Each year, you seem to up your digital marketing spend, but to what end?

It can be challenging to calculate a direct return on investment (ROI) for each dollar spent on your digital strategy, but certain clues can help determine what is working for you and what is working against you. These simple hints will tell you whether it is time to reinvest in or revisit your strategy.

For starters, don't be fooled.

Online companies that calculate ROI by taking credit for all patient leads from your website are misleading you. Many of those patients may have originated from offline marketing efforts. Patients often take more than five months to make a decision about cosmetic treatments and to choose a doctor, according to a study by CareCredit.1 During this time period, future patients look at information about you at multiple places online—directories, association hubs, review sites, media articles, and your own web page.

You can only accurately measure patient acquisition from the online location where the prospective patient contacted the practice, which is often the last step on a rather lengthy and circuitous journey. In these cases, it's not the destination, but the journey that holds the real clues.

It's not a lost cause, though.

Word-of-mouth or other offline marketing efforts typically lead to online searching. Prospective patients deriving from these efforts search using your name or practice name. Google often ranks the home page or “About Us” section of your site in response to this type of search. Consequently, these patients enter the site through the home page or a page about the doctor, and they are easy to identify from web analytics.

If they come through your home page, word-of-mouth marketing is at play, and reinvesting in these channels is a smart decision. If traffic to these pages is lackluster, consider revisiting your playbook and looking for other ways to increase word-of-mouth. It could also mean that search engines aren't favoring your site. There are many reasons you may not rank as high as you would like. If part of your marketing budget goes toward content marketing, make sure the content being generated is not duplicate or suspiciously similar to that on other sites. CopyScape (www.copyscape.com) is a free service that can check the quality of your content. Duplicate content may be penalized by search engines, making your site essentially invisible.

Also evaluate how many visitors enter your site through “landing pages” such as your procedure pages. Is your home page the only page experiencing an increase in traffic or is this also true of your procedure pages? If your website's SEO is set up properly, the interior pages of the site should rank for procedure-related searches. Your rhinoplasty page should rank for the search “rhinoplasty surgeon Beverly Hills.” If traffic on procedure pages is up, your SEO strategy is likely the reason, and reinvesting is prudent.

If traffic to your procedure pages is lower than you would like, however, it may be time to revisit your SEO strategy and/or the company that provides these services.

There are other ways to boost online moxie for free. Make sure to fill out your free profiles on the websites of associations and vendors. Most vendors have directories where you can post your name and practice name and a link to your website. Reviews are online at no cost to you and are a key piece of your SEO strategy because they rank well for searches that include your name and/or practice name. Moreover, when promoted properly, positive reviews can boost conversion.

Once you know what is broken, it is easier to fix it, and this doesn't always involve a hefty investment on your part.

1. CareCredit. Consumers' Path To Healthcare Purchases Study. (Conducted for CareCredit by Rothstein Tauber Inc. 2014 )