Performance Max is Google's everything campaign. One budget, one set of photos and headlines, and Google decides where the ads go: search results, Maps, YouTube, the Gmail inbox, apps and websites across the internet. You don't choose keywords. You choose what counts as a win, and Google goes and finds more of it.
That's the whole deal, and it's why Performance Max is the most dangerous campaign an urgent care can launch too early. It will find exactly what you told it to find. If you told it every phone call is a win, it will find phone calls. Plenty of the people who call an urgent care aren't coming in today. They're calling about last week.
Urgent Care Phones Ring All Day for Patients Who Already Came In
An urgent care visit doesn't end when the patient walks out. The results come back later. The prescription goes to a pharmacy that may not have it. The school wants a note. The bill arrives. Every one of those can turn into a phone call, and many of them go to the center's own number, the one on the Google listing and in the ads.
In our example market, Philadelphia, the urgent care reviews show how busy that line gets. Twenty-eight were about follow-up and test results, and 19 of those were complaints. Patients in our sample wrote things like:
- "Still no results 14 days later."
- "A dosage correction should take minutes, not days of repeated phone calls with no result."
- "never even followed up about my test results."
Add the calls about prices and insurance, the calls asking whether the X-ray tech is in today, and the calls about a bill, and the phone at a busy center is only partly a line for new patients.
The centers know this. All twelve urgent care and walk-in websites we profiled give patients a bill-pay link or a billing line of their own. Patients still call the center, because the center's number is the one they can find.
Performance Max Buys Whatever Your Conversion Goal Says Counts
Google describes Performance Max as goal-based: you give it your conversion goals, and its bidding works out, auction by auction, how likely each person is to complete one. Then it bids accordingly, across every channel it can reach.
That makes the conversion goal the entire brief. Performance Max can't read your mind, your call log or your front desk's frustration. It can only read which actions you've marked as conversions. If a 45-second call about a bill counts the same as a confirmed check-in, the model treats them the same. And a billing caller is easy to find. They already know your name.
Each campaign can have goals of its own. Google lets a campaign-level goal override the account's default goals, so you can hand Performance Max a narrower definition of success than the Search campaigns use. For urgent care, that's usually the right move.
Online Check-Ins Carry the Goal. Calls Have to Earn Their Place in It.
Chapter 1 set up the conversions: confirmed online check-ins and qualifying calls as primary, and results calls, billing calls and Directions clicks as secondary. Secondary actions show up in reports and stay out of bidding. That split matters most right here.
For Performance Max, we start with confirmed online check-ins as the goal. A check-in comes from someone who picked a center and a time and gave their details to be seen today. Nobody fills that form to ask about a bill.
Calls get added only after they've proven themselves. Chapter 7 asked you to listen to a sample of the calls the Search campaigns counted as conversions. Do that again before calls go anywhere near Performance Max. If most of the counted calls are new patients asking whether you're open or whether you take their insurance, calls can join the goal. If a real share are results and billing, keep calls out of the Performance Max goal until you can separate them, and let Search keep them.
Patients Calling About a Bill Search Your Name. The Brand Campaign Keeps Them Out of Performance Max.
Think about how a patient finds the number to call about last week's visit. They don't search "urgent care near me." They search your name.
That's where the brand campaign from Chapter 6 comes in. It already owns the searches for your center names, with its own budget. Left alone, Performance Max can show ads on those same searches, where it collects cheap clicks and easy "conversions" from people who were going to find you anyway, including the ones calling about a bill.
Google's own advice fits this exactly: when your brand runs in a campaign of its own, use brand exclusions to keep Performance Max off your brand searches. Add your group name, every center name, and any name patients use for you. That leaves Performance Max with the job worth paying for: people who don't know you yet.
Final URL Expansion Can Send an Urgent Care Ad to the Bill-Pay Page
Performance Max doesn't only choose where ads show. It can choose where they land. A setting called Final URL expansion lets Google swap the page you picked for a different page on your website that it thinks fits the search better. Google turns it on by default, and its own help page warns that it can land ads on pages you never meant to advertise.
For an urgent care, those pages are everywhere. Four of the five health systems in our sample keep bill pay on the same website as their urgent care pages. Many urgent care sites also carry a patient portal, a records request form and a careers section. Each one is a page Performance Max could decide is the best match for somebody.
The fix is a list of URL exclusions, set before launch:
- Bill pay, billing and insurance-claim pages
- The patient portal and its login pages
- Medical records requests
- Careers and job pages
- Any page for a service a center doesn't offer
If your urgent care pages live inside a big health system's website, the list gets longer, and the case for turning Final URL expansion off at launch gets stronger. Start with the location pages from Chapter 4 as the only destinations. Loosen it once the results say you can.
Google's Health Rules Keep Your Own Patient Lists Out of Performance Max
Audience signals are the other input Performance Max wants: your best guess at who the patients are. Google treats them as a head start, not a fence, and the campaign will reach people outside them.
For urgent care, the most useful hints are the ones you can't give. Google treats health as a sensitive category for personalized ads, and in that category four audience types are off the table: Customer Match lists, your own website visitor lists, audience expansion and lookalike segments. Google's own audiences, like in-market and life events, are still allowed, along with demographics (with some exceptions) and location.
Custom segments come with a catch. Google's rule is that a custom segment tied to sensitive landing pages or sensitive ad content will serve only in Display campaigns, and in every other campaign type it won't serve at all. Performance Max is one of those other types.
Google doesn't list urgent care by name, so which of your pages count as sensitive is a judgment call. Our reading: location pages, hours and prices are probably fine. Pages about a specific condition or test, like strep, a UTI or STD testing, fall squarely inside what Google calls health. Keep those pages out of your Performance Max signals, and don't build the campaign's assets around them.
Performance Max Launches After Search Has Proven What a Check-In Costs
In our rollout, Performance Max comes in months six or seven, not month one. By then, Isolation and Exploration have done three things Performance Max can't do for itself:
- Proven the conversion. The account is recording about 30 real conversions a month, and you've listened to enough calls to know which ones are patients.
- Found the real cost. You know what a check-in costs on Search, center by center. That number becomes Performance Max's target later, not on day one. Launch without a target cost, let it learn, and set the target once it has results of its own.
- Written the words. The headlines that won on Search, the ones from Chapter 8 built out of your own reviews, move into Performance Max. Don't let Google write them for you.
The pictures matter as much as the words, because Performance Max shows up on YouTube and in image placements where Search never goes. Use real photos of your centers, your waiting room and your staff, not stock photos of models in scrubs. And give it a real video, even a simple one shot on a phone. If you don't, Google's automation will build one out of your other assets by default, and you won't have chosen a single frame of it.
Next: Demand Gen for the Slow Months
Performance Max takes what Search has proven and spreads it across Google. Chapter 11 looks at the other campaign that reaches people who aren't searching yet, Demand Gen, and when in the year an urgent care should think about it.
Catch up on Chapter 1 for the conversions this chapter depends on and Chapter 9 for the settings under every campaign, or see all sixteen chapters on the guide home.
When urgent care groups hire us for Google Ads management, Performance Max doesn't launch until we've listened to the calls the account is counting.
