434,832 $ — $ — $ 1,434,832 |
Segment Reporting (Tables)
Segment Reporting (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Segment Reporting [Abstract] | |
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income from Continuing Operations Before Income Taxes | The following is a summary of segment revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income from continuing operations before income taxes: Year ended December 31, 2022 2021 2020 Segment revenues: U.S. dialysis Patient service revenues: External sources $ 10,488,327 $ 10,551,106 $ 10,475,273 Intersegment revenues 87,045 90,512 144,091 U.S. dialysis patient service revenues 10,575,372 10,641,618 10,619,364 Other revenues External sources 24,447 25,061 39,376 Intersegment revenues (10) 284 1,195 Total U.S. dialysis revenues $ 10,599,809 $ 10,666,963 $ 10,659,935 Other - Ancillary services Net patient service revenues 688,137 662,409 550,978 Other external sources 408,983 380,221 484,977 Intersegment revenues 4,206 4,294 16,743 Total ancillary services 1,101,326 1,046,924 1,052,698 Total net segment revenues 11,701,135 11,713,887 11,712,633 Elimination of intersegment revenues (91,241) (95,090) (162,029) Consolidated revenues $ 11,609,894 $ 11,618,797 $ 11,550,604 Segment operating margin (loss): U.S. dialysis $ 1,565,310 $ 1,974,988 $ 1,917,604 Other - Ancillary services (1) (96,579) (66,003) (76,261) Total segment margin 1,468,731 1,908,985 1,841,343 Reconciliation of segment operating margin to consolidated income from Corporate administrative support (129,669) (111,615) (146,707) Consolidated operating income 1,339,062 1,797,370 1,694,636 Debt expense (357,019) (285,254) (304,111) Debt prepayment, refinancing and redemption charges — — (89,022) Other (loss) income, net (15,765) 6,378 16,759 Income from continuing operations before income taxes $ 966,278 $ 1,518,494 $ 1,318,262 (1) Includes equity investment income of $1,898, $3,177 and $5,866 in 2022, 2021 and 2020, respectively. |
Summary of Depreciation and Amortization Expense by Segment | Depreciation and amortization expense by reportable segment was as follows: Year ended December 31, 2022 2021 2020 U.S. dialysis $ 690,949 $ 642,711 $ 594,552 Other - Ancillary services 41,653 37,904 35,883 $ 732,602 $ 680,615 $ 630,435 |
Summary of Expenditures for Property and Equipment by Segment | Expenditures for property and equipment by reportable segment were as follows: Year ended December 31, 2022 2021 2020 U.S. dialysis 533,600 $ 589,662 $ 646,870 Other - Ancillary services 69,829 51,803 27,671 $ 603,429 $ 641,465 $ 674,541 |
Summary of Assets by Segment | Summary of assets by reportable segment was as follows: Year ended December 31, 2022 2021 Segment assets U.S. dialysis (1) $ 15,084,454 $ 15,375,000 Other - Ancillary services (2) 1,843,798 1,746,488 Consolidated assets $ 16,928,252 $ 17,121,488 (1) Includes equity method and other investments of $113,781 and $112,500 in 2022 and 2021, respectively. (2) Includes equity method and other investments of $117,327 and $126,381 in 2022 and 2021, respectively and includes approximately $207,162 and $190,029 in 2022 and 2021, respectively, of net property and equipment related to the Company’s international operations. |
Supplemental Cash Flow Inform_2
Supplemental Cash Flow Information (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Supplemental Cash Flow Elements [Abstract] | |
Supplemental Cash Flow Information | The table below provides supplemental cash flow information: Year ended December 31, 2022 2021 2020 Cash paid: Income taxes, net $ 344,430 $ 209,754 $ 154,850 Interest, net $ 350,999 $ 279,002 $ 326,165 Non-cash investing and financing activities: Fixed assets under financing lease obligations $ 1,928 $ 31,690 $ 22,042 |
SEC Schedule, Article 12-09, Va
SEC Schedule, Article 12-09, Valuation and Qualifying Accounts (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
SEC Schedule, 12-09, Valuation and Qualifying Accounts [Abstract] | |
SEC Schedule, 12-09, Schedule of Valuation and Qualifying Accounts Disclosure | SCHEDULE II—VALUATION AND QUALIFYING ACCOUNTS Balance at Acquisitions Amounts Amounts written off Balance Description (dollars in thousands) Allowance for uncollectible accounts: Year ended December 31, 2022 $ — $ — $ — $ — $ — Year ended December 31, 2021 $ — $ — $ — $ — $ — Year ended December 31, 2020 $ 8,328 $ — $ 13,458 $ 21,786 $ — |
Organization and Summary of S_3
Organization and Summary of Significant Accounting Policies - Additional Information (Details) | 12 Months Ended |
Dec. 31, 2022 clinic entity patient state country | |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | |
Medicare Payment Rate Established By Statute Or Regulation For The Portion Of Payment Rates Paid By The Government Payor | 80% |
Number of legal entities that third parties held noncontrolling equity interests | entity | 689 |
United States | |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | |
Number of dialysis centers that the company operated or provided administrative services | clinic | 2,724 |
Number of states where dialysis centers are located | state | 46 |
Number of patients served | patient | 199,400 |
International Operations | |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | |
Number of dialysis centers that the company operated or provided administrative services | clinic | 350 |
Number of patients served | patient | 45,600 |
Number of countries in which dialysis centers located | country | 11 |
Revenue Recognition and Accou_2
Revenue Recognition and Accounts Receivable Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Revenue Recognition | |||
Other revenues | $ 433,430 | $ 405,282 | $ 524,353 |
Total revenues | 11,609,894 | 11,618,797 | 11,550,604 |
Intersegment Elimination | |||
Revenue Recognition | |||
Total revenues | (91,241) | (95,090) | (162,029) |
Medicare and Medicare Advantage | |||
Revenue Recognition | |||
Patient service revenues | 6,041,496 | 6,133,235 | 6,169,226 |
Other revenues | 345,340 | 326,696 | 419,662 |
Medicaid and Managed Medicaid | |||
Revenue Recognition | |||
Patient service revenues | 759,579 | 782,430 | 744,862 |
Other revenues | 1,546 | 1,321 | 1,227 |
Other Government Payors | |||
Revenue Recognition | |||
Patient service revenues | 801,912 | 791,641 | 715,298 |
Commercial Payors | |||
Revenue Recognition | |||
Patient service revenues | 3,660,522 | 3,596,721 | 3,540,956 |
Other revenues | 22,211 | 15,553 | 33,246 |
Other | |||
Revenue Recognition | |||
Other revenues | 68,529 | 66,290 | 88,156 |
U.S. dialysis | |||
Revenue Recognition | |||
Total revenues | 10,512,774 | 10,576,167 | 10,514,649 |
U.S. dialysis | Intersegment Elimination | |||
Revenue Recognition | |||
Total revenues | (87,035) | (90,796) | (145,286) |
U.S. dialysis | Medicare and Medicare Advantage | |||
Revenue Recognition | |||
Patient service revenues | 6,041,496 | 6,133,235 | 6,169,226 |
U.S. dialysis | Medicaid and Managed Medicaid | |||
Revenue Recognition | |||
Patient service revenues | 759,579 | 782,430 | 744,862 |
U.S. dialysis | Other Government Payors | |||
Revenue Recognition | |||
Patient service revenues | 336,991 | 328,256 | 334,714 |
U.S. dialysis | Commercial Payors | |||
Revenue Recognition | |||
Patient service revenues | 3,437,306 | 3,397,697 | 3,370,562 |
U.S. dialysis | Other | |||
Revenue Recognition | |||
Other revenues | 24,437 | 25,345 | 40,571 |
Other - Ancillary services | |||
Revenue Recognition | |||
Total revenues | 1,097,120 | 1,042,630 | 1,035,955 |
Other - Ancillary services | Intersegment Elimination | |||
Revenue Recognition | |||
Total revenues | (4,206) | (4,294) | (16,743) |
Other - Ancillary services | Medicare and Medicare Advantage | |||
Revenue Recognition | |||
Other revenues | 345,340 | 326,696 | 419,662 |
Other - Ancillary services | Medicaid and Managed Medicaid | |||
Revenue Recognition | |||
Other revenues | 1,546 | 1,321 | 1,227 |
Other - Ancillary services | Other Government Payors | |||
Revenue Recognition | |||
Patient service revenues | 464,921 | 463,385 | 380,584 |
Other - Ancillary services | Commercial Payors | |||
Revenue Recognition | |||
Patient service revenues | 223,216 | 199,024 | 170,394 |
Other revenues | 22,211 | 15,553 | 33,246 |
Other - Ancillary services | Other | |||
Revenue Recognition | |||
Other revenues | $ 44,092 | $ 40,945 | $ 47,585 |
Revenue Recognition and Accou_3
Revenue Recognition and Accounts Receivable - Additional Information (Details) $ in Thousands | 12 Months Ended | |
Dec. 31, 2022 USD ($) | Dec. 31, 2021 USD ($) | |
Revenue Recognition | ||
Accounts receivable | $ 2,132,070 | $ 1,957,583 |
Medicare bad debt claims | ||
Revenue Recognition | ||
Accounts receivable | 1,113,499 | $ 1,174,123 |
Accounts Receivable | ||
Revenue Recognition | ||
Accounts receivable | $ 0 | |
Percentage Of Accounts Receivable Six Months Or More Past Due | 18% | 16% |
Accounts Receivable Period Outstanding | 6 months | |
Accounts Receivable, Noncurrent, Threshold Period Past Due | 1 year | |
Customer Concentration Risk | Accounts Receivable | Third-Party Payor | ||
Revenue Recognition | ||
