2024 Update – This post has been updated with the latest available information after the U.S. Department of Health and Human Services (HHS) updated its guidance for HIPAA compliance when using online tracking technologies in a March 2024 update. The biggest change since it was originally written is that we no longer recommend our healthcare clients use Google Analytics or the latest GA4 version because ongoing guidance from the HHS indicates that even public visitor tracking on healthcare provider websites with non-HIPAA compliant tools like GA4 could still result in HIPAA violations. As a result, we recommend that our clients either use HIPAA-compliant tracking tools or tools that anonymize visitor data before sending it to Google Analytics and other non-HIPAA-compliant tracking tools.

A large, multi-location health care organization came to us with a challenge: with a 6-figure digital ad spend, they had no idea what their ROAS (Return on Ad Spend) was. In other words, they didn’t know if their digital ad campaign was a money pit or a valuable resource. It’s a challenge we’ve seen plenty of times in our health care advertising, and we were happy to help. We dove into their campaign and worked with some of their internal resources to develop a detailed ROAS measurement and tracking strategy.

The results? We found that some of their campaigns were incredibly profitable, while others cost more than they brought in. With this data, we were able to retarget and optimize their campaigns to make sure their digital ad spend really was helping to meet their goals.

In the end, we measured their campaign’s ROAS and then increased it significantly by leveraging that data. As an added benefit, this cold, hard ROAS data turned the organization’s leadership team from digital marketing skeptics into some of the campaign’s biggest supporters.

Digital Healthcare Advertising Challenges and Opportunities

Calculating a Return on Ad Spend (ROAS) from digital advertising can be complex. Doing it for healthcare marketing – where volume is unpredictable, patient privacy is essential, and revenue cycles can stretch into months – can seem downright impossible.

The good news is that while calculating an ROAS from digital healthcare advertising can be complex, it’s entirely achievable.

Protecting Patient Privacy

This isn’t just the right thing to do – it’s the law. In the United States, that law is called the Health Insurance Portability and Accountability Act (HIPAA), and it can be pretty intricate.

Millions of pages have been written about maintaining HIPAA compliance, and we’re not going to come close to covering everything you need to know about HIPAA compliance and marketing in this post. That’d be a whole different post—or possibly a book.

But, the core, critical HIPAA principles your agency or organization needs to adhere to in tracking your digital health care advertising are:

  • Minimize or eliminate any contact between your marketing team and any personally identifiable patient information.
  • Anyone who does come into contact with personally identifiable patient information needs to be properly trained and adhere to the same HIPAA standards as a doctor, nurse, or any other health care provider.
  • If you’re going to use any protected health information for the purposes of marketing, your patients need to clearly consent to that use. In addition, according to the latest HHS guidance, website banners or buttons asking if users will consent to tracking cookies does not constitute a valid HIPAA authorization.

2024 Update: While it may be possible to use Google Analytics/GA4 and other trackers on publicly accessible portions of healthcare providers’ websites without violating HIPAA, the compliance risks still likely outweigh the benefits. Consequently, we no longer recommend that healthcare providers use visitor tracking technologies on their websites that are not HIPAA-compliant or use tools to anonymize user data before sending it to non-HIPAA-compliant tracking tools. Of course, our recommendations for calculating ROAS can still help you reveal the digital marketing insight you’re looking for.

Setting the Groundwork – Tracking Inbound Leads

The goal of most digital healthcare growth agency advertising is to get someone to contact the healthcare organization and schedule an appointment. Usually, this will happen through a form submission or a phone call.

Leaving aside the fact that the forms themselves will likely need to be HIPAA-compliant, tracking form submissions isn’t too difficult. The important differentiation is that they’re tracked with a tool that doesn’t connect an individual submission to a unique individual.

Tracking phone calls is a bit more of a challenge. While some healthcare organizations may get most of their appointment requests via online forms, our experience shows that, for many, phone calls are still the primary way patients make appointments. Luckily, several good tools allow you to track website-generated calls, some of which are even HIPAA-compliant. CallRail, in particular, will allow you to send anonymized data back to your analytics platform so that you can view website-generated phone calls as (anonymous) events on that platform.

ROAS Tracking Method #1 – Averages

This is the simplest, most straightforward method of tracking the ROAS of your digital healthcare ad campaigns.  It minimizes the complications of patient privacy by relying entirely on anonymous data.

Essentially, you determine your average organization-wide per-lead value and multiply that by the number of inbound leads your digital advertising generates.

To calculate a ROAS with this method, you need to know:

  • Your average per-patient revenue
  • The average percentage of inbound leads that turn into visits
  • The cost of your healthcare advertising efforts
  • The quantity and type of leads generated by those advertising efforts

Here’s an example of what that might look like in the real world:

Bob’s hypothetical dental practice hired an agency that spent $5,000 on a digital Pay Per Click (PPC) campaign. That campaign generated 100 leads: 70 phone calls and 30 online appointment requests.

Bob knows that, on average, he makes $350 per visit. He also calculated that about 80% of his online appointment requests turn into office visits, while 70% of calls do. 

