This is Dimension 3 of 7 in the Patient Marketing Diligence Framework, a standard for evaluating whether a healthcare target’s patient acquisition is built to last or bought to look good for a sale.
Part 3 of 7 — The Patient Marketing Diligence (PMD) Framework
Before you trust a target’s CAC, ROAS, or growth trajectory, there’s one question worth asking first: verified against what?
Most reported marketing metrics are platform self-reported, numbers Google and Meta generate about their own performance, graded by the same systems that produced them. That’s not a minor caveat. It’s the reason Dimension 3 of the Patient Marketing Diligence framework, Attribution Integrity, exists as its own category rather than a footnote under efficiency or growth quality.
This dimension is different from the first two in the series in one important way: it doesn’t just measure its own risk. It gates confidence in everything else in the framework.
Why Platform-Reported Isn’t the Same as Verified
When a target hands over a CAC or conversion number, the natural next question is where that number actually came from. In most cases, it came from the ad platform itself, Google Ads or Meta reporting on conversions it tracked using its own pixel or tag, under attribution settings that are rarely reviewed once they’re initially configured.
That’s a structural conflict of interest, even when nobody’s doing anything deliberately misleading. Ad platforms are incentivized to show strong performance, since that’s what keeps advertisers spending. Default attribution windows tend toward generous, not conservative. View-through conversions, someone who merely saw an ad and later converted without clicking it, get counted in ways that inflate apparent impact. None of this requires bad faith. It just means unverified numbers should never be treated as ground truth.
What Verified Actually Looks Like
Real verification means reconciling platform-reported conversions against something outside the platform’s own control, typically a CRM or offline conversion import tied to actual booked or closed patients. When that reconciliation exists and is current, a reported CAC or ROAS means something concrete. When it doesn’t, the number is really just a claim the platform is making about itself.
This is where Salesforce offline conversion imports, CallRail or similar call tracking, and CRM-to-ad-platform integrations earn their keep. They convert a self-reported figure into a verified one by tying it back to something that actually happened in the business, a patient who called, booked, and showed up, not just a click the platform decided to count.
Where to Actually Check This
Start in Google Ads under Conversions, and look specifically at the attribution model, the conversion window settings, and whether conversions are counted as “Every” or “One” per click. These are frequently left at whatever the platform defaulted to during setup, which usually favors counting more conversions, not fewer.
Then request a sample month of CRM- or call-tracking-confirmed patients and independently match it against what the platform reported as conversions for that same period and campaign set. A gap under 10-15% is generally reasonable given real-world matching imperfections. A larger gap is a material finding, not rounding error, and should be treated as one.
If call tracking is in place, check whether the tracking numbers are dynamically inserted site-wide or statically assigned per campaign. Dynamic number insertion is far more accurate and much harder to misattribute; static numbers are easier to set up but far easier to get wrong, especially across multiple campaigns or locations.
Finally, if Enhanced Conversions or offline conversion import is active in Google Ads, ask directly for the match rate. A low match rate, well under half, means what’s being called “verified” data is still substantially estimated, even though it looks more sophisticated on paper.
Scoring It
The framework scores this dimension from live, reconciled offline/CRM conversion import at the top, where reported conversions tie to actual booked or closed patients rather than platform events, down to no attribution verification of any kind at the bottom, where reported performance is taken entirely at face value from ad platform dashboards.
The two Hard Flags matter more here than almost anywhere else in the framework. First, no CRM or call-tracking connection existing at all, meaning every reported metric is unverifiable platform self-reporting by definition. Second, a material discrepancy actually found between platform-reported conversions and real patient or revenue records for the same period, which isn’t just a documentation gap, it’s evidence the numbers themselves may be wrong.
Why It Matters for the Deal
This dimension determines how much confidence to place in every other number in the deal model. A deteriorating CAC trend, a strong non-brand demand split, a scalable acquisition engine, none of it means anything if the underlying conversion counts feeding those calculations can’t be trusted.
Unverified attribution isn’t a neutral gap in the data room. It’s a risk that the reported CAC, ROAS, and growth trajectory are directionally wrong, with real implications for the quality-of-earnings work already happening in parallel, and for any earnout or performance-based structure tied to marketing-driven growth.
This is Dimension 3 of 7 in the Patient Marketing Diligence Framework, a standard for evaluating whether a healthcare target’s patient acquisition is built to last or bought to look good for a sale.
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