Number of concentration risk customers | 0 | 0 |
Concentration risk percentage | 10% | 10% |
Earnings Per Share - Reconcilia
Earnings Per Share - Reconciliations of Numerators and Denominators Used to Calculate Basic and Diluted Net Income Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Net income (loss) attributable to DaVita Inc.: | |||
Net income from continuing operations | $ 546,948 | $ 978,450 | $ 783,295 |
Net income (loss) from discontinued operations | 13,452 | 0 | (9,653) |
Net income attributable to DaVita Inc. | $ 560,400 | $ 978,450 | $ 773,642 |
Weighted average shares outstanding: | |||
Weighted average shares outstanding during the period (in shares) | 92,992,000 | 105,230,000 | 119,797,000 |
Assumed incremental shares from stock plans (in shares) | 2,842,000 | 4,718,000 | 2,826,000 |
Weighted average shares - diluted (in shares) | 95,834,000 | 109,948,000 | 122,623,000 |
Basic net income (loss) attributable to DaVita Inc.: | |||
Basic net income from continuing operations (in usd per share) | $ 5.88 | $ 9.30 | $ 6.54 |
Basic net loss from discontinued operations per share attributable to DaVita Inc. (in usd per share) | 0.15 | 0 | (0.08) |
Basic net income per share attributable to DaVita Inc. (in usd per share) | 6.03 | 9.30 | 6.46 |
Diluted net income (loss) attributable to DaVita Inc.: | |||
Diluted net income from continuing operations per share attributable to DaVita Inc. (in usd per share) | 5.71 | 8.90 | 6.39 |
Diluted net loss from discontinued operations per share attributable to DaVita Inc. (in usd per share) | 0.14 | 0 | (0.08) |
Diluted net income per share attributable to DaVita Inc. (in usd per share) | $ 5.85 | $ 8.90 | $ 6.31 |
Anti-dilutive stock-settled awards excluded from calculation (in shares) | 1,058,000 | 116,000 | 2,301,000 |
Restricted Cash and Equivalents
Restricted Cash and Equivalents - Additional Information (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
Restricted Cash [Abstract] | ||
Restricted cash and equivalents | $ 94,903 | $ 93,060 |
Short-term and long-term inve_2
Short-term and long-term investments (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
Investment Holdings [Line Items] | ||
Debt securities | $ 82,879 | $ 23,226 |
Equity securities, FV-NI | 39,143 | 48,598 |
Total | 122,022 | 71,824 |
Debt securities, short-term investments | 67,872 | 8,227 |
Total Short-term investments | 77,693 | 22,310 |
Debt securities, long-term investments | 15,007 | 14,999 |
Total Long-term investments | 44,329 | 49,514 |
Certificates of deposit and other time deposits | ||
Investment Holdings [Line Items] | ||
Debt securities | 82,879 | 23,226 |
Equity securities, FV-NI | 0 | 0 |
Total | 82,879 | 23,226 |
Investments in mutual funds and common stock | ||
Investment Holdings [Line Items] | ||
Debt securities | 0 | 0 |
Equity securities, FV-NI | 39,143 | 48,598 |
Total | 39,143 | 48,598 |
Short-term Investments | ||
Investment Holdings [Line Items] | ||
Equity securities, FV-NI | 9,821 | 14,083 |
Other long-term Investments | ||
Investment Holdings [Line Items] | ||
Equity securities, FV-NI | $ 29,322 | $ 34,515 |
Other Receivables (Details)
Other Receivables (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
Accounts, Notes, Loans and Financing Receivable [Line Items] | ||
Other receivables | $ 413,976 | $ 427,321 |
Supplier rebates and non-trade receivables | ||
Accounts, Notes, Loans and Financing Receivable [Line Items] | ||
Other receivables | 303,225 | 294,574 |
Medicare bad debt claims | ||
Accounts, Notes, Loans and Financing Receivable [Line Items] | ||
Other receivables | $ 110,751 | $ 132,747 |
Property and Equipment (Details
Property and Equipment (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
Property, Plant and Equipment [Abstract] | ||
Land | $ 32,656 | $ 34,009 |
Buildings | 427,962 | 496,455 |
Leasehold improvements | 3,925,244 | 3,828,404 |
Equipment and information systems, including internally developed software | 3,759,274 | 3,292,176 |
New center and capital asset projects in progress | 376,633 | 592,063 |
Property, plant and equipment, gross, total | 8,521,769 | 8,243,107 |
Less accumulated depreciation | (5,265,372) | (4,763,135) |
Property and equipment, net | $ 3,256,397 | $ 3,479,972 |
Property and Equipment - Additi
Property and Equipment - Additional Information (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Property, Plant and Equipment [Line Items] | |||
Depreciation expense on property and equipment | $ 721,133 | $ 667,755 | $ 616,626 |
Capitalized interest | $ 12,677 | $ 15,275 | $ 17,944 |
Buildings | Minimum | |||
Property, Plant and Equipment [Line Items] | |||
Property, and equipment useful lives | 25 years | ||
Buildings | Maximum | |||
Property, Plant and Equipment [Line Items] | |||
Property, and equipment useful lives | 40 years | ||
Leasehold Improvements | Minimum | |||
Property, Plant and Equipment [Line Items] | |||
Property, and equipment useful lives | 10 years | ||
Equipment and Information Systems | Minimum | |||
Property, Plant and Equipment [Line Items] | |||
Property, and equipment useful lives | 3 years | ||
Equipment and Information Systems | Maximum | |||
Property, Plant and Equipment [Line Items] | |||
Property, and equipment useful lives | 15 years |
Intangibles - Amortizable Intan
Intangibles - Amortizable Intangible Assets Other Than Goodwill (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
Finite-Lived Intangible Assets [Line Items] | ||
Indefinite-lived licenses | $ 127,271 | $ 104,214 |
Noncompetition agreements | 51,408 | 70,495 |
Customer relationships and other | 53,779 | 63,714 |
Intangible assets, gross (excluding goodwill) | 232,458 | 238,423 |
Total intangible assets | 182,687 | 177,693 |
Noncompetition agreements | ||
Finite-Lived Intangible Assets [Line Items] | ||
Accumulated Amortization | (39,745) | (52,813) |
Customer relationships and other | ||
Finite-Lived Intangible Assets [Line Items] | ||
Accumulated Amortization | $ (10,027) | $ (7,917) |
Intangibles - Scheduled Amortiz
Intangibles - Scheduled Amortization Charges from Intangible Assets and Liabilities (Details) $ in Thousands | Dec. 31, 2022 USD ($) |
Noncompetition agreements | |
Expected Amortization Expense [Line Items] | |
2023 | $ 4,742 |
2024 | 2,849 |
2025 | 1,721 |
2026 | 1,092 |
2027 | 730 |
Thereafter | 529 |
Total | 11,663 |
Customer relationships and other | |
Expected Amortization Expense [Line Items] | |
2023 | 4,084 |
2024 | 3,956 |
2025 | 3,489 |
2026 | 3,489 |
2027 | 3,382 |
Thereafter | 25,352 |
Total | $ 43,752 |
Intangibles - Additional Inform
Intangibles - Additional Information (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Finite-Lived Intangible Assets [Line Items] | |||
Amortization expense from amortizable intangible assets, other than lease agreements | $ 11,469 | $ 12,860 | $ 13,809 |
Impairment of Intangible Assets (Excluding Goodwill) | $ 0 | $ 0 | $ 0 |
Noncompetition agreements | Minimum | |||
Finite-Lived Intangible Assets [Line Items] | |||
Finite-Lived Intangible Assets, Remaining Amortization Period | 3 years | ||
Noncompetition agreements | Maximum | |||
Finite-Lived Intangible Assets [Line Items] | |||
Finite-Lived Intangible Assets, Remaining Amortization Period | 10 years | ||
Customer Relationships | |||
Finite-Lived Intangible Assets [Line Items] | |||
Acquired Finite-lived Intangible Asset, Weighted-Average Period before Renewal or Extension | 2 years | 3 years | |
Customer Relationships | Minimum | |||
Finite-Lived Intangible Assets [Line Items] | |||
Finite-Lived Intangible Assets, Remaining Amortization Period | 10 years | ||
Customer Relationships | Maximum | |||
Finite-Lived Intangible Assets [Line Items] | |||
Finite-Lived Intangible Assets, Remaining Amortization Period | 20 years |
Equity Method and Other Inves_3
Equity Method and Other Investmetns Equity Method and Other Investments (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
Schedule of Equity Method Investments [Line Items] | ||
Equity method and other investments | $ 231,108 | $ 238,881 |
APAC joint venture | ||
Schedule of Equity Method Investments [Line Items] | ||
Equity method and other investments | 99,141 | 109,153 |
Adjusted cost method and other investments | ||
Schedule of Equity Method Investments [Line Items] | ||
Equity method and other investments | 15,564 | 14,543 |
Other equity method partnerships | ||
Schedule of Equity Method Investments [Line Items] | ||
Equity method and other investments | $ 116,403 | $ 115,185 |
Equity Method and Other Inves_4
Equity Method and Other Investments - Additional Information (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Equity Method Investment income from equity method investments | |||
Equity investment income (loss) from equity method investments in nonconsolidated dialysis partnerships. | $ 26,520 | $ 26,937 | $ 26,916 |
Equity method investment, significant impairments and other valuation adjustments | 0 | 0 | |
Other (loss) income | |||
Equity Method Investment income from equity method investments | |||
Equity investment income (loss) from other equity method investments | (4,703) | (1,292) | 0 |
