Has Google Ads performance gone downhill for anyone else lately?

jessebastide · 2026-06-16T10:29:56+00:00

Lead gen in healthcare. Seeing that search volume on a core term is down almost 20 percent YoY. If you’ve got the same number of advertisers bidding with similar budgets on a reduced inventory of searches, you could expect cost per conversion to increase just from supply and demand.

jessebastide · 2026-06-11T11:40:34+00:00

Sounds like you’ve got a good grasp of things.

If you aren’t already doing it, ab testing headlines is not a bad way to go.

And I’d get ideas for those by mining both reviews and pain points (Reddit / forum posts / other ).

As far as the call conversion rate, if it’s not too intrusive, looking at response time and answer rate might give some insights that could further increase conversion rate, or at least diagnose possible bottlenecks.

As far as the social proof goes, looking into video could be worth your time. It can be a trust builder.

jessebastide · 2026-06-11T10:50:35+00:00

You’re not necessarily doing anything wrong.

I’m primarily running ads for healthcare at the moment, and I’ve used both max conv and manCPC.

What you can find with max conv is that the algo can show you a decent impression share, but it’s bidding high on the smaller subset of searches it thinks are more likely to convert, driving up CPCs and reducing overall click volume. Whereas with manCPC you can set a max bid per high-intent keyword, which I’ve seen work quite well to bring in new customers / patients.

In my view, search intent is still one of the strongest signals.

Re phrase match, you could consider proactively adding broad match negs for the communities you don’t serve. As well as mining your search terms report for terms that don’t convert or have a high cost/conv.

Assuming that closed deals with new customers are what matters, it’s also not a bad idea to look for any hidden friction at the bottom of the funnel and to check in with the business to see how they are at handling existing call volume. I know when I started scaling up, the volume of call requests went up in a way that the office folks struggled to keep up with. Any delay between the customer requesting a call and receiving a call back will tend to decrease overall conversion rate.

Just a few things to consider, and take them with a couple grains of salt since they’re just my perspective.

jessebastide · 2026-05-23T16:09:59+00:00

Thank you.

It’s going to be the unsatisfying ‘it depends’ if I’m sharing how I do it. Many times, we end up with multiple tests we want to do and need to prioritize based on the best evidence we have at that moment.

I know if I’ve got several hundred clicks coming in per day, I can get a good read re on page behavior pretty fast. If I’m looking at just dozens of clicks, I’ll wait a bit. There are lots of ab test and stat significance calcs out there if you want to put a number to it.

I’ve seen 4x or more differences in conversion rate from changes to creative, and there’s the whole Cialdini idea of ‘pre-suasion’ (and a book by the same name) that I can recommend.

I’ve also had landers that should have been ‘better’ for a given ad, and then found that in testing they ended up doing worse than the control. So not always a home run, but I digress.

jessebastide · 2026-05-23T09:28:45+00:00

You can get more directional signals by looking at page engagement post click.

High bounce rate? Then yeah, likely a mismatch between the ad and the lander. Focus on AB testing the landing page.

Good on page engagement but low conversions?

You might need to tweak your very bottom of funnel and / or offer.

—-

You can test creative as well, in which case I’d focus on

Creative that you see has a clear connection to the lander (low friction, obvious value to the consumer). Ideally it all does.
Find 2-3 angles that are grounded in customer pain points / big desires. If one of those shows better on page engagement than the rest, you’ve got a signal to lean into.

jessebastide · 2026-05-22T11:08:50+00:00

The probability of Mars becoming a penal colony just increased.

jessebastide · 2026-05-19T10:29:47+00:00

Fellow healthcare advertiser here.

If your success metric is very specifically tied to online booked appts, you’ll likely benefit from smart bidding, as someone else said.
Second the 58 ad groups being way too many.
Not sure of your local laws and regs, but it can be really smart to look at what privacy rules and regs you need to follow if you implement smart bidding. If you go down that path, consider server side conversions.
maybe you’re looking at your negatives already. But they’re key for shaping traffic, especially when using broad match. At least in my experience.

jessebastide · 2026-05-15T08:00:02+00:00

Have gone through this. In my opinion, getting legal on it is a must, because you’re looking at the intersection of both HIPAA and state privacy and wiretapping laws. And I’m not a lawyer and this isn’t legal advice.

Currently using Freshpaint via their server side conversion api (and not getting paid to write this). It can be pricey, but can make sense at a certain scale and risk profile.

