Google Ads Optimization Score: What It Means for Clinics
Google Ads optimization score explained from Google's help pages, and which recommendations a clinic should accept, test or ignore, plus how to stop auto-apply.
Optimization score is Google's 0% to 100% estimate of how well your Google Ads account is set up to perform. It rises when you apply or dismiss Google's recommendations, so a 100% score does not mean your ads are profitable. It is not used in Quality Score or the ad auction. For a clinic, accept recommendations that fix tracking, disapprovals and missing assets, and treat budget, broad match, search partners and audience suggestions as tests, not instructions.
Last checked: 26 October 2026
What Google says optimization score is
Per Google Ads Help:
- It runs from 0% to 100%. Google describes 100% as an account that "can perform at its full potential".
- It is shown at campaign, account and manager account level.
- It only covers active Search, Display, Video Action, App, Performance Max, Demand Gen and Shopping campaigns.
- It is calculated in real time from your statistics, settings, campaign status, the likely impact of open recommendations and your recent recommendation history.
- Each recommendation shows an estimated "uplift". Google notes uplifts can add up to more than 100, because applying one recommendation can cancel another.
- Applying or dismissing recommendations changes the score. Google says an account can reach 100% by applying or dismissing all of them.
- Optimization score is not used by Quality Score. They are separate diagnostics.
The score is weighted towards a goal, such as conversions or clicks, based on your bid strategy. A green tick next to the score means Google understands your bid strategy. A yellow question mark or red minus means the score is aiming at a goal Google guessed or defaulted to, which may not be the one you care about.
What the score does not tell you
The score measures how closely your account follows Google's suggestions. It does not measure bookings, cost per patient or the quality of leads. Some practical consequences:
- A low score is not a penalty. Google says the score is not used by Quality Score, and it is not among the factors Google lists for Ad Rank. Your position and cost per click depend on bids and ad quality, covered in our Quality Score guide.
- Dismissing raises it too. An account can hit 100% while ignoring every suggestion, as long as each one is dismissed.
- Agencies have a reason to care. Google requires a Google Partners manager account to keep a minimum optimization score of 70% (Google Partners requirements). That is a reason for an agency to manage the score. It is not a reason for you to accept every recommendation.
How to see and act on your optimization score
- Sign in to Google Ads and open Recommendations from the left menu (under Campaigns in some layouts). The score is at the top.
- Filter by category: Bidding and budgets, Ads and assets, Keywords and targeting, Repairs.
- Open a recommendation with View recommendation. Read exactly what it will change, and in which campaigns.
- Click Apply, or use Save as experiment for eligible bid and budget recommendations so you can test against your current setup (Apply or dismiss recommendations).
- To reject one, click the X on its corner. To reject all of a type, use the three-dot menu and Dismiss all.
Applied changes appear in Change history, where you can undo them within 30 days. Partially applied recommendations cannot be undone. A dismissal lasts 28 or 60 days depending on the reason, and the recommendation can come back if Google still thinks it fits.
Which recommendations a clinic should accept, test or ignore
Recommendation names below are from Google's list of recommendation types. The verdicts are our view for clinics, dental practices and home healthcare providers in the UAE.
| Recommendation | Verdict for clinics | Why |
|---|---|---|
| Fix your conversion tracking / Set up conversion tracking | Accept | Without real booking, call and WhatsApp conversions, every bidding decision is guesswork. See our conversion tracking guide |
| Fix disapproved ads, sitelinks or ad destinations | Accept (fix, do not just dismiss) | Healthcare ads are often limited by policy. See why healthcare ads get disapproved |
| Add sitelinks, callouts, call or location assets | Usually accept | Useful if the text is accurate. Check claims against DHA advertising rules. See our assets guide |
| Remove conflicting negative keywords / Remove redundant keywords | Usually accept, after checking | Make sure a "conflict" is not a negative you added on purpose, such as "jobs" or "free" |
| Improve your responsive search ads | Review the suggested text | Generated headlines can include superlatives or promises a medical regulator would object to |
| Set up enhanced conversions | Accept if consent and data handling are in order | Improves measurement, but involves hashed customer data |
| Raise your budgets | Test only | More budget buys more of the same traffic. Raise it only when cost per booking is acceptable and your clinic can handle the extra patients. See how much a clinic should spend |
| Add broad match keywords | Test only, with Smart Bidding and solid tracking | Broad match can pull in job seekers, students and price-only searches. See our match types guide and negative keywords guide |
| Bid more efficiently with Maximize clicks | Usually ignore | Clicks are not patients. Use a conversion-based strategy once tracking works. See Smart Bidding |
| Adjust your CPA targets | Decide yourself | Google often suggests a looser target to win more volume. Set it from what a new patient is worth to you |
| Expand your reach with Google search partners | Test, then review placement data | Partner traffic behaves differently from Google Search. Judge it on bookings, not clicks |
| Use Display Expansion | Usually ignore for Search campaigns | Spends Search budget on Display, where intent to book is lower |
| Turn on AI Max / Create a Performance Max campaign | Test as an experiment | Can find new searches but reduces control. See our AI Max and Performance Max guides |
| Upload Customer Match lists / Set up audience sources | Check policy first | Google's health in personalized advertising policy says advertiser-curated audiences cannot be used when promoting in sensitive health categories |
Turn off auto-apply, or limit it
Google can apply some recommendations automatically. According to Google Ads Help, eligible types include adding broad match keywords, adding keywords, expanding to search partners, Display expansion, adding audiences, bid strategy changes and CPA or ROAS target changes. Auto-apply works at account level.
