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