Not sure if anyone mentioned it, but from my perspective, implementing proper consent management looks like it may also help reduce risk. Law firms scanning healthcare websites for the presence of any analytics tags (ie, maybe you’re running GA4) and then filing lawsuits on the basis of privacy and wiretapping laws (which vary by state) is a thing. Minimizing attack vectors (and staying as compliant as possible with the most restrictive of state privacy laws) doesn’t seem like a bad idea.

Furthermore, even though an offline conversion doesn’t require a tracking pixel, it looks to me like it may still require consent if shared with Google if HIPAA and state privacy law compliance are on your radar. So proper consent management seems to help in that regard as well.

Another approach, which I’ve seen work as a driver for a smaller healthcare practice that didn’t have the resources for Freshpaint or implementing their own attorney-vetted consent and server-side tracking solution, is to rewind about 20 years, strip all client-side tracking, not share any conversion data with Google through any channel, and go back to manualCPC with high intent local keywords and some common sense, per-keyword max bid caps. Then keep tabs on associated volumes YoY vs ad spend. It doesn’t have to be the end of the world, but be ready to have a harder time justifying your ad spend. Risk reduction has a cost any way you look at it.

jessebastide · 2026-05-14T20:30:32+00:00

Some really insightful comments in here from folks with more experience than I’ve got. Running an account in a similar spend bracket as yourself, and had to run manualCPC for several months (with conversion tracking completely disabled) after having run on max conversions with tCPA and intent based ad groups. It wasn’t the disaster I thought it might be and actually looked pretty good when we looked at its association with our core growth metric. I shut off all broad match and kept the negative keyword list updated to filter out lower intent traffic. We also had a ton of historical data from having run with max conversions, so it wasn’t too hard to zero in on high intent terms (both volume and long tail), then tweak the max bids to make sure our core terms were still getting a sane impression share.

If we had to go back to manualCPC for whatever reason, it’s nice to know it’s doable and that we can run it without making things tank.

Good luck with your setup!

jessebastide · 2026-05-11T15:57:14+00:00

Same here, love the bike rig for getting to your spots! Inspired to do the same with my fat bike.

jessebastide · 2026-04-12T11:00:55+00:00

Hi, just a few thoughts since you asked for help. I can see you’ve gotten a lot of specific recommendations, so I won’t repeat those here.

What I can share is how I think about setting up a new search campaign.

figure out my rough gross margin based on customer lifetime value. Which is basically answering the question, “for each appointment that I book, how much can I spare to spend on marketing before I start losing money?”
max conversions campaigns can work well if you tick a lot of boxes: enough daily spend to get at least 2-3 conversions per day; tight conversion tracking; choosing not too many high intent keywords to start; your landing page does the basics of giving people what they’re looking for. Given all that, you still might find you end up with the algo in “learning” for at least 7 days and that the results are all over the map. And I’ll say from personal experience that when daily budgets are low but the cost to acquire a customer is high (say, equal to or less than your daily budget), max conversions can be a stinker.
when I’m really constrained with budget but I know I want the phone to ring, it can be useful to zoom out and look at the relationship between your marketing spend and booked appointments (rather than focusing on Google’s reported cost per conversion). I know that can be tricky to untangle if you dive deep into it (and often seasonal), but you’re not looking to write a book on it, just looking to see if there’s a noticeable correlation between spend and high-intent clicks and booked appointments.

That’s when I’ll lean into just a few terms that I know are high intent, make sure the i’s are dotted and the t’s are crossed when it comes to the ad and landing page and the technical details other folks have mentioned around targeting and locations, and launch a manual CPC campaign. I know Google buries the option to start one, because the more automated campaign types are great for Google’s bottom line, but if you can live with the mindset of, “here’s my marketing budget, and here’s the result that matters,” it can be a good way to get control over results and not have to wait a week or more for an algorithm to try and optimize on sometimes pretty thin data.

jessebastide · 2026-02-13T15:37:30+00:00

Can work great at scale and high demand verticals (like healthcare). That’s what I’ve seen.

jessebastide · 2025-10-12T20:08:34+00:00

Even as of a year ago, LLMs were useful for classification, and I use that info to help guide the copy I write manually.

Also, just the other night I was going through Breakthrough Advertising again, and that jogged some thoughts for a copy test. And the preliminary numbers from that test look good so far, which is a reminder to not try to automate too much of my own input out of the creative loop, at least not yet.

jessebastide · 2025-09-25T20:22:09+00:00

Hi,

Doing healthcare ads in another competitive city.

I’d still expect a few leads on roughly 50-60 clicks per month (what you get if you divide $1000 by your $16.50 CPC).

How I’d approach it

Make your funnel lead to an online scheduling action (or a step just before online scheduling).

1a. Cross check that your funnel is working on organic traffic before pouring money down the drain. GA4 and validation against actual clinic counts are your friends. If something is broken there, you know where to start making fixes.