- Open Recommendations and go to the auto-apply settings.
- Switch off anything in the "test only" or "ignore" rows above.
- Check the History tab and Change history each month to see what was applied.
Auto-apply does not raise your budget, but broad match and partner expansion can change what that budget buys. Also watch Google's automated assets, which can add text you did not write. See our automated promotions news.
A monthly routine for clinic accounts
- Clear everything under Repairs first: disapprovals, broken destinations, missing ads.
- Apply measurement fixes, then check that bookings are still being recorded correctly.
- Apply accurate asset suggestions.
- Run growth suggestions (broad match, AI Max, budget) as experiments with a clear end date.
- Dismiss the rest, choosing the reason that fits, so the list stays readable.
- Judge the month on cost per booked patient, not on the score. Our audit checklist lists what to check.
Frequently asked questions
What is a good optimization score in Google Ads?
Google sets no target for advertisers. A clinic account at 70% with a healthy cost per booking is better than one at 100% that filled up with poor leads. Agencies in Google Partners must keep 70% or more on their manager account.
Does optimization score affect ad rank or cost per click?
Not directly. Google says it is not used by Quality Score, and it is not among the factors Google lists for Ad Rank. It reflects how many of Google's recommendations remain open.
Does dismissing a recommendation increase my optimization score?
Yes. Google says applying or dismissing recommendations changes the score, and an account can reach 100% by doing either for all of them.
Why does my optimization score keep dropping?
It is recalculated in real time. New recommendations appear as performance, settings and market trends change, and dismissed ones can return after 28 or 60 days.
Should I let my agency auto-apply recommendations?
Only for types you have agreed on. Ask which recommendations are set to auto-apply and check the History tab. Our guide to judging your agency covers what to ask.
Want a second opinion on which recommendations to take? Access One manages Google Ads only for healthcare and beauty businesses.
Sources
- Google Ads Help: About optimization score
- Google Ads Help: Check your optimization score
- Google Ads Help: Apply or dismiss recommendations
- Google Ads Help: Types of recommendations
- Google Ads Help: About applying recommendations automatically
- Google Ads Help: About Ad Rank
- Google Ads Help: How to become a Google Partner or Premier Partner
- Google Advertising Policies Help: Health in personalized advertising
Published 26 Oct 2026 · Access One
What changed for our clients
UAE clinics, hospitals and home healthcare brands that scaled with Google Ads.
Valiant ClinicPremium clinicNew patients tripled in one quarter.
Rebuilt the account around high-intent searches, each with its own landing page.
Liv HospitalHospitalEvery lead source became easy to measure.
Offline conversions sent back to Google Ads, so the team sees where each booked patient came from.
Justlife Home HealthcareHome healthcareBooked patients per dirham roughly doubled.
Spend moved to Search around urgent needs like post-surgery care and elderly falls.
Doctors For YouHome healthcareClosing rate from under 8% to the high teens.
WhatsApp conversion tracking, Search rebuilt around intent and a new qualifying script.
Clinica RamitaAesthetic clinic, JumeirahWe've seen a real difference, not just with the number of leads, but in the quality of patients coming in.
Infinity DentalDental & aesthetic clinicAfter the Google campaigns were reworked, the leads became much more serious and relevant.
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