Equity method investment, significant impairments and other valuation adjustments | $ 20,154 | ||
Company and Restricted Subsidiaries(1) | |||
Equity Method Investment income from equity method investments | |||
Ownership percentage by the Company | 75% | ||
APAC joint venture | |||
Equity Method Investment income from equity method investments | |||
Current economic interest in the APAC JV, Owned by Other Noncontrolling Investors | 25% | ||
Minimum | Company and Restricted Subsidiaries(1) | |||
Equity Method Investment income from equity method investments | |||
Ownership percentage by the Company | 30% | ||
Maximum | Company and Restricted Subsidiaries(1) | |||
Equity Method Investment income from equity method investments | |||
Ownership percentage by the Company | 65% | ||
Equity Method Investments In Nonconsolidated Dialysis Partnerships | |||
Equity Method Investment income from equity method investments | |||
Equity investment income (loss) from equity method investments in nonconsolidated dialysis partnerships. | $ 26,520 | $ 26,937 | $ 26,916 |
Number of equity method investments | 23 |
Goodwill - Changes in Carrying
Goodwill - Changes in Carrying Value of Goodwill by Reportable Segments (Details) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
Goodwill [Roll Forward] | ||
Beginning balance | $ 7,046,241 | $ 6,919,109 |
Acquisitions | 49,047 | 173,244 |
Divestitures | (3,350) | (1,745) |
Foreign currency and other adjustments | (15,328) | (44,367) |
Ending balance | 7,076,610 | 7,046,241 |
Goodwill | 7,195,599 | |
Accumulated impairment charges | (118,989) | |
U.S. dialysis | ||
Goodwill [Roll Forward] | ||
Beginning balance | 6,400,162 | 6,309,928 |
Acquisitions | 16,750 | 91,979 |
Divestitures | (87) | (1,745) |
Foreign currency and other adjustments | 0 | 0 |
Ending balance | 6,416,825 | 6,400,162 |
Goodwill | 6,416,825 | |
Accumulated impairment charges | 0 | |
Other - Ancillary services | ||
Goodwill [Roll Forward] | ||
Beginning balance | 646,079 | 609,181 |
Acquisitions | 32,297 | 81,265 |
Divestitures | (3,263) | 0 |
Foreign currency and other adjustments | (15,328) | (44,367) |
Ending balance | 659,785 | $ 646,079 |
Goodwill | 778,774 | |
Accumulated impairment charges | $ (118,989) |
Goodwill - Schedule of Reportin
Goodwill - Schedule of Reporting Units Goodwill Balances (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Goodwill [Line Items] | |||
Goodwill | $ 7,076,610 | $ 7,046,241 | $ 6,919,109 |
Percentage change in operating income used to evaluate fair value of reporting unit for goodwill assessment | 3% | ||
Percentage change in discount rate used to evaluate fair value of reporting unit for goodwill assessment | 1% | ||
Kidney Care | GERMANY | |||
Goodwill [Line Items] | |||
Goodwill | $ 281,781 | ||
Carrying amount coverage | 18.90% | ||
Sensitivities, Operating Income | (2.00%) | ||
Sensitivities, Discount rate | (9.20%) |
Goodwill - Additional Informati
Goodwill - Additional Information (Details) | 12 Months Ended |
Dec. 31, 2022 segment | |
Other reporting units | |
Goodwill [Line Items] | |
Number of operating segments that were considered at risk of significant goodwill impairment | 0 |
Other Liabilities (Details)
Other Liabilities (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
Other Liabilities Disclosure [Abstract] | ||
Payor refunds and retractions | $ 475,195 | $ 410,038 |
Insurance and self-insurance accruals | 68,440 | 55,548 |
Accrued interest | 34,162 | 32,926 |
Accrued non-income tax liabilities | 42,806 | 41,784 |
Other | 181,866 | 169,049 |
Other liabilities | $ 802,469 | $ 709,345 |
Income Taxes - Schedule of Inco
Income Taxes - Schedule of Income Before Income Taxes (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Income Tax Disclosure [Abstract] | |||
Domestic | $ 926,604 | $ 1,463,029 | $ 1,287,976 |
International | 39,674 | 55,465 | 30,286 |
Income (Loss) from Continuing Operations before Equity Method Investments, Income Taxes, Noncontrolling Interest, Total | $ 966,278 | $ 1,518,494 | $ 1,318,262 |
Income Taxes - Components of In
Income Taxes - Components of Income Tax Expense (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Current: | |||
Federal | $ 201,932 | $ 216,539 | $ 47,171 |
State | 55,593 | 15,601 | 21,442 |
International | 16,253 | 14,247 | 17,481 |
Total current income tax | 273,778 | 246,387 | 86,094 |
Deferred: | |||
Federal | (66,400) | 59,528 | 198,623 |
State | (12,289) | 5,342 | 27,206 |
International | 2,998 | (4,525) | 2,009 |
Total deferred income tax | (75,691) | 60,345 | 227,838 |
Continuing operations | $ 198,087 | $ 306,732 | $ 313,932 |
Income Taxes Income Taxes - All
Income Taxes Income Taxes - Allocation of Income Tax Expense (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Income Tax Disclosure [Abstract] | |||
Continuing operations | $ 198,087 | $ 306,732 | $ 313,932 |
Discontinued operations | 0 | 0 | 1,657 |
Income tax (benefit) expense from continuing and discontinued operations | $ 198,087 | $ 306,732 | $ 315,589 |
Income Taxes - Reconciliation B
Income Taxes - Reconciliation Between U.S. Federal Income Tax Rate and Our Effective Tax Rate From Continuing Operations (Details) | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Income Tax Disclosure [Abstract] | |||
Federal income tax rate | 21% | 21% | 21% |
State income taxes, net of federal benefit | 3.80% | 3% | 3.40% |
Equity compensation | (1.60%) | (2.40%) | 0% |
Federal and international tax rate adjustments | 0% | 1.30% | 0% |
Nondeductible executive compensation | 1.10% | 0.80% | 1.20% |
Political advocacy costs | 2.20% | 0.20% | 1.70% |
Unrecognized tax benefits | (1.10%) | (0.10%) | 0.40% |
Change in international valuation allowance | 1.20% | (1.00%) | 1.50% |
Credits | (1.20%) | (0.70%) | (0.70%) |
Other | 1.10% | 1.70% | 0.10% |
Impact of noncontrolling interests primarily attributable to non-tax paying entities | (6.00%) | (3.60%) | (4.80%) |
Effective tax rate | 20.50% | 20.20% | 23.80% |
Income Taxes - Deferred Tax and
Income Taxes - Deferred Tax and Liabilities Arising from Temporary Differences (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
Income Taxes [Line Items] | ||
Receivables | $ 18,304 | $ 8,430 |
Accrued liabilities | 71,346 | 67,993 |
Operating lease liabilities | 563,972 | 581,199 |
Net operating loss carryforwards | 173,531 | 162,987 |
Other | 58,827 | 52,434 |
Deferred tax assets | 885,980 | 873,043 |
Valuation allowance | (106,775) | (100,616) |
Net deferred tax assets | 779,205 | 772,427 |
Intangible assets | (690,914) | (644,039) |
Property and equipment | (181,704) | (283,913) |
Operating lease assets | (515,026) | (530,839) |
Investments in partnerships | (80,876) | (84,407) |
Other | (65,766) | (37,274) |
Deferred tax liabilities | (1,534,286) | (1,580,472) |
Net deferred tax liabilities | (755,081) | (808,045) |
Deferred tax liabilities | ||
Income Taxes [Line Items] | ||
Net deferred tax liabilities | (782,787) | (830,954) |
Other long-term assets | ||
Income Taxes [Line Items] | ||
Net deferred tax assets | $ 27,706 | $ 22,909 |
Income Taxes - Reconciliation o
Income Taxes - Reconciliation of Beginning and Ending Liability for Unrecognized Tax Benefits that Do Not Meet More-Likely-Than-Not Threshold (Details) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward] | ||
Beginning balance | $ 73,024 | $ 70,202 |
Additions for tax positions related to current year | 3,858 | 3,335 |
Additions for tax positions related to prior years | 24,683 | 22,616 |
Reductions related to lapse of applicable statute | (6,073) | (751) |
Reductions related to settlements with taxing authorities | (31,507) | (22,378) |
Ending balance | $ 63,985 | $ 73,024 |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Income Taxes [Line Items] | |||
Increase In Deferred Tax Assets Net | $ 46,692 | ||
Income tax expense | $ 198,087 | 306,732 | $ 313,932 |
Liability for unrecognized tax benefits | 63,985 | 73,024 | $ 70,202 |
Unrecognized tax benefits that would impact effective tax rate | 45,825 | ||
Unrecognized tax expense (benefit), income tax penalties and interest expense | 10,459 | (2,589) | |
Accrued interest and penalties related to unrecognized tax benefits, net of federal tax benefits | 8,208 | 15,275 | |
Additional paid-in capital | |||
Income Taxes [Line Items] | |||
Deferred taxes from partnership buyouts | 62,736 | ||
Indefinite Life Net Operating Losses | |||
Income Taxes [Line Items] | |||
Increase (decrease) in valuation allowance related to changes in the estimated tax benefit | 6,159 | ||
Purchases Of Noncontrolling Interests In Consolidated Partnerships | |||
Income Taxes [Line Items] | |||
Income tax expense | $ 16,044 | ||
Capital Loss Carryforward | |||
Income Taxes [Line Items] | |||
State capital loss carryforward, amount | $ 306,949 | ||
State capital loss carryforward, expiration date | Dec. 31, 2024 | ||
Domestic Tax Authority | |||
Income Taxes [Line Items] | |||
Net operating loss carryforwards | $ 71,049 | ||
Operating loss carryforwards, expiration date | Dec. 31, 2036 | ||
Domestic Tax Authority | Tax Year 2029 | |||
Income Taxes [Line Items] | |||