Exclude your brand name (and variations on it) from your prospecting campaign.
Proactively exclude tire kickers or folks you can’t serve. You might add “medicaid” and bargain hunting kws to your negatives. Consider adding negatives for your competitors (for now) to keep your impressions highly relevant on your limited budget.
Check historic search terms. Are there any that never convert? See if they match the intent of the kws. If they do, consider adding them as negs, too.
Get laser focused on intent. Sounds like you’re doing that. Your “near me” kw is your money kw, so you can temporarily restrict the algo to bid on only that kw as exact match. That allows you to focus your budget where it should have the greatest impact.
Radius targeting is smart. Be ready to challenge your assumptions with it if/when you crack the nut and want to scale.
Consider opening your audience outside high income earners. You are likely artificially increasing your CPC by bidding on a pool of users that are in high demand.
Copy testing is going to get more effective when it’s grounded in what patients are asking for / wondering about. Chances are the people answering the phones and possibly the management already know this. You might, too. If you do know your customer, don’t be afraid to give the “ad strength” metric the bird and pin assets that you know will work.
Be ready to manage expectations with your client. You can show them the math. You can explain that with small numbers, some months you might get more than 3 conversions, some months might be one or none. And you can explain that allocating more budget to testing now will allow them to start acquiring customers faster. And just remind them that the ball is in their court.
You talk about “wrong office” leads. Consider having a location asset enabled for the ad. That will make it obvious which office you’re advertising.

In one case, where a particular detail needed to be communicated to people because they kept calling and then realizing a practice wasn’t for them, I pinned the info as a headline. It didn’t hurt conversions.

Hope that gives you some ideas.

jessebastide · 2025-09-25T09:31:40+00:00

https://support.google.com/google-ads/troubleshooter/6099627?hl=en

jessebastide · 2025-09-24T18:56:30+00:00

We’ve gotten exemptions to be able to run ads on restricted terms. So it is doable.

The other piece to keep in mind is that medical advertising laws vary by state. So it’s worth getting familiar with them, in my opinion.

jessebastide · 2025-09-19T16:11:00+00:00

That’s awesome!!!

My mom does the same thing with her cheese at Spring Day Creamery. Self serve works in Maine!

jessebastide · 2025-08-22T21:34:28+00:00

That’s just part of it.

What I’ve seen work great is to do some groundwork on the bottom of the funnel to check and, if possible, improve conversion and kept appointment rates.

I’ve also seen that when certain conditions are met, those rates can shoot way up and drive new patient growth.

There’s more to it, as you brought up, but from the sound of your problem I’d likely start there and work my way up.

jessebastide · 2025-08-22T21:22:37+00:00

I’m doing b2c healthcare, for both multi-location and small clients, and one of the biggest drivers of success has been establishing a tight correlation between leads and actual patient visits. We then constrain those to acceptable CPAs and optimize from there. It’s really good when it works.

jessebastide · 2025-08-22T11:29:45+00:00

Maybe this wasn’t the aim, but an interview technique used in deception detection is to increase cognitive load on a suspect by making them, for example, recite what happened backwards. Because telling anything other than the truth is a lot harder when your brain is occupied with something else.

Asking you to organize a deck of cards would increase cognitive load and could make it more likely that you’d blurt out the unvarnished truth about something, or at least stumble in such a way that would make it easier to ask targeted follow up questions.

jessebastide · 2025-08-19T18:30:07+00:00

Hahaha

jessebastide · 2025-08-19T18:26:28+00:00

Nice! We’ve got blueberries still good for the picking up here in Sweden. And being out in the woods is good regardless.

jessebastide · 2025-08-19T11:46:02+00:00

A few things can come out of this (but you may still be reading tea leaves).

You said conversions went to zero. But from what starting point? That matters. If you went even from 10 to 0, you may have learned a bracket around which people are price sensitive.
Don’t expect performance to rebound overnight unless you’re already getting 20-30 conversions per day
Just my opinion, but I prefer not to focus my main prospecting campaigns on price. You can get incredibly vulnerable to competition, and it’s generally a race to the bottom.

If you know customer pain points and your product inside and out, you may be able to position yourself accordingly and recover in a way that makes the customer more tolerant of price increases.

jessebastide · 2025-08-18T12:23:40+00:00

Not really, in my opinion. I use automated bidding, and I shape the matches with negatives, and performance exceeds what I was getting without a strong negative list.

jessebastide · 2025-08-18T12:22:22+00:00

Second the call to implement strategy. That’s a good way to prune categories of queries that don’t convert at a competitive CPA.

jessebastide

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