A Search campaign sends each click where you tell it to. The knee ad group goes to the knee page, the hip ad group to the hip page, and nothing lands anywhere you didn't choose.
Performance Max works differently. Out of the box, it's allowed to pick the landing page itself, from anywhere on your website. For most businesses that's a convenience. For an orthopedic practice with a page about platelet-rich plasma injections somewhere on the site, it's a way to break a Google policy without writing a single word about PRP in an ad.
That's the risk this chapter is about, and it has a two-minute fix. The rest of the chapter covers when Performance Max belongs in an orthopedic account at all, and how to set it up so it helps.
Six of 11 Orthopedic Practice Sites Mention PRP. Performance Max Can Find Every One.
We read the websites of the 11 orthopedic practices profiled for this guide in our example market, Nashville, leaving out the one clinic that sells stem cell treatment as its whole business. Six of the 11 mention PRP, "biologics" or regenerative medicine somewhere.
It rarely sits on a page called "PRP." One large group lists "PRP injections" on its knee page. A sports medicine group lists "Regenerative medicine" among its treatments. Another practice's pain management page includes "Orthobiologics." An orthopedic urgent care chain's home page offers "regenerative options like PRP." One group covers it in a blog post: "PRP therapy is offered by several of our providers." A hand surgeon lists it under "Other therapies."
One practice went the other way and said so in writing: it focuses on "evidence-based, clinically proven care and not treatment trends such as using stem cells or platelet-rich plasma (PRP) to treat your symptoms." Four didn't mention it at all.
So in this sample, a practice was more likely than not to have PRP somewhere on its site. Often it's on the same knee or sports page an ad would send people to anyway.
Google Treats a PRP Page as an Ad for PRP
Google's policy on speculative and experimental medical treatments lists platelet-rich plasma by name, alongside stem cell therapy and other forms of regenerative medicine, and doesn't allow ads that promote them. Its health care policies apply to ads and to the pages they send people to, so an ad that says nothing about PRP can still land on a page that promotes it.
The penalty isn't instant, which is part of why practices get caught out. Google says violations of this policy won't lead to an immediate suspension; a warning comes at least 7 days before any account suspension. Practices that "got away with it" for a while are usually practices that hadn't been flagged yet. And the suspension is to the whole account, not the one ad.
There's a narrow exception for ads that are purely educational about these therapies. A practice page that lists PRP among the treatments you can book isn't that. A few states now allow physicians to offer some non-FDA-approved regenerative treatments if their ads carry a required notice. That's a state rule about what the practice may offer. It doesn't change what Google allows in its ads. Chapter 14 covers the PRP and stem cell searches themselves, and what an orthopedic practice can still bid on.
Final URL Expansion Picks the Landing Page After the Click, Not You
The setting behind all of this is called Final URL expansion. When it's on, Performance Max can replace the landing page you gave it with a page from your own domain that Google judges more relevant to the search. It comes switched on. Unless you exclude a page, Google treats every page on your domain as fair game, the knee page with the PRP bullet included.
Here's how that goes wrong. Someone searches "knee pain treatment." Your Performance Max campaign enters the auction, and Google looks across your site for the page that best matches knee pain. The knee page with "PRP injections" in its list of treatments is a strong match. The ad serves, the click lands there, and the ad is now promoting a treatment Google doesn't allow.
Search campaigns don't have this problem, because every ad group points to the page you chose, the way Chapter 4 set them up, and AI Max's version of the same feature is already off from Chapter 9. Performance Max is the campaign type where it comes back.
Two Minutes of URL Exclusions Protect the Whole Account
Performance Max lets you exclude pages from Final URL expansion. For an orthopedic practice, the list is short:
- Any page that promotes PRP, stem cells, "biologics" or regenerative medicine, including the knee, sports or pain page if the treatment is listed there. If it's on a page you want ads to use, the cleaner fix is to move the regenerative content to its own page and exclude that.
- The blog. Posts about treatment trends are the likeliest place for a PRP mention nobody remembers.
- Pages that aren't for new patients: bill pay, medical records requests, the patient portal login, careers, forms for existing patients.
