Three Ways Treatment Centers Are Wasting Money on Adwords

I often hear two contradictory things from treatment center owners...

One group tells me "we've tried adwords, but we can never get our cost-per-admit below [arbitrary scary figure], to the degree we can even determine what it is."

Which is funny, because another group is singing a different tune. Seeing cost-per-lead at $200 or below, and admitting between 10% and 30% of their leads.

So what makes the two groups different?

Last week I wrote about the perils of relying solely on your ads to do the heavy-lifting, and the wasted opportunity running them all to a generic homepage, or relying solely on GCLIDs to change up minute parts of your homepage.

In this post, however, I'm going to discuss something far more basic.

As a part of our application process before we work with a center, we do an audit of their existing campaigns. And - surprise surprise - most of the centers singing the "we can't seem to get the cost per admit at a reasonable level" are making some version of the same 3 basic mistakes.

Here they are...

Mistake One - Not Using Negative Keywords

At Admit Scout, we do a weekly optimization process on our clients' accounts. We look at plenty of factors, but far-and-away the number one factor in the first few months of a campaign?

Negative keywords.

Below is a screen shot of a recent optimization for a real client.


In just weeks of running this campaign, we've already got a total of 956 negative keywords.

By contrast, when we audit the campaigns of centers not working with Adwords professionals, we quite often see either no negative keywords at all, or no campaign-level negative keywords.


So why are negative keywords so important?

Think about the types of people who become your clients:

Do they have a casual interest in addiction treatment, like they're researching the subject for a paper?

Are they only interested in treatment if it's free?

Are they interested in injury rehab for their blown ACL?



Of course not.

They're interested in addiction treatment, in the short-term. For themselves, or family members. Not just reading up on it.

They have the ability to pay, or they're insured, so they're not looking for something for free.

So why would you want to pay for clicks - let alone calls - from people looking for free treatment, or sports-injury rehab?

That's what negative keywords protect you against.

If you're using "phrase match" keywords in your campaigns, Google says that "allows your ad to show only when someone's search includes the exact phrase of your keyword, or close variations of the exact phrase of your keyword, with additional words before or after".

That's great if your phrase is "detox southern California". Your ad will be triggered if someone searches "best detox southern California" or "detox southern California PPO insurance".

Delicious, but no

Delicious, but no

But, without negative keywords, you'll also pay for "free detox southern california", and "acai detox southern california".

(More on different types of search matches below!)

That's why you need an ever-evolving list of negative keywords.

Some of them, like "free" and "animal", are no-brainers. We keep a generic file of them that we apply to almost all campaigns.

Others are less intuitive, and require actually running campaigns, then seeing what your low-quality leads are searching, and gradually building up a client-specific negative keywords list.

Mistake Two - Not Understanding The Differences Amongst Broad, Phrase, and Exact Match Keywords

Google has enough money

Google has enough money

Of-a-feather with a lack of negative keywords, and the second-biggest mistake we routinely find while auditing the campaigns of centers who complain they're not getting good bang-for-their-Adwords-buck? Running afoul of broad, phrase, and exact match keywords.

It's an open-secret amongst those who've seen the inside of an Adwords dashboard that Google's default setting, when you first set up a campaign, is "broad match". One presumes Google wants its advertisers to succeed, so they keep spending money on ads. But one doesn't have to speculate that Google wants to make money. And broad-match keywords are an excellent way to transfer money directly into Google's coffers.

To understand why, let's break down the different types of keywords.

Broad Match, according to Neil Patel, means "Your ads will display regardless of the order of the words in the search string." 

For example, if you're using "rehab center" as a broad match keyword, your ad may be triggered by any of the following:

"alcohol treatment"

"treatment center"

"inpatient rehab"

All of which are probably great clicks. But your ad will also show for "free ACL rehabilitation" and "alcohol treatment accepts medicare", unless you've got negative keywords for every possible contingency.

Your keywords will be broad-match by default if you enter them into the keyword field with no additional punctuation.

Modified Broad, means that by adding a "+" to some words in the keyword, the ad will only show if those keywords are present. For example, if you're using "rehab +center", your ad won't display unless "center" is present.

But it will still show for "treatment center" and "free treatment center", unless you've got negative keywords. Modified broad also doesn't care in what order a searcher types in your keywords.

Phrase match, which we covered above, means that by putting quotation marks around your keyword, it will only display if that verbatim phrase is part of the search.

Awesome, but no

Awesome, but no

But if your phrase is "rehab southern california", you'll still pay for "equine rehab southern california" unless you have negative keywords.

Finally, there's exact match. Exact match means that by putting your keyword in brackets, like [best medical detox orange county], your ad will only be eligible for display if someone fat-fingers that verbatim phrase, without any other words.