So, Bob’s agency can plug all that data into this formula:

  • (70 Phone Calls * 70%) + (30 Online Appointment Requests * 80%) = 73 Estimated Appointments Generated
  • 73 Estimated Appointments * $350 Revenue = $25,550 in Campaign-Generated Revenue

The formula to calculate the ROAS of a campaign is:

  • ROAS = (Campaign Revenue)/ Campaign Costs
  • So, here that turns into ($25,550)/ $5,000 = 5.11 – more commonly expressed as 511%.

To put it another way, Bob earned $4.11 for every $1 invested in this campaign. With numbers like those, Bob’s marketing agency will have no trouble convincing him to continue his advertising.

Advantages and Limitations

The advantage of this method is that it’s pretty simple and can be calculated entirely without accessing any protected patient health information.

The limitation is that it doesn’t account for the type of services being rendered in any way.

That might be fine in a small or focused practice with little variation in per-patient revenue. It won’t work well in a larger institution with a wide range of services. Imagine applying this method in a hospital where a simple office visit could bring in $300 in revenue, but a total joint procedure could bring in $30,000.At best, this method would give a broad view of a campaign’s ROAS – so broad that it might be worth exploring more precise methods of calculating ROAS.

ROAS Tracking Method #2 – Service-Type Averages

This method is similar to #1 but considers the type of appointment each patient requests.

You need the same data as our previous method, with the addition of:

  • Average revenue per visit-type
  • Ad costs per visit-type

Imagine Bob’s same dental practice, but Bob has more data now.

He asked his agency to target three services, and he knows the average per-patient revenue for each service:

  • Annual cleanings – $150
  • Teeth whitening – $650
  • Invisible braces – $4,000

Now, Bob’s agency sets up unique campaigns for each service and tracks conversions unique to that campaign.

We’re getting past the simple-formula phase, so instead, here’s an example of a report that Bob’s agency might give him using this tracking method:

With this data, Dr. Bob and his agency can make a more informed decision about ways to optimize their future campaign, such as getting more annual cleanings in the door, which could have a fantastic ROI.

Advantages and Limitations

Like method #1, this ROI calculation method can be executed without accessing protected patient information. The downside is that it still relies on averages. That might be fine for a dental practice like our hypothetical Bob, where the revenue from one teeth-whitening appointment to another will be pretty consistent.

But what about healthcare facilities where revenue can vary widely for patients booking the same appointment type? Or just facilities that want the most accurate data possible?

Those facilities might want to explore the most accurate way of calculating return on ad spend.

ROAS Tracking Method #3 – Ultimate Precision

Let’s be clear from the start. This method requires the involvement of someone qualified and able to handle protected patient information covered by HIPAA. You’ll also need to ensure your patients have consented to letting you use their protected data this way.

Building and maintaining patient trust is critical to the success of any healthcare organization, so you’ll want to make that consent as clear and understandable as possible.

While the only protected data being accessed will be phone numbers and revenue, that’s still protected data under HIPAA regulations.

With that out of the way, here’s how the process works:

  • When a lead (a phone call or form submission) comes in, it is associated with a source (medium and campaign) inside the HIPAA-compliant environment where it’s stored.
  • After the organization’s revenue cycle is completed, a HIPAA-trained and qualified individual uses a unique identifier from that lead, such as a phone number, to associate it with the revenue from that encounter.
  • That individual tabulates that data and feeds it back to the marketing team – now totally absent any protected health information (PHI).

The marketing team will get a report that contains the precise revenue for a specific time period, broken down by:

  • Service type
  • Appointment source

With that data, they can create an ROI chart like Dr. Bob’s in method #2, but with sometimes significantly higher accuracy.

It’s also possible to automate much of this process. Still, with the wide variety of software tools in use by healthcare organizations, this will likely require a customized development effort.

Advantages and Limitations

The advantage of this method is that it gives you the most accurate ROAS possible for any digital healthcare campaign. Its downside is that it requires accessing data covered by HIPAA privacy regulations and obtaining patient consent.

It might be worth going through that trouble for large or complex healthcare organizations to obtain valuable insight into their marketing operations. For others, a more simple method might be more appropriate.

Which Method is Right For You?

You only need to answer four questions to figure out which return on advertising spend tracking method is appropriate for your organization:

  1. How variable is your revenue per appointment?
  2. How variable is your revenue within a specific appointment type?
  3. Do you have consent from your patients to use their data for specific marketing purposes?
  4. Do you have someone who can regularly safely handle HIPAA-protected information and provide the necessary reports or the capacity to automate that reporting?

Our advice?  Keep it simple when you can, but don’t be afraid to try to get more accurate data when it will provide valuable insight.

Need Help with ROAS?

Whatever method you choose, calculating return on ad spend is a critical step in assessing the success of any digital ad campaign, and being in the healthcare industry offers no exception to this rule. If you’d like more information and an explanation about the ROAS for your healthcare organization, learn more about our healthcare marketing agency experiences, including hospitals, specialty medical groups, genetics testing, and psychological health care.

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