The hulking Hickory Hollow Mall 鈥� a full 1.1 million square feet of retail space in southeastern Nashville 鈥� was shopping center in Tennessee. But like many malls, it鈥檚 been in a downward death spiral for more than a decade.
Now the mammoth complex surrounded by acres of parking is on track to join the ranks of malls making a transition into a booming economic sector: medicine. Vanderbilt University Medical Center has had such success reviving a different mall that its health system, Vanderbilt Health, plans to add medical clinics at the former Hickory Hollow Mall, rebranded a decade ago as the Global Mall at the Crossings.
鈥淭he possibilities for service offerings in a facility of this scale are endless,鈥� Dr. , the medical center鈥檚 CEO, announced in March. What big-city health systems need most is something shopping malls have plenty of: space and parking. They offer convenience for patients and practitioners, as well as costing less than expanding an existing hospital campus.
Nationwide, 32 enclosed malls house health care services in at least part of their footprint, according to a database kept by , a Georgia Tech urban design professor. One of the first was Jackson Medical Mall in Mississippi, . Nearly a third of those medical transformations have been announced since the start of the cCOVID-19 pandemic.
The more recent additions include the in Helena, Montana, where Benefis Health System is building a 60,000-square-foot primary care and specialty clinic on part of the 13-acre site that was razed in 2019. In Alexandria, Virginia, Inova Health System is part of a on the Landmark Mall site, which includes plans for a full-service hospital and trauma center.
The lockdowns brought by COVID 鈥� both required and voluntary 鈥� pushed many bricks-and-mortar retailers already on the brink . But medicine鈥檚 reuse of retail space is more than pandemic opportunism, according to a November article in the Harvard Business Review. The three the rise of telemedicine and continued push toward outpatient procedures will make malls increasingly attractive locations for health care.
The proposition makes sense for commercial real estate investors, too, especially as mall owners struggle. A few during the pandemic. Every mall owner is now looking for mixed-use opportunities, said Ginger Davis of Trademark Properties in Charleston, South Carolina.
In 2017, her company started redeveloping the Citadel Mall, whose anchor tenant is now the Medical University of South Carolina. The clinics and surgery centers are housed in the old J.C. Penney department store.
鈥淩ight now they鈥檙e doing surgery where people used to buy sheets and towels,鈥� Davis said.
In many cases, the transition to medicine is intended to complement what remains of the retail. At Citadel Mall, a spouse with a partner having outpatient surgery must stay on-site. But browsing Target, Davis said, still counts as on-site.
鈥淲e feel like this model can work in communities across the country that are struggling with similar malls that are underperforming,鈥� she said.
Since 2009, Vanderbilt Health has added 22 specialty clinics to nearly a half-million square feet of One Hundred Oaks, a mall still owned by investors. The mall retains big-box retailers on the ground floor, but the mall interior is now virtually all medical.
In some of these deals, such as those for Alexandria鈥檚 Landmark and Nashville鈥檚 Hickory Hollow malls, the local government has bought the mall property that the hospital system leases, so those portions no longer generate property taxes.
Some failing malls like Hickory Hollow in Nashville are in diverse neighborhoods that need increased access to health services. The surrounding ZIP codes had Nashville鈥檚 early in the pandemic and they have some of the lowest rates of primary care visits, according to survey data from the .
Mall locations remain desirable. Many are even more convenient to dense populations and interstates than when they were built nearly 50 years ago, before surrounding suburbs filled in.
When retiree Jennifer Johnson moved to Nashville to be closer to her grandchild, her family warned her not to see a doctor at Vanderbilt鈥檚 main campus, which is under perpetual construction. She quickly understood why.
鈥淚t鈥檚 a zoo,鈥� she said. 鈥淔irst you get to drive through the maze of the parking garage, which is under construction. Then you try to find out which elevator you鈥檙e going to get to, get to what floor you鈥檙e going to get to.鈥�
At One Hundred Oaks, she said, 鈥測ou can go straight up the escalator and straight down the hall 鈥� easy peasy.鈥�
Despite the size and age of many malls, they are fairly easy to navigate compared with many hospitals. In Charleston, the Citadel Mall uses football-style on the floor to help patients find the right clinic (a detail that its owner insisted on and dubbed the 鈥渟ecret sauce鈥�).
By contrast, many hospital campuses confound patients. Vanderbilt鈥檚 main site in the West End area of Nashville has been expanded since the first building was constructed in 1925.
鈥淢ost of these hospitals are in areas where there鈥檚 just no room to grow. And if you do, it鈥檚 so expensive,鈥� said , a former hospital administrator who leads health care consulting for accounting and consulting firm LBMC. 鈥淭hese buildings are old. They鈥檙e antiquated. They鈥檙e very expensive to maintain.鈥�
Malls make for a nice fit, at least for big health systems, McDonald said. They can essentially move everything short of the emergency room and intensive care unit 鈥� including surgery and imaging centers 鈥� and keep them clustered. While doctor offices are often scattered around a hospital district, in a mall setting, if someone needs an MRI, it鈥檚 right beyond the food court under the same sprawling roof.
鈥淚t just creates a whole lot more efficient flow for the patient going through the health care system with whatever infirmity they may have,鈥� McDonald said.
Vanderbilt鈥檚 renovation of the former Hickory Hollow Mall will also create an employment pipeline for medical technicians from Nashville State Community College, which already in what was previously a Dillard鈥檚 department store.
The mall has been mostly empty for years, which makes no sense to nearby resident Ricky Grigsby. The area around it is otherwise booming.
鈥淪omebody needs to do something with it,鈥� he said. 鈥淚t could be jobs for somebody.鈥�
Grigsby just retired from Vanderbilt after a career spent managing surgical instruments for busy operating rooms on the main campus. Now he鈥檚 a patient along with everyone else 鈥� looking for a more convenient place to receive care.
Bundling care in suburban shopping mall sites also makes sense because of their surrounding demographics, Dunham-Jones said. These areas are no longer filled primarily with young families, who first flocked to the planned neighborhoods and shopping centers built in the 1970s.
鈥淭he adults are still in the suburbs, but the kids have long since grown,鈥� Dunham-Jones said. And now those aging parents who remain are 鈥減retty heavy-duty health care consumers.鈥�
This story is from a partnership that includes Nashville Public Radio and Kaiser Health News.
(Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
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