As such, "free medical detox orange county" or "equine medical detox orange county" won't display.

Notice anything about the relationship between the specificity of your match criteria and the need for negative keywords? They're inversely related, right? The broader your match, the greater the need for negative keywords to protect you from garbage clicks.

So why not just use 100% exact match keywords?

Because it's impossible to predict what every qualified lead might be searching for.

Say you're using the exact match keyword from our earlier example: [best medical detox orange county].

Say someone searches "medically supervised detox southern california".

You'd probably like that click too, right? Well, with exact-match, your ad won't display unless you anticipate that exact search, and include it as well.

Neil Patel estimates that by using only exact-match, you're missing out on 41% of potential conversions.

Conclusion? It's a balancing act between including all-potential-clients and safeguarding your budget maximally, and more-art-than-science.

A hypothetical campaign might start off with a handful of exact-match keywords based on what's worked well for past-clients, and a handful of phrase-match keywords, because we don't yet 100% know all the keywords potential clients might search. We need them to show us.

Then, we'll refine from two-directions-at-once, adding negative keywords so we gradually waste less-and-less budget on our phrase match keywords, and adding exact-match keywords so we're capturing more and more of the phrases real clients are searching.

Mistake Three - Not Using SKAGs

I've written elsewhere about the advantages of the "full stack" relevance approach. Briefly, here's what that means:

With a full-stack approach, if someone searches "best inpatient rehab malibu"...

...they should see an ad with "best inpatient rehab malibu" in the headline.

Then, they should see some close variation of that phrase on the landing page, either (decent) because you're using dynamic keyword insertion or GCLIDs (just a fancy way of saying your generic landing page knows which ad your visitor came from and adjusts the text accordingly), or (better) you're using dedicated landing pages.

(For a far-more-in-depth discussion of the landing page side of this equation, read this.)

There are two reasons this top-to-bottom relevance is important:

We already discussed the first: making sure you're only paying for clicks from people actually interested in your services.

The second is lowering your cost-per-click (and cost-per-conversion) by closely matching the visitor's search intent.

To understand why, say you're searching "best raw food recipes for dogs".

Which ad are you more likely to click on?

This one?


...or this one?


And the number one way to achieve that top-to-bottom relevance is called SKAGs, or Single Keyword Ad Groups.

Remember that irrelevant result we got for "best raw food recipes for dogs"? That's likely because the advertiser was running multiple keyword variations to the same ad group, as this diagram illustrates:


The reason for the tight coherence of the second ad is likely that the advertiser is targeting only a few closely-related keywords with his/her ad group, as in the diagram below:


What would this look like for a treatment campaign? By adapting a strategy marketer Jonathan Dane describes specifically to treatment.

Say we determined that one of the core competencies of your treatment center was intensive outpatient treatment.

For the "intensive outpatient treatment" ad group, we'd start with only 3 variations on one search intent:

 +intensive +outpatient +treatment

"intensive outpatient treatment"

[intensive outpatient treatment]

Remember our match types? Pictured above are modified broad, which means any phrase that includes all those "+" words will trigger the ad...

...phrase match, which means anything that includes "intensive outpatient treatment" verbatim will trigger the ad, including searches with additional words before or after the search term...

...and exact match, which means that only the verbatim phrase will trigger the ad.

In the real world, and as you acquire more data about what your clients are searching, you may well include exact match variations like [intensive outpatient rehab] and [intensive outpatient rehabilitation].

Some marketers recommend creating new Single Keyword Ad Groups for what's called "longtail" search terms.

For example, say you were getting a lot of searches for "intensive outpatient treatment PPO accepted", which were triggering your ad because they matched the modified broad and phrase match variations closely enough.

The "best-practice" in that case is to create a new SKAG dedicated to "intensive outpatient treatment PPO accepted", in which you'd have those 3 match types, and an ad specific to PPO. This is a good idea, as long as the following is true:

-The extra words give you a differentiation or competitive advantage (check).

-There's high-enough search volume for it to be worth-the-trouble.

Stop Wasting Money on Adwords

I'm always warning center owners I speak with about two big caveats.

  1. Adwords for addiction treatment is a full-contact sport. If you've got an inpatient program with a high lifetime value, it can be extraordinarily profitable, but be prepared to invest big, because clicks and conversions aren't cheap.
  2. Be patient. Be prepared to pay $800 per conversion for the first month, and $450 per conversion the second month. It takes time to get down to really-dialed-in campaigns.

The post you've just read should give you some idea why...

We have to start with best-guesses, and let the data point us in the best direction to optimize things like negative keywords, match types, and ad groups.

There's an art to both putting yourself in a position to collect that data, and interpreting it.

But, done right, here's what it can do to a cost-per-conversion in real life:

Ready to see if your center's a fit? Just click here to book a no-obligation quick chat.