# Google Ads Optimization > 5.13x ROAS and 42.8% lower cost per lead for a medical practice with five offices across Dallas–Fort Worth. Source: https://go.cosmocalifornie.com/gads-overhaul-2-en Author: Sonny Hughey, Cosmo Californie Media Published: 2024-09-16 · Updated: 2026-10-14 Type: Case Study · Topic: Google Ads **In short:** A local medical practice with five offices in the Dallas–Fort Worth area was running one Google Ads campaign with one large radius, and performance had been slipping month over month. Cosmo Californie Media split it into six campaigns, five tied to an office with its own landing page and one covering the areas in between, with targeting drawn around freeways and how far people will drive. Over 20 weeks the cost per conversion halved and conversions doubled, and for the year Google Ads produced between $314,000 and $374,000 in revenue at a 5.13x return on $67,000 of ad spend. - **Client:** Multi-location medical practice, five offices (not named) - **Industry:** Healthcare, local services - **Services:** Google Ads audit, campaign restructure, location targeting - **Period:** 5 months (20-week optimisation window; revenue reported for the year) - **Tools:** Google Ads - **Reported in:** USD **$314,000–$374,000 Revenue Generated** --- ## Challenges / Opportunities This client has been running Google Ads for several years and was seeing their performance diminish slowly month over month. This client was a local business with multiple locations within and around a major metro area in the United States. Whenever we work with a new account, we spend a significant amount of time auditing the current account’s strategy and implementations. It is important to understand what a client is doing to know where it needs to go. To touch on some of the areas we look at: 1. Location targeting - is the current targeting maximizing the value of precise targeting, or is it broad targeting with one large footprint? Are we targeting people interested in the area or physically in the area (hidden setting) 2. Negative keywords - is the account leveraging negative keyword lists and are those lists organized? 3. Integrations - is the account linked with merchant center, google analytics, search console, tag manager, and other third party applications? 4. Extensions - are all the extensions being taken advantage of? 5. Many more….My team and I go through an extension checklist that covers over 50 items in the account and campaign settings. The biggest opportunities we found was in the location targeting and campaign setup. The client was using one large campaign for the entire dallas fort worth area with one large radius within that campaign. We knew we could segment further in the area, and provide more relevant ads to the users that were searching based upon where they were located. ## Work We Did / Lessons Learned After identifying the location targeting as an opportunitie we decided to break up the large campaign into 6 separate campaigns. 5 of the campaigns were connected to an office location sending users to that location specific landing page on the website. 1 campaign targeted all the areas in between the offices and sent those users to the home page, where they would have a choice to choose a location that best fit them. For each office specific campaign, we changed the headlines, descriptions, etc in the ad to match the location and area. In addition we audited the transportation options to arrive at the office. Were there freeways close by? Was there public transportation? How did those networks look near the office? All of this would decide how we would target. Many times a simple radius around a location has pockets of it that are not ideal locations for a lead. Our in depth analysis prevents the pockets from being targeted, improve CTR and Cost/Lead. For the campaign I’m using in this example, we identified that it was outside the metro area and any potential clients would be driving to the location, so highways would be our reference for targeting: ![Chart](https://assets.cdn.filesafe.space/isqcpFDwzlfBJ9K1l2nd/media/671b6308b62b365c6bd2aafb.png) We targeted further to the south (rural) from the office location than we did to the north (metro), because people are willing to drive farther when it is more rural of an area. ![Chart](https://assets.cdn.filesafe.space/isqcpFDwzlfBJ9K1l2nd/media/676029386876bdb0bce2f4ea.png) Above (after our changes) we can identify areas that aren’t performing well and adjust bids on those areas if necessary, etc. Before, with only one location, they had no insights into what areas they were targeting were performing well and the campaign was not agile and adjustable to allow for continuous improvement as it was after our changes. ## Results & Lasting Benefits We were able to cut in half the account’s cost per conversion over a 20 week period while doubling the number of conversions. For the entire year, Google Ads alone generated between $314,000-$374,000 in top line revenue and a 5.13x return on ad spend. Without advanced location targeting as one of the systems implemented on the campaigns and account in general, these results simply wouldn’t be possible. With Google Ads, the more segmented you are with each setting, the more power an account has to continuously improve and stay relevant to the user. Google’s goal is to make money on every click which does not fully align with a business owner’s goal to receive an ROI on that click. Google makes things relatively easy to setup, but if you aren’t an expert AND detailed AND data oriented you can miss out on the nuances of the platform. I’d love to talk to you more about your specific project and how I can help! - Sonny ![Chart](https://assets.cdn.filesafe.space/isqcpFDwzlfBJ9K1l2nd/media/66e851a3f552c93ccc72d1ee.png) ![Chart](https://assets.cdn.filesafe.space/isqcpFDwzlfBJ9K1l2nd/media/671b6272a3391ecf35080021.png) ## Questions ### What did the Google Ads audit cover? Location targeting (precise targeting against one broad footprint, and whether the account targets people in the area or merely interested in it), negative keyword lists and how they are organised, integrations with Merchant Center, Google Analytics, Search Console and Tag Manager, ad extensions, and a checklist of more than 50 items across account and campaign settings. The biggest opportunity here was the single campaign and single radius covering the whole metro. ### How was the campaign split? Into six campaigns. Five were tied to an office location and sent users to that location's landing page, with headlines and descriptions matched to the area. The sixth targeted the areas between offices and sent users to the home page to choose a location. For each office we looked at freeways and public transport, and in rural areas we targeted farther from the office because people are willing to drive farther. ### What were the results? Cost per conversion was cut in half over a 20-week period while conversions doubled. For the full year, Google Ads alone generated between $314,000 and $374,000 in top-line revenue, a 5.13x return on $67,000 of ad spend, with cost per lead down 42.8%. ### Why does location segmentation matter so much in Google Ads? A single radius around a location includes pockets that produce poor leads, and with one campaign there is no way to see which areas perform. With separate campaigns, bids can be adjusted by area and the account keeps improving. Google makes setup easy, and the nuance is where the return on each click comes from.