YTD performance for Los Altos, Jan 1 through May 13 2026. The infrastructure WNDR has built is sound. The data shows a sharp behavioral shift at the end of January that has not recovered. There are reasonable explanations and there are questions worth asking.
January's $66 cost per conversion was driven by five campaigns that all had their last spend on or before February 1: Brand ($9 CPA, 86% conversion rate), an original Performance Max ($33 CPA on 62 conversions), Cosmetic LP test ($54 CPA), After Hours ($38 CPA), and Dentist Near Me ($133 CPA). Together they delivered 88 of January's 107 conversions on $3,000 of spend. Without context from inside the agency, the data does not tell us why each was paused. It does tell us they were the most efficient channels in the account at the time.
Six shared negative-keyword lists totaling 3,300+ unique negatives applied across 11 campaigns. Service-line segmentation across 10 categories (Cosmetic, Crowns, Sedation, Emergency, General, plus paused Bonding / Smile Makeover / Invisalign). Long-tail keyword coverage anchored to Los Altos. The original Performance Max was structured with 10 themed audience asset groups, which is correct architecture. This is real work. The question is whether the current configuration is the right way to deploy it.
A clean look at what Performance Max is actually doing on this account, and the five paused campaigns whose unit economics deserve a second look.
On the surface PMax looks like the star: it spent $6,290 for 102 conversions at $62 CPA, while Search spent $30,215 for 109 conversions at $277 CPA. Use the toggle to see why those numbers may overstate PMax's real contribution.
At face value PMax is the leverage point. The next two views show why that read may be misleading on this specific account.
Healthy Search CTR is 3-8%. Healthy Display CTR is 0.3-0.8%. The currently running PMax at 1.12% suggests a heavy Display blend, where conversions are often view-through credits to banner impressions the user never actually clicked.
When the Brand campaign is paused, PMax is allowed to bid on and convert branded searches that would have cost almost nothing to capture through Brand. PMax then takes credit at its own (higher) CPC. Turning Brand back on would reveal what PMax is genuinely incremental on.
A reasonable positionCap PMax at 10-15% of total spend, not 17-25%. Require a Brand campaign running alongside it so PMax conversion credit can be cleanly separated from branded query capture. Move PMax to a secondary channel until offline conversion data confirms its leads become patients.
All five are currently off. Each generated conversions in January at the indicated CPA. There may be valid reasons each was paused. Each is worth a conversation.
The account has four conversion actions configured. Three are firing: Phone Call Lead (588 YTD), Submit Lead Form (116), Contact (220). Book Appointment has fired zero times in 133 days. Most likely the NewPatientSpecial booking widget is missing its conversion tag. Easy to verify with a test booking. Smart Bidding optimizes against what it can see, so a broken conversion action skews the algorithm.
Every audience signal attached to this account targets ultra-high-income consumers. That is a defensible cosmetic positioning. It is also a strategic choice that compounds with the ad copy. This is the conversation only the doctor can lead.
Performance Max asset groups are themed around Tech Workers, Affluent Audiences, Recent Movers, and Banking & Finance Avid Investors. The Cosmetic-Professionals audience targets investors and high-end professional consumers. The premise: high case value, low volume, ultra-premium positioning.
Median Bay Area professional household income is roughly $180,000. Most can't write a $25K check for veneers. Most can absolutely take $400 a month over five years through Care Credit, Sunbit, or Cherry. This audience is currently filtered out by income-signal targeting and repelled by ad copy that mentions financing in 0.5% of headlines.