Operating loss carryforwards, expiration date | Dec. 31, 2029 | ||
State | |||
Income Taxes [Line Items] | |||
Net operating loss carryforwards | $ 618,883 | ||
Operating loss carryforwards, expiration date | Dec. 31, 2042 | ||
Foreign Tax Authority | |||
Income Taxes [Line Items] | |||
Net operating loss carryforwards | $ 357,266 | ||
Operating loss carryforwards, expiration date | Dec. 31, 2023 |
Long-Term Debt - Schedule of Lo
Long-Term Debt - Schedule of Long-Term Debt (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Long-term debt disclosure | |||
Debt interest rate during period | 3.96% | ||
Financing lease obligations | $ 273,688 | ||
Long-term debt, weighted average interest rate, at point in time | 4.52% | ||
Long-term debt totals: | |||
Total debt principal outstanding | $ 8,968,519 | $ 8,964,865 | |
Discount and deferred financing costs | (44,498) | (56,685) | |
Carrying amount of long-term debt, net of unamortized discounts | 8,924,021 | 8,908,180 | |
Less current portion | (231,404) | (179,030) | |
Total long-term debt | 8,692,617 | 8,729,150 | |
Senior Notes 4.625% due 2030 | |||
Senior Notes: | |||
Senior Notes | $ 2,750,000 | 2,750,000 | |
Long-term debt disclosure | |||
Debt Instrument, Maturity Date | Jun. 01, 2030 | ||
Debt interest rate during period | 4.625% | ||
Debt Instrument, Fair Value Disclosure | $ 2,224,063 | ||
Senior Notes 3.75% due 2031 | |||
Senior Notes: | |||
Senior Notes | $ 1,500,000 | 1,500,000 | |
Long-term debt disclosure | |||
Debt Instrument, Maturity Date | Feb. 15, 2031 | ||
Debt interest rate during period | 3.75% | ||
Debt Instrument, Fair Value Disclosure | $ 1,115,625 | ||
Acquisition obligations and other notes payable | |||
Long-term debt disclosure | |||
Acquisition obligations and other notes payable | $ 120,562 | 130,599 | |
Debt instrument, maturity date, description | 2023-2036 | ||
Long-term debt, weighted average interest rate, at point in time | 6.56% | ||
Acquisition obligations and other notes payable, fair value | $ 120,562 | ||
Financing Lease | |||
Long-term debt disclosure | |||
Financing lease obligations | $ 273,688 | $ 299,128 | |
Debt instrument, maturity date, description | 2023-2038 | ||
Finance lease, weighted average discount rate, percent | 4.51% | 4.50% | 5.10% |
Revolving line of credit | |||
Senior Secured Credit Facilities: | |||
Secured Debt | $ 165,000 | $ 0 | |
Debt Instrument, Description of Variable Rate Basis | LIBOR + 1.75% | ||
Long-term debt disclosure | |||
Debt Instrument, Maturity Date | Aug. 12, 2024 | ||
Debt Instrument, Fair Value Disclosure | $ 165,000 | ||
Term Loan A | |||
Senior Secured Credit Facilities: | |||
Secured Debt | $ 1,498,438 | 1,596,875 | |
Debt Instrument, Description of Variable Rate Basis | LIBOR + 1.75% | ||
Long-term debt disclosure | |||
Debt Instrument, Maturity Date | Aug. 12, 2024 | ||
Debt Instrument, Fair Value Disclosure | $ 1,468,469 | ||
Term Loan B-1 | |||
Senior Secured Credit Facilities: | |||
Secured Debt | $ 2,660,831 | 2,688,263 | |
Debt Instrument, Description of Variable Rate Basis | LIBOR + 1.75% | ||
Long-term debt disclosure | |||
Debt Instrument, Maturity Date | Aug. 12, 2026 | ||
Debt Instrument, Fair Value Disclosure | $ 2,587,658 | ||
Senior Secured Credit Facilities | |||
Debt Instrument, footnotes to the table | |||
Debt Instrument, Unamortized Discount | 3,497 | 4,473 | |
Deferred Offering Costs | 18,816 | 27,207 | |
Senior Notes | |||
Debt Instrument, footnotes to the table | |||
Deferred Offering Costs | 36,203 | 40,914 | |
Debt Instrument, Unamortized Premium | $ 14,018 | $ 15,909 |
Long-Term Debt - Scheduled Matu
Long-Term Debt - Scheduled Maturities of Long-term Debt (Details) $ in Thousands | Dec. 31, 2022 USD ($) |
Debt Disclosure [Abstract] | |
2023 | $ 231,404 |
2024 | 1,587,867 |
2025 | 67,112 |
2026 | 2,627,310 |
2027 | 35,176 |
Thereafter | $ 4,419,650 |
Long-Term Debt - Derivative Ins
Long-Term Debt - Derivative Instruments (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Cash Flow Hedging | |||
Derivative [Line Items] | |||
Amount of debt expense reclassified from accumulated OCI into income | $ (8,806) | $ 4,133 | $ 5,313 |
2019 Interest Rate Cap Agreements Effective June 30, 2020 | |||
Derivative [Line Items] | |||
Derivative, effective date | Jun. 30, 2020 | ||
Derivative, expiration date | Jun. 30, 2024 | ||
2019 Interest Rate Cap Agreements Effective June 30, 2020 | Other long-term assets | |||
Derivative [Line Items] | |||
Derivative asset, fair value, gross asset | $ 139,755 | $ 12,203 | |
2019 Interest Rate Cap Agreements Effective June 30, 2020 | Cash Flow Hedging | |||
Derivative [Line Items] | |||
Amount of debt expense reclassified from accumulated OCI into income | (11,732) | ||
Recorded Other Comprehensive Income (Loss), Cash Flow Hedge, Gain (Loss), after Reclassification and Tax | $ 144,793 | ||
Derivative Instrument, Gain (Loss) Reclassified from AOCI into Income, Effective Portion, Statement of Income or Comprehensive Income [Extensible Enumeration] | Interest and Debt Expense | ||
2019 Interest Rate Cap Agreements Effective June 30, 2020 | Term Loan Facility | Maximum | |||
Derivative [Line Items] | |||
Notional amounts of interest rate agreements | $ 3,500,000 | ||
LIBOR plus interest margin | 2% |
Long-Term Debt - Effects of Int
Long-Term Debt - Effects of Interest Rate Swap and Cap Agreements (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Derivative Instruments, Gain (Loss) [Line Items] | |||
Amount of unrealized gains (losses) in OCI on interest rate cap agreements | $ 108,669 | $ 7,155 | $ (16,346) |
Cash Flow Hedging | |||
Derivative Instruments, Gain (Loss) [Line Items] | |||
Amount of unrealized gains (losses) in OCI on interest rate cap agreements | 108,669 | 7,155 | (16,346) |
Reclassification from accumulated other comprehensive income into net income | (8,806) | 4,133 | 5,313 |
Cash Flow Hedging | Interest Rate Cap | |||
Derivative Instruments, Gain (Loss) [Line Items] | |||
Amount of unrealized gains (losses) in OCI on interest rate cap agreements | 144,793 | 9,532 | (21,781) |
Reclassification from accumulated other comprehensive income into net income | $ (11,732) | 5,509 | 7,081 |
Derivative Instrument, Gain (Loss) Reclassified from AOCI into Income, Effective Portion, Statement of Income or Comprehensive Income [Extensible Enumeration] | Interest and Debt Expense | ||
Cash Flow Hedging | Income Tax Related To Cash Flow Hedges | |||
Derivative Instruments, Gain (Loss) [Line Items] | |||
Amount of unrealized gains (losses) in OCI on interest rate cap agreements | $ (36,124) | (2,377) | 5,435 |
Reclassification from accumulated other comprehensive income into net income | $ 2,926 | $ (1,376) | $ (1,768) |
Derivative Instrument, Gain (Loss) Reclassified from AOCI into Income, Effective Portion, Statement of Income or Comprehensive Income [Extensible Enumeration] | Income tax expense |
Long-Term Debt - Additional inf
Long-Term Debt - Additional information (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Debt Instrument [Line Items] | |||
Letters of Credit Outstanding, Amount | $ 0 | ||
Long-term debt, weighted average interest rate, at point in time | 4.52% | ||
Debt interest rate during period | 3.96% | ||
Long-term Debt, Percentage Bearing Fixed Interest, Percentage Rate | 51.30% | ||
Interest Expense, Debt | $ 339,247 | $ 267,049 | $ 282,932 |
Amortization of Debt Discounts, Premiums and Deferred Financing Costs | $ 17,772 | 18,205 | $ 21,179 |
Senior Secured Credit Facilities | |||
Debt Instrument [Line Items] | |||
Long-term debt, weighted average interest rate, at point in time | 4.59% | ||
Revolving line of credit | |||
Debt Instrument [Line Items] | |||
Secured debt, outstanding principal balance | $ 165,000 | 0 | |
Maximum borrowing capacity on revolving credit facilities | 1,000,000 | ||
Secured Letter of Credit | |||
Debt Instrument [Line Items] | |||
Letters of Credit Outstanding, Amount | 108,826 | ||
Term Loan A | |||
Debt Instrument [Line Items] | |||
Debt Instrument, Periodic Payment, Principal | 98,437 | ||
Secured debt, outstanding principal balance | 1,498,438 | 1,596,875 | |
Secured debt outstanding principal balance subject to LIBOR | 659,269 | ||
Term Loan B-1 | |||
Debt Instrument [Line Items] | |||
Debt Instrument, Periodic Payment, Principal | 27,432 | ||
Secured debt, outstanding principal balance | $ 2,660,831 | $ 2,688,263 | |
Term Loan A and Term Loan B-1 | Minimum | |||
Debt Instrument [Line Items] | |||
Debt Instrument, Term | 1 month | ||
Term Loan A and Term Loan B-1 | Maximum | |||
Debt Instrument [Line Items] | |||
Debt Instrument, Term | 12 months |
Leases Lease Expense Components
Leases Lease Expense Components (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Operating lease cost: | |||
Fixed lease expense | $ 552,194 | $ 547,923 | $ 541,090 |
Variable lease expense | 127,621 | 125,981 | 122,729 |
Financing lease cost: | |||
Amortization of leased assets | 27,079 | 26,846 | 24,720 |
Interest on lease liabilities | 12,776 | 13,988 | 14,421 |
Net lease cost | $ 719,670 | $ 714,738 | $ 702,960 |
Leases Leases Other Information
