How does one measure an anesthesia group’s value to an organization? To surgeons? To patients? The anesthesia group that lacks the ability to evolve relative to the implementation of the Affordable Care Act (ACA), quality care innovation, provider delivery dynamics, and personnel management are unsustainable. Why? It’s the “Adapt or Die” mentality. Look no further then industries outside of healthcare to see recent examples. Apple changed the game of purchasing music. Cellular phones killed the need for phone booths. Blockbuster video folded after a more efficient online streaming service was developed; Netflix is now a household name. How and why is this relevant to anesthesia? If failing to adapt is viewed as the dinosaurs Achilles heel then inefficiency can be viewed as an anesthesia groups Achilles heel. Cancellation of cases, delayed room starts, inadequate staffing, and preoperative clearance are all common areas that if not properly addressed by your anesthesia management corporation lead to costly inefficiencies, surgeon and facility dissatisfaction and a reduced patient care experience.