Or turn Final URL expansion off entirely and give each asset group its own page. For a small orthopedic account that's often the simpler choice, and it's the one we'd start with. Either way, open the site map and read every page with a treatment list before the campaign goes live. Whoever wrote the knee page three years ago may have added PRP to the list without anyone in marketing knowing, and the person building the campaign won't find it by skimming the home page.
Repeat the read whenever the site changes. A new blog post or a new service page can reopen the hole, and the exclusion list only covers the pages that existed the day you wrote it.
Performance Max Waits Until Search Has Earned It
With the landing-page risk handled, the next question is timing. One Performance Max budget can end up on a search results page, a YouTube video, a Gmail tab or Google Maps, and the campaign chooses among them by studying which past clicks turned into booked consults. With no conversion history, it has nothing to learn from.
So it comes after Search has done its work. The gate we use is conversion volume: Isolation and Exploration from Chapter 6 together need to be producing at least 30 quality conversions a month, and holding there. For most practices that's around months 6 or 7. Larger groups with bigger budgets get there sooner.
Set the campaign's goal to the same conversions that count everywhere else: booked new-patient consults and qualified calls, as Chapter 1 defined them, not page views or brochure downloads. Run the first weeks with no cost target at all, so the campaign can find its footing, and only then give it a target drawn from what a booked consult has really cost it.
Search Themes and Google's Own Segments Steer an Orthopedic Campaign. Your Patient List Can't.
Performance Max takes hints about who to reach, called audience signals. A signal points the campaign toward a kind of patient; it doesn't fence anyone out, and Google says as much. And in orthopedics, several of the strongest hints aren't available at all.
Google treats surgical procedures as a sensitive health category in personalized advertising. That rules out uploading your patient list, remarketing to past site visitors and building lookalike audiences from either. Custom segments built from sensitive health pages are fenced in too: Google lets them serve only in Display, only to non-sensitive audiences or by context, and other campaign types that use them won't serve at all. Uploading patients wasn't a good idea anyway. As Chapter 3 said, a list of people who had knee surgery at your practice is exactly the information HIPAA protects.
What's left still works:
- Search themes. Short descriptions of what people search for, like knee replacement, hip replacement or rotator cuff surgery, pulled from the procedure searches Isolation has already proven. If Google flags a health theme, drop it.
- Google's predefined segments. In-market and interest audiences Google builds itself, such as people researching health services.
- Presence location, with the same surgical counties added in Chapter 9. Performance Max doesn't inherit the Search campaign's map; set it again.
- Brand exclusions. Exclude the practice name and every surgeon's name, so Performance Max doesn't take credit for people already looking for you. Those searches belong in the brand campaign.
Skip the new-customer setting. Google's version works best when it can compare against a list of existing customers, and a practice can't hand Google its patient list.
One more thing works in your favor. When a search matches one of your Isolation exact match keywords exactly, Google gives it to the Search campaign, not Performance Max. The searches you've already priced by hand stay yours.
Your Clinic's Own Video Beats Anything Google Builds From Stock
Performance Max builds ads from the pieces you give it: headlines, descriptions, images and video. Give it good ones.
Start with the headlines that have already proven themselves in Search, the patient-voice lines from Chapter 8 that booked consults. Leave the machine-written assets off; they sound like every hospital ad in the market. Use real photos of your clinic, your surgeons and your imaging room, not stock images of models holding their knees. A good first shot list: the front desk, a surgeon at the X-ray screen, the physical therapy gym, the building from the parking lot so patients recognize it when they arrive. Any photo that shows a patient needs that patient's written permission first, because an ad that shows someone as your patient discloses protected health information, and HIPAA requires the patient's authorization for that.
And supply a video. Upload nothing and Google makes its own clip out of whatever images and lines it already has. Nobody picks a joint replacement surgeon off a slideshow. Thirty seconds of a surgeon explaining a knee X-ray, shot on a phone in a real exam room, does more than any template. It's the same moment patients praise in their reviews.
Next: Why Knee Surgery Season Starts in the Fall
Performance Max handles the searches and screens Google already knows how to reach. Chapter 11 covers Demand Gen and why knee replacement demand bunches up late in the year, so the time to introduce your surgeons is before fall.
The guide home has the full sequence.
For orthopedic groups that hand us their Google Ads management, the exclusion list is built from a page-by-page read of the site before Performance Max ever launches.