Leases Leases Other Information (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Leases term and discount rate | |||
Operating Lease, Weighted Average Remaining Lease Term | 8 years 2 months 12 days | 8 years 3 months 18 days | 8 years 8 months 12 days |
Finance Lease, Weighted Average Remaining Lease Term | 9 years 4 months 24 days | 10 years 6 months | 10 years 6 months |
Operating Lease, Weighted Average Discount Rate, Percent | 3.60% | 3.50% | 3.80% |
Leases Other Information [Abstract] | |||
Sale and Leaseback Transaction, Gain (Loss), Net | $ 28,005 | $ 17,137 | $ 34,301 |
Cash paid for amounts included in the measurement of lease liabilities: | |||
Operating Lease, Payments | 696,291 | 684,186 | 661,318 |
Finance Lease, Interest Payment on Liability | 20,103 | 21,343 | 20,981 |
Finance Lease, Principal Payments | 24,329 | 22,445 | 24,780 |
Net Operating Lease Assets Obtained In Exchange For Lease Liabilities | $ 278,108 | $ 361,101 | $ 401,559 |
Finance Lease | |||
Leases term and discount rate | |||
Finance lease, weighted average discount rate, percent | 4.51% | 4.50% | 5.10% |
Leases - Future Minimum Lease P
Leases - Future Minimum Lease Payments Under Non-Cancelable Operating and Capital Leases (Details) $ in Thousands | Dec. 31, 2022 USD ($) |
Operating leases | |
2023 | $ 492,566 |
2024 | 500,422 |
2025 | 452,080 |
2026 | 400,879 |
2027 | 333,580 |
Thereafter | 1,175,340 |
Total future minimum lease payments due under operating leases | 3,354,867 |
Less portion representing interest, operating lease liabilities | (456,398) |
Present value of lease liabilities, operating leases | $ 2,898,469 |
Operating Lease, Liability, Statement of Financial Position [Extensible Enumeration] | Current portion of operating lease liabilities, Long-term operating lease liabilities |
Finance leases | |
2023 | $ 37,442 |
2024 | 37,951 |
2025 | 38,125 |
2026 | 36,908 |
2027 | 35,569 |
Thereafter | 145,987 |
Total future minimum payments due under finance leases | 331,982 |
Less portion representing interest, financing lease liabilities | (58,294) |
Financing lease obligations | $ 273,688 |
Finance Lease, Liability, Statement of Financial Position [Extensible Enumeration] | Long-term debt |
Leases - Additional Information
Leases - Additional Information (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Leases Disclosure [Line Items] | |||
Finance Lease, Right-of-Use Asset | $ 319,546 | $ 322,060 | |
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible Enumeration] | Property and equipment, net of accumulated depreciation | Property and equipment, net of accumulated depreciation | |
Finance Lease Accumulated Depreciation | $ 101,361 | $ 75,252 | |
Rent Expense, Operating Leases | 719,670 | 714,738 | $ 702,960 |
Operating Lease | |||
Leases Disclosure [Line Items] | |||
Rent Expense, Operating Leases | $ 679,815 | $ 673,904 | $ 663,819 |
Minimum | |||
Leases Disclosure [Line Items] | |||
Lessee, Operating Lease, Term of Contract | 5 years | ||
Lessee, Operating Lease, Renewal Term | 5 years | ||
Maximum | |||
Leases Disclosure [Line Items] | |||
Lessee, Operating Lease, Term of Contract | 15 years | ||
Lessee, Operating Lease, Renewal Term | 10 years |
Employee Benefit Plans - Additi
Employee Benefit Plans - Additional Information (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Defined Benefit Plan Disclosure [Line Items] | |||
Employer matching contribution, percent of match | 50% | ||
Defined Benefit Plan, Benefit Obligation, Benefits Paid | $ 70,084 | $ 68,658 | $ 70,180 |
Minimum | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Voluntary Deferral Plan Contribution Cash Payout Period After Individuals Retirement Date | 1 year | ||
Voluntary Deferral Plan Contribution Cash Payout Period After Deferral Election | 3 years | ||
Maximum | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Employer matching contribution, percent of employees' gross wages | 6% | ||
Voluntary Deferral Plan Contribution Cash Payout Period After Individuals Retirement Date | 2 years | ||
Voluntary Deferral Plan Contribution Cash Payout Period After Deferral Election | 4 years | ||
Deferred Compensation Plan | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Maximum percentage of employees' base salary to be maintained into deferral account | 50% | ||
Non-qualified deferred compensation plan, contributions | $ 3,573 | 2,962 | 3,637 |
Deferred compensation plan, distributions | 3,731 | 11,887 | $ 3,139 |
Deferred Compensation Plan | Rabbi trusts | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Total fair value of assets held in trust | $ 32,944 | $ 38,019 |
Contingencies - Additional Info
Contingencies - Additional Information (Details) - US Attorney Prescription Drug Investigation $ in Thousands | 1 Months Ended |
Dec. 31, 2017 USD ($) | |
Other Commitments [Line Items] | |
Litigation settlement amount awarded to other party | $ 63,700 |
Incremental Cash Portion | |
Other Commitments [Line Items] | |
Litigation settlement amount awarded to other party | 41,500 |
Cash Paid For Portion Previously Refunded | |
Other Commitments [Line Items] | |
Litigation settlement amount awarded to other party | $ 22,200 |
Noncontrolling Interests Subj_2
Noncontrolling Interests Subject to Put Provisions and Other Commitments - Additional Information (Details) $ in Thousands | 12 Months Ended |
Dec. 31, 2022 USD ($) | |
Commitments And Contingencies Disclosure [Line Items] | |
Purchase Obligation, Due in Next Twelve Months | $ 712,802 |
Purchase Obligation, Due in Second Year | 469,760 |
Purchase Obligation, Due in Third Year | 362,431 |
Purchase Obligation, to be Paid, Year Four | 379,832 |
Off -Balance Sheet Financing Arrangements | $ 0 |
Minimum | |
Commitments And Contingencies Disclosure [Line Items] | |
Scheduled dissolution term of joint ventures | 10 years |
Maximum | |
Commitments And Contingencies Disclosure [Line Items] | |
Scheduled dissolution term of joint ventures | 50 years |
Commitments to Provide Operating Capital | |
Commitments And Contingencies Disclosure [Line Items] | |
Other potential commitments to provide operating capital to several dialysis centers | $ 9,038 |
Long-term Incentive Compensatio
Long-term Incentive Compensation and Shareholders’ Equity - Summary of Status of Awards Under Stock-Based Compensation Plans and Agreements (Details) - $ / shares | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Stock Appreciation Rights (SARs) | |||
Awards | |||
Outstanding at beginning of year (in shares) | 5,943,000 | ||
Granted (in shares) | 130,000 | ||
Exercised/ Vested (in shares) | (619,000) | ||
Canceled (in shares) | (64,000) | ||
Outstanding at end of period (in shares) | 5,390,000 | 5,943,000 | |
Exercisable at end of period (in shares) | 2,618,000 | ||
Weighted-average fair value of grants | $ 35.13 | $ 32.15 | $ 26.70 |
Weighted average exercise price | |||
Outstanding at beginning of year (USD per share) | 64.66 | ||
Granted (USD per share) | 110.63 | ||
Exercised (USD per share) | 63.59 | ||
Canceled (USD per share) | 55.53 | ||
Outstanding at end of period (USD per share) | 66 | $ 64.66 | |
Exercisable at end of period (USD per share) | $ 64.93 | ||
Weighted average remaining contractual life | |||
Outstanding at end of period | 1 year 7 months 13 days | ||
Exercisable at end of period | 1 year 3 months 25 days | ||
Stock units | |||
Awards | |||
Outstanding at beginning of year (in shares) | 3,385,000 | ||
Granted (in shares) | 1,152,000 | ||
Added by performance factor (in shares) | 136,000 | ||
Exercised/ Vested (in shares) | (1,269,000) | ||
Canceled (in shares) | (332,000) | ||
Outstanding at end of period (in shares) | 3,072,000 | 3,385,000 | |
Exercisable at end of period (in shares) | 0 | ||
Weighted-average fair value of grants (USD per share) | $ 107.60 | $ 109.50 | $ 77.83 |
Weighted average remaining contractual life | |||
Outstanding at end of period | 1 year 11 months 4 days | ||
Exercisable at end of period | 0 years |
Long-term Incentive Compensat_2
Long-term Incentive Compensation and Shareholders’ Equity - Summary of Range of Exercise Prices (Details) | 12 Months Ended |
Dec. 31, 2022 $ / shares shares | |
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items] | |
Awards outstanding (in shares) | shares | 5,390,000 |
Weighted average exercise price (USD per share) | $ 66 |
Awards exercisable (in shares) | shares | 2,618,000 |
Weighted average exercise price (USD per share) | $ 64.93 |
$50.01–$60.00 | |
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items] | |
Awards outstanding (in shares) | shares | 1,397,000 |
Weighted average exercise price (USD per share) | $ 52.41 |
Awards exercisable (in shares) | shares | 401,000 |
Weighted average exercise price (USD per share) | $ 52.41 |
Range of exercise prices, lower range (USD per share) | 50.01 |
Range of exercise prices, upper range (USD per share) | $ 60 |
$60.01–$70.00 | |
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items] | |
Awards outstanding (in shares) | shares | 3,462,000 |
Weighted average exercise price (USD per share) | $ 67.41 |
Awards exercisable (in shares) | shares | 2,212,000 |
