Forums Forums PPC tROAS or tCPA for a medical clinic that closes ~20–30 high-ticket ($20K) treatments per month?

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    tROAS or tCPA for a medical clinic that closes ~20–30 high-ticket ($20K) treatments per month?

    Posted by Sea-Tie-4242 on October 10, 2025 at 8:36 pm

    I run Google Ads for a private medical clinic that sells a single high-ticket treatment (~$20K).

    We close around 20–30 paying patients per month total (across all channels).
    Right now, our Performance Max and Search campaigns are optimized for tROAS, using two offline conversions from the CRM:

    • Consultation Scheduled (qualified lead)
    • Treatment Scheduled (actual paying patient)

    My question: Is tROAS even the right model for this kind of low-volume, high-value service business?

    Since the “Treatment Date Scheduled” event only happens 20–30 times per month, Google probably doesn’t have enough conversion data for reliable ROAS optimization.

    Would switching to tCPA (Target CPA) — focusing on getting more qualified consultations rather than revenue value — make more sense?

    Curious to hear from anyone managing high-ticket lead gen, medical, or low-volume, high-value accounts:

    • Does tROAS underperform when you only have a few dozen conversions/month?
    • How do you structure your conversion hierarchy (consult vs paying customer)?
    • Any success stories switching from tROAS → tCPA in this kind of setup?

    Thanks in advance — I’d love to compare notes with others running in similar niches.

    Sea-Tie-4242 replied 21 hours, 48 minutes ago 2 Members · 1 Reply
  • 1 Reply
  • ernosem

    Guest
    October 10, 2025 at 8:56 pm

    Why not Max Conversion Value?

  • freak_marketing

    Guest
    October 10, 2025 at 9:49 pm

    I think you should probably let the bidding algo (max conversions) optimize for qualified leads as the Primary Conversion, and manually optimize based on ROAS as Secondary Conversion.

  • Few_Presentation_820

    Guest
    October 10, 2025 at 11:53 pm

    tCPA is worth giving a shot because it gets more complex & difficult for Google to accurately optimize for high revenue jobs in lead gen even on tROAS. It might also take trial & error to get there while campaign getting the hit.

    I think you should definitely test out max conversions strategy with a custom experiment to see how it does. And as you are already importing the offline conversions, max conversions will optimize for better lead quality since has more signals & it’s overall way simpler to manage

  • fathom53

    Guest
    October 11, 2025 at 5:50 am

    Most start bidding will struggle a little if you have low amount of conversion per month to train Google. You should always optimize towards your main conversions. It may make sense to use a portfolio bid strategy if you have a handful of campaigns that get a few conversion each. That way Google can treat them as one campaign. Assuming your CPA goal is the same or similar across all the campaigns.

  • Available_Cup5454

    Guest
    October 11, 2025 at 7:23 pm

    Switch to tCPA using consultation bookings as the main conversion keep treatment events as secondary and reintroduce tROAS only once you have 50+ closed patient signals per month for stable optimization.

  • Awkward_Extension_11

    Guest
    October 11, 2025 at 7:45 pm

    I am in a very similar market, private medical high ticket but on going services as well. We have been utilizing tCPA for the past year, switched to Max Conversion Value last week. Happy to chat if you would like.

  • Physical-One-7966

    Guest
    October 12, 2025 at 12:14 pm

    Have you tried working with experiment campaigns?

    in our experience, you want to have like 30 conversions per month for tCPA, and as someone else mentioned 50 for tROAS. And below 30, max conversions.

    But this is all based on averages, general best practices, which, in practice, are not the same for everyone.

    My advice: don’t get too hung up on theory; start by testing experimental campaigns where you compare different bidding strategies!

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