PPC Cost Reduction Case Study: Appointment CPL Optimization

When the clinic team came to us, they had been paying ₹1,500 per appointment from Google Ads for so long that they had started treating it as the normal cost of acquisition in their category. They were not happy with it, but they had stopped questioning it. That is one of the most expensive mindsets a healthcare business can settle into.

As per our experience, we found healthcare has stronger intent in general. No one searches for a doctor without having any real reason for it. To catch those intents, well-targeted campaigns are enough, but this account is not.

We have seen the search term report for the last month, and that was a mess. Many of the search terms are containing medical information queries which don’t have any appointment intent. We have seen search terms of doctors from other clinics which may have been triggered due to broad match targeting and no search term exclusion with negative keywords. The client is getting clicks, but the traffic is just either in the topmost funnel or has the intent to see other doctors. The percentage of informational queries is higher than the transactional queries, and those should have been strictly optimized by adding to negatives. But no negative optimization have we found.

That is how broad match type uses can be sensitive in high CPC categories. The CPCs were always high in healthcare, and so some of the irrelevant clicks can drain the budget.

We launched new campaigns using phrase match and exact match keyword types that have true appointment intent, like specialist searches, treatment service searches, etc. We used those keyword terms, which are searched by a person when they may have decided that they need care. Still, we were adding negatives that had been optimized from day one. Symptoms and condition search terms are already in the negative list. The client has only one goal from Google Ads, which is to obtain appointments. So, we did not introduce any top-of-funnel campaigns. The reason we did not go for the full funnel is that the client had a limited budget, and their SEO is already serving well for informational queries and has good organic traffic volume. So, we made audiences from that traffic, which we used in retargeting campaigns later.

We also fixed the landing page problems that no one had noticed before. The landing pages were very generic and lacked trustworthiness. As a result, the patients were not getting explanations of promises that were made in ad copies. We started with manual bidding for 45 days and built conversion data with good appointment bookings. After getting the required signals, we moved to automated bidding and scaling.

As we had fixed the targeting and landing page issues, the CPL dropped in the first month itself to below Rs 500. The client team was shocked when we showed these results to them and appreciated our efforts. By 90 days of optimization, the blended CPA is controlled below Rs 300 with good lead volume, as retargeting campaigns are giving the best results.

₹1,500 → ₹300 is an 80% reduction in cost per appointment, achieved without increasing budget and without expanding into new campaign types.

What did we do special here? In my point of view, we engineered a high-intent targeting method. And in healthcare, Google Ads intent is the main factor for driving results. It was never a budget problem.

When you allow broad match to trigger ads on symptom queries and competitor doctor searches in a high-CPC category, the budget will be consumed before high-intent patients ever see your ad. The fix is not more spend. The fix is engineering high-intent targeting from the structure level upward, protecting the account with disciplined negatives, and refusing to let automation run before there is clean data to learn from.

Any clinic paying a ₹1,500+ CPL today is almost certainly not facing a market problem. They are facing the same structural targeting issues we fixed here.