Weighted average exercise price (USD per share) | $ 67.18 |
Range of exercise prices, lower range (USD per share) | 60.01 |
Range of exercise prices, upper range (USD per share) | $ 70 |
$70.01–$80.00 | |
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items] | |
Awards outstanding (in shares) | shares | 269,000 |
Weighted average exercise price (USD per share) | $ 75.85 |
Awards exercisable (in shares) | shares | 5,000 |
Weighted average exercise price (USD per share) | $ 70.32 |
Range of exercise prices, lower range (USD per share) | 70.01 |
Range of exercise prices, upper range (USD per share) | $ 80 |
$100.01–$110.00 | |
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items] | |
Awards outstanding (in shares) | shares | 132,000 |
Weighted average exercise price (USD per share) | $ 108.93 |
Awards exercisable (in shares) | shares | 0 |
Weighted average exercise price (USD per share) | $ 0 |
Range of exercise prices, lower range (USD per share) | 100.01 |
Range of exercise prices, upper range (USD per share) | $ 110 |
$110.01–$120.00 | |
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items] | |
Awards outstanding (in shares) | shares | 130,000 |
Weighted average exercise price (USD per share) | $ 110.63 |
Awards exercisable (in shares) | shares | 0 |
Weighted average exercise price (USD per share) | $ 0 |
Range of exercise prices, lower range (USD per share) | 110.01 |
Range of exercise prices, upper range (USD per share) | $ 120 |
Long-term Incentive Compensat_3
Long-term Incentive Compensation and Shareholders Equity - Summary of Weighted Average Valuation Inputs (Details) - Stock-settled Stock Appreciation Rights | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Expected term | 4 years 6 months | 4 years 6 months | 4 years 9 months 18 days |
Expected volatility | 34.30% | 34.30% | 28.20% |
Expected dividend yield | 0% | 0% | 0% |
Risk-free interest rate | 2.10% | 0.70% | 1.50% |
Long-term Incentive Compensat_4
Long-term Incentive Compensation and Shareholders’ Equity - Additional Information (Details) | 12 Months Ended | |||||
Dec. 31, 2022 USD ($) shares | Jul. 01, 2022 | Jan. 01, 2022 | Dec. 31, 2022 USD ($) $ / shares shares | Dec. 31, 2021 USD ($) $ / shares shares | Dec. 31, 2020 USD ($) $ / shares shares | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||
Aggregate intrinsic value of stock awards exercised | $ 149,442,000 | $ 208,585,000 | $ 49,258,000 | |||
Aggregate intrinsic value of stock awards outstanding | $ 289,942,000 | 289,942,000 | ||||
Aggregate intrinsic value of stock awards exercisable | 25,508,000 | 25,508,000 | ||||
Payments of ordinary dividends, common stock | 0 | 0 | 0 | |||
Stock-based compensation expense | 95,427,000 | 102,209,000 | 91,458,000 | |||
Estimated tax benefits recorded for stock-based compensation | 14,723,000 | 13,853,000 | 11,775,000 | |||
Unrecognized compensation cost related to nonvested stock-based compensation arrangements under equity compensation and stock purchase plans | $ 149,081,000 | $ 149,081,000 | ||||
Unrecognized compensation cost related to nonvested stock-based compensation arrangements under stock-based component of LTIP costs, weighted average remaining period (in years) | 1 year 3 months 18 days | |||||
Share-based Payment Arrangement, Expense, Tax Benefit | $ 24,805,000 | 46,990,000 | 8,957,000 | |||
Cash proceeds from stock option exercises | $ 0 | 0 | 0 | |||
Employee stock purchase plan | ||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||
Shares available for future grants | shares | 5,702,000 | 5,702,000 | ||||
Employee entitlement for purchase of the Company's common stock during each calendar year | $ 25,000 | |||||
Stock purchase price as percentage of fair market value | 85% | 100% | 100% | |||
Contributions used to purchase shares, employee-related current liabilities | $ 18,061,000 | $ 18,061,000 | $ 19,626,000 | $ 17,148,000 | ||
Stock issued for employee stock purchase plans | shares | 285,000 | 203,000 | 222,000 | |||
Expected volatility Rate | 31.70% | 39% | 40.40% | |||
Risk-free interest rate | 1.30% | 0.10% | 1% | |||
Share-based awards, fair value assumptions, expected dividend | $ 0 | $ 0 | $ 0 | |||
Weighted average fair value | $ / shares | $ 26.50 | $ 34.94 | $ 22.06 | |||
Stock Incentive 2020 Plan | ||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||
Stockbased Compensation Number Of Shares Available For Issuance Reduced By One Share Available For Every Four Shares Underlying SARS And Stock Options | shares | 1 | |||||
Stockbased Compensation Number Of Shares Underlying SARS And Stock Options, For One Full Share Available For Issuance | shares | 4 | |||||
Stockbased Compensation Number Of Shares Available For Issuance Reduced By One Share Available For Every One Share Underlying Other Full Share Type Of Award | shares | 1 | |||||
Stock-based Compensation Number Of Shares Underlying Full Share Types Of Stock-based Awards, For One Full Share Available For Issuance | shares | 1 | |||||
Shares available for future grants | shares | 6,815,000 | 6,815,000 | ||||
Stock Incentive 2020 Plan | Minimum | ||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||
Vesting period | 36 months | |||||
Stock Incentive 2020 Plan | Maximum | ||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||
Terms of award (in years) | 10 years | |||||
Vesting period | 48 months | |||||
Stock Incentive 2011 Plan | ||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||
Terms of award (in years) | 5 years | |||||
Full share awards to shares available, conversion ratio | 3.5 | |||||
Stock Incentive 2011 Plan | Minimum | ||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||
Vesting period | 36 months | |||||
Stock Incentive 2011 Plan | Maximum | ||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||
Vesting period | 48 months |
Stock Repurchases Tender Offer
Stock Repurchases Tender Offer (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Equity, Class of Treasury Stock [Line Items] | |||
Repurchase of common stock (in shares) | 8,095 | 13,877 | 16,477 |
Value of treasury stock acquired | $ 787,854 | $ 1,546,016 | $ 1,446,767 |
Treasury stock acquired, average cost per share | $ 97.33 | $ 111.41 | $ 87.80 |
Open Market Purchases | |||
Equity, Class of Treasury Stock [Line Items] | |||
Repurchase of common stock (in shares) | 8,095 | 13,877 | 8,495 |
Value of treasury stock acquired | $ 787,854 | $ 1,546,016 | $ 741,850 |
Treasury stock acquired, average cost per share | $ 97.33 | $ 111.41 | $ 87.32 |
Tender Offer | |||
Equity, Class of Treasury Stock [Line Items] | |||
Repurchase of common stock (in shares) | 0 | 0 | 7,982 |
Value of treasury stock acquired | $ 0 | $ 0 | $ 704,917 |
Treasury stock acquired, average cost per share | $ 0 | $ 0 | $ 88.32 |
Treasury Stock, Shares Repurchases, Table Footnotes: | |||
Treasury Stock Acquired, Average Cost Per Share, Clearing Price | $ 88 | ||
Share Repurchase Fees And Expenses | $ 2,529 |
Shareholder's equity Effects of
Shareholder's equity Effects of Changes in DaVita Inc's Ownership Interest (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items] | |||
Net (loss) income attributable to DaVita Inc. | $ 560,400 | $ 978,450 | $ 773,642 |
Additional paid-in capital | |||
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Changes, Net [Abstract] | |||
Purchase of noncontrolling interests | (6,586) | (13,853) | |
Purchases of noncontrolling interests | 4,364 | ||
Sale of noncontrolling interest | 939 | ||
Sale of noncontrolling interest | (264) | 0 | |
Noncontrolling Interest, Period Increase (Decrease) | (5,647) | (14,117) | 4,364 |
Net Income Attributable To Parent Net Of Transfers To Noncontrolling Interests. | $ 554,753 | $ 964,333 | $ 778,006 |
Shareholder's equity (Details)
Shareholder's equity (Details) - USD ($) $ in Thousands | 2 Months Ended | 12 Months Ended | ||||
Feb. 21, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | Dec. 17, 2021 | Dec. 10, 2020 | |
Stock repurchases | ||||||
Repurchase of common stock (in shares) | 8,095,000 | 13,877,000 | 16,477,000 | |||
Terminated Remaining Prior Share Repurchases Authorized, Amount | $ 329,302 | |||||
Stock Repurchase Program, Authorized Amount | $ 2,000,000 | $ 2,000,000 | ||||
Charter documents and Delaware law: | ||||||
Preferred stock, shares authorized (in shares) | 5,000,000 | 5,000,000 | ||||
Period During Which The Company Is Subject To Section 203 Of The Delaware General Corporation Law Limitation | 3 years | |||||
Payments to Noncontrolling Interests | $ 20,775 | $ 20,104 | $ 7,831 | |||
Treasury stock | ||||||
Stock repurchases | ||||||
Repurchase of common stock (in shares) | 8,095,000 | 13,877,000 | 16,477,000 | |||
Retirement of treasury stock (in shares) | (8,095,000) | (13,877,000) | (16,477,000) | |||
Subsequent Event | ||||||
Stock repurchases | ||||||
Repurchase of common stock (in shares) | 0 | |||||
Stock Repurchase Program, Remaining Authorized Repurchase Amount | $ 1,596,085 |
Accumulated Other Comprehensi_3
Accumulated Other Comprehensive (Loss) Income (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Comprehensive Income (Loss) [Line Items] | |||
