v3.26.1
Revenue Recognition Revenue Recognition
 6 Months Ended
Jun. 30, 2026
Text Block [Abstract]  
Revenue Recognition [Text Block] Revenue recognition
The following tables summarize the Company's segment revenues by primary payor source:
Three months ended June 30, 2026Three months ended June 30, 2025
U.S. dialysisOther — Ancillary servicesConsolidatedU.S. dialysisOther — Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage$1,749,289 $$1,749,289 $1,659,607 $$1,659,607 
Medicaid and Managed Medicaid226,944 226,944 217,699 217,699 
Other government88,848 236,377 325,225 83,104 224,937 308,041 
Commercial940,228 136,052 1,076,280 947,015 91,225 1,038,240 
Other revenues:
Medicare and Medicare Advantage151,824 151,824 140,149 140,149 
Medicaid and Managed Medicaid— — — — 
Commercial6,241 6,241 8,322 8,322 
Other(1)
6,514 26,215 32,729 5,966 21,054 27,020 
Eliminations of intersegment revenues(11,361)(3,087)(14,448)(16,716)(2,836)(19,552)
Total$3,000,462 $553,622 $3,554,084 $2,896,675 $482,851 $3,379,526 
Six months ended June 30, 2026Six months ended June 30, 2025
U.S. dialysisOther — Ancillary servicesConsolidatedU.S. dialysisOther — Ancillary servicesConsolidated
Dialysis patient service revenues:
Medicare and Medicare Advantage$3,424,703 $$3,424,703 $3,268,625 $$3,268,625 
Medicaid and Managed Medicaid439,773 439,773 424,208 424,208 
Other government181,788 484,556 666,344 159,850 435,301 595,151 
Commercial1,894,471 245,716 2,140,187 1,871,903 178,427 2,050,330 
Other revenues:
Medicare and Medicare Advantage260,331 260,331 239,103 239,103 
Medicaid and Managed Medicaid— — 2 2 
Commercial9,889 9,889 11,023 11,023 
Other(1)
12,790 53,823 66,613 11,974 36,654 48,628 
Eliminations of intersegment revenues(31,833)(6,375)(38,208)(28,450)(5,565)(34,015)
Total$5,921,692 $1,047,940 $6,969,632 $5,708,110 $894,945 $6,603,055 
(1)    Consists primarily of management service fees in the Company's U.S. dialysis business and research fees, management fees, and other non-patient service revenues in the Other - ancillary services businesses.
There are significant uncertainties associated with estimating revenue, many of which take several years to resolve. These estimates are subject to ongoing insurance coverage changes, geographic coverage differences, differing interpretations of contract coverage and other payor issues, as well as patient issues, including determination of applicable primary and secondary coverage, changes in patient insurance coverage and coordination of benefits. As these estimates are refined over time, both positive and negative adjustments to revenue are recognized in the current period.
Measurements of revenue for the Company's integrated kidney care (IKC) risk-based arrangements are complex, sensitive to a number of key inputs, and require meaningful estimates for a number of factors, including but not limited to member alignment data, third-party medical claims expense, outcomes on various quality metrics, and ultimate risk adjustment factor scores. Information and other measurement limitations on these factors may constrain revenue recognition for a risk-based arrangement until a period after the Company's performance obligations have been met. For its IKC business, the Company recognized revenues for performance obligations satisfied in previous years of $98,491 and $95,911 during the six months ended June 30, 2026 and 2025, respectively. The delay in recognition of these amounts resulted predominantly from measurement limitations and recognition constraints on the Company's value-based care contracts with health plans, many of which are complex. Recognition of revenue from the Company's government Comprehensive Kidney Care Contracting program also has certain constraints for plan years 2025 and 2026.
Customer contract assets. The carrying value of customer contract assets, which are included in contract assets and other receivables and other long-term assets on the Company’s consolidated balance sheet, was $399,165 and $310,541 as of June 30, 2026 and December 31, 2025, respectively.