Optimisation Score in Google Ads: What It Means and What It Does Not
A newly opened clinic was reviewing its Google Ads account and found that the optimisation score sat at 67 per cent. The team wondered whether that was bad. An outside review suggested it pointed to ads that were poorly configured and losing ground in the auction. But the score can also mislead. Following every suggestion blindly can waste money, while a low score is a prompt to look closer.
Here is what the optimisation score means, what it does not, and how a clinic should use it.
What the score is
The optimisation score is a percentage that Google shows for each account and campaign, estimating how well it is set up against Google’s own recommendations. A higher score suggests fewer unapplied suggestions. It is a rough indicator of setup, not a measure of profit or patient numbers.
What a low score can signal
A low score can point to real issues: missing ad variations, poor keyword coverage, unused settings or ads not meeting recommended standards. These can reduce relevance, so ads may lose out in the auction and appear less often. It is a useful prompt to investigate.
Optimisation score does not equal success
A high score does not guarantee good results. An account can score highly and still waste money on the wrong searches, or track the wrong conversions. Likewise, a moderate score can accompany excellent performance. Patients and profit matter more than any percentage.
Why Google’s suggestions are not always in your interest
Recommendations are designed to help advertisers use more of Google’s features, which often means spending more. Some suit clinics, and some do not. Treat them as ideas to evaluate, not instructions to follow. Always ask what an action would do for booked patients.
Review the recommendations one by one
Read each suggestion, and decide whether it fits your goals, service and budget. Apply those that make sense, and dismiss those that do not, with a note of why. A reasoned response is better than either accepting everything or ignoring it all.
Be wary of broad match and auto-apply
Some suggestions push broad matching, automated settings and auto-applied changes. For a small, specific service, these can widen targeting and waste budget. Turn off auto-apply unless you are sure, and check that any change fits your controls.
Look at what the score cannot see
It does not see your booking system, your profit margins, your capacity or the quality of your enquiries. It cannot tell whether you are attracting the right patients. Combine it with your own data for a true picture.
Use it as one signal among several
Judge the account by cost per booked patient, enquiry quality, search terms, impression share and conversion tracking accuracy, alongside the score. If the score is low but these are strong, you may be fine. If both are weak, act.
Improve the account for the right reasons
Fix real problems: add good ad variations, improve keyword structure, add missing assets and repair tracking. These often raise the score as a by-product. Improve for patients first, and let the score follow.
Ask your agency about the score
If you use an agency, ask what the score is, why, and what they are doing about it. A clear, reasoned answer is a good sign. A dismissive or vague one, or a score left untouched for months, may reflect infrequent management.
Check how often the account is managed
A low score can hint that nobody has looked at the account regularly. Check the change history for recent activity. Frequent, sensible changes show care. Long gaps suggest that the account is running on autopilot.
Watch impression share and lost auctions
Alongside the score, look at how often your ads could have appeared but did not, and why. Lost impressions due to rank suggest relevance or bid problems. This gives a more direct view of visibility than the score alone.
Do not chase 100 per cent
Perfection is not the goal, and some suggestions will never suit you. Aim for a sensible, well-understood setup that delivers booked patients at a good cost. A score in a healthy range, with strong results, is enough.
Document why you dismissed a suggestion
Keep a simple note of suggestions you rejected and the reason. If a new person takes over the account, they will not reapply ideas that were already considered. A short record also shows your agency’s reasoning, and helps you judge whether their decisions are sensible.
Focus on conversions before features
The most valuable improvement is often not a feature but accurate conversion tracking. If the account counts the wrong things, every automated setting optimises for them. Fix tracking first, then the score becomes a minor sideline, and your results follow what really matters.
Learn from the recommendations you accept
When you apply a suggestion, note the date and watch the effect. Over time you learn which types of recommendation help your account. This builds your own judgement about what to trust, and reduces the pull of anything that merely raises the score.
Do not let the score become a target for agencies
If an agency reports the score as its main achievement, ask what it has done for booked patients. A score is easy to lift with superficial changes. Real value shows in enquiries, bookings and cost per booked patient, which are harder to fake.
A quick checklist
- Treat the score as a prompt, not a verdict.
- Review recommendations one by one.
- Turn off auto-apply unless you are sure.
- Judge by cost per booked patient and enquiry quality.
- Check the change history for recent care.
- Do not chase 100 per cent.
Our companion article on feeding booking data back into Google Ads covers a measure that matters more than the score, and our guide to auditing your Google Ads account explains a fuller review. If you would like help, we are glad at Pulse Digital Health to talk.
Frequently asked questions
What is the optimisation score?
A percentage Google shows for accounts and campaigns, estimating how well they are set up against its recommendations. It is a rough indicator of setup, not of profit or patient numbers. Use the score as a prompt to look closer, not as a target. A prompt to look closer is useful, and a target to chase is not.
Is a low optimisation score bad?
It can signal real problems, such as missing ad variations or poor keyword coverage, and is worth investigating. But it does not prove poor results, so check cost per booked patient and enquiry quality as well. Compare it with cost per booked patient and enquiry quality. Real outcomes matter more than any percentage.
Should I follow every recommendation?
No. Some suit clinics and some mainly increase spend. Review each one, apply what fits your goals and dismiss the rest with a note of why. Read each recommendation and ask what it would do for bookings. Each suggestion should earn its place by helping bookings.
Should I turn off auto-apply?
Usually, unless you are sure. Automatic changes can widen targeting and waste budget for small, specific services. Keep automatic changes off unless you have reviewed them. Automatic changes can quietly widen targeting and waste money.
Can a high score still mean wasted money?
Yes. An account can score highly while spending on the wrong searches or tracking the wrong conversions. The score cannot see your bookings or profit. Check tracking, search terms and impression share as well. The score cannot see your bookings, your margins or your capacity.
What should I ask my agency about the score?
What it is, why, and what they are doing about it, plus how often they manage the account. Clear, reasoned answers are a good sign. Look at the change history to see how often the account is managed. Regular, sensible changes are a good sign of a well-managed account.