Beginning Balance of AOCI | $ (139,247) | ||
Ending Balance of AOCI | (69,186) | $ (139,247) | |
Interest rate cap agreements | |||
Comprehensive Income (Loss) [Line Items] | |||
Beginning Balance of AOCI | (1,178) | (12,466) | $ (1,433) |
Unrealized gains (losses) | 144,793 | 9,532 | (21,781) |
Related income tax | (36,124) | (2,377) | 5,435 |
Unrealized (losses) gains net | 108,669 | 7,155 | (16,346) |
Reclassification from accumulated other comprehensive losses (income) into net income | (11,732) | 5,509 | 7,081 |
Related income tax | 2,926 | (1,376) | (1,768) |
Reclassification from accumulated other comprehensive income (loss) into net income net of tax | (8,806) | 4,133 | 5,313 |
Ending Balance of AOCI | 98,685 | (1,178) | (12,466) |
Foreign currency translation adjustments | |||
Comprehensive Income (Loss) [Line Items] | |||
Beginning Balance of AOCI | (138,069) | (53,688) | (46,065) |
Unrealized gains (losses) | (30,554) | (83,375) | (7,080) |
Related income tax | 752 | (1,006) | (543) |
Unrealized (losses) gains net | (29,802) | (84,381) | (7,623) |
Reclassification from accumulated other comprehensive losses (income) into net income | 0 | 0 | 0 |
Related income tax | 0 | 0 | 0 |
Reclassification from accumulated other comprehensive income (loss) into net income net of tax | 0 | 0 | 0 |
Ending Balance of AOCI | (167,871) | (138,069) | (53,688) |
Accumulated other comprehensive (loss) income | |||
Comprehensive Income (Loss) [Line Items] | |||
Beginning Balance of AOCI | (139,247) | (66,154) | (47,498) |
Unrealized gains (losses) | 114,239 | (73,843) | (28,861) |
Related income tax | (35,372) | (3,383) | 4,892 |
Unrealized (losses) gains net | 78,867 | (77,226) | (23,969) |
Reclassification from accumulated other comprehensive losses (income) into net income | (11,732) | 5,509 | 7,081 |
Related income tax | 2,926 | (1,376) | (1,768) |
Reclassification from accumulated other comprehensive income (loss) into net income net of tax | (8,806) | 4,133 | 5,313 |
Ending Balance of AOCI | $ (69,186) | $ (139,247) | $ (66,154) |
Acquisitions - Components of Ro
Acquisitions - Components of Routine Acquisitions (Details) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 USD ($) Clinic | Dec. 31, 2021 USD ($) Clinic | Dec. 31, 2020 USD ($) Clinic | |
Business Acquisition [Line Items] | |||
Cash paid to acquire business | $ 57,308 | $ 187,050 | $ 182,013 |
Series of individually immaterial business acquisitions | |||
Business Acquisition [Line Items] | |||
Cash paid to acquire business | 57,308 | 187,050 | 182,013 |
Business combination contingent consideration acquisitions, earn-outs | 4,261 | 14,854 | 14,042 |
Deferred Purchase price and liabilities assumed | 15,076 | 10,226 | 20,415 |
Non-cash gain on acquiring additional ownership in business acquisition | 0 | 0 | 1,821 |
Aggregate purchase cost recognized | $ 76,645 | $ 212,130 | $ 218,291 |
Series of individually immaterial business acquisitions | U.S. dialysis | |||
Business Acquisition [Line Items] | |||
Number of businesses acquired | Clinic | 5 | 19 | 8 |
Series of individually immaterial business acquisitions | Foreign Dialysis Centers | |||
Business Acquisition [Line Items] | |||
Number of businesses acquired | Clinic | 11 | 17 | 66 |
Acquisitions - Assets acquired
Acquisitions - Assets acquired and liabilities assumed (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 |
Business Acquisition [Line Items] | |||
Goodwill | $ 7,076,610 | $ 7,046,241 | $ 6,919,109 |
Series of individually immaterial business acquisitions | |||
Business Acquisition [Line Items] | |||
Current assets | 6,389 | 9,134 | 23,607 |
Property and equipment | 7,481 | 9,277 | 37,457 |
Customer relationships | 0 | 17,200 | 34,625 |
Noncompetition agreements and other long-term assets | 1,066 | 9,964 | 10,168 |
Indefinite-lived licenses | 19,610 | 11,432 | 22,136 |
Goodwill | 49,047 | 173,244 | 130,057 |
Deferred income taxes | 0 | 0 | (3,962) |
Liabilities Assumed | (6,081) | (14,200) | (34,068) |
Noncontrolling interests assumed | (867) | (3,921) | (1,729) |
Aggregate purchase price | $ 76,645 | $ 212,130 | $ 218,291 |
Schedule Of Other Information R
Schedule Of Other Information Related To Acquired Intangibles and Goodwill (Details) - Series of individually immaterial business acquisitions - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Business Acquisition [Line Items] | |||
Goodwill deductible for tax purposes associated with acquisitions | $ 49,047 | $ 169,014 | $ 94,318 |
Customer Relationships | |||
Business Acquisition [Line Items] | |||
Amortizable intangible assets acquired, weighted-average estimated useful lives | 0 years | 10 years | 18 years |
Noncompetition agreements | |||
Business Acquisition [Line Items] | |||
Amortizable intangible assets acquired, weighted-average estimated useful lives | 4 years | 6 years | 5 years |
Acquisitions and Divestitures -
Acquisitions and Divestitures - Pro Forma Summary of Results of Operation (Details) - USD ($) $ / shares in Units, $ in Thousands | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
Business Combinations [Abstract] | ||
Pro forma total revenues | $ 11,624,270 | $ 11,706,823 |
Pro forma net income from continuing operations attributable to DaVita Inc. | $ 545,859 | $ 984,227 |
Pro forma basic net income per share from continuing operations attributable to DaVita Inc. | $ 5.87 | $ 9.35 |
Pro forma diluted net income per share from continuing operations attributable to DaVita Inc. | $ 5.70 | $ 8.95 |
Acquisitions and Divestitures_2
Acquisitions and Divestitures - Reconciliation of Changes in Contingent Earn-Out Obligations (Details) - Series of individually immaterial business acquisitions - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Business Acquisition [Line Items] | |||
Beginning balance | $ 33,600 | $ 30,248 | |
Acquisitions | 4,261 | 14,854 | $ 14,042 |
Foreign currency translation | 840 | (1,674) | |
Fair value remeasurements | (5,921) | (1,292) | |
Payments or other settlements | (7,358) | (8,536) | |
Ending balance | $ 25,422 | $ 33,600 | $ 30,248 |
Acquisitions and Divestitures_3
Acquisitions and Divestitures - Additional Information (Details) - USD ($) $ in Thousands | 12 Months Ended | |||
May 01, 2020 | Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Series of individually immaterial business acquisitions | ||||
Business Acquisition [Line Items] | ||||
Contingent earn-out obligations | $ 58,947 | |||
Fair value of contingent earn-out consideration | 25,422 | $ 33,600 | $ 30,248 | |
RMS Lifeline | ||||
Business Acquisition [Line Items] | ||||
Gain (Loss) on Divestiture | $ (16,252) | |||
Other Current Liabilities | Series of individually immaterial business acquisitions | ||||
Business Acquisition [Line Items] | ||||
Fair value of contingent earn-out consideration | 11,308 | |||
Other Long-term Liabilities | Series of individually immaterial business acquisitions | ||||
Business Acquisition [Line Items] | ||||
Fair value of contingent earn-out consideration | 14,114 | |||
Other companies | Series of individually immaterial business acquisitions | ||||
Business Acquisition [Line Items] | ||||
Fair value of contingent earn-out consideration | $ 25,422 | |||
Minimum | Other companies | Performance Targets or Quality Margins | ||||
Business Acquisition [Line Items] | ||||
Earn-out consideration payment period | 1 year | |||
Maximum | Other companies | Performance Targets or Quality Margins | ||||
Business Acquisition [Line Items] | ||||
Earn-out consideration payment period | 5 years |
Held for Sale and Discontinue_2
Held for Sale and Discontinued Operations - Additional Information (Details) - USD ($) $ in Thousands | 12 Months Ended | |||
Jun. 19, 2019 | Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | ||||
(Loss) gain on Disposition of Business | $ 0 | $ 0 | $ (16,252) | |
DMG - discontinued operations | ||||
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | ||||
Business Sale, Effective Date Of Sale | Jun. 19, 2019 | |||
Cash Provided by (Used in) Operating Activities, Discontinued Operations | 0 | 0 | 0 | |
Cash Provided by (Used in) Financing Activities, Discontinued Operations | 0 | 0 | 0 | |
Cash Provided by (Used in) Investing Activities, Discontinued Operations | 0 | $ 0 | 0 | |
Discontinued Operations, Held-for-sale | DMG - discontinued operations | ||||
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | ||||
Business Sale, Effective Date Of Sale | Jun. 19, 2019 | |||
Gain on disposition of business, additional purchase price payment | $ 13,452 | |||
(Loss) gain on Disposition of Business | (17,976) | |||
Discontinued Operation, Tax (Expense) Benefit from Provision for (Gain) Loss on Disposal | 1,657 | |||
Discontinued Operations, Held-for-sale | DMG - discontinued operations | Coronavirus Aid Relief And Economic Security Act Additional Tax Benefit Member [Member] | ||||
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | ||||
Discontinued Operation, Tax (Expense) Benefit from Provision for (Gain) Loss on Disposal | $ 9,980 |
Variable Interest Entities - Ad
Variable Interest Entities - Additional Information (Details) $ in Thousands | 12 Months Ended | |
Dec. 31, 2022 USD ($) Clinic | Dec. 31, 2021 USD ($) | |
Variable Interest Entity | ||
Number of business units relying on operating activities of nominee-owned legal entities | Clinic | 1 | |
Assets | $ 16,928,252 | $ 17,121,488 |
Liabilities | 14,703,452 | $ 14,750,508 |
Variable Interest Entity, Primary Beneficiary | ||
Variable Interest Entity | ||
Assets | 316,639 | |
Liabilities | $ 191,357 |
Fair Values of Financial Inst_3
Fair Values of Financial Instruments - Assets, Liabilities and Temporary Equity Measured at Fair Value on Recurring Basis (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
Assets | ||
Investments in equity securities | $ 39,143 | $ 48,598 |
Fair Value, Measurements, Recurring | ||
Assets | ||
Investments in equity securities | 39,143 | 48,598 |
Liabilities | ||
Contingent earn-out obligations | 25,422 | 33,600 |
Temporary equity | ||
Noncontrolling interests subject to put provisions | 1,348,908 | 1,434,832 |
Fair Value, Measurements, Recurring | Interest Rate Cap | ||
Assets | ||
Interest rate cap agreements | 139,755 | 12,203 |
Fair Value, Measurements, Recurring | Quoted prices in active markets for identical assets (Level 1) | ||
Assets | ||
Investments in equity securities | 39,143 | 48,598 |
Liabilities | ||
Contingent earn-out obligations | 0 | 0 |
Temporary equity | ||
Noncontrolling interests subject to put provisions | 0 | 0 |
Fair Value, Measurements, Recurring | Quoted prices in active markets for identical assets (Level 1) | Interest Rate Cap | ||
Assets | ||
Interest rate cap agreements | 0 | 0 |
Fair Value, Measurements, Recurring | Significant other observable inputs (Level 2) | ||
Assets | ||
Investments in equity securities | 0 | 0 |
Liabilities | ||
Contingent earn-out obligations | 0 | 0 |
Temporary equity | ||
Noncontrolling interests subject to put provisions | 0 | 0 |
Fair Value, Measurements, Recurring | Significant other observable inputs (Level 2) | Interest Rate Cap | ||
Assets | ||
Interest rate cap agreements | 139,755 | 12,203 |
Fair Value, Measurements, Recurring | Significant unobservable inputs (Level 3) | ||
Assets | ||
Investments in equity securities | 0 | 0 |
Liabilities | ||
Contingent earn-out obligations | 25,422 | 33,600 |
Temporary equity | ||
Noncontrolling interests subject to put provisions | 1,348,908 | 1,434,832 |
Fair Value, Measurements, Recurring | Significant unobservable inputs (Level 3) | Interest Rate Cap | ||
Assets | ||
Interest rate cap agreements | $ 0 | $ 0 |
Fair Values of Financial Inst_4
Fair Values of Financial Instruments (Details) $ in Thousands | Dec. 31, 2022 USD ($) |
Fair Value Disclosures [Abstract] | |
Potential Increase Decrease In Fair Value Of Noncontrolling Interests Due To Change In Weighted Average EBITDA Multiple | $ 168,000 |
Segment Reporting - Summary of
Segment Reporting - Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income from Continuing Operations Before Income Taxes (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Segment Reporting Information [Line Items] | |||
Other revenues | $ 433,430 | $ 405,282 | $ 524,353 |
Total revenues | 11,609,894 | 11,618,797 | 11,550,604 |
Operating Income (Loss) | 1,339,062 | 1,797,370 | 1,694,636 |
Corporate administrative support | (129,669) | (111,615) | (146,707) |
Debt expense | (357,019) | (285,254) | (304,111) |
Debt prepayment, refinancing and redemption charges | 0 | 0 | (89,022) |
Other (loss) income, net | (15,765) | 6,378 | 16,759 |
Income (Loss) from Continuing Operations before Equity Method Investments, Income Taxes, Noncontrolling Interest, Total | 966,278 | 1,518,494 | 1,318,262 |
Segment Reporting Information footnote: | |||
Equity investment income (loss) from equity method investments in nonconsolidated dialysis partnerships. | 26,520 | 26,937 | 26,916 |
U.S. dialysis | |||
Segment Reporting Information [Line Items] | |||
Total revenues | 10,512,774 | 10,576,167 | 10,514,649 |
Other - Ancillary services | |||
Segment Reporting Information [Line Items] | |||
Total revenues | 1,097,120 | 1,042,630 | 1,035,955 |
Operating Segments | |||
Segment Reporting Information [Line Items] | |||
Total revenues | 11,701,135 | 11,713,887 | 11,712,633 |
Operating Income (Loss) | 1,468,731 | 1,908,985 | 1,841,343 |
Operating Segments | U.S. dialysis | |||
Segment Reporting Information [Line Items] | |||
Dialysis patient service revenues before provision | 10,575,372 | 10,641,618 | 10,619,364 |
Total revenues | 10,599,809 | 10,666,963 | 10,659,935 |
Operating Income (Loss) | 1,565,310 | 1,974,988 | 1,917,604 |
Operating Segments | U.S. dialysis | External Sources | |||
Segment Reporting Information [Line Items] | |||
Dialysis patient service revenues before provision | 10,488,327 | 10,551,106 | 10,475,273 |
Other revenues | 24,447 | 25,061 | 39,376 |
Operating Segments | U.S. dialysis | Intersubsegment Eliminations | |||
Segment Reporting Information [Line Items] | |||
Dialysis patient service revenues before provision | 87,045 | 90,512 | 144,091 |
Other revenues | (10) | 284 | 1,195 |
Operating Segments | Other - Ancillary services | |||
Segment Reporting Information [Line Items] | |||
Dialysis patient service revenues before provision | 688,137 | 662,409 | 550,978 |
Other revenues | 408,983 | 380,221 | 484,977 |
Total revenues | 1,101,326 | 1,046,924 | 1,052,698 |
Operating Income (Loss) | (96,579) | (66,003) | (76,261) |
Segment Reporting Information footnote: | |||
Equity investment income (loss) from equity method investments in nonconsolidated dialysis partnerships. | 1,898 | 3,177 | 5,866 |
Operating Segments | Other - Ancillary services | Intersubsegment Eliminations | |||
Segment Reporting Information [Line Items] | |||
Dialysis patient service revenues before provision | 4,206 | 4,294 | 16,743 |
Intersegment Elimination | |||
Segment Reporting Information [Line Items] | |||
Total revenues | (91,241) | (95,090) | (162,029) |
Intersegment Elimination | U.S. dialysis | |||
Segment Reporting Information [Line Items] | |||
Total revenues | (87,035) | (90,796) | (145,286) |
Intersegment Elimination | Other - Ancillary services | |||
Segment Reporting Information [Line Items] | |||
Total revenues | $ (4,206) | $ (4,294) | $ (16,743) |
Segment Reporting - Summary o_2
Segment Reporting - Summary of Depreciation and Amortization Expense by Segment (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Segment Reporting Information [Line Items] | |||
Depreciation and amortization | $ 732,602 | $ 680,615 | $ 630,435 |
U.S. dialysis | |||
Segment Reporting Information [Line Items] | |||
Depreciation and amortization | 690,949 | 642,711 | 594,552 |
Other - Ancillary services | |||
Segment Reporting Information [Line Items] | |||
Depreciation and amortization | $ 41,653 | $ 37,904 | $ 35,883 |
Segment Reporting - Summary o_3
Segment Reporting - Summary of Expenditures for Property and Equipment by Segment (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Segment Reporting Information [Line Items] | |||
Expenditures for property and equipment | $ 603,429 | $ 641,465 | $ 674,541 |
U.S. dialysis | |||
Segment Reporting Information [Line Items] | |||
Expenditures for property and equipment | 533,600 | 589,662 | 646,870 |
Other - Ancillary services | |||
Segment Reporting Information [Line Items] | |||
Expenditures for property and equipment | $ 69,829 | $ 51,803 | $ 27,671 |
Segment Reporting - Summary o_4
Segment Reporting - Summary of Assets by Segment (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
ASSETS | ||
Assets | $ 16,928,252 | $ 17,121,488 |
Equity method and other investments | 231,108 | 238,881 |
Property and equipment, net of accumulated depreciation | 3,256,397 | 3,479,972 |
U.S. dialysis | ||
ASSETS | ||
Assets | 15,084,454 | 15,375,000 |
Equity method and other investments | 113,781 | 112,500 |
Other - Ancillary services | ||
ASSETS | ||
Assets | 1,843,798 | 1,746,488 |
Equity method and other investments | 117,327 | 126,381 |
Other - Ancillary services | International | ||
ASSETS | ||
Property and equipment, net of accumulated depreciation | $ 207,162 | $ 190,029 |
Segment Reporting - Additional
Segment Reporting - Additional Information (Details) | Jun. 19, 2019 |
DMG - discontinued operations | |
Segment Reporting Information [Line Items] | |
Business Sale, Effective Date Of Sale | Jun. 19, 2019 |
Supplemental Cash Flow Inform_3
Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Cash paid: | |||
Income taxes, net | $ 344,430 | $ 209,754 | $ 154,850 |
Interest, net | 350,999 | 279,002 | 326,165 |
Non-cash investing and financing activities: | |||
Fixed assets under financing lease obligations | $ 1,928 | $ 31,690 | $ 22,042 |
SCHEDULE II - VALUATION AND QUA
SCHEDULE II - VALUATION AND QUALIFYING ACCOUNTS (Details) - Allowance for uncollectible Accounts - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
SEC Schedule, 12-09, Valuation and Qualifying Accounts Disclosure [Line Items] | |||
Balance at beginning of year | $ 0 | $ 0 | $ 8,328 |
Acquisitions | 0 | 0 | 0 |
Amounts charged to income | 0 | 0 | 13,458 |
Amounts written off | 0 | 0 | 21,786 |
Balance at end of year | $ 0 | $ 0 | $ 0 |